Antimicrobial usage and associated residues and resistance emergence in smallholder beef cattle production systems in Nigeria: A One Health challenge.

Livestock intensification has facilitated antimicrobial use (AMU) with consequent antimicrobial resistance (AMR) development. We assessed AMU in beef farms, pathways for residues and resistance dissemination to humans, risk status, residues identification, and drivers for antimicrobial residues and resistance emergence in beef cattle production systems. A cross-sectional survey was conducted in randomly selected beef farms of Northern Nigeria, between 2018 and 2019. Traffic Light model and Disc Diffusion Test were used to assess risk status and determined residues, respectively. Data was analyzed using descriptive statistics and logistic regression models at 95% confidence level. About 92% (n = 608) farmers participated. The majority of farmers managing intensive (78.9%) and semi-intensive (76.6%) farms did not follow antimicrobial dosage instructions. Also, 72.4% and 83.9% of the farmers on intensive and semi-intensive systems, respectively, did not observed withdrawal periods after AMU. Furthermore, 71.5% farmers in intensive and 53.2% in semi-intensive farms used antimicrobials as growth promoters. Antimicrobials frequently used include tetracyclines, sulfonamides and penicillin. Antimicrobial residues and resistance dissemination pathways from beef herds were: consumption of contaminated meat with residues (p = 0.007); contacts with contaminated cattle and fomites (p < 0.001); and contaminated manure and aerosols in farm environment (p = 0.003). Significant drivers of residues and resistance emergence were antimicrobial misuse and overuse (OR = 2.72; 95% CI:1.93-3.83), non-enforcement of laws (OR = 2.98; 95% CI:2.11-4.21), poor education and expertise (OR = 1.52; 95% CI:1.09-2.12), and husbandry management system (OR = 10.24; 95% CI:6.75-15.54). The majority of intensive (63.6%) and semi-intensive (57.63%) farm systems belonged to Class 3 (Red risk) status. Antimicrobial residues were detected in 48.4% intensively and 34.4% semi-intensively managed farms. The study revealed poor practices of AMU in beef cattle production. Many factors were found to influenced antimicrobial residues and resistance occurrence and dissemination. A 'One Health' approach mitigation with adequate sanitation, hygiene, and good biosecurity measures will assure food safety, public and environmental health.

Synergy effects of ICT diffusion and foreign direct investment on inclusive growth in Sub-Saharan Africa.

The present study critically examines the synergy effect of information communication technology (ICT) diffusion and foreign direct investment (FDI) on inclusive growth in Sub-Saharan African (SSA) countries using a modified system-generalized method of moments (GMM) model based on panel data covering the period 2005-2020. This study differs significantly from the previous studies in four ways: (i) this study uses a more comprehensive measure of ICT by computing a composite ICT index, which takes into account several ICT indicators; (ii) some existing study uses a narrow proxy of inclusive growth using the Gini index as a proxy, while others consider three patterns of economic growth dynamics (GDP growth, real, and per capita GDP). For robust analysis, we computed a composite inclusive growth index that takes into account several shared growth indicators; (iii) our model captures the heterogeneity effect of the interaction term of FDI and ICT diffusions on two groups of SSA countries, unlike the previous studies that estimated the joint impact of FDI and ICT on the whole group of countries; (iv) we contribute to the extant studies by determining the threshold level at which ICT diffusion may determine the effect of FDI on inclusive growth. Overall, empirical results show that the positive effect of FDI on inclusive growth could intensify when ICT diffusion is beyond a given threshold level, while inflation and vulnerable unemployment deteriorate inclusive growth, among others. We are of the opinion that ICTs should engage to cushion present and future environmental threats/natural catastrophes through improving geographical monitoring and concerted reaction coupled with other policy recommendations paying special attention to Sustainable Development Goals (SDGs) fifteen (15)-inclusive growth.

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.

Clinical and procedural implications of congenital vena cava anomalies in adults: A systematic review.

BACKGROUND: Although congenital vena cava (CVC) anomalies in adults have implications for surgical and radiological interventions, the literature is scare and disparate. The aim of this systematic review was to assess cardiovascular clinical and procedural implications of CVC anomalies in adults without congenital heart disease. METHODS AND RESULTS: We searched PubMed and EMBASE from database conception through October 2018 for English-language studies describing the epidemiology of CVC anomalies or their clinical or procedural implications in humans. Two independent reviewers screened 7093 records and identified 16 relevant studies. We found two major implications of CVC anomalies: 1) congenital inferior vena cava (CIVC) anomalies are associated with a 50-100-fold higher risk of deep venous thrombosis, particularly among younger patients, and 2) persistent left superior vena cava (PLSVC) is associated with a 2-3-fold higher risk of supraventricular arrhythmias. PLSVC also poses technical challenges to cardiovascular electronic device implantation, requiring alterations in surgical approach and lengthening procedure and X-ray exposure times. Due to the large disparity in reported prevalence rates of CIVC anomalies, we performed a meta-analysis of CIVC anomaly prevalence including 8 studies, which showed a weighted prevalence of 6.8% (95% CI, 4.5-9.2%). CONCLUSION: These findings challenge the notion that CVC anomalies are rare and asymptomatic in adults. Rather, the literature indicates that CVC anomalies are not uncommon and have important clinical and procedural implications. To further understand the prevalence and implications of CVC anomalies, a robust US population-based study and nationwide registry is warranted in the current era of venous interventions.

Contribution of impaired renal function to cardiovascular risk prediction models in renal transplant recipients.

BACKGROUND: The Framingham risk score (FRS) and cardiovascular risk calculator for renal transplant recipients (CRCRTR-MACE) quantify cardiovascular risk in renal transplant recipients (RTR). In contrast to the FRS, the CRCRTR-MACE includes serum creatinine as a variable in the risk prediction equation. OBJECTIVE: To determine the influence of impaired renal function on performances of the two equations. METHODS: A chart review of 270 RTR transplanted from 1979 to 2012. High risk was defined at scores ≥20%. Standard statistical analyses included multivariate analysis (MVA), stepwise analysis, and odds ratio to estimate contributions of risk factors. RESULTS: Mean transplant duration was 9.51 ± 6.65 yr. Mean eGFR was 59.19 ± 28.26 mL/min/1.73 m(2) . FRS and CRCRTR-MACE scores of least 20% were present in 9.3% and 24.8%, respectively, while 7.2% and 11.2% of RTR with eGFR ≥60 mL/min/1.73 m(2) were high risk, respectively. Mean age, blood pressure, TC:HDL ratio, smoking, and diabetes were evenly distributed in patients with varying eGFR. FRS scores remained similar at wide eGFR range (≤30 mL/min/1.73 m(2) -≥90 mL/min/1.73 m(2) ), while CRCRTR-MACE scores significantly increased as eGFR decreased. CONCLUSIONS: CRCRTR-MACE identified more patients at high cardiovascular risk, even in those with more favorable renal function, suggesting a fundamental difference between the two calculators beyond renal function.

Survey of management of children with cleft lip and palate in teaching and specialist hospitals in Nigeria.

OBJECTIVE: A national survey was conducted to obtain an overall view of the current management of children with cleft lip and/or palate in Nigeria. METHOD: Questionnaires were sent to 44 identified cleft surgeons in all teaching and specialist hospitals in Nigeria. RESULTS: A total of 38 respondents returned completed questionnaires. The findings are as follows: (1) a majority of the surgeons (68.4%) are "low-volume operators," undertaking 10 or fewer new cleft repairs annually; (2) 86.8% of the surgeons repair cleft lip at 3 to 4 months of age, and the most common (71%) unilateral cleft lip repair method is the rotation-advancement technique; (3) 50% of the surgeons use straight line repair for bilateral cleft lip; (4) a majority (79%) of the respondents close the soft and hard palates as a single procedure; 47.3% of respondents use the von Langenbeck technique, 21.1% use the double-opposing Z-plasty and 21.1%, the palatal pushback; (5) in the management of protruding premaxilla, 52.6% of the respondents choose adhesive tape; (6) procedures such as alveolar bone grafting, rhinoplasty, and surgical treatment for velopharyngeal incompetence are rarely done as part of cleft management; and (7) the interdisciplinary team approach is practiced by 21% of respondents. CONCLUSIONS: Issues are raised regarding the current organization of cleft services. We hope the findings of this study will provide preliminary information needed for the eventual establishment of standard cleft management for children with cleft lip and palate deformity in Nigeria.

Metabolic effects of acute measles in chronically malnourished Nigerian children.

We hypothesized that acute measles infection imposes severe metabolic demands on malnourished children. Nigerian rural communities, characterized by severe poverty and extensive malnutrition, served as site for this study. Sixty-five children (mean [+/-SD] age 2.67 +/- 1.96 years) with measles and a randomly selected equal number of children (age 2.83 +/- 1.23 years) from the same communities but measles-free were studied. Both groups were serologically negative for human immunodeficiency virus. The percentages of nonmeasles group who were underweight and wasted as exemplified by weight for age (WAZ) and weight for height (WHZ) scores less than -2.0 SD were 43% and 23%, respectively. Comparative values for the measles group (66% and 54% respectively) were significantly (P < 0.01 or 0.001) different. Compared to the controls, measles-infected children had significantly (P < 0.001) higher plasma cortisol level, marked hyporetinemia (plasma retinol 0.62 +/- 0.24 micromol/L) and prominent reduction (P < 0.002) in the sum of serum essential amino acids. Measles promoted a TH(1) to TH(2) cytokine shift, with severe depletion of plasma interleukin (IL)-12, a key cytokine in the development of cell mediated immunity. IL-6, a key stimulator of hepatic acute phase protein response, was prominently (P < 0.002) increased in plasma in measles-infected children. Glucocorticoids exert effects on cytokine expression, as well as on cytokine receptor expression and cytokine-regulated biological responses. They enhance synergistically, the effects of IL-1 and IL-6 type cytokines on many acute phase proteins. Because of the prominent increase in circulating level of cortisol in acute measles, glucocorticoid treatment for associated sepsis may pose serious problems. Additionally, glucocorticoids antagonize several effects of retinoids at cellular and transcriptional levels, thus suggesting that hypercortisolemia may increase the requirement for retinoids.