Anticoagulation in Patients With COVID-19: JACC Review Topic of the Week.

Clinical, laboratory, and autopsy findings support an association between coronavirus disease-2019 (COVID-19) and thromboembolic disease. Acute COVID-19 infection is characterized by mononuclear cell reactivity and pan-endothelialitis, contributing to a high incidence of thrombosis in large and small blood vessels, both arterial and venous. Observational studies and randomized trials have investigated whether full-dose anticoagulation may improve outcomes compared with prophylactic dose heparin. Although no benefit for therapeutic heparin has been found in patients who are critically ill hospitalized with COVID-19, some studies support a possible role for therapeutic anticoagulation in patients not yet requiring intensive care unit support. We summarize the pathology, rationale, and current evidence for use of anticoagulation in patients with COVID-19 and describe the main design elements of the ongoing FREEDOM COVID-19 Anticoagulation trial, in which 3,600 hospitalized patients with COVID-19 not requiring intensive care unit level of care are being randomized to prophylactic-dose enoxaparin vs therapeutic-dose enoxaparin vs therapeutic-dose apixaban. (FREEDOM COVID-19 Anticoagulation Strategy [FREEDOM COVID]; NCT04512079).Dr Farkouh has received research grants from Amgen, Novo Nordisk, and Novartis. Dr Stone has received speaker honoraria from Infraredx; has served as a consultant to Valfix, TherOx, Robocath, HeartFlow, Ablative Solutions, Miracor, Neovasc, Abiomed, Ancora, Vectorious, Elucid Bio, Occlutech, CorFlow, Apollo Therapeutics, Impulse Dynamics, Cardiomech, Gore, and Amgen; and has equity/ options from Ancora, Cagent, Applied Therapeutics, Biostar family of funds, SpectraWave, Orchestra Biomed, Aria, Cardiac Success, Valfix, and Xenter. Dr Godoy is supported by the Frederick Banting and Charles Best Canada Graduate Scholarship (Doctoral Research Award) from the Canadian Institutes of Health Research. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.S

Smoke-free legislation and the incidence of paediatric respiratory infections and wheezing/asthma: interrupted time series analyses in the four UK nations

We investigated the association between introduction of smoke-free legislation in the UK (March 2006 for Scotland, April 2007 for Wales and Northern Ireland, and July 2007 for England) and the incidence of respiratory diseases among children. We extracted monthly counts of new diagnoses of wheezing/asthma and RTIs among children aged 0–12 years from all general practices in the Clinical Practice Research Datalink during 1997–2012. Interrupted time series analyses were performed using generalised additive mixed models, adjusting for underlying incidence trends, population size changes, seasonal factors, and pandemic influenza, as appropriate. 366,642 new wheezing/asthma diagnoses and 4,324,789 RTIs were observed over 9,536,003 patient-years. There was no statistically significant change in the incidence of wheezing/asthma after introduction of smoke-free legislation in England (incidence rate ratio (IRR) 0.94, 95% CI 0.81–1.09) or any other UK country (Scotland: IRR 0.99, 95% CI 0.83–1.19; Wales: IRR 1.09, 95% CI 0.89–1.35; Northern Ireland: IRR 0.96, 95% CI 0.76–1.22). Similarly no statistically significant changes in RTI incidence were demonstrated (England: IRR 0.95, 95% CI 0.86–1.06; Scotland: IRR 0.96, 95% CI 0.83–1.11; Wales: IRR 0.97, 95% CI 0.86–1.09; Northern Ireland: IRR 0.90, 95% CI 0.79–1.03). There were no demonstrable reductions in the incidence of paediatric wheezing/asthma or RTIs following introduction of smoke-free legislation in the UK

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

Meta-analysis of the association between sencondhand smoke exposure and physician-diagnosed childhood asthma

<p align="left">Introduction: Studies suggest an association between secondhand smoke exposure and the development of childhood asthma. Several countries are considering legislation to protect children from exposure.</p> <p align="left">Methods: A systematic review was conducted using MEDLINE, Embase, PubMed, and Web of Knowledge databases and a random effects meta-analysis was undertaken. Heterogeneity was assessed using the I2 test. Publication and small study biases were examined visually using a funnel plot and tested formally using Egger test. Univariate and multivariate meta-regression analyses were undertaken, including a subgroup analysis of cohort studies to examine the effect of duration of follow-up.</p> <p align="left">Results: Twenty relevant studies were identified (14 cross-sectional, 4 cohort, and 2 case–control) and provided 31 estimates of effect size. The pooled odds ratio was 1.32 (95% CI: 1.23, 1.42, p < .001). There was moderate heterogeneity (I2 = 74.2%, p < .001). On multivariate meta-regression analysis, effect size estimates were significantly higher for case–control studies (p = .042) and those using self-reported exposure to secondhand smoke (p = .050). There was no evidence of significant publication or small study bias (Egger test, p = .121).</p> <p align="left">Conclusions: There is now consistent evidence of a modest association between secondhand smoke and physician-diagnosed childhood asthma. These results lend support to continued efforts to reduce childhood exposure to secondhand smoke.</p&gt

Assessment of Information and Communication Technology for Selective Dissemination of Information and Current Awareness Services: A Case Study of University Libraries in the South-West Zone of Nigeria

Abstract Objective – To assess the use of information and communication technology (ICT) for selective dissemination of information (SDI) and current awareness services (CAS) in university libraries in the South-West zone of Nigeria. Methods – A descriptive research design was adopted. The instrument used for data collection was a structured questionnaire administered to a population consisting of 379 librarians, with 353 usable questionnaires retrieved. Results – Findings revealed that most university libraries in the South-West zone of Nigeria do not use ICT in delivery of SDI and CAS. It is evident in this study that despite the known positive effects of ICT in library services, traditional methods were predominantly used for SDI and CAS to the library users. The study revealed that erratic Internet services, insufficient training, inadequate ICT skills, and low support for ICT were hindrances towards ICT use for SDI and CAS. Conclusions – The integration of ICT features in library services for the delivery of CAS and SDI has been a challenge in university libraries in South-West Nigeria. Only a few libraries and a low percentage of librarians had adopted the use of ICT in the delivery of CAS and SDI, while a larger number of libraries resorted to the use of traditional methods. The level of ICT literacy among the librarians in this study is low, as a higher percentage of librarians did not have adequate ICT skill to use available online resources on the Internet and other ICT tools to deliver SDI and CAS in South-West, Nigeria. This is not unconnected to the fact that the training and technical support received by the librarians is inadequate, and the level of support that academic libraries received from their university managements in South-West Nigeria in terms of funding for ICT development is inadequate, which led to low Internet services

Analysis of Akangba Transmission substation protection system

The challenges of the Nigeria power system have deprived the yearning electricity consumer access to stable power supply. Apart from the incessant load shedding due to inadequate power generation capacities, poor power system protection design, lack of constant protection system review after several changes to the power network is one of the contributing factors for unstable power system and unplanned outages. The network engineers must devise method of reviewing the protection settings as changes are made to power system components. This motivates the adoption of power system symmetrical fault analysis model presented herein. The model was applied to Akangba Transmission substation using the network planning software (NEPLAN software). The results show the fault current flowing through every part of the network. The effect of network expansion, switching Scenarios /Component changes on the fault current and protection scheme was also verified. Protection engineers must therefore take note of changes in the power network configuration when planning protection coordination and relay setting. The method is interesting and can be used as a template for reviewing protection scheme when changes are made on the power network. This will ensure better power protection management, enhance stable power supply and reduce damage to expensive power components

Perception of poultry farmers on duck farming in Kwara State, Nigeria

The study assessed the perception of poultry farmers on duck farming in Kwara state, Nigeria. A random sampling technique was employed in selecting 80 poultry farmers used in the study. Analytical tools used include frequency counts, charts, mean, percentage and Pearson Product moment correlation. Results showed that the mean age of the respondents was 41.3 years with majority of the respondents (71.3%) were male while 28.8% were females. About 70% were married. Findings further showed that about 42% of the respondents were aware of duck farming, 23.9% of the respondents were aware of duck farming through Radio/TV. Furthermore, some of the perceived benefits of duck farming by poultry farmers were ducks have less mortality (̅=2.69), duck meat is tastier than broiler (̅ = 2.6) and ducks are less expensive (̅ = 2.53). The major constraints to duck farming in study area were lack of information and awareness about duck farming (1.794±0.503) and religious factors (1.575±0.521). Results of correlation analysis revealed that none of the socio economic characteristics tested were significant with the perceived knowledge of the respondents on the advantages of duck farming (p<0.05). It was concluded that the perception of poultry farmers to duck farming in study area was positive but were constrained by lack of information and awareness about duck farming (1.794±0.503) and religious factors (1.575±0.521). This is therefore a challenge for extension service delivery and as such poultry farmers and the general public, considering the nutritional, economic and other benefits of ducks, be given adequate innovative information on duck rearing.Keywords: Perception, Poultry, farmers, Duck farming, Kwara Stat

Assessment of the awareness of male and female singles on the association between HIV/AIDS and tuberculosis

Tuberculosis (TB) is an infectious disease which was declared a .global health emergency. by theWorld Health Organisation. The Federal Ministry of Health in Nigeria also declared TB a national emergency and inaugurated the National TB-HIV Working Group in 2006. Every year, 8-10 million people contact the disease and 2 million die from it.Although there are effective antimicrobial agents for the control and cure of TB, there remains an increase which is due to negligence, ignorance, improperapplication of available control measures and inadequate treatment. Nigeria has the fourth highest cases of TB in the world and at least 105,000 people die of TB in Nigeria annually. Many people are still ignorant about how TB is spread, its co-infection with HIV, and how TB is prevented or cured. All these are of public health importance, which contributes to the continuous spread and the stigma of the disease. The main objective of this study is to determine the level of awareness of male and female singles, about the association between tuberculosis and HIV/AIDS.Aquestionnaire was prepared for data collection and wasstandardised, using test-retest reliability method. The investigation is being conducted in some universities and this is the result from, Babcock University (BU), one of the institutions. Two hundred questionnaires were administered to male and female singles, volunteer students. The results showed that 98% of the students were aware of HIV/AIDS, while 64% hadheard of TB. The awareness of BU students on TB and its co-infection with HIV/AIDS was poor (31%). Also, 88.5% of the students were not aware of BCG vaccine, which is used for preventing Tuberculosis. Only 39.5% were aware that TB is contagious. The study revealed the need for awareness campaign, on TB and its co-infection with HIV/AIDS. Though the awareness of HIV/AIDS among Babcock University students was high, more efforts needs to be put into creating more awareness on TB, to ensure that individuals take precautions to avoid the spread of both HIV and TB. This will help in the control of HIV/AIDS and TB, within the community.  Keywords: tuberculosis, infectious disease, global health emergency, contagious, public health importance