Barriers and facilitators to human immunodeficiency virus sero-status disclosure in a tertiary health facility in Kano, Nigeria

Disclosure of Human Immunodeficiency Virus (HIV) sero-status to sexual partners, family and friends is essential in preventing HIV transmission. An array of benefits has been associated with disclosure; such as early referral to care and treatment, reduced stigma and increased social support. Objectives: We determined the prevalence, barriers and facilitators to HIV sero-status disclosure among clients attending the Antiretroviral (ARV) clinic in AminuKano-Teaching Hospital, Kano. Method: A descriptive cross-sectional study was conducted among 231 HIV positive patients attending ARV clinic at AKTH using a systematic sampling technique. Interviewer-administered semi-structured questionnaire was used to obtain respondent's socio-demographic characteristics, disclosure status, barriers and facilitators of HIV sero-status disclosure. We conducted univariate, bivariate and multivariate analysis using SPSS version 22, and a p- value ≤0.05 was considered as the level of significance. Results: The mean age of the respondents was 35 ± 8.64 years with a male to female sex distribution of 53% to 47 % respectively. Majority were not married (74.0%) and two thirds (67%) were Muslims. This study found that 60% of the respondents had disclosed their HIV sero-status and 97% of them had done so voluntarily. The fear of divorce/neglect (p<0.01, aOR=0.017, 95% CI=0.02-0.15) and fear of stigma (p<0.01, aOR=0.03, 95% CI= 0.00-0.03) were found as barriers to HIV sero-status disclosure. Financial difficulties (p<0.01, aOR=3.03, 95% CI=1.16-5.61) and the need for improved access to necessary medical care (p=0.04, aOR=6.52, 95% CI=1.85-23.15) were found to facilitate HIV sero status disclosure. Conclusion: The study found a low HIV sero-status disclosure in Kano. Disclosure being major recommendation by World Health Organisation and the Centres for Disease Control and Prevention requires strengthening during patients counselling and education sessions

Effects of menotrophin and chorulon on superovulation in Red Sokoto does

The aim of this study was to compare the efficiency of menotrophin, chorulon and their combinations in superovulation in Red Sokoto does. Fifteen healthy does weighed  between 14 and 25 kg were divided into 3 groups of 5 (n=5) each. All does in the 3 groups were synchronized with CIDR for 14 days. Superovulation was performed as follows: Group 1 were treated with 37.5 IU menotrophin for three days, group 2 were treated with 500IU chorulon for 1 day and group 3 were treated with 18.75 iμ  menotrophin for 3 days and 250IU chorulon for one day. The mean SEM superovulatory response in group 1, 2 and 3 was (2.6 0.92, 3.2 0.58 and 9.4 0.68) respectively. The superovulatory response showed no significant differences between group 1 and 2  however, there were statistically significance differences (p<0.01) between groups 1 and 3 and between 2 and 3. These result showed that the combination of Menotrophin and Chorulon effectively produces multiple ovulations as a result the use this  combination is advocated.Keywords: Chorulon, CIDR, Doe, Menotrophin, Sokoto, Superovulatio

Functional Outcome after Treatment of Aggressive Tumours in the Distal Radius: Comparison between Reconstruction using Proximal Fibular Graft and Wrist Fusion

Introduction: Restoration of a functional hand is the ultimate goal following a distal radius tumour resection. The early outcomes of mobile wrist reconstruction are satisfactory; however, long-term results are unpredictable due to late wrist instability and degenerative arthritis. Our aim is to compare mobile wrist reconstruction with wrist fusion (pan-carpal fusion) in our cohort of patients. Materials and Methods: A retrospective cohort study was performed for functional outcomes of all patients who underwent resection for distal radius tumour and treated with either fusion or reconstruction of the wrist in a single institution from years 2000-2013 with a minimum of three years follow-up. Results: Eleven patients were included in the study, six of whom had wrist reconstruction with proximal fibula graft and the remaining five wrist fusion, with a mean follow-up of 6.3 years. The mean Musculoskeletal Tumour Society (MSTS) score was 82.78%, ranging from 70% to 93.3%. Average grip strength compared to the normal contralateral hand was 60.0% for total wrist fusion, which was better than wrist reconstruction with 58.07%. There was no difference in the functional outcome between fusion and mobile reconstruction in our study. Osteoarthritis changes and subluxation of the wrist joint were the most common findings in the long-term follow-up for this group. Conclusion: There was no difference in the functional outcome of the long-term follow-up between the two groups

Metagenomic analysis of viruses associated with maize lethal necrosis in Kenya

Background: Maize lethal necrosis is caused by a synergistic co-infection of Maize chlorotic mottle virus (MCMV) and a specific member of the Potyviridae, such as Sugarcane mosaic virus (SCMV), Wheat streak mosaic virus (WSMV) or Johnson grass mosaic virus (JGMV). Typical maize lethal necrosis symptoms include severe yellowing and leaf drying from the edges. In Kenya, we detected plants showing typical and atypical symptoms. Both groups of plants often tested negative for SCMV by ELISA. Methods: We used next-generation sequencing to identify viruses associated to maize lethal necrosis in Kenya through a metagenomics analysis. Symptomatic and asymptomatic leaf samples were collected from maize and sorghum representing sixteen counties. Results: Complete and partial genomes were assembled for MCMV, SCMV, Maize streak virus (MSV) and Maize yellow dwarf virus-RMV (MYDV-RMV). These four viruses (MCMV, SCMV, MSV and MYDV-RMV) were found together in 30 of 68 samples. A geographic analysis showed that these viruses are widely distributed in Kenya. Phylogenetic analyses of nucleotide sequences showed that MCMV, MYDV-RMV and MSV are similar to isolates from East Africa and other parts of the world. Single nucleotide polymorphism, nucleotide and polyprotein sequence alignments identified three genetically distinct groups of SCMV in Kenya. Variation mapped to sequences at the border of NIb and the coat protein. Partial genome sequences were obtained for other four potyviruses and one polerovirus. Conclusion: Our results uncover the complexity of the maize lethal necrosis epidemic in Kenya. MCMV, SCMV, MSV and MYDV-RMV are widely distributed and infect both maize and sorghum. SCMV population in Kenya is diverse and consists of numerous strains that are genetically different to isolates from other parts of the world. Several potyviruses, and possibly poleroviruses, are also involved

Socio-demographic determinants of Toxoplasma gondii seroprevalence in migrant workers of Peninsular Malaysia

Background The number of migrants working in Malaysia has increased sharply since the 1970’s and there is concern that infectious diseases endemic in other (e.g. neighbouring) countries may be inadvertently imported. Compulsory medical screening prior to entering the workforce does not include parasitic infections such as toxoplasmosis. Therefore, this study aimed to evaluate the seroprevalence of T. gondii infection among migrant workers in Peninsular Malaysia by means of serosurveys conducted on a voluntary basis among low-skilled and semi-skilled workers from five working sectors, namely, manufacturing, food service, agriculture and plantation, construction and domestic work. Methods A total of 484 migrant workers originating from rural locations in neighbouring countries, namely, Indonesia (n = 247, 51.0%), Nepal (n = 99, 20.5%), Bangladesh (n = 72, 14.9%), India (n = 52, 10.7%) and Myanmar (n = 14, 2.9%) were included in this study. Results The overall seroprevalence of T. gondii was 57.4% (n = 278; 95% CI: 52.7–61.8%) with 52.9% (n = 256; 95% CI: 48.4–57.2%) seropositive for anti-Toxoplasma IgG only, 0.8% (n = 4; 95% CI: 0.2–1.7%) seropositive for anti-Toxoplasma IgM only and 3.7% (n = 18; 95% CI: 2.1–5.4%) seropositive with both IgG and IgM antibodies. All positive samples with both IgG and IgM antibodies showed high avidity (> 40%), suggesting latent infection. Age (being older than 45 years), Nepalese nationality, manufacturing occupation, and being a newcomer in Malaysia (excepting domestic work) were positively and statistically significantly associated with seroprevalence (P < 0.05). Conclusions The results of this study suggest that better promotion of knowledge about parasite transmission is required for both migrant workers and permanent residents in Malaysia. Efforts should be made to encourage improved personal hygiene before consumption of food and fluids, thorough cooking of meat and better disposal of feline excreta from domestic pets

Observed controls on resilience of groundwater to climate variability in sub-Saharan Africa

Groundwater in sub-Saharan Africa supports livelihoods and poverty alleviation1,2, maintains vital ecosystems, and strongly influences terrestrial water and energy budgets. Yet the hydrological processes that govern groundwater recharge and sustainability—and their sensitivity to climatic variability—are poorly constrained4. Given the absence of firm observational constraints, it remains to be seen whether model-based projections of decreased water resources in dry parts of the region4 are justified. Here we show, through analysis of multidecadal groundwater hydrographs across sub-Saharan Africa, that levels of aridity dictate the predominant recharge processes, whereas local hydrogeology influences the type and sensitivity of precipitation–recharge relationships. Recharge in some humid locations varies by as little as five per cent (by coefficient of variation) across a wide range of annual precipitation values. Other regions, by contrast, show roughly linear precipitation–recharge relationships, with precipitation thresholds (of roughly ten millimetres or less per day) governing the initiation of recharge. These thresholds tend to rise as aridity increases, and recharge in drylands is more episodic and increasingly dominated by focused recharge through losses from ephemeral overland flows. Extreme annual recharge is commonly associated with intense rainfall and flooding events, themselves often driven by large-scale climate controls. Intense precipitation, even during years of lower overall precipitation, produces some of the largest years of recharge in some dry subtropical locations. Our results therefore challenge the ‘high certainty’ consensus regarding decreasing water resources in such regions of sub-Saharan Africa. The potential resilience of groundwater to climate variability in many areas that is revealed by these precipitation–recharge relationships is essential for informing reliable predictions of climate-change impacts and adaptation strategies

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Prognostic model to predict postoperative acute kidney injury in patients undergoing major gastrointestinal surgery based on a national prospective observational cohort study.

Background: Acute illness, existing co-morbidities and surgical stress response can all contribute to postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. The aim of this study was prospectively to develop a pragmatic prognostic model to stratify patients according to risk of developing AKI after major gastrointestinal surgery. Methods: This prospective multicentre cohort study included consecutive adults undergoing elective or emergency gastrointestinal resection, liver resection or stoma reversal in 2-week blocks over a continuous 3-month period. The primary outcome was the rate of AKI within 7 days of surgery. Bootstrap stability was used to select clinically plausible risk factors into the model. Internal model validation was carried out by bootstrap validation. Results: A total of 4544 patients were included across 173 centres in the UK and Ireland. The overall rate of AKI was 14·2 per cent (646 of 4544) and the 30-day mortality rate was 1·8 per cent (84 of 4544). Stage 1 AKI was significantly associated with 30-day mortality (unadjusted odds ratio 7·61, 95 per cent c.i. 4·49 to 12·90; P < 0·001), with increasing odds of death with each AKI stage. Six variables were selected for inclusion in the prognostic model: age, sex, ASA grade, preoperative estimated glomerular filtration rate, planned open surgery and preoperative use of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. Internal validation demonstrated good model discrimination (c-statistic 0·65). Discussion: Following major gastrointestinal surgery, AKI occurred in one in seven patients. This preoperative prognostic model identified patients at high risk of postoperative AKI. Validation in an independent data set is required to ensure generalizability

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries