Combination of Penalty Function, Lagrange Multiplier and Conjugate Gradient Methods for the Solution of Constrained Optimization Problems

In this paper, we combined Langrage Multiplier, Penalty Function and Conjugate Gradient Methods (CPLCGM), to enable Conjugate Gradient Method (CGM) to be employed for solving constrained optimization problems. In the year past, Langrage Multiplier Method (LMM) has been used extensively to solve constrained optimization problems likewise Penalty Function Method (PFM). However, with some special features in CGM, which makes it unique in solving unconstrained optimization problems, we see that this features we be advantageous to solve constrained optimization problems if it can be properly amended. This, then call for the CPLCGM that is aimed at taking care of some constrained optimization problems, either with equality or inequality constraint but in this paper, we focus on equality constraints. The authors of this paper desired that, with the construction of the new Algorithm, it will circumvent the difficulties undergone using only LMM and as well as PFM to solve constrained optimization problems and its application will further improve the result of the Conjugate Gradient Method in solving this class of optimization problem. We applied the new algorithm to some constrained optimization problems and compared the results with the LMM and PFM

Case report of challenges in the management of a rare ductal dependent complex congenital heart disease in a Nigerian tertiary hospital

Objective: Complex congenital heart defects are rare and may be difficult to define. They often require early surgery for palliation or correction. A lack of facilities and manpower to provide surgery in developing countries often results in mortality.Case report: A 6 month old male infant referred to our unit on account of failure to thrive, cyanosis since birth, easy fatigability and breathlessness. On examination he was small for age with tachycardia and a grade III pansystolic murmur at the left lower sternal edge. Chest radiograph revealed an “egg on side” cardiac appearance with cardiomegaly. Echocardiography confirmed the presence of d-transposition of the great arteries with a patent foramen ovale, large ventricular septal defect and atresia of the proximal main pulmonary artery. The child died while being prepared for referral to a centre for palliative surgery. Conclusion: Transposition of the great arteries with pulmonary atresia is an uncommon congenital heart disease. Early intervention with palliative surgery is necessary to prevent mortality.Keywords: Congenital heart disease; pulmonary atresia with ventricular septal defect; great vessel anomaly; echocardiograph

Pediatric Blood Culture Isolates and Antibiotic Sensitivity Pattern in a Nigerian Tertiary Hospital

Introduction: There is a significant variation in the bacterial pathogens implicated in childhood septicemia and their antibiotic sensitivity patternfrom place to place. Sustained monitoring of this dynamics is therefore critical to rational antibiotic use. Materials and Methods: This study was thus conducted to determine the etiology of childhood septicemia and their antibiotic sensitivity pattern. Blood culture results (contaminants excluded), age, and sex of all pediatric patients with suspected septicemia between January 2013 and December 2014 were retrieved. Data were analyzed using SPSS version 20. Results: Over a 2‑year period, a total of 3680 blood samples were processed. Pathogenic bacteria were isolated in 701 samples (19%).    Staphylococcus aureus was the most common isolate (41.4%) and was most sensitive to ampicillin‑sulbactam (89%). Klebsiella species (21.7%),  coagulase‑negative Staphylococcus (14.7%), and Pseudomonas aeruginosa (11%) were other common organisms isolated. Virtually, all the isolates demonstrated a reliable susceptibility to ciprofloxacin except for S. aureus and Klebsiella species which were most sensitive to ampicillin‑sulbactam and imipenem, respectively. Conclusion: In conclusions, S. aureus is the leading cause of childhood septicemia in this locale. The significant rate of isolation of the supposedly less virulent organisms calls for an urgent review of potential risk factors and an appraisal of the hospital infection control policies and structures. Keywords: Antibiotics, isolates, paediatri

Gender roles in sourcing and sharing of banana planting material in communities with and without banana bunchy top disease in Nigeria

Open Access Journal; Published online: 17 Mar 2021Banana bunchy top disease (BBTD) is the most devastating disease of banana and plantain (Musa spp.). The disease spreads through the use of infected vegetative propagules and the banana aphid (Pentalonia nigronervosa) is the virus vector. This study seeks to understand the gender dimensions and sociocultural aspects of banana seed (vegetative propagule) sourcing and sharing practices among men and women farmers, and its influence on BBTD spread and disease control efforts. Data were collected from 300 banana farmers (187 men and 113 women) in BBTD and non-BBTD areas in southwest Nigeria. The results revealed that seed sharing within the communities is a social responsibility with members expected to share banana seed with the needy mainly as gifts rather than sold for cash. Men farmers mostly sourced seed from old fields, while women sourced seed from relatives. Harvesting of banana seed was predominantly the responsibility of men with women as helpers. Both men and women farmers in the non-BBTD area cultivated larger farm sizes and harvested more banana planting material than farmers in the BBTD area. The existing seed sourcing practices among men and women farmers heighten the risk of BBTD spread. Awareness raising on disease spread through infected seeds should consider gender-differentiated roles and social practices to reduce its spread within communities

African League Against Rheumatism (AFLAR) preliminary recommendations on the management of rheumatic diseases during the COVID-19 pandemic

Objectives To develop recommendations for the management of rheumatic and musculoskeletal diseases (RMDs) during the COVID-19 pandemic. Method A task force comprising of 25 rheumatologists from the 5 regions of the continent was formed and operated through a hub-and-spoke model with a central working committee (CWC) and 4 subgroups. The subgroups championed separate scopes of the clinical questions and formulated preliminary statements of recommendations which were processed centrally in the CWC. The CWC and each subgroup met by several virtual meetings, and two rounds of voting were conducted on the drafted statements of recommendations. Votes were online-delivered and recommendations were pruned down according to predefined criteria. Each statement was rated between 1 and 9 with 1–3, 4–6 and 7–9 representing disagreement, uncertainty and agreement, respectively. The levels of agreement on the statements were stratified as low, moderate or high according to the spread of votes. A statement was retired if it had a mean vote below 7 or a ‘low’ level of agreement. Results A total of 126 initial statements of recommendations were drafted, and these were reduced to 22 after the two rounds of voting. Conclusions The preliminary statements of recommendations will serve to guide the clinical practice of rheumatology across Africa amidst the changing practices and uncertainties in the current era of COVID-19. It is recognized that further updates to the recommendations will be needed as more evidence emerges

Predicting the Clinical Outcome of Severe Falciparum Malaria in African Children: Findings From a Large Randomized Trial

Four predictors were independently associated with an increased risk of death: acidosis, cerebral manifestations of malaria, elevated blood urea nitrogen, or signs of chronic illness. The standard base deficit was found to be the single most relevant predictor of death

COVAD survey 2 long-term outcomes: unmet need and protocol

Vaccine hesitancy is considered a major barrier to achieving herd immunity against COVID-19. While multiple alternative and synergistic approaches including heterologous vaccination, booster doses, and antiviral drugs have been developed, equitable vaccine uptake remains the foremost strategy to manage pandemic. Although none of the currently approved vaccines are live-attenuated, several reports of disease flares, waning protection, and acute-onset syndromes have emerged as short-term adverse events after vaccination. Hence, scientific literature falls short when discussing potential long-term effects in vulnerable cohorts. The COVAD-2 survey follows on from the baseline COVAD-1 survey with the aim to collect patient-reported data on the long-term safety and tolerability of COVID-19 vaccines in immune modulation. The e-survey has been extensively pilot-tested and validated with translations into multiple languages. Anticipated results will help improve vaccination efforts and reduce the imminent risks of COVID-19 infection, especially in understudied vulnerable groups

Spread of artemisinin resistance in Plasmodium falciparum malaria.

BACKGROUND: Artemisinin resistance in Plasmodium falciparum has emerged in Southeast Asia and now poses a threat to the control and elimination of malaria. Mapping the geographic extent of resistance is essential for planning containment and elimination strategies. METHODS: Between May 2011 and April 2013, we enrolled 1241 adults and children with acute, uncomplicated falciparum malaria in an open-label trial at 15 sites in 10 countries (7 in Asia and 3 in Africa). Patients received artesunate, administered orally at a daily dose of either 2 mg per kilogram of body weight per day or 4 mg per kilogram, for 3 days, followed by a standard 3-day course of artemisinin-based combination therapy. Parasite counts in peripheral-blood samples were measured every 6 hours, and the parasite clearance half-lives were determined. RESULTS: The median parasite clearance half-lives ranged from 1.9 hours in the Democratic Republic of Congo to 7.0 hours at the Thailand-Cambodia border. Slowly clearing infections (parasite clearance half-life >5 hours), strongly associated with single point mutations in the "propeller" region of the P. falciparum kelch protein gene on chromosome 13 (kelch13), were detected throughout mainland Southeast Asia from southern Vietnam to central Myanmar. The incidence of pretreatment and post-treatment gametocytemia was higher among patients with slow parasite clearance, suggesting greater potential for transmission. In western Cambodia, where artemisinin-based combination therapies are failing, the 6-day course of antimalarial therapy was associated with a cure rate of 97.7% (95% confidence interval, 90.9 to 99.4) at 42 days. CONCLUSIONS: Artemisinin resistance to P. falciparum, which is now prevalent across mainland Southeast Asia, is associated with mutations in kelch13. Prolonged courses of artemisinin-based combination therapies are currently efficacious in areas where standard 3-day treatments are failing. (Funded by the U.K. Department of International Development and others; ClinicalTrials.gov number, NCT01350856.)

A novel formulation of inhaled sodium cromoglicate (PA101) in idiopathic pulmonary fibrosis and chronic cough: a randomised, double-blind, proof-of-concept, phase 2 trial

Background Cough can be a debilitating symptom of idiopathic pulmonary fibrosis (IPF) and is difficult to treat. PA101 is a novel formulation of sodium cromoglicate delivered via a high-efficiency eFlow nebuliser that achieves significantly higher drug deposition in the lung compared with the existing formulations. We aimed to test the efficacy and safety of inhaled PA101 in patients with IPF and chronic cough and, to explore the antitussive mechanism of PA101, patients with chronic idiopathic cough (CIC) were also studied. Methods This pilot, proof-of-concept study consisted of a randomised, double-blind, placebo-controlled trial in patients with IPF and chronic cough and a parallel study of similar design in patients with CIC. Participants with IPF and chronic cough recruited from seven centres in the UK and the Netherlands were randomly assigned (1:1, using a computer-generated randomisation schedule) by site staff to receive PA101 (40 mg) or matching placebo three times a day via oral inhalation for 2 weeks, followed by a 2 week washout, and then crossed over to the other arm. Study participants, investigators, study staff, and the sponsor were masked to group assignment until all participants had completed the study. The primary efficacy endpoint was change from baseline in objective daytime cough frequency (from 24 h acoustic recording, Leicester Cough Monitor). The primary efficacy analysis included all participants who received at least one dose of study drug and had at least one post-baseline efficacy measurement. Safety analysis included all those who took at least one dose of study drug. In the second cohort, participants with CIC were randomly assigned in a study across four centres with similar design and endpoints. The study was registered with ClinicalTrials.gov (NCT02412020) and the EU Clinical Trials Register (EudraCT Number 2014-004025-40) and both cohorts are closed to new participants. Findings Between Feb 13, 2015, and Feb 2, 2016, 24 participants with IPF were randomly assigned to treatment groups. 28 participants with CIC were enrolled during the same period and 27 received study treatment. In patients with IPF, PA101 reduced daytime cough frequency by 31·1% at day 14 compared with placebo; daytime cough frequency decreased from a mean 55 (SD 55) coughs per h at baseline to 39 (29) coughs per h at day 14 following treatment with PA101, versus 51 (37) coughs per h at baseline to 52 (40) cough per h following placebo treatment (ratio of least-squares [LS] means 0·67, 95% CI 0·48–0·94, p=0·0241). By contrast, no treatment benefit for PA101 was observed in the CIC cohort; mean reduction of daytime cough frequency at day 14 for PA101 adjusted for placebo was 6·2% (ratio of LS means 1·27, 0·78–2·06, p=0·31). PA101 was well tolerated in both cohorts. The incidence of adverse events was similar between PA101 and placebo treatments, most adverse events were mild in severity, and no severe adverse events or serious adverse events were reported. Interpretation This study suggests that the mechanism of cough in IPF might be disease specific. Inhaled PA101 could be a treatment option for chronic cough in patients with IPF and warrants further investigation