Pattern and management of priapism in a tertiary hospital of North-Western Nigeria

Background: Priapism is a persistent penile erection that continues for more than four hours beyond sexual stimulation and orgasm or unrelated to sexual stimulation1. The objective is to document the pattern and management of priapism in our hospital.Methods: This is a retrospective study of patients managed for Priapism by Urology Unit of our hospital, from January 2009 to December 2015.Results: Thirty patients were managed for managed for priapism within the study period. The mean age at presentation was 23.9 ± 12.2 years with a range of 8- 55 years. Fifteen patients (57.7 %) presented beyond 72 hours of the onset of priapism. All the patients had ischaemic priapism. Half of the patients had sickle cell disease, two (7.7 %) had chronic myeloid leukaemia, five (19.2%) used aphrodisiacs and cause was not established in six (23.1%). The most effective forms of treatments were corporal aspiration and glanulocavernosal shunt. Hydroxyurea was used for the patients with leukaemia. Thirteen (50.0%) of the patients were loss to follow-up after their first visits. Three patients (11.5%) developed erectile dysfunction.Conclusion: Sickle cell disease is the commonest cause of ischaemic priapism in our practice. Late presentation is common and is usually associated with the development of erectile dysfunction.Keywords: priapism, sickle cell disease, aphrodisiacs, erectile dysfunction, treatments of ischaemic priapis

Process intensification of lemon grass oil in a pilot plant

The extraction of essential oil from lemon-grass was carried out using steam distillation in a locally designed and fabricated pilot plant of 100 kg/day capacity. The extraction pattern and economic analysis of the oil extracted were monitored over time. The extraction revealed that 0.414 litres of oil was produced in a day of five batches with a total production cycle per batch of 1.61 hours. The study further revealed that 94.3% of the oil was extracted in 60 minutes. The GCMS result shows the major components in the extracted Lemon grass oil were Oleic acid, Neral and Citral with percentage composition of 25.69%, 19.32% and 15.38% respectively. These percent compositions compare favourably with literature values. The properties of the Lemon grass oil were found to be: specific gravity, 0.8952; iodine value, 120.7g/g; saponification value, 201.3 mgKOH/g and cetane number, 43.7. The economic analysis on a monthly basis revealed a production cost (direct and indirect) of N160,050.00K and the expected net profit of N378,150.00K.Keywords: Essential Oil, Lemon Grass, Extraction, Pilot Plant and Process Intensificatio

Study of the role of dysprosium substitution in tuning structural, optical, electrical, dielectric, ferroelectric, and magnetic properties of bismuth ferrite multiferroic

Magnetoelectric multiferroics, which combine ferroelectric and magnetic characteristics, have potential use in a variety of electronic devices. In this work, Dy3+ substituted bismuth ferrites with the chemical formula Bi1−xDyxFeO3 (x = 0.0, 0.15, 0.30, 0.45, and 0.60) were synthesized using the sol-gel auto combustion process. The effect of Dysprosium substitution in BiFeO3 (BFO), on its structural, surface morphology, optical, electrical, dielectric, ferroelectric, and magnetic properties were studied. The rhombohedral perovskite structure of the space group (R3c) was confirmed via X-ray diffraction (XRD) analysis. Moreover, the crystallite size had a maximum value of 59.57 nm for x = 0.30. XRD and FTIR confirmed the substitution of Dy3+ into BFO ferrite. Further, the structural change and absorption bands confirmed the substitution of Dy3+ ions into the lattice. For x = 0.30, the energy bandgap of 2.81 eV was found. The resistivity and activation energy were minimum and drift mobility was maximum at x = 0.30 as compared to Dy3+ doped BFO samples. At low frequency, the dielectric loss was reduced, while at high frequency, the dielectric loss increased with increasing frequency. The saturated polarization (PS), electric polarization (EC), and remnant polarization (Pr) have values of 6.95 µC/cm2, 3.49 µC/cm2, and 1.53 kV/cm for x = 0.30, respectively. The maximum saturation magnetization and microwave frequencies were 10.89 emu/g and 2.41 GHz, respectively at Dy3+ concentration x = 0.30. These materials are suitable for electronic and microwave devices

Electrochemical comparison of SAN/PANI/FLG and ZnO/GO coated cast iron subject to corrosive environments

ZnO/GO (Graphene Oxide) and SAN (Styrene Acrylonitrile)/PANI (polyaniline)/FLG (Few Layers Graphene) nanocomposite coatings were produced by solution casting and sol-gel methods, respectively, to enhance corrosion resistance of ferrous based materials. Corrosive seawater and ‘produced crude oil water’ environments were selected as electrolytes for this study. Impedance and coating capacitance values obtained from Electrochemical Impedance Spectroscopy (EIS) (AC technique) showed enhanced corrosion resistance of nanocomposites coatings in the corrosive environments. Tafel scan (DC technique) was used to find the corrosion rate of nanocomposite coating. SAN/PANI/FLG coating reduced the corrosion of bare metal up to 90% in seawater whereas ZnO/GO suppressed the corrosion up to 75% having the impedance value of 100 ohms. In produced water of crude oil, SAN/PANI FLG reduced the corrosion up to 95% while ZnO/GO suppressed the corrosion up to 10%. Hybrid composites of SAN/PANI/FLG coatings have demonstrated better performances compared to ZnO/GO in the corrosive environments under investigation. This study provides fabrication of state-of-the-art novel anti corrosive nanocomposite coatings for a wide range of industrial applications. Reduced corrosion will result in increased service lifetime, durability and reliability of components and system and will in turn lead to significant cost savings

The burden of unintentional drowning: Global, regional and national estimates of mortality from the Global Burden of Disease 2017 Study

__Background:__ Drowning is a leading cause of injury-related mortality globally. Unintentional drowning (International Classification of Diseases (ICD) 10 codes W65-74 and ICD9 E910) is one of the 30 mutually exclusive and collectively exhaustive causes of injury-related mortality in the Global Burden of Disease (GBD) study. This study's objective is to describe unintentional drowning using GBD estimates from 1990 to 2017. __Methods:__ Unintentional drowning from GBD 2017 was estimated for cause-specific mortality and years of life lost (YLLs), age, sex, country, region, Socio-demographic Index (SDI) quintile, and trends from 1990 to 2017. GBD 2017 used standard GBD methods for estimating mortality from drowning. __Results:__ Globally, unintentional drowning mortality decreased by 44.5% between 1990 and 2017, from 531 956 (uncertainty interval (UI): 484 107 to 572 854) to 295 210 (284 493 to 306 187) deaths. Global age-standardised mortality rates decreased 57.4%, from 9.3 (8.5 to 10.0) in 1990 to 4.0 (3.8 to 4.1) per 100 000 per annum in 2017. Unintentional drowning-associated mortality was generally higher in children, males and in low-SDI to middle-SDI countries. China, India, Pakistan and Bangladesh accounted for 51.2% of all drowning deaths in 2017. Oceania was the region with the highest rate of age-standardised YLLs in 2017, with 45 434 (40 850 to 50 539) YLLs per 100 000 across both sexes. __Conclusions:__ There has been a decline in global drowning rates. This study shows that the decline was not consistent across countries. The results reinforce the need for continued and improved policy, prevention and research efforts, with a focus on low-and middle-income countries

EPIdemiology of Surgery-Associated Acute Kidney Injury (EPIS-AKI) : Study protocol for a multicentre, observational trial

More than 300 million surgical procedures are performed each year. Acute kidney injury (AKI) is a common complication after major surgery and is associated with adverse short-term and long-term outcomes. However, there is a large variation in the incidence of reported AKI rates. The establishment of an accurate epidemiology of surgery-associated AKI is important for healthcare policy, quality initiatives, clinical trials, as well as for improving guidelines. The objective of the Epidemiology of Surgery-associated Acute Kidney Injury (EPIS-AKI) trial is to prospectively evaluate the epidemiology of AKI after major surgery using the latest Kidney Disease: Improving Global Outcomes (KDIGO) consensus definition of AKI. EPIS-AKI is an international prospective, observational, multicentre cohort study including 10 000 patients undergoing major surgery who are subsequently admitted to the ICU or a similar high dependency unit. The primary endpoint is the incidence of AKI within 72 hours after surgery according to the KDIGO criteria. Secondary endpoints include use of renal replacement therapy (RRT), mortality during ICU and hospital stay, length of ICU and hospital stay and major adverse kidney events (combined endpoint consisting of persistent renal dysfunction, RRT and mortality) at day 90. Further, we will evaluate preoperative and intraoperative risk factors affecting the incidence of postoperative AKI. In an add-on analysis, we will assess urinary biomarkers for early detection of AKI. EPIS-AKI has been approved by the leading Ethics Committee of the Medical Council North Rhine-Westphalia, of the Westphalian Wilhelms-University Münster and the corresponding Ethics Committee at each participating site. Results will be disseminated widely and published in peer-reviewed journals, presented at conferences and used to design further AKI-related trials. Trial registration number NCT04165369

Mapping geographical inequalities in childhood diarrhoeal morbidity and mortality in low-income and middle-income countries, 2000–17 : analysis for the Global Burden of Disease Study 2017

Background Across low-income and middle-income countries (LMICs), one in ten deaths in children younger than 5 years is attributable to diarrhoea. The substantial between-country variation in both diarrhoea incidence and mortality is attributable to interventions that protect children, prevent infection, and treat disease. Identifying subnational regions with the highest burden and mapping associated risk factors can aid in reducing preventable childhood diarrhoea. Methods We used Bayesian model-based geostatistics and a geolocated dataset comprising 15 072 746 children younger than 5 years from 466 surveys in 94 LMICs, in combination with findings of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017, to estimate posterior distributions of diarrhoea prevalence, incidence, and mortality from 2000 to 2017. From these data, we estimated the burden of diarrhoea at varying subnational levels (termed units) by spatially aggregating draws, and we investigated the drivers of subnational patterns by creating aggregated risk factor estimates. Findings The greatest declines in diarrhoeal mortality were seen in south and southeast Asia and South America, where 54·0% (95% uncertainty interval [UI] 38·1–65·8), 17·4% (7·7–28·4), and 59·5% (34·2–86·9) of units, respectively, recorded decreases in deaths from diarrhoea greater than 10%. Although children in much of Africa remain at high risk of death due to diarrhoea, regions with the most deaths were outside Africa, with the highest mortality units located in Pakistan. Indonesia showed the greatest within-country geographical inequality; some regions had mortality rates nearly four times the average country rate. Reductions in mortality were correlated to improvements in water, sanitation, and hygiene (WASH) or reductions in child growth failure (CGF). Similarly, most high-risk areas had poor WASH, high CGF, or low oral rehydration therapy coverage. Interpretation By co-analysing geospatial trends in diarrhoeal burden and its key risk factors, we could assess candidate drivers of subnational death reduction. Further, by doing a counterfactual analysis of the remaining disease burden using key risk factors, we identified potential intervention strategies for vulnerable populations. In view of the demands for limited resources in LMICs, accurately quantifying the burden of diarrhoea and its drivers is important for precision public health

The global burden of cancer attributable to risk factors, 2010–19: a systematic analysis for the Global Burden of Disease Study 2019

BACKGROUND: Understanding the magnitude of cancer burden attributable to potentially modifiable risk factors is crucial for development of effective prevention and mitigation strategies. We analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 to inform cancer control planning efforts globally. METHODS: The GBD 2019 comparative risk assessment framework was used to estimate cancer burden attributable to behavioural, environmental and occupational, and metabolic risk factors. A total of 82 risk–outcome pairs were included on the basis of the World Cancer Research Fund criteria. Estimated cancer deaths and disability-adjusted life-years (DALYs) in 2019 and change in these measures between 2010 and 2019 are presented. FINDINGS: Globally, in 2019, the risk factors included in this analysis accounted for 4·45 million (95% uncertainty interval 4·01–4·94) deaths and 105 million (95·0–116) DALYs for both sexes combined, representing 44·4% (41·3–48·4) of all cancer deaths and 42·0% (39·1–45·6) of all DALYs. There were 2·88 million (2·60–3·18) risk-attributable cancer deaths in males (50·6% [47·8–54·1] of all male cancer deaths) and 1·58 million (1·36–1·84) risk-attributable cancer deaths in females (36·3% [32·5–41·3] of all female cancer deaths). The leading risk factors at the most detailed level globally for risk-attributable cancer deaths and DALYs in 2019 for both sexes combined were smoking, followed by alcohol use and high BMI. Risk-attributable cancer burden varied by world region and Socio-demographic Index (SDI), with smoking, unsafe sex, and alcohol use being the three leading risk factors for risk-attributable cancer DALYs in low SDI locations in 2019, whereas DALYs in high SDI locations mirrored the top three global risk factor rankings. From 2010 to 2019, global risk-attributable cancer deaths increased by 20·4% (12·6–28·4) and DALYs by 16·8% (8·8–25·0), with the greatest percentage increase in metabolic risks (34·7% [27·9–42·8] and 33·3% [25·8–42·0]). INTERPRETATION: The leading risk factors contributing to global cancer burden in 2019 were behavioural, whereas metabolic risk factors saw the largest increases between 2010 and 2019. Reducing exposure to these modifiable risk factors would decrease cancer mortality and DALY rates worldwide, and policies should be tailored appropriately to local cancer risk factor burden

Global, regional, and national age-sex-specific mortality and life expectancy, 1950–2017: a systematic analysis for the Global Burden of Disease Study 2017

BACKGROUND: Assessments of age-specific mortality and life expectancy have been done by the UN Population Division, Department of Economics and Social Affairs (UNPOP), the United States Census Bureau, WHO, and as part of previous iterations of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD). Previous iterations of the GBD used population estimates from UNPOP, which were not derived in a way that was internally consistent with the estimates of the numbers of deaths in the GBD. The present iteration of the GBD, GBD 2017, improves on previous assessments and provides timely estimates of the mortality experience of populations globally. METHODS: The GBD uses all available data to produce estimates of mortality rates between 1950 and 2017 for 23 age groups, both sexes, and 918 locations, including 195 countries and territories and subnational locations for 16 countries. Data used include vital registration systems, sample registration systems, household surveys (complete birth histories, summary birth histories, sibling histories), censuses (summary birth histories, household deaths), and Demographic Surveillance Sites. In total, this analysis used 8259 data sources. Estimates of the probability of death between birth and the age of 5 years and between ages 15 and 60 years are generated and then input into a model life table system to produce complete life tables for all locations and years. Fatal discontinuities and mortality due to HIV/AIDS are analysed separately and then incorporated into the estimation. We analyse the relationship between age-specific mortality and development status using the Socio-demographic Index, a composite measure based on fertility under the age of 25 years, education, and income. There are four main methodological improvements in GBD 2017 compared with GBD 2016: 622 additional data sources have been incorporated; new estimates of population, generated by the GBD study, are used; statistical methods used in different components of the analysis have been further standardised and improved; and the analysis has been extended backwards in time by two decades to start in 1950. FINDINGS: Globally, 18·7% (95% uncertainty interval 18·4–19·0) of deaths were registered in 1950 and that proportion has been steadily increasing since, with 58·8% (58·2–59·3) of all deaths being registered in 2015. At the global level, between 1950 and 2017, life expectancy increased from 48·1 years (46·5–49·6) to 70·5 years (70·1–70·8) for men and from 52·9 years (51·7–54·0) to 75·6 years (75·3–75·9) for women. Despite this overall progress, there remains substantial variation in life expectancy at birth in 2017, which ranges from 49·1 years (46·5–51·7) for men in the Central African Republic to 87·6 years (86·9–88·1) among women in Singapore. The greatest progress across age groups was for children younger than 5 years; under-5 mortality dropped from 216·0 deaths (196·3–238·1) per 1000 livebirths in 1950 to 38·9 deaths (35·6–42·83) per 1000 livebirths in 2017, with huge reductions across countries. Nevertheless, there were still 5·4 million (5·2–5·6) deaths among children younger than 5 years in the world in 2017. Progress has been less pronounced and more variable for adults, especially for adult males, who had stagnant or increasing mortality rates in several countries. The gap between male and female life expectancy between 1950 and 2017, while relatively stable at the global level, shows distinctive patterns across super-regions and has consistently been the largest in central Europe, eastern Europe, and central Asia, and smallest in south Asia. Performance was also variable across countries and time in observed mortality rates compared with those expected on the basis of development. INTERPRETATION: This analysis of age-sex-specific mortality shows that there are remarkably complex patterns in population mortality across countries. The findings of this study highlight global successes, such as the large decline in under-5 mortality, which reflects significant local, national, and global commitment and investment over several decades. However, they also bring attention to mortality patterns that are a cause for concern, particularly among adult men and, to a lesser extent, women, whose mortality rates have stagnated in many countries over the time period of this study, and in some cases are increasing

Mapping local patterns of childhood overweight and wasting in low- and middle-income countries between 2000 and 2017

A double burden of malnutrition occurs when individuals, household members or communities experience both undernutrition and overweight. Here, we show geospatial estimates of overweight and wasting prevalence among children under 5 years of age in 105 low- and middle-income countries (LMICs) from 2000 to 2017 and aggregate these to policy-relevant administrative units. Wasting decreased overall across LMICs between 2000 and 2017, from 8.4 (62.3 (55.1�70.8) million) to 6.4 (58.3 (47.6�70.7) million), but is predicted to remain above the World Health Organization�s Global Nutrition Target of <5 in over half of LMICs by 2025. Prevalence of overweight increased from 5.2 (30 (22.8�38.5) million) in 2000 to 6.0 (55.5 (44.8�67.9) million) children aged under 5 years in 2017. Areas most affected by double burden of malnutrition were located in Indonesia, Thailand, southeastern China, Botswana, Cameroon and central Nigeria. Our estimates provide a new perspective to researchers, policy makers and public health agencies in their efforts to address this global childhood syndemic. © 2020, The Author(s)