Self-harm with suicidal and non-suicidal intent in young people in sub-Saharan Africa: a systematic review

Background: Self-harm, whether attributed to suicidal or non-suicidal motives, is associated with several poor outcomes in young people, including eventual suicide. Much of our understanding of self-harm in young people is based on literature from Europe (particularly, the UK), North America, and Australia. We aimed to synthesise the available evidence on prevalence, the commonly reported self-harm methods, correlates, risk and protective factors, and reasons for self-harm, in adolescents (aged 10–25 years) in sub-Saharan Africa. Method: We searched MEDLINE, PsycINFO, PubMed, African Journals OnLine, and African Index Medicus for records from 1950 through August 2019, without language restrictions. We supplemented the database searches by searching relevant portals for postgraduate theses, reference harvesting, contacting authors for unpublished studies, and hand searching relevant print sources. We applied narrative synthesis to the evidence. Results: Seventy-four studies from 18 sub-Saharan African countries met the inclusion criteria. The median lifetime prevalence estimate was 10·3% (interquartile range [IQR] 4·6% – 16·1%); median 12-month prevalence estimate was 16·9% (IQR: 11·5% – 25·5%); median 6-month prevalence estimate was 18·2% (IQR: 12·7% – 21·8%); and the median 1-month prevalence estimate was 3·2% (IQR: 2·5–14·8%). Studies from Western sub-Saharan Africa reported the highest 12-month prevalence estimates (median = 24·3%; IQR = 16·9% – 27·9%). Clinical samples commonly reported overdose, whereas self-cutting was most commonly reported in non-clinical samples. Academic failure, sexual, emotional, and physical abuse, romantic relationship problems, family conflict, depression, and previous self-harm were identified as key correlates of self-harm. No study reported protective factors against self-harm. Conclusion: Variation in estimates was explained by small sample sizes and variation in definitions and measures used. Exploration of associations, risks and protective factors was based upon concepts and measures derived from high income countries. More detailed and culturally sensitive research is needed to understand the context-specific risks and protective factors for self-harm in adolescents in sub-Saharan Africa

Inevitable Caesarean Myomectomy

The standard teaching is to avoid caesarean myomectomy as much as possible for the fear of the attendant severe haemorrhage. Classical caesarean section in spite of its risk of uterine rupture in subsequentpregnancies had been prescribed in its place.We report a case of a 32 year old nullipara who had an inevitable removal of a huge intramural fibroid in order to assess the baby. A high dose oxytocin infusion, and skillful surgeryensured minimal intra operative and post operative blood loss.Keywords: caesarean myomectomy, inevitable, fibroid

Hepatitis B Vaccination Status and Needle stick Injuries among Medical Students in a Nigerian University

Background: Hepatits B virus (HBV) is the most common blood borne pathogen that poses an occupational risk to Health-care workers. The incidence of infection following needle stick injury has been reported to be high among medical students. Effective vaccines against HBV are available. The aim of this study was to determine the vaccination status and prevalence of needlestick injury among medical students in a tertiary institution in a developing country (Nigeria). Method: Information regarding hepatitis B status, history of needlestick injury and awareness of risk factors for HBV were obtained from clinical medical students using a self administered questionnaire. Three hundred and forty six students responded. Results: Three hundred and five (88.7%) agreed that medical education exposes one to HBV infection and 315 (91.6%) were aware of the availability of vaccine against HBV. Only 42 (47.7%) were vaccinated against HBV. Majority (57.4%) gave lack of opportunity as reason for non immunization while 34.7% had never given it a thought. One hundred and sixty-six (48%) of the respondents admitted to a previous needlestick injury and only 17 (10.2%) of those who reported history of needlestick injury had post-exposure prophylaxis against HBV infection. Conclusion: HBV vaccination status is very low among medical students in Nigeria and the prevalence of needle stick injuries is high. Universities must not only provide HBV vaccination free of charge but also enforce its use by these students. Nigerian Journal of Medicine Vol. 17 (3) 2008: pp. 330-33

Rosai-Dorfman Disease: A Diagnostic Albatross in a Female Patient with Bilateral Persistent Neck Masses. A Case Report

RosaiDorfman disease (sinus histiocytosis with massive lymphadenopathy) is an uncommon benign and often self limiting lymphoproliferative disease of unknown aetiology which was first described by Rosai and Dorfman in 1969. It usually presents with a multiple progressive painless bilateral cervical lymphadenopathy, low grade fever, polyclonal hypergammaglobulinemia and raised erythrocyte sedimentation rate. Extranodal diseases are uncommon but have been documented. Due to the rarity of this condition, the diagnosis may not be suspected clinically and fine needle aspiration cytology of neck nodes may miss the diagnosis. In this study, we present a 24 year old female who presented with bilateral cervical lymphadenopathy and right breast lump since childhood

Optimization of trial wave functions for use in quantum Monte Carlo with application to LiH

Methods for both partial and full optimization of wavefunction parameters are explored, and these are applied to the LiH molecule. A partial optimization can be easily performed with little difficulty. But to perform a full optimization we must avoid a wrong minimum, and deal with linear-dependency, time step-dependency and ensemble-dependency problems. Five basis sets are examined. The optimized wavefunction with a 3-function set gives a variational energy of -7.998 + 0.005 a.u., which is comparable to that (-7.990 + 0.003) 1 of Reynold's unoptimized \fin ( a double-~ set of eight functions). The optimized wavefunction with a double~ plus 3dz2 set gives ari energy of -8.052 + 0.003 a.u., which is comparable with the fixed-node energy (-8.059 + 0.004)1 of the \fin. The optimized double-~ function itself gives an energy of -8.049 + 0.002 a.u. Each number above was obtained on a Bourrghs 7900 mainframe computer with 14 -15 hrs CPU time

Enhancement of baryon-to-meson ratios around jets as a signature of medium response

We present a unique signal of jet-induced medium excitations: the enhancement of baryon-to-meson ratios around the quenched jets. To illustrate this, we study jet-particle correlations and the distributions of jet-induced identified particles with respect to the jet direction in Pb+Pb collisions at the LHC via a multi-phase transport model. We find a strong enhancement of baryon-to-meson ratios for associated particles at intermediate transverse momentum around the triggered jets in Pb+Pb collisions relative to p+p collisions, due to the coalescence of jet-excited medium partons. Since the lost energy from jets can diffuse to large angles, such baryon-to-meson-ratio enhancement is more pronounced for larger relative distance from the jet axis. We argue that the experimental confirmation of the enhancement of jet-induced baryon-to-meson ratios around the jets will provide an unambiguous evidence for the medium response to jet quenching in heavy-ion collisions.Comment: 6 pages, 3 figure

Relation Between Helicobacter Pylori, Inflammatory (neutrophil) Activity, Chronic Gastritis, Gastric Atrophy And Intestinal Metaplasia

Background: To determine the relation of Helicobacter pylori infection with chronic inflammation, atrophy, activity level and intestinal metaplasia. Patients and Methods: A cross-sectional study of 100 consecutive patients with dyspepsia. These patients were fasted for 12 hours and gastroscopic biopsy specimens were obtained from their gastric mucosae. The specimens were histologically evaluated for H. pylori, inflammatory activity, chronic inflammation, gastric atrophy and intestinal metaplasia. Results: There were 50(50%) females and 50(50%) males. The average ages of women and men were 36.3±11.5 and 42.9±12.8 respectively. Helicobacter pylori was found in 79%. Neutrophil activity was observed in 83%. Inflammation was found in 95%, glandular atrophy in 38%, intestinal metaplasia in 28% of the cases. Incidental (early gastric) cancer was found in 3%, dysplasia in 2% and reactive gastropathy in 7% of the cases. A statistically significant relationship was found between Helicobacter pylori colonization intensity and the degrees of neutrophil activity, chronic inflammation and intestinal metaplasia. Conclusion: We concluded that Helicobacter pylori infection results in neutrophil activation and chronic gastritis, and that it has a role in the development of intestinal metaplasia. The greater the intensity of Helicobacter pylori infection, the greater the degrees of neutrophil activation, chronic gastritis and intestinal metaplasia. Keywords: Helicobacter pylori, Gastritis, atrophy, Intestinal metaplasia, Gastric cancer, Jos Nigerian Journal of Clinical Practice Vol. 11 (3) 2008: pp. 270-27

Numerical Calibration of Steiner trees

International audienceIn this paper we propose a variational approach to the Steiner tree problem, which is based on calibrations in a suitable algebraic environment for polyhedral chains which represent our candidates. This approach turns out to be very efficient from numerical point of view and allows to establish whether a given Steiner tree is optimal. Several examples are provided

National neonatal resuscitation training program in Nigeria (2008-2012): A preliminary report

Background: Routine institutional training of doctors and nurses on newborn resuscitation have commenced, to improve the quality of resuscitation available to high-risk babies, in Nigeria, as a means of reducing newborn deaths in the country. Perinatal asphyxia contributes to 26% of newborn deaths in Nigeria. Perinatal asphyxia results when babies have difficulty establishing spontaneous respiration after birth.Materials and Methods: Between 2008 and 2012, doctors and nurses drawn from all the geo.political zones were trained using the Neonatal  Resuscitation Training (NRT) manual of the American Heart Association and the American Academy of Pediatrics. Questionnaire.based, cross.sectional surveys of doctor and nurse trainees from the six geo.political zones in Nigeria were conducted eight months after the primary training, to evaluate the post.training  neonatal resuscitation activities.Results: Over the period of study, 357 doctors and 370 nurse/midwives were primarily trained in NRT. The overall ratio of step down training was 1:22 with 1:18 for doctors and 1:26 for nurses. In 2008, the delivery attendance rates were 11 per doctor and 9 per nurse/midwife. These rates increased to 30 per doctor and 47 per nurse in 2012. Between 88 and 94% of the doctors and between 72 and 93% of the nurses successfully used bag and mask to help babies breathe in the post.training period. The nurses used bag and mask for infant resuscitation more frequently,   compared to doctors, with the rate fluctuating between two.to.one and four.to.one. Over the years, 87 to 94% of the doctors and 92 to 97% of the nurses/midwives trained other birth attendants.Conclusion: The NRT in Nigeria is well.subscribed and the frequency of secondary training is good.Key words: Birth asphyxia, birth attendants, delivery room care, neonatal resuscitation training, perinatal mortalit