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Summary Background: The association between tuberculosis (TB) and human immune deficiency virus (HIV) in adults has been well described. There is however, paucity of information on the association, if any, in Nigerian children. Objectives: The objective of the present study was to determine the prevalence of HIV among children diagnosed with TB and their treatment outcome. Design: This was a retrospective study of children diagnosed with TB between January 2000 and December 2004 in Sagamu. Method: Clinical records of children diagnosed with TB were reviewed. The number of HIV seropositive cases among them was also determined. Their demographic characteristics, clinical presentation and treatment outcomes were noted and comparisons made between those who were HIV positive and others who were HIV negative. Results: Seventy six children comprising 46 males and 30 females (M:F ratio, 1.5:1) were diagnosed with TB. Eight (10.5 percent) of these were HIV-infected. HIV sero-prevalence increased over the years although this was not statistically significant (X2=8.02; p=0.09). The major routes of transmission were mother-to-child (4/8) and blood transfusion (3/8). Only one case of sexually transmitted HIV was observed. HIV-infected children were significantly older than non-infected children (8.5+4.4 v 5.5+3.9 years; p=0.04), and more likely to have a negative Mantoux test. Mortality was significantly higher among children with TB and HIV CO infection than in those who were HIV negative (3/8 vs 2/68; p=0.01). Conclusions: The study showed a higher HIV sero-prevalence among children with TB than the national average. HIV and TB co-infection was associated with higher mortality. Effective strategies to prevent mother-to-child-transmission of HIV and to improve safe blood transfusion services should be vigorously pursued to stem the tide of HIV infection in children.

Objective: To evaluate the effect of Salacia lehmbachii (S. lehmbachii) ethanol root bark extract on estrous cycle and sex hormones in female rats. Methods: Forty-eight virgin rats with regular 4-day cycle were grouped into four and each group was further subdivided into ‘a’ and ‘b’ (n=6). Each group was orally treated for 28 days with 2 mL of distilled water (control), ethanol root bark extract of S. lehmbachii in doses of 250, 500 and 750 mg/kg/body weight (groups 2, 3, 4, respectively). Estrous cycle was determined daily using the vaginal smear method. Rats in ‘a’ subgroups were weighed and sacrificed on the 29th day, and blood was collected for serum generation which was used for hormonal assay and sex organs were removed and weighed. Rats in ‘b’ subgroups were discontinued from treatment for 2 weeks and the parameters above were reassessed. Results: The mean length of estrous cycle and duration of diestrous of treated rats were prolonged dose dependently compared to control. The increase was significant (P

Background: Though industrial disputes are a global phenomenon, there is a rising concern of its frequent occurrence in Sub-Saharan Africa. Objective: To assess the effect of industrial actions embarked upon by the health workers during the year 2014 on Tuberculosis (TB) notification in Ogun State, Nigeria. Methods: A retrospective review of TB notification in 2013 and 2014 was conducted. Quarterly TB case notification, the proportions of Human Immunodeficiency Virus (HIV) test, Co-trimoxazole (CPT) uptake and Antiretroviral Therapy (ART) uptake in the years 2013 and 2014 were compared using the Epi-info software. Results: There was a decline in the proportion of TB cases reported by the public sector health services and an increase in the proportion of TB cases reported by the private health facilities during the period of industrial disputes in the public health sector (doctors and non-doctors) (p = 0.001). Compared to the year 2013, the proportion of presumptive TB cases tested for HIV declined significantly during the period of the strike actions by the non-doctors but not during the strike actions by doctors in 2014. There was no difference in the uptake of Co-trimoxazole (p = 0.456 and 0.511) and Anti-retroviral Therapy (p = 0.192 and 0.544) by TB/HIV co-infected patients during the strike actions by the doctors and the non-doctors respectively. Conclusion: This study demonstrated the importance of Public-Private–Mix for TB case finding efforts in the developing countries, where there are incessant strike actions by health workers in the public sector.

Background: Childhood tuberculosis (TB) account for about 6% of the global TB burden, but there is a paucity of data on childhood TB at the national and state level in many countries in Sub-Saharan Africa. Objective: To assess the childhood TB case notification rates and explore associated factors at the state level in Nigeria. Methods: A retrospective ecological study was carried out to determine the childhood TB case notification rates in the 36 states and the Federal Capital Territory (FCT) in Nigeria. TB data was retrieved from the National TB and Leprosy Control Programme (NTBLCP) 2014 Annual Report using a proforma. The association between TB case notification rate at the state level and the six selected explanatory variables (Human Development Index, Bacillus Calmette-Guerin [BCG] coverage, percentage underweight, HIV positivity rate, mean household size and population density) were carried out using negative binomial regression in R statistical software. Results: A total of 91, 353 TB patients were notified to the World Health Organization (WHO) in 2014 by the NTBLCP. Of these, 5463 (6%) were children aged 0-14 years. The childhood TB notification rate was 6.99/100,000 population. The highest childhood TB case notification rate was recorded in Nasarawa State followed by Lagos and Oyo States. There were significant associations between childhood TB case notification rate and HIV positivity rate, percentage underweight, household size, population density and BCG coverage. Conclusion: The study showed that childhood TB case notification rate in Nigeria was low. TB case notification rate was associated with high HIV rate, percentage underweight, household size, population density and BCG coverage. There is the urgent need to address the associated risk factors to effectively control childhood TB in Nigeria.

Background: Infant mortality is a public health concern especially in developing countries, particularly Nigeria. Different models had been used independently to identify factors associated with infant mortality. Some of the used models sometimes violate the underlying assumption for the models. This study was designed to compare the models that have been previously used and identify the appropriate model using standard model selection criteria to analyse risk factors for infant mortality in Nigeria. Methods: The study utilised 2008 Nigeria Demographic and Health Survey (NDHS) data with a sample size of 7107. The NDHS was a stratified two-stage cluster design where a questionnaire was used to collect data on the birth history of women aged 15-49 years. The models employed for this study were: Logit, Probit and Clog-log. The model selection criteria were Akaike Information Criterion (AIC), Residual Deviance and Vuong test. The model with the smallest criteria was considered to be the best fit. Results: The results showed that Infant Mortality in Nigeria can be appropriately modelled by Clog-log model. The models and corresponding AIC values were: Logit (6171.1), Probit (6212.6) and Clog-log (6126.6). The residual deviance included: Logit (6135.1), Probit (6176.6) and Clog-log (6090.6). Clog-log had the smallest AIC and residual deviance values; hence, it was of the best fit. Home delivery and delivery by professionals had negative significant associations with infant mortality while women's education (primary/no education) and birth order had positive significant association, (p < 0.05). Conclusion: The best model for infant mortality evaluation in Nigeria was Clog-log. Generally, improved women’s education would significantly reduce Infant Mortality in Nigeria.

Background: Diabetes mellitus predisposes to both bacterial and fungal infections, includingCandida species. Hitherto, Candida albicans has been identified as the most common opportunistic pathogen amongpatients with diabetes mellitus. More recently, Non-Candida albicans Candida (NCAC) species are increasingly recognized as the cause of candida infections. Objective: To determine the prevalence of vulvovaginal candidiasis (VVC) as well as the species of Candida frequently identified among women with diabetes mellitus in Ibadan, Nigeria. Methods: A cross-sectional study of 213 women diagnosed with diabetes mellitus was carried out in 2010. Direct microscopy and fungal cultures of high vaginal swabs were done using Sabouraud--Dextrose Agar and ChromAgar. Results: The prevalence of VVC among 213 women with diabetic mellitus was 18.8% (40/213). The predominant Candida species isolated were Candida glabrata (30.0%), C. albicans and C. tropicalis (17.5%) each and C. Gulliermondii (15.0%). Diabetic women had higher rates of moderate and heavy growth of Candida density. Twenty-nine (72.5%) patients with candidiasis were symptomatic and the most common symptom was vulval/vaginal itching 48.3% (14/29). Conclusion: This study put the prevalence rate of VVC among women with diabetes mellitus in Ibadan at 18.8%. The most common Candida species isolated was C.glabrata and majority of the patients were symptomatic.

Abstract Background Limited research has explored the effect of Circle of Willis (CoW) anatomy among blunt cerebrovascular injuries (BCVI) on outcomes. It remains unclear if current BCVI screening and scanning practices are sufficient in identification of concomitant COW anomalies and how they affect outcomes. Methods This retrospective cohort study included adult traumatic BCVIs at 17 level I-IV trauma centers (08/01/2017-07/31/2021). The objectives were to compare screening criteria, scanning practices, and outcomes among those with and without COW anomalies. Results Of 561 BCVIs, 65% were male and the median age was 48 y/o. 17% (n = 93) had a CoW anomaly. Compared to those with normal CoW anatomy, those with CoW anomalies had significantly higher rates of any strokes (10% vs. 4%, p = 0.04), ICHs (38% vs. 21%, p = 0.001), and clinically significant bleed (CSB) before antithrombotic initiation (14% vs. 3%, p

Phyllodes tumors (PTs) are a rare group of mammary fibroepithelial lesions accounting for up to 1% of breast tumors. They display biologic diversity, ranging from benign to malignant. PTs of the breast are mostly found in females aged 35–55 years and are rare in adolescents and the elderly. They usually present as a fast growing, painless breast mass. The treatment of choice for PTs is complete excision with clear margins. In patients with large PTs, breast reconstruction results in better outcome and increased satisfaction. Our patient, a 39-year-old female presented with an enlarging breast mass over a period of 6 months. Physical examination showed a large, ulcerated mass involving the entire right breast. Histopathology revealed features of a malignant PT. Total mastectomy and immediate reconstruction with a pedicled latissimus dorsi myocutaneous flap and symmetrization reduction mastopexy of the left breast was done. At 6 months, the patient has not shown any gross tumor recurrence with acceptable cosmesis.

Objective:Mammographic screening and management of breast cancer (BC) in elderly women are controversial and continue to be an important health problem. To investigate, through members of the Senologic International Society (SIS), the current global practices in BC in elderly women, highlighting topics of debate and suggesting perspectives.Materials and Methods:The questionnaire was sent to the SIS network and included 55 questions on definitions of an elderly woman, BC epidemiology, screening, clinical and pathological characteristics, therapeutic management in elderly women, onco-geriatric assessment and perspectives.Results:Twenty-eight respondents from 21 countries and six continents, representing a population of 2.86 billion, completed and submitted the survey. Most respondents considered women 70 years and older to be elderly. In most countries, BC was often diagnosed at an advanced stage compared to younger women, and age-related mortality was high. For this reason, participants recommended that personalized screening be continued in elderly women with a long life expectancy.In addition, this survey highlighted that geriatric frailty assessment tools and comprehensive geriatric evaluations needed to be used more and should be developed to avoid undertreatment. Similarly, multidisciplinary meetings dedicated to elderly women with BC should be encouraged to avoid under- and over-treatment and to increase their participation in clinical trials.Conclusion:Due to increased life expectancy, BC in elderly women will become a more important field in public health. Therefore, screening, personalized treatment, and comprehensive geriatric assessment should be the cornerstones of future practice to avoid the current excess of age-related mortality. This survey described, through members of the SIS, a global picture of current international practices in BC in elderly women.

Abstract Background The Basic Emergency Care: Approach to the acutely ill and injured course was developed to train health care providers to recognize, stabilize, and treat critically ill patients in resource-limited settings. This study evaluates the Basic Emergency Care course as a tool for improving the emergency medicine knowledge and skills of medical students in a lower-middle income country. Methods This prospective study was conducted with senior medical students at the University of Nairobi School of Medicine in October 2021. Participants’ knowledge was assessed with multiple choice pre- and post-course examinations. Pre- and post-course surveys assessed participants’ confidence in managing acutely ill and injured patients using a 4-point Likert scale. Results A total of 30 students from the graduating medical school class participated in the study. Post-course examination scores (mean 94.5%, range 80–100%) showed a significant improvement (p

Abstract Background Antimicrobial resistance (AMR) is an important global health concern, projected to contribute to significant mortality, particularly in developing countries. This study aimed to determine the knowledge, perceptions of clinical health professions students towards antimicrobial resistance and rational use of medicine and confidence level to prescribe antimicrobials. Methods An online descriptive cross-sectional survey was conducted among clinical health professions students across 9 medical schools in Uganda. A semi-structured questionnaire using Kobo Toolbox form was shared among participants via WhatsApp Messenger (Meta, California, USA). Knowledge was categorized using modified Bloom’s cut-off. One-way ANOVA, Chi-square or Fisher’s exact test, and logistic regression were used to assess the association between dependent and independent variables. A p

Background: Salacial lehmbachii stem bark is used traditionally for the treatment of diabetes mellitus and its associated complications. Treatment of diabetes is necessary to reduce these complications. Methods: In this study, the antidiabetic and antihyperlipidemic potential of S. lehmbachii ethanol stem bark extract was evaluated in alloxan-induced diabetic rats at a dose of 100 mg/kg, 200 mg/kg, and 400 mg/kg p.o. daily for 21 days. Blood glucose levels, serum total cholesterol (TC), triglycerides (TG), high density lipoprotein (HDL), low density lipoprotein (LDL), and very low density lipoprotein (VLDL) were assessed in the animals. Results: Treatment of alloxan-induced diabetic rats with S. lehmbachii stem bark extract showed significant (p<0.01) reduction in blood glucose levels when compared with diabetic control. The elevated levels of serum cholesterol, triglycerides, LDL, and VLDL were significantly (p<0.01) reduced by S. lehmbachii stem bark extract, while the level of HDL significantly (p<0.01) increased. Conclusions: The results obtained suggest that S. lehmbachii stem bark extract has the potential to treat diabetes condition and hyperlipidemic disorders. [ABSTRACT FROM AUTHOR]

Synapse dysfunction and loss are central features of neurodegenerative diseases, caused in part by the accumulation of protein oligomers. Amyloid-β, tau, prion, and α-synuclein oligomers bind to the cellular prion protein (PrPC), resulting in the activation of macromolecular complexes and signaling at the post-synapse, yet the early signaling events are unclear. Here we sought to determine the early transcript and protein alterations in the hippocampus during the pre-clinical stages of prion disease. We used a transcriptomic approach focused on the early-stage, prion-infected hippocampus of male wild-type mice, and identify immediate early genes, including the synaptic activity response gene, Arc/Arg3.1, as significantly upregulated. In a longitudinal study of male, prion-infected mice, Arc/Arg-3.1 protein was increased early (40% of the incubation period), and by mid-disease (pre-clinical), phosphorylated AMPA receptors (pGluA1-S845) were increased and metabotropic glutamate receptors (mGluR5 dimers) were markedly reduced in the hippocampus. Notably, sporadic Creutzfeldt-Jakob disease (sCJD) post-mortem cortical samples also showed low levels of mGluR5 dimers. Together, these findings suggest that prions trigger an early Arc response, followed by an increase in phosphorylated GluA1 and a reduction in mGluR5 receptors.

Abstract Background COVID-19 is still a major global threat for which vaccination remains the ultimate solution. Uganda reported 40,751 cases and 335 deaths as of 9 April 2021 and started its vaccination program among priority groups like health workers, teachers, those with chronic diseases among others in early March 2021. Unanimous uptake of the COVID-19 vaccine is required to subsequently avert its spread; therefore, we assessed COVID-19 vaccine acceptability, hesitancy, and associated factors among medical students in Uganda. Methods This study employed an online descriptive cross-sectional survey among medical students across 10 medical schools in Uganda. A structured questionnaire via Google Form was conveniently sent to eligible participants via WhatsApp. Each medical school had a coordinator who consistently shared the data tool in the WhatsApp groups. Chi-square or Fisher’s exact test, and logistic regression were used to assess the association between vaccine acceptability with demographics, COVID-19 risk perception, and vaccine hesitancy. Results We surveyed 600 medical students, 377 (62.8%) were male. COVID-19 vaccine acceptability was 37.3% and vaccine hesitancy 30.7%. Factors associated with vaccine acceptability were being male (adjusted odds ratio (aOR) = 1.9, 95% CI 1.3–2.9, p=0.001) and being single (aOR= 2.1, 95% CI 1.1–3.9, p=0.022). Very high (aOR= 3.5, 95% CI 1.7–6.9, p

Background: The supportive learning environment can enhance impartating of knowledge and skills. Objective: To assess the learning environment at the School of Medicine of the University of Nairobi using the Dundee Ready Educational Environment Measure (DREEM) tool. Methods: A cross-sectional survey carried in 2019 out among medical students during their clinical years to obtain their perceptions about the learning environment at the School of Medicine of the University of Nairobi. The DREEM tool was used for the survey. Data were entered and analyzed in SPSS version19. Comparisons were performed using analysis of variance (ANOVA). p≤0.05 was considered statistically significant. Results: We obtained 619 responses (77.4%) from 800 tools distributed. The total mean score of DREEM was 93.3/200. This is a 46.7% score overall indicating a poor perception of the learning environment. Year IV was the class with the poorest perception with a p

Background: The educational environment (EE) has a significant influence on effective student learning. The Dundee Ready Education Environment Measure (DREEM) is a validated tool to assess the EE. A DREEM survey done in early 2019 among medical students at the University of Nairobi highlighted many problems. It was therefore important to explore why such perceptions existed among the medical students. Objectives: To explore medical students’ perceptions of the medical education learning environment at the University of Nairobi. Methods: Qualitative focus group discussions (FGD) were held among medical students in years III to VI in groups of between 8and 12 students. The discussions were recorded using a Samsung J6 phone voice recorder, transcribed, coded, and analysed for themes until saturation was reached. Results: We held six FGD with medical students in years III to VI and identified four thematic areas: 1) poor educational infrastructure, 2) poor educational structure, 3) teacher-centred teaching, and 4) lack of social support for students in difficulties. Conclusion: Exploring the perceptions of the EE confirmed students have a poor view of the educational environment. The issues raised are good feedback on teaching, governance and the social culture of the institution.

Proteolytic enzymes, also known as peptidases, are critical in all living organisms. Peptidases control the cleavage, activation, turnover, and synthesis of proteins and regulate many biochemical and physiological processes. They are also involved in several pathophysiological processes. Among peptidases, aminopeptidases catalyze the cleavage of the N-terminal amino acids of proteins or peptide substrates. They are distributed in many phyla and play critical roles in physiology and pathophysiology. Many of them are metallopeptidases belonging to the M1 and M17 families, among others. Some, such as M1 aminopeptidases N and A, thyrotropin-releasing hormone-degrading ectoenzyme, and M17 leucyl aminopeptidase, are targets for the development of therapeutic agents for human diseases, including cancer, hypertension, central nervous system disorders, inflammation, immune system disorders, skin pathologies, and infectious diseases, such as malaria. The relevance of aminopeptidases has driven the search and identification of potent and selective inhibitors as major tools to control proteolysis with an impact in biochemistry, biotechnology, and biomedicine. The present contribution focuses on marine invertebrate biodiversity as an important and promising source of inhibitors of metalloaminopeptidases from M1 and M17 families, with foreseen biomedical applications in human diseases. The results reviewed in the present contribution support and encourage further studies with inhibitors isolated from marine invertebrates in different biomedical models associated with the activity of these families of exopeptidases.

Background: Ki67 levels have been shown to have good predictive value in breast cancer treatment. There is paucity of data on Ki67 levels in predicting response to neoadjuvant chemotherapy (NACT) in Kenya. This study evaluated the utility of Ki67 in predicting response to NACT. Methods: This was a prospective observational study carried out at Kenyatta National Hospital between December 2017 and January 2019 on patients with locally advanced breast cancer. We recruited 61 women through consecutive sampling technique. Data collected included patient demographics, pre-treatment tumor size, Ki67 levels and tumor biology. After 3 cycles of first-line chemotherapy, ultrasonography was used to determine response. Data were analyzed by SPSS for proportion of change in tumor size. The response was correlated with tumor biology and pretreatment levels of Ki67 using chisquare at a 95% confidence interval. A p-value

BackgroundLockdown is an important public health approach aimed at curbing the raging effect of the coronavirus disease-2019 (COVID-19). This study aimed at determining the impact of prolonged lockdown on mental health and access to mental health services among undergraduate students in Uganda.MethodsAn online cross-sectional study was conducted anonymously among undergraduates across 10 universities in Uganda. The Distress Questionnaire-5 (DQ-5) and the Patient Health Questionnaire-2 (PHQ-2) were used. Logistic regression analysis was conducted to determine factors associated with psychological distress.ResultsWe enrolled 366 participants with a mean age of 24.5 ± 4.6 years. The prevalence of psychological distress was 40.2% (n = 147) (cut off 14/25 based on DQ-5) while depression stood at 25.7% (n = 94; cut off 3/6 based on PHQ-2) with mean scores of 12.1 ± 4.6 and 1.7 ± 1.6 respectively. Female gender (aOR: 1.6, 95%CI: 1.0–2.6, p = 0.032), pursuing a non-medical program (aOR: 2.2, 95%CI: 1.3–3.7, p = 0.005) were factors associated with psychological distress while non-medical program (aOR: 2.2, 95%CI: 1.3–3.7, p = 0.005) was associated with increased depression. Access to mental health services was associated with both reduced distress (aOR: 0.5, 95%CI: 0.3–0.8, p = 0.005) and depression (aOR: 0.6, 95%CI: 0.3–0.9, p = 0.034). A majority (65.3%) of the participants reported knowing how to access mental health care and 188 (51.4%) reported having needed emotional support but, only 67 (18.3%) ever sought care from a mental health professional. Of those who had access, only 10 (7%), and 13 (9%) accessed a counselor or a mental health unit, respectively. The barriers to accessibility of mental health care included financial limitations (49.5%), lack of awareness (32.5%), lack of mental health professionals (28.4%), and stigma (13.9%).ConclusionAmong university students in Uganda during the COVID- 19 lockdown, the burden of psychological distress and depression was substantial. However, access to mental health services was limited by several factors.

Abstract Background HIV-1 infection remains a major public health concern despite effective combination antiretroviral therapy (cART). The virus enters the central nervous system (CNS) early in infection and continues to cause HIV-associated neurocognitive disorders (HAND). The pathogenic mechanisms of HIV-associated brain injury remain incompletely understood. Since HIV-1 activates the type I interferon system, which signals via interferon-α receptor (IFNAR) 1 and 2, this study investigated the potential role of IFNAR1 in HIV-induced neurotoxicity. Methods We cross-bred HIVgp120-transgenic (tg) and IFNAR1 knockout (IFNAR1KO) mice. At 11–14 months of age, we performed a behavioral assessment and subsequently analyzed neuropathological alterations using deconvolution and quantitative immunofluorescence microscopy, quantitative RT-PCR, and bioinformatics. Western blotting of brain lysates and an in vitro neurotoxicity assay were employed for analysis of cellular signaling pathways. Results We show that IFNAR1KO results in partial, sex-dependent protection from neuronal injury and behavioral deficits in a transgenic model of HIV-induced brain injury. The IFNAR1KO rescues spatial memory and ameliorates loss of presynaptic terminals preferentially in female HIVgp120tg mice. Similarly, expression of genes involved in neurotransmission reveals sex-dependent effects of IFNAR1KO and HIVgp120. In contrast, IFNAR1-deficiency, independent of sex, limits damage to neuronal dendrites, microgliosis, and activation of p38 MAPK and restores ERK activity in the HIVgp120tg brain. In vitro, inhibition of p38 MAPK abrogates neurotoxicity caused similarly by blockade of ERK kinase and HIVgp120. Conclusion Our findings indicate that IFNAR1 plays a pivotal role in both sex-dependent and independent processes of neuronal injury and behavioral impairment triggered by HIV-1.

Background: Performing surgical procedure on a pregnant woman may have major consequences for the fetus, patient, healthcare worker and institution. Assessment of pregnancy status in women of reproductive age when admitted to hospital is therefore an important safety practice. Documentation of likelihood of pregnancy among women admitted in the surgical units of Kenyatta National Hospital (KNH) is not known. Objective: To assess documentation of pregnancy status and possibility of pregnancy before surgery at KNH. Methods: This was a retrospective study involving all surgical units of female patients of reproductive age with various diagnoses and scheduled to undergo surgery between January 2011 and December 2016. Data collected included documentation of age, parity, last menstrual period, level of education, use of family planning, and pregnancy status confirmation using urine or serum beta human chorionic gonadotrophin (HCG) and ultrasound. Results: We analysed data from 331 patient records. All (100%) of the sampled records had age of the patient recorded, 43% had information on parity documented, 35% had last normal menstrual period recorded, and only 26% of the records showed information on use of family planning. 19 (5.7%) patients were confirmed to be pregnant using ultrasound and urine β-HCG. Conclusion: Although only a small proportion of women admitted in surgical units were pregnant, data on likelihood of pregnancy as deduced from information on age, last menstrual period and use of family planning were missing.

Abstract Background and Aim Breast cancer is the leading cancer in terms of incidence in Kenya. We conducted a breast cancer awareness and screening pilot to assess feasibility of rolling out a national screening program in Kenya. Methods Conducted in Nyeri County during October–November 2019, the pilot had three phases; awareness creation, screening (clinical breast examination and/or imaging) and final evaluation (post‐screening exit interviews and retrospective screening data review). Descriptive statistics on awareness, screening process and outputs were derived. Results During the pilot, 1813 CBE, 217 breast ultrasounds and 600 mammograms were performed. Mammography equipment utilization increased from 11% to 83%. Of 49 women with suspicious lesions on mammography, only 22 (44.9%) had been linked to care 4 months after the campaign. Of 532 exit interview respondents; 95% (505/532) were ≥35 years of age; 80% (426/532) had been reached by the awareness campaign. Majority (75% [399/532]) had received information from community health volunteers; 68% through social groups. Majority (79% [420/532]) felt the campaign had changed their behavior on breast health. Although 77% (407/532) had knowledge on self breast examination (SBE); only 13% practiced monthly SBE. More than half (58% [306/532]) had previously undertaken a CBE. Approximately 70% (375/528) were unaware of mammography before the pilot; 86% (459/532) had never previously undertaken a mammogram. Fifty‐five percent (293/532) of respondents had screening waiting times of >120 min. Conclusion Community health workers can create breast cancer screening demand sustainably. Adequate personnel and effective follow‐up are crucial before national roll‐out of a breast cancer screening program.

Early in the HIV pandemic, it became evident that people living with HIV (PLWH) develop a wide range of neurological and neurocognitive complications. Even after the introduction of combination antiretroviral therapy (cART), which dramatically improved survival of PLWH, the overall number of people living with some form of HIV-associated neurocognitive disorders (HAND) seemed to remain unchanged, although the incidence of dementia declined and questions about the incidence and diagnosis of the mildest form of HAND arose. To better understand this complex disease, several transcriptomic analyses have been conducted in autopsy samples, as well as in non-human primates and small animal rodent models. However, genetic studies in the HIV field have mostly focused on the genetic makeup of the immune system. Much less is known about the genetic underpinnings of HAND. Here, we provide a summary of reported transcriptomic and epigenetic changes in HAND, as well as some of the potential genetic underpinnings that have been linked to HAND, and discuss future directions with hurdles to overcome and angles that remain to be explored.

Background: Breast cancer survival is linked to early detection, and timely and appropriate treatment. Survival depends on the stage and biological behaviour of the tumour. It is unclear how different molecular subtypes impact on axillary node involvement. Objective: This study sought to determine the correlation between hormonal receptor status with axillary nodal status in breast carcinoma. Methodology: A cross sectional study was carried out at Kenyatta National Hospital surgical wards and histopathology laboratory. Patients with a histological diagnosis of breast cancer, scheduled to undergo a modified radical mastectomy, were recruited. Data collected included age at diagnosis, parity, menopausal status, clinical examination findings, stage of the disease clinically and pathologically, and hormonal receptor status. Data were analyzed using SPSS version 21.0. Results: We enrolled 79 women with invasive breast carcinoma. Mean age was 48 (SD=14.5) years. Most (48.1%) presented with stage III tumour. Most tumours (58.2%) were luminal A. Correlation between molecular type and nodal involvement was not significant. Luminal B was significantly present in those above 50 years (p=0.011). Conclusion: The most common molecular type of breast cancer was luminal A, but luminal B disease which was prevalent in women more than 50 years old was the only molecular subtype that had a positive correlation with axillary nodal status

Background: Despite improvement in many aspects of acute trauma care, uncontrolled bleeding is responsible for more than 50% of all trauma related deaths within the first two days of admission. Objective: This study sought to determine the incidence of coagulopathy among major trauma patients and their associated outcome. Methods: A prospective descriptive study carried at KNH among major trauma patients. Coagulation status was determined within 30 minutes of arrival. Outcomes assessed included length of hospital stay, transfusion requirement and mortality for 30 days. Fischer’s exact test was used to analyze categorical variables and Student T test used to analyze continuous variables. Results: The majority (85.7%) of the 140 patients recruited were male and, the mean age was 29.4 years (SD=12.0). Coagulopathy was present in 52.1% of the patients. The mean ISS on admission was 23.3 (SD=4.8), patients with coagulopathy had a higher ISS 22.2 (SD=5.2, p=0.018). The patients with coagulopathy stayed longer in hospital 12 days and their mortality was higher 21 (95.5%) p

Background: Interventional endoscopy enables one time diagnosis and treatment of gastrointestinal diseases with minimally invasive therapy and improved disease outcome. Local use has remained low with minimal reporting. Knowledge of current practice at a tertiary level may promote utilization of interventional gastrointestinal endoscopy. Objective: To describe the practice of interventional gastro intestinal endoscopy at Kenyatta National Hospital. Methods: In a prospective descriptive study consecutive sampling was used. Main variables were interventional procedure offered, sedation mode and immediate outcome of the procedure. Results: There were 211 cases and interventional endoscopy accounted for 21.7% of these. The male: female ratio was 1:0.9. The median age group was 41-50 years. Variceal band ligation, ERCP and esophageal stenting were the three most common procedures. No mortalities were recorded during the period of study. Conclusion: Our report describes application of interventional endoscopy in a variety of gastrointestinal diseases with acceptable immediate outcome.

Background: There has been a marked increase of the prevalence of adenocarcinoma of the esophagus across the globe, with the risk factors including gastroesophageal reflux disease (GERD) and Barrett’s esophagus. It is not known whether the trend is similar locally. Objective: To describe the prevalence and clinicopathological characteristics of adenocarcinoma of the esophagus at Kenyatta National Hospital (KNH).Methods: This was a cross sectional descriptive study of patients presenting with dysphagia at the surgical outpatient unit and the Endoscopy Unit by consecutive sampling. The patients’ demographic and clinical data were obtained using a structured questionnaire. The findings at endoscopy including site of tumor and histopathological findings were recorded. The data was analyzed using SPSS version 22.0. The histological subtypes were presented as a proportion. Results: A total of 74 patients were recruited. The mean age at diagnosis of esophageal cancer was 57.7 years. The mean duration of symptomatology was 4.5 months, with 66.2% of the patients presenting with wasting at diagnosis. The prevalence of adenocarcinoma amongst esophageal tumors was 18.9%. Conclusion: There is increasing occurrence of adenocarcinoma, demonstrating a higher rate than a decade earlier. Further studies are needed to elucidate the risk factors locally.

Background: Blunt abdominal trauma (BAT) is an important cause of morbidity and mortality among trauma patients. Base deficit (BD) has been proposed as an early available tool alongside focused assessment with sonography for trauma (FAST) in the screening of patients suspected to have BAT and also to help guide the selective use of CT scan. Objective: To determine the use of BD as an indicator of significant BAT. Methods: This was an observational study carried out at the Kenyatta National Hospital from February to May 2015. Patient with suspected BAT admitted into Accident & Emergency were enrolled. Data collected included clinical assessment, BD, FAST findings, CT-scan, and laparotomy were recorded. Data was analyzed using SPSS 17.0. Comparison of mean values of BD between different groups of patients (dischargedfrom A&E, managed conservatively or operated) was performed using ANOVA. Results: Patients who had significant abdominal injury had sensitivity and specificity of 82.98% and 65.91 % respectively at BD of -4.15.The PPV and NPV were 56.52% and 87.88 % respectively. At this cut-off point, AUC was 0.863 (p=0.037). Conclusion: Due to high NPV, BD could rule out significant abdominal injuries but can also predict need for exploratory laparotomy when less than -6.85.

Background: The deleterious effects of intra-abdominal hypertension and abdominal compartment syndrome, affect almost every system. Patients at risk are critically ill, in whom it leads to altered organ perfusion and end-organ dysfunction/failure. The five cases reported highlight the diagnostic and management challenges. Case Presentation: Five patients with variable degrees of multiple organ dysfunction/failure as evidenced by derangements in laboratory and clinical parameters are presented. Non-surgical interventions including insertion or repositioning of a nasogastric tube, insertion of flatus tube, careful titration of IV fluid requirements and appropriate adjustments of ventilator setting were instituted. All five did not respond to initial management and decompressive laparotomy or re-opening of the abdomen was planned. Conclusion: Abdominal compartment syndrome can be prevented by regular measurement of intra-abdominal pressure in patients at risk. Non-surgical means should precede decompressive laparotomy but timely surgical intervention is crucial.

Background: There has been a marked increase of the prevalence of adenocarcinoma of the esophagus across the globe, with the risk factors including gastroesophageal reflux disease (GERD) and Barrett’s esophagus. It is not known whether the trend is similar locally. Objective: To describe the prevalence and clinicopathological characteristics of adenocarcinoma of the esophagus at Kenyatta National Hospital (KNH).Methods: This was a cross sectional descriptive study of patients presenting with dysphagia at the surgical outpatient unit and the Endoscopy Unit by consecutive sampling. The patients’ demographic and clinical data were obtained using a structured questionnaire. The findings at endoscopy including site of tumor and histopathological findings were recorded. The data was analyzed using SPSS version 22.0. The histological subtypes were presented as a proportion. Results: A total of 74 patients were recruited. The mean age at diagnosis of esophageal cancer was 57.7 years. The mean duration of symptomatology was 4.5 months, with 66.2% of the patients presenting with wasting at diagnosis. The prevalence of adenocarcinoma amongst esophageal tumors was 18.9%. Conclusion: There is increasing occurrence of adenocarcinoma, demonstrating a higher rate than a decade earlier. Further studies are needed to elucidate the risk factors locally.

Introduction: COVID-19 pandemic has resulted in disruptions in delivery of Tuberculosis services especially, in resource-limited settings. Provisional data by the WHO from 84 countries indicates that about 1.4 million fewer people received care for tuberculosis in 2020 than in 2019. This study assessed the effect of COVID-19 pandemic on tuberculosis case notification rates in Ogun state, Nigeria., Methods: A retrospective review of presumptive TB and diagnosed TB cases that were notified in 2019 and 2020. Analysis was done using Epi-info version 7.2.3.1. Level of statistical significance was p < 0.05., Results: A total of 3102 and 3326 confirmed cases were reported in 2019 and 2020 respectively with an increase of 7.2%. There was significant decline in total number of cases notified in Q2, 2020 compared to 2019 (p=0.001) with a significant increase in proportion of TB cases notified by private facilities from 11.65% in 2019 to 20.27% in 2020., Conclusion: Total TB cases notified in Ogun state increased during the covid-19 pandemic. There was significant decline in TB cases during the lockdown but an increase in proportion of TB cases notified by private facilities demonstrating that private facilities can withstand disruptions to TB case notifications due to the Covid-19 pandemic., (© 2023 Daniel OJ et al.)

Background: Parents play a significant role in the sexual orientation and behaviours of their children. Lack of communication between parents and their children about sexual matters may contribute to engagement of young people in risky sexual behaviours., Objectives: To assess the pattern of parent-youth sexual discussions and its association with sexual activity among unmarried undergraduates in a Nigerian university., Methods: A descriptive cross-sectional study was conducted among 400 undergraduates aged 15-24 years in a tertiary institution in Ogun state, Nigeria. A structured selfadministered questionnaire was used for data collection. Data was analyzed using the Statistical Package for the Social Sciences (SPSS) version 21.0. The level of significance was set at p <0.05., Results: Parent-youth discussions on sexual issues had occurred in 225 (56.2%) of the respondents, with mothers being more involved than fathers; onset was at secondary school level in nearly three-fifths. There was no statistically significant relationship between parent-youth sexual discussions and engagement in sexual intercourse (p = 0.666); however, parental visit(s) on campus was associated with a significant reduction in sexual intercourse (p = 0.006)., Conclusion: Engagement of youths in sexual discussions by their parents is still low and such discussions are often not impactful in preventing pre-marital sex. Parental supervisory visits for undergraduates on campus may be helpful in consolidating the desired effect of such sexual discussions, and should be encouraged., Competing Interests: The Authors declare that no competing interest exists., (Copyright © 2022 by West African Journal of Medicine.)

Background: With the improvement in the capacity to diagnose multidrug-resistant/rifampicin-resistant tuberculosis (MDR/RR-TB) patients due to the increased number of GeneXpert machines in Nigeria, the number of patients diagnosed surpassed the bed capacity at MDR-TB treatment centres. Community DR-TB treatment is an important option to improve access to care for MDR/RR-TB patients. However, few studies have determined the outcome of community management of MDR-TB patients, which this study aims to address., Methods: We conducted a retrospective study of MDR/RR-TB patients initiated on treatment in the community in Lagos, Nigeria, between 1 January 2015 and 31 December 2016. Data were retrieved from DR-TB treatment cards/registers. The treatment outcomes of these patients were assessed at the end of treatment and categorized according to national TB guidelines., Results: A total of 150 DR-TB patients commenced treatment during the study period. Adherence was 64.7%, with the majority of patients experiencing mild (56.5%) adverse drug events. Treatment was successful in 70% of patients. The only predictor of successful treatment was treatment adherence., Conclusions: The study shows that community initiation of MDR-TB treatment is feasible and results in a high treatment success rate. Adherence counselling before and during treatment is essential for a favourable treatment outcome., (© The Author(s) 2021. Published by Oxford University Presson behalf of Royal Society of Tropical Medicine and Hygiene.)

Background: The first reported case of the novel coronavirus (COVID 19) in Nigeria was on the 27th of February 2020. Since then, the country has witnessed a steady increase in the number of patients confirmed with the disease. As of April 27th 2021, a total of 164,756 confirmed COVID-19 cases were notified making it the fifth-highest number of cases in the African region. This study aims to determine the spatial distribution of COVID-19 in Nigeria, identify clusters and determine factors associated with COVID-19., Methods: The study used secondary data of COVID-19 cases notified in each of the 36 states and the Federal Capital Territory between 27th February and 9th June, 2020. The Global and Local Moran'sItest were used to identify significant spatial clusters. The negative binomial regression model was used to identify factors associated with COVID-19 and p d" 0.05 was regarded as statistically significant., Results: The Local Moran I identified Lagos State as the significant cluster for COVID-19 in Nigeria at p<0.05. Higher GDP per capita and lower literacy rates were significantly associated with COVID-19 cases reported by the states while population density, BCG coverage and average temperature were not significantly associated., Conclusion: The study identified Lagos State as the hotspot for the COVID-19 pandemic in Nigeria. The states with lower literacy rate and higher GDP per capita reported a higher number of COVID-19 cases. Proactive measures are needed to control of the infection in Lagos state while improving the literacy about the disease transmission and control measures., Competing Interests: The Authors declare that no competing interest exists., (Copyright © 2021 by West African Journal of Medicine.)

Aims: The risk of potential harms prompted the UK government to introduce the Psychoactive Substances Act in 2016. The aim of the present study was to evaluate the impact and effectiveness of this new legislation on patterns of novel psychoactive substance (NPS) awareness, use, experiences and risk awareness in a self-selected sample of UK consumers to inform education and policy., Methods: The Bristol Online Survey was advertised on the Bluelight drug forum and social media Facebook pages and University email between 7 January and 7 February 2015 (168 responses) and 9 March to 18 September 2017 (726 responses). UK country of residence responses were extracted for analysis (SPSS)., Results: In a predominantly university-educated, young (< 25 years) self-selecting sample, 1 year after introduction of the legislation, NPS use (in males, under 18s, those educated to school/college level, P < .001) has increased, whilst health risk awareness has not changed and remains poor. Users are switching to sourcing NPSs via street dealers (49%) and the darknet (31%) and showing an increase in preference for the herbal NPS Salvia divinorum (P < .05). The main reasons for NPS use remain the influence of friends (69%) in a social setting and to get high (76%) usually in combination with alcohol, cannabis or ecstasy., Conclusion: Regulation alone, so far, has not impacted on health risk awareness, NPS drug demand and culture in our UK survey sample. Alongside regulation, NPS health promotion education (particularly in schools, colleges) is needed that addresses resilience and both the risks and beneficial effects of NPS., (© 2019 The British Pharmacological Society.)