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Background Much of the recent literature on bromelain based enzymatic debridement of burn injury has focused on its use in smaller burn injury and specialist areas such as the hands or genitals (Krieger et al., 2012; Schulz et al., 2017a,b,c,d). This is despite the original papers describing its use in larger burn injury (Rosenberg et al., 2004, 2014). The current EMA license for Nexobrid™ advises that it should not be used for burn injuries of more than 15% TBSA and should be used with caution in patients with pulmonary burn trauma and suspected pulmonary burn trauma. The original safety and efficacy trial of NexoBrid™ limited its use to 15% TBSA aliquots with concern regarding the effect of bromelain on coagulation. In a European consensus paper of experienced burns clinicians, now on its second iteration, 100% of respondents agreed that “up to 30% BSA can be treated by enzymatic debridement based on individual decision” (Hirche et al., 2017). Hofmaenner et al.’s recent study on the safety of enzymatic debridement in extensive burns larger than 15% provides some further evidence that “bromelain based enzymatic debridement can be carried out safely in large-area burns” (Hofmaenner et al., 2020) but the literature is scant in these larger debridement areas. In our centre we have been using enzymatic debridement for resuscitation level burn injury since 2016. We have gained significant learning in this time; this article aims to describe our current protocol for enzymatic debridement in this patient population and highlight specific learning points that might aid other centres in using enzymatic debridement for larger burn injury. Method We performed a search of the IBID database to identify all adult patients who satisfied the inclusion criteria of resuscitation level burn injury (defined as total burn surface area (TBSA) ≥15% in patients aged >16 years), or level 3 admission following burn injury and who underwent Enzymatic Debridement. A case note review was completed, and details comprising patient demographics, TBSA, mechanism of burn, presence of inhalation injury, sequencing of debridement, length of ICU and hospital stay, blood product utilisation and the need for autografting were recorded. No ethical approval has been sought for this retrospective review. Results We identified 29 patients satisfying the inclusion criteria (Table 1). Between June 2016 and June 2020 the average total burn size of patients who had at least some of their burn treated by enzymatic debridement increased from 21.4% in 2016/17 to 34.7% in 2019/20. In these patients the actual area treated by enzymatic debridement also increased from 11.9% TBSA to 20.3% TBSA. 19 patients (66%) had enzymatic debridement performed within 24 h of injury, a further 2 patients (7%) within 48 h after injury. Patients were more likely to have enzymatic debridement commenced in the first 24 h after injury if they had circumferential limb injury (39% vs 9%) or were planned for enzyme only debridement (78% vs 28%). Those who were planned for combination enzyme and surgical debridement were more likely to have enzymatic debridement commenced after the first 48 h (75%). We have performed enzymatic debridement overnight on one occasion, for a patient who presented with circumferential limb injury and was determined to undergo urgent debridement. Conclusion Much of the literature has described the use of enzymatic debridement in smaller burns, and specialist areas. However, it is our opinion that the advantages of enzymatic debridement appear to be greater in larger burns with a facility for whole burn excision on the day of admission in the ICU cubicle. We have demonstrated significantly reduced blood loss, improved dermal preservation, reduced need for autografting, and a reduction in the number of trips to theatre. We would advocate that both the team and the patient need to be as prepared as they would be for a traditional surgical excision. The early part of our learning curve for enzymatic debridement in resuscitation level injuries was steep, and we were able to build on experience from managing smaller injuries. We recommend any team wishing to using enzymatic debridement gain experience in the same way and develop robust local pathways prior to attempting use in larger burn injuries.

Hepatitis and TB co-infection in PLWHA is now a major source of co-morbidity and of public health concern. HIV and Hepatitis are two viruses with overlapping epidemics and shared routes of transmission. The clinical course of HCV is accelerated in patients with HIV with resultant end-stage Liver disease as a major cause of death. Most studies in my environment failed to identify significant risk factors for HCV infection thus making intervention difficult. The study was a descriptive cross-sectional study carried out among consecutive consenting HIV positive pregnant women attending the antenatal clinic of ABUTH-Zaria Nigeria. Relevant information was obtained using a structurally administered questionnaire while Enzyme Linked Immunosorbent assay Biotech Laboratories UK was used for anti Hepatitis C antibodies assay. Twenty four of the 285 samples tested positive for anti HCV antibodies giving a co-infection rate of 8.4%. Lack of formal education was associated with HCV-HIV co-infection (p 0.05). This study revealed a high HCV co-infection with significant association with non-formal educational status. Improving female education may be one important strategy for its prevention.

Background In 2015, Nigeria’s estimated 317,700 stillbirths accounted for 12.2% of the 2.6 million estimated global stillbirths. This suggests that Nigeria still makes substantial contribution to the global burden of stillbirths. This study was conducted to determine the prevalence and identify the causes and factors associated with stillbirth in eight referral hospitals in Nigeria. Methods This was a cross-sectional study of all deliveries over a period of 6 months in six general hospitals (4 in the south and 2 in the north), and two teaching hospitals (both in the north) in Nigeria. The study population was women delivering in the hospitals during the study period. A pre-tested study protocol was used to obtain clinical data on pregnancies, live births and stillbirths in the hospitals over a 6 months period. Data were analyzed centrally using univariate, bivariate and multivariate logistic regression analyses. The main outcome measure was stillbirth rate in the hospitals (individually and overall). Results There were 4416 single births and 175 stillbirths, and a mean stillbirth rate of 39.6 per 1000 births (range: 12.7 to 67.3/1000 births) in the hospitals. Antepartum (macerated) constituted 22.3% of the stillbirths; 47.4% were intrapartum (fresh stillbirths); while 30.3% was unclassified. Acute hypoxia accounted for 32.6% of the stillbirths. Other causes were maternal hypertensive disease (6.9%), and intrapartum unexplained (5.7%) among others. After adjusting for confounding variables, significant predictors of stillbirth were referral status, parity, past experience of stillbirth, birth weight, gestational age at delivery and mode of delivery. Conclusion We conclude that the rate of stillbirth is high in Nigeria’s referral hospitals largely because of patients’ related factors and the high rates of pregnancy complications. Efforts to address these factors through improved patients’ education and emergency obstetric care would reduce the rate of stillbirth in the country. Trial registration Trial Registration Number NCTR91540209. Nigeria Clinical Trials Registry. http://www.nctr.nhrec.net/ Registered April 14th 2016.

Pregnancy and lactation are usual but stressful physiological conditions accompanied by changes in calcium and phosphate metabolism and their regulatory hormones which may lead to calcium-related disorders in pregnant women. This study aimed to evaluate the changes in serum levels of calcium, phosphate, vitamin D and their regulatory hormones in pregnant and lactating women in Zaria, Nigeria. A cross‑sectional descriptive study was conducted at Ahmadu Bello University Teaching Hospital, Zaria for three (3) months. Blood samples were collected, anthropometric measurements (weight, height and body mass index) of 179 women were taken. Serum calcium, phosphate, vitamin D, parathyroid hormone and calcitonin were determined using standard methods. Data were presented as mean ± SD, analysis was performed using one-way ANOVA and Pearson’s correlation analysis. Values were considered significant at p ≤ 0.05. There was a significant decrease in serum calcium concentration (p < 0.01) during the third trimester of pregnancy and lactation. An increase in serum concentration of vitamin D, parathyroid hormone, and calcitonin in the 2nd trimester and a decrease during the third trimester and lactation although not statistically significant when compared with the control. There was a negative correlation between serum calcium concentration and gestational age (r = 0.255) while no correlation between gestational age and serum phosphate concentration. Changes in serum calcium, vitamin D, parathyroid hormone and calcitonin during pregnancy and lactation has been demonstrated suggesting a relationship between calcium metabolism and these hormones at some stages of pregnancy

Evasion of apoptosis is associated with treatment resistance and metastasis in colorectal cancer (CRC). Various cellular processes are associated with evasion of apoptosis. These include overexpression of pro-apoptotic proteins (including p53 and PD-L1), anti-apoptotic proteins (BIRC7/Livin and Bcl-2), chemokine receptors (including DARC), and dysregulation of DNA mismatch repair proteins (including MSH2 and PMS2). The aim of this study was to determine the effect of folinic acid, 5-FU and oxaliplatin (FOLFOX) as a single agent and aspirin plus FOLFOX in various combinations on the aforementioned proteins in human CRC, SW480 cell line and rat models of N-Methyl-N-Nitrosourea (NMU)-induced CRC. In addition, effects of the NMU-induced CRC and chemotherapeutic regimens on haematological and biochemical parameters in the rat models were studied. Immunohistochemistry, immunofluorescence and immunoblot techniques were used to study the expression pattern of the related proteins in the human CRC cells pre- and post-treatment. Double contrast barium enema, post-mortem examination and histological analyses were used to confirm tumour growth and the effect of the treatmentin vivoin rat models. Notably, we found in human mucinous CRC, a significant increase in expression of the BIRC7/Livin post-FOLFOX treatment compared with pre-treatment (p= 0.0001). This increase provides new insights into the prognostic role of BIRC7/Livin in evasion of apoptosis and facilitation of treatment resistance, local recurrence and metastasis particularly among mucinous CRCs post-FOLFOX chemotherapy. These poor prognostic features in the CRC may be further compounded by the significant suppression of DARC, PD-L1, PMS2 and overexpression of MSH2 and anti-apoptotic Bcl-2 and p53 proteins observed in our study (p < 0.05). Importantly, we found a significant reduction in expression of BIRC7/Livin and reactivation of DARC and PD-L1 with a surge in Annexin V expression in rat models of CRC cells post-treatment with a sequential dose of aspirin plus FOLFOX compared with other treatmentsin vivo(p

Background The paucity of human resources for health buoyed by excessive workloads has been identified as being responsible for poor quality obstetric care, which leads to high maternal mortality in Nigeria. While there is anecdotal and qualitative research to support this observation, limited quantitative studies have been conducted to test the association between the number and density of human resources and risk of maternal mortality. This study aims to investigate the association between client-provider ratios for antenatal and delivery care and the risk of maternal mortality in 8 referral hospitals in Nigeria. Methods Client-provider ratios were calculated for antenatal and delivery care attendees during a 3-year period (2011–2013). The maternal mortality ratio (MMR) was calculated per 100,000 live births for the hospitals, while unadjusted Poisson regression analysis was used to examine the association between the number of maternal deaths and density of healthcare providers. Results A total of 334,425 antenatal care attendees and 26,479 births were recorded during this period. The client-provider ratio in the maternity department for antenatal care attendees was 1343:1 for doctors and 222:1 for midwives. The ratio of births to one doctor in the maternity department was 106:1 and 18:1 for midwives. On average, there were 441 births per specialist obstetrician. The results of the regression analysis showed a significant negative association between the number of maternal deaths and client-provider ratios in all categories. Conclusion We conclude that the maternal mortality ratios in Nigeria’s referral hospitals are worsened by high client-provider ratios, with few providers attending a large number of pregnant women. Efforts to improve the density and quality of maternal healthcare providers, especially at the first referral level, would be a critical intervention for reducing the currently high rate of maternal mortality in Nigeria. Trial registration Trial Registration Number: NCTR91540209. Nigeria Clinical Trials Registry. Registered 14 April 2016.

Background: Hyperprolactinemia is an extremely common disorder, especially among reproductive age women, affecting about one-third of infertile females. There is a paucity of data on the pattern of clinical presentation of hyperprolactinemia among infertile female patients in Nigeria. This study, therefore, aimed to determine the pattern of clinical presentation of hyperprolactinemic infertile female patients in Ahmadu Bello University Teaching Hospital (ABUTH), Zaria, Northern Nigeria. Materials and Methods: Blood sample of 120 infertile female patients aged 15–45 years attending the infertility clinic at ABUTH over 9 months was taken. Data on clinical signs and symptoms were collected using interview-administered questionnaire. Serum prolactin was assayed by microwell enzyme-linked immunosorbent assay technique based on the noncompetitive sandwich principle. Data obtained were analyzed using SPSS version 20 (Syntron Bioresearch. Inc. California, United States of America (USA)). Results: The mean serum level of prolactin concentration at presentation was 31 ng/ml (range, 2.5–109 ng/ml). Sixty-two patients (51.7%) had hyperprolactinemia and 58 (48.3%) had normal prolactin level. The majority of those with hyperprolactinemia 58.6% were in the 25–34 years' age group. Of those with hyperprolactinemia, majority (27.4%) presented with galactorrhea and others presented with symptoms such as menstrual abnormalities, recurrent abortion, hirsutism, and mixed presentations. However, 25.8% of them were symptomless. Conclusion: Galactorrhea was the most common mode of presentation among infertile hyperprolactinemic females in ABUTH, and a larger proportion were symptomless.

Background : Brucellosis in animals has been identified as a common cause of miscarriage. It is the most common zoonotic disease that leads to considerable morbidity in humans. It is rarely diagnosed in hospitals in Nigeria, and debate exists as to whether it is a more common cause of miscarriage in humans compared to other infective agents, especially with the finding of antibrucella activity in human amniotic fluid. Brucellosis in humans is a treatable disease and risk factors for transmission are prevalent in Zaria. Objective : The objective of this study was to determine the seroprevalence of brucellosis among women with miscarriage. Materials and Methods : This was a descriptive cross‑sectional study involving 121 women aged between 15 and 49 years with miscarriage who presented to Ahmadu Bello University Teaching Hospital (ABUTH), Zaria from August 2014 to May 2015. Information on socio‑demographic characteristics, reproductive profile, and risk factors for contracting Brucella infection were obtained using a questionnaire. Blood samples were obtained and analysed for Brucella IgG and IgM using indirect enzyme‑linked immunosorbent assay kits. The data was analysed with SPSS, version 20.0. Results : The mean age of the participating women was 29.07 years [standard deviation (SD) ±6.74]. The seroprevalence of brucellosis was 19.0%; 17.4% of the women had a recent infection, and 1.7% had a chronic infection. Age, history of previous miscarriage, consumption of milk products and consumption of roasted meat/barbecue had positive relationships with recent Brucella infection (χ 2 = 9.706, P = 0.046; χ 2 = 7.300, P = 0.026; χ 2 = 3.169, P = 0.049; χ 2 = 3.012, P = 0.050, respectively). Chronic Brucella infection had a positive relationship with number of pregnancies (χ 2 = 8.036, P = 0.018). Regression analyses showed that age, history of previous miscarriage and history of recent miscarriage in animals reared were positively correlated with Brucella seropositivity and miscarriage (χ 2 = 13.200, P = 0.022; χ 2 = 9.795, P = 0.007; χ 2 = 7.890, P = 0.005, respectively). Conclusion : There is a high prevalence of brucellosis among women with miscarriage in Zaria. The burden of the disease should be appreciated and routinely tested to prevent reoccurrence. Key words : Brucellosis ; miscarriage; prevalence.

While open innovation ecosystems allow a firm to harness external sources of value creation, these external ties can also constrain its ability to adapt its innovation strategy to pursue new opportunities. This article looks at how an incumbent firm approached such constraints, and used cognitive artifacts to transform its value chain into a collaborative ecosystem. It examines the case of a 3D printing-enabled shift to mass customization of orthopedic medical implants. The results demonstrate how firms can use artifacts to build a shared understanding across heterogeneous stakeholders as they explore and develop new open innovation models, and how this process can be managed flexibly to avoid adopting a locally (rather than globally) optimal strategy.

Context: Consequent upon changes in social norms over the years, there has been an increase in the age of marriage and childbirth in women. The older parturient poses a great challenge to the managing obstetrician and a greater challenge to attaining safe motherhood. Aim: To determine the obstetric performance and complications developed during pregnancy and delivery of women with advanced maternal age. Settings and Design: This was a retrospective (case–control) study. Setting: This study was conducted in an ANC and labour ward of ABUTH, Zaria, Nigeria. Materials and Methods: The antenatal and delivery records of women with advanced maternal age (≥35 years) and those within 20–25 years of age from 2002 to 2006 were reviewed. Records of 294 women with advanced maternal age, and 322 of those aged 20–25 years were used. Results: A total of 57% of women with advanced maternal age developed complications compared with 24% in those aged 20–25 years. A total of 13% had chronic hypertension, while 26.2% had pregnancy-induced hypertension. Labour was augmented in 12.2% of those who had spontaneous vertex delivery and 6.2% had EMLSC/S. Low birth weight babies occurred in 11.6% necessitating admission into the SCBU and 5.4% had stillborn. Conclusion: This shows the considerable risk in pregnancies of women with advanced maternal age. It is recommended that to minimise complications; preconception care, antenatal care and skilled attendant at delivery are paramount.

The African continent is facing enormous challenges from cancer crisis, and the lack of reliable population database on cancer incidence and mortality hinders high quality decision on prevention and management modalities. The objective of this study is to analyze the trend of malignant tumors in a population of rural Africans attending Ahmadu Bello University Teaching (ABUTH) Hospital Zaria, Nigeria with particular emphasis on the first eighteen (18) frequently diagnosed cancers over a period of 46 consecutive years (1972 - 2019) excluding the year 1988. Histologically diagnosed cancers from the population-based cancer registry of the ABUTH Zaria were included in this study. There were 19, 884 histologically diagnosed cancers over 46 years in ABUTH Zaria with the following in descending order: Cervical cancer 2,335 (12%, [squamous cell carcinoma = 1, 809; others = 529]), Breast cancer 1,982 (10% [invasive ductal carcinoma = 1,589; others = 393]), Lymphoma 1,927 (10% [non–Hodgkin’s lymphoma = 1,335; Hodgkin’s lymphoma = 492]), Sarcomas 1,177 (6% [Kaposi sarcoma = 296; Rhabdomyosarcoma = 172; Osteosarcoma = 166; Dermatofibrosarcoma = 102; Fibrosarcoma = 83; others = 358]), Prostate cancer 1,073 (5%), Colorectal cancer 816 (4% [other adenocarcinomas = 666, mucinous adenocarcinoma = 93; signet ring cell adenocarcinoma =14, others = 43]), Non- melanoma skin cancer 717 (4%), Eye/ Orbit cancer 537 (3% [retinoblastoma = 302; squamous cell eye cancer = 153; others = 82]), Bladder cancer 515 (3%), Liver cancer 481 (2% [primary liver cell carcinoma = 399; others = 79]), Salivary gland cancer 398 (2%), Melanoma 394 (2%), Ovarian cancer 278 (1%), Nasopharyngeal cancer 235 (1%), Kidney cancer 201 (1% [nephroblastoma = 113; renal cell carcinoma = 77; others = 11]), Esophageal cancer 145 (1%), Thyroid cancer 122 (1%), Pancreatic cancer 60 (0.29%) and Others 7,053 (33%). This total, exclude referred cancer cases to oncology department of ABUTH from other hospitals across the country which makes up 60% of cancer cases treated in institution and a handful of clinically diagnosed cases. The results show unusual change in trend with: 2 fold increase for cervical cancer, 6 fold increase for Breast cancer, 8 fold increase for Prostate cancer, 3 fold increase for colorectal cancer; 6 fold increase for Pancreatic cancer, 13 fold increase for Nasopharyngeal cancer and 16 fold increase for Oesophageal cancer when comparing incidence of cancer from 2011-2019 with 1972-1980. However, the results show 12 fold decrease for Liver cancer and 3 fold decrease each for Lymphoma and Non-melanoma skin cancer when comparing cancer cases from 2011-2019 with 1972 - 1980. Understanding the phenomenon behind the rapid change in trend of different cancer types in sub Saharan Africa may contribute to addressing cancer challenges and better policy decision on cancer in the continent. Citation Format: Faruk Mohammed, Abdulmumini Hassan Rafindadi, Sani Ibrahim, Yawale Iliyasu, Sirajo Mohammed Aminu, Ahmed Adamu, Adamu Abdullahi, Aishatu Maude Suleiman, Abdullahi Mohammed, John Idoko, Abdulkadir Lawal Rafindadi, Danladi Amodu Ameh, Bello Kumo, Ahmad Bello, Abdullahi Jubril Randawa, Usman Mohammed Aminu, Muhammad Manko, Tajudeen Olasinde, Mohammed Dauda Maigatari, Ahmed Mai, LMD Yusuf, Abdullahi Alfa Mohammed, Yahaya Ukwenya, Oguntayo Olanrewaju Adekunle, Maitama Yusuf Hussaini. Emerging demographic changes of first eighteen (18) most common cancers among West Africans in Zaria Nigeria (1972 – 2019) [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-156.

Ovarian cysts in pregnancy are usually managed conservatively but surgical treatment is done for complicated cases. The diagnosis of complicated ovarian cyst in pregnancy is challenging, management often poses a dilemma to the obstetrician and is a source of anxiety to the patient because it can be associated with adverse pregnancy outcome. Complicated ovarian cysts in pregnancy accounted for 16.7% of all surgically managed ovarian cyst accidents (3/18) in our institution. It was also the most common indication for non-pregnancy-related laparotomy in pregnancy (3/6). The mean age of the patients was 31 ± 5.6 years, 66.7% (2/3) were primigravidae and all had cyst complication in the second trimester. All women presented with abdominal pain but accurate initial preoperative diagnosis was made in only 33.3%. Mean presentation to surgery interval was 46.7 h. All patients received tocolytic argents. The mean size of the cyst was 10.9 cm, commonest complication was torsion, and all cysts were benign. The commonest surgery performed was salpingo-oophorectomy. Surgical intervention was associated with favorable perinatal outcome in most cases with fetal loss seen when cyst was rapidly increasing in size or ≥15 cm in size. Prompt diagnosis and intervention enables preservation of affected adnexa.

Lorretta F Ntoimo,1,2 Friday E Okonofua,1,3,4 Rosemary N Ogu,1,3,5 Hadiza S Galadanci,6 Mohammed Gana,7 Ola N Okike,8 Kingsley N Agholor,9 Rukiyat A Abdus-Salam,10 Adetoye Durodola,11 Eghe Abe,12 Abdullahi J Randawa13 On behalf of the WHARC WHO FMOH MNCH Implementation Research Study Team 1WHO Implementation Research Group, The Women’s Health and Action Research Centre, Benin City, Edo State, 2Department of Demography and Social Statistics, Federal University Oye-Ekiti, Ekiti State, 3Centre of Excellence in Reproductive Health Innovation, University of Benin, Benin City, Edo State, 4Vice Chancellors Office, University of Medical Sciences, Ondo City, Ondo State, 5Department of Obstetrics and Gynaecology, University of Port Harcourt, Port Harcourt, Rivers State, 6Aminu Kano Teaching Hospital, Kano, Kano State, 7General Hospital, Minna, Niger State, 8Karshi General Hospital, Federal Capital Territory, Abuja, 9Central Hospital, Warri, Delta State, 10Adeoyo Maternity Hospital, Ibadan, Oyo State, 11General Hospital, Ijaye, Abeokuta, Ogun State, 12Central Hospital, Benin City, Edo State, 13Department of Obstetrics and Gynaecology, Ahmadu Bello University, Zaria, Kaduna State, Nigeria Introduction: While reports from individual hospitals have helped to provide insights into the causes of maternal mortality in low-income countries, they are often limited for policymaking at national and subnational levels. This multisite study was designed to determine maternal mortality ratios (MMRs) and identify the risk factors for maternal deaths in referral health facilities in Nigeria.Methods: A pretested study protocol was used over a 6-month period (January1–June 30, 2014) to obtain clinical data on pregnancies, births, and maternal deaths in eight referral hospitals across eight states and four geopolitical zones of Nigeria. Data were analyzed centrally using univariate, bivariate, and multivariate statistics.Results: The results show an MMR of 2,085 per 100,000 live births in the hospitals (range: 877–4,210 per 100,000 births). Several covariates were identified as increasing the odds for maternal mortality; however, after adjustment for confounding, five factors remained significant in the logistic regression model. These include delivery in a secondary health facility as opposed to delivery in a tertiary hospital, non-booking for antenatal and delivery care, referral as obstetric emergency from nonhospital sources of care, previous experience by women of early pregnancy complications, and grandmultiparity.Conclusion: MMR remains high in referral health facilities in Nigeria due to institutional and patient-related factors. Efforts to reduce MMR in these health facilities should include the improvement of emergency obstetric care, public health education so that women can seek appropriate and immediate evidence-based pregnancy care, the socioeconomic empowerment of women, and the strengthening of the health care system. Keywords: maternal death, maternal mortality ratio, emergency obstetric care, pregnancy care, tertiary hospital

Available evidence suggests that the low use of antenatal, delivery, and post-natal services by Nigerian women may be due to their perceptions of low quality of care in health facilities. This study investigated the perceptions of women regarding their satisfaction with the maternity services offered in secondary and tertiary hospitals in Nigeria. Five focus group discussions (FGDs) were held with women in eight secondary and tertiary hospitals in four of the six geo-political zones of the country. In all, 40 FGDs were held with women attending antenatal and post-natal clinics in the hospitals. The questions assessed women’s level of satisfaction with the care they received in the hospitals, their views on what needed to be done to improve patients’ satisfaction, and the overall quality of maternity services in the hospitals. The discussions were audio-taped, transcribed, and analyzed by themes using Atlas ti computer software. Few of the participants expressed satisfaction with the quality of care they received during antenatal, intrapartum, and postnatal care. Many had areas of dissatisfaction, or were not satisfied at all with the quality of care. Reasons for dissatisfaction included poor staff attitude, long waiting time, poor attention to women in labour, high cost of services, and sub-standard facilities. These sources of dissatisfaction were given as the reasons why women often preferred traditional rather than modern facility based maternity care. The recommendations they made for improving maternity care were also consistent with their perceptions of the gaps and inadequacies. These included the improvement of hospital facilities, re-organization of services to eliminate delays, the training and re-training of health workers, and feedback/counseling and education of women. A women-friendly approach to delivery of maternal health care based on adequate response to women’s concerns and experiences of health care will be critical to curbing women’s dissatisfaction with modern facility based health care, improving access to maternal health, and reducing maternal morbidity and mortality in Nigeria. Trial Registration Number NCTR No: 91540209. Nigeria Clinical Trials Registry. http://www.nctr.nhrec.net/ . Registered April 14th 2016.

Colorectal cancer (CRC) has disproportionately overburden Africans with advanced stage at diagnosis and higher mortality rate due in part to issues that include grossly inadequate resources for management and poor understanding of the pathobiology of the disease. Accumulating evidences support the effectiveness of Aspirin in prevention and inhibition of CRC occurrence and cellular growth respectively. The utilisation of 5-fluorouracil (5-FU)-based regimens which include folinic acid, 5-FU and oxaliplatin (FOLFOX) combination in CRC management have not completely halt the distant recurrences and poor prognosis of CRC. In this study, we highlighted evidences that prove Aspirin plus FOLFOX to be promising alternative for clinical trial in Black men with CRC. Our study aims in this research were: to identify the expression pattern of BIRC7 in human CRC cells, SW480 cell line and N-methyl-N-nitrosourea (NMU)-induced CRC in rat; to determine the relationship between BIRC7 and BCL2, p53, PDL-1, MSH1, PMS2, DARC and Annexin V expression in CRC. to examine the efficacy of Aspirin plus neoadjuvant FOLFOX on the BIRC7 in CRC cells in-vivo in rat. Results show significant (P = 0.0001) expression of the BIRC7 in the CRC tissues compared to normal sections. When comparing this expression with Data from TCGA data bank, we observed a significant increase in BIRC7 expression in Caucasian than the Black and Indian and The expression pattern of the BIRC7 was significantly higher (P = 0.0001) in CRC not otherwise specified compared to mucinous CRC histology. The SW480 cell line show increased expression of the BIRC7 protein in-vitro. There was significant expression of the BIRC7 in the NMU-induced CRC cells compared the normal colonic lesion. There was increased expression of the BCL-2 and reduced expression of p53 in the human CRC cases and in the NMU-induced CRC cells model. There was increased expression of the Annexin V, absence of the MSH1, PMS2, PDL1 and DARC protiens in the CRC sections. Aspirin plus FOLFOX may serve as an important adjuvant treatment component for colorectal cancer metastasis and local recurrence in Blacks, Caucasian and Asians. There is need to explore the potential of Aspirin plus FOLFOX for clinical trial in colorectal cancer management in Blacks and other population using approach from our findings. Citation Format: Faruk Mohammed, Sani Ibrahim, Sirajo Mohammed Aminu, Ahmed Adamu, Adamu Abdullahi, Abdulmumini Hassan Rafindadi, Yawale Iliyasu, John Idoko, Abdullahi Jubril Randawa, Mohammed Sani Shehu, Atara Ntekim, Abdullahi Mohammed, Aishatu Maude Suleiman, Yahaya Ukwenya, Khalid Zahir Shah, Ahmad Bello, Sani Abubakar, Kasimu Umar Adoke, Cheh Augustin Awasum, Ahmad Mai, Hussaini Yusuf Maitama, Dauda Maigatari. Aspirin plus FOLFOX for colorectal cancer management: A promising alternative for clinical trial in Africans with the disease [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 720.

ObjectiveTo assess the existing knowledge and skills relating to Emergency Obstetrics Care (EMOC) among health providers in eight referral maternity hospitals in Nigeria.Study designA cross-sectional study of skilled health providers (doctors, nurses and midwives) working in the hospitals during the period.SettingSix general hospitals (4 in the south and 2 in the north), and two teaching hospitals (both in the Northern part) of the country.PopulationAll skilled providers offering EMOC services in the hospitals during the study.MethodsA pre-tested self-administered questionnaire was used to obtain information relating to socio-demographic characteristics, the respondents' knowledge and skills in offering specific EMOC services (as compared to standard World Health Organization recommendations), and their confidence in transferring the skills to mid-level providers. Data were analyzed with univariate, bivariate, binary and multinomial logistic regression analyses. Main outcome measures: knowledge and skills in EMOC services by hospital and overall.ResultsA total of 341 health providers (148 doctors and 193 nurses/midwives) participated in the study. Averagely, the providers scored less than 46% in a composite EMOC knowledge score, with doctors scoring considerable higher than the nurses/midwives. Similarly, doctors scored higher than nurses/midwives in the self-reporting of confidence in carrying out specific EMOC functions. Health providers that scored higher in knowledge were significantly more likely to report confidence in performing specific EMOC functions as compared to those with lower scores. The self-reporting of confidence in transferring clinical skills was also higher in those with higher EMOC knowledge scores.ConclusionThe knowledge and reported skills on EMOC by health providers in referral facilities in Nigeria was lower than average. We conclude that the in-service training and re-training of health providers should be included in national policy and programs that address maternal mortality prevention in referral facilities in the country.Trial registrationNigeria Clinical Trials Registry 91540209.