Unplanned vaginal delivery after repeated Caesarean birth in Nigerian women

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Micro-Credit Access and Profitability on Crop Production in Orhionmwon Local Government Area of Edo State, Nigeria

This study focused on the effect of micro-credit on the profitability of cropproduction in Orhionmwon Local Government Area of Edo State, Nigeria. A sample size of 166 small-scale farmers was randomly selected from the farming communities in Orhionmwon Local Government Area. Ninety two (92) beneficiaries and 74 non-beneficiaries were randomly selected from the study area. A well-structured questionnaire and scheduled interviews were used to obtain data from the farmers. The data collected were  subjected to descriptive statistics such as frequency counts, percentages and mean scores. The mean scores were compared using the t-test. Results showed that the respondents in the study area were almost  uniformly distributed gender-wise. The females were however slightly more, both among the beneficiaries (58.7%) and non-beneficiaries (52.7%). The mean years of farming for both the credit beneficiaries and  non-beneficiaries were 32 years and 34 years respectively. Most of the farmers had farm holdings less than 2.5 ha. The profit margin obtained from the beneficiaries was higher than that of the non-beneficiaries. For maize, it was N145,40.66/ha against N139,178.69/ha, for yam,  N671,588.06/ha against N552,927.93/ha, for cassava N377,194.99/ha against N223,000.74/ha and for plantain N681,416.68/ha against  N430,756.59/ha. Untimely delivery of loan was indicated as the greatest constraint to loan acquisition by the beneficiaries while the  non-beneficiaries identified high interest rate charges by the microfinance bank and distance as the greatest reasons for not accessing loans. © JASE

Climate Variability and Its Effects on Gender and Coping Strategies in Baringo County, Kenya

Climate variability has often been described as one of the most pressing environmental challenges. Our lifestyles, economy, health, income, livelihood and our social well-being are all affected by climate. This paper therefore, assessed climate variability, its effect of gender and coping strategies they adopt in Baringo County, Kenya. Descriptive and inferential statistics were used in analyzing the data obtained for the study. Findings show that there is consisent decrease in rainfall and increase in temperature in recent times. Male gender dominates household decisions and roles such as land preparation, livestock keeping/feeding, pesticide application and fence construction in Baringo County, Kenya while the female gender dominates household roles such as water supply, domestic home chores and more of agricultural activities. Livestock migration was the major traditional coping strategy adopted in Baringo County. 56.8% of the respondents shows that cutting grasses for livestock was the major short term coping strategy adopted while Rainfall harvesting and storage (5.92%) was the least adopted in the studied area. Long term coping strategy to climate variability mostly adopted by the rural populace in is livestock migration (48.52%), it was also observed here that the least long term coping strategy adopted is finding alternative job as reputed by 4.44% of the respondents. Special intervention projects such as rain water harvesting techniques, drought resistant crops, short term crops etc, should be provided to rural populace/dwellers in Baringo County, and other parts of Kenya experiencing severe variability in climate, resulting to drought

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چکیده هدف پژوهش حاضر ارزشیابی دور ة آموزشی الکترونیکی رشته کارشناسی ارشد مهندسی فنّاوری اطلاعات دانشگاههای تربیت مدرس ،خواجه نصیر الدین طوسی و امیرکبیر بر اساس الگوی رودریک سیمز است. در این تحقیق از روش توصیفی استفاده شده است. نمون ۀ آماری پژوهش 151 نفر از دانشجویان، استادان و آموزشیاران دور ة آموزش الکترونیکی رشتۀ کارشناسی ارشد مهندسی فنّاوری اطلاعات دانشگاههای تربیت مدرس، خواجه نصیرالدین طوسی و امیرکبیر بودند. در این پژوهش پایایی پرسشنامه 93/0 به دست آمد. نتایج نشان داد که دورههای آموزش الکترونیکی در دانشگاههای خواجه نصیر و تربیت مدرس غالباً در حد نسبتاً مطلوب ارزیاب ی شده و در دانشگاه امیرکبیر وضعیت مؤلفهها در مقایسه با نتایج خواجه نصیر و تربیت مدرس مطلوب تر ارزشیابی شده است

Factors associated with viral non-suppression among patients on antiretroviral therapy (ART) at the Federal Medical Centre, Abeokuta, Ogun State, Nigeria

Objectives: Human Immunodeficiency Virus (HIV) remains a public health issue with more than 25 million deaths since 1990.  As of 2019, Nigeria has a national prevalence of 1.4% among 15- 49 years and about 1.9 million people living with HIV, according to the Joint United Nations Programme on HIV/AIDS. This study assessed the factors responsible for unsuppressed viral load among patients accessing care at Federal Medical Centre HIV Clinic in Abeokuta, southwest Nigeria. Methods: The study design was descriptive cross-sectional. Data was collected using the qualitative method; an In-depth interview was conducted among 20 virally unsuppressed HIV patients currently on Antiretroviral Therapy (ART) at Federal Medical Centre Abeokuta. The participants were purposively selected. The data were analyzed using thematic analysis. Results: Although almost all the participants were aware of HIV, their knowledge of HIV was inadequate. Non- adherence to drugs, side effects of medications, the psychological effects of the disease, forgetfulness, and combination of anti-retroviral drugs with local herbs and alcohol were the associated factors of viral non-suppression among the patients. Conclusion: Scaling up psychological care services using Short Message Services (SMS) to improve viral suppression is, therefore, strongly recommended

Association of HIV-Induced Immunosuppression and Clinical Malaria in Nigerian Adults

Despite the growing body of evidence on the interaction between HIV and malaria in sub-Saharan Africa, there is a dearth of data on clinical malaria in HIV-infected patients in Nigeria. We determined the burden of clinical malaria in HIVinfected adult Nigerians and further investigated the association between their immunological status and the rates of clinical malaria. Ninety seven antiretroviral treatment-naïve HIV-infected adults were enrolled in a cross-sectional study from August to December, 2009. The participants had a complete clinical evaluation, thick and thin blood films for malaria parasites and CD4 cell count quantification. Clinical malaria was defined as having fever (temperature ≥ 37.5oC or history of fever within 48 hours) and a malaria parasite density above the median value obtained for subjects with co-existing fever and parasitaemia. Clinical malaria was diagnosed in 10 out of 97 patients (10.3%). Lower CD4 cell counts were associated with increasing rates of clinical malaria which was 0% at CD4 cell count of ≥ 500, 2.6% at 200-499 and 30% at <200 cells/μL (χ2 = 18.3, p = 0.0001). This association remained significant after controlling for other factors in a multivariate analysis (AOR=22.98, 95% C.I: 2.62-20.14, p = 0.005). An inverse relationship between CD4 cell count and parasite density was demonstrated (regression co-efficient = -0.001, p = 0.0002). More aggressive malaria control measures are highly needed in severely immunosuppressed HIV-infected patients.Keywords: HIV, Immunosuppression, Clinical malaria, Adult

Macroscopic nucleation phenomena in continuum media with long-range interactions

Nucleation, commonly associated with discontinuous transformations between metastable and stable phases, is crucial in fields as diverse as atmospheric science and nanoscale electronics. Traditionally, it is considered a microscopic process (at most nano-meter), implying the formation of a microscopic nucleus of the stable phase. Here we show for the first time, that considering long-range interactions mediated by elastic distortions, nucleation can be a macroscopic process, with the size of the critical nucleus proportional to the total system size. This provides a new concept of "macroscopic barrier-crossing nucleation". We demonstrate the effect in molecular dynamics simulations of a model spin-crossover system with two molecular states of different sizes, causing elastic distortions.Comment: 12 pages, 4 figures. Supplementary information accompanies this paper at http://www.nature.com/scientificreport

The Debrisoft ® monofilament debridement pad for use in acute or chronic wounds: A NICE medical technology guidance

As part of its Medical Technology Evaluation Programme, the National Institute for Health and Care Excellence (NICE) invited a manufacturer to provide clinical and economic evidence for the evaluation of the Debrisoft ® monofilament debridement pad for use in acute or chronic wounds. The University of Birmingham and Brunel University, acting as a consortium, was commissioned to act as an External Assessment Centre (EAC) for NICE, independently appraising the submission. This article is an overview of the original evidence submitted, the EAC’s findings and the final NICE guidance issued. The sponsor submitted a simple cost analysis to estimate the costs of using Debrisoft® to debride wounds compared with saline and gauze, hydrogel and larvae. Separate analyses were conducted for applications in home and applications in a clinic setting. The analysis took an UK National Health Service (NHS) perspective. It incorporated the costs of the technologies and supplementary technologies (such as dressings) and the costs of their application by a district nurse. The sponsor concluded that Debrisoft® was cost saving relative to the comparators. The EAC made amendments to the sponsor analysis to correct for errors and to reflect alternative assumptions. Debrisoft® remained cost saving in most analyses and savings ranged from £77 to £222 per patient compared with hydrogel, from £97 to £347 compared with saline and gauze, and from £180 to £484 compared with larvae depending on the assumptions included in the analysis and whether debridement took place in a home or clinic setting. All analyses were severely limited by the available data on effectiveness, in particular a lack of comparative studies and that the effectiveness data for the comparators came from studies reporting different clinical endpoints compared with Debrisoft®. The Medical Technologies Advisory Committee made a positive recommendation for adoption of Debrisoft® and this has been published as a NICE medical technology guidance (MTG17).The Birmingham and Brunel Consortium is funded by NICE to act as an External Assessment Centre for the Medical Technologies Evaluation Programme

Aggravation de l’anémie et polymorphisme de l’haptoglobine au cours de la drépanocytose au Sénégal

La drépanocytose homozygote s’accompagne d’une augmentation de l’hémoglobine (Hb) plasmatique, susceptible d’exposer les hématies à un stress oxydant. L’haptoglobine présente trois phénotypes majeurs (Hp1-1, Hp 2-1 et Hp 2-2) susceptibles de fixer l’hémoglobine extracellulaire avec une efficacité différente. L’objectif de ce travail est de voir si la connaissance du phénotype d’Hp pouvait constituer un élément prédictifde l’anémie sévère. Pour cela, il a été recruté 68 drépanocytaires  homozygotes, âgés de 5 à 31 ans. Pour chaque patient, un témoin de même sexe et de même âge ± 2 ans a été recruté. Le phénotypage de l’Hp a été réalisé par électrophorèse sur gel de polyacrylamide. Les résultats du dosage de l’Hb font ressortir que les taux d’Hb sont significativement différentes chez les patients comparées à celles des témoins (p = 0,001). Lorsque la répartition a été faite en fonction du phénotype d’Hp, une différence statistiquement significative a étéretrouvée entre le phénotype Hp1-1 et le phénotype Hp2-2 (p < 0,001) chez les patients et non chez les témoins. Les résultats de cette étude préliminaire suggéreraient que la connaissance du phénotype d’Hp seraitun facteur prédictif de l’anémie sévère au cours de la drépanocytose.Mots clés : Drépanocytose, anémie, phénotypes d’haptoglobine

Management of small bowel volvulus in a patient with simultaneous pancreas-kidney transplantation (SPKT): a case report

There are several surgical complications which can occur following simultaneous pancreas-kidney transplantation (SPKT). Although intestinal obstruction is known to be a common complication after any type of abdominal surgery, the occurrence of small bowel volvulus, which is one of the rare causes of intestinal obstruction, following SPKT has not been published before. A 24-year-old woman suffering from type I diabetes mellitus with complications of nephropathy resulting in end stage renal disease (ESRD), neuropathy and retinopathy underwent SPKT. On the postoperative month 5, she was brought to the emergency service due to abdominal distention with mild abdominal pain. After laboratory research and diagnostic radiological tests had been carried out, she underwent exploratory laparotomy to determine the pathology for acute abdominal symptoms. Intra-operative observation revealed the presence of an almost totally ischemic small bowel which had occurred due to clockwise rotation of the mesentery. Initially, simple derotation was performed to avoid intestinal resection because of her risky condition, particularly for short bowel syndrome, and subsequent intestinal response was favorable. Thus, surgical treatment was successfully employed to solve the problem without any resection procedure. The patient's postoperative follow-up was uneventful and she was discharged from hospital on postoperative day 7. According to our clinical viewpoint, this study emphasizes that if there is even just a suspicion of acute abdominal problem in a patient with SPKT, surgical intervention should be promptly performed to avoid any irreversible result and to achieve a positive outcome