Co-administration of artemisinin and Ricinodendron heudelotii leaf extract—effects on selected antioxidants and liver parameters in male Wistar rats

Startling rate of malaria parasite resistance to artemisinin and its derivatives has led to possible herb–drug antimalarial combination therapy. This study assessed the effect of co-administration of artemisinin and Ricinodendron heudelotii extract on certain liver and antioxidant indices in rats. Four groups containing ten rats each were administered distilled water (group A), artemisinin only (group B), artemisinin with R. heudelotii extract (group C), and R. heudelotii extract only (group D). Serum biochemical values and antioxidant parameters were determined using standard methods respectively. The results revealed that the total protein level increased significantly (p < 0.05) in group C. Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) activities increased significantly (p < 0.05) in the group administered artemisinin only but was regulated to control level both in groups C and D. The liver reduced gutathione (GSH) concentration decreased in the group administered artemisinin only. Similarly, malondialdehyde (MDA) level significantly increased (p < 0.05) in group A while groups C and D showed decrease in MDA and catalase concentrations. Histological examination showed that few of the hepatocytes were necrotic in the group administered artemisinin only while the group administered artemisinin and extract showed mild to moderate central venous congestion and periportal cellular infiltration. The study indicates that the bioactive constituents of the R. heudelotii extract might either have a regulatory effect on artemisinin toxicity or synergistically enhance its activity. Such bioconstituents can further be isolated and characterized for drug development to tackle Plasmodium falciparum resistance

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

BUDGET PADDING AND NATIONAL DEVELOPMENT IN NIGERIA

The concept of budget padding was new in 2016 dictionary of Nigeria politics. This entrench budgetary process over the years as billions of naira was illegally padded through inflating the budget to trillions of naira and this has derailed the objectives of the budget preparation suspiciously. It has been observed that budget padding came in due to conflict of interest between the subordinate and superior, principal and agent, legislature that gain advantageous information against Nigerian masses. Budget padding is a persistent corruption, act of illicit enrichment of limited funds or resources that undermines policy changes for socio-economic development in Nigeria. This new budgetary act has led to poverty, inequality, unemployment, destitution, diseases, illiteracy and poor living standard among citizens. This paper examined budget padding and national development in Nigeria. The paper is anchored on prebendalism theory as its framework using qualitative method. The paper in its findings, opined that lawmakers inserted whooping sum in the budget, certain funds proposed by the executive for key infrastructures were either removed from the budget or slashed by the National Assembly and this corrupt action undermine national development. The abnormal conduct of budget padding by national assembly is a national embarrassment and it has imposed a lot of moral disgrace on Nigerian State. It is on this premise that the paper recommend that there is need for presidency to engage consulting firm to audit the financial bill to ensure accountability and hitch free budget preparation

The influence of family characteristics on glycaemic control among adult patients with type 2 diabetes mellitus attending the general outpatient clinic, National Hospital, Abuja, Nigeria

Background: There is an increasing epidemic of diabetes worldwide with many patients not achieving set treatment targets. Family interventions in diabetes patient management, a proven adjunct, have not been fully integrated to patient care.Method: A cross-sectional and descriptive study was conducted in the outpatient clinic of the Department of Family Medicine, National Hospital, Abuja. A total of 156 adult patients with type 2 diabetes were recruited between August and October 2012 with 145 (93%) completing the study. The Statistical Package for Social Sciences (SPSS) version 17.0 was used to enter and analyse the data.Results: A total of 145 subjects (81 females, 64 males) were studied. Assessment of the relationship between the family characteristics and glycaemic control was significant for family functional status by APGAR (Adaptability, Partnership, Growth, Affection, and Resolve), which represents the questionnaire categories and social support by the Modified Scale for Perceived Social Support (MSPSS), p-value 0.000.Conclusion: There was a significant relationship between family function and social support and glycaemic control among type 2 diabetic patients attending the general outpatient clinic in the National Hospital, Abuja, Nigeria

Knowledge and Compliance with Standard Precaution Among Healthcare Workers in A South-East Nigerian Tertiary Hospital

Background: Adherence to standard precautions (SP) is critical to reducing the burden of nosocomial infections. Objective: We assessed the knowledge and practice of SP among healthcare workers (HCWs). Methodology: A cross-sectional study was conducted among HCWs in Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi Anambra State, Nigeria using self-administered questionnaire and key informant interview. Results: Mean age and employment duration of subjects were 33.4±11.9 and 6.0 ± 6.7 years, respectively. Majority of the 341 HCWs had heard about SP (82.1%) and agreed that it should be applied to all patient care (78.0%). Only 45.7% of them correctly cited ≥2 components of SP. Two-third of participants reported that SP was poorly practiced in their unit mainly due to inadequate supply of materials (63.1%), inadequate staff training/retraining (62.2%), inadequate support by management (51.4%) and unavailable standard operating procedures (SOPs) on SP (37.8%). Compliance with SP and specifically, personal protective equipment (PPE) use were 65.1% and 76.2%, respectively. Profession (p=0.023), awareness about SP (p&lt;0.001), SOP display in prominent places (p&lt;0.001) and regular supply of running water (p&lt;0.001) were significantly associated with SP compliance. Key informant interview revealed lack of written SP policies or its communication to HCWs, lack of training/retraining of HCWs and lack of materials required for SP practice. Conclusion: Knowledge of basic concept and practice of SP was not satisfactory among HCWs. Major barriers to SP were lack of materials, training and active support by hospital management. Awareness, SOP display in prominent places and regular supply of running water positively influenced SP compliance. Having written policies and communicating such to all HCWs, consistent supply of necessary materials, intensified training, and regular supervision are recommended Keywords: Universal precautions, Nosocomial infections, Tertiary hospitals, Health Personnel, Nigeri

Adaptation of the Wound Healing Questionnaire universal-reporter outcome measure for use in global surgery trials (TALON-1 study): mixed-methods study and Rasch analysis

BackgroundThe Bluebelle Wound Healing Questionnaire (WHQ) is a universal-reporter outcome measure developed in the UK for remote detection of surgical-site infection after abdominal surgery. This study aimed to explore cross-cultural equivalence, acceptability, and content validity of the WHQ for use across low- and middle-income countries, and to make recommendations for its adaptation.MethodsThis was a mixed-methods study within a trial (SWAT) embedded in an international randomized trial, conducted according to best practice guidelines, and co-produced with community and patient partners (TALON-1). Structured interviews and focus groups were used to gather data regarding cross-cultural, cross-contextual equivalence of the individual items and scale, and conduct a translatability assessment. Translation was completed into five languages in accordance with Mapi recommendations. Next, data from a prospective cohort (SWAT) were interpreted using Rasch analysis to explore scaling and measurement properties of the WHQ. Finally, qualitative and quantitative data were triangulated using a modified, exploratory, instrumental design model.ResultsIn the qualitative phase, 10 structured interviews and six focus groups took place with a total of 47 investigators across six countries. Themes related to comprehension, response mapping, retrieval, and judgement were identified with rich cross-cultural insights. In the quantitative phase, an exploratory Rasch model was fitted to data from 537 patients (369 excluding extremes). Owing to the number of extreme (floor) values, the overall level of power was low. The single WHQ scale satisfied tests of unidimensionality, indicating validity of the ordinal total WHQ score. There was significant overall model misfit of five items (5, 9, 14, 15, 16) and local dependency in 11 item pairs. The person separation index was estimated as 0.48 suggesting weak discrimination between classes, whereas Cronbach's α was high at 0.86. Triangulation of qualitative data with the Rasch analysis supported recommendations for cross-cultural adaptation of the WHQ items 1 (redness), 3 (clear fluid), 7 (deep wound opening), 10 (pain), 11 (fever), 15 (antibiotics), 16 (debridement), 18 (drainage), and 19 (reoperation). Changes to three item response categories (1, not at all; 2, a little; 3, a lot) were adopted for symptom items 1 to 10, and two categories (0, no; 1, yes) for item 11 (fever).ConclusionThis study made recommendations for cross-cultural adaptation of the WHQ for use in global surgical research and practice, using co-produced mixed-methods data from three continents. Translations are now available for implementation into remote wound assessment pathways

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P &lt; 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)