The role of medical-grade maggots in facilitating healing of diabetic foot ulcers in Kano, northern Nigeria: a case series.

OBJECTIVE: Approximately 13% of people living with diabetes develop one or more ulcers during the course of the disease, and diabetic foot ulcer (DFU) is responsible for >60% of lower limb amputations worldwide. This case series aimed to demonstrate the effectiveness of medical-grade maggots on DFUs in promoting wound healing and reducing related hospital stays in northern Nigeria. METHOD: Maggot debridement therapy (MDT) was applied to the DFUs of patients who consented to this treatment between January-August 2021 at the Orthopaedic Unit of the Aminu Kano Teaching Hospital (AKTH), Kano, Nigeria. Sterile first instar larvae of Lucilia sericata were obtained indigenously and applied using the confinement (free-range) method under aseptic procedure. RESULTS: A total of 15 patients with DFUs of Wagner classification grades III (33.3%) and IV (66.7%), were seen and documented. The patients included 10 (66.7%) females and five (33.3%) males, giving a female:male ratio of 2:1. The mean age (±standard deviation) of the respondents was 51.6±10.8 years. The surface area of the wounds ranged from 24-140cm2, with a median value of 75cm2. Among the patients, 60% had two cycles of MDT, with a median duration of five days. Most of the wounds (53.3%) were debrided within five days; 13.3% (two wounds) took seven days to be fully debrided. A paired sample t-test showed a statistically significant association between wound surface area and therapy duration (t=8.0; p=0.000) and between wound surface area and cycles of therapy (t=8.3; p=0.000). Before maggot application, 14 (93.3%) DFUs were completely (100%) covered with slough and only one (6.7%) was 95% covered with slough. After maggot application, 10 (66.7%) wounds were completely debrided while five (33.3%) wounds required bedside surgical debridement to achieve complete debridement. A paired sample t-test showed statistically significant difference between the pre- and post-MDT slough covering the wounds (t=45.1; p=0.000). CONCLUSION: In this case series, MDT was successfully used in the debridement of DFUs, which facilitated the healing process with an encouraging clinical outcome.

Efficiency and productivity analysis of maternal and infant healthcare services in Sub-Saharan Africa.

The paper examines the efficiency and productivity of Sub-Saharan African (SSA) countries towards maternal and infant healthcare services between 2015 and 2019. Data envelopment analysis is utilised to evaluate efficiency, and Malmquist-Luenberger's (ML) productivity estimation is employed for productivity analysis. The results indicate inefficiency in SSA maternal and infant healthcare services. Average efficiency is pegged at 85%, and 60% of the countries evaluated had below-average efficiency. Effects of socioeconomic dynamics of countries were analysed. Preliminary estimations on the impact of Gross domestic product (GDP), education, urban population, and total population on efficiency are not significant. Although GDP and education sometimes show that they influence efficiency positively. Sensitivity analysis indicates efficiency to be more responsive to health expenditure, as well as to nurses and midwives. ML Productivity decomposition into technical efficiency change and technological change indicates improvement in technical efficiency as the principal driver of efficiency and productivity. Policy recommendations are made in line with the findings, requirements, and constraints of SSA countries.

Maggot debridement therapy and complementary wound care: a case series from Nigeria.

OBJECTIVE: Maggot debridement therapy (MDT) is an emerging procedure involving the application of sterile maggots of the Dipteran species (commonly Lucilia sericata) to effect debridement, disinfection and promote healing in wounds not responding to antimicrobial therapy. Data on MDT in sub-Saharan Africa (including Nigeria) are scarce. This study aimed to use medicinal grade maggots as a complementary method to debride hard-to-heal necrotic ulcers and thereby promote wound healing. METHOD: In this descriptive study, we reported on the first group of patients who had MDT at Aminu Kano Teaching Hospital (AKTH), a tertiary hospital in northern Nigeria. The first instar larvae of Lucilia sericata were applied using the confinement (free-range) maggot therapy dressing method under aseptic conditions. RESULTS: Diabetic foot ulcer (DFU) grade III-IV constituted more than half of the wounds (53.3%), followed by necrotising fasciitis (30%), and post-traumatic wound infection (10%). Others (6.7%, included pyomyositis, surgical site infection and post traumatic wound infection). The median surface area of the wounds was 56cm2. Of the 30 patients, half (50%) had two MDT cycles with a median time of four days. Of the wounds, 22 (73%) were completely debrided using maggots alone while eight (27%) achieved complete debridement together with surgical debridement. Wound culture pre-MDT yielded bacterial growth for all the patients and Staphylococcus aureus was the predominant isolate in 17 wounds (56.7%) while Pseudomonas aeruginosa and Streptococcus pyogenes were predominant in five wounds (16.7%) each. Only four (13.3%) wound cultures yielded bacterial growth after MDT, all Staphylococcus aureus. CONCLUSION: A good prognosis was achieved post-MDT for various wounds. MDT effectively debrides and significantly disinfects wounds involving different anatomical sites, thus enhancing wound healing and recovery. MDT is recommended in such wounds.

Effects of Calcination Holding Time on Properties of Wide Band Gap Willemite Semiconductor Nanoparticles by the Polymer Thermal Treatment Method.

Willemite is a wide band gap semiconductor used in modern day technology for optoelectronics application. In this study, a new simple technique with less energy consumption is proposed. Willemite nanoparticles (NPs) were produced via a water-based solution consisting of a metallic precursor, polyvinylpyrrolidone (PVP), and underwent a calcination process at 900 °C for several holding times between 1-4 h. The FT-IR and Raman spectra indicated the presence of metal oxide bands as well as the effective removal of PVP. The degree of the crystallization and formation of the NPs were determined by XRD. The mean crystallite size of the NPs was between 18.23-27.40 nm. The morphology, particle shape and size distribution were viewed with HR-TEM and FESEM analysis. The willemite NPs aggregate from the smaller to larger particles with an increase in calcination holding time from 1-4 h with the sizes ranging between 19.74-29.71 nm. The energy values obtained from the experimental band gap decreased with increasing the holding time over the range of 5.39 eV at 1 h to at 5.27 at 4 h. These values match well with band gap obtained from the Mott and Davis model for direct transition. The findings in this study are very promising and can justify the use of these novel materials as a potential candidate for green luminescent optoelectronic applications.

Efficiency and productivity analysis of innovation, human capital, environmental, and economic sustainability nexus: case of MENA countries.

Innovation, human capital, economic, and environmental nexus is essential in sustainable development. The Middle East and North Africa (MENA) is an emerging market with the potential to transcend the dilemma of attaining economic and environmental sustainability. Data envelopment analysis through the Malmquist-Luenberger productivity index is utilized to estimate MENA country's innovation, human capital, economic, and economic sustainability efficiency and productivity. Results indicate an upward trend in efficiency, with a 26% increase in average efficiency between 2017 and 2019 compared to 2011 and 2016. However, there is variation in efficiency between countries. The decomposition of the productivity index into technical change and technological change indicates that the efficiency growth in 2017-2019 could be attributed to technical improvement than technological increase. However, there is a shift to more technological progress than technical increase. Study shows that developing human capital and capacity is as integral to sustainable development as innovation advancement. Strategies to simultaneously augment human capital and innovation towards sustainable development are presented.

People's willingness to use COVID-19 self-testing in Nigeria: a cross-sectional survey.

OBJECTIVES: Nigeria has been badly affected by the COVID-19 pandemic, and the poor testing coverage in the country may make controlling the spread of COVID-19 challenging. The aim of this study was to assess the general public's acceptability of SARS-CoV-2 self-testing as an approach which could help to address this gap. SETTING: A household-based survey was conducted in five urban and five rural local government areas in the states of Akwa Ibom, Anambra, Benue, Kaduna and Lagos, in mid-2021. PARTICIPANTS: 2126 respondents (969 were female) participated. A five-pronged, probabilistic sampling approach was used to recruit individuals older than 17 years and available to participate when randomly approached in their households by the surveyors. A 35-item questionnaire was used to collect data on their values towards SARS-CoV-2 self-testing. Primary outcomes were: likelihood to use a self-test; willingness to pay for a self-test; and likely actions following a reactive self-test result. RESULTS: Of the total 2126 respondents, 14 (0.66%) were aware of COVID-19 self-testing, 1738 (81.80%) agreed with the idea of people being able to self-test for COVID-19, 1786 (84.05%) were likely/very likely to use self-tests if available, 1931 (90.87%) would report a positive result and 1875 (88.28%) would isolate if they self-tested positive. Factors significantly associated with the use of a self-test were having a college education or higher (adjusted Odds Ratio (AOR): 1.55; 95% CI: 1.03 to 2.33), full-time employment (AOR: 1.67; 95% CI: 1.06 to 2.63), feeling at moderate/high risk of COVID-19 (AOR: 2.43; 95% CI: 1.70 to 3.47) and presence of individuals at risk of COVID-19 within the household (AOR: 1.38; 95% CI: 1.06 to 1.78). CONCLUSION: A majority of Nigerians agree with the concept of COVID-19 self-testing and would act to protect public health on self-testing positive. Self-test implementation research is necessary to frame how acceptability impacts uptake of preventive behaviours following a positive and a negative self-test result.

Novel Tools for Lassa Virus Surveillance in Peri-domestic Rodents.

Background: Lassa fever (LF) is a rodent-borne disease endemic to West Africa. In the absence of licensed therapeutics or vaccines, rodent exclusion from living spaces remains the primary method of preventing LF. Zoonotic surveillance of Lassa virus (LASV), the etiologic agent of LF, can assess the burden of LASV in a region and guide public health measures against LF. Methods: In this study, we adapted commercially available LASV human diagnostics to assess the prevalence of LASV in peri-domestic rodents in Eastern Sierra Leone. Small mammal trapping was conducted in Kenema district, Sierra Leone between November 2018-July 2019. LASV antigen was detected using a commercially available LASV NP antigen rapid diagnostic test. LASV IgG antibodies against LASV nucleoprotein (NP) and glycoprotein (GP) were tested by adapting a commercially available semi-quantitative enzyme linked immunosorbent assay (ELISA) for detection of mouse-related and rat-related species IgG. Findings: Of the 373 tested specimens, 74 (20%) tested positive for LASV antigen. 40 (11%) specimens tested positive for LASV NP IgG, while an additional 12 (3%) specimens only tested positive for LASV GP IgG. Simultaneous antigen presence and IgG antibody presence was linked in Mastomys sp. specimens (p < 0.01), but not Rattus sp. specimens (p = 1). Despite the link between antigen presence and IgG antibody presence in Mastomys sp., the strength of antigen response did not correlate with the strength of IgG response to either GP IgG or NP IgG. Interpretation: The tools developed in this study can aid in the generation of valuable public health data for rapid field assessment of LASV burden during outbreak investigations and general LASV surveillance. Funding: Funding for this work was supported by the National Institute of Allergy and Infectious Diseases National Institute of Health, Department of Health and Human Services under the following grants: International Collaboration in Infectious Disease Research on Lassa fever and Ebola - ICIDR - U19 AI115589, Consortium for Viral Systems Biology - CViSB - 5U19AI135995, West African Emerging Infectious Disease Research Center - WARN-ID - U01AI151812, West African Center for Emerging Infectious Diseases: U01AI151801.

Seroprevalence of anti-Lassa Virus IgG antibodies in three districts of Sierra Leone: A cross-sectional, population-based study.

BACKGROUND: Lassa virus (LASV), the cause of the acute viral hemorrhagic illness Lassa fever (LF), is endemic in West Africa. Infections in humans occur mainly after exposure to infected excrement or urine of the rodent-host, Mastomys natalensis. The prevalence of exposure to LASV in Sierra Leone is crudely estimated and largely unknown. This cross-sectional study aimed to establish a baseline point seroprevalence of IgG antibodies to LASV in three administrative districts of Sierra Leone and identify potential risk factors for seropositivity and LASV exposure. METHODOLOGY AND PRINCIPAL FINDINGS: Between 2015 and 2018, over 10,642 participants from Kenema, Tonkolili, and Port Loko Districts were enrolled in this cross-sectional study. Previous LASV and LF epidemiological studies support classification of these districts as "endemic," "emerging," and "non-endemic", respectively. Dried blood spot samples were tested for LASV antibodies by ELISA to determine the seropositivity of participants, indicating previous exposure to LASV. Surveys were administered to each participant to assess demographic and environmental factors associated with a higher risk of exposure to LASV. Overall seroprevalence for antibodies to LASV was 16.0%. In Kenema, Port Loko, and Tonkolili Districts, seroprevalences were 20.1%, 14.1%, and 10.6%, respectively. In a multivariate analysis, individuals were more likely to be LASV seropositive if they were living in Kenema District, regardless of sex, age, or occupation. Environmental factors contributed to an increased risk of LASV exposure, including poor housing construction and proximity to bushland, forested areas, and refuse. CONCLUSIONS AND SIGNIFICANCE: In this study we determine a baseline LASV seroprevalence in three districts which will inform future epidemiological, ecological, and clinical studies on LF and the LASV in Sierra Leone. The heterogeneity of the distribution of LASV and LF over both space, and time, can make the design of efficacy trials and intervention programs difficult. Having more studies on the prevalence of LASV and identifying potential hyper-endemic areas will greatly increase the awareness of LF and improve targeted control programs related to LASV.

Efficiency Analysis of Syrian Refugees' Healthcare Services in Turkey and Other 3RP States.

Access to healthcare for refugees is often contextually and conceptually diverse. This study set out to evaluate the efficiency of the healthcare services provided for Syrian refugees in Turkey and other refugee response and resilience plan (3RP) states. Data envelopment analysis is utilized for efficiency analysis using primary healthcare system indicators. Efficiency is broken down into pure technical efficiency and scale efficiency to identify causes of inefficiency. Normative analysis is used to employ a teleological approach to better understand current refugee healthcare policies. The findings show a decline in the overall efficiency for Turkey and other 3RP states. However, Turkey's operational practices could be a model for other 3RP states due to its relatively high pure technical efficiency. Scale inefficiency negatively impacts the overall efficiency of Turkey's service, while other 3RP states exhibit a rather consistent performance. The study concludes that Turkey's healthcare system for refugees is inefficient, resulting in inadequate access for Syrian refugees. As such, operational and scale efficiency must be synergized for Turkey to fulfill its obligation to provide adequate healthcare for Syrian refugees. Additionally, COVID-19 was found to have exacerbated the challenges Syrian refugees face accessing healthcare. Policy recommendations have been made in line with the findings of the study.

Physicochemical analysis and intermediate pyrolysis of Bambara Groundnut Shell (BGS), Sweet Sorghum Stalk (SSS), and Shea Nutshell (SNS).

ABSTRACTThe current work focused on the intermediate pyrolysis of Bambara Groundnut Shells (BGS-G1), Sweet Sorghum Stalk (SSS), and Shea Nutshells (SNS). These feedstocks are readily available as wastes or by-products from industrial and agricultural activities. The thermo-gravimetric analysis of the biomass samples exhibited decomposition and devolatilization potentials in the temperature range of 110-650°C. The kinetic modelling resulted in the activation energy of BGS G1 being the lowest as 20.43 kJ/mol and SNS as the highest 24.89 kJ/mol among the three biomass samples. Intermediate pyrolysis was conducted in a vertical tube reactor at a temperature of 600°C, with nitrogen flow at 10 ml/min and heating rate ≥ 33.0℃/min. The yield of pyrolysis bio-oil was 38.0 ± 6.4, 44.2 ± 6, and 39.7 ± 5.2 wt.% for BGS-G1, SSS, and SNS, respectively. The HHV of bio-oil varied as 23.7 ± 1.8, 23.8 ± 1.8, to 26.5 ± 2.0 MJ/kg for BGS-G1 SSS and SNS respectively. The biochar recorded the lowest HHV for BGS-G1 as 18.8 ± 1.2 MJ/kg and the highest for SNS as 26.4 ± 1.8 MJ/kg. The FTIR of bio-oil revealed significant functional groups, and GC-MS (Gas Chromatography and Mass Spectrometry) analysis categorized the compounds in bio-oils as ketones, furans, phenolics, acids, phenols and benzene derivatives. The physicochemical analysis of the feedstocks and the products (bio-oil and biochar) showed their potential for bioenergy and biochemical (green chemicals) production.

Extraskeletal Osteosarcoma: A Case Report.

Extraskeletal osteosarcoma (ESO) is a rare form of osteosarcoma that has no attachment to bone and can be found in the thigh, retroperitoneum, chest, breast, orbit, retropharyngeal space etc. Literature about ESO is still mainly case reports and case series with few reported cases in our environment. We therefore report this 52-year-old with swelling at the left shoulder which progressed over a 3-year period. Pre-operative evaluation (both clinical, radiological and histopathological) were in favor of soft tissue sarcoma. A wide local excision showed no bony attachment intra-operatively. Histology of the specimen confirmed ESO. Patient had adjuvant chemotherapy and was followed up for 14 months before this report with no sign of local recurrence or distant metastases.

Early Functional Outcome of Hemiarthroplasty in the Elderly with Neck of Femur Fracture: A Single Centre's Experience.

Introduction: Neck of femur fractures in the elderly population are common and often a devastating condition. The optimal treatment has been a subject of debate. Arthroplasty has been shown to be the most viable treatment option. The high cost of total hip replacement makes hemiarthroplasty a suitable option in our environment. Materials and Methods: This study was designed to measure the outcome of hemiarthroplasty after femoral neck fracture using Harris hip score in patients aged 60 and above at the National Orthopaedic Hospital, Dala, Kano, Nigeria. Results: Twenty-five consecutive patients 60 years and above with femoral neck fracture who met the inclusion criteria and gave consent were enrolled into the study. The mean Harris hip score at the pre-operative period was 16.92. Fourth week after the surgery, the mean Harris hip score was 69.96. The score rose further to 75.24 and 80.96 at 12 weeks and 6 months post-operatively. The difference between the mean pre-operative and post-operative scores at 4th week, 12th week, and 6th month was statistically significant. During the pre-operative period, all patients had a poor Harris hip score grade. Six months after the surgery, 7 patients (28%) had an excellent Harris hip score grade, 12 patients (48%) had good grades, and 1 patient (4%) had a fair Harris hip score grade. Five patients (20%) had a poor Harris hip score grade at 6 months. Conclusion: From the findings of this study, it can be concluded that early functional outcomes of hemiarthroplasty for femoral neck fracture in the elderly are good and satisfactory.

Polymer Thermal Treatment Production of Cerium Doped Willemite Nanoparticles: An Analysis of Structure, Energy Band Gap and Luminescence Properties.

The contemporary market needs for enhanced solid-state lighting devices has led to an increased demand for the production of willemite based phosphors using low-cost techniques. In this study, Ce3+ doped willemite nanoparticles were fabricated using polymer thermal treatment method. The special effects of the calcination temperatures and the dopant concentration on the structural and optical properties of the material were thoroughly studied. The XRD analysis of the samples treated at 900 °C revealed the development and or materialization of the willemite phase. The increase in the dopant concentration causes an expansion of the lattice owing to the replacement of larger Ce3+ ions for smaller Zn2+ ions. Based on the FESEM and TEM micrographs, the nanoparticles size increases with the increase in the cerium ions. The mean particles sizes were estimated to be 23.61 nm at 1 mol% to 34.02 nm at 5 mol% of the cerium dopant. The optical band gap energy of the doped samples formed at 900 °C decreased precisely by 0.21 eV (i.e., 5.21 to 5.00 eV). The PL analysis of the doped samples exhibits a strong emission at 400 nm which is ascribed to the transition of an electron from localized Ce2f state to the valence band of O2p. The energy level of the Ce3+ ions affects the willemite crystal lattice, thus causing a decrease in the intensity of the green emission at 530 nm and the blue emission at 485 nm. The wide optical band gap energy of the willemite produced is expected to pave the way for exciting innovations in solid-state lighting applications.

Integrated analysis of energy-economic development-environmental sustainability nexus: Case study of MENA countries.

The new industrialization necessitates the integration of energy efficiency, economic development, and environmental sustainability. However, quantifying the efficiency of renewable energy towards economic development is an ongoing debate. On this basis, this study presents a multi net-put efficiency and conventional efficiency approach to analyze non-renewable energy and renewable energy efficiency towards economic development and environmental sustainability nexus. Data Envelopment Analysis (DEA) is utilized to estimate multi net-put conventional and renewable energy efficiency. Likewise, the Autoregressive Distributed Lag (ARDL) Pooled Mean Group (PMG) approach is applied to examine the impact of non-renewable efficiency on economic growth, total natural resource rent and environmental quality. Results show that the efficiency nexus of conventional energy is significant and higher (98%) than renewable energy (69.5%) for the evaluated period (2006-2016). Nonetheless, conventional energy efficiency of the panel of MENA countries worsen the environmental quality, thus does not enhance environmental sustainability especially in the long-run. The results also posit that economic growth in the panel of MENA countries is detrimental to the region's environmental sustainability. Further analysis indicates that the inefficiency of renewable energy nexus has more to do with scale size inadequacy rather than operational deficiency. Therefore, resources and policies must be targeted towards up scaling renewable energy capacity accompanied with cautious and target oriented strategy.

Transnational resource generativity: Efficiency analysis and target setting of water, energy, land, and food nexus for OECD countries.

Depletion of natural resources needs quantification and efficiency analysis of the use of resources to improve sustainability. This paper evaluates the efficiency of Organization for Economic Co-Operation and Development (OECD) countries in terms of Water-Energy-Land-Food (WELF-Nexus) to ensure sustainability and environmental viability for both present and future generations. An input-output index system is built at a transnational level. Composite and intrinsic indicators are introduced to incorporate the interconnections and tradeoffs between sectors of the nexus and outcomes of the nexus. The nonparametric benchmarking order-α model, resulting from Data Envelopment Analysis (DEA) is used to estimate WELF-Nexus efficiency of each country, and to alleviate the intricacies of using composite and intrinsic indicators. To ensure resource generativity, an output target setting model that accommodates predefined input is proposed. Results show variation in performance among OECD members, with an annual average efficiency score of 68%, 69% and 78% in 2007, 2012, and 2016. Sensitivity analysis was performed to measure the effect of drought on WELF efficiency, a decrease of about 13% on average WELF efficiency was observed. Outputs improvement was recommended for each country: Lithuania (14%), Mexico (10%) and 11% for Hungary, Latvia, and Turkey due to their high inefficiency. The study provides a robust framework for policy making and shows that a win-win strategy for the nexus must be implemented to achieve WELF-Nexus efficiency, given the trade-offs within its sectors. Furthermore, it highlights that innovative-driven policies will enhance WELF-Nexus efficiency and sustainability.

Efficiency Analysis of Healthcare System in Lebanon Using Modified Data Envelopment Analysis.

The inflow of refugees from Syria into Lebanon necessitates a robust and efficient healthcare system in Lebanon to withstand the growing demand for healthcare service. For this purpose, we evaluate the efficiency of healthcare system in Lebanon from 2000 through 2015 by applying a modified data envelopment analysis (DEA) model. We have selected four output variables: life expectancy at birth, maternal mortality ratio, infant mortality rate, and newly infected with HIV and two input variables: total health expenditure (% of GDP) and number of hospital beds. The findings of the paper show improvement in the efficiency of the healthcare system in Lebanon after the widespread of the health system reform in 2005. It also shows that reduction in health expenditure does not necessarily reduce efficiency if operational and technical aspect of the healthcare system is improved. The study infers that the healthcare system in Lebanon is capable of withstanding the increase in health demand provided further resources are made available and the existing technical and operational improvement are maintained.

Estimating efficiency of Directive 2011/24/EU cross-border healthcare in member states.

Aim: Directive 2011/24/EU on patients' rights in cross-border healthcare facilitates EU citizens' access to and reimbursement for healthcare provided or prescribed in a member state other than the member state of affiliation. Materials & methods: The efficiency of cross-border healthcare policy is evaluated using data envelopment analysis of relevant items in Eurobarometer Survey on Safety and Quality of Care and Patients' Rights in the EU. Results: Our study shows policy inefficiency in 52% of the 25 EU member states included in the analysis. Addressing difficulties patients encounter while seeking reimbursement from their national health service or health insurer and reducing the number of adverse events patients experience when receiving healthcare improves policy efficiency. Conclusion: Our findings confirm that there is country-level variation in cross-border healthcare policy efficiency.

Dry Gangrene in Children with Typhoid Intestinal Perforation: A Report of Two Cases.

Intestinal perforation is a life-threatening complication of typhoid fever commonly seen in developing countries, but extraintestinal complications are infrequently reported. We report herein two cases of gangrene seen in children managed for typhoid intestinal perforation, highlighting the challenges faced in their management.