Recurrent Strokes in a Woman with a History of Thrombotic Thrombocytopenic Purpura

Thrombotic thrombocytopenic purpura (TTP) is a microangiopathy characterized by mechanical hemolytic anemia, resulting in end-organ damage. We describe a case of TTP which presented as an ischemic stroke. The patient presented with stroke as the primary manifestation of TTP despite a normal platelet count and mildly elevated lactate dehydrogenase level (LDH). The patient underwent two transfusions of fresh frozen plasma (FFP), and ADAMTS13 levels confirmed the diagnosis of TTP after discharge. This case demonstrates the importance of maintaining a high index of suspicion for TTP in the setting of normal laboratory values and reveals the many atypical manifestations of TTP

Home management of childhood diarrhoea: Need to intensify campaign

A review of home management of childhood diarrhea in under-five children among 203 Nigerian mothers was carried out over a period of 3 months in order to ascertain how effectively they manage their children with diarrhea outside a hospital setup (infrastructural health facility). Mothers whose children had diarrhea, with or without other symptoms, and presented at the Children’s Out Patient unit (CHOP), of the UNTH over the study period were consecutively interviewed through a questionnaire designed for the study. The questionnaires were designed and administered by the authors. There were 30 mothers in social class 1; 59 in social class 2; 52 in social class 3; 13 in social class 4, and 7 mothers in social class 5. Information was obtained on the method of detection, causes of diarrhea, and treatment including their knowledge and use of oral rehydration salts with or without anti diarrheal and antibacterial agents. Out of the 203 mothers interviewed, 140 (71%) correctly defined diarrhea. 112 (55.2%) could identify correct causes of childhood diarrhea. Only 80 (39.4%) could correctly manage diarrhea at home. About 76% (154 mothers) knew that they should use an oral rehydration salt; of this number, 56 (27.6%) could correctly prepare SSS, while 29 (14.3%) could do the same for the UNICEF ORS. In addition, anti bacterial, anti-diarrheal, and/or herbal preparations were used by 38 (18.7%) of the mothers. The level of knowledge of oral rehydration therapy has dropped in our locality since its inception in the early 1990s. There is need to intensify maternal education in this area since we now have a new generation of mothers who were not there during the inception of the program

Implementing National HIV/AIDS Strategy 2015 Treatment Targets Is Cost-effective and Would Save Lives: What Other Evidence Do We Need?

In response to persistently elevated human immunodeficiency virus (HIV) incidence in the United States, the Obama administration released the first National HIV/ AIDS Strategy (NHAS) in 2010 to concentrate national attention on ending the domestic epidemic and coordinate the nation’s response. The NHAS incorporated measurable objectives to help repair defects in the continuum of HIV care that contributed to high HIV infection rate

Preventing HIV among women - A step forward, but much farther to go

The 900,000 new HIV infections among women globally in 2015 attest to the urgent need for the dissemination of effective new HIV-prevention products for women. Most women are infected with HIV by means of sexual activity with men. Therefore, the treatment of persons with HIV is one of the most effective strategies for the prevention of new cases of HIV infection among women. However, few countries have attained the level of antiretroviral coverage in the population that is required to eliminate transmission, and women need prevention methods that they can control themselves. Long-acting products that decrease the burden of adherence are especially needed. This issue of the Journal reports the results of two trials that move HIV prevention a step closer

Concurrent sexual partnerships among African Americans in the rural south

Abstract Purpose To investigate concurrent sexual partnerships among heterosexual African Americans, 18 to 59 years old, in rural North Carolina. Methods Household interviews with persons randomly selected from the NC driver's license file were conducted to identify overlap among the 3 most recent sexual partnerships. Results Concurrency prevalence in the past 5 years was 53% (men) and 31% (women). Most (61%) respondents believed that a recent partner had had a concurrent partnership. Multivariate analysis revealed strong associations between concurrency and male gender, being unmarried, age of sexual debut, and incarceration of a sex partner. Conclusions Concurrent partnerships may increase rates of heterosexual HIV among blacks in the rural Southeastern United States. Future research should examine the context that supports this network pattern

Peer pressure and home environment as predictors of disruptive and risky sexual behaviours of secondary school adolescents

Background: Not much is understood about the predictive power of home environment and peer pressure on disruptive behaviour and risky sexual behaviour of adolescents.Objectives: The study investigated the predictive power of home environment and peer pressure on disruptive behaviour and risky sexual behaviour of adolescents in secondary school class two in Enugu State, Nigeria. Four research questions and four null hypotheses guided the study.Methods: The design was a cross sectional survey of correlational study. The study was carried out in the six Education zones in Enugu State, Nigeria. The population was all the 31,680 senior secondary class two (SS11) adolescents in 285 secondary schools in Enugu State, Nigeria in 2015/2016 academic session. The instruments for data collection were an observation schedule, an interview session and a structured questionnaire of four clusters. To determine the R-squares for each regression model, a multivariate multiple regression model was conducted using “MANOVA” and “MVREG”.Results: This study indicates adolescents who reported their home environments to be stimulated displayed compliant behavior and none or lowered risky sexual behaviour, whilst those with chaotic and unstimulated home environment displayed disruptive behaviours. It was found that adolescents who show a heightened sensitivity to positive peer pressure demonstrated compliant and no or lowered risky sexual behavior whilst, those that are engaged with negative peer pressure strongly exhibit disruptive and risky sexual behaviour.Conclusion: Unstimulated home environment and negative peer group could consequently interact to predispose these adolescents to disruptive behaviour and risky sexual behaviour.Keywords: Home, peer group, disruptive, behaviour, adolescents

EXPLOITING GENETIC ALGORITHM IN STRING CASH DISPENSE DISPUTE

The cash transaction dispense dispute seems to be an ugly daily experience to bank customers. Most times the customers’ debited funds would not be auto reversed within the 24 hours given by inter-switch. At this point, customers have to report officially to their banks to get the problem sorted out manually by filling the dispute form. In some cases, after filling the form, they have to wait for at least seven business working days before the un-dispensed debited funds are reversed. This might be very excruciating on the customer, especially when un-dispensed cash is the only money on him/her. In this paper, our core interest is to solve the problem of delay in reversing debited funds using a genetic algorithm approach based on numerical integration. The result of the new system revealed how dispensed disputes are resolved within seconds without delay using the optimal fitness function values of the genetic algorithm that validates the customers’ claims and makes refunds. The system is independent of inter-switch and its flexibility allows customers to report their dispensed dispute online, especially when it is not reversed within allotted seconds. The research paper data set and the results were tested and analyzed using MATLAB software application

Diversity in the US Infectious Diseases Workforce: Challenges for Women and Underrepresented Minorities

Research documents significant gender-based salary inequities among physicians and ongoing inadequacies in recruitment and promotion of physicians from underrepresented minority groups. Given the complexity of the social forces that promote these disparities, their elimination will likely require quantitative and qualitative research to understand the pathways that lead to them and to develop effective solutions. Interventions to combat implicit bias will be required, and structural interventions that hold medical school leadership accountable are needed to achieve and maintain salary equity and racial and gender diversity at all levels

Perception of child adoption among parents/care‑givers of children attending pediatric outpatients’ clinics in Enugu, South East, Nigeria

Background: There has been an increasing interest by couples in child adoption due to its acceptability in recent times in our locale. The enactment of the Child’s Right Act in Nigeria has harmonized child adoption process across the nation. With the rising demand for babies from child care institutions by many Nigerian couples, there is need to ascertain their perception of child adoption.Objectives: To evaluate the perception of child adoption among parents/care‑givers of children attending Pediatric Clinics in Enugu.Materials and Methods: The parents and care‑givers of children attending pediatrics out‑patients clinics in Enugu, Enugu State, South East, Nigeria  served as the respondents. Two hundred and fifty nine of them were selected by convenience sampling method after obtaining their informed written consent. The data were obtained using semi ‑ structured questionnaire that was administered by an interviewer and subsequently analyzed using SPSS Version 15.0.Results: Many caregivers (respondents) (94.2.7%) had heard of child adoption and 79.2% of them understood the actual meaning of the term child adoption. About 1.9% of them had adopted previously. Majority of the respondents (73.87%) prefers to adopt a child during its neonatal age with a slight preference for adoption of male babies. 15.1% and 8.9% of the respondents gave private hospitals and middle men, respectively, as sources of child adoption. Knowledge of the Government adoption laws and process was generally below average (49.2%) among the respondents.Conclusion: Continued advocacy and public enlightenment campaigns should be strengthened in order to harmonize adoption process in our setting.Key words: Child adoption, parents/care‑givers, perceptio

Concurrent Partnerships, Nonmonogamous Partners, and Substance Use Among Women in the United States

Objectives. We determined the prevalence, distribution, and correlates of US women's involvement in concurrent sexual partnerships, a sexual-network pattern that speeds population-wide HIV dissemination. Methods. We used sexual partnership dates reported by 7643 women in the 2002 National Survey of Family Growth to determine prevalence of concurrent sexual partnerships during the preceding 12 months. We examined associations between concurrency and sociodemographic characteristics and risk behaviors. Results. Prevalence of concurrent partnerships was 5.7% based on reported partnerships and 8.3% after adjustment for possible underreporting. Concurrency was associated with younger age (22 to 24 years: prevalence odds ratio [POR]=2.44) versus older age (40 to 44 years); marital status (formerly married: POR=6.56; never married: POR=3.81; vs married); Black race/ethnicity (POR=1.78); younger age at first sexual intercourse (12 to 13 years: POR=2.89) versus 18 years or older); having a nonmonogamous sexual partner (POR=6.96); having intercourse while ‘‘high’’ on drugs or alcohol (POR=1.61); binge drinking (POR=1.70); and crack or cocaine use (POR=2.72). Conclusions. The association of concurrency with nonmonogamous sexual partners and substance use suggests the existence of extensive sexual networks that link people at higher risk for HIV infection with increased opportunities for disseminating infection