Sucrose assimilation and the role of sucrose transporters in plant wound response

Plant cells are commonly exposed to a variety of injuries such as mechanical and herbivore wounding. Wounding is a continual threat to the survival of all organisms and an open wound caused bymechanical or herbivore wounding is a potential infection site for pathogens, thus expression of defense genes at the wound site is a barrier against opportunistic pathogens. Wounding in multicellulareukaryote cells result in marked changes in gene repression that contribute to cell defense and repairs. The sudden changes in cellular metabolism and additional metabolism requirements for these woundedtissues or cells can only be met by an increased utilization of exogenously supplied carbohydrate in the form of sucrose. Sucrose transporters’ involvement in the import of sucrose from the apoplastic cells will be of great significance for the cellular metabolic needs, and also for energy and carbon requirements for the activation of defense responses of the adjacent injured tissues or cells

Childhood pneumonia at the University of Ilorin Teaching Hospital, Ilorin Nigeria

Background/Objectives: Pneumonia is a leading cause of morbidity and mortality in children and thus this study was designed to document the sociodemographic, clinical features as well as the bacterial agents  responsible for pneumonia in children seen at University of Ilorin Teaching Hospital.Methodology: A descriptive cross -sectional study of children aged one month to 14 years with features of pneumonia admitted between July 1st 2010 and June 31st, 2011 was carried out. Sociodemograpic data, clinical features, complications and outcome were obtained. Chest radiographs and blood samples for culture of bacterial organism and full bloodcounts were obtained in all children.Results: Pneumonia accounted for 13.3% (167 out of 1254) of the all admissions during this period. The male: female ratio was 1.5:1, and 101(60.5%) of the children were infants. Bronchopneumonia was identified in 147(88%) children, lobar pneumonia in 15 (9%) while 5(3%) had a combination of both. Cough, fever, difficulty in breathing, tachypnoea andchest wall recessions were recognised as clinical features in the study population. Bacteraemia was present in 46(27%)children and Staphylococcus aureus was the most common organism cultured from the blood of children with pneumonia present in 11 (23.9%) out of the 46 (100.0%) isolates. Heart failure was associated complication present in 52 of the 60 children with one or more complications accounting for over 30% of all patients. Eleven out of the 15 children with lobar pneumonia hadpneumonia-related complications which was significantly higher compared to 46 of 157 children with bronchopneumonia, p=0.003. The case fatality was 6.6%. Eight (72.7%) of the children that died were infants while the remaining three (27.3%) were aged between 12 and 60 months. The mean duration of hospitalization among those who survived of 6.5 ±5.0 days was significantly lower than the corresponding value of 10.2 ±12.3 days in those that died, p= 0.042. Conclusion: Pneumonia-related mortality and morbidity is high in under-five children, with the infant age group most affected. Bronchopneumonia is the most prevalent ALRI diagnosis but lobar pneumonia is associated with a higher mortality

Febrile Convulsion among Hospitalized Children Aged Six Months to Five Years and Its Association With Haemoglobin Electrophoretic Pattern

BACKGROUND: Febrile convulsion and sickle cell disease are common in tropical countries and both are associated with significant morbidity and mortality. Worldwide, Nigeria has the highest prevalence of sickle cell disease. However, there is a dearth of knowledge on the haemoglobin electrophoresis in patients with febrile convulsions.METHODS: This was a hospital based, descriptive, cross-sectional study of the relationship between haemoglobin genotype and febrile convulsion at the University of Ilorin Teaching Hospital over a period of 12 months. A self-designed pretested questionnaire was administered on the subjects, and necessary examinations and investigations were conducted.RESULTS: Of a total of 1675 children admitted into the emergency paediatric unit during the study period, children aged 6 months–5 years that presented with febrile convulsions were 167(10%) . Of this, 1,212 were aged 6 months-5 years. Thus, the age specific, hospital-based prevalence was 13.8%. The M:F was 1.1:1. Their Haemoglobin genotype distribution was AA 131(78.4%), AS 23(13.8%), AC 6(3.6%), SS 6(3.6%), and 1(0.6%) SC. The mean age of the sickle cell disease patients was higher at 46.0±13.5 months compared to 29.2±15.4 months in the non-sickle cell disease patients (p=0.005). The mean packed cell volume in subjects with sickle cell anaemia was 8.8±1.5%; the only case of haemoglobin SC had packed cell volume of 20%, while the non-sickle cell disease patients had a normal PCV. Malaria was present in 80.4% of them.CONCLUSION: Febrile convulsion remains a common cause of hospitalisation. It is uncommon in haemoglobin SS where severe anaemia is always an accompanying derangement. The packed cell volume is nearly normal in children with normal haemoglobin genotype.KEYWORDS: Febrile Convulsion, haemoglobin genotype, children, Malari

Missed vaccination opportunities at a secondary health facility in Ilorin, Nigeria

Background: Immunization remains a key strategy in the control of childhood diseases, with a child expected to have five visits according to the current National Programme on Immunization. The study aimed to identify missed vaccination visits and the associated factors in children presenting at the general out-patient clinic of a secondary health facility in Ilorin, Nigeria.Method: Through a descriptive cross-sectional study, the vaccination data of all children seen at the out-patient clinic were critically reviewed over a period of one month. Socio-demographic and immunization details were obtained and reasons for missed vaccination documented. Those that had missed vaccination were commenced on the needed vaccine(s) after counselling of their parent(s), and adequate follow-up was instituted.Results: Eighty-two (5.1%) children out of 1603 seen had missed at least one vaccine visit. The mean (SD) age of the children was 20.1(14.9) months. The male to female ratio was 1.1:1. Thirty-nine (47.2%) children had missed one visit while 43(52.7%) had missed two or more visits; 16(19.5%) had missed all five visits. Major reasons for missed visits were ill child(26.8%), ignorance about routine vaccine but received vaccine during the National Immunization Days(NID) (19.5%), mother travelled (14.6%), forgot(9.8%), and reaction to previous vaccine(6.1%).Conclusion: The missed opportunity for immunization is high therefore health care providers should enquire about the vaccination status of children at all contact. There is a need to increase awareness on illnesses that are not contra-indications to vaccination, and routine vaccine status should be checked during NID.Keywords: Missed, Opportunity, Vaccination, Children, Routine, Immunizatio

Serum zinc levels as a predictor of clinical features and outcome of paediatric acute lower respiratory infections in Nigeria

Background: Malnutrition, especially macronutrient deficiency, has been shown to be interrelated with ALRI-related morbidity and mortality. However the import of zinc deficiency has only recently become the focus of research attention.Objective: The current study was carried out in Ilorin, Kwara State, Nigeria to determine the relationship between serum zinc levels, clinical features and outcome in hospitalized children with acute lower respiratory infections(ALRI).Method: A descriptive crosssectional hospital-based study involving 120 children aged two months to five years with ALRI. Socio-demographic, clinical and laboratory data were obtained. The serum zinc was analyzed with a Jenway™ spectrophotometer after initial preparation with theQuantiChrom™ zinc assay kit.Results: Children with tachypnoea and crepitations had significantly lower mean serum zinc levels compared to the corresponding values in those without these features (each p<0.05). Significantly higher mean serum zinc level was recorded in children with grunting respiration compared with thosewithout grunting (p=0.028). Agerelated tachypnoea, grunting, and crepitations remained significant (each p<0.05) following a linear  regression analysis. The mean serum zinc level in children with multiple complications was significantly lower than the corresponding level recorded in children who had one complication, p=0.020. No significant differencewas found between the mean serum zinc level of the children who were discharged compared with the corresponding level recorded in those that died, p=0.589.Conclusion: The presence of crepitations had the strongest clinical association with a low serum zinc level. Children managed for ALRI would benefit from post-treatment zinc supplements and appropriate zinc-rich sources of food at discharge.Keywords: Children zinc respiratory infection

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone