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Mohamed Sheikh Hassan,1,2 Ahmet Bakir,1 Nor Osman Sidow,1 Umut Erkok,3 Said Abdirahman Ahmed,4 Maryan Dahir Abshir,5 Ayhan Ayhan Köksal6 1Department of Neurology, Mogadishu Somalia Turkish Training and Research Hospital, Mogadishu, Somalia; 2Faculty of Medicine and Surgery, Mogadishu University, Mogadishu, Somalia; 3Department of Gynecology and Obstetrics, Mogadishu Somalia Turkish Training and Research Hospital, Mogadishu, Somalia; 4Department of Cardiology, Mogadishu Somalia Turkish Training and Research Hospital, Mogadishu, Somalia; 5Department of Medical Laboratory, Mogadishu Somalia Turkish Training and Research Hospital, Mogadishu, Somalia; 6University of Health Sciences, Istanbul Başakşehir Cam and Sakura City Hospital, Istanbul, TurkiyeCorrespondence: Mohamed Sheikh Hassan, Mogadishu Somalia Turkish Training and Research Hospital, Mogadishu, Somalia, Email dr.m.qalaf@gmail.comIntroduction: Spontaneous Intracerebral hemorrhage (ICH) in young patients is less common and not well studied compared to ICH in older patients. The etiology, risk factors and outcome of ICH in young patients may have regional and ethnic differences. The study aims to investigate the clinical characteristics, risk factors, etiology and outcome of spontaneous intracerebral hemorrhage in young adults in Somalia.Methods: The study enrolled 168 young patients with ICH (16– 50 years) admitted to the neurology department of a tertiary hospital from 2019 to 2022. The information about the demographic details, documented ICH risk factors, etiology and patients’ clinical status were retrieved. The etiology of ICH was determined based on clinical, laboratory and radiological findings. Intra-hospital survival status and associated factors were assessed.Results: The mean age of the patients was 35± 8.6 years. 99 (59%) of patients were male while 69 (41%) were females. Hypertension 48 (29%) was the most common risk factor, followed by substance abuse. Hypertensive hemorrhage was the most common etiology of ICH 60 (35.7%), followed by cerebral venous thrombosis (CVT) 5(15%), substance abuse 23 (13.7%) and arteriovenous malformation (AVM) in 10 (6%). AVM, CVT, cavernoma, eclampsia, substance abuse and cryptogenic etiology were more common in the 2nd and 3rd decades whereas hypertension was more common in the 4th and 5th decade. Intrahospital mortality was 28% in this study. Factors predicting intrahospital mortality were hematoma volume of greater than 30mL, thrombolytic etiology, brainstem ICH location, substance abuse related etiology, presence of associated mass effect, low GCS score on admission, high systolic blood pressure on admission, and the presence of chronic renal failure.Conclusion: In this study, hypertension, substance abuse, CVT and vascular malformation are the leading causes of ICH in young adults. Intracerebral hemorrhage in the young has different spectrum of etiologies and factors associated with short-term mortality compared to older patients.Keywords: intracerebral hemorrhages, young patients, etiology, outcome

Said Abdi Mohamed,1 Nor Osman Sidow,1,2 Bakar Ali Adam,1 Mohamed Sheikh Hassan,1,3 Abdiwahid Ahmed Ibrahim,1 Mohamed Farah Osman,1 Abdulkadir Ahmed,1 Abdullahi Ali Roble4 1Department of Neurology, Mogadishu-Somalia Turkey Recep Tayyip Erdoğan Training and Research Hospital, Mogadishu, Somalia; 2Faculty of Medicine and Surgery, Jazeera University, Mogadishu, Somalia; 3Faculty of Medicine and Surgery, Mogadishu University, Mogadishu, Somalia; 4Department of Ophthalmology, Mogadishu-Somalia Turkey Recep Tayyip Erdoğan Training and Research Hospital, Mogadishu, SomaliaCorrespondence: Nor Osman Sidow, Tel +252618300616, Email ziidoow113@gmail.comAbstract: Sturge-Weber syndrome is a rare, sporadic, progressive neurocutaneous condition that presents with congenital hamartomatous malformations, epilepsy, and a variety of facial symptoms. We discussed a rare case of an eighteen-year-old female child who came to our neurology department with status epilepticus, mental impairment, and a port-wine in the lateral left side of her face. We diagnosed Sturge-Weber syndrome after a thorough neurological and radiological evaluation. The purpose of presenting this case is to illustrate both the characteristic presentation and the complications associated with managing Sturge-Weber syndrome.Keywords: sturge-weber, seizure, port-wine

Yassir Balla,1 Abdullahi Said Hashi,2 Ahmed Adam Osman,3,4 Mohamed Sheikh Hassan,5 Eren Mutlu3 1Department of Internal Medicine, Somali-Sudanese Specialized hospital, Mogadishu, Somalia; 2Department of Anesthesiology and Reanimation, Mogadishu Somalia Turkish Training and Research Hospital, Mogadishu, Somalia; 3Department of Radiology, Mogadishu Somalia Turkish Training and Research Hospital, Mogadishu, Somalia; 4Faculty of Medicine and Surgery, University of Somalia, Mogadishu, Somalia; 5Department of Neurology, Mogadishu Somalia Turkish Training and Research Hospital, Mogadishu, SomaliaCorrespondence: Ahmed Adam Osman, Department of Radiology, Mogadishu Somalia Turkish Training and Research Hospital, Mogadishu, Somalia, Email fahadyare41@gmail.comAbstract: Cerebral sinovenous thrombosis (CSVT) encompasses a spectrum of disorders involving thrombosis of the cerebral venous system. As shown by previous epidemiological studies, the prevalence of cerebral sinovenous thrombosis is 4– 7 cases per million people. Nephrotic syndrome was very rarely associated with thrombosis cerebral veins or sinuses. Hypercoagulability and thrombotic complications in nephrotic syndrome are most commonly seen in deep veins of the lower extremities and renal veins. Our case highlights a unique scenario in which cerebral sinovenous thrombosis was the initial presentation of nephrotic syndrome in a patient that was not an important past medical or surgical problem. The patient was brought to the emergency department with severe headache, vomiting, altered mental status, and generalized body swelling. Laboratory results showed proteinuria, hypoalbuminemia and hyperlipidemia. Non-contrast brain CT demonstrated hemorrhagic venous infarct associated with vasogenic edema. A subsequent brain MR venogram demonstrated occlusion of superior sagittal and right transverse sinuses. She was managed with low molecular weight heparin and intervenous corticosteroids then shifted to rivaroxaban and oral steroids, respectively, which resulted in massive clinical improvement and resolution of thrombus.Keywords: nephrotic syndrome, cerebral venous sinus thrombosis, MR venography

Abdisalam Abdullahi Yusuf,1 Ismail Gedi Ibrahim,2,3 Ibrahim Mohamed Hirsi,1 Ali Adali,1 Yonis Yusuf Hassan,1 Mehmet Zeki Yasar,1 Ismail Mohamoud Abdullahi,4 Mohamed Sheikh Hassan3,5 1Department of Pediatric, Mogadishu Somalia Turkish Training and Research Hospital, Mogadishu, Somalia; 2Department of Radiology, Mogadishu Somalia Turkish Training and Research Hospital, Mogadishu, Somalia; 3Faculty of Medicine and Surgery, Mogadishu University, Mogadishu, Somalia; 4Department of Pathology, Mogadishu Somalia Turkish Training and Research Hospital, Mogadishu, Somalia; 5Department of Neurology, Mogadishu Somalia Turkish Training and Research Hospital, Mogadishu, SomaliaCorrespondence: Abdisalam Abdullahi Yusuf, Email taqi1434@gmail.comAbstract: Mucormycosis is a potentially fatal condition with a high mortality rate, particularly when there is extra nasal involvement, and it is rare for patients with fungal brain disease to survive. It mostly affects patients who are metabolically or immunologically compromised, which constitutes one of the three classical stages of the progression of Rhino-Orbito-Cerebral Mucormycosis (ROCM). Stage I: infection of the nasal mucosa and paranasal sinuses; Stage II: orbital involvement; Stage III: cerebral involvement.Here, we report a case of rhino-orbital cerebral mucormycosis in a 14-year-old girl with no known risk factor who presented with periorbital edema, right eye proptosis, fever, and extreme facial pain, which progressively worsened to confusion and left leg weakness in 3 days after admission. The final diagnosis was rhino-orbital-cerebral mucormycosis. The infection was successfully treated using liposomal amphotericin and surgical debridement to remove infected orbital tissue. Mucormycosis is a potentially fatal disease that necessitates prompt diagnosis and treatment. Children are rarely infected with mucormycosis. The majority of studies show that people are typically between 40 and 50 years old. ROCM is typically diagnosed using clinical symptoms and histopathologic evaluation; however, imaging is critical in determining the presence of intracranial lesions. The standard treatment for ROCM is amphotericin B at a recommended dose of 1.0– 1.5 mg/kg/day for weeks or months, depending on the clinical response and severity of adverse drug reactions, particularly nephrotoxicity.Rhino-orbital cerebral mucormycosis in a healthy female child is uncommon; early diagnosis and prompt treatment with Amphotericin B should be necessary. Devastating consequences will result from a delayed diagnosis.Keywords: mucormycosis, orbital cellulitis, liposomal amphotericin B, cerebral involvement

Said Abdirahman Ahmed,1 Mohamed Omar Hassan,1 Ishak Ahmed Abdi,1 Mohamed Abdullahi Mohamud,1 Mohamud Mire Waberi,1 Ahmed Elmi Abdi,1 Abdullahi Mohamed Hassan Fujeyra,2 Abdijalil Abdullahi Ali,3 Mohamed Sheikh Hassan4 1Department of Cardiology at Mogadishu Somali-Turkish Training and Research Hospital, Mogadishu, Somalia; 2Dean College of Medicine and Health Science at Abrar University, Mogadishu, Somalia; 3Cardiovascular Surgery Department at Mogadishu Somali-Turkish Training and Research Hospital, Mogadishu, Somalia; 4Neurology Department at Mogadishu Somali-Turkish Training and Research Hospital, Mogadishu, SomaliaCorrespondence: Said Abdirahman Ahmed, Mogadishu Somalia Turkish Training and Research Hospital, Digfer Road, Mogadishu, Somalia, Tel +252615583381, Email Saciidcabdi114@gmail.comAbstract: The sinuses of Valsalva are three pouch-like dilations at the root of the aorta, just above the aortic valve. Aneurysms of the sinuses of Valsalva can be congenital or acquired secondary to infective endocarditis. Here, we describe the case of a 41-year-old male patient who presented to the cardiology department of our hospital with fatigue and dyspnea on exertion for long periods. He had a history of infective endocarditis, smoking and substance abuse, like khat. Cardiovascular examination showed a murmur consistent with aortic regurgitation. Other systemic examinations, including those of the neurological, respiratory and abdominal, were unremarkable. Laboratory investigations were normal. Cardiac imaging, like transthoracic, trans-esophageal and cardiac computed tomography showed an aneurysm of the sinus Valsalva dissecting in to the interventricular septum. The patient was managed with metoprolol 25 mg, perindopril 10 mg and furosemide 20 mg and recommended for surgery but unfortunately it is not available in our country.Keywords: sinus of valsalva aneurysm, Av valve, cardiac CT, infective endocarditis

Abdinasir Mohamed Elmi,1 Abdiwahid Ahmed Ibrahim,2 Mohamed Sheikh Hassan,2,3 Faisal Abdi Osoble Osman,1 Cihan Çelik,1 Abdikadir Mohamed Dirie,1 Ismail Gedi Ibrahim1 1Radiology Department, Mogadishu Somali Turkish Training and Research Hospital, Mogadishu, Somalia; 2Neurology Department, Mogadishu Somali Turkish Training and Research Hospital, Mogadishu, Somalia; 3Faculty of Medicine and Surgery, Mogadishu University, Mogadishu, SomaliaCorrespondence: Abdinasir Mohamed Elmi, Radiology Department, Mogadishu Somali Turkish Training and Research Hospital, Mogadishu, Somalia, Email taagsade001@gmail.comIntroduction: Epilepsy is a neurological disorder characterized by abnormal, fast, synchronous neuronal discharge from the cerebral cortex. This abnormal excitation of the brain is usually short and self-limiting and can last anywhere from a few seconds to a few minutes. Neuroimaging and electroencephalography (EEG) are two widely used techniques to differentiate, verify, or exclude the diagnosis of epilepsy. The study aims to identify the frequency of EEG and MRI abnormalities in pediatric epilepsy and their correlations, aiming to improve diagnostic and treatment methods for these children.Materials and Methods: In this cross-sectional retrospective study, we evaluated pediatric patients aged 0– 18 years who visited the Neurology Polyclinic between July 2022 and July 2023, were diagnosed with epilepsy in accordance with the ILAE 2014 epilepsy guidelines, and had undergone neuroimaging at the hospital’s radiology department. Demographic information and clinical data, including the patient’s age, gender, history of trauma, and congenital infection, were assessed. In all patients, a surface electroencephalogram (EEG) and brain magnetic resonance imaging (MRI) were performed.Results: Our study recruited 102 pediatric patients aged between 0– 18 years, including 63 (61.8%) boys and 39 (37.2%) girls. An electroencephalogram (EEG) and MRI study have been done on all patients. An abnormal EEG study was seen in 79 (77.45%) participants, and an abnormal MRI was noted in 45 (44.1%) patients. The EEG and MRI were both abnormal in 34 cases (33.3%). The study found no significant correlation between magnetic resonance imaging and electroencephalographic findings (P =0.779).Conclusion: We observed multiple abnormalities on neuroimaging in pediatric epileptic patients. Even though our sample size was small, our results demonstrated that there is no statistically significant relationship between EEG and MRI results.Keywords: pediatric epilepsy, electroencephalography, magnetic resonance imaging

Mohamed Omar Hassan,1 Said Abdirahman Ahmed,1 Mohamed Sheikh Hassan,2 Diyar Köprülü1 1Department of Cardiology, Mogadishu Somali Turkish Training and Research Hospital, Mogadishu, Somalia; 2Department of Neurology, Mogadishu Somali Turkish Training and Research Hospital, Mogadishu, SomaliaCorrespondence: Mohamed Omar Hassan, Email drmohamedyalax@gmail.comIntroduction: The door-to-balloon time, the time between a patient’s arrival at the hospital and percutaneous coronary intervention, is crucial for managing myocardial infarction. Aiming for less than 90 minutes is recommended, as shortened times are associated with improved outcomes. However, limited healthcare resources, infrastructure, transportation and poverty impact management, leading to poorer outcomes and delayed door to balloon time. Addressing these challenges and their causes is essential for optimal care.Methodology: A retrospective analysis of 103 patients’ medical history records from May 2022 to June 2023 at the Mogadishu Somali Turkish Training and Research Hospital in Somalia was conducted. The data was mainly collected from the hospital’s electronic medical records system, analyzing patient demographics, clinical characteristics, and angiographical records. The study analyzed variables responsible for door-to-balloon (D2B) time delay, patient angiography results, cause of delay, procedure length, etc.Results: A study of 103 patients who had angiography performed between May 2022 and July 2023 was done. The predominant gender in the study was 73% male, with a mean age of 58 years. The most common risk factors were hypertension (33%), smoking (38%), and diabetes (39%). Of all the vessels, the Left Anterior Descending (LAD) was the most commonly obstructed (63%). Time delays from door-to-balloon were frequent, median door-to-balloon time was 169 minutes, frequently brought on by social problems and financial limitations. The majority (77.4%) of the patients had only percutaneous angiography (PCI), while 22.6% were recommended for bypass following PCI of the infarct-related artery (IRA). Complications in the delayed treatment group were the main cause of the death rate of 24.2%.Conclusion: Door-to-balloon time is crucial for acute myocardial infarction treatment which is challenging in impoverished countries like Somalia. Investments in healthcare infrastructure, public health education, and emergency services can improve patient outcomes.Keywords: door-to-balloon time, Somalia, myocardial infarction, ST segment elevation myocardial infarction

Mohamed Omar Hassan,1 Said Abdirahman Ahmed,1 Mohamed Sheikh Hassan,2 Mohamed Abdullahi Mohamud,1 Ahmed Elmi Abdi1 1Department of Cardiology, Mogadishu Somali Turkish Training and Research Hospital, Mogadishu, Somalia; 2Department of Neurology, Mogadishu Somali Turkish Training and Research Hospital, Mogadishu, SomaliaCorrespondence: Mohamed Omar Hassan, Email drmohamedyalax@gmail.comIntroduction: Myocardial infarction and cardiovascular disease are significant global health issues, particularly in Somalia. The Somali population faces challenges due to armed conflict, limited education, and underdeveloped healthcare infrastructure. Cardiovascular risk factors like diabetes, hypertension, and obesity are prevalent, and Somali people face increased susceptibility.Methods: This study examined Somalia residents’ perceptions, attitudes, and behaviors towards myocardial infarction using a cross-sectional paper-based questionnaire. The sample consisted of 313 urban residents in Mogadishu, aged 20 and above. The questionnaire was written in Somali and was designed for the demographic. Knowledge, attitude, and practice scores were categorized into two groups, with associations between knowledge, attitude, and practice with sociodemographic and health characteristics assessed using Logistic Regression.Results: This study analyzed data from A random sample of participants who arrived at the hospital for various reasons regarding their perceptions, attitudes, and responses towards myocardial infarction. The mean age was 42 ± 19 years, with 54% being male and 46% female. Hypertension was the most common comorbidity, followed by dyslipidemia and diabetes. Over half of the respondents had no formal education, and only 3.8% had a smoking history. About 5.7% had a previous history of myocardial infarction. The mean knowledge score was 11.07 ± 0.697, with 53.35% of respondents not knowing enough about myocardial infarction. The majority of the patients showed a favorable attitude, but only a slight majority could recognize symptoms of myocardial infarction. The majority of the patients had inadequate practice and behavior, with 53.6% not practicing regularly or engaging in sports.Conclusion: The research highlights gaps in Mogadishu’s Somali community’s knowledge and practices regarding myocardial infarction. It emphasizes the need for health education, primary care, and community involvement to improve cardiovascular health awareness and reduce MI incidence.Keywords: myocardial infarction, Somalia, cardiovascular disease, knowledge, practice

Diyar Köprülü,1 Said Abdirahman Ahmed,1 Mohamed Sheikh Hassan,2 Mohamud Mire Waberi,1 Ishak Ahmed Abdi,1 Ahmed Elmi Abdi,1 Abdijalil Abdullahi Ali,3 Mohamed Omar Hassan1 1Department of Cardiology, Mogadishu Somali Turkish Training and Research Hospital, Mogadishu, Somalia; 2Department of Neurology, Mogadishu Somali Turkish Training and Research Hospital, Mogadishu, Somalia; 3Department of Cardiovascular Surgery, Mogadishu Somali Turkish Training and Research Hospital, Mogadishu, SomaliaCorrespondence: Mohamed Omar Hassan, Email drmohamedyalax@gmail.comIntroduction: Coronary Artery Disease (CAD) is the leading cause of death and disability adjusted life years worldwide, primarily in low- and middle-income nations. The study aims to determine if khat use is linked to a more complicated form of CAD and a larger lesion burden. The SYNergy between Percutaneous Coronary Intervention with TAXus and cardiac surgery (SYNTAX) score is used to assess CAD severity and degree.Methodology: This observational, hospital-based descriptive study enrolled patients referred for coronary angiograms from August 2022 to May 2023. Data was collected from Khat and Non-Khat users, and analyzed using the SYNTAX score. The study compared demographics, clinical presentations, coronary angiographic findings and lesion complexity between Khat and Non-Khat users.Results: This study enrolled 177 participants, with a khat chewer group being (45.2%) compared to non-khat chewers (54.8%). The age distribution was similar, with 79.7% male and 20.3% female. Smoking was more common in the khat group (38.4%). Risk factors included hypertension, diabetes mellitus, dyslipidemia, and chronic kidney disease. There was no significant difference in lesion complexity between khat users and non-khat users.Khat chewing patients had a higher incidence of acute coronary syndrome (54% vs 24%) and higher incidence of spontaneous coronary dissection.Conclusion: The research suggests that khat use could be harmful to the cardiovascular system, including the coronary arteries. More research is required to completely understand the underlying mechanisms of action and evaluate the impact of khat on coronary arteries.Keywords: khat chewing, coronary artery disease, percutaneous coronary intervention, Somalia

Mohamed Sheikh Hassan,1 Mohamud Mire Waberi,2 Nor Osman Sidow,1 Mohamed Omar Hassan,2 Hakan Akyüz,2 Ishak Ahmed Abdi,2 Ahmed Muhammad Bashir,3 Said Abdirahman Ahmed2 1Department of Neurology, Mogadishu Somali Turkish Training and Research Hospital, Mogadishu, Somalia; 2Department of Cardiology, Mogadishu Somali Turkish Training and Research Hospital, Mogadishu, Somalia; 3Department of Internal Medicine, Mogadishu Somali Turkish Training and Research Hospital, Mogadishu, SomaliaCorrespondence: Mohamed Sheikh Hassan, Department of Neurology, Mogadishu Somali Turkish Training and Research Hospital, Mogadishu, Somalia, Email dr.m.qalaf@gmail.comBackground and Aims: The etiological investigation of the potential cardiac source of acute ischemic stroke is important for the secondary prevention of recurrent and future embolization. Transthoracic echocardiography is one of the most useful investigations for the assessment of the potential cardiac etiology of ischemic stroke. Our aim is to evaluate echocardiographic findings in patients with acute ischemic stroke admitted to a tertiary care hospital in Mogadishu, Somalia.Methods: This was a retrospective observational study conducted in the neurology department of a tertiary care hospital in Mogadishu, Somalia. We enrolled 315 patients with acute ischemic stroke admitted to the hospital who had undergone transthoracic echocardiography between March 2019 and March 2022. We analyzed transthoracic echocardiography findings, ischemic stroke subtypes, and their associated comorbidities. We also compared the demographic data, comorbidity, and survival status of patients with abnormal echo findings to those with normal echo findings.Findings: The mean age of patients was 62± 12 years. Co-morbidities were present in about 251 (80%) of the subjects, hypertension was the most common comorbidity 99 (31.4%), followed by diabetes 72 (23%), and hyperlipidemia 37 (11.7%). Overall cardiac pathology in this study was 170 (54%). Forty-seven (15%) of the patients had low ejection fraction on transthoracic echocardiography. Male patients had slightly less left ventricular systolic dysfunction than female patients. 100 (32%) had left ventricular diastolic dysfunction (LVDD), while 113 (36%) had left ventricular hypertrophy (LVH). Patients with hypertension and diabetes had more echo abnormalities compared to others (P-values of 0.047 and 0.024, respectively). More abnormal echo findings were seen in patients who died during hospitalization than in those who survived (P = 0.008). Severe left ventricular systolic dysfunction was associated with higher mortality (P < 0.001).Conclusion: Most patients with stroke in this study had abnormal echocardiograms; however, only a few had cardioembolic strokes. Abnormalities in echocardiography were more common in patients who died during hospitalization than in those who survived.Keywords: acute ischemic stroke, cardiac dysfunction, echocardiography

Touseef Amna,1 M Shamshi Hassan,2 Jieun Yang,1 Myung-Seob Khil,2 Ki-Duk Song,3 Jae-Don Oh,3 Inho Hwang1 1Department of Animal Sciences and Biotechnology, 2Department of Organic Materials and Fiber Engineering, Chonbuk National University, Jeonju, South Korea; 3Genomic Informatics Center, Hankyong National University, Anseong, South Korea Abstract: Recently, substantial interest has been generated in using electrospun biomimetic nanofibers of hybrids, particularly organic/inorganic, to engineer different tissues. The present work, for the first time, introduced a unique natural and synthetic hybrid micronanofiber wound dressing, composed of virgin olive oil/copper oxide nanocrystals and polyurethane (PU), developed via facile electrospinning. The as-spun organic/inorganic hybrid micronanofibers were characterized by scanning electron microscopy (SEM), energy dispersive X-ray analysis, X-ray diffraction, electron probe microanalysis, and transmission electron microscopy. The interaction of cells with scaffold was studied by culturing NIH 3T3 fibroblasts on an as-spun hybrid micronanofibrous mat, and viability, proliferation, and growth were assessed. The 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay results and SEM observation showed that the hybrid micronanofibrous scaffold was noncytotoxic to fibroblast cell culture and was found to benefit cell attachment and proliferation. Hence our results suggest the potential utilization of as-spun micronanoscaffolds for tissue engineering. Copper oxide–olive oil/PU wound dressing may exert its positive beneficial effects at every stage during wound-healing progression, and these micronanofibers may serve diverse biomedical applications, such as tissue regeneration, damaged skin treatment, wound healing applications, etc. Conclusively, the fabricated olive oil–copper oxide/PU micronanofibers combine the benefits of virgin olive oil and copper oxide, and therefore hold great promise for biomedical applications in the near future. Keywords: micronanofibers, copper oxide, wound healing, polyurethane, olive oil

Touseef Amna1, M Shamshi Hassan2, Ki-Taek Nam2, Yang You Bing3, Nasser AM Barakat2, Myung-Seob Khil2, Hak Yong Kim1,21Center for Healthcare Technology Development, 2Department of Organic Materials and Fiber Engineering, Chonbuk National University, Jeonju, Korea; 3Animal Science and Technology College, Henan University of Science and Technology, Luoyang, ChinaAbstract: The aim of this study was to fabricate camptothecin/iron(III) oxide (CPT/Fe2O3)-loaded poly(D,L-lactide-co-glycolide) (PLGA) composite mats to modulate the CPT release and to improve the structural integrity and antitumor activity of the released drug. The CPT/ Fe2O3-loaded PLGA ultrafine fibers were prepared for the first time by electrospinning a composite solution of CPT/Fe2O3 and neat PLGA (4 weight percent). The physicochemical characterization of the electrospun composite mat was carried out by scanning electron microscopy, energy dispersive X-ray spectroscopy, electron probe microanalysis, thermogravimetry, transmission electron microscopy, ultraviolet-visible spectroscopy, and X-ray diffraction pattern. The medicated composite fibers were evaluated for their cytotoxicity on C2C12 cells using Cell Counting Kit-8 assay (Sigma-Aldrich Corporation, St Louis, MO). The in vitro studies indicated a slow and prolonged release over a period of 96 hours with mild initial burst. Scanning electron microscopy, thermogravimetry, and X-ray diffraction studies confirmed the interaction of CPT/Fe2O3 with the PLGA matrix and showed that the crystallinity of CPT decreased after loading. Incorporation of CPT in the polymer media affected both the morphology and the size of the CPT/Fe2O3-loaded PLGA composite fibers. Electron probe microanalysis and energy dispersive X-ray spectroscopy results confirmed well-oriented composite ultrafine fibers with good incorporation of CPT/Fe2O3. The cytotoxicity results illustrate that the pristine PLGA did not exhibit noteworthy cytotoxicity; conversely, the CPT/Fe2O3 composite fibers inhibited C2C12 cells significantly. Thus, the current work demonstrates that the CPT/Fe2O3-loaded PLGA composite fibers represent a promising chemotherapeutic system for enhancing anticancer drug efficacy and selectively targeting cancer cells in order to treat diverse cancers.Keywords: camptothecin, C2C12 cells, Fe2O3 nanoparticles, electrospinning, cytotoxicity

BackgroundReagent strip to detect microhematuria as a proxy for Schistosoma haematobium infections has been considered an alternative to urine filtration for individual diagnosis and community-based estimates of treatment needs for preventive chemotherapy. However, the diagnostic accuracy of reagent strip needs further investigation, particularly at low infection intensity levels.MethodsWe used existing data from a study conducted in Tanzania that employed urine filtration and reagent strip testing for S. haematobium in two villages, including a baseline and six follow-up surveys after praziquantel treatment representing a wide range of infection prevalence. We developed a Bayesian model linking individual S. haematobium egg count data based on urine filtration to reagent strip binary test results available on multiple days and estimated the relation between infection intensity and sensitivity of reagent strip. Furthermore, we simulated data from 3,000 hypothetical populations with varying mean infection intensity to infer on the relation between prevalence observed by urine filtration and the interpretation of reagent strip readings.Principal findingsReagent strip showed excellent sensitivity even for single measurement reaching 100% at around 15 eggs of S. haematobium per 10 ml of urine when traces on reagent strip were considered positive. The corresponding specificity was 97%. When traces were considered negative, the diagnostic accuracy of the reagent strip was equivalent to urine filtration data obtained on a single day. A 10% and 50% urine filtration prevalence based on a single day sampling corresponds to 11.2% and 48.6% prevalence by reagent strip, respectively, when traces were considered negative, and 17.6% and 57.7%, respectively, when traces were considered positive.Conclusions/significanceTrace results should be included in reagent strip readings when high sensitivity is required, but excluded when high specificity is needed. The observed prevalence of reagent strip results, when traces are considered negative, is a good proxy for prevalence estimates of S. haematobium infection by urine filtration on a single day.

A cross-sectional survey of agricultural areas, combined with routinely monitored mosquito larval information, was conducted in urban Dar es Salaam, Tanzania, to investigate how agricultural and geographical features may influence the presence of Anopheles larvae. Data were integrated into a geographical information systems framework, and predictors of the presence of Anopheles larvae in farming areas were assessed using multivariate logistic regression with independent random effects. It was found that more than 5% of the study area (total size 16.8 km2) was used for farming in backyard gardens and larger open spaces. The proportion of habitats containing Anopheles larvae was 1.7 times higher in agricultural areas compared to other areas (95% confidence interval = 1.56-1.92). Significant geographic predictors of the presence of Anopheles larvae in gardens included location in lowland areas, proximity to river, and relatively impermeable soils. Agriculture-related predictors comprised specific seedbed types, mid-sized gardens, irrigation by wells, as well as cultivation of sugar cane or leafy vegetables. Negative predictors included small garden size, irrigation by tap water, rainfed production and cultivation of leguminous crops or fruit trees. Although there was an increased chance of finding Anopheles larvae in agricultural sites, it was found that breeding sites originated by urban agriculture account for less than a fifth of all breeding sites of malaria vectors in Dar es Salaam. It is suggested that strategies comprising an integrated malaria control effort in malaria-endemic African cities include participatory involvement of farmers by planting shade trees near larval habitats.

We report a cluster-randomised trial of a home-based counselling strategy, designed for large-scale implementation, in a population of 1.2 million people in rural southern Tanzania. We hypothesised that the strategy would improve neonatal survival by around 15%.In 2010 we trained 824 female volunteers to make three home visits to women and their families during pregnancy and two visits to them in the first few days of the infant's life in 65 wards, selected randomly from all 132 wards in six districts in Mtwara and Lindi regions, constituting typical rural areas in Southern Tanzania. The remaining wards were comparison areas. Participants were not blinded to the intervention. The primary analysis was an intention-to-treat analysis comparing the neonatal mortality (day 0-27) per 1,000 live births in intervention and comparison wards based on a representative survey in 185,000 households in 2013 with a response rate of 90%. We included 24,381 and 23,307 live births between July 2010 and June 2013 and 7,823 and 7,555 live births in the last year in intervention and comparison wards, respectively. We also compared changes in neonatal mortality and newborn care practices in intervention and comparison wards using baseline census data from 2007 including 225,000 households and 22,243 births in five of the six intervention districts. Amongst the 7,823 women with a live birth in the year prior to survey in intervention wards, 59% and 41% received at least one volunteer visit during pregnancy and postpartum, respectively. Neonatal mortality reduced from 35.0 to 30.5 deaths per 1,000 live births between 2007 and 2013 in the five districts, respectively. There was no evidence of an impact of the intervention on neonatal survival (odds ratio [OR] 1.1, 95% confidence interval [CI] 0.9-1.2, p = 0.339). Newborn care practices reported by mothers were better in intervention than in comparison wards, including immediate breastfeeding (42% of 7,287 versus 35% of 7,008, OR 1.4, CI 1.3-1.6, p < 0.001), feeding only breast milk for the first 3 d (90% of 7,557 versus 79% of 7,307, OR 2.2, 95% CI 1.8-2.7, p < 0.001), and clean hands for home delivery (92% of 1,351 versus 88% of 1,799, OR 1.5, 95% CI 1.0-2.3, p = 0.033). Facility delivery improved dramatically in both groups from 41% of 22,243 in 2007 and was 82% of 7,820 versus 75% of 7,553 (OR 1.5, 95% CI 1.2-2.0, p = 0.002) in intervention and comparison wards in 2013. Methodological limitations include our inability to rule out some degree of leakage of the intervention into the comparison areas and response bias for newborn care behaviours.Neonatal mortality remained high despite better care practices and childbirth in facilities becoming common. Public health action to improve neonatal survival in this setting should include a focus on improving the quality of facility-based childbirth care.ClinicalTrials.gov NCT01022788.

To identify risk factors and describe the pattern of spread of the 1997 cholera epidemic in a rural area (Ifakara) in southern Tanzania, we conducted a prospective hospital-based, matched case-control study, with analysis based on the first 180 cases and 360 matched controls. Bathing in the river, long distance to water source, and eating dried fish were significantly associated with risk for cholera. Toxigenic Vibrio cholerae O1, biotype El Tor, serotype Ogawa, was isolated in samples from Ifakara's main water source and patients' stools. DNA molecular analyses showed identical patterns for all isolates.

Despite recent improvements in child survival in sub-Saharan Africa, neonatal mortality rates remain largely unchanged. This study aimed to determine the frequency of delivery and newborn-care practices in southern Tanzania, where neonatal mortality is higher than the national average. All households in five districts of Southern Tanzania were approached to participate. Of 213,220 female residents aged 13-49 years, 92% participated. Cross-sectional, retrospective data on childbirth and newborn care practices were collected from 22,243 female respondents who had delivered a live baby in the preceding year. Health facility deliveries accounted for 41% of births, with nearly all non-facility deliveries occurring at home (57% of deliveries). Skilled attendants assisted 40% of births. Over half of women reported drying the baby and over a third reported wrapping the baby within 5 minutes of delivery. The majority of mothers delivering at home reported that they had made preparations for delivery, including buying soap (84%) and preparing a cloth for drying the child (85%). Although 95% of these women reported that the cord was cut with a clean razor blade, only half reported that it was tied with a clean thread. Furthermore, out of all respondents 10% reported that their baby was dipped in cold water immediately after delivery, around two-thirds reported bathing their babies within 6 hours of delivery, and 28% reported putting something on the cord to help it dry. Skin-to-skin contact between mother and baby after delivery was rarely practiced. Although 83% of women breastfed within 24 hours of delivery, only 18% did so within an hour. Fewer than half of women exclusively breastfed in the three days after delivery. The findings suggest a need to promote and facilitate health facility deliveries, hygienic delivery practices for home births, delayed bathing and immediate and exclusive breastfeeding in Southern Tanzania to improve newborn health.