Assessment of probability of pulmonary arterial hypertension among HIV-1 infected patients on haart and its relationship with Cd4 cells Count and viral load

HIV patients are more likely to develop cardiovascular disease than the general population and have a 2500-fold increased risk of developing pulmonary artery hypertension (PAH). HIV associated pulmonary hypertension was said to be more severe and is associated with higher mortality. Methodology: Across-sectional conducted among consecutive HIV patients age greater than 18 years receiving treatment at the antiretroviral therapy (ART) clinic of the Federal Medical Centre Nguru Yobe State Northeastern Nigeria. Results: One hundred and twenty (120) subjects were recruited into the study, thirteen had incomplete data and were excluded from the analysis. There was a significant negative correlation between CD4 cells count with tricuspid regurgitant flow velocity (TRv), pulmonary regurgitant flow velocity (PRv), pulmonary artery trunk diameter (PATd), right ventricular to left ventricular internal diameter (RV/LV) ratio, left ventricular eccentricity index (LVEI), and right atrial area (RAA), while the correlation between CD4 cells count and right ventricular acceleration time (RVAT) was positive and significant. On the other hand, the correlations between viral load and TRv, PRv, PATd, RV/LV ratio, and RAA were positive and significant while that between viral load and RVAT was negative and significant. Conclusions: This study revealed that HIV patients with low CD4 cell count and high viral load had a high probability of developing PAH (significant negative relationship between variables associated with the probability of PAH with CD4 cell count and significant positive relationship with viral load), In HIV patients the probability of developing PAH decreases with adequate treatment (that suppress viral replication and increases CD4 count). We, therefore, recommend routine assessment of the probability of PAH in patients with HIV infection particularly those with low CD4 cell count and high viral load and encourage early commencement of HAART to prevent the development of pulmonary arterial hypertension

Speciation of Potentially Toxic Metals from the Mine Impacted soils: A Case Study of Riruwai Mining Area, Kano State, Northern Nigeria

Mining and smelting sectors contribute significantly to global growth on a regional and local scale. However, the operations are causing significant environmental damage, particularly pollution of the soil with potentially toxic metals (PTMs).  In this study, the speciation of PTMs (arsenic, cadmium, chromium, mercury, manganese, nickel, lead and zinc) from the mine impacted soils of Riruwai mining area was investigated using a modified Tessier sequential extraction method. The findings of the study revealed that all the PTMs examined are considerably associated with non-residual fractions in all the sampling locations. This indicates that all the PTMs investigated in the study area may be highly mobile in the soils and hence potentially toxic. The concentrations of PTMs in the soil’s geochemical fractions were found to vary with the sampling locations, with active mining sites significantly (p ≤ 0.05) recording the highest value, followed by farmland, while the lowest value was reported at the control site. Therefore, to protect the environment and the health of the local populace, PTMs in the soils of the study area should be regularly monitored and a treatment program should be put in place

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Comparative studies of the curing and hardening process of soaps produced from locally processed saturated and unsaturated fatty acids

This paper presents a comparative study of the curing and hardening processes of five soaps produced from Nigerian local oils (Palm oil, Palm-kernel Oil, Groundnut oil, Shea-butter oil and Tallow oil). The curing process was investigated by drying the soap samples under natural conditions and obtaining their daily moisture loss for duration of 21 days. Hardness tests based on the Brinell Hardness Methodology was conducted using a locally improvised manual indenter with a test load of 6.585kgf or 64.553N. Graphical plots of the moisture loss versus a one day time interval showed that all the soaps exhibited similar behaviour in the curing process, characterized by exponential decay in the rate of moisture loss. Superimposition of the curves into one graph showed very close fitting between the curves, indicating that the rates of moisture loss are very close. Graphs of the hardening process of the soaps showed that there are similarities in the hardening behaviour of the soaps with the curves exhibiting two hardening regions, a region of non-linear hardening and a region of constant hardening. Results showed that the hardness of the soaps varies in this order: tallow (1.88 HN) &gt;shea butter (0.3 HN) &gt;palm kernel (0.25 HN &gt;palm Oil (0.15 HN) &gt; groundnut oil (0.13 HN)

Comparative studies of the curing and hardening process of soaps produced from locally processed saturated and unsaturated fatty acids

This paper presents a comparative study of the curing and hardening processes of five soaps produced from Nigerian local oils (Palm oil, Palm-kernel Oil, Groundnut oil, Shea-butter oil and Tallow oil). The curing process was investigated by drying the soap samples under natural conditions and obtaining their daily moisture loss for duration of 21 days.&nbsp; Hardness tests based on the Brinell Hardness Methodology was conducted using a locally improvised manual indenter with a test load of 6.585kgf or 64.553N.&nbsp; Graphical plots of the moisture loss versus a one day time interval showed that all the soaps exhibited similar behaviour in the curing process, characterized by exponential decay in the rate of moisture loss.&nbsp; Superimposition of the curves into one graph showed very close fitting between the curves, indicating that the rates of moisture loss are very close. Graphs of the hardening process of the soaps showed that there are similarities in the hardening behaviour of the soaps with the curves exhibiting two hardening regions, a region of non-linear hardening and a region of constant hardening. Results showed that the hardness of the soaps varies in this order:&nbsp; tallow (1.88 HN) &gt;shea butter (0.3 HN) &gt;palm kernel (0.25 HN &gt;palm Oil (0.15 HN) &gt; groundnut oil (0.13 HN). Cite as: Mohammed UF, Akeeb NA, Kalgo YB. Comparative studies of the curing and hardening process of soaps produced from locally processed saturated and unsaturated fatty acids. Alger. J. Eng. Technol. 2021, 5:1-8.&nbsp; http://dx.doi.org/10.5281/zenodo.5525420 References Kuntom, A., W.L. Siew and V.A. Tan. Characterisation of Palm acid oil. Journal of American Oil and Chemical Society. 1994:71:525-528. Gunstone, F.D., J.L. Harwod and F.B. Padley. The Lipid Handbook. Chapman and Hall Limited, London. 1986:236-261. Kevin, M.D. (2007). The Water Discount. Journal of Handcrafter Soap Makers Guild, Issue 2008-2. Synthesis of Soap. [Online]. Available from: http://www.chem.latech.edu/~deddy/chem122m/L06U00Soap122.htm. (Accessed: February 24th 2021]. Zauro, S.A., et al. Production and Analysis of Soaps using Locally Available Raw Materials. Alixir Journal of Applied Chemistry. 2016:l(96):41479-41483 Basic Properties of Engineering Materials [Online]. Available from: http://www.youtube.com/watch?v=AZ_UqgMps9I. [Accessed: January 5th, 2020]. Determining Material Properties through Testing. [Online]. Available from: http://www.youtube.com/watch?v=liiopCScMcK. [Accessed: July 19th, 2019]. What is Soap? [Online]. Available from: http://www.youtube.com/watch?v=9_u4zP5s9is.[Accessed: 21st, February, 2021

Heavy Metals Contamination Levels in the Vegetables Grown around Riruwai Mining Area, Kano State, Nigeria

Vegetables grown in mining areas can accumulate significant amounts of heavy metals (HMs), which can cause serious developmental disorders and have long-term negative effects on public health. In the present study, the HMs contamination level in vegetables grown around the Riruwai mining area in Kano State, Nigeria, was investigated. Fifteen (15) vegetable samples were collected, including lettuce (Lacuta sativa L.), tomato (Solanum lycopersicum L.), and bean (Phaseolus vulgaris L.), as well as their corresponding soils. The levels of As, Cd, Cr, Hg, Mn, Ni, Pb, and Zn in all the samples were determined using Microwave Plasma Atomic Emission Spectrometry, and the measured concentrations were used to calculate the bioaccumulation factor (BAF). The results of the study revealed that HMs concentrations in the investigated vegetables were found to be significantly high, with the majority of levels exceeding the WHO/FAO (2007) recommended limit, and the concentration of HMs in the soil decreased in the order of Zn > Mn > Cr > Pb > As > Ni > Cd > Hg, with As, Pb, and Zn exceeding the WHO/FAO (2001) recommended limit. Pollution levels were found to significantly differ between HMs and vegetable types. BAF results revealed that cadmium is an accumulator of all the studied vegetables (BAFs > 1), while mercury was found to be an accumulator of L. sativa. Higher concentrations of these metals in vegetables and soil, particularly arsenic, cadmium, lead, and zinc, necessitate immediate scientific attention and further research to determine the optimum concentration required for human health. Planting of vegetables for human and animal consumption should be stopped until this is accomplished

Contamination and risk assessment of heavy metals in water and fish obtained in Bunza River in Kebbi State, Nigeria

Background: Fish are consumed worldwide due to their nutritional and health benefits; however, heavy metal pollution is compromising their safety. This study aimed to determine heavy metal safety in water and fish, specifically tilapia (Oreochromis niloticus) and catfish (Clarias gariepinus), collected from Bunza River in Kebbi State, Nigeria. Methods: Water and fish samples underwent analysis for zinc (Zn), cadmium (Cd), copper (Cu), and lead (Pb) using atomic absorption spectroscopy. The obtained values were then utilized to assess the associated health risks. Results: The atomic absorption spectroscopy of fish revealed significant differences (P < 0.05) between heavy metal concentrations in the fish organs and FAO/WHO standards. It indicated non-tolerable concentrations of copper (1.77-5.24 mg kg-1) and lead (1.85-4.53 mg kg-1). The estimated daily intake (EDI) of Pb and Cd through fish consumption was above the recommended daily intake (RDI). However, the hazard quotient (HQ) and health risk index (HI) of all the heavy metals were within tolerable limits ( < 1). On water samples, non-tolerable levels of the heavy metals and significant differences (P < 0.05) were observed when compared with the standards. The water samples had average concentrations of Cu (4.64 ± 0.62 mg kg-1), Pb (1.78 ± 0.70 mg kg-1), Cd (0.50 ± 0.02 mg kg-1), and Zn (18.90 ± 3.08 mg kg-1). The average daily ingestion (ADI) and HQ of the heavy metals through the consumption of the water were above the recommended limits. Conclusion: Based on the results, the fish and water samples could cause heavy metal-related toxicity. There is a need for policies aimed at decontaminating the river