Feasibility of awake craniotomy for brain arteriovenous malformations: A scoping review.

Background: Brain Arteriovenous Malformations (AVMs) located in proximity to eloquent brain regions are associated with poor surgical outcomes, which may be due to higher rates of postoperative neurological deterioration. Current treatment protocols include stereotactic radiosurgery, transarterial embolization, and surgical resection under general anesthesia. Awake Craniotomy (AC) allows intraoperative mapping of eloquent areas to improve post-operative neurologic outcomes. Objectives: We reviewed the current literature reporting surgical outcomes and assessed the feasibility of AC for AVM resection. Methods: The PRISMA guidelines were utilized as a template for the review. Three databases including PubMed, Scopus, and Cochrane Library were searched using a predefined search strategy. After removing duplicates and screening, full texts were analyzed. Outcomes including the extent of resection, intra-operative and post-operative complications, and long-term neurologic outcomes were assessed. Results: 12 studies were included with a total of 122 AVM cases. Spetzler-Martin grading was used for the classification of the AVMs. The asleep-awake-asleep protocol was most commonly used for AC. Complete resection was achieved in all cases except 5. Intraoperative complications included seizures (n = 2) and bleeding (n = 4). Short-term post-operative complications included hemorrhage (n = 3), neurologic dysfunctions including paresis (n = 3), hemiplegia (n = 10), dysphasia/aphasia (n = 6), cranial nerve dysfunction (n = 3), and pulmonary embolism (n = 1). Almost all neurological deficits after surgery gradually improved on subsequent follow-ups. Conclusion: AVMs may shift the anatomical location of eloquent brain areas which may be mapped during AC. All studies recommended AC for the resection of AVMs in close proximity to eloquent areas as mapping during AC identifies the eloquent cortex thus promoting careful tissue handling which may preserve neurologic function and/or predict the postoperative functional status of the patients We, therefore, conclude that AC is a viable modality for AVMs resection near eloquent language and motor areas.

Undergraduate medical teaching with remote consultations in general practice: a realist evaluation.

BACKGROUND: Supervisors historically educated students in primary care in face-to-face contexts; as a result of COVID-19, students now experience patient consultations predominantly remotely. There is a paucity of evidence regarding the facilitators and barriers to supervising students for excellent educational impact in the remote consultation environment. AIM: To understand the facilitators and barriers to educating medical students using remote consultations in primary care, and the consequences for students in terms of educational impact. DESIGN & SETTING: A realist evaluation methodology was adopted to identify causal chains of contexts, mechanisms, and outcomes, describing how the teaching and learning functioned on a sample of medical students and GP tutors from two medical schools in London, UK. METHOD: An initial programme theory was developed from the literature and a scoping exercise informed the data collection tools. Qualitative data were collected through online questionnaires (49 students, 19 tutors) and/or a semi-structured interview (eight students, two tutors). The data were coded to generate context-mechanisms-outcome configurations outlining how the teaching and learning operated. RESULTS: The results demonstrated a sequential style of supervision can positively impact student engagement and confidence, and highlighted a need to address student preparation for remote patient examinations. Students found passive observation of remote patient encounters disengaging, and, in addition, reported isolation that impacted negatively on their experiences and perceptions of primary care. CONCLUSION: Student and tutor experiences may improve through considering the supervision style adopted by tutors, and through interventions to reduce student isolation and disengagement when using remote patient consultations in primary care.

Post-operative Vesicoenterocutaneous Fistula with Multiple Intestinal Knotting: A Case Report.

Herein is a case of a 51-year-old farmer who presented to our facility with initial leakage of urine but later urine mixed with faeces from the lower abdomen after two previous abdominal surgeries. He had an open transvesical prostatectomy due to benign prostate enlargement complicated by leakage of urine from lower abdominal wall scar. A repeat surgical intervention to correct the urine leakage was followed by recurrence of urine leakage and later by leakage of feculent urine from the lower anterior abdominal wall. At our facility, he had exploratory laparotomy with manual unknotting of ileal loops, fistula tracts excision, resection, and end-to-end ileoileal anastomosis. The bladder wall was repaired with suprapubic cystostomy. Although the finding of asymptomatic multiple small bowel knotting was incidental in the index case, its timely management averted a sitting timed bomb that may lead to a diagnostic dilemma with catastrophic consequences.

Asymptomatic Rotavirus infections among children in Maiduguri, Borno state, Northeast, Nigeria.

Background: Rotavirus remains one of the main causative agents of gastroenteritis in young children. This happens, especially in countries (e.g., Nigeria) that have not yet introduced the vaccine into the national immunization program. A significant prevalence of Rotavirus infection both in children and adults without major symptoms has earlier been reported. This study aimed at defining the prevalence of asymptomatic Rotavirus infection from apparently healthy children in Maiduguri, Borno State, Northeastern Nigeria. Methods: A total of 269 stool samples were randomly collected from apparently healthy children <15 years of age from July 2017 to June 2018. All samples were screened using a commercially available enzyme-linked immunosorbent assay kit for the presence of Rotavirus antigen. The Rotavirus-positive samples were further subjected to polyacrylamide gel electrophoresis (PAGE) to determine their RNA electropherotypes. Results: A total of 59 stool samples (19.9%) were Rotavirus positive with peaks observed in the cold dry season, among male children, and 6-10 years of age group. A total of 50 randomly selected Rotavirus-positive samples were subjected to PAGE, and none of the samples showed either long or short profiles. Conclusion: This study shows that Rotavirus can be shed into environments without any signs and symptoms. In view of this, the Rotavirus vaccine should be considered a priority and be introduced in the existing national immunization program in Nigeria, particularly in Borno State.

RésuméContexte: Le rotavirus reste l'un des principaux agents responsables de la gastro-entérite chez les jeunes enfants. Cela se produit, en particulier dans les pays (par exemple, le Nigéria) qui n'ont pas encore introduit le vaccin dans le programme national de vaccination. Une prévalence significative de l'infection à rotavirus chez les enfants et les adultes sans symptômes majeurs a été signalée précédemment. Cette étude visait à définir la prévalence de l'infection asymptomatique à rotavirus chez des enfants apparemment en bonne santé à Maiduguri, dans l'État de Borno, au nord-est du Nigéria. Méthodes: Un total de 269 échantillons de selles ont été prélevés au hasard sur des enfants apparemment en bonne santé âgés de moins de 15 ans de juillet 2017 à juin 2018. Tous les échantillons ont été criblés à l'aide d'un kit de dosage immunosorbant lié aux enzymes disponible dans le commerce pour la présence d'antigène rotavirus. Les échantillons positifs pour le rotavirus ont en outre été soumis à une électrophorèse sur gel de polyacrylamide (PAGE) pour déterminer leurs électrophérotypes d'ARN. Résultats: Un total de 59 échantillons de selles (19,9%) étaient positifs pour le rotavirus avec des pics observés pendant la saison sèche froide, chez les enfants de sexe masculin et le groupe d'âge de 6 à 10 ans. Un total de 50 échantillons positifs au Rotavirus sélectionnés au hasard ont été soumis à PAGE, et aucun des échantillons n'a montré de profils longs ou courts. Conclusion: Cette étude montre que le rotavirus peut être répandu dans des environnements sans aucun signe ni symptôme. Compte tenu de cela, le vaccin contre le rotavirus devrait être considéré comme une priorité et être introduit dans le programme national de vaccination existant au Nigéria, en particulier dans l'État de Borno.

Decision Making Autonomy and Maternal Healthcare Utilization among Nigerian Women.

BACKGROUND AND OBJECTIVES: Low assess to ante-natal care (ANC) services continue to pose a major public health challenge leading to high maternal mortality rates in developing countries. Non-utilization of ANC services among about a quarter of Nigerian women of reproductive age remains a major concern in the actualization of Sustainable Development Goals. Considering the complexity of healthcare utilization in Nigeria, the relationship between a particular health care utilization pattern and women autonomy has not been fully examined. This study examines the patterns of women autonomy and their relationships with ANC utilization in Nigeria. METHODS: This was a cross-sectional analysis of the 2013 nationally representative data from the Nigerian Demographic and Health Survey (NDHS). Factor analysis/score were used to construct women autonomy index, while chi-square and logistic regression were used to establish the relationships between the response and exposure variables. RESULTS: There is a strong relationship between women decision making autonomy status and ANC services among Nigeria women. The odds of utilizing ANC services among women with more decision making autonomy were significantly 3.79 higher than among women with low decision-making autonomy. The use of ANC increases as age, education and wealth status of respondents increase. CONCLUSIONS AND GLOBAL HEALTH IMPLICATIONS: These results indicate that women autonomy is undoubtedly a major determinant of ANC utilization in Nigeria.

Demonstration of chemistry at a point through restructuring and catalytic activation at anchored nanoparticles.

Metal nanoparticles prepared by exsolution at the surface of perovskite oxides have been recently shown to enable new dimensions in catalysis and energy conversion and storage technologies owing to their socketed, well-anchored structure. Here we show that contrary to general belief, exsolved particles do not necessarily re-dissolve back into the underlying perovskite upon oxidation. Instead, they may remain pinned to their initial locations, allowing one to subject them to further chemical transformations to alter their composition, structure and functionality dramatically, while preserving their initial spatial arrangement. We refer to this concept as chemistry at a point and illustrate it by tracking individual nanoparticles throughout various chemical transformations. We demonstrate its remarkable practical utility by preparing a nanostructured earth abundant metal catalyst which rivals platinum on a weight basis over hundreds of hours of operation. Our concept enables the design of compositionally diverse confined oxide particles with superior stability and catalytic reactivity.