Prevalence of end-digit preference in recorded blood pressure by nurses: a comparison of measurements taken by mercury and electronic blood pressure-measuring devices

Objectives: When compared with the use of a mercury  sphygmomanometer, the use of a validated digital blood pressure (BP) measuring device eliminates the risk of exposure to mercury. Digital devices are also associated with a lesser degree of end-digit preference (EDP). EDP refers to the occurrence of a particular end digit more frequently than would be expected through chance alone. There have been only a few reports from Africa on the occurrence of EDP in BP measurement. This study examined EDP in BP taken by nurses before and after the introduction of a digital BP-measuring device. Design: The design was a retrospective study. Settings and subjects: We reviewed the BP readings of 58 patients who presented at the dedicated clinic for people living with human immunodeficiency virus/acquired immune deficiency syndrome of Ladoke Akintola University of Technology Teaching Hospital, Osogbo, Nigeria, before and after the introduction of the digital BP-measuring device. Outcome measures: The prevalence of end-digit zero of systolic and diastolic BP readings before and after the introduction of the digital device was compared using McNemar’s test. Results: There was a large and significant fall in end-digit zero when BP readings that were taken using the mercury and digital devices were compared (systolic 98.1% vs. 10.9%, p-value < 0.001; diastolic 97.1% vs. 14.9%, p-value < 0.001 (McNemar’s test). Conclusion: There was a significant reduction in the frequency of end-digit zero when BP was taken with the digital devicerather than the mercury device. Regular training and certification of healthcare workers in BP measurement is recommended to ensure a high quality BP measurement standard.Keywords: blood pressure measurement, mercury sphygmomanometer, digital blood pressure-measuring devices, end-digit preferenc

Levels of awareness and concentrations of heavy metals in the blood of electronic waste scavengers in Nigeria

Background - Electronic waste (e-waste) contains both valuable and hazardous materials. E-waste scavengers specialize in the collection and crude recycling of waste electronics to retrieve valuable metals, which are then sold. These activities provide an income for scavengers, but also expose them to toxic heavy metals such as lead (Pb) and copper (Cu). Objectives - The aim of the present study was to investigate the level of awareness and concentrations of heavy metals (Pb, Cu, zinc (Zn) and manganese (Mn)) in the blood levels of e-waste scavengers at Jakande dumpsite, Alaba International Market, Lagos, Nigeria. Methods - Material and data were collected by empirical survey with the use of a questionnaire to obtain information from e-waste scavengers. Blood samples of the scavengers in the present study (30 adult males exposed to recycling processes) were collected and concentrations of heavy metals were determined through acid digestion and the use of an atomic absorption spectrophotometer (AGILENT 55B AA, 2010). Results - The geometric means of blood levels of Pb, Cu, Zn and Mn were 11.0, 33.85, 126.15 and 19.38 µg / dL, respectively. High concentrations of Pb and Mn (11.0 and 19.38 µg / dL) were found in the blood samples, while Zn and Cu (126.15 and 33.85 µg / dL) showed low concentrations. The maximum blood level of lead (BPb) (24.0 µg / dL) was extremely high compared to the maximum BPb of occupationally exposed males. Statistical analysis of the questionnaires showed that all of the respondents were male, and more than half (56.7%) were between 21-30 years of age and had been involved in recycling of e-waste for 1-5 years. The results showed that 83% of the respondents were aware that hazardous fractions in e-waste require special treatment, while 76.7% were aware of the possible negative impact on their health. Conclusions - Lack of education, poverty and lack of effective enforcement of e-waste management and regulations are the major contributors to the current situation and thus scavengers carry on with their activities unhindered. The authors recommend the use of protective clothing, sensitization visits and awareness campaigns on the safe disposal of hazardous components

Changes in mediators of inflammation and pro-thrombosis after 12 months of dietary modification in adults with metabolic syndrome.

Objective: This study evaluated the effects of a 12-month dietary modification on indices of inflammation and pro-thrombosis in adults with metabolic syndrome (MS). Materials and methods: This longitudinal study involved 252 adults with MS recruited from the Bodija market, Ibadan and its environs. Participants were placed on 20%, 30% and 50% calories obtained from protein, total fat and carbohydrate respectively and were followed up monthly for 12 months. Anthropometry and blood pressure were measured using standard methods. Fasting plasma glucose (FPG), total cholesterol (TC), triglycerides (TG), high density lipoprotein-cholesterol (HDL-C), fibrinogen, plasminogen activator inhibitor-1 (PAI-1)], interleukin-6 (IL-6) and interleukin-10 (IL-10) were measured using spectrophotometric methods and ELISA as appropriate. Data was analysed using ANCOVA, Student\u2019s t-test, Mann-Whitney U and Wilcoxon signed-rank tests. P-values less than 0.05 were considered significant. Results: After 6 months of dietary modification, there was a significant reduction in waist circumference (WC), while the levels of HDL-C, fibrinogen and PAI-1 were significantly increased when compared with the corresponding baseline values. However, WC and fibrinogen reduced significantly, while HDL-C and IL-10 significantly increased after 12 months of dietary modification as compared with the respective baseline values. Conclusion: Long-term regular dietary modification may be beneficial in ameliorating inflammation and pro-thrombosis in metabolic syndrome

The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study

AIM: The SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery. METHODS: This was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin. RESULTS: Overall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P < 0.001). After adjustment, delay was not associated with a lower rate of complete resection (OR 1.18, 95% CI 0.90-1.55, P = 0.224), which was consistent in elective patients only (OR 0.94, 95% CI 0.69-1.27, P = 0.672). Longer delays were not associated with poorer outcomes. CONCLUSION: One in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease

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

Evaluating the quality characteristics of kunun produced from dry-milled sorghum

Kunun is a traditional beverage in Nigeria produced by wet milling from sorghum, maize or millet. This work evaluates kunun produced from dry-milled sorghum flour. The sorghum was dehulled, milled and sieved to obtain flour. The flour was steeped for 24 h and mixed with spices to produce kunun and the quality of the resultant kunun was compared with that of kunun manufactured by the wet-milling process. With dry-milling process, the yield of kunun was 80% while the yield from the wet-milling process was 60%. Titratable acidity was lower in kunun samples prepared from dry-milled sorghum (0.40%) than in the kunun manufactured by wet milling (0.55%). The pH and total soluble solid of kunun prepared from dry milled sorghum were higher (5.10 and 14.82, respectively) than kunun from wet milling process (4.12 and 13.42, respectively). Protein content recorded for dry milled sample was 5.55% and that of wet milled sample was 4.20%. Crude fibre content was also assessed to be 0.25% for dry milled sample and 0.45% for wet milled sample. Kunun samples from wet milling process were preferred to those from dry milling process. Microbial counts indicate that both samples were free from feacal contamination. Total viable count for kunun samples prepared from dry milling process was 1.0 x 04, and for wet milled sample total viable count was 1.6 x 104

Changing rural urban linkages in Africa in a globalizing economy

The role of rural-urban linkages is critically vital for Africa‟s development in this era of rapid socio-economic transformation. A better understanding of cities and how they relate both to the rural and urban development is needed in view of the continuous changes in development. This paper argues that many of Africa‟s development  problems such as poverty and food insecurity are best tackled through approaches that recognise the links between the two. Further, the paper proposes the “Kizuna” approach, which emphasises strong symbiotic bonds between rural and urban communities to addressing most problems that face the African society. Moreover, the paper argues that elements of „Kizuna‟ are already evident in the various social networks and kinships that guide the interactions between rural and urban dwellers in Africa. However, these bonds still need formal recognition and deliberate policy interventions aimed at enhancing their potential to foster poverty reduction and sustainable development.Keywords: Rural-urban-continuum, livelihood options, environmental damage, sustainable development, Kizun