Effects of nutritional supplements on the re-infection rate of soil-transmitted helminths in school-age children : a systematic review and meta-analysis

Background The effect of nutritional supplements on the re-infection rate of species-specific soil-transmitted helminth infections in school-aged children remains complex and available evidence on the subject matter has not been synthesized. Methods The review included randomised controlled trials (RCTs) and cluster RCTs investigating food supplements on school-aged children between the age of 4–17 years. A search for RCTs was conducted on eight databases from inception to 12th June 2019. Cochrane Risk of Bias tool was used to assess the risk of bias in all included studies. Meta-analysis and narrative synthesis were conducted to describe and analyze the results of the review. Outcomes were summarized using the mean difference or standardized mean difference where appropriate. Results The search produced 1,816 records. Six studies met the inclusion criteria (five individually RCTs and one cluster RCT). Four studies reported data on all three STH species, while one study only reported data on Ascaris lumbricoides infections and the last study reported data on only hookworm infections. Overall, the risk of bias in four individual studies was low across most domains. Nutritional supplementation failed to statistically reduce the re-infection rates of the three STH species. The effect of nutritional supplements on measures of physical wellbeing in school-aged children could not be determined. Conclusions The findings from this systematic review suggest that nutritional supplements for treatment of STH in children should not be encouraged unless better evidence emerges. Conclusion of earlier reviews on general populations may not necessarily apply to children since children possibly have a higher re-infection rate

Outcome of neonatal surgeries in Nnewi, Nigeria

Background: A surgical neonate is a challenge, especially in developing countries such as Nigeria, where neonatal surgical practice is still evolving. Mortality is still high compared with developed nations. Data from developing countries on this emerging aspect of paediatric surgery, however, are scarce. We reviewed all neonatal surgical cases that were managed at the Nnamdi Azikiwe University Teaching Hospital Nnewi, a tertiary institution located in the South Eastern region of Nigeria, with a view of determining the outcome.Patients and methods: This was a retrospective review of Hospital records of infants aged 0–28 days who were treated at the Special Baby Care Unit of the hospital from January 2009 to June 2012.Results: Out of 1863 babies admitted to the Special Care Baby Unit of the hospital, 147 (8%) were surgical cases. There were 91 males and 56 females (M: F=1.6 : 1). The mean weight of the babies was 2.5 kg (range=0.1–4.3 kg). Thirty-two babies (16.9%) were premature. The most frequent indication for admission is gastrointestinal conditions, accounting for 78.2% of all neonatal surgeries. The most common procedure carried out was intestinal anastomosis and repair (36%). One hundred and thirteen neonates (76.9%) presented beyond 48 h of onset of symptoms. Of the delayed cases, 65% sought medical attention early at the primary and secondary health centres, but referral was delayed from periods ranging from 2 to 21  days (mean=5 days). Only 15 of the neonates had a valid prenatal ultrasound diagnosis. In only three of the cases were the mothers referred for planned delivery and specialist care. Infective conditions (sepsis, surgical site infection, respiratory tract infections) accounted for 45.4% of morbidity. Mortality was higher in the late presenters, premature babies, babies with weight less than 2.5 kg and in thoracic surgeries. Overall, 41 neonates died, yielding a mortality of 27.9%.Conclusion: The high morbidity and mortality from neonatal surgeries still persists. Factors that negatively affect the outcome include late presentation, prematurity, low birth weight and thoracic surgeries. Enhanced prenatal diagnosis,early patient referral, further personnel training and improvement in facilities will improve outcome.Keywords: late presentation, mortality, neonatal surgery, Nigeria, outcom

REACTION OF SHARE PRICES TO DIVIDEND POLICY OF NON-FINANCIAL FIRMS IN NIGERIA: A PANEL DATA APPROACH

The study analyzed how share prices react to dividend policies of non-financial firms in Nigeria. Data were collected from a sample of 31 non-financial firms using an ex post facto research design from 2013 to 2019, resulting in 217 firm-specific observations. Descriptive statistics, diagnostic tests, and inferential statistics were used as statistical tools of analysis. Results revealed that dividend per share positively and significantly affects share prices of sampled firms. This finding affirms Gordon’s bird in hand theory that share prices are affected by dividend. Dividend payout ratio, dividend yield, firm, size and firm age do not have significant effect on share prices of sampled firms. Consequently, the study recommends that firms should ensure that a good dividend policy is implemented and that dividend per share policies are maintained, as this has been empirically demonstrated to influence share prices

Is the femoral neck-shaft angle an independent risk factor for hip fractures? An observational study

Background: The femoral neck-shaft angle (FNSA) has been implicated in the aetiology of hip fractures. The longer moment arm of a higher FNSA has been theorized to impart a greater deforming force to the greater trochanter, which may cause a hip fracture.Methods: A prospective study that involves adults with hip fractures and a control group matched for age and sex. The FNSA of both groups were measured on an anteroposterior X-ray of the pelvis. The mean FNSA were compared with a paired samples t-test, and a binary logistic regression analysis was run with the FNSA as a predictor variable and the presence of hip fracture as an outcome variable.Results: A total of 150 patients were recruited for the study, 75 per group. The mean age of patients with hip fractures was 71.30 years (S.D.=14.34), and that of the control group was 73.94 years (S.D.=12.55), p=0.264. The mean FNSA of the study group was 133.96o (S.D.=3.77) while that of the control group was 131.05o (S.D.=3.86), p<0.001. Increasing FNSA imparts a higher risk of having a hip fracture, O.R.=1.24 (95% C.I, 1.12-1.37).Conclusions: Individuals with higher FNSA demonstrated a significantly increased risk of developing hip fractures. However, the exact cut-off point of the FNSA, which predisposes to the risk of these fractures, remains to be elucidated.

Systematic reviews as a “lens of evidence”: determinants of cost-effectiveness of breast cancer screening

Systematic reviews with economic components are important decision tools for stakeholders seeking to evaluate technologies, such as breast cancer screening (BCS) programs. This overview of systematic reviews explores the determinants of the cost‐effectiveness of BCS and assesses the quality of secondary evidence. The search identified 30 systematic reviews that reported on the determinants of the cost‐effectiveness of BCS, including the costs of breast cancer and BCS. While the quality of the reviews varied widely, only four out of 30 papers were considered to be of a high quality. We did not identify publication bias in the original evidence on the cost‐effectiveness of mammography screening; however, we highlight a need for improved clarity in both reporting and data verification. The reviews consisted mainly of studies from high‐income countries. Breast cancer costs varied widely among the studies. Factors leading to higher costs included: time (diagnosis and last months before death), later stage or metastases, recurrence of the disease, age below 64 years and type of follow‐up (more intensive or more specialized). Overall, screening with mammography was considered cost‐effective in the age range 50‐69 years in Western European and Northern American countries but not for older or younger women. Its cost‐effectiveness was questionable for low‐income settings and Asia. Mammography screening was more cost‐effective with biennial screening compared to annual screening and single reading using computer‐aided detection vs double reading. No information on the cost‐effectiveness of ultrasonography was found, and there is much uncertainty on the cost‐effectiveness of CBE because of methodological limitations

Health state utilities of a population of Nigerian hypertensive patients

<p>Abstract</p> <p>Background</p> <p>Establishment of the health impact of hypertension on quality of life of Nigerians is a step towards controlling the disease. The study aimed to provide a Nigerian specific reference list of utility scores of hypertensive patients with various interacting conditions.</p> <p>Findings</p> <p>An interviewer-based, cross-sectional study was conducted using hypertensive patients in two purposively selected tertiary hospitals located in South-Eastern Nigeria. Health Utility Index Mark 3 (HUI3) was used.</p> <p>A total of 384 participants with either hypertension alone or with hypertension-associated complications were interviewed in the two tertiary hospitals.</p> <p>The overall mean utility score was 0.35 +/- 0.42. Patients with hypertension alone had the highest overall mean utility score (0.57 +/- 0.29) while hypertensive patients with stroke had the lowest overall mean score (0.04 +/- 0.36). Being a male, increase in age and mean arterial blood pressure, emergency visit and loss of work due to illness were associated with significant decrease in overall utility scores.</p> <p>Conclusions</p> <p>This study presented a reference for health state utilities of a population of Nigerian hypertensive patients.</p

Assessment of complications following use of pneumatic tourniquet for elective orthopedic procedures at National Orthopedic Hospital, Enugu

Background: A pneumatic tourniquet is a constricting or compressing device with an inflatable cuff used to control venous or arterial circulation to an extremity for a period of time. Tourniquet safety is related to the cuff pressure and duration of application. The objective of this study was to determine the common complications that follow the use of pneumatic tourniquet in elective orthopaedic surgical procedures at National Orthopaedic Hospital Enugu.Methods: This was a prospective study over 18 month period (June 2014 – November 2015) at National Orthopaedic Hospital, Enugu. Following ethical approval and written informed consent, patients who met the inclusion criteria were consecutively recruited. The study was conducted using the ‘intelligent pneumatic tourniquet’ with single bladder reusable cylindrical cuff. The cuff pressure was determined in each case by addition of 100mmHg to the baseline systolic BP for the upper limbs and 150 mmHg to the baseline systolic BP for the lower limbs. The data collected included patients’ demographics, cuff pressure, cuff location, tourniquet duration and complication encountered among other parameters.Results: A total of 160 procedures in 152 patients were included and analyzed using SPSS version 20.0. The prevalence rate of 1.9% for nerve palsy, 1.3% for tourniquet pain, 1.9% for surgical site infection and 5.6% for pressure sore were found in the study. No other complication was encountered.Conclusions: From the results of this study, it is concluded that the use of pneumatic tourniquet under the prescribed conditions is associated with low prevalence of complications

Epidemiology of lumbar disc herniations in adults with low back pain in Enugu, Nigeria

Background: Lumbar intervertebral disc herniation is used to describe a spectrum of anatomical abnormalities involving disc extension beyond the interspace. It follows a tear in the annulus fibrosus of the intervertebral disc. It is one of the most common causes of low back pain among adults. The study aims to assess the epidemiological pattern of lumbar disc herniations among adults with low back pain in Enugu urban.Methods: The study was a prospective study at National Orthopedic Hospital Enugu and Annunciation Specialist Hospital Enugu. Following ethical approval and written informed consent, patients who met the inclusion criteria were consecutively recruited. The MRI scans of the participants were viewed using DICOM® (Digital Imaging and Communications in Medicine) software on laptop computer. The data included the patients’ demographics, functional disability index for back pain, weight, height, the anatomical level(s) and site(s) of the herniated disc among other parameters.Results: A total of 81 subjects who met the inclusion criteria were included and analyzed using SPSS version 20.0. The mean age of the subjects is 52.99±13.13 years. The most common affected age group is 51-60 years (27.2%). Majority of the subjects (68; 84%) had multiple level herniations which usually includes L4 level(74; 91.4%).Conclusions: That multilevel lumbar disc herniation is far more common than single level herniation with a prevalence of 84% among adults with low back pain in Enugu urban. That, there is statistically significant association of lumbar disc herniation and increasing age

Bacillus anthracis Peptidoglycan Stimulates an Inflammatory Response in Monocytes through the p38 Mitogen-Activated Protein Kinase Pathway

We hypothesized that the peptidoglycan component of B. anthracis may play a critical role in morbidity and mortality associated with inhalation anthrax. To explore this issue, we purified the peptidoglycan component of the bacterial cell wall and studied the response of human peripheral blood cells. The purified B. anthracis peptidoglycan was free of non-covalently bound protein but contained a complex set of amino acids probably arising from the stem peptide. The peptidoglycan contained a polysaccharide that was removed by mild acid treatment, and the biological activity remained with the peptidoglycan and not the polysaccharide. The biological activity of the peptidoglycan was sensitive to lysozyme but not other hydrolytic enzymes, showing that the activity resides in the peptidoglycan component and not bacterial DNA, RNA or protein. B. anthracis peptidoglycan stimulated monocytes to produce primarily TNFα; neutrophils and lymphocytes did not respond. Peptidoglycan stimulated monocyte p38 mitogen-activated protein kinase and p38 activity was required for TNFα production by the cells. We conclude that peptidoglycan in B. anthracis is biologically active, that it stimulates a proinflammatory response in monocytes, and uses the p38 kinase signal transduction pathway to do so. Given the high bacterial burden in pulmonary anthrax, these findings suggest that the inflammatory events associated with peptidoglycan may play an important role in anthrax pathogenesis