The Seashell Development Model

Small and new organizations (SNOs) of any nature face similar challenges in a contemporary context defined by the blurring of lines between the private, public and academic sectors and an economy where knowledge is the most valuable currency. The liability of smallness asserts that small organizations fail because of weaknesses in management, infrastructure and capacity, while the liability of newness asserts that new organizations fail because of weaknesses in trust, credibility and support. The Seashell Development Model provides an integrated framework that directly addresses the liabilities of smallness and newness in this contemporary context. The creation of the Seashell Model comprised a synthesis of the most recent research and well established theories in the disciplines of: networking; collaboration; donor, investor and corporate sponsor behavior; fundraising; collaborative innovation and swarm creativity; knowledge flow and knowledge management; capacity building; Triple Helix engagement, partnership building and boundary spanning; leadership theory, charisma-building and semantic translation; team theory; goal setting theory; information dissemination; change management, and collaborative inquiry. At the 2017 United Nations ECOSOC partnership forum, the importance of private-public partnerships and capacity building dominated diplomatic dialogue. The Seashell Development Model hinges on the power of human relationships to transcend the disintegrating boundaries between sectors. It provides a comprehensive framework from the inception of the organization to the courtship of higher level investors, donors and corporate sponsors, allowing SNOs of any nature to leverage the intellectual and human capital of their networks to succeed in this dynamic contemporary context

A rare image of spontaneous enterocutaneous fistula in morbidly obese patient with metabolic syndrome

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Persistent Vomiting as a Manifestation of Coronavirus Disease‑2019

Coronavirus disease-2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus-2. It often manifest with respiratory symptoms such as cough, fever, and difficulty in breathing. In addition to pulmonary involvement, COVID-19 is also associated with several extrapulmonary manifestations. The extrapulmonary pathology of COVID‑19 could be due to either extrapulmonary  dissemination of the virus and its replication, as has been observed for other zoonotic coronaviruses or widespread immunopathological complications of the disease. We report a case of an 18-year-old female who presented with persistent vomitingas the only presentation of COVID-19. Clinical evaluation including a battery of investigation such as hematological, biochemical,imaging, and endoscopy did not reveal any abnormality. However, her nasopharyngeal and nasal swab samples tested positive forSARS-CoV-2 by polymerase chain reaction (PCR). We placed her on the approved COVID-19 regimen comprising lopinavir/ritonavir,zinc sulfate, hydroxychloroquine and azithromycin with augmentin, vitamin C, metoclopramide and intravenous fluid for one week.The vomiting subsided within 48-h of commencing the medications, and she became asymptomatic after 72-h. Repeat PCR after 12 days returned negative for SARS-CoV-2. This case report highlights the unusual clinical feature of COVID-19. It, therefore, underscores the need to thoroughly investigate symptomatic patients and also to optimize standard precaution as potentially infectious diseases such as COVID-19 may “masquerade” as a vague constitutional symptom(s). Keywords: Coronavirus disease-2019, polymerase chain reaction, severe acute respiratory syndrome coronavirus – 2, vomitin

Incidence of anaemia among HIV-infected patients treated with zidovudine-containing antiretroviral therapy in northeastern Nigeria

Background: Zidovudine (AZT) is a common component of antiretroviral therapy (ART) in resource-limited settings. However, AZT is associated with myelotoxity that often presents with anaemia. The aim of this study was to determine the incidence of anaemia among patients initiated on AZT-containing and non-AZT containing ART regimens.Methods: In this retrospective analysis, records from 800 ART-naïve HIV-infected patients were abstracted by simple random sampling from program databases. Rates of anaemia were compared between patients initiated on AZT- versus non- AZT-containing ART regimens. Patients were stratified according to absence (Group A) or presence (Group B) of baseline anaemia defined as haemoglobin < 10.5g/dl. Incidence was calculated as total cases of AZT-induced anaemia (group A) or worsening of anaemia (group B) during the study period divided by person-time at risk and adjusted per 100 person-years. Average time-to-event and survival curve were estimated using Kaplan Meier survival analysis.Results: In group A (without baseline anaemia), the incidence of anaemia in the AZT-exposed versus non-exposed cohorts was 73.3 and 17.6 per 100 patient years at 6 months, and 60.5 and 8.5 per 100 patient years at 12 months, respectively. In group B, the incidence of worsening anaemia was 65.9 and 26.2 per 100 patient years at 6 months, and 57.5 and 17.9 per 100 patient years after 12 months in AZT-exposed and AZT-unexposed cohorts, respectively. The estimated time to event (developing anaemia) was 2.3 (1.5 – 3.4) months, while estimated to event (worseninig anaemia) was 2.0 (1.5 – 4.0).Conclusions: HIV-infected patients initiated on AZT-containing ART are 2.7 and 4.5 more likely to develop anaemia at 6 and 12 months, respectively, compared to those initiating a non-AZT containing regimen. When censored at 12 months the overall incidence of AZT-related anaemia was estimated at 22.3% (38.2 incidences per person years). Majority (75%) of the AZT-related anaemia occurred early with estimated time-to-event occurring within the first 3.8 monthsKeywords: Anaemia, Zidovudine, Antiretroviral therapy, Incidenc

Ovarian Tuberculosis masquerading as ovarian cancer in HIV infected patient: a plea to avoid unnecessary surgery

Female patients who present with adnexial mass and weight loss should not be presumed to have ovarian carcinoma until after extensive investigation. This is to avoid the mistake of radical surgery with its attendant morbidity and mortality. An important disease to consider in our environment is ovarian TB that respond well to medication. A 35 year old HIV-1 positive house wife presented with fever, persistent vomiting, progressive weight loss, vague abdominal pain and swelling. Patient occasionally ingest unpasteurized milk since childhood but had no sustained contact with adult with chronic cough. She had no menstrual abnormality. Imaging  studies revealed right ovarian mass measuring 11.8cmx10cm. Right ovarian malignancy was highly  suspected, for which she underwent exploratory laporotomy. Histopathology result was consistent with tuberculous granuloma. Chest radiograph was normal. Her CD4 count was 541cells/ul. Patient was  commenced on anti tuberculotic therapy based on the Nigerian National TB control and she responded well. Tuberculosis of the ovary can masquerade as ovarian cancer, especially among HIV patients in regions where TB-HIV co infections is endemic, it should be ruled out before performing extended surgery.Key words: Ovarian TB, ovarian cancer, HIV-TB co infectio

Clinical Characteristics of COVID‑19 in a Tertiary Health Facility in Northeast Nigeria

Aim: The coronavirus disease 2019 (COVID‑19), caused by a newly identified β‑coronavirus (severe acute respiratory syndrome  coronavirus‑2), has a varied clinical manifestation. We evaluated the clinical features of COVID‑19 in symptomatic patients that presented for care at a Federal Medical Centre Nguru, Northeast Nigeria. Methodology: In this retrospective cohort study, we reviewed and analyzed relevant information abstracted from the medical records of symptomatic COVID‑19 patients that were managed from March 14 to October 14, 2020, in the facility. Results: Clinical records of 55 symptomatic COVID‑19 patients were evaluated in this study. Their mean age was 49.1 ± 16.3 (females 51.4 ± 15.6, males 48.5 ± 17.2, P = 0.601) with females constituting 47.2% of the studied patients. Fever (87.3%), cough (67.3%), sore throat (49.1%) and rhinorrhea (41.8%) were the most common clinical feature. Other features included difficulty in breathing (25.5%) and ageusia (14.6%). Gastrointestinal symptoms such as diarrhea, vomiting and abdominal pain were seen in 10.9%, 18.2%, and 9.1%, respectively. Twenty‑one (38.2%) patients had a preexisting health condition. Chronic kidney disease was the most common; it was seen in 34% of patients, other common conditions included hypertensive heart disease (24%), and diabetes mellitus (16%). Conclusion: Respiratory symptoms are the most common presentation of COVID‑19 in our setting. However, some patients also presented with additional extrapulmonary symptoms. A significant proportion, 38.2% of symptomatic COVID‑19 patients, had preexisting health  conditions. Keywords: Clinical characteristics, coronavirus disease 2019, Northeast Nigeri

How Should A Deaf Car Drive?

This thesis seeks to determine whether a self-driving car's behavior should depend on the hearing status of its passengers: namely, hard-of-hearing (including deaf) or hearing. It is believed that auditory deprivation provokes adaptations in visual attention. These adaptations may lead to atypical movement patterns that can translate to different driving practices, and therefore, potentially, to different preferences about how a self-driving car should behave. Here we pose the question: is there a difference in driving behavior preferences between hearing and hard-of-hearing passengers? To determine this we created various driving scenarios in the CARLA photo-realistic simulator. These simulations show driving situations on highways, in cities, at T-junctions, and interactions with pedestrians. These simulations were placed in scenario pairs and we asked hearing and deaf participants through an online survey to indicate which scenarios they found preferable. Our results show that no significant differences were found in the level of defensiveness and lane change frequency among the two populations. On the other hand, significant differences were found in lane preference between the deaf and hearing drivers. In both highway and city scenarios hearing drivers choose the left lane more often while the deaf choose the right lane. Once in the right lane, deaf drivers are less likely to leave this lane. This suggests a possible aversion to speed due to the left lane usually being the passing lane or fast lane, while the right lane is slower. These results indicate that hearing status is a valid factor in driving behavior and should be accounted for in the design of how self-driving cars behave

HIV sero-positive status among clients aged ≥ 50 years that presented for care in a tertiary health facility in northeastern Nigeria.

The introduction of highly active antiretroviral therapy (HAART) has transformed HIV infection from hopeless to manageable health condition comparable to non-infectious diseases such as asthma and diabetes mellitus. This modest achievement has reduced morbidity and mortality and increased longevity and quality of life among HIV infected persons. Although reports from developing countries such as Nigeria, shows that youth within the reproductive are most affected by the scourge of HIV/AIDS. Older patients with features that may be indicative of HIV infection are often overlooked in favour of other differential diagnosis. Objective: To document HIV positive sero-status among client aged 50 years and above that necessitated HIV test as part of their clinical evaluation after voluntary counseling and testing at a tertiary health facility. Method: Record of 1674 adults participants that presented for care between January 2009- December 2013, were retrieved for this study. Results: The HIV-seropositive status among the participants was 370 (22.1%). It showed a female preponderance of 136 (26.0%) than 234 (20.0%) in males. The peak annual prevalence was observed in the year 2010, steady decline was observed thereafter. Overall, older participants between 60-70 years had higher HIV-seropositivity status. This study shows one out four males and five females with index of suspicion either based on clinical presentation or risky sexual behavior are positive for HIV infection. Conclusion: This report underscores the need to explore other risk factors that may be peculiar to older segment of the society and introduce HIV intervention strategies for the older populations. Delivery of HIV intervention measures and services to this segment of the population is expedient. Measures and interventions should take into consideration the peculiarities, specific vulnerabilities and HIV-related challenges faced by this group of clients

Risk factors for hepatitis C virus sero-positivity among haemodialysis patients receiving care at Kidney Centre in a tertiary health facility in Maiduguri, Nigeria

Hepatitis C virus (HCV) is an important health care problem in haemodialysis. Hepatitis C virus is both a cause and complication of kidney diseases. Yet there are limited information on antibody against HCV in patients on haemodialysis. The purpose of this study was to determine the prevalence of anti-HCV and the risk factors associated with HCV infection in a cohort of 100 participants on haemodialysis. They were consecutively recruited into the study, anti-HCV testing was made by the 3rd-generation ELISA System (C-100, C-33c, C-22). The prevalence of HCV antibody was 15%, risk factors associated with HCV antibody were history of blood transfusion and duration of session of haemodialysis; the risk increased with increased with the number of blood transfusion and seasons of haemodialysis. The observed high prevalence of HCV antibody among patients on haemodialysis reflect the quality of healthcare services and the standards of infection control practices in our haemodialysis units. Routine screening for HCV should be done before blood transfusion using third generation ELISA assays with high sensitivity and specificity. Safety measures should be taken in our haemodialysis units to prevent cross infection among patients and staffs. These safety measures include; discarding syringes, needles, gloves, bloodlines and dialysers after single use, and the use of sterile dressings on each patient visit

Seroprevalence and associated risk factors of hepatitis E virus infection among pregnant women attending Maiduguri teaching hospital, Nigeria

Background: Hepatitis E Virus (HEV) is a major public health problem in developing countries and often fatal among pregnant women in the third trimester. Objectives: The study investigated the sero-prevalence and risk factors of HEV infection among pregnant women attendee of University of Maiduguri Teaching Hospital, Maiduguri, Nigeria. Methods: The cross-sectional study was carried out between 4th January 2016 to 30th May, 2016. One hundred and eighty blood samples from pregnant women who consented and enrolled for the study were analyzed for anti – HEV IgM using a quality assured commercial Enzyme Linked Immunosorbent Assay (ELISA) kit. Structured questionnaires were used to collate the sociodemographic characteristics and risk factor of study subjects. Results: Out of the 180 pregnant women sampled, the anti-HEV IgM seroprevalence of 13.3% was recorded.  The seroprevalence was significantly higher in the age range of 31 – 35 years (26.5%) and least in age range ≤ 20 years (4.9%) (p=0.009).  The highest seroprevalence was recorded in the third trimester 14.1% followed by second (p>0.05). After logistic regression, nature of toilet system, and source of water consumption were significant risk factors for active HEV infection (p˂0.05). Conclusion: Based on the 10.8 % pooled national prevalence of HEV infection in Nigeria, this study recorded a significantly high level of anti – HEV IgM seropositivity, an indication of recent and active HEV infection among pregnant women at the study area. Also, these infections are most among the pregnant women in their third trimester. HEV infection was related to personal, water and environmental hygiene