Telemedicine as a tool to prevent multi-drug resistant tuberculosis in poor resource settings: Lessons from Nigeria

Background This mini review aims to provide an overview of the role of telemedicine in preventing multi-drug resistant tuberculosis (MDR-TB) in Nigeria. The specific objectives include examining the potential benefits of telemedicine, identifying the challenges associated with its implementation, and highlighting the importance of addressing infrastructure limitations and data privacy concerns. Methods This minireview is based on a comprehensive analysis of existing literature, including scholarly articles, and reports,. A systematic search was conducted using electronic databases, such as PubMed and Google Scholar, to identify relevant publications related to telemedicine and MDR-TB prevention in Nigeria. The selected articles were assessed for their relevance, and key findings were synthesized to provide an overview of the role of telemedicine in addressing the challenges of MDR-TB in Nigeria. Results The review demonstrates that telemedicine has the potential to significantly contribute to MDR-TB prevention efforts in Nigeria. The benefits of telemedicine include improved access to specialized care, enhanced patient adherence to treatment, and potential cost savings. However, challenges such as infrastructure limitations and data privacy concerns need to be addressed for successful implementation. Integrating telemedicine into the healthcare system has the potential to strengthen MDR-TB prevention, particularly in underserved areas, including within Nigeria. Specifically, the integration of telemedicine into the healthcare system can enhance access to specialized care, improve patient adherence, and potentially reduce costs associated with MDR-TB management. Conclusions Addressing infrastructure challenges, ensuring data privacy and security, and fostering trust among healthcare providers and patients are critical for successful implementation of telemedicine. Further research and policy frameworks are needed to guide the effective implementation and scale-up of telemedicine in MDR-TB prevention efforts in Nigeria

Higher dose corticosteroids in patients admitted to hospital with COVID-19 who are hypoxic but not requiring ventilatory support (RECOVERY): a randomised, controlled, open-label, platform trial

BACKGROUND: Low-dose corticosteroids have been shown to reduce mortality for patients with COVID-19 requiring oxygen or ventilatory support (non-invasive mechanical ventilation, invasive mechanical ventilation, or extracorporeal membrane oxygenation). We evaluated the use of a higher dose of corticosteroids in this patient group. METHODS: This randomised, controlled, open-label platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]) is assessing multiple possible treatments in patients hospitalised for COVID-19. Eligible and consenting adult patients with clinical evidence of hypoxia (ie, receiving oxygen or with oxygen saturation <92% on room air) were randomly allocated (1:1) to either usual care with higher dose corticosteroids (dexamethasone 20 mg once daily for 5 days followed by 10 mg dexamethasone once daily for 5 days or until discharge if sooner) or usual standard of care alone (which included dexamethasone 6 mg once daily for 10 days or until discharge if sooner). The primary outcome was 28-day mortality among all randomised participants. On May 11, 2022, the independent data monitoring committee recommended stopping recruitment of patients receiving no oxygen or simple oxygen only due to safety concerns. We report the results for these participants only. Recruitment of patients receiving ventilatory support is ongoing. The RECOVERY trial is registered with ISRCTN (50189673) and ClinicalTrials.gov (NCT04381936). FINDINGS: Between May 25, 2021, and May 13, 2022, 1272 patients with COVID-19 and hypoxia receiving no oxygen (eight [1%]) or simple oxygen only (1264 [99%]) were randomly allocated to receive usual care plus higher dose corticosteroids (659 patients) versus usual care alone (613 patients, of whom 87% received low-dose corticosteroids during the follow-up period). Of those randomly assigned, 745 (59%) were in Asia, 512 (40%) in the UK, and 15 (1%) in Africa. 248 (19%) had diabetes and 769 (60%) were male. Overall, 123 (19%) of 659 patients allocated to higher dose corticosteroids versus 75 (12%) of 613 patients allocated to usual care died within 28 days (rate ratio 1·59 [95% CI 1·20–2·10]; p=0·0012). There was also an excess of pneumonia reported to be due to non-COVID infection (64 cases [10%] vs 37 cases [6%]; absolute difference 3·7% [95% CI 0·7–6·6]) and an increase in hyperglycaemia requiring increased insulin dose (142 [22%] vs 87 [14%]; absolute difference 7·4% [95% CI 3·2–11·5]). INTERPRETATION: In patients hospitalised for COVID-19 with clinical hypoxia who required either no oxygen or simple oxygen only, higher dose corticosteroids significantly increased the risk of death compared with usual care, which included low-dose corticosteroids. The RECOVERY trial continues to assess the effects of higher dose corticosteroids in patients hospitalised with COVID-19 who require non-invasive ventilation, invasive mechanical ventilation, or extracorporeal membrane oxygenation. FUNDING: UK Research and Innovation (Medical Research Council), National Institute of Health and Care Research, and Wellcome Trust

Baricitinib in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial and updated meta-analysis

Background: We aimed to evaluate the use of baricitinib, a Janus kinase (JAK) 1–2 inhibitor, for the treatment of patients admitted to hospital with COVID-19. Methods: This randomised, controlled, open-label, platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]), is assessing multiple possible treatments in patients hospitalised with COVID-19 in the UK. Eligible and consenting patients were randomly allocated (1:1) to either usual standard of care alone (usual care group) or usual care plus baricitinib 4 mg once daily by mouth for 10 days or until discharge if sooner (baricitinib group). The primary outcome was 28-day mortality assessed in the intention-to-treat population. A meta-analysis was done, which included the results from the RECOVERY trial and all previous randomised controlled trials of baricitinib or other JAK inhibitor in patients hospitalised with COVID-19. The RECOVERY trial is registered with ISRCTN (50189673) and ClinicalTrials.gov (NCT04381936) and is ongoing. Findings: Between Feb 2 and Dec 29, 2021, from 10 852 enrolled, 8156 patients were randomly allocated to receive usual care plus baricitinib versus usual care alone. At randomisation, 95% of patients were receiving corticosteroids and 23% were receiving tocilizumab (with planned use within the next 24 h recorded for a further 9%). Overall, 514 (12%) of 4148 patients allocated to baricitinib versus 546 (14%) of 4008 patients allocated to usual care died within 28 days (age-adjusted rate ratio 0·87; 95% CI 0·77–0·99; p=0·028). This 13% proportional reduction in mortality was somewhat smaller than that seen in a meta-analysis of eight previous trials of a JAK inhibitor (involving 3732 patients and 425 deaths), in which allocation to a JAK inhibitor was associated with a 43% proportional reduction in mortality (rate ratio 0·57; 95% CI 0·45–0·72). Including the results from RECOVERY in an updated meta-analysis of all nine completed trials (involving 11 888 randomly assigned patients and 1485 deaths) allocation to baricitinib or another JAK inhibitor was associated with a 20% proportional reduction in mortality (rate ratio 0·80; 95% CI 0·72–0·89; p<0·0001). In RECOVERY, there was no significant excess in death or infection due to non-COVID-19 causes and no significant excess of thrombosis, or other safety outcomes. Interpretation: In patients hospitalised with COVID-19, baricitinib significantly reduced the risk of death but the size of benefit was somewhat smaller than that suggested by previous trials. The total randomised evidence to date suggests that JAK inhibitors (chiefly baricitinib) reduce mortality in patients hospitalised for COVID-19 by about one-fifth. Funding: UK Research and Innovation (Medical Research Council) and National Institute of Health Research

Sensing, measuring and modelling the mechanical properties of sandstone

We present a hybrid framework for simulating the strength and dilation characteristics of sandstone. Where possible, the grain-scale properties of sandstone are evaluated experimentally in detail. Also, using photo-stress analysis, we sense the deviator stress (/strain) distribution at the microscale and its components along the orthogonal directions on the surface of a V-notch sandstone sample under mechanical loading. Based on this measurement and applying a grain-scale model, the optical anisotropy index K0 is inferred at the grain scale. This correlated well with the grain contact stiffness ratio K evaluated using ultrasound sensors independently. Thereafter, in addition to other experimentally characterised structural and grain-scale properties of sandstone, K is fed as an input into the discrete element modelling of fracture strength and dilation of the sandstone samples. Physical bulk scale experiments are also conducted to evaluate the load-displacement relation, dilation and bulk fracture strength characteristics of sandstone samples under compression and shear. A good level of agreement is obtained between the results of the simulations and experiments. The current generic framework could be applied to understand the internal and bulk mechanical properties of such complex opaque and heterogeneous materials more realistically in future

Colonialism and contemporary African migration

Scholars of international migration have paid scant attention to the phenomenon of bifurcated social identity of African migrants and their efforts to reinvent or re- and deconstruct a certain image of self in their everyday life. This article aims to offer a more nuanced approach to studying the phenomenon of Africans’ involvement in voluntary migration to the West. Drawing on Goffman’s idea of “dramaturgy,” the article enunciates ways that African immigrants and migrants manage their impression and represent themselves to their peers and social groups in home societies. Using selected cases of African immigrants and migrants in the West, the article enunciates, first, how African migrants (re) present their myriad of experiences to their peers and social groups in home societies as well as the effect of those representations on prospective migrants and, second, why African migrants construe themselves in a particular way to their peers and social groups in home societies. A speculative application of phenomenology to existing qualitative data on African immigration and migration is offered to explicate the lifeworld of African migrants in their oscillation between ancestral and current societies and their seemingly insatiable desire for Euro-American countries

Heteromorpha trifoliata (Dombwe) accelerates acetic acid-induced peptic ulters: a preliminary study in the rat

No Abstract. Central African Journal of Medicine Vol. 45 (2) 1999: pp. 35-3

Wireless Sensor Network for Real-time Flood Monitoring Based on 6loWPAN Communication Standard

Riverine flood is a major disaster faced by most countries and has significant adverse effect on long term economic growth of affected regions and their environments. Several systems have previously employed different technologies to monitor riverine flood but are expensive with low accuracy and consumes high amount of energy. In this paper, we proposed an energy efficient and accurate flood monitoring system. The system leverages on Internet Protocol Version 6 over Low Power Wireless Personal Area Network (6loWPAN) technology to construct a Wireless Sensor Network (WSN) comprising of two XM1000 motes and a rule-base water level monitoring application. The motes were configured using NesC programming for flood monitoring with Basestation and water level sensing applications. The water level sensing mote samples and transmits real-time water level information to the Basestation mote which interfaces with a rule-based water level monitoring application. The application compares current water level with a predetermined threat level and alerts relevant agencies when flood is imminent via an email. The results obtained from the emulation of the developed system showed that, it achieved an accuracy of 95.3% in water level monitoring with a Mean Squared Error of 5.1. The power consumed in transmitting a packet of 2 bytes payload plus other overhead was 0.4μJ and 0.0396mJ with and without 6loWPAN configuration respectively

MANAGEMENT OF A CHRONIC NECROTIZING WOUND IN A DOG USING NATURAL HONEY THERAPY

Infected skin wounds are common in pet animals. Following an infected severe bite wound in a dog with marked necrotic aftermath, natural honey was successfully used alongside systemic antibiotic therapy to hasten healing. The condition improved with speed and regeneration of skin tissue, avoiding sloughing. The wound took 168 days to heal and to form a scar. Natural honey can be considered as a wound management tool, as it is both highly effective, can render a low cost therapy and less managemental expenditure compared to other specialized therapies and techniques