Client waiting time in an urban primary health care centre in Lagos

Background: Primary Health Care is the usual entry point into the health system and has the potential to touch the lives of most people. However one of the reasons for poor uptake of health services at primary health care facilities in Nigeria is long waiting time. This study was carried out to assess client waiting time and attitude towards services received at an urban Primary Health Centre in Lagos State.Methodology: The study design was quasi experimental (before and after) with a descriptive, cross sectional study component. Client flow analysis and client exit interviews were conducted among consenting patients attending the General Out patient Clinic within the first 2 weeks of July 2013, using flow analysis charts and an interviewer- administered questionnaire. Four doctors from the Teaching Hospital's Department of Community Health started attending to patients as the intervention, and the flow analysis charts were administered in the immediate post intervention period. Analysis was conducted using the statistical package for social sciences version 19.Results: The majority of clients interviewed were females (80%). Client waiting time was long with patients spending an average of 137.6±70 minutes before seeing a doctor for an average of 8.6±12 minutes. Over 90% of clients had a favourable attitude towards the services received at the PHC, although 54.3% felt improvements were needed. The waiting time reduced to an average of 88.7±45 minutes upon an increase in the number of doctors providing medical consultations.Conclusion: Reducing client waiting time at Primary Health Care centres is achievable and may improve patronage and ultimately serve as a cost effective strategy in health care delivery on a national scale.Keywords: Client waiting time, Primary health care,  Flow analysi

Nutrition status of children in a well-child clinic in Lagos Nigeria

The burden of malnutrition is evident around the world and more pronounced in developing countries affecting vulnerable groups such as infants, children under five years of age and pregnant women. This study assessed the nutritional status of infants and children aged 9-59 months who visited a well-child clinic at a teaching hospital in Lagos Nigeria. A descriptive cross-sectional study was conducted on 207 children consecutively recruited at a well-child clinic in 2013. Data was collected using structured interviewer-administered questionnaires. Information collected includes the sociodemographic details of each child and caregiver. In addition, selected anthropometric measurements, biochemical tests comprising serum ferritin and total blood protein levels as well as dietary information for each child participant were obtained by trained data collectors. The sampled children were aged 9-59 months, with slightly over half (53.6%) being 12 months old and above. There were more female children and the number of Fathers 84.1%who had attained tertiary education was higher (84.1%) than that of mothers (76.3%). Serum protein and ferritin levels were less than the normal reference values in 1.8% and 26.2% of the children respectively, while the prevalence of underweight children was 4.9% and 8.1% of the children were overweight based on weight-for-age z-scores. Results from the dietary survey showed that the children consumed fewer proteins than carbohydrates. Furthermore, only 18.8% and 12.6% of parents reported feeding their children fruits and vegetables. Significantly more mothers (97.5%) with tertiary education had children with normal weight for age (P<0.05). Despite the low prevalence of malnutrition among the sampled population, it was found that consumption of fruits and vegetables was low, yet these are major sources of vital micronutrients. Results indicated that the prevalence of malnutrition among the study group was generally low. Therefore, steps must be taken to ensure nutrition specific and nutrition sensitive intervention programs aimed at improving the nutritional status of childrenKey words: Nutritional status, assessment, children, weight, ferritin, protein, diet, malnutrition, clini

Cytomegalovirus antibodies among healthy blood donors at Lagos University Teaching Hospital

Objectives. Cytomegalovirus (CMV) is found worldwide in all geographical locations and socio-economic groups and is the virus most frequently transmitted to a developing child before birth. This study aimed to determine the prevalence and risk factors for CMV antibodies among healthy blood donors at Lagos University Teaching Hospital (LUTH).Methods. A cross-sectional study was carried out among consecutively recruited replacement blood donors attending the blood donor clinic at LUTH. A 5 ml blood sample was collected from each consenting participant and serum-assayed for CMV IgG/IgM using an enzyme-linked immunosorbent assay (ELISA)-based kit.Results. A total of 122 healthy donors were recruited; 96% of the donors were IgG anti-CMV positive while 19.5% were IgM anti-CMV positive. Previous history of blood transfusion was not significantly related to CMV positivity.Conclusion. The seroprevalence of CMV appears to be very high in this environment among healthy blood donors. Based on previous studies that showed a decrease in the incidence of CMV disease when blood is screened for CMV (IgM), the incidence of the disease can be decreased in Lagos if blood is screened for CMV

The Information Of The Milky Way From 2MASS Whole Sky Star Count: The Bimodal Color Distributions

The J-Ks color distribution (CD) with a bin size of 0.05 magnitude for the entire Milky Way has been carried out by using the Two Micron All Sky Survey Point Source Catalog (2MASS PSC). The CDs are bimodal, which has a red peak at 0.8 < J-Ks < 0.85 and a blue peak at 0.3 < J-Ks < 0.4. The colors of the red peak are more or less the same for the whole sky, but that of the blue peak depend on Galactic latitude, (J-Ks ~ 0.35 at low Galactic latitudes and 0.35 < J-Ks < 0.4 for other sky areas). The blue peak dominates the bimodal CDs at low Galactic latitudes and becomes comparable with the red peak in other sky regions. In order to explain the bimodal distribution and the global trend shown by the all sky 2MASS CDs, we assemble an empirical HR diagram, which is composed by observational-based near infrared HR diagrams and color magnitude diagrams, and incorporate a Milky Way model. In the empirical HR diagram, the main sequence stars turnoff the thin disk is relatively bluer, (J-Ks)0 = 0.31, when we compare with the thick disk which is (J-Ks)0 = 0.39. The age of the thin/thick disk is roughly estimated to be around 4-5/8-9 Gyr according to the color-age relation of the main sequence turnoff. In general, the 2MASS CDs can be treated as a tool to census the age of stellar population of the Milky Way in a statistical manner and to our knowledge this is a first attempt to measure the age.Comment: Accepted by ApJ on Sept. 11 201

Triage of women with equivocal or low-grade cervical cytology results: a meta-analysis of the HPV test positivity rate

Introduction Methods Results Discussion Conclusion Abstract Consistent evidence underlines the utility of human papillomavirus (HPV) DNA testing in the management of women with equivocal cervical cytological abnormalities, but not in case of low-grade lesions. We performed a meta-analysis including studies where the high-risk probe of the Hybrid Capture-II is used to triage these two cytological categories. The triage test-positivity rate reflects the colposcopy referral workload.Data were pooled on the HPV test positivity rate in women with atypical squamous cells of undetermined significance (ASCUS/ASC-US) or low-grade squamous intraepithelial lesions (LSIL), derived from different cytological classification systems. The meta-analysis was restricted to studies, published between 1991 and 2007. A random-effect model was applied for meta-analytical pooling and the influence of covariates on the HPV positivity rate was analyzed by meta-regression. The variation by age was assessed within individual studies since age strata were not defined uniformly. On an average, 43% (95% CI: 40-46%) of women with ASCUS/ASC-US were high-risk HPV positive (range 23-74%). In women with LSIL, the pooled positivity rate was 76% (95% CI: 71-81%; range 55-89%). In spite of considerable inter-study heterogeneity, the difference in HPV positivity between the two triage groups was large and highly significant: 32% (95% CI: 27-38%). HPV rates dropped tremendously as age and cutoffs of test positivity increased. Other factors (cytological classification system, country, continent, collection method and year of publication) had no statistically significant impact, except in LSIL triage where HPV positivity was significantly lower in European compared to American studies. Women with LSIL, especially younger women, have high HPV positivity rates suggesting limited utility of reflex HPV triaging these cases. Research is needed to identify more specific methods to triage women with low-grade squamous cervical lesions

3-Fluoro-4-hydroxyprolines:Synthesis, conformational analysis and stereoselective recognition by the VHL E3 ubiquitin ligase for targeted protein degradation

Hydroxylation and fluorination of proline alters the pyrrolidine ring pucker and the trans:cis amide bond ratio in a stereochemistry-dependent fashion, affecting molecular recognition of proline-containing molecules by biological systems. While hydroxyprolines and fluoroprolines are common motifs in medicinal and biological chemistry, the synthesis and molecular properties of prolines containing both modifications, i.e., fluoro-hydroxyprolines, have not been described. Here we present a practical and facile synthesis of all four diastereoisomers of 3-fluoro-4-hydroxyprolines (F-Hyps), starting from readily available 4-oxo-l-proline derivatives. Small-molecule X-ray crystallography, NMR spectroscopy, and quantum mechanical calculations are consistent with fluorination at C³ having negligible effects on the hydrogen bond donor capacity of the C⁴ hydroxyl, but inverting the natural preference of Hyp from C⁴-exo to C⁴-endo pucker. In spite of this, F-Hyps still bind to the von Hippel–Lindau (VHL) E3 ligase, which naturally recognizes C⁴-exo Hyp in a stereoselective fashion. Co-crystal structures and electrostatic potential calculations support and rationalize the observed preferential recognition for (3<i>R</i>,4<i>S</i>)-F-Hyp over the corresponding (3<i>S</i>,4<i>S</i>) epimer by VHL. We show that (3<i>R</i>,4<i>S</i>)-F-Hyp provides bioisosteric Hyp substitution in both hypoxia-inducible factor 1 alpha (HIF-1α) substrate peptides and peptidomimetic ligands that form part of PROTAC (proteolysis targeting chimera) conjugates for targeted protein degradation. Despite a weakened affinity, Hyp substitution with (3<i>S</i>,4<i>S</i>)-F-Hyp within the PROTAC MZ1 led to Brd4-selective cellular degradation at concentrations >100-fold lower than the binary <i>K</i>_d for VHL. We anticipate that the disclosed chemistry of 3-fluoro-4-hydroxyprolines and their application as VHL ligands for targeted protein degradation will be of wide interest to medicinal organic chemists, chemical biologists, and drug discoverers alike

SHELS: Optical Spectral Properties of WISE 22 \mu m-selected Galaxies

We use a dense, complete redshift survey, the Smithsonian Hectospec Lensing Survey (SHELS), covering a 4 square degree region of a deep imaging survey, the Deep Lens Survey (DLS), to study the optical spectral properties of Wide-field Infrared Survey Explorer (WISE) 22 \mu m-selected galaxies. Among 507 WISE 22 \mu m-selected sources with (S/N)_{22\mu m}>3 (\simS_{22\mu m}>2.5 mJy), we identify the optical counterparts of 481 sources (\sim98%) at R<25.2 in the very deep, DLS R-band source catalog. Among them, 337 galaxies at R<21 have SHELS spectroscopic data. Most of these objects are at z<0.8. The infrared (IR) luminosities are in the range 4.5x10^8 (L_sun) < L_{IR} < 5.4x10^{12} (L_sun). Most 22 \mu m-selected galaxies are dusty star-forming galaxies with a small (<1.5) 4000 \AA break. The stacked spectra of the 22 \mu m-selected galaxies binned in IR luminosity show that the strength of the [O III] line relative to H\beta grows with increasing IR luminosity. The optical spectra of the 22 \mu m-selected galaxies also show that there are some (\sim2.8%) unusual galaxies with very strong [Ne III] \lambda 3869, 3968 emission lines that require hard ionizing radiation such as AGN or extremely young massive stars. The specific star formation rates (sSFRs) derived from the 3.6 and 22 \mu m flux densities are enhanced if the 22 \mu m-selected galaxies have close late-type neighbors. The sSFR distribution of the 22 \mu m-selected galaxies containing active galactic nuclei (AGNs) is similar to the distribution for star-forming galaxies without AGNs. We identify 48 dust-obscured galaxy (DOG) candidates with large (\gtrsim1000) mid-IR to optical flux density ratio. The combination of deep photometric and spectroscopic data with WISE data suggests that WISE can probe the universe to z\sim2.Comment: 18 pages, 17 figures. To appear in Ap

Reduced Efficacy of Natural Selection on Codon Usage Bias in Selfing Arabidopsis and Capsella Species

Population genetic theory predicts that the efficacy of natural selection in a self-fertilizing species should be lower than its outcrossing relatives because of the reduction in the effective population size (Ne) in the former brought about by inbreeding. However, previous analyses comparing Arabidopsis thaliana (selfer) with A. lyrata (outcrosser) have not found conclusive support for this prediction. In this study, we addressed this issue by examining silent site polymorphisms (synonymous and intronic), which are expected to be informative about changes in Ne. Two comparisons were made: A. thaliana versus A. lyrata and Capsella rubella (selfer) versus C. grandiflora (outcrosser). Extensive polymorphism data sets were obtained by compiling published data from the literature and by sequencing 354 exon loci in C. rubella and 89 additional loci in C. grandiflora. To extract information from the data effectively for studying these questions, we extended two recently developed models in order to investigate detailed selective differences between synonymous codons, mutational biases, and biased gene conversion (BGC), taking into account the effects of recent changes in population size. We found evidence that selection on synonymous codons is significantly weaker in the selfers compared with the outcrossers and that this difference cannot be fully accounted for by mutational biases or BGC