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Prolonged use of antiretroviral agents has been clearly associated with nephrotoxicity, suggesting deterioration of renal function in patients receiving Highly Active Antiretroviral Therapy (HAART). The present study was designed to investigate the therapeutic efficacy of resveratrol (RV) in the treatment toxins-induced renal impairment. Twenty-four adult male Wistar rats weighing 70-90 g were divided into four groups and subjected to the following treatments: Control A (distilled water), B (HAART), C (RV-2.5 mg/kg), D (RV- 2.5 mg/kg) + HAART. Assessment included renal histological examination; renal function indicators such as serum creatinine and blood urea nitrogen; serum electrolyte levels including sodium, chloride, potassium, bicarbonate; and oxidative stress biomarkers such as malondialdehyde, catalase and glutathione and superoxide dismutase. Adverse effects of HAART include adverse histological changes, such as tubular atrophy, vacuolization, tubular granular degeneration and glomerular capillaries abnormalities. Compared to the other treatment cohorts, serum creatinine, blood urea nitrogen (BUN), sodium, chloride and malondialdehyde (MDA) levels were significantly increased, while antioxidant enzyme activities such as catalase (CAT) and superoxide dismutase (SOD) and glutathione (GSH) levels were notably decreased. Renal structure remained largely unchanged after RV administration, with some recovery in histological abnormalities. Visible improvements, including reduced inflammation, reduced necrosis, reduced vacuolization and improved tubule and glomerular configuration, were also observed. In addition, RV notably increased antioxidant enzyme levels (SOD, CAT, and GSH) and decreased BUN, serum creatinine and MDA levels. RV helped mitigate HAART-induced structural abnormalities and renal dysfunction, while improving renal morphology. However, further investigation of these mechanisms is needed. [ABSTRACT FROM AUTHOR]

Objective: To determine the perinatal mortality rate in Lagos University Teaching Hospital at the close of the 20th century. Materials and Methods: Routinely collected data from the Departments of Obstetrics & Gynaecology and Paediatrics from January 1996 to December 2000, were analysed. The data included total deliveries, stillbirths and early neonatal deaths. Results: A total of 6,759 deliveries, including 163 multiple pregnancies, occurred during the period. There were 573 perinatal deaths comprising 471(69.7/1000) stillbirths and 102(16.2/ 1000) early neonatal deaths. Autopsy was performed on 115 of the 573 deaths resulting in a perinatal autopsy rate of 20.1 percent. The overall perinatal mortality rate was 84.8/1000 while the perinatal mortality rate for singletons was 83/1000. Analysis of the deaths by the Wigglesworth classification showed that 46.6 percent of the deaths were normally formed macerated stillbirths, 38.7 percent were due to asphyxial conditions and 8.9 percent were attributed to conditions associated with immaturity. Lethal congenital malformations accounted for 3.7 percent while other specific conditions were responsible for 2.1 percent of the deaths. Conclusion: These rates are still very high and strategies to decrease perinatal mortality will need to focus on antenatal and intrapartum obstetric care. All those involved in obstetric and neonatal care require regular education on the need for prompt identification of problems, early referral and prompt intervention.

CdSeTe/CdMgTe double heterostructures were produced with both n-type and unintentionally doped absorber layers. Measurements of the dependence of photoluminescence intensity on excitation intensity were carried out, as well as measurements of time-resolved photoluminescence decay after an excitation pulse. It was found that decay times under very low photon injection conditions are dominated by a non-radiative Shockley-Read-Hall process described using a recombination center with an asymmetric capture cross section, where the cross section for holes is larger than that for electrons. As a result of the asymmetry, the center effectively extends photoluminescence decay by a hole trapping phenomenon. A reduction in electron capture cross section appeared at doping densities over 1016cm-3. An analysis of the excitation intensity dependence of room temperature photoluminescence revealed a strong relationship with doping concentration. This allows estimates of the carrier concentration to be made through a non-destructive optical method. Iodine was found to be an effective n-type dopant for CdTe, allowing controllable carrier concentrations without an increased rate of non-radiative recombination. [ABSTRACT FROM AUTHOR]

Summary: The effects of Virgin coconut oil as an adjuvant to highly active antiretroviral therapy (HAART) were investigated on the testicular ultrastructure and biochemical markers in rats. Twenty male Sprague‐Dawley rats, weighing 153‐169 g were divided into four groups and treated as follows: control A (distilled water), B (HAART), C (HAART+Virgin coconut oil 10 ml/kg) and D (Virgin coconut oil [VCO] 10 ml/kg). Testicular segments were evaluated using transmission electron microscopy. Serum was assayed for testosterone, luteinising hormone, follicle stimulating hormone and testicular tissue for malondialdehyde and glutathione. Ultrastructure of basement membrane (Bm), mitochondria and spermatocytes was normal in the control group. HAART‐treated group showed significant increase (p < .01) in Bm thickness with significant decrease in Leydig cell nuclear diameter (p < .05) and volume (p < .01) when compared with control group. Mitochondrial cristae appear collapsed, and Sertoli cells showed cytoplasmic vacuolations. HAART+VCO group showed improved ultrastructural details in Bm, and Sertoli cell and Leydig cells show abundant lipid droplets. Virgin coconut oil‐treated group showed thinning of Bm with otherwise normal ultrastructural features of organelles. HAART‐treated group showed significant increase (p < .01) in testosterone levels. There was no significant effect on malondialdehyde and glutathione levels. Virgin coconut oil improved testicular morphology and reversed HAART‐induced ultrastructural alterations. Further studies on putative mechanism are required. [ABSTRACT FROM AUTHOR]

Background: The aim of this study is to evaluate the impact of coexistence of metabolic syndrome (MS) and type 2 diabetes mellitus (T2DM) on the estimated cardiovascular risk as calculated using the United Kingdom Prospective Diabetic Study risk engine (UKPDS-RE) and also to determine the impact of the coexistence of MS and T2DM on the 10-year risk of developing coronary heart disease and stroke. Methodology: This is a cross-sectional study in which convenience sampling technique was used to recruit 124 consecutive persons with T2DM and 96 controls using a questionnaire administered technique. The World Health Organization (WHO) criterion was used to define MS and the UKPDS-RE was used to identify persons with increased risk for stroke and those with increased risk for coronary heart disease. The data obtained were analyzed using SPSS version 16. Statistical comparisons were made with chi-square for comparison of proportions. A P-value of less than 0.05 was taken as statistically significant. Results: Fifteen subjects were identified as having an increased 10-year risk for stroke and ten as having an increased risk for a coronary event. The odds of a T2DM subject with MS having an increased risk for stroke compared with a T2DM subject without MS was 0.95791 while the odds of a T2DM subject with MS developing an increased risk for a coronary event compared with a T2DM subject without MS was =3.4513. Conclusion: MS was more common in subjects with T2DM compared with controls (irrespective of the diagnostic criteria used) and MS appears to increase the risk of a coronary event in subjects with T2DM by threefold. Also from this study, MS did not appear to cause an additional increase in the risk of stroke in subjects with T2DM. [ABSTRACT FROM AUTHOR]

Objective(s): Broad range of metabolic changes associated with highly active antiretroviral therapy (HAART) has been reported over decades including reproductive perturbations. The current study aimed at investigating the role of Hypoxis hemerocallidea (Hyp) in the seminal and morphometric alterations in the testes of streptozotocin-nicotinamide-induced diabetic rats under HAART.Materials and Methods: Sixty-two adult male Sprague-Dawley rats were divided into A-H groups, containing 6 rats in the control group A and 8 rats in the treatment groups B-H. Diabetes was induced by intraperitoneal injection of nicotinamide (110 mg/kg BW) followed by streptozotocin (45 mg/kg BW). The animals were then subjected to various treatments with HAART, Hyp, and melatonin.Results: weights (body and testicular), histological, histochemical, seminal fluid, and morphometric analyses were carried out. Sperm count and motility were reduced in HAART (P

Objective: The objective of this study is to assess the treatment outcomes in patients with hyperglycemic emergencies and to ascertain the factors associated with outcome, with emphasis on the determinants of outcome. Method: A total of 105 patients admitted to the Accident and Emergency unit, who fulfilled the criteria for hyperglycemic emergencies, were selected. The information extracted included sociodemographic, clinical, and laboratory data, as well as hospitalization outcome. Results: Of the 105 subjects that participated in the study, hyperosmolar hyperglycemic nonketotic state (HHNK) was seen in 50% (53) of the subjects, while diabetic ketoacidosis (DKA) was seen in 31% (29), normo-osmolar nonketotic hyperglycemic state (NNHS) in 12% (13), and mixed hyperglycemic emergency in 7% (10) of the subjects. The overall mortality rate in this study was 4.8%. Three deaths were recorded in patients with HHNK, while DKA and NNHS each had one death. Three of the deaths occurred within the first 24 hours of admission while the other two were more than 24 hours after admission. The mean (standard deviation) total duration of hospital stay was 24.2 days (SD), and the range of stay was 0.5-88 days. Conclusion: The most common type of hyperglycemic emergency seen in this study was HHNK. Also, the presence of infection, and sex of the study subject, were significant determinants of outcome in this study. [ABSTRACT FROM AUTHOR]

The article discusses the definition, diagnosis, risks, prevention and treatment options of diabetes mellitus. It describes a chronic metabolic disorder of several aetiology portrayed by hyperglycaemia with disturbances of carbohydrate, fat, and protein metabolism due to lack in insulin. Type-1 diabetes mellitus can be presented at any age because of variability in the rate of beta-cell destruction. One of the etiologies for diabetes mellitus is said to be metabolic abnormalities that worsen insulin secretion.

Many developing countries seem to be unable to establish water quality standards. The only reasonable hope for the foreseeable future seems to he in voluntary action by industries prompted, perhaps, by gentle persuasion by public-spirited individuals or groups. This paper reports an effort in this direction, involving an interplay of data collection and analysis, and dialogue. [ABSTRACT FROM AUTHOR]

Connections between neurons can be mapped by acquiring and analysing electron microscopic brain images. In recent years, this approach has been applied to chunks of brains to reconstruct local connectivity maps that are highly informative 1-6 , but nevertheless inadequate for understanding brain function more globally. Here we present a neuronal wiring diagram of a whole brain containing 5 × 10 7 chemical synapses 7 between 139,255 neurons reconstructed from an adult female Drosophila melanogaster 8,9 . The resource also incorporates annotations of cell classes and types, nerves, hemilineages and predictions of neurotransmitter identities 10-12 . Data products are available for download, programmatic access and interactive browsing and have been made interoperable with other fly data resources. We derive a projectome-a map of projections between regions-from the connectome and report on tracing of synaptic pathways and the analysis of information flow from inputs (sensory and ascending neurons) to outputs (motor, endocrine and descending neurons) across both hemispheres and between the central brain and the optic lobes. Tracing from a subset of photoreceptors to descending motor pathways illustrates how structure can uncover putative circuit mechanisms underlying sensorimotor behaviours. The technologies and open ecosystem reported here set the stage for future large-scale connectome projects in other species., (© 2024. The Author(s).)

In two previous studies, we showed that supplementing a high-fat (HF) diet with 9% w/w U. dioica protects against fat accumulation, insulin resistance, and dysbiosis. This follow-up study in C57BL6/J mice aimed at testing: (i) the efficacy of the vegetable at lower doses: 9%, 4%, and 2%, (ii) the impact on intestinal T and B cell phenotype and secretions, (iii) impact on fat and glucose absorption during excess nutrient provision. At all doses, the vegetable attenuated HF diet induced fat accumulation in the mesenteric, perirenal, retroperitoneal fat pads, and liver but not the epididymal fat pad. The 2% dose protected against insulin resistance, prevented HF diet-induced decreases in intestinal T cells, and IgA + B cells and activated T regulatory cells (Tregs) when included both in the LF and HF diets. Increased Tregs correlated with reduced inflammation; prevented increases in IL6, IFNγ, and TNFα in intestine but not expression of TNFα in epididymal fat pad. Testing of nutrient absorption was performed in enteroids. Enteroids derived from mice fed the HF diet supplemented with U. dioica had reduced absorption of free fatty acids and glucose compared to enteroids from mice fed the HF diet only. In enteroids, the ethanolic extract of U. dioica attenuated fat absorption and downregulated the expression of the receptor CD36 which facilitates uptake of fatty acids. In conclusion, including U. dioica in a HF diet, attenuates fat accumulation, insulin resistance, and inflammation. This is achieved by preventing dysregulation of immune homeostasis and in the presence of excess fat, reducing fat and glucose absorption., (Copyright © 2024 Elsevier Inc. All rights reserved.)

The properties of kale as a functional food are well established. We sought to determine how fermentation further enhances these properties. We tested different fermentation conditions: (i) spontaneous fermentation with naturally occurring bacteria, (ii) spontaneous fermentation with 2% salt, (iii) Lactococcus lactis , (iv) Lactobacillus acidophilus , (v) mixture of L. lactis and L. acidophilus , (vi) mixture of L. lactis , L. acidophilus , and Clostridium butyricum. We quantified selected bioactive components using high-performance liquid chromatography (HPLC) and antinutritional factors using a gravimetric method and spectrophotometry. We then determined (i) the antioxidant capacity of the vegetable, (ii) anti-inflammation capacity, and (iii) the surface microbiota composition by 16S sequencing. All fermentation methods imparted some benefits. However, fermentation with mixed culture of L. lactis and L. acidophilus was most effective in increasing polyphenols and sulforaphane accessibility, increasing antioxidant activity, and reducing antinutritional factors. Specifically, fermentation with L. lactis and L. acidophilus increased total polyphenols from 8.5 to 10.7 mgGAE/g (milligrams of gallium acid equivalent per gram) and sulforaphane from 960.8 to 1777 μg/g (microgram per gram) but decreased the antinutritional factors oxalate and tannin. Total oxalate was reduced by 49%, while tannin was reduced by 55%-65%. The antioxidant capacity was enhanced but not the anti-inflammation potential. Both unfermented and fermented kale protected equally against lipopolysaccharide (LPS)-induced inflammation in RAW 264.7 macrophages and prevented increases in inducible nitric oxide synthase (iNOS), tumor necrosis factor-alpha (TNF-α), interleukin-1 beta (IL-1β), and interleukin-6 messenger RNA (IL-6 mRNA) expression by 84.3%, 62%, 68%, and 85.5%, respectively. Unfermented and naturally fermented kale had high proportions of sulfur reducing Desulfubrio and Proteobacteria usually associated with inflammation. Fermenting with L. lactis and/or L. acidophilus changed the bacterial proportions, reducing the Proteobacteria while increasing the genera Lactobacilli and Lactococcus. In summary, fermentation enhances the well-known beneficial impacts of kale. Fermentation with mixed cultures of L. lactis and L. acidophilus imparts higher benefits compared to the single cultures or fermentation with native bacteria present in the vegetable., Competing Interests: The authors declare no conflict of interest., (© 2024 The Authors. Food Science & Nutrition published by Wiley Periodicals LLC.)

Background: Older adults may be limited in their ability to access care that meets their health goals owing to disease burden, financial instability, and psychosocial barriers. A home-based primary care (HBPC) program established in 2020 within a large family medicine practice uses the Patient Priorities Care (PPC) approach to identify and address patients' health priorities. When incorporated as part of the HBPC model of care, the PPC approach has the potential to enhance person-centered care for older adults in a way that best supports their health goals., Objective: The objective of this study is to summarize common recommendations for alignment of care with patients' health outcome goals after implementation of the PPC approach in an HBPC population., Methods: This retrospective study was exempt from review by an institutional review board. After enrollment in the HBPC program, patients participated in a PPC priorities identification conversation to identify their health outcome goals and care preferences. Through chart review, 2 researchers independently categorized these goals based on the set of values they most reflect: connecting, managing health, enjoying life, and functioning. Aspects of care in place before enrollment in HBPC were considered to determine any adjustments that needed to be made to align care with patients' identified priorities., Results: The most common value associated with patients' most desired health outcome goal was functioning (n = 33, 66%). For secondary and tertiary health outcome goals, the most common value identified was managing health (secondary, n = 28, 56%; tertiary, n = 22, 44%). Common recommendations made to align care with patients' identified priorities included stopping potentially harmful medications, starting medications for untreated conditions, starting physical or occupational therapy, and adjusting medications., Conclusion: Through the PPC approach, patients' values were identified and care was assessed to aid in attainment of individualized health outcome goals and tailor care to What Matters most., Competing Interests: Disclosure The authors declare no relevant conflicts of interest or financial relationships., (Copyright © 2023 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.)

Humans and rodents exhibit a divergent obesity phenotype where not all individuals exposed to a high calorie diet become obese. We hypothesized that in C57BL/6NTac mice, despite a shared genetic background and diet, variations in individual gut microbiota function, immune cell phenotype in the intestine and adipose determine predisposition to obesity. From a larger colony fed a high-fat (HF) diet (60% fat), we obtained twenty-four 18-22-week-old C57BL/6NTac mice. Twelve had responded to the diet, had higher body weight and were termed obese prone (OP). The other 12 had retained a lean frame and were termed obese resistant (OR). We singly housed them for three weeks, monitored food intake and determined insulin resistance, fat accumulation, and small intestinal and fecal gut microbial community membership and structure. From the lamina propria and adipose tissue, we determined the population of total and specific subsets of T and B cells. The OP mice with higher fat accumulation and insulin resistance harbored microbial communities with enhanced capacity for processing dietary sugars, lower alpha diversity, greater abundance of Lactobacilli and low abundance of Clostridia and Desulfobacterota. The OR with less fat accumulation retained insulin sensitivity and harbored microbial communities with enhanced capacity for processing and synthesizing amino acids and higher diversity and greater abundance of Lactococcus, Desulfobacterota and class Clostridia. The B cell phenotype in the lamina propria and mesenteric adipose tissue of OR mice was characterized by a higher population of IgA + cells and B1b IgM + cells, respectively, compared to the OP. We conclude that variable responses to the HF diet are associated with the function of individuals' gut microbiota and immune responses in the lamina propria and adipose tissue.

Kale ( Brassica oleracea var. acephala), a food rich in bioactive phytochemicals, prevents diet-induced inflammation and gut dysbiosis. We hypothesized that the phytochemicals protect against the lipopolysaccharide (LPS)-induced acute inflammation which results from gut dysbiosis and loss of gut barrier integrity. We designed this study to test the protective effects of the whole vegetable by feeding C57BL/6J mice a rodent high-fat diet supplemented with or without 4.5% kale (0.12 g per 30 g mouse) for 2 weeks before administering 3% dextran sulfate sodium (DSS) via drinking water. After one week, DSS increased the representation of proinflammatory LPS (P-LPS)-producing genera Enterobacter and Klebsiella in colon contents, reduced the representation of anti-inflammatory LPS (A-LPS)-producing taxa from Bacteroidales , reduced the expression of tight junction proteins, increased serum LPS binding protein, upregulated molecular and histopathological markers of inflammation in the colon and shortened the colons. Mice fed kale for 2 weeks before the DSS regime had a significantly reduced representation of Enterobacter and Klebsiella and instead had increased Bacteroidales and Gram-positive taxa and enhanced expression of tight junction proteins. Downstream positive effects of dietary kale were lack of granuloma in colon samples, no shortening of the colon and prevention of inflammation; the expression of F4/80, TLR4 and cytokines 1L-1b, IL-6, TNF-a and iNOS was not different from that of the control group. We conclude that through reducing the proliferation of P-LPS-producing bacteria and augmenting the integrity of the gut barrier, kale protects against DSS-induced inflammation.

Background Patient Priorities Care (PPC) aims to identify and integrate patient goals and preferences into health care decision-making to provide more personalized care for multimorbid older individuals. Home-based primary care (HBPC) is a model of care delivery that supports aging in place. HBPC-integrated pharmacists can identify patient priorities and communicate with the team to ensure care is aligned with what matters most. Objectives Evaluate patients' perceptions of having priorities identification conversations with the pharmacist; identify the value domains represented by patients' health outcome goals. Setting HBPC program at a large family medicine practice where pharmacists are core members of the interdisciplinary team. Intervention Pharmacists led priorities identification conversations for patients newly enrolled in HBPC. Care preferences and health outcome goals were documented in the medical record and communicated during HBPC team meetings. Design This was a prospective, observational study of HBPC enrollees. After the priorities identification conversation, a three-question survey was administered to identify patients' perceptions of the conversation and interaction with the pharmacist. Health outcome goals and care preference statements were reviewed to determine with which value domain(s) they most aligned. Descriptive statistics were used for results analysis. Results Pharmacists led conversations with 30 participants. Average overall satisfaction with the conversation was 4.6 on a 5-point Likert scale (1 = least, 5 = most satisfied). Ninety-three percent of patients felt it was appropriate to have a pharmacist lead these conversations. Ninety-seven percent believed it was important/very important to discuss their values and goals with their health care team. The predominant value domains represented were Managing Health (43%) and Functioning (40%). Conclusion Patients were mostly satisfied with having PPC conversations and felt it was appropriate for a pharmacist to lead these conversations. Managing health conditions and preserving function were the most frequent value domains associated with patients' goals and care preferences.

Acute hypocalcaemia can be life-threatening and must be diagnosed promptly. The gold-standard investigation is ionised calcium, which is measured on most blood gas analysers. Total calcium measurements are inaccurate in severe depletion even if 'corrected' or 'adjusted' for albumin. We present an illustrative case of a woman in her 30s with symptomatic hypocalcaemia and a very low ionised calcium on VBG analysis. Emergency calcium replacement was delayed due to a falsely reassuring corrected calcium result. Our discussion includes a systematic literature review on the use of ionised calcium in emergency and acute medical settings. We suggest cognitive biases that may explain clinical over-reliance on corrected calcium, and call for the inclusion of ionised calcium values in major treatment guidelines for acute hypocalcaemia., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2022. No commercial re-use. See rights and permissions. Published by BMJ.)

Due to advances in automated image acquisition and analysis, whole-brain connectomes with 100,000 or more neurons are on the horizon. Proofreading of whole-brain automated reconstructions will require many person-years of effort, due to the huge volumes of data involved. Here we present FlyWire, an online community for proofreading neural circuits in a Drosophila melanogaster brain and explain how its computational and social structures are organized to scale up to whole-brain connectomics. Browser-based three-dimensional interactive segmentation by collaborative editing of a spatially chunked supervoxel graph makes it possible to distribute proofreading to individuals located virtually anywhere in the world. Information in the edit history is programmatically accessible for a variety of uses such as estimating proofreading accuracy or building incentive systems. An open community accelerates proofreading by recruiting more participants and accelerates scientific discovery by requiring information sharing. We demonstrate how FlyWire enables circuit analysis by reconstructing and analyzing the connectome of mechanosensory neurons., (© 2021. The Author(s), under exclusive licence to Springer Nature America, Inc.)

Introduction: Heart failure hospitalization is a hallmark of disease progression associated with increased morbidity and mortality. Benefits of multidisciplinary clinics have been established in the care of heart failure patients and can be particularly impactful post-hospital discharge., Objective: This study aimed to investigate the impact of a clinical pharmacist-integrated model of care within a Heart Failure Bridge Clinic (HFBC) at a large tertiary care referral center., Methods: In this single-center retrospective study, patients with left ventricular ejection fraction (LVEF) ≤40% discharged from Mission Hospital (Asheville, North Carolina) between August 2018 and July 2019 were screened. Patients in the HFBC arm had a clinic visit inclusive of a clinical pharmacist within 30 days of hospital discharge and were compared with a control group of patients with a usual care provider clinic visit. The HFBC provided clinical assessment, detailed heart failure education, and medication reconciliation and adjustment with an emphasis on optimization of Guideline Directed Medical Therapy (GDMT). Patients were followed for 90 days for the primary end point of hospitalization, emergency department (ED) visit, or death., Results: A total of 1463 patients (HFBC, n = 307; control, n = 1156) comprised our final cohort. After accounting for baseline variables, 90-day cumulative probability of hospitalization, ED visit, or death favored HFBC patients (26% vs 32%, P = .0275). Comprehensive review of medications prior to and after HFBC appointment demonstrated significant alterations to therapies (30% GDMT addition, 27% GDMT titration, 7.2% discontinuation of medications associated with worsening heart failure, and 28% loop diuretic adjustment)., Conclusion: Clinical pharmacist-integrated HFBC allows for focused medication review and optimization and is associated with a 19% relative risk reduction in hospitalization, ED visit, or death at 90 days., Competing Interests: CONFLICT OF INTEREST The authors declare no conflicts of interest.

Background: There is a need for more observational studies across different clinical settings to better understand the epidemiology of the novel COVID-19 infection. Evidence on clinical characteristics of COVID-19 infection is scarce in secondary care settings in Western populations., Methods: We describe the clinical characteristics of all consecutive COVID-19 positive patients (n = 215) admitted to the acute medical unit at Fairfield General Hospital (secondary care setting) between 23 March 2020 and 30 April 2020 based on the outcome at discharge (group 1: alive or group 2: deceased). We investigated the risk factors that were associated with mortality using binary logistic regression analysis. Kaplan-Meir (KM) curves were generated by following the outcome in all patients until 12 May 2020., Results: The median age of our cohort was 74 years with a predominance of Caucasians (87.4%) and males (62%). Of the 215 patients, 86 (40%) died. A higher proportion of patients who died were frail (group 2: 63 vs group 1: 37%, p < 0.001), with a higher prevalence of cardiovascular disease (group 2: 58 vs group 1: 33%, p < 0.001) and respiratory diseases (group 2: 38 vs group 1: 25%, p = 0.03). In the multivariate logistic regression models, older age (odds ratio (OR) 1.03; p = 0.03), frailty (OR 5.1; p < 0.001) and lower estimated glomerular filtration rate (eGFR) on admission (OR 0.98; p = 0.01) were significant predictors of inpatient mortality. KM curves showed a significantly shorter survival time in the frail older patients., Conclusion: Older age and frailty are chief risk factors associated with mortality in COVID-19 patients hospitalised to an acute medical unit at secondary care level. A holistic approach by incorporating these factors is warranted in the management of patients with COVID-19 infection.

Background: Haemorrhage is a leading cause of maternal mortality worldwide and hysterectomy may become necessary to save life. This procedure is associated with significant morbidity and mortality., Objective: To determine the, indications, risk factors and the management outcome for the procedure in our unit., Methods: A retrospective case controlled study of 34 cases of emergency obstetric hysterectomy (EOH) performed at the Lagos University Teaching Hospital over a period often years was carried out., Results: The incidence of EOH was 2.56 per thousand deliveries. Increasing parity, history of previous caesarean section, placenta praevia and current delivery by caesarean section were significant risk factors for the procedure. The indications were ruptured uterus (61.8%), intractable haemorrhage during caesarean section (32.4%), and uterine atony (5.9%). Majority (73.5%) of the patients had subtotal hysterectomy but the outcome indices were similar for the total and subtotal procedures. The case fatality rate was 11.8%. Post-operative complications included anemia (100%), urinary tract infection (UTI) (14.7%) and wound infection (11.7%)., Conclusion: The incidence of EOH in our unit has increased since the last study published in 1983, but the associated mortality has decreased. The indications differed in proportion from those in developed countries although the risk factors were similar. The outcome indices were similar for the total and the subtotal procedures. EOH is still associated with considerable maternal morbidity and mortality which can be reduced by provision of better obstetric care for the population.