Differential effect of residual oil fly ash (ROFA), ambient particulate matter and diesel exhaust particle (DEP) on the human pulmonary alveolar epithelium

Epidemiological studies have shown that exposure to particulate matter (PM) contributes to cardiopulmonary morbidity and mortality. Evidence suggests that the diesel exhaust in ambient air in major cities mediates a significant proportion of the adverse health effects. However, it has been speculated that these effects might be increased in cities within the oil and gas producing countries as a result of a combined effect of inhaling both diesel exhaust particles (DEP) and residual oil fly ash (ROFA) It is hypothesised that the nature and degree of alveolar epithelial reactivity will depend on the physico-chemistry of the particles, and that DEP/ROFA mixture will result in greater bio-reactivity compared to the same amount of DEP and ROFA alone. The specific aim is to determine the physico-chemical characteristics of ambient PM, DEP, ROFA and DEP/ROFA mixture and to compare their cellular reactivity/effects on human alveolar epithelium in vitro. The physico-chemical composition of the particles was determined using transmission electron microscope and energy dispersive x-ray spectrometer (TEM/EDX) analysis. Primary human alveolar type 2 epithelial cells (AT2) and a transformed human alveolar type 1 (TT1) epithelial cell line were exposed to ambient particles, ROFA, DEP and a ROFA/ DEP (1:1) mixture. Reactive oxygen species (ROS) production and cell viability were evaluated using the dichlorofluorescin (DCFDA) and 3-(4, 5-dimethylthiazol-2-yl)-2, 5-diphenyltetrazolium (MTT) assay respectively. Enzyme-linked immunosorbent assay (ELISA) was used to quantify release of CXCL8, IL-6, and CCL2. TEM/EDX results revealed that transition metals and other reactive elements were present in the samples. The result also showed that ambient PM has an amorphous structure which made particle size difficult to determine. The estimated average diameters of ROFA and DEP were 74 ±17nm and 65 ± 2nm respectively. When mixed, it was 76 ± 24nm. Morphologically, these particles have large spherical, agglomerate and crystalline structures. Cellular exposures to PM were associated with significant increases in cytokine and chemokine release compared to non-treated controls (P< 0.002). At high concentrations (50 and 100μg/ml) the ROFA/DEP mixtures caused a significant increase in IL-6, CXCL8, and CCL2 release by TT-1 cells compared to exposure to an equivalent amount of DEP or ROFA alone (P<0.05). Ambient PM induced a higher level of mediator release compared to those observed with DEP while the DEP/ROFA mixture reduced cell viability and also triggerd rapid intracellular ROS release greater than that observed with ambient PM, DEP or ROFA alone. All these changes are concentration- and exposure time-dependent. However, the results are not statistically significant. In conclusion, DEP/ROFA mixture resulted in significant changes in cytokines/chemokines induction, ROS release and reduction in cell viability compared to DEP and ROFA alone (as well as PM). There was very little difference in particle size and shape, suggesting that differences between the reactivity of the test materials could be related to surface chemistry, for example elemental composition, although this could not be deduced in the current study. Other organic components might also be important, although they were not analysed in this investigation. Consequently, future work is needed to unravel the specific role of transition metals, as well as the organic and other inorganic components of the particles, in their cellular reactivity. It is also possible that mixing of ROFA and DEP causes reactions between volatile chemical components that enhances their cellular reactivity. These unique findings are of significance to those who live or work in cities where there are likely to be high levels of both types of emissions, which might have significant health effects

Estimating the uptake of brain imaging and 30-days stroke mortality in Nigeria : a meta-analysis of hospital-based studies

Purpose This study aims to estimate the computed tomography (CT) and Magnetic resonance imaging (MRI) uptake, stroke subtypes and 30-days case-fatality in Nigeria. Methods Stroke diagnosis and mortality data were identified from relevant databases. A random effect meta-analysis was conducted to obtain the pooled percentage uptake of CT/MRI, including 30-days case fatality and a meta-regression-like epidemiological model was applied on all data points. Findings A total of 24 studies involving 5874 stroke patients conducted in predominantly tertiary referral hospitals met the inclusion criteria. The pooled CT/MRI uptake in the last seven years was 46.66% (95% CI  = 15.35 to 77.98, 8 studies). There were significant variations in the prevalence of stroke subtypes. The pooled prevalence ischemic stroke was highest (55.32%, 95% CI 48.67 to 61.97, 16 studies), followed by intracerebral haemorrhage (ICH) (32.69%, 95% CI 25.54 to 39.83, 16 studies), subarachnoid haemorrhage (SAH) (3.76%, 95% CI 2.30 to 5.22, 14 studies). In addition, the stroke of undetermined aetiology was found to be 16.57% (95% CI, 7.44–25.70, 8 studies). Overall, the 24-h, one-week and 30-days case-fatality from stroke were 10.84% (95% CI, 4.48–17.20), 24.62% (95% CI, 17.20–32.04) and 33.28% (95% CI, 27.80–38.77), respectively. There was a moderate negative correlation between prevalence of brain imaging uptake and ischaemic stroke, albeit not statistically significant (Spearman rho = 0.333, p-value = .412). Conclusion Uptake of CT/MRI procedure for stroke is poor in Nigeria. Although poverty, inaccessibility and influence of major risk factors remain pronounced, scaling up of effective strategies for stroke prevention and management should be a major public health policy priority in Nigeria

Secular trends in the prevalence of female genital mutilation/cuttings among girls: a systematic analysis

Background Current evidence on the decline in the prevalence of female genital mutilation or cutting (FGM/C) has been lacking worldwide. This study analyses the prevalence estimates and secular trends in FGM/C over sustained periods (ie, 1990–2017). Its aim is to provide analytical evidence on the changing prevalence of FGM/C over time among girls aged 0–14 years and examine geographical variations in low-income and middle-income countries. Methods Analysis on the shift in prevalence of FGM/C was undertaken using the Demographic Health Survey (DHS) and Multiple Indicator Cluster Survey (MICS) data sets from Africa and Middle East. A random-effects model was used to derive overall prevalence estimates. Using Poisson regression models, we conducted time trends analyses on the FGM/C prevalence estimates between 1990 and 2017. Findings We included 90 DHS and MICS data sets for 208 195 children (0–14 years) from 29 countries spread across Africa and two countries in Western Asia. The prevalence of FGM/C among children varied greatly between countries and regions and also within countries over the survey periods. The percentage decline in the prevalence of FGM/C among children aged 0–14 years old was highest in East Africa, followed by North and West Africa. The prevalence decreased from 71.4% in 1995 to 8.0% in 2016 in East Africa. In North Africa, the prevalence decreased from 57.7% in 1990 to 14.1% in 2015. In West Africa, the prevalence decreased from 73.6% in 1996 to 25.4% in 2017. The results of the trend analysis showed a significant shift downwards in the prevalence of FGM/C among children aged 0–14 years in such regions and subregions of East Africa, North Africa and West Africa. East Africa has experienced a much faster decrease in the prevalence of the practice (trend=−7.3%, 95% CI −7.5% to −7.1%) per year from 1995 to 2014. By contrast, the decline in prevalence has been much slower in North Africa (trend=−4.4%, 95% CI −4.5% to −4.3%) and West Africa (trend=−3.0%, 95% CI −3.1% to −2.9%). Conclusion The prevalence of FGM/C among children aged 0–14 years varied greatly between countries and regions and also within countries over the survey periods. There is evidence of huge and significant decline in the prevalence of FGM/C among children across countries and regions. There is a need to sustain comprehensive intervention efforts and further targeted efforts in countries and regions still showing high prevalence of FGM/C among children, where the practice is still pervasive

Estimating morbidity due to stroke in Nigeria: a systematic review and meta-analysis

The response to stroke in Nigeria is impaired by inadequate epidemiologic information. We sought to collate available evidence and estimate the incidence of stroke and prevalence of stroke survivors in Nigeria. Using random effects meta-analysis, we pooled nationwide and regional incidence and prevalence of stroke from the estimates reported in each study. Eleven studies met our selection criteria. The pooled crude incidence of stroke in Nigeria was 26.0 (12.8-39.0) /100,000 person-years, with this higher among men at 34.1 (9.7-58.4) /100,000, compared to women at 21.2 (7.4-35.0) /100,000. The pooled crude prevalence of stroke survivors in Nigeria was 6.7 (5.8-7.7) /1000 population, with this also higher among men at 6.4 (5.1-7.6) /1000, compared to women at 4.4 (3.4-5.5) /1000. In the period 2000-2009, the incidence of stroke in Nigeria was 24.3 (95% CI: 11.9-36.8) per 100,000, with this increasing to 27.4 (95% CI: 2.2-52.7) per 100,000 from 2010 upwards. The prevalence of stroke survivors increased minimally from 6.0 (95% CI: 4.6-7.5) per 1000 to 7.5 (95% CI: 5.8-9.1) per 1000 over the same period. The prevalence of stroke survivors was highest in the South-south region at 13.4 (9.1-17.8) /100,000 and among rural dwellers at 10.8 (7.5-14.1) /100,000. Although study period does not appear to contribute substantially to variations in stroke morbidity in Nigeria, an increasing number of new cases compared to survivors may be due in part to limited door-door surveys, or possibly reflects an increasing mortality from stroke in the country. [Abstract copyright: Copyright © 2019 Elsevier B.V. All rights reserved.

Prevalence of dementia in Nigeria: a systematic review of the evidence

Background The burden of dementia is poorly understood in Nigeria. We sought to gather available epidemiologic evidence on dementia in Nigeria to provide country-wide estimates of its prevalence and associated risks. Methods We searched MEDLINE, EMBASE, Global Health, Africa Journals Online (AJOL) and Google Scholar for epidemiologic studies on dementia in Nigeria from 1990 to 2018. We pooled crude estimates using random effects meta-analysis. A meta-regression epidemiologic model, using the United Nations demographics for Nigeria, was used to estimate the absolute number of people living with dementia in Nigeria in 1995 and 2015. Results Our searches returned 835 studies, of which nine were selected. These included 10,820 individuals with a median age of 74.4 years. Heterogeneity ( I2 =98.8%, P<0.001) was high across studies. Five studies were conducted in the South-west, and four studies were rated as high quality. The pooled crude prevalence of dementia in Nigeria was 4.9% (95% confidence interval (CI) 3.0-6.9) with prevalence significantly higher in women (6.7%, 3.6-9.9) compared to men (3.1%, 1.2-5.0). Age 80+ (odds ratio (OR) 1.6, 1.3-1.9), female sex (OR 2.2, 1.4-3.4) and BMI ≤18.5 (OR 3.5, 1.2-10.1) were significant risks for dementia in Nigeria. Using our epidemiologic model, we estimated that the number of dementia cases increased by over 400% over a 20-year period, increasing from 63,512 in 1995 to 318,011 in 2015 among persons aged ≥60 years. Conclusion Our findings suggest the prevalence and cases of dementia have increased in Nigeria over the last two decades. Population-wide response to dementia is lacking

British Association of dermatologists guidelines for biologic therapy for psoriasis 2020 – a rapid update

The overall aim of the guideline is to provide up‐to‐date, evidence‐based recommendations on the use of biologic therapies targeting TNF (adalimumab, etanercept, certolizumab pegol, infliximab), IL12/23p40 (ustekinumab), IL17A (ixekizumab, secukinumab), IL17RA (brodalumab) and IL23p19 (guselkumab, risankizumab, tildrakizumab) in adults, children and young people for the treatment of psoriasis; consideration is given to the specific needs of people with psoriasis and psoriatic arthritis

Estimating the prevalence of overweight and obesity in Nigeria in 2020: a systematic review and meta-analysis

Background Targeted public health response to obesity in Nigeria is relatively low due to limited epidemiologic understanding. We aimed to estimate nationwide and sub-national prevalence of overweight and obesity in the adult Nigerian population. Methods MEDLINE, EMBASE, Global Health, and Africa Journals Online were systematically searched for relevant epidemiologic studies in Nigeria published on or after 01 January 1990. We assessed quality of studies and conducted a random-effects meta-analysis on extracted crude prevalence rates. Using a meta-regression model, we estimated the number of overweight and obese persons in Nigeria in the year 2020. Results From 35 studies (n = 52,816), the pooled crude prevalence rates of overweight and obesity in Nigeria were 25.0% (95% confidence interval, CI: 20.4–29.6) and 14.3% (95% CI: 12.0–15.5), respectively. The prevalence in women was higher compared to men at 25.5% (95% CI: 17.1–34.0) versus 25.2% (95% CI: 18.0–32.4) for overweight, and 19.8% (95% CI: 3.9–25.6) versus 12.9% (95% CI: 9.1–16.7) for obesity, respectively. The pooled mean body mass index (BMI) and waist circumference were 25.6 kg/m2 and 86.5 cm, respectively. We estimated that there were 21 million and 12 million overweight and obese persons in the Nigerian population aged 15 years or more in 2020, accounting for an age-adjusted prevalence of 20.3% and 11.6%, respectively. The prevalence rates of overweight and obesity were consistently higher among urban dwellers (27.2% and 14.4%) compared to rural dwellers (16.4% and 12.1%). Conclusions Our findings suggest a high prevalence of overweight and obesity in Nigeria. This is marked in urban Nigeria and among women, which may in part be due to widespread sedentary lifestyles and a surge in processed food outlets, largely reflective of a trend across many African settings

Epidemiology of physical inactivity in Nigeria: a systematic review and meta-analysis

Background Physical activity is crucial to preventing noncommunicable diseases. This study aimed to provide up-to-date evidence on the epidemiology of insufficient physical activity across Nigeria to increase awareness and prompt relevant policy and public health response. Methods A systematic literature search of community-based studies on physical inactivity was conducted. We constructed a meta-regression epidemiologic model to determine the age-adjusted prevalence and number of physically inactive persons in Nigeria for 1995 and 2020. Results Fifteen studies covering a population of 13 814 adults met our selection criteria. The pooled crude prevalence of physically inactive persons in Nigeria was 52.0% (95% CI: 33.7–70.4), with prevalence in women higher at 55.8% (95% CI: 29.4–82.3) compared to men at 49.3% (95% CI: 24.7–73.9). Across settings, prevalence of physically inactive persons was significantly higher among urban dwellers (56.8%, 35.3–78.4) compared to rural dwellers (18.9%, 11.9–49.8). Among persons aged 20–79 years, the total number of physically inactive persons increased from 14.4 million to 48.6 million between 1995 and 2020, equivalent to a 240% increase over the 25-year period. Conclusions A comprehensive and robust strategy that addresses occupational policies, town planning, awareness and information, and sociocultural and contextual issues is crucial to improving physical activity levels in Nigeria