Shifting forward: Urban ecology in perspective.

The world has become urban; cities increasingly shape our worldviews, relation to other species, and the large-scale, long-term decisions we make. Cities are nature, but they need to align better with other ecosystems to avoid accelerating climate change and loss of biodiversity. We need a science to guide urban development across the diverse realities of global cities. This need can be met, in part, by shifts in urban ecology and its linkages to related sciences. This perspective is a "synthesis of syntheses", consolidating ideas from the other articles in the Special Section. It re-examines the role of urban ecology, and explores its integration with other disciplines that study cities. We conclude by summarizing the next steps in the ongoing shift in urban ecology, which is fast becoming an integral part of urban studies.

Pattern of in-patient neurologic review: An experience from a Tertiary Hospital North-Western Nigeria.

BACKGROUND: Increase in neurologic diseases burden has increased the demand for neurology services globally, despite the shortcomings of shortage and maldistribution of neurologists worldwide, including Sub-Saharan Africa. This has placed significant pressure on the few available neurologists to provide optimal and effective services in our resource-challenged settings. METHODS: Neurology referrals were prospectively reviewed over a period of 3 months. Sociodemographic characteristics of the patients, the initial diagnosis by the requesting team, the reasons for the consult/referral, the requesting personnel, duration of hospital stay before request, the time interval between receiving the request and review, the working and final diagnosis after the review, and the diagnostic outcome of neurologic review were analyzed using Predictive Analytics Software® version 18.0.0 for Windows (Chicago, Illinois, USA). RESULTS: Fifty-three hand written in-patient requests were reviewed over the period of study given an average rate of 4.4/week. The mean age was 50.8 ± 16.1 years, and the median length of stay before a review was 1 day (interquartile range: 1-2.5 days). Diagnostic outcome of the reviews were; new diagnoses in 4 (11.3%), the incorrect diagnosis changed in 8 (15.1%), contribution to the differential diagnosis in 15 (28.3%), and contribution to management plans in 24 (45.3%) patients. The association between diagnostic outcomes and mortality in our study was not statistically significant (χ2 = 6.66, P = 0.08). CONCLUSION: Our study showed that in-patient neurologic reviews led to significant improvement in diagnostic and management plans. Appropriate policy guidelines should focus more on efficient ways of maximizing benefits of these reviews to patients without overburdening the few available neurologists in our environment.

Factors associated with death and predictors of 1-month mortality in nontraumatic coma in a tertiary hospital in Northwestern Nigeria.

BACKGROUND: Coma occurring in the course of an illness ordinarily implies a poor prognosis and early prognostication is important for treatment decisions. The study was undertaken to study the factors associated with mortality in nontraumatic coma in a tertiary institution. MATERIALS AND METHODS: In this prospective observational study, adults with clinically confirmed coma Glasgow coma scale (GCS) score of ≤8, admitted consecutively to the emergency unit of a tertiary hospital in Northwestern Nigeria over a period of 18 months were recruited. Vital parameters, severity of coma by GCS and neurological signs were recorded. The etiology of coma was determined on the basis of history, clinical examination, and laboratory investigations. Outcome was determined within 1 month of onset of coma by patients' death or survival. RESULTS: A total of 194 patients (140 males and 54 females) were recruited with mean age was 53.7 ± 1.4. The predominant etiological factors were central nervous system (CNS) infections (28.9%), toxic and metabolic (28.9%), and stroke (23.7%). Overall, 1-month mortality was 49%. On univariate analysis, the factors that showed significant association with outcome were gender, blood pressure, GCS, breathing pattern, pupillary size, pupillary reaction, papiloedema, and abnormal posturing. Abnormal pupillary size, severe hypertension, and GCS score ≤5 were independent predictors of in-hospital 1-month mortality in nontraumatic coma. CONCLUSION: The independent important predictors of nontraumatic 1-month coma mortality in a developing country setting were GCS ≤ 5, abnormal pupillary size, and severe hypertension.