Clinical tools for evaluating the severity of overactive bladder: A systematic review of psychometric properties.

OBJECTIVES: To systematically evaluate the evidence describing the psychometric properties of clinical measures for assessing overactive bladder symptoms (urinary urgency with or without urge urinary incontinence, urinary frequency and nocturia). To evaluate the quality of this evidence-base using the COnsensus-based Standards for selecting health status Measurement INstruments (COSMIN) checklist and the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) tools. DATA SOURCES: Five electronic databases (CINAHL, EMBASE, MEDLINE, Scopus and Web of Science) were searched from dataset inception to August 2023. REVIEW METHODS: Study screening, data extraction and quality appraisal were performed by two independent authors. Inclusion criteria were studies testing one or more psychometric properties of clinical tools for the assessment of overactive bladder symptoms among adults aged 18 years and older for both sexes. The methodological quality and quality of the evidence were evaluated using the COSMIN checklist and GRADE tools, respectively. RESULTS: The search identified 40 studies totalling 10,634 participants evaluating the psychometric properties of 15 clinical tools. The COSMIN methodological quality was rated good for most measures, and the GRADE quality of evidence ranged from low (13%) to high (33%). The Overactive Bladder Symptom Score, Overactive Bladder Questionnaire and Neurogenic Bladder Symptom Score were of good methodological and high-GRADE evidence qualities. CONCLUSION: Overactive Bladder Symptom Score, the Overactive Bladder Questionnaire and the Neurogenic Bladder Symptoms Score are promising psychometrically sound measures. The Overactive Bladder Symptom Score has been applied to the most culturally diverse populations supported by studies of good methodological and high-GRADE evidence quality.

Significant Variation in the Detection Rates of Proximal Serrated Polyps Among Academic Gastroenterologists, Community Gastroenterologists, and Colorectal Surgeons in a Single Tertiary Care Center.

INTRODUCTION: Recent studies have demonstrated that the protective effect of colonoscopy against colorectal cancer is lower in the proximal colon. Proximal serrated polyps, including sessile serrated adenomas and proximal hyperplastic polyps, can be frequently missed and pose a risk of interval cancers. AIM: To investigate the overall adenoma detection rate (ADR) and the proximal serrated polyp detection rate (PSPDR) among academic gastroenterologists, community gastroenterologists, and colorectal surgeons from a single institution, all of whom have received formal training in colonoscopy during their fellowship. METHODS: All complete screening colonoscopies for patients aged 50 or older with a good to excellent bowel preparation performed by different endoscopists at Medstar Washington Hospital Center (Washington, DC) from July 2015 to December 2017 were reviewed. Pathology reports of the resected polyps were manually reviewed. RESULTS: A total of 2850 screening colonoscopies meeting the inclusion criteria were performed by 18 endoscopists (6 academic, 7 community, and 5 colorectal surgeons). There was no significant difference in the mean ADR among the three groups of endoscopists: academic gastroenterologists, community gastroenterologists, and colorectal surgeons (40.3% vs 36.0% vs 39.6%, respectively). However, academic gastroenterologists had a significantly higher PSPDR compared to community gastroenterologists or colorectal surgeons (12.3% vs 5.4% vs 4.5%, respectively, ANOVA p = 0.006). CONCLUSION: Our novel data show that academic gastroenterologists had a significantly higher PSPDR compared to community gastroenterologists or colorectal surgeons despite a comparable overall ADR among the three groups. PSPDR may be considered as an important quality indicator for colonoscopy, apart from ADR.

The Benefits of a Guideline on Safe Termination of Pregnancy for Legal Indications: An Illustrative Case Report of a Hydranencephaly.

After years of the worsening burden of unsafe abortion and attendant morbidities and mortalities in Nigeria, a National Guideline on the Safe termination of pregnancy for legal indications was enunciated. This report presents and discusses an illustrative case of a hydranencephaly that benefited from it. A 43-year old multipara was informed during routine ultrasonography at booking for antenatal care, at 16 weeks of gestation, of a major defect in her baby and advised to meet her physician. Following a repeat high- resolution ultrasonography and discussions between the Obstetricians, Neurosurgeon, and Ultrasonologist, the woman was counseled on the diagnosis. At her insistence and provision of written consent, medical abortion with Mifepristone and Misoprostol was successfully instituted.

Evaluating repetitive transcranial magnetic stimulation for neurogenic overactive bladder management in stroke survivors: A randomized sham-controlled trial protocol.

BACKGROUND: Neurogenic overactive bladder (OAB) is a distressing condition in stroke. Existing neurogenic OAB management is expensive, unstandardized regimens, or invasive. Evaluating the effectiveness of repetitive transcranial magnetic stimulation (rTMS) remains crucial. We aimed to (1) compare the effectiveness of active-rTMS with sham-rTMS on neurogenic OAB symptoms, (2) analyze whether rTMS is cost-effective, and (3) explore the rTMS's experiences on participants' symptoms. METHODS: This is a randomized, sham-controlled, double-blinded trial with embedded qualitative and cost-effectiveness studies. A total of 110 stroke survivors with neurogenic OAB symptoms were screened for eligibility; 60 participants were eligible for inclusion and were randomly assigned to either the active (n = 30) or sham-rTMS (n = 30) groups using a computer-generated randomization schedule. The active-rTMS group received low-frequency rTMS of 1200 pulses per session lasting 20 min thrice weekly to pelvic floor muscle representation at the contralesional primary motor cortex. The sham-rTMS group received low-frequency stimulation at a 20 % resting motor threshold using the same coil as the active-rTMS but was configured to reduce the TMS-induced electrical fields significantly. The primary and secondary outcome measures were assessed at baseline, post-intervention (week 4) and follow-up (week 8). The analysis of covariance (ANCOVA) analysis compared changes in the study groups. Quality-adjusted life-years (QALY) were measured to evaluate the cost-effectiveness while EQ-5D-5L estimated QALY changes. Additionally, the focus group discussion data were thematically analyzed. CONCLUSIONS: The findings from this rTMS intervention study will be useful in alleviating neurogenic OAB symptoms and enhancing patient satisfaction in a cost-effective way.

Coping strategies of internally displaced persons and the host community in a region of armed conflict: A cross-sectional study.

BACKGROUND: Conflict leads to the displacement of people, making it more difficult for them to cope with increasing stress. In war-affected regions, people use different strategies to cope with their stress. This study examines the coping strategies of internally displaced persons (IDPs) and those in host communities in war zones. METHODS: People living in the IDP camp and host communities in Maiduguri, Nigeria were recruited using a convenient sampling strategy. A 28-item Hausa version of the Brief COPE Scale wasused for data collection. Data were analyzed using linear regression and presented as unstandardized beta (B) and standard error (SE). RESULTS: A total of 562 participants were recruited (IDPs, n = 281; and the host communities, n = 281). Problem- and emotion-focused coping strategies were identified as the most common approaches used in host communities; however, dysfunctional strategies were morecommon among the IDPs. Age (younger or older adulthood) was identified as a predictor forthe use of emotion-, problem-, and dysfunctional-focused coping strategies. CONCLUSION: Host communities were more likely to use a problem-and emotion-focused approach to coping, while IDPs were more likely to use dysfunctional strategies. Location and demographic factors (being single, aged 18-29years, >50 years and older) also influenced coping.

Quality in neonatal mortality audits: Results of pilot study from district of Dhule, Maharashtra.

Introduction: As per WHO guidelines, it is important to have quality among mortality audit documents to improve outcome in health services. Objective: To assess quality of facility-based neonatal mortality audits implementation. Methodology: Mixed-method descriptive analysis was conducted. Totally, 96 death review documents were reviewed. The 25 healthcare workers were interviewed in depth. Observation analysis done for audit meetings using WHO modified checklist for quality in audit toolkit. Results: The observation of audit meetings highlighted that almost half of the members were not communicated regarding vision of audit and framework of audit and review meetings. In quantitative analysis, it was found that secondary care hospitals were not having accuracy and consistency in audit documentation. Conclusion: The quality of neonatal death audit was poor due to challenges faced by the hospitals in creating an enabling atmosphere, which can be overcome by sharing the vision of audit with the whole staff of the hospital. A standard operating procedure for audit committee to be adopted to implement action plans. Commitment, investment, and intentional leadership from everyone, including all healthcare workers, can make these ambitious goals attainable.

Effects of nonsurgical, minimally or noninvasive therapies for urinary incontinence due to neurogenic bladder: a systematic review and meta-analysis.

Objective: To determine the effects of nonsurgical, minimally or noninvasive therapies on urge urinary incontinence (UUI) symptoms and quality of life (QoL) in individuals with neurogenic bladder (NGB). Data Sources: Cochrane library, EMBASE, MEDLINE, PEDro, Scopus, and Web of Science databases were searched from inception to September 2021. Review Methods: Randomized controlled trials that compared therapies such as intravaginal electrical stimulation (IVES), transcutaneous electrical nerve stimulation (TENS), neuromuscular electrical stimulation (NMES), transcutaneous tibial nerve stimulation (TTNS), pelvic floor muscle training (PFMT), and behavioural therapy (BT) to control were included. Study screening, data extraction, and study quality assessments were performed by two independent authors. Results: Fourteen trials with 804 participants were included in the study after screening of 4281 potentially relevant articles. Meta-analyses revealed a significant effect of electrical stimulation on UUI due to multiple sclerosis (standardized mean difference (SMD): -0.614; 95% confidence interval (CI): -1.023, -0.206; p = 0.003) and stroke (SMD: -2.639; 95% CI: -3.804, -1.474; p = 0.000). The pooled analyses of TTNS (weighted mean difference (WMD): -12.406; 95% CI: -16.015, -8.797; p = 0.000) and BT (WMD: -9.117; 95% CI: -14.746, -3.487; p = 0.002) revealed significant effects of these interventions on QoL in people with Parkinson's disease. However, meta-analyses revealed nonsignificant effects for PFMT (WMD: -0.751; 95% CI: -2.426, 0.924; p = 0.380) and BT (WMD: -0.597; 95% CI: -1.278, 0.083; p = 0.085) on UUI due to Parkinson's disease. Conclusions: Our meta-analyses found electrical stimulation to be beneficial for improving the symptoms of UUI among people with multiple sclerosis and those with stroke. Our review also revealed that TTNS and BT might improve QoL for people with NGB due to Parkinson's disease, although the effects of PFMT and BT on UUI warrant further investigation.

Molecular characterization of Newcastle disease virus vaccines in Nigeria.

Background and Aim: Newcastle disease (ND) caused by ND virus (NDV) is a serious impediment to effective poultry production in developing countries such as Nigeria. Despite employing vaccination and other control measures to curtail this disease, its severe forms still persist. This study aimed to confirm the virus strains in the NDV vaccine brands commonly used in Nigeria. Materials and Methods: We employed reverse-transcription polymerase chain reaction (RT-PCR), sequencing, and sequence analysis to characterize NDV strains in four NDV vaccines commonly used in Nigeria. Fragments of 300 bp from NDV fusion genes from the vaccines were amplified. Polymerase chain reaction products were sequenced and analyzed using multiple sequence alignment and phylogenetic analyses to characterize the vaccine viruses as pathotypes. Results: All the vaccines gave positive results, confirming the presence of NDV. Multiple sequence alignment and phylogenetic analyses revealed that two of the vaccines had the lentogenic pathotype, while the other two had the mesogenic or velogenic pathotype. Conclusion: This study provides information to facilitate strategies for regular control of the quality of vaccines in Nigeria.

Prevalence of Anxiety and Depression Among the General Population in Africa During the COVID-19 Pandemic: A Systematic Review and Meta-Analysis.

Background: Medical and socio-economic uncertainties surrounding the COVID-19 pandemic have had a substantial impact on mental health. This study aimed to systematically review the existing literature reporting the prevalence of anxiety and depression among the general populace in Africa during the COVID-19 pandemic and examine associated risk factors. Methods: A systematic search of the following databases African Journal Online, CINAHL, PubMed, Scopus, and Web of Science was conducted from database inception until 30th September 2021. Studies reporting the prevalence of anxiety and/or depression among the general populace in African settings were considered for inclusion. The methodological quality of included studies was assessed using the Agency for Healthcare Research and Quality (AHRQ). Meta-analyses on prevalence rates were conducted using Comprehensive Meta-analysis software. Results: Seventy-eight primary studies (62,380 participants) were identified from 2,325 studies via electronic and manual searches. Pooled prevalence rates for anxiety (47%, 95% CI: 40-54%, I2 = 99.19%) and depression (48%, 95% CI: 39-57%, I2 = 99.45%) were reported across Africa during the COVID-19 pandemic. Sex (female) and history of existing medical/chronic conditions were identified as major risk factors for anxiety and depression. Conclusions: The evidence put forth in this synthesis demonstrates the substantial impact of the pandemic on the pervasiveness of these psychological symptoms among the general population. Governments and stakeholders across continental Africa should therefore prioritize the allocation of available resources to institute educational programs and other intervention strategies for preventing and ameliorating universal distress and promoting psychological wellbeing. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021228023, PROSPERO CRD42021228023.

Trend and enhanced surveillance of Monkeypox during COVID-19 pandemic in Nigeria.

Monkeypox (MPX) is a viral zoonosis with lesions like smallpox. Though rare in Nigeria, sporadic outbreaks have been reported in 17 states since September 2017. Unfortunately, the COVID-19 pandemic has further reduced surveillance and reporting of MPX disease. This study seeks to assess the effect of an enhanced surveillance approach to detect MPX cases and measure the cumulative incidence of MPX in priority states in Nigeria. We identified three priority states (Rivers, Delta and Bayelsa) and their Local Government Areas (LGAs) based on previous disease incidence. We also identified, trained, and incentivized community volunteers to conduct active case searches over three months (January to March 2021). We supported case investigation of suspected cases and followed up on cases in addition to routine active surveillance for MPX in health facilities and communities. Weekly and monthly follow-up was carried out during the same period. Out of the three states, 30 hotspots LGAs out of the 56 LGAs (54%) were engaged for enhanced surveillance. We trained three state supervisors, 30 LGA surveillance facilitators and 600 Community informants across the three priority states. Overall, twenty-five (25) suspected cases of MPX were identified. Out of these, three (12%) were confirmed as positive. Enhanced surveillance improved reporting of MPX diseases in hotspots LGAs across the priority states. Extension of this surveillance approach alongside tailored technical support is critical intra and post-pandemic.

Lung carcinoma: its profile and changing trends.

BACKGROUND: Lung Carcinoma is the leading causes of morbidity and mortality worldwide with an incidence of 1.3 million cases per year. This study was undertaken to determine prevalence of various histological types of lung carcinoma and to analyse their changing trends with time. METHODS: This is a retrospective analytical study. A total of 330 cases of lung carcinoma were analysed from 2003 to 2008. Cases from Khyber Pakhtunkhwa and Federally Administered Tribal Area (FATA) were included in this study. Furthermore, only cases of lung carcinoma were considered while other malignancies were excluded. RESULTS: Squamous Cell carcinoma was found in 42.7% of cases. Overall male to female ratio was 2.67:1. Prevalence of Squamous Cell carcinoma increased from 32% to 57.9% while that of Small Cell carcinoma increased from 12% to 17.1%. Unspecified type showed decrease from 36% to 5.3%. Increase in the prevalence of Squamous Cell carcinoma was found in both males and females while change in the prevalence of Small Cell carcinoma was found on!y in males. CONCLUSION: Squamous Cell carcinoma was the most prevalent variant of lung carcinoma in our region, followed by Adenocarcinoma. Male to female ratio across different histological patterns did not show significant variation. Increase in the prevalence of Squamous Cell carcinoma was statistically significant in both males and females while in case of Small Cell carcinoma change in its prevalence was also significant in males.

Investigation of the Electrical Properties of Microtubule Ensembles under Cell-Like Conditions.

Microtubules are hollow cylindrical polymers composed of the highly negatively-charged (~23e), high dipole moment (1750 D) protein α, ß- tubulin. While the roles of microtubules in chromosomal segregation, macromolecular transport, and cell migration are relatively well-understood, studies on the electrical properties of microtubules have only recently gained strong interest. Here, we show that while microtubules at physiological concentrations increase solution capacitance, free tubulin has no appreciable effect. Further, we observed a decrease in electrical resistance of solution, with charge transport peaking between 20-60 Hz in the presence of microtubules, consistent with recent findings that microtubules exhibit electric oscillations at such low frequencies. We were able to quantify the capacitance and resistance of the microtubules (MT) network at physiological tubulin concentrations to be 1.27 × 10-5 F and 9.74 × 104 Ω. Our results show that in addition to macromolecular transport, microtubules also act as charge storage devices through counterionic condensation across a broad frequency spectrum. We conclude with a hypothesis of an electrically tunable cytoskeleton where the dielectric properties of tubulin are polymerisation-state dependent.

Analytical Method Development and Validation for the Simultaneous Estimation of Abacavir and Lamivudine by Reversed-phase High-performance Liquid Chromatography in Bulk and Tablet Dosage Forms.

OBJECTIVE: A simple rapid, accurate, precise, and reproducible validated reverse phase high performance liquid chromatography (HPLC) method was developed for the determination of Abacavir (ABAC) and Lamivudine (LAMI) in bulk and tablet dosage forms. METHODS: The quantification was carried out using Symmetry Premsil C18 (250 mm × 4.6 mm, 5 µm) column run in isocratic way using mobile phase comprising methanol: water (0.05% orthophosphoric acid with pH 3) 83:17 v/v and a detection wavelength of 245 nm and injection volume of 20 µl, with a flow rate of 1 ml/min. RESULTS: In the developed method, the retention times of ABAC and LAMI were found to be 3.5 min and 7.4 min, respectively. The method was validated in terms of linearity, precision, accuracy, limits of detection, limits of quantitation, and robustness in accordance with the International Conference on Harmonization guidelines. CONCLUSION: The assay of the proposed method was found to be 99% - 101%. The recovery studies were also carried out and mean % recovery was found to be 99% - 101%. The % relative standard deviation from reproducibility was found to be <2%. The proposed method was statistically evaluated and can be applied for routine quality control analysis of ABAC and LAMI in bulk and in tablet dosage form. SUMMARY: Attempts were made to develop RP-HPLC method for simultaneous estimation of Abacavir and Lamivudine for the RP-HPLC method. The developed method was validated according to the ICH guidelines. The linearity, precision, range, robustness were within the limits as specified by the ICH guidelines. Hence the method was found to be simple, accurate, precise, economic and reproducible. So the proposed methods can be used for the routine quality control analysis of Abacavir and Lamivudine in bulk drug as well as in formulations. Abbreviations Used: HPLC: High-performance liquid chromatography, UV: Ultraviolet, ICH: International Conference on Harmonization, ABAC: Abacavir, LAMI: Lamivudine, HIV: Human immunodeficiency virus, AIDS: Acquired immunodeficiency syndrome, NRTI: Nucleoside reverse transcriptase inhibitors, ARV: Antiretroviral, RSD: Relative standard deviation, RT: Retention time, SD: Standard deviation.