Thermal and pressure stability of myrosinase enzymes from black mustard (Brassica nigra L. W.D.J Koch. var. nigra), brown mustard (Brassica juncea L. Czern. var. juncea) and yellow mustard (Sinapsis alba L. Subsp Maire) seeds

This study investigates the effects of temperature and pressure on inactivation of myrosinase extracted from black, brown and yellow mustard seeds. Brown mustard had higher myrosinase activity (2.75 un/mL) than black (1.50 un/mL) and yellow mustard (0.63 un/mL). The extent of enzyme inactivation increased with pressure (600-800 MPa) and temperature (30-70 °C) for all the mustard seeds. However, at combinations of lower pressures (200-400 MPa) and high temperatures (60-80 °C), there was less inactivation. For example, application of 300 MPa and 70 °C for 10 minutes retained 20%, 80% and 65% activity in yellow, black and brown mustard, respectively, whereas the corresponding activity retentions when applying only heat (70 °C, 10min) were 0%, 59% and 35%. Thus, application of moderate pressures (200-400 MPa) can potentially be used to retain myrosinase activity needed for subsequent glucosinolate hydrolysis

Prevalence of Rhesus C and D Alloantibodies among Rhesus-Negative Women of Child Bearing Age at a Tertiary Hospital in South-West Nigeria

Background: A major cause of hemolytic disease of the fetus and newborn (HDFN) is an incompatibility of the Rhesus (Rh) blood group between the mother and fetus. Aim: To determine the prevalence of Rh c and D alloantibodies among Rh-negative women of childbearing age (18–49 years). We conducted a cross-sectional study among women who attended the antenatal, gynecology and blood donor clinics at a Tertiary Hospital in South-West Nigeria from January to August 2019. Serological typing of Rh c and D was done manually with the tube test using anti-c and anti-D antisera, while indirect antiglobulin test was then performed to screen for Rh antibodies. Subjects and Methods: Data was analyzed using Stata 16.1 software; Categorical data was summarized using frequency and percentages while continuous variables were described using the mean and standard deviation or median and interquartile range. Pearson's Chi-square (or Fisher's exact) test was used to test for association between categorical variables and Rh status. P values of ≤0.05 were assumed to be statistically significant. Results: A total of 700 consenting women, comprising 505 pregnant (72.1%) and 195 non-pregnant (27.9%) women were recruited into this study. The mean age was 30.7 ± 4.9 years. All (100%) participants were Rhc positive while 641 (91.6%) were RhD positive and 59 (8.4%) were RhD negative. All 59 RhD negative subjects tested negative for anti-D. There was no statistically significant difference between proportion of RhD-negative women who had a jaundiced baby and the proportion of RhD-positive women who had a jaundiced baby (15.6% vs. 18.6%, P = 0.540). Conclusions: This study did not identify any Rhc and D alloantibodies in the study population suggesting there is a low risk of alloimmunization and HDFN due to anti-Rhc and D in this population

Market level characteristic factors influencing smallholder coffee marketers in Kogi State, Nigeria

The study assessed the market level characteristic factors influencing coffee marketing among coffee farmers in the study area. The study was carried out in Kogi State and purposive sampling technique was used to select eighty four respondents. Data were collected from the respondents with the use of structured questionnaire and the data collected were analyzed using descriptive statistics (frequency and percentages) as well as multi-variate regression analysis. Result of the descriptive analysis shows that the mean age of the farmers was 64 years while 60% of the farmers had no access to formal education. Regression analysis revealed that farm size, variety of coffee, marketing channels, trading experience, membership of association, price satisfaction and selling method constituted major characteristic marketing factors influencing coffee marketing in the study area and they all affected coffee marketing at 1% significant level. Based on the findings, the study therefore recommended that efforts should be made to assess variety of coffee that is more preferred by the buyers. Also, farmers should be given incentives to increase their farm holdings for higher productivity

Upheaval in cancer care during the COVID-19 outbreak

On Monday, 23 March 2020, Nigeria recorded its first mortality from the novel global COVID-19 outbreak. Before this, the country reported 36 confirmed cases (at the time of writing) and has discharged home two cases after weeks of care at a government-approved isolation center in Lagos State. This first mortality was that of a 67-year-old man with a history of multiple myeloma, a type of blood cancer. He was undergoing chemotherapy and had just returned to Nigeria following medical treatment in the United Kingdom. The novel COVID-19 pandemic has grounded several global activities including the provision of health care serves to people with chronic conditions such as cancer. Evidence from China suggests that cancer patients with COVID-19 infection are a vulnerable group, with a higher risk of severe illness resulting in intensive care unit admissions or death particularly if they received chemotherapy or surgery. This letter is an attempt to suggests practicable interventions such as the use of existing digital health platforms to limit patients' and oncology professionals’ physical interaction as a way of reducing the risk of COVID-19 infection transmission amongst cancer patients and oncologists, as well as outlining effective strategies to ensure that cancer care is not completely disrupted during the outbreak

Review of Nasal Foreign Bodies in Children at a Rural Federal Medical institution in South West, Nigeria

Otolaryngologist frequently encountered nasal foreign bodies particularly among children. This study reviews the types of nasal foreign bodies, clinical presentation, treatment options, and outcome in children seen at Ido-Ekiti, South West Nigeria. This was a retrospective review of all children with nasal foreign body that were managed over a period of 5 years, at the Federal Medical Centre, Ido-Ekiti, Nigeria. A total of 52 out of 65 patients with nasal foreign bodies had complete data for analysis. The male: female ratio was 1.4:1, aged 1-11 years with a mean of 3.4 years ± 1.6 SD. The age group 0-5 years was mostly affected in 90.4%. The commonest foreign bodies were stones in 19.2% of cases. Right nasal cavity was mostly affected in 78.8% patients. Source of referral of patients to ENT Clinic was from general outpatient department (GOPD) in 42.3%. Attempt at removal of foreign body before presentation was made in 26.9 % of our patients. Rhinorrhoea was commonest form of presentation in 24 patients with 6 of them having associated foul smelling. Majority, 34.6% present in our clinic within one day of foreign body insertion. Most of the foreign bodies (76.9%) were removed under direct vision with Jobson-Horne probe or Nasal forceps. General anaesthesia was used in 23.1% cases. Minimal bleeding was noticed in 23.1 % of the patients. No mortality was recorded. Nasal foreign bodies are common in pediatric setting usually below the age of 5 years. Early recognition and referral of difficult cases to Otolaryngologist will prevent morbidity and mortality. Health education and public awareness on the danger of foreign body in the nose, keeping small objects away and constant watchful with monitoring of these children at home and schools is advocated

Health care expenditure disparities in the European Union and underlying factors: a distribution dynamics approach

This paper examines health care expenditure (HCE) disparities between the European Union countries over the period 1995-2010. By means of using a continuous version of the distribution dynamics approach, the key conclusions are that the reduction in disparities is very weak and, therefore, persistence is the main characteristic of the HCE distribution. In view of these findings, a preliminary attempt is made to add some insights into potentially main factors behind the HCE distribution. The results indicate that whereas per capita income is by far the main determinant, the dependency ratio and female labour participation do not play any role in explaining the HCE distribution; as for the rest of the factors studied (life expectancy, infant mortality, R&D expenditure and public HCE expenditure share), we find that their role falls somewhat in between

Insulin resistance drives hepatic de novo lipogenesis in nonalcoholic fatty liver disease

BACKGROUNDAn increase in intrahepatic triglyceride (IHTG) is the hallmark feature of nonalcoholic fatty liver disease (NAFLD) and is decreased by weight loss. Hepatic de novo lipogenesis (DNL) contributes to steatosis in individuals with NAFLD. The physiological factors that stimulate hepatic DNL and the effect of weight loss on hepatic DNL are not clear.METHODSHepatic DNL, 24-hour integrated plasma insulin and glucose concentrations, and both liver and whole-body insulin sensitivity were determined in individuals who were lean (n = 14), obese with normal IHTG content (n = 26), or obese with NAFLD (n = 27). Hepatic DNL was assessed using the deuterated water method corrected for the potential confounding contribution of adipose tissue DNL. Liver and whole-body insulin sensitivity was assessed using the hyperinsulinemic-euglycemic clamp procedure in conjunction with glucose tracer infusion. Six subjects in the obese-NAFLD group were also evaluated before and after a diet-induced weight loss of 10%.RESULTSThe contribution of hepatic DNL to IHTG-palmitate was 11%, 19%, and 38% in the lean, obese, and obese-NAFLD groups, respectively. Hepatic DNL was inversely correlated with hepatic and whole-body insulin sensitivity, but directly correlated with 24-hour plasma glucose and insulin concentrations. Weight loss decreased IHTG content, in conjunction with a decrease in hepatic DNL and 24-hour plasma glucose and insulin concentrations.CONCLUSIONSThese data suggest hepatic DNL is an important regulator of IHTG content and that increases in circulating glucose and insulin stimulate hepatic DNL in individuals with NAFLD. Weight loss decreased IHTG content, at least in part, by decreasing hepatic DNL.TRIAL REGISTRATIONClinicalTrials.gov NCT02706262.FUNDINGThis study was supported by NIH grants DK56341 (Nutrition Obesity Research Center), DK20579 (Diabetes Research Center), DK52574 (Digestive Disease Research Center), and RR024992 (Clinical and Translational Science Award), and by grants from the Academy of Nutrition and Dietetics Foundation, the College of Natural Resources of UCB, and the Pershing Square Foundation

What Are the Contextual Enablers and Impacts of Using Digital Technology to Extend Maternal and Child Health Services to Rural Areas? Findings of a Qualitative Study From Nigeria

Background: Strengthening health systems to improve access to maternity services remains challenging for Nigeria due partly to weak and irregular in-service training and deficient data management. This paper reports the implementation of digital health tools for video training (VTR) of health workers and digitization of health data at scale, supported by satellite communications (SatCom) technology and existing 3G mobile networks. Objective: To understand whether, and under what circumstances using digital interventions to extend maternal, newborn and child health (MNCH) services to remote areas of Nigeria improved standards of healthcare delivery. Methods: From March 2017 to March 2019, VTR and data digitization interventions were delivered in 126 facilities across three states of Nigeria. Data collection combined documents review with 294 semi-structured interviews of stakeholders across four phases (baseline, midline, endline, and 12-months post-project closedown) to assess acceptability and impacts of digital interventions. Data was analyzed using a framework approach, drawing on a modified Technology Acceptance Model to identify factors that shaped technology adoption and use. Results: Analysis of documents and interview transcripts revealed that a supportive policy environment, and track record of private-public partnerships facilitated adoption of technology. The determinants of technology acceptance among health workers included ease of use, perceived usefulness, and prior familiarity with technology. Perceptions of impact suggested that at the micro (individual) level, repeated engagement with clinical videos increased staff knowledge, motivation and confidence to perform healthcare roles. At meso (organizational) level, better-trained staff felt supported and empowered to provide respectful healthcare and improved management of obstetric complications, triggering increased use of MNCH services. The macro level saw greater use of reliable and accurate data for policymaking. Conclusions: Simultaneous and sustained implementation of VTR and data digitization at scale enabled through SatCom and 3G mobile networks are feasible approaches for supporting improvements in staff confidence and motivation and reported MNCH practices. By identifying mechanisms of impact of digital interventions on micro, meso, and macro levels of the health system, the study extends the evidence base for effectiveness of digital health and theoretical underpinnings to guide further technology use for improving MNCH services in low resource settings. Trial Registration: ISRCTN32105372

Stakeholder perspectives and requirements to guide the development of digital technology for palliative cancer services: a multi-country, cross-sectional, qualitative study in Nigeria, Uganda and Zimbabwe

Introduction: Coverage of palliative care in low and middle-income countries is very limited, and global projections suggest large increases in need. Novel approaches are needed to achieve the palliative care goals of Universal Health Coverage. This study aimed to identify stakeholders’ data and information needs and the role of digital technologies to improve access to and delivery of palliative care for people with advanced cancer in Nigeria, Uganda and Zimbabwe. Methods: We conducted a multi-country cross-sectional qualitative study in sub-Saharan Africa. In-depth qualitative stakeholder interviews were conducted with N = 195 participants across Nigeria, Uganda and Zimbabwe (advanced cancer patients n = 62, informal caregivers n = 48, health care professionals n = 59, policymakers n = 26). Verbatim transcripts were subjected to deductive and inductive framework analysis to identify stakeholders needs and their preferences for digital technology in supporting the capture, transfer and use of patient-level data to improve delivery of palliative care. Results: Our coding framework identified four main themes: i) acceptability of digital technology; ii) current context of technology use; iii) current vision for digital technology to support health and palliative care, and; iv) digital technologies for the generation, reporting and receipt of data. Digital heath is an acceptable approach, stakeholders support the use of secure data systems, and patients welcome improved communication with providers. There are varying preferences for how and when digital technologies should be utilised as part of palliative cancer care provision, including for increasing timely patient access to trained palliative care providers and the triaging of contact from patients. Conclusion: We identified design and practical challenges to optimise potential for success in developing digital health approaches to improve access to and enhance the delivery of palliative cancer care in Nigeria, Uganda and Zimbabwe. Synthesis of findings identified 15 requirements to guide the development of digital health approaches that can support the attainment of global health palliative care policy goals

Understanding data and information needs for palliative cancer care to inform digital health intervention development in Nigeria, Uganda and Zimbabwe: protocol for a multicountry qualitative study

Introduction: Palliative care is a clinically and cost‐effective component of cancer services in sub-Saharan Africa (SSA). Despite the significant need for palliative cancer care in SSA, coverage remains inadequate. The exploration of digital health approaches could support increases in the quality and reach of palliative cancer care services in SSA. However, there is currently a lack of any theoretical underpinning or data to understand stakeholder drivers for digital health components in this context. This project addresses this gap through engaging with key stakeholders to determine data and information needs that could be supported through digital health interventions. Methods and analysis: This is a multicountry, cross-sectional, qualitative study conducted in Nigeria, Uganda and Zimbabwe. In-depth interviews will be conducted in patients with advanced cancer (n=20), caregivers (n=15), health professionals (n=20) and policy-makers (n=10) in each of the three participating countries. Data from a total of 195 interviews will transcribed verbatim and translated into English before being imported into NVivo software for deductive framework analysis. The analysis will seek to understand the acceptability and define mechanisms of patient-level data capture and usage via digital technologies. Ethics and dissemination: Ethics approvals have been obtained from the Institutional Review Boards of University of Leeds (Ref: MREC 18–032), Research Council of Zimbabwe (Ref: 03507), Medical Research Council of Zimbabwe (Ref: MRCZ/A/2421), Uganda Cancer Institute (Ref: 19–2018), Uganda National Council of Science and Technology (Ref: HS325ES) and College of Medicine University of Lagos (Ref: HREC/15/04/2015). The project seeks to determine optimal mechanisms for the design and development of subsequent digital health interventions to support development, access to, and delivery of palliative cancer care in SSA. Dissemination of these findings will occur through newsletters and press releases, conference presentations, peer-reviewed journals and social media. Trial registration number: ISRCTN1572771