Soft Tissue Reconstruction After Sacral Neoplasm Resection: The University of California San Francisco Experience.

PURPOSE: Resection of sacral neoplasms such as chordoma and chondrosarcoma with subsequent reconstruction of large soft tissue defects is a complex multidisciplinary process. Radiotherapy and prior abdominal surgery play a role in reconstructive planning; however, there is no consensus on how to maximize outcomes. In this study, we present our institution's experience with the reconstructive surgical management of this unique patient population. METHODS: We conducted a retrospective review of patients who underwent reconstruction after resection of primary or recurrent pelvic chordoma or chondrosarcoma between 2002 and 2019. Surgical details, hospital stay, and postoperative outcomes were assessed. Patients were divided into 3 groups for comparison based on reconstruction technique: gluteal-based flaps, vertical rectus abdominus myocutaneous (VRAM) flaps, and locoregional fasciocutaneous flaps. RESULTS: Twenty-eight patients (17 males, 11 females), with mean age of 62 years (range, 34-86 years), were reviewed. Twenty-two patients (78.6%) received gluteal-based flaps, 3 patients (10.7%) received VRAM flaps, and 3 patients (10.7%) were reconstructed with locoregional fasciocutaneous flaps. Patients in the VRAM group were significantly more likely to have undergone total sacrectomy (P < 0.01) in a 2-stage operation (P < 0.01) compared with patients in the other 2 groups. Patients in the VRAM group also had a significantly greater average number of reoperations (2 ± 3.5, P = 0.04) and length of stay (29.7 ± 20.4 days, P = 0.01) compared with the 2 other groups. The overall minor and major wound complication rates were 17.9% and 42.9%, respectively, with 17.9% of patients experiencing at least 1 infection or seroma. There was no association between prior abdominal surgery, surgical stages, or radiation therapy and an increased risk of wound complications. CONCLUSIONS: Vertical rectus abdominus myocutaneous flaps are a more suitable option for patients with larger defects after total sacrectomy via 2-staged anteroposterior resections, whereas gluteal myocutaneous flaps are effective options for posterior-only resections. For patients with small- to moderate-sized defects, local fasciocutaneous flaps are a less invasive and effective option. Paraspinous flaps may be used in combination with other techniques to provide additional bulk and coverage for especially long postresection wounds. Furthermore, mesh is a useful adjunct for any reconstruction aimed at protecting against intra-abdominal complications.

Surface Reaction of Electroosmotic Flow-Driven Free Antigens With Immobilized Magnetic-Microbeads-Tagged-Antibodies in Microchannels.

Immunoassays based on reactions between target pathogen (antigen; Ag) and antibody (Ab) are frequently used for Ag detection. An external magnetic field was used to immobilize magnetic microbeads-tagged-antibodies (mMB-Ab) on the surface of a microchannel in the capture zone. The mMB-Ab was subsequently used for Ag detection. The objective of this numerical study, with experimental validation, is to assess the surface reaction between mMB-Ab and Ag in the presence of electro-osmotic flow (EOF). First, immobilization of mMB-Ab complex in the wall of the capture zone was achieved. Subsequently, the Ag was transported by EOF toward the capture zone to bind with the immobilized mMB-Ab. Lastly, mMB-Ab:Ag complex was formed and immobilized in the capture zone. A finite volume solver was used to implement the above steps. The surface reaction between the mMB-Ab and Ag was investigated in the presence of electric fields (E): 150 V/cm-450 V/cm and Ag concentrations: 0.001 M-1000 M. The depletion of mMB-Ab increases with time as the E decreases. Furthermore, as the concentration of Ag decreases, the depletion of mMB-Ab increases with time. These results quantify the detection of Ag using the EOF device; thus, signifying its potential for rapid throughput screening of Ag. This platform technology can lead to the development of portable devices for the detection of target cells, pathogens, and biomolecules for testing water systems, biological fluids, and biochemicals.

Functional donor-site morbidity following reconstruction with pectoralis major flaps: A systematic review.

Background: Pectoralis major muscle/myocutaneous flaps (PMMFs) are commonly used in reconstructive surgery, but may result in shoulder disability on the donor side. A systematic review evaluating this morbidity could be beneficial for guiding patients and providers considering this procedure. Methods: In October 2022, a systematic review of studies evaluating quantitative/qualitative measures of functional morbidity after PMMF was conducted. The results were categorized into PMMF's effect on range of motion (ROM), strength, and ability to complete shoulder-related activities/quality of life. Results: Eleven studies were included for analysis, which analyzed standard PMMF and two PMMF variants that spared portions of the muscle. Three of five studies demonstrated reduced shoulder ROM for standard PMMF versus controls lasting at least 4 months after head and neck reconstruction. Two of five studies, including two prospective studies demonstrated reduced shoulder strength for standard PMMF versus controls lasting at least 3 months after surgery. Five of nine studies found significant impairment in the ability to conduct shoulder-related activities, including work, up to one year postoperatively for standard PMMF versus controls. Muscle-sparing PMMF variants exhibited more promising outcomes in some categories. Conclusion: Standard PMMF results in prolonged reductions in shoulder ROM and strength, which may impair patients in shoulder-related activities. Other reconstructive options should be considered in patients who frequently participate in such activities. For patients requiring PMMF, muscle-sparing PMMF variants should be considered as alternatives to the standard PMMF.

Broadening the capture of natural products mentioned in FAERS using fuzzy string-matching and a Siamese neural network.

Increased sales of natural products (NPs) in the US and growing safety concerns highlight the need for NP pharmacovigilance. A challenge for NP pharmacovigilance is ambiguity when referring to NPs in spontaneous reporting systems. We used a combination of fuzzy string-matching and a neural network to reduce this ambiguity. Our aim is to increase the capture of reports involving NPs in the US Food and Drug Administration Adverse Event Reporting System (FAERS). For this, we utilized Gestalt pattern-matching (GPM) and Siamese neural network (SM) to identify potential mentions of NPs of interest in 389,386 FAERS reports with unmapped drug names. A team of health professionals refined the candidates identified in the previous step through manual review and annotation. After candidate adjudication, GPM identified 595 unique NP names and SM 504. There was little overlap between candidates identified by each (Non-overlapping: GPM 347, SM 248). We identified a total of 686 novel NP names from FAERS reports. Including these names in the FAERS collection yielded 3,486 additional reports mentioning NPs.

Evaluation of antibiotic use and analysis of ciprofloxacin and gentamicin residue in fish samples from farms in Lagos, Nigeria.

Antibiotic use in aquaculture for increase yield has been established over time; however, consumption of such fish may lead to inadvertent intake of sub therapeutic doses of antibiotics. Therefore, this study aimed to investigate the extent of antibiotic use in fish farming and ciprofloxacin and gentamicin residues in fish that are consumed in Lagos, Nigeria. It was conducted in two parts: a survey of 60 fish producers to assess their use of antibiotics and an analysis of ciprofloxacin and gentamicin residues in fish organs using high-performance liquid chromatography (HPLC). The survey found that twenty-nine (48%) of the farms used antibiotics, with oxytetracycline being the most common (20%), followed by ciprofloxacin (15%); gentamicin (5%); neomycin (8.33%); and probiotics (13%). HPLC analysis of fish liver and fillet samples showed that Lagos Island had the lowest residual ciprofloxacin dose (0.3014ug/g), while Lagos mainland had the greatest residual ciprofloxacin dosage (113.78765ug/g). The mean gentamicin residue in flesh of fish from farms in Lagos Island LGA was 0.37ug/g while that obtained for liver of fish samples from Surulere LGA was 2.12ug/g). The largest (5.3240ug/g) and lowest (0.2661ug/g) residual gentamicin antibiotic concentrations were found in fishes harvested from farms located in Surulere and Lagos Island, respectively. The residue levels were within the permitted range set by the WHO, but continuous regulatory surveillance is necessary to prevent antimicrobial resistance spread and improved food safety. The study has revealed that fish produced in the study area contained residues of the commonly used antibiotics hence farmers should be encouraged to consult veterinarians in cases of disease treatment for judicious use of antibiotics while self-medication and purchase of antibiotics from vendors should be discouraged.

Type of pots used in cooking may influence the iron content of commonly consumed vegetables in Nigeria: A laboratory based comparative study.

Iron deficiency anemia is a major public health problem, especially in resource-poor countries. Cooking pots may contribute some appreciable amount of trace metals into food by way of leaching. The effects of iron and aluminum cooking pots on iron content of two commonly consumed vegetables were investigated. The pH content was determined using pH meter while the moisture was determined using a moisture content analyzer. The iron content was determined using Atomic Absorption Spectrophotometer (AAS). The mean difference in the pH of African spinach (VA) 7.2±0.0 and Lagos spinach (VL) 7.2±0.0 was not significant (p>0.05). The mean moisture content of African spinach and Lagos spinach were 8.7±0.0 g/100g and 18.2±0.1 g/100g respectively. The difference in the moisture content was however statistically significant (p <0.05). The iron content of African spinach boiled in aluminum pot [VA (Al)] (5.9±0.0 mg/100g) was statistically different from the fresh sample of African spinach, VA (12.7±0.2 mg/100g) (p <0.05) but the amount of iron lost as a result of boiling in aluminum pot was 6.8mg / 100g. The iron content of African spinach boiled in iron pot [VA (Fe)] (15.9±0.0 mg/100g) was also statistically different from the fresh sample of African spinach (p <0.05). However, the amount of iron added (leached) as a result of boiling was 3.2 mg/100g. The same trend was observed in the Lagos spinach boiled in aluminum and iron pots. However, the iron lost as a result of boiling in aluminum pot (0.2 mg/100g) was not significant (p>0.05) while a greater amount of iron (5.5 mg/100g) was added (leached) when Lagos spinach was boiled in iron pot. Cooking in iron pots will conserve iron during boiling and improve iron intake from the vegetables.

Satisfaction and perceived impact of virtual learning during COVID-19 lockdown: A case study of an online nursing research conference.

AIM: This study aimed to assess nurses' satisfaction and perceptions of the impact of virtual learning. DESIGN: A descriptive cross-sectional survey. METHOD: 236 nurses attending an online conference from several parts of Nigeria participated in the study. Analysed data were summarized and presented in tables and graphs, while linear regression was used to measure the associations. RESULTS: Most of the respondents perceived the programme as highly impactful. All three domains: learner-content interaction (p = 0.020), learner-instructor interaction (p = 0.000) and learner-learner interaction (p = 0.000), were found to be statistically significantly associated with the perceived impact of the programme, and thus statistically significant predictors of the effects of online learning (p = 0.02), (F = 5.471). Conclusively, the Interaction of learners with learning content, lecturers and other learners was seen as determinants of an effective and impactful online education. It is recommended that nursing training institutions embrace online learning either as the leading platform or as an adjunct to a face-to-face method.

HIV Knowledge and Screening Practices among In-School Adolescents in a Semi-Urban Community of Osun State, Southwest Nigeria.

BACKGROUND: Adolescents and youths are currently one of the main sub-populations responsible for most Human Immunodeficiency Virus (HIV) new cases in Nigeria due to their high-risk sexual practices. Yet, most Nigerian adolescents have poor HIV knowledge and are not aware of their HIV status. STUDY OBJECTIVES: We assessed respondents' HIV knowledge, their attitude to screening, testing practice and identified predictors of HIV screening among youths (15-24 years old) in Iwo, Osun State, Nigeria. METHODS: Cross-sectional design was employed and a multistage sampling method was used to recruit 360 eligible schooling youths in three secondary schools (private and public coeducational schools). A semi-structured, interviewer administered questionnaire was used for data collection. Both descriptive and inferential statistics were carried out at p<0.05. RESULTS: Mean age (±SD) of the respondents was 15±4.71 years. The majority (75.6%) of the respondents had heard about HIV. Overall, only 57.6% of respondents possessed a comprehensive knowledge of HIV but a majority (80.6%) of them had a positive attitude to HIV screening. Only 20.6% of the respondents had ever screened for HIV, 70.0% of them had pre-and post-test counselling. The most prevalent reason for non-screening is fear of getting a positive result (48.3%). Predictors of HIV screening uptakes included respondents' age (AOR = 2.95; 95%CI = 2.25-6.01), school type (AOR = 2.9;95%CI = 1.99-11.25), class level (AOR = 3.21;95% CI = 2.13-8.12) and attitude to screening (AOR = 2.51;95% CI = 2.01-6.39). CONCLUSION: Despite a high awareness rate and overwhelming positive attitude, HIV screening practice was low in the study setting. There is a need for health policymakers to further prioritise adolescents and youths in the race to end HIV epidemics in Nigeria.

CONTEXTE: Les adolescents et les jeunes sont actuellement l'une des principales sous-populations responsables de la plupart des nouveaux cas de virus de l'immunodéficience humaine (VIH) au Nigeria en raison de leurs pratiques sexuelles à haut risque. Pourtant, la plupart des adolescents nigérians ont une faible connaissance du VIH et ne sont pas conscients de leur statut sérologique. OBJECTIFS DE L'ÉTUDE: Nous avons évalué les connaissances des répondants sur le VIH, leur attitude à l'égard du dépistage, les pratiques de dépistage et identifié les facteurs prédictifs du dépistage du VIH chez les jeunes (15-24 ans) à Iwo, dans l'État d'Osun, au Nigeria. MÉTHODES: Une étude transversale a été employée et une méthode d'échantillonnage à plusieurs niveaux a été utilisée pour recruter 360 jeunes scolarisés éligibles dans trois écoles secondaires (privées et publiques). Un questionnaire semi-structuré, administré par un enquêteur, a été utilisé pour la collecte des données. Des statistiques descriptives et inférentielles ont été réalisées à p<0,05. RÉSULTATS: L'âge moyen (±SD) des personnes interrogées était de 15±4,71 ans. La majorité (75,6 %) des personnes interrogées avaient entendu parler du VIH. Dans l'ensemble, seulement 57,6 % des personnes interrogées avaient une connaissance approfondie du VIH, mais la majorité d'entre elles (80,6 %) avaient une attitude positive à l'égard du dépistage du VIH. Seules 20,6 % des personnes interrogées avaient déjà effectué un dépistage du VIH, mais 70 % d'entre elles avaient bénéficié d'un conseil avant et après le test. La raison la plus fréquente de l'absence de dépistage est la peur d'obtenir un résultat positif (48,3 %). Les facteurs prédictifs de la participation au dépistage du VIH comprenaient l'âge des répondants (AOR=2,95 ; 95%CI=2,25-6,01), le type d'école (AOR=2,9;95%CI=1,99-11,25), le niveau de classe (AOR=3,21;95% CI=2,13-8,12) et l'attitude à l'égard du dépistage (AOR=2,51;95% CI=2,01-6,39). CONCLUSION: Malgré un taux de sensibilisation élevé et une attitude très positive, la pratique du dépistage du VIH était faible dans le contexte de l'étude. Il est nécessaire que les décideurs en matière de santé accordent une plus grande priorité aux adolescents et aux jeunes dans la course à l'éradication de l'épidémie de VIH au Nigéria. Mots clés: VIH/SIDA, Adolescents, Jeunes, Jeunes, Nigeria.

Revascularisation of type 2 diabetics with coronary artery disease: Insights and therapeutic targeting of O-GlcNAcylation.

AIM: Coronary artery bypass graft (CABG) using autologous saphenous vein continues to be a gold standard procedure to restore the supply of oxygen-rich blood to the heart muscles in coronary artery disease (CAD) patients with or without type 2 diabetes mellitus (T2DM). However, CAD patients with T2DM are at higher risk of graft failure. While failure rates have been reduced through improvements in procedure-related factors, much less is known about the molecular and cellular mechanisms by which T2DM initiates vein graft failure. This review gives novel insights into these cellular and molecular mechanisms and identifies potential therapeutic targets for development of new medicines to improve vein graft patency. DATA SYNTHESIS: One important cellular process that has been implicated in the pathogenesis of T2DM is protein O-GlcNAcylation, a dynamic, reversible post-translational modification of serine and threonine residues on target proteins that is controlled by two enzymes: O-GlcNAc transferase (OGT) and O-GlcNAcase (OGA). Protein O-GlcNAcylation impacts a range of cellular processes, including trafficking, metabolism, inflammation and cytoskeletal organisation. Altered O-GlcNAcylation homeostasis have, therefore, been linked to a range of human pathologies with a metabolic component, including T2DM. CONCLUSION: We propose that protein O-GlcNAcylation alters vascular smooth muscle and endothelial cell function through modification of specific protein targets which contribute to the vascular re-modelling responsible for saphenous vein graft failure in T2DM.

Hypertension and its Clinical Correlates in a Rural Community in South Western Nigeria.

BACKGROUND: Hypertension is the commonest cardiovascular risk factor globally and is a cause of untold morbidity and mortality. However, its clinical correlates at the community level have not been well elucidated. METHODS: History taking, anthropometric measurements, electrocardiograms and laboratory investigations were done for all the study subjects. Ethical approval was obtained from the institution's ethical body. Analysis was done using SPSS version 20. Two hundred people were recruited for the study. The prevalence of hypertension in the community was 58.5% with 31(15.5%) being newly diagnosed. The Body Mass Index [BMI] (28.2±6vs 25.6±5.3; P=0.003),Waist-Hip ratio (0.9±0.08 vs 0.86±0.06; p= 0.001), total cholesterol (5.675±1.8 vs 4.6±1.7, P=0.000), triglycerides (1.19±0.85 vs 0.91±0.59; p=0.019), LDL cholesterol (3.38±1.6 vs 2.66±1.5; p=0.002), heart rate (82.4±15.8 vs 76.8±11.2; p=0.018) QRS duration (84.8±13.4 vs 80.5±11.2; p=0.040), and QTc (0.423±0.041 vs 0.402±0.035; p=0.001) were higher in those with hypertension. NYHA functional class was worse in hypertensives (p=0.041). Prevalence of left ventricular hypertrophy (LVH) in hypertensives ranged from 2.6 to 48.2%, depending on the criteria used. Systolic blood pressure, pulse pressures, HDL levels and hip circumferences were higher in those with electrocardiographic LVH. Systolic blood pressure (OR:1.045, P=0.006; CI: 1.013-1.079) and a normal BMI (OR: 0.159, p= 0.004; CI: 0.045-0.559) were the independent predictors of LVH in this study. CONCLUSION: The prevalence of hypertension is rising, even in rural populations, with accompanying LVH, higher QTc and florid cardiovascular risk factors. It is therefore imperative to tighten the reins of control of blood pressure and other cardiovascular risk factors before the cardiovascular morbidity and mortality explode in the rural communities.

CONTEXTE: L'hypertension est le facteur de risque cardiovasculaire le plus courant dans le monde et est une cause de morbidité et de mortalité indicibles. Cependant, ses corrélats cliniques au niveau communautaire n'ont pas été bien élucidés. MÉTHODES: Des antécédents, des mesures anthropométriques, des électrocardiogrammes et des examens de laboratoire ont été effectués pour tous les sujets de l'étude. L'approbation éthique a été obtenue de l'organe déontologique de l'institution. L'analyse a été effectuée à l'aide de la version 20 de SPSS. Deux cents personnes ont été recrutées pour l'étude. La prévalence de l'hypertension dans la communauté était de 58,5%, 31 (15,5%) nouvellement diagnostiqués. L'indice de masse corporelle [IMC] (28,2 ± 6 vs 25,6 ± 5,3; P = 0,003), le rapport taille-hanches (0,9 ± 0,08 vs 0,86 ± 0,06; p = 0,001), le cholestérol total (5,675 ± 1,8 vs 4,6 ± 1,7, P = 0,000), triglycérides (1,19 ± 0,85 vs 0,91 ± 0,59; p = 0,019), cholestérol LDL (3,38 ± 1,6 vs 2,66 ± 1,5; p = 0,002), fréquence cardiaque (82,4 ± 15,8 vs 76,8 ± 11,2; p = 0,018) Durée du QRS (84,8 ± 13,4 vs 80,5 ± 11,2; p = 0,040) et l'intervalle QTc (0,423 ± 0,041 vs 0,402 ± 0,035; p = 0,001) étaient plus élevés chez les personnes souffrant d'hypertension. La classe fonctionnelle NYHA était pire chez les hypertendus (p = 0,041). La prévalence de l'hypertrophie ventriculaire gauche (LVH) chez les hypertendus variait de 2,6 à 48,2%, selon la critères utilisés. La pression artérielle systolique, les pressions de pouls, les taux de HDL et la circonférence de la hanche étaient plus élevés chez les personnes atteintes de LVH électrocardiographique. La pression artérielle systolique (OR: 1,045, P = 0,006; IC: 1,013­1,079) et un IMC normal (OR: 0,159, p = 0,004; IC: 0,045­0,559) étaient les prédicteurs indépendants de l'HGV dans cette étude. CONCLUSION: La prévalence de l'hypertension est en hausse, même dans les populations rurales, accompagnée de LVH, d'un QTc plus élevé et de facteurs de risque cardiovasculaires florissants. Il est donc impératif de resserrer les rênes du contrôle de la pression artérielle et des autres facteurs de risque cardiovasculaire avant que la morbidité et la mortalité cardiovasculaires n'explosent dans les communautés rurales. Mots clés: Hypertension, hypertrophie ventriculaire gauche, indice de masse corporelle, HDL.

Risk of Obstructive Sleep Apnoea among Adults in a Rural Community in Southwest Nigeria.

BACKGROUND: Obstructive sleep apnoea (OSA) is a common medical condition which has long been recognized as a major contributor to morbidity and mortality in developed countries but that remains underdiagnosed, particularly in rural communities. This study aimed to assess the prevalence of adults who have a high risk of obstructive sleep apnoea in a sample of adults living in Ejigbo, a rural community in south western Nigeria. METHODS: This was a community-based cross-sectional descriptive study done to assess the prevalence of high risk of obstructive sleep apnoea in adult residents of the community using the STOP-BANG questionnaire. Data collected include socio-demographic characteristics, anthropometric measurements and blood pressure. A blood sample was also taken for lipid profile. Factors associated with a high risk of obstructive sleep apnoea were identified. RESULTS: The study involved 257 participants out of which 88 (34.2%) had a high risk of OSA. Risk of obstructive sleep apnoea was significantly associated with male sex (p<0.001), age (p<0.001), body mass index (BMI) (p=0.001), neck circumference (p<0.001), cigarette smoking (p=0.039) and low density lipoprotein (p=0.043). CONCLUSION: Obstructive sleep apnoea is relatively common in the study area. This calls for urgent preventive measures to stem the tide and mitigate the associated morbidity and mortality.

Gluten-free cookies with low glycemic index and glycemic load: optimization of the process variables via response surface methodology and artificial neural network.

This research investigates the effect of baking temperature and time on the resistant starch (RS), glycemic index (GI) and glycemic load (GL) of gluten-free cookies, optimized the processing parameter using a chemometrics approach of response surface methodology (RSM) and artificial neural network (ANN). The in-vitro starch digestibility of the formulated cookies exhibited a monophasic starch digestogram. Increase in resistant starch, and a decrease in the predicted GI of the cookies, was associated with low temperature and high baking time. The use of RSM and ANN modelling techniques accurately predict the RS, pGI and GL (coefficient of determinant, R2 > 0.93 and root mean square of error = 0.43-0.62) of the gluten-free cookies. The optimal condition for the production of cookies with high RS, low pGI and GL were baking temperature of 158 °C and baking time of 20 min with predicted RS value of 19.61 g/100g of dry starch, pGI value of 56.98 and GL value 52.64.

Pre-Transition Readiness in Adolescents and Young Adults with Four Chronic Medical Conditions in South East Nigeria - An African Perspective to Adolescent Transition.

INTRODUCTION: When a child reaches a certain age, he or she moves over to the adult physician. For this to maximally benefit the child, there has to be a process of equipping the child with skills required for taking on more responsibilities. Transitioning involves a process in which the adolescent with chronic illness is prepared ahead of time to enable them to eventually transfer to adult care with good outcomes. In high-income countries with well-organized health financing, the transitioning process begins as early as 12 years. In Africa, this process is not as organized and most hospitals would write a referral letter once the child turns 18 and transfer to adult clinic. In four of our chronic disease clinics (asthma, HIV, sickle cell anaemia and chronic kidney diseases) patients up to 24 years old are still attending the paediatric clinics. Understanding transition readiness among African adolescents remains a gap. Our findings will form a basis for informed practices for adolescent clinics in African countries. METHODS: This was a descriptive cross-sectional study of pre-transition readiness in adolescents and young adults with chronic illnesses attending four outpatient specialist clinics in a tertiary hospital in Enugu Nigeria. This was done using the validated STARx Questionnaire. Total scores were computed and scores nearer the upper limit of 90 were acceptable, while mean subdomain scores of 4 and above were considered as optimal level of transition readiness. Demographic and clinical data were also collected. Acceptability to move on to adult-oriented care was documented using binary response (yes/no). Cross tabulations were done, and likelihood ratios obtained for predictors of acceptability of transition. Significant value was set at p-value of ≤0.05. RESULTS: A total of 142 adolescents and young adults aged 12 to 24 years were studied. There were 38.0% (54), 24.6% (35), 22.5% (32) and 14.8% (21) from HIV, sickle cell anaemia, asthma and nephrology clinics, respectively. Their mean age was 15.6 years ± 2.4, and 48.6% (69) were male. The mean total transition readiness score was 56±14 and this was not nearer the higher spectrum of total scores obtainable. Highest mean scores (3.7) occurred in the knowledge subdomain while least mean score (2) was noted in the use of medication reminders. The males had highest scores in the knowledge subdomain while the females were better informed about medication adherence and were more inquisitive about their chronic illness. Only about 37% (53) of the adolescents and young adults welcomed the idea of moving on to adult-care clinics. Children who had less frequent emergency hospital visits and better treatment outcome accepted the idea of transfer to adult care. Irrespective of the age all participants had suboptimal subdomain scores. High scores did not influence the participants' choice to embrace transfer to adult care. CONCLUSION: There is suboptimal transition readiness irrespective of the age. The older age groups were less willing to transfer to adult care. Better disease knowledge and better communication skills did not positively influence acceptability of transfer to adult care.

Caregivers' knowledge and practice toward pressure ulcer prevention in national orthopedic hospital, Enugu, Nigeria.

INTRODUCTION: Globally, nurses are known to care for hospitalized patients and the presence or absence of pressure ulcers is being regarded as a performance measure of quality nursing care. The study aims to determine the knowledge and practice of caregivers towards pressure ulcer prevention for hospitalized patients in National Orthopaedic Hospital, Enugu. METHOD: A cross sectional descriptive survey design was adopted among eighty-five (85) caregivers who met the inclusion criteria and participated in the study. Ethical approval and informed consent of participants was obtained before data collection using a pre-tested semi-structured questionnaire and checklist. Descriptive analysis and Chi-square statistical test was used to test for association between variables. RESULT: Results revealed poor knowledge 67.3% of pressure ulcer prevention among caregivers. Inadequate staffing 93.5%, heavy workload 92.9%, were highest perceived barriers to pressure ulcer prevention. The test of hypothesis showed that there is a significant relationship between years of service of caregivers and knowledge of pressure ulcer P = 0.000. CONCLUSION: It was concluded that in-service training, recruitment of more staff and ensuring availability of the necessary equipment are some of the important steps to improve nurses' knowledge and practice regarding prevention of pressure ulcer.

Changing trend in nutrition and food consumption predisposes school children to overweight and obesity in Ile-Ife, Osun State, Nigeria.

BACKGROUND: The consumption of instant foods like pasta and sweetened soft drinks have virtually replaced the traditional diets among children. This changing trend in food consumption could negatively affect the health status of school-aged children. AIM: The aim of this study is to investigate the effect of consumption of instant foods (pasta) on anthropometric parameters and nutrient intake among children in Ile-Ife, Nigeria. METHODS: Participants (126 healthy children, 66 boys and 60 girls, aged 4-12 years) were recruited from nursery and primary schools in Ife Central Local Government, Ile-Ife. The anthropometric measurements were taken and participants were classified based on body mass index (BMI) percentiles. A food frequency questionnaire was administered to evaluate participants' pasta consumption patterns, while food intakes were obtained through 24-h dietary recall. The samples of food consumed by the children were analyzed for their nutrient contents. Nutrient intake was calculated using the data obtained from 24-h dietary recall and the results were compared with the recommended dietary allowances. RESULTS: The average estimated energy intakes were 6167 kJ and 6095 kJ for male and female participants, respectively. The energy intake per kg body weight increased with increasing frequency of the consumption of pasta. There was a positive correlation ( r = 0.873 and 0.998 at P ≤ 0.05 for male and female participants, respectively) between energy intake and weight. The BMI classification showed that 12% of males and 17% of females were overweight or obese. CONCLUSION: It can be concluded that the consumption of pasta could predispose children to overweight/obesity.

Complications, length of stay, and cost of cholecystectomy in kidney transplant recipients.

We hypothesized that cholecystectomy may be riskier for kidney transplant recipients (KTR) given their lifelong immunosuppression, physiologic impact of renal failure, and increased risk of gallstone and biliary disease. Using NIS, we compared mortality, morbidity, length of stay and cost in KTR vs non-KTR following cholecystectomy in the US from 2000 to 2011, adjusting for patient and hospital level factors, including transplant center status. Mortality was higher (OR 2.4), morbidity was higher (OR 1.3), LOS was longer (ratio 1.2), and costs were greater (ratio 1.1) for KTR compared to non-KTR following cholecystectomy. While it is clear that KTR are a high risk group following cholecystectomy, the cause of this increased risk requires further investigation.

Clinical indications, image acquisition and data interpretation for white blood cells and anti-granulocyte monoclonal antibody scintigraphy: an EANM procedural guideline.

INTRODUCTION: Radiolabelled autologous white blood cells (WBC) scintigraphy is being standardized all over the world to ensure high quality, specificity and reproducibility. Similarly, in many European countries radiolabelled anti-granulocyte antibodies (anti-G-mAb) are used instead of WBC with high diagnostic accuracy. The EANM Inflammation & Infection Committee is deeply involved in this process of standardization as a primary goal of the group. AIM: The main aim of this guideline is to support and promote good clinical practice despite the complex environment of a national health care system with its ethical, economic and legal aspects that must also be taken into consideration. METHOD: After the standardization of the WBC labelling procedure (already published), a group of experts from the EANM Infection & Inflammation Committee developed and validated these guidelines based on published evidences. RESULTS: Here we describe image acquisition protocols, image display procedures and image analyses as well as image interpretation criteria for the use of radiolabelled WBC and monoclonal antigranulocyte antibodies. Clinical application for WBC and anti-G-mAb scintigraphy is also described. CONCLUSIONS: These guidelines should be applied by all nuclear medicine centers in favor of a highly reproducible standardized practice.

Outcomes Following Colorectal Resection in Kidney Transplant Recipients.

BACKGROUND: Kidney transplant recipients (KTR) are at increased risk of requiring colorectal resection compared to the general population. Given the need for lifelong immunosuppression and the physiologic impact of years of renal replacement, we hypothesized that colorectal resection may be riskier for this unique population. METHODS: We investigated the differences in mortality, morbidity, length of stay (LOS), and cost between 2410 KTR and 1,433,437 non-KTR undergoing colorectal resection at both transplant and non-transplant centers using the National Inpatient Sample between 2000 and 2013, adjusting for patient and hospital level factors. RESULTS: In hospital, mortality was higher for KTR in comparison to non-KTR (11.1 vs 4.3%, p < 0.001; adjusted odds ratio [aOR] 2.683.594.81) as were overall complications (38.5 vs 31.5%, p = 0.001; aOR 1.081.301.56). LOS was significantly longer (10 vs 7 days, p < 0.001; ratio 1.421.531.65) and cost was significantly greater ($23,056 vs $14,139, p < 0.001; ratio 1.421.541.63) for KTR compared to non-KTR. While LOS was longer for KTR undergoing resection at transplant centers compared to non-transplant centers (aOR 1.68 vs 1.53, p = 0.03), there were no statistically significant differences in mortality, overall morbidity, or cost by center type. CONCLUSIONS: KTR have higher mortality, higher incidence of overall complications, longer LOS, and higher cost than non-KTR following colorectal resection, regardless of center type. Physicians should consider these elevated risks when planning for surgery in the KTR population and counsel patients accordingly.

Surgical approach, cost, and complications of appendectomy in kidney transplant recipients.

Kidney transplant recipients (KTRs) have greater morbidity and length of stay (LOS) following certain surgical procedures than non-KTR. Given that appendectomy is one of the most common surgical procedures, we investigated differences in outcomes between 1336 KTR and 2 640 247 non-KTR postappendectomy at transplant and nontransplant centers in the United States from 2000 to 2011, using NIS data and adjusting for patient-level and hospital-level factors. Postoperative complications were identified using ICD-9 codes. Among KTR, there were no post-appendectomy in-hospital deaths, compared to a 0.2% in non-KTR (P = .5). Overall complications were similar among KTR and non-KTR (17.0% vs 11.6%; aOR:0.77 1.121.61 ). LOS and costs were greater for KTR compared to non-KTR (LOS ratio 1.19 1.311.45 ; cost ratio 1.11 1.171.26 ). Only 44.8% of KTR had laparoscopic approach compared to 54.5% of non-KTR, but had similar complication rates (10.6 vs 8.7%, P = .5). When treated at transplant centers, KTR had similar complications (aOR 0.44 0.791.43 ), but longer LOS (ratio 1.21 1.371.55 ) and greater hospital-associated costs (ratio 1.19 1.291.41 ) than non-KTR. Conversely, at nontransplant centers, KTR and non-KTR had similar complications (aOR 0.75 1.232.0 ), LOS (ratio 0.84 0.961.09 ), and cost (ratio 0.93 1.011.10 ). Contrary to other procedures, KTR did not constitute a high-risk group for patients undergoing appendectomy.

Frailty and Postkidney Transplant Health-Related Quality of Life.

BACKGROUND: Health-related quality of life (HRQOL) reflects a patient's disease burden, treatment effectiveness, and health status and is summarized by physical, mental, and kidney disease-specific scales among end-stage renal disease patients. Although on average HRQOL improves postkidney transplant (KT), the degree of change depends on the ability of the patient to withstand the stressor of dialysis versus the ability to tolerate the intense physiologic changes of KT. Frail KT recipients may be extra vulnerable to either of these stressors, thus affecting change in HRQOL after KT. METHODS: We ascertained frailty, as well as physical, mental, and kidney disease-specific HRQOL in a multicenter prospective cohort of 443 KT recipients (May 2014 to May 2017) using Kidney Disease Quality of Life Instrument Short Form. We quantified the short-term (3 months) rate of post-KT HRQOL change by frailty status using adjusted mixed-effects linear regression models. RESULTS: Mean HRQOL scores at KT were 43.3 (SD, 9.6) for physical, 52.8 (SD, 8.9) for mental, and 72.6 (SD, 12.8) for kidney disease-specific HRQOL; frail recipients had worse physical (P < 0.001) and kidney disease-specific HRQOL (P = 0.001), but similar mental HRQOL (P = 0.43). Frail recipients experienced significantly greater rates of improvement in physical HRQOL (frail, 1.35 points/month; 95% confidence interval [CI], 0.65-2.05; nonfrail, 0.34 points/month; 95% CI, -0.17-0.85; P = 0.02) and kidney disease-specific HRQOL (frail, 3.75 points/month; 95% CI, 2.89-4.60; nonfrail, 2.41 points/month; 95% CI, 1.78-3.04; P = 0.01), but no difference in mental HRQOL (frail, 0.54 points/month; 95% CI, -0.17-1.25; nonfrail, 0.46 points/month; 95% CI, -0.06-0.98; P = 0.85) post-KT. CONCLUSIONS: Despite decreased physiologic reserve, frail recipients experience improvement in post-KT physical and kidney disease-specific HRQOL better than nonfrail recipients.