Gynaecological malignancies in Azare, North-East Nigeria: an assessment of types, stage at presentation and treatment affordability

Background: In many parts of the world, presentations for most gynecological cancers are late; this makes treatment difficult due to the cost of chemotherapy or radiotherapy which form the bedrock for cure or palliation. Objective of this study was to determine the types, stage at diagnosis, affordability of care and outcome of treatment of gynaecological cancers in Federal Medical Centre Azare, Bauchi State, Nigeria.Methods: All cases of gynaecological cancers seen over a ten-year period, from 1st January, 2003 to 31st December, 2012 were reviewed retrospectively. The number of all gynaecological cases seen during the period was also extracted.Results: Gynaecological cancer cases accounted for 11.84 % of 8,642 gynaecological cases seen during the period of study.  The mean age and parity of the women were 42±5 SD years and 5±1 SD respectively. Cervical cancer accounted for 55 %, ovarian cancer 30%, endometrial cancer 6%, choriocarcinoma 5%, secondaries/ cancers of undetermined origin were 4%.  Ninety-two percent presented with advanced stage of diseases. Only 25.3% could afford the cost of full treatment, and 8.4% attained cure of their disease. The modalities of treatment available were surgery and chemotherapy.Conclusions: Cervical and Ovarian Cancers remain the leading types of gynaecological cancers in our environment and late presentations are frequent occurrence. Late presentation and unaffordability of treatments are major challenges associated with the management of these patients. Early presentation and funding mechanisms for gynaecological cancers are keys to improved cure rate and reduced mortality

Local Rice Production Trend Analyses and Consumption in Benue State, Nigeria: 1980 – 2016

The research examined local rice production trends and factors inhibiting the consumption of local rice from 1980 to 2016 in Benue State. Primary data were collected with the aid of questionnaire in Benue State, while secondary data were obtained from Benue Agricultural and Rural Development Authority (BNARDA) in 2017. Multistage random sampling method was employed in selecting respondents. Primary data were collected from one hundred and fifty six (156) respondents. Descriptive statistics, Z – test, Growth model and Kendal’s coefficient of concordance were used for the analysis. The results revealed that from 1980 to 2016, a total of 9.5mt of local rice was produced in Benue State. The result also shows that the respondents were all married (99%), with household size of 1 - 10 persons (95%) and mean household size of about 8 persons. The result further indicated that majority of respondents’ attained tertiary school level. The result also shows that the respondents had low income (40.3%).  The mean quantity of local rice production was 257,333.06mt per year. The instantaneous growth trends of local rice production and price were 0.00122 and 0.01103, and compound growth rate as 3.72 and 3.76 respectively. The result also indicated that many of the respondents were above the age of 41 years (49%) with the mean age of 47 and all respondents male. The presence of stones, poor aroma, impure rice and broken grain were some of the factors inhibiting consumption of local rice in Benue State. The study recommended that the policies that focus on increasing growth rate of local rice in Benue State should be intensified. Breeders and Scientists should make effort in breeding rice with aroma. The processors of local rice should use modern processing mills like rice polisher and des-stoners to mill quality local rice that will be acceptable to consumers

Morphological, anatomical and molecular characterisation of the leaves of Isoberlinia doka Craib and Stapf and Isoberlinia tomentosa (Harms) Craib and Stapf

Background: Isoberlinia (Craib and Stapf) is a genus with high economic and pharmacological values. Aim: This study aimed at establishing the morphological, anatomical and molecular characterisation of the leaves of I. doka and I. tomentosa, which were conducted for proper authentication. Setting: The leaves of I. doka and I. tomentosa were obtained from Shika, kaduna State, Nigeria. Method: Morphological and anatomical characters were determined according to standard procedures, while molecular identifications were performed using ribulose-1,5-bisphosphate carboxylase (rbcl) gene and internal transcribed spacer (ITS) DNA barcode’s region. Result: Morphological studies revealed similar features for both species except for the shiny leaves of I. doka and rough abaxial surfaces of I. tomentosa because of the presence of trichomes. Variations were observed in their epidermal features, stomatal index, stomata frequency, presence or absence of trichomes, trichomes frequency and their quantitative anatomical features. The quantity and quality of DNA measured at A260/280 ratio using nanodrop spectrophotometer were 29.1 ng/μL and 1.74 ng/μL for I. doka, respectively, while the I. tomentosa concentration and purity were 71.1 ng/μL and 1.85 ng/μL, respectively. Agarose gel electrophoresis revealed two DNA bands with 700 bp (rbcl) and 600 bp (ITS). The sequence analysis revealed maximum identity with National Centre for Biotechnology Information (NCBI) GeneBank Isoberlinia species. Evolutionary analysis supported the monophyletic origin of the genus Isoberlinia. The morphological and anatomical characters of I. doka and I. tomentosa leaves have provided a significant taxonomy tool for proper authentication of this plant. Conclusion: The findings ascertained that ITS and rbcl served as an improved and efficient tool for species identification of these studied species and could serve as potential DNA barcodes for these taxa. Contribution: This article suggests that further studies the on screening of these plants, for various pharmacological potentials, might be useful for new drug development

Intravenous versus oral iron for iron deficiency anaemia in pregnant Nigerian women (IVON): study protocol for a randomised hybrid effectiveness-implementation trial

Background Anaemia in pregnancy is highly prevalent in African countries. High-dose oral iron is the current recommended treatment for pregnancy-related iron deficiency anaemia (IDA) in Nigeria and other African countries. This oral regimen is often poorly tolerated and has several side effects. Parenteral iron preparations are now available for the treatment of IDA in pregnancy but not widely used in Africa. The IVON trial is investigating the comparative effectiveness and safety of intravenous ferric carboxymaltose versus oral ferrous sulphate standard-of-care for pregnancy-related IDA in Nigeria. We will also measure the implementation outcomes of acceptability, feasibility, fidelity, and cost-effectiveness for intravenous ferric carboxymaltose. Methods This is an open-label randomised controlled trial with a hybrid type 1 effectiveness-implementation design, conducted at 10 health facilities in Kano (Northern) and Lagos (Southern) states in Nigeria. A total of 1056 pregnant women at 20–32 weeks’ gestational age with moderate or severe anaemia (Hb < 10g/dl) will be randomised 1:1 into two groups. The interventional treatment is one 1000-mg dose of intravenous ferric carboxymaltose at enrolment; the control treatment is thrice daily oral ferrous sulphate (195 mg elemental iron daily), from enrolment till 6 weeks postpartum. Primary outcome measures are (1) the prevalence of maternal anaemia at 36 weeks and (2) infant preterm birth (<37 weeks’ gestation) and will be analysed by intention-to-treat. Maternal full blood count and iron panel will be assayed at 4 weeks post-enrolment, 36 weeks’ gestation, delivery, and 6 weeks postpartum. Implementation outcomes of acceptability, feasibility, fidelity, and cost will be assessed with structured questionnaires, key informant interviews, and focus group discussions. Discussion The IVON trial could provide both effectiveness and implementation evidence to guide policy for integration and uptake of intravenous iron for treating anaemia in pregnancy in Nigeria and similar resource-limited, high-burden settings. If found effective, further studies exploring different intravenous iron doses are planned. Trial registration ISRCTN registry ISRCTN63484804. Registered on 10 December 2020. Clinicaltrials.govNCT04976179. Registered on 26 July 2021 The current protocol version is version 2.1 (080/080/2021)

Intravenous versus oral iron for iron deficiency anaemia in pregnant Nigerian women (IVON): study protocol for a randomised hybrid effectiveness-implementation trial.

BACKGROUND: Anaemia in pregnancy is highly prevalent in African countries. High-dose oral iron is the current recommended treatment for pregnancy-related iron deficiency anaemia (IDA) in Nigeria and other African countries. This oral regimen is often poorly tolerated and has several side effects. Parenteral iron preparations are now available for the treatment of IDA in pregnancy but not widely used in Africa. The IVON trial is investigating the comparative effectiveness and safety of intravenous ferric carboxymaltose versus oral ferrous sulphate standard-of-care for pregnancy-related IDA in Nigeria. We will also measure the implementation outcomes of acceptability, feasibility, fidelity, and cost-effectiveness for intravenous ferric carboxymaltose. METHODS: This is an open-label randomised controlled trial with a hybrid type 1 effectiveness-implementation design, conducted at 10 health facilities in Kano (Northern) and Lagos (Southern) states in Nigeria. A total of 1056 pregnant women at 20-32 weeks' gestational age with moderate or severe anaemia (Hb < 10g/dl) will be randomised 1:1 into two groups. The interventional treatment is one 1000-mg dose of intravenous ferric carboxymaltose at enrolment; the control treatment is thrice daily oral ferrous sulphate (195 mg elemental iron daily), from enrolment till 6 weeks postpartum. Primary outcome measures are (1) the prevalence of maternal anaemia at 36 weeks and (2) infant preterm birth (<37 weeks' gestation) and will be analysed by intention-to-treat. Maternal full blood count and iron panel will be assayed at 4 weeks post-enrolment, 36 weeks' gestation, delivery, and 6 weeks postpartum. Implementation outcomes of acceptability, feasibility, fidelity, and cost will be assessed with structured questionnaires, key informant interviews, and focus group discussions. DISCUSSION: The IVON trial could provide both effectiveness and implementation evidence to guide policy for integration and uptake of intravenous iron for treating anaemia in pregnancy in Nigeria and similar resource-limited, high-burden settings. If found effective, further studies exploring different intravenous iron doses are planned. TRIAL REGISTRATION: ISRCTN registry ISRCTN63484804 . Registered on 10 December 2020 Clinicaltrials.gov NCT04976179 . Registered on 26 July 2021 The current protocol version is version 2.1 (080/080/2021)

Can the Non-pneumatic Anti-Shock Garment (NASG) reduce adverse maternal outcomes from postpartum hemorrhage? Evidence from Egypt and Nigeria

<p>Abstract</p> <p>Background</p> <p>Postpartum hemorrhage (PPH) is the leading cause of maternal mortality and severe maternal morbidity. The Non-pneumatic Anti-Shock Garment (NASG), a first-aid lower-body compression device, may decrease adverse outcomes from obstetric hemorrhage. This article is the first to report the effect of the NASG for PPH.</p> <p>Methods</p> <p>This pre-intervention/NASG study of 854 women was conducted in four referral facilities in Nigeria and two in Egypt between 2004-2008. Entry criteria were women with PPH due to uterine atony, retained placenta, ruptured uterus, vaginal or cervical lacerations or placenta accreta with estimated blood loss of ≥ 750 mL and one clinical sign of shock. Differences in demographics, conditions on study entry, treatment and outcomes were examined. The Wilcoxon rank-sum test and relative risks with 95% confidence intervals were calculated for primary outcomes - measured blood loss, emergency hysterectomy, mortality, morbidity (each individually), and a combined variable, "adverse outcomes", defined as severe morbidity and mortality. A multiple logistic regression model was fitted to test the independent association between the NASG and the combined severe morbidity and mortality outcome.</p> <p>Results</p> <p>Measured blood loss decreased by 50% between phases; women experienced 400 mL of median blood loss after study entry in the pre-intervention and 200 mL in the NASG phase (p < 0.0001). As individual outcomes, mortality decreased from 9% pre-intervention to 3.1% in the NASG phase (RR 0.35, 95% CI 0.19-0.62); severe morbidity decreased from 4.2% to 1%, in the NASG phase (RR 0.24, 95% CI 0.09-0.67). As a combination, "adverse outcomes," decreased from 12.8% to 4.1% in the NASG phase (RR 0.32, 95% CI 0.19-0.53). In a multiple logistic regression model, the NASG was associated with the combined outcome of severe maternal morbidity and mortality (OR 0.42, 95% CI 0.18-0.99).</p> <p>Conclusion</p> <p>In this non-randomized study, in which bias is inherent, the NASG showed promise for reducing blood loss, emergency hysterectomy, morbidity and mortality associated with PPH in referral facilities in Egypt and Nigeria.</p

Diagnostic characteristics of the 20-minute whole blood clotting test in detecting venom-induced consumptive coagulopathy following carpet viper envenoming

Introduction Envenoming by Echis spp. (carpet or saw-scaled vipers) causes haemorrhage and coagulopathy and represents a significant proportion of snakebites in the savannah regions of West Africa. Early diagnosis of envenoming is crucial in the management of these patients and there is limited evidence on the utility of the 20-minute whole blood clotting test (20WBCT) in diagnosing venom-induced consumptive coagulopathy (VICC) following envenoming by Echis ocellatus. Methods A prospective observational cohort study was conducted at the Kaltungo General Hospital in North-eastern Nigeria from September 2019 to September 2021. Standardised 20WBCTs were conducted by trained hospital staff and citrated plasma samples were collected at numerous timepoints. Prothrombin time (PT) and international normalised ratio (INR) were determined using a semi-automated analyser and INR values were calculated using international sensitivity indices (ISI). The sensitivity, specificity, positive predictive values (PPV), negative predictive values (NPV), and likelihood ratios of the 20WBCT compared to an INR ≥ 1.4 were calculated, alongside 95% confidence intervals. Results We enrolled 121 patients into our study, with a median age of 26 (18.0–35.0) years and a male predominance (75.2%). The 20WBCT was positive (abnormal) in 101 out of 121 patients at timepoint 0h, of which 95 had an INR ≥ 1.4, giving a sensitivity of 87.2% (95%CI 79.4–92.8). Among patients with a negative 20WBCT (normal), six had an INR < 1.4 giving a specificity of 50% (95%CI 21.1–78.9%). The positive and negative likelihood ratios were 1.7 (95%CI 1.6–1.9) and 0.3 (95%CI 0.1–0.4) respectively. Conclusion The 20WBCT is a simple, cheap, and easily accessible bedside test with a high sensitivity for the detection of patients with venom induced consumptive coagulopathy (VICC) following envenoming by E. ocellatus, although false positives do occur. Repeated 20WBCTs can identify patients with new, persistent, and rebound coagulopathy

Global, regional, and national burden of disorders affecting the nervous system, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BackgroundDisorders affecting the nervous system are diverse and include neurodevelopmental disorders, late-life neurodegeneration, and newly emergent conditions, such as cognitive impairment following COVID-19. Previous publications from the Global Burden of Disease, Injuries, and Risk Factor Study estimated the burden of 15 neurological conditions in 2015 and 2016, but these analyses did not include neurodevelopmental disorders, as defined by the International Classification of Diseases (ICD)-11, or a subset of cases of congenital, neonatal, and infectious conditions that cause neurological damage. Here, we estimate nervous system health loss caused by 37 unique conditions and their associated risk factors globally, regionally, and nationally from 1990 to 2021.MethodsWe estimated mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs), with corresponding 95% uncertainty intervals (UIs), by age and sex in 204 countries and territories, from 1990 to 2021. We included morbidity and deaths due to neurological conditions, for which health loss is directly due to damage to the CNS or peripheral nervous system. We also isolated neurological health loss from conditions for which nervous system morbidity is a consequence, but not the primary feature, including a subset of congenital conditions (ie, chromosomal anomalies and congenital birth defects), neonatal conditions (ie, jaundice, preterm birth, and sepsis), infectious diseases (ie, COVID-19, cystic echinococcosis, malaria, syphilis, and Zika virus disease), and diabetic neuropathy. By conducting a sequela-level analysis of the health outcomes for these conditions, only cases where nervous system damage occurred were included, and YLDs were recalculated to isolate the non-fatal burden directly attributable to nervous system health loss. A comorbidity correction was used to calculate total prevalence of all conditions that affect the nervous system combined.FindingsGlobally, the 37 conditions affecting the nervous system were collectively ranked as the leading group cause of DALYs in 2021 (443 million, 95% UI 378–521), affecting 3·40 billion (3·20–3·62) individuals (43·1%, 40·5–45·9 of the global population); global DALY counts attributed to these conditions increased by 18·2% (8·7–26·7) between 1990 and 2021. Age-standardised rates of deaths per 100 000 people attributed to these conditions decreased from 1990 to 2021 by 33·6% (27·6–38·8), and age-standardised rates of DALYs attributed to these conditions decreased by 27·0% (21·5–32·4). Age-standardised prevalence was almost stable, with a change of 1·5% (0·7–2·4). The ten conditions with the highest age-standardised DALYs in 2021 were stroke, neonatal encephalopathy, migraine, Alzheimer's disease and other dementias, diabetic neuropathy, meningitis, epilepsy, neurological complications due to preterm birth, autism spectrum disorder, and nervous system cancer.InterpretationAs the leading cause of overall disease burden in the world, with increasing global DALY counts, effective prevention, treatment, and rehabilitation strategies for disorders affecting the nervous system are needed

Ethanolic Allium sativum extract down-regulates the pelF gene involved in Pseudomonas aeruginosa biofilm formation

Exploration of efficacious plant extracts that can reduce or inhibit Pseudomonas aeruginosa biofilm formation is necessary. Allium sativum is a suitable candidate because of its relative abundance. This study was carried out to determine the effect of ethanolic A. sativum extract on the expression of the P.aeruginosa biofilm gene, pelF. The presence of the pelF gene in the isolates used for this study was confirmed via polymerase chain reaction (PCR) and agarose gel electrophoresis. P. aeruginosa culturestreated with 1 g/ml of the A. sativum extract had the least turbidity (6.7 absorbance value at A600). The expression profile of the pelF gene in the treated cultures was determined via PCR using cDNA synthesized from RNA isolated from the treated P. aeruginosa cultures. The amplicons from the PCR were analyzed via agarose gel electrophoresis and a concentration dependent down-regulation of the pelF gene was observed. Further quantification of the pelF gene’s expression was performed via realtime PCR using rpoB as the reference gene. A 4-fold down-regulation of the gene was observed at 0.5and 1 g/ml concentrations, respectively. This study suggests that the suppression of the pelF gene of P. aeruginosa by A. sativum extracts plays a role in the inhibition of P. aeruginosa biofilm formation. This is the first study to elucidate the effect of A. sativum on the expression of any of the pel genes