Unveiling the strong positive relationship: Maternal characteristics and neonatal outcomes in the Better Outcomes in Labour Difficulty (BOLD) study - a secondary analysis validating neonatal near miss classification.

Background: The near miss concept, denoting near collisions between aircraft, originated in aeronautics, but has recently been transferred to the neonatal context as a way of evaluating the quality of health services for newborns, especially in settings with reduced child mortality. However, there is yet no consensus regarding the underlying criteria. The most common indicators used to assess health care quality include mortality (maternal and neonatal) and life-threatening conditions. Using the World Health Organization (WHO) Better Outcomes in Labour Difficulty (BOLD) prospective cohort study data set, we conducted a secondary analysis to validate the near miss concept and explore the association between maternal and neonatal outcomes. Methods: We studied 10 203 singleton mothers treated between December 2014 and November 2015 in nine Nigerian and four Ugandan hospitals. We validated the near miss concept by testing the diagnostic accuracy (sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and odds ratio (OR)) using death as the reference variable and calculating the maternal and neonatal case fatality rates. We performed ordinal and binomial logistic regression, with the independent variables being those that had P < 0.1 in the univariate analyses. We considered the significance level of 5%. Results: We validated the neonatal near miss concept using the BOLD study data. We observed maternal and neonatal case fatality rates of 70.2% and 6.5%, with an increasing severity relationship between maternal and neonatal outcomes (P < 0.05). Ordinal logistic regression showed that gestational age <37 or >41 weeks and <8 antenatal consultations were related to a higher risk of neonatal severe outcomes, while maternal age between 30 and 34 years functioned as a protective factor against severe neonatal outcomes (SNO). Binomial logistic regression showed gestational age <37(OR = 1.46; 95% confidence interval (CI) = 1.07-1.94) or >41 weeks (OR = 2.26; 95% CI = 1.55-3.20), low educational level (OR = 1.76; 95% CI = 1.12-2.69), overweight/obesity (OR = 1.23; 95% CI = 1.02-1.47), one previous cesarean section (OR = 1.90; 95% CI = 1.36-2.61), one previous abortion (OR = 1.25; 95% CI = 1.00-1.56), and previous chronic condition (OR = 1.83; 95% CI = 1.37-2.41) were risk factors for SNO. Conclusions: The neonatal near miss concept could be used as a parameter for analysis in different health systems, to ensure that measuring of neonatal severity is comparable across health care units. In this analysis, we observed a progressive association between maternal severity and the severity of the newborns' outcomes.

Supporting claustrophobic patients during magnetic resonance imaging examination- the radiographer perspective.

INTRODUCTION: Some patients cannot complete their magnetic resonance imaging (MRI) examinations because of claustrophobia. Evidence showed that supportive instruction is an effective intervention used to assist claustrophobic patients in MRI. However, the effectiveness of this intervention depends on the experience and education level of the MRI radiographer. This study aimed to understand the views of MRI radiographers on supporting claustrophobic patients and develop a guide to improve the effectiveness of the intervention. METHODS: A qualitative descriptive approach utilising focus group discussion was considered suitable. A purposive sampling method was used to enrol eligible participants into the study. The study was advertised in print newspapers and on social media platforms. There were seven MRI radiographers in the focus group discussion. The conversation was recorded and transcribed for analysis, with content analysis employed to group the data into relevant codes and categories. RESULTS: The radiographer's understanding of claustrophobia and knowledge of the interventions used to support claustrophobic patients were the key elements that influenced claustrophobic patients' experience in MRI. However, there were some factors inhibiting the radiographer's ability to support these patients. These factors include insufficient appointment slots, availability of supportive tools and support with developing communication skills. CONCLUSION: Communication and identifying anxiety signs are essential for MRI radiographers to address patient anxiety during examinations. This might increase the MRI examination completion rate and give the patient a positive experience in the department. IMPLICATIONS FOR PRACTICE: MRI radiographers can better understand how to support claustrophobic patients. Also, the guide developed from the data could help improve consistency in the use of supportive instruction in clinical practice.

Clinical Utility of Procalcitonin and C-Reactive Protein in the Management of Neonatal Sepsis in a Resource-Limited Nigerian Hospital.

BACKGROUND: Neonatal sepsis is an invasive infection of the bloodstream in neonates and a leading cause of morbidity and mortality among them. AIM: To investigate the role of procalcitonin (PCT) and C-reactive protein (CRP) in the management of neonatal sepsis. MATERIALS AND METHODS: This was a prospective case-control study over one-year period using convenience sampling. Blood samples for PCT and CRP were taken from all neonates, while blood culture and white blood cell count samples were additionally taken from babies with neonatal sepsis. PCT and CRP were repeated at 24 and 48 hours. The continuous variables were found to have a nonparametric distribution. They were presented as median and interquartile range, and compared using Wilcoxon signed rank and Friedman test as appropriate. RESULTS: The blood culture analysis yielded a prevalence of 12.7% with Staphylococcus aureus being the commonest organism. Baseline concentrations of PCT (1.28 ng/ml) and CRP (17.31 mg/L) in neonates with sepsis were higher than that of controls (PCT-0.63 ng/ml, CRP-5.40 mg/L). PCT concentrations decreased after two days of antibiotic treatment, while CRP concentrations decreased after a day. The concentration of both decreased to normal levels after two days of treatment. CONCLUSION: This study showed that CRP was more reliable in monitoring antibiotic therapy, unlike other studies which suggested PCT. In cases where the management of neonatal sepsis may be limited by a low blood culture yield, therapeutic monitoring may be aided by CRP and/or PCT.

Dalbergiella welwitschia (Baker) Baker f. alkaloid-rich extracts attenuate liver damage in streptozotocin-induced diabetic rats.

This experiment was conducted to evaluate the Dalbergiella welwitschia alkaloid-rich extracts on liver damage in streptozotocin-induced diabetic rats. Hence, to induce diabetes, 45 mg/kg body weight of streptozotocin was intraperitoneally injected into the Wistar rats. Subsequently, 5 % (w/v) of glucose water was given to the induced animals for 24 h. Thus, the animals (48) were grouped into five groups (n = 8), containing normal control (NC), diabetic control (DC), diabetic rats placed on low (50 mg/kg body weight) and high (100 mg/kg body weight) doses of D. welwitschi alkaloid-rich leaf extracts (i.e. DWL and DWH respectively), and diabetic rats administered 200 mg/kg body weight of metformin (MET). The animals were sacrificed on the 21st day of the experiment, blood and liver were harvested, and different liver damage biomarkers were evaluated. The results obtained demonstrated that diabetic rats administered DWL, DWH and MET significantly (p < 0.05) increased hepatic AST, ALT, albumin, SOD, CAT, GSH, and GPX levels when compared to DC with no significant (p > 0.05) different when compared with NC. Also, diabetic rats administered DWL, DWH and MET revealed a significant (p < 0.05) decrease in GGT and MDA levels, as well as, fragmented DNA and protein carbonyl levels when compared to DC with no significant (p > 0.05) different when compared with NC. In addition, histological examination revealed that diabetic rats placed on DWL, DWH and MET normalized the hepatocytes. Consequently, it can be inferred that alkaloid-rich extracts from D. welwitschi leaf could be helpful in improving liver damage associated with diabetes mellitus rats.

Supporting claustrophobic patients during Magnetic Resonance Imaging examination- the patient perspective.

INTRODUCTION: Magnetic Resonance Imaging (MRI) is a common imaging modality used to diagnose disease and monitor treatment. However, some patients cannot complete their MRI examination as a result of claustrophobia. The recent developments in the MRI scanner design may have reduced the incidence of claustrophobia in MRI. This study aimed to explore the claustrophobic patients' experience to better understand how to support them. METHODS: A qualitative descriptive approach using focus groups was deemed appropriate for the study. The research was advertised in a print newspaper and on social media platforms for eligible participants to contact the researcher. Six claustrophobic patients were recruited to the focus group meeting. The discussion was audio recorded and transcribed. Content analysis was used to analyse the data into code and categories. RESULTS: Four themes emerged from the data analysis, which included examination preparation, information provision, coping mechanisms and MR scanner design. Participants reported that the confined space in the MRI scanner bore is responsible for their anxiety during MRI. However, the majority of the participants believe that they would be able to complete the examination if, in advance of their scan, they were shown the MRI scanner and what they would be required to do. CONCLUSION: Several coping mechanisms were shared by the participants on how they were able to complete their MRI examination despite their claustrophobia. MRI radiographers should endeavour to use these mechanisms to support their patients in practice. Also, the findings emphasise the importance of virtual reality and clear communication with patients in preparing them for their MRI examinations. IMPLICATIONS FOR PRACTICE: The findings of this study may be used to enhance claustrophobic patients' experience in MRI. It also identified those aspects of the MRI examination that matter most to patients with claustrophobia in order to provide a suitable intervention to support these patients.

Relationship between Serum Uric Acid and Hypertension among Secondary School Adolescents in Ekiti State, Nigeria.

BACKGROUND: With the seemingly increasing trend of childhood hypertension, high serum uric acid (SUA) levels might be an indicator of essential hypertension among adolescents. OBJECTIVE: To determine the SUA levels of hypertensive students and randomly selected controls and find the association, if any, between SUA level and blood pressure (BP) among secondary school students in Ido-Osi Local Government Area (LGA). METHODOLOGY: The study was a nested case-control study conducted among selected secondary school students in IdoOsi LGA from June 2017 to March 2018. Of the 573 students screened for hypertension, SUA was assayed from 31 hypertensive students and an equal number of age- and sexmatched controls. Serum uric acid greater than 5.5 mg/ dL was taken as high. Statistical analysis included chi-square and Pearson correlation. RESULTS: There was a positive correlation between SUA level and both systolic BP (p < 0.013) and diastolic BP (p < 0.017). The mean (SD) serum uric acid level of the hypertensive students [5.39 (2.08) mg/ dL] was higher than that of the controls [4.24 (1.81) mg/ dL] (p = 0.023). Hypertensive students with hyperuricaemia had a higher mean (SD) systolic BP than those with low uric acid: 138.67 (14.81) versus 128.68 (10.04); p =0.037. CONCLUSION: The mean serum uric acid level of students with hypertension was higher than that of the non-hypertensive students and high SUA levels appear to more prominently affect systolic than diastolic blood pressures among the cohort of hypertensive students.

CONTEXTE: Compte tenu de la tendance apparemment croissante de l'hypertension chez les enfants, des taux élevés d'acide urique sérique (AUS) pourraient être un indicateur d'hypertension essentielle chez les adolescents. OBJECTIF: Déterminer les niveaux d'acide urique sérique des élèves hypertendus et des témoins choisis au hasard et trouver l'association, le cas échéant, entre le niveau d'acide urique sérique et la tension artérielle chez les élèves du secondaire dans la zone de gouvernement local (LGA) d'Ido-Osi. MÉTHODOLOGIE: L'étude était une étude cas-témoins imbriquée menée auprès d'élèves du secondaire sélectionnés dans la zone de gouvernement local d'Ido-Osi de juin 2017 à mars 2018. Sur les 573 élèves dépistés pour l'hypertension, le SUA a été dosé chez 31 élèves hypertendus et un nombre égal de témoins appariés selon l'âge et le sexe. Un taux d'acide urique sérique supérieur à 5,5 mg/ dL a été considéré comme élevé. L'analyse statistique a porté sur le chi-carré et la corrélation de Pearson. RÉSULTATS: Il y avait une corrélation positive entre le niveau de SUA et la tension systolique (p < 0,013) et la tension diastolique (p< 0,017). Le niveau moyen (SD) d'acide urique sérique des étudiants hypertendus [5,39 (2,08) mg/ dL] était plus élevé que celui des témoins [4,24 (1,81) mg/ dL] (p = 0,023). Les étudiants hypertendus présentant une hyperuricémie avaient une TA systolique moyenne (SD) plus élevée que ceux ayant un faible taux d'acide urique : 138,67 (14,81) contre 128,68 (10,04); p =0,037. CONCLUSION: Le taux moyen d'acide urique sérique des étudiants hypertendus était plus élevé que celui des étudiants non hypertendus et les taux élevés d'acide urique sérique semblent affecter davantage la pression artérielle systolique que la pression artérielle diastolique dans la cohorte d'étudiants hypertendus. Mots-clés: Adolescents, hypertension, relation, acide urique sérique.

Evaluation of Primary School Health Environment in Ido/Osi Local Government Area, Ekiti State, Nigeria.

BACKGROUND: School environment entails the sum total of the physical, biological, social, and emotional environment within which members of the school community operate. It is essential to make the school environment healthy to promote and protect the health of school pupils as well as their safety. This study aimed at finding the level of implementation of a Healthy School Environment (HSE) in Ido/Osi Local Government Area (LGA) of Ekiti State. METHODOLOGY: A cross-sectional descriptive study carried out among 48 private and 19 public primary schools using a standardised checklist and direct observation. RESULTS: The teacher-to-pupil ratio was 1:16 in public schools and 1:10 in private schools. The leading source of water in 47.8% of the schools was well water. Most, 97%, of the schools practiced open dumping of refuse. Private schools had more school buildings with strong walls and good roofs with doors and windows which provided adequate ventilation compared to the public schools (p- 0.001). No school was located close to an industrial area, however, none had a safety patrol team. Only 34.3% of schools had a fence and 31.3% had terrains prone to flooding. Only 3% of the schools, all private schools, attained the minimum acceptable score on the school environment. CONCLUSION: The status of school environment was poor in the study location and school ownership did not make any much impact as there was no difference in the situations of school environment between public and private schools.

CONTEXTE: L'environnement scolaire est l'ensemble des conditions physiques, biologiques, sociales et émotionnelles dans lesquelles évoluent les membres de la communauté scolaire. Il est essentiel de rendre l'environnement scolaire sain afin de promouvoir et de protéger la santé des élèves ainsi que leur sécurité. Cette étude visait à déterminer le niveau de mise en œuvre de l'environnement scolaire sain (HSE) dans la zone de gouvernement local (LGA) d'Ido/Osi de l'État d'Ekiti. MÉTHODOLOGIE: Une étude descriptive transversale a été menée dans 48 écoles primaires privées et 19 écoles primaires publiques à l'aide d'une liste de contrôle standardisée et d'une observation directe. RÉSULTATS: Le ratio enseignant/élèves était de 1:16 dans les écoles publiques et de 1:10 dans les écoles privées. La principale source d'eau dans 47,8 % des écoles était l'eau de puits. La plupart des écoles (97%) pratiquaient le dépôt d'ordures à l'air libre. Les écoles privées avaient plus de bâtiments scolaires avec des murs solides et de bons toits avec des portes et des fenêtres qui fournissaient une ventilation adéquate par rapport aux écoles publiques (p- 0.001). Aucune école n'était située à proximité d'une zone industrielle, mais aucune ne disposait d'une équipe de patrouille de sécurité. Seules 34,3 % des écoles disposaient d'une clôture et 31,3 % étaient situées sur des terrains inondables. Seules 3 % des écoles, toutes privées, ont atteint le score minimum acceptable en matière d'environnement scolaire. CONCLUSION: L'état de l'environnement scolaire était médiocre dans la région étudiée et la propriété de l'école n'avait pas beaucoup d'impact car il n'y avait pas de différence dans la situation de l'environnement scolaire entre les écoles publiques et les écoles privées. Mots-clés: État d'Ekiti, Environnement sain, Gouvernement Local, Nigeria, École Primaire, Environnement Scolaire.

Factors influencing sonographer-led bowel ultrasound services in the UK.

INTRODUCTION: There is a growing understanding of the potency of bowel ultrasound leading to an increasing application of ultrasound in examining different bowel conditions. However, sonographers' involvement in bowel ultrasound is under-researched. This study investigated the factors influencing sonographers' experience in adult bowel ultrasound. METHODS: A convenience sampling method was used to promote the study in April 2021. A mixed methods online questionnaire was utilised to explore the participants' views. Quantitative data were analysed using descriptive analysis on Excel, while qualitative data were analysed using inductive thematic analysis. RESULTS: Almost half of the participants (53%; n = 16) indicated low confidence in using ultrasound to examine the bowel for abnormalities. While 63% of the participants reported having high confidence in examining the bowel for suspected appendicitis, 70% (n = 21) reported low confidence in carrying out ultrasound in examining Inflammatory bowel disease. Furthermore, 23 participants (77%) indicated a high interest in bowel ultrasound training. Qualitative findings revealed mixed opinions on bowel ultrasound practice. Factors influencing sonographers' experience are the need for more training opportunities, preference for other imaging modalities, management challenges, radiologists' influence, sonographers' perspectives, and positive perspectives. CONCLUSION: Several factors influence sonographers' confidence in using ultrasound for bowel abnormalities. However, the findings emphasise the need for more research into the future design and implementation of sonographers' bowel ultrasound training. IMPLICATION FOR PRACTICE: This study brings new insight to an under-researched area on the scope of sonography practice, highlighting some sonographers' experience, opinions, and involvement in bowel ultrasound. It further strengthens the argument for more training to be made available to sonographers on bowel ultrasound.

Enhanced adsorptional-photocatalytic degradation of chloramphenicol by reduced graphene oxide-zinc oxide nanocomposite.

Improper discharge of waste dry cell batteries and untreated antibiotics laden effluents to the environment pose serious threat to the sustenance of the ecosystem. In this study, synthesis of reduced graphene oxide-ZnO (rGO-ZnO) nanocomposite was achieved via a bioreduction process using waste dry cell battery rod as graphene oxide (GO) precursor. The nanocomposite was applied in the ultraviolet photocatalytic degradation of chloramphenicol (CAP) at 290 nm in the presence of hydrogen peroxide. RGO-ZnO nanocomposite was characterized by SEM, TEM, XRD, BET and FTIR. TEM image of the nanocomposite revealed a polydispersed, quasi-spherical zinc oxide on a coarse reduced graphene oxide surface. XRD patterns showed sharp, prominent crystalline wurtzite hexagonal phases of ZnO and rGO. BET surface area of the nanocomposite was 722 m2/g with pore size of 2 nm and pore volume of 0.4 cc/g. % photo-removal efficiency increased with increasing irradiation time but diminished at higher pH, temperature and CAP concentration. Photocatalytic adsorption process fitted more accurately into the Freundlich model (R2 = 0.99) indicating a multilayer adsorption mechanism. 92.74% reduction in chemical oxygen demand (COD) level of veterinary effluent was obtained after treatment with the nanocomposite thus affirming its effectiveness in real waste water samples.

Radiographer's confidence in managing patients with claustrophobia during magnetic resonance imaging.

INTRODUCTION: Claustrophobia is a major problem experienced by some patients referred for magnetic resonance imaging (MRI). This results in significant costs and delays to healthcare service provision due to appointment cancellations or patients' inability to complete MRI examinations. Radiographers may use several strategies to effectively manage patients with claustrophobia during MRI. This study aimed to determine radiographer's confidence in managing patients with claustrophobia and evaluate the perceived effectiveness of the intervention approaches employed. METHODS: With institutional ethical approval, an online survey was conducted (15th September to 9th November 2020) among Kuwaiti MRI radiographers. The survey was designed to obtain information relating to participant demographics and the perceived confidence of radiographers in their use of interventions to manage claustrophobia during MRI procedures. Data obtained were analysed using the Statistical Package for the Social Sciences (v.26). RESULTS: A total of 144 valid responses were obtained. Of the respondents, 82% (n = 118) were confident that they could support claustrophobic patients during MRI examinations. Almost all respondents (97.9%, n = 141) employed various claustrophobia reduction and relaxation techniques to improve patient experience and increase scan completion rates. There was a significant association between radiographer's level of education (rs = +0.18, p = 0.028) and experience (rs = +0.33, p < 0.001) with their confidence managing claustrophobic patients. While participating radiographers considered lectures and training the most effective methods to improve their skills in managing such patients, educating claustrophobic patients prior to their MRI scan was the most effective technique for facilitating scan completion. CONCLUSION: Kuwaiti MRI radiographers are confident in applying different claustrophobic management techniques to improve patient compliance. Patient education, through supportive discussion, prior to their MRI examination was identified as the most effective intervention for managing claustrophobia. IMPLICATIONS FOR PRACTICE: Patient education before MRI examination is necessary to enhance their experience and optimise scan completion rates. In addition, it is essential that MR radiographers develop their practical competence in supporting patients with claustrophobia during their scans.

The global impact of the COVID-19 pandemic on clinical radiography practice: A systematic literature review and recommendations for future services planning.

INTRODUCTION: Worldwide, reports and experiences indicate that there has been extensive re-organisation within diagnostic imaging and radiotherapy departments in response to the COVID-19 pandemic. This was necessary due to changes in workload and working practice guidelines that have evolved during the pandemic. This review provides a comprehensive summary of the global impact of the COVID-19 pandemic on radiography practice, service delivery and workforce wellbeing. METHODS: A systematic review methodology was adopted to obtain data from primary studies of qualitative, quantitative, and mixed methods designs from databases (PubMed, Science Direct, Cumulative Index of Nursing and Allied Health Literature [CINAHL], and SCOPUS: all 2020 to present). The included articles were subjected to information extraction and results-based convergent synthesis. RESULTS: The electronic database search yielded 10,420 articles after removal of duplicates. Of these, 31 articles met the final inclusion criteria with some (n = 8) fully focussed on radiotherapy workforce and service delivery. The pandemic impact on radiography practice is broadly themed around: training, communication, and information dissemination; infrastructure, technology, and clinical workflow; and workforce mental health and well-being. CONCLUSION: Globally, most radiographers received inadequate training for managing COVID-19 patients during the initial acute phase of the pandemic. Additionally, there were significant changes to clinical practice, working patterns and perceived increase in workload due to surges in COVID-19 patients and the consequent strict adherence to new infection protocols. These changes, coupled with fear emanating from the increased risk of the workforce to contracting the infection, contributed to anxiety and workplace-related stress during the pandemic. IMPLICATIONS FOR PRACTICE: Local pandemic response strategies must be appropriately developed from standard protocols in readiness for safe clinical practice and well-being management training of practitioners.

Addressing the global surge of COVID-19 cases: Insights from diagnostics, improved treatment strategies, vaccine development and application.

BACKGROUND AND AIM: As the rage of coronavirus disease 2019 (COVID-19) pandemic continues to spread globally, much effort is being directed to contain it through various efforts - genomic studies, drug discoveries, clinical trials, vaccine development, and the innovation of diagnostic techniques. However, some pertinent areas involving accurate and sensitive diagnostics, immunoglobulin specificity, evolution of mutant strains of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and the drug combination strategy to combat it still require more attention. METHODS: This review critically examines the COVID-19 response and containment operations. It also addresses some standing challenges involving the areas of diagnostics, vaccine development and prospect, and treatment strategies in relation to antiviral drug treatment and immunotherapy. Designated set of keywords such as "SARS-CoV-2;" "coronavirus;" "severe acute respiratory syndrome coronavirus;" "repurposed;" "vaccination;" "containment;" "laboratory diagnostic;" "immunotherapy;" "antiviral;" "antiparasitic;" "antibiotic;" "antiprotozoal;" "antibody;" "anti-inflammatory;" "antitumor;" "corticosteroid;" "hypertensive drug;" "statin;" "supplement;" and "biological" along with "COVID-19" were inserted on electronic databases to retrieve articles and clinical trial information relevant to the study objectives. The search databases included ClinicalTrials.gov, NIH.gov, PubMed, Scinapse, CINAHL, Medline, Google Scholar, Academic Search Premier, SAGE, EBSCO Host, and Scopus. RELEVANCE FOR PATIENTS: The difficulties associated with SARS-CoV-2 rapid mutations are unceasingly evolving and re-evolving. These pose serious concerns and downplay the efficacy and effectiveness of the current pipeline antiviral drugs and vaccines. Entities encompassing immunotherapy, antiviral drug therapies, viral genomics, protein-protein interaction, and improved diagnostics as well as drug combination strategy against the emerging genetic variability of SARS-CoV-2 were critically appraised. This study suggests that robust collaborations in the development of more sensitive, rapid and accurate diagnostics, development of immunoglobulin specific agents and improved anti-viral treatment focus against multiple mutant genes of SARS-CoV-2 should be aggressively pursued for the overall benefits of COVID-19 patients.

COVID-19 PANDEMIC: IMPACT ON GYNAECOLOGICAL ENDOSCOPY AT THE UNIVERSITY COLLEGE HOSPITAL IBADAN.

The impact of the COVID-19 pandemic on endoscopic services in a low resource economy is formidable. With the emergence of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), there has been genuine concerns about the risk of transmission during gynaecological endoscopy via the diffusion of contaminated aerosols generated from CO2 leakage and smoke created by energy devices. A pragmatic step in mitigating transmission at the University College Hospital, Ibadan, resulted in the closure of the Endoscopic unit for 3 months whilst deploying increased hygienic methods coupled with social distancing. This however had its unintended consequences of delay and increased backlog of cases aside the economic losses. Developing a unit-based policy/protocol in response to any future unforeseen occurrence should take front stage in the planning and administration of the unit. Adopting global best practices and guidelines from researched evidence is not only imperative but desirable especially in the context of limited resources.

Problem based learning in radiography education: A narrative review.

OBJECTIVES: Radiography practice is fast developing with new imaging updates and challenging scenarios to deal with on a frequent basis. There is a need to equip students with the skill to be independent learners and develop critical thinking skills, so they can change their practice as the profession evolves. Problem Based Learning (PBL) has widely been adopted in medical and nursing training worldwide as a result of its desirable benefits. In order to ascertain the efficacy of the technique, this paper presents a review of the essential aspects of PBL, such as the theories, process, key roles and implication for radiography education and practice. KEY FINDINGS: The use of a defined model provides a useful structure to the PBL exercise with the addition of reflection, which is a pertinent inclusion within the process. The role of the facilitator in PBL is significant to students' learning as they help guide the students to the learning outcomes and provide support to the group; however, their skills development is an important factor to consider in PBL. CONCLUSION: This teaching approach has key benefits in radiography education and training in particular, its impact on preparing students for autonomous clinical practice. IMPLICATIONS FOR PRACTICE: The application of PBL in developing students' critical thinking and decision-making abilities support the narrowing of the spoon-feeding expectation of students and render it a useful pedagogical implementation within radiography programmes.

Maternal BMI at the time of birth and selected risk factors associated with severe neonatal outcomes: a secondary analysis of the WHO Better Outcomes in Labour Difficulty (BOLD) project.

The main objective of this secondary analysis was to describe the nutritional status of the Better Outcomes in Labour Difficulty (BOLD) project study population and determine possible associations between maternal nutritional status (as reflected by maternal BMI at the time of birth) and severe neonatal outcomes (SNO). We also analysed previous and index maternal pathologies to determine associations with neonatal outcomes. We used the classification designed by Atalah for maternal BMI and compared with the Hyperglycaemia and Adverse Pregnancy Outcome study one. To describe the nutritional status of this population, figures of distribution and test of normality related to weight and BMI were presented for the women and their babies. To explore the association between maternal BMI data and SNO, the χ2 test was performed. To identify a maternal characteristic or a group of characteristics that could predict SNO, we used Fisher's exact test using previous maternal pathology collected in the BOLD project as well as that in the index pregnancy. In this study, BMI at the time of birth was not associated with neonatal near miss or death. We found that previous maternal obesity, diabetes and chronic hypertension were associated with SNO. Maternal pathology in the index pregnancy such as other obstetric haemorrhage, pre-eclampsia, anaemia and gestational diabetes was associated with SNO.

Development of caesarean section prediction models: secondary analysis of a prospective cohort study in two sub-Saharan African countries.

BACKGROUND: Caesarean section is recommended in situations in which vaginal birth presents a greater likelihood of adverse maternal or perinatal outcomes than normal. However, it is associated with a higher risk of complications, especially when performed without a clear medical indication. Since labour attendants have no standardised clinical method to assist in this decision, statistical tools developed based on multiple labour variables may be an alternative. The objective of this paper was to develop and evaluate the accuracy of models for caesarean section prediction using maternal and foetal characteristics collected at admission and through labour. METHOD: This is a secondary analysis of the World Health Organization's Better Outcomes in Labour Difficulty prospective cohort study in two sub-Saharan African countries. Data were collected from women admitted for labour and childbirth in 13 hospitals in Nigeria as well as Uganda between 2014 and 2015. We applied logistic regression to develop different models to predict caesarean section, based on the time when intrapartum assessment was made. To evaluate discriminatory capacity of the various models, we calculated: area under the curve, diagnostic accuracy, positive predictive value, negative predictive value, sensitivity and specificity. RESULTS: A total of 8957 pregnant women with 12.67% of caesarean births were used for model development. The model based on labour admission characteristics showed an area under the curve of 78.70%, sensitivity of 63.20%, specificity of 78.68% and accuracy of 76.62%. On the other hand, the models that applied intrapartum assessments performed better, with an area under the curve of 93.66%, sensitivity of 80.12%, specificity of 89.26% and accuracy of 88.03%. CONCLUSION: It is possible to predict the likelihood of intrapartum caesarean section with high accuracy based on labour characteristics and events. However, the accuracy of this prediction is considerably higher when based on information obtained throughout the course of labour.

Daytime Versus Night-Time Emergency Abdominal Operations: Perspective from a Low-Middle-Income Country.

BACKGROUND: Emergency abdominal operations carry significant risk of mortality and morbidity. The time of the day when such operations are performed has been suggested as a predictor of outcome. A retrospective comparison of outcomes of daytime and night-time emergency abdominal operations was conducted. METHODS: Clinical data of patients who had abdominal operations over a five-year period were obtained. Operations were classified as 'daytime' (group A) if performed between 8.00 am and 7.59 pm or 'night time' if performed between 8.00 pm and 7.59 am (group B). Post-operative outcomes were compared. RESULTS: A total of 267 emergency abdominal operations were analysed: 161 (60.3%) were performed in the daytime while 106 (39.7%) were performed at night. The case mix in both groups was similar with appendectomies, bowel resections and closure of bowel perforations accounting for the majority. Baseline characteristics and intra-operative parameters were similar except that 'daytime' operations had more consultant participation (p = 0.01). Mortality rates (13.7% in group A and 12.3% in group B, p = 0.2), re-operation rates (9.3% in group A and 10.4% in group B, p = 0.7) and duration of hospital stay (group A-11.1 days, group B-12.4 days p = 0.4) were similar. ASA status, re-operation and admission into the intensive care unit were identified as predictors of mortality. CONCLUSION: Timing of emergency abdominal operations did not influence outcomes. In resource-limited settings where access to the operating room is competitive, delaying operations till daytime may be counterproductive. Patients' clinical condition still remains the most important parameter guiding time of operation.

Automated phone call and text reminders for childhood immunisations (PRIMM): a randomised controlled trial in Nigeria.

BACKGROUND: Sub-Saharan Africa has high under-5 mortality and low childhood immunisation rates. Vaccine-preventable diseases cause one-third of under-5 deaths. Text messaging reminders improve immunisation completion in urban but not rural settings in sub-Saharan Africa. Low adult literacy may account for this difference. The feasibility and impact of combined automated voice and text reminders on immunisation completion in rural sub-Saharan Africa is unknown. METHODS: We randomised parturient women at the Mother and Child Hospitals Ondo State, Nigeria, owning a mobile phone and planning for child immunisation at these study sites to receive automated call and text immunisation reminders or standard care. We assessed the completion of the third pentavalent vaccine (Penta-3) at 18 weeks of age, immunisation completion at 12 months and within 1 week of recommended dates. We assessed selected demographic characteristics associated with completing immunisations at 12 months using a generalised binomial linear model with 'log' link function. Feasibility was assessed as proportion of reminders received. RESULTS: Each group had 300 mother-baby dyads with similar demographic characteristics. At 18 weeks, 257 (86%) and 244 (81%) (risk ratio (RR) 1.05, 95% CI 0.98 to 1.13; p=0.15) in the intervention and control groups received Penta-3 vaccine. At 12 months, 220 (74%) and 196 (66%) (RR 1.12, 95% CI 1.01 to 1.25; p=0.04) in the intervention and control groups received the measles vaccine. Infants in the intervention group were more likely to receive Penta-3 (84% vs 78%, RR 1.09, 95% CI 1.01 to 1.17; p=0.04), measles (73% vs 65%, RR 1.13, 95% CI 1.02 to 1.26; p=0.02) and all scheduled immunisations collectively (57% vs 47%, RR 1.13, 95% CI 1.02 to 1.26; p=0.01) within 1 week of the recommended date. No demographic character predicted immunisation completion. In the intervention group, 92% and 86% reported receiving a verification reminder and at least one reminder during the study period, respectively. CONCLUSION: Paired automated call and text reminders significantly improved immunisation completion and timeliness. TRIAL REGISTRATION NUMBER: NCT02819895.

Pregnancy-related acute kidney injury: Etiologies and short-term outcomes in a tertiary hospital in Southwest Nigeria.

Although the incidence of pregnancy-related acute kidney injury (PRAKI) is declining in developing countries, it still remains a major cause of maternal and fetal morbidity and mortality. The aim of this study was to determine the etiologies, short-term outcomes, and their predictors in patients with PRAKI managed in a tertiary health facility in Southwest Nigeria over a four-year period. This was a four-year retrospective review of clinical records of patients managed for PRAKI in University of Medical Sciences Teaching Hospital, Ondo State, Nigeria. Thirty-two women with a mean age of 31.09 ± 7.50 years had PRAKI during the period reviewed. Twenty-four (75%) patients were multiparous and PRAKI was most common in the postpartum period (56.3%). Twenty-three patients (71.9%) were in RIFLE Stage 3, 24 (75%) received blood transfusion, 5 (15.6%) required intensive care unit (ICU) care, 24 (75%) needed dialysis while 19 (59.4%) had hemodialysis. The common causes of PRAKI were obstetric hemorrhage in 16 (50%), sepsis in seven (21.9%), and eclampsia in six (18.8%). Maternal and fetal mortality were 34.4% and 50% respectively. Seventeen (53.1%) had full renal recovery and only one (3.1%) became dialysis dependent. Significant factors that were associated with maternal mortality were admission to ICU (P = 0.01), hypotension (P = 0.02), and impaired consciousness (P <0.001) PRAKI is still relatively common and significantly contributes to maternal and perinatal mortality in Nigeria. Obstetric hemorrhage which is the most common cause of PRAKI is preventable and treatable. There is a need for physicians to effectively prevent and manage obstetric hemorrhage.

Effects of Telfairia Occidentalis Leaf Extract on Plasma Lactate and Liver Glycogen in Rats.

Telfairia occidentalis is a green vegetable popularly consumed among the native of Africa and it is generallybelieved to be of medicinal and nutritional value. Studies have reported its hypoglycaemic and hyperglycaemic effects inrats. In addition to these conflicting reports, the mechanisms for its effects on blood glucose remain inconclusive. Theobjective of this study was to investigate the mechanism involved in the increased blood glucose following treatment withT. occidentalis. Twenty five (25) male albino rats (200-250g) were randomly divided into 5 groups (n=5/group). Rats in thecontrol group received normal saline while rats in other groups were orally treated with 100 or 200 mg/kg body weight ofthe extract for either 1 or 2 weeks. At the end of the treatment, the rats were anaesthetized and blood samples were collectedfor the estimation of some biochemical parameters. The results showed significant decreases in plasma glucose after 1 weekof treatment with 100 mg/kg and 200 mg/kg. However, after 2 weeks of treatment with both doses, plasma glucose levelsincreased significantly and were higher than those of the control and the rats treated for 1 week with both doses. There werealso dose- and duration-dependent decreases in glycogen concentration in the treated rats, especially those treated for twoweeks. Glucose-6-phosphatase activity and liver glycogen concentration were lower in rats treated for 2 weeks whencompared with those treated for 1 week with both doses. Moreover, plasma lactate concentration was lower in the treatedgroups when compared with control. The results suggest that Telfairia occidentalis-induced lowering of plasma glucose afterone week of treatment probably favoured lactate oxidation/gluconeogenesis and elicited breakdown of liver glycogen whichresulted in increased plasma glucose after two weeks of treatment.