African Health Sciences 2022-05-09T10:43:06+00:00 Dr James Tumwine Open Journal Systems <p>African Health Sciences is an open access, free online, internationally refereed journal publishing original articles on research, clinical practice, public health, policy, planning, implementation and evaluation, in the health and related sciences relevant to Africa and the tropics. African Health Sciences acknowledges support provided by the African Health Journals Partnership Project that is funded by the US National Institutes of Health (through the National Library of Medicine and the Fogarty International Center) and facilitated by the Council of Science Editors.</p> <p>Indexed on MEDLINE/PUBMED; PUBMED CENTRAL; African Index Medicus; HINARI; Bioline; AJOL; Science Citation Index - Clarivate (Thompson Reuters)&nbsp;<strong>Impact factor (2018):</strong> <strong>0.842. CiteScore (2018): 0.99.</strong></p> <p>Other websites related to this journal include:&nbsp; <a title="" href="" target="_blank" rel="noopener"></a></p> <p>African Health Sciences encourages authors to now submit their papers online to the following website: <a title="" href="" target="_blank" rel="noopener"></a></p> Sexual reproductive health, NCDs and infectious diseases 2022-04-28T09:43:37+00:00 James K Tumwine <p>NIL.</p> 2022-04-28T00:00:00+00:00 Copyright (c) Determinants of female condom use among female tertiary students in the Hohoe Municipality of Ghana using the Health Belief Model 2022-04-29T10:10:01+00:00 Enyonam Amevor Elvis Tarkang <p><strong>Background:</strong> Besides abstinence, the condom has proven to be the only effective method of preventing sexually transmitted infections (STIs), including HIV/AIDS. This study investigated the determinants of female condom (FC) use among female tertiary students in the Hohoe Municipality, Ghana using the Health Belief Model (HBM).</p> <p><strong>Methods:</strong> A cross-sectional design was adopted. Data were collected using a structured questionnaire in January 2019 and analysed using STATA version 14.0. Logistic regression was used to measure the strength of associations between the dependent and independent variables. A p-value &lt;0.05 was considered statistically significant.</p> <p><strong>Results:</strong> The overall utilisation of the FC was 35.0%. Among the constructs of the HBM, it was perceived self-efficacy for FC use that was significantly associated with FC use: respondents who had the confidence to convince their partners to use the FC were 2 times more likely to use it than respondents who did not [AOR =2.15(CI: 1.26, 3.71); p= 0.005].</p> <p><strong>Conclusion:</strong> Female students in the current study exhibited poor utilization of the FC. Health promotion interventions should, therefore, focus on increasing their self-efficacy for FC use.</p> <p><strong>Keywords:</strong> Female condom use; Health Belief Model; Female tertiary students; Hohoe; Ghana.</p> 2022-04-29T00:00:00+00:00 Copyright (c) Condom use and risk factors of inconsistent or low use of the condoms during heterosexual anal intercourse in sub-Saharan Africa: a scoping review 2022-04-29T10:19:05+00:00 Princess Nyoni Nigel James <p><strong>Background:</strong> Anal intercourse (AI) has been reported to be the riskiest among other sexual intercourses in spreading human immunodeficiency virus (HIV) and the risk could be minimized by the use of condoms. Whilst AI is believed to be practised mainly by men who have sex with men, AI has also been reported to occur in heterosexual relationships. However, data on condom use during heterosexual AI are inadequate in sub-Saharan Africa.</p> <p><strong>Method:</strong> A scoping review of English language published articles on condom use during heterosexual anal sex, whose studies were conducted in Sub-Saharan Africa from January 2010 to May 2020 was conducted. Articles were searched systematically on PubMed and Google Scholar electronic databases. Heterosexual AI was defined as penile penetrative anal sex<br>between a man and a woman regardless of the sexual orientation of the 2 parties involved in the act of heterosexual AI.</p> <p><strong>Findings:</strong> A total of 21 studies were eligible for analysis. Most of the studies (17 out of 21) reported females to be involved in heterosexual AI whilst 9 out of 21 studies reported males to be involved in heterosexual AI. The lifetime prevalence estimate of condom use during heterosexual AI ranged from 29%-97.5%. Other prevalence estimates of condom use during<br>heterosexual anal intercourse were reported over various recall periods which were: 12 months’ recall period with prevalence estimates ranging from 2.9%-59%; prevalence estimates for the past 3 months which ranged from 50%-94.4%; 1 month’s recall period with prevalence estimates ranging from 5%-96% and prevalence estimates for the last intercourse experienced ranging from 1%-55%. Condom use during heterosexual AI was generally low and/or inconsistent among female sex workers (FSWs), men who have sex with men and women (MSMW) and some women in the general population. There were no risk factors identified in the study for the inconsistent or low use of condoms during heterosexual AI.</p> <p><strong>Conclusion:</strong> Evidence from this study suggests condom use during heterosexual AI could be fairly low especially among groups such as FSWs, MSMW and some women in the general population. Risk factors for using condoms inconsistently or using condoms less during heterosexual AI are not clear. Heterosexual anal intercourse and condom use during the AI<br>practice is generally an under-studied subject in Sub-Saharan Africa. Future studies need to explore on heterosexual AI and condom use practices during AI comprehensively so that there can be concrete evidence on the subject which will inform targeted interventions aimed at reducing HIV among heterosexual populations in SSA.</p> <p><strong>Keywords:</strong> Heterosexual anal intercourse; condom use; sub-Saharan Africa.</p> 2022-04-29T00:00:00+00:00 Copyright (c) Contraceptive acceptability and associated factors among young women (15-24) living with HIV/AIDS: a hospital-based study in Kampala, Uganda 2022-04-29T10:47:41+00:00 Muzeyi Wani Janet Nakigudde Hildah Tendo Nansikombi Philip Orishaba Dennis Kalibbala Joan N Kalyango Steven M Kiwuwa <p><strong>Introduction:</strong> In Uganda, over 43% of all pregnancies among young women (15-24 years) living with HIV are either unwanted or mistimed. Unintended pregnancies account for 21.3% of neonatal HIV infections. The objective was to determine acceptability of contraceptives and associated factors among young women living with HIV attending HIV clinics in<br>Kampala.</p> <p><strong>Methods:</strong> Between February and May 2019, 450 young women attending public HIV clinics (Kisenyi HC IV, Kiswa HC III and Komamboga HC III) in Kampala were systematically enrolled in a cross sectional study and interviewed using structured questionnaires. We used modified Poisson regression to determine the factors associated with acceptability of contraceptive.<br>Data were analyzed using STATA 13.0. Statistical significance was determined at a P values &lt; 0.05.</p> <p><strong>Results:</strong> Contraceptive acceptability was 40.7% (95% CI: 27.6%-53.6%). Older age group (20-24 years) (aPR; 2.42, 95%CI; 1.06-5.52, P = 0.035), age at sex debut ≥ 18 years (aPR;1.25,95%CI; 1.13-1.38, P&lt;0.001), having friend on contraceptives (aPR; 1.90, 95%CI; 1.10 - 3.26; P =0.021) and being married (aPR; 1.20, 95%CI; 1.09 - 1.32, P&lt;0.001) were significantly associated with acceptability of contraceptives.</p> <p><strong>Conclusion:</strong> There is a low acceptability for contraceptives. Younger age group who are not yet married need to be targeted.</p> <p><strong>Keywords:</strong> Contraceptive acceptability; young women; HIV/AIDS; Kampala; Uganda.</p> 2022-04-29T00:00:00+00:00 Copyright (c) Ability and willingness to pay for family planning services in low resource settings: evidence from an operational research 2022-04-29T11:36:57+00:00 Nazarius Mbona Tumwesigye Fredrick Makumbi Aggrey Mukose Lynn Atuyambe Cissie Namanda Sarah Ssali Ritah Tweheyo Andrew Gidudu Carole Sekimpi Catherine Verde Hashim Martha Nicholson Ritah Nakigudde Waddimba Peter Ddungu <p><strong>Objective:</strong> This paper establishes levels and patterns of ability and willingness to pay (AWTP) for contraceptives, and associated factors.</p> <p><strong>Study design:</strong> A three-stage cluster and stratified sampling was applied in selection of enumeration areas, households and individuals in a baseline survey for a 5-year Family planning programme. Multivariable linear and modified Poisson regressions are used to establish factors associated with AWTP.</p> <p><strong>Results:</strong> Ability to pay was higher among men (84%) than women (52%). A high proportion of women (96%) and men (82%) were able to pay at least Ug Shs 1000 ($0.27) for FP services while 93% of women and 83% of men who had never used FP services will in future be able to pay for FP services costed at least Shs 2000 ($0.55). The factors independently associated with AWTP were lower age group (&lt;25 years), residence in urban areas, attainment of higher education level, and higher wealth quintiles.</p> <p><strong>Conclusion:</strong> AWTP for FP services varied by different measures. Setting the cost of FP services at Shs 1000 ($0.27) will attract almost all women (96%) and most of men (82%). Key determinants of low AWTP include residence in poor regions, being from rural areas and lack of/low education.</p> <p><strong>Implications statement:</strong> Private providers should institute price discrimination for FP services by region, gender and socio-economic levels. More economic empowerment for disadvantaged populations is needed if the country is to realise higher contraceptive uptake. More support for total market approach for FP services needed.</p> <p><strong>Keywords:</strong> Ability-to-pay; willingness-to-pay; total market approach; market segmentation; family planning.</p> 2022-04-29T00:00:00+00:00 Copyright (c) Factors associated with risky sexual behaviour among sexually experienced undergraduates in Osun state, Nigeria 2022-04-29T12:14:23+00:00 Akinlolu Omisore Ifeoluwa Oyerinde Omoniyi Abiodun Zainab Aderemi Titilayo Adewusi Iseoluwa Ajayi Temitope Fagbolade Sukurat Miskilu <p><strong>Background:</strong> Risky sexual behavior (RSB) is common among youths which predispose them to sexually transmitted infections. This study sets out to identify the factors associated with RSB among undergraduates in Osun state.</p> <p><strong>Methods:</strong> The study design was descriptive cross sectional and a total of 550 respondents from two universities in Osun state were sampled using a multistage sampling technique, out of which data from 266 sexually experienced respondents was further analyzed. Data collected via a semi–structured self-administered questionnaire and analyzed using univariate, bivariate and multivariate analyses.</p> <p><strong>Results:</strong> The 266 respondents consisted of 54.5% males and 45.5% females and larger percentage of them were in the age group 15-24years. Seven out of ten respondents (69.9%) were sexually active while 65.8% were involved in at least one RSB. Of the 266 respondents, 28.6% ever had concurrent multiple sexual partners, 15.8% used alcohol/drugs at last sex while 48.1% did not use condom at last sex. More males (71.7%), alcohol users (76.8%), drug users (78.0%), pornography watchers (82.7%), internet users (71.2%) respondents “not in good terms with mum” (86.7%) and “those whose mum doesn’t instruct them morally” (84.2%) were involved in RSB compared to their respective counterparts (p&lt;0.05). However, there were no identifiable predictors of RSB on regression analysis.</p> <p><strong>Conclusion:</strong> Risky Sexual Behavior is prevalent among undergraduates with males being more involved, among other associated factors. Concerned stakeholders should engage youths via behavioral change communication strategies so as to significantly reduce their involvement in RSB.</p> <p><strong>Keywords:</strong> Behaviour; experienced; factors, risky; sexual undergraduates.</p> 2022-04-29T00:00:00+00:00 Copyright (c) Factors associated with risky sexual behaviour among clients undertaking HIV testing and counselling services at a secondary referral hospital Lagos, Nigeria 2022-05-04T10:00:55+00:00 Olusola Adedeji Adejumo Bisola Ibironke Adebayo Sunday Adesola Abimbola Bowale Esther Ngozi Adejumo Stella Atewe Olayinka Sijuade Andrew Airauhi Oluwajimi Sodipo Yeside Shogbamimu <p><strong>Background:</strong> This study determined the prevalence of risky sexual behaviour and its associated factors among clients who accessed HIV counselling and testing services at a secondary referral hospital in Lagos, Nigeria.</p> <p><strong>Methods:</strong> A retrospective review of clients’ records was conducted. The Client Intake Form of people who accessed HIV counselling and testing services at Mainland Hospital in Lagos, Nigeria between July 1, 2016, and December 31, 2017, were reviewed. Multivariate analysis was conducted to determine the associated factors of risky sexual behaviour.</p> <p><strong>Results:</strong> A total of 4273 client’s records were analyzed, 3884 (90.9%) reported having sex before HIV counselling and testing (HCT). The prevalence of risky sexual behaviour among clients was 41.5%. More males and HIV positive clients had unprotected sex with a casual partner three months before HIV counselling and testing (p &lt; 0.05). More singles than the married had unprotected sex with casual partners (p &lt;0.001) and multiple sexual partners (p =0.002). The prevalence of risky sexual behaviour reduced with advancing age. Being single and having an HIV infection were associated with risky sexual behaviour in this study.</p> <p><br><strong>Conclusion:</strong> Age, marital status and HIV status were associated factors of risky sexual behaviour.</p> <p><br><strong>Keywords:</strong> Risky sexual behaviour; associated factors; HIV counselling; testing.</p> 2022-04-29T00:00:00+00:00 Copyright (c) Reporting of sexual and gender-based violence and associated factors among survivors in Mayuge, Uganda 2022-04-29T13:04:47+00:00 Jacquellyn Nambi Ssanyu Noel Namuhani Christine Kayemba Nalwadda <p><strong>Background:</strong> Reporting of Sexual and Gender-Based Violence (SGBV) allows survivors to access support services to minimize the impact of the violence on their lives. However, research shows that most SGBV survivors do not report.</p> <p><strong>Objective:</strong> We aimed to determine the proportion of survivors of SGBV in Mayuge District, Uganda, who report SGBV and the factors associated with reporting.</p> <p><strong>Methods:</strong> Using a cross-sectional study design, we analyzed data of SGBV survivors in eight villages in Mayuge district collected in a baseline survey of a larger experimental study. Data were analysed using Modified Poisson Regression.</p> <p><strong>Results:</strong> Of the 723 participants, 65% were female. Only 31.9% had reported the SGBV experienced. Reporting was 43% lower among survivors aged 45 years and older (p-value = 0.003), and 41% lower among survivors with higher than a primary school education (p-value = 0.005). Likewise, reporting was 37% lower among survivors who relied on financial support from their partners (p-value = 0.001). Female survivors were also 63% more likely to report (p-value = 0.001), while survivors who were separated/widowed were 185% more likely to report than those who were never married (p-value = 0.006).</p> <p><strong>Conclusion:</strong> Reporting of SGBV by survivors in Mayuge was found to below.</p> <p><strong>Keywords:</strong> Sexual and Gender-Based Violence; survivors; Mayuge; Uganda.</p> 2022-04-29T00:00:00+00:00 Copyright (c) A Study of Female Genital Mutilation of African-Descent Iranians in Qeshm Island 2022-04-29T13:14:01+00:00 Arabahmadi Amirbahram <p><strong>Background:</strong> This article investigates the practice of female genital mutilation (FGM) as a long-held custom in Qeshm Island, which makes many African-descended women face different physical and psychological health problems.</p> <p><strong>Objective:</strong> To investigate the prevalence of female genital mutilation in Qeshm Island and the traditional mode of thinking of Afro-Iranian people of the Island about this practice.</p> <p><strong>Methods:</strong> This study is based on the descriptive analysis method. The questions of the study are (a) Why female genital mutilation is still practiced in Qeshm Island; (b) What are the mental and physical effects of female genital mutilation on women; and (c) How government or NGOs are fighting against this tradition.</p> <p><strong>The results:</strong> This article has found out that female genital mutilation resulted in many lifelong diseases and sexual degradation in African-descended women of Qeshm Island. This article also illustrates that the best way to combat this wrong tradition is to inform people by gradual training without any insult to their beliefs.<br><strong>Conclusion:</strong> This study reveals the prevalence of a false tradition and the necessity of behavioral change. In doing so, the government and NGOs' strong actions and attracting the support of the community elders are also needed.</p> <p><strong>Keywords:</strong> Female Genital Mutilation; Gender Discrimination; Human Rights violation; NGOs' Campaign; Qeshm Island.</p> 2022-04-29T00:00:00+00:00 Copyright (c) Premenstrual syndrome: consultation sources and the impact on women’s quality of life 2022-04-29T13:24:45+00:00 Ruba M Jaber Asma O Alghzawi Hadeel H Salameh <p><strong>Introduction:</strong> The main aim of this study was to explore the sources of consultation that women seek during premenstural syndrome (PMS), and to establish the association between the severity of PMS and how it affects the quality of life.</p> <p><strong>Methods:</strong> Cross sectional study of 179 female patients, using an Arabic validated version of the shortened premenstrual assessment form, and a 7-item quality of life questionnaire that was developed by the researchers. The questionnaire was tested for validity and reliability via a pilot study before the initiation of data collection. Data was analyzed using SPSS version 19.</p> <p><strong>Results:</strong> 179 women participated in the study, with more than half of them aged between 20-30 years old. PMS prevalence was 88%; patient’s predominantly sought help from their relatives (51%), followed by physicians (34%). There was no association found between the severity of premenstrual symptoms and seeking consultation. PMS symptoms affected women’s daily activities (p-value 0.039), their satisfaction with their general appearance (p-value 0.001) and weight (p-value 0.022), and affected their relationships with family<br>members (p-value 0.001) and other people (p-value 0.002).</p> <p><strong>Conclusion:</strong> PMS is a common condition that affects women and their quality of life in several ways. Physicians and primary health care providers must be more vigilant in detecting the presence of PMS.</p> <p><strong>Keywords:</strong> Premenstrual syndrome; quality of life; consultation.</p> 2022-04-29T00:00:00+00:00 Copyright (c) Menstrual hygiene management in public high schools in Ghana 2022-04-29T13:33:54+00:00 Patience Aseweh Abor <p>In the ten (10) regions of Ghana. The findings showed that most girls in Public Senior High Schools in Ghana had prior knowledge about menstruation from their mothers and sisters prior to menarche. It was revealed that majority of the girls mentioned hormones as the cause of menstruation, whilst others mentioned the uterus, bladder, vagina, and other parts of the female reproductive system. A few of them had no idea what causes menstruation. The findings again revealed that most girls use sanitary pads, while some use other materials during menstruation. Less than half of the sample of girls in this study were able to change their pads twice daily or more. About half of the girls cleansed their genital parts only when bathing during menstruation using soup and water mostly. Half of the schools used pblic tap/standpipe as their main source of water and the rest used other sources of water. Also, most schools have toilet facilities.Some useful recommendations are proffered with the aim of improving MHM in public high schools in Ghana.</p> 2022-04-29T00:00:00+00:00 Copyright (c) Cervical precancerous lesions at the Tchibanga Regional Hospital and the University Hospital in Gabon in 2018: smartphone as a screening tool for diagnosis 2022-04-29T13:49:48+00:00 Nathalie Ambounda Ledaga Sylvain Honore Woromogo Felicite Emma Yagata-Moussa Audin Serge Mavoungou Vicky Noel Simo Tekem <p><strong>Background:</strong> Cervical precancerous lesions are disorders that can induce discolouration changes. Their detection is difficult in remote areas in the absence of adequate equipment. The objectives were to evaluate Smartphone performance in diagnosing cervical precancerous lesions in Tchibanga, Gabon.</p> <p><strong>Methods:</strong> It was an interventional cross-sectional study to evaluate the validity and reliability of the smartphone as a tool for diagnosing atypical changes in the cervix. Study period was between July 1, 2017 to February 28, 2018 at the Tchibanga Regional Hospital (CHRT) and the University Hospital (CHU). The variability between examiners was determined according to Cohen's Kappa formula. The Gold standard test was the cytology.</p> <p><strong>Results:</strong> Compared to the examiner -1, the examiner - 2 found a high percentage of inflammations as atypical transformations: 15.3% versus 9%. With regard to smartphonic impressions, the examiner-1 found the normal impressions almost equal to that of the examiner-2, 72.9% versus 72.2%. The concordance between positive smartphonic impressions was 93.8% and 95.5% between negative smartphonic impressions, with k = 0.86.</p> <p><strong>Conclusion:</strong> In view of the above, the concordance between positive and negative smart phonic impressions was 93.8 and 95.5% with k = 0.86. The performance parameters being good, there is a need to use the smartphone as a tool for the diagnosis of precancerous lesions.</p> <p><strong>Keywords:</strong> Diagnosis; cervical precancerous lesions; Tchibanga; smartphone.</p> 2022-04-29T00:00:00+00:00 Copyright (c) Identification of HPV16’s E6 gene in suspected cases of cervical lesions and docking study of its L1 protein with active components of Echinacea purpurae 2022-04-29T14:05:56+00:00 Yusuf Lukman Doro A Bala Kabir I Malik Abdulkadir Saidu Kumurya A Saleh Bala J Abubakar Aliyu I Abubakar <p><strong>Background:</strong> HPV 16 is the primary etiologic agent of cervical cancer and the presence of L1 and E6 oncoproteins are largely responsible for its virulence. It was the objective of this study to identify HPV16 isolates from suspected cases of cervical cancer at Specialist Hospital Sokoto and Sir Yahaya Memorail Hospiatal Birnin Kebbi, Nigeria and also to identify<br>potent HPV16’s L1 protein inhibitor using in silico analysis.</p> <p><strong>Methods:</strong> A total of 144 cervical samples consisting of 21 low grade squamous intraepithelial lesion, 6 high grade lesion and 117 negative pap smears were collected. The samples were subjected for molecular detection using PCR targeting E6 gene of the virus. Data generated for the molecular prevalence was statistically analyzed using Chi-square method. AutoDock Vina was used to carry out the molecular docking between 2hr5 and Chicoric acid, curcumin and Echinacoside.</p> <p><strong>Results:</strong> Out of the 144 samples, 24 samples were positive for the PCR representing 16.9% molecular prevalence rate. There is statistically significant association between cyto-diagnoses and presence of HPV16 (P &lt; 0.05). Docking analysis showed that the Chicoric acid components of Echinacea purpurae have strong binding affinity (-8.7 kcal/mol) to the L1 protein of the HPV.</p> <p><strong>Conclusion:</strong> This study provides data on HPV 16 epidemiology in northern Nigeria, and also provides novel evidence for consideration on certain interacting residues, when synthesizing Anti-HPV compounds in the wet lab.</p> <p><strong>Keywords:</strong> HPV; Echinacea purpurae; chicoric acid; echinacoside; curcumin.</p> 2022-04-29T00:00:00+00:00 Copyright (c) Human Papillomavirus types prevalence and their association with cervical dysplasia among HIV and non-HIV infected women attending reproductive health clinics in Eastern Kenya 2022-04-29T14:27:52+00:00 Njue James Kinotia Margaret Muturib Lucy Kamauc Raphael Lwembed <p><strong>Background:</strong> Human Papillomavirus (HPV) causes over 99% of all cervical cancer globally. In 2019; it was responsible for 3,286 deaths in Kenya. Understanding the epidemiological distribution of HPV genotypes by cervical dysplasia and HIV infection is important in designing prevention strategy and management of cervical cancer.</p> <p><strong>Objective:</strong> To determine HPV genotypes prevalence and their distribution by cervical dysplasia, social-demographic and risk factors associated with cervical cancer among HIV-infected women aged 18-48 years seeking reproductive healthcare in Eastern Kenya.</p> <p><strong>Methods:</strong> Cervical specimens were obtained for cytology, HPV-genotyping, histology while social-demographic factors were collected using a questionnaire and analysed using Pearson chi-square test.</p> <p><strong>Results:</strong> 317 womencases: 161(50.8%); control 156(49.2%), mean age: 34.3, range 18-46 years were recruited. Thirteen HPV genotypes associated with cervical dysplasia were: CIN1{cases: HPV81[12(3.8%), HPV11[2(0.6%); control: HPV53 and HPV66[1(0.3%)}, CIN2 {cases: HPV11, HPV16, HPV661(0.3%), HPV816(1.9%) and single case1(0.3%) of HPV9, HPV11, HPV16, HPV44, HPV66, HPV81 HPV88, HPV53 and HPV58; control: HPV81[2(0.6%)} and invasive cancer {cases: HPV16[1(0.3%) and HPV81[3(0.9%); control: HPV16<br>and HPV66[1(0.3%).</p> <p><strong>Conclusions:</strong> Cervical dysplasia was associated with more mixed-lr/hrHPV genotypes among HIV-infected than HIV-uninfected women. The finding adds to the pool of knowledge the epidemiological data required in determining the population at risk for cervical cancer.</p> <p><strong>Keywords:</strong> Human Papillomavirus; cervical dysplasia; HIV; Eastern Kenya.</p> 2022-04-29T00:00:00+00:00 Copyright (c) Axillary nodal metastasis and resection margins as predictors of Loco Regional Recurrence in Breast Cancer Patients 2022-04-30T02:24:42+00:00 O O Ayandipo O J Adepoju G O Ogun O O Afuwape O Y Soneye I B Ulasi <p><strong>Background:</strong> Surgical resection margins (RM), axillary nodal involvement and lymph node ratio (LNR) determine loco-regional control (LRC) in breast cancer management. Late presentation precludes breast conservation therefore surgical option is usually mastectomy and adjuvant chemoradiation minimize loco-regional recurrence (LRR).</p> <p><strong>Objective:</strong> We investigated the prognostic role of lymph nodes positive for malignancy (pN), LNR and RM on LRR of breast cancer in a tertiary hospital in Ibadan, Nigeria.</p> <p><strong>Methods:</strong> Longitudinal cohort study of 225 females with breast carcinoma managed and followed up for 5-years with end point of LRR or not. Chi-square test and logistic regression analysis were used to evaluate the interaction of resection margin and proportion of metastatic lymph nodes with LRR. The receiver-operator curve was plotted to determine the proportion of metastatic lymph nodes which predicted LRR.</p> <p><strong>Results:</strong> Ninety-nine percent had modified radical mastectomy and 163 (72.4%) had negative resection margins. A mean of 11 axillary lymph nodes were harvested at surgery. The age, positive resection margin and number of harvested nodes with malignant cells are associated with LRR. The overall 5-year LRR rate was 16%.</p> <p><strong>Conclusion:</strong> LRR is dependent on lymph node involvement as well as and tumor aggressiveness.</p> <p><strong>Keywords:</strong> Recurrence; breast cancer; Ibadan; Axillary nodes; resection margins.</p> 2022-04-29T00:00:00+00:00 Copyright (c) Evaluation of definitive histopathological results of patients diagnosed with endometrial polyps: a tertiary care center experience 2022-04-30T02:39:56+00:00 Reyhan Gündüz Elif Ağaçayak Gülcan Okutucu Ulaş Alabalik Mehmet Sıddık Evsen <p><strong>Objectives:</strong> To determine the premalignancy and malignancy prevalence in patients diagnosed with endometrial polyps and to investigate factors affecting premalignancy and malignancy.</p> <p><strong>Methods:</strong> In our retrospective study, patients who were diagnosed with endometrial polyp with endometrial samples and who underwent polypectomy by hysteroscopy or hysterectomy within one year were included.</p> <p><strong>Results:</strong> Premalignant / malignant histopathological results were detected in 7 (2.8%) patients. There were no statistically significant differences in histopathological results and endometrial sampling indications between premenopausal and postmenopausal patients. Hysterectomy in patients with premalignant/ malignant results and hysteroscopy in patients with benign results were found to be significantly different. There was not a statistically significant difference between patients with benign results and those with premalignant/malignant results in menopausal status, symptoms, status of hormone replacement therapy and endometrial polyp size.</p> <p><strong>Conclusion:</strong> The possibility of premalignant/ malignant results in patients diagnosed with endometrial polyps should be kept in mind. The menopausal status, symptoms, sizes of endometrial polyps and whether or not the patient is on hormone replacement therapy should be considered while making the management plan. However, these should not be the decisive factors on their own.</p> <p><strong>Keywords:</strong> Endometrial polyp; premalignancy; malignancy; hysteroscopy; hysterectomy; endometrial sampling.</p> 2022-04-29T00:00:00+00:00 Copyright (c) Endometriosis in an indigenous African women population 2022-04-30T03:58:13+00:00 Samuel Ohayi Nnaemeka Onyishi Sunday Mbah <p><strong>Introduction:</strong> Endometriosis is the existence of endometrial tissue outside the endometrial cavity. It has high prevalence in women living in developed countries but is believed to be rare among indigenous African women.<br><strong>Objectives:</strong> This study aimed to determine the prevalence and characteristics of endometriosis in an indigenous African women population.</p> <p><strong>Methods:</strong> Gynaecological specimens received and diagnosed as endometriosis in a teaching hospital’s Histopathology laboratory over a 5-year period was retrospectively reviewed. Data obtained were analysed by simple statistical methods.</p> <p><strong>Results:</strong> There were 25 diagnosed cases of endometriosis representing 0.9% of gynaecological specimens received in the period. Patients’ average age is 38.4±8.4 years; peak age was 31- 40 years (n=10; 40%). Myometrium is the most common site (n=16; 64%), other sites include umbilicus and round ligament etc. Pelvic pain, 36% and irregular uterine bleeding, 28% are most common symptoms. There was primary and secondary infertility in 20% and 16% of cases respectively. The umbilical and suprapubic masses had symptoms that synchronised with the patient’s menstrual cycle.</p> <p><strong>Conclusion:</strong> Endometriosis has low prevalence in our population. Women presenting with chronic pelvic pain, infertility and menstrual disorders should be evaluated for endometriosis. Population-based study is required to further characterize the condition in our population.</p> <p><strong>Keywords:</strong> Endometriosis; indigenous African women; endometrial tissue; chronic pelvic pain; infertility; abnormal uterine bleeding.</p> 2022-04-29T00:00:00+00:00 Copyright (c) Predictors of utilization of facility-based ante-natal care and delivery services in a Nigerian Rural Community 2022-04-30T04:08:49+00:00 Aniekan Etokidem Iwasam Agbor Anastasia Isika Boniface Ago Nkese Mkpanam <p><strong>Background:</strong> With maternal mortality ratio of 2,000/100,000 live births and perinatal mortality rate of 40/1,000 total births, Cross River State is one of the states with the highest maternal and perinatal deaths in Nigeria. One of the causes of these poor health indices is low utilization of facility-based maternal and child healthcare services during pregnancy and childbirth.&nbsp;</p> <p><strong>Objective:</strong> To assess the predictors of utilization of antenatal care and delivery services in Akpabuyo, a rural community in Cross River State of Nigeria.</p> <p><strong>Method:</strong> This was an analytical cross-sectional survey. Data were collected from 370 pregnant women between June and July, 2013 and analyzed using SPSS version 25.</p> <p><strong>Results:</strong> Binary logistic regression showed that compared with women with tertiary education, women with non-formal education were less likely to attend antenatal clinic (AOR=0.510, 95% CI=0.219-1.188) although the difference was not statistically significant. Also, compared with farmers, full-time housewives were less likely to deliver in a health facility (AOR=0.650, 95% CI=0.305-1.389) while civil servants were nearly five times more likely to deliver in the health facility (AOR=4.750, 95%CI=1.616-13.962).</p> <p><strong>Conclusion:</strong> The predictors of antenatal care and facility delivery services utilization identified by the study were educational status and occupation. This raises the need for policies and programmes to ensure girl child education and the economic empowerment of women.</p> <p><strong>Keywords:</strong> Maternal; Perinatal; Mortality; Child healthcare; Antenatal care; Delivery.</p> 2022-04-29T00:00:00+00:00 Copyright (c) Demographic and psychosocial risk factors for adolescent pregnancies among sexually active girls in the slums of Kampala, Uganda 2022-04-30T04:22:50+00:00 Monica H Swahn Rachel Culbreth Sydney Adams Rogers Kasirye Jenelle Shanley <p><strong>Background/Introduction:</strong> Adolescent pregnancy is a global public health issue and often linked to adverse health outcomesfor both the mother and child. Youth and adolescents living in the slums of Kampala, Uganda face many environmental and psychosocial adversities, and are at a high risk of experiencing adolescent pregnancy. The goal of this study was<br>to determine the correlates of adolescent pregnancy among sexually active girls living in the slums of Kampala.</p> <p><strong>Methods:</strong> This study is based on a cross-sectional survey conducted in 2014 on youth and adolescents living in the slums of Kampala, Uganda (n=1,134) who were attending Uganda Youth Development Link drop-in centers. IRB approvals were granted.</p> <p><strong>Results:</strong> In this study, 30.4% of girls reported a pregnancy. Girls who reported a pregnancy were more likely to have less than a primary education, to have lived on the streets, live in a house with more than two rooms, to drink alcohol, to have an STI, and have been raped and use condoms inconsistently, than girls who did not report a pregnancy.</p> <p><strong>Conclusions:</strong> These findings may inform pregnancy prevention interventions among adolescent girls living in Kampala. Interventions may benefit from incorporating alcohol use prevention strategies, particularly for alcohol use during sex.</p> <p><strong>Keywords:</strong> Adolescent pregnancies; sexually active girls; Kampala slums; Uganda.</p> 2022-04-29T00:00:00+00:00 Copyright (c) Fatal maternal complication due to neurofibromatosis type 1-associated giant pigmented plexiform neurofibromas in pregnancy: a case report and literature review 2022-04-30T04:40:01+00:00 Leo Odongo Matthias Goebeler Hermann Kneitz John C Lule Godwin Turyasingura <p>NIL</p> 2022-04-29T00:00:00+00:00 Copyright (c) Maternal and neonatal outcomes of grand multiparity in Khartoum, Sudan 2022-04-30T04:57:16+00:00 Elmugabil Abdelmageed Hassan Bahaeldin Alhabrdi Nadiah Ahmed Abdelbagi Rayis Duria Adam Ishag <p><strong>Objectives:</strong> Grand multiparity is a major health problem that leads to adverse maternal and perinatal outcomes. We aimed to assess the maternal and perinatal outcomes of grand multiparity.</p> <p><strong>Methods:</strong> A case-control study was conducted in Saad Abualila Hospital, Khartoum, Sudan from February to December 2019. The cases were grand multiparous (≥ 5 deliveries) women. The controls were women with low parity (multiparous women who delivered two to four times). Maternal and perinatal characteristics were compared between the two groups. Logistic regression analysis was performed.</p> <p><strong>Results:</strong> There was a significant association between grand multiparity and higher maternal age (adjusted odds ratio [AOR]=1.19, 95% confidence interval [CI]=1.16-1.23), lower education level (AOR=3.38, 95% CI=2.49-5.58) and lower antenatal care attendance (AOR=1.73, 95% CI=1.02-2.92). Grand multiparous women were at increased risk for Anemia (AOR=1.48, 95% CI=1.08-2.03), diabetes mellitus (AOR=10.61, 95% CI=4.89-23.00), caesarean delivery (AOR=1.87, 95% CI=1.40-2.48), preterm birth (AOR=1.90, 95% CI=1.37-2.62) and admission to the neonatal intensive care unit (AOR=3.8, 95% CI=1.95-7.75).</p> <p><strong>Conclusions:</strong> Grand multiparity was associated with poor maternal and neonatal outcomes. Development of a national health program addressing family planning, health education and improvement of antenatal, intrapartum and neonatal care are needed.</p> <p><strong>Keywords:</strong> Grand multiparity; multiparous; maternal outcome; neonatal outcome; Sudan.</p> 2022-04-29T00:00:00+00:00 Copyright (c) Feto-maternal outcomes of caesarean delivery in Federal Medical Centre, Asaba: a two year review 2022-04-30T05:07:37+00:00 Sunday Jombo Chukwuma Ossai Daniel Onwusulu Samuel Ilikannu Adeniyi Fagbemi <p><strong>Background:</strong> The upward trend of caesarean section and its associated morbidity/mortality especially in low and middle income areas makes regular appraisal of the procedure necessary.</p> <p><strong>Objective:</strong> To evaluate caesarean section; its rate, indications, and maternal and fetal outcomes in Asaba.</p> <p><strong>Methods:</strong> A retrospective study of all caesarean sections carried out at the obstetrics unit of the Federal Medical Centre, Asaba, between July 1, 2018 and June 31, 2020. Data was analyzed using SPSS version 20.</p> <p><strong>Results:</strong> There were 2778 deliveries during the period, out of which 705 had caesarean sections, giving an overall caesarean section rate of 25.4%.There were 456 (64.7%) emergency caesarean sections. The commonest indication for caesarean section was repeat caesarean section 196 (27.8%), while cephalo-pelvic disproportion 87 (12.3%) was the commonest indication for emergency caesarean section. Majority of the babies had low APGAR score at 1min and 5mins, 126 (27.6%) and 50 (11.0%) from emergency than elective caesarean section 16 (6.4%) and 5 (2.0%) at 1min and 5mins respectively (x2=17.963, P&lt;0.001). There were 31 (4.2%) perinatal deaths out of which majority 28 (6.1%) were from emergency caesarean sections (x2=9.412 P=0.002). The commonest post-operative complication was postpartum anaemia (140 (19.9%) while caesarean section case fatality was 0.6%.</p> <p><strong>Conclusion:</strong> This study showed a caesarean section rate of 25.4% with repeat caesarean section and Cephalopelvic disproportion being the most common indication for elective and emergency caesarean section respectively. Emergency caesarean section accounted for most of the cases and is associated with a higher risk of maternal and perinatal morbidity and mortality.</p> <p><strong>Keywords:</strong> Caesarean section; caesarean section rate; maternal; fetal outcomes.</p> 2022-04-29T00:00:00+00:00 Copyright (c) Multiple uterine perforations during manual vacuum aspiration: the need to increase the clinical awareness of attending healthcare professionals 2022-04-30T05:14:18+00:00 Nnabuike C Ngene <p><strong>Background:</strong> The risk of uterine perforation during manual vacuum aspiration (MVA) is reduced by using Karman cannula (which has a rounded tip) during the procedure.</p> <p><strong>Methods:</strong> A 35-year-old multigravida at 13 gestational weeks presented with vaginal bleeding of a day duration and ultrasound evidence of retained products of conception suggestive of incomplete miscarriage. The patient was rhesus D positive and stable. She had MVA which was performed using Karman cannula, and developed severe vaginal bleeding. The differential diagnoses were incomplete uterine evacuation and uterine perforation.</p> <p><strong>Results:</strong> During a laparotomy in Lloyd-Davies position, haemoperitoneum and six uterine perforations on the anterior and fundal parts, each approximately 5 mm in length (Figure 1), were found. The perforations were repaired and a check uterine curettage under oxytocic cover showed an empty uterus. The abdominal cavity was washed and closed. She was transfused three units of red blood cell concentrate and had a normal six weeks follow-up.</p> <p><strong>Conclusion:</strong> When an instrument inserted into the uterus is pushed beyond the estimated depth of the uterus, a perforation must be suspected and the condition may be managed conservatively. A surgical procedure complicated by surgeon’s loss of perception (in this case tactile) of tissues’ anatomy is hazardous.</p> <p><strong>Keywords:</strong> Image of uterine perforation; manual vacuum aspiration; uterine sounding.</p> 2022-04-29T00:00:00+00:00 Copyright (c) Diagnosis and treatment of obstetrics disseminated intravascular coagulation in resource limited settings 2022-04-30T05:31:36+00:00 Helen C Okoye Theresa U Nwagha Angela O Ugwu Ifeanyi E Menuba Augustine N Duru Emmanuel O Ugwu Feanyichukwu U Ezebialu Stephen C Eze Aloysuis O Ugwu <p><strong>Background:</strong> Disseminated intravascular coagulation (DIC) is one of the commonest causes of abnormal bleeding during pregnancy and puerperium. Its successful management is a challenging feat in resource limited settings (RLS).</p> <p><strong>Aim:</strong> To determine Obstetricians’ approach in diagnosing and treating obstetrics DIC in a RLS</p> <p><strong>Method:</strong> A semi-structured pre-tested 4-sectioned questionnaire was used to collect demographic data of Nigerian obstetricians and data on their practice in the diagnosis and treatment of obstetrics DIC.</p> <p><strong>Results:</strong> A total of 171 obstetricians responded. Preeclampsia was the most frequent cause identified (70.2%) followed by postpartum haemorrahge (58.3%). Platelet count determination was the test mostly used (95.9%) to make a diagnosis of DIC whereas, antithrombin assay was the least (20.6%) requested investigation. While about two-third would monitor the evolution of DIC, a little less than half of the obstetricians would not repeat laboratory testing more than every 2 days, reason mainly (61.8%) due to patient’s financial constraint. Almost three-quarter of them preferred fresh whole blood as the first line of treatment of DIC.</p> <p><strong>Conclusion:</strong> DIC remains a challenge in the obstetrics practice in RLS especially in investigations, monitoring and index of suspicion for non-overt DIC.</p> <p><strong>Keywords:</strong> Investigations; DIC; Obstetrician; diagnosis; treatment.</p> 2022-04-29T00:00:00+00:00 Copyright (c) Mentorship during transition period: a challenge for newly qualified midwives in Limpopo province of South Africa 2022-04-30T05:46:05+00:00 Khathutshelo Simane-Netshisaulu Maria Maputle Lizzy Mutshinyalo Netshikweta Hilda Shilubane <p><strong>Background:</strong> Mentorship is a process in which structured support is provided to new graduates of the profession to facilitate theireffective transitional journey to professional autonomy.</p> <p><strong>Objectives:</strong> To explore and describe the mentoring process as experienced by newly qualified midwives and experienced midwives<br>during thetransition period.</p> <p><strong>Methods:</strong> Aqualitative approach was used. Five hospitals were selected from Limpopo province. The study was conducted in a maternity unit of each selected hospital. Population comprised of all newly qualified midwives as well as all experienced midwives working at institutions under study. Non-probability, purposive sampling method was used to select twenty-five newly qualified and twenty-five experienced midwives working in maternity wards of selected hospitals. In-depth face-to-face interviews were conducted for data collection.</p> <p><strong>Results:</strong> Ineffective mentoring processes were reported, where only a few experienced midwives seemed ready to provide informal and unstructured support to graduates. Experienced midwives recognised their mentoring role however, felt they did not have sufficient knowledge and skills regarding mentoring process. Shortage of staff and increased workload were reported as challenges which negatively affected the mentoring process.</p> <p><strong>Conclusion:</strong> Mentoring is an effective process for facilitation of graduates’ transition process to become registered autonomous midwifery practitioners. However, they were not effectively mentored; consequently, negatively affecting their development to professional maturity.</p> <p><strong>Keywords:</strong>&nbsp;Experienced midwives; mentoring; mentor; newly qualified midwives.</p> 2022-04-29T00:00:00+00:00 Copyright (c) Clinical and biochemical spectrum of metabolic cardiomyopathy in Egyptian children 2022-04-30T06:12:42+00:00 Zeinab Salah Seliem Dina Ahmed Mehaney Laila Abd elmoteleb Selim Sonia Ali El-Saiedi Reem Ibrahim Ismail Nihal Magdi Almenabawy Rasha Ibrahim Ammar Inas AbdElsattar Saad Mohammed Mosad Soliman Mohamed A Elmonem <p><strong>Background:</strong> Inborn errors of metabolism (IEMs) commonly present with pediatric cardiomyopathy. Identification of the underlying cause is necessary as it may lead to improved outcomes.</p> <p><strong>Objectives:</strong> We aimed to investigate the diagnostic rate, the clinical, and biochemical spectra of IEMs among Egyptian pediatric patients presenting with cardiomyopathy, and their outcome measures.</p> <p><strong>Methods:</strong> We retrospectively analyzed the clinical, biochemical, and radiological data of 1512 children diagnosed with cardiomyopathy at Cairo University Children’s Hospital over a 5-year duration.</p> <p><strong>Results:</strong> Two hundred twenty-nine children were clinically suspected as IEMs and underwent metabolic workup. Nineteen different IEMs were confirmed in 57 (24.4%) of the suspected children. Their median age at presentation was 2.6 years and the majority had extra-cardiac manifestations. Hypertrophic cardiomyopathy represented 43/57 (75.4%) of confirmed cases, while dilated cardiomyopathy represented 13/57 (22.8%), and one patient presented with a mixed phenotype. Twenty- six patients (45.6%) survived, while 31 patients (54%) either died or were lost to follow up and assumed deceased.</p> <p><strong>Conclusions:</strong> We developed for the first time a database and a diagnostic scheme for metabolic cardiomyopathies in Egyptian children. With the recent introduction of enzyme replacement therapy, many metabolic disorders became treatable, thus establishing an early and accurate diagnosis is extremely important.</p> <p><strong>Keywords:</strong> Cardiomyopathy; inborn errors of metabolism; pediatric.</p> 2022-04-29T00:00:00+00:00 Copyright (c) Prevalence and determinants of cardiac arrhythmias and conduction anomalies in adults aged ≥ 40 years in Jimma Town, Southwest of Ethiopia: a cross-sectional study 2022-04-30T06:24:07+00:00 Iyasu Tadesse Bukata Elsa Tegene Teshome Gobena Yohannes Markos Woldesenbet <p><strong>Background:</strong> The prevalence of cardiac arrhythmia (CA) in the Ethiopian population is unknown. A community study was conducted to assess the magnitude and predictors of CAs in adults aged≥40 years in Jimma Town.</p> <p><strong>Methods:</strong> A community-based cross-sectional study was conducted in Jimma town from May to July 2017. A total of 634 adults aged 40 years or older were selected using a systematic sampling technique from six kebeles of the Town. Study participants were screened for CA using a 12-lead ECG machine. Face-to-face interviews, anthropometric, important clinical measurements were performed. Data analysis was done using SPSS for windows version 21.0.</p> <p><strong>Results:</strong> A total of 634 study participants, significant CA occurred in 217 individuals (34.2%). Conduction abnormalities and sinus bradycardia were the commonest findings (25.4%). Premature beats (ventricular 1.9%, atrial 1.1%) and atrioventricular nodal reentrant tachycardia (2.1%) were the next most frequent arrhythmias. Arrhythmias were independently associated with smoking(AOR=1.9;P=.047), hypertension(AOR=1.5;P=.02), heart failure(AOR=2.06;P=.023), prior<br>stroke(AOR=4.9;P=.001), previous history of MI(AOR=1.78;P=.039), vigorous intensity activities(AOR=0.56;P=.024), solidified vegetable oil consumption(AOR=3.5;P=.004), and occupation(pensioner, none)[AOR=1.7;P=.017].</p> <p><strong>Conclusion:</strong> CA is highly prevalent in Jimma. Hypertension and history of heart diseases are the most potent predictors of cardiac arrhythmia. Large-scale screening for early detection of arrhythmia has important implications for treatment.</p> <p><strong>Keywords:</strong> Cardiac arrhythmia; prevalence; risk-factors; 12-lead ECG; Jimma Town.</p> 2022-04-29T00:00:00+00:00 Copyright (c) A comparative analysis on risk of pulmonary hypertension in children with Atrio-ventricular (AV) canal defect: a multi-centre study 2022-04-30T06:34:54+00:00 Josephat Maduabuchi Chinawa Chika Onyinyechi Duru Awoere Tamunosiki Chinawa Bartholomew Friday Chukwu <p><strong>Objectives:</strong> This study is aimed at determining the risk of pulmonary hypertension in children with AV canal defect when compared<br>with children with other congenital heart disease.</p> <p><strong>Methods:</strong> A descriptive study carried out in three institutions over a six-year period among children who presented with AV canal defect and their controls who presented with other congenital heart defects.</p> <p><strong>Results:</strong> A large proportion of the children with AV canal (77.5%) had pulmonary hypertension. Among the patients with pulmonary hypertension, 45.2% were males compared 54.8% females (χ2 = 3.2, p = 0.2). There was a positive correlation between pulmonary hypertension and size of VSD and ASD, although the correlation was not significant (Pearson correlation coefficient = 0.01 and 0.4, p = 0.9 and 0.1 respectively). Children with AV canal defect had higher odds of developing most clinical symptoms and pulmonary hypertension than children with other congenital heart disease and this is statistically significant.</p> <p><strong>Conclusion:</strong> Majority of children with AV canal defect presented with pulmonary hypertension. These children present with higher odds of having pulmonary hypertension and clinical symptoms than children with other types of congenital heart disease.</p> <p><strong>Keywords:</strong> AV canal defect; pulmonary hypertension; children; odds.</p> 2022-04-29T00:00:00+00:00 Copyright (c) Knowledge and indulgence in substance abuse among adolescents in Anambra state, South-East Nigeria 2022-04-30T06:47:00+00:00 Ogochukwu Ofiaeli Chioma Ifeoma Udigwe Bridget Chizalu Ndukwu Ifeyinwa Obiageli Emelumadu Fidelia <p><strong>Background:</strong> Substance abuse is a growing societal problem with adolescents being at increased risk. The few studies in Nigerian adolescents have not factored in their knowledge base with regard to the concept of substance abuse.</p> <p><strong>Objectives:</strong> This study determined the indulgence in and knowledge of substance abuse and associated factors among adolescents.</p> <p><strong>Methods:</strong> This was a questionnaire based study involving 10 to 19year olds recruited from an adolescent summer camp in Anambra state, South-East Nigeria.</p> <p><strong>Results:</strong> The data of 276adolescents was analyzed, male–91, 33%, M: F = 1: 2. Mean age was 16.4 ± 1.4years. 13.8% (38) accepted they had abused substances in the past; 74.3% (205) had the correct knowledge of the meaning of substance abuse; 10.1% (28) admitted taking substances for pleasure. The substances taken included Alcohol (67.9%), Cigarette (25.0%), Tramadol (10.7%), Cocaine (7.1%), among others. Multiple substances were taken 28.6% of the time. Age category had no significant association with the abuse of substances (X2–2.656, p = 0.282). Stratified by age category, gender had a significant association with substance abuse in Late adolescence (n = 11; M–9, 81.8%; F–2, 18.2%; X2 = 6.893, p = 0.016) but not Mid-adolescence (n = 27; M – 10, 37.0%; F – 17, 63.0%; X2 = 0.749, p = 0.500).</p> <p><strong>Conclusion:</strong> An unacceptable proportion of the adolescents were already exposed to substances/drugs in spite of having suboptimal knowledge. Adolescents need to be educated on substance abuse and its dangers in order to curb this in the society.</p> <p><strong>Keywords:</strong> Drug abuse; adolescence; knowledge; Nigeria.</p> 2022-04-29T00:00:00+00:00 Copyright (c) Alcohol consumption and cigarette smoking: a health-risk behaviour among secondary school learners in South Africa 2022-04-30T06:56:08+00:00 Nonhlanhla P L Zwane Ntsieni S Mashau Violet K Moselakgomo <p><strong>Background:</strong> Health-risk behaviours such as tobacco smoking and alcohol are now identified among adolescents in most of the secondary schools of South Africa.</p> <p><strong>Objective:</strong> The study investigated the prevalence of smoking and alcohol use as health risk behaviours among secondary school learners in Thembisile Hani municipality of Mpumalanga province in South Africa.</p> <p><strong>Methods:</strong> A quantitative descriptive research design was used for the study. A simple random sampling was employed in the selection of schools and proportional stratified sampling was used to select learners from each school according to grades. Closed-ended questionnaires were used to collect data from learners in their schools. Data were analysed using SPSS version 26.0.</p> <p><strong>Results:</strong> Out of 385 learners, 64.4% have drank alcohol whilst 64.7% have smoked cigarette in the school premises. The socio-economic status of many learners such as the employment and income of the family was found to be one of the factors exposing them to alcohol and tobacco use.</p> <p><strong>Conclusions:</strong> There was high prevalence of alcohol use and smoking among learners in secondary schools. Excessive use of alcohol and smoking could affect the health of learners in their late life and therefore community collaboration to curb the problem is crucial.</p> <p><strong>Keywords:</strong> Alcohol consumption; Health-risks; Smoking; Secondary School Learners; Tobacco.</p> 2022-04-29T00:00:00+00:00 Copyright (c) Psychotic symptoms and its association with substance use disorders among adult prisoners in correctional institution: a facility based cross-sectional study in Southwest Ethiopia 2022-04-30T07:03:22+00:00 Arefayne Alenko Habtamu Kerebih <p><strong>Introduction:</strong> The prevalence of psychotic symptoms among prisoners is increasing rapidly throughout the world. It imposes considerable personal and public health burden. In recent years psychotic symptoms among prisoners has been widely emphasized and the current study aimed to assess psychotic symptoms and its association with substance use disorders among adult prisoners in correctional institution in Southwest Ethiopia.</p> <p><strong>Method:</strong> Facility based cross-sectional study design was conducted in Jimma Correctional Institution among 336 prisoners selected by systematic random sampling method in June 2017. Data was collected by face to face interview using structured questionnaire. Data was analyzed using SPSS version 21.0. Multivariable logistic regression was computed to identify independent associated factors.</p> <p><strong>Results:</strong> The prevalence of psychotic symptoms among prisoners was found to be 43%. Poor social support (AOR: 4.12, 95%CI: 1.39-12.66), alcohol use disorder (AOR: 4.03, 95%CI: 1.58-10.27), stressful life events (AOR: 2.19, 95%CI: 1.14-4.21), and common mental disorders (AOR: 5.53, 95%CI: 2.56-11.91) were independently associated with single psychotic symptom.</p> <p><strong>Conclusion:</strong> This study showed high prevalence of psychotic symptoms. Psychotic symptoms were significantly associated with poor social support, alcohol use disorder, stressful life events and common mental disorders. It is essential to have screening mechanism and management practice for psychotic symptoms.</p> <p><strong>Keywords:</strong> Psychotic symptoms; substance use; prisoners; Ethiopia.</p> 2022-04-29T00:00:00+00:00 Copyright (c) A mixed-methods, cross-sectional study of perceived stigma among Ugandans with epilepsy 2022-05-01T04:53:45+00:00 Mark Haddy Nalubwama Carol Blixen Nelson Sewankambo Martha Sajatovic Elly Katabira <p><strong>Background:</strong> Epilepsy is associated with stigma and negatively impacts the lives of people living with epilepsy (PLWE) and their immediate families. More understanding of the stigma and discrimination experienced by PLWE in sub-Saharan Africa is needed.</p> <p><strong>Methods:</strong> In a cross-sectional, mixed methods study, forty- eight PLWE who met the study inclusion criteria were enrolled. In depth interviews and focus group discussions were conducted and were audiotaped and transcribed verbatim. Analysis was conducted using a thematic, constant comparative approach with an emphasis on dominant themes. Perceived stigma was measured using the Kilifi epilepsy stigma score. Associations between socio-demographic factors and Kilifi epilepsy stigma score were assessed.</p> <p><strong>Results:</strong> The median age of the study participants was 25 years, with median age (IQR) of epilepsy onset of 12 (6-18) years. The prevalence of high-perceived stigma was 31.9% (15/48). Seizure frequency was associated with high levels of perceived stigma (p-value of 0.038). Psychological abuse, rejections at home, places of employment and schools, poor relationships and intimacy and unmet engagements in social activities were cited as the perceived stigmatizing aspects among PLWE.</p> <p><strong>Conclusion:</strong> In this Ugandan sample perceived stigma remains unacceptably high and interventions to address it are urgently needed in our settings.</p> <p><strong>Keywords:</strong> Epilepsy; Stigma; Uganda.</p> 2022-04-29T00:00:00+00:00 Copyright (c) Musculocutaneous and median nerve branching: anatomical variations. Case Series from UR clinical anatomy and literature review 2022-05-01T05:32:19+00:00 Olivier Kubwimana Albert Ndata Andrew Ivang Paul Ndahimana Albert Nzayisenga Jean Claude Byiringiro Julien Gashegu <p><strong>Introduction:</strong> The brachial plexus is highly variable, which is a well-known anatomical fact. Repeated observations on anatomical variations, however, constitute current trends in anatomical research.</p> <p><strong>Case series:</strong> In an anatomical dissection course, three uncommon variations in the brachial plexus were identified in three young adults’ cadavers. In one case, the musculocutaneous nerve gave a branch to the median nerve, while the median nerve gave or received musculocutaneous branches in the two remaining corpses.</p> <p><strong>Conclusion:</strong> Anatomical variations of the brachial plexus do occur in our setting. The cases we presented are about anatomical variations of branching patterns of the median and musculocutaneous nerves. Knowledge of those variations is essential for surgery and regional anesthesia of the upper limbs.</p> <p><strong>Keywords:</strong> Anatomical variations; brachial plexus; median nerve; musculocutaneous nerve; upper limb.</p> 2022-04-29T00:00:00+00:00 Copyright (c) Neurological disorders in Northern Tanzania: A 6-year prospective hospital-based case series 2022-05-01T05:53:11+00:00 William P Howlett Sarah J Urasa Venance P Maro Richard W Walker Kajiru G Kilonzo Patrick J Howlett Marieke CJ Dekker <p><strong>Background:</strong>The burden of neurological disorders is large and altered by the HIV epidemic.</p> <p><strong>Objectives:</strong> We describe the pattern of neurological disorders and their association with HIV infection in adult patients attending a consultant hospital in Northern Tanzania.</p> <p><strong>Methods:</strong> In this prospective cross-sectional study, we collected data on adult neurological referrals over a 6-year period between 2007-13. The odds of HIV infection, across neurological categories adjusted for age and sex, was calculated.</p> <p><strong>Results:</strong> Of 2037 participants, 54.8% were male and 45.2% were female. The median age of participants was 43 years. The results for HIV screening were available for 992/2037 (48.7%) patients, of whom 306 (30.8%) were seropositive. The most frequent neurological disorders were cerebrovascular disease (19.9%), paraplegia (13.6%), and peripheral neuropathies (8%). Taken together CNS infection accounted for 278/2037 (13.6%). The adjusted odds (aOR) of HIV infection was highest amongst infections; brain abscesses (aOR 107, 95% CI 35.1-470.4) and meningitis/encephalitis (aOR 40.1, 95% CI 13.6-172.9), but also raised in cerebrovascular disease, paraplegia, peripheral neuropathies, cranial nerve palsies, seizures, cerebllar disorders, movement disorders, motor neuron disease and<br>headache.</p> <p><strong>Conclusion:</strong> The main pattern of neurological disorders in Northern Tanzania is presented. The odds of HIV infection was highest in CNS infections and in a wide range of non-communicable neurological disorders.</p> <p><strong>Keywords:</strong> Tanzania; neurological; disorder; neurological disease; hospital; HIV</p> 2022-04-29T00:00:00+00:00 Copyright (c) Association between physical activity knowledge and attitude on diabetes among normal weight and overweight/obese type-2 diabetic patients: a rural community-based cross-sectional study 2022-05-01T06:21:20+00:00 Ranakishor Pelluri Srikanth Kongara Jithendra Chimakurthy Vanitha Rani Nagasubramanian <p><strong>Background:</strong> Physical activity is one of the most important regimens for the treatment of diabetes. Hence, we aimed to examine the association between physical activity knowledge (PAK), knowledge and attitude on diabetes among rural T2DM patients.</p> <p><strong>Objectives:</strong> The PAK, knowledge and attitude on diabetes were targeted to evaluate in rural Indian T2DM patients.</p> <p><strong>Methodology:</strong> A cross-sectional community-based survey was carried out with eighty-four patients with known T2DM in rural population of India.</p> <p><strong>Results:</strong> Among 84 patients, 46 were overweight/obese and 38 patients with normal weight were participated in our study. The odds of smoking were found to be a significant socio-demographic risk factor (OR: 4.42, 95% CI 0.93-20.33 and P&lt;0.001) compared to non-smokers. The PAK categories such as A, B &amp; D had associated with BMI. The OR, 95% CI and P. Value are (5.610, 2.18-14.38 and P&lt;0.001; 1.72, 0.72-4.12 and P 0.030; 2.55, 1.05-6.20 and P 0.047) except in category C. Iilliterates, low annual income, poor knowledge on T2DM and negative attitude, OR (4.50; 12.87; 10.80 and 47.66) were reported disagree or don’t know with PAK questionnaire.</p> <p><strong>Conclusion:</strong> The results have impact on the design of new education programs will assist in preventing and managing complications related to T2DM.</p> <p><strong>Keywords:</strong> Physical activity knowledge; Attitude; Body mass index; Type-2 Diabetes Mellitus.</p> 2022-04-29T00:00:00+00:00 Copyright (c) Dry eye disease and meibomian gland dysfunction among a clinical sample of type 2 diabetes patients in Ghana 2022-05-01T06:44:53+00:00 Emmanuel K Abu Amanfo O Ofori Samuel B Boadi-Kusi Stephen Ocansey Richard K Yankah Samuel Kyei Asante Y Awuku <p><strong>Objective:</strong> To evaluate dry eye disease and meibomian gland dysfunction among type 2 diabetes patients</p> <p><strong>Methods:</strong> A hospital-based cross-sectional study was conducted. Parameters assessed included meibum expressibility and quality, Schirmer test 1, tear breakup time (TBUT), ocular surface staining, blink rates and Ocular Surface Disease Index (OSDI) scores. Dry eye was diagnosed based on a combination of subjective symptoms, tear function and ocular surface staining.</p> <p><strong>Results:</strong> Prevalence of DED and MGD were 72.3% and 55.3% respectively. Symptomatic dry eye (OSDI scores) was significantly associated with duration of diabetes (rs = 0.11, P = 0.028) and the presence of conjunctival disorders (OR = 2.09, P = 0.002). MGD was a risk factor for DED (OR = 1.99, P = 0.008); ocular surface damage, the presence of eye lid lesions, abnormal Schirmer test and reduced TBUT were significantly associated with MGD, the strongest predictor being ocular surface damage (OR = 3.21, P = 0.001). OSDI scores had no association with the presence of corneal lesions possibly due to reduced corneal sensitivity.</p> <p><strong>Conclusion:</strong> DED and MGD were prevalent among the patients and therefore there is the need for dry eye assessment as a routine clinical management protocol for patients with type 2 diabetes.</p> <p><strong>Keywords:</strong> Dry eye disease; meibomian gland dysfunction; type 2 diabetes; Ghana.</p> 2022-04-29T00:00:00+00:00 Copyright (c) The antimicrobial peptide alpha defensin correlates to type 2 diabetes via the advanced glycation end products pathway 2022-05-01T07:14:49+00:00 Mohammed El-Mowafy Abdelaziz Elgaml Naglaa Abass Amany A Mousa Mohamed N Amin <p><strong>Background:</strong> Diabetes is a serious health problem that results in high mortality rates worldwide. α-defensins are antimicrobial peptides of the innate immune system that contribute to inflammation. However, data on serum levels of α-defensin in patients suffering from type 2 diabetes are limited.</p> <p><strong>Objectives:</strong> This study aimed to assess the possible changes in α-defensin serum levels in patients suffering from type 2 diabetes and to investigate its correlation with relevant biomarkers.</p> <p><strong>Methodology:</strong> Analysis of serum α-defensin levels in 47 type 2 diabetics with diabetic neuropathy, 19 type 2 diabetics with no complications and 19 healthy control subjects by enzyme-linked immunosorbent assay was established. Furthermore, measurement of advanced glycation end products (AGEs) and fasting blood glucose (FBG) serum levels was performed, together with the lipid profile analysis.</p> <p><strong>Results:</strong> The serum levels of α-defensin were higher in patients with and without diabetic neuropathy in comparison to control subjects. In addition, there was a significant correlation between α-defensin serum levels and AGEs and FBG serum levels as well as with the body mass index.</p> <p><strong>Conclusions:</strong> α-defensins are significantly elevated in serum of type II diabetics, and correlate with AGEs serum levels indicating a crosstalk that may aggravate inflammation in type 2 diabetes.</p> <p><strong>Keywords:</strong> Alpha defensing; Advanced glycation end products; Hyperglycemia; Inflammation; Innate immunity; Type 2 diabetes.</p> 2022-04-29T00:00:00+00:00 Copyright (c) The association between lifestyle-related risk factors and survival in patients with colorectal cancer in an urban South African cohort 2022-05-01T08:28:58+00:00 Megan Whelan Heleen van Aswegen Ronel Roos June Fabian Brendan Bebington Cert Neph <p><strong>Background:</strong> Lifestyle-related factors have been linked with risk for colorectal cancer. Data describing the relationship between lifestyle factors of South African patients who present with colorectal cancer and their survival is sparse.<br><strong>Objectives:</strong> The objectives were to describe the profile of patients with colorectal cancer; to determine the association between lifestyle-related factors and survival, and to compare results of patients in the private and public sectors.</p> <p><strong>Methods:</strong> A retrospective review and secondary analysis of information of patients with colorectal cancer were conducted. The independent samples t-test and Mann Whitney U test were administered to determine differences in the clinical presentation. Pearson’s Chi-Squared and Eta (η) tests were used to determine the association between survival and lifestyle-related factors.<br><strong>Results:</strong> Data of 441 patients were included. When compared to the public sector cohort, patients in the private sector cohort were older (p=0.0110), had earlier stages of cancer at the time of diagnosis (p&lt;0.001), had a higher percentage of current alcohol consumption (p&lt;0.001) and had higher survival rates (p&lt;0.001). Waist circumference was shown to have a large-strength effect on survival (η2=0.266).<br><strong>Conclusion:</strong> Emphasis should be placed on anthropometric screening and education to effect long-term behaviour change. Physiotherapists are well placed to provide screening and non-pharmacological interventions for patients with colorectal cancer.</p> <p><strong>Keywords:</strong> Cancer survival; risk factors; physiotherapy.</p> 2022-04-29T00:00:00+00:00 Copyright (c) Exploring the use of p53 protein expression as an indicator of oesophageal cancer severity from a high incidence rural area of Africa 2022-05-01T08:50:22+00:00 Eugene J Ndebia Thandazile Ngonyama Steve Molaoa <p><strong>Background:</strong> The expression of p53 has been associated with the severity of other types of cancer. There is scanty information when it comes to oesophageal cancer.</p> <p><strong>Objective:</strong> This study aimed to explore the use of p53 protein expression as an indicator of oesophageal cancer severity from a high-risk incidence in the African rural population.</p> <p><strong>Methods:</strong> Fifty-one patients newly diagnosed with oesophageal cancer were recruited from the endoscopic unit at Nelson Mandela Academic Hospital in Mthatha, South Africa. The serological expression of p53 was measured using the ELISA method and the severity of oesophageal cancer expressed in grade was obtained from the histopathology report from patient’s oesophageal biopsies.<br><strong>Results:</strong> We found that the expression of p53 was equally distributed among the histological grades of cancer with the value of 2495 pg/mL ± 1736 pg/ mL for lower grades and 2520 ± 1539 pg/mL for higher grades. Furthermore, we found that the level of p53 expression was equally distributed in patients from grade 1, 2, 3, and 4.</p> <p><strong>Conclusion:</strong> The expression of p53 protein does not vary according to the histological grade of oesophageal cancer in the given population, therefore may not be helpful as a prognostic factor.</p> <p><strong>Keywords:</strong> Exploring the use of p53 protein expression; as an indicator of oesophageal cancer severity; from a high incidence rural area of Africa.</p> 2022-04-29T00:00:00+00:00 Copyright (c) Turnaround time and barriers to treatment of newly diagnosed cancer in Uganda: a mixed-methods longitudinal study 2022-05-01T09:43:35+00:00 Solomon Kibudde Eve Namisango Annet Nakaganda Mackuline Atieno Joy Bbaale Martin Nabwana Fatia Kiyange Meg O’brien Emmanuel BK Luyirika Jackson Orem <p><strong>Introduction:</strong> Cancer represents a growing public health concern. Late-stage at diagnosis, limited access to effective treatment, and loss to follow-up are responsible for dismal outcomes.</p> <p><strong>Objective:</strong> To describe care pathways, turnaround times, and identify barriers to timely initiation of cancer treatment</p> <p><strong>Methods:</strong> Using a sequential mixed-methods design involving focus group discussions, we followed up 50 participants between January, and June 2018. We computed the median observed turnaround time to treatment (TTT) at each care step and reported delay as deviations from the proposed ideal turnaround times.</p> <p><strong>Results:</strong> The ideal TTT with either chemotherapy, or radiotherapy, or surgery was 8, 14, and 21 days respectively. At a median follow-up time of 35.5 days (IQR 17-66), only 29 of the 50 study participants had completed all steps between registration and initiation of treatment, and the observed median TTT was 16 days (9 – 22 days) for chemotherapy, and 30 days (17 – 49 days) for radiotherapy, reflecting a significant delay (p-value = 0.017). Reported barriers were; shortage of<br>specialists, patients required visits to outside facilities for staging investigations, prohibitive costs, poor navigation system and time wastage.</p> <p><strong>Conclusions:</strong> When compared to the recommended ideal turnaround time, there was significant institutional delay in access to chemotherapy and radiotherapy attributed to multiple external and internal healthcare system barriers.</p> <p><strong>Keywords:</strong> Turnaround time; steps; barriers; waiting time; cancer; Uganda.</p> 2022-04-29T00:00:00+00:00 Copyright (c) Association of MTHFR gene polymorphism C677T (rs1801133) studies with early primary knee osteoarthritis in a South Indian population: a hospital-based study 2022-05-09T10:02:24+00:00 Subhadra Poornima Swarnalatha Daram Rama Krishna Devaki Ramchander Merugu Krishna Subramanyam <p>Osteoarthritis (OA) is the most commonly occurring disease of middle and elderly population, which is characterized by focal loss of joint articular cartilage, osteophyte formation and sub chondral bone remodeling. Classical risk factors of OA include age, gender, weight, joint injury, trauma, however hereditary component is one of the main crucial factors. Several<br>genome wide association studies and candidate gene approaches have identified genetic variants involved in the influence and association of OA. In the current study influence of Methylene tetra hydro folate reductase MTHFR C677T (rs1801133) gene with early primary knee OA was evaluated.<br>In this study 400 samples were included (200 cases &amp; 200 controls). DNA was extracted &amp; processed for PCR- RFLP evaluation and genotype analysis. Statistical analysis was performed &amp; results indicated a lack of association between MTHFR gene polymorphism and early primary KOA. The stratification was done based on age &amp; gender and also both. Individual’s<br>i.e females below the age of 40 years are more prone to the disease when compared with males. MTHFR gene polymorphism showed a lack of association with early primary knee osteoarthritis. To the best of our knowledge this is the first study from south India.</p> <p><strong>Keywords:</strong> Polymorphism; MTHFR gene; Osteoarthritis; molecular analysis.</p> 2022-04-29T00:00:00+00:00 Copyright (c) Fibroblast Growth Factor 23 (FGF 23) and intact parathyroid hormone (iPTH) as markers of mineral bone disease among Nigerians with non-diabetic kidney disease 2022-05-01T12:14:46+00:00 Yemi R Raji Samuel O Ajayi Abiodun M Adeoye Olukemi Amodu Bamidele O Tayo Babatunde L Salako <p><strong>Background:</strong> Excess cardiovascular burden in patients with chronic kidney disease (CKD) has been attributed to the occurrence of CKD–Mineral Bone Disease (CKD – MBD). This study aimed to determine the spectrum of CKD-MBD among Nigerians with CKD using Fibroblast Growth Factor 23 (FGF 23) and intact Parathyroid Hormone (iPTH).</p> <p><strong>Methods:</strong> Cross sectional survey of 105 patients with non-diabetic CKD and 104 controls. Information obtained were demographics, aetiology of CKD, features of CKD-MBD. Serum iPTH and FGF 23 were assayed.</p> <p><strong>Results:</strong> The mean ages were 48.7±15.3 vs 48.6±17.4 years while 54.7% and 45.2% were males for cases and controls, respectively. The mean plasma FGF 23 (392.8±35.3 vs 133.8±22.7 RU/mL and plasma iPTH (289±25.6 vs 118±10.8 ng/L, respectively. The frequency of elevated FGF 23 (45.7% vs 24.0%, p&lt;0.01) and abnormal iPTH (53.3% vs 14.1%, p- 0.01) were higher in cases. The prevalence of MBD were (59.0% vs 14.4%, p&lt;0.01) in cases and controls while dialysis status OR 2.94, 95% CI (1.2803–5.3645), and elevated FGF 23 OR, 1.87, 95% CI (1.1782–5.4291) were associated with CKD-MBD.</p> <p><strong>Conclusion:</strong> The study demonstrated high prevalence of CKD-MBD among patients with non-diabetic CKD while FGF23 and iPTH were useful assays in the diagnosis of CKD-MBD among Nigerians with CKD.</p> <p><strong>Keywords:</strong> CKD; mineral bone disease; diagnostic; FGF 23; parathyroid hormone.</p> 2022-04-29T00:00:00+00:00 Copyright (c) Assessing the protective effect of Crassocephalum vitellinum against Rifampicin- induced hepatotoxicity in Wistar rats 2022-05-01T12:41:28+00:00 Kenedy Kiyimba Emmanuel Tiyo Ayikobua Daniel Chans Mwandah Samuel Baker Obakiro <p><strong>Background:</strong> <em>Crassocephalum vitellinum</em> is widely used by traditional medical practitioners and local people in East Africa to manage a large number of ailments including hepatitis 1. However, its hepatoprotective effects had not been evaluated prior to this study. The aim of this study was to assess the effect of an ethanolic leaf extract of <em>Crassocephalum vitellinum</em> against rifampicin-induced liver toxicity in Wistar rats.</p> <p><strong>Methods:</strong> Increasing doses of an ethanolic leaf extract of <em>C. vitellinum</em> were administered to Wistar rats daily for 35 days, together with rifampicin given orally as suspension. After the treatment period, Assessment of hepatoprotective activity was done by analysis of serum levels of biochemical and histopathological effects on the liver.</p> <p><strong>Results:</strong> The results showed that administration of <em>C. vitellinum</em> extract significantly prevented drug- induced increase in serum levels of liver biomarker enzymes and also decreased the hepatocellular necrosis and inflammatory cells infiltration.<br><strong>Conclusion:</strong> The plant extract loweres the liver biomarker enzymes (ALT, ALP, AST) and preserves the histomorphology of the hepatocytes which is suggestive that the plant possess hepatoprotective properties.</p> <p><strong>Keywords:</strong> <em>Crassocephalum vitellinum</em>; antitubercular drugs; drug-induced hepatotoxicity; hepatoprotective agents.</p> 2022-04-29T00:00:00+00:00 Copyright (c) CCR5-Δ32 gene variant frequency in the Nigerian and Zimbabwean populations living in North Cyprus 2022-05-01T12:59:07+00:00 Basil Chukwuebuka Ndikom Mahmut Cerkez Ergoren Murat Sayan Gamze Mocan Umut Fahrioğlu <p><strong>Background:</strong> The cystine-cystine chemokine receptor 5 (CCR5) is the primary HIV co-receptor involved in the viral entry process into human cells. The 32 bp deletion variant within the CCR5 gene (CCR5-Δ32) plays a very important role in viral recognition and progression of AIDS.</p> <p><strong>Objective:</strong> The current study was aimed at evaluating the CCR5-Δ32 gene variation frequency in Nigerian and Zimbabwean populations residing in Northern Cyprus.</p> <p><strong>Methods:</strong> A total number of 211 subjects (103 Nigerians and 108 Zimbabweans) were analyzed. Nigerian population was further analyzed with respect to the three major ethnicities: Igbo, Hausa, and Yoruba. Polymerase Chain Reaction was used to determine the CCR5-Δ32 gene variant status.</p> <p><strong>Results:</strong> All studied subjects from both sampling groups were homozygous for the CCR5 wild type gene (CCR5–wt), meaning neither heterozygous nor homozygous genotypes of CCR5-Δ32 gene variant were observed.<br><strong>Conclusion:</strong> This study observed the absence of CCR5-Δ32 deletion gene in the Nigeria and Zimbabwean populations living in Northern Cyprus. These populations lack the genetic advantage over HIV infection and may also show a rapid progression towards AIDS. Additionally, these populations could impact the local gene frequency as these two populations interact more and more.</p> <p><strong>Keywords</strong>: CCR5-Δ32; HIV; Nigerian; Zimbabwean; CCR5; North Cyprus.</p> 2022-04-29T00:00:00+00:00 Copyright (c) Effects of hypohydration and fluid balance in athletes’ cognitive performance: a systematic review 2022-05-01T13:08:38+00:00 Adiele Dube Chantell Gouws Gerrit Breukelman <p><strong>Background:</strong> The effects of progressive body fluid loss on athletic and cognitive performance are known to result from exposure to environmental heat stress, morphologic factors, and limited fluid replenishment. Athletes need to restore lost body water. However, athletes may fail to maintain euhydration during exercise. This systematic review investigated hypohydration and fluid balance effects on an athlete’s cognitive function.</p> <p><strong>Methods:</strong> The PubMed, Sports Discuss, and Ebsco databases were searched for studies reporting on hypohydration, fluid balance and heat on cognitive performance in sport. Multiple phrases including hydration, dehydration, fluid balance, mood, cognition, vigilance, decision making, and brain were explored. Participants in the studies did either receive fluid or did not receive fluid during exercise.</p> <p><strong>Results:</strong> Twenty-four trials (n=493 participants) from 24 articles met the inclusion criteria. Significant hypohydration, &gt;2% body mass loss was reported consistently in 16 publications. Five articles where hypohydration was associated with heat stress and limited fluid intake (3-5% body mass loss) impaired cognitive performance. Mood disturbance, fatigue, and ratings of perceived exertion constantly complemented hypohydration impairment on cognition.</p> <p><strong>Conclusion:</strong> Findings show that hypohydration impairs cognitive performance and mood at higher levels of 3-5% body mass loss. However, sport-specific cognitive protocols of accessing hypohydration and fluid balance in individual and team sports remain equivocal.</p> <p><strong>Keywords:</strong> Hypohydration; cognition; mood; fluid replenishment.</p> 2022-04-29T00:00:00+00:00 Copyright (c) Mechanical vestibular stimulation versus traditional balance exercises in children with Down syndrome 2022-05-01T13:43:33+00:00 Ibrahim Nahla M Salem Elham El-Sayed Abd-Elraouf Ehab Ragaa Abd El hamid Amr Abd El Ghafar <p><strong>Background:</strong> regaining balance control is the key to decrease risk of falls in children with Down syndrome.</p> <p><strong>Objectives:</strong> To compare between the effect of mechanical vestibular stimulation and balance exercises on balance in children with Down syndrome.</p> <p><strong>Methods:</strong> Thirty children participated in the study. They were divided randomly and equally into; group A and group B, both groups received the designed program with regular balance exercises for group A and mechanical vestibular stimulation for group B, treatment was conducted for one hour 3 times per week for 3 successive months. Balance as stability indexes (regarding anteroposterior, mediolateral and over all stability indexes) was evaluated before and after treatment by Biodex balance system.</p> <p><strong>Results:</strong> T-test was conducted to compare the mean values of stability indexes between groups. Non-significant difference between groups was recorded before treatment (p value &gt; 0.05), while improvement was recorded when comparing post and pretreatment results for both groups (p &gt; 0.0001). More significant improvement was recorded for group B when comparing the post treatment results with group A (p &gt; 0.05).</p> <p><strong>Conclusion:</strong> Mechanical vestibular stimulation is better added to the rehabilitation program to improve balance in children with Down syndrome.</p> <p><strong>Keywords:</strong> Balance exercises; down syndrome; mechanical vestibular stimulation.</p> 2022-04-29T00:00:00+00:00 Copyright (c) Cassia fistula nutrition rich flower tea derived biotic nanoparticles synthesis, characterization and their antioxidant and anti-hyperglycaemic properties 2022-05-01T14:23:38+00:00 Chinnadurai Veeramani Ahmed S El Newehy Mohammed A Alsaif Khalid S Al-Numair <p><strong>Background:</strong> <em>Cassia fistula</em> (CF) is a nutrient-rich flowering plant and it has been used to cure numerous human health problems including cardiac diseases, bacterial infection, and inflammation.</p> <p><strong>Objective:</strong> The purpose of this study was to investigate the production and characterisation of biomimetic iron oxide nanoparticles (ICF) derived from CF flower tea as well as evaluate their antioxidant and anti-hyperglycemic properties.</p> <p><strong>Methodology:</strong> CF tea derived ICF synthesis and characterized by established physical-chemical methods. Moreover, this synthesized ICF were checked for their antioxidant and anti-hyperglycemic properties such as alpha-amylase, glucose intake, total antioxidant (TAA), ferrous reducing (FA), and radical scavenging (DPPH) properties.</p> <p><strong>Results:</strong> The synthesized ICF characterization and size were confirmed primarily by described physical and chemical methods. Our findings revealed that ICF have a powerful antihyperglycemic mechanism by involving alpha-amylase inhibition and enhanced glucose absorption. Meanwhile, this ICF exhibited distinguished antioxidant competence by improving TAA and free radical scavenging (TAA, DPPH) properties. Finally, this ICF has proven anti-hyperglycemic and antioxidant mechanisms due to their presence of nano-sized biomolecules.</p> <p><strong>Conclusion:</strong> In this study, it might be concluded that the CF is the best source for iron oxide nanoparticles production with clarity, small size and high solidity. Moreover, this nanoparticle has proven in vitro anti-hyperglycemic and antioxidant mechanisms.</p> <p><strong>Keywords:</strong> Nanoparticles; drug delivery; iron III chloride; Cassia fistula; glucose mechanism.</p> 2022-04-29T00:00:00+00:00 Copyright (c) In vitro antioxidant and cytotoxicity activities of selected indigenous South African medicinal plants 2022-05-01T15:12:42+00:00 Yonela Vakele Frederick Odun-Ayo Lalini Reddy <p><strong>Background:</strong> Medicinal plants are regarded as a large source of phytochemicals that may have anticancer properties. This could lead to the development of innovative drugs or alternative therapy against cancer.</p> <p><strong>Objective:</strong> This study was designed to determine the antioxidant and cytotoxicity effect of 5 selected indigenous South African medicinal plants namely; <em>Bulbine frutescens</em>,<em> Bulbine natalensis</em>,<em> Chlorophytum comosum</em>,<em> Kniphofia uvaria</em>, and<em> Tulbaghia violacea</em>.</p> <p><strong>Method:</strong> Phytochemical extracts namely; methanol, 50%, 100% ethanol, and water extracts were prepared from the root and shoot of the plants. The antioxidant effect of methanol extracts of the plant materials was performed using a DPPH assay. A preliminary cytotoxicity screening of the phytochemical extracts in the human colon (Caco-2), cervical (HeLa), and hepatocellular (HepG2) cell lines were determined followed by the half-maximal inhibitory concentration (IC50) using MTT assay.</p> <p><strong>Result:</strong> The methanol root extract of <em>B. natalensis</em> and <em>B. frutescens</em> (33.20% and 26.33% respectively) and shoot extract of<em> K. uvaria</em> (17.10%) showed the highest antioxidant. Out of the 5 plants, only 100% ethanol extract of <em>C. comosum</em>, <em>K. uvaria</em>, and <em>T. violacea</em> caused more than 80% cytotoxicity in HepG2 and Caco-2 cell lines. The shoot of <em>B. frutescens</em> (10.43 μg/ml), <em>K. uvaria</em> (23.0 μg/ml), and root of <em>C. comosum</em> (23.77 μg/ml) were the most active with the highest cytotoxicity.</p> <p><strong>Conclusion:</strong> <em>C. comosum</em>, <em>K. uvaria</em>, and <em>T. violacea</em> possess significant cytotoxicity that is promising in developing alternative drugs against colon and liver cancers. Our results provided new pieces of evidence for antioxidant and cytotoxic activities of these plants which could be useful for developing new anticancer therapies.</p> <p><strong>Keywords:</strong> In vitro antioxidant; cytotoxicity activities; South African medicinal plants; <em>C. comosum</em>, <em>K. uvaria</em>, <em>T. violacea</em>.</p> 2022-04-29T00:00:00+00:00 Copyright (c) Trauma unit admissions at the Ugandan National Referral Hospital: a descriptive study 2022-05-01T18:45:49+00:00 Tonny Stone Luggya Annet Alenyo Ngabirano Richardson Sarah Jackie Mabweijano John Osire Lilian Achieng Josephine Nabulime Alex Bangirana <p><strong>Background:</strong> Injuries are a neglected epidemic globally accounting for 9% global deaths; 1.7 times that of HIV, TB and malaria combined. Trauma remains overlooked with key research and data focusing on infectious diseases yet Uganda has one of the highest rates of traumatic injury. We described demographics of patients admitted to Mulago Hospital’s Shock Trauma Unit within the Emergency Department.</p> <p><strong>Methods:</strong> This was a retrospective record review Trauma Unit admissions from July 2012 to December 2015. Information collected included: age, sex, time of admission, indication for admission and mechanism of trauma.</p> <p><strong>Results:</strong> 834 patient records were reviewed. The predominant age group was 18-35 with majority of patients being male. 54% of patients presented during daytime with 46% admitted in the evening hours or overnight. Mechanism of injury was documented in 484 cases. The most common mechanism was Road Traffic Accident (67.4%), followed by assault (12.8%) and mob violence (5.6%). The most common indication for admission was traumatic brain injury (84.5%), followed by haemodynamic instability (20.0%) and blunt chest injury (6.1%).</p> <p><strong>Conclusion:</strong> There’s a significant burden of high-acuity injury particularly among males with RTAs as the leading cause of admission associated with Traumatic Brain Injury as main admission indication.</p> <p><strong>Keywords:</strong> Emergency care; Trauma; Uganda; Traumatic Brain Injuries; Accidents, Injury.</p> 2022-04-29T00:00:00+00:00 Copyright (c) Metabolic syndrome and its components among HIV/AIDS patients on Antiretroviral Therapy and ART-Naïve Patients at the University of Calabar Teaching Hospital, Calabar, Nigeria 2022-05-01T20:17:38+00:00 Ebot Ojong Bassey Iya Jules Djeufouata Forwah Ndeh Augusta Nsonwu Vigny Njongang Maisie Etukudo Chinyere Usoro Julie Ekpo <p><strong>Background:</strong> Although an increasing access to ART in sub-Saharan Africa has made it possible for HIV/AIDS patients to live longer, clinicians managing such patients are faced with the challenge of drug-related metabolic complications.</p> <p><strong>Methods:</strong> A cross -sectional study was carried out at the University of Calabar Teaching Hospital, Nigeria, on three groups of participants; namely HIV patients on ART, ART-naïve patients and HIV negative subjects (n =75). Demographic and anthropometric data were collected using a well-structured questionnaire while biochemical parameters were measured using colorimetric methods.</p> <p><strong>Results:</strong> The highest prevalence of MS was associated with the HIV/AIDS patients on ART (i.e. 32.0 %, and 50.3% for NCEP-ATP III and IDF criteria respectively). Patients on ART had significant increases (p&lt; 0.05) in waist to hip ratio, FPG, serum TG and LDL-c; and a significantly higher (p&lt; 0.05) prevalence of hypertension, diabetes, low HDL-c and hypertriglyceridaemia compared to the ART-naïve patients. Low serum HDL-c was the most prevalent form of dyslipidaemia in all<br>three groups and the most prevalent component of MS in HIV patients.</p> <p><strong>Conclusion:</strong> ART increases the risk of MS and CVD. HIV/AIDS patients on ART should be advised on lifestyle modifications and undertake regular assessment of their cardiovascular risk factors.</p> <p><strong>Keywords:</strong> HIV/AIDS patients; antiretroviral therapy; ART-Naïve patients; Calabar Teaching Hospital; Calabar; Nigeria.</p> 2022-04-29T00:00:00+00:00 Copyright (c) Serum protein concentration and amino acid profile of HIV/HBV co-infected subjects on HAART in Plateau State, Nigeria 2022-05-01T20:39:37+00:00 Chidi Uzoma Igwe Emmanuel Emagba Ewuga Cosmas Onyedikachi Ujowundu Ignatius Oparaji Onyeocha Viola Adaku Onwuliri <p><strong>Background:</strong> Human immunodeficiency virus (HIV) and hepatitis B virus (HBV) are currently two important blood-borne human pathogens of major public health concern with high prevalence rates in Africa.</p> <p><strong>Objectives:</strong> The study assessed the impact of HIV and HBV mono- and co-infections on serum total protein, albumin, globulin fractions and plasma free amino acids concentrations.</p> <p><strong>Methods:</strong> This was a cross-sectional study on adult (25 – 64 years old) patients on Highly Active Antiretroviral Therapy attending AIDS Preventive Initiative in Nigeria Centre, Jos University Teaching Hospital, Plateau State, Nigeria. It involved 80 subjects; 20 HIV/HBV co-infected, 20 each of HIV and HBV mono-infected controls, and 20 seronegative controls.</p> <p><strong>Results:</strong> Significant (p&lt;0.05) increases in total protein and gamma globulin but a reduction in albumin concentrations were observed in the HIV/HBV co-infected group. Similarly, significant (p&lt;0.05) increases in alpha-1 and alpha-2 globulin concentrations were observed in the mono- and co-infected groups compared to the seronegative control group. There were significant (p&lt;0.05) increases in the glucogenic, aromatic and branched-chain amino acid concentrations of the HIV/HBV co-infected subjects.</p> <p><strong>Conclusion:</strong> The study suggests prognostic importance of alpha and gamma globulin fractions of serum protein as well as amino acid profile in the management of HIV/HBV co-infection.</p> <p><br><strong>Keywords:</strong> Total protein; albumin; globulin; amino acid; viral infection.</p> 2022-04-29T00:00:00+00:00 Copyright (c) The burden and types of anaemia among HIV infected, ART-naive injection substance users in Kenya 2022-05-01T21:00:26+00:00 Emmanuel Mulaya Khazalwa Tom Were David Hughes Mulama Valentine Budambula <p><strong>Introduction:</strong> Illicit substance use and HIV infection cause haematological derangements. Anaemia characterized by a reduction in the quality and quantity erythrocytes is the most common disorder in both HIV-positive persons and illicit substance users.</p> <p><strong>Objective:</strong> To describe anaemia burden, types, and its association with HIV in injectable substance users in Mombasa, Kenya.</p> <p><strong>Methods:</strong> This descriptive case-control study evaluated red cell indices and morphology in 494 adults. The primary outcome was anaemia. The association of anaemia with HIV in injection substance users was determined using the chi-square test.</p> <p><strong>Results:</strong> The participants included 275 injection substance users (ISU), (HIV-positive, n=62 and HIV-negative, n=213); and 219 non-injection substance users (nonISU), (HIV-positive, n=33 and HIV-negative, n=186). Overall, 49% were anaemic with anaemia burden significantly differing across the groups, Χ2(3, N=494) =12.1, p=0.0070. Anaemia burden was higher in HIV-positive ISU compared to HIV-negative ISU (odds ratio (OR) = 1.59, 95% confidence interval (CI): 0.85, 2.96); and HIV-positive nonISU compared to HIV-negative nonISU (OR = 0.37, 95% confidence interval (CI): 0.17, 0.79). Most of the anaemia was dimorphic in both HIV-positive (ISU, 67% and nonISU, 52%) and HIV-negative (ISU, 43% and nonISU, 55%) participants.</p> <p><strong>Conclusion:</strong> Infection with HIV is associated with increased risk of anaemia in injectable and non-injectable substance users. Majority of the anaemia was dimorphic suggestive of multiple aetiologies. Establishing the related aetiologies is essential for the effective treatment of anaemia. The accurate evaluation of thin blood films remains an essential tool in diagnosing an array of haematologic disorders and as a reference for further tests and patient management.</p> <p><strong>Keywords:</strong> Anaemia; HIV/AIDS; substance use.</p> 2022-04-29T00:00:00+00:00 Copyright (c) Predictors of non-adherence to medication and time to default from treatment on HIV infected patients under HAART: a comparison of joint and separate models 2022-05-02T02:29:06+00:00 Koyachew Bitew Abebe Awoke Seyoum Tegegne <p><strong>Back ground:</strong> Ethiopia is one of the Sub-Saharan Africa with the highest number of people living with HIV. Amhara region is one of the regions in the country in which many people are under medication. The main objective of this research was to identify significant predictors of non-adherence to medication and time to default from treatment for HIV infected patients under HAART.</p> <p><strong>Methods:</strong> A retrospective secondary data were obtained from a random sample of 220 HIV patients under HAART. Separate and joint modeling approaches were conducted in data analysis. Joint modeling was conducted for analysis of non-adherence to medication and the time to default from treatment. In the joint model, a GLMM and Cox PH sub-models were fit together for non-adherence to medication and time to default from treatment.</p> <p><strong>Results:</strong> The significant predictors for the variables of interests in current investigation were length of visiting time(AOR of 95% CI=0.866 (0.752, 0.997), female patients(AOR of 95% CI= 0.219 (0.067, 0.717)), patients disclosed the disease(AOR of 95% CI= 0.353 (0.194,0.641)), patients who got social support(AOR of 95% CI= 0.252 (0.194,0.631)), patients living with parter(AOR of 95% CI=0.188 (0.042,0.844)), patients with owner of cell phone(AOR of 95%CI= 0.272 (0.081,0.916)), urban HIV patients(AOR of 94%CI= 0.238 (0.078,0.722)), patients with working functional status(AOR of 95% CI= 0.234 (0.079,0.692)), patients with normal BMI(AOR of 95% CI=0.921 (0.881, 0.963)), patients with high baseline CD4 cell count(AOR of 95% CI=0.873 (0.552, 0.997)).</p> <p><strong>Conclusion:</strong> Some groups of HIV patients were non-adherent to medication and defaulted from treatment. Health related education is recommended for non-adherent patients to be adherent for the prescribed medication and live long in the treatment.</p> <p><strong>Keywords:</strong> Non-adherence; separate model; joint model; time to default; HAART.</p> 2022-04-29T00:00:00+00:00 Copyright (c) Factors affecting adherence to anti-retroviral therapy among women attending HIV clinic of a tertiary health institution in SouthEastern, Nigeria 2022-05-02T02:40:23+00:00 Hope C Opara Peace N Iheanacho Blessing Nebo Justin A Ingwu Chinenye J Anetekhai Agnes N Anarado <p><strong>Background:</strong> Strictly adherence to antiretroviral therapy (ART) is needed to achieve viral suppression. Studies have focused on HIV positive pregnant women’s adherence. Factors affecting non-pregnant HIV positive women’s adherence has been understudied in Enugu</p> <p><strong>Objective:</strong> The study objective was to identify factors affecting adherence to ART among HIV positive women attending retroviral clinic of a tertiary hospital in Enugu.</p> <p><strong>Methods:</strong> Using a descriptive cross-sectional design, a pre-tested structured questionnaire was used for data collection among 286 HIV positive women aged 18 years and above. Data were analyzed using descriptive statistics of proportions, percentages, and means. Responses with a mean score of ≥2.5 were taken as important factor affecting adherence.</p> <p><strong>Results:</strong> Overall adherence was 56.2%. Participants were considered adherent if they took ≥95% of their prescribed ART. Lack of transport fare (2.69 ±1.36), long-distance to clinic (2.82±1.26), health workers’ poor attitude (2.74±1.28), and lack of partners’ and parents’ support (2.57±1.05) affected adherence negatively while ease in renewing prescription and minimal side effects of drugs enhanced adherence. Enfuvirtide (21.1%) and Lamivudine (17.4%) were drugs that were mostly<br>skipped.</p> <p><strong>Conclusions:</strong> Adherence to ART was low among the women attending the HIV clinic in Enugu. Adherence counseling and education should be provided before ART initiation. Strategies to reduce stigma, increase family support, and improve healthcare providers’ attitudes should be employed.</p> <p><strong>Keywords:</strong> Adherence; anti-retroviral therapy; factors; women; HIV Clinic; Enugu.</p> 2022-04-29T00:00:00+00:00 Copyright (c) Magnitude and trend of HIV and Treponema pallidum infections among blood donors in Offinso-North District, Ghana: a nine-year retrospective, cross-sectional study 2022-05-09T10:43:06+00:00 Charles Nkansah Dorcas Serwaa Felix Osei-Boakye Richard Owusu-Ampomah <p><strong>Introduction:</strong> Blood transfusion poses a high public health risk to recipients; hence no effort recommended to eradicate or minimize the danger of transmitting the infections.<br>bReproductive Biology should be underestimated at minimizing the risk of TTIs. This study determined the prevalence and trend of HIV and syphilis infections in voluntary blood donors.</p> <p><strong>Method:</strong> A retrospective analysis of secondary data from consecutive prospective voluntary blood donors who accessed Nkenkaasu District Hospital’s Blood Bank from January 2010 to December 2018 was conducted.</p> <p><strong>Result:</strong> Cumulatively, HIV and <em>Treponema pallidum</em> seropositivity identified in the present study was high (19.1%, [95% C.I (0.026-0.028)]) . The prevalence of HIV and syphilis infections were 10.9% (95% C.I (0.098-0.120)) and 8.9% (95% C.I (0.073-0.92)) respectively. Prospective female blood donors were less likely to test positive for <em>T. pallidum</em> than males (OR 0.511, [0.340 – 0.769], p=0.001), but the infection was similar among different ages. The data showed downward trend for both HIV and <em>T. pallidum</em> seropositivity, (slope=-2.9467, p&lt;0.0001) and (slope=-0.7117, p&lt;0.0001) respectively.</p> <p><strong>Conclusion:</strong> Seroprevalence of HIV and <em>Treponema pallidum</em> were high, and their individual or combined seropositivity pose a significant threat to the safety of blood. Extensive and continuous screening for high-risk behaviours and infectious markers before blood donation is therefore Unit, Department of Obstetrics and Gynaecology, College of Medicine, Pan African University of Life and Earth Sciences Institute (PAULESI), University of Ibadan, Ibadan, Nigeria.</p> <p><strong>Keywords:</strong> Blood donors; HIV; magnitude; trend; <em>Treponema pallidum</em>.</p> 2022-04-29T00:00:00+00:00 Copyright (c) Detection of tem-1 and class-1 integrons in multidrug resistant uropathogens from HIV patients with asymptomatic bacteriuria in a Tertiary Care Hospital, SouthWest Nigeria 2022-05-02T03:21:06+00:00 Olubisi Ajala Babatunde Odetoyin Temilola Owojuyigbe Adebola Onanuga <p><strong>Background:</strong> Human immunodeficiency virus (HIV) infected individuals are at increased risk of asymptomatic bacteriuria (ASB) due to immune suppression. The increasing resistance of uropathogens necessitates the need for regular monitoring of their profile to reduce drug resistance.</p> <p><strong>Objectives:</strong> We determined the prevalence of ASB and the characteristics of antibiotic-resistant uropathogens isolated from HIV patients.</p> <p><strong>Methods:</strong> Mid-stream urine samples from 100 HIV positive and 100 HIV negative healthy individuals were cultured for significant bacteriuria. The isolates were identified by standard techniques and their susceptibility patterns determined by the Kirby-Bauer disc diffusion technique. All the Gram-negative isolates were screened for ESBL production by combined disc method, ESBL genes and class 1 integrons by Polymerase chain reaction.</p> <p><strong>Results:</strong> Nine (9%) HIV positive individuals and 4 (4%) healthy individuals had ASB yielding a total of 13 (6.5%) uropathogens dominated by Escherichia coli (53.9%). All isolates were multidrug resistant. Five isolates harboured both the blaTEM-1 gene and class 1integrons while Serratia liquefaciens produced ampC.</p> <p><strong>Conclusion:</strong> There is a higher burden of ASB characterized by multi-drug resistant uropathogens among HIV patients. Thus emphasizing the need for continuous resistance surveillance and antibiotic stewardship in our environment to reduce drug resistance and prevent treatment failure.</p> <p><strong>Keywords:</strong> Antimicrobial resistance; TEM 1; asymptomatic bacteriuria; HIV; uropathogens; Class 1 integrons.</p> 2022-04-29T00:00:00+00:00 Copyright (c) Co-occurrence of antibiotic resistance and virulence Genes in Methicillin Resistant Staphylococcus aureus (MRSA) Isolates from Pakistan 2022-05-02T03:49:13+00:00 Ufaq Tasneem Mahnoor Majid Khalid Mehmood Redaina Fazal Ur Rehman Saadia Andleeb Muhsin Jamal <p><strong>Introduction:</strong> Methicillin resistant <em>Staphylococcus aureus</em> (MRSA) is one of the major human pathogen that is associated with hospital as well as community acquired infections and is responsible for huge amount of life-threatening diseases.</p> <p><strong>Objective:</strong> Objective of the study was to determine MRSA prevalence, their antibiotic sensitivity patterns, frequency of virulence genes (sea, seb, sed, tst, hla, hld) and their co-occurrence with resistance marker mecA among Rawalpindi and its nearby regions of Pakistani clinical isolates.</p> <p><strong>Methodology:</strong> The present study was carried out to identify the virulence and antibiotic resistance genes that co-occur in MRSA through polymerase chain reaction. Antibiotic sensitivity, presence of virulence genes and their co-occurrence with resistance marker mecA were analyzed.</p> <p><strong>Results:</strong> These isolates were found resistant to number of antibiotics i.e. Amoxicillin (16.1%), Cefixime (48.38%), Doxycycline (27.415), Trimethoprim/sulfamethoxazole (37.09%), Clindamycin (30.64%), Erythromycin (83.87%), Penicillin (100%), Vancomycin (4.83%), Ciprofloxacin (70.96%), Tetracycline (20%), Linezolid (3.22%) and Fusidic acid (11.295). The frequency of antibiotic resistant gene (mecA) was 69.35% and that of virulence genes hla, hld, sea, seb, sed and tst was 100, 100, 53.2, 30.6, 3.2 and 24.2% respectively. Amongst all examined genes, hla and hld genes had the highest and sed gene had the lowest frequency. The maximum coexistence of genes was observed for hla+hld+mecA gene combination (42 out of 62 isolates).</p> <p><strong>Conclusion:</strong> This study reports the presence of multidrug resistant, vancomycin-resistant and mecA negative MRSA isolates in infected patients of Rawalpindi and nearby regions of Pakistan that may have attributed to treatment failures, adaptability of new virulence characteristics and spread of antibiotic resistance.</p> <p><strong>Keywords:</strong> Methicillin resistant <em>Staphylococcus aureus</em>; Antibiotic resistance; Virulence; mecA; Pakistan.</p> 2022-04-29T00:00:00+00:00 Copyright (c) Sero-prevalence of Hepatitis B virus surface antigen and associated factors among women of reproductive age in Bench Maji Zone, Southwest Ethiopia: Community based cross-sectional study 2022-05-02T04:03:15+00:00 Alemayehu Sayih Belay Sisay Shewasinad Yehualashet Dejene Derseh Abateneh Kindie Mitiku Kebede <p><strong>Background:</strong> Hepatitis B virus infection is one of the leading causes of liver diseases which occurs worldwide particularly in developing countries. It is often caused by prenatal transmission from mother to child or household transmission from a close contact during early childhood. It causes different complications like; jaundice, induces premature labor, and prematurity.</p> <p><strong>Objective:</strong> The aim of this study was to estimate the sero-prevalence of hepatitis B virus surface antigen and associated factors among women of reproductive age in Bench Maji Zone, South West Ethiopia.</p> <p><strong>Methods:</strong> A community-based cross-sectional study was conducted from December 15th, 2016 to February 15th, 2017. Multistage sampling technique was applied to select study participants. Logistic regression analysis was applied and p-values &lt; 0.05 was used to see the significant association between dependent and independent variables.</p> <p><strong>Results:</strong> A total of 330 participants were included in this study yielding 98.8% response rate. The sero-prevalence of hbsag among women of reproductive age was 28(8.5%). Having multiple sexual partners (AOR = 18.73, 95% CI = [3.65, 96.21) history of unprotected sex (AOR = 9.39, 95% CI = [1.64, 53.77) were found to be significantly associated with sero-prevalence of HBV.</p> <p><strong>Conclusions:</strong> The sero-prevalence of HBV infection among women of reproductive age was highly endemic. Hence, behavioral education and communication programs focusing on reduction of risky sexual behaviors should be designed to reduce HBV infection.</p> <p><strong>Keywords:</strong> Ethiopia; Hepatitis B virus; Hepatitis B surface antigen; women; reproductive age.</p> 2022-04-29T00:00:00+00:00 Copyright (c) Prevalence and risk factors of Hepatitis D virus antibody among asymptomatic carriers of Hepatitis B virus: a community survey 2022-05-02T04:17:00+00:00 Uchenna C Okonkwo Henry C Okpara Kenneth Inaku Tony M Aluka Evaristus S Chukwudike Yeonun Ogarekpe Emin J Emin Osim Hodo Akaninyene A Otu <p><strong>Background:</strong> Hepatitis D virus (HDV) can cause a chronic infection in the presence of hepatitis B surface antigen and contribute to the burden of chronic liver disease especially in regions where chronic hepatitis B virus (HBV) infection is endemic.</p> <p><strong>Aim:</strong> To determine the prevalence and risk factors of HDV among asymptomatic carriers of HBsAg in Cross River State, Nigeria.</p> <p><strong>Methods:</strong> This was a cross-sectional study conducted among apparently healthy adults resident in Cross River State, Nigeria. A structured questionnaire was used to collect socio-demograhic data and risk factors for HBV/HDV infection. Participants blood samples were screened for HBsAg. Samples that were HBsAg positive were further screened for anti-HDVIgM. Statistical analysis was performed using statistical package for social sciences (SPSS) version 20.</p> <p><strong>Results:</strong> A total of 90 HBsAg positive samples were assayed. The prevalence of anti-HDV IgM was 5.6% (95% CI 1.1-10.1). The HDV positive subjects were mostly females (80%), reported family size of &gt;5 members (80%), had female circumcision (75%) and took injections from Non-certified health care practitioners (NCHCPs). None of the assessed risk factors were significantly associated with HDV infection (p &gt;0.05).</p> <p><strong>Conclusion:</strong> Hepatitis D virus is moderately prevalent amongst asymptomatic HBsAg carriers in Cross River State, Nigeria.</p> <p><strong>Keywords:</strong> Hepatitis D virus; Hepatitis B virus; community survey.</p> 2022-04-29T00:00:00+00:00 Copyright (c) Circulation of hepatitis B virus genotype-E among outpatients in tertiary hospitals in the Niger-Delta region of Nigeria 2022-05-02T04:30:13+00:00 Chinenye F Umego Clement I Mboto Atim D Asitok Linda C Osaji Uwem E George Uwem O Edet Elizabeth N Mbim Temitope OC Faleye Olubusuyi M Adewumi Johnson A Adeniji <p><strong>Introduction:</strong> Hepatitis B virus (HBV) infection continues to be a significant public health challenge globally, with higher disease burden in developing countries. HBV genotypes are associated with different geographical regions and clinical outcomes. Limited information exists on epidemiology of HBV in the Niger-Delta region (South-South) of Nigeria. Consequently, this study was designed to characterise hepatitis B virus infection among outpatients in selected tertiary hospitals in the region.</p> <p><strong>Methodology:</strong> Between June and August 2017, consenting nine hundred asymptomatic out-patients were enrolled and initially screened for HBV infection using one step Hepatitis B surface antigen (HBsAg) strip and subsequently re-tested using HBsAg and Hepatitis B core total antibody (anti-HBc) specific Enzyme-Linked Immunosorbent Assay (ELISA). Blood serum with detectable HBsAg were subsequently subjected to DNA extraction, S-gene amplification using a nested polymerase chain reaction (PCR) protocol, gel electrophoresis, sequencing and phylogenetic analysis.</p> <p><strong>Results:</strong> Seroprevalence of HBsAg was 4.6% (95% CI 2.5-7.1) and anti-HBc was 10.1% (95% confidence interval (CI) 6.1-15.3). Of the 41 HBsAg positive samples subjected to DNA extraction and HBV S-gene specific PCR, only 6 (14.6%) yielded the expected~408bp band. Phylogenetic analysis based on HBV pre-S/S sequences identified all six typable samples as genotype E, subtype ayw4 of the West African clade.</p> <p><strong>Conclusion:</strong> Results of the study confirm the presence and circulation of HBV genotype-E in the Niger-Delta region of Nigeria, thus corroborating the inclusion of the country in the Genotype E crescent. The authors advocate value-added HBV intervention in the region and the country at large.</p> <p><strong>Keywords:</strong> HBsAg; HBV; Niger-Delta; Nigeria; South-South.</p> 2022-04-29T00:00:00+00:00 Copyright (c) Incidence of Dengue fever, serotypes, clinical features, and laboratory markers: a case study of 2019 outbreak at district Shangla, KP, Pakistan 2022-05-02T04:42:43+00:00 Abid Ur Rehman Faheem Anwar Muhammad Tayyab Ihteshamul Haq Mohsina Haq Ashfaq Ahmed Hala Haq Abbas Saleem Khan <p><strong>Background:</strong> Dengue is a widely spread mosquito-borne infection in humans, which in recent decades declared is public health problem globally. The dengue virus contains 4 different serotypes (DENV-1, DENV-2, DENV-3, and DENV-4) which belong to the genus Flavivirus.</p> <p><strong>Aims:</strong> A descriptive experimental study was conducted to determine the epidemiology, types of Dengue serotypes, clinical features, laboratory probe, and markers for primary diagnosis of dengue virus infection in hospitalized patients.</p> <p><strong>Methodology:</strong> A total of 691 suspects were diagnosed from August to October 2019 in district Shangla KP, Pakistan. Serological tests were used for nonstructural protein-1 antigen (NS1), and antibodies (immunoglobulin-M (IgM) &amp; Immunoglobulin-G (IgG)) while real-time PCR was used to confirm the cases. The data was statistically analyzed using IBM-SPSS Statistics 20 version.</p> <p><strong>Results:</strong> The dengue virus infection was more prevalent in the male group (68.09%) than the female group (31.1%). A large number of patients were from rural areas (63.5%) while from urban areas were (36.4%), whereas Besham tehsil was found the most affected compared to other regions. The most prevalent serotype observed in our study was DENV-3 (56.60%) while DENV-4 was the least prevalent serotype (1.88%). Among the age-wise analysis of dengue-virus-infected individuals, the age group of 19–37 years (64.07%) was found the most affected group. The month-wise analysis revealed that the highest number of infections (49.8%) were recorded in September. Significant differences were noticed among blood parameters.</p> <p><strong>Conclusion:</strong> The possible reasons for the dengue overwhelming in the study area could be less or lack of awareness particularly regarding the transmission of viral infections, improper sewage management, and no effective vector control strategies that lead the dengue outbreaks in the study population.</p> <p><strong>Keywords:</strong> Dengue; Outbreak; DENV; real-time PCR; RNA Virus; Pakistan.</p> 2022-04-29T00:00:00+00:00 Copyright (c) Anxiety and depression levels of healthcare workers during the Covid-19 pandemic 2022-05-03T06:36:35+00:00 Onur Turan Nilgün Yılmaz Demirci Güntülü AK Şule Akçay Ülkü Aka Aktürk Semra Bilaçeroğlu Funda Coşkun Oğuz Köktürk Arzu Mirici Cengiz Özdemir Nazan Şen Ülkü Yilmaz <p><strong>Background:</strong> Coronavirus disease 2019 (covid-19), which causes a pandemic in the world, has started to appear in turkey since March 2020. Healthcare workers are at the top of the groups most at risk for covid-19 infection, which can have a negative impact on psychological state.</p> <p><strong>Objectives:</strong> It was aimed to evaluate anxiety and depression levels among healthcare workers.</p> <p><strong>Methods:</strong> this cross-sectional study performed via an online survey in april 2020. Participants answered questions about sociodemographic features, personal views and experiences about covid-19 and the hospital anxiety and depression scale (hads).</p> <p><strong>Results:</strong> A total of 300 healthcare workers,193 men and 107 women, participated in the survey. According to hads, 44.6% of participants scored above anxiety and 68.2% scored above depression cut-off points. Being younger than 50 and taking care of covid-19 patients in hospitals were independently associated with anxiety risk. Female gender, young age (less than 50) and having comorbidity were independent risk factors for depression.</p> <p><strong>Conclusion:</strong> Healthcare workers were at high risk of anxiety and depression during covid-19 outbreak. For this reason, psychological support should be given, especially to the group with high risk.</p> <p><strong>Keywords:</strong> Healthcare workers; anxiety; depression; covid-19</p> 2022-04-29T00:00:00+00:00 Copyright (c) A gender comparison of psychological distress among medical students in Nigeria during the Coronavirus pandemic: a cross-sectional survey 2022-05-03T07:11:44+00:00 Oluwaseun Mercy Idowu OyinOluwa Gloria Adaramola Boluwatife Samson Aderounmu Ifeoluwa Delight Olugbamigbe Olaoluwa Ezekiel Dada Adeyinka Christopher Osifeso Oluseun Peter Ogunnubi Oluwakemi Ololade Odukoya <p><strong>Background:</strong> The Coronavirus disease (COVID-19) pandemic as a large scale stressor could have negative effects on the mental health of medical students. Since gender differences in mental health may exist, it is important to see if a large scale stressor like the pandemic may be associated with variances in the psychological distress between both genders.</p> <p><strong>Objectives:</strong> To assess and compare the psychological distress of male and female medical students during the COVID-19 pandemic.</p> <p><strong>Methods:</strong> A cross-sectional survey was carried out among 1010 medical students from three universities in southwestern Nigeria within the first six months of the first reported case of the COVID-19 pandemic. The respondents were purposively selected. Data was obtained online on participants’ demographic and psychological distress using the General Health Questionnaire 12 (GHQ-12). Data was analyzed using the SPSS version 21, student t and chi-square tests were used to assess gender differences, and multivariate regression to assess the predictors of psychological distress among both genders. p values less than 0.05were considered statistically significant.</p> <p><strong>Results:</strong> Overall, female participants (OR=1.455, 95% CI= 1.095-1.936) were twice more likely to have experienced psychological distress than males during the COVID-19 pandemic. Age (OR=0.922, 95% CI= 0.867-0.979), being in pre-clinical years (OR= 1.394, 95% CI= 1.004-1.938), having a family income less than 100,000 naira (OR= 1.379, 95% CI=1.442-6.723) a previous history of mental illness (OR=3.077, 95% CI= 1.430-6.615) and having a relative/acquaintance diagnosed with COVID 19(OR=1.646, 95% CI= 1.062-2.551) were independently associated with psychological distress among the respondents. When comparing both genders,<br>among females, age (OR=0.886, 95% CI= 0.803-0.978), family income less than 100,000 naira (OR=1.898, 95% CI= 1.306-2.759) and a previous history of mental illness (OR=5.266, 95% CI= 1.894-14.635) were associated with psychological distress, while, being in pre-clinical years (OR= 1.713, 95% CI= 1.052-2.790) was associated with psychological distress among males.</p> <p><strong>Conclusion:</strong> Females had more psychological distress compared to male students. It is recommended that gender-specific interventions addressing psychological distress among medical students are instituted.</p> <p><strong>Keywords:</strong> Psychological distress; psychological impact; gender; COVID-19; medical students.</p> 2022-04-29T00:00:00+00:00 Copyright (c) Perceptions about tuberculosis and perceived tuberculosis-related stigma and associated factors among the mining community in Eswatini 2022-05-03T08:03:16+00:00 Charles Maibvise Mduduzi Shongwe Vama Jele Priscilla Dlamini Wisdom Chiviya <p>NIL</p> 2022-04-29T00:00:00+00:00 Copyright (c) Mycobacterium tuberculosis mixed infections and drug resistance in sub-Saharan Africa: a systematic review 2022-05-03T08:19:04+00:00 Lisa Nkatha Micheni Serawit Deyno Joel Bazira <p><strong>Background:</strong> Sub-Saharan Africa, is a region that records high rates of TB infection. Mycobacterium tuberculosis mixed strain infection, especially when the strains involved are of different susceptibilities, is an area of great interest because it is linked with an increased risk of treatment failure and transmission of resistant strains within the population. This paper reviewed original studies that reported MTB mixed infection and heteroresistance in the region between 2010 and 2020 to understand the extent of mixed strain infection and heteroresistance in the region. This information is very critical in the control of TB and ending the TB epidemic by 2035 as per the World Health Organization's vision.</p> <p><strong>Methods:</strong> Pubmed, Scopus, JSTOR, AJOL, and Google Scholar databases were searched through both key terms and subject headings. The literature was screened, assessed for the quality and evidence synthesized.</p> <p><strong>Results:</strong> Eighteen original articles were included in this review after having met the inclusion criteria. The frequency of mixed strain infection reported in these studies varied between 2.8% and 21.1% while drug resistance range between 0.06% to 19% depending on the study design and the drug susceptibility screening technique utilized. The majority of the studies (50%) utilized Spoligotyping in conjunction with MIRU-VNTR typing in the detection of mixed infections.</p> <p><strong>Conclusion:</strong> Despite the scarcity of data on mixed infections and heteroresistance in sub–Saharan Africa, various studies have revealed that these conditions are frequent in the region than previously thought. Given the evidence of the effect of mixed infections on drug resistance and treatment outcome, we conclude that mixed infection is an unavoidable topic for future studies.</p> <p><strong>Keywords:</strong> Tuberculosis; mixed infection; drug resistance.</p> 2022-04-29T00:00:00+00:00 Copyright (c) The EPIYA-ABCC motif of Helicobacter pylori cagA gene and gastric carcinogenesis in Casablanca population 2022-05-03T08:42:32+00:00 Mohamed R Jouimyi Ghizlane Bounder Hasna Boura Imane Essaidi Asmaa Bendahmane Hakima Benomar Khalid Zerouali Halima Lebrazi Anass Kettani Valérie C Gbonon Maachi Fatima <p><strong>Background:</strong> <em>H. pylori</em> infection induce atrophic gastritis (AG) and intestinal metaplasia (IM) that can lead to gastric cancer (GC). The severity of gastric lesions is related to <em>H. pylori</em> genetic diversity. The oncogenic potential of<em> H. pylori</em> cagA virulence factor is linked to its high polymorphic EPIYA motifs.</p> <p><strong>Objectives:</strong> Our aim was to evaluate the association of EPIYA motifs with the risk of AG and IM in Casablanca population.</p> <p><strong>Methods:</strong> A total of 210 patients suffering from gastric lesions (chronic gastritis, AG, and IM) was enrolled. <em>H. pylori</em> infection and the type of lesions were diagnosed by ureC PCR and histological examination, respectively. Detection of the cagA gene, and the type of EPIYA motifs, were carried out by PCR</p> <p><strong>Results:</strong> The prevalence of <em>H. pylori</em> and cagA gene was 95% and 37%, respectively. CagA-positive strains were associated with the risk of IM. The EPIYA motifs detected were: EPIYA-ABC (58%), EPIYA-ABCC (22%), and EPIYA-AB (20%). The EPIYA-ABCC motif was associated with the risk of IM (p-value = 0.007), compared to AG (p-value = 0.28).</p> <p><strong>Conclusion:</strong> The EPIYA-ABCC motif might be a useful marker for the identification of patients at high risk of developing IM that can lead to GC.</p> <p><strong>Keywords:</strong> cagA gene; EPIYA motifs; gastric carcinogenesis.</p> 2022-04-29T00:00:00+00:00 Copyright (c) Diarrhoeagenic Escherichia coli isolated from children with acute diarrhoea at Rakai hospital, Southern Uganda 2022-05-03T09:02:06+00:00 Fredrick Masiga Edgar Kigozi Christine Florence Najjuka Henry Kajumbula David Patrick Kateete <p><strong>Background:</strong> Diarrhoeagenic <em>Escherichia coli</em> (DEC) is a leading cause of childhood diarrhoea. This study estimated the prevalence of DEC and DEC pathotypes among children with acute diarrhoea in Southern Uganda.</p> <p><strong>Methods:</strong> A cross-sectional study was conducted on 267 children less than 5 years with acute diarrhoea, admitted to Rakai General Hospital in Southern Uganda. Faecal samples were collected from the children and processed for isolation of <em>E. coli</em>. The presence of DEC and the distribution of DEC pathotypes were determined by polymerase chain reaction.</p> <p><strong>Results:</strong> A total of 102 (38.2%, 102/267) children had DEC of various pathotypes – enteroaggregative <em>E. coli</em> (EAEC) (14.2%); enteropathogenic <em>E. coli</em> (EPEC) (6.7%); enterotoxigenic <em>E. coli</em> (ETEC) (6%); enteroinvasive <em>E. coli</em> (EIEC) (7.5%); enterohemorrhagic <em>E. coli</em> (EHEC) (3%); and cell-detaching <em>E. coli</em> (CDEC) (0.75%). The difference in the overall prevalence of DEC was not significant regarding HIV but individually, EAEC and CDEC were associated with HIV-positive status while ETEC was associated with HIV-negative status.</p> <p><strong>Conclusions:</strong> DEC is prevalent in children with acute diarrhoea in Southern Uganda and its identification in children should be considered among strategies for combatting childhood diarrhoea in Africa.</p> <p><strong>Keywords:</strong> Childhood diarrhea; <em>Escherichia coli</em>; Diarrhoeagenic <em>Escherichia coli</em> (DEC); Enteroaggregative <em>Escherichia coli</em> (EAEC); Enteropathogenic <em>Escherichia coli</em> (EPEC); Enterotoxigenic <em>Escherichia coli</em> (ETEC); Enteroinvasive <em>Escherichia coli</em> (EIEC); Enterohemorrhagic <em>Escherichia coli</em> (EHEC); Rakai General Hospital; Uganda.</p> 2022-04-29T00:00:00+00:00 Copyright (c) Resistance of Anopheles gambiae sensu lato to Pirimiphos-methyl Insecticide in Kakamega County, Highlands of Western Kenya 2022-05-03T09:29:40+00:00 Nicholas Kitungulu Bernard Guyah Mark Webale Nathan Shaviya Maxwell Machani David Mulama Bryson Ndenga <p><strong>Background:</strong> Insecticide treated bed nets and Indoor residual spraying remains the principal interventional malaria control strategies. To achieve malaria disease eradication, vector control programmes that monitor insecticide resistance profiles are necessary.</p> <p><strong>Objective:</strong> The study evaluated pirimiphos-methyl susceptibility of <em>Anopheles gambiae</em> sensu lato in Kakamega County, western Kenya.</p> <p><strong>Methods:</strong> Adult Anopheles gambiae sensu lato mosquitoes were assayed using World Health Organization tube bioassay against 0.25% pirimiphos-methyl. Susceptible and non-susceptible populations were characterized to species-level using Polymerase Chain Reaction. Susceptible and resistant mosquitoes were further subjected to G119S Acetylcholisterase (ace 1R) mutation detection.</p> <p><strong>Results:</strong> <em>Anopheles arabiensis</em> was the predominant species in all study population Mumias east (62%), Malava (68%), Ikolomani (77%) and Lurambi (82%). Results showed phenotypic susceptibility to pirimiphos-methyl. Mortality was low in Mumias east (80.6%) and high in Lurambi (89.0%). G119S mutations ranged from 3.0% to 8.9% in <em>Anopheles arabiensis</em> whereas G119S mutations were relatively low ranging from 0.0% to 3.1% in <em>Anopheles gambiae</em> s.s populations. Study populations tested were consistent with Hardy-Weinberg equilibrium (P&gt;0.05).</p> <p><strong>Conclusion:</strong> We observed pirimiphos-methyl resistance in <em>Anopheles arabiensis</em> and <em>Anopheles gambiae</em> s.s. study populations. Results showed G119S mutation in resistance population. Resistance monitoring and management are urgently required.</p> <p><strong>Keywords:</strong> <em>Anopheles gambiae</em> s.l; G119S mutation; Pirimiphos-methyl; Resistance.</p> 2022-04-29T00:00:00+00:00 Copyright (c) Parvovirus b19 infection in children with sickle cell disease, watch out for splenomegaly! A case report 2022-05-03T09:43:47+00:00 Julia Alonso de la Hoz Lucía Llorente Otones Marta Herreros Sáenz María José Rivero Martín <p><strong>Background:</strong> Sickle cell disease (SCD) is an inherited hemoglobinopathy characterized by the presence of hemoglobin S in red blood cells. This polymerizes, distorting the red blood cells, which occlude the microcirculation and have a shorter halflife, giving rise to a chronic hemolytic anemia. This anemia is worsened by parvovirus B19, as it compromises the erythroid precursor, causing a decrease in erythrocyte production. These patients sometimes present with splenic sequestration, characterized by acute blood entrapment in the spleen, with clinical signs of hypovolemic shock. The simultaneous appearance of both leads to an extremely severe situation that requires urgent action.</p> <p><strong>Objective:</strong> To describe the case of a patient with SCD and splenic sequestration, in which the suspicion of concomitant aplastic crisis affected her prognosis.</p> <p><strong>Clinical case:</strong> 3-year-old girl with homozygous SCD, presenting with fever, cough, vomiting and pain in the lower limbs. Upon arrival, hemodynamic instability, mucocutaneous pallor, and splenomegaly were observed. Hemogram on admission showed an acute drop in haemoglobin level with reticulocytopenia. Splenic sequestration was suspected, along with aplastic crisis, so she received a blood transfusion, subsequently showing progressive improvement. Human parvovirus B19-specific IgM and IgG antibodies were detected in the serum.</p> <p><strong>Conclusion:</strong> Patients with SCD and parvovirus B19 infection must be closely observed for splenomegaly since an early identification of an enlarging spleen can lead to an early diagnosis of this complication.</p> <p><strong>Keywords:</strong> Sickle cell disease; child; human parvovirus b19; splenomegaly; aplastic anemia; splenic sequestration.</p> 2022-04-29T00:00:00+00:00 Copyright (c) Molecular detection of pathogenic bacteria in the colonic biopsies from patients with Ulcerative Colitis 2022-05-03T10:01:20+00:00 Thanaa El A Helal Hoda E El Abdel Wahab Sally M Saber Waleed H Abdelaaty Mohamed M Eltabbakh Ahmed M Aref Mohamed H Dawood <p><strong>Background/Aim:</strong> Ulcerative Colitis (UC) is an inflammatory bowel disease which is common in many areas of the world including Egypt. A lot of controversy regarding the pathogenesis of UC exist. The current study is an attempt to detect some pathogenic bacteria in UC patients.</p> <p><strong>Materials and methods:</strong> Endoscopic colonic biopsies obtained from 40 patients with ulcerative colitis and 20 controls were analyzed by means of real-time PCR technique for the presence of <em>Clostridium difficile</em>, <em>Helicobacter Pylori</em> (<em>H. pylori</em>) and pathogenic <em>Escherichia Coli</em> (<em>E. coli</em>) which are positive for KPC and/or OXA-48.</p> <p><strong>Results:</strong> All patients and control samples were negative for <em>Clostridium difficile</em>. Three of the 40 patient samples (7.5%) and none of the 20 controls were positive for <em>H. pylori</em> with no significant difference between the two groups. KPC-positive <em>E. coli</em> were detected in 11 of the 40 patients (27.5%) and in none of the controls with a significant difference between the two groups (P=0.01). All patients and control samples were negative for OXA-48 positive <em>E. coli</em>.</p> <p><strong>Conclusion:</strong> Although this study does not support the claim that <em>Clostridium difficile</em> and/or <em>H. pylori</em> have a role in UC, it greatly suggests that pathogenic <em>E. coli</em> may be involved in one way or another in the course of UC.</p> <p><strong>Keywords:</strong> Ulcerative colitis; Colonic biopsies; <em>Clostridium difficile</em>; <em>H. pylori</em>; <em>E. coli</em>.</p> 2022-04-29T00:00:00+00:00 Copyright (c) The predictive role of psychological toughness and adaptability on the actual well-being of mothers with handicapped children 2022-05-03T10:34:03+00:00 Mir Hamid Salehian <p><strong>Background and Aim:</strong> Handicapped children cause psychological problems for mothers. As mothers' actual well-being is so important in the family and society, the aim of this research was to predict the role of psychological toughness and adaptability on the actual well-being of mothers with handicapped children.</p> <p><strong>Materials and Methods:</strong> The research was descriptive correlational study with volunteer mothers of handicapped children (n=150). Data collection tools were: Ahwaz Kiamarsi et al. (1998) psychological toughness questionnaire, Connor and Davidson adaptability scale (2003), Lyubomerisky and Leper actual well-being scale (1999) and Diener life satisfaction scale (2009). Pearson correlation coefficient and multiple linear regression analysis were used to analyze the data using SPSS 21 version.</p> <p><strong>Results:</strong> The results showed that psychological toughness and its components (commitment, control, struggle) have a significant positive relationship with the actual well-being of mothers with handicapped children and its dimensions (actual well-being and life satisfaction) and is able to predict their well-being.</p> <p><strong>Discussion:</strong> Therefore, it can be said that by promoting adaptability, mothers with handicapped children can resist and overcome stressors as well as factors that cause many psychological problems. By reducing psycho-emotional problems in mothers, mental well-being and life satisfaction are improved.</p> <p><strong>Conclusion:</strong> The actual well-being of mothers with handicapped children can be predicted by their psychological toughness and adaptability.</p> <p><strong>Keywords:</strong> Psychological toughness; adaptability; actual well-being; handicapped children.</p> 2022-04-29T00:00:00+00:00 Copyright (c) Cataract surgery outcomes: comparison of the extracapsular cataract extraction and manual small incision cataract surgery techniques 2022-05-03T10:48:24+00:00 Amukelani Jimmy Zitha Nishanee Rampersad <p><strong>Background:</strong> Blindness and visual impairment are public health problems and constitute an important socio-economic burden in sub-Saharan Africa. Understanding the outcomes of cataract surgery will improve our knowledge of risk factors for poor outcomes. Previous studies have focused exclusively on the phacoemulsification technique with limited attention to the extracapsular cataract extraction (ECCE) and manual small incision cataract surgery (MSICS) techniques.</p> <p><strong>Objectives:</strong> To compare the cataract surgery outcomes between the ECCE and MSICS techniques.</p> <p><strong>Methods:</strong> The study was an observational research design that used the LogMAR visual acuity (VA) chart, subjective refraction, slit lamp and ophthalmoscope to collect data. The participants were followed for a period of six-weeks post-surgery and outcomes were recorded. Data were presented using frequencies, percentages and means ± standard deviation.</p> <p><strong>Results:</strong> The sample included 101 participants, with a mean age of 66.32 ± 15.99 years. Fifty and 51 participants had undergone the ECCE and MSICS techniques respectively. Overall, one-hundred participants had poor pre-surgery VA and subjective refractions were generally not possible due to the severity of cataracts present. The mean aided post-surgery VA was 0.31 LogMAR and 0.13 LogMAR in the ECCE and MSICS groups respectively (p &lt; 0.001). The mean post-surgery refractive astigmatism was similar in the ECCE (-2.06 D) and MSICS (-1.80 D) groups (p = 0.110). The spherical equivalence was approximately -0.50 D higher in the MSICS group, but not statistically significant (p = 0.330). Approximately one out of every five participants (n = 21) had post-surgery ocular complications such as corneal opacity and haziness as well as posterior capsular absence.</p> <p><strong>Conclusions:</strong> The MSICS technique showed better post-surgery outcomes than the ECCE technique.</p> <p><strong>Keywords:</strong> Cataract surgery outcomes; extracapsular cataract surgery; manual small incision cataract surgery; ocular complications.</p> 2022-04-29T00:00:00+00:00 Copyright (c) The expression analysis of IL-6, IL-18, IL-21, IL-23, and TGF-β mRNA in the nasal mucosa of patients with Allergic rhinitis 2022-05-03T11:06:55+00:00 Yousef Mirzaei Zohreh Savari Farshad Yazdani-Nafchi Najmeh Salehi-Vanani Elnaz Fallahi Ashkan Pirayesh Mohammadali Zahmati Maryam Anjomshoa Nader Bageri Milad Sabzevary-Ghahfarokhi Hedayatollah Shirzad Mohamad Ali Zamani <p><strong>Background:</strong> The profile of inflammatory and suppressing cytokines is important to contribute to the disruption of TH1/TH2 balance in Allergic rhinitis (AR).</p> <p><strong>Objective:</strong> This study aimed to assess the expression levels of IL-6, IL-18, IL-21, IL-23, and TGF-β in nasal biopsies in AR patients and evaluate its correlation with the severity of AR.<br>Material and method: The study included 30 patients with mild persistent allergic rhinitis (MPAR), patients with moderate-to-severe (M/S) PAR, and 30 healthy individuals. The biopsies of nasal inferior turbinate mucosa were collected from each participant. The expression of IL-6, IL-18, IL-21, IL-23, and TGF-β was evaluated by the quantitative real-time polymerase<br>chain reaction. The degree of eosinophil infiltration into the nasal mucosa, blood eosinophils, and total serum IgE level were also measured.</p> <p><strong>Result:</strong> The expression of IL-6, IL-18, and IL-23 in patients with AR significantly increased compared to the control group. Conversely, the gene expression of the TGF-β declined in the M/S PAR group rather than the AR- group. The data did not show a significant difference in the expression of the IL-21 gene between AR+ and AR- groups.</p> <p><strong>Conclusion:</strong> We suggested that inflammatory cytokines including IL-6, IL-18, and IL-23 may be involved in the severity of AR and associated with markers of inflammation.</p> <p><strong>Keywords:</strong> Allergic rhinitis; inflammation; interleukin-23; Nasal Mucosa.</p> 2022-04-29T00:00:00+00:00 Copyright (c) Frequencies and ethnic distribution of ABO and RhD blood groups in the Volta region of Ghana, towards effective blood bank services 2022-05-03T11:17:13+00:00 George N Doku William K Agbozo Rabia A Annor Priscilla E Mawudzro Elizabeth E Agbeli <p><strong>Background:</strong> Blood is an essential body fluid for the transport of substances to all parts of the body. Knowledge of blood group distribution within any population is important in determining the direction of blood bank inventory for emergency blood services.</p> <p><strong>Objective:</strong> We report for the first time the blood group distribution pattern for the Volta region of Ghana.</p> <p><strong>Method:</strong> Data were extracted and analyzed from 14,360 medical records of blood donors and recipients at seven major hospitals within the Volta region for a period of seven years (2012 to 2018)</p> <p><strong>Results:</strong> ABO distribution within the region was 46.3%, 18.9%, 24.4%, 3.1%, 4.4%, 1.7%, 1.3% and 0.1% for O+, A+, B+, AB+, O-, A-, B- and AB- blood groups respectively. Rh (D)+ to Rh (D)- ratio was 92.5/7.5% respectively. Blood group O+ (&gt;35 %) was highest in all ethnic groups in the region.</p> <p><strong>Conclusion:</strong> Healthcare facilities in the region should adopt a strategy to stock-pile sufficient O+ blood which is the prevalent blood group in the region. All types of blood groups were reported hence our findings should provide information to guide clinical practice and/or blood transfusion services in the region.</p> <p><strong>Keywords:</strong> ABO and RhD blood groups; Volta region of Ghana; towards effective blood bank services.</p> 2022-04-29T00:00:00+00:00 Copyright (c) Predictivity of fatty liver index for non-alcoholic fatty liver disease in lean females with polycystic ovary syndrome 2022-05-03T13:36:29+00:00 Didem Arıkan Attila Önmez Erson Aksu Nicel Taşdemir <p><strong>Background:</strong> Fatty liver index (FLI) is a simple tool used to predict non-alcoholic fatty liver disease (NAFLD). The role of FLI in polycystic ovary syndrome (PCOS) for the prediction of NAFLD has not been elucidated.</p> <p><strong>Methods:</strong> This case-control study was from January 2014 to January 2016. Anthropometric measurements, biochemical testing, and abdominal ultrasonography were performed in 83 premenopausal otherwise healthy women with PCOS and 58 controls. NAFLD was diagnosed by ultrasound. The predictivity of FLI for NAFLD in lean and overweight/obese females with PCOS was analyzed.</p> <p><strong>Results:</strong> The γ-glutamyl transferase levels were significantly higher in the females with PCOS than in the controls (p = 0.001). In women with PCOS, FLI was significantly higher in females with NAFLD comparing to those without NAFLD (47.1 ± 33.6 vs. 16.9 ± 21.6; p = 0.001). For the PCOS group, Body Mass Index had the strongest relationship with FLI (p &lt; 0.05, r = 0.908). FLI &lt; 30 was calculated for all the lean females. The lean females with PCOS had a significantly higher rate of NAFLD (27.5%<br>vs. 8.8%; p = 0.041) than lean controls.</p> <p><strong>Conclusion:</strong> An FLI &lt; 30 was not sufficient to rule out NAFLD in the lean PCOS patients.</p> <p><strong>Keywords:</strong> Polycystic ovary syndrome; non-alcoholic fatty liver disease; fatty liver index.</p> 2022-04-29T00:00:00+00:00 Copyright (c) Train the trainer: improving health education for children and adolescents in Eswatini 2022-05-03T11:38:21+00:00 E McAdams B Tingey D Ose <p><strong>Background:</strong> Eswatini has the highest HIV prevalence in the world. One issue at the root of health in Eswatini is a lack of basic health knowledge among children and adolescents, which amplifies the likelihood of disease transmission and poor health outcomes.<br><strong>Objectives:</strong> To address the lack of basic health education and to improve health knowledge, we developed and evaluated a medical education program to train shepherds (train-the-trainer) who are supporting children and adolescents at local CarePoints.</p> <p><strong>Methods:</strong> To determine the change between pre-test scores and post-test scores, both a paired t-test and mixed-effects regression were performed.</p> <p><strong>Results:</strong> The program had 67 total participants, mostly female (67.2%), with an average age of 27.1 years. Following the medical education program, participants had a statistically significant increase in post-training scores. Years of prior schooling, age, and gender did not show a statistically significant effect on post-training scores.</p> <p><strong>Conclusion:</strong> Teaching basic health education knowledge to CarePoint shepherds is effective to increase their knowledge and awareness with respect to relevant health topics. This model of directed medical education could be expanded to other community members in Eswatini to bridge gaps in health knowledge and disease awareness. A similar model could be employed in other developing countries with limited health education and limited access to health information.</p> <p><strong>Keywords:</strong> Health Education for Children; Adolescents in Eswatini.</p> 2022-04-29T00:00:00+00:00 Copyright (c) Conceptualization and practices in digital health: voices from Africa 2022-05-03T11:47:22+00:00 Gertjan van Stam <p>This paper presents voices from Africa on digital health in Africa. These voices were gleaned during interviews and an online, focus group session in May 2020, during which 30 experts across Africa, among others from the South, were asked about their experiences and observations on the conceptualisation of, and practices in, digital health in their respective communities and countries. Extensive input was provided, both orally and textually. The quotes gathered and presented in this paper indicate that there is a distinct need for the respectful co-development of digital health interventions in Africa. In addition, the quotes show how a one-size-fits-all solution approach does not exist, it is not a solution to Africa. Further, the community-focus, fit, and fragmentation of existing activities digital health interventions is questioned. The narratives provide a rich resource indicating capable and local agency and the need to address power-differences in international health development.<br><br></p> <p><strong>Keywords:</strong> Digital health; Africa; ethnography.</p> 2022-04-29T00:00:00+00:00 Copyright (c) Vitamin A- and C-rich Pouteria camito fru it derived superparamagnetic nanoparticles Synthesis, characterization, and their cytotoxicity 2022-05-03T12:07:40+00:00 Chinnadurai Veeramani Ahmed S El Newehy Mohammed A Alsaif Khalid S Al-Numair <p><strong>Background:</strong> Recently, green nanoparticles are gaining importance in drug development because of their lower toxicity, sustainability, cost effectiveness, simplicity, and ecofriendly nature compared with toxic chemicals.</p> <p><strong>Objective:</strong> In this study, we developed a nontoxic method for synthesizing iron oxide nanoparticles by using the fruit of Pouteria caimito that is rich in vitamin A and C and evaluated their cytotoxicity.</p> <p><strong>Methods:</strong> Pouteria caimito fruit¬–derived superparamagnetic nanoparticles (PCSNs) were characterized using physical and chemical methods, and their cytotoxicity was examined using the 3-(4, 5-dimethylthiazol-2-yl)-2–5-diphenyltetrazolium bromide (MTT) assay.</p> <p><strong>Results:</strong> Ultraviolet–visible spectroscopy (UV–Vis spectro) analysis of PSNs showed a peak at 277 nm. Transmission electron microscopy (TEM) findings showed that PSNs exhibited a nanorod shape with their sizes ranging from 9.41 nm to 16.96 nm (average size: 13.08 nm). The findings of dynamic light scattering (DLS) indicated that the particle size was 186.<br>6–847.3 d.nm with an average of 367.5 d.nm. The Zeta potential analysis indicated that PSNs exhibited uniform surface charge distribution, and their surface charge was equal to −13.7 mV. Fourier-transform infrared spectroscopy (FTIR) analysis showed background-color:#fcfcfc"&gt;that PSNs exhibited bands at 3412, 1629, 1384, 1075, 818, 697, and 471 cm−1.<br>Energy-dispersive X-ray spectroscopy (EDX) results showed that iron was the major element present in PCSNs, followed by other biomolecules such as C, O, and Cl, indicating the production of iron oxide nanoparticles.</p> <p><strong>Conclusion:</strong> The Pouteria caimito fruit that possesses strong oxidizing and nontoxic properties can be a potentially attractive source for the production of iron oxide nanoparticles. Moreover, the cytotoxicity assay results revealed that iron oxide nanoparticles synthesized using the Pouteria caimito fruit extract derived can be used for targeting cancer cells and treating other diseases because of their nontoxic nature. These nanoparticles can be used for the treatment of cancer and other diseases in the future.</p> <p><strong>Keywords:</strong> Fruit; Pouteria caimito; ferric chloride; superparamagnetic nanoparticles; cytotoxicity.</p> 2022-04-29T00:00:00+00:00 Copyright (c) Knowledge, attitudes, and practices towards drug-food interactions among patients at public hospitals in eThekwini, KwaZulu-Natal, South Africa 2022-05-03T12:17:23+00:00 Emmanuella C Osuala Boikhutso Tlou Elizabeth B Ojewole <p><strong>Background:</strong> Drug-food interactions can lead to adverse drug reactions and therapy failure which can potentially impact patient safety and therapy outcome.</p> <p><strong>Objectives:</strong> This study assessed patients’ knowledge, attitudes and practices regarding drug-food interactions.</p> <p><strong>Methods:</strong> A cross-sectional study was conducted among patients at three public hospitals in eThekwini, KwaZulu-Natal. Statistical analysis was performed using SPSS® version 25. The association between demographic variables and patients’ knowledge, attitudes and practices were assessed.</p> <p><strong>Results:</strong> Of the 342 patients, 70.5% were female, and the mean age was 42.87±0.89 years. Almost 50% of patients had secondary level education, and 64% were unemployed. About 52% of patients had high knowledge of drug-food interactions; however, only 30-50% of the patients could identify potential drug-food interactions of their drugs. More than half<br>of the patients (51.5%) answered that they took multivitamin pills with medications and 61.7% responded they consulted healthcare professionals for drug-food interactions’ information before taking new medications. Few patients (15.2%) had experienced drug-food interactions.</p> <p><strong>Conclusions:</strong> Overall, patients had gaps in their knowledge and practices, and positive attitudes towards drug-food interactions. Many patients could not identify food items that can potentially interact with their drugs. It is important that education and medication counselling are provided to patients to prevent drug-food interactions, ensure optimal drug therapy and patient safety.</p> <p><strong>Keywords:</strong> Drug-food interactions; patients; knowledge; attitudes; practices.</p> 2022-04-29T00:00:00+00:00 Copyright (c) Retrospective evaluation of inpatients admitted to a tertiary hospital in Somalia for Pediatric surgery 2022-05-03T12:25:34+00:00 Yeliz Kart Cüneyt Uğur Abdishakur Mohamed Abdi <p><strong>Objective:</strong> The aim is to reflect on the epidemiology of the patient population at a tertiary hospital for pediatric surgery, diagnostic pattern, and mortality in Somalia retrospectively.</p> <p><strong>Methods:</strong> In this study, 163 patient who were hospitalized to Pediatric Surgery Clinic of Mogadishu Somalia Turkey Recep Tayyip Erdoğan Training and Research Hospital in 2018 were included. Data regarding age, gender, diagnosis, surgical condition, mortality rate and cause of the death were recorded from the patient charts and the institutional digital database</p> <p><strong>Results:</strong> Of 163 patients 47 were female (28.8%) and 116 were male (71.2%). The mean age of the patients was 6.4 ± 4.8 years. The main diagnoses were congenital malformation (34.4%), acute abdomen (25.8%), traumatic injury (23.3%), infection (9.8%) and neoplasm (6.1%). Mortality rate was 9.8% and the leading cause of death was sepsis by 87.5%. Perforated appendicitis, intestinal obstruction and intussusception were creating the 68.7% of the diseases that result in death.</p> <p><strong>Conclusions:</strong> Our results show that two-thirds of the surgical deaths could be prevented with timely presentation. We think that the health policymakers in Somalia should focus on how to improve the access to surgical care, patient transfer, timely presentation, and training of pediatric surgeons and to overcome the poor surgical outcomes.</p> <p><strong>Keywords:</strong> Surgery; children; epidemiology; mortality; Somalia.</p> 2022-04-29T00:00:00+00:00 Copyright (c)