EVALUATION OF THE STATISTICAL SIGNIFICANCE OF COMPACTIVE EFFORTS, SLAG AND CEMENT ON THE GEOTECHNICAL FEATURES OF LATERITE SOIL

This study investigated the statistical significance of compactive efforts, steel slag and cement on the geotechnical features of the laterite soil. Steel slag and cement were incorporated into the soil. Some geotechnical tests were performed on slag-cement-soil samples. Findings showed that the liquid limit (LL) and plasticity index (PI) decreased with increasing slag content, while cement addition increased LL and PI. As compactive efforts increased, MDD and CBR increased with a corresponding decrease in OMC. A more significant influence of the compactive effort and steel slag on the geotechnical features of the laterite than that of cement was observed

EVALUATION OF THE STATISTICAL SIGNIFICANCE OF COMPACTIVE EFFORTS, SLAG AND CEMENT ON THE GEOTECHNICAL FEATURES OF LATERITE SOIL

This study investigated the statistical significance of compactive efforts, steel slag and cement on the geotechnical features of the laterite soil. Steel slag and cement were incorporated into the soil. Some geotechnical tests were performed on slag-cement-soil samples. Findings showed that the liquid limit (LL) and plasticity index (PI) decreased with increasing slag content, while cement addition increased LL and PI. As compactive efforts increased, MDD and CBR increased with a corresponding decrease in OMC. A more significant influence of the compactive effort and steel slag on the geotechnical features of the laterite than that of cement was observed

Prevalence of rheumatic heart disease in North-Central Nigeria: a school-based cross-sectional pilot study.

OBJECTIVES: To present epidemiological data on rheumatic heart disease (RHD), the most common acquired heart disease in children and young adults in low- and middle-income countries, for North-Central Nigeria. METHODS: In this pilot study, we conducted clinical and echocardiography screening on a cross section of randomly selected secondary schoolchildren in Jos, North-Central Nigeria, from March to September 2016. For outcome classification into borderline or definite RHD, we performed a confirmatory echocardiography using the World Heart Federation criteria for those suspected to have RHD from the screening. RESULTS: A total of 417 secondary schoolchildren were screened, of whom 247 (59.2%) were female. The median age was 14 years (IQR: 13-15). Clinical screening detected 8/417 children, whereas screening echocardiography detected 42/417 suspected cases of RHD. Definitive echocardiography confirmed 9/417 with RHD corresponding to a prevalence of 21.6 per 1000 (95% CI, 6.7-36.5). All but one of the confirmed RHD cases (8/9) were borderline RHD corresponding to a prevalence of 19.2 per 1000 (95% CI, 8.3-37.5) for borderline RHD and 2.4 per 1000 (95% CI, 0.1-13.3) for definite RHD. RHD was more common in boys and cardiac auscultation missed over 50% of the cases. CONCLUSIONS: This study showed a high prevalence of RHD among secondary schoolchildren in North-Central Nigeria with a vast predominance of asymptomatic borderline lesions. Larger school-based echocardiography screening using portable or handheld echocardiography aimed at early detection of subclinical RHD should be adopted

Clinical Outcomes in 3343 Children and Adults with Rheumatic Heart Disease from 14 Low and Middle Income Countries: 2-Year Follow-up of the Global Rheumatic Heart Disease Registry (the REMEDY study)

Background: There are few contemporary data on the mortality and morbidity associated with rheumatic heart disease or information on their predictors. We report the 2-year follow-up of individuals with rheumatic heart disease from 14 low- and middle-income countries in Africa and Asia. Methods: Between January 2010 and November 2012, we enrolled 3343 patients from 25 centers in 14 countries and followed them for 2 years to assess mortality, congestive heart failure, stroke or transient ischemic attack, recurrent acute rheumatic fever, and infective endocarditis. Results: Vital status at 24 months was known for 2960 (88.5%) patients. Two-thirds were female. Although patients were young (median age, 28 years; interquartile range, 18–40), the 2-year case fatality rate was high (500 deaths, 16.9%). Mortality rate was 116.3/1000 patient-years in the first year and 65.4/1000 patient-years in the second year. Median age at death was 28.7 years. Independent predictors of death were severe valve disease (hazard ratio [HR], 2.36; 95% confidence interval [CI], 1.80–3.11), congestive heart failure (HR, 2.16; 95% CI, 1.70–2.72), New York Heart Association functional class III/IV (HR, 1.67; 95% CI, 1.32–2.10), atrial fibrillation (HR, 1.40; 95% CI, 1.10–1.78), and older age (HR, 1.02; 95% CI, 1.01–1.02 per year increase) at enrollment. Postprimary education (HR, 0.67; 95% CI, 0.54–0.85) and female sex (HR, 0.65; 95% CI, 0.52–0.80) were associated with lower risk of death. Two hundred and four (6.9%) patients had new congestive heart failure (incidence, 38.42/1000 patient-years), 46 (1.6%) had a stroke or transient ischemic attack (8.45/1000 patient-years), 19 (0.6%) had recurrent acute rheumatic fever (3.49/1000 patient-years), and 20 (0.7%) had infective endocarditis (3.65/1000 patient-years). Previous stroke and older age were independent predictors of stroke/transient ischemic attack or systemic embolism. Patients from low- and lower-middle–income countries had significantly higher age- and sex-adjusted mortality than patients from upper-middle–income countries. Valve surgery was significantly more common in upper-middle–income than in lower-middle– or low-income countries. Conclusions: Patients with clinical rheumatic heart disease have high mortality and morbidity despite being young; those from low- and lower-middle–income countries had a poorer prognosis associated with advanced disease and low education. Programs focused on early detection and the treatment of clinical rheumatic heart disease are required to improve outcomes. </jats:sec

Carbapenem resistance expressed by Gram-negative bacilli isolated from a cohort of Libyan patients

Background and objectives: Carbapenem-resistant Enterobacteriaceae (CRE) and other Gram-negative bacteria are among the most common pathogens responsible for both community and hospital acquired infection. The global spread of cephalosporinases in Enterobacteriaceae has led to the increased use of carbapenems resulting in the emergence and rapid spread of CRE. This has become an alarming public health concern, yet the condition in Libya remains unclear. The aim of this study was to obtain a better understanding of CRE strains prevalent in Libyan patients by investigating their phenotypic characteristics and antibiograms. Methods: Gram-negative bacterial species were collected from Misrata Central Hospital, Misrata Cancer Centre and Privet Pathology Laboratories. Clinical samples and swabs were obtained from hospitalised and non-hospitalised patients and from mechanical ventilation and suction machines. Patients who had received antibiotic therapy for at least three days prior to the study were excluded. The identification and characterization of the isolated species were achieved using the growth characteristics on MacConkey and blood agar, spot tests and API 20E or API 20NE biochemical testing systems. Screening for carbapenem resistance was performed using the disk diffusion method with carbapenem 10 μg and cephalosporin 30 μg disks and minimum inhibitory concentrations (MIC) determined using the Sensititre Gram-negative Xtra plate format (GNX2F). All strains demonstrating resistance or reduced susceptibility to one of the four carbapenems were subjected to carbapenememase activity detection using the RAPIDEC CARBA NP test, Modified Hodge test and carbapenem inactivation methods. Results: A total of one hundred and forty isolates representing fourteen bacterial species were isolated from 140 non-duplicated specimens. Clinical specimens included urine samples (96/140, 68.57%), sputum (15/140, 10.71%), surgical wound swabs (18/140, 12.85%), foot swabs from diabetes mellitus (DM) patients (6/140, 4.29%), ear swabs (3/140, 2.14%) and wound swabs (2/140, 1.43%). Thirty-four (24.29%) isolates demonstrated resistance to at least one of the four carbapenems with Klebsiella pneumoniae representing 73.53% (25 isolates) of all carbapenem resistant species, followed by 8.82% for Pseudomonas aeruginosa (3 isolates), 5.88% for both Proteus mirabilis (2 isolates) and Escherichia coli (2 isolates) and 2.94% for both Citrobacter koseri (1 isolate) and Rahnella aquatilis (1 isolate). The other isolates were either susceptible or cephalosporinase producers. Conclusion: This study has revealed the high rate of carbapenem resistance amongst Libyan patients and emphasizes the crucial need for accurate screening, identification and susceptibility testing to prevent further spread of nosocomial and community acquired resistance. This may be achieved through the establishment of antibiotic stewardship programmes along with firm infection control practices.National Research Foundation of South Africa; Libyan GovernmentWeb of Scienc

Childhood acquired heart diseases in Jos, north central Nigeria

Background: The patterns of childhood acquired heart diseases (AHD) vary in different parts of the world and may evolve over time. We aimed to compare the pattern of childhood AHD in our institution to the historical and contemporary patterns in other parts of the country, and to highlight possible regional differences and changes in trend. Materials and Methods: Pediatric echocardiography records spanning a period of 10 years were reviewed. Echocardiography records of children with echocardiographic or irrefutable clinical diagnoses of AHD were identified and relevant data extracted from their records. Results: One hundred and seventy five children were diagnosed with AHD during the period, including seven that had coexisting congenital heart disease (CHD). They were aged 4 weeks to 18 years (mean 9.84΁4.5 years) and comprised 80 (45.7%) males and 95 (54.3%) females. Rheumatic heart disease (RHD) was the cause of the AHD in 101 (58.0%) children, followed by dilated cardiomyopathy (33 cases, 18.9%) which was the most frequent AHD in younger (under 5 years) children. Other AHD encountered were cor pulmonale in 16 (9.1%), pericardial disease in 15 (8.6%), infective endocarditis in 8 (4.6%) and aortic aneurysms in 2 (1.1%) children. Only one case each of endomyocardial fibrosis (EMF) and Kawasaki Disease were seen during the period. Conclusions: The majority of childhood acquired heart diseases in our environment are still of infectious aeitology, with RHD remaining the most frequent, particularly in older children. Community-based screening and multicenter collaborative studies will help to better describe the pattern of AHD in our country. More vigorous pursuit of the Millennium development goals will contribute to reducing the burden of childhood acquired heart diseases in the country

Knowledge and application of APGAR score among residents in a tertiary hospital

Introduction: The APGAR score rapidly assesses the condition of the newborn at birth and is a predictor of neonatal mortality. Despite the fact that this scoring system is limited by inter and intra-observer variation, its knowledge is essential to residents involved in newborn care at delivery. This study was therefore carried out to determine the knowledge and application of the APGAR score by these residents. Materials and Methods: The questionnaire-based survey was conducted at the Jos University Teaching Hospital and administered to all consecutive residents in pediatrics, obstetrics and gynecology (O and G), anesthesia, family medicine and public health. Domains assessed both knowledge and application of the APGAR scoring system. Data analyzed with the Epi Info 3.5.1 and P < 0.05 was considered as statistically significant. Results: Of the 74 completed questionnaires, 21 were filled by Pediatric residents, 27 by O and G residents and 26 by other residents. Residents with 10-15 years of work experience had a significantly higher mean score on their knowledge compared with those with <10 years work experience (P = 0.015). The mean application score was significantly higher among the Pediatric residents compared with the O and G and other residents (P = 0.015). Using linear regression, there was a significant association between the knowledge and application of the APGAR scoring system - coefficient = 0.179, P ≤ 0.001. Conclusion: Adequate knowledge and application of the APGAR scoring system by residents who use it frequently is necessary to avoid its misuse. Training and retraining of these residents on the correct use of the APGAR score during neonatal resuscitation is important to ensure adequate knowledge and its proper application

Cardiovascular disease risk profile in Nigerian school children

>Background: Cardiovascular disease (CVD) is a major cause of death among adults worldwide. It is acknowledged that its risk factors have their roots in childhood. The present study evaluated CVD risk factors in primary school children in a Nigerian peri-urban setting.Methodology: This cross-sectional study was carried out in two primary schools in Jos South local government area, Plateau State, Nigeria. The 241 children studied were chosen using a systematic random sampling technique to select the children from each school. Pretested questionnaire was used to elicit the information on family characteristics and individual characteristics while standard anthropometric and laboratory procedures were used in evaluating the CVD risk factors.Results: Overall, 137 (56.8%) were females (M:F = 0.76), 151 (62.7%) were from the middle class, 59 (24.5%) from lower class while 31 (12.9%) were from the upper class. The overall prevalence of at least one cardiovascular risk factor was 54%. Sedentary lifestyle was the most common CVD risk factor in 32.4% of subjects followed by obesity (13.7%), adverse CVD event in family (11.6%), high low-density cholesterol (10.3%), high total cholesterol (TC) (9.1%), and hypertension (9.1% combine, 7.1% diastolic, and 5.8% systolic). Linear regression analysis showed that body mass index (BMI) for age (β = 0.41, P < 0.001), systolic blood pressure (BP) (β = 0.94, P = 0.03), diastolic BP (β =1.26, P = 0.01), and TC (β = 0.07, P = 0.04) significantly rise with age. BMI for age (P = 0.02) was significantly higher in female subjects compared with their male counterparts.Conclusions: From the findings of the present study, interventions related to modifiable risk factors, such as encouragement of physical exercise and sports in schools, healthy and prudent diet, and weight control programs should be undertaken early in life so as to help control the development of and the epidemic of CVD in later life

Profile of congenital heart disease in infants born following exposure to preeclampsia.

BackgroundEvents in pregnancy play an important role in predisposing the newborn to the risk of developing CHD. This study evaluated the association between maternal preeclampsia and her offspring risk of CHD.MethodsThis is a cohort study of 90 sex-matched neonates (45 each born to women with preeclampsia and normal pregnancy) in Jos, Nigeria. Anthropometry was taken shortly after delivery using standard protocols. Echocardiography was performed within 24 hours of life and repeated 7 and 28 days later. SPSS version 25 was used in all analyses. Statistical significance was set at pResultsCongenital heart disease (CHD) was observed in 27 (30.0%) of newborns of women with preeclampsia compared with 11 (12.1%) of newborns without preeclampsia (pConclusionCHD may be more common in newborns of women with preeclampsia underscoring the need for fetal and newborn screening for CHD in women with preeclampsia so as to improve their infant's well being