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Purpose The importance of smartphones in enhancing students learning, research and development is well-established in many published studies. Nevertheless, due to numerous challenges, Nigerian students are yet to reap from the benefits of smartphones in terms of accessing vital information for learning and development. Therefore, this study aims to develop a framework that will enhance Nigerian students’ ability to use smartphones for learning. Design/methodology/approach The SERVQUAL Theory Framework is adapted to actualize the research aim. Moreover, a qualitative (in-depth interview) research approach was used to interview 60 students from 3 public universities in Nigeria. Purposive sampling technique was used to select the interviewees, and the interview data were analysed using thematic content analysis. Findings The findings identified the critical constraints that deter Nigerian students from reaping the full potential of smartphones for learning. The constraints are categorized into three groups which include telecommunication companies’ hiccups, such as high cost of internet, poor network services and coverage; government obstacles, such as high tax policies, insufficient electricity supply and lack of basic infrastructure; and university barriers, such as unavailability of Wi-Fi connection for students, lack of equipped university libraries and poor management. Originality/value Thus, a holistic Framework for Enhancing Students Smartphones Learning Ability was established to provide fundamental recommendations to the Nigerian Government, telecommunication companies in Nigeria and Nigerian universities to tackle the pressing issues hindering Nigerian students from using their smartphones for learning. This will enhance the smartphone learning experience of Nigerian students.

Cryptococcus gattii is an underrecognized cause of meningitis, especially in nonendemic regions. This report details C gattii disease progression from admission to autopsy in an otherwise healthy 40-year-old male in Texas. It brings awareness to an often unsuspected organism that can cause severe infection requiring early recognition and treatment in immunocompetent individuals.

ObjectiveOpioid and benzodiazepine co-prescribing is associated with a substantial increase in opioid overdose deaths. In this study, we examine the prescribing trends of substitutes of opioids and benzodiazepines alone or in combination, compared with opioids and benzodiazepines.DesignRetrospective cohort study.SettingData were collected using a 20% national sample of Medicare beneficiaries from 2013 to 2018.Participants4.1–4.3 million enrollees each year from 2013 to 2018.InterventionNone.Primary outcomeWe employ a generalised linear mixed models to calculate ORs for opioid use, benzodiazepine or Z-drug (benzos/Z-drugs) use, opioid/benzos/Z-drugs 30-day use, gabapentinoid use and (selective serotonin reuptake inhibitors (SSRI) and serotonin norepinephrine reuptake inhibitors (SNRIs)) use, adjusted for the repeated measure of patient. We then created two models to calculate the ORs for each year and comparing to 2013.ResultsOpioid and benzos/Z-drugs use decreased by 2018 (aOR 0.626; 95% CI 0.622 to 0.630) comparing to 2013. We demonstrate a 36.3% and 9.9% increase rate of gabapentinoid and SSRI/SNRI use, respectively. Furthermore, combined gabapentinoid and SSRI/SNRI use increased in 2018 (aOR 1.422; 95% CI 1.412 to 1.431).ConclusionLittle is known about the prescribing pattern and trend of opioid and benzodiazepine alternatives as analgesics. There is a modest shift from prescribing opioid and benzos/Z-drugs (alone or in combination) towards prescribing non-opioid analgesics—gabapentinoids with and without non-benzos/Z-drugs that are indicated for anxiety. It is unclear if this trend towards opioid/benzos/Z-drugs alternatives is associated with fewer drug overdose death, better control of pain and comorbid anxiety, and improved quality of life.

Education is wise, hopeful, and respectful cultivation of learning and change are undertaken in the belief that we all shall have the chance to share in life. Education is necessary for each and everyone in order to improve knowledge, way of living as well as social and economic status in life. It also plays a fundamental role in our career growth as well as in personal growth. However, despite the fact that education is important for human development, rural education receives less attention from the government in its reform agenda. This may be because the education Ministry is usually located in urban areas. This lack of attention from the government has produced several setbacks to the development of rural education, starting from poor infrastructures, lack of qualified teachers to inadequate laboratories and libraries. Based on these problems, it can be said that rural students may not be able to compete with their counterparts in urban schools.

Background Gabapentin is a commonly used medication for neuropathic pain and epilepsy that is prescribed by a wide range of medical specialties. Adverse effects including asterixis and myoclonus have been described in patients with chronic kidney disease, but myokymia has not been previously reported. Case presentation A 69-year-old man with a history of traumatic brain injury, peripheral neuropathy, amnesia, and posttraumatic stress disorder presented to the hospital after multiple falls attributed to acute onset muscle spasms. He reported taking a total daily dose of 9600 mg of gabapentin, as prescribed. Physical examination demonstrated stimulus-sensitive myoclonus, painful muscle spasms in all extremities, and myokymia in his bilateral calves. Diffuse action tremors, as well as tongue tremors, were also observed.Initial workup, including basic laboratory investigations, brain imaging, and electroencephalogram, was unrevealing. Gabapentin toxicity was suspected, and a gabapentin holiday was initiated with the improvement of myokymia by hospital day 3. The patient was found to have a high gabapentin level (25.8 μg/mL; reference range, 2.0-20.0 μg/mL) measured the morning after hospital presentation. After restarting on a lower dose of gabapentin with multimodal pain control, the patient continued to improve with diminution of his myoclonus, tremor, and gait instability. Conclusions Myokymia is a newly described motor symptom associated with gabapentin toxicity. The mechanism of gabapentin-associated myokymia is currently unknown. A brief medication holiday resulted in the resolution of motor symptoms without significant withdrawal symptoms. Knowledge of this newly reported adverse manifestation can aid physicians in the diagnosis of gabapentin toxicity and prompt treatment, as gabapentin levels are not widely or immediately available.

There is a paucity of information worldwide on the health problems among pesticide traders that are occupationally exposed to pesticides. A study was conducted in the Sultanate of Oman to investigate pesticide handling and their health risk perception by pesticide traders, and how these are impacted by their level of education, training, and the use of personal protection equipment (PPE). A total of 63 traders were randomly selected in four Regions (Al Batinah, Al Dhahirah, Al Dakhiliyah and Al Sharqiyah) in the Sultanate of Oman. Participation was based on full informed consent and assurances of confidentiality. The survey adopted the interview format, using hard copies of questionnaires. About 90% of the traders with formal pesticide training used some form of PPE, compared to 19% among those with no pesticide training. All (100%) of the trained traders had knowledge of pesticide regulations, informed customers on the proper use of pesticides and knew that pesticides could be dangerous. The corresponding percentages among the untrained traders were 13, 12 and 60, respectively. Among all the traders, the most reported health symptoms were headache (73%), skin irritation (71.4%) and salivation (63.5%). In as much as many farm workers and other pesticide end-users depend on the traders for information on pesticides, it is suggested that training be made mandatory for all pesticide traders. The use of PPE should also be made mandatory and pesticide inspectors should be made to inspect the pesticide shops regularly to ensure compliance.

A study was conducted among greenhouse and open field pesticide workers at the Batinah Coast of Oman in 2008 - 2009 to compare their level of pesticide exposure. A total of 74 greenhouse and 79 open field pesticide workers using pesticide mixtures consisting mostly of organophosphates were interviewed. Eighteen self-reported toxicity symptoms were recorded, with 9 and 3 of them being more prevalent among the greenhouse and open field workers, respectively. Although toxicity symptoms were generally higher among the greenhouse workers, it was observed that many of them indulged in smoking and gum chewing during pesticide application and these habits may have contributed to increased exposure. Most of the workers complained of discomfort when using protective devices, therefore it is recommended that protective materials adapted to the climate and socio-economic conditions of the pesticide workers be developed, and that they be encouraged to use them through appropriate educational efforts and incentives.

Elderly individuals are a fast-rising segment of the US population and are at high risk of permanent disability and premature death secondary to traumatic injuries such as burn injury. The current paper will review the extant literature to understand the prevalence of burn injury in the elderly, the neurocognitive complications unique to the aged that places this cohort at risk, and evidence-based recommendations to reduce the early and late neurocognitive effects of burn injury in the aged. The elderly are a high-risk population for burn injury and its neurological sequela. This risk, at least in part, reflects multiple factors: age-related changes in the central and peripheral nervous system; multiple pre-existing co-morbidities (such as dementia and COPD); polypharmacy; suboptimal social support; and increased susceptibility to hypothermia, burn-related infections, and electrolyte and metabolic dysregulations.

Background: Fractures of the distal humerus constitute between 0.5% and 2% of all fractures, and about one‑third of fractures around the elbow joint. This study was aimed at classifying the patterns of distal humeral fractures among Nigerians.Materials and Methods: The study was carried out retrospectively at the Department of Medical Records, National Orthopedic Hospital, Igbobi, Lagos State, Nigeria. Plain films of X‑ray (both anteroposterior and lateral views) that were taken between 2007 and 2012. The films were from a total number of 144 patients of ages ranging from birth to 100 years (0–100 years), comprising of 88 males and 56 females. Distal humeral fractures were classified according to Müller’s classification for the Association for the Study of Internal Fixation. Comparisons of the patterns of distal humeral fractures were made between the sexes, sides affected, age groups, and causes of the fractures. Results: The results showed that the most frequent type of distal humeral fractures was extra‑articular fractures (50.7% [73/144]) followed by partial articular fractures (31.9% [46/144]), while the least frequent was complete articular fractures (17.4% [25/144]).Conclusion: This study shows to a great extent that there is a pattern for distal humeral fractures among Nigerians. This type of epidemiologic studies offers important data that contributes to improvement in fracture management and treatment.Keywords: Distal, fractures, humerus, Nigerians, pattern

Background Recent evidence suggests that nitric oxide produced via the neuronal nitric oxide synthase is involved mainly in the early response to sepsis, whereas nitric oxide derived from the inducible nitric oxide synthase is responsible during the later phase. We hypothesized that early neuronal and delayed inducible nitric oxide synthase blockade attenuates multiple organ dysfunctions during sepsis. Methods Sheep were randomly allocated to sham-injured, nontreated animals (n = 6); injured (48 breaths of cotton smoke and instillation of Pseudomonas aeruginosa into the lungs), nontreated animals (n = 7); and injured animals treated with a neuronal nitric oxide synthase inhibitor from 1 to 12 h and an inducible nitric oxide synthase inhibitor from 12 to 24 h postinjury (n = 6). Results The injury induced arterial hypotension, vascular leakage, myocardial depression, and signs of renal and hepatic dysfunctions. The treatment significantly attenuated, but did not fully prevent, the decreases in mean arterial pressure and left ventricular stroke work index. Although the elevation of creatinine levels was partially prevented, the decreases in urine output and creatinine clearance were not affected. The injury-related increases in bilirubin levels, international normalized ratio, and lipid peroxidation in liver tissue were significantly attenuated. Although plasma nitrite/nitrate levels were significantly increased versus baseline from 12-24 h in controls, plasma nitrite/nitrate levels were not increased in treated animals. Conclusions The combination treatment shows potential benefit on sepsis-related arterial hypotension and surrogate parameters of organ dysfunctions in sheep. It may be crucial to identify the time course of expression and activation of different nitric oxide synthase isoforms in future investigations.

Although pesticides are used to mitigate crop losses by pests, farm workers’ poor knowledge and bad habits during application may cause serious health consequences. This study investigates the knowledge and habits of farm workers in the Sultanate of Oman and how these are related to the self-reported acute symptoms caused by pesticide exposure. A total of 153 pesticide workers in Al Batinah Region of Oman were interviewed face to face about their pesticide knowledge, habits and self-reported acute symptoms. About 57% of the farm workers either had no formal education or had only some primary school education, and 80% had no knowledge of warning labels and the names of banned pesticides. There was a significant difference (p

Acute lung injury (ALI) by smoke inhalation with subsequent pneumonia and sepsis represents a major cause of morbidity and mortality in burn patients. The aim of the present study was to develop a murine model of ALI and sepsis to enhance the knowledge of mechanistic aspects and pathophysiological changes in patients with these injuries. In deeply anesthetized female C57BL/6 mice, injury was induced by four sets of cotton smoke using an inhalation chamber. Afterward, live Pseudomonas aeruginosa (3.2x10(7) colony-forming units) was administered intranasally. The indicated dose of bacteria was determined based on the results of a dose-response study (n=47). The following study groups were monitored for survival over 96h: (1) sham injury group, (2) only smoke inhalation group, (3) only bacteria group, and (4) smoke inhalation plus bacteria group. Each group included 10 mice. The survival rates were 100%, 90%, 30%, and 10%, respectively. The double hit injury was associated with excessive releases of pro-inflammatory cytokines in the plasma, and enhanced neutrophil accumulation, increased lipid peroxidation, and excessive formation of reactive nitrogen species in the lung. In mice receiving only smoke inhalation injury, no systemic cytokine release and increased lung tissue lipid peroxidation were observed. However, smoke alone significantly increased neutrophil accumulation and formation of reactive nitrogen species in lung tissue. In conclusion, bacterial pneumonia is predominantly responsible for mortality and morbidity in this novel murine model of smoke inhalation and pulmonary sepsis. Reactive oxygen and nitrogen species mediate the severity of lung injury.

Methicillin-resistant Staphylococcus aureus (MRSA) infections with severe outcomes such as sepsis and septic shock are progressively increasing in both the community and in hospital settings. We hypothesized that overexpression of reactive nitrogen and oxygen species and vascular endothelial growth factor (VEGF) play a pivotal role in cardiovascular collapse associated with vascular hyperpermeability in MRSA sepsis. Twelve sheep were surgically prepared and randomized into a control (noninjured; n = 6) and a sepsis (injured; n = 6) group. Animals in the sepsis group were subjected to cotton smoke inhalation and instillation of 2.5 x 10(11) colony-forming units of live MRSA into both lungs. Cardiovascular variables in the control group remained stable, whereas the MRSA sepsis group developed a hypotensive and hyperdynamic circulatory shock state beginning at 6 h associated with significantly increased vascular permeability evidenced by increased prefemoral lymph flow starting at 12 h and permeability index from 12 to 18 h, higher fluid accumulation from 12 to 24 h, and significantly decreased plasma protein concentration and oncotic pressure beginning at 6 h compared with control animals. Myocardial 3-nitrotyrosine (3-NT) protein, poly (adenosine diphosphate-ribose), and VEGF mRNA expressions measured after the 24-h experiment were significantly increased in the injured animals as well. These results evidence that excessive production of reactive radicals and VEGF may play a major role in cardiovascular collapse and vascular hyperpermeability in MRSA sepsis.