Injury Characteristics among Traumatic Brain Injury Patients on Admission at a National Teaching and Referral Hospital in Kenya

Introduction: Traumatic brain injury (TBI) is one of the leading causes of admissions in hospitals globally. It is associated with significant morbidity and mortality.TBI is a neurosurgical emergency and timely intervention is critical to favorable outcome. Study objective: To determine the injury characteristics among traumatic brain injury patients on admission at a national teaching and referral hospital in Kenya Methodology: A descriptive cross-sectional design was used for this study, with purposive sampling method being adopted. Data was collected from 91 patients with traumatic brain injuries by use of a check list. Results: The results showed that majority of the patients had severe head injury (n=79). There was a significant relationship between age above 40 years, low GCS and severity of brain injury (P= 0.042). There was no significant relationship between severity of brain injury and patients’ gender, marital status and level of education. However occupation yielded a significant association with severe brain injury with casual laborers having the lowest GCS (P=0.042). Conclusion: Majority of patients who had polytrauma had severe TBI at admission. Key words: Brain Injury, Injury characteristics, Traumatic Injury, Brain injury on admission

Determinants of the outcome on traumatic brain injury patients at Kenyatta National Hospital

Introduction: Traumatic brain injury (TBI) is among the leading causes of admissions in hospitals globally. TBI has been attributed with significant morbidity, mortality and disability. Most injuries have mainly been attributed to motor accidents and falls from heights.Traumatic brain injuries represent a significant and growing disease burden in the developing world, and one of the leading causes of death in economically active adults in many low- and middle-income countries.In Kenya, motor vehicle accidents, assaults and motorcycle are significant causes. Per vehicle mile travelled, motorcycle riders have a 34-fold higher risk of death in a crash than people driving vehicles and 8 times more likely to be injured. neurological injury progresses over hours and days, resulting in a secondary injury. Inflammatory and neurotoxic processes result in vasogenic fluid accumulation within the brain, contributing to raised intracranial pressure, hypoperfusion, and cerebral ischaemia a secondary injury may be amenable to intervention. Almost one-third of patients who die after a TBI will talk or obey commands before their death.Physiological insults, Hypoxia, hypotension, hyper - or hypocapnia, hyper - or hypoglycaemia have all been shown to increase the risk of secondary brain injuryObjectives: To determine the patients’ factor, clinical care and systems factor affecting outcome of Traumatic Brain Injury (TBI) patients at Kenyatta National Hospital. Which led to a poor outcome of above 40 years, casual laborers, Polytrauma and time lapse from trauma to hospitalization experienced. The clinical care factors indicating good outcome which included; diagnosis and medication, Nursing care and clinical setting A&E, CCU. Length of hospitalization >10 days. Protocols factors; Patients in surgical wards recording poor outcome.Design: The rationale for using purposive sampling was to be able to distinguish between traumatic brain injury patients, who did not have any neurological problems before the injury, and those who had suffered neurological problems prior to trauma. A descriptive cross-sectional design, Purposive sampling and Quantitative approach to data collection, analysis and presentation was adopted.Setting: The study was carried out at the Accident and Emergency department (A&E), Critical care unit (CCU) and surgical wards of Kenyatta National Hospital (KNH).Subjects: Patients with TBI within 72 hours of injury, aged between 18- 65 years and should have had no previous neurological problem.Results: Patient factors; that led to poor outcome; above 40 years (p=0.042), casual laborers (p=0.043), Polytrauma (p=0.042) and time lapse from trauma to hospitalization (p=0.051). The clinical care factors indicated good outcome which included; diagnosis and medication (p=0.001), Nursing care (p=0.055) and clinical setting A&E (p=0.051), CCU (p=0.032). Length of hospitalization >10 days (p=0.050). Protocols factors; Patients in surgical wards had poor outcome (p=0.051).Conclusion: Patient factor's influenced outcome of TBI, Intensive care and longer time of hospitalization is paramount for better outcome.Recommendation: Setup of a Trauma Neuro Ward and training of Neuro Teams to facilitate professional and quality care to improve outcome of Traumatic Brain Injury patient

Natural Products-Based Drug Design against SARS-CoV-2 Mpro 3CLpro

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has received global attention due to the serious threat it poses to public health. Since the outbreak in December 2019, millions of people have been affected and its rapid global spread has led to an upsurge in the search for treatment. To discover hit compounds that can be used alone or in combination with repositioned drugs, we first analyzed the pharmacokinetic and toxicological properties of natural products from Brazil’s semiarid region. After, we analyzed the site prediction and druggability of the SARS-CoV-2 main protease (Mpro), followed by docking and molecular dynamics simulation. The best SARS-CoV-2 Mpro complexes revealed that other sites were accessed, confirming that our approach could be employed as a suitable starting protocol for ligand prioritization, reinforcing the importance of catalytic cysteine-histidine residues and providing new structural data that could increase the antiviral development mainly against SARSCoV-2. Here, we selected 10 molecules that could be in vitro assayed in response to COVID-19. Two compounds (b01 and b02) suggest a better potential for interaction with SARS-CoV-2 Mpro and could be further studied.Research Dean and Graduate Studies of the Federal University of Pará (PROPESP/UFPA)Brazilian National Council for Scientific and Technological Development (CNPq)Brazilian Coordination for Improvement of Personnel Higher Education (CAPES)Bahia Research Foundation (FAPESB, grant numbers APP071/2011, JCB-0039/2013, and RED-008/2013

Prognostic indicators and outcomes of hospitalised COVID-19 patients with neurological disease: An individual patient data meta-analysis

BACKGROUND: Neurological COVID-19 disease has been reported widely, but published studies often lack information on neurological outcomes and prognostic risk factors. We aimed to describe the spectrum of neurological disease in hospitalised COVID-19 patients; characterise clinical outcomes; and investigate factors associated with a poor outcome. METHODS: We conducted an individual patient data (IPD) meta-analysis of hospitalised patients with neurological COVID-19 disease, using standard case definitions. We invited authors of studies from the first pandemic wave, plus clinicians in the Global COVID-Neuro Network with unpublished data, to contribute. We analysed features associated with poor outcome (moderate to severe disability or death, 3 to 6 on the modified Rankin Scale) using multivariable models. RESULTS: We included 83 studies (31 unpublished) providing IPD for 1979 patients with COVID-19 and acute new-onset neurological disease. Encephalopathy (978 [49%] patients) and cerebrovascular events (506 [26%]) were the most common diagnoses. Respiratory and systemic symptoms preceded neurological features in 93% of patients; one third developed neurological disease after hospital admission. A poor outcome was more common in patients with cerebrovascular events (76% [95% CI 67-82]), than encephalopathy (54% [42-65]). Intensive care use was high (38% [35-41]) overall, and also greater in the cerebrovascular patients. In the cerebrovascular, but not encephalopathic patients, risk factors for poor outcome included breathlessness on admission and elevated D-dimer. Overall, 30-day mortality was 30% [27-32]. The hazard of death was comparatively lower for patients in the WHO European region. INTERPRETATION: Neurological COVID-19 disease poses a considerable burden in terms of disease outcomes and use of hospital resources from prolonged intensive care and inpatient admission; preliminary data suggest these may differ according to WHO regions and country income levels. The different risk factors for encephalopathy and stroke suggest different disease mechanisms which may be amenable to intervention, especially in those who develop neurological symptoms after hospital admission

Prognostic indicators and outcomes of hospitalised COVID-19 patients with neurological disease: An individual patient data meta-analysis.

BackgroundNeurological COVID-19 disease has been reported widely, but published studies often lack information on neurological outcomes and prognostic risk factors. We aimed to describe the spectrum of neurological disease in hospitalised COVID-19 patients; characterise clinical outcomes; and investigate factors associated with a poor outcome.MethodsWe conducted an individual patient data (IPD) meta-analysis of hospitalised patients with neurological COVID-19 disease, using standard case definitions. We invited authors of studies from the first pandemic wave, plus clinicians in the Global COVID-Neuro Network with unpublished data, to contribute. We analysed features associated with poor outcome (moderate to severe disability or death, 3 to 6 on the modified Rankin Scale) using multivariable models.ResultsWe included 83 studies (31 unpublished) providing IPD for 1979 patients with COVID-19 and acute new-onset neurological disease. Encephalopathy (978 [49%] patients) and cerebrovascular events (506 [26%]) were the most common diagnoses. Respiratory and systemic symptoms preceded neurological features in 93% of patients; one third developed neurological disease after hospital admission. A poor outcome was more common in patients with cerebrovascular events (76% [95% CI 67-82]), than encephalopathy (54% [42-65]). Intensive care use was high (38% [35-41]) overall, and also greater in the cerebrovascular patients. In the cerebrovascular, but not encephalopathic patients, risk factors for poor outcome included breathlessness on admission and elevated D-dimer. Overall, 30-day mortality was 30% [27-32]. The hazard of death was comparatively lower for patients in the WHO European region.InterpretationNeurological COVID-19 disease poses a considerable burden in terms of disease outcomes and use of hospital resources from prolonged intensive care and inpatient admission; preliminary data suggest these may differ according to WHO regions and country income levels. The different risk factors for encephalopathy and stroke suggest different disease mechanisms which may be amenable to intervention, especially in those who develop neurological symptoms after hospital admission

Integrated strategies for durable rice blast resistance in sub-Saharan Africa

Rice is a key food security crop in Africa. The importance of rice has led to increasing country-specific, regional, and multinational efforts to develop germplasm and policy initiatives to boost production for a more food-secure continent. Currently, this critically important cereal crop is predominantly cultivated by small-scale farmers under suboptimal conditions in most parts of sub-Saharan Africa (SSA). Rice blast disease, caused by the fungus Magnaporthe oryzae, represents one of the major biotic constraints to rice production under small-scale farming systems of Africa, and developing durable disease resistance is therefore of critical importance. In this review, we provide an overview of the major advances by a multinational collaborative research effort to enhance sustainable rice production across SSA and how it is affected by advances in regional policy. As part of the multinational effort, we highlight the importance of joint international partnerships in tackling multiple crop production constraints through integrated research and outreach programs. More specifically, we highlight recent progress in establishing international networks for rice blast disease surveillance, farmer engagement, monitoring pathogen virulence spectra, and the establishment of regionally based blast resistance breeding programs. To develop blastresistant, high yielding rice varieties for Africa, we have established a breeding pipeline that utilizes real-Time data of pathogen diversity and virulence spectra, to identify major and minor blast resistance genes for introgression into locally adapted rice cultivars. In addition, the project has developed a package to support sustainable rice production through regular stakeholder engagement, training of agricultural extension officers, and establishment of plant clinics