Sustainable Health Development Goals (SHDG): breaking down the walls.

The worlds governments failed to achieve the Health for All 2000 goals from the Alma Ata Declaration of 1978. Although a lot of milestones have been covered since 2000, the worlds governing authorities are unlikely to achieve the current Millennium Development Goals (MDGs) which expire by the end of this year. The inability to achieve these goals may be linked to the multiplicity of health-related directives and fragmentation of health systems in many countries. However, with the proposed 17 sustainability development goals, health has only one universal aim: to ensure healthy lives and promote wellbeing for all at all ages. Accomplishing this will require a focus on health systems (system-thinking), commonization of services and full integration of services with total dismantling of vertical programs across the world

Ebola virus disease epidemic in West Africa: Lessons learned and issues arising from West African countries

© Royal College of Physicians 2015. All rights reserved.The current Ebola virus disease (EVD) outbreak ravaging three nations in West Africa has affected more than 14,000 persons and killed over 5,000. It is the longest and most widely spread Ebola epidemic ever seen. At the time of this overview (written November 2014), having affected eight different nations, Nigeria and Senegal were able to control and eliminate the virus within a record time. Ghana has successfully, to date, kept the virus away from the country, despite economic and social relationships with affected nations. What lessons can we learn from Nigeria, Senegal and Ghana in the current epidemic? How can the world improve the health systems in low- and middle-income countries to effectively manage future outbreaks? Recently, the Royal College of Physicians launched a new partnership with the West African College of Physicians to curtail the effects of HIV/AIDS, malaria and tuberculosis in the region. We believe that strengthened health systems, skilled human resources for health and national ownership of problems are key to effective management of outbreaks such as EVD

Knowledge management for small and medium contractors

Effective knowledge management is increasingly considered as a cornerstone of sustainable business success. Knowledge management systems are strategically valuable for both ensuring consistency and continuous improvement of various aspects such as quality delivery, productivity and competitiveness. The small and medium enterprises (SMEs) in the construction industry are mostly operating under tighter timeframes, narrower profit margins and more constrained resources. Hence the recently commenced SMILE-SMC (Strategic Management with Information Leveraged Excellece for Small and Medium Contractors) project aims to support the information and knowledge management needs of the small and medium contractors in Hong Kong. This paper presents some snapshots on the SMILE-SMC project, and its conceptualized deliverables with some highlights of recent developments.postprin

Fruits and vegetables moderate blood pressure, fibrinogen concentration and plasma viscosity in Nigerian hypertensives

Fruits and vegetables contain vital components such as potassium, antioxidants, vitamins and folic acid that might contribute to lowering blood pressure which is a major risk factor in cardiovascular disorders. However, the results of the few investigations on the correlation between intake of fruits and vegetables and cardiovascular disease have been inconsistent. Worse still, there is dearth of information on disease prevention with fruits and vegetables in Africans. Thus, we investigated the relative effect of fruits and vegetables on blood pressure, viscosity of blood and fibrinogen level. Ten weeks intervention study with ≥ 3 times daily consumption of fruits and vegetables by hypertensive patients was conducted. The fruits and vegetables included in the test diet were oranges, banana, pawpaw,  mango, pineapple, grape, tangerine, garden egg, okra, pumpkin leaf, spinach,  amaranthus and water leaf. The patients were allowed to consume the food servings while their eating habit was not restricted. Blood pressure, blood viscosity and plasma fibrinogen and nutrient intake were determined before and during  intervention. The complementary fruits and vegetables included in the normal dietary regimen of the patients during the 10 weeks study increased the levels of potassium, calcium, phosphorus, antioxidants and dietary fiber significantly  compared to the baseline values (P<0.01). The systolic and diastolic blood  pressure were significantly lowered; percentage differences of – 9.01 and –3.73 (P<0.01) respectively were observed after 10 weeks. Percentage differences of –6.02, -38.86 and –5.29 (P<0.05.) were observed for haematocrit, blood viscosity and plasma fibrinogen respectively compared with the base line. Fruits and vegetables lowered the systolic and diastolic blood pressure, blood viscosity and plasma fibrinogen. The decrease in haematocrit and fibrinogen could influence reduction in blood viscosity thereby preventing premature CVD in hypertensive. Daily intake of fresh fruit and vegetable might be beneficial for the prevention and as therapeutic regime for cardiovascular complications.Key Words: Hypertension, Fruits, Vegetables, Fibrinogen, Viscosit

Timing of antiretroviral therapy and TB treatment outcomes in patients with TB-HIV in Myanmar.

SETTING: Integrated HIV Care programme, Mandalay, Myanmar. OBJECTIVES: To determine time to starting antiretroviral treatment (ART) in relation to anti-tuberculosis treatment (ATT) and its association with TB treatment outcomes in patients co-infected with tuberculosis (TB) and the human immunodeficiency virus (HIV) enrolled from 2011 to 2014. DESIGN: Retrospective cohort study. RESULTS: Of 1708 TB-HIV patients, 1565 (92%) started ATT first and 143 (8%) started ART first. Treatment outcomes were missing for 226 patients and were thus not included. In those starting ATT first, the median time to starting ART was 8.6 weeks. ART was initiated after 8 weeks in 830 (53%) patients. Unsuccessful outcome was found in 7%, with anaemia being an independent predictor. In patients starting ART first, the median time to starting ATT was 21.6 weeks. ATT was initiated within 3 months in 56 (39%) patients. Unsuccessful outcome was found in 12%, and in 20% of those starting ATT within 3 months. Patients with CD4 count <100/mm(3) had a four times higher risk of an unsuccessful outcome. CONCLUSIONS: Timing of ART in relation to ATT was not an independent risk factor for unsuccessful outcome. Extensive screening for TB with rapid and sensitive diagnostic tests in HIV-infected persons and close monitoring of anaemia and immunosuppression are recommended to further improve TB treatment outcomes among patients with TB-HIV

Determination of the antimicrobial susceptibility pattern of enterobacteriaceae in a tertiary health center of Northeastern Nigeria.

Gram negative resistance particularly amongst species of has emerged as a worldwide threat affecting the efficacy of our commonly used antimicrobial agents. These threats affect the quality of care and results in prolonged hospitalization and increase in health care cost. We set out to evaluate the occurrence and profile of antimicrobial resistance from clinical isolates of in a tertiary health center of north-eastern, Nigeria. Method: Confirmed species of isolated from 225 patients that were admitted in various units of University of Maiduguri Teaching Hospital (UMTH) Maiduguri were tested for susceptibility to 6 antimicrobial agents; ampicillin (10µg), aztreonam (30µg), gentamicin (10µg), ceftriaxone (30µg), ciprofloxacin (5µg) and amoxicillin/clavulanic acid (20/10µg) using the clinical and laboratory standards institute (CLSI) breakpoints. Results: A total of 225 clinical variants of were isolated during the study period. The specie with the highest proportion was with 73(32.4%) and this was followed closely by with 61(27.1%). The result of the susceptibility testing on this species of showed ampicillin (10µg) with the highest resistance of 118(52.4%) while aztreonam(30µg) has the lowest resistance of 58(25.8%). Conclusion: There is the existence of widespread resistance to mostly the beta lactam agents among species of with the exception of Aztreonam. Irrational use of antibiotics must be discouraged so as to reduce this emerging threat. Stringent infection control and antibiotic stewardship programshould be established and sustained in our hospitals nationwide

Understanding the Degradation of Core-Shell Nanogels Using Asymmetrical Flow Field Flow Fractionation

Nanogels are candidates for biomedical applications, and core-shell nanogels offer the potential to tune thermoresponsive behaviour with the capacity for extensive degradation. These properties were achieved by the combination of a core of poly(N-isopropylmethacrylamide) and a shell of poly(N-isopropylacrylamide), both crosslinked with the degradable crosslinker N,N'-bis(acryloyl)cystamine. In this work, the degradation behaviour of these nanogels was characterised using asymmetric flow field flow fractionation coupled with multi-angle and dynamic light scattering. By monitoring the degradation products of the nanogels in real-time, it was possible to identify three distinct stages of degradation: nanogel swelling, nanogel fragmentation, and nanogel fragment degradation. The results indicate that the core-shell nanogels degrade slower than their non-core-shell counterparts, possibly due to a higher degree of self-crosslinking reactions occurring in the shell. The majority of the degradation products had molecule weights below 10 kDa, which suggests that they may be cleared through the kidneys. This study provides important insights into the design and characterisation of degradable nanogels for biomedical applications, highlighting the need for accurate characterisation techniques to measure the potential biological impact of nanogel degradation products

Pituitary macroadenomas: are combination antiplatelet and anticoagulant therapy contraindicated? A case report

<p>Abstract</p> <p>Background</p> <p>Pituitary apoplexy is a life-threatening endocrine emergency that is caused by haemorrhage or infarction of the pituitary gland, commonly within a pituitary adenoma. Patients classically present with headache, ophthalmoplegia, visual field defects and altered mental state, but may present with a typical symptoms such as fever and altered conscious level.</p> <p>Case presentation</p> <p>A 57-year-old female with a known pituitary macroadenoma was treated for suspected acute coronary syndrome with aspirin, clopidogrel and full dose enoxaparin. She developed a severe and sudden headache, nausea and vomiting and visual deterioration. A CT scan showed haemorrhage into the pituitary macroadenoma. She underwent neurosurgical decompression. Post-operatively her visual fields and acuity returned to baseline. She was continued on hydrocortisone and thyroxine replacement on discharge.</p> <p>Conclusion</p> <p>This case illustrates the risks of anticoagulation in a patient with a known pituitary macroadenoma, and raises the issue of whether these tumours present a relative contraindication to the use of dual antiplatelet and anticoagulation in acute coronary syndrome.</p

Clinical effects of Garcinia kola in knee osteoarthritis

<p>Abstract</p> <p>Objectives</p> <p>Over the past years, there has been a growing number of knee osteoarthritis (KOA) patients who are not willing to comply with long-term non-steroidal anti-inflammatory drugs (NSAID) treatment and wish to use herbal anti- rheumatic medicine. This study assessed the clinical effects of <it>Garcinia kola </it>(GK) in KOA patients.</p> <p>Patients and methods</p> <p>Prospective randomized, placebo controlled, double blind, clinical trial approved by the institutional medical ethics review board and written informed consent obtained from each patient. All KOA patients presenting at the Obafemi Awolowo University Teaching Hospital complex were recruited into the study. The patients were grouped into four (A = Placebo, B = Naproxen, C = <it>Garcinia kola</it>, D = Celebrex). The drugs and placebo were given twice a day per oral route. Each dose consisted of 200 mg of <it>G. kola</it>, Naproxen (500 mg), Celebrex (200 mg) and Ascorbic acid (100 mg). The primary outcome measure over six weeks study period was the change in mean WOMAC pain visual analogue scales (VAS). Secondary outcome measures included the mean change in joint stiffness and physical function (mobility/walking).</p> <p>Results</p> <p>143 patients were recruited, 84 (58.7%, males – 24, females – 60) satisfied the selection criteria and completed the study. The effect of knee osteoarthritis bilateralism among the subjects was not significant on their outcome (p > 0.05). The change in the mean WOMAC pain VAS after six weeks of <it>G. kola </it>was significantly reduced compared to the placebo (p < 0.001). Multiple comparisons of the mean VAS pain change of <it>G. kola </it>group was not lowered significantly against the naproxen and celebrex groups (p > 0.05). The onset of <it>G. kola </it>symptomatic pain relief was faster than the placebo (p < 0.001). However, it was slower than the active comparators (p > 0.05). The duration of therapeutic effect of <it>Garcinia kola </it>was longer than the placebo (p > 0.001). <it>G. kola </it>period of effect was less than naproxen and celebrex (p < 0.001). <it>G. kola </it>subjects had improved mean change mobility/walking after six weeks better than the control group(p < 0.001). The mean change in mobility of the <it>G. kola </it>group when compared to the active comparators was not significantly better (p < 0.05). The mean change of knee joint stiffness (p < 0.001) and the change of mean WOMAC score (p < 0.001) were improved on <it>Garcinia kola </it>as compared to the placebo. The mid term outcome of eleven <it>Garcinia kola </it>subjects after cessation of use had a mean pain relief period of 17.27 +/- 5.15 days (range: 9–26 days). There was no significant cardiovascular, renal or drug induced adverse reaction to <it>Garcinia kola</it>.</p> <p>Conclusion</p> <p><it>Garcinia kola </it>appeared to have clinically significant analgesic/anti-inflammatory effects in knee osteoarthritis patients. <it>Garcinia kola </it>is a potential osteoarthritis disease activity modifier with good mid term outcome. Further studies are required for standardization of dosages and to determine long-term effects.</p