Premature discharge of children from hospital admission at Ahmadu Bello University Teaching Hospital Zaria: A 3-year review

Introduction: Leaving hospital care prematurely could threaten the healthy survival of and expose children to a risk of harmful alternatives. It is also a concern and a challenge to healthcare providers and the health system. A better understanding of its characteristic could help mitigate the impact on children.Objective: To determine the prevalence, types of, and reasons for premature hospital discharge amongst children.Methods: We carried out a threeyear retrospective review of case notes of children who were taken away from hospital admission by their parents/caregivers before they were due for discharge.  Socio-demographic, clinical anddischarge information were collected and data was entered into Microsoft® Excel® for Mac 2011 (Version 14.1.0), cleaned and analysed. Results were presented as percentages, statistical means and standard deviations, tables and charts.Results: There were 56 cases of premature discharge out of 2858 admissions, giving a prevalence of 2.0%. Under-five children constituted 65.4%, with a male: female ratio of 2.3:1. Thirty-one (55.3%) children were absconded with while 25 (44.7%) were taken away by caregivers against medical advice. The commonest diagnoses were protein-energy malnutrition and pneumonia and majority were from poor socio-economic family background. The commonest reasons for discharge AMA were unaffordable costs and perception of improvement of child’s medical condition.Conclusion: Socio-economic factors were significant determinants of utilization of in-patient hospital services for the children studied. There is a need for provision of affordable health care as well as efficient discharge policy to protect children from potential risks associated with premature hospital discharge.Keywords: Children; admission; premature discharge; discharge against medical advice; absconding; elopemen

Studies of some risk factors for re-introduction and spread of highly-pathogenic avian influenza in two states of Nigeria

Highly pathogenic avian influenza (HPAI) occurred in Nigeria about seven years ago affecting a wide range of avian species and human. HPAI being a major emerging zoonosis and a devastating disease of birds occupies the topmost position in the World Organisation for Animal Health list A poultry diseases . It requires emergency responses to speedily detect and control outbreaks, avoid spread and prevent  future reoccurrence. Risk assessment links disease ecology with farmer's attitudes and practices in the agent-host environment relationship. As an example, a qualitative risk assessment was conducted on poultry farmer-risk practices for the introduction and spread of HPAI in two north eastern States of Nigeria. High risk based poultry management and marketing procedures, inadequate poultry housing were areas of major concern in these states. Future high risk of AI reintroduction and spread still existed, early detection enabling prompt implementation of control strategies where given undue attention. Recent global advances in AI control strategies could only be of value with early outbreak detection. Farmers must change attitudes towards adapting biosecurity measures, improvement in early detection skills would assist preparedness in the efforts to rapidly detect and act against future HPAI outbreak in Nigeria. Key words: Risk factors, avian influenza, spread, Nigeri

Sterol 14α-demethylase mutation leads to amphotericin B resistance in Leishmania mexicana

Amphotericin B has emerged as the therapy of choice for use against the leishmaniases. Administration of the drug in its liposomal formulation as a single injection is being promoted in a campaign to bring the leishmaniases under control. Understanding the risks and mechanisms of resistance is therefore of great importance. Here we select amphotericin B-resistant Leishmania mexicana parasites with relative ease. Metabolomic analysis demonstrated that ergosterol, the sterol known to bind the drug, is prevalent in wild-type cells, but diminished in the resistant line, where alternative sterols become prevalent. This indicates that the resistance phenotype is related to loss of drug binding. Comparing sequences of the parasites’ genomes revealed a plethora of single nucleotide polymorphisms that distinguish wild-type and resistant cells, but only one of these was found to be homozygous and associated with a gene encoding an enzyme in the sterol biosynthetic pathway, sterol 14α-demethylase (CYP51). The mutation, N176I, is found outside of the enzyme’s active site, consistent with the fact that the resistant line continues to produce the enzyme’s product. Expression of wild-type sterol 14α-demethylase in the resistant cells caused reversion to drug sensitivity and a restoration of ergosterol synthesis, showing that the mutation is indeed responsible for resistance. The amphotericin B resistant parasites become hypersensitive to pentamidine and also agents that induce oxidative stress. This work reveals the power of combining polyomics approaches, to discover the mechanism underlying drug resistance as well as offering novel insights into the selection of resistance to amphotericin B itself

Solid-state fermentation of oil palm frond petiole for lignin peroxidase and xylanase-rich cocktail production

In current practice, oil palm frond leaflets and stems are re-used for soil nutrient recycling, while the petioles are typically burned. Frond petioles have high commercialization value, attributed to high lignocellulose fiber content and abundant of juice containing free reducing sugars. Pressed petiole fiber is the subject of interest in this study for the production of lignocellulolytic enzyme. The initial characterization showed the combination of 0.125 mm frond particle size and 60% moisture content provided a surface area of 42.3 m2/g, porosity of 12.8%, and density of 1.2 g/cm3, which facilitated fungal solid-state fermentation. Among the several species of Aspergillus and Trichoderma tested, Aspergillus awamori MMS4 yielded the highest xylanase (109 IU/g) and cellulase (12 IU/g), while Trichoderma virens UKM1 yielded the highest lignin peroxidase (222 IU/g). Crude enzyme cocktail also contained various sugar residues, mainly glucose and xylose (0.1–0.4 g/L), from the hydrolysis of cellulose and hemicellulose. FT-IR analysis of the fermented petioles observed reduction in cellulose crystallinity (I900/1098), cellulose–lignin (I900/1511), and lignin–hemicellulose (I1511/1738) linkages. The study demonstrated successful bioconversion of chemically untreated frond petioles into lignin peroxidase and xylanase-rich enzyme cocktail under SSF condition

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

Child Sexual Abuse in Minna, Niger State Nigeria

Background: Child sexual abuse is a widespread form of child abuse that has remained the most under-reported. In our communities, much remains unknown of this act which often leaves victims traumatised with unsavoury memory that tends to affect their psychosocial development. The study evaluted the socio-demographic features and the nature of sexual abuse as seen in the outpatient department of general hospital Minna, Niger state. Patients and Methods: The case notes of patients who presented to the General Out-patient Department (GOPD) of General Hospital Minna were analysed for cases, of sexual assault, sexual abuse or rape seen between January 2008 and December 2008. Results: A total of 32 cases were seen, 90.1% of whom were children less than 17 years old; 75% were aged 6 – 15 years. All the cases were of the penile penetrative type (vaginal in girls and anal in boys). All the perpetrators were adult males known to, and resident in, the neighbourhood of their victims. Conclusion: There is need to build the capacity of health care providers to enable them manage child sexual abuse and its long-term effects in Minna