A fuzzy synthetic evaluation of the challenges of smart city development in developing countries

Purpose: This study presents a fuzzy synthetic evaluation of the challenges of smart city realisation in developing countries, using Nigeria as a case study. By defined and delineating the problems facing the country, more viable directions to attaining smart city development can be achieved. Design/Methodology/ Approach: The study adopted a post-positivist philosophical stance with a deductive approach. A structured questionnaire was used to gather data from built environment professionals involved in the delivery of Nigerian public infrastructures. Six dimensions of the challenges of smart cities were identified from literature and explored. These are governance, economic, social, technological, environmental, and legal issues. Data gathered were analysed using Cronbach alpha test for reliability, Shapiro-Wilks test for normality, Kruskal-Wallis H-Test for consistency, and Fuzzy synthetic evaluation test for the synthetic evaluation of the challenges of smart city attainment. Findings: The findings revealed that all six assessed dimensions have a significant impact on the attainment of smart cities in Nigeria. More specifically, issues relating to environmental, technological, social and legal challenges are more prominent. Originality/Value: The fuzzy synthetic approach adopted provides a clear, practical insight on the issues that need to be addressed before the smart city development can be attained within developing countries

Pattern of Presentation and Treatment of Dental Caries - Related Cases at the University of Benin Teaching Hospital: A Retrospective Study.

This study was carried out to assess the pattern of presentation and treatment of Dental Caries- related cases among children and adolescence presenting in Paediatric Dentistry clinic of the University of Benin Teaching Hospital. The clinical records of enrolled 1251 patients aged 16 years and below who presented with caries or its sequelae and treated at the Paediatric Dentistry clinic between June 2004 and June 2008 were analysed using the Decayed, Missing and Filled Teeth/ decayed, missing and filled teeth (DMFT/dmft) index to evaluate dental caries. The total mean DMFT/dmft of the study group was 1.46 with highest mean dmft amongst those aged 0-6 years. More females (55.3%) presented at the clinic than males (44.7%). Age 7 (10.5%) had the highest frequency in the study which had a mean age of 9.3. Acute apical periodontitis (45.6%) was the highest diagnosed condition followed by dental caries (44.2%), dento-alveolar abscess (5.8%), irreversible pulpitis (3.9%) and the least was chronic pulpitis (0.1%). Early childhood caries (ECC) accounted for about 28.9% of the entire study group. Extraction was the most frequently carried out treatment procedure (52.4%). Glass ionomer restoration constituted 27.2%, Amalgam 9.4% of the treatment rendered and Pulp therapy (Pulp capping, Pulpotomy, Pulpectomy and Root canal therapy) constituted 2.4%, 2.3%, 3.7%, and 2.5% respectively. In conclusion, we found that the most of the children presenting with caries related problems had acute apical periodontitis (45.6%) with caries conditions affecting mostly a single tooth (71.5%). The study also found that the 0- 6 years age group with early childhood caries (ECC) had the highest dmft of 1.65 and is an indication poor early dental attendance and need for strong preventive strategies. The study also showed extraction (52.4%) as the highest mode of treatment further reinforcing the need for early oral health education and screening.Keywords: Dental Caries, Caries Sequelae, Early Childhood Caries, Treatment, Benin Cit

Incidence, clinical characteristics, and risk factors of peripartum cardiomyopathy in Nigeria : results from the PEACE Registry

Aims: The aim of this study was to describe the incidence, clinical characteristics and risk factors of peripartum cardiomyopathy (PPCM) in Nigeria. Methods and Results: The study was conducted in 22 hospitals in Nigeria, and PPCM patients were consecutively recruited between June 2017 and March 2018. To determine factors associated with PPCM, the patients were compared with apparently healthy women who recently delivered, as controls. Four hundred six patients were compared with 99 controls. The incidence and disease burden (based on the rate of consecutive recruitment of subjects) varied widely between the six geographical zones of Nigeria. From the North-West zone, 72.3% of the patients was recruited, where an incidence as high as 1 per 96 live births was obtained in a centre, while the disease was uncommon (7.6% of all recruited patients) in the South. Majority of the patients (76.6%) and controls (74.8%) (p = 0.694) were of Hausa-Fulani ethnic group. Atrial fibrillation, intracardiac thrombus, stroke, and right ventricular systolic dysfunction were found in 1.7%, 6.4%, 2.2%, and 54.9% of the patients, respectively. Lack of formal education (odds ratio [OR] 3.08, 95% confidence interval [1.71, 5.53]; P < 0.001), unemployment (OR: 3.28 [2.05, 5.24]; P < 0.001), underweight (OR: 13.43 [4.17, 43.21]; P < 0.001) and history of pre-eclampsia (OR: 9.01 [2.18, 37.75]; P = 0.002) emerged as independent PPCM risk factors using regression models. Customary hot baths (OR: 1.24 [0.80, 1.93]; P = 0.344), pap enriched with dried lake salt (OR: 1.20 [0.74, 1.94]; P = 0.451), and Hausa-Fulani ethnicity (OR: 1.11 [0.67, 1.84]; P = 0.698) did not achieve significance as PPCM risk factors. Conclusions: In Nigeria, the burden of PPCM was greatest in the North-West zone, which has the highest known incidence. PPCM was predicted by sociodemographic factors and pre-eclampsia, which should be considered in its control at population level. Postpartum customary birth practices and Hausa-Fulani ethnicity were not associated with PPCM in Nigeria

Assessment, endoscopy, and treatment in patients with acute severe ulcerative colitis during the COVID-19 pandemic (PROTECT-ASUC): a multicentre, observational, case-control study

BackgroundThere is a paucity of evidence to support safe and effective management of patients with acute severe ulcerative colitis during the COVID-19 pandemic. We sought to identify alterations to established conventional evidence-based management of acute severe ulcerative colitis during the early COVID-19 pandemic, the effect on outcomes, and any associations with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and severe COVID-19 outcomes. MethodsThe PROTECT-ASUC study was a multicentre, observational, case-control study in 60 acute secondary care hospitals throughout the UK. We included adults (≥18 years) with either ulcerative colitis or inflammatory bowel disease unclassified, who presented with acute severe ulcerative colitis and fulfilled the Truelove and Witts criteria. Cases and controls were identified as either admitted or managed in emergency ambulatory care settings between March 1, 2020, and June 30, 2020 (COVID-19 pandemic period cohort), or between Jan 1, 2019, and June 30, 2019 (historical control cohort), respectively. The primary outcome was the proportion of patients with acute severe ulcerative colitis receiving rescue therapy (including primary induction) or colectomy. The study is registered with ClinicalTrials.gov, NCT04411784. FindingsWe included 782 patients (398 in the pandemic period cohort and 384 in the historical control cohort) who met the Truelove and Witts criteria for acute severe ulcerative colitis. The proportion of patients receiving rescue therapy (including primary induction) or surgery was higher during the pandemic period than in the historical period (217 [55%] of 393 patients vs 159 [42%] of 380 patients; p=0·00024) and the time to rescue therapy was shorter in the pandemic cohort than in the historical cohort (p=0·0026). This difference was driven by a greater use of rescue and primary induction therapies with biologicals, ciclosporin, or tofacitinib in the COVID-19 pandemic period cohort than in the historical control period cohort (177 [46%] of 387 patients in the COVID-19 cohort vs 134 [36%] of 373 patients in the historical cohort; p=0·0064). During the pandemic, more patients received ambulatory (outpatient) intravenous steroids (51 [13%] of 385 patients vs 19 [5%] of 360 patients; p=0·00023). Fewer patients received thiopurines (29 [7%] of 398 patients vs 46 [12%] of 384; p=0·029) and 5-aminosalicylic acids (67 [17%] of 398 patients vs 98 [26%] of 384; p=0·0037) during the pandemic than in the historical control period. Colectomy rates were similar between the pandemic and historical control groups (64 [16%] of 389 vs 50 [13%] of 375; p=0·26); however, laparoscopic surgery was less frequently performed during the pandemic period (34 [53%] of 64] vs 38 [76%] of 50; p=0·018). Five (2%) of 253 patients tested positive for SARS-CoV-2 during hospital treatment. Two (2%) of 103 patients re-tested for SARS-CoV-2 during the 3-month follow-up were positive 5 days and 12 days, respectively, after discharge from index admission. Both recovered without serious outcomes. InterpretationThe COVID-19 pandemic altered practice patterns of gastroenterologists and colorectal surgeons in the management of acute severe ulcerative colitis but was associated with similar outcomes to a historical cohort. Despite continued use of high-dose corticosteroids and biologicals, the incidence of COVID-19 within 3 months was low and not associated with adverse COVID-19 outcomes