COVID-19 vaccination in Africa: A case of unsatisfied expectation and ill-preparedness.

With a population of 1.3 billion people, of which 56% reside in rural settings, Africa seemed ill-prepared to handle the distribution of a COVID-19 vaccine. In addition, the capacity needed for a successful COVID-19 vaccination campaign in Africa surpassed the available resources in local and state health agencies. As a result, African governments were advised to coordinate resources, health officials, and vaccinators, including local health practitioners, medical technicians, and pharmacists for the largest-ever vaccination campaign in Africa. Although the rolling out of the SARS-COV-2 vaccine was, as expected, slow in many African countries, and not yet enough to cover the entire population in Africa, the mass vaccination campaign in Africa must continue to ensure that priority for vaccination is extended beyond front-liners (healthcare workers) and specific high-risk populations, which has largely been the case in some African countries. This article highlights the overarching areas that we believe need to be prioritized to enhance Africa's effectiveness and coverage in the mass COVID-19 vaccination program.

SARS-CoV-2 variants and pregnant Women: A cause for Concern?

During pregnancy, women are at an increased risk of getting sick from respiratory viruses and when compared to non-pregnant women, pregnant women are more susceptible to severe illness from COVID-19. Owing to this fact and the emergence of a more infectious COVID-19 variants, pregnant women are currently classified as a vulnerable population, along with pediatric patients and older adults. While scientists are still learning more about the new variants, it is becoming clear that COVID-19 infected pregnant women are also at a real increased risk of poor pregnancy outcomes, as premature birth and babies born with lifelong health issues are possible if people become infected during pregnancy. Added to these facts, recommendation for COVID-19 has largely varied globally. The conspiracy-laden information on social media has led to pregnant women being hesitant about getting COVID-19 vaccine. Furthermore, as the transmissibility of COVID-19 is higher with this variant and the health system for maternal care in many countries regarded as "very bad" there is need to clearly highlight the impacts of the variants and for countries to speed up vaccination programme to reach all members of society.

The haematology of Jamaicans: red cell indices in HbAA, HbAS, HbAC, and HbA-HPFH genotypes.

Based in the parish of Manchester in central Jamaica, the Manchester Project offered free detection of haemoglobin genotype to senior classes in 15 secondary schools between 2008 and 2013. Restricting the database to 15,103 students aged 15.0-19.9 years provided an opportunity to examine the red cell characteristics of the different haemoglobin genotypes, including normal (HbAA) in 85.0%, the sickle cell trait (HbAS) in 9.7%, HbC trait (HbAC) in 3.5% and hereditary persistence of foetal haemoglobin (HbA-HPFH) in 0.4%. Compared to the normal HbAA phenotype, HbAS had significantly increased mean cell haemoglobin concentration (MCHC), red cell count (RBC), and red cell distribution width (RDW) and decreased mean cell volume (MCV) and mean cell haemoglobin (MCH), these differences being even more marked in HbAC. Compared to HbAA, the HbA-HPFH had significantly increased RDW, but there were no consistent differences in other red cell indices, and there were no significant differences in haematological indices between the two common deletion HPFH variants, HPFH-1 and HPFH-2. Although these changes are unlikely to be clinically significant, they contribute to an understanding of the haematological spectrum of the common haemoglobin genotypes in peoples of African origin.

Childhood Head Growth and Educational Attainment in an Indian Cohort.

BACKGROUND: There is minimal information about the association of head growth at different stages of childhood with cognitive ability. OBJECTIVE: To determine the relationship of newborn head size and head growth during infancy, childhood and adolescence with attained education, a proxy for cognitive ability. STUDY DESIGN: Prospective birth cohort study. SETTING: Married women living in South Delhi between 1969 and 1973. PARTICIPANTS: The New Delhi Birth Cohort study followed up 8030 newborns born in 1969-1973 with head circumference, weight and height measurements at birth and 6-12 monthly until adulthood. Of these, 1526 men and women were followed up at the age of 26-32 years. OUTCOMES: Association between years of schooling, as an indicator of cognitive ability, and newborn head circumference and conditional measures of head growth during infancy, childhood and adolescence. RESULTS: In unadjusted analyses, newborn head size was positively associated with years of education [(b (95% CI)=0.30 (0.14 to 0.47) years per SD head circumference], as was head growth from birth to 6 months [b (95% CI)=0.44 (0.28 to 0.60) years per SD conditional head growth], 6 months to 2 years [b (95% CI)=0.31 (0.15 to 0.47) years per SD conditional head growth] and 2 to 11 years [b (95% CI)=0.20 (0.03 to 0.36) years per SD conditional head growth]. There were similar findings for height and body mass index (BMI). In the adjusted model containing all growth measures, gestational age, and socio-economic status (SES) at birth as predictors, only SES was positively associated with educational attainment. CONCLUSION: Educational attainment in this population is positively associated with socioeconomic status and its influence on inter-related early life (fetal, infant and childhood) factors like nutritional status and brain growth.

Improving Food Safety Culture in Nigeria: A Review of Practical Issues.

As a developing nation and the most populous nation in Africa, Nigeria has enormous challenges connected with food safety culture. To produce and provide safe, secure and nutritious food, consumers and food businesses must abide by a set of shared values known as food safety culture. In Nigeria, food safety culture is a complex subject due to Nigeria's heterogeneous and diverse nature, as demonstrated by its over 250 ethnic groups. As Nigeria becomes more urbanized and incomes continue to fluctuate at robust rates, few Nigerians are conscious of food safety issues. In addition, oversight from government regulators around food safety require improvement. Public engagement in food safety issues has not witnessed a promising trajectory in recent years. In this article, we provide a review of the food safety culture in Nigeria and its role and influence on various cases of food safety issues in Nigeria. Of interest to this paper are studies exploring consumer and food handler perceptions and behavior regarding food safety. In addition, keen attention is devoted to areas that are in need of additional research to help address practical and on-the-ground challenges associated with Nigeria's food safety practices. This article suggests that improving food safety culture in Nigeria requires both applying the best management and communication approaches in different regions and understanding the local food safety practices.

Community distribution of oxygen: a unique COVID-19 intervention.

The rapid spread of COVID-19 around the world has exposed some long-standing deficiencies in health systems, particularly in environments with low financial and medical resources. Most patients ill with COVID-19 require oxygen and supportive therapy for survival as there remains no conclusively established curative therapy. Following a number of critical research work and drawing from a millennia-long evolution of medical practice, respiratory support has been identified as a paramount intervention to ensure lives are saved when supportive care is required, and oxygen is an essential commodity to achieve this. This letter focuses on the numerous means for oxygen delivery to health facilities and in turn the end users and expands on the importance of innovation to improve oxygen supply. We describe a community distribution system with a telemedicine structure that can be leveraged for oxygen delivery.

Eradication of wild poliovirus in Nigeria: Lessons learnt.

Introduction: On August 24, 2020, Nigeria recorded a monumental success by achieving the aim of a "wild polio-free country" after completing three years without any case of wild poliovirus (WPV). Methods: For this commentary, we consulted relevant publications, official documents, and working plans and policy statements of the relevant organizations responsible for Nigeria's Polio Eradication Initiative. Results: Efforts to curb the challenges the Polio Eradication Initiative (PEI) faced in Nigeria through effective partnerships, the CORE Group Polio Project (CGPP), Volunteer Community Mobilizers (VCMs), and Global Polio Eradication Initiative (GPEI) partners proved successful, as it resulted in Nigeria being removed from the list of endemic countries in September 2015, and subsequently declared free of WPV on August 24, 2020, following an absence of indigenous transmission for three years. Conclusion: Unrelenting prioritization of polio eradication and global support is still needed to achieve a polio-free world.

Threats of COVID-19 to Achieving United Nations Sustainable Development Goals in Africa.

The negative impacts of the COVID-19 pandemic have been exacerbated in Africa by hunger, poor health care, poor educational systems, poverty, and lack of potable water and sanitation. With the pandemic and a worrying global recession as a result of COVID-19, our ability to achieve the 17 United Nations sustainable development goals (SDGs) in the post-pandemic era has been questioned. There is concern that the economic stagnation caused by COVID-19 will not only push more populations below the poverty line but also limit international support to ensure progress toward achieving the SDGs in Africa. This article highlights how the COVID-19 pandemic could threaten the actualization of the SDGs in Africa. We assessed relevant published literature, observations, and current global trends. Our results suggest that although the improvement of healthcare systems has become a priority in Africa, there is a need to ensure that some SDGs are not sacrificed to achieve control of the pandemic. Despite the pandemic, African countries need to identify policies that will not compromise the implementation of the SDGs and/or jeopardize previously achieved SDG targets.

The 100 Most-Cited Papers in Traumatic Injury of the Spine.

BACKGROUND: Traumatic injury to the spine can be a complex diagnostic and therapeutic entity often with devastating consequences. Outside of the isolated vertebral column injury costs; annual costs associated with spinal cord injury (SCI) are estimated to exceed $9.7 billion. OBJECTIVE: To identify the 100 most-cited articles on spine trauma. METHODS: The Thomson Reuters Web of Science citation indexing service was queried. The articles were sorted by times cited in descending order. Two independent reviewers reviewed the article titles and abstracts to identify the top 100 most-cited articles. RESULTS: The top 100 articles were found to be cited between 108 (articles #99-100) and 1595 times (article #1). The most-cited basic science article was cited 340 times (#12 on the top 100 list). The oldest article on the top 100 list was from 1953 and most recent from 2012. The number of patients, when applicable, in a study ranged from 9 (article #34) to 34,069 (article #5). Top 100 articles were published in 41 different journals with a wide range of specialities and fields most commonly multidisciplinary. Basic science research encompassed 34 of the 100 articles on the list. CONCLUSIONS: We present the 100 most-cited articles in spinal trauma with emphases on important contributions from both basic science and clinical research across a wide range of authors, specialties, patient populations, and countries. Recognizing some of the most important contributions in the field of spinal trauma may provide insight and guide future work.

Ominous Occurrence of Spinal Intradural Primary Malignant Peripheral Nerve Sheath Tumor Four Decades following Radiation Therapy for Testicular Seminoma.

Primary intradural malignant peripheral nerve sheath tumor (MPNST) is an extremely rare diagnosis and is associated with an extremely poor prognosis. A 77-year-old man diagnosed with an intradural MPNST, more than 40 years after radiation for a testicular seminoma, is reported. Intradural MPNSTs of the spine outside the setting of neurofibromatosis is extremely rare and can masquerade as common benign nerve sheath tumors, on imaging. An older age at presentation with short duration of symptoms and prior regional radiation treatment encompassing the spine in the treatment field regardless of remoteness should alert the oncologists and neurosurgeons to the possible existence of this rare and aggressive tumor, as the management, and overall prognosis of this tumor is distinctly different compared to the usual intradural spinal tumors.

Facial Sensory Restoration After Trigeminal Sensory Rhizotomy by Collateral Sprouting From the Occipital Nerves.

BACKGROUND AND IMPORTANCE: Lesioning procedures are effective for trigeminal neuralgia (TN), but late pain recurrence associated with sensory recovery is common. We report a case of recurrence of type 1A TN and recovery of facial sensory function after trigeminal rhizotomy associated with collateral sprouting from upper cervical spinal nerves. CLINICAL PRESENTATION: A 41-yr-old woman presented 2 yr after open left trigeminal sensory rhizotomy for TN with pain-free anesthesia in the entire left trigeminal nerve distribution. Over 18 mo, she developed gradual recovery of facial sensation migrating anteromedially from the occipital region, eventually extending to the midpupillary line across the distribution of all trigeminal nerve branches. She reported recurrence of her triggered lancinating TN pain isolated to the area of recovered sensation with no pain in anesthetic areas. Nerve ultrasound demonstrated enlargement of ipsilateral greater and lesser occipital nerves, and occipital nerve block restored facial anesthesia and resolved her pain, indicating that recovered facial sensation was provided exclusively by the upper cervical spinal nerves. She underwent C2/C3 ganglionectomy, and ganglia were observed to be hypertrophic. Postoperatively, trigeminal anesthesia was restored with complete resolution of pain that persisted at 12-mo follow-up. CONCLUSION: This is the first documented case of a spinal nerve innervating a cranial dermatome by collateral sprouting after cranial nerve injury. The fact that typical TN pain can occur even when sensation is mediated by spinal nerves suggests that the disorder can be centrally mediated and late failure after lesioning procedures may result from maladaptive reinnervation.

Effects of a health education intervention on hypertension-related knowledge, prevention and self-care practices in Nigerian retirees: a quasi-experimental study.

BACKGROUND: Education is vital to increasing knowledge, improving prevention and self-care practices for hypertension in older adults. This study aimed to determine the effectiveness of a health education intervention in improving hypertension (HT) knowledge, prevention and self-care practices among retirees in Enugu State, South-east, Nigeria. METHODS: In this quasi-experimental study, we enrolled 400 participants in Enugu and Nsukka cities in Enugu State, south-east Nigeria. Participants were assigned to the treatment and control groups. Participants in the intervention/treatment group (T-group) received the intervention provided by public health experts and nurses and participants in the control group (C-group) received health talk without the intervention. Data collected at baseline (before intervention), 16 weeks (4th month) and follow-up (5th month) included demographic variables, knowledge about hypertension, prevention and self-care practices. We used paired samples t-test, Chi-square test and one-way ANOVA repeated measures for data analyses. RESULTS: The mean age of the participants was 65.9 (± 8.9) years, the mean SBP and DBP were 136.5 (± 13.3) and 87.9 (± 9.1) respectively. More than half of the participants were (50.3%) were males, and the mean BMI was 23.9 (± 5.1) kg/m2. The paired comparison analysis showed that the mean HT knowledge score significantly increased in the T-group between baseline and 1 month (4th month) post-intervention compared to those in the C-group (P < 0.0001). Also, PA (P = 0.007), sleep pattern and quality (P = 0.003), substance use abstinence (P = 0.000), healthy diet (P = 0.000), and medication adherence (P = 0.000) improved significantly in the T-group compared to the control between baseline and 1 month after intervention. The repeated measures analyses showed statistically significant effects (between-groups analysis) for all outcomes with small to large effect sizes. Similarly, the repeated measures ANOVA analyses showed significant time-by-group interaction effects (within-groups) for all the outcomes with small to large effect sizes. CONCLUSION: Community-based health education intervention targeted at older adults can increase HT knowledge, improve prevention and self-care practices of hypertension at the population level.

Infant and childhood growth and frailty in old age: the Helsinki Birth Cohort Study.

BACKGROUND: Evidence from life course studies highlights the importance of infant and childhood growth as risk factors for adulthood chronic diseases. METHODS: In this sub-study of the Helsinki Birth Cohort Study, we studied 1078 individuals who had both information on body size from birth to 12 years of age and who were assessed for frailty according to the Fried criteria at the mean age of 71 years. RESULTS: Greater BMI gain between 2 and 11 years in boys was associated with frailty in old age (age-adjusted RRR 2.36, 95% CI 1.21, 4.63). No similar associations were observed in girls. CONCLUSIONS: Men who were frail in old age experienced accelerated BMI gain in childhood compared with those men who were not frail. This was not observed in women, which suggests that the patterns of early growth predisposing to frailty may vary by sex.

Resection of 2 Intradural Extramedullary Cervical Spine Tumors in a Patient With Neurofibromatosis Type 2: 3-Dimensional Operative Video.

This 3-dimensional operative video illustrates resection of 2 cervical spine schwannomas in a 19-yr-old female with neurofibromatosis type 2. The patient presented with lower extremity hyperreflexity and hypertonicity. Magnetic resonance imaging (MRI) demonstrated 2 contrast-enhancing intradural extramedullary cervical spine lesions causing spinal cord compression at C4 and C5. The patient underwent a posterior cervical laminoplasty with a midline dural opening for tumor resection. Curvilinear spine cord compression is demonstrated in the operative video. After meticulous dissection, the tumors were resected without complication. The dural closure was performed in watertight fashion followed by laminoplasty using osteoplastic titanium miniplates and screws. Postoperative MRI demonstrated gross total resection with excellent decompression of the spinal cord. The postoperative course was uneventful. The natural history of this disease, treatment options, and potential complications are discussed.

Repeated recurrence of thoracic spine stenosis following decompression alone for ossification of the ligamentum flavum: case report.

Ossification of the ligamentum flavum (OLF) is a well-recognized but rare cause of thoracic myelopathy. Its subtle and variable clinical presentation often makes the diagnosis challenging. The treatment of symptomatic OLF requires surgical intervention, with the most common surgical procedure being a posterior decompression with or without instrumentation. Recurrence of ossification and stenosis after surgery is rare and usually occurs at the same intervertebral level. Multiple recurrences of ossification and stenosis are exceptionally rare. The authors report the case of OLF in a 60-year-old man who experienced recurrence of ossification and stenosis twice after posterior decompression surgeries alone. The patient was ultimately treated with revision decompression and instrumented fusion. The authors also present a pertinent review of the literature.