Pre-operative pulmonary assessment and risk factors for post-operative pulmonary complications in elective abdominal surgery in Nigeria

Background and Objectives: Post-operative pulmonary complications (PPCs) are recurring causes of rising morbidity and mortality in surgeries. This study sought to evaluate pre-operative risk factors for PPCs in abdominal surgerypatients in Nigeria.Methodology: This was a prospective study in patients booked for surgery in 2014. Biodata, medical his tory, pre-operative respiratory and cardiovascular examination findings, body mass index, serum albumin, serum urea, ventilatory function, chest x-rays and oxygen saturation were obtained. The association between pre-operative variables and PPCs was determined.Results: The pre-operative spirometry was predominantly restrictive (62%). Overall, the prevalence of PPCs was 52%. This included non-productive cough (14%), isolated productive cough (10%), productive cough with abnormal chest finding (16%), pneumonia (8%), pleural effusion (5%), ARDS (2%). Percentage predicted FEV1 and FVC were lower in participants with PPCs. (p= 0.03 and p=0.01respectively). Pre-operative cough, shortness of breath and consolidation were associated with PPCs (p< 0.05). Post-operative respiratory rate and pulse rate in participants with PPCs were higher than the values in those without PPCs (p=0.03 and p=0.05).Conclusion: The prevalence of PPCs was high in this study. Pre-operative cough, shortness of breath, consolidation, abnor- mally low percentage predicted FEV1 and FVC were associated with PPCs.Keywords: Post-operative pulmonary complications, pre-operative assessment, risk factors, cough, shortness of breath, consol- idation, pneumonia, elective abdominal surgeries, Nnewi, Nigeria

Evaluation of urinalysis parameters and antimicrobial susceptibility of uropathogens among out-patients at University of Cape Coast hospi

Background: Urinary tract infection (UTI) is a major global public health issue. The gold standard for diagnosing UTI is urine culture. This is however labour intensive and time consuming. Many prescribers therefore rely on urinalysis in diagnosing UTI. This study sought to evaluate the performance of some parameters of urinalysis as predictors of urine culture positivity. The common causative agents and their antibiotic susceptibility patterns were also determined. Methods: A cross sectional study was carried out at the University of Cape Coast Hospital from July 2017 – December 2017 among out-patients. The performance characteristics of leukocyte esterase (3+) and nitrite reactions were estimated and compared with urine culture. Antimicrobial susceptibility tests were done using disc diffusion technique described by Kirby-Bauer. Results: Prevalence of UTI in this study was 30.0% (64/213). The most prevalent pathogen was E. coli (20, 31.2%), followed by S. saprophyticus (9, 14.1%). Most of the bacteria (52, 94.5%) were sensitive to amikacin, followed by ciprofloxacin (42, 76.3%). The most sensitive (94.4%) of the parameters was pus cells [>5 white blood cells (WBC) per high power field (HPF)] and the least sensitive was the nitrite test (21.0%). The leukocyte esterase test showed the highest accuracy of 91.1%. Conclusion: The study supports the recommendation of the use of oral ciprofloxacin as the first line treatment of uncomplicated UTI by the Ghana Standard Treatment Guidelines (2017). Funding: No funding was provided for this study. Keywords: urine tract infection, urinalysis, uropathogens, Cape Coas

The context, influences and challenges for undergraduate nurse clinical education: Continuing the dialogue

Introduction – Approaches to clinical education are highly diverse and becoming increasingly complex to sustain in complex milieu Objective – To identify the influences and challenges of providing nurse clinical education in the undergraduate setting and to illustrate emerging solutions. Method: A discursive exploration into the broad and varied body of evidence including peer reviewed and grey literature. Discussion - Internationally, enabling undergraduate clinical learning opportunities faces a range of challenges. These can be illustrated under two broad themes: (1) Legacies from the past and the inherent features of nurse education and (2) Challenges of the present, including, population changes, workforce changes, and the disconnection between the health and education sectors. Responses to these challenges are triggering the emergence of novel approaches, such as collaborative models. Conclusion(s) – Ongoing challenges in providing accessible, effective and quality clinical learning experiences are apparent

Stable isotope (δ18O and δ13C) sclerochronology of Callovian (Middle Jurassic) bivalves (Gryphaea (Bilobissa) dilobotes) and belemnites (Cylindroteuthis puzosiana) from the Peterborough Member of the Oxford Clay Formation (Cambridgeshire, England): Evidence of palaeoclimate, water depth and belemnite behaviour

Incremental δ18O and δ13C signals were obtained from three well-preserved specimens of Cylindroteuthis puzosiana and from three well-preserved specimens of Gryphaea (Bilobissa) dilobotes from the Peterborough Member of the Oxford Clay Formation (Cambridgeshire, England). Through-ontogeny (sclerochronological) δ18O data from G. (B.) dilobotes appear to faithfully record seasonal temperature variations in benthic Callovian waters of the study area, which range from c. 14 °C to c. 17 °C (arithmetic mean temperature c. 15 °C). Water depth is estimated to have been in the region of c. 50 m, based upon comparisons between these data, previously published non-incremental sea surface δ18O values, and a modern analogue situation. Productivity in Callovian waters was comparable with that in modern seas, based upon δ13C data from G. (B.)dilobotes, with 13C depletion occurring during warmer periods, possibly related to an interaction between plankton blooms and intra-annual variations in mixing across a thermocline. Incremental δ18O data from C.puzosiana provide temperature minima of c.11 °C for all specimens but with maxima varying between c.14 °C and c.16 °C for different individuals (arithmetic mean values c. 13 °C). Temperatures for late ontogeny, when the C. puzosiana individuals must have been living close to the study site and hence the analysed specimens of G. (B.) dilobotes, are closely comparable to those indicated by the latter. However, for significant portions of ontogeny C. puzosiana experienced temperatures between c. 2 °C and c. 3 °C cooler than the winter minimum as recorded by co-occurring G. (B.) dilobotes. Comparisons with modern seas suggest that descent to a depth of c. 1000 m would be necessary to explain such cool minimum temperatures. This can be discounted due to the lack of deep waters locally and due to estimates of the depth tolerance of belemnites. The most likely cause of cool δ18O signals from C. puzosiana is a cosmopolitan lifestyle including migration to more northerly latitudes. Mean δ13C values from C. puzosiana are comparable with those from G.(B.)dilobotes. However, the incrementally acquired data are highly variable and probably influenced by metabolic effects.The probable identification of migratory behaviour in C. puzosiana calls into question the reliability of some belemnite species as place-specific palaeoenvironmental archives and highlights the benefits of adopting a sclerochronological approach

Advertising, product quality, and complex evolving marketing systems

The paper analyses the advertising as power vs. advertising as information controversy as well as its recent empirical testing. It is stressed that this distinction focuses too much on the interaction between consumer and manufacturer while ignoring the retailer as an important stake-holder. To compensate for this lack, a complex marketing system perspective is introduced in which consumer, retailer, and manufacturer interact. However, these complex marketing systems might drift towards market equilibria which are against the consumer interests: that is, firmsmight lock out brands from the market by means of trade and sales promotions and then use advertising to protect their position. Consequently brands of better quality and/or innovative brands are barred from trade shelves

Influence of palaeoweathering on trace metal concentrations and environmental proxies in black shales

The mineralogical and chemical compositions of Lower Carboniferous (Tournaisian) marine black shale from the Kowala quarry, the Holy Cross Mountains, Poland, were investigated. This study focuses on disturbances in palaeoenvironmental proxies caused by palaeoweathering, which progressively changed the major and trace element abundances. Palaeomagnetic investigations reveal that the Devonian – Carboniferous succession was weathered during the Permian-Triassic by the infiltration of oxidizing fluids related to karstification following post-Variscan exhumation. The weathering process led to vermiculitization of chlorite, partial dissolution of calcite and replacement of pyrite by hematite and goethite. Moreover, the concentrations of some trace metals, including Co, Cu, Pb, Mo, Ni, As and U, significantly decreased. Consequently, some elemental abundance ratios that are used as environmental proxies, including U/Th, Ni/Co and V/Cr, were altered. Elements that are bound to iron sulphides (e.g., Mo) appear to be especially prone to mobilization by even a lightly weathered black shale. The documented weathering, including changes in elemental concentrations, can potentially create misinterpretations of the original palaeoenvironmental conditions. In addition, the palaeoweathering of the studied samples appears to have substantially changed the carbon, oxygen, nitrogen and molybdenum stable isotope values. The nitrogen and molybdenum stable isotope ratios, in particular, appear to be most sensitive to the effects of weathering and therefore are good indicators of (palaeo)weathering processes. The major cause of these changes is the decay of organic matter and pyrite. For the organic carbon stable isotopes ratios, the main factor that controlls this process appears to be the preferential degradation of labile organic matter. A combination of the total organic carbon (TOC), total sulphur (TS) content, Mo concentration and stable isotope compositions seems to be the most useful for identify (palaeo)weathering. Our results suggest that reductions in TS and Mo in tandem with diminished Mo stable isotope values in the absence of obvious changes to the TOC content provide the most compelling evidence of (palaeo)weathering

Pre-operative pulmonary assessment and risk factors for post-operative pulmonary complications in elective abdominal surgery in Nigeria

Background and Objectives: Post-operative pulmonary complications (PPCs) are recurring causes of rising morbidity and mortality in surgeries. This study sought to evaluate pre-operative risk factors for PPCs in abdominal surgerypatients in Nigeria. Methodology: This was a prospective study in patients booked for surgery in 2014. Biodata, medical his tory, pre-operative respiratory and cardiovascular examination findings, body mass index, serum albumin, serum urea, ventilatory function, chest x-rays and oxygen saturation were obtained. The association between pre-operative variables and PPCs was determined. Results: The pre-operative spirometry was predominantly restrictive (62%). Overall, the prevalence of PPCs was 52%. This included non-productive cough (14%), isolated productive cough (10%), productive cough with abnormal chest finding (16%), pneumonia (8%), pleural effusion (5%), ARDS (2%). Percentage predicted FEV1 and FVC were lower in participants with PPCs. (p= 0.03 and p=0.01respectively). Pre-operative cough, shortness of breath and consolidation were associated with PPCs (p<0.05). Post-operative respiratory rate and pulse rate in participants with PPCs were higher than the values in those without PPCs (p=0.03 and p=0.05). Conclusion: The prevalence of PPCs was high in this study. Pre-operative cough, shortness of breath, consolidation, abnormally low percentage predicted FEV1 and FVC were associated with PPCs. DOI: https://dx.doi.org/10.4314/ahs.v19i1.51 Cite as: Ufoaroh CU, Ele PU, Anyabolu AE, Enemuo EH, Emegoakor CD, Okoli CC, et al. Pre-operative pulmonary assessment and risk factors for post-operative pulmonary complications in elective abdominal surgery in Nigeria. Afri Health Sci. 2019;19(1). 1745-1756. https:// dx.doi. org/10.4314/ ahs. v19i1.5

Severe acute respiratory syndrome coronavirus 2 serosurveillance in a patient population reveals differences in virus exposure and antibody-mediated immunity according to host demography and healthcare setting

Identifying drivers of SARS-CoV-2 exposure and quantifying population immunity is crucial to prepare for future epidemics. We performed a serial cross-sectional serosurvey throughout the first pandemic wave among patients from the largest health board in Scotland. Screening of 7480 patient sera showed a weekly seroprevalence ranging from 0.10% to 8.23% in primary and 0.21% to 17.44% in secondary care, respectively. Neutralisation assays showed that around half of individuals who tested positive by ELISA assay, developed highly neutralising antibodies, mainly among secondary care patients. We estimated the individual probability of SARS-CoV-2 exposure and quantified associated risk factors. We show that secondary care patients, males and 45-64-year-olds exhibit a higher probability of being seropositive. The identification of risk factors and the differences in virus neutralisation activity between patient populations provided insights into the patterns of virus exposure during the first pandemic wave and shed light on what to expect in future waves