Relationship Between the 6-minute Walk Test and Correlates of Type 2 Diabetes: Indication for caution in exercise prescription

Physical exercise is adjudged effective in the prevention and co-management of Type 2 diabetes (T2D). However, because of the different levels of exercise capacity; it must be prescribed with caution based on the individual’s peculiarities. The link between the 6-minute walk test and some correlates of T2D was investigated. This cross-sectional study of 58 consenting patients with T2D was conducted at the diabetes clinic of a secondary health centre in Kano, Nigeria. The measurements included the 6-Minute Walk Distance (6MWD) for exercise capacity and the T2D correlates including age, body mass index, waist circumference and waist-hip ratio. The relationships between the parameters were determined using the Pearson’s correlation coefficient at a significance level of 0.05. The participants consisted of 36 males (62.1%) and 22 females (37.9%). The mean 6MWD for males was 302 ± 33.28 meters and was shorter in women. The 6MWD correlated significantly (P < 0.05) with each of age [r = -0.78 (males), -0.62 (females)], waist circumference [r = -0.82 (males), -0.77 (females)] and body mass index [r = -0.66 (males), -0.74 (females)], while the waist hip ratio correlated significantly with the 6MWD only in the male participants (r = -0.59). Low exercise capacity in patients with T2D was associated with higher age and adiposity. Prescription of physical exercise to patients with T2D who present with one or a combination of these variables should be done with care in order not to exceed safe limits. KEY WORDS: type 2 diabetes, physical exercise, age, body mass index, waist circumference and waist-hip rati

Outbreak of Fatal Childhood Lead Poisoning Related to Artisanal Gold Mining in Northwestern Nigeria, 2010.

Background: In May 2010, a team of national and international organizations was assembled to investigate children's deaths due to lead poisoning in villages in northwestern Nigeria. Objectives: To determine the cause of the childhood lead poisoning outbreak, investigate risk factors for child mortality, and identify children aged <5 years in need of emergency chelation therapy for lead poisoning. Methods: We administered a cross-sectional, door-to-door questionnaire in two affected villages, collected blood from children aged 2-59 months, and soil samples from family compounds. Descriptive and bivariate analyses were performed with survey, blood-lead, and environmental data. Multivariate logistic regression techniques were used to determine risk factors for childhood mortality. Results: We surveyed 119 family compounds. One hundred eighteen of 463 (25%) children aged <5 years had died in the last year. We tested 59% (204/345) of children, aged <5 years, and all were lead poisoned (≥10 µg/dL); 97% (198/204) of children had blood-lead levels ≥45 µg/dL, the threshold for initiating chelation therapy. Gold ore was processed inside two-thirds of the family compounds surveyed. In multivariate modeling significant risk factors for death in the previous year from suspected lead poisoning included: the child's age, the mother performing ore-processing activities, community well as primary water source, and the soil-lead concentration in the compound. Conclusion: The high levels of environmental contamination, percentage of children aged <5 years with elevated blood-lead levels (97%, >45 µg/dL), and incidence of convulsions among children prior to death (82%) suggest that most of the recent childhood deaths in the two surveyed villages were caused by acute lead poisoning from gold ore-processing activities. Control measures included environmental remediation, chelation therapy, public health education, and control of mining activities

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p&lt;0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p&lt;0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

Mortality of emergency abdominal surgery in high-, middle- and low-income countries

Background: Surgical mortality data are collected routinely in high-income countries, yet virtually no low- or middle-income countries have outcome surveillance in place. The aim was prospectively to collect worldwide mortality data following emergency abdominal surgery, comparing findings across countries with a low, middle or high Human Development Index (HDI). Methods: This was a prospective, multicentre, cohort study. Self-selected hospitals performing emergency surgery submitted prespecified data for consecutive patients from at least one 2-week interval during July to December 2014. Postoperative mortality was analysed by hierarchical multivariable logistic regression. Results: Data were obtained for 10 745 patients from 357 centres in 58 countries; 6538 were from high-, 2889 from middle- and 1318 from low-HDI settings. The overall mortality rate was 1⋅6 per cent at 24 h (high 1⋅1 per cent, middle 1⋅9 per cent, low 3⋅4 per cent; P < 0⋅001), increasing to 5⋅4 per cent by 30 days (high 4⋅5 per cent, middle 6⋅0 per cent, low 8⋅6 per cent; P < 0⋅001). Of the 578 patients who died, 404 (69⋅9 per cent) did so between 24 h and 30 days following surgery (high 74⋅2 per cent, middle 68⋅8 per cent, low 60⋅5 per cent). After adjustment, 30-day mortality remained higher in middle-income (odds ratio (OR) 2⋅78, 95 per cent c.i. 1⋅84 to 4⋅20) and low-income (OR 2⋅97, 1⋅84 to 4⋅81) countries. Surgical safety checklist use was less frequent in low- and middle-income countries, but when used was associated with reduced mortality at 30 days. Conclusion: Mortality is three times higher in low- compared with high-HDI countries even when adjusted for prognostic factors. Patient safety factors may have an important role. Registration number: NCT02179112 (http://www.clinicaltrials.gov)

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Exercise Capacity in Type 2 Diabetes Patients: A Preliminary Investigation

To enhance glycaemic control and improve general well being, physical exercises, in addition to drugs and/or diet are usually prescribed to patients with Type 2 Diabetes mellitus (T2D). Assessment of the capacity of these patients to exercise based on the simple Six Minute Walk Test (6MWT) is however not sufficiently documented. We compared the exercise capacities of 58 T2D volunteers matched with 60 non-diabetic individuals using the 6MWT on a 50-meter corridor. The self paced Six Minutes Walk Distance (6MWD) was our outcome measure and it was taken as a display of the exercise capacity of the participants. The diabetic participants had significantly lower (t = 30.5046, P < 0.05) 6MWD (318.57 ± 43.7, 95% CI = 306.74-329.25 m) than the non-diabetic sample (596. 43 ± 54.78, 95% CI = 582.57-610.29 m) indicating lower exercise capacity. In the diabetic sample, we found significant differences in the 6MWD of the age groups (F = 9.4738, P < 0.05) and body mass index classifications (F = 3.3416, P < 0.05) but not for the duration of their diabetes. We found exercise capacity to be lower in patients with T2D than non-diabetic subjects and this was found to be lower in T2D patients who were older and overweight or obese. Exercise prescriptions for T2D patients should consider these factors to avoid exercise induced eventualities

Bioefficacy of ethanolic leaf extracts of some botanicals against cowpea beetle, Callosobruchus maculatus F. [Coleoptera: Chrysomelidae]

No Abstract

Isolation and Identification of Mycotoxigenic Fungi Associated with Dried Tomato Chips from Gusau, Zamfara State, Nigeria

Chipping and sun drying is the most popular and traditional method of tomato preservation in major tomato producing areas in northern Nigeria. The drying is done in open and on a mat or at times on bare floor including shoulder of roads or any surface that is unhygienic. Tomato is an important vegetable crop that is consumed worldwide. It has numerous vital vitamins and other nutrients that promote health and well being of humans. Tomato has been found to be beneficial in the management of diseases such as cancer, cardiovascular and so on. The improper drying of tomato and poor storage has in many reports been found to be more suitable for pathogenic fungi to grow and produce their secondary metabolites which may be poisonous to humans. A total of fifty (50) dried tomato samples were obtained from nine (9) different markets in Gusau, Zamfara state, Nigeria and screened for the presence of fungi. Isolation and identification was done using cultural and cellular examinations. Fungi Isolation was carried out on potato dextrose agar and malt extract agar, samples were inoculated and incubated for at 5 days at 25oC. Identification of the fungi was based on colonial morphology on the plates and microscopic observation in comparison with mycological key. Fungi isolated are mostly of Aspergillus and Penicillium genera. Aspergillus niger was found to be the highest occurring fungi with 52.3%, other fungi isolated were Penicillium oxalicum, Aspergillus flavus each accounting for 6.8% of isolated and identified fungi. Penicillium chermesium, Aspergillus parasiticus, Aspergillus fumigatus, Curvularia americana with 4.5% each and Rhodotorula glutinins, Fomitopsis meliae, Penicillium vericussum, Chaetominum, Aspergillus nidulans and Aspergillus sydowii with 2.3% each. Some of these fungi species are known to produce toxins which could be harmful to both humans and livestock

A Spatiotemporal Appraisal of Road Traffic Accident in Kaduna Metropolis, Nigeria

Purpose: Road accident has been claiming lives and no amount of research will be enough to expose the causes and dangers. This study appraises the causes and analyses the variation of road accidents in the Kaduna metropolis, intending to reduce it. Research methodology: The data used was obtained from Federal Road Safety Corps and complemented by the researchers' field survey. Eight members of the research team went to the 24 bus stops identified each month rotationally. Both descriptive and inferential statistics were applied in the analysis. Results: There was a high correlation of mortality and road accident injuries as confirmed by r-value 0.7 using pearson product moment correlation. Accidents occur most in the morning and afternoon and the season with most accident occurrence was the dry season. The combination of over speeding and other factors were the major causes of road accidents. Limitations: The study used data published in 2016, although a follow-up data verification was conducted in 2017 and 2018. Therefore, the study is old and the results might have changed and might not necessarily be reliable. Contribution: Road accidents hot spots areas, causes, and patterns were exposed to guide the road users in order to avoid the accident. The study can also be replicated in other study areas with similar characteristics

Health, well-being, and burnout amongst Early Career Doctors in Nigeria.

BackgroundEarly Career Doctors (ECDs) in Nigeria are faced with many individual and systemic problems, which consequently adversely affect their health, well-being, patient care and safety.ObjectiveThis study, the second phase of the Challenges of Residency Training and Early Career Doctors in Nigeria (CHARTING II) Study, sought to examine the risk factors and contributors to the health, well-being and burnout amongst Nigerian ECDs.MethodsThis was a study of health, well-being and burnout amongst Nigerian ECDs. Outcome variables included burnout, depression, and anxiety, which were respectively assessed using the Copenhagen Burnout Inventory (CBI) and Oldenburg Burnout Inventory (OLBI), Patient Health Questionnaire (PHQ-9) depression scale, and Generalized Anxiety Disorder (GAD-7) scale. The quantitative data obtained was analysed using the IBM SPSS, version 24. Associations between categorical outcome and independent variables were assessed using chi square, with level of significance set at ResultsThe mean body mass index (BMI), durations of smoking and alcohol consumption of the ECDs were 25.64 ± 4.43 kg/m2 (overweight range), 5.33 ± 5.65 years and 8.44 ± 6.43 years respectively. Less than a third (157, 26.9%) of the ECDs exercised regularly. The most common disease conditions affecting the ECDs were musculoskeletal (65/470, 13.8%) and cardiovascular diseases (39/548, 7.1%). Almost a third (192, 30.6%) of the ECDs reported experiencing anxiety. Male and lower cadre ECDs were more likely than female and higher cadre ECDs to report anxiety, burnout and depression.ConclusionThere is an urgent need to prioritize the health and well-being of Nigerian ECDs, so as to optimize patient care and improve Nigeria's healthcare indices