MRDPGA: a multiple restart dynamic population genetic algorithm for scheduling road traffic

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Factors Contributing to Low Uptake of Cervical Screening in a Population at Risk

Introduction: Many factors have been attributed to the unacceptably high incidences of cervical cancer and deaths from cervical cancer in developing countries and include lack of organized cervical cancer screening services and especially lack of information on cervical cancer by women.Aims and Objectives: This study aims to find the contributing factors to knowledge, attitude and practice of cervical screening in women.Materials and Methods: This study was carried out using a self  administered questionnaire filled by 271 women who attended gynaecological and family planning clinics.Results: About 212 (78.2%) of the respondents have heard about cancer before, 144 (53.1%) of respondents were aware that cervical cancer can be prevented by screening. 187 (66.8%) have no idea about the cause of cervical cancer, 64.6% said they wish to be screened, but 242 (89.3%) have never been screened for cervical cancer.Discussion: The respondents in this study have demonstrated a high level of awareness of cervical cancer but low uptake of cervical cancer screening services. There is therefore the need to improve on the knowledge of the disease and also to pass on correct messages concerning cervical cancer to the community using multiple channels of communication.Key Words: Cervical Cancer, Screening, Preventio

Laparoscopy and hysteroscopy in a Tertiary Hospital: A 4 year review

Objective: To determine various indications for laparoscopy and hysteroscopy in Aminu Kano Teaching, hospital (AKTH), Kano.Materials and Methods: This is a descriptive study conducted at the (AKTH, which involved all the patients who had laparoscopy and or hysteroscopy from January 2011 to December 2014 (4 year). Records of patients who had laparoscopy or hysteroscopy in AKTH within the study period were retrieved from the operation record book; their case files were retrieved, studied and recorded in a proforma. Data were analyzed using the Statistical Package for Social Sciences.Results: The total number of patients who had diagnostic laparoscopy within the 4‑year study period was 221, but only 197 files were retrieved, giving a retrieval rate of 89.1%. The total number of patients who had diagnostic hysteroscopy was 28, but only 23 case files were retrieved, giving a retrieval rate of 82.1%. Five patients underwent both laparoscopy and hysteroscopy. The mean age and standard deviation of patients who had laparoscopy was 28.7 ± 5.8 years. The mean age and standard deviation of patients who had hysteroscopy was 32.3 ± 5.9 years. The most frequent indication for laparoscopy was for primary infertility 89 (45.2%), followed by secondary infertility 78 (39.6%). Asherman’s syndrome was the most common indication for hysteroscopy accounting for 52.1% of the procedure.Conclusion: Infertility is the most common indication for laparoscopy in this centre whereas Asherman’s syndrome is the leading indication for hysteroscopy. Nearly all the procedures were diagnostic endoscopy.Keywords: Anaesthesia; hysteroscopy; laparoscop

Instrumental vaginal delivery in Usmanu Danfodiyo University Teaching Hospital, Sokoto: A ten‑year review

Background: Instrumental vaginal delivery is one of the key elements of essential obstetric care that mimics spontaneous vaginal delivery in order to expedite delivery with minimal maternal and neonatal morbidity. The objectives of the study were to determine the rate of instrumental deliveries, the common indications, and compare outcome and complications between forceps and vacuum deliveries.Materials and Methods: This was a retrospective cross‑sectional study on instrumental vaginal deliveries carried out in UDUTH over 10 years from January 2007 to December 2016. The list of cases was obtained, the case files were retrieved and relevant information was obtained. Data analysis was done using SPSS version 21. Level of significance was set at P < 0.05.Results: The instrumental vaginal delivery rate was 2.06%. Vacuum deliveries accounted for 83.3% (n = 524) but forceps deliveries accounted for 16.7% (n = 105). The most common indication for both was delayed second stage of labor due to malposition. There was no statistical difference in the mean APGAR scores at 1st and 5th min between babies delivered by vacuum and those delivered by forceps. Majority had no complication and there was no statistical association between the type of procedure and maternal or fetal complications observed during the procedure (χ2 = 3.18, P = 0.2).Conclusion: The rate of instrumental vaginal delivery is much lower than that reported in some centers in Nigeria and globally. Majority of the cases had no complication and there was no significant difference in complications observed between vacuum and forceps deliveries.Keywords: Complications; forceps delivery; rate; vacuum deliver

South African women’s perspectives on self-sampling for cervical cancer screening: A mixed-methods study

Background. Self-sampling as a method of screening for cervical cancer and its precursors is an attractive option for low-resource settings. However, to allow successful integration of self-sampling into national screening programmes, it is necessary to understand women’s perceptions and beliefs surrounding this method of sampling the cervix.Objectives. To explore women’s attitudes to self-collection of samples for cervical screening in a low-resource setting in South Africa (SA).Methods. Mixed methods were used to meet the study objectives. We recruited women aged 30 - 65 years into a study in Cape Town, SA, to participate in a cross-sectional survey. All women collected a vaginal self-sample, and underwent visual inspection with acetic acid, colposcopy, and collection of cervical samples and appropriate histology specimens by a doctor. Women had a quantitative questionnairebased exit interview. A subset of these women participated in focus group discussions (FGDs).Results. A total of 822 women answered the exit survey questionnaire and 41 women participated in the FGDs. Most women from the survey had a positive perception of self-sampling, with 93.6% of the women reporting not feeling embarrassed and 89.4% reporting experiencing no discomfort at all when taking a self-sample. This was  corroborated by the FGD participants, who found self-sampling easier, more comfortable and less embarrassing than clinician sampling. However, many women (64.7%) felt more confident when the sample was taken by a clinician, despite having a positive attitude towards self-sampling. In most cases this was because they thought that the clinician would take a better sample, as explained by the FGD  participants. Although 93.9% of the women were  willing to collect a selfsample, the women in the FGDs expressed a preference for doing so at the health facility  rather than at home. There were many reasons for this, including the cost of returning to the clinic with the sample.Conclusions. Attitudes regarding self-sample collection were positive in this study population. Participants were willing to perform selfsampling, but expressed concerns regarding the quality of the specimen and the financial implications of returning to the clinic with it. Pilot implementation studies will be useful before this method of sampling is adopted and integrated into screening programmes

New Approaches for the Treatment of Chronic Graft-Versus-Host Disease: Current Status and Future Directions

Chronic graft-versus-host disease (cGvHD) is a severe complication of allogeneic hematopoietic stem cell transplantation that affects various organs leading to a reduced quality of life. The condition often requires enduring immunosuppressive therapy, which can also lead to the development of severe side effects. Several approaches including small molecule inhibitors, antibodies, cytokines, and cellular therapies are now being developed for the treatment of cGvHD, and some of these therapies have been or are currently tested in clinical trials. In this review, we discuss these emerging therapies with particular emphasis on tyrosine kinase inhibitors (TKIs). TKIs are a class of compounds that inhibits tyrosine kinases, thereby preventing the dissemination of growth signals and activation of key cellular proteins that are involved in cell growth and division. Because they have been shown to inhibit key kinases in both B cells and T cells that are involved in the pathophysiology of cGvHD, TKIs present new promising therapeutic approaches. Ibrutinib, a Bruton tyrosine kinase (Btk) inhibitor, has recently been approved by the Food and Drug Administration (FDA) in the United States for the treatment of adult patients with cGvHD after failure of first-line of systemic therapy. Also, Janus Associated Kinases (JAK1 and JAK2) inhibitors, such as itacitinib (JAK1) and ruxolitinib (JAK1 and 2), are promising in the treatment of cGvHD. Herein, we present the current status and future directions of the use of these new drugs with particular spotlight on their targeting of specific intracellular signal transduction cascades important for cGvHD, in order to shed some light on their possible mode of actions

Effects of Mother's Illness and Breastfeeding on Risk of Ebola Virus Disease in a Cohort of Very Young Children.

BACKGROUND: Young children who contract Ebola Virus Disease (EVD) have a high case fatality rate, but their sources of infection and the role of breastfeeding are unclear. METHODS/PRINCIPAL FINDINGS: Household members of EVD survivors from the Kerry Town Ebola Treatment Centre in Sierra Leone were interviewed four to 10 months after discharge to establish exposure levels for all members of the household, whether or not they became ill, and including those who died. We analysed a cohort of children under three years to examine associations between maternal illness, survival and breastfeeding, and the child's outcome. Of 77 children aged zero to two years in the households we surveyed, 43% contracted EVD. 64 children and mothers could be linked: 25/40 (63%) of those whose mother had EVD developed EVD, compared to 2/24 (8%) whose mother did not have EVD, relative risk adjusted for age, sex and other exposures (aRR) 7·6, 95%CI 2·0-29·1. Among those with mothers with EVD, the risk of EVD in the child was higher if the mother died (aRR 1·5, 0·99-2·4), but there was no increased risk associated with breast-feeding (aRR 0·75, 0·46-1·2). Excluding those breastfed by infected mothers, half (11/22) of the children with direct contact with EVD cases with wet symptoms (diarrhoea, vomiting or haemorrhage) remained well. CONCLUSION/SIGNIFICANCE: This is the largest study of mother-child pairs with EVD to date, and the first attempt at assessing excess risk from breastfeeding. For young children the key exposure associated with contracting EVD was mother's illness with EVD, with a higher risk if the mother died. Breast feeding did not confer any additional risk in this study but high risk from proximity to a sick mother supports WHO recommendations for separation. This study also found that many children did not become ill despite high exposures

Variability in Intrahousehold Transmission of Ebola Virus, and Estimation of the Household Secondary Attack Rate.

Transmission between family members accounts for most Ebola virus transmission, but little is known about determinants of intrahousehold spread. From detailed exposure histories, intrahousehold transmission chains were created for 94 households of Ebola survivors in Sierra Leone: 109 (co-)primary cases gave rise to 317 subsequent cases (0-100% of those exposed). Larger households were more likely to have subsequent cases, and the proportion of household members affected depended on individual and household-level factors. More transmissions occurred from older than from younger cases, and from those with more severe disease. The estimated household secondary attack rate was 18%

Risk factors assessment of bovine tuberculosis among abattoir personnel in Gombe State, Northeastern Nigeria: A One-Health approach

Aim: Bovine tuberculosis (bTB) is an important milk-borne zoonosis that affects cattle production and poses serious threat to public health. This study aimed at assessing the risk factors as well as the level of awareness, attitude, and practices of abattoir personnel toward bTB in Gombe Township Abattoir, Gombe State. Materials and Methods: A prospective survey was conducted between October 2015 and December 2015. During the survey, a total of 112 close-ended structured questionnaires were administered to the abattoir personnel to assess their level of awareness of bTB. Results: Of these respondents, the majority were males (79%), butchers (49%) and about 40% were under the productive age brackets of 26-35 years. Majority of the respondents (85.7%) were aware of the zoonotic nature of the disease. However, only a few of the respondents (44.6%) wear personal protective equipments (PPEs) clothes while handling or in contact with carcasses during the slaughtering process. Only a few among the respondents (24.1% and 31.2%) consumed unpasteurized milk and unaware of eating of improperly cooked meat as a risk factor of bTB, respectively. About 75.7% of the respondents believed that the habit of eating and drinking inside the abattoir and during slaughtering operations has no any significant effects on their health. The results obtained show a statistically significant association between respondents' awareness of bTB and their occupational status, duration of exposure to cattle carcasses, and knowledge about the disease (p<0.05); and the odds of being aware of bTB was 10.0, 5.07, and 4.2, respectively. Conclusion: This study demonstrates the need for public health authorities to intervene in bTB prevention and control through the creation of avenues for enlightenment on the zoonotic risk associated with bTB. The risk factors associated with bTB transmission as indicated by the personnel's practice and awareness levels in Gombe township abattoir are preventable through the use of PPEs clothing