Population Pharmacokinetics and Absolute Oral Bioavailability of Lasalocid after Single Intravenous and Intracrop Administration in Laying Hens.

Lasalocid sodium is a polyether carboxylic ionophore agent authorized by the EU for use as a coccidiostat in broilers, turkeys, and pullets up to 16 weeks of age, except for laying hens. However, laying hens are the most common nontarget species exposed to lasalocid sodium, mainly due to cross-contamination from feed mills. This exposure may result in potential drug residue deposition in eggs, which could potentially expose consumers to the drug. The breeds commonly used for commercial egg production in Poland are Isa Brown and Green-legged Partridge hens, which have been found to significantly differ in egg-laying performance. This variability may also affect the pharmacokinetics of lasalocid. Data on lasalocid plasma pharmacokinetics in laying hens are lacking. In this study, we aimed to determine typical population pharmacokinetic parameters, absolute oral bioavailability, and how breed may influence the pharmacokinetics of lasalocid. Twenty-layer hens of the two breeds were used in this study. Lasalocid was administered orally at a single dose of either 1 mg or 5 mg/kg body weight or intravenously at a dose of 1 mg/kg body weight, in a crossover design with a three-week washout period between study periods. Blood samples were collected for 72 h, and lasalocid concentrations were measured using high-performance liquid chromatography with fluorescence detection. A population pharmacokinetic analysis was conducted using nonlinear mixed effects modeling. Standard numerical and graphical criteria were used to select the best model, and a stepwise covariate modeling approach was used to determine any influencing factors. The best model was a three-compartment mammillary model with first-order absorption, transit compartments, and linear elimination. The estimated absolute oral bioavailability was low (36%). It was found that breed significantly influenced not only absorption but also the elimination of lasalocid. This study revealed that lasalocid absorption and elimination varied between the two breeds. This variability in pharmacokinetics may result in breed-related differences in drug residue accumulation in eggs, and ultimately, the risk associated with consumer exposure to drug residues may also vary.

Total replacement of soybean meal with alternative plant-based ingredients and a combination of feed additives in broiler diets from 1 day of age during the whole growing period.

The capacity of combinations of feed enzymes, natural betaine and a probiotic, combined with alternative plant-based ingredients, to totally replace soybean meal (SBM) in a broiler diet was evaluated. Day-old Ross 308 males (2,574) were assigned to 9 treatments (13 pens/treatment, 22 birds/pen) in a completely randomized design. All diets were pelleted and fed ad libitum in 4 phases: starter, grower, finisher 1, finisher 2 (0-10, 10-21, 21-35, and 35-42 d of age, respectively). Treatments included: 1) control diet containing SBM (SBM control), supplemented with phytase (PhyG), at 2,000, 1,500, 1000 and 1,000 FTU/kg in each phase and xylanase (X) at 750 U/kg, [crude protein (CP): 23.5%, 22.0%, 20.2% and 19.3% in each phase]; 2) to 5), alternative (ALT), SBM-free diets, containing the same CP level as the control ("CP high"), supplemented with PhyG as in the control, protease (P, 800 U/kg) and in 2) xylanase (750 U/kg) (ALT+PhyG+P+X), 3) xylanase-ß-glucanase (XB, 1,200 U/kg and 152 U/kg) (Alt+PhyG+P+XB), 4) XB plus betaine (800 g/ton) (ALT+PhyG+P+XB+Bet), and 5) XB plus a probiotic [150,000 colony forming units (CFU)/g] (ALT+PhyG+P+XB+Prob); 6) to 9) as treatments 2) to 5) but with CP reduced by -2.0 to -1.5% points vs. control ('CP low'). Final (d 42) BW and overall (d 0-42) feed conversion ratio (FCR) of birds fed the SBM control exceeded breeder objectives (+3.8% and -1.9%, respectively). Overall FCR was reduced and d 42 BW increased in birds fed "low" vs. "high" CP (P < 0.01). Overall FCR and feed intake were not different in ALT+PhyG+XB+P+Bet and ALT+PhyG+XB+P+Prob vs. the control, whereas final BW was reduced (P < 0.05) in all ALT treatments but close to breeder objectives (98.3%) in ALT+PhyG+XB+P+Prob. Feed costs of this treatment were similar to the control. Total replacement of SBM with alternative plant-based ingredients in a CP-low diet supplemented with hydrolytic enzymes and probiotics can achieve growth performance outcomes close to commercial breeder objectives.

Citizen science mitigates the lack of distributional data on Nigerian birds.

Citizen science projects are expanding globally, with the African continent, particularly Nigeria, registering significant growth. Here, we document and analyse novel operations of the Nigerian Bird Atlas Project (NIBAP), 2015-2022. This project has employed the use of ornithologists, mainly trained at the A. P. Leventis Ornithological Research Institute (APLORI) located in Jos, Nigeria, and its 28 bird clubs established across Nigeria to enlist 827 bird enthusiasts that contribute regular and near real-time data about bird distribution and relative abundance in the country. Interestingly, NiBAP has recorded about 75% of the bird species known from Nigeria in only about 50% of Nigeria's total surface area, including 39 nationally threatened species. The Common Bulbul Pycnonotus barbatus, Laughing Dove Spilopelia senegalensis, and Grey-backed Camaroptera Camaroptera brevicaudata were the most commonly recorded species, while Amurum Forest Reserve, Rennajj Fish Farm, and Obudu Cattle Ranch were the most surveyed sites during the period. Thus, our approach reveals how to increase involvement of nature enthusiasts, ornithologists, and a regional research institute to build local capacity and contribute rich information necessary to alleviate the lack of distributional data about Afrotropical avifauna. We strongly recommend our approach to boost other citizen science projects across Africa and beyond to address the huge lack of biodiversity data, create public awareness, and foster conservation education.

CASE FATALITY RATE OF CHILDHOOD TUBERCULOSIS: EXPERIENCE FROM FEDERAL TEACHING HOSPITAL GOMBE: A TWO DECADE REVIEW.

Introduction: Tuberculosis (TB) was the leading cause of death from an infectious agent worldwide, until the Coronavirus (COVID-19) pandemic, ranking above HIV/AIDS. Nigeria ranks 6th among the 30 TB high-burden countries (TB, TB/HIV, DRTB) and 1st in Africa. The estimated case fatality rate (CFR) of TB in Sub-Sahara Africa (SSA) is 15%. Objective: To review the Tuberculosis case fatality rate (TCFR) in children diagnosed with TB from 2000-2019 in Federal Teaching Hospital Gombe. Methodology: All cases of Tuberculosis (TB) diagnosed in children using ICD 10 classification were retrieved and analyzed. These included deaths from TB. The mainstay of TB diagnosis was clinical using TB Score (81%), Gene Xpert was 7%, and AFB was 10%. Results: 26,716 children were admitted; 383 had TB out of which 208(54.3%) were males and 175 (45.7%) females. TB constituted 1.4% of Paediatric admissions. Children 0 -5 years constituted 46.7% (179/383) of cases and 11 - 18 years were 31.3% (120/383). Fulani, Hausa, and Tangale constituted 43.6% (167), 21.1% (81), and 6.8% (26) of TB cases respectively. TB admissions were highest between 2015 and 2019 (31.8%). TB adenitis was the most common extrapulmonary TB. Tuberculosis/HIV co-infection accounted for 103(27%), out of which 74% (44) died. Overall TCFR was 15.6%; TCFR was 16.3% in males and 14.8% in females. The TCFR was 46.7% in 0-5yrs; 15% in 6-9yrs and 38.3% in 10-18yrs.Fulani had the highest CFR (11.9%). Tuberculosis CFR was highest between 2010-2014 (30.0%) and lowest in 2005-2009 (21.6%). Conclusion: The Tuberculosis CFR is comparable to SSA CFR.

PATTERN OF RENAL DISEASES AMONG CHILDREN ATTENDING PAEDIATRIC NEPHROLOGY CLINIC, FEDERAL TEACHING HOSPITAL, GOMBE.

Introduction: Children present with a spectrum of renal diseases depending on age, sex, and geographic location among other factors. With the absence of a paediatric renal registry in Nigeria, this will provide part of the regional data necessary for the Nigerian renal registry. Methodology: A retrospective study where cases of renal diseases that presented in a nephrology clinic over a 2-year period were retrieved from the nurses' and doctors' records and analysed. Results: A total of 147 children were reviewed, male and female were 101 and 46 respectively with M: F being 2.2: 1. Mean age was 9.59 ± 4.58 years, age distribution were <5 years (23.0; 15.6%), 5-9 years (52; 35.4%) and ≥ 10 years (72.0; 49.0%). The majority (77.0; 52.4%) had low socioeconomic status. Majority (145; 98.6%) were acquired renal diseases while ectopic kidney (2.0; 1.4%) was the only CAKUT. Acute glomerulonephritis (49; 33.3%), urinary tract infections (37; 25.2%) and nephrotic syndrome (30.0; 20.4%) were the major acquired renal diseases. Acute kidney injury (AKI) and chronic kidney disease (CKD) were seen in 9 (6.1%) and 13 (8.8%) respectively. Urolithiasis, sickle cell nephropathy, and primary enuresis were seen in 5(3.4%) and 1 (0.7%) respectively. The mean age of children with CAKUT and acquired renal diseases were13.00 ±1.41 and 9.54±4.59 years (P=0.290) while that of AKI and CKD were 10.89±5.21 and 14.15±3.24 years respectively (P= 0.084). Conclusion: Childhood renal diseases increase with age and are more common among adolescents, especially the chronic forms. Regular screening and aggressive treatment are recommended in adolescents.

OBSTRUCTIVE UROPATHY FROM BILATERAL URETERIC CALCULI IN AN INFANT WITH DIARRHOEA DISEASE.

Introduction: Urolithiasis is the presence of mineral deposits in the urinary tract. It is rare in under-5 children and in Sub-Saharan Africa. Although metabolic abnormality is implicated in 50% of cases, infection, decreased urine volume and flow (dehydration state) have been implicated. We report a case of bilateral ureteric calculi in an infant with diarrhoea disease and dehydration. Case Report: A.S, is an 8-month-old male with prolonged loose, large-volume stool, large-volume vomiting, high-grade fever, body weakness, and peri-orbital swelling that progressed to generalized body swelling and absent urine for 2 days. He was conscious, afebrile (36.90C), pale with anasarca. Had distended abdomen with ascites. Dyspnea, coarse crepitation, and hypoxemia. Tachycardia (PR -180/min) Hypertensive (BP - 125/79mmHg). PCV - 20%, WBC - 24,000/l, platelet - 110,000/l. Creatinine (1030 umol/l), Urea - 30mmol/l, Multi drug resistant E.Coli. Bilateral Grade II nephritis, hydro-uretero-nephrosis, right pelvi-ureteric and left vesico-ureteric junction calculi. Managed for Diarrhoea disease complicated with Bilateral Obstructive uropathy secondary to Bilateral Ureteric Calculi. Had bilateral open ureteric exploration, ureterolithotomy, Stenting, intraoperative transfusion, antibiotics, analgesics, and IVF. 24-hr post-surgery: urine output (3.26ml/kg/hr): right stent (210ml), left stent (423ml) while urethral catheter (150ml), 742umol/l, Urea: 26mmol/l 48-hr post-surgery: Urine output 5.1ml/kg/hr (1224ml/24hr); Cr: 424umol/l, Urea: 16mmo/l 5 days post-surgery: Urine output 3.1ml/kg/hr (725ml/24hr); Cr: 47umol/l, Urea: 4.6 mmo/l, Patient was discharged home and currently on follow-up in paediatric nephrology and urology clinics. Conclusion: A high index of suspicion of obstructive uropathy in children with diarrhoea disease, and dehydration, who have developed acute kidney injury is recommended.

Remediation of hydrocarbons and metals by hydrocarbon utilizing Pseudomonas taiwanensis YSA-17 isolated from soil contaminated with petroleum.

Careless handling of petroleum in petrochemical industries releases toxic hydrocarbons and metals to soil and water. The aim of the present study was to isolate hydrocarbon-utilizing and metal-tolerant bacteria. Hydrocarbon-utilizing bacteria from petroleum-contaminated soils were isolated on the Bushnell Hass medium. Hydrocarbon degradation by Pseudomonas taiwanensis strain YSA-17 was observed by gas chromatography-mass spectrometry. Bioaccumulation of metals by strain YSA-17 was assessed in nutrient broth. Among different strains, YSA-17 showed the highest potential for hydrocarbon utilization. After 20 days of incubation, YSA-17 completely degraded one compound and during its degradation, there was the formation of 13 new compounds which were absent in uninoculated control. Results of scanning electron microscope and Fourier transmission infrared (FTIR) indicated degradation of hydrocarbons. FTIR showed the formation of new functional groups in YSA-17 inoculated medium. Expression of the total quantity of hydrocarbon-degrading gene (AlkB and NehAc) in petroleum-amended nutrient broth inoculated with strain YSA-17 enhanced significantly during 20 days of incubation compared to control. YSA-17 also significantly removed metals. This study concluded that bioinoculant can be utilized for the bioremediation of pollutants cocontaminated with hydrocarbons and metals. Petroleum-contaminated soil will be remediated for pollutants.

Environmental and psychosocial predictors of cervical cancer screening among women in Gwagwalada Area Council, Abuja, North Central, Nigeria.

Cervical cancer (CC) is the second leading cause of cancer morbidity and mortality among Nigerian women. Although screening is a cost-effective strategy for reducing its burden, uptake remains sub-optimal. A descriptive cross-sectional study was conducted among 514 sexually active women aged ≥25 years in Gwagwalada Area Council, Abuja, Nigeria using a semi-structured interviewer administered questionnaire. Mean age of respondents was 38.4±11.6years. 246(46.9%) had good knowledge of CC screening while 268(51.2%) had poor knowledge. Religion (aOR:1.8 [95% CI: 1.1 - 3.1]), location (aOR:1.2 [95% CI: 1.2 - 3.4) and number of children (aOR:2.3 [95% CI: 1.3 - 3.9]) were predictors for screening. Poor access routes to health facilities (aOR:0.5 [95% CI: 0.2 - 0.9]), high cost of screening (aOR:0.4 [95% CI: 0.2 - 0.9]), unaware of screening centers (aOR:0.4 [95% CI: 0.2 - 0.9]) and long waiting hours (aOR:0.5 [95% CI: 0.2 - 0.9) were identified environmental predictors. Fear of positive diagnosis/stigma (aOR:0.3 [95% CI: 0.1 - 0.9]), unacceptable touch (aOR:0.2 [95% CI: 0.1 - 0.8), deficiency in awareness programs (aOR:0.3 [95% CI: 0.2 - 0.7]), and not aware of appropriate screening age (aOR:0.1 [95% CI: 0.1 - 0.4]) were identified psychosocial predictors. This study highlights the need to intensify enlightenment programs, subsidize screening services, and encourage community screening.

Knowledge of Healthcare Professionals on Hepatitis B Virus Infection and Vaccination Uptake in a Tertiary Hospital in Nigeria.

BACKGROUND/OBJECTIVES: Healthcare professionals (HCPs) play a key role in the prevention of hepatitis B virus (HBV) infection. HCPs are expected to have adequate basic knowledge of HBV and readily uptake HBV vaccination as they are a high-risk group, especially those that have direct contact with blood and/or blood products. This study was aimed at assessing the knowledge of and vaccination uptake of HBV among HCPs in a Nigerian tertiary hospital. METHODS: This was a cross-sectional study in which self-administered questionnaires were used to obtain data from different categories of HCPs in a tertiary hospital. The associations between categorical variables were tested using Chi-square test and a P value of 0.05 or less was considered significant. RESULTS: A total of 355 HCPs comprising 149 medical doctors, 180 nurses and 26 laboratory scientists participated in the study. Majority (90.0%) of the respondents correctly identified blood and/or blood products transfusion, needle stick injury, sharing of sharps and vertical transmission as routes of HBV transmission. About 83.4% of the participants were aware that HBV could be transmitted through unprotected sex. However, 39.2% and 15.8% of the participants reported kissing and HBV vaccination as routes of transmission, respectively. Their knowledge and uptake of HBV vaccination was, however, good. CONCLUSION: While majority of the HCPs had good knowledge of the routes of HBV transmission, few still had misconceptions about the routes of transmission, a situation which may cause social discord in the society especially among closely related individuals and potentially result in poor uptake of the highly effective HBV vaccine.

CONTEXTE/OBJECTIFS: Les professionnels de la santé jouent un rôle clé dans la prévention de l'infection par le virus de l'hépatite B (VHB). On s'attend à ce qu'ils aient des connaissances de base suffisantes sur le VHB et qu'ils acceptent facilement la vaccination contre le VHB car ils constituent un groupe à haut risque, en particulier ceux qui sont en contact direct avec du sang et/ou des produits sanguins. Cette étude visait à évaluer les connaissances et l'acceptation de la vaccination contre le VHB parmi le personnel soignant d'un hôpital tertiaire nigérian. MÉTHODES: Il s'agit d'une étude transversale dans laquelle des questionnaires auto-administrés ont été utilisés pour recueillir des données auprès de différentes catégories de professionnels de la santé dans un hôpital tertiaire. Les associations entre les variables catégorielles ont été testées à l'aide du test du chi carré et une valeur P de 0,05 ou moins a été considérée comme significative. RÉSULTATS: Au total, 355 professionnels de la santé, dont 149 médecins, 180 infirmières et 26 laborantins, ont participé à l'étude. La majorité (90,0 %) des personnes interrogées ont correctement identifié la transfusion de sang et/ou de produits sanguins, les blessures par piqûre d'aiguille, le partage d'objets tranchants et la transmission verticale comme étant des voies de transmission du VHB. Environ 83,4 % des participants savaient que le VHB pouvait être transmis lors de rapports sexuels non protégés. Cependant, 39,2 % et 15,8 % des participants ont déclaré que le baiser et la vaccination contre le VHB étaient des voies de transmission, respectivement. Leur connaissance et leur participation à la vaccination contre le VHB étaient cependant bonnes. CONCLUSION: Alors que la majorité des professionnels de santé avaient une bonne connaissance des voies de transmission du VHB, quelques-uns avaient encore des idées fausses sur les voies de transmission, une situation qui peut causer des discordes sociales dans la société, en particulier parmi les personnes étroitement liées, et potentiellement entraîner une faible utilisation du vaccin hautement efficace contre le VHB. Mots-clés: Virus de l'hépatite B, Professionnels de la santé, Vaccination, Connaissances.

Assessing the Burden of Kidney Disease among Type 2 Diabetic Subjects Attending a Semi-Urban Tertiary Health Facility in South-West Nigeria.

BACKGROUND AND OBJECTIVES: Diabetes Mellitus (DM) remains an important public health issue and its complications are important causes of morbidity and mortality. Diabetic nephropathy (DN) is one of these complications and could be prevented/delayed by early detection. This study determined the burden of DN among patients with type 2 diabetes (T2DM). METHODS: This cross-sectional, hospital-based study was conducted among 100 T2DM patients attending the medical outpatient clinics of a tertiary hospital in Nigeria and 100 age- and sex-matched healthy controls. The procedure included collection of sociodemographic parameters, urine for microalbuminuria and blood samples for estimation of fasting plasma glucose, glycated haemoglobin (HbA1c), and creatinine. Estimated creatinine clearance (eGFR) was derived from two formulae - Cockroft Gault formula, and Modification of Diet in Renal Disease study (MDRD) for staging chronic kidney disease. Data were analysed using the IBM SPSS version 23 software. RESULTS: Participants' ages ranged from 28 years to 73 years [mean 53.0 (±10.7) years] with males accounting for 56% of the population and females 44%. Mean HbA1c was 7.6 (±1.8) % among the subjects; 59% had poor glycaemic control with HbA1c >7% (p-value <0.001). Overt proteinuria was present in 13% of T2DM participants while 48% had microalbuminuria compared to the non-diabetic group where 2% had overt proteinuria and 17% had microalbuminuria. Using the eGFR, chronic kidney disease was present in 14% of T2DM group and in 6% of the non-diabetic population. Increased age [OR= 1.09; 95%CI (1.03-1.14)], male sex [OR = 3.50; 95%CI (1.13 10.88)], and duration of diabetes [OR =1.01; 95%CI (1.00-1.01)] were associated with DN. CONCLUSION: The burden of diabetic nephropathy is high in the T2DM patients attending our clinic and this is linked with advancing age.

CONTEXTE ET OBJECTIFS: Le diabète sucré (DM) reste un problème de santé publique important, et ses complications sont des causes importantes de morbidité et de mortalité. La néphropathie diabétique (DN) est l'une de ces complications et pourrait être évitée/ retardée par une détection précoce. Cette étude a déterminé le poids de la néphropathie diabétique chez les patients atteints de diabète detype 2 (DT2). MÉTHODES: Cette étude transversale en milieu hospitalier a été menée auprès de 100 patients atteints de diabète de type 2 fréquentant les consultations médicales externes d'un hôpital tertiaire au Nigeria, et de 100 témoins sains appariés selon l'âge et le sexe. La procédure comprend la collecte de paramètres sociodémographiques, d'urine pour la microalbuminurie et d'échantillons de sang pour l'estimation de la glycémie à jeun, de l'hémoglobine glyquée (HbA1c) et de la créatinine. La clairance estimée de la créatinine (eGFR) a été calculée à partir de deux formules : i) la formule de Cockroft Gault ii) l'étude de Modification de diète en maladie rénale (MDRD) pour la stadification de l'insuffisance rénale chronique. Les données ont été analysées à l'aide du logiciel IBM SPSS version 23. RÉSULTATS: Les participants étaient âgés de 28 à 73 ans [moyenne 53,0 (±10,7) ans], les hommes représentant 56 % de la population et les femmes 44 %. L'HbA1c moyenne était de 7,6 (±1,8) % chez les sujets ; 59 % avaient un mauvais contrôle glycémique avec une HbA1c >7 % (valeur p <0,001). Une protéinurie manifeste était présente chez 13 % des participants atteints de DT2, tandis que 48 % présentaient une microalbuminurie, par rapport au groupe non diabétique, où 2 % présentaient une protéinurie manifeste et 17 % une microalbuminurie. En utilisant le DFGe, la maladie rénale chronique était présente chez 14 % du groupe DT2 et chez 6 % de la population non diabétique. L'âge élevé [OR= 1,09 ; 95%CI (1,03 - 1,14)], le sexe masculin [OR = 3,50 ; 95%CI (1,13 - 10,88)] et la durée du diabète [OR =1,01 ; 95%CI (1,00 - 1,01)] étaient associés à la DN. CONCLUSION: Le fardeau de la néphropathie diabétique est élevé chez les patients atteints de DT2 qui fréquentent notre clinique et ceci est lié à l'âge avancé. Mots-clés: Maladie rénale diabétique, Complications du diabète, Diabète de type 2, Durée du diabète, Âge, Hypertension.

Dolor abdominal inespecífico, un cuadro a vigilar / Non-specific abdominal pain, a case to keep under observation

El dolor abdominal es un síntoma inespecífico, común a múltiples procesos, con una alta prevalencia en la población general. Representa el 15-20% de los motivos de consulta en los servicios de urgencias.1 La mayoría de estos dolores tienen una etiología benigna, por lo que el objetivo inicial de la asistencia médica es identificar a aquellos pacientes cuyo dolor abdominal sea debido a una patología grave2. En ocasiones, puede tener una evolución tanto rápida como tórpida pudiendo provocar un abdomen agudo. El abdomen agudo se define como un dolor abdominal de instauración reciente, que requiere de un diagnóstico rápido y preciso debido a la posibilidad de que derive en un tratamiento quirúrgico urgente. Para ello es importante una buena anamnesis y exploración, enfocado a detectar signos y síntomas de alarma. Si no es diagnosticado y tratado de forma adecuada y precoz, puede originar consecuencia como sepsis, shock, insuficiencia renal, con elevada mortalidad3. A continuación presentamos el caso de una paciente con dolor abdominal inespecífico y pruebas complementarias anodinas en el inicio del cuadro, que evoluciona en las siguientes horas, obligando a la paciente a consultar de nuevo, llegando a precisar una intervención quirúrgica de urgencia. Se trata de un caso que nos obliga a determinar múltiples diagnósticos diferenciales y cómo abordar esta clínica tan frecuente como cambiante. (AU)

Abdominal pain is a nonspecific symptom, common to multiple processes, with a high prevalence in the general population. It represents 15-20% of the reasons for consultation in the Emergency Department1. Most of these pains have a benign etiology, so the initial objective of medical care is to identify those patients whose abdominal pain is due to a serious pathology2. Sometimes, it can have both a fast and torpid evolution and can cause an acute abdomen. Acute abdomen is defined as abdominal pain of recent onset, which requires a rapid and accurate diagnosis due to the possibility that it may lead to urgent surgical treatment. For this, a good history and examination is important, focused on detecting alarm signs and symptoms. If it is not diagnosed and treated properly and early, it can cause consequences such as sepsis, shock, kidney failure, with high mortality3. Below we present the case of a patient with nonspecific abdominal pain and anodyne complementary tests at the beginning of the condition, which evolves in the following hours, forcing the patient to consult again, eventually requiring an emergency surgical intervention. This is a case that forces us to determine multiple differential diagnoses and how to approach this clinic that is as frequent as it is changing. (AU)

Conflicts of interest in electrophysiology and devices presentations.

AIMS: Industry collaboration with arrhythmia and devices research is common. However, this results in conflicts of interest (CoI) for researchers that should be disclosed. This study aimed to examine the quality of CoI disclosures in arrhythmia and devices presentations. METHODS: Recorded presentations from the Arrhythmia & Devices section of the ESC Annual Congress 2016-2020 were assessed. The number of words, conflicts, and time displayed was documented for CoI declarations. Meta-data including sponsorship by an industry partner, presenter sex, and institution were obtained. RESULTS: Of 1153 presentations assessed, 999 were suitable for inclusion. CoI statements were missing from 7.2% of presentations, and 58% reported ≥1 conflict. Those with conflicts spent less time-per-word on their disclosures (median 150 ms, interquartile range [IQR] 83-273 ms) compared with those without conflicts (median 250 ms, IQR 125-375 ms). One-in-eight presentations were sponsored (12.8%, n = 128). CoI statements were more likely to be missing in sponsored presentations (14.8%, n = 19) compared with non-sponsored presentations (6.1%, n = 53), P = 0.0003. Sponsored presentations contained a greater median number of CoIs (10, IQR 6-18) compared with non-sponsored sessions (1, IQR 0-5), P < 0.0001. Time-per-word spent on COI disclosures was 50% lower in sponsored sessions (125 ms, IQR 75-231 ms) compared with non-sponsored sessions (250 ms, IQR 125-375 ms), P < 0.0001. CONCLUSION: The majority of those presenting arrhythmia and devices research have CoIs to declare. Declarations were often missing or displayed for short periods of time. Presenters in sponsored sessions, while being more conflicted, had a lower standard of declaration suggesting a higher risk of potential bias which viewers had insufficient opportunity to assess.

Evaluating a novel consensus bacterial 6-phytase variant on growth performance of broilers fed U.S. commercial diets deficient in nutrients and energy through 63 days of age.

An experiment was conducted to evaluate the efficacy of a novel consensus bacterial 6-phytase variant expressed in Trichoderma reesei (PhyG) in broilers fed corn-soybean meal-based diets with application of dose-specific full nutrient and energy matrix values. Ross 708, straight-run broilers (n = 2,016) were assigned to one of 7 dietary treatments, with 12 replicate pens/diet and 24 birds/pen. Diets were a nutrient adequate control (PC), nutrient reduced negative controls 1, 2, and 3 (NC1, NC2, and NC3) with reductions in available phosphorus (avP) by 0.15%, 0.18%, and 0.19%, calcium (Ca) by 0.17%, 0.20%, and 0.21%, dig amino acids (AA) by 0.02%-0.05%, sodium (Na) by 0.03%-0.05%, and metabolizable energy (ME) by 62.8, 68.8, and 69.5 kcal/kg, respectively. Other diets were the NC1, NC2, and NC3 respectively supplemented with 500 (PhyG500), 1,000 (PhyG1000), and 2,000 (PhyG2000) FTU/kg. Over the 63-day feeding period, decreasing nutrient specifications lowered body weights (P < 0.05) in broilers from 4,518 g in PC to 4,256 g and 4,191 g and increased body weight-corrected feed conversion ratio (FCR, P < 0.05) from 1.92 in PC to 2.06 and 2.08 in the NC2 and NC3, respectively. Compared with PC, PhyG maintained (P > 0.05) BW in broilers fed PhyG500 (4,474 g), PhyG1000 (4,417 g), and PhyG2000 (4,449 g). Moreover, PhyG at all dose-levels maintained (P > 0.05) overall FCR vs. PC. The NC1, NC2, and NC3 diets decreased (P < 0.05) tibia ash vs. PC, and each PhyG500, PhyG1000, and PhyG2000 completely restored tibia ash to the similar levels (P > 0.05) as the PC. Carcass yield was decreased (P < 0.05) by NC1 (80.63%), NC2 (80.51%), and NC3 (80.31%) vs. PC (81.96%) with complete alleviation by PhyG500 (82.11%), PhyG1000 (81.80%), and PhyG2000 (81.54%). In conclusion, the novel consensus phytase variant completely compensated for the reduction in dietary avP, Ca, dig AA, and ME at each dose-level and maintained growth performance, bone quality, carcass characteristics, and nutrient digestibility in a typical corn-soybean mean based diet fed to broilers through 63 days of age.

As any reduction in dietary nutrients can negatively impact broiler productivity mitigating these effects is imperative. Dietary reductions in minerals, amino acids, and energy can all result in decreased growth and performance. Previous studies have demonstrated that exogenous phytase added to poultry diets can mitigate decreased growth caused by diets deficient in minerals, amino acids, and energy. In this current study, the addition of dose-dependent digestible AA and ME matrix values in addition to a mineral (P and Ca) down-specification in novel consensus bacterial 6-phytase variant supplemented diets resulted in maintained growth performance, bone quality, carcass characteristics, and nutrient digestibility equivalent to those of a nutritionally adequate diet. This study demonstrated the extra-phosphoric efficacy of phytase, at on top of the phosphoric efficacy, in a typical corn-soybean meal based diet fed to broilers through 63 days of age. The results of this current study confirmed that it is possible to account for phytase contributions for increased AA and energy availability, in addition to P and Ca.

Stem bark chloroform extract of Bombax costatum Pellegr. & Vuillet exhibit anticonvulsant and neuroprotective effects in pentylenetetrazole-induced seizures in rats.

AIM OF THE STUDY: The study aimed at evaluating the potentials of stem bark extracts of Bombax costatum (B. costatum) on seizure, pentylenetetrazole (PTZ) induced kindling and associated changes in wistar albino rats. MATERIALS AND METHODS: Phase 1 evaluated which extract of B. costatum (chloroform, ethanol and n-hexane) is most effective in preventing seizure in acute PTZ-induced (85mg/kg) seizure in rats. Phase 2 evaluated the potentials of stem bark chloroform extract of B. costatum in PTZ-kindled rats at a dose 250 and 500mg/kg in comparison to diazepam. As its effects on memory, oxidative stress markers, neurotransmitters and brain histology were evaluated. Phase 3 determined the probable curative effects of B. costatum on fully kindled rats. RESULTS: In phase 1, Chloroform extract of B. coststum 500mg/kg is the most effective (P<0.05) in preventing seizure as compared to ethanol and n-hexane extracts. In phase 2, chloroform extract of B. costatum delayed the development of kindling, improved kindling associated cognitive impairment and alterations of glutamate and gamma-aminobutyric acid (GABA). Further, it attenuated oxidative stress besides the maintenance of neuronal architecture of the hippocampus. CONCLUSION: Conclusively, chloroform stem bark extract of B. costatum antagonizes PTZ-induced seizure progression, protects against kindling induced cognitive impairment and oxidative stress. Additionally, it also increases the brain level of GABA at high dose and prevented against kindling-induced hippocampal disruptions. Hence, this justifies its use traditionally in the treatment of epileptic seizures.

Incidencia, prevalencia y patrones de tratamiento del cáncer de próstata metastásico hormonosensible en España: Estudio ECHOS / Incidence, prevalence, and treatment patterns in metastatic hormone-sensitive prostate cancer in Spain: ECHOS study

Introducción y objetivo: El manejo de los pacientes con cáncer de próstata hormonosensible metastásico (CPHSm) ha cambiado en los últimos años debido a la autorización de nuevos medicamentos. El objetivo fue caracterizar la prevalencia, incidencia y patrones de tratamiento para el CPHSm en España.Pacientes y métodos: Estudio multicéntrico, observacional, longitudinal, retrospectivo en condiciones de práctica clínica habitual con pacientes con CPHSm atendidos en hospitales españoles entre 2015 y 2019 (estudio ECHOS). Las historias clínicas se extrajeron de la base de datos BIG-PAC (geográficamente representativa).Resultados: Se incluyeron los datos de 379 hombres con CPHSm. La prevalencia varió entre 12,2-14,6%. Hubo de 671 a 824 nuevos casos anualmente, con una tendencia creciente. La incidencia media en el periodo del estudio fue de 2,5%, con valores anuales en el rango 2,2-3%. Los nuevos casos anuales de pacientes de novo y recurrentes osciló en el rango 7-11 y 77-104, respectivamente, sin tendencia observada. Mayoritariamente eran pacientes recurrentes (91%) y de alto volumen tumoral (68,6%). La primera línea de tratamiento fue la combinación de docetaxel y terapia de deprivación de andrógenos (TDA) (53%), seguida por TDA sola (23,8%), combinación de TDA y abiraterona (11,1%) y radioterapia (8,6%). En los 12 meses anteriores al diagnóstico de metástasis, la mayoría se sometieron a una prostatectomía (84,9%). El resto había recibido radioterapia (12%) o no recibieron tratamiento (3,8%).Conclusiones: El estudio ECHOS proporciona datos epidemiológicos y patrones de tratamiento actuales en la práctica clínica en pacientes con CPHSm en España. Los resultados obtenidos destacan la necesidad médica de terapias dirigidas. (AU)

Introduction and objective: The management of patients with metastatic hormone-sensitive prostate cancer (mHSPC) has changed in recent years due to the approval of new drugs. The aim of this study was to evaluate the prevalence, incidence, and treatment patterns in mHSPC in Spain.Patients and methods: Multicenter, observational, longitudinal, retrospective study in routine clinical practice of patients diagnosed with mHSPC treated in Spanish hospitals between 2015 and 2019 (ECHOS study). Electronic medical records were extracted from BIG-PAC database, which contains geographically representative Spanish centers.Results: Data from 379 men with mHSPC were included. The prevalence of mHSPC ranged between 12.2-14.6% per year, representing from 671 to 824 annual cases with an increasing trend. The mean incidence along the 4-year period was 2.5%, with annual incidence ranging 2.2-3.0%. New annual cases of de novo and recurrent disease ranged between 7-11 and 77-104, respectively, with no trend being observed. These patients were mostly recurrent (91%) with high-volume disease (68.6%). The most common first-line therapy was ADT combined with docetaxel (53%), followed by ADT alone (23.8%), combination of ADT and abiraterone (11.2%), and radiotherapy (8.6%). In the last 12 months before diagnosis of metastasis, most men had been submitted to radical prostatectomy (84.9%). The remaining patients had received radiotherapy (12%) or no treatment at all (3.8%).Conclusions: The ECHOS study provides epidemiologic data and current patterns of treatment in clinical practice of patients with mHSPC in Spain. These results emphasize the medical need of targeted treatments in these clinical settings. (AU)

Incidence, prevalence, and treatment patterns in metastatic hormone-sensitive prostate cancer in Spain: ECHOS study.

INTRODUCTION AND OBJECTIVE: The management of patients with metastatic hormone-sensitive prostate cancer (mHSPC) has changed in recent years due to the approval of new drugs. The aim of this study was to evaluate the prevalence, incidence, and treatment patterns in mHSPC in Spain. PATIENTS AND METHODS: Multicenter, observational, longitudinal, retrospective study in routine clinical practice of patients diagnosed with mHSPC treated in Spanish hospitals between 2015 and 2019 (ECHOS study). Electronic medical records were extracted from BIG-PAC database, which contains geographically representative Spanish centers. RESULTS: Data from 379 men with mHSPC were included. The prevalence of mHSPC ranged between 12.2-14.6% per year, representing from 671 to 824 annual cases with an increasing trend. The mean incidence along the 4-year period was 2.5%, with annual incidence ranging 2.2-3.0%. New annual cases of de novo and recurrent disease ranged between 7-11 and 77-104, respectively, with no trend being observed. These patients were mostly recurrent (91%) with high-volume disease (68.6%). The most common first-line therapy was ADT combined with docetaxel (53%), followed by ADT alone (23.8%), combination of ADT and abiraterone (11.2%), and radiotherapy (8.6%). In the last 12 months before diagnosis of metastasis, most men had been submitted to radical prostatectomy (84.9%). The remaining patients had received radiotherapy (12%) or no treatment at all (3.8%). CONCLUSIONS: The ECHOS study provides epidemiologic data and current patterns of treatment in clinical practice of patients with mHSPC in Spain. These results emphasize the medical need of targeted treatments in these clinical settings.

Colonoscopy in Zaria: Indications and findings.

Background: Colonoscopy is an important procedure in the management of colorectal diseases. During a colonoscopy, one can visualize the mucosa of the large bowel and perform therapeutic procedures. Aim: The aim of this study is to review the indications and findings of colonoscopy in our center. Data on age, gender, indications, and findings at endoscopy were extracted from the endoscopy unit register. Patients and Methods: The study is a retrospective descriptive one and included all patients who underwent colonoscopy between June 2017 to December 2019 at the endoscopy unit of Ahmadu Bello University Teaching Hospital (ABUTH), Zaria. Data on age, gender, indications, and findings at endoscopy were extracted from the endoscopy unit register. The data obtained were analyzed using the Statistical Package for the Social Sciences (SPSS) statistical software version 20. Results: One hundred and twenty-five patients had a colonoscopy during the period under review with a male to female ratio of 1.9:1. The age range of the patients was 3 to 85 years and the mean age was 46.7 ± 16.7 The most common indications for colonoscopy in our center were lower gastrointestinal bleeding (40 (32%)), followed by suspected colonic tumors (37 (29.6%)), and hemorrhoids (18 (14.4%)). The commonest findings were hemorrhoids (50 (40%)), colonic tumors (25 (20%)), and colitis (21 (16.8%)). Conclusion: A colonoscopy is an effective tool in the management of colorectal diseases. Lower gastrointestinal bleeding was the commonest indication for colonoscopy in our center and hemorrhoids and colorectal tumors were the commonest findings.

Cáncer de próstata resistente a la castración no metastásico: recomendaciones de manejo / Non-metastatic castration-resistant prostate cancer: management recommendations

Introducción y objetivo: La supervivencia y calidad de vida (QoL) de los pacientes con cáncer de próstata resistente a la castración no metastásico (CPRCnm) se deteriora de forma muy significativa cuando llegan a desarrollar metástasis. Los antiandrógenos de nueva generación (apalutamida, enzalutamida y darolutamida) pueden prolongar la supervivencia libre de metástasis (SLM) y la supervivencia global (SG) en estos pacientes, manteniendo su QoL.Material y método: Tras una revisión sistemática de la literatura, un comité científico alcanzó un consenso sobre recomendaciones sencillas y prácticas que unifiquen y mejoren el manejo de los pacientes con CPRCnm en las consultas de urología.Resultados: Se dan recomendaciones sobre la frecuencia de determinación de antígeno prostático específico (PSA) y pruebas de imagen en pacientes con CPRCnm. También se destaca la importancia de las comorbilidades en el paciente con CPRCnm y se ofrecen recomendaciones sobre la valoración funcional y de la QoL que se pueden llevar a cabo en la consulta de urología. Se revisa la eficacia, seguridad y efectos sobre la QoL de los antiandrógenos de nueva generación.Conclusiones: Para la evaluación del tratamiento de pacientes con CPRCnm, es necesario tener en cuenta no solo la edad, sino también las comorbilidades y la QoL. Los antiandrógenos de nueva generación son una opción de tratamiento segura y eficaz en los pacientes con CPRCnm. Las recomendaciones de trabajo pueden servir de ayuda para optimizar su manejo de los pacientes con CPRCnm en las consultas de urología. (AU)

Introduction and objective: Survival and quality of life (QoL) of patients with non-metastatic castration-resistant prostate cancer (nmCRPC) deteriorate significantly when they develop metastases. New generation antiandrogens (apalutamide, enzalutamide and darolutamide) can prolong metastasis-free survival (MFS) and overall survival (OS) in these patients, maintaining their QoL.Material and methods: After the performance of a systematic review of the literature, a scientific committee reached a consensus on simple and practical recommendations to consolidate and improve the management of patients with nmCRPC in urology consultations.Results: Recommendations are made on the frequency of PSA determination and imaging tests in patients with nmCRPC. The importance of co-morbidities in patients with nmCRPC is also highlighted, and recommendations are also made on functional and QoL assessment that can be carried out during urology consultations. The efficacy, safety, and effects on QoL of new generation antiandrogens are reviewed.Conclusions: To evaluate treatment of patients with nmCRPC, it is necessary to consider co-morbidities and QoL, in addition to age. New generation antiandrogens are a safe and effective treatment option for patients with nmCRPC. The recommendations of this review can be helpful in optimizing the management of nmCRPC patients in urology consultations. (AU)

Impact of quality improvement initiatives to improve CKD referral patterns: a systematic review protocol.

INTRODUCTION: Chronic kidney disease (CKD) is a global-health problem. A significant proportion of referrals to nephrologists for CKD management are early and guideline-discordant, which may lead to an excess number of referrals and increased wait-times. Various initiatives have been tested to increase the proportion of guideline-concordant referrals and decrease wait times. This paper describes the protocol for a systematic review to study the impacts of quality improvement initiatives aimed at decreasing the number of non-guideline concordant referrals, increasing the number of guideline-concordant referrals and decreasing wait times for patients to access a nephrologist. METHODS AND ANALYSIS: We developed this protocol by using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Protocols (2015). We will search the following empirical electronic databases: MEDLINE, Embase, Cochrane Library, CINAHL, Web of Science, PsycINFO and grey literature for studies designed to improve guideline-concordant referrals or to reduce unnecessary referrals of patients with CKD from primary care to nephrology. Our search will include all studies published from database inception to April 2021 with no language restrictions. The studies will be limited to referrals for adult patients to nephrologists. Referrals of patients with CKD from non-nephrology specialists (eg, general internal medicine) will be excluded. ETHICS AND DISSEMINATION: Ethics approval will not be required, as we will analyse data from studies that have already been published and are publicly accessible. We will share our findings using traditional approaches, including scientific presentations, open access peer-reviewed platforms, and appropriate government and public health agencies. PROSPERO REGISTRATION NUMBER: CRD42021247756.

The Indirect Victims of COVID-19: Perception of Non-COVID-19 Patients about the Effect of Closure of the Medical Outpatient Services on their Health.

BACKGROUND: In order to reduce COVID-19 transmission and protect healthcare workers, the outpatient departments (OPDs) in many hospitals worldwide were closed down in the early days of the pandemic. Patients being managed for chronic medical illnesses who subsequently suffered reduced access to healthcare have been described as "the patients left behind". AIM: The study aimed at assessing the impact of the closure of the Medical OPD in University of Ilorin Teaching Hospital (UITH) on the health and perceived well-being of patients with chronic medical illnesses. METHODS: A cross-sectional study of 180 patients with chronic medical illnesses attending the MOPD in UITH. RESULTS: Mean age of participants was 50.2±18.2years, 92 (51.1%) were male, median duration of attending MOPD was 21 months (IQR 12-36). 92 patients (51.1%) perceived a negative affectation of their well-being by the closure of MOPD. Being >50 years was associated with a perception of negative affectation of well-being (P=0.042). 140 patients (77.8%) had clinic appointments that fell within the period under review. 67(69.3%) of the 97 patients who had medical complaints during the period could not reach a doctor and this was associated with a perception of negative affectation of their wellbeing. The commonest action they took was to do nothing (28.3%), three (4.5%) resorted to herbal concoctions. 19 (29.9%) felt their complaints were urgent. CONCLUSION: Our study identifies that patients with chronic medical illness are potential victims of COVID-19 related disruption of healthcare services. Healthcare managers in Nigeria must develop alternatives such as telemedicine that sustain face-to-face medical interaction during eventualities.

CONTEXTE: Afin de réduire la transmission de la COVID-19 et protéger les travailleurs de la santé, les services ambulatoires (OPD) dans de nombreux hôpitaux dans le monde ont été fermés dans les premiers jours de l'Pandémie. Patients pris en charge pour des maladies chroniques quipar la suite souffert d'un accès réduit aux soins de santé ont été décrit comme "les patients laissés pour compte". OBJECTIF: L'étude visait à évaluer l'impact de la fermeture de l'OPD médical à l'hôpital universitaire d'Ilorin (UITH) la santé et le bien-être perçu des patients atteints de chroniquesMaladies. MÉTHODES: Une étude transversale de 180 patients atteints de chroniques maladies médicales fréquentant le MOPD à l'UITH. RÉSULTATS: L'âge moyen des participants était de 50.2 ±18.2 ans, 92 ans(51.1 %) étaient des hommes, la durée médiane de la participation au MOPD était de 21mois (IQR 12-36). 92 patients (51.1 %) ont perçu un résultat negative l'affectation de leur bien-être par la fermeture du MOPD. Être >50ans était associée à une perception d'affectation négative de bien-être (P= 0.042). 140 patients (77.8 %) avaient des rendez-vous à la clinique qui s'inscrivait dans la période considérée. 67 (69.3 %) des 97 patients qui ont eu des problèmes médicaux au cours de la période n'ont pas pu atteindre un et cela était associé à une perception d'affectation negative de leur bien-être. L'action la plus courante qu'ils ont prise était de ne rien faire (28.3%), deux (4.5%) ont eu recours à des concoctions à base de plantes. 19 (29.9 %) ont ressenti leurs plaintes étaient urgentes. CONCLUSION: Notre étude identifie que les patients atteints demaladie chronique les maladies médicales sont des victimes potentielles des perturbations liées à la COVID-19des services de santé. Les gestionnaires de soins de santé au Nigeria doivent se developper des solutions de rechange comme la télémédecine qui soutiennent la médecine en personne interaction lors d'éventualités. Mots-clés: Maladie COVID-19, Maladies chroniques, COVID-19 fermeture connexe des services médicaux ambulatoires, perception.