One-pot synthesis of novel chitosan-salicylaldehyde polymer composites for ammonia sensing.

Chitosan (Chs)-salicylaldehyde (Sal) polymer derivatives were formed via the reaction of Chs-Sal with zinc oxide nanoparticles (ZnO NPs) and beta-cyclodextrin (ß-CD). These polymers were synthesized through inclusion with ß-CD and doping with ZnO NPs to give pseudopolyrotaxane and Chs-Sal/ZnO NPs composite, respectively, for low-temperature detection and sensing of NH3 vapors as great significance in environmental control and human health. Additionally, the polymer (Chs-Sal/ß-CD/ZnO NPs) was prepared via the insertion of generated composite (Chs-Sal/ZnO NPs) through ß-cyclodextrin ring. The structural and morphological characterizations of the synthesized derivatives were confirmed by utilizing FTIR, XRD and, SEM, respectively. Also, the optical properties and thermal gravimetric analysis (TGA) of the synthesized polymers were explored. The obtained results confirmed that using ß-CD or ZnO NPs for modification of polymer (Chs-Sal) dramatically enhanced thermal stability and optical features of the synthesized polymers. Investigations on the NH3-sensing properties of Chs-Sal/ß-CD/ZnO NPs composite were carried out at concentrations down to 10 ppm and good response and recovery times (650 s and 350 s, respectively) at room temperature (RT) and indicated that modification by ß-CD and doping with ZnO NPs effectively improves the NH3-sensing response of Chs-Sal from 712 to 6192 using Chs-Sal/ß-CD/ZnO NPs, respectively, with low LOD and LOQ of 0.12 and 0.4 ppb, respectively.

Potential biomarkers in Japanese encephalitis from different hosts and geographical locations.

Japanese encephalitis (JE) is a single-stranded, mosquito-borne, positive-sense RNA flavivirus that causes one of the most severe encephalitides. There are treatments available for those who contact this illness; however, there are no known cures. This disease has a 30% fatality rate, and of the people who survive, 30-50% develops neurologic and psychiatric sequelae. The JE virus genome size is 10.98 kb and contains two coding DNA sequences (CDS), two genes, and 15 mature peptides; the CDS polyprotein is 10.3 kb. In this study, we used 29 genomics sequences of the JE virus reported from different countries and infecting different animals and analysed vast dimensions of the genomic annotation of JE comparatively to understand its evolutionary aspects. The extensive SNPs analysis revealed that KF907505.1, reported from Taiwan, has only three SNPs, similar to sequences reported from India. Repeat and polymorphism analyses revealed that the genome tends to be similar in most JE sequences.

Tick-borne haemoparasitic diseases in small ruminants in Pakistan: Current knowledge and future perspectives.

Livestock industry is an essential part of Pakistan's economy, and a variety of ruminants (including sheep and goats) are reared for the increasing demand of milk, meat and hide products. Haemoparasitic illnesses such as theileriosis, anaplasmosis, and babesiosis are a significant health risk for small ruminants in our country. Information regarding distribution patterns, the tick species involved and effective strategies to control tick-borne diseases (TBD) in goats and sheep of Pakistan is limited. To this end, it is required to assess the present rank of TBDs in small ruminants of Pakistan with a note on their vector ticks in order to control and identify the gaps in the knowledge of TBDs. This will recommend areas for future research and will add to the understanding of these diseases and will draw attention to the need for better-quality tools for the diagnosis and control of TBDs in small ruminants of Pakistan.

Possible vertical transmission of corona virus disease 19 (COVID-19) from infected pregnant mothers to neonates: a multicenter study.

INTRODUCTION: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is highly contagious with various possible routes of transmission, resulting in high mortality globally. Controversy exists regarding the vertical transmission of the SARS-CoV-2 infection to fetuses of COVID-19-infected women. The aim of this study was to investigate the possibility of the vertical transmission of SARS-CoV-2 from COVID-19-infected mothers to their neonates. MATERIALS AND METHODS: We prospectively collected demographical and clinical characteristics of 31 COVID-19 positive pregnant women and their neonates. All mothers and neonates were tested for SARS-CoV-2 infection using the real-time polymerase chain reaction on nasopharyngeal swabs and breast milk samples. Antenatal and placental abnormalities were ultrasonically and histopathologically examined. In cord blood samples, the immunoglobins (Ig) M and IgG were estimated qualitatively. RESULTS: The women's mean age and gestational age were 31 years and 38 weeks, respectively, with 58% undergoing an elective cesarean section. Gestational diabetes was reported in 29% of cases, 64.5% of women were medically free and only 16.12% were symptomatic. A normal antenatal ultrasound was observed in 77.42% of cases. Nine cord blood samples were positive for IgG. Villous infarction (24%), villous agglutination, and chorangiosis (51%), accelerated villous maturation (21%) and reduced and hypercoiling were reported for 6.97% of the umbilical cords. Three newborns had possible vertical transmission of SARS-CoV-2 infection, of which, two were preterm and IUFD. The third neonate was born full-term, admitted to NICU and later discharged in good health. CONCLUSION: Our findings support the possibility of the direct vertical transmission of the SARS-CoV-2 infection to neonates from infected mothers. Further studies with a larger sample size are required to validate the current findings.

Prognostic factors and outcomes of COVID-19 cases in Ethiopia: multi-center cohort study protocol.

BACKGROUND: The coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus (SARS-CoV-2) and became pandemic after emerging in Wuhan, China, in December 2019. Several studies have been conducted to understand the key features of COVID-19 and its public health impact. However, the prognostic factors of COVID-19 are not well studied in the African setting. In this study, we aim to determine the epidemiological and clinical features of COVID-19 cases, immunological and virological courses, interaction with nutritional status, and response to treatment for COVID-19 patients in Ethiopia. METHODS: A multi-center cohort study design will be performed. Patients with confirmed COVID-19 infection admitted to selected treatment centers will be enrolled irrespective of their symptoms and followed-up for 12 months. Baseline epidemiological, clinical, laboratory and imaging data will be collected from treatment records, interviews, physical measurements, and biological samples. Follow-up data collection involves treatment and prognostic outcomes to be measured using different biomarkers and clinical parameters. Data collection will be done electronically using the Open Data Kit (ODK) software package and then exported to STATA/SPSS for analysis. Both descriptive and multivariable analyses will be performed to assess the independent determinants of the treatment outcome and prognosis to generate relevant information for informed prevention and case management. The primary outcomes of this study are death/survival and viral shedding. Secondary outcomes include epidemiological characteristics, clinical features, genetic frequency shifts (genotypic variations), and nutritional status. DISCUSSION: This is the first large prospective cohort study of patients in hospitals with COVID-19 in Ethiopia. The results will enable us to better understand the epidemiology of SARS-CoV-2 in Africa. This study will also provide useful information for effective public health measures and future pandemic preparedness and in response to outbreaks. It will also support policymakers in managing the epidemic based on scientific evidence. TRIAL REGISTRATION: The Protocol prospectively registered in ClinicalTrials.gov (NCT04584424) on 30 October, 2020.

Fournier's gangrene: Presentation and predictors of mortality in Zaria, Nigeria.

Background: Fournier's gangrene is an infectious urological emergency with associated morbidity and varying rates of mortality in the world. Various predictors of mortality such as advancing age, Fournier's Gangrene Severity Index (FGSI), anatomical extent of the disease, or presence of risk factors have been studied in the literature, though with conflicting results. Aim: The aim of the study was to determine the presentation and predictors of mortality in our environment, Nigeria. Patients and Methods: A review of medical records of all the patients managed from April 2012 to December 2018 at a tertiary referral center in Nigeria was conducted. Data on clinical presentation, FGSI, management, and outcome were retrieved and analyzed. Statistical Analysis: Descriptive studies using mean and standard deviation were used for continuous variables, Fischer's exact test was used to compare categorical variables among survivors and nonsurvivors, and logistic regression analysis was used to describe the relationships of these variables with mortality. Results: The mean age of the 31 patients was 60 ± 12 years. All were men, with 9 (29.0%) patients without clinical evidence of immunosuppression or predisposing factor (idiopathic). Fourteen (45%) had documented evidence of immunosuppression. All the patients had a polymicrobial infection; however, Escherichia coli was the most common organism cultured seen in 26 (83.9%) patients. The initial empirical antibiotic regimen of choice was a combination of intravenous ceftriaxone and metronidazole in 26 (83.8%) patients and intravenous ciprofloxacin and metronidazole in 5 (16.1%) patients. Mortality was recorded in three patients representing a rate of 9.6%. Anatomical extent of the disease, anemia requiring blood transfusion, severity of infection, and FGSI were all found to be the statistically significant variable of mortality in these patients using the Fischer exact test. Furthermore, on regression analysis only the FGSI and blood transfusion were significant with P < 0.05. Conclusion: Fournier's gangrene is a disease of the older men with a higher mortality rate when the FGSI is >9 or anemia requiring blood transfusion is present.

RésuméContexte: La gangrène de Fournier est une urgence urologique infectieuse associée à une morbidité et à des taux de mortalité variables Dans le monde. Divers prédicteurs de mortalité tels que l'âge avancé, l'indice de gravité de la gangrène de Fournier (FGSI), l'étendue anatomique. De la maladie ou la présence de facteurs de risque ont été étudiés dans la littérature, mais avec des résultats contradictoires. Objectif: le but du L'étude visait à déterminer la présentation et les prédicteurs de la mortalité dans notre environnement, au Nigeria. Patients et méthodes: un examen de la Des dossiers de tous les patients pris en charge d'avril 2012 à décembre 2018 dans un centre de référence tertiaire au Nigéria ont été réalisés. Les données Sur la présentation clinique, FGSI, la gestion et les résultats ont été récupérés et analysés. Analyse statistique: études descriptives Utilisant la moyenne et l'écart type ont été utilisés pour les variables continues, le test exact de Fischer a été utilisé pour comparer les variables catégorielles Parmi les survivants et les non-survivants, et une analyse de régression logistique a été utilisée pour décrire les relations de ces variables avec Mortalité. Résultats: l'âge moyen des 31 patients était de 60 ± 12 ans. Tous étaient des hommes, avec 9 (29,0%) patients sans preuve clinique D'immunosuppression ou de facteur prédisposant (idiopathique). Quatorze (45%) avaient des preuves documentées d'immunosuppression. Tout Les patients avaient une infection polymicrobienne; cependant, Escherichia coli était l'organisme le plus couramment cultivé chez 26 (83,9%) Les patients. Le schéma antibiotique empirique initial de choix était une association de ceftriaxone intraveineuse et de métronidazole. 26 (83,8%) patients et ciprofloxacine et métronidazole par voie intraveineuse chez 5 (16,1%) patients. La mortalité a été enregistrée chez trois patients Représentant un taux de 9,6%. Étendue anatomique de la maladie, anémie nécessitant une transfusion sanguine, gravité de l'infection et FGSI Ont tous été trouvés comme étant la variable statistiquement significative de la mortalité chez ces patients en utilisant le test exact de Fischer. En outre, Sur l'analyse de régression, seuls le FGSI et la transfusion sanguine étaient significatifs avec P <0,05. Conclusion: la gangrène de Fournier est une Maladie des hommes plus âgés avec un taux de mortalité plus élevé lorsque le FGSI est> 9 ou une anémie nécessitant une transfusion sanguine est présente.

Extent of spongiofibrosis and length of strictures: Findings at sonourethrography and urethroplasty.

INTRODUCTION: The purpose of this study was to diagnose urethral stricture and to determine the extent of spongiofibrosis as well as the length of stricture using sonourethrography and compare it with intraoperative findings. PATIENTS AND METHODS: It was a cross sectional observational study from September 2017-August 2018. All patients who presented with urethral stricture, scheduled for urethroplasty, and consented to the study were enrolled. The extent of spongiofibrosis and length of strictures were determined at sonourethrography and subsequently at urethroplasty. Sensitivity, specificity, positive predictive value and negative predictive values of sonourethrography in the determination of length of stricture was done. Spearman correlation coefficient(r) was used to describe the association between the extent of spongiofibrosis found at sonourethrography and at urethroplasty. RESULTS: A total of 84 patients were evaluated during the study period. The median age at presentation was 45years. 81% of the patients had moderate spongiofibrosis on sonourethrography. There was a significant correlation of 71.4% between the extent of spongiofibrosis on sonourethrography and at urethroplasty. In evaluation for the length of strictures, sonourethrography had a sensitivity of 84.6% specificity of 82.7%, PPV of 68.7% and NPV 92.3%. CONCLUSION: Sonourethrography is a valuable tool in the evaluation of urethral strictures. Its radiation free readily available even in resource-poor settings and gives a good evaluation of extent of spongiofibrosis as well as the length of strictures. It's use in the preoperative evaluation of strictures may improve the outcome of the management of strictures.

Knowledge, practice and associated factors towards the prevention of COVID-19 among high-risk groups: A cross-sectional study in Addis Ababa, Ethiopia.

BACKGROUND: Coronavirus disease (COVID-19) is a highly transmittable virus that continues to disrupt livelihoods, particularly those of low-income segments of society, around the world. In Ethiopia, more specifically in the capital city of Addis Ababa, a sudden increase in the number of confirmed positive cases in high-risk groups of the community has been observed over the last few weeks of the first case. Therefore, this study aims to assess knowledge, practice and associated factors that can contribute to the prevention of COVID-19 among high-risk groups in Addis Ababa. METHODS: A cross-sectional in person survey (n = 6007) was conducted from 14-30 April, 2020 following a prioritization within high-risk groups in Addis Ababa. The study area targeted bus stations, public transport drivers, air transport infrastructure, health facilities, public and private pharmacies, hotels, government-owned and private banks, telecom centers, trade centers, orphanages, elderly centers, prison, prisons and selected slum areas where the people live in a crowded areas. A questionnaire comprised of four sections (demographics, knowledge, practice and reported symptoms) was used for data collection. The outcomes (knowledge on the transmission and prevention of COVID-19 and practice) were measured using four items. A multi variable logistic regression was applied with adjustment for potential confounding. RESULTS: About half (48%, 95% CI: 46-49) of the study participants had poor knowledge on the transmission mode of COVID-19 whereas six out of ten (60%, 95% CI: 58-61) had good knowledge on prevention methods for COVID-19. The practice of preventive measures towards COVID-19 was found to be low (49%, 95% CI: 48-50). Factors that influence knowledge on COVID-19 transmission mechanisms were female gender, older age, occupation (health care and grocery worker), lower income and the use of the 8335 free call centre. Older age, occupation (being a health worker), middle income, experience of respiratory illness and religion were significantly associated with being knowledgeable about the prevention methods for COVID-19. The study found that occupation, religion, income, knowledge on the transmission and prevention of COVID-19 were associated with the practice of precautionary measures towards COVID-19. CONCLUSION: The study highlighted that there was moderate knowledge about transmission modes and prevention mechanisms. Similarly, there was moderate practice of measures that contribute towards the prevention of COVID-19 among these priority and high-risk communities of Addis Ababa. There is an urgent need to fill the knowledge gap in terms of transmission mode and prevention methods of COVID-19 to improve prevention practices and control the spread of COVID-19. Use of female public figures and religious leaders could support the effort towards the increase in awareness.

Spectrum of urological emergencies and surgical interventions in a single tertiary health center.

Objectives: Emergency urologic conditions are relatively common, albeit rarely life threatening, there is often a need for prompt and expedient management in order to avert severe or permanent morbidities. This study aimed to evaluate the spectrum of Urologic emergencies and interventions offered in a tertiary hospital in Nigeria. Patients and methods: We retrospectively reviewed the records of patients who were managed in our institution for emergency urologic conditions over a period of 6 years (2011-2017). The data extracted included; the demographic information, diagnosis and the treatment offered. The data obtained were analyzed using SPSS version 20. Data were displayed using mean +/- standard deviation and percentages. Results: The records of a total of 681 patients were retrieved and they span across almost all ages with age range or 2-90 years. Urinary retention was the commonest emergency seen, accounting for 51.7% of the patients. Testicular torsion was the next most common (10%), others are bilateral ureteric obstruction and priapism with 5.4% and 5.3% respectively. Suprapubic cystostomy (SPC) was the commonest operative procedure performed (37.6%). The age range for patients with urinary retention was 3-90 years, though the peak incidence was in the 7th decade (37.3%). Patients with testicular torsion were young adults between the ages of 11 and 44 years. Conclusion: Urinary retention was the commonest urologic emergency followed by testicular torsion. Though urethral catheterization was successful in most patients urinary retention, making it the commonest procedure. SPC was the commonest emergency operative procedure performed. Other emergencies occurred sporadically.

Ureteric Injuries Following Obstetrics and Gynaecologic Surgeries: A Single-Center Experience.

Background: Ureteric injuries are not uncommon in obstetric and gynaecologic surgeries. Some specific procedures predispose to these injuries. Recognition is often delayed. This study aims to present a single-center experience on the presentation, risk factors, and management of ureteric injuries. Methodology: We retrospectively reviewed case files of patients primarily presenting or referred to our urology division with ureteric injuries following obstetrics or gynaecologic surgeries from June 2005 to May 2015. Data extracted included the time of presentation or recognition, the specific offending surgery, the laterality, and site involved, the repair performed, and outcome. Results: Twenty-three patients had injuries (with a total of 25 ureters involved owing to 2 bilateral injuries). Caesarian-section is the commonest offending surgery in 13 (56.5%). The reasons for early recognition were sudden anuria in two and urinary leakage in the operating field in four patients constituting 26.0%, while 17 (74.0%) were recognized in the post-operative period. Urinary fistulae were the commonest presentation in 13 (76.5%) patients recognized postoperatively. Transection and ligation are the commonest mechanisms of injury. The distal third was the site involved in all patients, while ureteroneocystostomy alone was the most predominant repair in 18 (72.0%). Ureteroneocystostomy with Psoas hitch and Boari flap reconstruction was offered in six (24.0%) suggesting greater than5cm ureteral loss. Conclusions: Ureteric injuries often occur following obstetrics and gynaecologic surgeries. Caesarian-section is the commonest predisposing surgery in our center. Prompt recognition and repair is recommended.

Assessment of Health-care Research and Its Challenges among Medical Doctors in Nigeria.

INTRODUCTION: Health-care research in Nigeria has been growing over the years but is constrained by many difficulties. This study aimed to identify the challenges encountered in health-care research and suggest policies to address these problems. MATERIALS AND METHODS: It was a cross-sectional study of medical doctors who have been involved in health-related researches. All participants filled a self-administered online questionnaire comprising 31 questions in five sections. The responses were analyzed using the Google forms and the Statistical Package for the Social Sciences software version 23. RESULTS: The mean age of the study participants was 41.0 ± 8.4 years. Three-quarters of the respondents (75.5%) worked in teaching hospitals. Nearly all (96.6%) carried out their studies using personal funds and only one in 10 had been involved in high-budget projects (≥₦1,000,000). The generation of quality researches was impeded by the restriction of literature review to free online journals (93.2%), incomplete health records (88.0%), limited access to research kits (65.7%), limited use of advanced statistical analysis (29.8%), and challenges with obtaining ethical approval (21.2%). Despite the average online visibility of these researches (52.2%), only 28.5% stated that it has been locally adopted to influence medical practice in their center. CONCLUSION: There is a wide disparity in research capacity among hospital tiers. It is important to leverage on and expand existing partnerships to provide institutional access to premium literature, offer robust, and assessable financial support for the conduct of high-quality researches and provide a framework to bridge the gap in the use of these works to influence practice change in Nigeria.

Analysis of the Determinants, Characteristics and Management of Recurrent Urethral Strictures.

BACKGROUND: The presentation and management of the recurrent urethral stricture varies and depends largely on the initial treatment and the characteristics of the recurrent stricture. What are the likely determinants of recurrence? PATIENTS AND METHODS: This is a retrospective review of all patients who had urethroplasties from January 2013 to December 2017 for anterior urethral strictures in our institution. Patients with a recurrence of the strictures were identified and reviewed, while patients with hypospadias and posterior urethral stenosis or contractures were excluded from the study. The etiology, length, site, and type of urethroplasties were evaluated as variables that may contribute to the recurrence of strictures using inferential statistics and logistic regression analysis. Time to recurrence was analyzed using the Kaplan-Meier method. RESULTS: A total of 206 urethroplasties for anterior urethral strictures were evaluated with recurrence of strictures noted in 29 patients and a recurrence rate of 14.1%. Recurrence was higher in long-segment strictures, penobulbar strictures, and postinflammatory strictures. Pedicle flaps were used in 45% of the strictures that reoccurred. Using Chi-square, the length, site, of urethroplasties were statistically significant determinants of recurrence; however, only the site of stricture was found to be statistically significant following logistic regression analysis. The site of recurrence was in the bulbar urethra in 79% and the penile urethra in 21%. The choice of treatment of the recurrent strictures was anastomotic urethroplasty in 76.5%. The mean time to failure in this study was 13 months with a range of 6-120 months. CONCLUSION: In this study, the site of stricture was found to be the most determinant of stricture recurrence, with penobulbar strictures mostly implicated. Long-segment strictures were also noted to contribute to some extent in recurrence. These recurrent strictures were mostly short-segment strictures in the bulbar urethra which were amenable to excision and anastomosis to achieve cure.

Assessment of Isoniazid Preventive Therapy Outcome Among People Living with HIV in a Referral Hospital, Northeast Ethiopia.

BACKGROUND: Tuberculosis is said to be one of the prevalent opportunistic infections and the leading cause of death among people living with human immunodeficiency virus. Although isoniazid preventive therapy (IPT) is thought to reduce the incidence of TB in HIV patients, its implementation has faced many obstacles. This study was concerned with the assessment of the outcome of IPT among people living with HIV who were on follow-up at Dessie referral Hospital (DRH), Northeast, Ethiopia. METHODS: A retrospective study of medical records of 220 patients, who were enrolled at Dessie Referral Hospital from January 10/2016 to December 11/2018, were conducted from March 23/2019 to April 6/2019. A systematic random sampling method was used to select the samples for the study, and a data abstraction format was used to capture the data. All data were entered, cleared and analyzed using SPSS version 21. Chi-square test was used to identify the association of outcome between the two IPT groups, and P-value <0.05 was considered as statistical significance. RESULTS: The total TB prevalence in this study was 25 (11.36%). The occurrence of TB in the IPT group was 9(4.09%) and 16 (7.27%) for the non-IPT group but not statistically significant (p=0.137). From the study, about 40.9% of patients developed opportunistic infections. Of these, 62.81% and 37.18% of opportunistic infections were developed among patients in the non-IPT and the IPT groups, respectively (p=0.002), which were statistically significant, and the IPT completion rate was 61.81%. CONCLUSION: Although the current study showed that the IPT had not significantly reduced the prevalence of TB between IPT and the non-IPT group, the IPT has shown to significantly reduce the prevalence of opportunistic infections.

Frequency of impaired fasting glucose in first degree relatives of Type-II diabetic patients and its association with Body Mass Index.

OBJECTIVES: To determine the frequency of impaired fasting glucose in first degree relatives of people with Type-II diabetes and its association with BMI. METHODS: This cross-sectional study was conducted in Diabetic clinic of Shaikh Zayed Hospital, Lahore from July to December 2017. Individuals aged ≥35 years, first degree relatives of people with Type-II diabetes, were selected and their fasting blood glucose levels were checked twice a week apart. Study participants were divided into 3 groups. Group-I were those with normal fasting blood glucose (FBS: <100mg/dl), Group-II were those with impaired fasting glucose (100-125mg/dl), considered as high risk and Group-III included those who turned out to be having frank diabetes (FBS: ≥126mg/dl). Exclusion criteria were known diabetes and pregnancy. Proportions of impaired fasting glucose levels versus BMI were compared using Chi-square test. Significance was considered at P <0.001. RESULTS: A total of hundred subjects were included in the study with the mean age of 44.27 years. Sixty percent participants had normal FBS, 31% showed impaired FBS and 09% had frank diabetes (P <0.001). Significant association was found between impaired fasting glucose and BMI, as with increasing BMI the frequency of impaired fasting glucose increases. CONCLUSION: First-degree relatives of people with Type-II diabetes showed higher frequency of impaired fasting glucose and obesity was an important risk factor.

Ixodid tick species and two tick-borne pathogens in three areas in the Sudan.

Ticks are important parasites from economic and public health points of view because of their ability to reduce farm animals' productivity and transmit zoonotic diseases. We conducted this cross-sectional study between January and March 2016 and between March and April 2017 to identify tick species in West Darfur, Al-Jazeera, and the River Nile states in the Sudan and to investigate whether these ticks carry Rickettsia spp. and Crimean-Congo hemorrhagic fever (CCHF) virus. In total, 1593 ticks were collected from 207 animals and identified based on morphology or 16S rRNA gene and tested for Rickettsia spp. and CCHF virus either individually or as pools containing 2 to 10 pooled ticks using molecular methods. Overall, 14 tick species belonging to three genera, namely Amblyomma, Hyalomma, and Rhipicephalus, were identified. Hyalomma anatolicum and Rhipicephalus evertsi evertsi were the most frequent ticks. A total of 561 tests comprised of individual or pooled ticks were conducted and 13.7% (77/561) were positive for Rickettsia spp. which were mostly Rickettsia aeschlimannii and R. africae. The highest positivity was noticed among H. rufipes collected from cattle and camels in West Darfur. However, none of the screened Hyalomma ticks harbored CCHF viral RNA. These findings suggest that there might be a risk of zoonotic transmission of Rickettsia spp. by ticks but zoonotic transmission of CCHF virus is apparently doubtful. An in-depth and a country-wide epidemiological study is needed to better understand the dynamic of Rickettsia spp. and CCHF virus in the Sudan.

Post partumpneumomediastinum (Hamman syndrome): A case report.

Excessive pushing and valsalva during labour is associated with subcutaneous emphysema and pneumomediastinum during labour and post partum. Although rare but is a potentially serious complication that must be identified and managed appropriately to avoid its rare consequence called malignant pneumomediastinum, requiring surgical intervention. A 30 year old, primigravida, presented to a tertiary care hospital with complaints of shortness of breath of 4 days duration after a normal vaginal delivery. CT chest showed bilateral consolidation and pneumomediastinum. She was managed conservatively with supportive measures and was clinically stable before being discharged on request to a nearby health facility. On follow up complete resolution of pneumomediastinum was reported. Recognition of post partum pneumomediastinum, its presentation and associated complications need to be acknowledged in a teriary care hospital, with proper management. Although the condition is rare, but in subsequent pregnancies physicians need to be cautious, and instrumental delivery or caesarean section may be considered to avoid excessive valsalva. No definite evidence of recurrence has been proven.

Managing the sequelae of urology medical tourism: A single center experience.

BACKGROUND: Medical tourism is a fast-growing business worldwide with almost every country involved as either a provider and/or consumer. The degree of participation may vary depending on the status of health-care system in that country. This study aims to present our experience in the management of patients who sought urologic care abroad or returned from medical tourism with urologic complications. METHODS: The method of study was based on the documentation of interaction with patients, patients' relations and their agents in a questionnaire between January 2010 and December 2015. The data obtained included, their demographics, indications/motivations for seeking treatment abroad, procedures performed and complications. We also documented the secondary procedures that were performed and complications managed in our center. The data were entered into Microsoft Excel and analysed using descriptive statistics, tables and figures. RESULTS: A total of 113 have either indicated intention of going to seek for urological care abroad or had already had urologic procedures abroad but were attending our clinic for follow up or for management of complications. Only about 12% of these patients were found to have genuine indications for seeking care abroad. Most of the indications were not justifiably based on the current capabilities of our health facility but more due to a lack of trust in the system or at worst pretentious. CONCLUSION: Patients seek for treatment abroad for variable reasons but and most could not be justified based on available local options. India and some Middle-East countries were the favoured destinations, and the quality of care and relative lower cost are the major attractions. The rising trend in medical tourism is fuelled by the poor state of our health-care system, perceived dearth of expertise and a general apathy and lack of trust.

Variable presentation of retrocaval ureter: Report of four cases and review of literature.

Retrocaval ureter is a rare anomaly in which the ureter passes behind the inferior vena cava due to abnormal embryogenesis. Very few cases have been reported from Africa. Although the anomaly is congenital, patients become symptomatic in the third or fourth decade of life. We reviewed the records of four patients with the diagnosis of retrocaval ureter and managed in our centre between January 2010 and December 2016. Three patients presented with recurrent colicky right flank pain while one was asymptomatic. Two patients each had Type I and Type II retrocaval ureters, respectively. Surgical repairs were achieved in the three symptomatic cases and recovery was uneventful. Retrocaval ureter, though congenital, manifests in young adults and it may be symptomatic. Pre-operative diagnosis may be difficult when the lesion is high and mimics pelviureteric junction obstruction. Thus, a high index of suspicion is required for pre-operative diagnosis. Under-reporting and asymptomatic cases may account for the low incidence.

Prognostic Factors and Outcome of Management of Ischemic Priapism in Zaria, Nigeria.

OBJECTIVES: The objective of this study was to determine the nuances of management, prognostic factors, and outcome of ischemic priapism in patients seen at Ahmadu Bello University Teaching Hospital, Zaria, Nigeria. PATIENTS AND METHODS: We retrospectively studied the case notes of all patients managed for ischemic priapism in the Ahmadu Bello University Teaching Hospital, Zaria, over a period of 10 years (2006-2015). The data extracted included patients' age, occupation, duration of painful penile erection, and previous episodes. Addition information including precipitating factors, hemoglobin genotype, treatment, and complications was also retrieved. Data obtained were analyzed using SPSS version 20. RESULTS: The records of a total of forty patients managed for priapism over the period under review were retrieved. Thirty-three (82.5%) of these patients had an operative intervention. The mean age was 23.7 years with a range of 8-53 years. Sixty percent of patients were young adults in their third decade of life. The minimum duration of erection at presentation was 18 h and a maximum period of 10 days with a mean of 105.5 h (4 days). Thirty-three patients (82.5%) had sickle cell anemia (HbSS). Erectile dysfunction (ED) accounted for 60% of all forms of postpriapism complications. Five patients (12.5%) had residual tumescence from fibrosis, and three patients had recurrence outside the immediate postoperative period. Duration of symptoms before surgical intervention, SSA and previous episodes were the most important prognostic factors. CONCLUSION: Priapism is a disease of the young, mostly sickle cell anemic patients. Late presentation remains the norm in our environment, hence a higher incidence of ED. The distal penile shunt is an effective means of achieving detumescence even with failed conservative management. Favorable outcome is highly dependent on the duration of erection and early intervention.

Prognostic factors and outcome of management of ischemic priapism in Zaria, Nigeria

Objectives: The objective of this study was to determine the nuances of management, prognostic factors, and outcome of ischemic priapism in patients seen at Ahmadu Bello University Teaching Hospital, Zaria, Nigeria. Patients and Methods: We retrospectively studied the case notes of all patients managed for ischemic priapism in the Ahmadu Bello University Teaching Hospital, Zaria, over a period of 10 years (2006­2015). The data extracted included patients' age, occupation, duration of painful penile erection, and previous episodes. Addition information including precipitating factors, hemoglobin genotype, treatment, and complications was also retrieved. Data obtained were analyzed using SPSS version 20. Results: The records of a total of forty patients managed for priapism over the period under review were retrieved. Thirty-three (82.5%) of these patients had an operative intervention. The mean age was 23.7 years with a range of 8­53 years. Sixty percent of patients were young adults in their third decade of life. The minimum duration of erection at presentation was 18 h and a maximum period of 10 days with a mean of 105.5 h (4 days). Thirty-three patients (82.5%) had sickle cell anemia (HbSS). Erectile dysfunction (ED) accounted for 60% of all forms of postpriapism complications. Five patients (12.5%) had residual tumescence from fibrosis, and three patients had recurrence outside the immediate postoperative period. Duration of symptoms before surgical intervention, SSA and previous episodes were the most important prognostic factors. Conclusion: Priapism is a disease of the young, mostly sickle cell anemic patients. Late presentation remains the norm in our environment, hence a higher incidence of ED. The distal penile shunt is an effective means of achieving detumescence even with failed conservative management. Favorable outcome is highly dependent on the duration of erection and early intervention