Nevin Manimala

West Afr J Med. 2021 May 29;38(5):454-459.

ABSTRACT

BACKGROUND: The advent of laparoscopy has been a notable landmark in surgery; however, there is a slow progress to widespread utilization in West Africa.

AIMS: To study the awareness and practice of laparoscopic surgery among trainee surgeons in Nigerian tertiary hospitals while highlighting measures to mitigate challenges.

MATERIALS AND METHODS: A cross-sectional study conducted during a 2-week West African College of Surgeons update course in September 2018 at Ilorin, Kwara State, Nigeria. A structured questionnaire was distributed to registered trainee surgeons for completion. Data collated included demographics, cognitive knowledge, common procedures in centres, referrals, routine practice, performing laparoscopic surgeon, and routine practice. Statistical analysis was done using IBM SPSS Statistics for Windows version 20 Armonk NY USA.

RESULTS: There were 184 registered trainee surgeons with 80 respondents from 26 Nigerian tertiary health facilities. The age range was 29 -51 years (mean 35.0 ± 4.4) and a mean training duration of 3.3 years (R2= 0.12). Seven (63.6%) senior registrars and 54(76.3%) registrars were reported as first assistants in laparoscopic surgeries performed but no unassisted surgery. Four (15.4%) represented centres had no laparoscopy equipment or expertise. A non-referral rate of 52/80(65.0%) for laparoscopic surgery was recorded.

CONCLUSION: Laparoscopic surgery is practiced in some Nigerian tertiary hospitals with trainee surgeons actively involved in performing these surgeries. However, there is limited unassisted experience by trainee surgeons in the basic laparoscopic surgeries predominantly performed.

PMID:34051717

West Afr J Med. 2021 May 29;38:445-453.

ABSTRACT

BACKGROUND: Globally, childhood malnutrition remains a major public health issue. It is thus imperative to contextually analyse Infant and Young Child Feeding (IYCF) practices in resource-poor settings like Nigeria.

STUDY OBJECTIVES: This study assessed key complementary feeding indicators among 6-23-month-old children attending the immunization clinic of Bowen University Teaching Hospital, Ogbomoso, Nigeria.

METHODOLOGY: Cross-Sectional design was employed, and Systematic Random Technique used to recruit 198 consenting caregivers. Validated interviewer-administered, semi-structured questionnaire was used for data collection. Both descriptive and inferential statistics were carried out.

RESULTS: Mean±SD age of the children was 11.27±5.16 months. Only 57.6% of the infants had breastfeeding within 1-hour of life. Not less than 91.4% of the infants had Exclusive breastfeeding (EBF) but Infant formula was the main breastmilk substitute among children without EBF. In all, 83.0% of the infants had Minimum Meal Diversity, 90.4% had Minimum Meal Frequency but only 57.6% had Minimum Acceptable Diet (MAD). The significant predictors of MAD were early commencement of breastfeeding, reception of complementary feeding counselling during pregnancy, EBF practice and whether the child had MUAC which was at least 11cm.

CONCLUSION: IYCF practices was sub-optimal in the studysetting. There is urgent need for policy makers to design evidence-informed strategic framework for effective implementation and evaluation of the existing IYCF policy in Nigeria. Emphasis should be placed on complementary feeding education/counselling using relevant Information, Education and Communication (IEC) channels/materials. Good IYCF practices ensure optimum child growth/ development, prevent childhood diseases, and can ultimately help Nigeria to attain SDG-3 by 2030.

PMID:34051716

Radiol Oncol. 2021 May 31. doi: 10.2478/raon-2021-0024. Online ahead of print.

ABSTRACT

BACKGROUND: The aim of the study was to derive and compare metabolic parameters relating to benign and malignant pulmonary nodules using dynamic 2-deoxy-2-[fluorine-18]fluoro-D-glucose (¹⁸F-FDG) PET/CT, and nodule perfusion parameters derived through perfusion computed tomography (CT).

PATIENTS AND METHODS: Twenty patients with 21 pulmonary nodules incidentally detected on CT underwent a dynamic ¹⁸F-FDG PET/CT and a perfusion CT. The maximum standardized uptake value (SUV_max) was measured on conventional ¹⁸F-FDG PET/CT images. The influx constant (K_i ) was calculated from the dynamic ¹⁸F-FDG PET/CT data using Patlak model. Arterial flow (AF) using the maximum slope model and blood volume (BV) using the Patlak plot method for each nodule were calculated from the perfusion CT data. All nodules were characterized as malignant or benign based on histopathology or 2 year follow up CT. All parameters were statistically compared between the two groups using the nonparametric Mann-Whitney test.

RESULTS: Twelve malignant and 9 benign lung nodules were analysed (median size 20.1 mm, 9-29 mm) in 21 patients (male/female = 11/9; mean age ± SD: 65.3 ± 7.4; age range: 50-76 years). The average SUV_max values ± SD of the benign and malignant nodules were 2.2 ± 1.7 vs. 7.0 ± 4.5, respectively (p = 0.0148). Average K_i values in benign and malignant nodules were 0.0057 ± 0.0071 and 0.0230 ± 0.0155 min^-1, respectively (p = 0.0311). Average BV for the benign and malignant nodules were 11.6857 ± 6.7347 and 28.3400 ± 15.9672 ml/100 ml, respectively (p = 0.0250). Average AF for the benign and malignant nodules were 74.4571 ± 89.0321 and 89.200 ± 49.8883 ml/100g/min, respectively (p = 0.1613).

CONCLUSIONS: Dynamic ¹⁸F-FDG PET/CT and perfusion CT derived blood volume had similar capability to differentiate benign from malignant lung nodules.

PMID:34051709 | DOI:10.2478/raon-2021-0024

Ecotoxicol Environ Saf. 2021 May 26;220:112375. doi: 10.1016/j.ecoenv.2021.112375. Online ahead of print.

ABSTRACT

129 Shenzhen residents’ hair samples were collected and the metal/metalloid concentrations of Hg, As, Pb, Cd, Cr, Cu, Mn, Zn, Fe and Ni were detected. Meanwhile, the relationships between metal/metalloid contents in human hair and gender, age, seafood diet habit, smoking habit, as well as the housing type (dwelling environment) were analyzed. Results showed that the average content of Hg, As, Pb, Cd, Cr, Cu, Mn, Zn, Fe and Ni in human hair of Shenzhen residents was 0.76 ± 0.96, 0.10 ± 0.04, 5.25 ± 4.88, 0.25 ± 0.33, 0.60 ± 0.31, 13.84 ± 3.67, 2.82 ± 2.01, 196.90 ± 145.01, 12.20 ± 5.10 and 0.34 ± 0.32 μg/g, respectively. Compared with other regions at home and abroad, most metal/metalloids in Shenzhen residents were at a moderate level, and the highly toxic elements (i.e. Pb, Cd, As and Hg) didn’t exceed the upper limit of normal values in China. Statistical analysis showed that the young male people contained significantly higher (p < 0.05) level of Pb (in age group of 20-30 years old) and Fe (in age group of 20-40 years old) in hair than the female people. Smokers had significantly (p < 0.05) higher level of Cd (0.35 μg/g) but lower level of Zn (101.24 µg/g) than non-smokers (Cd: 0.17 μg/g; Zn: 252.63 µg/g). Hg and Pb contents in hair of Shenzhen people were positively related with the frequencies of seafood consumption and the age, respectively. Moreover, residents lived in private buildings (well decorated house) accumulated significantly higher (p < 0.05) levels of Pb, Cr, Fe and Ni as compared with those lived in public rental house and village house (no decoration or simple decoration), suggesting that decoration material was also an important way for human exposure to heavy metals.

PMID:34051662 | DOI:10.1016/j.ecoenv.2021.112375

Comp Immunol Microbiol Infect Dis. 2021 May 15;77:101665. doi: 10.1016/j.cimid.2021.101665. Online ahead of print.

ABSTRACT

This study aimed to investigate the epidemiology of 10 suspicious pathogenic bacteria in 250 stomach contents of aborted calf, lamb, and goat foetuses in 2019. The 155 positive samples obtained from PCR consisted of 53 (58.88 %) bacteria from 90 lamb samples, 10 (43.47 %) bacteria from 23 goat samples, and 92 (67.15 %) bacteria from 137 calf samples. The five most common bacteria associated with abortions were Brucella melitensis, 52 (20.9 %); B. abortus, 13 (5.2 %); Leptospira spp., 34 (13.6 %); Campylobacter fetus, 52 (20.9 %); and Coxiella burnetii, 4 (1.6 %). The highest rate of B. melitensis (65.4 %), B. abortus (69.2 %), Leptospira spp. (67.6 %), and C. fetus (50 %) was detected in the aborted calf samples. The highest individual rate was that of C. fetus (5.2 %). The flock-herd rates of B. melitensis, B. abortus, Leptospira spp., C. fetus, and C. burnetii infections in the 29 farms studied were 34.48 %, 20.69 %, 62.06 %, 82.75 %, and 3.44 %, respectively, with a confidence level and interval of 95 %. The frequency of abortions caused by Leptospira spp. and Campylobacter fetus may be related to increasing in B. melitensis. The rates of aborted calf, lamb, and goat foetuses among the various sampling periods and regions were significantly (P < 0.01) different. In conclusion, precautions should be applied to reduce the spread of these bacterial agents in high-risk areas and to eliminate the risk of harbouring these zoonotic infections in humans. Therefore, these results must be taken into account in the development of control and protection strategies against abortions in animals.

PMID:34051649 | DOI:10.1016/j.cimid.2021.101665

Tuberculosis (Edinb). 2021 May 25;129:102086. doi: 10.1016/j.tube.2021.102086. Online ahead of print.

ABSTRACT

BACKGROUND: Mycobacterium tuberculosis (MTB) sRNAs are abundant. However, the level of MTB sRNA in peripheral blood remains elusive.

METHODS: Twenty MTB sRNAs annotated in the reference genome of H37Rv were detected in the plasma of 170 active pulmonary tuberculosis patients and 124 healthy people by qRT-PCR detection system. The differential expression of sRNAs were analyzed in two groups. The value of sRNAs for diagnosis of active tuberculosis were evaluated by ROC curve analysis.

RESULTS: Eight of the 20 sRNAs (MTS2823, MTS0997, MTS1338, ASdes, G2, C8, mcr15 and MTS1082) were found in at least 50% of the samples detected. The relative expression levels of MTS2823, MTS0997, MTS1338 and ASdes in plasma of tuberculosis patients were statistically higher than those in healthy controls. ROC curve analysis showed that the AUC of MTS0997, MTS1338, MTS2823 and ASdes were 0.8935 (95% CI 0.8109-0.9760), 0.8722 (95% CI 0.7862-0.9581), 0.8208 (95% CI 0.7246-0.9170) and 0.5792 (95% CI 0.4240-0.7344), respectively. The AUC value of combination of MTS0997, MTS1338 and MTS2823 was 0.914 (95% CI 0.8281-0.9926).

CONCLUSIONS: MTB sRNAs MTS2823, MTS0997 and MTS1338 have the potential to be plasma biomarkers for active pulmonary tuberculosis.

PMID:34051642 | DOI:10.1016/j.tube.2021.102086

Physiotherapy. 2021 Mar 26;112:55-63. doi: 10.1016/j.physio.2021.03.016. Online ahead of print.

ABSTRACT

OBJECTIVE: To explore entry-level physiotherapy students’ attitudes and beliefs relating to weight bias and stigmatisation in healthcare.

DESIGN: Cross sectional survey of physiotherapy students.

METHODS: All final year physiotherapy students (n = 215) enrolled in entry-level physiotherapy programmes in the Republic of Ireland were invited to participate. Each received a questionnaire, consisting of 72 questions, within four key sections. Descriptive statistics and frequencies were used to analyse the data.

RESULTS: A response rate of 83% (179/215) was achieved. Whilst physiotherapy students, overall, had a positive attitude towards people with obesity, 29% had a negative attitude towards people with obesity, 24% had a negative attitude towards managing this population and most (74%) believed obesity was caused by behavioural and individual factors. Over one third of students (35%) reported that they would not be confident in managing patients with obesity and more than half (54%) felt treating patients with obesity was not worthwhile.

CONCLUSION: This study provides preliminary findings to suggest that weight stigma-reduction efforts are warranted for physiotherapy students. Helping students to understand that obesity is a complex, chronic condition with multiple aspects requiring a multi-faceted approach to its management might be the first step towards dispelling these negative attitudes towards patients living with obesity. Inclusion of a formal obesity curriculum should perhaps now be part of the contemporary physiotherapy students’ education.

PMID:34051594 | DOI:10.1016/j.physio.2021.03.016

Int J Nurs Stud. 2021 May 2;120:103955. doi: 10.1016/j.ijnurstu.2021.103955. Online ahead of print.

ABSTRACT

BACKGROUND: Caregivers of patients with chronic conditions or disability experience fatigue, burden and poor health-related quality of life. There is evidence of the effectiveness of support interventions for decreasing this impact. However, little is known about the benefits of home-based nursing intervention in primary health care.

OBJECTIVES: To evaluate the effectiveness of a home-based, nurse-led-intervention (CuidaCare) on the quality of life of caregivers of individuals with disabilities or chronic conditions living in the community, measured at 12-month follow-up.

METHODS: A pragmatic, two-arm, cluster-randomized controlled trial with a 1-year follow-up period was performed between June 2013 and December 2015. Consecutive caregivers aged 65 years or older, all of whom assumed the primary responsibility of caring for people with disabling conditions for at least 6 months a year, were recruited from 22 primary health care centers. Subsequently, 11 centers were randomly assigned to usual care group, and 11 were assigned to the intervention group. The caregivers in the intervention group received the usual care and additional support (cognitive restructuring, health education and emotional support). The primary outcome was quality of life, assessed with the EQ-5D instrument (visual analog scale and utility index score); the secondary outcome variables were perception of burden, anxiety, and depression. Data were collected at baseline, at the end of the intervention, and at the 6- and 12-month follow-up visits. We analyzed the primary outcome as intention-to-treat, and missing data were added using the conditional mean single imputation method.

RESULTS: A total of 224 caregivers were included in the study (102 in the intervention group and 122 in the usual care group). Generalized Estimating Equation models showed that the CuidaCare intervention was associated with a 5.46 point (95% CI: 2.57; 8.35) change in the quality of life, as measured with the visual analog scale adjusted for the rest of the variables at 12 months. It also produced an increase of 0.04 point (95% CI: 0.01; 0.07) in the utilities. No statistically significant differences were found between the two groups at 12 months with respect to the secondary outcomes.

CONCLUSIONS: The findings suggest that incorporating a home-based, nurse-led-intervention for caregivers into primary care can improve the health-related quality of life of caregivers of patients with chronic or disabling conditions.

PMID:34051585 | DOI:10.1016/j.ijnurstu.2021.103955

Early Hum Dev. 2021 May 17;158:105394. doi: 10.1016/j.earlhumdev.2021.105394. Online ahead of print.

ABSTRACT

BACKGROUND: Increased survival of preterm neonates who require hospitalization at the Neonatal Intensive Care Unit has led to an increase in infections. This study aims to describe the temporal trend, risk factors, and outcome of healthcare-associated infections in a NICU of a high complexity hospital, with emphasis on the differences of incidence between bacterial and fungal infections.

METHODS: The study was carried out from January 2013 to December 2016, with daily follow-up of the newborns by the National Healthcare Safety Network.

RESULTS: The study included 881 newborns, of whom 214 had a bacterial infection, 19 had fungi infection, and 12 bacterial and fungal infections associated. The hospital infection rate was 12/1000 patient-days. SNAPPE>24, days of hospitalization and PICC days were independent risk factors for the development of fungal and bacterial infection, respectively, with statistical significance for bacterial and fungal infections. The mortality rate was 2.6 times higher in those who had fungal infection than in those who had a bacterial infection. The occurrence of invasive infections was higher in the years 2015 and 2016 and Gram-negative bacteria and yeasts were more frequent, impacting morbidity and mortality.

CONCLUSIONS: The use of invasive devices is a risk factor for the occurrence of HAI caused by bacteria and fungi. The frequency of deaths was higher in the group of neonates with fungal infection. These results point to the importance of constant epidemiological surveillance and measures of effective control of infections in NICU.

PMID:34051584 | DOI:10.1016/j.earlhumdev.2021.105394

Epilepsy Res. 2021 May 12;174:106670. doi: 10.1016/j.eplepsyres.2021.106670. Online ahead of print.

ABSTRACT

OBJECTIVE: To determine the 30-day readmission rate after Epilepsy Monitoring Unit (EMU) discharge in a nationally representative sample, as well as patient, clinical, and hospital characteristics associated with readmission.

METHODS: This is a retrospective cohort study of adults discharged from an elective hospitalization with continuous video electroencephalography (vEEG) monitoring, sampled from the Healthcare Cost and Utilization Project’s 2014 Nationwide Readmissions Database. Descriptive statistics were used to quantify and characterize readmission within 30 days and logistic regression models were built to examine factors associated with readmission.

RESULTS: 6869 admissions met inclusion criteria, with 292 people (4.2 %) readmitted within 30 days. 79.5 % (n = 232/292) of all readmissions were non-elective. Patient characteristics associated with readmission included a higher Elixhauser comorbidity score [adjusted odds ratio (AOR) 1.03, 95 % confidence interval (CI) 1.02-1.04 per 1 point increase in Elixhauser score], a longer length of stay [AOR 1.05, 95 % CI 1.02-1.09 per one day increase in length], non-routine discharge [AOR 1.85, 95 %CI 102-3.38], and comorbid brain tumor diagnosis [AOR 2.55, 95 %CI 1.46-4.46]. Female sex was inversely associated with 30-day readmission [AOR 0.68, 95 % CI 0.54-0.85]. The most common reason for readmission was epilepsy or convulsion (27.6 %), followed by sepsis (5.8 %) and complications of surgical procedures or medical care (5.5 %).

CONCLUSIONS: Patients electively admitted for continuous vEEG monitoring are infrequently readmitted. These data provide a preliminary national readmission benchmark for patients with elective admissions for vEEG monitoring.

PMID:34051574 | DOI:10.1016/j.eplepsyres.2021.106670