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This study examined the optimization of growth conditions of Serratia marcescens isolated from a loamy soil of the Federal University Technology Minna Nigeria, for prodigiosin production. The different optimized conditions examined were extraction solvents, incubation time, pH, temperature, carbon sources, organic nitrogen sources, inorganic nitrogen sources and agitation levels. The result reveals that methanol is an ideal solvent recording absorbance of 0.69nm, which is slightly followed by ethanol and acetone with absorbance of 0.4nm and 0.3nm respectively. The bacterium produced maximum level of pigment after 36 hours of incubation (22.20µg/L), although pigment production was observed from 12 hours of incubation onwards (7.40µg/L). The pigment production declined after 36 hours of incubation. The results also revealed that pigment production by S. marcescens was maximum at 25°C (25.10µg/L) followed by 30oC (22.50µg/L). The optimal production was obtained at pH 7 (25.00mg/ml) with dextrose as optimal source of carbon (22.40mg/ml). There was no pigment production at static condition but maximum pigment production was recorded at 150 rpm (22.50µg/L). All the inorganic nitrogen sources caused a reduced biomass production. Among the organic nitrogen sources tested, yeast extract supported maximum pigment (26.75µg/L) but peptone led to a decreased pigment production (9.15µg/L) compared to other organic sources. Addition of urea did not support pigment as well as biomass production. Statistical analysis shows significant differences (p

Background: Major limb amputation is a serious but usually preventable public health problem that is often associated with profound social, psychological and economic impacts on the patient and family. The objective of this study was to evaluate the trend, indications and short term complications of major limb amputations and to compare our experience with that of other published data. Methods: A retrospective study of medical records of all patients who underwent major limb amputations at a Nigeria teaching hospital between 2006 and 2013. Information about age, sex, indications, level of amputation, facilities where patients had initial care before presenting in our centre, complications and outcomes of care were studied. Results: One hundred and sixty-five major limb amputations were done in 158 patients with bilateral lower limb amputations in seven of them. 60.8% of these were due to severe extremity trauma with irreversible vascular damage while diabetic foot gangrene accounted for 30.4%. Complications included wound infections (24.2%), flap necrosis (3.6%), phantom limb pain (2.4%) and knee flexion deformity (0.6%). Mortality was 0.2%. Conclusion: Trauma with irreversible vascular damage is still the leading indication for major limb amputation in our hospital. [ABSTRACT FROM AUTHOR]

Background: The gold standard in the care of the multiply injured is the prompt identification of all life-threatening and associated injuries by using the Advanced Trauma Life Support protocol (ATLS). The main objective of this study was to determine the incidence of missed injuries in patients presenting to our hospital and to identify the primary contributing factors for each missed injury. Methods: An initial evaluation of our trauma registry data for missed injuries in a 90% population of trauma victims yielded an incidence of 12%. However, to determine the true incidence of missed injuries, a prospective tertiary trauma survey was performed on all injured patients admitted during a six month period. After the primary and secondary surveys, all injuries and treatments were documented in the patients' trauma medical records. They were then re-examined immediately by the senior orthopaedic registrars and subsequently by the investigator. Results: Fifty-two missed injuries were found in 46 patients (10.5%) out of 438 cases. Reasons for missed injuries include haemodynamic instability 3 (0.7%), head injury 17 (3.9%), low index of suspicion 5 (1.1%), lack of symptoms 6 (1.4%) and technical problems 12 (2.7%). Conclusion: There is a need to re-appraise our trauma care practice to reduce the incidence of missed injuries. [ABSTRACT FROM AUTHOR]

Background: Operative fixation of ankle fractures is becoming popular in developing countries. The concern however is the outcome of care. The objective was to evaluate the results of open reduction and internal fixation (ORIF) of fractures of the ankle in our hospital. Methods: All cases ORIF of fractures of the ankle at the University College Hospital (UCH), Ibadan between March 2010 and December 2012 were recruited into the study. The indications for surgery, techniques of fixation, time interval between injury and presentation as well as outcome measures like time to union, complications and functional outcomes were evaluated. Results: Seventy patients who had ORIF of ankle fractures were studied. Twenty-one (30%) were open fractures while forty-nine (70%) were closed. Sixty (85.7%) patients presented within the first week of injury, 4 (5.7%) after 4 weeks, 4 (5.7%) after 6 weeks and 2 (2.9%) after 52 weeks. Time to union averaged 12.6±4.1weeks. Complications included wound infection 14.3%, wound dehiscence with exposed implants 2.9%, malunion 8.6% and non union 5.7%. Good to excellent functional outcomes were achieved in 77.1% of the patients. Conclusion: ORIF is a viable option in the treatment of ankle fractures. [ABSTRACT FROM AUTHOR]

Objective: To report attitudes to psychiatry before and after their psychiatric posting, among final-year medical students of a Nigerian University using the 30-item Attitude To Psychiatry questionnaire. Participants and Methods: A total of 126 students participated pre-clerkship, while 135 students participated in the post-clerkship phase of the study. Results: Approximately 54% of the students scored above the Attitude To Psychiatry questionnaire midpoint (90) at the pre-clerkship assessment, while 41% of the students scored higher than 90 at the post-clerkship phase. The mean (± standard deviation) score also decreased significantly (p = 0.03) from 90.6 (± 9.4) pre-posting to 88.2 (± 8.2) at the end. Facets that showed appreciable decline were those that evaluated the teaching of the subject, symptom worry being made worse by treatment, and perceived job satisfaction of psychiatrists by the students. Conclusion: The general attitude to psychiatry of this group of medical students witnessed an unfavourable trend after psychiatric exposure. Some of the areas that need to be improved upon undergraduate teaching in psychiatry. [ABSTRACT FROM AUTHOR]

Objectives: Evidence indicates that people living with HIV (PLHIV) are more impacted by COVID-19. The burden of SARS-CoV-2 infection among PLHIV is unknown in Nigeria., Methods: We conducted repeated cross-sectional SARS-CoV-2 serosurveys in 14 states and the Federal Capital Territory in Nigeria among PLHIV who had an HIV viral load (VL) test during April 2022-January 2023. Evidence of SARS-CoV-2 immunoglobulin G (IgG) antibodies was assessed using a multiplex bead assay (MBA) to measure IgG to spike (S), receptor binding domain (RBD), and nucleocapsid (N) proteins to identify potential infection and/or vaccination status., Results: Between April 2022 and January 2023, 47,614 remnant VL samples were included and tested for SARS-CoV-2 antibodies. Seroprevalence of SARS-CoV-2 infection, defined as IgG antibodies to spike and RBD591 [S+] and nucleocapsid [N+], (S+N+), ranged between 21·1% (95% CI: 11·4-31·8) in Ekiti State in January 2023 to 71·4% (95% CI 71·9-81·9) in Gombe State in November 2022, with overall steady trends within and between states over time, across age and sex., Conclusions: High rates of SARS-CoV-2 antibody seroprevalence among PLHIV in Nigeria were observed. This underscores the need to understand the association between HIV and SARS-CoV-2 to inform strategies to reduce the threat posed by COVID-19., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Ltd.)

Background: One of the great challenges in the management of open fractures is postoperative infection with a higher incidence in Gustilo-Anderson type III fractures. Definitive management of such fractures in developing countries is usually with external fixators with its attendant complications such as deep fracture-related infection, non-union, and consequent increased re-operation rates. Recently, there has been a novel method of using antibiotic-cement coated implants such as intramedullary nails and locking plates in the treatment of infected non-unions with reported excellent outcomes. This protocol aims to describe the hypothesis, objectives, design and statistical analysis of a randomized control trial that compares the infection rate between the use of antibiotics-cement coated plate and external fixation in the management of Gustilo-Anderson type III long bone fractures., Methods: This is a multicentre, open-label, parallel group, superiority, randomized, control trial. All patients with type III long bone fractures who present at the emergency department will be screened for enrolment and only those patients that meet the inclusion criteria will be registered for the study. Patients will be randomized using a centralized 24-hr computerized randomization system into two groups: antibiotic-cement coated plate group and the external fixation group. The primary outcome will be occurrence of infection at any time during the course of one year follow-up which will be counted once for each of the patients. The secondary outcomes are union rate, re-operation rate and change in Health Related Quality of Life (HRQoL) from baseline to end of follow-up. Analysis will be done using R (R Core Team, 2023) and Rstudio (Rstudio Team, 2023)., Discussion: Literature has shown that use of antibiotic-coated plate in the management of severe open long bone fractures is effective in reducing infection rate. A significant difference in infection rate with use of antibiotic-cement coated plate compared to use of external fixator for open fractures will be a welcome intervention in developing countries., Trial Registration: The study protocol is registered with ClinicalTrials,gov (NCT06193330)., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Management of hypertension is challenging in multi-cultural and multi-ethnic sub-Saharan African countries like Nigeria. This diversity calls for multi-dimensional interventional approaches for hypertension control. This study assessed the treatment seeking behaviour and associated factors among adults with high blood pressure from three ethnic groups in Nigeria. A cross-sectional study was conducted among 762 adults with high blood pressure from three purposively selected States representing the three main tribes in Nigeria. Using a multistage stratified sampling technique, five communities were selected from two Local Government Areas (LGAs) stratified into urban and rural LGAs in each State. All consenting respondents in each community were consecutively screened for hypertension and recruited. A pretested interviewer-administered questionnaire was used to obtain information on socio-demographic characteristics, treatment seeking behaviour and factors affecting their choice. Data were summarized using descriptive statistics. Relationship between individual, health-related factors and treatment seeking behaviour, as well as the predictors were assessed using a binary logistic regression. at p<0.05 Participants' mean age was 55.4 ± 16.6 years, 63.0% were females and most were Igbo speaking (39.9%). About half (368, 48.3%) were unaware of their status. Of those aware, most (58.9%) went to hospital upon diagnosis of hypertension while some sought advice from health care professionals (28.5%) mostly Hausas, others either went to chemists (6.2%) or did nothing (5.1%), predominantly Yorubas. Significant predictors of orthodox treatment seeking practices for hypertension were female gender [(AOR = 2.60; 95%CI (1.18-5.71)], availability of medicine and personnel [(AOR = 8.7; 95%CI (4.15-18.3)] and perceived good quality of care [(AOR = 4.88; 95%CI (1.81-13.1)]. Orthodox treatment was the common choice among adults with high blood pressure. To further encourage patronage of orthodox treatment, the health facilities should be adequately equipped with medications and trained personnel to improve the quality of care. Targeted education on continuous practice of orthodox treatment is recommended., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Bamgboye et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Multiple sclerosis is the predominant autoimmune disorder affecting the central nervous system in adolescents and adults. Specific treatments are categorized as disease-modifying, whereas others are symptomatic treatments to alleviate painful symptoms. Currently, no singular conventional therapy is universally effective for all patients across all stages of the illness. Nevertheless, cannabinoids exhibit significant promise in their capacity for neuroprotection, anti-inflammation, and immunosuppression. This review will examine the traditional treatment for multiple sclerosis, the increasing interest in using cannabis as a treatment method, its role in protecting the nervous system and regulating the immune system, commercially available therapeutic cannabinoids, and the emerging use of cannabis in nanomedicine. In conclusion, cannabinoids exhibit potential as a disease-modifying treatment rather than merely symptomatic relief. However, further research is necessary to unveil their role and establish the safety and advancements in nano-cannabinoid medicine, offering the potential for reduced toxicity and fewer adverse effects, thereby maximizing the benefits of cannabinoids.

Background: Missed appointments is a significant challenge to efficient running of physiotherapy departments and it has cost implications. In this study, wait time, and pattern, predictors and impact of Missed appointments (MAs) on cost, efficiency and recovery time was assessed among Nigerian patients receiving physiotherapy., Method: In this retrospective study a total of 3,243 physiotherapy appointments were booked between 2009 and 2019 at an Outpatient Physiotherapy Clinic in Nigeria. Data were collected on Missed appointments, on costs of of treatment and on socio-demographic characteristics. The total revenue loss due to missed appointments was calculated as a product of the total of Missed appointments and cost per treatment; recovery time was also estimated., Results: Missed appointments were 1,701 out of 3,243 booked (52.5%) and the average wait time for the first appointment was 9.6 ± 23.2 days. The proportion of Missed appointments was higher among females (50.2%), patients who were not resident of the same location as the clinic (45.3%), patients with orthopaedic conditions (56.2%) and patients referred from an orthopaedic surgeon (32.8%). Females, those who live within the city, and those with neurological/medical conditions were 1.68, 1.24, and 1.52 times more likely to have Missed appointments compared to males (OR = 1.68, Confidence intervals = 1.44 - 1.96, p = < 0.001), those who live outside the city (OR = 1.24, CI = 1.05 - 1.46, p = 0.01), and to those who have orthopaedic conditions (OR = 1.52, CI = 1.20 - 1.93, p = < 0.001), respectively. Using per treatment schedule cost of N1000 (an equivalent of $ 2.31), a 52.5% Missed appointments rate resulted in lower efficiency of 76.6% with an efficiency ratio of 0.23. Further, a 52.5% Missed appointments rate could potentially impact patient recovery time by 3402 days if Missed appointments slow a patient recovery process by 2 days., Conclusions: Missed appointments for physiotherapy treatment pose a significant challenge in terms of costs, efficiency, and patient recovery time. Thus, an innovative reminder system may help reduce patients' non-attendance to physiotherapy and its consequences.

Background: Globally, the medical and teaching professions are two major professions with the highest prevalence of burnout, and academic physicians bestride the two professions. This study investigated the prevalence and associated factors of burnout among academic physicians working in tertiary hospitals in Nigeria., Methodology: This was a self-administered online survey. Burnout was measured using the Maslach Burnout Inventory for Educators (MBI-ES) on Google Form and sent to 256 academic physicians in tertiary hospitals across Nigeria using the WhatsApp broadcast feature. MBI-ES was categorized into two categories (Burnout and No Burnout), and binary logistic regression was used to test the influence of 13 predictors on the three dimensions of MBI-ES as well as MBI in its entirety., Findings: A total of 155 academic physicians responded, resulting in a response rate of 60.5%. There were 121 (80.7%) males and 29 (19.3%) females (five cases respondents omitted this detail). Eighty-seven respondents exhibited moderate to high burnout in at least one of the dimensions of the MBI, translating to a prevalence rate of 57.7% in our study. Five variables, number of peer reviewed articles published, hours of weekly teaching, enjoyment of academic writing, apathy to teaching and religion were all significantly associated with burnout. Moderate to high emotional exhaustion was reported by 30.8% (45 respondents), moderate to high depersonalization by 5.5% (8 respondents),, and low to moderate personal accomplishment by 43.5% (67 respondents).Eight variables: religion, geopolitical zone of practice, enjoyment of academic writing, apathy toward teaching, university ownership, number of published peer-reviewed articles, salary, and supplementary income were significantly associated with emotional exhaustion, while the number of weeks spent teaching in a year and teaching hours/week were significantly associated with depersonalization and personal accomplishment, respectively. Age (OR 1.302, CI 1.080-1.570), Teaching hours/week (OR 0.924, CI 0.854-0.999), Salary (OR 0.996, CI 0.993-1.0), and supplementary salary (OR 0.996, CI 0.993-0.999) were found to significantly predict emotional exhaustion., Conclusion: The study reveals a high prevalence of burnout (57.7%) among academic physicians in Nigeria, highlighting an urgent need for targeted interventions and policy changes. Given the significant role these professionals play in healthcare and medical education, immediate action is essential to address this issue. Future research should focus on evaluating the effectiveness of preventive measures and exploring the long-term impacts of burnout., (© 2023. The Author(s).)

Objective: We aimed to investigate the clinical utility of follow-up oesophagogastroduodenoscopy (OGD2) in patients with severe oesophagitis (Los Angeles grades C or D) through evaluating the yield of Barrett's oesophagus (BO), cancer, dysplasia and strictures. Second, we aimed to determine if the Clinical Frailty Scale (CFS) may be used to identify patients to undergo OGD2s., Design/method: Patients in NHS Lothian with an index OGD (OGD1) diagnosis of severe oesophagitis between 1 January 2014 and 31 December 2015 were identified. Univariate analysis identified factors associated with grade. Patients were stratified by frailty and a diagnosis of stricture, cancer, dysplasia and BO., Results: In total 964 patients were diagnosed with severe oesophagitis, 61.7% grade C and 38.3% grade D. The diagnostic yield of new pathology at OGD2 was 13.2% (n=51), new strictures (2.3%), dysplasia (0.5%), cancer (0.3%) and BO (10.1%). A total of 140 patients had clinical frailty (CFS score ≥5), 88.6% of which were deceased at review (median of 76 months). In total 16.4% of frail patients underwent OGD2s and five new pathologies were diagnosed, none of which were significantly associated with grade. Among non-frail patients at OGD2, BO was the only pathology more common (p=0.010) in patients with grade D. Rates of cancer, dysplasia and strictures did not vary significantly between grades., Conclusion: Our data demonstrate that OGD2s in patients with severe oesophagitis may be tailored according to clinical frailty and only be offered to non-frail patients. In non-frail patients OGD2s have similar pick-up rates of sinister pathology in both grades of severe oesophagitis., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: This study evaluated pregnant women's perception and level of satisfaction with quality of antenatal care received at Plateau State Specialist Hospital., Materials and Methods: The study employed a hospital-based cross-sectional design. Convenience sampling was used to select two hundred and thirty-eight (238) women attending antenatal clinic at the Plateau State Specialist Hospital. A validated semi-structured interviewer-administered questionnaire with a Cronbach's Alpha score of 0.83 was used for data collection. Respondent's perception was measured on a 36-point rating scale and the level of satisfaction on a 9-point rating scale. Data was subjected to descriptive analysis and Pearson's correlation was used to test for hypothesis., Results: The mean age was 28.79 years. Most of the respondents were married (81.9%), twenty-eight percent of the respondents had two children. The respondent's perception of quality of antenatal care shows a mean score of 25.0± 4.61 which indicates that the respondents had positive perception of the quality of antenatal care (69.4%). Also, the respondent's level of satisfaction with the quality of antenatal care received shows a mean score of 6.50 ± 1.8 indicating that they were very satisfied (72.2%) with quality of antenatal care. There was a significant relationship between the respondent's perception of the quality of antenatal care and level of satisfaction of the quality of antenatal care service (r= 0.43; p< 0.003)., Conclusion: The respondents had positive perception and are satisfied with the quality of antenatal care services received. A Periodic patient satisfaction survey should be established as part of the antenatal evaluation to provide feedback for continuous quality improvement., Competing Interests: The authors declared no conflict of interests., (© 2023 Titilayo O et al.)

Objective: To translate the Health Literacy Questionnaire (HLQ) to Serbian language and examine its psychometric characteristics., Methods: This cross-sectional study was conducted among 295 people with chronic diseases from the Foča region (Republic of Srpska, Bosnia and Herzegovina). The HLQ was translated according to the translation integrity procedure. Construct validity was tested using confirmatory factor analysis (CFA) using the maximum likelihood estimator and reliability was estimated using the α and ω coefficients., Results: Minor linguistic differences in 17 items were observed between the original and the initial forward translation and were corrected. The parameters of one-factor CFA on domains 3 and 8 fitted well. The parameters of the CFA for domains 1, 2, 4, 5, 6, 7 and 9 were acceptable after modification using residuals' correlation. The α and ω coefficients for all domains were good to excellent (>0.80)., Conclusion: Each domain of the HLQ in Serbian has acceptable construct validity and overall good reliability. This study adds to the growing evidence that the HLQ is a useful tool to provide in-depth multidimensional information on health literacy to improve researchers and policymakers understanding of the health literacy strengths, needs and preferences across cultures and languages.

Background: Health literacy is an important multidimensional concept of public health concern and a determinant of health outcomes and access to healthcare which requires robust measurement. The objective of this study was to culturally adapt and establish the psychometric properties of the Yoruba version of the Health Literacy Questionnaire., Methods: A cross-sectional survey of Nigeria Yoruba speaking adults was conducted with the Health Literacy Questionnaire following its translation and adaptation. Data were subject to psychometric evaluation (confirmatory factor analysis, composite reliability, Cronbach's alpha, intra class correlation) and association with sociodemographic variables., Results: A total of 258 adults with mean age 26.7 years participated in the study. The easiest scale to score highly was 'Actively managing my health' and hardest was 'Ability to find good health information' and 'Navigating the healthcare system'. Six one-factor models fitted well without correlated residuals but the other three had a good fit after model modification. Composite reliability and Cronbach's α of ≥ 0.7 were observed for all scales, suggesting good internal consistency of the scales. Test-retest reliability of the Yoruba translation of the Health Literacy Questionnaire was moderate to good in all scales, intra class correlation ranging from 0.66 to 0.76., Conclusion: The Health Literacy Questionnaire was successfully translated and culturally adapted and demonstrated good content and construct validity and high composite reliability. The Yoruba translation of the Health Literacy Questionnaire has the potential of being a useful clinical tool for the assessment of health literacy, especially among Yoruba speaking community of Nigeria. Thereby helping to improve the health outcomes through access to healthcare.

Conclusion: The Y-SBT have acceptable psychometric properties. It is recommended for use among Yoruba speaking patients with LBP., Background: Translating questionnaires into local languages is essential as it aids easy accessibility and understanding of such questionnaires by patients and their health caregivers. The STarT Back Tool (SBT), validated tool used to classify subgroups of persons with Low-Back Pain, has few translated versions. We translated the STarT Back Tool into the Yoruba language and established its psychometric properties among patients with long-term non-specific Low-Back Pain., Methods: Following the Lenz protocol, the SBT was successfully cross-culturally adapted into the Yoruba language. One hundred consenting patients (mean age = 57.0±11.43 years, 55% females) took part in the validation phase, while 53 of them participated in the test-retest phase. Psychometric indices of the Y-SBT assessed showed internal consistency, intraclass correlation coefficient (ICC), ceiling and floor effects and divergent validity., Results: The sub- and total Cronbach's α score for Y-SBT was 0.704 and 0.857, respectively. The test-retest reliability of the sub- and total scores of the Y-SBT yielded an ICC of 0.82 (95% CI: 0.74 - 0.87) and 0.89 (95% CI: 0.84 - 0.93), respectively. The divergent validity for sub- and total-scores of the Y-SBT based on Quadruple Visual Analogue Scale score for on-going pain was r = 0.374 (p = 0.001) and r = 0.432 (p = 0.001), respectively. The Y-SBT had no ceiling or floor effects.

The effects of temperature on corrosion resistance of Silver-Cobalt oxide and Titanium Dioxide (Ag/Co 3 O 4 /TiO 2 ) nanocomposite coated AISI 1020 in a high-temperature environment was investigated. The Ag, Co 3 O 4 and TiO 2 nanoparticles were individually produced by mixing the salt precursors with extract of Piptadeniastrum Africana leaf under the optimized synthesis conditions. The nanocomposite was produced by mixing Ag, Co 3 O 4 and TiO 2 nanoparticles (NPs) in equal proportions to constitute 75 wt% of the composite. 10 wt% epoxy resin and its hardener in the ratio (1:1) were added to serve as the binder, while 15 wt% of CNT was introduced to serve as support. The produced Ag/Co 3 O 4 /TiO 2 nanocomposite was coated on the surface of mild steel (AISI 1020) by the dipping method. The coated samples were heated in a muffle furnace to 35, 100, 200, and 300 °C. Microstructural evolution of the coatings was investigated using X-ray diffraction, scanning electron microscopy and energy dispersive spectrometer. The corrosion resistance of the coated and heated and un-heated steel samples was determined using the potentiodynamic polarization method. The results show that Ag/Co 3 O 4 /TiO 2 nanocomposite coated sample cured at 100 °C exhibited the highest corrosion resistance of 195.12 Ω.

Conclusion: This is the first study to assess the psychometric properties of the Y-SF-12. It appears to be valid and may be an appropriate tool for assessing health-related quality of life among Yoruba population. The tool may help to improve the health outcomes of individuals, and redress health inequalities in low and middle-income countries., Background: Short Form 12 (SF-12) health survey has found its utility in clinical and research settings because of its short length that spares time. Though several translations into other languages do exist there is none available in Yoruba language. Hence, this study's objective was to culturally adapt and determine the reliability and validity of the Yoruba translated version of the SF-12., Methods: Forward and backward translations of SF-12 into Yoruba version of SF-12 (Y-SF-12) were done using the International Quality of Life Assessment Project Guidelines. Healthy participants were assessed using both English and Yoruba versions of SF-12 for the validation phase, and two weeks later were reassessed with the Y-SF-12 for the reliability phase., Results: Participants were 225 males and 171 females. The mean scores for each scale range from 73.4 to 86.1, with no gender difference. All scale and domain scores evidenced a negative skew and ranges from -1.79 to -0.62. Concurrent validity (0.879 - 0.938) and convergent validity (0.786 - 0.907) appeared to be good as reflected by their correlation values. The internal consistency of Y-SF-12 was good as Cronbach's Alpha ranged between 0.899 and 0.968, while the Intraclass Correlation Coefficient (ICC) ranged between 0.775 and 0.949.

Congenital heart disease (CHD) in low-and-middle income countries (LMIC) is often characterized by late presentation resulting from inadequate screening and healthcare access in these regions. Accurate estimates of the burden of CHD among school children are often lacking. The objective of this study was to determine the prevalence and distribution of CHD among school children in two communities (urban and semi-urban) in south western Nigeria. Using clinical assessment and portable echocardiography, 4107 school children aged 5 years to 16 years in Lagos, Nigeria, were selected using a multistage sampling procedure and screened for CHD. Diagnosis of CHD was made after echocardiography. Children identified with CHD were referred to a tertiary hospital for appropriate cardiac care. The 4,107 children screened had a mean age of 11.3 ± 2.7 years and 53.7% were females. Twenty seven children had echocardiography-confirmed CHD, representing a prevalence of CHD among school children in Lagos, Nigeria of 6.6 per 1000 children. Acyanotic CHD constituted 96.3% of detected cases. Two children diagnosed with CHD (Tetralogy of Fallot and severe pulmonary valve stenosis respectively) had successful intervention. The prevalence of previously undiagnosed CHD among school children in Lagos Nigeria is substantial and highlights gaps in the health care system and school health programs. Echocardiographic screening of school children provides an opportunity for missed early diagnosis and treatment of CHD and reduces the prevalence of first-diagnosed CHD in adulthood. Therefore, focused clinical examination of school children followed by echocardiography is a strategy that could bridge this diagnostic and treatment gap in CHD., (© 2020 Wiley Periodicals, Inc.)

Community-led tuberculosis (TB) active case finding is widely promoted, heavily funded, but many efforts fail to meet expectations. The underlying reasons why TB symptom screening programs underperform are poorly understood. This study examines Nigerian stakeholders' insights to characterize the mechanisms, enabling structures and influences that lead programs to succeed or fail. Eight focus group discussions were held with Community Health Workers (CWs) from four models of community-based TB screening and referral. In-depth interviews were conducted with 2 State TB program managers, 8 Community based organizations (CBOs), and 6 state TB and Leprosy Local Government supervisors. Transcripts were coded using Framework Analysis to assess how divergent understandings of CWs' roles, expectations, as well as design, political and structural factors contributed to the observed underperformance. Altruism, religious faith, passion, and commitment to the health and well-being of their communities were reasons CWs gave for starting TB symptom screening and referral. Yet politicized or donor-driven CWs' selection processes at times yielded implementers without a firm grounding in TB or the social, cultural, and physical terrain. CWs encountered suspicion, stigma, and hostility in both health facilities and communities. As the interface between the TB program and communities, CWs often bore the brunt of frustrations with inadequate TB services and CBO/iNGO collaboration. Some CWs expended their own social and financial capital to cover gaps in the active case finding (ACF) programs and public health services or curtailed their screening activities. Effective community-led TB active case finding is challenging to design, implement and sustain. Contrary to conventional wisdom, CWs did not experience it as inherently empowering. Sustainable, supportive models that combine meaningful engagement for communities with effective program stewardship and governance are needed. Crucially effective and successful implementation of community-based TB screening and referral requires a functional public health system to which to refer., Competing Interests: Declaration of competing interest All authors declares no conflict of interest., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Objective: Echocardiographic screening for Rheumatic Heart Disease (RHD) in Africa has revealed prevalence rates in the range of 0.5-7.4%. There are no recent large population-based studies in Nigeria. The objective of the study was to determine the prevalence of RHD in a large sample of Nigerian school children., Methods: Using portable transthoracic echocardiography and auscultation, school children aged 5 years to 16 years in Lagos, Nigeria were screened for RHD. Diagnosis was based on the 2012 World Heart Federation echocardiographic criteria., Results: The 4107 children screened had mean age of 11.3 years (SD = 2.6) and 2206 (53.7%) were females. There were 38 children with abnormal echocardiograms, of which 11 (0.27%) showed RHD including two cases of definite RHD giving a prevalence of 2.7/1000 [2.9/1000 in the peri-urban, 2.4/1000 in the urban area). Echocardiography detected RHD 10 times better than auscultation [echocardiography 11 (0.27%) vs. auscultation 1 (0.02%); P = 0.003]. The remaining 27 children with abnormal echocardiograms had congenital heart defects (CHD) giving a prevalence of 6.6/1000 for CHD, a yield higher than for RHD., Conclusion: Prevalence of RHD among school children in Lagos, South West Nigeria is low compared to other African countries, possibly due to better access to medical care and antibiotic treatment for infections. Our data provides evidence that RHD prevalence may vary substantially within sub-Saharan Africa, necessitating targeted population-based sampling to better understand disease burden and distribution. Further work is needed to compare within- and between-country RHD prevalence as a basis for programme planning and control efforts., (© 2019 John Wiley & Sons Ltd.)

Purpose: Laminin N-terminus (LaNt) α31 is a relatively unstudied protein derived from the laminin α3 gene but structurally similar to netrins. LaNt α31 has, to date, been investigated only in two-dimensional (2D) keratinocyte culture where it influences cell migration and adhesion, processes integral to wound repair. Here we investigated LaNt α31 distribution in ocular surface epithelium, during limbal stem cell activation, and corneal wound healing., Methods: Human, mouse, and pig eyes, ex vivo limbal explant cultures, and alkali burn wounds were processed for immunohistochemistry with antibodies against LaNt α31 along with progenitor cell-associated proteins. LaNt α31 expression was induced via adenoviral transduction into primary epithelial cells isolated from limbal explants, and cell spreading and migration were analyzed using live imaging., Results: LaNt α31 localized to the basal layer of the conjunctival, limbal, and corneal epithelial cells. However, staining was nonuniform with apparent subpopulation enrichment, and some suprabasal reactivity was also noted. This LaNt α31 distribution largely matched that of keratin 15, epidermal growth factor receptor, and transformation-related protein 63α (p63α), and displayed similar increases in expression in activated limbal explants. During active alkali burn wound repair, LaNt α31 displayed increased expression in limbal regions and loss of basal restriction within the cornea. Distribution returned to predominately basal cell restricted once the wounded epithelium matured. Cultured corneal epithelial cells expressing LaNt α31 displayed increased 2D area and reduced migration, suggesting a functional link between this protein and key wound repair activities., Conclusions: These data place LaNt α31 in position to influence laminin-dependent processes including wound repair and stem cell activation.

The whole-genome sequence of Bacillus velezensis strain SB1216, isolated from the Great Salt Plains of Oklahoma, showed the presence of a 3,814,720-bp circular chromosome and no plasmids. The presence of a novel 870-bp extracellular RNase gene is predicted to be responsible for this strain's antitumor activity., (Copyright © 2017 Marasini et al.)

Background: Temprano ANRS 12136 was a factorial 2 × 2 trial that assessed the benefits of early antiretroviral therapy (ART; ie, in patients who had not reached the CD4 cell count threshold used to recommend starting ART, as per the WHO guidelines that were the standard during the study period) and 6-month isoniazid preventive therapy (IPT) in HIV-infected adults in Côte d'Ivoire. Early ART and IPT were shown to independently reduce the risk of severe morbidity at 30 months. Here, we present the efficacy of IPT in reducing mortality from the long-term follow-up of Temprano., Methods: For Temprano, participants were randomly assigned to four groups (deferred ART, deferred ART plus IPT, early ART, or early ART plus IPT). Participants who completed the trial follow-up were invited to participate in a post-trial phase. The primary post-trial phase endpoint was death, as analysed by the intention-to-treat principle. We used Cox proportional models to compare all-cause mortality between the IPT and no IPT strategies from inclusion in Temprano to the end of the follow-up period., Findings: Between March 18, 2008, and Jan 5, 2015, 2056 patients (mean baseline CD4 count 477 cells per μL) were followed up for 9404 patient-years (Temprano 4757; post-trial phase 4647). The median follow-up time was 4·9 years (IQR 3·3-5·8). 86 deaths were recorded (Temprano 47 deaths; post-trial phase 39 deaths), of which 34 were in patients randomly assigned IPT (6-year probability 4·1%, 95% CI 2·9-5·7) and 52 were in those randomly assigned no IPT (6·9%, 5·1-9·2). The hazard ratio of death in patients who had IPT compared with those who did not have IPT was 0·63 (95% CI, 0·41 to 0·97) after adjusting for the ART strategy (early vs deferred), and 0·61 (0·39-0·94) after adjustment for the ART strategy, baseline CD4 cell count, and other key characteristics. There was no evidence for statistical interaction between IPT and ART (p interaction =0·77) or between IPT and time (p interaction =0·94) on mortality., Interpretation: In Côte d'Ivoire, where the incidence of tuberculosis was last reported as 159 per 100 000 people, 6 months of IPT has a durable protective effect in reducing mortality in HIV-infected people, even in people with high CD4 cell counts and who have started ART., Funding: National Research Agency on AIDS and Viral Hepatitis (ANRS)., (Copyright © 2017 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Background: Deaths from motorcycle accident injuries have remained a major public health issue in Nigeria over the years., Aim: The study is to determine the age and gender distribution of the victims and to identify the cause of death and the anatomical pattern of injuries seen., Methodology: This is a 5-year autopsy-based study of all motorcycle accident deaths seen in Lagos State University Teaching Hospital between December 2009 and November 2014. The data were retrieved from autopsy reports, hospital case notes extracts from police diary and were analysed using SPSS version 20., Results: Motorcycle accidents accounted for 156 (2.8%) of all the autopsies done (5,661), and 156 (18.4%) of all Road Traffic Accidents (RTA) autopsies (849) performed over the study period, with a male: female ratio of 6:1. The peak age of victims was 31-40 years (30.9%). Head injuries accounted for most (41.4%) of the injuries seen, and the majority of the victims died of craniocerebral injury 53 (50.7%)., Conclusion: This study showed that males in the fourth decade of life are the major victims of motorcycle accident death. The majority of the victims were the rider of the motorcycle. Most of them died of the craniocerebral injury.

Campylobacter spp. commonly cause gastrointestinal illness in humans. Poultry meats have long been considered the predominant source of these infections, but few in-depth Campylobacter source attribution studies have been completed. We analyzed more than 1,300 Campylobacter isolates recovered from a number of animal and food sources, including dairy and beef cattle, pigs, poultry, and retail poultry meat, and compared them with Campylobacter isolates recovered from human clinical samples. Each isolate was subtyped using pulsed-field gel electrophoresis (PFGE) with SmaI and queried against the Centers for Disease Control and Prevention PulseNet database to identify human isolates with indistinguishable patterns. Half (49.5%) of the PFGE patterns from poultry animal and retail meat isolates were indistinguishable from patterns of at least one human isolate. Among the isolates from beef and dairy cows, 56.6 and 65.0%, respectively, of their PFGE patterns were indistinguishable from those of human isolates. Only a small portion of the PFGE patterns of Campylobacter isolated from pigs (9.5%) were found to have PFGE patterns in common with human isolates. These data imply that cattle may be larger contributors to Campylobacter infections than previously recognized and help further our understanding of potential sources of human campylobacteriosis.

Background: Oxygen is important for the treatment of hypoxaemia associated with pneumonia, malaria, and other medical, obstetric, and surgical conditions. Access to oxygen therapy is limited in many of the high mortality settings where it would be of most benefit., Methods: A needs assessment of 12 non-tertiary hospitals in south-west Nigeria, assessing structural, technical and clinical barriers to the provision of safe and effective oxygen therapy., Results: Oxygen supply was reported to be a major challenge by hospital directors. All hospitals had some access to oxygen cylinders, which were expensive and frequently ran out. Nine (75%) hospitals used oxygen concentrators, which were limited by inadequate power supply and lack of maintenance capacity. Appropriate oxygen delivery and monitoring devices (nasal prongs, catheters, pulse oximeters) were poorly available, and no hospitals had clinical guidelines pertaining to the use of -oxygen for children. Oxygen was expensive to patients (median US$20/day) and to hospitals. Estimated oxygen demand is reported using both a constant mean-based estimate and adjustment for seasonal and other variability., Conclusions: Making oxygen available to sick children and neonates in Nigerian hospitals will require: improving detection of hypoxaemia through routine use of pulse oximetry; improving access to oxygen through equipment, training, and maintenance structures; and commitment to building hospital and state structures that can sustain and expand oxygen initiatives.

Background: Studies have established that growth of children usually falters during the preschool age when the child is usually left in the hands of other care givers; as parents go to work. Feeding of the preschool children is sometimes solely under the care of Day Care Staff (DCS) whoselevel of knowledge and practice of nutritional care is unknown. Knowledge and practices of nutritional care among DCS in selected preschools were investigated., Method: A descriptive cross-sectional study design was used and 400 DCS were randomly selected for interview. A validated questionnaire with 50-point knowledge scale was used to collect information from the target population and this was complemented with observational checklist to assess the level of practice of nutritional care and environmental hygiene. Data obtained were analysed using both univariate and bivariate analyses including Chi-square test at p=0.05 level of significance., Results: Most of the DCS were female (97.5%) and 47.5% specialised in child education. Few (28.8% and 25.0%) of the DCS had ever received training on child nutritional care during pre-service and in- service training, respectively. Only 20.0% of DCS had good knowledge of nutritional care, which reflected in the activities observed. Age was significantly associated with knowledge of preschool nutritional care.., Conclusion: Knowledge of day care staff on nutritional care of preschool children was found to be poorer as the age of staff increases. This may also contribute to the poor practices observed. Training on nutritional care among day care staff, especially the older ones is suggested.

Calcific uraemic arteriolopathy (CUA), a potentially life-threatening vasculopathy of the skin and subcutaneous tissues is rarely associated with advanced chronic kidney disease (CKD) particularly in patients on haemodialysis. It is more frequently reported in whites than in blacks and commonly accompanies hyperphosphataemia, elevated calcium-phosphate product and marked secondary hyperparathyroidism. We report a rare case of CUA that complicated end stage renal disease secondary to obstructive uropathy in a 68 year old Nigerian. The risk factors for CUA, diagnosis, management and our peculiar limitations were reviewed and discussed.

Although telerehabilitation systems represent one of the most technologically appealing clinical solutions for the immediate future, they still present limitations that prevent their standardization. Here we propose an integrated approach that includes three key and novel factors: (a) fully immersive virtual environments, including virtual body representation and ownership; (b) multimodal interaction with remote people and virtual objects including haptic interaction; and (c) a physical representation of the patient at the hospital through embodiment agents (e.g., as a physical robot). The importance of secure and rapid communication between the nodes is also stressed and an example implemented solution is described. Finally, we discuss the proposed approach with reference to the existing literature and systems.

Background: Hypertension is an important worldwide public-health challenge because of its high frequency and concomitant risks of cardiovascular and kidney disease. Previous studies have documented that hypertension may begin in adolescence, perhaps even in childhood., Objectives: This study set out to determine the prevalence of pre-hypertension and hypertension in adolescence in a Nigerian community., Methods: A cross-sectional screening of blood pressure of secondary school students was conducted in Sagamu local government area of Ogun State, Nigeria. Total sample of 1638 adolescents aged between 12 and 18 years were chosen from stratified schools and from various classes of selected schools. Their blood pressure was assessed., Results: The prevalence of pre-hypertension in this population ranged from 0-10.5% in male students and 0-2.9% in female students across the age. In the whole population the prevalence of systolic and diastolic pre-hypertension were 1.6% and 0.5% respectively for male adolescents while that of female students were 0.4% and 0.5% respectively. The low prevalence of 0.1% was observed for systolic and diastolic hypertension in male and 0.1% for female systolic hypertension. Furthermore, pre-hypertension prevalence was increased with age., Conclusion: In conclusion, our data demonstrated a low prevalence of pre-hypertension and hypertension in Nigerian adolescents living in Sagamu local government area of Ogun state, south west Nigeria.

The authors report a case of recurrent intestinal obstruction due to complete transmural migration of a retained surgical sponge into the small intestine. A 41-year-old woman presented with recurrent episodes of intestinal obstruction following a previous laparotomy in a private hospital for some gynaecologic procedures. Relaparotomy revealed a mass within the ileum which was resected and, when dissected out, was found to be a completely intraluminal retained surgical sponge. Although rare in daily practice, a retained intraperitoneal foreign body should be remotely considered in patients who present with new abdominal symptoms complex following a history of previous laparatomy.

Extra-intestinal manifestations of Clostridium difficile infection are uncommon. Most cases are associated with gastrointestinal disease and often occur as a mixed infection with other gut flora. We report a case of breast abscess following monomicrobial C. difficile bacteraemia in a female with background chronic hepatitis C infection and alcoholic liver disease. No evidence of colitis was found. Our case shows that C. difficile is indeed capable of spreading from the gastrointestinal tract.

Unlabelled: Endoscopic removal of colon polyps is the main tool in colorectal cancer prevention programs. Although several quality indicators and guidelines have been proposed, polypectomy practices are still subject to great variation among endoscopist and little data is available regarding polypectomy practices in real life settings., Methods: The records of the 1061 screening colonoscopies performed in 2010 in a tertiary care teaching hospital in Bucharest were reviewed and all colonoscopies where at least one polyp was detected were selected for analysis. The number of detected polyps, the resection rate and method used for polypectomy were studied and compared to colonoscopy quality indicators previously reported in literature., Results: 941 polyps were detected in 395 patients. Invasive colorectal cancer was found in 42 patients. 548 polyps (58.23%) were removed endoscopically, with at least one polyp being resected in 283 patients (71.5%), resulting in a polypectomy rate of 26.67% in the entire study population. Cold forceps resection was the most commonly used method for the resection of polyps less than 5 mm in size, while for larger polyps hot snare was the preferred method. Concomitant invasive carcinoma and a larger number of polyps were predictive of incomplete removal of all detected polyps., Conclusion: Most quality indicators were met in our study group, with suboptimal performance regarding histological documentation of detected polyps and establishing a polyp-free colon.

AIDS is a major public health problem in Nigeria. HIV counseling and testing (HCT) service is an important component of prevention and control programs. Little information is available about young persons' knowledge and use of HCT services in Nigeria. This study assessed knowledge of HIV/AIDS and use of HCT services among secondary school students and apprentices in Ibadan, Nigeria. Data were collected through 16 focus group discussions (FGD) and administration of a 36-item questionnaire to 1,281 randomly selected male and female secondary school students and apprentices aged 15-25 years. The respondents consisted of 54% apprentices and 46% students. Although virtually all respondents were aware of AIDS, only 15.8% of the sample had heard about HCT. Of those who were aware of HCT, 30.1% knew where to access the service. Students had superior knowledge of HCT than apprentices. Only 7% of those aware of HCT had ever taken the test. The percentage of those who had reportedly taken the test ranged from 11.3% of female apprentices to 6.3% of male students, 5.3% of female students, and 5.2% of male apprentices. The barriers identified by FGD participants to use of HCT services are fear of stigmatization, perceived exorbitant cost of testing, lack of knowledge of where HCT service are available, and belief that HCT is meant for only sexually active persons. However, 82.6% of the entire sample expressed the willingness to take HCT if it is provided free of charge, and there is a guarantee of confidentiality of results. Young persons have limited knowledge of HCT and under-utilize this service. Establishment of new HCT centers, promotion activities using the media, and peer education are recommended to increase uptake of this service among young persons in Nigeria.

Background: Drug resistance in Plasmodium falciparum poses a major threat to malaria control. Combination anti-malarial therapy, including artemisinins, has been advocated to improve efficacy and limit the spread of resistance. The fixed combination of oral artemether-lumefantrine (AL) is highly effective and well-tolerated. Artemisinin/naphtoquine (AN) is a fixed-dose ACT that has recently become available in Africa. The objectives of the study were to compare the efficacy and safety of AN and AL for the treatment of uncomplicated falciparum malaria in a high transmission-intensity site in Ivory Coast., Methods: We enrolled 122 participants aged 6 months or more with uncomplicated falciparum malaria. Participants were randomized to receive either artemisinin/naphtoquine or artemether/lumefantrine with variable dose according to their weight. Primary endpoints were the risks of treatment failure within 28 days, either unadjusted or adjusted by genotyping to distinguish recrudescence from new infection., Results: Among 125 participants enrolled, 123 (98.4%) completed follow-up. Clinical evaluation of the 123 participants showed that cumulative PCR-uncorrected cure rate on day 28 was 100% for artemisinin/naphtoquine and 98.4% for artemether/lumefantrine. Both artemisinin-based combinations effected rapid fever and parasite clearance., Interpretation: These data suggest that Arco could prove to be suitable for use as combination antimalarial therapy. Meanwhile, pharmacokinetic studies and further efficacy assessment should be conducted before its widespread use can be supported.

Saccharomyces cerevisiae, Candida krusei, C. tropicalis, Geotrichum candidum, G. fermentans and Rhodotorula graminis were isolated during the fermentation of maize for ogi production. All the isolates except Geotrichum fermentans and Rhodotorula graminis were able to degrade phytate. All the yeasts strains exhibited lipase and esterase activities. Only S. cerevisiae (2.60%) and C. krusei (7.41%) exhibited amylase activities. Candida sp. produced wider zone of inhibition than the other yeasts strains tested during lipase activity while S. cerevisiae strains produced significantly wider zone of clearing as compared to the other yeasts for esterase activities. The study of inter-relationships between Lactobacillus plantarum and yeasts (C. krusei and S. cerevisiae) showed that the growth of the yeast strains were enhanced during fermentation by the presence of the lactic acid bacteria, but the growth of the L. plantarum strain was significantly enhanced especially by the C. krusei.

Summary: The EMBL Nucleotide Sequence Database, maintained at the European Bioinformatics institute, is Europe's primary nucleotide sequences database. Its entries are subject to changes, but only the most recent versions are preserved in the database. The EMBL Sequence Version Archive is a new publicly available database retaining also the earlier versions of these entries., Availability: http://www.ebi.ac.uk/embl/sva/

The response of goats infected with caprine arthritis encephalitis virus was evaluated by estimating the binding antibodies in serum. The immunoreactive proteins of the CAEV, strain 63, were determined by immunobloting the lysate against the serum of the infected goat. The major proteins identified were of the molecular weights of 135, 120, 56, 44, 38, 28, 20 and 13 kDa. Proteins with less prominence were of the molecular weights of 96, 32 and 30 kDa. The responses to the viral proteins at several stages of the infection were examined. Antibodies to viral proteins of 135, 121 and 90 kDa were the first to appear in the goat kids that were apparently infected through breast-feeding by infected dam. The time of appearance of these antibodies in the serum varied widely between the goats from one to six months, and preceded the appearence of antibodies to other proteins by two to four weeks. Salient variations revealed in the immunoblot patterns reflect the differences in the immunological responses by the goats to the viral proteins. Littermate goat kids infected through the same dam showed slightly different responses. In the same manner, dissimilarities were observed in the patterns produced by the serums of the damand the corresponding offsprings, when run against the same virus lysate. This study indicates that some differences occur in the immunoblot pattern when this assay is used for diagnosis, although such discrepancies should not affect the interpretation of the diagnostic assay. The host differences in the response to the viral proteins also suggest the potential problems that can be encountered developing an effective vaccine for CAEV, if the binding antibody production reflects that of the neutralizing antibodies in the goats. For effective vaccine coverage, there should be little variability in the immunogenicity of candidate vaccine antigens among the hosts.

Six different strains of yeast, namely Candida krusei, C. tropicalis, Pichia saitoi, Saccharomyces cerevisiae, P. anomala and Zygosaccharomyces bailii were found present in cassava-fermenting water in the early part of the fermentation. The latter part of the fermentation was dominated in all cases by three strains of yeast namely C. krusei, C. tropicalis and Z. bailii. All the yeast strains exhibited amylolytic capabilities while none was able to produce cellulase. All the strains except Zygosaccharomyces spp. exhibited polygalacturonase activity, but only C. krusei was able to produce linamarase. In a study on the inter-relationships between C. krusei and Lactobacillus plantarum, the growth of the yeast strain was not enhanced in cassava by the presence of the lactic acid bacteria, but the growth of the L. plantarum strain was significantly enhanced when co-inoculated with C. krusei.