A review of stakeholders and interventions in Nigeria's electricity sector

In this paper, we explored the interplay between the electricity market structure, methods of electricity trading and different stakeholder dynamics within the Nigerian Electricity Supply Industry (NESI) with a view to understanding how these interplays impact on various forms of interventions in the Nigerian electricity sector. We started off by exploring the market structure and electricity trading system within the Nigerian electricity sector and reviewed the various stakeholder groups within centralized and decentralized electricity systems in Nigeria's electricity sector by highlighting their core responsibilities and the dynamics at play in satisfying their interests. This study revealed that: (1) external stakeholder groups (such as donor agencies and multi-lateral organizations) exert more influence in Nigeria's electricity sector through financial interventions; (2) lack of coordination and engagement among various stakeholder groups pose a challenge to effective electricity infrastructure interventions that address the needs of people in society. The study concludes by highlighting the implications of these challenges and the need to address the rising complexities and uncertainties for better stakeholder involvement in addressing the salient challenges in the sector

Incidence and Pattern of Retinal Detachment in a Tertiary Eye Hospital in Nigeria

Objectives: The aim was to determine the hospital incidence, pattern and clinical presentation of retinal detachment at the Guinness Eye Center, Onitsha, Nigeria. Materials and Methods: Case files of all retinal detachment patients seen at the Guinness Eye Center Onitsha between June 1997 and May 2012 were reviewed. Information on age, gender, symptoms duration, type and anatomic location of detachment, presenting visual acuity, and predisposing factors were analyzed. Results: A total of 93 patients (99 eyes) were seen with a male preponderance (M:F = 2:1) and age range 10–89 years; median ‑ 61 years; mode ‑ 55 years; incidence ‑ 0.13%. Rhegmatogenous retinal detachment comprised 93.6%. Symptoms duration was 5 days to 8 years; median ‑ 9 months; mode ‑ 6 months. All the affected eyes had low vision with 79.8% blind; of the unaffected eyes, 40.2% had low vision with 24.7% being blind. Trauma was the precipitating factor in 33 (35.5%) patients. Proliferative vitreoretinopathy, 19 (19.2%) eyes, and lattice degeneration, 13 (13.1) eyes, were the commonest ocular risk factors. Common ocular co‑morbidities in the affected eyes were cataract, 13 (13.1%) eyes; uveitis, 9 (9.1%) and glaucoma, 6 (6.1%) eyes. Supero‑temporal, subtotal and total detachment constituted 84.8%; the macula was detached in 91.4%. The tears in eyes with rhegmatogenous detachment ranged from 1 to 6, with 51 (54.8%) having multiple tears. 10 (10.8%) eyes had giant tears; 6 (6.5%) had dialysis and 3 (3.2%) had coexisting macula holes; in 73.1% the tears were located in the superior retina. Conclusions: Retinal detachment incidence is low in our hospital; most patients presented late with severe visual loss. A community‑based study will provide more information on the magnitude of the problem. Education of the public on retinal detachment symptoms, the predisposing/precipitating factors and the need for early reporting to hospital are required.Keywords: Incidence, Nigeria, pattern, retinal detachmen

Safety of Transcatheter Aortic Valve Replacement in Patients with Aortic Aneurysm: A Propensity-Matched Analysis

Introduction There is a paucity of data regarding the outcomes of transcatheter aortic valve replacement (TAVR) among patients with thoracic or abdominal aortic aneurysms (AA). Using the Nationwide Inpatient Sample (NIS) database, we explored the safety of TAVR among patients with a diagnosis of AA. Methods We queried the National Inpatient Sample database (2012–2017) for hospitalized patients undergoing TAVR, using ICD-9 and ICD-10 codes for endovascular TAVR. Reports show that \u3e 95% of endovascular TAVR in the US is via transfemoral access, so our population are mostly patients undergoing transfemoral TAVR. Using propensity score matching, we compared the trends and outcomes of TAVR procedures among patients with versus without AA. Results From a total sample of 29,517 individuals who had TAVR procedures between January 2012 and December 2017, 910 had a diagnosis of AA. In 774 matched-pair analysis, all-cause in-hospital mortality was similar in patients with and without AA OR 0.63 [(95% CI 0.28–1.43), p = 0.20]. The median length of stay was higher in patients with AA: 4 days (IQR 2.0–7.0) versus 3 days (IQR 2.0–6.0) p = 0.01. Risk of AKI [OR 1.01 (0.73–1.39), p = 0.87], heart block requiring pacemaker placement [OR 1.17 (0.81–1.69), p = 0.40], aortic dissection [OR 2.38 (0.41–13.75), p = 0.25], acute limb ischemia [OR 0.46 (0.18–1.16), p = 0.09], vascular complications [OR 0.80 (0.34–1.89), p = 0.53], post-op bleeding [OR 1.12 (0.81–1.57), p = 0.42], blood transfusion [OR 1.20 (0.84–1.70), p = 0.26], and stroke [OR 0.58 (0.24–1.39), p = 0.25] were similar in those with and without AA. Conclusions Data from a large nationwide database demonstrated that patients with AA undergoing TAVR are associated with similar in-hospital outcomes compared with patients without AA. Key Summary Points Patients with a diagnosis aortic aneurysm (thoracic or abdominal) undergoing transcatheter aortic valve replacement (TAVR) have same risk of periprocedural complications as those without a diagnosis of aortic aneurysms (AA). Patients with a diagnosis of aortic aneurysm had a longer length of hospital stay. Further studies are needed to determine how specific features of aortic aneurysm such as size, shape, thrombus burden, or calcifications affect the safety of TAVR