The Contribution of Dysphagia to Acute Stroke Morbidity and Mortality in Nigeria: A Prospective Study

Background: The assessment of time-trend morbidity and mortality in acute stroke is critical to clinical policy decisions and resource allocation. Objectives: To determine the prevalence of dysphagia in acute stroke and the impact of dysphagia on short term stroke outcome (30 days post-stroke). Methods: This was a prospective longitudinal study. Bedside screening for dysphagia modified Rankin score (MRS) and Barthel Index (BI) were performed on acute stroke patients on day 1, day 7, day 14 and day 30 after stroke to determine the frequency of dysphagia. Patients with dysphagia were then compared with age- and gender-matched controls (stroke patients without dysphagia) in terms of stroke characteristics and 30-day outcome. Results:Of the recruited 200 patients, 99 (49.5%) had dysphagia. Patients with intracerebral haemorrhagic stroke had a significantly higher prevalence of dysphagia (64% vs 36%; p Conclusion: Severe stroke, subcortical stroke and haemorrhagic stroke types were significantly associated with dysphagia at baseline. Dysphagia adversely influenced 30-days morbidity and case fatality in this cohort of acute stroke patients

Sequences of numbers obtained by digit and iterative digit sums of Sophie Germain primes and its variants

Sequences were generated by the digit and iterative digit sums of Sophie Germain and Safe primes and their variants. The results of the digit and iterative digit sum of Sophie Germain and Safe primes were almost the same. The same applied to the square and cube of the respective primes. Also, the results of the digit and iterative digit sum of primes that are not Sophie Germain are the same with the primes that are notSafe. The results of the digit and iterative digit sum of prime that are either Sophie Germain or Safe are like the combination of the results of the respective primes when considered separatel

Development and Evaluation of a Combined Castor Seed Roaster-Oil Expeller

This study evaluated optimal process parameters for mechanical oil expression from castor seeds after designing a castor seed roaster-expeller. The effect of input variables (Moisture Content at 6, 7, 8, 9 and 10% db; Roasting Temperature at 80, 90, 100,110 and 120oC and Applied Pressure at 15, 20, 25, 30 and 35 MPa) on the oil yield, expression efficiency, expression loss and energy used were determined using Central Composite Design in Response Surface Methodology for the optimization and modelling. Analysis of Variance was employed to determine the level of significance (P≤ 0.05). The optimum expression efficiency, expression loss and minimum energy used were 72.86%, 0.63% and 584.19 Watts obtained at experimental conditions of 15.00 MPa applied pressure, 6% moisture content and 85.52°C heating temperature respectively. The R2 values of the developed models ranged from 0.813 to 0.982 at 95% confidence level. The developed combined castor seed roaster-oil expeller was found to be efficient and developed models showed adequate prediction with good relationships between dependent and independent variables. Keywords: castor seed, oil extraction, modeling, optimization DOI: 10.7176/ISDE/11-1-07 Publication date: January 31st 2020

Genetic Variations, Heritability and Genetic Advance Studies among Okra Accessions grown in different Agro-ecological Zones in Nigeria

Some level of variation within crop varieties is highly important for its improvement with the aids of good plant breeding methods. A field research experiment was carried out with the aim to estimate genetic variation and heritability in the okra accessions grown in different agro-ecological zones in Nigeria. Twenty okra accessions were obtained from various locations in different agro-ecological zones of Nigeria. Twenty okra accessions were evaluated between April to August 2018 at Ekiti State University Teaching and Research Farm, Ekiti State. These twenty okra accessions constituted the treatment, which was lied out in a RCBD in a three replicates. The result were highly significant (p<0.01) for all the traits studied. Magnitude of the phenotypic coefficient of variances were slightly higher than genotypic coefficient of variances in this study which showed that environment did not much influence the estimates of genetic performance. The coefficient of phenotypic and genotypic variances were high in the traits studied. Heritability estimates ranges from 75.04% for days to 50% flowering to 98.85% for weight of 100 seeds. High heritability with high genetic advance were observed for all the studied traits indicating that they are governed by additive gene action and this could be improved through simple selection except days to 50% flowering with the lowest heritability value coupled with the lowest genetic advance value lesser than 10%

Determinants of skilled care utilization among pregnant women residents in an urban community in Kwara State, Northcentral Nigeria

Background: Skilled attendant at delivery (SBA) is one of the key indicators used in assessing progress towards improved maternal health. This study aimed at identifying factors influencing SBA utilization in Ilorin, Nigeria.Methods: This cross-sectional study was carried out using multi-stage sampling technique among 400 participants in Ilorin, Northcentral Nigeria. A pre-tested questionnaire was used for data collection, and data analysis was done using descriptive and inferential statistics.Results: SBA supervised 73.8% births. Determinants of skilled birth attendance at delivery include higher education (AOR; 10.94, 95% CI; 3.60-33.26), having only one child (AOR; 4.33, 95% CI; 1.18-15.82), having at least 4 ANC attendance (AOR; 18.84, 95% CI; 8.95-55.82) and residing near delivery sites (AOR; 11.49, 95% CI; 2.43-55.56).Conclusion: The proportion of births supervised by SBA needs improvement in Northcentral Nigeria. Full implementation of reproductive health policies will enhance skilled births in Nigeria.Keywords: Skilled birth attendants, Antenatal care, utilizatio

Otorhinolaryngological Manifestation of Allergy in South Western Nigerian Children

Background: Allergy is a systemic, chronic and recurrent disorder of otorhinolaryngological importance. This disorder is often neglected with late presentation in paediatric age group. This study aimed at determining the prevalence, sociodemographic features, trigger factors, clinical features, complications, quality of life, associated comorbid illnesses and treatment outcome among children. Materials and Methods: This was a prospective hospital based study of children with allergy in our center. The study was carried out over a period of one year from May 2017 to April 2018. Data were obtained by using pretested self-administered questionnaire. Data obtained were documented, collated and analyzed by using SPSS version 18.0 Results: Prevalence of allergy in this study was 8.6%. There were 60.2% male with male to female ratio of 1.5:1. There was positive family history of allergy in 55.9% patients. Perennial allergy was the commonest in 68.3% of the children. Major forms of allergens were 71.5% inhalant and 9.7% ingestant. The common self-reported trigger factors were dust, cold weather and smoke in 58.1%, 41.9% and 22.0% respectively. Major associated comorbid illnesses in this study were 43.5% adenotonsillar hypertrophy. Commonest allergic symptoms were runny nose in 38.7%. The commonest affected organ was nose in 46.8%. Commonly affected quality of life was 22.6% irritability, 20.4% absenteeism, 19.9% sleep disruption and 12.9% impaired social life. Common complications were 48.9% secondary infection, 46.2% otitis media/externa, 44.1% injury, 42.5% foreign body impaction and 40.3% pharyngitis. Treatment of allergy leads to improvement and recovery from the clinical features in 52.2%. No significant improvement in 47.8%. Conclusion: Allergy is a systemic disease affecting ear, nose and throat. It affects all paediatric age group with associated comorbid illnesses, complications and affectation of quality of life at presentation in majority of the patients

Contributions of uterine fibroids to infertility at Ile‑Ife, South‑Western Nigeria

Background: Uterine fibroid is the most common tumor of the female genital tract. The benign tumors often grow into large sizes and assume unsightly shapes with concomitant symptoms and signs. Being a predominantly reproductive age disease, concurrent infertility and symptomatic uterine fibroids pose management challenges. Individualization of the patient is thus essential to the success of the reproductive outcome.Objectives: This study determined the prevalence, trend, management modalities, pregnancy outcome, and exposition of factors affecting pregnancy outcome among patients presenting with uterine fibroids and infertility at the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC).Materials and Methods: This is a retrospective study of case records of 106 women managed for uterine fibroids and infertility over a 5‑year period (January 1, 2012, to December 31, 2016) at the OAUTHC. The outcome measure is the pregnancy rate among those who had a myomectomy.Results: About a quarter of women with infertility had symptomatic uterine fibroids and this represents about 35%–40% of the overall number of women presenting as uterine fibroid within the study. About 84.9% had uterine size &gt;12 weeks at presentation. Two‑third of the patients had open myomectomy alone with 43.9% achieving conception thereafter. Conception rate for myomectomy with tuboplasty was 31.3% whereas myomectomy with subsequent in vitro fertilization (IVF) was 50%. Pregnancy rate decreased with increasing size of the uterus before myomectomy.Conclusion: Symptomatic fibroid was significantly prevalent among women with infertility. Myomectomy improves fertility potential and success rate of IVF. Uterine fibroid has both direct and indirect effect on infertility and pregnancy rate in this group of the patient can be improved through routine screening for uterine fibroids and early removal of the fibroids before they grow into giants size.Keywords: Infertility; myomectomy; pregnancy outcome; uterine fibroid

Primary umbilical endometriosis: Radical excision (omphalectomy) and laparoscopic management of associated pelvic endometriosis in a low resource tertiary hospital

Primary umbilical endometriosis (PUE) is a rare condition affecting 0.5 – 1% of all extragenital endometriosis cases. We reviewed the data of five women with umbilical endometriosis retrospectively. The age range was 29 – 46 years, and they were all nulligravid at presentation. Common clinical presentation was umbilical pain and masses, dysmenorrhea, and primary infertility. Radical umbilical excision was performed to remove the nodule as a definitive treatment. Diagnostic laparoscopy was performed, followed by varying degrees of operative laparoscopic procedures. They all had endometriosis in the pelvis. Three out of five women operated became pregnant and had live births. Complete resolution of clinical symptoms with a reduction in umbilical and menstrual pain scores occurred. In resource-constrained settings, diagnosis, and treatment of PUE may be challenging. Clinical suspicion and appropriate case management are critical for good reproductive outcomes and quality of life. &nbsp; L'endométriose ombilicale primaire (PUE) est une maladie rare affectant 0,5 à 1 % de tous les cas d'endométriose extragénitale. Nous avons examiné les données de cinq femmes atteintes d'endométriose ombilicale rétrospectivement. La tranche d'âge était de 29 à 46 ans, et ils étaient tous nulligravides à la présentation. Le tableau clinique commun était la douleur et les masses ombilicales, la dysménorrhée et l'infertilité primaire. Une excision ombilicale radicale a été réalisée pour retirer le nodule comme traitement définitif. La laparoscopie diagnostique a été réalisée, suivie de divers degrés de procédures laparoscopiques opératoires. Ils avaient tous une endométriose du bassin. Trois femmes opérées sur cinq sont tombées enceintes et ont eu des naissances vivantes. Une résolution complète des symptômes cliniques avec une réduction des scores de douleur ombilicale et menstruelle s'est produite. Dans les milieux à ressources limitées, le diagnostic et le traitement du PUE peuvent être difficiles. La suspicion clinique et une prise en charge appropriée des cas sont essentielles pour de bons résultats en matière de reproduction et une bonne qualité de vie

A reliability and validity study of the Palliative Performance Scale

<p>Abstract</p> <p>Background</p> <p>The Palliative Performance Scale (PPS) was first introduced in1996 as a new tool for measurement of performance status in palliative care. PPS has been used in many countries and has been translated into other languages.</p> <p>Methods</p> <p>This study evaluated the reliability and validity of PPS. A web-based, case scenarios study with a test-retest format was used to determine reliability. Fifty-three participants were recruited and randomly divided into two groups, each evaluating 11 cases at two time points. The validity study was based on the content validation of 15 palliative care experts conducted over telephone interviews, with discussion on five themes: PPS as clinical assessment tool, the usefulness of PPS, PPS scores affecting decision making, the problems in using PPS, and the adequacy of PPS instruction.</p> <p>Results</p> <p>The intraclass correlation coefficients for absolute agreement were 0.959 and 0.964 for Group 1, at Time-1 and Time-2; 0.951 and 0.931 for Group 2, at Time-1 and Time-2 respectively. Results showed that the participants were consistent in their scoring over the two times, with a mean Cohen's kappa of 0.67 for Group 1 and 0.71 for Group 2. In the validity study, all experts agreed that PPS is a valuable clinical assessment tool in palliative care. Many of them have already incorporated PPS as part of their practice standard.</p> <p>Conclusion</p> <p>The results of the reliability study demonstrated that PPS is a reliable tool. The validity study found that most experts did not feel a need to further modify PPS and, only two experts requested that some performance status measures be defined more clearly. Areas of PPS use include prognostication, disease monitoring, care planning, hospital resource allocation, clinical teaching and research. PPS is also a good communication tool between palliative care workers.</p

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London