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(see <a href=""></a>)</p> Non communicable diseases persist despite being overshadowed by Covid-19 globally <p>Nil</p> James K Tumwine Copyright (c) 2021-04-16 2021-04-16 21 1 i iv The efficacy of dapagliflozin for type 1 diabetes: a meta-analysis of randomized controlled studies <p><strong>Introduction:</strong> The efficacy of dapagliflozin for type 1 diabetes remains controversial. We conduct a systematic review and meta-analysis to explore the treatment efficacy of dapagliflozin versus placebo in patients with type 1 diabetes.</p> <p><strong>Methods:</strong> We have searched PubMed, EMbase, Web of science, EBSCO and Cochrane library databases through May 2019 for randomized controlled trials (RCTs) assessing the effect of dapagliflozin versus placebo for type 1 diabetes. This meta-analysis is performed using the random-effect model.</p> <p><strong>Results:</strong> Six RCTs are included in the meta-analysis. Overall, compared with control group for type 1 diabetes, dapagliflozin treatment shows favorable impact on glycated hemoglobin HbA1c ( standard mean difference SMD=-3.93; 95% confidence interval CI =-4.44 to -3.48; P&lt;0.00001), HbA1c reduction of ≥0.5% (risk ratio RR=1.98; 95% CI=1.65 to 2.39; P&lt;0.00001), and fasting plasma glucose FPG (SMD=-0.93; 95% CI=-1.77 to -0.10; P=0.03). There is no statistical difference of hypo- glycemia (RR=1.09; 95% CI=0.66 to 1.79; P=0.75) or adverse events (RR=1.07; 95% CI=0.96 to 1.20; P=0.20) between two groups, but the incidence of ketone-related events is higher than those in control group (RR=0.28; 95% CI=3.96 to 11.52; P=0.01).</p> <p><strong>Conclusion:</strong> Dapagliflozin treatment benefits to reduce HbA1c and FPG for type 1 diabetes.</p> <p><strong>Keywords:</strong> Dapagliflozin; type 1 diabetes; glycemic control; randomized controlled trials.</p> Jian Ma Yanhong Zhao Huihui Fan Jia Liu Copyright (c) 2021-04-16 2021-04-16 21 1 1 7 Association analysis of vitamin D receptor gene polymorphisms in North England population with Type 2 diabetes mellitus <p><strong>Background:</strong> Numerous diabetes susceptibility loci, include a region consisting vitamin D receptor gene found in chromo- some 12q, have been known using genome wide screens.</p> <p><strong>Aim:</strong> The aim of present study is to probe the relationship between polymorphism of vitamin D receptor gene (single nu- cleotide polymorphisms) and type 2 diabetes mellitus (T2DM). Five hundred T2DM patients and 200 healthy subjects with normal HbA1c( ≤ 5.0 %), fasting blood sugar (≤ 120 mg/dL) and random blood sugar (≤ 140 mg/dL) were enrolled.</p> <p><strong>Metholodgy:</strong> The genotypes were found by polymerase chain reaction restriction fragment length polymorphism and DNA sequencing.</p> <p><strong>Results:</strong> revealed that no considerable differences in frequencies of genotype and allele of the Bsm I and Fok I polymor- phisms between healthy and patients in the North England (For Fok I: OR = 1.11, 95% CI: 0.72–1.12; for Bsm I: OR = 1.35, 95% CI: 0.79–1.98).</p> <p><strong>Conclusion:</strong> It is recommended that both following polymorphisms of vitamin D receptor gene may not considerably add to the progression of T2DM in the North England.</p> <p><strong>Keywords:</strong> T2DM; DNA Sequencing; Polymerase Chain Reaction-Restriction Fragment Length Polymorphism (PCR-RFLP); Single nucleotide Polymorphism (SNP);VDR.</p> Naila Abdul Sattar Sumera Shaheen Fatma Hussain Amer Jamil Copyright (c) 2021-04-16 2021-04-16 21 1 8 14 Associations of transcription factor 7-Like 2 (TCF7L2) gene polymorphism in patients of type 2 diabetes mellitus from Khyber Pakhtunkhwa population of Pakistan <p><strong>Background:</strong> Type 2 diabetes mellitus (T2DM) is the most prevalent component of metabolic syndrome. Environmental factors and various complex genes like transcription factor 7-like 2 (<em>TCF7L2</em>) gene have involved in the disease development.</p> <p><strong>Objective:</strong> To determine <em>TCF7L2</em> genetic association (rs7903146C/T and rs12255372G/T) in T2DM patients of Khyber Pakhtunkhwa population of Pakistan.</p> <p><strong>Subjects and methods:</strong> This study comprised of 176 subjects including 118 T2DM patients and 58 healthy controls. Genomic DNA was extracted and genotype of common variants (rs7903146 C/T and rs12255372 G/T) was carried out by amplification-refractory mutation system (ARMS)-PCR of sequence specific oligonucleotides.</p> <p><strong>Results:</strong> The distribution of genotype of <em>TCF7L2</em> SNPs (rs7903146 C/T and rs12255372 G/T) was significantly associated with T2DM as compared to the controls (p &lt;0.0001). The genetic models of the rs7903146 (C/T) and rs12255372 (G/T) SNPs were significantly associated between cases and controls (p &lt;0.0001). On the other hand, the significant association was observed between the two SNPs and different biochemical parameters like serum fasting glucose, lipid profile, creatinine and blood HbA1c levels (p &lt;0.05).</p> <p><strong>Conclusion:</strong> It is concluded that the SNPs of the <em>TCF7L2</em> gene are significantly associated with T2DM disease susceptibil- ity in the population of Khyber Pakhtunkhwa of Pakistan.</p> <p><strong>Keywords:</strong> <em>T2DM</em>; <em>TCF7L2</em>; Genetic association, ARMS-PCR, Single nucleotide Polymorphism (SNPs), Khyber Pakh- tunkhwa.</p> Taha Hameed Zahid Khan Muhammad Imran Saif Ali Abdullah Abdo Albegali Muhammad Ikram Ullah Hasan Ejaz Copyright (c) 2021-04-16 2021-04-16 21 1 15 22 Prevalence of overweight/obesity and its associated factors among a sample of Moroccan type 2 diabetes patients <p><strong>Background:</strong> Obesity constitutes a major risk factor for the development of diabetes, and has been linked with poor gly- caemic control among type 2 diabetic patients.</p> <p><strong>Aims:</strong> This study examines the prevalence of overweight/obesity and associated factors in type 2 diabetic patients in the Beni-Mellal Khenifra region in Morocco.</p> <p><strong>Methods:</strong> A questionnaire-based cross-sectional study was conducted in 2017 among 975 diabetes patients attending pri- mary health centres. Demographic and clinical data were collected through face-to-face interviews. Anthropometric meas- urements, including body weight, height and waist circumference, were taken using standardized techniques and calibrated equipment.</p> <p><strong>Results:</strong> The prevalence of overweight was 40.4%, the general obesity was 28.8% and the abdominal obesity was 73.7%. Using multivariate analysis, we noted that the general obesity was associated with female sex (AOR= 3,004, 95% CI: 1.761- 5.104, P&lt;0.001), increased age (AOR=2.192, 95% CI: 1.116-4.307, P&lt;0.023) and good glycaemic control (AOR=1.594, 95% CI: 1.056-2.407, P=0.027), whereas abdominal obesity was associated wih female sex (AOR=2.654, 95% CI: 1.507-4.671, P&lt;0.001) and insulin treatment (AOR=2.927, 95% CI: 1.031-8.757, P=0.048).</p> <p><strong>Conclusion:</strong> Overweight, general obesity and abdominal obesity were high among participants, especially among women. Taken together, these findings urge the implementation of a roadmap for this diabetic subpopulation to have a new lifestyle.</p> <p><strong>Keywords:</strong> Obesity; overweight; abdominal obesity; type 2 diabetes; Morocco.</p> Ahmed Chetoui Kamal Kaoutar Keltoum Boutahar Abdeslam El Kardoudi Soufiane Elmoussaoui Fatiha Chigr Mohamed Najimi Copyright (c) 2021-04-16 2021-04-16 21 1 23 31 Dietary knowledge, attitude and practice among type 2 diabetes mellitus patients in Sudan: a hospital-based cross-sectional study <p><strong>Background:</strong> In Sudan, the prevalence of diabetes in adults was estimated at 19.1% in 2015. This study assessed dietary knowledge, attitude, and practices (KAP) of type 2 diabetes mellitus (T2DM) patients in Sudan.</p> <p><strong>Methods:</strong> We randomly selected 238 T2DM patients from a list of 2460 patients from the Jabber Abulizz Hospital. We interviewed them face-to-face using a structured questionnaire. Multivariate logistic regression analyses were performed to investigate the determinants of KAP regarding the recommended diets for T2DM patients.</p> <p><strong>Results:</strong> Majority of the patients demonstrated good knowledge (54.6%), positive attitude (79%); and good practice (58%). The result revealed that patients with formal education had 3.0 (95% CI: 1.6-5.7) times higher odds of having good diabetic dietary knowledge than those with informal education. While patients who had good knowledge and a positive attitude were respectively 4.7 (95% CI: 2.4-8.9) and 3.2 (95% CI: 1.5-6.7) times more likely to follow dietary recommendations than the patients with poor knowledge and negative attitudes.</p> <p><strong>Conclusion:</strong> Irrespective of the socio-demographic position, the good knowledge and the positive attitude towards the rec- ommended diet, all the T2DM patients complied with the dietary recommendations. These findings highlight the need for improving knowledge and promoting positive attitudes towards the recommended diet among T2DM patients.</p> <p><strong>Keywords:</strong> Dietary knowledge; type 2 diabetes mellitus; Sudan.</p> Halla Mahagoub Idrees Adam Yousif Mohammed Elmosaad Abd Elbasit Elawad Ahmed Asif Khan Ilias Mahmud Copyright (c) 2021-04-16 2021-04-16 21 1 32 40 Intra-tumoral distribution of Ki-67 and Cyclin D1 in ER+ mammary carcinoma: quantitative evaluation <p><strong>Background:</strong> In spite of the strong evidence demonstrating the role of overexpression of Ki-67 and Cyclin D1 markers in breast carcinomas, clinical and pathological data remain to be discussed. This can be explained partly by intratumor het- erogeneity.</p> <p><strong>Objectives:</strong> To define the prevalence and clinical significance of Ki-67 and Cyclin D1 overexpression in primary breast tumors ER positive, while highlighting the existence of intratumor heterogeneity in this type of cancer.</p> <p><strong>Materials and methods:</strong> 51 ER positive breast cancer tumors were used to evaluate the intratumoral distribution of Ki-67 and Cyclin D1 expression. Image acquisition and visualization of the markers were performed by optical microscopy and stereology sampling method.</p> <p><strong>Results:</strong> The mean Ki-67 labeling index was distributed heterogeneously in the same tumor, from 20.67±6.87 to 45.10±10.65. The coefficient of variation (COV) revealed dispersion values between 13.4% and 42.9%. Associated with positive ER status, all the tumors presented a Cyclin D1 expression with a COV varying between 19% and 28.5% and a mean labeling index fluctuating between 19.40±4.42 and 41.64±10.08 within the same patient showing important intratumor heterogeneous distribution.</p> <p><strong>Conclusion:</strong> In this study, we have adopted a strictly quantitative approach to evaluate and demonstrate intratumor hetero- geneity. This establishes one of the main factors for poor response to cancer therapy. To achieve this, intratumor heteroge- neity should be usually definable and quantifiable but this domain awaits future progress and methods need to move towards a better understanding of molecular and cellular mechanisms that initiate and maintain this tumor heterogeneity.</p> <p><strong>Keywords:</strong> Breast cancer; Cyclin D1; ER+; Intra-tumoral heterogeneity; Ki-67.</p> Mohammedi Latifa Djillali Doula Fatima Mesli Farida Senhadji Rachid Copyright (c) 2021-04-16 2021-04-16 21 1 41 6 Clustering time trends of breast cancer incidence in Africa: a 27-year longitudinal study in 53 countries <p><strong>Background:</strong> Breast cancer is the most common, frequently diagnosed cancer with the highest incidence among female worldwide. Although the incidence is decreasing in developed countries, it is on increase in most of the African countries.</p> <p><strong>Objective:</strong> This study aimed to identify different time trends of breast cancer incidence among African countries using latent mixture approach.</p> <p><strong>Methods:</strong> The information includes newly diagnosed breast cancer patients per 100,000 women for 53 African countries in a period of 1990-2016. Latent mixture modeling was performed in Mplus 7.4 software.</p> <p><strong>Results:</strong> The overall trend of breast cancer in Africa was increasing. Latent mixture model with 5 clusters was estimated as the best using fit indices and linear growth trajectories were specified for each cluster. Nigeria was the only country which belongs to a cluster with negative slope indicating a slow decrease in the breast cancer incidence; also, Seychelles was the only country that showed a sharp increase over time. 31 countries belonged to a cluster with a slope of 0.08, indicating that the incidence of breast cancer is almost constant over time. Cluster 3 including Algeria, Angola, Botswana, Central African Republic, Cote d’lvoire, Equatorial Guinea, Lesotho, Libya, Namibia, Somalia, Sudan, Swaziland, Uganda and Zimbabwe and cluster 2 including Gabon, Mauritius, Morocco, South Africa, Tunisia and Congo showed a slow and moderate increase in the incidence of breast cancer, respectively.</p> <p><strong>Conclusion:</strong> Providing health education programs is essential in African countries with rising trend of breast cancer during the last decades.</p> <p><strong>Keywords:</strong> Africa; breast cancer; incidence; latent mixture model; trend.</p> Mehran Saberian Kamran Mehrabani Hadi Raeisi Shahraki Copyright (c) 2021-04-16 2021-04-16 21 1 47 53 Histopathologic spectrum of childhood tumours in a Tertiary Hospital: a ten-year review <p><strong>Background:</strong> There has been a growing public health burden of childhood tumours in low and middle income countries (LMICs) as the trend in epidemiological transition continues to vary.</p> <p><strong>Objective:</strong> The objective of this report is to determine the spectrum of childhood tumours at a tertiary hospital in Nigeria.</p> <p><strong>Methods:</strong> A retrospective review of the histopathology register over the period January 2006 to December 2015.</p> <p><strong>Results:</strong> The total paediatric tumour cases was 248, including 143 (57.7%) females and 105 (42.3%) males, aged 0 – 12 years (mean 6.1years ± 3.97 SD). The age group 2 - 5 year cohort had the highest prevalence of tumour. The predominant tumour based on tissue of origin was epithelial neoplasms 88 (35.5%), vascular neoplasms 56 (22.6%), neural neoplasm 42 (16.9%), mesenchymal neoplasm 37 (14.9%), germ cell neoplasm 13 (5.2%) and haematopoietic neoplasms 12 (4.8%). Majority of the tumours were benign, 148 (59.7%) and malignant 100 (40.3%). The most predominant benign tumour was haemangioma 33 (13.3%) and predominant malignant tumour was lymphoma 22 (8.9%).</p> <p><strong>Conclusion:</strong> Benign tumours remain the commonest neoplasm of children in this hospital-based data. Development and implementation of a tumour registry would provide a more comprehensive information.</p> <p><strong>Keywords:</strong> Childhood tumours; spectrum; haemangioma; lymphoma.</p> Said M Amin Vincent E Nwatah Emmanuel A Ameh Abdurasaq R Oyesegun Adewumi B Oyesakin Copyright (c) 2021-04-16 2021-04-16 21 1 54 9 The Newcastle satisfaction with nursing scales in a Mexican Oncology Hospital <p><strong>Objectives:</strong> The principal aim of this study was to identify whether the Newcastle Satisfaction with Nursing Scales (NSNS) could be used on cancer patients.</p> <p><strong>Methods:</strong> This was a descriptive, cross-sectional study carried out on cancer patients (n = 298).</p> <p><strong>Results:</strong> We found that a majority of cancer patients were around 50 years old (hospitalized patients [HP]: 49.5 ± 14.9; chemotherapy outpatients [COP]: 49.4 ± 12.7), were female (HP: 74%; COP: 63.5%), and had received education at least up to elementary level (HP: 70%; COP: 80%). Breast cancer was the principal type of cancer (&gt;34%) in both groups (HP and COP). The groups were comparable in age, sex distribution, place of origin, educational qualification, and type of cancer. Among HP, the experience and satisfaction scales of the NSNS showed good internal consistency (n = 235, α &gt;0.9, r &gt; 0.7), while among COP, only the satisfaction scale showed good internal consistency (n = 62, α = 1.00). Most patients’ perceptions (level of satisfaction) of hospitalization and chemotherapy services were positive (98% and 97%, respectively).</p> <p><strong>Conclusion:</strong> An NSNS instrument specifically designed for ambulatory care cancer patients is necessary for it to be useful in assessing cancer patients' perception of nursing care. This will help improve the quality of care in Mexico. The presence of cancer by itself could modify the patients’ satisfaction level. Further large-scale studies are required to inves- tigate the patients’ perceptions of nursing care using the NSNS on different cancer patient groups.</p> <p><strong>Keywords:</strong> Spanish satisfaction tool; hospital; patient satisfaction; oncology nursing; health care evaluation mechanisms.</p> Cecilia Rodríguez-Herrera José de Jesús López-Jiménez Azucena del Toro-Valero Nora Magdalena Torres-Carrillo Norma Torres-Carrillo Carlos Alberto Godínez-Peña Ana Cecilia Méndez-Magaña Melva Guadalupe Herrera-Godina Ana Lilia Fletes-Rayas Copyright (c) 2021-04-16 2021-04-16 21 1 60 6 Characteristics and outcomes of patients with multiple myeloma at the Uganda Cancer Institute <p><strong>Purpose:</strong> Data on multiple myeloma (MM) in sub-Sahara Africa is scarce. In Uganda, there is a progressively increasing incidence of MM over the years.</p> <p><strong>Methods:</strong> We performed a retrospective study on 217 patients with MM at the UCI using purposive sampling method. The objectives of the study were to determine the clinical characteristics, treatment outcomes, 5 year overall survival and predic- tors of survival of patients with MM at the UCI from 01 January 2008 to 31 December 2012.</p> <p><strong>Results:</strong> There were 119 (54.8%) males; the mean(SD) age of the study population at presentation was 59(12.8) years; 183(84.3%) patients presented with bone pain, and 135 (61.9%) had skeletal pathology; 186(85.3%) were HIV negative, and 152(70%) had Durie-Salmon stage III. The median overall survival was 2.5 years, (95% CI, 0.393-0.595); factors significantly associated with worse survival were Durie-Salmon stage III disease, HR=5.9, 95% CI (1.61 – 21.74; P=0.007) and LDH &gt;225 U/L HR=3.3, 95% CI (0.57 – 5.92; P=0.029).</p> <p><strong>Conclusion:</strong> Most patients with multiple myeloma at the UCI were diagnosed at a relatively young age, presented with late stage disease and bone pain, and had a shorter survival time. Factors associated with worse survival were Durie-Salmon stage III and LDH &gt;225 U/L.</p> <p><strong>Keywords:</strong> Multiple myeloma; Uganda cancer institute.</p> Clement D Okello Yusuf Mulumba Abrahams Omoding Henry Ddungu Kristen Welch Cheryl L Thompson Andrew J Cowan Matthew M Cooney Jackson Orem Copyright (c) 2021-04-16 2021-04-16 21 1 67 74 Prevalence and factors associated with hypertension among rural community dwellers in a local government area, South West Nigeria <p><strong>Background:</strong> Many African countries including Nigeria are said to be at various stages of an epidemiological transition from communicable to non-communicable diseases (NCD).</p> <p><strong>Objective:</strong> This study determined the current pattern and correlates of hypertension among adults in some rural commu- nities in South West Nigeria.</p> <p><strong>Methods:</strong> It was a descriptive cross-sectional study of 1012 individuals across 16 rural communities. The respondents’ blood pressure, weight, height and waist circumference were measured. Bivariate and multivariate analyses were done.</p> <p><strong>Results:</strong> Among the participants, 461 (45.6%) had hypertension out of whom 217 (47.1%) and 244 (52.9%) had stage 1 and stage 2 hypertension respectively. The systolic, diastolic and mean arterial blood pressures increased with age. The significant predictors of hypertension were; increasing age (p&lt;0.001), higher waist circumference (p = 0.01) and overweight / obesity (p = 0.03). While systolic blood pressure (SBP) had the strongest correlation with age, waist circumference (WC) was the strongest correlate of diastolic blood pressure (DBP).</p> <p><strong>Conclusion:</strong> Despite being a rural population, there was a high prevalence of hypertension in the study area.</p> <p><strong>Keywords:</strong> Prevalence; hypertension; rural; community; Nigeria.</p> Owigho P Opreh Temitope O Olajubu Kunmi J Akarakiri Vojtech Ligenza John T Amos Adebanke V Adeyeye Olufunke Z Oyelade Funmilayo C Oyewole Copyright (c) 2021-04-16 2021-04-16 21 1 75 81 Uric acid lowering improves insulin sensitivity and lowers blood pressure: a meta-analysis of randomized parallel-controlled clinical trials <p><strong>Objectives:</strong> This meta-analysis aimed to investigate whether uric acid lowering treatment can improve β-cell function and insulin sensitivity.</p> <p><strong>Methods:</strong> PubMed, Cochrane Library, EMBASE and China Biology Medicine were searched up to March 1, 2020. Rand- omized controlled clinical trials of urate lowering therapy in hyperuricemia patients were included in meta-analysis. Effect size was estimated as mean difference with 95% confidence interval (CI).</p> <p><strong>Results:</strong> Our search yielded 7 eligible trials with 503 participants. This meta-analysis showed that uric acid-lowering thera- py decreased fasting insulin -1.43 μIU/ml (weighted mean differences (WMD, 95% CI -2.78 to -0.09), homeostasis model assessment of insulin resistance -0.65 (WMD, 95% CI -1.05 to -0.24), systolic blood pressure -2.45 mm Hg (WMD, 95%CI -4.57 to -0.33) and diastolic blood pressure -3.41 mm Hg (WMD, 95%CI -3.87 to -2.95). However, the treatment had no significant effect on fasting plasma glucose (WMD -0.19 mmol/L, 95%CI -0.42 to 0.05), homeostasis model assessment of β-cell function index (WMD -0.02, 95%CI -0.28 to 0.24), total cholesterol (WMD 0.18 mg/dl; 95%CI, -1.39 to 1.75) and triglyceride (WMD 3.15 mg/dl, 95% CI -9.83 to 16.14).</p> <p><strong>Conclusion:</strong> Uric acid-lowering therapies might improve insulin sensitivity and lower blood pressure, but had no significant effect on HOMA-β and serum lipids.</p> <p><strong>Keywords:</strong> Hyperuricemia; uric acid lowering treatment; β-cell function; insulin sensitivity.</p> Qunchuan Zong Guanyi Ma Tao Wang Copyright (c) 2021-04-16 2021-04-16 21 1 82 95 Monocyte-to-HDL-cholesterol ratio is associated with Ascending Aorta Dilatation in Patients with Bicuspid Aortic Valve <p><strong>Background:</strong> The importance of monocyte count-to-HDL-cholesterol ratio (MHR) in cardio- vascular diseases has been shown in various studies. Ascending aortic dilatation (AAD) is a common complication in the patients with bicuspid aortic valve. In this study, we aimed to investigate the relationship between MHR and the presence of aortic dilatation in the pa- tients with bicuspid aortic valve.</p> <p><strong>Methods:</strong> The study population included totally 347 patients with bicuspid aortic valve.169 patients with aortic dilatation (ascending aorta diameter ≥ 4.0 cm) and 178 patients with no aortic dilatation. Echocardiographic and laboratory measure- ment was done and compared between groups.</p> <p><strong>Results:</strong> The mean age of the participants was 44.7 ± 15.4 years and average ascending aorta diameter was 3.2 ± 0.3 cm in dilatation negative group and 4.4 ± 0.4 cm in positive group. MHR was significantly increased in in patients with aortic dilatation. MHR and uric acid level was independently associated with the presence of aortic dilatation in the patients with bicuspid aortic valve.</p> <p><strong>Conclusion:</strong> We found a significant relationship between MHR and aortic dilatation in the patients with bicuspid aortic valve.</p> <p><strong>Keywords:</strong> Bicuspid aorta; aorta aneurysm; monocyte HDL ratio; inflammation.</p> Burak Acar Cagrı Yayla Murat Gul Mustafa Karanfil Sefa Unal Fatih Uçar Serdar Mevlut Kuyumcu Ahmet Goktug Ertem Yasin Ozen Mustafa Bilal Ozbay Ozcan Ozeke Sinan Aydogdu Copyright (c) 2021-04-16 2021-04-16 21 1 96 104 Comparison of heart rate response and heart rate recovery after step test among smoker and non-smoker athletes <p><strong>Background:</strong> Exercise performance depend on the ability of the cardiovascular system to respond to a wide range of met- abolic demands and physical exertion.</p> <p><strong>Objectives:</strong> To investigate the habitual smoking effects in heart rate response and heart rate recovery after step test in ath- letes.</p> <p><strong>Methods:</strong> Seventy-eight physically healthy active athletes (45 non-smokers and 33 smokers) aging 27±8years old, participat- ed in this study. All participants completed the International Physical Activity Questionnaire and performed the six-minute step test. Cardiovascular parameters such (resting heart rate, peak heart rate, heart rate at 1 min after testing, heart rate re- covery, recovery time, blood pressure at rest, and post-testing blood pressure) were recorded.</p> <p><strong>Results:</strong> Smoker-athletes had higher resting heart rate (76 ± 9bpm vs. 72 ± 10bpm, p&lt;0.05), maximum heart rate (154 ± 18bpm vs. 147 ± 17bpm, p&lt;0.05) and recovery time (7min 25sec ± 6min 31sec vs. 4min 21sec ± 4min 30sec, p&lt;0.05) than non-smoker athletes. Scores from the IPAQ were approximately the same (Μ=7927 ± 10303, Μ= 6380 ± 4539, p&lt;0.05).</p> <p><strong>Conclusion:</strong> Smoking was found to affect athletes' cardiovascular fitness. The change of the athletes’ heart rate recovery and recovery time contributes to the adaptation of cardiovascular function in training requirements.</p> <p><strong>Keywords:</strong> Smoking; athletes; heart rate recovery; heart rate reserve; six-minute step test.</p> Garyfallia Pepera Zogka Panagiota Copyright (c) 2021-04-16 2021-04-16 21 1 105 11 What differs former, light and heavy smokers? Evidence from a post-conflict setting <p><strong>Background:</strong> Evidence suggests that people who live in regions affected by the armed conflict are more likely to smoke.</p> <p><strong>Objective:</strong> The purpose of this study was to assess factors associated with smoking status in a sample of students in the northern Kosovo province.</p> <p><strong>Materials and methods:</strong> A total of 514 students enrolled in University in Kosovska Mitrovica, Kosovo, were recruited be- tween April to June 2015 at Student Public Health Center during mandatory health checks. Participants filled in socio-demo- graphic and behavioral questionnaire and Beck Depression Inventory (BDI). Based on responses about smoking, students were categorized in non-smokers, former smokers, light smokers (1-13 cigarettes/day) and heavy smokers (&gt; 13 cigarettes/ day).</p> <p><strong>Results:</strong> Of 514 students, 116 (22.6%) classified themselves as smokers. Higher education level of fathers (Odds ra- tio [OR]=2.89, 95% confidence interval [CI] 1.30-6.44, p=0.009), not living with smokers (OR=0.42, 95%CI 0.15-0.97, p=0.017) and longer exposure to second hand smoke (OR=1.07, 95%CI 1.01-1.13, p=0.036) was associated with former smoking. Studying medical and natural sciences (OR=2.07, 95%CI 1.05-4.18, p=0.040), consuming alcohol (OR=2.98, 95%CI 1.19-10.03, p=0.020), living with smokers (OR=2.88, 95%CI 1.49-5.56, p=0.002), longer exposure to second hand smoke (OR=1.06, 95%CI 1.01-1.11, p=0.019) and having a more intense depressive symptoms (OR=1.08, 95%CI 1.03-1.13, p=0.002) was associated with light smoking. Being male (OR=0.22, 95%CI 0.07-0.41, p=0.001), older (OR=1.47, 95%CI 1.21-1.78, p=0.001), living with smokers (OR=3.78, 95%CI 1.69-8.07, p=0.001), longer daily exposure to second-hand smoke (OR=1.10, 95%CI 1.04-1.16, p=0.001), and having more severe depressive symptoms (OR=1.12, 95%CI 1.07-1.18, p=0.001) were associated with heavy smoking.</p> <p><strong>Conclusion:</strong> Smoking prevention and cessation programs should include the entire community, because exposure to en- vironmental second hand smoke may facilitate initiation and more intense smoking. Screening of student smokers for depression should be prioritized in the process of rebuilding the framework for primary and secondary prevention in the post-conflict period.</p> <p><strong>Keywords:</strong> Students; smoking; tobacco; prevention.</p> Tatjana Gazibara Marija Milic Milan Parlic Jasmina Stevanovic Nebojsa Mitic Gorica Maric Darija Kisic Tepavcevic Tatjana Pekmezovic Copyright (c) 2021-04-16 2021-04-16 21 1 112 22 Risk factors for hazardous drinking in university students from South Africa and Belgium: a cross-cultural comparison study <p><strong>Background:</strong> Previous studies have associated certain risk factors with hazardous drinking in students. However, big cultur- al and geographical differences exist regarding alcohol use.</p> <p><strong>Objectives:</strong> To determine whether or not there was a difference in hazardous drinking between Belgian and South African university students and to establish the risk factors that contribute to hazardous drinking in university students (calculated using the AUDIT-C) from a developing country (South Africa) and a developed country (Belgium).</p> <p><strong>Methods:</strong> An online survey assessing hazardous drinking among university students in South Africa (University of KwaZu- lu-Natal, UKZN) and Belgium (University of Antwerp, UoA) was conducted, using the shortened version of the Alcohol Use Disorder Identification Test (AUDIT-C). Risk factors in males and females for hazardous drinking were explored using multivariate logistic regression analysis.</p> <p><strong>Results:</strong> In total, 499 students were included in the study (250 UoA and 249 UKZN students). A significant higher amount of male (94.8%) as well as female (92.4%) UoA students drank alcohol in the last year compared to the male (66.2%) and female (67.8%) UKZN students (p&lt;0.001). Additionally, a significant higher amount of UoA students were hazardous drinkers, compared to the UKZN students (p&lt;0.001). Multivaiate analysis showed that male UoA students were almost 6 times more likely to be hazardous drinkers than male UKZN students (OR=5.611, p=0.005). Female UoA students were more than twice as likely to be hazardous drinkers than female UKZN students (OR=2.371, p=0.016).</p> <p><strong>Conclusion:</strong> This study found a significant difference in hazardous drinking between Belgian and South African university students.</p> <p><strong>Keywords:</strong> Hazardous drinking; university students; South Africa; Belgium.</p> Yasemin Inaç Ynke Larivière Muhammad Hoque Guido Van Hal Copyright (c) 2021-04-16 2021-04-16 21 1 123 31 A preliminary study of skin bleaching and factors associated with skin bleaching among women living in Zimbabwe <p><strong>Background:</strong> Skin bleaching was reported to be commonly practiced among women and Africa was reported to be one of the most affected yet the subject is not given much attention in public health research in Zimbabwe despite the adverse effects of skin bleaching on health.</p> <p><strong>Method:</strong> This study was an exploratory cross-sectional survey to explore skin bleaching, skin bleaching patterns and factors associated with skin bleaching among women living in Zimbabwe. An online self-administered questionnaire was sent out to women on social network i.e. WhatsApp, Facebook, LinkedIn and Twitter.</p> <p><strong>Findings:</strong> A total number of 260 respondents, mean age 31.69 (SD, 8.12) years participated in the survey. The prevalence of skin bleaching among the participants was 31.15%. The major reason reported for skin bleaching was to have smooth and healthy skin alongside other factors such as beauty, gaining social favours for example getting married and good jobs. Occupation, complexion and marital status were associated with skin bleaching. The odds of skin bleaching for participants who were employed was 1.45(95% confidence interval [CI],0.32-1.91);p-value 0.02, dark skinned participants 2.56(95% CI, 0.76-2.87);p-value 0.01 and unmarried participants 2.87(95% CI,0.29-3.58);p-value 0.03. <strong>Conclusion:</strong> Evidence from the research suggests skin bleaching might be common among women living in Zimbabwe and possibly poses serious health threats to the women. Skin bleaching seems to be deep rooted in colourism. The colourism seems to be taken advantage of by the cosmetic industry which produce the potentially hazardous products which promise the revered light skin to women but which comes with a price. However, the study provides a base for future studies to ex- plore more on skin bleaching practices among women living in Zimbabwe.</p> <p><strong>Keywords:</strong> Skin bleaching; skin bleaching products; women; Zimbabwe.</p> Princess Nyoni-Kachambwa Wanapa Naravage Nigel F James Marc Van der Putten Copyright (c) 2021-04-16 2021-04-16 21 1 132 9 Atrial electromechanical delay and p wave dispersion associated with severity of chronic obstructive pulmonary disease <p><strong>Background:</strong> The aim of this study was to evaluate atrial electromechanical delay (AEMD) with both electrocardiography (ECG) and echocardiography in patients with Chronic Obstructive Pulmonary Disease (COPD).</p> <p><strong>Methods:</strong> Total of 110 patients were included in this cross-sectional case-control study. P-wave dispersion (PWD) was measured on a 12-lead ECG. Atrial electromechanical intervals (PA) were measured as the time interval between the onset of the P wave on the ECG and the beginning of the late diastolic A wave.</p> <p><strong>Results:</strong> PWD was found to be 40.9±9.2 ms in the healthy control group, 45.6±8.2 ms in the mild COPD and 44.8±8.7 ms in the severe COPD group (p&lt;0.05). Intra-right atrial EMD was found to be 10.7±5.8 ms in mild COPD, 11.0±7 ms in severe COPD, and it was 16.4±7.3 ms in healthy control group (p&lt;0.001). Interatrial EMD was detected to be 29.5±9.1 ms in the control group, 24.1±9 ms in mild COPD group, and 23.9±11.1 ms in the severe COPD group (p&lt;0.001).</p> <p><strong>Conclusion:</strong> Both mild and severe COPD groups decreased PWD, increased tricuspid PA and significantly decreased inter- and right intra-AEMD times in comparison to the control group.</p> <p><strong>Keywords:</strong> Atrial eletromechanical delay; chronic obstructive pulmonary disease; P wave dispersion.</p> Yunus Celik Nesligül Yıldırım Vahit Demir Cağlar Alp Omer Sahin Mehmet Tolga Doğru Copyright (c) 2021-04-16 2021-04-16 21 1 140 9 Relationship of oxidative stress and antioxidant response with vaso-occlusive crisis in sickle cell anaemia <p><strong>Background:</strong> Though sickle cell anaemia (SCA) is known to promote oxidative stress, there is paucity of information on the relationship between oxidative stress and vaso-occlusive crisis (VOC).</p> <p><strong>Objective:</strong> This study was undertaken to evaluate the relationship of oxidative stress and antioxidant response with VOC in SCA.</p> <p><strong>Methods:</strong> A cross-sectional case-control study was carried out at University of Nigeria Teaching Hospital (UNTH), Itu- ku-Ozalla, Enugu Nigeria involving 116 individuals which included 36 SCA subject, 40 sickle cell carriers (AS) and 40 healthy individuals (AA). Baseline information as well as the frequency of VOC was obtained from the participants and anaemia as well as oxidative stress and antioxidant indices were assessed in blood.</p> <p><strong>Results:</strong> Anaemia was prevalent (88.9 %) in SCA individuals compared to AS (52.5%) and AA (47.5 %) individuals. Nitric oxide scavenging (NOS) and superoxide dismutase (SOD) activities as well as glutathione level were significantly (p&lt;0.005) lower while catalase activity was higher in SCA individuals compared to controls (AA and AS). Higher malondialdehyde (MDA) level was associated with very severe VOC while low level of NOS activity was associated with severe VOC in SCA individuals.</p> <p><strong>Conclusion:</strong> Sickle cell anaemia exhibited oxidative stress and alteration in the levels of antioxidant indices which was pos- sibly associated with vaso-occlusive crisis.</p> <p><strong>Keywords:</strong> Sickle cell anaemia; oxidative stress; antioxidant; vaso-occlusive crisis.</p> Godwill Azeh Engwa Amanda Okolie John Paul Chinedu Chidili Precious Amara Okore Paul Chigozie Onu Maryrose Onyinye Ugwu Daniella Ebeshe Oko Paschaline U Ferdinand Copyright (c) 2021-04-16 2021-04-16 21 1 150 8 Indian scenario of IgA nephropathy: a systematic review and meta-analysis <p><strong>Background:</strong> IgA nephropathy (IgAN) is most common primary glomerulopathy. There are variations in prevalence of IgAN and its clinical features in different studies from India.</p> <p><strong>Aim:</strong> To summarize overall scenario of IgAN in India.</p> <p><strong>Methods:</strong> In this systematic review, studies related to IgAN and related renal disease were included. Data searched were PubMed, EMBASE, Google scholar, and Cochrane Database from inception to 31st January 2019.</p> <p><strong>Results:</strong> Total 49 studies (N=2480) were included: 21studies (N=2309) of primary IgAN; 19 studies (N=21) of Secondary IgAN; four studies (N=133) of IgA vasculitis nephropathy (IgAVN); and five studies (N=17) of IgA dominant nephropathy (IgADN). Prevalence of IgAN was 16.5% in India. Age of affected persons was ranging from 27.2±16.7 to 48.6±21.3 years . Male female ratio was 1.8:1. Clinical features of Primary IgAN, IgAVN, IgADN &amp; Secondary IgAN were microscopic hematuria (49.6%, 44.4%, 15.6% &amp; 59.5%), macroscopic hematuria (5.1%, 0.4%,40.9%,&amp; 35.7%), Subnephrotic proteinuria (42.1%, 29.4%, 23.2%, &amp; 52.3%), nephrotic proteinuria (16.0%, 4.4%, 76.8%,&amp; 47.6%), and hypertension (25.8%,18.3%, 35.5%,&amp; 47.6%).. The 24 hours proteinuria was ranging from 2.6±1.5 to 4.7±2.3 gm/day and serum creatinine (mg/dl) was ranging from 0.9±0 to 3.5±3.9 mg/dl. Histolomorphologically, all type of IgAN showed mesangial hypercellularity and Immunofluorescence revealed IgA deposition.</p> <p><strong>Conclusion:</strong> The overall prevalence of primary IgAN in India was 16.5%. The subnephrotic proteinuria and microscopic hematuria were common clinical features.</p> <p><strong>Keywords:</strong> IgA Nephropathy; histomorphology; prevalence; India.</p> Anju Khairwa Copyright (c) 2021-04-16 2021-04-16 21 1 159 65 Isolated acute pseudobulbar palsy with infarction of artery of percheron: case report and literature review <p><strong>Introduction:</strong> Pseudobulbar palsy (PBP) is characterized by supranuclear lesions in the corticobulbar pathway. Neoplasia, inflammatory, demyelinating, and stroke are possible etiologies of this disorder.</p> <p><strong>Case report:</strong> We report an elderly female who presented with dysarthria. She was dysarthric with a hypernasal voice, no apraxia or aphasia was observed. Tongue movements were slow with limited amplitude. Her soft palate dropped bilaterally; gag reflex was present. Also, she reported swallowing difficulty and choking with her saliva. Bilateral vertical and horizontal gaze were intact to either voluntary or oculocephalic movements. A cranial CT scan was suggestive of artery of Percheron (AOP) infarction. Brain magnetic resonance imaging showed hypersignal on diffusion-weighted and T2-weighted images and hyposignal on apparent diffusion coefficient in both thalami. CT angiography scan revealed an AOP originating from the left posterior cerebral artery. The swallowing study with a videofluoroscopic demonstrated oral and pharyngeal phases with severe dysfunction.</p> <p><strong>Conclusion:</strong> To the authors’ knowledge, there are two cases of individuals with artery of Percheron infarction who devel- oped PBP associated with other clinical syndromes. Still, isolated PBP following infarction of Percheron’s artery was not reported. We hypothesized that the PBP may have occurred because of the existence of vascular territory variations in the perforating arteries that arise from the AOP.</p> <p><strong>Keywords:</strong> Pseudobulbar palsy; thalamus; infarction.</p> Jamir Pitton Rissardo Ana Fornari Caprara Copyright (c) 2021-04-16 2021-04-16 21 1 166 71 Medical mortality in an emergency department in Nigeria: the transition is obvious! <p><strong>Introduction:</strong> The emergency department (ED), a major entry point into the hospital, provides an insight to the type of cases seen, the quality of care and mortality spectrum in a health institution. We aim to identify the spectrum of medical causes of mortality in our ED, the demographic pattern and duration of stay before death.</p> <p><strong>Method:</strong> This is a retrospective study that looked at medical mortality in the ED from January 2004 to December 2009. We obtained data on the demographics and causes of death from the medical records and case notes of the deceased.</p> <p><strong>Results:</strong> A total of 16587 patients were admitted during the period under review, of these 1262 (7.61%) died in the ED. The male to female ratio was 1.58:1.0 [772 males (61.2%), and 489 females (38.8%)]. Mortality was highest among the 20-45years age range, followed by 46-65 years, &gt;65years and &lt; 20 years in decreasing frequency [589(46.7%), 421(33.4%), 186 (14.8%) and 66(5.2%) respectively]. The three most common causes of death were stroke 315(25%), HIV related illness- es 126(10.0%), and heart failure 123(9.7%). Most deaths occurred less than 24hours of admission, 550(43.6%), followed by one day (36.0%) and two days (10.8%) post admissions respectively.</p> <p><strong>Conclusion:</strong> The commonest cause of death in the ED was stroke. The burden of death was highest in the younger age group, with most occurring less than 24 hours of admission.</p> <p><strong>Keywords:</strong> Emergency department; duration; mortality.</p> AD Olusegun-Joseph O Akande E Otrofanowei EO Nwoye OB Olopade JN Ajuluchukwu Copyright (c) 2021-04-16 2021-04-16 21 1 172 9 Association of variable number of tandem repeats (VNTR) and T941G polymorphism of monoamine oxidase (MAO-A) gene with aggression in Pakistani subjects <p><strong>Background:</strong> Human behavioral traits are known to be significantly heritable. Certain individuals have a greater tendency of negative behavioral aspects including aggression. The quest to identify tunderlying genetic causes has led to identification of a number of genetic markers, one of them is the monoamine oxidase-A (MAO-A) gene.</p> <p><strong>Objective:</strong> We aimed to genotype a variable number of tandem repeats (VNTRs) in the promoter region and a functional SNP within this gene (T941G, dbSNP ID: rs6323) in the recruited cohort of 482 subjects.</p> <p><strong>Methods:</strong> After DNA isolation, genotyping was done by PCR-RFLP and the results were confirmed by sequencing.</p> <p><strong>Results:</strong> For VNTRs, the results showed, highest frequency of 3.5 repeats in males and 4 repeats in females in the promoter region. The genotype frequencies for the SNP in cases were GG=16.3%, TG=20.6% and TT=63.1%, while in controls, the frequencies were GG=12.7%, TG=6.3%, and TT=81.0%. The allele frequencies were significantly different between cases and controls (p=0.015; OR=1.51; CI=1.085-2.102).</p> <p><strong>Conclusion:</strong> The selected VNTR and SNP appeared to be significantly associated with aggression. These VNTRs and SNP have not been studied previously in the Pakistani population, hence they represent a unique ethnic group. These results, however, would have to be replicated in larger cohorts.</p> <p><strong>Keywords:</strong> Aggression; MAO-A gene; VNTRs; T941G; rs6323; Pakistan.</p> Sumbal Sarwar Shabana Shahida Hasnain Copyright (c) 2021-04-16 2021-04-16 21 1 180 8 COVID-19: sitting is the new smoking; the role of exercise in augmenting the immune system among the elderly <p><strong>Introduction:</strong> Like smoking, sedentary lifestyle is an issue of great concern because of its deleterious health challenges and implications. Given the global spread of the new coronavirus (COVID-19), social isolation regulations and laws have been implemented in many countries to contain the spread of the virus and this has caused a drastic shift from the usual physically demanding life to a sedentary lifestyle characterized by significantly reduced physical activities and prolong sitting.</p> <p><strong>Methods/Data Source:</strong> Human and nonhuman primate literature was examined to compare experimental and clinical modulation of inflammatory cytokines by exercised-induced myokines.</p> <p><strong>Data synthesis:</strong> Experimental and clinical evidence was used to examine whether exercised-induced myokines can prime the immune system of the elderly population during the COVID-19 pandemic.</p> <p><strong>Conclusion:</strong> The immune system changes with advancement in age which increases the likelihood of infectious disease morbidity and mortality in older adults. Several epidemiological studies have also shown that physical inactivity among geri- atric population impacts negatively on the immune system. Evidences on the importance of exercise in priming the immune system of elderly individuals could be an effective therapeutic strategy in combating the virus as it may well be a case of “let those with the best immune system win”.</p> <p><strong>Keywords:</strong> Exercise; immune system; sedentary lifestyle; myokines.</p> Olorunfemi Tokunbo Taiwo Abayomi Damilare Adekomi Ibukun Oyeyipo Copyright (c) 2021-04-16 2021-04-16 21 1 189 93 COVID-19 mortality rate prediction for India using statistical neural networks and gaussian process regression model <p>The primary purpose of this research is to identify the best COVID-19 mortality model for India using regression models and is to estimate the future COVID-19 mortality rate for India. Specifically, Statistical Neural Networks ( Radial Basis Function Neural Network (RBFNN), Generalized Regression Neural Network (GRNN)), and Gaussian Process Regression (GPR) are applied to develop the COVID-19 Mortality Rate Prediction (MRP) model for India. For that purpose, there are two types of dataset used in this study: One is COVID-19 Death cases, a Time Series Data and the other is COVID-19 Confirmed Case and Death Cases where Death case is dependent variable and the Confirmed case is an independent varia- ble. Hyperparameter optimization or tuning is used in these regression models, which is the process of identifying a set of optimal hyperparameters for any learning process with minimal error. Here, sigma (σ) is a hyperparameter whose value is used to constrain the learning process of the above models with minimum Root Mean Squared Error (RMSE). The perfor- mance of the models is evaluated using the RMSE and 'R2 values, which shows that the GRP model performs better than the GRNN and RBFNN.</p> <p><strong>Keywords:</strong> Covid-19; India; mortality rate; mortality prediction; regression model; hyperparameter tuning; GPR; GRNN; RBFNN.</p> S Dhamodharavadhani R Rathipriya Copyright (c) 2021-04-16 2021-04-16 21 1 194 206 Corona viruses: reaching far beyond the common cold <p><strong>Background:</strong> Human coronaviruses (HCoVs) are one of the most common causes of the “common cold”. Some HCoV strains, however, can cause fatal respiratory disease. Some examples of these diseases are severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS), and Coronavirus Disease 19 (COVID-19). This article will review the etiology, clinical features, diagnosis, and management of HCoVs.</p> <p><strong>Methods:</strong> A systematic literature review was performed using the terms “human coronaviruses”, “MERS-CoV”, “SARS- CoV”, “SARS-CoV2”, “COVID-19”, and “common cold” in OVID MEDLINE, PubMed, and Cochrane Library.</p> <p><strong>Findings:</strong> Most HCoVs cause mild upper respiratory infections which resolve with supportive care and no sequelae. In recent decades, however, there have been outbreaks of novel HCoVs that cause more severe disease. This is largely due to HCoVs having large genomes which undergo frequent recombination events, leading to the emergence of novel and more virulent strains of the virus. These severe respiratory illnesses can lead to acute respiratory distress requiring invasive intervention, such as mechanical ventilation. These severe infections can lead to long-lasting sequelae in patients. Scientists continue to investigate potential treatments for these viruses, though supportive care remains the gold standard. Scientists have succeeded in devel- oping numerous vaccines for the SARS-CoV-2 virus, and ongoing data collection and analysis will shed even more light on the next steps in fighting the COVID-19 pandemic.</p> <p><strong>Conclusion:</strong> Due to the frequency of recombination events and the subsequent emergence of novel strains, HCoVs are be- coming more prevalent, making them a global health concern as they can lead to epidemics and pandemics. Understanding the epidemiology, etiology, clinical features, diagnosis, and management of HCoVs is important, especially during this worldwide pandemic.</p> <p><strong>Keywords:</strong> Coronavirus; common cold; severe respiratory disease; COVID-19.</p> Kathleen M Coerdt Amor Khachemoune Copyright (c) 2021-04-16 2021-04-16 21 1 207 13 Risk factors of multidrug-resistant bacteria in community-acquired urinary tract infections <p><strong>Background:</strong> Urinary tract infections (UTIs) are one of the most seen infection among community.</p> <p><strong>Objectives:</strong> In this cross-sectional study we aimed to investigate the risk factors of multidrug-resistant (MDR) bacteria that caused community-acquired UTI (CA-UTI).</p> <p><strong>Methods:</strong> Consecutive patients admitted to the Urology and Infectious Diseases policlinics with the diagnosis of CA-UTI were included in the study. A standard form including possible predisposing factors for MDR bacteria was applied.</p> <p><strong>Results:</strong> In total, 240 patients (51.3% females) were enrolled in the study. The mean age of participants were 59.8 ± 18.3 years old. <em>Escherichia coli</em> (n =166; 69.2%)was the most frequently isolated bacteria and its incidence was higher in females than in males (p=0.01). In total, 129 (53.8%) of the identified pathogens were MDR bacteria. According to multivariate analysis, the use of antibiotics three or more times increased the risk of infection with MDR bacteria by 4.6 times, the history of urinary tract infection in the last 6 months by 2 times, being male and over 65 years old by 3 times.</p> <p><strong>Conclusion:</strong> Doctors should consider prescribing broad-spectrum antibiotics in patients with severe UTIs with a history of UTI, advanced age, male gender, and multiple antibiotic usage, even if they have a CA-UTI.</p> <p><strong>Keywords:</strong> Urinary tract infection; community acquired; multidrug-resistant; male; multiple antibiotic usage; advanced age.</p> Ertugrul Guclu Fikret Halis Elif Kose Aziz Ogutlu Oğuz Karabay Copyright (c) 2021-04-16 2021-04-16 21 1 214 9 Prevalence of lower urinary tract symptoms in nurses and civil servants working at a hospital: a cross-sectional study <p><strong>Background:</strong> Lower urinary tract symptoms (LUTS) are common in women and can interrupt daily living activities of the individuals. The study aimed at determining the LUTS prevalence and the influencing factors in nurses and civil servants working at a hospital.</p> <p><strong>Methods:</strong> This cross-sectional and descriptive study was conducted with 158 female nurses and 105 female civil servants. The data were obtained with a data collection form and the Bristol Female Lower Urinary Tract Symptoms-Short Form.</p> <p><strong>Results:</strong> This paper exposes that the prevalence of at least one LUTS was 94.2% in nurses and 97.1% in civil servants. The most common LUTS symptoms of nurses and civil servants were urgency (60.1%nurses, 81.9%civil servants) and urge incontinence (59.5%nurses, 81.9%civil servants). Nurses (60.8%) expressed significantly higher rates of having inadequate time going to the toilet due to their work conditions compared to the civil servants (41.9%) (p&lt;0.05). BFLUTS-SF scores in terms of age, BMI, parity, having cesarean and vaginal delivery and urinary incontinence in their previous pregnancies were compared between two groups, statistically significant differences were found (p&lt;0.05).</p> <p><strong>Conclusion:</strong> Workplace conditions of the health workers should be reorganizing to have healthy urinary habits for prevent- ing them from the development of LUTS.</p> <p><strong>Keywords:</strong> Lower urinary tract symptoms; prevalence; nurses; civil servants.</p> Gulsah Kok Semra Kocaoz Gulten Guvenc Aygul Akyuz Copyright (c) 2021-04-16 2021-04-16 21 1 220 9 Early hearing threshold changes and peculiarities of audiometric assessments among patients in a drug-resistant tuberculosis treatment center <p><strong>Background:</strong> Hearing threshold changes occurred relative to baseline at both one and two weeks after onset of aminogly- coside therapy.</p> <p><strong>Objectives:</strong> To assess changes in audiometric hearing thresholds between pre-treatment values and two weeks into therapy. To document observed changes, and occurrence of ototoxicity within the period.</p> <p><strong>Methods:</strong> Prospective analytical cohort study on drug-resistant tuberculosis patients. Basic demographic parameters were taken. Three-point audiometric assessments within two weeks into therapy were done. Percentage of patients with ototoxic- ity were calculated. Pure tone threshold changes between the three audiometric values were compared.</p> <p><strong>Results:</strong> Audiograms of 53 patients comprising 56.6% males; age range was 13 to 91 years. Both air and bone conduction hearing thresholds significantly worsened between baseline and one week into therapy (p=0.011, and 0.015 respectively), and between baseline and two weeks into therapy (p=0.003 and 0.042 respectively). Minimal insignificant reduction occurred between both air and bone conduction hearing values of week 1 and week 2 of therapy (p= 1.000 and 0.856 respectively). By audiometric criteria, 4 patients (7.5%) developed ototoxicity within two weeks of treatment.</p> <p><strong>Conclusion:</strong> Audiometric assessments within two weeks into therapy with anti-tuberculous therapy may not represent baseline audiometry. 7.5% of the patients developed ototoxicity within two weeks of therapy.</p> <p><strong>Keywords:</strong> Early hearing threshold changes; audiometric assessments; tuberculosis treatment center.</p> Olusola A Sogebi Bolanle O Adefuye Ebenezer A Ajayi Copyright (c) 2021-04-16 2021-04-16 21 1 230 7 Prevalence and factors associated with non-adherence to multi-drug resistant tuberculosis (MDR-TB) treatment at Mulago National Referral Hospital, Kampala, Uganda <p><strong>Background:</strong> In Uganda, 12% of previously treated TB cases and 1.6% of new cases have MDR-TB and require specialized treatment and care. Adherence is crucial for improving MDR-TB treatment outcomes. There is paucity of information on the extent to which these patients adhere to treatment and what the drivers of non-adherence are.</p> <p><strong>Methods:</strong> We conducted a cohort study using retrospectively collected routine program data for patients treated for MDR- TB between January 2012 – May 2016 at Mulago Hospital. We extracted anonymized data on non-adherence (missing 10% or more of DOT), socio-economic, demographic, and treatment characteristics of the patients. All participants were sen- sitive to MDR-TB drugs after second line Drug Susceptible Testing (DST) at entry into the study. Factors associated with non-adherence to MDR-TB treatment were determined using generalized linear models for the binomial family with log link and robust standard errors. We considered a p- value less than 0.05 as statistically significant.</p> <p><strong>Results:</strong> The records of 227 MDR- TB patients met the inclusion criteria, 39.4% of whom were female, 32.6% aged be- tween 25 – 34 years, and 54.6% living with HIV/AIDS. About 11.9% of the patients were non-adherent. The main driver for non-adherence was history of previous DR-TB treatment; previously treated DR-TB patients were 3.46 (Adjusted prev- alence ratio: 3.46, 95 % CI: 1.68 - 7.14) times more likely to be non-adherent.</p> <p><strong>Conclusion:</strong> One in 10 MDR-TB patients treated at Mulago hospital is non-adherent to treatment. History of previous DR- TB treatment was significantly associated with non-adherence in this study. MDR-TB program should strengthen adherence counselling, strengthen DST surveillance, and close monitoring for previously treated DR-TB patients.</p> <p><strong>Keywords:</strong> Non-adherence; multi-drug resistant tuberculosis; treatment.</p> Charles Batte Martha S Namusobya Racheal Kirabo John Mukisa Susan Adakun Achilles Katamba Copyright (c) 2021-04-16 2021-04-16 21 1 238 47 User - provider perspectives to overcome the challenges of TB/HIV service integration at Mulago National Referral Hospital _ Kampala <p><strong>Background:</strong> Tuberculosis and Human Immunodeficiency Virus epidemics in sub-Saharan Africa have been closely related and persistent, proving a considerable burden for healthcare provision. This has complicated utilization of services, with noted opinions on the integration of these services from both users and providers of the services.</p> <p><strong>Objectives:</strong> To establish the users and the provider’s perspectives in overcoming the challenges of TB/HIV services inte- gration at Mulago National Referral Hospital.</p> <p><strong>Methods:</strong> Descriptive cross-sectional design, with predominantly qualitative methods was used. Qualitative aspect adopted phenomenological design. Participants were randomly selected for FGDs and Key informants. An observation checklist collected quantitative data from the patients to measure level of services integration.</p> <p><strong>Findings:</strong> Level of service integration of TB/HIV services was at 68% (below the acceptable 100% level). Opinions from the users pointed to; increasing number of work-days for TB/HIV service provision, strengthening sensitisation and health education and integrating other services like reproductive health services, among others. Health care providers opinions pointed to increasing trainings for health workers, increasing staffing and need for more support from Ministry of Health.</p> <p><strong>Conclusion:</strong> Opinions from both users and providers were similar. These ranged from increasing awareness to the users and healthcare providers about the integration of services.</p> <p><strong>Keywords</strong>: User - provider perspectives; TB/HIV service integration; Mulago National Referral Hospital.</p> Jane Namakula Katende Kizito Omona Copyright (c) 2021-04-16 2021-04-16 21 1 248 53 Cytological physiognomies and genotype distribution of human papillomaviruses among HPV/HIV co-infected and HPV mono-infected women <p><strong>Background:</strong> Co-infection of High Risk Human Papillomavirus (HR-HPV) and HIV is thought to favour initiation of intraepithelial squamous cell lesion and subsequent progression to cervical carcinoma.</p> <p><strong>Objectives:</strong> Evaluation of cytological physiognomies in relation to possible age influence and the genotype distribution of human papillomaviruses among HPV/HIV co-infected and HPV monoinfected women in Kisii, Kenya.</p> <p><strong>Methods:</strong> The case-control study enrolled 42 HPV/HIV co-infected and 42 HPV monoinfected women. Cervical swabs were collected in ThinPrep vials for HPV tying and cytological analysis. HPV subtypes were assayed by Xpert® HPV system (GXHPV-CE-10).</p> <p><strong>Results:</strong> Mono-infected women aged 30-39 years had the highest proportion of low grade squamous intraepithelial lesion (LSIL) at 14 (16.67%) while the co-infected aged 50-59 years had the highest proportion of high grade squamous intraepi- thelial lesion (HSIL) at 9 (10.71%). HPV-16 genotype was the most predominant and it increased with age rise. Older coin- fected and mono-infected women (&gt;40 years) had HSIL and LSIL as the most predominant cytological grade respectively.</p> <p><strong>Conclusion:</strong> The predominance of HPV-16 and HPV-18/45 genotypes in the study setting is a consideration that would benefit targeted prophylactic vaccination programs. HPV testing and cervical cancer screening for young and older women on a regular basis ought to be reinforced.</p> <p><strong>Keywords:</strong> Human immunodeficiency virus (HIV); Human Papillomavirus (HPV); co-infection; genotype; cytology.</p> Lucy Wanja Karani Stanslaus Musyoki Robert Orina Christopher Khayeka-Wandabwa Benuel Nyagaka Copyright (c) 2021-04-16 2021-04-16 21 1 254 62 First line antiretroviral treatment failure and associated factors among people living with HIV in northwest Ethiopia <p><strong>Background:</strong> Anti-retroviral treatment enhances the immune status and reduces unwanted outcomes. However, develop- ment of treatment failure and drug resistance raises concern over lifelong treatments to chronic diseases such as HIV/AIDS.</p> <p><strong>Objectives:</strong> This study determined proportion of treatment failure (TF) and identified factors associated with TF among people living with human immunodeficiency virus (HIV) in Bahir Dar, Northwest Ethiopia.</p> <p><strong>Methods:</strong> Facility based cross sectional study was carried out from November, 2017 to April, 2018. Sociodemographic and clinical data were collected using structured questioner. Blood sample was collected and analyzed for viral load, complete blood count (CBC), liver and kidney function test and CD4 count. A patient is declared as treatment failure when viral load value is higher than 1000 RNA copies/ml in two consecutive viral load analyses within three months interval. Data were entered and analyzed using SPSS version 23. To identify factors associated with TF, logistic regressions model was employed.</p> <p><strong>Results:</strong> A total of 430 people who had six months and above antiretroviral treatment (ART) follow up were enrolled in the study. Of these, 57.9% were females &amp; the mean age was 38 years. The mean month of ART follow up was 83 months. In the first viral load analysis, 106 (24.7%) of the cohort were virologically failed. These failed people were followed for 3 months with intensive adherence support; then second viral load analysis showed a viralogical failure among 65 people of the second cohort. Thus, the overall viralogical failure or TF was 15.1%. The re-suppression rates were 41(38.7%). Male gender, people with history of drug discontinuation, poor adherence, irregular time of drug intake, multiple sexual practice showed significant association with TF. Moreover, base line and current CD4 counts of &lt;200 cells/ml also demonstrated significant association with TF.</p> <p><strong>Conclusion:</strong> Significant proportion of treatment failure was reported in the present study. Moreover, behavioral factors such as drug discontinuation, poor adherence, multiple sexual partner were associated with treatment failure. Hence, to avoid TF, regular patient counseling and monitoring should be in place. To identify the predictors for treatment failure, further follow-up study is desirable.</p> <p><strong>Keywords:</strong> HIV; viral load; treatment failure; Ethiopia.</p> Andualem Genet Zewdie Mekonnen Endalew Yizengaw Daniel Mekonnen Copyright (c) 2021-04-16 2021-04-16 21 1 263 72 Neurological manifestations following cured malaria: don’t forget post-malaria neurological syndrome <p><strong>Introduction:</strong> Cerebral malaria which occurs during the active infection is the most common neurological complication of malaria. Other complications including post-malaria neurological syndrome (PMNS) can rarely occur following complete recovery from the disease. We report a case of post-malaria neurological syndrome in a Tunisian patient.</p> <p><strong>Case presentation:</strong> A 26-year-old Tunisian man with no past medical history was admitted in 2016 for a muscle weakness of the 4 limbs, seizures, tetraparesis and myoclonus which appeared after he returned from Côte d’Ivoire where he had been treated three weeks ago for Plasmodium falciparum malaria with favorable outcome. Blood smears for malaria were negative. Brain MRI showed multiple hypersignal cerebral lesions. Investigations didn’t show any infectious, metabolic, toxic, vascular or tumoral etiology. Thus, the diagnosis of PMNS was considered. The patient was treated with methylprednisolone with favorable outcome. Two years later, he was completely asymptomatic.</p> <p><strong>Conclusion:</strong> PMNS should be considered in patients with neurological symptoms occurring within two months of cured acute disease in which blood smears for malaria are negative and other etiologies have been ruled out. In most cases, the disease is self-limited while in severe cases corticosteroid therapy should be prescribed with favorable outcome.</p> <p><strong>Keywords:</strong> Post-malaria neurological syndrome; immunologic; corticosteroid.</p> Foued Bellazreg Dorsaf Slama Nadia Ben Lasfar Maha Abid Houneida Zaghouani Sana Rouis Wissem Hachfi Amel Letaief Copyright (c) 2021-04-16 2021-04-16 21 1 273 6 The impact of selenium administration on severe sepsis or septic shock: a meta-analysis of randomized controlled trials <p><strong>Introduction:</strong> The efficacy of selenium administration to treat severe sepsis or septic shock remains controversial. We con- duct a systematic review and meta-analysis to explore the impact of selenium administration on severe sepsis or septic shock.</p> <p><strong>Methods:</strong> We search PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases through May 2020 for randomized controlled trials (RCTs) assessing the effect of selenium administration on severe sepsis or septic shock. Me- ta-analysis is performed using the random-effect model.</p> <p><strong>Results:</strong> Five RCTs involving 1482 patients are included in the meta-analysis. Overall, compared with control group in septic patients, selenium administration is not associated with reduced 28-day mortality (RR=0.93; 95% CI=0.73 to 1.19; P=0.58), but results in substantially decreased all-cause mortality (RR=0.78; 95% CI=0.63 to 0.98; P=0.03) and length of hospital stay (MD=-3.09; 95% CI=-5.68 to -0.50; P=0.02).</p> <p><strong>Conclusion:</strong> Selenium administration results in notable decrease in all-cause mortality and length of hospital stay, but shows no substantial influence on the 28-day mortality, length of ICU stay, duration of vasopressor therapy, the incidence of acute renal failure, adverse events, and serious adverse events for septic patients.</p> <p><strong>Keywords:</strong> Selenium administration; septic shock; randomized controlled trials.</p> Lin Kong Qing Wu Bo Liu Copyright (c) 2021-04-16 2021-04-16 21 1 277 85 Risk factors for wound infection caused by Methicillin Resistant Staphylococcus aureus among hospitalized patients: a case control study from a tertiary care hospital in India <p><strong>Background:</strong> Methicillin Resistant <em>Staphylococcus aureus</em> (MRSA) causes infection in hospitals and communities. The preva- lence and risk factors of MRSA infection is not homogenous across the globe.</p> <p><strong>Objective:</strong> To find the risk factors of MRSA infection among hospitalized patients.</p> <p><strong>Methods:</strong> Cross-sectional case control study was conducted at a tertiary care hospital in India. The risk factors were collected using checklist from 130 MRSA and 130 Methicillin sensitive <em>staphylococcus aureus</em> (MSSA) infected patients. The pathogens were isolated from the wound swabs according to Clinical and Laboratory Standards Institute guidelines.</p> <p><strong>Results:</strong> Both the groups were comparable in terms of age, gender, diabetic status, undergoing invasive procedures, urinary catheterization and smoking (p&gt;0.05). Multivariate logistic regression revealed surgical treatment (OR 4.355; CI 1.03, 18.328; p=0.045), prolonged hospitalization (OR 0.307; CI 0.11, 0.832; p=0.020), tracheostomy (OR 5.298, CI 1.16, 24.298; p=0.032), pressure/venous ulcer (OR 7.205; CI 1.75, 29.606; p=0.006) and previous hospitalization (OR 2.883; CI 1.25, 6.631; p=0.013) as significant risk factors for MRSA infection.</p> <p><strong>Conclusion:</strong> Surgical treatment, prolonged and history of hospitalization, having tracheostomy for ventilation and pressure/venous ulcer were the key risk factors. Therefore, special attention has to be given to the preventable risk factors while caring for hospitalized patients to prevent MRSA infection.</p> <p><strong>Keywords:</strong> MRSA; infection; India.</p> Latha Thimmappa Anil Bhat Manjunatha Hande Chiranjay Mukhopadhyay Elsa Devi Baby Nayak Anice George Copyright (c) 2021-04-16 2021-04-16 21 1 286 94 Ectopic pregnancy at the Gambian Tertiary hospital <p><strong>Background/Aims:</strong> Ectopic pregnancy is a gynaecological emergency with significant burden of maternal mortality and morbidity in the tropics. The incidence reported in the literature range from 1:60 to 1:250 pregnancies. The aim was to determine incidence and risk factors of ectopic pregnancy in the Gambia.</p> <p><strong>Methodology:</strong> A longitudinal study of ectopic pregnancy at Gambian tertiary hospital from January 2016 to April 2018. Data was collected from patients’ folders, entered into SPSS version 20 and analysed with de- scriptive statistics. The test of variation and significance was by ANOVA and Chi-square respectively with error margin set at 0.05 and confidence interval of 95%.</p> <p><strong>Results:</strong> A total number of 2562 pregnancies were recorded, 43 were ectopic pregnancies. The estimated incidence was 0.2%. Majority of the patients were between 26 – 35 years (56%), primiparous (32%), heterogeneous marriage (82%) and housewives (86%). Occupation was not associated with ruptured or unruptured ectopic pregnancy (p-0.421). Low parity was associated with more ectopic pregnancy than high parity (p-0.001). The commonest clinical feature was abdominal pain (65.1%), whilst the most prominent risk factors were pelvic inflamma- tory disease (27.9%) and previous abortion (23.3%). Ectopic pregnancy was seasonal.</p> <p><strong>Conclusion:</strong> The incidence rate of 0.2% was in the range reported in the literature. Low parity, previous abortion and pelvic inflammatory disease were the risk factors.</p> <p><strong>Keywords:</strong> Ectopic; pregnancy; incidence; risk factors.</p> Matthew Anyanwu Grace Titilope Copyright (c) 2021-04-16 2021-04-16 21 1 295 303 Factors that influence management of postpartum hemorrhage among midwives in a rural setting in Kenya <p><strong>Background:</strong> Postpartum hemorrhage is the cumulative blood loss of 500 milliliters or more in a spontaneous vaginal delivery and approximately 1,000 milliliters or more for caesarean section birth and a leading cause of maternal mortality<sup>1</sup>.</p> <p><strong>Objective:</strong> The overall aim of the study was to determine midwives’ factors that influence the management of PPH.</p> <p><strong>Methods:</strong> A descriptive cross-sectional study that employed a quantitative approach through the use of a research self- ad- ministered questionnaire and an observational checklist targeting midwives were used. 85 midwives filled the questionnaire and 71 were observed respectively. The study was hospital- based conducted in Muranga County, Kenya. Convenience sam- pling technique was used to select the midwives in the study sites.</p> <p><strong>Results:</strong> The following factors were statistically significant in influencing management of postpartum hemorrhage; age (P-value = 0.021). professional qualification ( P= 0.047), experience in management of PPH ( P= 0.032) and training on emergency PPH ( P= 0.010), knowledge factors that were found to influence the management of PPH positively include knowledge on; prevention of PPH (p value-0.000), correct use of prophylactic uterotonic agents ( P= 0.000), uterotonics use ( P= 0.043), uterine massage during 3rd stage of labour ( P= 0.012), examination of the placenta ( P= 0.034), management of PPH (P= 0.028), causes and diagnosis of PPH ( P= 0.001), (Fischer’s exact value= 0.043).</p> <p><strong>Conclusion:</strong> Results of the study indicate a statistical association between midwives’ factors and management of PPH.</p> <p><strong>Keywords:</strong> Midwifery factors; management of postpartum haemorrhage.</p> Doris Mumbi Muthoni Priscilla Njeri Kabue Elizabeth Kurwa Ambani Copyright (c) 2021-04-16 2021-04-16 21 1 304 10 Midwives’ challenges in the management of postpartum haemorrhage at rural PHC facilities of Limpopo province, South Africa: an explorative study <p><strong>Background:</strong> Postpartum haemorrhage is one of the causes of the rise in maternal mortality. Midwives’ experiences related to postpartum haemorrhage (PPH) management remain unexplored, especially in Limpopo. The purpose of the study was to explore the challenges experienced by midwives in the management of women with PPH.</p> <p><strong>Methods:</strong> Qualitative research was conducted to explore the challenges experienced by midwives in the management of women with PPH. Midwives were sampled purposefully. Unstructured interviews were conducted on 18 midwives working at primary health care facilities. Data were analysed after data saturation.</p> <p><strong>Results:</strong> After data analysis, one theme emerged “challenges experienced by midwives managing women with PPH” and five subthemes, including: “difficulty experienced resulting in feelings of frustrations and confusion and lack of time and shortage of human resource inhibits guidelines consultation”.</p> <p><strong>Conclusion:</strong> The study findings revealed that midwives experienced difficulty when managing women with postpartum haemorrhage. For successful implementation of maternal health care guidelines, midwives should be capacitated through training, supported and supervised in order to execute PPH management with ease.</p> <p><strong>Keywords:</strong> Midwifery in South Africa; implementation of maternal guidelines; postpartum haemorrhage; maternal mortality.</p> Thifhelimbilu Irene Ramavhoya Maria Sonto Maputle Rachel Tsakani Lebese Lufuno Makhado Copyright (c) 2021-04-16 2021-04-16 21 1 311 9 Caesarean delivery rate and indications at a secondary healthcare facility in Ibadan, South Western Nigeria: a five-year review <p><strong>Background:</strong> Caesarean delivery is an essential surgical skill within the primary care setting aimed at reducing maternal morbidity and mortality.</p> <p><strong>Objectives:</strong> To determine the rate and indications for caesarean deliveries with a view to improving on the service delivery in the study area.</p> <p><strong>Methods:</strong> A retrospective review of all caesarean deliveries over a five-year period, January 1st, 2012 to December 31st, 2016.</p> <p><strong>Results:</strong> A total of 2321 deliveries were recorded during the study duration and 481 of them were through caesarean sec- tion (CS) giving a caesarean section rate of 20.4%. The rate was higher in the multigravida 255 (53.1%). The commonest indication for caesarean section was previous caesarean section 131 (27.2%). Emergency caesarean delivery accounted for 278 (57.8%). Only 16 (3.3%) stayed more than five days postoperatively while the rest, 465 (96.7%), stayed less than five days. There was a gradual yearly increase in rate from 12.1% in 2012 to 19.5% in 2016.</p> <p><strong>Conclusion:</strong> The rate of CS in this study has shown a gradual yearly increase with emergency CS having a higher percentage. Early diagnosis and referral of high-risk pregnancies from peripheral hospitals could reduce emergency CS among the study population.</p> <p><strong>Keywords:</strong> Caesarean section; rate; secondary healthcare; Nigeria.</p> Waheed O Ismail Ibrahim S Bello Samuel A Olowookere Azeez O Ibrahim Tosin A Agbesanwa Wulaimat A Adekunle Copyright (c) 2021-04-16 2021-04-16 21 1 320 6 Why do married women procure abortion? Experiences from Ile-Ife, south western Nigeria <p><strong>Background:</strong> In Nigeria, about 1.25million induced abortions occur annually and the country accounts for one-fifth of abor- tion-related deaths globally.</p> <p><strong>Objectives:</strong> The study aimed to assess the determinants of induced abortion among married women.</p> <p><strong>Methods:</strong> A mixed methods study was conducted in Ile-Ife, Nigeria. The quantitative component employed a cross-sectional study design while the qualitative aspect comprised focus group discussions. Information on contraceptives use, unintended pregnancy and induced abortion were obtained from 402 married women (with at least one child) aged 18-49 years using a semi-structured questionnaire. Four focus group discussion sessions were conducted among women of reproductive age.</p> <p><strong>Results:</strong> Majority (67.2%) of respondents had ever used a contraceptive method. However, 34.3% of the women have had un- intended pregnancies and 14.2% had induced abortion. FGD findings revealed that non-use of contraceptives and contraceptive failure were major reasons for unintended pregnancies and induced abortion. The significant predictors of induced abortion were non-use of contraceptives, age≥ 40 years and multiparity.</p> <p><strong>Conclusion:</strong> Induced abortion still occur among married women particularly those not using contraceptives, aged ≥40 years and those with high parity. More emphasis should be placed on making contraceptives more accessible to married women.</p> <p><strong>Keywords:</strong> Induced abortion; unwanted pregancies; married women; Nigeria.</p> Ibitola Eunice Ojo Temitope Olumuyiwa Ojo Ernest Okechukwu Orji Copyright (c) 2021-04-16 2021-04-16 21 1 327 37 Sonographic measurement of ear length among normal fetuses of pregnant Igbo women in port Harcourt, Nigeria <p><strong>Background:</strong> Fetal ear length measurement has been associated with some clinical values: sonographic marker for chromo- somal aneuploidy and for biometric estimation of fetal gestational age.</p> <p><strong>Objectives:</strong> To establish a baseline reference value for fetal ear length and to assess relationship between fetal ear length and gestational age.</p> <p><strong>Methods:</strong> Ear length measurements were obtained prospectively from fetuses in 551 normal singleton pregnancies of 15 to 41 weeks gestation. Normal cases were defined as normal sonographic findings during examination plus normal infant post-delivery. The relationship between gestational age (GA) in weeks and fetal ear length (FEL) in millimeters were analyzed by simple linear regression. Correlation of FEL measurements with GA, biparietal diameter (BPD), Head circumference (HC), Abdominal Circumference (AC), Femur Length (FL) and maternal age (MA) were also obtained.</p> <p><strong>Results:</strong> Linear relationships were found between FEL and GA (FEL=0.872GA-2.972). There was a high correlation between FEL and GA (r = 0.837; P = .001). Good linear relationship and strong positive correlation were demonstrated between FEL and BPD, AC, HC, and FL (p&lt;0.05).</p> <p><strong>Conclusion:</strong> The result of this study provides normal baseline reference value for FEL. The study also showed good linear relationship and good correlation between FEL and fetal biometric measurements.</p> <p><strong>Keywords:</strong> Fetal ear length; sonographic measurement; chromosomal aneuploidy.</p> Felicitas Idigo Kingsley Ajibo Angel-Mary Anakwue Uloma Nwogu Ebbi Robinson Copyright (c) 2021-04-16 2021-04-16 21 1 338 48 A possible model for estimating birth length of babies from common parental variables using a sample of families in Lagos, Nigeria <p><strong>Background:</strong> Length at birth is important for evaluating childhood growth and development. It is of interest in Pediatrics because of its implications for perinatal and postnatal morbidity and mortality. Predicting birth length will be useful in an- ticipating and managing possible complications associated with pregnancy and birth of babies with abnormal birth length.</p> <p><strong>Objective:</strong> The aim was to identify easily accessible parental determinants of baby’s birth length in Lagos, Nigeria, using a sample of patients attending a government hospital.</p> <p><strong>Methods:</strong> Parental anthropometrics and other data were obtained from 250 couples by actual measurements, oral interviews and questionnaires. Baby’s birth length was measured immediately after delivery by qualified, a well-trained obstetric nurse, and association between parental and offspring parameters were assessed.</p> <p><strong>Results:</strong> Weight gain, maternal weight, parity and mid-parental height were the significant parental explanatory variables of offspring birth length. They were the most suitable variables for a generated model for predicting babies’ birth length from parental variables in the study.</p> <p><strong>Conclusion:</strong> A model that might be useful for predicting babies’ birth length from easily accessible parental variables was produced. This model may complement ultrasonographic data for predicting baby’s birth length with a view to achieving better perinatal and postnatal care.</p> <p><strong>Keywords:</strong> Parental anthropometrics; birth length; association; model; correlation.</p> Idowu Adewumi Taiwo Adenike Adeleye Ijeoma Chinwe Uzoma Copyright (c) 2021-04-16 2021-04-16 21 1 349 56 Socio-demographic determinants of neonatal mortality in Algeria according to MICS4 data (2012-2013) <p><strong>Background:</strong> Neonatal mortality remains a public health problem in developing countries, including Algeria. Information on this indicator makes it possible to assess government efforts to improve the living conditions of target populations.</p> <p><strong>Objectives:</strong> This study aims to identify some determinants associated with this mortality from data of multiple indicator cluster survey conducted in Algeria in 2012-2013 (mics 4).</p> <p><strong>Methods:</strong> A retrospective case-control study including 1047 cases and 1041 controls. From a logistic regression model, we appreciated the role of different factors, socio-demographic, economic and geographic (Mother's age, level of education, wealth index, area of residence) in newborn survival. <strong>Results:</strong> The main factors associated with neonatal mortality were rural residence (p&lt;0.01; OR= 1.3 ; CI 1.08-1.54), South geographical area (p&lt;0.05; OR=1.5 ; CI 1.18-1.84), low education level of mother (p&lt;0.01; OR= 2.10 ; CI 1.35– 3.29), early age of maternal procreation (p&lt;0.001; OR=4.34 ; CI 2.19– 14.40), the birth rank "7 and over" (&lt;0.01; OR = 1.57; CI 1.13 – 2.44) and the two lowest wealth indices (p &lt;0.001; OR = 2 ; 1.45- 2.62 and p &lt;0.01; OR = 1.66; CI 1.23-2.26).</p> <p><strong>Conclusion:</strong> In addition to the various reproductive health strategies already adopted by the authorities for health promo- tion and family planning, action should be taken to evaluate their implementation with sustained assistance for disadvantaged people and in risk areas.</p> <p><strong>Keywords:</strong> Neonatal mortality; Algeria; MICS4 data (2012-2013).</p> Adel Sidi-Yakhlef Meryem Boukhelif Amaria Aouar Metri Copyright (c) 2021-04-16 2021-04-16 21 1 357 61 Associated risk factors of underweight among under-five children in Ethiopia using multilevel ordinal logistic regression model <p><strong>Background:</strong> Malnutrition is associated with both under nutrition and over nutrition which causes the body to get improp- er amount of nutrients to maintain tissues and organ function. Under nutrition is the result of insufficient intake of food, poor utilization of nutrients due to illnesses, or a combination of these factors. The purpose of this study was to identify associated risk factors and assess the variation of underweight among under-five children of different regions in Ethiopia.</p> <p><strong>Methods:</strong> Ethiopian Demography and Health Survey (EDHS-2016) weight-to-age data for under-five children is used. In order to achieve the objective of this study; descriptive, single level and multilevel ordinal logistic regression analysis were used.</p> <p><strong>Results:</strong> From a total of 8935 children about 8.1% were severely underweight, 17.1% were moderately underweight and 74.8% were normal. The test of heterogeneity suggested that underweight varies among region and multilevel ordinal model fit data better than single level ordinal model.</p> <p><strong>Conclusion:</strong> Educational level of mother, religion, birth order, type of birth, sex of child, mother body mass index, birth size of child, existence of diarrhea for last two weeks before survey, existence of fever for last two weeks before survey, duration of breast feeding, age child and wealth index had significant effect on underweight among under-five children in Ethiopia. The finding revealed that among the fitted multilevel partial proportional odds model, the random intercept model with fixed coefficients is appropriate to assess the risk factors of underweight among under-five children in Ethiopia. The findings of this study have important policy implications. The government should work closely with both the private sector and civil society to teach women to have sufficient knowledge, awareness and mechanisms of improving under-five under- weight for children’s wellbeing.</p> <p><strong>Keywords:</strong> Underweight; Partial proportional odds model; Multilevel partial proportional odds model; under-five children.</p> Nigussie Adam Birhan Denekew Bitew Belay Copyright (c) 2021-04-16 2021-04-16 21 1 362 72 Hysterosalpingography: a potential alternative to laparoscopy in the evaluation of tubal obstruction in infertile patients? <p><strong>Background:</strong> Evaluation of the fallopian tubes are important for infertile patients. The two most important diagnostic procedures used to evaluate tubal patency are hysterosalpingography and laparoscopy.</p> <p><strong>Objectives:</strong> To asses the hysterosalpingography and laparoscopy results of patients diagnosed with infertility and investigate the diagnostic value of hysterosalpingography in patients with tubal factor infertility.</p> <p><strong>Methods:</strong> The hysterosalpingography and laparoscopy results of 208 patients who presented to the Obstetrics and Gyne- cology Clinic at Dicle University, Faculty of Medicine between January 2014- January 2018 were retrospectively evaluated. Hysterosalpingography and laparoscopy results were compared with regard to the investigation of the presence of tubal obstruction and of the pelvic structures that could cause tubal obstruction. The specificity, sensitivity, positive, and negative predictive values of hysterosalpingography were computed.</p> <p><strong>Results:</strong> The number of patients evaluated was 208. The ratio of primary infertile patients was 57.2% and 42.8% was secondary infertile. Hysterosalpingography was found to have a specificity of 64.6%, the sensitivity of 81.3%, the positive predictive value of 56.4%, and a negative predictive value of 86% in the determination of tubal obstruction.</p> <p><strong>Conclusion:</strong> Patients with suspected tubal infertility can primarily be examined using hysterosalpingography in considera- tion of the invasive nature and the higher complication rate of laparoscopy.</p> <p><strong>Keywords:</strong> Infertility; hysterosalpingography; laparoscopy; tubal factor.</p> Reyhan Gündüz Elif Ağaçayak Gülcan Okutucu Özge Kömürcü Karuserci Nurullah Peker Mehmet Güli Çetinçakmak Talip Gül Copyright (c) 2021-04-16 2021-04-16 21 1 373 8 The impact of motherless paternity testing in a South African population <p><strong>Background:</strong> Paternity investigations play an important role in determining biological relatedness, and in South Africa, the outcome of these investigations impacts medical, judicial and home affairs decisions. Short Tandem Repeat (STR) analysis is utilised to perform paternity and kinship analysis, due to the polymorphic nature of STR loci. The cost associated with paternity testing is high, and there is a demand for motherless testing.</p> <p><strong>Objectives:</strong> This study aims to determine what the impact of motherless testing would have been by evaluating 6182 pa- ternity trio cases.</p> <p><strong>Methods:</strong> The AmpFLSTR™ Identifiler™ PCR Amplification kit was used to profile each of the trio cases. A scenario was created where the mother was eliminated from the test results to determine if the paternity outcome would change.</p> <p><strong>Results:</strong> Putative fathers were excluded in 27% of all cases, and in 2.5% of those cases, putative fathers would have been falsely included, had the mother not been tested. These false inclusions are attributed to coincidental STR loci that are shared between the mother and the putative father. The addition of loci to the STR profiling kit may resolve the issue; however, comparable STR data with more loci will have to be evaluated to ensure it overcomes the issue of coincidentally shared loci between unrelated individuals.</p> <p><strong>Conclusion:</strong> We would recommend that within our setup and within similar setups, the mother always be included for test- ing, except in extreme scenarios such as death. False inclusion of putative fathers could have serious legal implications for testing laboratories.</p> <p><strong>Keywords:</strong> Motherless paternity testing; South African population.</p> André A De Kock Jean JF Kloppers Copyright (c) 2021-04-16 2021-04-16 21 1 379 84 Prevalence and determinants of asphyxia neonatorum among live births at Debre Tabor General Hospital, North Central Ethiopia: a cross-sectional study <p><strong>Background:</strong> More than one third of the neonatal deaths at Neonatal Intensive Care Unit of Debre Tabor General Hos- pital (DTGH) are attributable to birth asphyxia. Most of these neonates are referred from maternity ward of the hospital. However, there is no recent evidence on the prevalence and specific determinants of birth asphyxia at DTGH. Besides, public health importance of factors like birth spacing weren’t addressed in the prior studies.</p> <p><strong>Methods:</strong> A cross sectional study was conducted on a sample of 240 newborns at delivery ward. The collected data were cleaned, coded and entered into Epi -data version 4.2 and exported to Stata version 14. Binary logistic regression model was considered and statistical significance was declared at P&lt; 0.05 using adjusted odds ratio.</p> <p><strong>Results:</strong> The prevalence of asphyxia neonatorum was 6.7 % based on the fifth minute APGAR score. From multi-variable logistic regression analysis, antenatal obstetric complications (AOR = 2.63, 95% CI: 3.75, 14.29), fetal malpresentation (AOR = 3.17, 95% CI: 1.21, 15.20), premature rupture of fetal membranes (AOR = 6.56, 95% CI: 3.48, 18.12) and meconium stained amniotic fluid (AOR = 2.73, 95% CI: 1.76, 14.59) were significant predictors.</p> <p><strong>Conclusion:</strong> The prevalence of fifth minute asphyxia neonatorum was relatively low. Fortunately, its predictors are modifi- able. Thus, we can mitigate the problem even with our limited resources such as enhancing the existing efforts of antenatal and intra-partum care, which could help early detection and management of any obstetric and neonatal health abnormality.”</p> <p><strong>Keywords:</strong> Birth asphyxia; asphyxia neonatorum; prevalence; determinants; Ethiopia.</p> Wubet Alebachew Bayih Tadesse Gashaw Tezera Abebaw Yeshambel Alemu Demeke Mesfin Belay Habtamu Shimelis Hailemeskel Metadel Yibeltal Ayalew Copyright (c) 2021-04-16 2021-04-16 21 1 385 96 Anti-inflammatory potential of dichloromethane leaf extracts of Eucalyptus globulus (Labill) and Senna didymobotrya (Fresenius) in mice <p><strong>Background:</strong> Inflammation is an immune response characterized by swelling, redness, pain and heat. Inflammation is main- ly managed using conventional medicines that are associated with many side effects. Plant-based remedies are considerably better alternative therapies for they have fewer side effects.</p> <p><strong>Objective:</strong> This study aimed at determining the anti-inflammatory potential of dichloromethane (DCM) leaf extracts of <em>Eucalyptus globulus</em> and <em>Senna didymobotrya</em> in mice.</p> <p><strong>Methods:</strong> Fresh leaves of these plants were harvested from Embu County, Kenya. Quantitative phytochemical analysis was done using Gas Chromatography-Mass Spectrometry (GC-MS). Anti-inflammatory test comprised nine groups of five animals each: normal, negative, positive controls and 6 experimental groups. Inflammation was induced with Carrageenan. One hour post-treatment, the different groups were intraperitoneally administered with the reference drug, diclofenac, 3% DMSO and six DCM leaf extracts at doses of 25, 50, 100, 150, 200 and 250mg/kgbw.</p> <p><strong>Results:</strong> GC-MS results revealed α-phellandrene, camphene, terpinolene, and limonene among others. Anti-inflammatory effects showed that extract doses of 100,150,200 and 250mg/kg bw significantly reduced the inflamed paw. Doses of 200 and 250mg/kgbw in both plants were more potent and compared with diclofenac. <em>E. globulus</em> extract dose of 250mg kg bw reduced inflamed paw in the 1<sup>st</sup> , 2<sup>nd</sup>, 3<sup>rd</sup> and 4<sup>th</sup> hours, by 2.27,6.52,9.09 and 10.90% respectively while <em>S.didymobotrya</em> at similar dose ranges, inflamed paw reduced by 2.41, 5.43, 8.31 and 9.05% respectively.</p> <p><strong>Conclusion:</strong> <em>E. globulus</em> and <em>S. didymobotrya</em> have potent anti-inflammatory activities, attributed to their constituent phyto- chemicals. This study confirms the traditional use of these plants in treating inflammation.</p> <p><strong>Keywords:</strong> <em>Eucalyptus globulus</em>; <em>Senna didymobtrya</em>; inflammation; phytochemicals.</p> Joseph Kiambi Mworia Cromwell Mwiti Kibiti Joseph JN Ngeranwa Mathew Piero Ngugi Copyright (c) 2021-04-16 2021-04-16 21 1 397 409 Herbal medicine used by the community of Koneba district in Afar Regional State, Northeastern Ethiopia <p><strong>Background:</strong> Pastoral communities of the Afar people in northeastern Ethiopia use medicinal plants for various health problems. However, very limited scientific documents are found addressing ethnomedicinal knowledge of the community.</p> <p><strong>Objective:</strong> This study aimed at documenting herbal medicine and the associated knowledge from Koneba district of Afar Regional State, Ethiopia.</p> <p><strong>Methods:</strong> Purposive sampling method was used to select study sites and key informants. General informants were selected through simple random sampling methods. Semi-structured interviews and guided field walk were used to collect data while Informant Consensus Factor (ICF), Fidelity Level (FL) and Preference Ranking were used to analyze and verify data.</p> <p><strong>Results:</strong> A total of 67 medicinal plant species used to treat humans and livestock ailments were recorded and collected. Thirteen medicinal plant species were mentioned as effective medicine against snake bite (ICF; 0.68) while nine species used to treat malaria, common cold and fever (ICF: 0.67). <em>Cyphostemma adenocaule</em> (Steud. ex A.Rich.) Desc. ex Wild &amp; R.B.Drumm. was the most preferred species used to combat snakebite, which was prevalent in the area.</p> <p><strong>Conclusion:</strong> Snake bite, malaria, common cold and fever are common health problems in the study area. Efficient use of herbal medicine has minimized the impact of these diseases.</p> <p><strong>Keywords:</strong> Ethnomedicine; informant consensus; snakebite.</p> Ali Zeynu Tigist Wondimu Sebsebe Demissew Copyright (c) 2021-04-16 2021-04-16 21 1 410 7 Patient patronage and perspectives of traditional bone setting at an outpatient orthopaedic clinic in Northern Tanzania <p><strong>Background:</strong> Much of Sub-Saharan Africa meets the rising rates of musculoskeletal injury with traditional bone setting, especially given limitations in access to allopathic orthopaedic care. Concern for the safety of bone setter practices as well as recognition of their advantages have spurred research to understand the impact of these healers on public health.</p> <p><strong>Objectives:</strong> Our study investigates the role of bone setting in Tanzania through patient utilization and perspectives.</p> <p><strong>Methods:</strong> We surveyed 212 patients at the outpatient orthopaedic clinic at Kilimanjaro Christian Medical Centre (KCMC) in Moshi, Tanzania. Surveys were either self-administered or physician-administered. Summary statistics were calculated using XLSTAT. Open responses were analyzed using a deductive framework method.</p> <p><strong>Results:</strong> Of all surveys, 6.3% (n=13) reported utilizing traditional bone setting for their injury prior to presenting to KCMC. Of the self-administered surveys, 13.6% (n=6) reported utilizing bone setting compared to 4.3% (n=7) of the physician-ad- ministered surveys (p=0.050). Negative perceptions of bone setting were more common than positive perceptions and the main reason patients did not utilize bone setting was concern for competency (35.8%, n=67).</p> <p><strong>Conclusion:</strong> Our study found lower bone setting utilization than expected considering the reliance of Tanzanians on tradi- tional care reported in the literature. This suggests patients utilizing traditional care for musculoskeletal injury are not seeking allopathic care; therefore, collaboration with bone setters could expand allopathic access to these patients. Patients were less likely to report bone setter utilization to a physician revealing the stigma of seeking traditional care, which may present an obstacle for collaboration.</p> <p><strong>Keywords:</strong> Bone setting; traditional medicine; traditional practitioners; orthopaedics; trauma.</p> Elizabeth B Card Joy E Obayemi Octavian Shirima Praveen Rajaguru Honest Massawe Ajay Premkumar Neil P Sheth Copyright (c) 2021-04-16 2021-04-16 21 1 418 26 Quality of life of adult individuals with intestinal stomas in Uganda: a cross sectional study <p><strong>Introduction:</strong> Intestinal stomas remain important life-saving surgical options in a wide range of gastrointestinal pathologies globally. Living with a stoma has potential to impair the patient’s quality of life, often with associated negative psychological effects.</p> <p><strong>Objective:</strong> To evaluate the quality of life among intestinal stoma patients under Mulago National Referral Hospital (MNRH), with emphasis on psychological effects and effects on family-social interactions.</p> <p><strong>Methodology:</strong> A cross-sectional study carried out at surgical outpatient clinics of MNRH between January and June 2018. Data was collected using Stoma-QOL questionnaire, PHQ-9 and GAD-7 from 51 participants who had lived with intestinal stomas for at least a month.</p> <p><strong>Results:</strong> Of the 51 participants, male: female ratio was 4:1 and aged 18-84 years (mean age 44.04+18.47 years). 76.5% had colostomy; 23.5% had ileostomy. Majority (88.2%) had temporary stomas. The overall mean Stoma-QOL score was 55.12+ 17.04. Only about a quarter (24%) of participants had Stoma-QOL scores &gt;70 (best). Most patients exhibited negative psy- chological effects (anxiety-100%, concerns about changed body image - 96.1% and depression - 88.4%).</p> <p><strong>Conclusion:</strong> Most participants had low levels of stoma-related quality of life, suffered negative psychological effects and exhibited limited social interactions. This calls for efforts to support Stoma patients adapt beter life.</p> <p><strong>Keywords:</strong> Stoma; Quality of Life (Stoma-QOL); Psychological effects; Patient Health Questionnaire (PHQ-9); General- ized Anxiety Questionnaire (GAD-7).</p> Yasin Ssewanyana Badru Ssekitooleko Bashir Suuna Emmanuel Bua Joseph Wadeya Timothy K Makumbi William Ocen Kizito Omona Copyright (c) 2021-04-16 2021-04-16 21 1 427 36 Distribution of phthisis bulbi and status of fellow eyes at a tertiary eye-care centre in Nigeria: a ten-year review <p><strong>Background:</strong> Phthisis bulbi is an irreversible cause of visual loss with insufficient evidence about its aetiology and status of patients’ fellow eyes.</p> <p><strong>Objectives:</strong> To identify the distribution of patients with phthisis bulbi and determine the status of their fellow eyes at Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria.</p> <p><strong>Methods:</strong> We analysed data retrospectively retrieved from medical records of patients diagnosed with phthisis bulbi at in- itial clinic visit from January 2008 to December 2017. Information abstracted included biodata, laterality of phthisical eye, duration and aetiology of phthisis bulbi, visual acuity, and morbidities present in fellow eyes.</p> <p><strong>Results:</strong> Seventy-nine patients presented with unilateral phthisis bulbi. The mean age was 51±21.2 years and forty (50.6%) were males. The commonest aetiologies of phthisis bulbi were trauma 37 (46.8%), infection 17 (21.5%) and uveitis/inflam- mation 11 (13.9%). Seventy (88.6%) patients had morbidities in their fellow eye such as glaucoma 26 (32.9%), refractive errors 23 (29.1%) and cataract 22 (27.9%). Forty (50.6%) patients were either visually impaired or blind in their fellow eye (p=0.001).</p> <p><strong>Conclusion:</strong> The commonest cause of phthisis bulbi was trauma. Approximately nine out of ten patients had ocular mor- bidities in their fellow eye. A thorough follow-up of patients with phthisis bulbi is recommended.</p> <p><strong>Keywords:</strong> Fellow eye; Nigeria; ocular trauma; distribution; phthisis bulbi.</p> Bolajoko A Adewara Sarat A Badmus Olukemi T Olugbade Edak Ezeanosike Bernice O Adegbehingbe Copyright (c) 2021-04-16 2021-04-16 21 1 437 44 Visual function, spectacle independence, and patients’ satisfaction after cataract surgery- a study in the Central Region of Ghana <p><strong>Background:</strong> Reduced visual function is associated with diminished quality of life as well as decreased physical and mental health. Poor visual function related to cataracts is also a risk factor for falls and traffic accidents, which may lead to hospital admissions and limit independence.</p> <p><strong>Objective:</strong> To evaluate patients’ satisfaction, visual functions and spectacle independence among patients in the Central Region of Ghana who had cataract surgery in one eye.</p> <p><strong>Methods:</strong> A hospital-based prospective cohort study was carried out on 146 patients booked for cataract surgery: 16 were lost through follow-ups whilst 130 completed the study. Visual functions including visual acuity, contrast sen- sitivity, stereopsis and colour vision were assessed before and after a month of cataract surgery. Objective and subjective refractions were performed to determine the post-surgery refractive status of the participants. Participants completed the NEI-VFQ 25 questionnaire and the scores obtained were used as a construct of their satisfaction.</p> <p><strong>Results:</strong> The NEI-VFQ 25 questionnaire scores indicated patients’ satisfaction was high with an average quality of life score of 77.46. Patients satisfaction was strongly correlated with contrast sensitivity (r=0.653, p&lt;0.001) but moderately correlated with visual acuity (r=-0.554, p&lt;0.001), stereopsis (r=0.490, p&lt;0.001) and colour vision (r=0.466, p&lt;0.001). Contrast sensitivity was a better predictor of patients’ satisfaction than visual acuity and stereopsis. Spectacle independence at distance was achieved in only 44.6% of the participants and 5.4% at near. There was a significant (p&gt;0.001) association between spectacle independence and the two types of cataract surgery performed which included Small Incision Cataract Surgery (SICS) and Extracapsular Cataract Extraction (ECCE). Among those who were spectacle independent, 53.4% of them were low vision patients.</p> <p><strong>Conclusion:</strong> Satisfaction of patients after cataract surgery was high but was greatly influenced by visual functions with contrast sensitivity being a better predictor of satisfaction than visual acuity and stereopsis. Spectacle independence after cataract surgery was low at distance and extremely low at near. The type of cataract surgery performed influenced thespec- tacle independence.</p> <p><strong>Keywords:</strong> TNO; contrast sensitivity; spectacle independence; cataract surgery; intraocular lens.</p> Samuel Kyei Bio Kwadwo Amponsah Kofi Asiedu Yaw Osei Akoto Copyright (c) 2021-04-16 2021-04-16 21 1 445 56 Mercury hygiene and biomedical waste management practices among dental health-care personnel in public hospitals in Lagos State, Nigeria <p><strong>Background:</strong> Indiscriminate disposal of hospital wastes including mercury/amalgam wastes pose a serious threat to life and environment. There is a growing concern about biomedical waste (BMW) management among health care workers, however there are limited reports on BMW management by dental personnel in developing countries.</p> <p><strong>Objectives:</strong> This study investigated the level of knowledge of BMW, observance of proper mercury hygiene and BMW management practice among public dental personnel in Lagos State, Nigeria.</p> <p><strong>Methods:</strong> A cross-sectional study regarding BMW management across public hospitals in Lagos State, Nigeria was con- ducted following institutional ethics committee approval. A self-administered questionnaire was utilized to obtain data from different facilities selected by purposive and simple random sampling techniques as applicable. The questionnaires were dis- tributed among 437 respondents by convenience sampling. The resulting data were statistically tested using Chi-square and G-test with p-value &lt; 0.05 indicating significant level.</p> <p><strong>Results:</strong> Amongst 437 respondents, majority were females (62.5%) and the highest proportion fell within the age range of 25–34 years (44.4%). Only 17.2% of the respondents had good knowledge of BMW management/legislation and 4.1% had good BMW practice. Less than half (49.4%) of respondents disposed mercury-contaminated materials inside the trash and majority (92.2%) did not observe proper mercury hygiene. Significantly better mercury hygiene practices were observed in secondary facilities (p=0.040).</p> <p><strong>Conclusion:</strong> A minor proportion of public dental personnel had good knowledge and practice of proper mercury hygiene and BMW management. This shows there is an urgent need for training of health personnel on proper BMW handling and disposal in developing countries like Nigeria.</p> <p><strong>Keywords:</strong> Biomedical waste management; mercury hygiene; dental personnel; Nigeria.</p> John Oluwatosin Makanjuola Uyi Idah Ekowmenhenhen Lillian Lami Enone Donna Chioma Umesi Oladunni Mojirayo Ogundana Godwin Toyin Arotiba Copyright (c) 2021-04-16 2021-04-16 21 1 457 69 Access to root canal treatment in a Nigerian sub-population: assessment of the effect of dental health insurance <p><strong>Background:</strong> The final pathway of tooth mortality lies between tooth extraction, and the more expensive and less accessible root canal treatment (RCT).</p> <p><strong>Aim:</strong> To determine the extent to which individuals’ financial resources as measured by socioeconomic status and dental insurance coverage affects their access to RCT.</p> <p><strong>Methods:</strong> A hospital-based study that used a 15-item questionnaire to collect data among patients scheduled for RCT. All scheduled subjects (N = 291) over a one-year period constituted the sample for the study. Using the SPSS software, associa- tions between the subjects’ variables, and the dental insurance status were carried out with Chi square and independent t test respectively at 95% confidence interval.</p> <p><strong>Results:</strong> Two hundred and ninety-one subjects were to have 353 RCTs within the study period. A high proportion (79.7%, p &lt; 0.001) of the subjects had dental health insurance, majority (95.3%) of which was government funded. 20.9% of those with previous tooth loss was due to inability to afford cost of RCT. The lowest socioeconomic group had the highest pro- portion (90%, p = 0.421) of insured that visited for RCT.</p> <p><strong>Conclusion:</strong> Dental insurance increased access to RCT. Socioeconomic status did not affect dental insurance status and dental visit for RCT.</p> <p><strong>Keywords:</strong> Dental insurance; health insurance; root canal treatment.</p> Paul Ikhodaro Idon Olawale Akeem Sotunde Temiloluwa Olawale Ogundare Janada Yusuf John Oluwatosin Makanjuola Abdulmumini Mohammed Chibuzor Emmanuel Igweagu Olusegun Alalade Copyright (c) 2021-04-16 2021-04-16 21 1 470 7 Knowledge and practices of seeking informed consent for medical examinations and procedures by health workers in the Democratic Republic of Congo <p><strong>Background:</strong> Informed consent (IC) is linked to the ethical principle of respecting patient autonomy, respect for human rights and ethical practice, while in many countries it is a standard procedure. Anecdotally, it should be noted that in the Democratic Republic of Congo (DRC) in many instances ICs are not obtained systematically. To date, no research appears to have been conducted on this matter. This study aimed to assess the knowledge and practice of obtaining IC from patients among health care providers (HCP) in the DRC.</p> <p><strong>Methods:</strong> This was a cross-sectional study, with a convenient sampling of 422 participants. Data from the questions were collected on an imported Microsoft Excel spreadsheet for review at INSTAT.TM The authors set IC's accurate knowledge and practice at 80% or higher. The Fisher Exact test was used to compare categorical association results, and a p-value &lt; 0.05 was considered statistically significant.</p> <p><strong>Results:</strong> Results showed that giving information in detail to patients on their medical condition was associated with formal training on medical ethics and IC (p: 0.0028; OR: 1.894; CI: 1.246 to 2.881), which was also associated with answering the patient’s questions in detail (p: 0.0035; OR: 1.852; CI: 1.236 to 2.774). About 127(30.09 %) of participants scored 80% or higher. Extracurricular training was associated with withholding information from patients, up to 27 times more than other factors (p&lt; 0.0001; OR: 27.042; CI: 13.628 to 53.657). when it comes to get IC, HCP with many years of practice scored better than others, in one of the question the odd ratio was closer to 7 ( p&lt; 0.0001; OR: 6.713; CI: 4.352 to 10.356). Only 47(11.14%) of the participants scored 80% or more of the questions about practice of IC.</p> <p><strong>Conclusion:</strong> For a variety of reasons, knowledge and practice of IC among HCPs was very low. A common programme for the country as part of formal training might lead to an improvement. In addition, patients’ education on IC should be displayed in waiting areas at all medical centres.</p> <p><strong>Keywords:</strong> Informed consent; medical examinations; procedures by health workers in the Democratic Republic of Congo.</p> Doudou Nzaumvila Patrick Ntotolo Indiran Govender Philip lukanu JD Landu Niati Didier Sanduku Tombo Bongongo Copyright (c) 2021-04-16 2021-04-16 21 1 478 88