Integrative phytochemical, ligand structure based drug design nephroprotective potential of Annona muricata flower-petals.

This study was aimed at investigating the ability of extract of Annona muricata (AM) flower-petals in ameliorating the toxic effects of acetaminophen on the kidneys of albino rats. The biochemical results showed a marked increase in AM 200 mg (32.84 ± 0.14) and AM 400 mg (32.64 ± 0.78). Increase levels of total protein in AM 200 mg (77.00 ± 5.65) displays nephroprotective potential of the flower extract. Reduction of renal activities of serum urea in AM 400 mg group (6.41 ± 0.22) indicates its protective potency against acetaminophen induced kidney damage. Increased activities of SOD levels at 200 mg (4.97 ± 0.05) and CAT levels at 200 mg (23.39 ± 1.13). This study showed that A. muricata has good prospects of being a nephroprotective drug candidate.

A systematic review of actors, actions, and outcomes of community-based efforts to prevent or reduce methamphetamine use.

Background: There has been an increase in methamphetamine use across the globe, despite widespread control of the drug, prevention, and treatment. Community-based approaches have proven effective in tackling diverse health-related challenges including substance use; however, little is known regarding community programs targeting methamphetamine use. We conducted a systematic literature review on community programs aimed at tackling the use of methamphetamine across the globe. Method: Relevant literature from peer-reviewed and gray literature sources were systematically identified. A grid template was used to extract and synthesize findings from retrieved literature regarding themes of actors, actions, and outcomes related to identified programs. Results: A total of 19 documents met our inclusion criteria. Some of the dominant actors in efforts to reduce methamphetamine use in communities were local councils, drug enforcement units, influential persons in the community, people who use or had used methamphetamine, business corporations, and already-existing health promoting platforms. Actions taken were typically education/awareness/information campaigns. Drug enforcement agencies appeared to make little gains when acting alone, and appeared to drive dealers and users underground. Many of the efforts made at the community level were alluded to be beneficial; however, it was difficult to quantify the impact of programs. Community-level efforts also tended to cascade to other drugs. Conclusion: Community-based actors and actions are diverse and critical to the prevention of methamphetamine use. There is a need to better coordinate and integrate different actors and interventions so that outcomes can be better monitored and evaluated for greater effectiveness in reducing methamphetamine use.

Quality attributes of date and wheat flour pineapple juice blended cookies as affected by different baking temperatures.

Studying the effects of temperature on cookies are necessary especially if the impact on quality attributes are to be deduced. More so, blending wheat flour, date flour, and pineapple juice could improve the nutrient quality required in modern-day cookies. This current study investigated the quality attributes of date and wheat flour pineapple juice blended cookies as affected by different baking temperatures. With pineapple juice serving as water substitute, the formulated date, and wheat flour blends adhered to the following ratios: 100:0, 90:10, 80:20, and 70:30. Baking cookies involved two different temperatures (160 °C and 180 °C) with constant time (30 min). Quality attributes determined proximate composition, micronutrients, physical and functional properties, and microbial and sensory qualities. Cookies proximate results showed moisture (6.89-7.40%), protein (8.73-10.22%), fat (14.37-15.99%), fiber (1.02-1.11%), ash (0.77-1.20%) and carbohydrate (64.85-67.71%). Various ranges appeared, from energy values (434.90-444.10 kcal), minerals (calcium = 33.18-62.45 mg/100 g; iron = 3.47-5.75 mg/100 g; potassium = 100.07-358.63 mg/100 g), vitamins (vitamin A =1.99-4.89 mg/100 g; vitamin C = 0.04-0.15 mg/100 g), physical (weight = 7.4-7.75 g; diameter = 3.50-4.01 cm; thickness = 0.99-1.20 cm; volume = 3.11-3.77 cm3; density = 2.06-2.41 g/cm3; spread ratio = 2.92-4.05 cm3), to functional (water absorption = 1.14-1.18 g/g; oil absorption capacity = 1.31-1.33 g/g; bulk density = 0.74-0.76 g/mL) properties. The microbial loads seemed somewhat acceptable as overall acceptability favoured sample WDFb (90% wheat, 10% date flour). The acceptability of cookies baked at 160 °C over those baked at 180 °C suggests the need for further studies to determine the energy requirements, and long-term environmental implications such (baking) temperatures would pose.

Health disclosure mediates stigma-psychological well-being link among Vesico-Vaginal fistula patients.

There is strong link between health stigma and poor psychological wellbeing among Vesico-Vaginal fistula (V.V.F.) patients, yet no study to date has investigated the variables mediating this link. This study investigated the mediating role of health disclosure on the relationship between health stigma and psychological wellbeing among V.V.F. patients in Nigeria. Participants were 183 women (aged 14-70 years; mean age 22.88 years, SD = 5.64) conveniently drawn from a National Obstetric Fistula Hospital facility in south-east Nigeria. Participants completed measures of health stigma, health disclosure and psychological wellbeing. Results showed that health disclosure mediated the association between health stigma and psychological wellbeing. The results indicated that increased health stigma would lead to decreased health disclosure which in turn, would lead to poor psychological wellbeing. Our findings highlighted the relevance of health disclosure in the management of stigma impacts on health and wellbeing of V.V.F. patients.

Locating event centrality in associations of emotion regulation with posttraumatic stress disorder symptoms and posttraumatic growth in emerging adults.

Previous research suggests that cognitive reappraisal (CR) and expressive suppression (ES) strategies of emotion regulation (ER) are associated with posttraumatic stress disorder (PTSD) and posttraumatic growth (PTG). How the patterns of these associations may vary in the context of event centrality (EC) however requires investigation to help delineate groups for whom the impact of event centrality may be more salient. We examined whether EC would moderate the associations of CR and ES with PTSD symptoms clusters and PTG domains among 388 emerging adults (18-30 year-olds) of Tiv ethnic group who were survivors of armed attack by Fulani herdsmen and were temporarily sheltered in two internally displaced persons' (IDPs') camps in North-central Nigeria. They completed self-report measures of the variables. Results indicated that EC strengthened the negative associations of CR and the positive associations of ES with avoidance, hyper-arousal and total PTSD symptoms, but not intrusion symptoms. For the PTG domains, EC only strengthened the positive association between CR and personal strength and weakened the association of ES with greater appreciation of life. These findings suggest that primary intervention programs that incorporate training of armed attack survivors in cognitive reappraisal strategy centered on the traumatic event could be effective in controlling PTSD but be less critical in engendering PTG. They also show that the psychological processes that underlie PTSD and PTG are related but involve nuances even within PTSD, and do not seamlessly set into the Janoff-Bulman's "strength through suffering" model of PTG. More research is required to test the model.

Predictors of outcome of chest tube drainage of nonpurulent exudative pleural effusions.

Background: Although chest tube drainage is the primary management method for many pleural effusions, it has a failure rate of 9.4-48%. In this study, we examined the factors that predict the outcome of management of nonpurulent exudative effusions. The aim of this study was to determine the predictors of outcomes of chest tube drainage of pleural effusions. Methodology: Consecutive patients who had a chest tube drainage of nonpurulent exudative pleural effusions were followed up in a prospective observational cohort study until extubation and discharge. Data on the management of the patients were recorded, analysed and compared between groups of patients with good and poor outcomes. Results: Of the 52 patients studied, 38 had good outcomes, while 14 had poor outcomes. The mean±sd age was 39.7±15.9 years. Multivariate analysis demonstrated that empyema thoracis complicating drainage was an independent predictor of a poor outcome, while the duration of drainage ≤14 days and duration of illness before presentation <30 days were predictive of a good outcome. Conclusion: Our results show that the development of empyema thoracis during drainage, a long duration of drainage and a prolonged period of illness before presentation are predictive of the outcome of chest tube drainage.

Surgical Treatment of Valvular Heart Disease in Nigeria: A 6-Year Experience.

Surgical treatment of valvular heart disease in Nigeria, the most populous country in sub-Saharan Africa, is adversely affected by socioeconomic factors such as poverty and ignorance. To evaluate our experience in this context, we identified all patients who underwent surgery for acquired or congenital valvular heart disease at our Nigerian center from February 2013 through January 2019. We collected data from their medical records, including patient age and sex, pathophysiologic causes and types of valvular disease, surgical treatment, and outcomes. Ninety-three patients (43 males [46.2%]; mean age, 38.9 ± 10.0 yr [range, 11-80 yr]) underwent surgical treatment of a total of 122 diseased valves, including 72 (59.0%) mitral, 26 (21.3%) aortic, 21 (17.2%) tricuspid, and 3 (2.5%) pulmonary. The most prevalent pathophysiologic cause of disease was rheumatic (87 valves [71.3%]), followed by functional (20 [16.4%]), congenital (8 [6.6%]), degenerative (5 [4.1%]), and endocarditic (2 [1.6%]). All 3 diseased pulmonary valves had annular defects associated with congenital disease. Surgical treatment included mechanical prosthetic replacement of 92 valves (75.4%), surgical repair of 29 (23.8%), and bioprosthetic replacement of 1 (0.8%). We conclude that, in Nigeria, valvular disease is mainly rheumatic, affects mostly younger to middle-aged individuals, and is usually treated with prosthetic replacement.

Bullying and Suicide Ideation: Testing the Buffering Hypothesis of Social Support in a Sub-Saharan African Sample.

Substantial evidence indicates that adolescents and young adults have a disproportionately high incidence of most forms of violence, including suicide. Suicidality often includes suicidal ideation. The present study examined the relationship between bullying and suicidal ideation, and further tested whether social support moderates the association between the dimensions of bullying (verbal bullying, physical bullying, and bullying victimization) and suicidal ideation among adolescent secondary school students. A cross-sectional design was adopted for the study. Participants were 394 students (249 boys, 145 girls) drawn from two secondary schools in Nsukka semi-urban area, in southeast Nigeria. Participants completed the Illinois Bully Scale, the Columbia-Suicide Severity Rating Scale, and the Multidimensional Scale of Perceived Social Support (MSPSS). Hayes' regression-based PROCESS macro was used to analyze the data. Verbal bullying, physical bullying, and victimization were independently positively associated with suicidal ideation. Social support was not independently significantly associated with suicidal ideation, but it moderated the relationship between victimization and suicidal ideation. The positive relationship between victimization and suicidal ideation was strongest for adolescents who had low social support, compared to those who had moderate or high social support. This finding is consistent with the buffering hypothesis of social support, suggesting that supportive relationships for victims can mitigate suicidal ideation.

Post-operative fever (POF) after cardiac surgery in a low- and middle-income-country: 7-year institutional experience.

BACKGROUND: Post-operative fever (POF) after cardiac surgery in a developing country is of great concern because of the associated morbidity and mortality. In our country, we experience this complication more because of a high rate of malaria infestations, gastroenteritis, and malnutrition. We also experience a low yield of positive diagnostic tests when POF develops; this is partly due to expense and the prioritisation of other essential items in our poorly equipped cardiac ICU. AIMS/OBJECTIVE: To assess the causes of POF after cardiac surgery and determine its impact on the outcome on patients. MATERIALS AND METHODS: International Cardiac Surgery Mission teams visited our centre for 7 years (2013-2019). During this period, a significant number of cardiac surgeries were performed. A retrospective study of patients with POF was performed with data from our hospital's database, and included standard demographics; types of surgery performed, and management protocols being used in the peri-operative care. RESULTS: A total of 242 patients were treated during the study period and underwent 266 surgeries. Of these, 151 (56.8%) and 115 (43.2%) were adult and paediatric cases respectively. Ages ranged between 0 and 90 years; 34 (14.1%) had POF. When we evaluated the clinical and associated laboratory findings, pyrexia (temp >38.0 °C) and elevated white blood cell count with differential neutrophilia were present in 10 patients (29.4%). The time of onset and duration of POF were between <24 and >144 hours. In the invasive procedure related to POF, sternotomy infections were present in seven patients (18.4%). Malaria infestations and breach in sterility protocol were predominant. CONCLUSION: The management of POF in the cardiac ICU was complicated by the requirement of co-operation from a larger number of specialties than is usually required in advanced centres with special expertise in malaria confirmation. We, therefore, introduced structured clinical, laboratory, and appropriate interventions to treat POF more aggressively. We found that more careful attention to peri-operative details to ensure strict observation of sterility protocol with anti-malaria prophylaxis led to improvements in our centre's outcomes.

An ethylene cross-bridged pentaazamacrocycle and its Cu2+ complex: constrained ligand topology and excellent kinetic stability.

Rigid and topologically constrained ethylene cross-bridged tetraazamacrocycles have been increasingly utilised for thirty years as they form remarkably stable transition metal complexes for catalysis, biomedical imaging, and inorganic drug molecule applications. Extending these benefits to pentaazamacrocycles has been achieved and a first transition metal complex prepared and structurally characterized.

Invasive Pulmonary Cryptococcal Infection Masquerading as Lung Cancer with Brain Metastases: A Case Report.

Cryptococcosis, a global disease problem, seen frequently in the immuno-suppressed, also affects patients without apparent immuno-suppression. Pulmonary cryptococcosis patients often present as cryptococcal pneumonia, whereas intracranial cryptococcosis presents with meningitis. We present a 33-year-old immunocompetent man, diagnosed with invasive pulmonary cryptococcal disease with spread to the brain. This case is unique because the patient was previously treated for tuberculosis and presented with typical bronchopulmonary thoracic, extra-thoracic as well as computed tomography (CT) scan features suggestive of lung cancer. Cryptococcosis was diagnosed by identification of oval thick-walled yeast on histology of lung biopsy specimen. The patient was treated with flucytosine and fluconazole initially and subsequently with Amphotericin B and fluconazole. He made clinical improvement with the resolution of symptoms but had residual radiological features. Invasive cryptococcosis affecting the lung and brain may present with a clinical picture similar to metastatic lung cancer. We recommend routine fungal stains and fungal culture in suspected cases.

La cryptococcose, une maladie mondiale, fréquemment observée chez les sujets immunodéprimés, affecte également les patients sans immunodépression apparente. Les patients atteints de cryptococcose pulmonaire se présentent souvent comme une pneumonie cryptococcique tandis que la cryptococcose intracrânienne se présente avec une méningite. Nous présentons un homme immunocompétent de 33 ans, diagnostiqué avec une maladie pulmonaire invasive cryptococcique avec propagation au cerveau. Ce cas est unique car le patient a déjà été traité pour tuberculose et s'est présenté avec des caractéristiques bronchopulmonaires thoraciques, extra-thoraciques ainsi qu'une tomodensitométrie (TDM) typiques suggérant un cancer du poumon. La cryptococcose a été diagnostiquée par l'identification d'une levure ovale à paroi épaisse sur l'histologie d'un échantillon de biopsie pulmonaire. Le patient a été traité initialement par Flucytosine et Fluconazole, puis par Amphotéricine B et Fluconazole. Il a fait une amélioration clinique avec la résolution des symptômes mais avait des caractéristiques radiologiques résiduelles. La cryptococcose invasive affectant le poumon et le cerveau peut présenter un tableau clinique similaire au cancer du poumon métastatique. Nous recommandons des colorations fongiques de routine et une culture fongique dans les cas suspects.

Emotional reactivity and surgical anxiety. The protective nature of perceived social support.

The study examined whether emotional reactivity is associated with surgical anxiety among patients scheduled for elective surgery, and whether any of the dimensions of perceived social support moderates this relationship. Participants consisted of 210 adult patients (females = 117, 55.7%) admitted for surgery at University of Nigerian Teaching Hospital, Ituku-Ozala, Enugu State, Nigeria. Applying cross-sectional design, participants completed the Anxiety Specific to Surgery Questionnaire, Emotion Reactivity Scale, and Multidimensional Scale of Perceived Social Support approximately 24 h before their respective surgery. Results showed that emotional reactivity was positively associated with surgical anxiety at low and moderate but not at high levels of perceived family social support. Emotional reactivity was positively associated with surgical anxiety only at low level of friends and significant others support but not at moderate or high levels of perceived support from friends or significant others. We concluded that anxiety reduction intervention programmes for surgical patients should consider integrating social support for its protective nature in improving surgical outcome.

Roles of Religious Commitment, Emotion Regulation and Social Support in Preoperative Anxiety.

Surgery is a relatively commonplace medical procedure in healthcare settings. The mental health status of the person undergoing surgery is vital, but there is dearth of empirical studies on the mental health status of surgery patients, particularly with regard to the factors associated with anxiety in surgical conditions. This study investigated the roles of religious commitment, emotion regulation (cognitive reappraisal and expressive suppression) and social support in preoperative anxiety in a sample of 210 surgical inpatients from a Nigerian tertiary healthcare institution. A cross-sectional design was adopted. Before the surgery, respondents completed the state anxiety subscale of State-Trait Anxiety Inventory, Religious Commitment Inventory, Emotion Regulation Questionnaire and Multidimensional Scale of Perceived Social Support. After controlling for relevant demographic factors, regression results showed that cognitive reappraisal, social support and interpersonal religious commitment were negatively associated with preoperative anxiety, while expressive suppression was positively associated with preoperative anxiety. The emotion regulation strategies made robust and significant explanation of variance in preoperative anxiety. Appropriate interventions to promote interpersonal religious commitment, encourage cognitive reappraisal and enhance social support quality may improve mental health outcomes in surgery.

Establishing a sustainable open heart surgery programme in Nigeria, a low-income country: which is the best model?

BACKGROUND: In any country, the development of open heart surgery programme parallels stable political climate, economic growth, good leadership, and prudent fiscal management. This is lacking in a country like Nigeria without a functional cardiac hospital. OBJECTIVE: To review and compare the various models being adopted towards establishing a sustainable open heart surgery programme in Nigeria. MATERIALS AND METHODS: For ethnic and cultural reasons, Nigeria is divided into six geopolitical regions. Each region has one or more Federal Teaching Hospitals including medical centres. The hospitals have trained cardiothoracic surgeons and cardiologists as well as other auxiliary staff. After attainment of democratic rule in 1999, individual hospitals have devised various models to establish sustainable open heart surgery programme. The number of hospitals in each region, the models devised, and the limitations including the outcome were studied and analysed. RESULTS: Each geopolitical zone has about three to four centres, either public or private, trying to establish the programme. There are six different models. Each centre has been trying the different models since the year 2000. The oldest of the model is cardiac mission and the newest is employment of highly skilled retired expatriate consultant cardiac surgeon to help develop the local team. Inadequate funds, lack of governmental support, and brain drain syndrome have largely affected the programme.

Domiciliary use of transcutaneous electrical stimulation for patients with obstructive sleep apnoea: a conceptual framework for the TESLA home programme.

Obstructive sleep apnoea (OSA) is a global health problem of increasing prevalence. Effective treatments are available with continuous positive airway pressure (CPAP) therapy and mandibular advancement devices (MAD). However, there is limited long-term adherence to therapy, as CPAP and MAD require permanent usage to avoid recurrence of the symptoms and adverse ill health. Alternative treatments would aid in the treatment cascade to manage OSA effectively whenever standard therapy has been trialled and failed. Hypoglossal nerve stimulation (HNS), an invasive approach to stimulate the pharyngeal dilator muscles of the upper airway during sleep, has been approved for the treatment of OSA by several healthcare systems in recent years. In parallel to the development of HNS, a non-invasive approach has been developed to deliver electrical stimulation. Transcutaneous electrical stimulation in obstructive sleep apnoea (TESLA) uses non-invasive electrical stimulation to increase neuromuscular tone of the upper airway dilator muscles of patients with OSA during sleep. Data from previous feasibility studies and randomised controlled trials have helped to identify a subgroup of patients who are "responders" to this treatment. However, further investigations are required to assess usability, functionality and task accomplishment of this novel treatment. Consideration of these factors in the study design of future clinical trials will strengthen research methodology and protocols, improve patient related outcome measures and assessments, to optimise this emerging therapeutical option. In this review, we will introduce a conceptual framework for the TESLA home programme highlighting qualitative aspects and outcomes.

Event centrality influences posttraumatic stress disorder symptoms via core beliefs in internally displaced older adults.

OBJECTIVES: There is substantial evidence regarding the role of event centrality (EC) in posttraumatic stress disorder (PTSD) symptoms, but little research has examined the explanatory pathways linking EC with PTSD symptoms severity. The present study examined whether core beliefs (CB) mediates the relationship between EC and PTSD symptoms in internally displaced older adults. METHOD: Internally displaced older adults (N = 279; mean age = 62 years) sheltered in two camps located in north-central Nigeria, completed Tiv language versions of self-report measures, namely, the Harvard Trauma Questionnaire, the Centrality of Event Scale, Core Beliefs Inventory, and provided relevant demographic information. RESULTS: Analysis indicated that EC and CB were linked to greater PTSD symptoms as well as re-experiencing/intrusion, avoidance and hyperarousal symptoms severity. The mediator path was significant which implies that CB was a pathway through which EC influences PTSD symptoms clusters and overall PTSD symptomatology. CONCLUSION: A traumatic event becoming more central in a person's identity and life story distorts entrenched beliefs about oneself, others and the world, thereby resulting in greater PTSD symptoms. Our findings suggest that considerations of disrupted world assumptions may be a salient target for prevention and treatment efforts.

Somatic symptoms among prison inmates: contributions of emotion regulation, dispositional mindfulness, and duration of stay in prison.

PURPOSE: The modern prison system is not only a necessity to keep the public safe but also a mode of punishment for crimes. The correctional role of prisons is hampered in situations of mental illness, given that mental illness in the prison or correctional setting is a serious security risk. Few studies have given attention to the modifiable factors that may influence the mental health status of prison inmates, especially in developing countries. The purpose of this paper is to investigate emotion regulation (ER), dispositional mindfulness and duration of stay as factors in somatic symptoms among prison inmates. DESIGN/METHODOLOGY/APPROACH: Participants were 209 prison inmates drawn from a prison in Eastern Nigeria, who completed measures of ER (cognitive reappraisal and expressive suppression), mindfulness and somatization. FINDINGS: Results of a hierarchical multiple regression indicated that cognitive reappraisal predicted somatic complaints but it was only among older prison inmates, while expressive suppression was not a significant predictor of somatic complaints. Dispositional mindfulness was a negative predictor of somatic complaints among younger and older prison inmates. Duration of stay in prison positively predicted somatic complaints among prison inmates in emerging adulthood only (younger inmates), but not among older inmates. RESEARCH LIMITATIONS/IMPLICATIONS: Frequent use of cognitive reappraisal strategy of ER by prisoners may not always be productive in reducing somatic complaints, and the length of time in prison may influence somatic symptoms especially for younger prisoners. The possible benefits of incorporating mindfulness-based therapies in psychosocial interventions to reduce somatic complaints in correctional settings deserves further investigation. ORIGINALITY/VALUE: To date, there is limited research on somatic complaints of prisoners in the developing societies, particularly the psychosocial factors that may contribute to mental health problems.

Surgical management of CHD in the adult population: the role of humanitarian cardiac surgery mission in Nigeria.

BACKGROUND: The clinical effects of CHD can occur during the neonatal period, childhood, adolescent, and even adulthood. Some CHD in the adult population have indications for surgical management. OBJECTIVE: The objective of this study was to review the role of humanitarian cardiac surgery missions in the surgical management of CHD in the adult population in a developing country.Materials and methodOver a 5.5-year period - June, 2003, February, 2013-October, 2017 - five different humanitarian cardiac surgery teams visited National Cardiothoracic Center of Excellence, Nigeria. During the period, they operated on adults with CHD. A retrospective study of the patients treated was performed using data obtained from our Hospital Information Technology Department. The demography of the patients, types of CHD, operative modalities, as well as the outcome was analysed using Microsoft Excel. The results were presented in arithmetic of percentages using tables. RESULTS: During the period, a total of 18 CHD patients were treated.

Utilisation of blood and blood products during open heart surgery in a low-income country: our local experience in 3 years.

BACKGROUND: In Nigeria, access to open heart surgery (OHS) is adversely affected by insufficient blood and blood products, including the challenges because of the lack of patient-focused blood management strategies owing to the absent requisite point-of-care tests in the operating theatre (OR)/ICU. In addition, the limited availability of altruistic blood donors including the detection of transfusion transmitted infections more commonly among non-altruistic blood donors is another burden affecting the management of excessive bleeding during and after open heart surgery in our country. OBJECTIVE: The objective of this study was to review our local experience in the use of blood and blood products during open heart surgery and compare the same with the literature.Materials and methodsIn a period of 3 years (March, 2013-February, 2016), we performed a retrospective review of those who had open heart surgery in our institution. The data were obtained from our hospital health information technology department. The data comprised demography, types of operative procedures and units of blood and blood products transfused per procedure, including the details regarding the usage of the cell saver, as well as those who had severe bleeding requiring excessive blood transfusion. RESULTS: During the study period, 102 patients had open heart surgery, an average of 34 cases in a year. Among them, there were 75 (73.53%) males and 37 (36.27%) females, giving a ratio of 2:1. The ages of the patients were from 0.6 (7/12) to 74 years. Mitral valve procedure was the most common (n=22, 21.6%) surgery type. Transfusion requirements averaged 1.9 units of fresh frozen plasma, 0.36 units of platelet concentrate, and 1.68 units of packed cells per procedure. The least common surgical procedure was common atrium repair (n=1, 0.01%). CONCLUSION: Open heart procedure is a very complex procedure requiring cardiopulmonary bypass with associated severe perioperative bleeding. The attendant blood loss and haemostatic challenges are combated by intricate and selective transfusions of allogeneic blood and or blood products.

Prolonged incarceration and prisoners' wellbeing: livid experiences of awaiting trial/pre-trial/remand prisoners in Nigeria.

PURPOSE: Awaiting trial prisoners (ATPs) are represented in prisons globally, and may stay for long periods in detention. This group is however underrepresented in literature on incarcerated persons. We aim to explore the lived experiences of ATPs detained for prolonged years in a sub-Saharan country; examining what they make of their status and how their conditions have affected their wellbeing. METHOD: Eight inmates awaiting trial for armed robbery and murder offences, held for between 8 years and 15 years participated in a focus group discussion. Hermeneutic phenomenology guided the interpretation of transcripts. RESULT: ATPs recount disbelief and negative emotional experiences upon incarceration. Alienated and uncertain about their status, ATPs experience intensified distressful ruminations which impact wellbeing. ATPs re-rationalized incarceration and made social comparisons which breed poor perception of self. ATPs nonetheless recounted hopefulness, made favorable comparisons; and find consolation in religious beliefs. CONCLUSION: Prolonged years spent awaiting trial fuels a deterioration of wellbeing. Alternatives to incarceration are urgently needed for ATPs. Distressful experiences recalled by the inmates beg for the inclusiveness of ATPs in programs that promote wellbeing. The Good Lives Model holds potentials for building an inclusive framework to accommodate ATPs in prison interventions.