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Maria J Abou El-Ola,1 Mariam A Rajab,2 Dania I Abdallah,3 Ismail A Fawaz,4 Lyn S Awad,5 Hani M Tamim,6 Ahmad O Ibrahim,7 Anas M Mugharbil,7 Rima A Moghnieh8 1Department of Obstetrics and Gynaecology, Makassed General Hospital, Beirut, Lebanon; 2Department of Pediatrics, Makassed General Hospital, Beirut, Lebanon; 3Department of Pharmacy, Makassed General Hospital, Beirut, Lebanon; 4Department of Internal Medicine, Iklim Health Foundation Hospital, Mazboud, Mount Lebanon, Chouf, Lebanon; 5Department of Pharmacy, Makassed General Hospital, Beirut, Lebanon; 6Department of Internal Medicine, American University of Beirut, Beirut, Lebanon; 7Division of Hematology/Oncology, Department of Internal Medicine, Makassed General Hospital, Beirut, Lebanon; 8Division of Infectious Diseases, Department of Internal Medicine, Makassed General Hospital, Beirut, Lebanon Background: Human papillomavirus (HPV) infection is an established predisposing factor of cervical cancer. In this study, we assessed the awareness about genital warts, cervical cancer, and HPV vaccine among mothers having girls who are at the age of primary HPV vaccination attending a group of schools in Lebanon. We also assessed the rate of HPV vaccination among these girls and the barriers to vaccination in this community. Subjects and methods: This is a cross-sectional, school-based survey. A 23-item, self-administered, anonymous, pretested, structured questionnaire with closed-ended questions was used to obtain data. The questionnaire was sent to the mothers through their student girls, and they were asked to return it within a week. Data were analyzed using the Statistical Package for Social Sciences version 21.0. Bivariate analysis was performed using the chi-square test to compare categorical variables, whereas continuous variables were compared using the Student’s t-test. Fisher’s exact test was used when chi-square test could not be employed. Results: The response rate in our survey was 39.4%. Among the responders, the rate of awareness about HPV infection was 34%, where 72% of the mothers had heard about cervical cancer, and 34% knew that a vaccine is available to prevent cervical cancer. HPV vaccination uptake rate was 2.5%. This lack of vaccination was primarily attributed to the low rate of mothers’ awareness about the vaccine (34%). Factors significantly affecting awareness about the vaccine were the mothers’ marital age, nationality, level of education, employment, and family income. Barriers to HPV vaccination, other than awareness, were uncertainty about safety or efficacy of the vaccine, conservative ideas of mothers regarding their girls’ future sexual life, and relatively high price of the vaccine. Conclusion: Vaccine uptake is low among eligible girls attending this group of schools. The barriers to vaccination are multiple; the most important one is the mothers’ lack of knowledge about HPV, cervical cancer, and the modes of prevention. Awareness campaigns along with a multimodal strategy that targets the identified barriers would be recommended to achieve higher rates of HPV vaccination. Keywords: awareness, barriers, cervical cancer, human papillomavirus, knowledge, Lebanon, mothers, schools, vaccine

Background: Quantitative myocardial blood flow (MBF) on positron-emission tomography myocardial perfusion imaging is a measure of the overall health of the coronary circulation. The ability to adequately augment blood flow, measured by myocardial blood flow reserve (MBFR), is associated with lower major adverse cardiovascular events and all-cause mortality. The age-specific ranges of MBFR in patients without demonstrable coronary artery disease have not been well established. We aimed to determine the effect of age and sex on MBF in a cohort of patients without demonstrable coronary artery disease., Methods: Patients who underwent positron-emission tomography myocardial perfusion imaging studies from 2012 to 2022 on positron-emission tomography/computed tomography cameras were included if the summed stress score was 0, the coronary calcium score was 0, and the left ventricular ejection fraction was ≥50%. Those with known coronary artery disease, prior history of coronary intervention, diabetes, heart/kidney/liver transplant, cirrhosis, or chronic kidney disease stage IV+ were excluded. MBF was calculated using a net retention model (ImagenQ, Cardiovascular Imaging Technologies, Kansas City), and quantile regression models were developed to predict MBF., Results: Among 2789 patients (age 59.9±13.0 years, 76.4% females), median rest MBF was 0.73 (0.60-0.91) mL/min·g, stress MBF was 1.72 (1.41-2.10) mL/min·g, and MBFR was 2.31 (1.96-2.74). Across all ages, males augmented MBF in response to vasodilator stress to a greater degree than females but achieved lower absolute stress MBF. Younger males in particular achieved a higher MBFR than their female counterparts, and this gap narrowed with increasing age. Predicted MBFR for a 20-year-old male was 3.18 and female was 2.50, while predicted MBFR for an 80-year-old male was 2.17 and female was 2.02., Conclusions: In patients without demonstrable coronary artery disease, MBFR is higher in younger males than younger females and decreases with age in both sexes. Age- and sex-specific MBFR may be important in risk prediction and guidance for revascularization and warrant further study., Competing Interests: Dr Bateman has received research grant support from Bracco, GE Healthcare, Jubilant Drax Image, and Spectrum Dynamics; has served as a consultant to GE Healthcare and Synektik; and has an equity interest in Cardiovascular Imaging Technologies. The other authors report no conflicts.

Diabetes Mellitus is one of the oldest diseases known to humankind, dating back to ancient Egypt. The disease is a chronic metabolic disorder that heavily burdens healthcare providers worldwide due to the steady increment of patients yearly. Worryingly, diabetes affects not only the aging population but also children. It is prevalent to control this problem, as diabetes can lead to many health complications. As evolution happens, humankind starts integrating computer technology with the healthcare system. The utilization of artificial intelligence assists healthcare to be more efficient in diagnosing diabetes patients, better healthcare delivery, and more patient eccentric. Among the advanced data mining techniques in artificial intelligence, stacking is among the most prominent methods applied in the diabetes domain. Hence, this study opts to investigate the potential of stacking ensembles. The aim of this study is to reduce the high complexity inherent in stacking, as this problem contributes to longer training time and reduces the outliers in the diabetes data to improve the classification performance. In addressing this concern, a novel machine learning method called the Stacking Recursive Feature Elimination-Isolation Forest was introduced for diabetes prediction. The application of stacking with Recursive Feature Elimination is to design an efficient model for diabetes diagnosis while using fewer features as resources. This method also incorporates the utilization of Isolation Forest as an outlier removal method. The study uses accuracy, precision, recall, F1 measure, training time, and standard deviation metrics to identify the classification performances. The proposed method acquired an accuracy of 79.077% for PIMA Indians Diabetes and 97.446% for the Diabetes Prediction dataset, outperforming many existing methods and demonstrating effectiveness in the diabetes domain., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Idris et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

The thermochemical conversion of CO 2 into methanol, a process known for its selectivity, often encounters a significant obstacle: the reverse water gas reaction. This problem emerges due to the demanding high temperatures and pressures, causing instability in catalytic performance. Recent endeavours have focused on innovatively designing catalysts capable of withstanding such conditions. Given the costliness of experimental approaches, a theoretical framework has emerged as a promising avenue for addressing the challenges in methanol production. It has been reported that transition metals, especially Pd, provide ideal binding sites for CO 2 molecules and hydrogen atoms, facilitating their interactions and subsequent conversion to methanol. In the geometric single-atom form, their surface enables precise control over the reaction pathways and enhances the selectivity towards methanol. In our study, we employed density functional theory (DFT) to explore the conversion of CO 2 to CH 3 OH on Pd 1 -Cu(111) and Pd 1 -Ag(111) single-atom alloy (SAA) catalysts. Our investigation involved mapping out the complex reaction pathways of CO 2 hydrogenation to CH 3 OH using microkinetic reaction modelling and mechanisms. We examined three distinct pathways: the COOH* formation pathway, the HCOO* formation pathway, and the dissociation of CO 2 * to CO* pathway. This comprehensive analysis encompassed the determination of adsorption energies for all reactants, transition states, and resultant products. Additionally, we investigated the thermodynamic and kinetic profiles of individual reaction steps. Our findings emphasised the essential role of the Pd single atom in enhancing the activation of CO 2 , highlighting the key mechanism underlying this catalytic process. The favoured route for methanol generation on the Pd 1 -Ag(111) single-atom alloy (SAA) surface unfolds as follows: CO 2 * progresses through a series of transformations, transitioning successively into HCOO*, HCOOH*, H 2 COOH*, CH 2 O*, and CH 2 OH*, terminating in the formation of CH 3 OH*, due to lower activation energies and higher rate constants.

This study employs diverse machine learning models, including classic artificial neural network (ANN), hybrid ANN models, and the imperialist competitive algorithm and emotional artificial neural network (EANN), to predict crucial parameters such as fresh water production and vapor temperatures. Evaluation metrics reveal the integrated ANN-ICA model outperforms the classic ANN, achieving a remarkable 20% reduction in mean squared error (MSE). The emotional artificial neural network (EANN) demonstrates superior accuracy, attaining an impressive 99% coefficient of determination ( R 2 ) in predicting freshwater production and vapor temperatures. The comprehensive comparative analysis extends to environmental assessments, displaying the solar desalination system's compatibility with renewable energy sources. Results highlight the potential for the proposed system to conserve water resources and reduce environmental impact, with a substantial decrease in total dissolved solids (TDS) from over 6,000 ppm to below 50 ppm. The findings underscore the efficacy of machine learning models in optimizing solar-driven desalination systems, providing valuable insights into their capabilities for addressing water scarcity challenges and contributing to the global shift toward sustainable and environmentally friendly water production methods ., Competing Interests: The authors declare there is no conflict., (© 2024 The Authors This is an Open Access article distributed under the terms of the Creative Commons Attribution Licence (CC BY 4.0), which permits copying, adaptation and redistribution, provided the original work is properly cited (http://creativecommons.org/licenses/by/4.0/).)

Background: Liver cirrhosis (LC) is a common complication of chronic liver disease. Its prevalence has increased markedly over the last few years. With liver cirrhosis comes cardiovascular morbidity and mortality. It is important that the detection of the abnormalities by echocardiography be given priority, as this can change the clinical outcome of these patients with cardiovascular abnormalities in liver cirrhosis., Aim: This study aims to determine the prevalence of pulmonary hypertension in LC patients., Methods and Materials: A cross-sectional analytical study was carried out at JUTH (Jos University Teaching Hospital) over a period of one year. We recruited 210 adult patients with liver cirrhosis from the gastroenterology clinic and wards for this study. Data from these patients were collected with questionnaires administered by the interviewer and analysed using SPSS 23 statistical software (IBM Corp., Armonk, NY). The data obtained are presented in tables and charts. Categorical variables were expressed as proportions and frequencies, while continuous data were expressed as the median, mean, and standard deviation., Results: Pulmonary hypertension was found in 30.5% of the participants, with mild pulmonary hypertension being the most common. No one had severe pulmonary hypertension. There was an increased risk of developing pulmonary hypertension in patients with coughs, easy fatigability, bilateral leg swelling, abdominal swelling, and ascites (P<0.05)., Conclusion: The result showed that there is a high prevalence of pulmonary hypertension in patients with liver cirrhosis., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Enenche et al.)

Objectives: We aimed to identify the prevalence, bacterial isolates, antimicrobial susceptibility profile, and factors associated with asymptomatic bacteriuria (ASB) in patients with type 2 diabetes mellitus (T2DM) in rural southwestern Nigeria., Methods: We performed a hospital-based cross-sectional study of patients with T2DM and ASB. Demographic and clinical data were collected using questionnaires. Urine samples were cultured using standard laboratory procedures, and bacterial colonies were isolated and antimicrobial sensitivity was performed using the disc diffusion technique. Relationships between variables were assessed using adjusted odds ratios (AORs) and 95% confidence intervals (CIs)., Results: Of the 280 participants, 73 (26.1%) had ASB (95% CI: 20.9%-31.2%). The most commonly identified isolate was E. coli (45/73; 61.7%), 100.0% of which were sensitive to cefuroxime but resistant to ciprofloxacin. Female sex (AOR, 6.132; 95% CI: 2.327-16.157), living below the poverty line (AOR, 2.066; 95% CI: 1.059-4.029), uncontrolled blood glucose (AOR, 2.097; 95% CI: 1.000-4.404), and a history of indwelling urethral catheterization (AOR, 14.521; 95% CI: 4.914-42.908) were associated with ASB., Conclusion: The findings suggest that cefuroxime should be used as an empirical treatment, pending urine culture and sensitivity, and that efforts should be made to prevent ASB in rural southwestern Nigeria., Competing Interests: Declaration of conflicting interestThe authors declare that there is no conflict of interest.

The Internet of Things has a bootloader and applications responsible for initializing the device's hardware and loading the operating system or firmware. Ensuring the security of the bootloader is crucial to protect against malicious firmware or software being loaded onto the device. One way to increase the security of the bootloader is to use digital signature verification to ensure that only authorized firmware can be loaded onto the device. Additionally, implementing secure boot processes, such as a chain of trust, can prevent unauthorized access to the device's firmware and protect against tampering during the boot process. This research is based on the firmware bootloader and application dataflow taint analysis and security assessment of IoT devices as the most critical step in ensuring the security and integrity of these devices. This process helps identify vulnerabilities and potential attack vectors that attackers could exploit and provides a foundation for developing effective remediation strategies., Competing Interests: The authors declare that they have no competing interests., (© 2023 Bhardwaj et al.)

Aim Hepatitis B is a preventable infection with transmission of the virus through sex, by blood and from mother to child during childbirth. Young adults are prone to some of these risk factors, yet data on awareness and knowledge of hepatitis B among them is still limited in Nigeria and none from our locality. The purpose of this study was to assess the knowledge and awareness of hepatitis B among young adults attending a tertiary health institution in Nigeria with the aim of giving recommendations based on the findings. Methods A total of 223 young adults who attended the adolescent and young adult clinic of the Family Medicine Department of the Ekiti State University Teaching Hospital, Ado Ekiti between 1 March and 31 May 2023 were analyzed using a predesigned self-administered questionnaire. Knowledge of hepatitis B was assessed by asking 12 questions relating to awareness of the disease, basic knowledge, route of transmission, the seriousness of the disease when compared to human immunodeficiency virus (HIV), complications from the disease, their vaccination status and the number of doses received by the participants. Results The prevalence of awareness of hepatitis B among respondents was 88 (39.5%). Of the 223 respondents studied, 158 (70.9%) had a poor knowledge score of the disease. There was a significant association between the highest educational background of the respondents and awareness of hepatitis B (p=0.05). Awareness of hepatitis B was also associated with previous participation in any health screening (p=0.04) and vaccine awareness (p=<0.001). The majority of the respondents with good knowledge scores of hepatitis B preferred social media for disseminating information about their health (p=0.03). Out of all the participants studied, only one (0.4%) had completed the three doses of the hepatitis B vaccine with 11 (4.9%) of them yet to get fully vaccinated. Conclusion Efforts are needed to target social media platforms with information about hepatitis B and vaccination. With awareness campaigns of hepatitis B directed at various social media platforms, this population at risk could be educated about the disease and the benefits of vaccination. The low vaccination state among the respondents brought to the fore the urgent need for the government to ensure the provision of appropriate interventions for viral hepatitis among young adults., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Agbesanwa et al.)

The correction of grammatical errors in natural language processing is a crucial task as it aims to enhance the accuracy and intelligibility of written language. However, developing a grammatical error correction (GEC) framework for low-resource languages presents significant challenges due to the lack of available training data. This article proposes a novel GEC framework for low-resource languages, using Arabic as a case study. To generate more training data, we propose a semi-supervised confusion method called the equal distribution of synthetic errors (EDSE), which generates a wide range of parallel training data. Additionally, this article addresses two limitations of the classical seq2seq GEC model, which are unbalanced outputs due to the unidirectional decoder and exposure bias during inference. To overcome these limitations, we apply a knowledge distillation technique from neural machine translation. This method utilizes two decoders, a forward decoder right-to-left and a backward decoder left-to-right, and measures their agreement using Kullback-Leibler divergence as a regularization term. The experimental results on two benchmarks demonstrate that our proposed framework outperforms the Transformer baseline and two widely used bidirectional decoding techniques, namely asynchronous and synchronous bidirectional decoding. Furthermore, the proposed framework reported the highest F1 score, and generating synthetic data using the equal distribution technique for syntactic errors resulted in a significant improvement in performance. These findings demonstrate the effectiveness of the proposed framework for improving grammatical error correction for low-resource languages, particularly for the Arabic language., Competing Interests: The authors declare that they have no competing interests., (© 2023 Mahmoud et al.)

Objectives . To evaluate carotid artery intima-media thickness (CIMT) and lipid profile in children with epilepsy on long-term antiepileptic drug (AED) monotherapy. Methods . We included 60 children with epilepsy receiving valproate, carbamazepine, or levetiracetam monotherapy and 60 controls. A high-resolution B-mode ultrasound was used to measure (CIMT). Measurement of serum lipids was done. Results . Patients on valproate (0.44 ± 0.03, P  ≤ .001), carbamazepine (0.43 ± 0.03with P  ≤ .001), and levetiracetam (0.44 ± 0.02 with P  ≤ .001) monotherapy showed significantly higher CIMT compared to controls. CIMT was correlated with age ( P  = .041, r  = .112) AEDs{valproate ( P  = .005, r  = .731), carbamazepine ( P  = .038, r  = .365), and levetiracetam ( P  = .036, r  = .155)}, duration of treatment ( P  = .001, r  = .313), TC( P  = .001, r  = .192), TG ( P  = .014, r  = .018), and LDL ( P  = .001, r  = .219). HDL ( P  = .003, r  = -.126). Seizure severity and Apo A1 were insignificantly involved. Conclusion . Long-term monotherapy with valproate, carbamazepine, and levetiracetam in epileptic children was associated with significant abnormalities in CIMT., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2023.)

In various thermodynamic procedures and the optimisation of thermal manipulation, nanofluids flowing through porous media represent an emerging perspective. The main objective of this study, from the perspective of thermal applications, was the investigation of the flow of nanofluid over a horizontal stretched surface embedded in a porous medium. The effects of the chemical reactions on the surface, magnetic field, and thermal radiations were invoked in the mathematical formulation. The non-Darcy model examines the fluid flow in the porous media. The principles of thermodynamics were employed to integrate entropy optimisation methods with the established theoretical approach to analyse the thermal behaviour of nanomaterials in the chemical reactive diffusion processes. Using the Tiwari-Das nanofluid model, the volume fraction of the nanomaterials was merged in the mathematical equation for the flow model. Water was taken as a base fluid and nanoparticles composed of aluminium oxide (Al 2 O 3 ) and silver (Ag) were used. The significance of radiation, heat production, and ohmic heating were included in the energy equation. Furthermore, an innovative mathematical model for the diffusion of the autocatalytic reactive species in the boundary layer flow was developed for a linear horizontally stretched surface embedded in a homogeneous non-Darcy porous medium saturated with the nanofluid. The computer-based built-in bvp5c method was used to compute numerically these equations for varied parameters. It is clear that the magnetic parameter has a reversal influence on the entropy rate and velocity. Temperature and velocity are affected in the opposite direction from a higher volume fraction estimate. Thermal field and entropy were increased when the radiation action intensified. The inclusion of nanoparticle fraction by the volume fraction of nanoparticles and Brinkman number also enhances the system entropy. Entropy production can be minimized with the involvement of the porosity factor within the surface., Competing Interests: The authors have no conflicts of interest., (This journal is © The Royal Society of Chemistry.)

Background: Type 2 diabetes mellitus (T2DM) is a disease of public health importance globally with an increasing burden of undiagnosed pre-diabetes and diabetes in low- and middle-income countries, Nigeria in particular. Pre-diabetes and diabetes are established risk factors for cardiovascular complications. However, data are scanty on the current prevalence of these conditions in Nigeria, based on haemoglobin A1c (HbA1c) diagnosis as recommended by the WHO in 2009. We aimed to determine the prevalence of pre-diabetes, diabetes, and undiagnosed diabetes among the adult population of Nigeria using HbA1c., Methodology: A cross-sectional, multi-site population study was carried out in selected states in Nigeria (namely, Ekiti, Lagos, Osun, Oyo, and Kwara states) involving 2,708 adults (≥18 years) in rural and urban community dwellers, without prior diagnosis of pre-diabetes or diabetes. Participants with ongoing acute or debilitating illnesses were excluded. Data were collected using an interviewer-administered pretested, semi-structured questionnaire. Socio-demographic, clinical (weight, height, blood pressure, etc.), and laboratory characteristics of participants including HbA1c were obtained. Data were analysed using STATA version 16., Results: The mean age of participants was 48.1 ± 15.8 years, and 65.5% were female. The overall prevalence of pre-diabetes and undiagnosed diabetes was 40.5% and 10.7%, respectively, while the prevalence of high blood pressure was 36.7%. The prevalence of pre-diabetes was the highest in Lagos (48.1%) and the lowest in Ekiti (36.7%), while the prevalence of diabetes was the highest in Kwara (14.2%) and the lowest in Ekiti (10%). There was a significant association between age of the participants (p< 0.001), gender (p = 0.009), educational status (p = 0.008), occupation (p< 0.001), tribe (p = 0.004), marital status (p< 0.001), blood pressure (p< 0.001), and their diabetic or pre-diabetic status. Independent predictors of diabetes and pre-diabetes include excess weight gain, sedentary living, and ageing. Participants within the age group 45-54 years had the highest total prevalence (26.6%) of pre-diabetes and diabetes., Conclusion: Over half of the respondents had pre-diabetes and diabetes, with a high prevalence of undiagnosed diabetes. A nationwide screening campaign will promote early detection of pre-diabetes and undiagnosed diabetes among adult Nigerians. Health education campaigns could be an effective tool in community settings to improve knowledge of the risk factors for diabetes to reduce the prevalence of dysglycaemia., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Ajayi, Balogun, Olopade, Ajani, Soyoye, Bolarinwa, Olamoyegun, Alatishe-Muhammad, Odeniyi, Odukoya, Fasanmade, Diyaolu, Otrofanowei, Akase, Agabi, Adejimi, Ajetunmobi, Durowade, Gabriel-Alayode, Ibrahim, Ezekpo, Elegbede, Lamidi, Owolabi, Yusuf, Adetunji, Ogunmodede, Ameen, Biliaminu and Nasiru.)

Background: There is increasing evidence suggesting that adolescents are contributing to the populations at risk of malaria. This study determined the prevalence of malaria infection among the adolescents and examined the associated determinants considering socio-demographic, Long Lasting Insecticide Nets (LLINs) usage, and hematological factors in rural Southwestern Nigeria., Methods: A hospital-based cross-sectional study was conducted between July 2021 and September 2022 among 180 adolescents who were recruited at a tertiary health facility in rural Southwestern Nigeria. Interviewer administered questionnaire sought information on their socio-demographics and usage of LLINs. Venous blood samples were collected and processed for malaria parasite detection, ABO blood grouping, hemoglobin genotype, and packed cell volume. Data were analyzed using SPSS version 20. A p-value <0.05 was considered statistically significant., Results: The prevalence of malaria infection was 71.1% (95% CI: 68.2%-73.8%). Lack of formal education (AOR = 2.094; 95% CI: 1.288-3.403), being a rural residence (AOR = 4.821; 95% CI: 2.805-8.287), not using LLINs (AOR = 1.950; 95% CI: 1.525-2.505), genotype AA (AOR = 3.420; 95% CI: 1.003-11.657), genotype AS (AOR = 3.574; 95%CI: 1.040-12.277), rhesus positive (AOR = 1.815; 95% CI:1.121-2.939), and severe anemia (AOR = 1.533; 95% CI: 1.273-1.846) were significantly associated with malaria infection., Conclusion: The study revealed the prevalence of malaria infection among the adolescents in rural Southwestern Nigeria. There may be need to pay greater attention to adolescent populations for malaria intervention and control programs., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 IBRAHIM et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Network function virtualization (NFV) is a rapidly growing technology that enables the virtualization of traditional network hardware components, offering benefits such as cost reduction, increased flexibility, and efficient resource utilization. Moreover, NFV plays a crucial role in sensor and IoT networks by ensuring optimal resource usage and effective network management. However, adopting NFV in these networks also brings security challenges that must promptly and effectively address. This survey paper focuses on exploring the security challenges associated with NFV. It proposes the utilization of anomaly detection techniques as a means to mitigate the potential risks of cyber attacks. The research evaluates the strengths and weaknesses of various machine learning-based algorithms for detecting network-based anomalies in NFV networks. By providing insights into the most efficient algorithm for timely and effective anomaly detection in NFV networks, this study aims to assist network administrators and security professionals in enhancing the security of NFV deployments, thus safeguarding the integrity and performance of sensors and IoT systems.

Whereas dithionite has been extensively used as a reducing agent in soil and sediment remediation, here, we demonstrate that it can be used as a potential source of oxidizing radical in oxic soils with potential application in organic pollutant remediation. Benzoic acid was used as a probe compound and the generation of its oxidative product para-hydroxybenzoic acid ( p -HBA) was detected to quantify the production of oxidative radicals (ROS). By increasing the dithionite concentration from 2.5-10 Mm, the accumulated P-HBA concentration in 120 min increased from 15.0-27 µM. Whereas, above 10 mM, the p-HBA concentration decreased due to radical scavenging. Increasing soil dosage from 2.5-15 g/100 mL the accumulated p-HBA amount increased from 22.8-33.7 µM. Temperature 25-35 o C and pH 6.2-7.5 were favoured for p-HBA generation. Furthermore, we investigated the roles of different active intermediates in the reaction system and proposed the mechanism behind the ROS genearation. This study suggested that dithionite can be used as an active reagent for advanced oxidation remediation in oxic soil medium.

Objective: The level of immunity against pathogens decreases with old age. As a result, the elderly may be regarded to be at increased risk of malaria morbidity and fatality. There is paucity of studies on malaria among the elderly population in Osun East district, Southwest Nigeria. This study aimed to determine the prevalence of malaria and its association with medical comorbidities among the elderly., Methods: A descriptive cross-sectional study was carried out, which involved 972 adult residents of five communities in Osun State, who were selected using a multistage random sampling technique. Data was collected with aid of a structured questionnaire. The medical history of respondents and anthropometric measures were obtained. The presence of malaria parasitaemia in the respondents was determined by rapid diagnostic test (RDT). Appropriate descriptive and inferential analyses were done., Results: Out of the 972 respondents, 504 (51.9%) were 60 years and above. The overall prevalence of malaria RDT positivity was 4%. The positivity rate was higher among the elderly (4.6%) compared to those less than 60 years (3.4%), albeit not statistically significant ( p  = 0.36). Among these elderlies, 52.6% and 16.1% used insecticide-treated nets and insecticide sprays, respectively. There was no association between the prevalence of malaria positivity and comorbid conditions, such as hypertension ( p  = 0.37), overweight/obesity ( p  = 0.77), or diabetes ( p  = 0.15). Malaria positivity rate was also not significantly associated with the use of insecticide-treated nets ( p  = 0.64) or insecticide sprays ( p  = 0.45)., Conclusion: The malaria positivity rate was higher among the elderly in the study area, although not statistically significant. The prevalence was not associated with comorbid medical conditions., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2023.)

Background: Pyroptosis is an inflammatory programmed cell death accompanied by activation of inflammasomes and maturation of pro-inflammatory cytokines interleukin-1β (IL-1β) and IL-18. Pyroptosis is closely linked to the development of diabetic cardiomyopathy (DC). Pomegranate peel extract (PPE) exhibits a cardioprotective effect due to its antioxidant and anti-inflammatory properties. This study aimed to investigate the underlying mechanisms of the protective effect of PPE on the myocardium in a rat model of DC and determine the underlying molecular mechanism. Methods: Type 1 diabetes (T1DM) was induced in rats by intraperitoneal injection of streptozotocin. The rats in the treated groups received (150 mg/kg) PPE orally and daily for 8 weeks. The effects on the survival rate, lipid profile, serum cardiac troponin-1, lipid peroxidation, and tissue fibrosis were assessed. Additionally, the expression of pyroptosis-related genes (NLRP3 and caspase-1) and lncRNA-MALAT1 in the heart tissue was determined. The PPE was analyzed using UPLC-MS/MS and NMR for characterizing the phytochemical content. Results: Prophylactic treatment with PPE significantly ameliorated cardiac hypertrophy in the diabetic rats and increased the survival rate. Moreover, prophylactic treatment with PPE in the diabetic rats significantly improved the lipid profile, decreased serum cardiac troponin-1, and decreased lipid peroxidation in the myocardial tissue. Histopathological examination of the cardiac tissues showed a marked reduction in fibrosis (decrease in collagen volume and number of TGF-β-positive cells) and preservation of normal myocardial structures in the diabetic rats treated with PPE. There was a significant decrease in the expression of pyroptosis-related genes (NLRP3 and caspase-1) and lncRNA-MALAT1 in the heart tissue of the diabetic rats treated with PPE. In addition, the concentration of IL-1β and caspase-1 significantly decreased in the heart tissue of the same group. The protective effect of PPE on diabetic cardiomyopathy could be due to the inhibition of pyroptosis and downregulation of lncRNA-MALAT1. The phytochemical analysis of the PPE indicated that the major compounds were hexahydroxydiphenic acid glucoside, caffeoylquinic acid, gluconic acid, citric acid, gallic acid, and punicalagin. Conclusion: PPE exhibited a cardioprotective potential in diabetic rats due to its unique antioxidant, anti-inflammatory, and antifibrotic properties and its ability to improve the lipid profile. The protective effect of PPE on DC could be due to the inhibition of the NLRP3/caspase-1/IL-1β signaling pathway and downregulation of lncRNA-MALAT1. PPE could be a promising therapy to protect against the development of DC, but further clinical studies are recommended., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Abo-Saif, Ragab, Ibrahim, Abdelzaher, Mehanyd, Saber-Ayad and El-Feky.)

Wireless Local Area Networks (WLANs) have become an increasingly popular mode of communication and networking, with a wide range of applications in various fields. However, the increasing popularity of WLANs has also led to an increase in security threats, including denial of service (DoS) attacks. In this study, management-frames-based DoS attacks, in which the attacker floods the network with management frames, are particularly concerning as they can cause widespread disruptions in the network. Attacks known as denial of service (DoS) can target wireless LANs. None of the wireless security mechanisms in use today contemplate defence against them. At the MAC layer, there are multiple vulnerabilities that can be exploited to launch DoS attacks. This paper focuses on designing and developing an artificial neural network (NN) scheme for detecting management-frames-based DoS attacks. The proposed scheme aims to effectively detect fake de-authentication/disassociation frames and improve network performance by avoiding communication interruption caused by such attacks. The proposed NN scheme leverages machine learning techniques to analyse patterns and features in the management frames exchanged between wireless devices. By training the NN, the system can learn to accurately detect potential DoS attacks. This approach offers a more sophisticated and effective solution to the problem of DoS attacks in wireless LANs and has the potential to significantly enhance the security and reliability of these networks. According to the experimental results, the proposed technique exhibits higher effectiveness in detection compared to existing methods, as evidenced by a significantly increased true positive rate and a decreased false positive rate.

Background: Cervical cancer is ranked globally in the top three cancers for women younger than 45 years, with the average age of death at 59 years of age. The highest burden of disease is in low-to-middle income countries (LMICs), responsible for 90% of the 311,000 cervical cancer deaths in 2018. This growing health disparity is due to the lack of quality screening and treatment programs, low human papillomavirus (HPV) vaccination rates, and high human immunodeficiency virus (HIV) co-infection rates. To address these gaps in care, we need to develop a clear understanding of the resources and capabilities of LMICs' health care facilities to provide prevention, early diagnosis through screening, and treatment for cervical cancer., Objectives: This project aimed to assess baseline available cervical cancer prevention, early diagnosis, and treatment resources, at facilities designated as Health Center III or above, in Gulu, Uganda., Methods: We adapted the World Health Organization's Harmonized Health Facility Assessment for our own HFA and grading scale, deploying it in October 2021 for a cross-sectional analysis of 21 health facilities in Gulu., Results: Grading of Health Center IIIs (n = 16) concluded that 37% had "excellent" or "good" resources available, and 63% of facilities had "poor" or "fair" resources available. Grading of Health Center IVs and above (n = 5) concluded that 60% of facilities had "excellent" or "good" resources, and 40% had "fair" resources available., Discussion: The analysis of health facilities in Gulu demonstrated subpar resources available for cervical cancer prevention, early diagnosis, and treatment. Focused efforts are needed to expand health centers' resources and capability to address rising cervical cancer rates and related health disparities in LMICs. The development process for this project's HFA can be applied to global cervical cancer programming to determine gaps in resources and indicate areas to target improved health equity., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Chongsuwat et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Asymptomatic malaria infections have received less attention than symptomatic malaria infections in major studies. Few epidemiological studies on asymptomatic malaria infections have often focused on pregnant women and children under-five years of age as the most vulnerable groups. However, there is limitation on data regarding asymptomatic infections among the old adult populations, particularly in the study area. Therefore, this study determined the prevalence of asymptomatic malaria infection by microscopy and its determinants among residents of Ido- Ekiti, Southwestern Nigeria., Methods: A hospital-based cross-sectional study was conducted between July and September 2021 among 232 consenting apparently healthy individuals aged 40 years and above who were recruited during a free health screening program using a standardised interviewer-administered questionnaire. The questionnaire sought information on respondents' socio-demographics, presence and types of co-morbidity, and the prevention methods being adopted against malaria infection. Venous blood samples were collected and processed for asymptomatic infections using Giemsa-stained blood smear microscopy. Data were analysed using SPSS version 21. Multivariate logistic regression was used to identify factors associated with asymptomatic infections., Results: Of the total 232 respondents, 19.0% (48/232) were confirmed to be infected with Plasmodium falciparum (95% confidence interval (CI): 14.1% - 24.6%). Lack of formal education (Adjusted odds ratio (AOR): 5.298, 95% (CI): 2.184-13.997), being diabetic (AOR: 4.681, 95% CI: 1.669-16.105), and not sleeping under Long Lasting Insecticide Net (LLINs) (AOR: 4.594, 95% CI: 1.194-14.091), were the determinants of asymptomatic Plasmodium falciparum infection., Conclusion: The prevalence of asymptomatic Plasmodium falciparum was 19%. Lack of formal education, being diabetic, and not sleeping under LLINs were the determinants of asymptomatic infections., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Ibrahim et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Acid modification of orange peels (OPAC); an agro-waste, using ortho-phosphoric acid was carried out. OPAC was characterized using FTIR and SEM, BET and elemental Analysis techniques respectively. It was then used for the adsorption of metformin (MET) from aqueous solutions. OPAC has different functional groups and prominent pore sizes suitable for the sorption of MET. Experimental parameters such as effects of contact time, MET initial concentrations, solution temperature and solution pH were investigated. Optimum MET adsorption onto OPAC was obtained at a contact time: of 240 minutes, Initial MET concentration: 5 mg/L, Temperature: 323 K, and pH 7. The highest percentage of MET removal using OPAC was 97.23%. Sorption data were fitted into four different isotherm models; Langmuir, Freundlich, Tempkin, and Dubinin-Radushkevich. Freundlich isotherm model best explained the sorption data with the high affinity of adsorption ( R 2 value) observed at 303 K. Langmuir isotherm gives an optimum monolayer sorption capacity of 50.99 mg/g at 323 K. Kinetic studies of the sorption process were investigated using pseudo-first-order, pseudo-second-order, Elovich, and Intraparticle diffusion kinetic models, and the data fitted best the pseudo-second-order kinetic model. Thermodynamic studies revealed that the sorption process is spontaneous, feasible, and endothermic. The energy of activation, E a suggests a physisorption mechanism of MET sorption onto OPAC. Conclusively, OPAC was an efficient adsorbent for the sorption of MET from aqueous solutions. NOVELTY STATEMENT Orange peel activated carbon (OPAC) adsorbent gave a higher q o value for metformin removal from aqueous solution than other adsorbents previously reported in the literature.The highest percentage of removal of metformin drug-using OPAC was 97.23%. This is highly commendable.

Objectives: There is an observed paucity of data regarding the predictors of asthma mortality in Nigeria. This study aimed to ascertain the clinical presentations and predictors of acute severe asthma mortality in rural Southwestern Nigeria., Methods: A retrospective observational study using a data form and a standardized questionnaire was used to review the 124 patients admitted at Emergency Department between January 2015 and December 2019. The data were analyzed using SPSS Version 22.0. The results were presented in descriptive and tabular formats. Binary logistic regression analysis was used to determine the predictors of asthma mortality and a p -value <.05 was considered statistically significant., Results: A total of 124 patients were studied. The acute severe asthma mortality was 4.8% and its predictors were older age (Crude odds Ratio (COR), 14.857; 95% CI: 2.489-88.696, p < .001), Tobacco smoking (COR, 6.741; 95% CI: 1.170-38.826, p = .016), more than three co-morbidities (COR, 2.750; 95% CI: 1.147-26.454, p = 0.012), diabetes mellitus (COR, 13.750; 95% CI: 2.380-79.433, p < .001), Human Immunodeficiency virus (COR, 117.000; 95% CI: 9.257-1479.756, p < .001), ≥2 days before presentation (COR, 7.440; 95% CI: 1.288-42.980, p = .039), and Short-acting-B2-agonists overuse (COR, 7.041; 95% CI: 1.005-62.165, p = .044)., Conclusion: The mortality rate was 4.8% and its predictors were older age patients, tobacco smoking, multiple co-morbidities, diabetes mellitus, HIV, SP02 <90%, delay presentation, and Short-acting-B2-agonists over use, The study showed that there is high prevalence of asthma mortality in rural Southwestern Nigeria. The findings may be used to plan for asthma preventions and control programs in rural settings, and may also provide an impetus for prospective research on these outcomes.

Objectives: We aimed to evaluate the use of intravenous levetiracetam as the first-line treatment of neonatal seizures compared with phenobarbital., Methods: The study was conducted on 104 neonates (0-28 days) with clinical seizures after inclusion criteria. They were assigned in equal ratio into 2 groups; 1 included neonates who received phenobarbitone, and the other included neonates who received levetiracetam. Neonates were loaded with 20 mg/kg of intravenous drug-A (phenobarbitone) or drug-B (levetiracetam). In persistent seizures, a second loading dose of the same drug was given. Crossover to other drugs occurred if seizures persisted after the second dose of the same drug. The proportion of neonates who achieved cessation of seizures following the first or second loading dose of either drug-A or drug-B (PB or LEV) was the main outcome measure provided that they remained free of seizure for the following 24 hours., Results: After 1 or 2 doses of Levetiracatam or Phenobarbitone, clinical seizures stopped (and remained seizure-free for 24 hours) in 41 (78.84%) and 34 (65.38%) patients, respectively ( P  = .01). Neonates in the LEV group showed better seizure control than neonates in the PB group (RR = 0.57; 95% CI (0.17, 0.80). We did not report any adverse drug reactions in the LEV group. However, 12 (23.07%) neonates developed adverse drug reactions in the PB Group., Conclusion: Levetiracetam is considered an effective and safe drug as a first-line AED in neonatal seizures., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2022.)

Background and Aim: Gentamycin-induced nephrotoxicity is related to stimulation of oxidative stress and inflammatory cascades leading to apoptotic renal damage. Heme oxygenase-1 (HO-1) induction considered to be an adaptive response against oxidative tissue damage. Our study aimed to investigate the possible nephroprotective role of HO-1 inducers (hemin and erythropoietin (EPO)) and elucidate their potential underlying molecular mechanisms by assessing their antioxidant, anti-apoptotic, and anti-inflammatory properties., Methods: Kidney function markers (urea and creatinine), lipid peroxidation and antioxidant markers (MDA and GPx), inflammation and apoptotic markers (IL-6 and Bcl-2), and the relative gene expression levels of Nrf2 and HO-1 were assessed. Histopathological changes of the kidney were examined., Results: Nephrotoxic rats pretreated with hemin showed significant decrease in serum level of urea, creatinine, and MDA, compared to non-treated group. The kidney tissues also showed significant elevation of Bcl2 level, but significant decrease of IL-6, compared to non-treated group. Moreover, hemin pre-treatment significantly upregulated gene expression of Nrf2 and HO-1 in kidney tissue to near the normal control group. On the other hand, pretreatment with EPO showed significant upregulation of HO-1 gene expression but didn't show significant difference in Nrf2 gene expression compared to control group. The histopathological examination of kidney supported the biochemical results., Conclusion: The current results proved that hemin rather than EPO, showed reno-protective effects in rats, which was mediated by activation of Nrf2 signaling pathway. This could be also attributed to the observed anti-inflammatory, antioxidant, and anti-apoptotic properties of hemin. In this regard, EPO showed lower potency., Competing Interests: Conflict of interest statement The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022. Published by Elsevier Masson SAS.)

Although a plethora of targeted anticancer small molecule drugs became available, the low response rate and drug resistance imply the continuous need for expanding the anticancer chemical space. In this study, a novel series of nicotinonitrile derivatives was designed, synthesized and evaluated for cytotoxic activities in HepG2 and MCF-7 cells. All derivatives showed high to moderate cytotoxic activity against both cell lines, with cell-type and chemotype-dependent cytotoxic potential. The normal HEK-293 T cells were ca. 50-fold less susceptible to the cytotoxic effect of the inhibitors. The in vitro enzyme inhibitory activity of selected active cytotoxic derivatives 8c, 8e, 9a, 9e and 12 showed that they have sub- to one digit micromolar 50 % inhibitory concentration (IC 50 ) against the three Pim kinase isoforms, with 8e being the most potent (IC 50  ≤ 0.28 μM against three Pim kinases), comparable to the pan kinase inhibitor, Staurosporine. In HepG2, 8e induced cell cycle arrest at the G2/M phase. Apoptotic mechanistic studies with 8c and 8e in HepG2 cells, indicated a significant upregulation in both P53 and caspase-3 relative gene expression, as well as increased Bax/Bcl-2 protein expression level. Further, docking studies combined with molecular dynamic simulation showed a stable complex with high binding affinity of 8e to Pim-1 kinase; exploiting a negative electrostatic potential surface interaction with the added dimethyl amino group in the new compounds. Moreover, in silico ADME profile prediction indicated that all compounds are orally bioavailable and most of them can penetrate the blood-brain barrier. This study presents novel nicotinonitrile derivatives as auspicious hits for further optimization as antiproliferative agents against liver cancer cells and promising pan Pim kinase inhibitors at submicromolar concentrations., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Background and Objectives: The understanding of adolescents about themselves affects their choices and actions when their health is concerned. This study assessed the relationship between family background, perceived self-concept and health seeking behaviour of adolescents., Methods: This was a prospective cross-sectional study involving three secondary schools in Ekiti State, South-western Nigeria. A total of 352 students were recruited through multistage random sampling technique. The Personal Self-Concept Questionnaire (PSC) was used to assess the adolescents' personal self-concept while the health seeking behaviour was adapted from the Botsha Bophelo Adolescent Health Study (BBAHS) adapted questionnaire. The family background was sought from the respondents. Demographic variables were described as means and standard deviations. Categorical variables were reported as frequency distribution and proportions with the Pearson correlation test used to assess the relationship of relevant variables with self-concept., Results: There was negative correlation between the adolescents' family social class and their autonomy self-concept (r = -0.117; p<0.029). Out of the 42% who had any form of ill-health, 29.6% had sought for medical attention, 8.5% were sexually exposed, 4% and 4.8% were screened for HIV and the use of contraception respectively. Having been hospitalized in the past six months related with their general self-concept (r = -0.124; p<0.02) and sense of fulfillment (r = -0.118; p<0.027). Use of cannabis negatively correlated with general self-concept (r = -0.132; p<0.013) and honesty self-concept (r = -0.127; p<0.017). Sexual exposure correlated negatively with emotional self-concept (r = -0.116; p<0.03)., Conclusion: From this study, the socioeconomic class of the family of the adolescents affected their individuality. In addition, adolescents with high self-concept will not easily seek for appropriate medical attention., Competing Interests: The Authors declare that no competing interest exists., (Copyright © 2022 by West African Journal of Medicine.)

Background: There is still a need for more studies to evaluate the role of vitamin D 3 in pediatric migraine prophylaxis. Objectives: We aimed to evaluate the effects and safety of vitamin D 3 supplementation to topiramate on pediatric migraine. Methods: A double-blinded prospective clinical trial was conducted on 5- to 14-year-old children with migraine. They were randomly assigned in a 1:1 ratio into 2 groups, one with vitamin D 3 supplementation (the supplementation group) and the other without vitamin D supplementation (the placebo group). The supplementation group received topiramate plus one 5000-IU dose of vitamin D 3 daily for 4 months. The placebo group received topiramate with a placebo capsule without any effective substances. The primary outcomes were a monthly frequency of headache attacks, a good response to intervention, and reduction in migraine severity, duration, and disability before and after treatment. Fifty-six children completed the trial. Vitamin D 3 supplementation to topiramate was more effective than the placebo group in the reduction of monthly frequency (6231.31 vs 9792.24 times, P  = .01) and disability score for migraines (17 566.43 vs 25 187.65, P  = .04). A good response was observed in 76.13% of patients in the vitamin D 3 supplementation group and 53.5% of patients in the placebo group, and vitamin D 3 supplementation was significantly more effective than placebo ( P  = .01). Side effects were observed in 13.3% and 20% of the intervention group and placebo groups, respectively, P  = .5. Conclusion: Vitamin D 3 supplementation in pediatric migraine prophylaxis could be a well-tolerated, safe, and effective strategy.

In IoT networks, the de facto Routing Protocol for Low Power and Lossy Networks (RPL) is vulnerable to various attacks. Routing attacks in RPL-based IoT are becoming critical with the increase in the number of IoT applications and devices globally. To address routing attacks in RPL-based IoT, several security solutions have been proposed in literature, such as machine learning techniques, intrusion detection systems, and trust-based approaches. Studies show that trust-based security for IoT is feasible due to its simple integration and resource-constrained nature of smart devices. Existing trust-based solutions have insufficient consideration of nodes' mobility and are not evaluated for dynamic scenarios to satisfy the requirements of smart applications. This research work addresses the Rank and Blackhole attacks in RPL considering the static as well as mobile nodes in IoT. The proposed Security, Mobility, and Trust-based model (SMTrust) relies on carefully chosen trust factors and metrics, including mobility-based metrics. The evaluation of the proposed model through simulation experiments shows that SMTrust performs better than the existing trust-based methods for securing RPL. The improvisation in terms of topology stability is 46%, reduction in packet loss rate is 45%, and 35% increase in throughput, with only 2.3% increase in average power consumption.

Introduction: The predictors of community-acquired pneumonia (CAP) mortality are important outcome measures in epidemiological studies and clinical trials. There is an observed paucity of data regarding the predictors of mortality of CAP in Nigeria. Few studies from the urban centres have been reported in the literature, with none from the rural centres. The objective of this study is to ascertain the clinical presentations, risk factors, and predictors of mortality among patients admitted for CAP in rural Southwestern Nigeria., Methods: A retrospective observational study using a data form and a standardised questionnaire reviewed the 176 patients admitted to Southwestern Nigeria hospital between January 2015 and December 2019. The data were analysed using SPSS Version 22.0. The results were presented in descriptive and tabular formats., Results: A total of 176 patients were studied. Their mean age was 53.3±16.8 years. There were more males, 112 (63.6%), than females. The most common clinical presentations were cough, fever and sputum expectoration. The case fatality rate was 9.1% and its predictors were older aged patients [Adjusted Odds Ration (AOR), 4.135: 95% Confidence Interval (CI) (1.389-12.315); p =0.005], hypoxia [AOR, 11.118: 95% CI (2.607-47.405); p<0.001], tobacco smoking [AOR, 3.632: 95% CI (1.459-9.039); p=0.008], chronic obstructive pulmonary disease (COPD) [AOR, 10.111: 95%CI (2.370-43.139); p <0.001], and human immunodeficiency virus (HIV) [AOR, 9.444: 95% CI (4.304-20.725), p<0.001]., Conclusion: The case -fatality rate was 9.1%, and its predictors were older age patients, patients with hypoxia, tobacco smoking, COPD, and HIV. This study strengthens the argument on the higher prevalence of CAP and its mortality in rural Southwestern Nigeria. The findings may provide an impetus for prospective research on these outcomes., Competing Interests: The authors declare that they have no conflicts of interest., (© 2022 The Authors. Published by Elsevier B.V. on behalf of African Federation for Emergency Medicine.)

Objective: We determined the malaria prevalence and ascertained the degree of agreement among rapid diagnostic tests (RDTs), urine malaria tests, and microscopy in malaria diagnosis of adults in Nigeria., Methods: This was a cross-sectional study among 384 consenting patients recruited at a tertiary health facility in southwestern Nigeria. We used standardized interviewer-administered questionnaires to collect patients' sociodemographic information. Venous blood samples were collected and processed for malaria parasite detection using microscopy, RDTs, and urine malaria tests. The degree of agreement was determined using Cohen's kappa statistic., Results: The malaria prevalence was 58.3% (95% confidence interval [CI]: 53.0-63.1), 20.6% (95% CI: 16.6-25.0), and 54.2% (95% CI: 49.0-59.2) for microscopy, RDTs, and urine malaria test, respectively. The percent agreement between microscopy and RDTs was 50.8%; the expected agreement was 45.1% and Cohen's kappa was 0.104. The percent agreement between microscopy and urine malaria tests was 52.1%; the expected agreement was 50.7% and Cohen's kappa was 0.03., Conclusion: The malaria prevalence was dependent on the method of diagnosis. This study revealed that RDTs are a promising diagnostic tool for malaria in resource-limited settings. However, urine malaria test kits require further improvement in sensitivity prior to field use in malaria-endemic settings.

Objectives: The study determined the prevalence of malaria infection and its association with socio-demographics, environmental, housing, and co-morbid ailment factors., Methods: The study was a cross-sectional of 330 consented adult febrile patients who were recruited at a tertiary health facility in rural Southwestern Nigeria. The standardized interviewer-administered questionnaire sought information on their socio-demographics, environmental, housing, and co-morbid ailment factors. Venous blood samples were collected and processed for malaria parasite detection, retroviral screening, glycated hemoglobin, and hemoglobinopathy. Data were analyzed using SPSS version 20. The strength of the association between independent and dependent variables was measured using odds ratio and 95% confidence interval with a significant level ( p value <0.05)., Results: The prevalence of malaria parasitemia was 63.3% (95% confidence interval: 57.9%-68.5%). Being a farmer ( p  = 0.002), lack of formal education ( p  = 0.043), low-income earners ( p  = 0.031), presence of bushes ( p  = 0.048), stagnant water ( p  = 0.042), not sleeping under long-lasting insecticide-treated nets ( p  < 0.001), and sickle cell disease ( p  = 0.041) were significantly associated with malaria infection., Conclusion: The study revealed that there is a high prevalence of malaria infection in rural Southwestern Nigeria. There may be a need to pay greater attention to adult populations in rural areas for malaria intervention and control programs., Competing Interests: Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2022.)

Background: A high rate of unintended pregnancy is said to be driving population growth, particularly in Sub-Saharan Africa, where approximately half of all pregnancies are unintended, coming too soon or even unwanted. Most of these unintended pregnancies could have been prevented with effective family planning services. There, however, remains an unmet gap between the women's reproductive intention and their contraceptive behaviour., Objectives: This study determined the prevalence of unmet needs for family planning and examined its determinants among women of reproductive age group at a tertiary health facility in Southwest Nigeria., Design: This was a hospital-based cross-sectional study., Methods: Two hundred eighty-five sexually active women were recruited using a pre-tested, semi-structured, validated, interviewer-administered questionnaire. The questionnaire assessed the respondent's socio-demographic characteristics, obstetrics and gynaecological history, and contraceptive history. Relevant clinical parameters were measured and recorded. Data were analysed using SPSS version 21. Multivariable logistic regression analysis was done using a 5% significance level to identify the determinants of unmet needs for family planning., Results: The prevalence of unmet family planning needs for prevention, spacing and limiting were 28.8%, 33.1% and 38.1%, respectively, with 58.2% overall prevalence of unmet needs. The commonest reason for the non-uptake of contraceptives among those with unmet need was the fear of side effects (66.3%). The odds of having unmet needs for family planning were higher for respondents with four or fewer children (adjusted odds ratio (AOR): 7.731; 95% confidence interval (CI): 28.504-2.907, p  = 0.002) and those with one partner (AOR: 2.008; 95% CI: 3.669-1.090, p  = 0.025)., Conclusion: A high rate of unmet family planning needs was found in the study. This requires specific interventions and policies towards increasing contraceptive uptake, such as intensified health education aimed at allaying fears related to the side effects., (© The Author(s) 2022.)

Diabetes mellitus is the most common chronic metabolic disorder worldwide. The present study was designed to investigate the potential role of cinnamon bark extract oligomeric proanthocyanidins (OPCs) in controlling streptozotocin (STZ)-induced hyperglycemia and to clarify the underlying molecular mechanisms underlying its effects. For this purpose, 60 male rats were equally divided into six groups as follows: The normal control group; OPC control group (non-diabetic rats treated with OPC at 300 mg/kg orally for 21 days); the untreated diabetic control group; the wortmannin control group [diabetic rats treated with wortmannin at 1 mg/kg, intraperitoneal (i.p.) on the final day of the experiment]; the OPC diabetic group (diabetic rats treated with OPC at 300 mg/kg orally for 21 days); and the OPC diabetic + wortmannin co-treated group (diabetic rats treated with OPC at 300 mg/kg/day for 21 consecutive days and then 24 h after the final OPC dose treated with a single wortmannin injection at 1 mg/kg, i.p.). The results indicated that OPC ameliorated the diabetic state, as evidenced by a significant decrease in serum glucose levels, and a significant increase in the levels of insulin, amylin, insulin receptor phosphorylation, glycogen and glucose transporter-4 translocation; it also improved the lipid profile in STZ-diabetic rats. On the whole, the findings of the present study provide biochemical evidence that OPC treatment is effective as an anti-diabetic and anti-hyperlipidemic agent by enhancing glucose uptake through the activation of insulin receptor kinase activity and the PI3K/Akt pathway., Competing Interests: The authors declare that they have no competing interests., (Copyright: © El-Ashmawy et al.)

Introduction: Stroke mortality and its predictors are important outcome measures in stroke epidemiological studies and clinical trials. There is an observed paucity of data regarding the clinical presentations and predictors of stroke mortality in Southwestern Nigeria. Few available related studies have centred on hospitals in the urban and sub-urban areas; however, none in the rural settings. This study, therefore, focuses on the clinical presentations and predictors of stroke mortality at the adult Emergency Centre of a tertiary hospital situated in rural Southwestern Nigeria., Methods: A retrospective survey, using data form and standardized questionnaire, was used to study the patients admitted for stroke between January 2015 and December 2019. The data were analysed using SPSS Version 22.0. The results were presented in descriptive and tabular formats., Results: A total of 276 patients were studied. Their mean age was 67.3 ± 11.1 years. The most common clinical presentations were hemiparesis and cranial nerve deficit. The case of fatality was 10.1%. The predictors of stroke mortality were age ≥65 years [(AOR = 12.752; 95% CI: (1.022-159.190), p  = 0.048)], Glascow coma score <8 [(AOR = 50.348; 95% CI: (7.779-325.866), p  < 0.001)], uncontrolled blood pressure [(AOR = 23.321; 95% CI: (2.449-221.927), p  = 0.006)], presence of atrial fibrillation [(AOR = 16.456; 95% CI: (2.169-169.336), p  = 0.009)], convulsion [(AOR = 25.889; 95% CI: (2.374-282.296), p  = 0.008)], heart failure [(AOR = 30.284; 95% CI: (3.265-256.347), p  < 0.001)], and a repeat stroke [(AOR = 32.617; 95% CI: (2.410-441.381), p = 0.009)]., Conclusion: The 7-day fatality was 10.1%. The predictors of stroke mortality were poor Glascow coma score, uncontrolled blood pressure, atrial fibrillation, heart failure, convulsion and a repeat stroke. This study strengthens the argument on the higher prevalence of stroke and its mortality in rural Southwestern Nigeria. Our findings may provide an impetus for prospective research on this outcome., Competing Interests: The authors declare that they have no conflicts of interest., (© 2021 Published by Elsevier Ltd. CC BY 4.0.)

Background: Anemia is one of the most common complications of Chronic Kidney Disease (CKD). The vast majority of Egyptian CKD patients are interchangeably treated with Darbepoetin Alfa (DPA) and Epoetin Alfa (EPA) to achieve and maintain target hemoglobin levels. Our study aimed to compare the efficacy and safety of DPA versus EPA for managing anemia amongst Egyptian patients with CKD undergoing dialysis., Methods: A multicenter, open label, randomized, prospective, parallel study was conducted. Patients with CKD undergoing dialysis with Hb level < 10 g/dl were enrolled. The primary efficacy endpoint was the change in hemoglobin concentration at the evaluation period (weeks 20-24). Prespecified adverse events of interest following administration, including blood transfusions requirement, blood pressure and hemoglobin excursions, the relationship between C - Reactive Protein (CRP) and hemoglobin, were assessed., Results: Only 98 of 104 enrolled patients completed the study, fifty patients received EPA, and 48 patients received DPA. Our results showed that a significantly higher percentage of patients who achieved target Hb level ≥ 11 g/dL in DPA treated group vs. EPA as well as the meantime to achieve Hb level ≥ 10 g/dL was shorter in DPA treated group. Safety profiles of both treatments were similar. A negative correlation was observed between serum CRP and hemoglobin level in hemodialysis patients., Conclusion: Our study showed that DPA was more effective and well tolerated in achieving and maintaining Hb levels with lower dosing frequency compared to EPA. Furthermore, CRP is recommended to be routinely measured where patients with higher CRP require high ESA doses., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Introduction: Considering the magnitude of deaths prevailing in the accident and emergency department (AED) in health facilities of sub-Sahara Africa, there is a need to have information on the burden of admissions and deaths due to surgical emergencies. Few studies in Nigerian hospitals in urban and suburban areas have been documented, but none in the rural setting. The objectives of this study were to ascertain the sociodemographic profile, causes and outcomes of admissions, and the pattern and causes of deaths due to surgical emergencies., Methods: A retrospective survey using a data form and a predetermined questionnaire was used to review the patients admitted for surgical emergencies at the AED of a tertiary hospital in rural southwestern Nigeria from January 2015 to December 2019. The data were analyzed using SPSS version 22.0. The results were presented in descriptive and tabular formats., Results: Surgical emergencies constituted 43.9% of all admissions. The mean age of admissions was 42 ± 16.9 years, and majorities were in the young and middle-aged groups. There were more males (66.4%) than females (33.6%). Trauma(60.9%) of which road traffic accident (RTAs)(56.0%), was the leading mechanism of trauma. The mortality rate was 5.4% and was caused majorly by RTAs (33.0%), diabetes mellitus foot ulcers (11.0%), and malignancies (9.8%)., Conclusion: In this study, surgical emergencies constituted 43.9%, and a majority of the patients were male. Trauma caused by RTA is the most cause of admission. The mortality rate was 5.4%. This finding may provide an impetus for prospective research on this outcome., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 Journal of Emergencies, Trauma, and Shock.)

Background: Omega-3 may have a role in the treatment of drug- resistant epilepsy., Objectives: To evaluate omega-3 supplementation in seizure control in children with attention deficit hyperactivity disorder (ADHD) and intractable epilepsy., Patients and Methods: Sixty children with ADHD and intractable epilepsy were enrolled. They were randomly assigned in a double-blind fashion in a 1:1 ratio into the omega-3 supplementation group or the placebo group in addition to risperidone and antiepileptic drugs. All patients were assessed for the frequency and severity of the epileptic attacks at baseline, monthly, and at 6 months from the beginning of the study; 30 children received omega-3 and the other 30 children received placebo., Results: At baseline, the median number of seizures per month was 5 in both groups. After one month, this median decreased to 3 and became 2 after two months of supplementation with omega-3 in the supplementation group while it remained 5 in the control group. After 3 months and till the end of the study, this median decreased to 0 while it remained 5 in the control group throughout the study period. Children who were supplemented with omega-3 showed a significant decrease in the monthly frequency of seizure attacks after six months of supplementation compared to the baseline before supplementation (P < 0.05) There was no significant decrease in the severity of the seizures attacks among our patients with omega-3 supplementation (P > 0.05)., Conclusion: Omega 3 may help in achieving good seizure control in children with ADHD and intractable epilepsy., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Objective: We determined the prevalence of poor glycemic control and associations with sociodemographics, comorbid conditions, and medication adherence among patients with type 2 diabetes mellitus (T2DM) at a tertiary hospital in southwestern Nigeria., Methods: We conducted a retrospective observational study among 300 patients with T2DM using systematic random sampling. We used a semi-structured questionnaire to collect information on respondents' sociodemographic profile, lifestyle, comorbid conditions, and antidiabetic medications. Adherence was determined using the Morisky Medication Adherence Scale. Fasting blood samples were tested using a glycated hemoglobin marker. Multivariate logistic regression was used to identify factors associated with poor glycemic control., Results: Respondents' mean age was 61.9 ± 11.8 years. The prevalence of poor glycemic control was 40.0% (95% confidence interval [CI]: 34.4%-45.8%). The adjusted odds ratio (95% CI) for factors associated with poor glycemic control was 2.522 (1.402-4.647) for older age, 1.882 (1.021-3.467) for low income, 1.734 (1.013-3.401) for obesity, 2.014 (1.269-5.336) for non-initiation of insulin therapy, and 1.830 (1.045-3.206) for poor medication adherence., Conclusion: Older age, lower income, obesity, non-initiation of insulin, and poor medication adherence were associated with poor glycemic control. These variables may help clinicians identify patients at high risk of poor glycemic control.

Objectives: We aimed to investigate the risk factors predicting the development of intractable epilepsy in children with cerebral palsy (CP), with an emphasis on perinatal characteristics, seizure semiology, imaging, and EEG findings., Materials & Methods: Following a descriptive, retrospective, case-control design, 106 children with CP and epilepsy from 2015 to 2020 were studied (46 children with CP and intractable epilepsy and 60 with CP and controlled epilepsy). Data were retrieved from medical records of participants (i.e., demographics, clinical characteristics, perinatal history, etiology of seizure and CP, seizure semiology, intellectual functions, therapeutic options, brain imaging, and EEG findings)., Results: We established a model of the most important risk factors that can predict intractable epilepsy in children with CP. The model included the additive effect of a poor Apgar score at 5 minutes, the presence of neonatal seizures, focal epilepsy, and focal slowing on the EEG background (Area under the receiver operating characteristic of 0.810)., Conclusion: The findings can be used to identify intractable epilepsy in children who suffer from CP with further support by offering early therapeutic interventions intended to reduce the burden of refractory seizures.

Purpose: The usage of LLITNs in malaria vector control has resulted in the reduction in malaria deaths among higher-risk groups (pregnant women and under-fives). However, there exists asymptomatic infection among older children, thereby making them a reservoir of malaria transmission. This study aimed at assessing the impact of LLITN usage on malaria prevalence among school-age children (SAC) in Ekiti, South Western Nigeria., Methods: Cross-sectional, two-stage cluster sampling technique was used to collect data from SAC during May and June 2017. A total of 1313 (Oye LGA: 657 and Ikole LGA: 656) SAC in selected public primary schools participated in the study. Sociodemographic information as well as data on LLITN usage the previous night was obtained using pretested, semistructured questionnaires adapted from the standardized Malaria Indicator Survey (MIS) tools. Malaria infection was diagnosed by using the rapid diagnostic test (RDT) on blood samples that were collected by finger prick from each child. Data were analyzed using the Statistical Package for Social Sciences (SPSS) for Windows software version 26 (SPSS Inc., Chicago, IL, USA)., Results: Usage of LLITNs among SAC was significantly higher in Ikole LGA than in Oye ( p < 0.001). Socioeconomic factors (access to electricity, mother's occupation, and household size) showed significant associations with LLITN usage ( p < 0.001) in both Oye and Ikole LGAs. Malaria prevalence was significantly low among SAC utilizing LLITNs in both Oye and Ikole LGAs ( p < 0.001). There was a significant association between gender and malaria prevalence among SAC with males having higher prevalence than females ( p < 0.001). Socioeconomic factors were significantly associated with malaria prevalence in both LGAs ( p < 0.001)., Conclusion: The usage of LLITNs caused a significant reduction in malaria prevalence among the school-age children in the study areas; hence, sensitization on usage should be scaled up towards malaria elimination., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2021 Adejumoke Oluwatosin Omonijo et al.)

Background: Caesarean delivery is an essential surgical skill within the primary care setting aimed at reducing maternal morbidity and mortality., Objectives: To determine the rate and indications for caesarean deliveries with a view to improving on the service delivery in the study area., Methods: A retrospective review of all caesarean deliveries over a five-year period, January 1 st , 2012 to December 31 st , 2016., Results: A total of 2321 deliveries were recorded during the study duration and 481 of them were through caesarean section (CS) giving a caesarean section rate of 20.4%. The rate was higher in the multigravida 255 (53.1%). The commonest indication for caesarean section was previous caesarean section 131 (27.2%). Emergency caesarean delivery accounted for 278 (57.8%). Only 16 (3.3%) stayed more than five days postoperatively while the rest, 465 (96.7%), stayed less than five days. There was a gradual yearly increase in rate from 12.1% in 2012 to 19.5% in 2016., Conclusion: The rate of CS in this study has shown a gradual yearly increase with emergency CS having a higher percentage. Early diagnosis and referral of high-risk pregnancies from peripheral hospitals could reduce emergency CS among the study population., (© 2021 Ismail WO et al.)

Background: Perinatal asphyxia (PA) is a major cause of morbidity and mortality in which dramatic transient impairment in liver functions occurs in some patients. Objectives: We aimed to evaluate the state of the liver in cases of Perinatal asphyxia and to assess the severity of hepatic impairment in relation to different grades of HIE. Patients and Methods: This case-control study was conducted on 100 full-term newborns with perinatal asphyxia (Group I) and 50 healthy neonates served as controls (Group II). All biochemical parameters of liver function were measured on the 1st, 3rd, and 10th day after birth. These parameters include serum alanine transferase (ALT), aspartate transferase (AST), alkaline phosphatase (ALP), lactate dehydrogenase (LDH), total protein, serum albumin, serum bilirubin (total and direct), and international normalized ratio (INR), in both cases and controls. Results: Among babies with PA, 25 (25%) had an Apgar score of 0 to 3 (severe PA), 43 (43%) had an Apgar score of 4 to 5 (moderate PA) and 32 (32%) had an Apgar score of 6 to 7 (mild PA) at 5 minutes of life. HIE was found in 39% among cases of PA and the remaining 61% were normal. Among babies with PA and HIE; 25.7% had stage I, 41% had stage II and 33.3% had stage III. Impaired liver function was reported in 48% of asphyxiated babies. On the first day of life, ALT, AST, ALP, LDH, PT, and INR were significantly higher in Group I compared to Group II. However, total protein and serum albumin were significantly lower in Group I compared to Group II. ALT and AST showed a positive correlation with the severity of HIE. On the third day of life, LDH rises as the stage of HIE progressed from stage 0 to stage 3. The difference in LDH among most stages of HIE was statistically significant. Conclusion: Liver enzymes can be used as an easy early diagnostic marker to differentiate between babies with asphyxia and those without asphyxia. Also, liver enzymes can be used for the detection of the severity of PA., Competing Interests: Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2021.)

Background: Attention-deficit hyperactivity disorder (ADHD) is a common disorder in children, but its etiology and pathogenesis are still unclear., Aims: The aims of this study were to measure the level of serum interleukin-6 (IL-6) and tumor necrosis factor alpha (TNF-α) as markers of immune system involvement in children with ADHD, and to study their correlation with symptoms severity of ADHD., Materials and Methods: The study was conducted on 80 children diagnosed as ADHD based on the criteria adapted from the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition . Eighty healthy children of matched age and sex served as a control group. All children enrolled in the study were subjected to history taking, clinical examination, and psychometric tests. Assay for serum IL-6 and TNF-α for all patients and controls was performed using enzyme-linked immunosorbent assay., Results: The mean serum level of IL-6 was 26.11 ± 11.14 and 6.23 ± 2.52 in children with ADHD and controls, respectively. Children with ADHD showed significantly higher serum IL-6 levels than the control group ( P = 0.001). Serum IL-6 showed no significant correlation with the intelligence quotient (IQ) or the Abbreviated Conners' Rating Scale scores for parents. However, TNF-α showed no significant differences between the two groups and no significant correlation with the IQ or the Abbreviated Conners' Rating Scale scores for parents., Conclusion: Serum IL-6 levels were significantly higher in children with ADHD compared to controls; however, the IL-6 levels did not correlate with ADHD symptoms severity. Increased IL-6 levels may contribute to the etiology of ADHD., Competing Interests: There are no conflicts of interest., (Copyright: © 2021 Journal of Pediatric Neurosciences.)