Ascaris lumbricoides: The risk factors and effects on growth of schoolchildren within Samaru, Zaria, Nigeria

Intestinal helminthiasis affects children’s health and physical growth. Finding the prevalence of Ascaris lumbricoides, risk factors and effects on growth of children in Samaru, Zaria were the foci of this study. Fresh faecal samples were collected from 203 consented children in seven selected schools. Weight and height data were measured and body mass index was calculated for each child. Samples were processed by formol-ether concentration technique and examined for ova of Ascaris lumbricoides with light microscope. Data were analyzed by statistical tools. Overall prevalence of Ascaris lumbricoides was 2.0%. The infection was absent in children from private schools, but those from public schools were significantly infected (P=0.042, OR >1). Male children were more infected (2.1%) than females (1.9%). Children below 10 years old had no ascariasis, while children of 10-11 and 12-13 years old had 2.5% and 2.9% infections respectively. Children who eat raw vegetables (OR =1.021) or work on farms (OR =2.636) were more at risk of ascariasis. No sign/symptom was associated with ascariasis. Ascaris lumbricoides was present only in children whose body weights were ≤38.0kg with significantly low body mass index of <18.50 (OR >1). Ascariasis is preventable given proper environmental sanitation, safe water and adequate sanitary facilities

Risk factors and effects of hookworm infections on anthropometric indices of school children in Samaru, Zaria, Nigeria

Rural communities in Nigeria suffer a great deal of parasitic infections. The effect is severe on children. Parasitic infections affect the health of schoolchildren by causing malnutrition, anaemia, reduced cognitive ability and poor performance in school. This study was aimed at assessing the prevalence of hookworm infections, associated risk factors and their effects on anthropometric indices of schoolchildren in Samaru, Zaria. Children across public and private schools were enlightened about the disease. Fresh morning faecal samples were collected from each of 203 consented pupils. The samples were examined for hookworm eggs by formol-ether concentration technique. Prevalence of hookworms was 4.9%. Children in four out of seven schools were found with hookworm infections (P=0.000). Children from public schools were significantly more infected with hookworms (7.9%, P=0.050) than those in the private schools. Male schoolchildren had higher hookworm infections (5.8%) than the females (4.7%, P>0.05). The youngest children of age 6-7 years old were the most infected (9.1%); followed by those of 10-11 years old who had 5.8% infections. Children who walked barefooted (6.5%), consumed raw vegetables (5.1%) or engaged in farming (5.3%) were more infected with hookworms than those who did not, but the relationship was not significant (P>0.00). Only fever (3.0%) was found among infected children (P=0.582), other symptoms did not occur among those infected with the hookworms. Children with weight of 39-48kg had the highest infection of 8.0%. Weight, height and BMI were not statistically associated with hookworm infections among the children. However, most of the children (87.2%) had underweight BMI

Syphilis in a Nigerian Paramilitary Agency: Need for Treatment Policy

Background: Sexually transmitted diseases are widespread in the developing countries and constitute a major public health problem in Sub-Saharan Africa. More recently, there has been a resurgence of syphilis. The aim of this study was to determine the seroprevalence rate of syphilis among newly recruited senior cadres of a Nigerian Security Agency. Method: Eight hundred and fifteen newly recruited men and women sent for serological test for syphilis (STS) in our laboratory were all screened accordingly using Rapid Plasma Reagin (RPR) test. All those that were positive wee confirmed using treponema pallidum haemagglutination (TPHA) test. Results: The seroprevalence rate of treponema pallidum infection was 4.0% (95%CI = 2.8% -5.6%). The rate was significantly higher among women (8.0%) compare to men (3.4%) (\u3c72 = 5.3 df = 1 P = 0.02). Considered by age, the highest seroprevalence of 6.7% was seen among oldest recruits (30-39) years age group compared to 4.2% among the younger ones. This trend was however, not statistically significant (\u3c72trend = 1.6 df =3 P = 0.20). Conclusion: Syphilis seropositivity is highly prevalent among the paramilitary population hence the need for prophylactic treatment with benzathine penicillin to be instituted for seropositive individuals as a matter of policy by the government. This could reduce the incidence of HIV infection among Nigerians.Contexte: Les maladies sexuellement transmissibles sont largement r\ue9pondues dans les pays en d\ue9veloppement et constituent un probl\ue8me majeur de sant\ue9 publique en Afrique sub-Saharienne. Plus r\ue9cemment il y'a recrudescence de la syphilis. Le but de cette \ue9tude \ue9tait de d\ue9terminer le taux de s\ue9ropr\ue9valence de la Syphilis chez des cadres sup\ue9rieurs nouvellement recrut\ue9s au sein d'une Agence Nig\ue9riane de S\ue9curit\ue9. M\ue9thodes : Huit cents quinze hommes et femmes nouvellement recrut\ue9s ont b\ue9n\ue9fici\ue9 d'une s\ue9rologie syphilitique dans notre laboratoire en utilisant le test rapide RPR (Rapid Plasma Reagin). Tous les tests positifs ont \ue9t\ue9 confirm\ue9s par le test de treponema pallidum haemagglutination (TPHA). R\ue9sultats: Le taux de s\ue9ropr\ue9valence de l'infection \ue0 treponema pallidum \ue9tait de 4,0% (95%CI=2,8%-5,6%). Le taux \ue9tait significativement plus haut chez les femmes (8,0%) compar\ue9 aux hommes (3,4%)(\u3c72 = 5.3 df = 1 P = 0.02). Concernant l'\ue2ge, les taux de s\ue9ropr\ue9valence les plus \ue9lev\ue9s \ue9taient retrouv\ue9s parmi les sujets les plus \ue2g\ue9s (30-39) compar\ue9s \ue0 4,2% chez les sujets les plus jeunes. Cette tendance n'est pas toutefois pas statistiquement significative (\u3c72trend = 1.6 df =3, P = 0.20). Conclusion: La S\ue9ropositivit\ue9 syphilitique a une grande pr\ue9valence dans la population de paramilitaires, d'o\uf9 la n\ue9cessit\ue9 d'une prophylaxie par de la benzathine penicillin, qui doit \ueatre institu\ue9e pour les sujets s\ue9ropositifs devant l'absence de strat\ue9gie gouvernementale. Cela pourrait r\ue9duire l'incidence de l'infection \ue0 VIH au Nigeria

Heterogeneously catalyzed lignin depolymerization

Biomass offers a unique resource for the sustainable production of bio-derived chemical and fuels as drop-in replacements for the current fossil fuel products. Lignin represents a major component of lignocellulosic biomass, but is particularly recalcitrant for valorization by existing chemical technologies due to its complex cross-linking polymeric network. Here, we highlight a range of catalytic approaches to lignin depolymerisation for the production of aromatic bio-oil and monomeric oxygenates

Inhibition of Mesothelin as a Novel Strategy for Targeting Cancer Cells

Mesothelin, a differentiation antigen present in a series of malignancies such as mesothelioma, ovarian, lung and pancreatic cancer, has been studied as a marker for diagnosis and a target for immunotherapy. We, however, were interested in evaluating the effects of direct targeting of Mesothelin on the viability of cancer cells as the first step towards developing a novel therapeutic strategy. We report here that gene specific silencing for Mesothelin by distinct methods (siRNA and microRNA) decreased viability of cancer cells from different origins such as mesothelioma (H2373), ovarian cancer (Skov3 and Ovcar-5) and pancreatic cancer (Miapaca2 and Panc-1). Additionally, the invasiveness of cancer cells was also significantly decreased upon such treatment. We then investigated pro-oncogenic signaling characteristics of cells upon mesothelin-silencing which revealed a significant decrease in phospho-ERK1 and PI3K/AKT activity. The molecular mechanism of reduced invasiveness was connected to the reduced expression of β-Catenin, an important marker of EMT (epithelial-mesenchymal transition). Ero1, a protein involved in clearing unfolded proteins and a member of the ER-Stress (endoplasmic reticulum-stress) pathway was also markedly reduced. Furthermore, Mesothelin silencing caused a significant increase in fraction of cancer cells in S-phase. In next step, treatment of ovarian cancer cells (OVca429) with a lentivirus expressing anti-mesothelin microRNA resulted in significant loss of viability, invasiveness, and morphological alterations. Therefore, we propose the inhibition of Mesothelin as a potential novel strategy for targeting human malignancies

Effects of tranexamic acid on death, disability, vascular occlusive events and other morbidities in patients with acute traumatic brain injury (CRASH-3): a randomised, placebo-controlled trial

Background Tranexamic acid reduces surgical bleeding and decreases mortality in patients with traumatic extracranial bleeding. Intracranial bleeding is common after traumatic brain injury (TBI) and can cause brain herniation and death. We aimed to assess the effects of tranexamic acid in patients with TBI. Methods This randomised, placebo-controlled trial was done in 175 hospitals in 29 countries. Adults with TBI who were within 3 h of injury, had a Glasgow Coma Scale (GCS) score of 12 or lower or any intracranial bleeding on CT scan, and no major extracranial bleeding were eligible. The time window for eligibility was originally 8 h but in 2016 the protocol was changed to limit recruitment to patients within 3 h of injury. This change was made blind to the trial data, in response to external evidence suggesting that delayed treatment is unlikely to be effective. We randomly assigned (1:1) patients to receive tranexamic acid (loading dose 1 g over 10 min then infusion of 1 g over 8 h) or matching placebo. Patients were assigned by selecting a numbered treatment pack from a box containing eight packs that were identical apart from the pack number. Patients, caregivers, and those assessing outcomes were masked to allocation. The primary outcome was head injury-related death in hospital within 28 days of injury in patients treated within 3 h of injury. We prespecified a sensitivity analysis that excluded patients with a GCS score of 3 and those with bilateral unreactive pupils at baseline. All analyses were done by intention to treat. This trial was registered with ISRCTN (ISRCTN15088122), ClinicalTrials.gov (NCT01402882), EudraCT (2011-003669-14), and the Pan African Clinical Trial Registry (PACTR20121000441277). Results Between July 20, 2012, and Jan 31, 2019, we randomly allocated 12 737 patients with TBI to receive tranexamic acid (6406 [50·3%] or placebo [6331 [49·7%], of whom 9202 (72·2%) patients were treated within 3 h of injury. Among patients treated within 3 h of injury, the risk of head injury-related death was 18·5% in the tranexamic acid group versus 19·8% in the placebo group (855 vs 892 events; risk ratio [RR] 0·94 [95% CI 0·86-1·02]). In the prespecified sensitivity analysis that excluded patients with a GCS score of 3 or bilateral unreactive pupils at baseline, the risk of head injury-related death was 12·5% in the tranexamic acid group versus 14·0% in the placebo group (485 vs 525 events; RR 0·89 [95% CI 0·80-1·00]). The risk of head injury-related death reduced with tranexamic acid in patients with mild-to-moderate head injury (RR 0·78 [95% CI 0·64-0·95]) but not in patients with severe head injury (0·99 [95% CI 0·91-1·07]; p value for heterogeneity 0·030). Early treatment was more effective than was later treatment in patients with mild and moderate head injury (p=0·005) but time to treatment had no obvious effect in patients with severe head injury (p=0·73). The risk of vascular occlusive events was similar in the tranexamic acid and placebo groups (RR 0·98 (0·74-1·28). The risk of seizures was also similar between groups (1·09 [95% CI 0·90-1·33]). Interpretation Our results show that tranexamic acid is safe in patients with TBI and that treatment within 3 h of injury reduces head injury-related death. Patients should be treated as soon as possible after injury. Funding National Institute for Health Research Health Technology Assessment, JP Moulton Charitable Trust, Department of Health and Social Care, Department for International Development, Global Challenges Research Fund, Medical Research Council, and Wellcome Trust (Joint Global Health Trials scheme)

Twelve-month observational study of children with cancer in 41 countries during the COVID-19 pandemic

Introduction Childhood cancer is a leading cause of death. It is unclear whether the COVID-19 pandemic has impacted childhood cancer mortality. In this study, we aimed to establish all-cause mortality rates for childhood cancers during the COVID-19 pandemic and determine the factors associated with mortality. Methods Prospective cohort study in 109 institutions in 41 countries. Inclusion criteria: children <18 years who were newly diagnosed with or undergoing active treatment for acute lymphoblastic leukaemia, non-Hodgkin's lymphoma, Hodgkin lymphoma, retinoblastoma, Wilms tumour, glioma, osteosarcoma, Ewing sarcoma, rhabdomyosarcoma, medulloblastoma and neuroblastoma. Of 2327 cases, 2118 patients were included in the study. The primary outcome measure was all-cause mortality at 30 days, 90 days and 12 months. Results All-cause mortality was 3.4% (n=71/2084) at 30-day follow-up, 5.7% (n=113/1969) at 90-day follow-up and 13.0% (n=206/1581) at 12-month follow-up. The median time from diagnosis to multidisciplinary team (MDT) plan was longest in low-income countries (7 days, IQR 3-11). Multivariable analysis revealed several factors associated with 12-month mortality, including low-income (OR 6.99 (95% CI 2.49 to 19.68); p<0.001), lower middle income (OR 3.32 (95% CI 1.96 to 5.61); p<0.001) and upper middle income (OR 3.49 (95% CI 2.02 to 6.03); p<0.001) country status and chemotherapy (OR 0.55 (95% CI 0.36 to 0.86); p=0.008) and immunotherapy (OR 0.27 (95% CI 0.08 to 0.91); p=0.035) within 30 days from MDT plan. Multivariable analysis revealed laboratory-confirmed SARS-CoV-2 infection (OR 5.33 (95% CI 1.19 to 23.84); p=0.029) was associated with 30-day mortality. Conclusions Children with cancer are more likely to die within 30 days if infected with SARS-CoV-2. However, timely treatment reduced odds of death. This report provides crucial information to balance the benefits of providing anticancer therapy against the risks of SARS-CoV-2 infection in children with cancer

Burden of disease scenarios for 204 countries and territories, 2022–2050: a forecasting analysis for the Global Burden of Disease Study 2021

Background: Future trends in disease burden and drivers of health are of great interest to policy makers and the public at large. This information can be used for policy and long-term health investment, planning, and prioritisation. We have expanded and improved upon previous forecasts produced as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) and provide a reference forecast (the most likely future), and alternative scenarios assessing disease burden trajectories if selected sets of risk factors were eliminated from current levels by 2050. Methods: Using forecasts of major drivers of health such as the Socio-demographic Index (SDI; a composite measure of lag-distributed income per capita, mean years of education, and total fertility under 25 years of age) and the full set of risk factor exposures captured by GBD, we provide cause-specific forecasts of mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) by age and sex from 2022 to 2050 for 204 countries and territories, 21 GBD regions, seven super-regions, and the world. All analyses were done at the cause-specific level so that only risk factors deemed causal by the GBD comparative risk assessment influenced future trajectories of mortality for each disease. Cause-specific mortality was modelled using mixed-effects models with SDI and time as the main covariates, and the combined impact of causal risk factors as an offset in the model. At the all-cause mortality level, we captured unexplained variation by modelling residuals with an autoregressive integrated moving average model with drift attenuation. These all-cause forecasts constrained the cause-specific forecasts at successively deeper levels of the GBD cause hierarchy using cascading mortality models, thus ensuring a robust estimate of cause-specific mortality. For non-fatal measures (eg, low back pain), incidence and prevalence were forecasted from mixed-effects models with SDI as the main covariate, and YLDs were computed from the resulting prevalence forecasts and average disability weights from GBD. Alternative future scenarios were constructed by replacing appropriate reference trajectories for risk factors with hypothetical trajectories of gradual elimination of risk factor exposure from current levels to 2050. The scenarios were constructed from various sets of risk factors: environmental risks (Safer Environment scenario), risks associated with communicable, maternal, neonatal, and nutritional diseases (CMNNs; Improved Childhood Nutrition and Vaccination scenario), risks associated with major non-communicable diseases (NCDs; Improved Behavioural and Metabolic Risks scenario), and the combined effects of these three scenarios. Using the Shared Socioeconomic Pathways climate scenarios SSP2-4.5 as reference and SSP1-1.9 as an optimistic alternative in the Safer Environment scenario, we accounted for climate change impact on health by using the most recent Intergovernmental Panel on Climate Change temperature forecasts and published trajectories of ambient air pollution for the same two scenarios. Life expectancy and healthy life expectancy were computed using standard methods. The forecasting framework includes computing the age-sex-specific future population for each location and separately for each scenario. 95% uncertainty intervals (UIs) for each individual future estimate were derived from the 2·5th and 97·5th percentiles of distributions generated from propagating 500 draws through the multistage computational pipeline. Findings: In the reference scenario forecast, global and super-regional life expectancy increased from 2022 to 2050, but improvement was at a slower pace than in the three decades preceding the COVID-19 pandemic (beginning in 2020). Gains in future life expectancy were forecasted to be greatest in super-regions with comparatively low life expectancies (such as sub-Saharan Africa) compared with super-regions with higher life expectancies (such as the high-income super-region), leading to a trend towards convergence in life expectancy across locations between now and 2050. At the super-region level, forecasted healthy life expectancy patterns were similar to those of life expectancies. Forecasts for the reference scenario found that health will improve in the coming decades, with all-cause age-standardised DALY rates decreasing in every GBD super-region. The total DALY burden measured in counts, however, will increase in every super-region, largely a function of population ageing and growth. We also forecasted that both DALY counts and age-standardised DALY rates will continue to shift from CMNNs to NCDs, with the most pronounced shifts occurring in sub-Saharan Africa (60·1% [95% UI 56·8–63·1] of DALYs were from CMNNs in 2022 compared with 35·8% [31·0–45·0] in 2050) and south Asia (31·7% [29·2–34·1] to 15·5% [13·7–17·5]). This shift is reflected in the leading global causes of DALYs, with the top four causes in 2050 being ischaemic heart disease, stroke, diabetes, and chronic obstructive pulmonary disease, compared with 2022, with ischaemic heart disease, neonatal disorders, stroke, and lower respiratory infections at the top. The global proportion of DALYs due to YLDs likewise increased from 33·8% (27·4–40·3) to 41·1% (33·9–48·1) from 2022 to 2050, demonstrating an important shift in overall disease burden towards morbidity and away from premature death. The largest shift of this kind was forecasted for sub-Saharan Africa, from 20·1% (15·6–25·3) of DALYs due to YLDs in 2022 to 35·6% (26·5–43·0) in 2050. In the assessment of alternative future scenarios, the combined effects of the scenarios (Safer Environment, Improved Childhood Nutrition and Vaccination, and Improved Behavioural and Metabolic Risks scenarios) demonstrated an important decrease in the global burden of DALYs in 2050 of 15·4% (13·5–17·5) compared with the reference scenario, with decreases across super-regions ranging from 10·4% (9·7–11·3) in the high-income super-region to 23·9% (20·7–27·3) in north Africa and the Middle East. The Safer Environment scenario had its largest decrease in sub-Saharan Africa (5·2% [3·5–6·8]), the Improved Behavioural and Metabolic Risks scenario in north Africa and the Middle East (23·2% [20·2–26·5]), and the Improved Nutrition and Vaccination scenario in sub-Saharan Africa (2·0% [–0·6 to 3·6]). Interpretation: Globally, life expectancy and age-standardised disease burden were forecasted to improve between 2022 and 2050, with the majority of the burden continuing to shift from CMNNs to NCDs. That said, continued progress on reducing the CMNN disease burden will be dependent on maintaining investment in and policy emphasis on CMNN disease prevention and treatment. Mostly due to growth and ageing of populations, the number of deaths and DALYs due to all causes combined will generally increase. By constructing alternative future scenarios wherein certain risk exposures are eliminated by 2050, we have shown that opportunities exist to substantially improve health outcomes in the future through concerted efforts to prevent exposure to well established risk factors and to expand access to key health interventions