Dominant higher-order vortex gyromodes in circular magnetic nanodots.

The transition to the third dimension enables the creation of spintronic nanodevices with significantly enhanced functionality compared to traditional 2D magnetic applications. In this study, we extend common two-dimensional magnetic vortex configurations, which are known for their efficient dynamical response to external stimuli without a bias magnetic field, into the third dimension. This extension results in a substantial increase in vortex frequency, reaching up to 5 GHz, compared to the typical sub-GHz range observed in planar vortex oscillators. A systematic study reveals a complex pattern of vortex excitation modes, explaining the decrease in the lowest gyrotropic mode frequency, the inversion of vortex mode intensities, and the nontrivial spatial distribution of vortex dynamical magnetization noted in previous research. These phenomena enable the optimization of both oscillation frequency and frequency reproducibility, minimizing the impact of uncontrolled size variations in those magnetic nanodevices.

Collective spin waves in RKKY interlayer-coupled Ni80Fe20/Ru/Ni80Fe20nanowire arrays.

We report on a comprehensive investigation of collective spin waves in Ruderman-Kittel-Kasuya-Yosida (RKKY) interlayer-coupled Ni80Fe20(10 nm)/Ru(1.0 nm)/ Ni80Fe20(10 nm) nanowire (NW) arrays. We employed Brillouin light scattering to probe the field- and wavevector-dependences of the spin-wave frequency spectra. The acquired data were subsequently analyzed and interpreted within the framework of a microscopic Hamiltonian-based method, enabling a detailed understanding of the observed spin-wave behavior. We observed the propagation of Bloch-type collective spin waves within the arrays, characterized by distinct magnonic bandwidths that stem from the combined influence of RKKY interlayer and inter-NW dynamical dipolar interactions.

Tailoring magnon modes by extending square, kagome, and trigonal spin ice lattices vertically via interlayer coupling of trilayer nanomagnets.

In this work high-frequency magnetization dynamics and statics of artificial spin-ice lattices with different geometric nanostructure array configurations are studied where the individual nanostructures are composed of ferromagnetic/non-magnetic/ferromagnetic trilayers with different non-magnetic thicknesses. These thickness variations enable additional control over the magnetic interactions within the spin-ice lattice that directly impacts the resulting magnetization dynamics and the associated magnonic modes. Specifically the geometric arrangements studied are square, kagome and trigonal spin ice configurations, where the individual lithographically patterned nanomagnets (NMs) are trilayers, made up of two magnetic layers ofNi81Fe19of 30 nm and 70 nm thickness respectively, separated by a non-magnetic copper layer of either 2 nm or 40 nm. We show that coupling via the magnetostatic interactions between the ferromagnetic layers of the NMs within square, kagome and trigonal spin-ice lattices offers fine-control over magnetization states and magnetic resonant modes. In particular, the kagome and trigonal lattices allow tuning of an additional mode and the spacing between multiple resonance modes, increasing functionality beyond square lattices. These results demonstrate the ability to move beyond quasi-2D single magnetic layer nanomagnetics via control of the vertical interlayer interactions in spin ice arrays. This additional control enables multi-mode magnonic programmability of the resonance spectra, which has potential for magnetic metamaterials for microwave or information processing applications.

Clinical and Epidemiological Characteristics of Hospitalized COVID-19 Patients in an Isolation Centre in South-West Nigeria.

INTRODUCTION: The clinical presentation of coronavirus disease 2019 (COVID-19) can vary widely, and while the primary infection involves the respiratory system, other organs can also be affected. This study presents the clinical and epidemiological characteristics of hospitalized COVID-19 patients in a tertiary hospital in Ado Ekiti, South-West Nigeria. MATERIALS AND METHODS: This is a retrospective study involving COVID-19 patients admitted to the isolation ward between August 2020 and January 2021. The data used for this study was obtained from the patient's medical record, which includes demographic characteristics, clinical presentation, baseline co-morbidities, and laboratory investigations. RESULTS: The average age of the patients was 60.3 years, and more than two-thirds were male. The most common symptoms were fever, shortness of breath, cough, and tiredness. Comorbidities identified among the patients included diabetes mellitus, heart disease, obesity, and chronic kidney disease. The most common radiological findings were bilateral homogeneous patchy opacities and peripheral fluffy infiltrates. The overall mortality rate was 21.9%, with 13 deaths in patients with severe disease. Age and duration of admission were found to be significant predictors of death. CONCLUSION: The results of this study provide valuable insights into the clinical presentation of COVID-19 in Nigeria and may guide future management strategies for similar infections.

Numerical study of heat transfer, pressure drop and entropy production characteristics in inclined heat exchangers with uniform heat flux using mango bark/CO2 nanofluid.

For sustainable low-carbon cities, using sustainable urban energy system solutions is imperative. CO2-based bionanofluid is one proposed energy system solution that is sustainable and environmentally friendly. This paper examines the thermal-hydraulic and entropy production properties of mango bark/CO2 nanofluid for industrial-inclined gas cooling applications. The influence of gravitational force (in terms of tube inclination angle), volume fraction, and Reynolds number on the heat transfer, pressure drop, and entropy production of CO2-based mango bark nanofluids in laminar flow through a circular aluminum tube are numerically studied. The bionanofluid flows through a tube with an inner radius of 2.25 mm, a length of 970.0 mm, and an initial temperature of 320.0 K. A constant heat flux of -10.0 W/m2 is applied to the flow at its walls. The laminar flow regime with Reynolds numbers of 100, 400, 700, and 1000 are subjected to flow inclinations of ±90°, ±60°, ±45°, ±30°, and 0° and bionanofluid volume fractions of 0.5%, 1.0%, and 2.0%. Results show that ±45° tube inclination angle offers the optimal heat transfer coefficient, maximum pressure drop, and minimum total entropy production rates for Re > 100; however, for Re = 100, these occur at the inclination angle of -30° and +60°. The pressure drop shows less sensitivity to the inclination angle; however, it offers peak values at the same inclination angles as the heat transfer coefficient for the respective Reynolds number values. The maximum thermal enhancements due to gravitational effect are 42%, 93.98%, 121.28%, and 150% for Reynolds numbers of 100, 400, 700, and 1000, respectively, while that due to nanofluid volume fraction are less than 16%.

Uncovering the Burden of Diabetes in Ekiti State, Nigeria: Insights From a Statewide, Household-Based, Cross-Sectional Study.

INTRODUCTION: Diabetes mellitus (DM) is an important global public health challenge, and the burden of the disease is huge, particularly in low- and middle-income countries (LMICs), where the majority of people with this condition reside. Undiagnosed DM is more prevalent in LMICs. The aim of this study is to determine the prevalence and associated factors for DM in Ekiti State. MATERIALS AND METHODS: A cross-sectional, household-based survey using a four-stage multistage sampling design and the World Health Organization (WHO)-STEPS survey manual was conducted from July to September 2020 as a part of the Ekiti State coronavirus disease 2019 (COVID-19) survey. Of the 5,145 sampled households, 4,726 individuals gave consent to participate in the survey. Out of these, 3043 had fasting plasma glucose results available and were included in the analysis. RESULTS: There were 2257 (74.2%) women and 786 (25.8%) men. The prevalence of DM was 6.5% (6.5% in males and 6.6% in females, P = 0.946). Diabetes was found to be more prevalent among those with a secondary school education or higher (10.9%); employed in the formal sector (13.4%); separated, divorced, or widowed (8.5%); with raised blood pressure (9.3%); and who were aged 30-59 years (all P < 0.05). Multivariable logistic regression showed that age, education, occupation, and hypertension were all positively and significantly associated with an increased risk of DM. CONCLUSION: The prevalence of DM in Ekiti State is high, and its predictors include advancing age, hypertension, education, and occupation. This calls for scaling up public health interventions for controlling DM, targeting the identified risk factors among the people of Ekiti.

Doctors' and Nurses' Knowledge and Perceived Barriers Regarding Acute Oxygen Therapy in a Tertiary Care Hospital in Nigeria.

Purpose: Oxygen may cause serious consequences when administered wrongly. This study aimed to assess doctors' and nurses' knowledge of acute oxygen therapy and perceived delivery barriers. Participants and Methods: We conducted a cross sectional study among 202 healthcare providers (134 doctors and 68 nurses) in a Nigerian hospital. The validated Acute Oxygen Therapy Questionnaire (AOTQ), which consisted of 21 knowledge assessment questions, was self administered by participants. Provider's knowledge was classified as good if the score was≥80% and poor if < 60%. Results: Overall, 26.7% (37.3% doctors and 5.9% nurses) had good knowledge of acute oxygen therapy (AOT), 35.9% were aware, and 19.3% used the AOT guidelines. The commonest source of knowledge on oxygen therapy was medical /nursing school (75.2%). The participants' mean knowledge score was 14.75 ± 2.83(possible score of 0-21). Doctors in postgraduate (PG) training obtained the highest score (15.96±2.48) among the participants (F=12.45, df=4, p<0.001). Most doctors (62%) and 23.5% of nurses considered oxygen as a drug. More doctors (52.2%) than nurses (14.7%) believed that a doctor's order was mandatory before oxygen administration, contrary to guidelines recommendations. Most nurses did not know that breathlessness does not always signify hypoxemia and that asymptomatic anemia was not an indication for oxygen. Concerning oxygen prescription, 39.7% of nurses and 64.2% of doctors knew that it should be prescribed to achieve a target saturation range rather than a fixed dose. In acute oxygen delivery in COPD, doctors and nurses exhibited poor knowledge of the appropriate device and flow rate. The reported barriers to oxygen delivery were: a shortage of oxygen supply, inadequate delivery devices, power outages and out of pocket costs. Conclusion: A significant proportion of doctors and nurses had poor knowledge of acute oxygen therapy, poor awareness and infrequently used AOT guidelines, and reported pertinent delivery barriers that warrant educational and administrative interventions.

Diet supplemented with boiled unripe plantain (Musa paradisiaca) exhibited antidiabetic potentials in streptozotocin-induced Wistar rats.

The ameliorating effect and antidiabetic properties of diets augmented with boiled unripe plantain (20%-40%) in high fat fed/low dose of streptozotocin induced diabetic rats in comparison with the administration of acarbose were evaluated in this study using standard methods. High fat fed/low dose of streptozotocin (25 mg/kg body weight) was given to twenty-five male Wistar rats to induce diabetes leaving out 5 normal rats to serve as control. The animals were separated into five with six rats in each group and the experiment continued for 14 days. Investigations on the blood glucose concentration, enzymes (α-amylase, α-glucosidase, angiotensin I converting enzyme), thiobarbituric reaction substance (TBARS), High-density lipoprotein-cholesterol (HDL-c), and antioxidant status were determined. The findings revealed a rise in blood glucose level and the activities of α-amylase, α-glucosidase, angiotensin I converting enzyme, thiobarbituric reaction substance (TBARS) in untreated diabetic rats in group II while a reverse was observed in diabetic rats (Group IV and V) on exposure to diets augmented with boiled unripe plantain. The obtained overall results in diet treated groups are similar to that of acarbose treated groups. The untreated diabetic rats (Group II) exhibited contrary results of the biochemical assays. This finding showed that boiled unripe plantain can provide the therapeutic measures that needed to be further explored as possible future economic means of managing diabetes in developing nations. PRACTICAL APPLICATIONS: As diabetes has been implicated to disrupt various pathways involved in the metabolism of macromolecules, there are proposed adoptive methods of preventing them among which is the inhibition of starch hydrolyzing enzymes, increasing the enzymatic antioxidant status and prevention of lipid peroxidation, Plantain by-product which is known as an inexpensive food can be prepared to manage the condition of diabetes in patients. Our former in vitro findings have revealed the bioactive contents of unripe plantain product which has been further explored in vivo to experiment is nutritional benefits. The study therefore proposes that unripe plantains, when boiled, can provide the necessary natural therapeutic measures to be considered as a potential economic means of managing diabetes in underdeveloped countries.

Coronavirus Disease 2019 (COVID-19) Pandemic across Africa: Current Status of Vaccinations and Implications for the Future.

The introduction of effective vaccines in December 2020 marked a significant step forward in the global response to COVID-19. Given concerns with access, acceptability, and hesitancy across Africa, there is a need to describe the current status of vaccine uptake in the continent. An exploratory study was undertaken to investigate these aspects, current challenges, and lessons learnt across Africa to provide future direction. Senior personnel across 14 African countries completed a self-administered questionnaire, with a descriptive analysis of the data. Vaccine roll-out commenced in March 2021 in most countries. COVID-19 vaccination coverage varied from low in Cameroon and Tanzania and up to 39.85% full coverage in Botswana at the end of 2021; that is, all doses advocated by initial protocols versus the total population, with rates increasing to 58.4% in Botswana by the end of June 2022. The greatest increase in people being fully vaccinated was observed in Uganda (20.4% increase), Botswana (18.5% increase), and Zambia (17.9% increase). Most vaccines were obtained through WHO-COVAX agreements. Initially, vaccination was prioritised for healthcare workers (HCWs), the elderly, adults with co-morbidities, and other at-risk groups, with countries now commencing vaccination among children and administering booster doses. Challenges included irregular supply and considerable hesitancy arising from misinformation fuelled by social media activities. Overall, there was fair to reasonable access to vaccination across countries, enhanced by government initiatives. Vaccine hesitancy must be addressed with context-specific interventions, including proactive programmes among HCWs, medical journalists, and the public.

Tuning spin wave modes in yttrium iron garnet films with stray fields.

The nanopatterning of Yttrium Iron Garnets (YIGs) has proven to be a non-trivial problem even with advances in modern lithography techniques due to non-compatibility with a conventional complementary metal oxide semiconductor platform. In an attempt to circumvent this problem, we demonstrate a simple and reliable method to indirectly pattern YIG films on a Gadolinium Gallium Garnet (GGG) substrate. We fabricated exchange-coupled arrays of Py dots onto the underlying YIG films using nanostencil lithography. The stray fields generated from the Py dots were used to transfer patterned magnetic information to the underlying YIG films. The static and dynamic properties of the fabricated hybrid YIG/Py dot structure and reference YIG film were characterized using the focused magneto-optic Kerr effect and by broadband ferromagnetic resonance spectroscopy. For the reference YIG film, as expected, a single field-dependent resonance mode with a narrow linewidth was observed in contrast to the splitting into three distinct resonance modes for the YIG/Py dot structure as predicted by micromagnetic simulations. We have thus shown that it is possible to utilize stray field effects from easily patternable magnetic materials for the development of future YIG-based magnonic devices.

Etiology and Clinical Patterns of Chronic Cough in the Chest Clinic of a Tertiary Hospital in Nigeria.

Purpose: The burdens of chronic cough are mostly reported from Western and Asian countries. We aimed to determine the etiology and clinical patterns of chronic cough (CC) in the chest clinic of a tertiary hospital in Nigeria. Patients and Methods: This survey was a cross-sectional study of 218 patients. Chronic cough was defined as cough >8 weeks duration. The evaluation and diagnosis of patients was based on a diagnostic protocol developed from the international respiratory societies cough guidelines and a previous study. Results: The median age of patients was 50 years (interquartile range 30-68). One etiology was identified in 96.3% of cases; dual etiologies in 2.3%, and 1.4% had an unexplained cough. The most frequent causes of cough were COPD (33.5%), PTB (27.1%), and asthma (21.1%) which included 3 cases of cough variants of asthma (CVA). Other causes were post-tuberculosis lung disease (bronchiectasis and fibrosis) in 6.9%, lung cancer in 4.7%, and interstitial lung disease (ILD) in 3.2%. Gastroesophageal-related cough (GERC) accounted for <1.0%. Before the age of 45, the chronic cough was more frequent in the females than in the males, and the commonest cause was asthma, whereas, beyond age ≥ 45, the occurrence in males surpasses that of the females, and the commonest cause was COPD. Eighty-six percent reported shortness of breath as the most associated symptom. Systemic hypertension (15.6%) was the most frequent comorbidity, followed by HIV infection (3.7%). Chest radiograph, sputum GeneXpert MTB/RIF for TB, spirometry, and detailed history and trial of treatment, were enough to identify the cause in 72% of cases. Conclusion: The etiology and clinical patterns of chronic cough in this study are different from the western countries. When evaluating and managing chronic cough, clinicians in sub-Saharan Africa and TB endemic countries should consider these geographical variations in etiologies and clinical presentation.

COVID-19: Challenges and coping strategies in radiology departments in Nigeria.

Context: COVID-19 came suddenly, bringing to the fore the challenges inherent in the health system. In a developing country, such as Nigeria, which already had myriad problems with funds and equipment in the health sector. Aims: This study aims to examine the challenges encountered by the staff in Radiology facilities and how they combated the challenges. Settings and Design: A descriptive cross-sectional study of radiology facilities in Nigeria. Subjects and Methods: Radiologists from nine government and four private facilities who attended to COVID-19 patients were asked to fill questionnaires on challenges faced and their coping strategies. Responses were sent through E-mail. Statistical Analysis Used: Data from the responses were analyzed using Microsoft excel for Mac 2011 and presented as figures and tables. Results: Majority of the government 7 (77.8%) and private facilities 4 (100%) had no equipment dedicated only to COVID-19 patients. Seven (77.8%) government facilities complained of inadequate staff, poor availability of personal protective equipment (PPEs) 8 (88.9%), and lack of technology for remote viewing 7 (77.8%). Fear of cross-infection was a challenge in one of the facilities 1 (11.1%). Coping strategies adopted include ensuring less traffic in the department by discouraging walk-in patients and canceling non-emergent cases, booking suspected/confirmed cases for lighter times, using old film for face shields and cloth for facemasks, staff education on COVID-19 and preventive measures, and sending reports to physicians through E-mail. Conclusions: There were a lot of challenges during the COVID-19 crisis, with government hospitals experiencing more challenges than private facilities. The challenges included among others inadequate staff strength and lack of technology for remote viewing. Some were overcome using education and by production of facemasks/shields production using recycled materials.

RésuméLe contexte: COVID-19 came suddenly, bringing to the fore the challenges inherent in the health system. Dans un pays en développement, comme Le Nigeria, qui avait déjà une myriade de problèmes de fonds et d'équipements dans le secteur de la santé. Objectifs : Cette étude vise à examiner les défis rencontrés par le personnel des établissements de radiologie et comment ils ont relevé les défis. Paramètres et conception: une section descriptive étude des installations de radiologie au Nigeria. Sujets et méthodes: Radiologues de neuf établissements publics et de quatre établissements privés qui ont participé aux patients COVID-19 ont été invités à remplir des questionnaires sur les défis rencontrés et leurs stratégies d'adaptation. Les réponses ont été envoyées par courrier électronique. Analyse statistique utilisée: Les données des réponses ont été analysées à l'aide de Microsoft Excel pour Mac 2011 et présentées sous forme de figures et de tableaux. Résultats: La majorité des établissements publics 7 (77,8 %) et privés 4 (100 %) ne disposaient d'aucun équipement dédié uniquement aux patients COVID-19. Sept (77,8 %) établissements publics se sont plaints d'un personnel inadéquat, d'une faible disponibilité des équipements de protection individuelle (EPI) 8 (88,9 %), et le manque de technologie pour la visualisation à distance 7 (77,8 %). La peur d'une infection croisée était un défi dans l'un des établissements 1 (11,1 %). Faire faceles stratégies adoptées comprennent la réduction de la circulation dans le service en décourageant les patients sans rendez-vous et en annulant les cas non urgents, en réservant les cas suspects/confirmés pour des périodes plus légères, en utilisant un vieux film pour les écrans faciaux et un tissu pour les masques faciaux, la formation du personnel sur COVID-19 et mesures préventives et l'envoi de rapports aux médecins par courrier électronique. Conclusions: Il y a eu beaucoup de défis pendant la COVID-19 crise, les hôpitaux publics étant confrontés à plus de défis que les établissements privés. Les défis comprenaient entre autres l'insuffisance la force du personnel et le manque de technologie pour la visualisation à distance. Certains ont été surmontés grâce à l'éducation et à la production de masques faciaux/boucliers utilisant des matériaux recyclés. Mots-clés: défis, les stratégies d'adaptation, COVID-19, Nigeria.

Urban-Rural Differences in the Epidemiology of Asthma and Allergies in Nigeria: A Population-Based Study.

PURPOSE: Urbanization is associated with the risk of developing allergic conditions. Few studies have evaluated the urban-rural disparity of allergic diseases in sub-Saharan Africa. OBJECTIVE: To compare the epidemiology of adult asthma and allergies in urban and rural Nigeria. SUBJECTS AND METHODS: A population-based cross-sectional study was performed among 910 subjects in Kwara State, North Central Nigeria, comprising 635 urban and 275 rural adults who were randomly selected. We used standardized questionnaires for data collection. RESULTS: The age-adjusted prevalence of adults reporting a previous "asthma attack" or "currently taking asthma medication" within the preceding 12 months (ECRHS asthma definition) was 3.4% urban, 0.5% rural, current allergic rhinoconjunctivitis (26.2% urban, 22.2% rural), and current skin allergy (13.9% urban, 10.5% rural). The age-adjusted prevalence of "physician-diagnosed allergic conditions": asthma (3.3% urban, 1.5% rural), allergic rhinoconjunctivitis (4.9% urban, 3.2% rural), and skin allergy (4.8% urban, 4.6% rural) were higher in urban areas than in rural areas. Urban areas recorded a higher age-adjusted 12 months prevalence of wheezing, night waking by breathlessness, night waking by chest tightness, asthma attack (p=0.042), and current use of asthma medication (p=0.031) than the rural areas. In the urban areas, 81% of those with asthma significantly had current allergic rhinoconjunctivitis, and 40.5% had current skin allergy, whereas in the rural areas, all subjects with asthma had current allergic rhinoconjunctivitis and 12.5% had current skin allergy (p=0.482). The most common trigger for asthma attack/respiratory symptoms among the urban household was exposure to environmental smoke (17.2%), and among the rural household, it was dust exposure (18.2%). Living in urban areas significantly increased the odds of having asthma [aOR: 5.6 (95% CI:1.6-19.6)] and allergic rhinoconjunctivitis [aOR: 1.7 (95% CI: 1.2-2.4)]. CONCLUSION: This study shows that urban residents frequently reported more allergic and respiratory symptoms and were at risk of having asthma and allergic rhinitis compared to rural residents. The findings would assist the physicians in understanding the urban-rural differences in the occurrence of allergic conditions, symptom triggers, and comorbidity, which are relevant in patient's clinical evaluation, treatment, and disease prevention.

Prevalence and correlates of sexual dysfunction among patients with mental disorders in a tertiary hospital in Southwest Nigeria.

BACKGROUND: Sexual dysfunction is more common among patients with mental disorders compared to the general population. Despite this high occurrence, information regarding sexual dysfunction as well as their correlates in patients receiving care for mental disorders in developing countries is still sparse. AIM: To determine the prevalence and correlates of sexual dysfunction among patients with mental disorders receiving care in a tertiary hospital in Southwest Nigeria. SETTING: This study was performed at the psychiatric outpatient clinic at the University College Hospital, Ibadan, Southwest Nigeria. METHODS: A cross-sectional study was conducted on a convenience sample of 238 adults aged 18-60 years. Socio-demographic and clinical information was obtained from all recruited patients. Sexual dysfunction was assessed using the International Index of Erectile Function questionnaire for men and the Female Sexual Function Index questionnaire for women. Questionnaires for measuring depression, medication adherence and autonomic medication side effects were also administered. Associations between sexual dysfunction and socio-demographic and clinical factors were explored. RESULTS: The prevalence rates of sexual dysfunction among male and female participants were 84.7% and 95.7%, respectively. In the multivariate analysis, employment status and autonomic side effects of psychotropic medications significantly predicted male sexual dysfunction, while religion and employment status were predictors of female sexual dysfunction. CONCLUSION: Sexual dysfunction is very common among patients with mental disorders, with higher rates in female participants. There is a need for clinicians to consider routine screening for sexual dysfunction in psychiatric outpatients with a view of providing psychosocial interventions to improve patient's quality of life.

Differentiated Strain-Control of Localized Magnetic Modes in Antidot Arrays.

The control of localized magnetic modes has been obtained in Ni60Fe40 square lattice (600 nm) antidot arrays. This has been performed by tailoring the magnetoelastic field at the scale of the antidot primitive cell. The corresponding heterogeneous strain field distributions have been generated by a PZT substrate and enhanced by the incorporation of a supporting compliant layer. It has been highlighted by a differentiated variation of magnetic energy directly due to the local magnetoelastic field felt by each magnetic mode, probed by ferromagnetic resonance spectroscopy. A modeling, involving micromagnetic simulations (to locate the magnetic modes), full-field simulations (to evaluate the strain field distributions), and an analytical model generally dedicated to continuous film that we have extended to those magnetic modes, shows a good agreement with the experimental data. This approach is very promising to develop multichannel systems with simultaneous and differentiated controlled frequencies in magnetic devices.

Family physicians/GP and Internist opinions, familiarity and practice behaviour regarding clinical practice guidelines (CPGs) of common medical conditions in Nigeria.

BACKGROUND: Few studies exist on physicians' opinions, attitudes, familiarity and practice behaviour regarding clinical practice guidelines in sub-Saharan Africa. OBJECTIVES: To determine the opinions, familiarity, and practice behaviour regarding clinical practice guidelines (CPGs) and factors associated with their use among internists and family physicians/GP in Nigeria. METHODS: A semi-structured questionnaire regarding guidelines of five common medical conditions: hypertension, diabetes mellitus, tuberculosis, asthma and hepatitis B encountered in everyday medical practice were self-administered by 183 doctors across the country. RESULTS: Over 90% of respondents believed that guidelines were evidence-based, improved management outcomes, and quality of care, nevertheless, 57.4% were against using them in litigations against doctors. The majority (>70%) of the respondents were familiar with the guidelines except that of hepatitis B. Overall, guidelines were used regularly by 45.9%, used in part by 23.5% and 30.6% never used it. Approximately 50% of physicians had immediate accessibility to them at the point of care. The proportions of respondents reporting a change in practice behaviour ranged from 37.7-57.9% depending on the guideline. The factors associated with guideline-related behaviour change were familiarity with its contents, postgraduate educational training, increased helpfulness score, and practiced >5 years. CONCLUSIONS: The present study shows that most physicians have favourable opinions and are familiar with these guidelines, however, the proportions reporting changes in their patient management because of the guidelines are not satisfactory. It is important to ensure guidelines accessibility and promotes factors that encourage their implementation in medical practice.

Stimulation of an anti-tumor immune response with "chromatin-damaging" therapy.

Curaxins are small molecules that bind genomic DNA and interfere with DNA-histone interactions leading to the loss of histones and decondensation of chromatin. We named this phenomenon 'chromatin damage'. Curaxins demonstrated anti-cancer activity in multiple pre-clinical tumor models. Here, we present data which reveals, for the first time, a role for the immune system in the anti-cancer effects of curaxins. Using the lead curaxin, CBL0137, we observed elevated expression of several group of genes in CBL0137-treated tumor cells including interferon sensitive genes, MHC molecules, some embryo-specific antigens suggesting that CBL0137 increases tumor cell immunogenicity and improves recognition of tumor cells by the immune system. In support of this, we found that the anti-tumor activity of CBL0137 was reduced in immune deficient SCID mice when compared to immune competent mice. Anti-tumor activity of CBL0137 was abrogated in CD8+ T cell depleted mice but only partially lost when natural killer or CD4+ T cells were depleted. Further support for a key role for the immune system in the anti-tumor activity of CBL0137 is evidenced by an increased antigen-specific effector CD8+ T cell and NK cell response, and an increased ratio of effector T cells to Tregs in the tumor and spleen. CBL0137 also elevated the number of CXCR3-expressing CTLs in the tumor and the level of interferon-γ-inducible protein 10 (IP-10) in serum, suggesting IP-10/CXCR3 controls CBL0137-elicited recruitment of effector CTLs to tumors. Our collective data underscores a previously unrecognized role for both innate and adaptive immunity in the anti-tumor activity of curaxins.

Knowledge and Attitude of Physicians Towards the Cost of Commonly Prescribed Medicines: A Case Study in Three Nigerian Healthcare Facilities.

OBJECTIVE: One of the core principles of rational prescribing is consideration of the cost of the medicines prescribed, especially in countries with high patient copayments and low incomes such as Nigeria. Little is known about Nigerian physicians' knowledge about the cost of commonly prescribed medicines. The principal objective of the study was to assess the knowledge of Nigerian physicians about the cost of commonly prescribed medicines. METHODS: Descriptive cross-sectional survey conducted among physicians in 3 tertiary institutions in Nigeria. Apart from socio-demographic and other information, questions about the estimated costs of branded and generic versions of 11 commonly prescribed medications were included in the questionnaire. RESULTS: One hundred and seventy-nine (179; 95.7%) respondents agreed that costs of medicines were important when writing prescriptions, although only 7 (3.7%) of them had any formal training in the economics of healthcare. The median percentages of respondents with accurate estimated costs for generic and originator brands were 6.2% and 12%, respectively. Respondents were more knowledgeable about the cost of medicines used for the treatment of infectious diseases (malaria, bacterial infections) than noncommunicable diseases (diabetes mellitus, hypertension, and dyslipidemia). CONCLUSIONS: The knowledge of Nigerian physicians in the 3 participating hospitals about the costs of commonly prescribed medicines was poor. This is despite their awareness about the importance of costs of medicines when prescribing.

Increased Prevalence in Alzheimer Disease in the Northeast Tennessee Region of the United States.

OBJECTIVES: This study describes the changes in prevalence odds ratios (PORs) for Alzheimer disease (AD) in the northeast Tennessee region (NTR) during a 3-year period, describes the statistical assessment process, and critically assesses the database from which the statistical association was derived. The article also examines several beliefs pertinent to the clinical management of AD in the NTR from the perspective of professionals delivering services. METHODS: We extracted prevalence data for NTR counties for 2013, 2014, and 2015 from the Centers for Medicare & Medicaid Services Geographic Variation Public Use File. We used the crude prevalence and the 2010 US Census Data fixed population for each county to compute the POR. The 2013 Economic Research Service Rural-Urban Continuum Codes were used to identify rural and urban counties in the NTR. We collected primary data on the perceived observation of the increasing prevalence in the NTR during the last 3 years and barriers to early diagnosis through an online survey from 44 experts and professionals working in AD-related fields within the NTR. RESULTS: The PORs of AD in rural counties in NTR increased by 18.3%, 4.7%, and 19% compared with urban counties for 2013, 2014, and 2015, respectively. The POR of AD for the entire NTR region increased by 22.7%, 22.5%, and 21.2% compared with other regions in Tennessee for 2013, 2014, and 2015, respectively. Compared with 2012, 68.4% of respondents currently work with more individuals with AD; 71.8% reported that the NTR has a higher number of late-stage diagnoses of AD. A total of 92.3% strongly agreed that early detection of AD is important, and 95% agreed that early diagnosis could prolong the lives of patients with AD; 51.2% were unaware of existing AD screening services. Reported barriers were denial, lack of patient awareness, inefficient screening methods, communication, and lack of community resources. CONCLUSIONS: Increased prevalence of AD among inhabitants in the NTR and identified barriers to early screening or diagnosis in the management of AD were identified. Access to early screening techniques must be prioritized in deprived areas within the NTR. Healthcare providers and medical professionals in the NTR must be well equipped with the required training and resources to respond adequately to the increasing prevalence of AD.