Malnutrition in Sickle Cell Anemia: Implications for Infection, Growth and Maturation

Sickle cell anemia (SCA) is a genetic disease that affects mostly individuals of African and/or Hispanic descent, with the majority of cases in sub-Saharan Africa. Individuals with this disease show slowed growth, delayed sexual maturity, and poor immunologic function. These complications could partly be explained by the state of undernutrition associated with the disease. Proposed mechanism of undernutrition include protein hypermetabolism, decreased dietary intake possibly from interleukin-6-related appetite suppression, increased cardiac energy demand/expenditure, and increased red cell turnover. All the above mechanisms manifest as increased resting energy expenditure. Nutritional intervention utilizing single or multiple nutrient supplementation has led to improved clinical outcome, growth, and sexual maturation. Studies are currently underway to determine the best possible approach to applying nutritional intervention in the management of SCA. Management of SCA will, of necessity, involve a nutritional component, given the sociodemographic distribution of those most affected by the disease, the ease of a nutritional approach, and the wider reach that such an approach will embody

Benefit Incidence Analysis of Government Spending on Education in Anambra State, Nigeria.

Education services have been identified as one of the most important services the poor need to escape from poverty. Governments generally devote significant portion of her budget to provision of education services in developing countries. This study employed the non-behavioural method of benefit incidence analysis to assess how equitably government expenditure in education has been well targeted across households and gender in Anambra state, Nigeria. The study found that primary and secondary education were absolutely progressive across households, absolute progressive for female and just progressive for male primary education spending, while secondary education spending is just progressive across both sexes. Among other policies, strict implementation of the compulsory free basic education as stated in the National Policy on Education was recommended. Keywords: Benefit incidence analysis, progressivity, concentration curve, public expenditure, education

A bone to pick-cellular and molecular mechanisms of bone pain in sickle cell disease

The bone is one of the most commonly affected organs in sickle cell disease (SCD). Repeated ischemia, oxidative stress and inflammation within the bone is largely responsible for promoting bone pain. As more individuals with SCD survive into adulthood, they are likely to experience a synergistic impact of both aging and SCD on their bone health. As bone health deteriorates, bone pain will likely exacerbate. Recent mechanistic and observational studies emphasize an intricate relationship between bone remodeling and the peripheral nervous system. Under pathological conditions, abnormal bone remodeling plays a key role in the propagation of bone pain. In this review, we first summarize mechanisms and burden of select bone complications in SCD. We then discuss processes that contribute to pathological bone pain that have been described in both SCD as well as non-sickle cell animal models. We emphasize the role of bone-nervous system interactions and pitfalls when designing new therapies especially for the sickle cell population. Lastly, we also discuss future basic and translational research in addressing questions about the complex role of stress erythropoiesis and inflammation in the development of SCD bone complications, which may lead to promising therapies and reduce morbidity in this vulnerable population

Racial/Ethnic Differences in Poststroke Rehabilitation Outcomes

Background. Significant racial and ethnic disparities in stroke incidence, severity, and morbidity have been consistently reported; however, less is known about potential differences in poststroke rehabilitation outcomes. Objective. To examine racial and ethnic differences in poststroke rehabilitation outcomes. Methods. We completed an in-depth search of Medline and several major journals dedicated to publishing research articles on stroke, rehabilitation, and racial-ethnic patterns of disease over a 10-year period (2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012). We identified studies that reported rehabilitation outcomes and the race or ethnicity of at least two groups. Results. 17 studies involving 429,108 stroke survivors met inclusion criteria for the review. The majority (94%) of studies examined outcomes between Blacks and Whites. Of those studies examining outcomes between Blacks and Whites, 59% showed that Blacks were generally less likely to achieve equivalent functional improvement following rehabilitation. Blacks were more likely to experience lower FIM gain or change scores (range: 1-60%) and more likely to have lower efficiency scores (range: 5-16%) than Whites. Conclusions. Black stroke survivors appear to generally achieve poorer functional outcomes than White stroke survivors. Future studies are warranted to evaluate the precise magnitude of these differences, whether they go beyond chance, and the underlying contributory mechanisms

Sickle cell trait and risk of cognitive impairment in African-Americans: The REGARDS cohort

Background: Sickle cell anemia may be associated with cognitive dysfunction, and some complications of sickle cell anemia might affect those with sickle cell trait (SCT), so we hypothesized that SCT is a risk factor for cognitive impairment. Methods: The Reasons for Geographic and Racial Differences in Stroke (REGARDS) study enrolled a national cohort of 30,239 white and black Americans from 2003 to 7, who are followed every 6 months. Baseline and annual global cognitive function testing used the Six-Item Screener (SIS), a validated instrument (scores range 0-6; ≤ 4 indicates cognitive impairment). Participants with baseline cognitive impairment and whites were excluded. Logistic regression was used to calculate the association of SCT with incident cognitive impairment, adjusted for risk factors. Linear mixed models assessed multivariable-adjusted change in test scores on a biennially administered 3-test battery measuring learning, memory, and semantic and phonemic fluency. Findings: Among 7743 participants followed for a median of 7·1 years, 85 of 583 participants with SCT (14·6%) developed incident cognitive impairment compared to 902 of 7160 (12·6%) without SCT. In univariate analysis, the odds ratio (OR) of incident cognitive impairment was 1·18 (95% CI: 0·93, 1·51) for those with SCT vs. those without. Adjustment did not impact the OR. There was no difference in change on 3-test battery scores by SCT status (all p > 0·11). Interpretation: In this prospective cohort study of black Americans, SCT was not associated with incident cognitive impairment or decline in test scores of learning, memory and executive function. Funding: National Institutes of Health, American Society of Hematology

REVIVING EDUCATION IN NIGERIA FOR SUSTAINABLE ECONOMIC GROWTH: ISSUES, PROBLEMS AND PROSPECTS

Education has been identified as a critical agent in the development of a modern society because it plays a pivotal role in training and building human capacity for the nation. It is argued “as information grows exponentially, and its incorporation in the production process becomes increasing complex, the ability to absorb, and adapt new knowledge is determined by the nature, quality and quantity of the education system”. Nigerian government played the „Ostrich‟ while its educational system headed for a total collapse. This paper in a quest to examining the issues pertaining to the decay, finds poor funding, limited access to good education, obsolete curricula, brain drain, corruption, incessant University strikes, examination malpractice, inept leadership, and poor budgetary allocation to education as part of the problem. Our simple regression findings show a positive relationship between education, health and economic growth. Therefore, except the system is revived and revamped, it will be a mirage for the country to catch up with the global competitiveness. As a way forward, Government must increase funding, tackle corruption and improve infrastructure. Excellence must be rewarded and indigenous R&D improved. They must stem the tide of brain drain by creating environment for good education

Comparative Assessment of Some Rapid Diagnostic Test (RDT) Kits for Malaria Diagnosis in Ibadan, Nigeria

Background:  Deployment of sound diagnostic deliverables remains a crucial component of malaria control and prevention programme in Africa. This study aims to make a comparative assessment of the efficacy of three famous brands of rapid diagnostic kits (RDT) available in Nigerian market, with the traditional Giemsa staining (microscopic) method, in testing for malaria in endemic zones, also to provide relevant information and guidance to individuals, health care service providers, test kit manufacturers as well as health corporate organizations. Methods: Giemsa microscopy along with RDT kits (Acon, Paracheck and SD Bioline) were carried out on 525 patient samples presumed to present with acute uncomplicated malaria by clinical diagnosis. In addition, the total WBC count and haematocrit were conducted on the blood samples. Results: Out of the 525 samples recruited, three hundred (300) 57.1% were found positive by Giemsa microscopy. SD Bioline had a positivity rate of 260 (49.5%) while Acon and Paracheck trailed behind with 200 (38.1%) and 150 (28.6%) samples respectively. The sensitivity, specificity and efficiency of the three RDT kits were as follows: SD Bioline (86.3%, 99.6%, 92%); Paracheck (50%, 97.7%, 70.4%) and Acon (66.7%, 100%, 80.9%) respectively. Children within the age bracket 0-10 years had the highest malaria positivity rate (F=5.29; p< 0.05). 115 (38.3%) of children in this age group were positive for malaria with Mean PCV of 30.65 ± 0.52 compare to non-malaria control. The dominant malaria species was P. falciparum with 280 (93.3%) cases. However, an appreciable cases of P. falciparum & P. vivax 15 (5.0%) along with P. falciparum & P. malariae 5 (1.7%) co-infections were confirmed. It was also observed that the haematocrit value for individuals correlated inversely with the parasite density (r = -0.78; p< 0.05). Conclusion and Recommendation: Giemsa microscopy method still remains the gold standard for malaria diagnosis in limited resources endemic zones and recommends that imported RDT kits for malaria should be validated before use in developing countries. Keywords: Giemsa Microscopy; Rapid Diagnostic Kits; Parasite Density; Co-Infection; Malaria Contro

Perspectives on Cognitive Phenotypes and Models of Vascular Disease

Clinical investigations have established that vascular-Associated medical conditions are significant risk factors for various kinds of dementia. And yet, we are unable to associate certain types of vascular deficiencies with specific cognitive impairments. The reasons for this are many, not the least of which are that most vascular disorders are multi-factorial and the development of vascular dementia in humans is often a multi-year or multi-decade progression. To better study vascular disease and its underlying causes, the National Heart, Lung, and Blood Institute of the National Institutes of Health has invested considerable resources in the development of animal models that recapitulate various aspects of human vascular disease. Many of these models, mainly in the mouse, are based on genetic mutations, frequently using single-gene mutations to examine the role of specific proteins in vascular function. These models could serve as useful tools for understanding the association of specific vascular signaling pathways with specific neurological and cognitive impairments related to dementia. To advance the state of the vascular dementia field and improve the information sharing between the vascular biology and neurobehavioral research communities, National Heart, Lung, and Blood Institute convened a workshop to bring in scientists from these knowledge domains to discuss the potential utility of establishing a comprehensive phenotypic cognitive assessment of a selected set of existing mouse models, representative of the spectrum of vascular disorders, with particular attention focused on age, sex, and rigor and reproducibility. The workshop highlighted the potential of associating well-characterized vascular disease models, with validated cognitive outcomes, that can be used to link specific vascular signaling pathways with specific cognitive and neurobehavioral deficits

Innovations for inclusive and sustainable growth of domestic food value chains: Fruits and vegetables value chains in Nigeria scoping report

Fruits & vegetable value chains (F&V VC) in Nigeria hold significant potential to continue toward sustainable, inclusive food system transformation. Domestic food system growth, including that of F&V, remains crucial in achieving a healthy food environment and serving as a source of various micronutrients. There is a need for bundles of innovations to address multiple challenges along F&V VC in Nigeria, characterized by a set of challenges that are unique to developing countries and F&V. V&F VC consists of many small actors, farmers, and traders, whereby limited vertical coordination can lead to significant efficiency loss along the value chain. Seasonal and temporal variations in supply-demand gaps for F&V commodities are substantial, and considerable scope exists for reducing losses and enhancing the overall efficiency of the domestic F&V sector. Policy environments are also favorable for such efforts, as the latest Agricultural Policy documents highlight the Nigerian government’s interest in modernizing F&V VC. Given the significant involvement of women and youths in the sector, F&V VC development has substantial potential to contribute to Nigeria's inclusive development of agrifood systems. The current domestic F&V VC in Nigeria suffers from various sets of problems. Access to quality seeds is limited due to the significant use of recycled seeds, limited supply, and high costs of certified seeds. Cooling practices are inefficient due to insufficient access to the grid and off-grid electricity, limited knowledge of intermediate cooling methods applicable at the farm gate, and constraining quality preservations at farm gate storage, during transportation, and storage at market premises. Processing is insufficient due to the high costs of processing equipment and limited knowledge of the construction and operation of simpler, less resource-dependent processing facilities, including drying of F&V commodities. Inappropriate packing, such as the use of Rafia baskets instead of Reusable Plastic Crates, which are commonly recognized, is still prevalent, potentially due to limited market coordination. Based on the stakeholder consultations, desk reviews, validation workshops, and availability of external resources, we identified the following as critical interventions to pilot various innovation bundles. Intervention #1 provides improved varieties and quality seeds, combined with agronomy training and certification, in northern Nigeria through the collaboration with East West Seeds and Wageningen University & Research. Intervention #2 provides off-grid cooling and cool transportation, including forced-air evaporative cooling units at farm clusters and the combination of small and large refrigerated trucks for local and longer-distance transportation, through the collaboration with ColdHubs and MIT-Lab. Intervention #3 introduces improved solar dryers and provides training on appropriate, hygienic processing methods, building, and utilization of these driers (possibly combined with the introduction of a business model), through the collaboration with World Vegetable Center and Nigerian Stored Products Research Institute. Intervention #4 provides plastic crates using various rental arrangements and improves market access for farmers through collaboration with private companies, including Bunkasa. Intervention #5 supplements interventions #1, #2, and #3 and provides improved information through certification and labeling. Lastly, Intervention #6 strengthens linkages between existing solar powered cold storages to supplement other interventions

Association of Sickle Cell Trait With Chronic Kidney Disease and Albuminuria in African Americans

The association between sickle cell trait (SCT) and chronic kidney disease (CKD) is uncertain