Antibiotic resistance profile and phenotypic detection of beta-lactamase-producers among gram-negative bacteria isolated from the gut of household cockroaches in and around University Of Ibadan

Background: Cockroaches are carriers of numerous microorganisms. However, there is paucity of information on their role as potential reservoir for beta-lactamase  producers.Objectives: This research determined the antibiotics susceptibility profile of Beta-lactamase producing Gram-negative bacteria isolated from the gut of  household cockroaches in selected locations in and around University of Ibadan, Oyo state.Materials and Methods: Thirty Cockroaches from different locations in and around University of Ibadan were collected between June 2015 and March, 2016, and their intestinal homogenates cultured on different selective media for the isolation of  bacteria. The isolates were identified using a combination of biochemical tests and 16S rRNA sequencing. Antibiotic susceptibility testing was done using the  disc-diffusion technique and phenotypic detection of extended-spectrum  beta-lactamase (ESBL), AmpC-beta-lactamase (AmpC) and Metallo- beta-lactamase (MBL) production was done using double-disc synergy,  cefoxitin/cloxacillin and imipenem/EDTA double-disc methods respectively.Results: A total number of 58 bacteria belonging to nine genera; Pseudomonas, Proteus, Klebsiella, Salmonella, Enterobacter, Escherichia, Serratia, Shigella and Raoultella were isolated. Higher percentage of the isolates exhibited resistance to  erythromycin (90%), azithromycin (87.5%), amoxicillin (84.5%), ampicillin  (74.1%), amoxicillin-clavulanic acid (74.1%), cefoxitin (67.2%) and  chloramphenicol (54%), while lower percentage showed resistance to aztreonam (25%), ertapenem (13%), cefotaxime (8.6%), ceftazidime (10.3%), cefepime (5.2%), ciprofloxacin (3.5%), gentamicin (5.2%) and imipenem (0%). MDR  phenotype was recorded among 82% of the isolates, 17.2% were positive for ESBL, 12% for AmpC and 13.8% for MBL production.Conclusion: This study identified household cockroaches Periplaneta americana, as a potential reservoir for MDR and beta-lactamase-producing isolates.Keywords: Susceptibility testing, ESBL, AmpC, MBL, Beta-Lactamase, MDR, Household cockroache

Global Retinoblastoma Presentation and Analysis by National Income Level

Importance: Early diagnosis of retinoblastoma, the most common intraocular cancer, can save both a child's life and vision. However, anecdotal evidence suggests that many children across the world are diagnosed late. To our knowledge, the clinical presentation of retinoblastoma has never been assessed on a global scale. Objectives: To report the retinoblastoma stage at diagnosis in patients across the world during a single year, to investigate associations between clinical variables and national income level, and to investigate risk factors for advanced disease at diagnosis. Design, Setting, and Participants: A total of 278 retinoblastoma treatment centers were recruited from June 2017 through December 2018 to participate in a cross-sectional analysis of treatment-naive patients with retinoblastoma who were diagnosed in 2017. Main Outcomes and Measures: Age at presentation, proportion of familial history of retinoblastoma, and tumor stage and metastasis. Results: The cohort included 4351 new patients from 153 countries; the median age at diagnosis was 30.5 (interquartile range, 18.3-45.9) months, and 1976 patients (45.4) were female. Most patients (n = 3685 84.7%) were from low-and middle-income countries (LMICs). Globally, the most common indication for referral was leukocoria (n = 2638 62.8%), followed by strabismus (n = 429 10.2%) and proptosis (n = 309 7.4%). Patients from high-income countries (HICs) were diagnosed at a median age of 14.1 months, with 656 of 666 (98.5%) patients having intraocular retinoblastoma and 2 (0.3%) having metastasis. Patients from low-income countries were diagnosed at a median age of 30.5 months, with 256 of 521 (49.1%) having extraocular retinoblastoma and 94 of 498 (18.9%) having metastasis. Lower national income level was associated with older presentation age, higher proportion of locally advanced disease and distant metastasis, and smaller proportion of familial history of retinoblastoma. Advanced disease at diagnosis was more common in LMICs even after adjusting for age (odds ratio for low-income countries vs upper-middle-income countries and HICs, 17.92 95% CI, 12.94-24.80, and for lower-middle-income countries vs upper-middle-income countries and HICs, 5.74 95% CI, 4.30-7.68). Conclusions and Relevance: This study is estimated to have included more than half of all new retinoblastoma cases worldwide in 2017. Children from LMICs, where the main global retinoblastoma burden lies, presented at an older age with more advanced disease and demonstrated a smaller proportion of familial history of retinoblastoma, likely because many do not reach a childbearing age. Given that retinoblastoma is curable, these data are concerning and mandate intervention at national and international levels. Further studies are needed to investigate factors, other than age at presentation, that may be associated with advanced disease in LMICs. © 2020 American Medical Association. All rights reserved

The relationship between basal blood pressure and body mass index in apparently healthy Nigerian adolescent students

Background: In contrast to the situation in developed countries, very few studies have been done on blood pressure (BP) determinants among Nigerian adolescents.   Aim: To evaluate the relationship between basal BP and body mass index (BMI) in a group of healthy Nigerian secondary school students. Methods: This was a cross-sectional study of 1080 adolescent students selected by a two-stage multi-phase cluster sampling technique. The height, weight and BP of each student were taken using standard methods. Pearson correlation was used to describe the strength of association between variables.  Multiple stepwise regressions were conducted to determine the individual or combined contribution(s) of some variables to the variation in BP levels. Results: Mean BMI for males and females were 17.63 ± 2.54 kg/m2 and 18.87 ± 1.81 kg/m2 respectively. Forty six students (4.3%) were overweight. Mean systolic and diastolic BPs were 113.13 + 11.44 mm Hg and 68.29 + 8.07 mm Hg respectively. Thirty-five subjects (3.2%) had systolic or diastolic BP above the 95th percentile for age and sex.  Twenty-four (68.6%) of these subjects were also found to be overweight.  A moderate positive correlation was observed between both systolic and diastolic BP and BMI. Regression analysis showed that weight, height and BMI were predictors of systolic BP.  Height and BMI were the only predictors of diastolic BP.  Conclusion: These findings suggest that there is a moderate association between basal BP and BMI.  Recommendation:  Control/prevention of the accumulation of excess body fat in adolescence is recommended.   Keywords: Body mass index, Blood pressure, Adolescent, Nigerian

Fuzzy Logic-based Data Controlled Wireless Sensor Network Routing Protocol for Flood Early Warning

Floods account for 15% of all natural disasters related deaths. Therefore, early flood warning systems using wireless network of sensors installed in flood prone areas is necessary to provide early notice of impending flood. This research focuses on the use of an energy efficient routing protocol to prolong the life time of the Network. The importance of this is to minimize energy consumption as necessary for reliable field operations. It adopts the use of mandami Fuzzy logic-based data controlled routing protocol (F-DCRP).Simulation was carried out for the F-DCRP, LEACH and Crisp Data controlled routing protocol (DCRP). The performance of the three protocols were obtained and compared. The result showed that Cluster head (CH) load was better shared uniformly among all the nodes. Percentage of packets dropped showed that the proposed F-DCRP was 10% lower compared to DCRP and 50% lower compared to LEACH resulting in more packets sent per round and greater reliability compared to LEACH and DCRP. The network lifetime was also improved by 40 % when compared to LEACH and DCRP

Relationship between expansion strategy and growth of charismatic churches in Ghana

This paper examines the relationship between expansion strategy and growth of charismatic churches in Ghana using 100 churches through a survey questionnaire administration. The study used an exploratory, relational and descriptive approach with a cross sectional and a quantitative design that relied on both primary and secondary sources of data. Evidence of growth of the charismatic churches was highlighted by increase in the number of church branches, number of members, total monthly tithes, total work force and value of assets. Church strategies were found to be positively correlated to church growth with the most vital strategy being prayer. Other important growth strategies were: evangelism, type of sermon, membership welfare and service structure. The Franchise/ Business model was found to yield better church growth than the Episcopal model.Keywords: Franchise, Business model, Episcopal model, charismatic churche

Global Impact of COVID-19 on Stroke Care and IV Thrombolysis

OBJECTIVE: To measure the global impact of COVID-19 pandemic on volumes of IV thrombolysis (IVT), IVT transfers, and stroke hospitalizations over 4 months at the height of the pandemic (March 1 to June 30, 2020) compared with 2 control 4-month periods. METHODS: We conducted a cross-sectional, observational, retrospective study across 6 continents, 70 countries, and 457 stroke centers. Diagnoses were identified by their ICD-10 codes or classifications in stroke databases. RESULTS: There were 91,373 stroke admissions in the 4 months immediately before compared to 80,894 admissions during the pandemic months, representing an 11.5% (95% confidence interval [CI] -11.7 to -11.3, p < 0.0001) decline. There were 13,334 IVT therapies in the 4 months preceding compared to 11,570 procedures during the pandemic, representing a 13.2% (95% CI -13.8 to -12.7, p < 0.0001) drop. Interfacility IVT transfers decreased from 1,337 to 1,178, or an 11.9% decrease (95% CI -13.7 to -10.3, p = 0.001). Recovery of stroke hospitalization volume (9.5%, 95% CI 9.2-9.8, p < 0.0001) was noted over the 2 later (May, June) vs the 2 earlier (March, April) pandemic months. There was a 1.48% stroke rate across 119,967 COVID-19 hospitalizations. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was noted in 3.3% (1,722/52,026) of all stroke admissions. CONCLUSIONS: The COVID-19 pandemic was associated with a global decline in the volume of stroke hospitalizations, IVT, and interfacility IVT transfers. Primary stroke centers and centers with higher COVID-19 inpatient volumes experienced steeper declines. Recovery of stroke hospitalization was noted in the later pandemic months. © 2021 American Academy of Neurology

Global Retinoblastoma Presentation and Analysis by National Income Level

This cross-sectional analysis reports the retinoblastoma stage at diagnosis across the world during a single year, investigates associations between clinical variables and national income level, and investigates risk factors for advanced disease at diagnosis. Key PointsQuestionIs the income level of a country of residence associated with the clinical stage of presentation of patients with retinoblastoma? FindingsIn this cross-sectional analysis that included 4351 patients with newly diagnosed retinoblastoma, approximately half of all new retinoblastoma cases worldwide in 2017, 49.1\% of patients from low-income countries had extraocular tumor at time of diagnosis compared with 1.5\% of patients from high-income countries. MeaningThe clinical stage of presentation of retinoblastoma, which has a major influence on survival, significantly differs among patients from low-income and high-income countries, which may warrant intervention on national and international levels. ImportanceEarly diagnosis of retinoblastoma, the most common intraocular cancer, can save both a child's life and vision. However, anecdotal evidence suggests that many children across the world are diagnosed late. To our knowledge, the clinical presentation of retinoblastoma has never been assessed on a global scale. ObjectivesTo report the retinoblastoma stage at diagnosis in patients across the world during a single year, to investigate associations between clinical variables and national income level, and to investigate risk factors for advanced disease at diagnosis. Design, Setting, and ParticipantsA total of 278 retinoblastoma treatment centers were recruited from June 2017 through December 2018 to participate in a cross-sectional analysis of treatment-naive patients with retinoblastoma who were diagnosed in 2017. Main Outcomes and MeasuresAge at presentation, proportion of familial history of retinoblastoma, and tumor stage and metastasis. ResultsThe cohort included 4351 new patients from 153 countries; the median age at diagnosis was 30.5 (interquartile range, 18.3-45.9) months, and 1976 patients (45.4\%) were female. Most patients (n=3685 {[}84.7\%]) were from low- and middle-income countries (LMICs). Globally, the most common indication for referral was leukocoria (n=2638 {[}62.8\%]), followed by strabismus (n=429 {[}10.2\%]) and proptosis (n=309 {[}7.4\%]). Patients from high-income countries (HICs) were diagnosed at a median age of 14.1 months, with 656 of 666 (98.5\%) patients having intraocular retinoblastoma and 2 (0.3\%) having metastasis. Patients from low-income countries were diagnosed at a median age of 30.5 months, with 256 of 521 (49.1\%) having extraocular retinoblastoma and 94 of 498 (18.9\%) having metastasis. Lower national income level was associated with older presentation age, higher proportion of locally advanced disease and distant metastasis, and smaller proportion of familial history of retinoblastoma. Advanced disease at diagnosis was more common in LMICs even after adjusting for age (odds ratio for low-income countries vs upper-middle-income countries and HICs, 17.92 {[}95\% CI, 12.94-24.80], and for lower-middle-income countries vs upper-middle-income countries and HICs, 5.74 {[}95\% CI, 4.30-7.68]). Conclusions and RelevanceThis study is estimated to have included more than half of all new retinoblastoma cases worldwide in 2017. Children from LMICs, where the main global retinoblastoma burden lies, presented at an older age with more advanced disease and demonstrated a smaller proportion of familial history of retinoblastoma, likely because many do not reach a childbearing age. Given that retinoblastoma is curable, these data are concerning and mandate intervention at national and international levels. Further studies are needed to investigate factors, other than age at presentation, that may be associated with advanced disease in LMICs