An appraisal of blood pressure control and its determinants among patients with primary hypertension seen in a primary care setting in Western Nigeria

Background: Achieving guideline-recommended blood pressure is imperative in reducing the rising tide of uncontrolled hypertension and its attendant sequelae, which are major causes of morbidity and mortality globally. The aim of the study was to describe the pattern of blood pressure control and identify the factors influencing blood pressure control among patients with primary hypertension seen at family medicine clinics of FMC, Abeokuta.Methods: This was a descriptive cross-sectional hospital-based study. A systematic random sampling technique was used in selecting 360 hypertensive respondents over four months. Data were collected through a pre-tested interviewer-administered questionnaire. The Statistical Package for the Social Sciences (SPSS) version 17.0 was used to analyse data.Results: Blood pressure was controlled in 167 (46.4%) of the respondents. The independent predictors of blood pressure control were female gender (p = 0.001, OR = 2.494, 95% confidence interval (CI) = 1.477–4.214), regular use of medication (p = 0.001, OR = 2.900, 95% CI = 1.508–5.577), regular clinic attendance (p < 0.001, OR = 3.512, 95% CI = 1.772–6.960), and absence of diabetes mellitus (p < 0.001, OR = 7.357, 95% CI = 3.190–16.966).Conclusions: The rate of blood pressure control among the hypertensive respondents was low. Multiple independent predictors of controlled blood pressure call for a team-based approach as well as multiple approaches including education of patients, expansion of a community-based health insurance programme and intensification of treatment efforts when managing hypertensive patients.Keywords: blood pressure control, family medicine clinics, primary hypertensio

Prospective Comparative Trial of Ceftriaxone versus Ceftazidime as Prophylactic Perioperative Antimicrobials in Neurosurgery

Background: Previous reports have suggested that both ceftriaxone and ceftazidime are effective as prophylactic perioperative antibiotics in neurosurgery. This study was designed to compare the infection rates following the use of these antibiotics as prophylactic agents during neurological surgery in our centre. In a tertiary hospitalMethods: This was a prospective study in which patients were allocated into two groups. One group received ceftriaxone (Roche-rocephine) and the other group received ceftazidime (GlaxoSmithKline – fortum). Patients were followed up for evidence of surgical site infections for up to 6 weeks after discharge. Clinical and or laboratory evidence of wound infection were used as outcome measure.Results: There were 118 patients, 58 patients received ceftriaxone and 60 patients received ceftazidime. Infection occurred in 4 (6.9%) in the ceftriaxone group and in 9 (15%) in the ceftazidime group. The difference was not statistically significant. The infection rate following ventriculoperitoneal (VP) shunting procedure was similar (11.8%) in both groups.Conclusion: Our study confirmed the efficacy of ceftriaxone and ceftazidime in preventing surgical site infection that may follow neurosurgical procedures, but the difference in infection rates following the use of their use was not statistically significant

Volume-aware design of composite molds.

We propose a novel technique for the automatic design of molds to cast highly complex shapes. The technique generates composite, two-piece molds. Each mold piece is made up of a hard plastic shell and a flexible silicone part. Thanks to the thin, soft, and smartly shaped silicone part, which is kept in place by a hard plastic shell, we can cast objects of unprecedented complexity. An innovative algorithm based on a volumetric analysis defines the layout of the internal cuts in the silicone mold part. Our approach can robustly handle thin protruding features and intertwined topologies that have caused previous methods to fail. We compare our results with state of the art techniques, and we demonstrate the casting of shapes with extremely complex geometry

Integrated computational framework for the design and fabrication of bending-active structures made from flat sheet material

This paper introduces an integrated computational design framework for the design and realization of arbitrarily-curved bending-active architectural structures. The developed framework consists of a series of methods that enable the production of a complex 3D structures composed of a set of flat 2D panels whose mechanical properties are locally tuned by varying the shape of embedded spiraling patterns. The resulting panels perform as variable stiffness elements, and they are optimized to match a desired target shape once assembled together. The presented framework includes all the steps for the physical delivery of architectural objects, including conception, static assessment, and digital fabrication. The developed framework has been applied to an architectural scale prototype, which demonstrates the potential of integrating architectural design, computational simulation, structural engineering, and digital fabrication, opening up several possible novel applications in the building sector.</p

Five-year mortality in a cohort of people with schizophrenia in Ethiopia

<p>Abstract</p> <p>Background</p> <p>Schizophrenia is associated with a two to three fold excess mortality. Both natural and unnatural causes were reported. However, there is dearth of evidence from low and middle income (LAMIC) countries, particularly in Africa. To our knowledge this is the first community based report from Africa.</p> <p>Methods</p> <p>We followed a cohort of 307 (82.1% males) patients with schizophrenia for five years in Butajira, rural Ethiopia. Mortality was recorded using broad rating schedule as well as verbal autopsy. Standardized Mortality Ratio (SMR) was calculated using the mortality in the demographic and surveillance site as a reference.</p> <p>Result</p> <p>Thirty eight (12.4%) patients, 34 men (11.1%) and 4 women (1.3%), died during the five-year follow up period. The mean age (SD) of the deceased for both sexes was 35 (7.35). The difference was not statistically significant (p = 0.69). It was 35.3 (7.4) for men and 32.3 (6.8) for women. The most common cause of death was infection, 18/38 (47.4%) followed by severe malnutrition, 5/38 (13.2%) and suicide 4/38 (10.5%). The overall SMR was 5.98 (95% CI = 4.09 to7.87). Rural residents had lower mortality with adjusted hazard ratio (HR) of 0.30 (95% CI = 0.12-0.69) but insidious onset and antipsychotic treatment for less than 50% of the follow up period were associated with higher mortality, adjusted HR 2.37 (95% CI = 1.04-5. 41) and 2.66(1.054-6.72) respectively.</p> <p>Conclusion</p> <p>The alarmingly high mortality observed in this patient population is of major concern. Most patients died from potentially treatable conditions. Improving medical and psychiatric care as well as provision of basic needs is recommended.</p

Evaluation of the safety of C-spine clearance by paramedics: design and methodology

<p>Abstract</p> <p>Background</p> <p>Canadian Emergency Medical Services annually transport 1.3 million patients with potential neck injuries to local emergency departments. Less than 1% of those patients have a c-spine fracture and even less (0.5%) have a spinal cord injury. Most injuries occur before the arrival of paramedics, not during transport to the hospital, yet most patients are transported in ambulances immobilized. They stay fully immobilized until a bed is available, or until physician assessment and/or X-rays are complete. The prolonged immobilization is often unnecessary and adds to the burden of already overtaxed emergency medical services systems and crowded emergency departments.</p> <p>Methods/Design</p> <p>The goal of this study is to evaluate the safety and potential impact of an active strategy that allows paramedics to assess very low-risk trauma patients using a validated clinical decision rule, the Canadian C-Spine Rule, in order to determine the need for immobilization during transport to the emergency department.</p> <p>This cohort study will be conducted in Ottawa, Canada with one emergency medical service. Paramedics with this service participated in an earlier validation study of the Canadian C-Spine Rule. Three thousand consecutive, alert, stable adult trauma patients with a potential c-spine injury will be enrolled in the study and evaluated using the Canadian C-Spine Rule to determine the need for immobilization. The outcomes that will be assessed include measures of safety (numbers of missed fractures and serious adverse outcomes), measures of clinical impact (proportion of patients transported without immobilization, key time intervals) and performance of the Rule.</p> <p>Discussion</p> <p>Approximately 40% of all very low-risk trauma patients could be transported safely, without c-spine immobilization, if paramedics were empowered to make clinical decisions using the Canadian C-Spine Rule. This safety study is an essential step before allowing all paramedics across Canada to selectively immobilize trauma victims before transport. Once safety and potential impact are established, we intend to implement a multi-centre study to study actual impact.</p> <p>Trial Registration</p> <p>ClinicalTrials.gov <a href="http://www.clinicaltrials.gov/ct2/show/NCT01188447">NCT01188447</a></p

Effects of tranexamic acid on death, disability, vascular occlusive events and other morbidities in patients with acute traumatic brain injury (CRASH-3): a randomised, placebo-controlled trial

Background Tranexamic acid reduces surgical bleeding and decreases mortality in patients with traumatic extracranial bleeding. Intracranial bleeding is common after traumatic brain injury (TBI) and can cause brain herniation and death. We aimed to assess the effects of tranexamic acid in patients with TBI. Methods This randomised, placebo-controlled trial was done in 175 hospitals in 29 countries. Adults with TBI who were within 3 h of injury, had a Glasgow Coma Scale (GCS) score of 12 or lower or any intracranial bleeding on CT scan, and no major extracranial bleeding were eligible. The time window for eligibility was originally 8 h but in 2016 the protocol was changed to limit recruitment to patients within 3 h of injury. This change was made blind to the trial data, in response to external evidence suggesting that delayed treatment is unlikely to be effective. We randomly assigned (1:1) patients to receive tranexamic acid (loading dose 1 g over 10 min then infusion of 1 g over 8 h) or matching placebo. Patients were assigned by selecting a numbered treatment pack from a box containing eight packs that were identical apart from the pack number. Patients, caregivers, and those assessing outcomes were masked to allocation. The primary outcome was head injury-related death in hospital within 28 days of injury in patients treated within 3 h of injury. We prespecified a sensitivity analysis that excluded patients with a GCS score of 3 and those with bilateral unreactive pupils at baseline. All analyses were done by intention to treat. This trial was registered with ISRCTN (ISRCTN15088122), ClinicalTrials.gov (NCT01402882), EudraCT (2011-003669-14), and the Pan African Clinical Trial Registry (PACTR20121000441277). Results Between July 20, 2012, and Jan 31, 2019, we randomly allocated 12 737 patients with TBI to receive tranexamic acid (6406 [50·3%] or placebo [6331 [49·7%], of whom 9202 (72·2%) patients were treated within 3 h of injury. Among patients treated within 3 h of injury, the risk of head injury-related death was 18·5% in the tranexamic acid group versus 19·8% in the placebo group (855 vs 892 events; risk ratio [RR] 0·94 [95% CI 0·86-1·02]). In the prespecified sensitivity analysis that excluded patients with a GCS score of 3 or bilateral unreactive pupils at baseline, the risk of head injury-related death was 12·5% in the tranexamic acid group versus 14·0% in the placebo group (485 vs 525 events; RR 0·89 [95% CI 0·80-1·00]). The risk of head injury-related death reduced with tranexamic acid in patients with mild-to-moderate head injury (RR 0·78 [95% CI 0·64-0·95]) but not in patients with severe head injury (0·99 [95% CI 0·91-1·07]; p value for heterogeneity 0·030). Early treatment was more effective than was later treatment in patients with mild and moderate head injury (p=0·005) but time to treatment had no obvious effect in patients with severe head injury (p=0·73). The risk of vascular occlusive events was similar in the tranexamic acid and placebo groups (RR 0·98 (0·74-1·28). The risk of seizures was also similar between groups (1·09 [95% CI 0·90-1·33]). Interpretation Our results show that tranexamic acid is safe in patients with TBI and that treatment within 3 h of injury reduces head injury-related death. Patients should be treated as soon as possible after injury. Funding National Institute for Health Research Health Technology Assessment, JP Moulton Charitable Trust, Department of Health and Social Care, Department for International Development, Global Challenges Research Fund, Medical Research Council, and Wellcome Trust (Joint Global Health Trials scheme)

In vitro and in vivo antioxidant activities of the aqueous extract of Celosia argentea leaves

Objective: The aqueous extract of Celosia argentea var. cristata L. leaves at 100, 200, and 400 mg/kg body weight (b.w.) was investigated against cadmium (Cd)-induced oxidative stress in Wistar rats. The in vitro antioxidant of the extract was evaluated using ammonium thiocyanate, reducing power, and membrane stabilizing models. Materials and Methods: For the in vivo study, 30 male rats ( Rattus norvegicus ) weighing 138.02 ± 7.02 g were completely randomized into 6 groups (A-F) of 5 animals each. Animals in groups A and B received 0.5 ml of distilled water and the same volume containing 8 mg/kg b.w. of Cd, respectively, for 7 days orally. Animals in groups C, D, E, and F were treated like those in group B except that they received 100 mg/kg b.w. of ascorbic acid, and 100, 200, and 400 mg/kg b.w. of the extract, respectively, in addition to Cd. Results: Phytochemical screening revealed the presence of alkaloids (0.61%), saponins (2.93%), cardiac glycosides (0.21%), cardenolides (0.20%), phenolics (3.26%), and flavonoids (2.38%). A total of 10 mg/ml of the extract inhibited linoleic acid oxidation by 67.57%. The highest reducing power was 100 mg/ml as against 10 mg/ml for ascorbic acid. In addition, 2 mg/ml of the extract produced a membrane stabilizing activity of 63.49% as against 77.46% for indomethacin. Compared with the distilled water control group, the administration of Cd alone significantly (P < 0.05) decreased the alkaline phosphatase activity of the rat liver and brain. This decrease was accompanied by a corresponding increase in the serum enzyme. The simultaneous administration of the extract and Cd produced an enzyme activity that compared favorably (P > 0.05) with the animals that received Cd and ascorbic acid. In addition, the reduction in the superoxide dismutase and catalase activity of the liver and brain of the animals, serum uric acid, albumin and bilirubin, and also the increase in the serum malondialdehyde content in animals treated with Cd alone was attenuated by the extract; the values compared well (P > 0.05) with those simultaneously administered with Cd and ascorbic acid. Conclusion: Overall, the results indicated that the aqueous extract of C. argentea leaves attenuated Cd-induced oxidative stress in the animals, with the best result at 400 mg/kg b.w. The antioxidant activity of the extract may be attributed to the phenolic and flavonoid components of the extract. The induction of antioxidant enzymes and scavenging of free radicals may account for the mechanism of action of the extract as an antioxidant

Management of pressure ulceration using fenestrated foam and honey: preliminary report of 51 cases treated at Ibadan

No Abstract. NQJHM Vol. 8 (4) 1998: pp. 264-26