Sonographic Determination of Normative Values of Infra-Renal Aortic Diameter in a Negroid Population in Nigeria

Objective: To establish normal values of infra-renal aortic diameter and to determine its relationship with anthropometric variables.Methods: A prospective and cross sectional clinical study involving 742 subjects (369 males and 373 females) aged 18 to 45 years which was carried out in Nigeria in 2012. Subjects were scanned supine and at rest. Measurements were taken from freezed longitudinal images using an exterior landmark of lumbar regions and an interior landmark of aortic bifurcation. The average of two values was recorded as the infra-renal aortic diameter. Statistical Package for the Social Sciences v16.0 was used for data analyses. The probability value adopted for statistical significance was p < 0.05.Results: The mean infra-renal aortic diameter for male and female subjects was 15.0mm ± 1.8mm and 13.5 ± 2.0mm respectively. There was a statistically significant difference between both means (p = 0.000). Pearson correlation showed significant correlations between infra-renal aortic diameter and waist circumference (r = 0.493), weight (r = 0.465), BSA (r = 0.432), BMI (r = 0.403), height (r = 0.238) and age (r = - 0.033). Conclusion: A normogram for infra-renal aortic diameter is generated. The study would be relevant in the determination of abdominal aortic dilatation in young adults. It might also find usefulness in pre-transplantation assessment of the vessel and screening of siblings of patient who have infra-renal aortic aneurysm

SARS-CoV-2 infection and antibody seroprevalence in routine surveillance patients, healthcare workers and general population in Kita region, Mali: an observational study 2020–2021

Objective: To estimate the degree of SARS-CoV-2 transmission among healthcare workers (HCWs) and general population in Kita region of Mali. Design: Routine surveillance in 12 health facilities, HCWs serosurvey in five health facilities and community serosurvey in 16 villages in or near Kita town, Mali. Setting: Kita region, western Mali; local health centres around the central (regional) referral health centre. Participants: Patients in routine surveillance, HCWs in local health centres and community members of all ages in populations associated with study health centres. Main outcome measures: Seropositivity of ELISA test detecting SARS-CoV-2-specific total antibodies and real-time RT-PCR confirmed SARS-CoV-2 infection. Results: From 2392 routine surveillance samples, 68 (2.8%, 95% CI: 2.2% to 3.6%) tested positive for SARS-CoV-2 by RT-PCR. The monthly positivity rate was 0% in June–August 2020 and gradually increased to 6% by December 2020 and 6.2% by January 2021, then declined to 5.5%, 3.3%, 3.6% and 0.8% in February, March, April and May 2021, respectively. From 397 serum samples collected from 113 HCWs, 175 (44.1%, 95% CI: 39.1% to 49.1%) were positive for SARS-CoV-2 antibodies. The monthly seroprevalence was around 10% from September to November 2020 and increased to over 40% from December 2020 to May 2021. For community serosurvey in December 2020, overall seroprevalence of SARS-CoV-2 antibodies was 27.7%. The highest age-stratified seroprevalence was observed in participants aged 60–69 years (45.5%, 95% CI: 32.3% to 58.6%). The lowest was in children aged 0–9 years (14.0%, 95% CI: 7.4% to 20.6%). Conclusions: SARS-CoV-2 in rural Mali is much more widespread than assumed by national testing data and particularly in the older population and frontline HCWs. The observation is contrary to the widely expressed view, based on limited data, that COVID-19 infection rates were lower in 2020–2021 in West Africa than in other settings

Association of C-reactive protein with bacterial and respiratory syncytial virus-associated pneumonia among children aged <5 years in the PERCH study

Background. Lack of a gold standard for identifying bacterial and viral etiologies of pneumonia has limited evaluation of C-reactive protein (CRP) for identifying bacterial pneumonia. We evaluated the sensitivity and specificity of CRP for identifying bacterial vs respiratory syncytial virus (RSV) pneumonia in the Pneumonia Etiology Research for Child Health (PERCH) multicenter case-control study. Methods. We measured serum CRP levels in cases with World Health Organization-defined severe or very severe pneumonia and a subset of community controls. We evaluated the sensitivity and specificity of elevated CRP for "confirmed" bacterial pneumonia (positive blood culture or positive lung aspirate or pleural fluid culture or polymerase chain reaction [PCR]) compared to "RSV pneumonia" (nasopharyngeal/oropharyngeal or induced sputum PCR-positive without confirmed/suspected bacterial pneumonia). Receiver operating characteristic (ROC) curves were constructed to assess the performance of elevated CRP in distinguishing these cases. Results. Among 601 human immunodeficiency virus (HIV)-negative tested controls, 3% had CRP ≥40 mg/L. Among 119 HIVnegative cases with confirmed bacterial pneumonia, 77% had CRP ≥40 mg/L compared with 17% of 556 RSV pneumonia cases. The ROC analysis produced an area under the curve of 0.87, indicating very good discrimination; a cut-point of 37.1 mg/L best discriminated confirmed bacterial pneumonia (sensitivity 77%) from RSV pneumonia (specificity 82%). CRP ≥100 mg/L substantially improved specificity over CRP ≥40 mg/L, though at a loss to sensitivity. Conclusions. Elevated CRP was positively associated with confirmed bacterial pneumonia and negatively associated with RSV pneumonia in PERCH. CRP may be useful for distinguishing bacterial from RSV-associated pneumonia, although its role in discriminating against other respiratory viral-associated pneumonia needs further study

Zero-Option Defendants: United States v. McLellan and the Judiciary\u27s Role in Protecting the Right to Compulsory Process

How does one obtain evidence located outside the United States for a criminal trial? For prosecutors, the answer is an exclusive treaty process: Mutual Legal Assistance Treaties (MLATs). Defendants, on the other hand, may only use an unpredictable, ineffective, non-treaty process: letters rogatory. The result is a selective advantage for law enforcement at the expense of the defendant. Though this imbalance necessarily raises Sixth Amendment Compulsory Process Clause concerns, MLATs have remained largely undisturbed because defendants still have some form of process, albeit a lesser one. But what happens when the letters rogatory process is also closed off to the defendant? When a defendant has no option but to rely on the government to submit an MLAT request on his behalf, can a district court compel the government to do so on behalf of this “zero-option defendant”? Recently, in United States v. McLellan, the First Circuit sought to answer this question. This Comment explores the role of federal courts in protecting the rights of zero-option defendants in the MLAT context. It examines the First Circuit’s reasoning in McLellan and concludes that McLellan suffers from a fundamental misunderstanding of judicial compulsory power in the face of constitutionally-violative acts by the Executive Branch. This Comment proposes that, for zero-option defendants, judicial compulsory power is necessary to prevent the Compulsory Process Clause from becoming a dead letter

Survey of Hepatitis B and C infections in an unselected population of members of a sports club in Aba, Abia State, Nigeria

Background: Member of Aba Spots club including some of the family members were screened for the prevalence of Hepatitis B and C infection. Testing members of the Aba Spots club along with their family members is a strategy to identify undiagnosed hepatitis B and C virus infections inAba, Nigeria. We also assessed how the social life of members of Aba Spots Club may influence the acquisition of Hepatitis B and C infections. Materials and Methods: Demorgraphic information of members was collected as blood samples were analyzed for each member using commercially procured test strips. Proportions of those tested for Hepatitis B and C infections were determined.Results: Among the 470 members, 211; comprising 139 club members and 72 family members, were accessible for Hepatitis B and C infection survey. Prevalence of Hepatitis B and C infection was 3(1.4%) and that of Hepatitis C was 2 (0.95%), with an overall prevalence of 5 (2.4%). No pastresults of infection and immunization were noted among the subjects. Conclusion: This study offers opportunity to capture, identify and educate infected and unaffected members of the society on the health hazards associated with Hepatitis B and C infections. Those with known positive hepatitis status also received treatment and those considered susceptible were educated on how to initiate preventive action (e.g. vaccination).Key words: Hepatitis B and C, Surve

Phenotypic Correlations of Body Weight and Linear Body Traits in Heavy, Medium and Low Body Weight Lines of Sigmond Strain of Japanese quails in Humid Rainforest Zone of Nigeria

Data on 126 Sigmond strain of Japanese quail chicks consisting of 42 each of heavy, medium and low body weight lines were used to estimate phenotypic correlations (rp ) among body weight (BWT) and linear body traits at 2, 4 and 6 weeks of age. The linear body traits considered were breast girth (BG), shank length (SL), keel length (KL) and wing length (WL). The rp between BWT and the linear traits were strong, positive and significant (P &lt; 0.001; P &lt; p 0.01) at all the ages for the heavy and medium lines. The values ranged between 0.678 – 0.850 (heavy), 0.630 – 0.844 (medium) at age 2, 0.631 – 0.827 (heavy), 0.561 – 0.730 (medium) at week 4 and 0.676 – 0.824 (heavy), 0.561 – 0.730 (medium) at week 6. Significant correlations were only observed between BWT and BG and SL (week 2 and 4) and BWT and BG, SL and KL (week 6) for the low line. The phenotypic associations observed among the linear body traits were also strong, positive and significant for the heavy and medium lines at week 2, 4 and 6. Significant correlations were noted for the low line only between BG and KL (0.508) and KL and WL (0.803) at week 2, KL and WL (0.520) at age 4 and BG and SL (0.647) and BG and KL (0.928) at week 6. The results obtained in this study indicates that heavier and/or medium-sized quails would yield higher proportions of BG, SL, KL and WL and that these traits could be used to phenotypically improve BWT in Japanese quails. The all positive rp associations among the linear traits also indicate that phenotypic selection in any one trait would lead to improvement of their associating traits.Keywords: Body weight, linear body traits, phenotypic correlation, Japanese quai

Seeking Care for Pediatric Diarrheal Illness from Traditional Healers in Bamako, Mali

Diarrhea is a leading cause of child mortality worldwide. Early recognition of symptoms and referral to medical treatment are essential. In 2007, we conducted a Healthcare Utilization and Attitudes Survey (HUAS) of 1,000 children randomly selected from a population census to define care-seeking patterns for diarrheal disease in Bamako, Mali, in preparation for the Global Enteric Multicenter Study (GEMS). We found that 57% of caretakers sought care for their child's diarrheal illness from traditional healers, and 27% of caretakers sought care from the government health center (GHC). Weighted logistic regression showed that seeking care from a traditional healer was associated with more severe reported diarrheal disease, like decreased urination (odds ratio [OR] = 3.35, 95% confidence interval [95% CI] = 1.19–9.41) and mucus or pus in stool (OR = 4.42, 95% CI = 1.35–14.51), along with other indicators of perceived susceptibility. A locally designed traditional healer referral system was, therefore, created that emphasized more severe disease. This system may serve as a model for health systems in West Africa

Prevalence of chronic kidney disease in Nigeria: systematic review of population-based studies

Innocent Ijezie Chukwuonye,1 Okechukwu Samuel Ogah,2 Ernest Ndukaife Anyabolu,3 Kenneth Arinze Ohagwu,1 Ogbonna Collins Nwabuko,4 Uwa Onwuchekwa,5 Miracle Erinma Chukwuonye,6 Emmanuel Chukwuebuka Obi,1 Efosa Oviasu7 1Division of Nephrology, Department of Internal Medicine, Federal Medical Centre, Umuahia, Abia State, 2Division of Cardiology, Department of Internal Medicine, University College Hospital Ibadan, Oyo State 3Division of Nephrology, Department of Internal Medicine, Chukwuemeka Odumegwu Ojukwu University Teaching Hospital Awka, Anambra State, 4Department of Haematology, Federal Medical Centre, Umuahia, 5Division of Nephrology, Department of Internal Medicine, Abia State University Teaching Hospital, Aba, 6Department of Family Medicine, Federal Medical Centre, Umuahia, 7Division of Nephrology, Department of Internal Medicine, University of Benin Teaching Hospital, Benin City, Nigeria Background: The aim of this study was to identify and discuss published population-based studies carried out in Nigeria that have information on the prevalence of chronic kidney disease (CKD) and have also used the Kidney Disease Outcomes Quality Initiative (KDOQI) practice guidelines in defining CKD, with emphasis on the performance of three estimating equations for glomerular filtration rate (GFR) &ndash; Modification of Diet in Renal Disease (MDRD), Cockcroft&ndash;Gault, and CKD epidemiology collaboration (CKD-EPI) creatinine equation. Materials and methods: A systematic literature search was carried out in Google, MEDLINE, PubMed, and AJOL database, with the aim of identifying relevant population-based studies with information on the prevalence of CKD in a location in Nigeria. Results: Seven cross-sectional population-based studies were identified. Two of the studies used the Cockcroft&ndash;Gault and observed a prevalence of 24.4% and 26%. Four of the studies used the MDRD and the prevalences observed were 12.3%, 14.2%, 2.5%, and 13.4%. One of the studies used the CKD-EPI equation and the prevalence was 11.4%. The male to female ratios of CKD prevalence in six studies were 1:1.9, 0.8:1, 1:1.6, 1:2, 1:1.8, 1:1.4, and the observed risk factors in the studies were old age, obesity, diabetes mellitus, hypertension, family history of hypertension, family history of renal disease, low-income occupation, use of traditional medication, low hemoglobin, and abdominal obesity. Conclusion: The prevalence of CKD was high but variable in Nigeria, influenced by the equation used to estimate the GFR. MDRD and CKD-EPI results are agreeable. There is a need for more population-based studies, with emphasis on repeating the GFR estimation after 3 months in subjects with GFR &lt;60 mL/min/1.7 m2. Keywords: CKD, Cockcroft&ndash;Gault, Modification of Diet in Renal Disease, CKD epidemiology collaboration creatinine equatio

Efficacy of nine-valent pneumococcal conjugate vaccine against pneumonia and invasive pneumococcal disease in The Gambia: randomised, double-blind, placebo-controlled trial.

BACKGROUND: Pneumonia is estimated to cause 2 million deaths every year in children. Streptococcus pneumoniae is the most important cause of severe pneumonia. We aimed to assess the efficacy of a nine-valent pneumococcal conjugate vaccine in children. METHODS: We undertook a randomised, placebo-controlled, double-blind trial in eastern Gambia. Children age 6-51 weeks were randomly allocated three doses of either pneumococcal conjugate vaccine (n=8718) or placebo (8719), with intervals of at least 25 days between doses. Our primary outcome was first episode of radiological pneumonia. Secondary endpoints were clinical or severe clinical pneumonia, invasive pneumococcal disease, and all-cause admissions. Analyses were per protocol and intention to treat. FINDINGS: 529 children assigned vaccine and 568 allocated placebo were not included in the per-protocol analysis. Results of per-protocol and intention-to-treat analyses were similar. By per-protocol analysis, 333 of 8189 children given vaccine had an episode of radiological pneumonia compared with 513 of 8151 who received placebo. Pneumococcal vaccine efficacy was 37% (95% CI 27-45) against first episode of radiological pneumonia. First episodes of clinical pneumonia were reduced overall by 7% (95% CI 1-12). Efficacy of the conjugate vaccine was 77% (51-90) against invasive pneumococcal disease caused by vaccine serotypes, 50% (21-69) against disease caused by all serotypes, and 15% (7-21) against all-cause admissions. We also found an efficacy of 16% (3-28) against mortality. 110 serious adverse events arose in children given the pneumococcal vaccine compared with 131 in those who received placebo. INTERPRETATION: In this rural African setting, pneumococcal conjugate vaccine has high efficacy against radiological pneumonia and invasive pneumococcal disease, and can substantially reduce admissions and improve child survival. Pneumococcal conjugate vaccines should be made available to African infants