Evaluation of practice change following SAFE obstetric courses in Tanzania: a prospective cohort study.

Anaesthesia has been shown to contribute disproportionately to maternal mortality in low-resource settings. This figure exceeds 500 per 100,000 live births in Tanzania, where anaesthesia is mainly provided by non-physician anaesthetists, many of whom are working as independent practitioners in rural areas without any support or opportunity for continuous medical education. The three-day Safer Anaesthesia from Education (SAFE) course was developed to address this gap by providing in-service training in obstetric anaesthesia to improve patient safety. Two obstetric SAFE courses with refresher training were delivered to 75 non-physician anaesthetists in the Mbeya region of Tanzania between August 2019 and July 2020. To evaluate translation of knowledge into practice, we conducted direct observation of the SAFE obstetric participants at their workplace in five facilities using a binary checklist of expected behaviours, to assess the peri-operative management of patients undergoing caesarean deliveries. The observations were conducted over a 2-week period at pre, immediately post, 6-month and 12-month post-SAFE obstetric training. A total of 320 cases completed by 35 participants were observed. Significant improvements in behaviours, sustained at 12 months after training included: pre-operative assessment of patients (32% (pre-training) to 88% (12 months after training), p < 0.001); checking for functioning suction (73% to 85%, p = 0.003); using aseptic spinal technique (67% to 100%, p < 0.001); timely administration of prophylactic antibiotics (66% to 95%, p < 0.001); and checking spinal block adequacy (32% to 71%, p < 0.001). Our study has demonstrated positive sustained changes in the clinical practice amongst non-physician anaesthetists as a result of SAFE obstetric training. The findings can be used to guide development of a checklist specific for anaesthesia for caesarean section to improve the quality of care for patients in low-resource settings.

Nigeria's energy review: Focusing on solar energy potential and penetration.

In Nigeria, the rapid population increase and the overreliance on fossil fuel have created significant environmental, health, political, and economic consequences leading to severe socio-economic drawbacks. These factors have developed a wide gap between energy demand and supply due to insufficient local production, necessitating a clean energy supply for all. The photovoltaic device's economic and environmental merits have made it the most suitable clean energy alternative to help developing countries such as Nigeria achieve the SDG-7. However, apart from the device's low efficiency, which is undergoing intensive study globally, other factors affect the penetration of the technology in developing countries, particularly Nigeria. This report systematically reviews the literature on the country's energy crisis and renewable energy potential, leading to an overview of solar energy potential and penetration. The potential of the technology and its penetration in the country were provided. A list highlighting challenges hindering technology penetration was also provided, and a solution for each was recommended.

Biological properties of carbon powders synthesized using chemical vapour deposition and detonation methods.

Carbon powders can be synthesized using variety of CVD and detonation methods. Several interesting properties of carbon powder particles make them a very attractive material examined in many laboratories all over the world. However there is a lack of information discussing investigation of carbon powders directed to its application in pharmaceutical-cosmetic industry and medicine. Earlier investigation results proved that diamond powders present properties fighting free radicals. Presented work discusses the influence of carbon powder particles manufactured using MW/RF PACVD, RF PACVD and detonation methods onto hydro-lipid skin coat. Before the biological examinations physicochemical properties of carbon powders were determined. Grain size, shape and chemical composition of carbon powders were determined using the scanning electron microscopy. Surface functional groups were characterized by IR Fourier-transform spectroscopy and X-ray photoelectron spectroscopy. Structure and phase composition were investigated by means of the Raman spectroscopy. Results of allergy tests performed on laboratory mice proved that carbon powder particles synthesized using different methods do not cause allergy. In the following stage, the group of 20 patients applied the formula including carbon powder on their face skin. The influence of carbon powder onto hydro-lipid skin coat was determined by measurement of such parameters as: pH reaction, skin temperature, lipid fotometry and level of hydration. Additionally, macro pictures of places where the cream had been applied were registered. As the result of the investigation it was found that powders synthesized using various methods present different physicochemical properties which may individually affect the face skin parameters. The noticeable improvement of hydro-lipid skin coat kilter was observed.

Association between HER-2/neu over-expression and clinico-pathologic parameters of breast cancer in northern Malaysia.

BACKGROUND: Breast cancer is the commonest cancer affecting women world wide. Breast cancer is a leading cause of cancer related mortality in Asian countries. Management of breast cancer depends on several tumour-related and patient related factors. HER-2/neu over-expression has been associated with a poor prognosis in breast cancer. We assessed HER-2/neu over expression pattern in unselected breast cancer cases in terms of clinico-pathologic parameters to identify any associations between them. METHODS: Two hundred cases of breast cancer were evaluated at Advanced Medical and Dental Institute and Hospital Kepala Batas from 2002 to 2007. HER-2/neu status was confirmed in breast cancer tissues by immunohistochemistry. Immunohistochemical expression of HER-2/neu was evaluated according to the published scoring guidelines of the 'Hercep Test' (Dako, Carpinteria, CA). Data were analysed to identify any association between HER-2/neu and clinico-pathologic parameters. RESULTS: HER-2/neu over expression was found in 63 (31.5%) tumours out of 200. When assessed for various age groups no significant association was found. However, a high percentage (75%) of over-expression was noted in the 81-85 years age group. No association was found with different racial groups (Malay, Chinese and Indians), with lymph node status or with grade of tumour. However a positive association was observed with oestrogen receptor and progesterone receptor expression. CONCLUSION: There was no association between HER-2/neu over expression and age, race, lymph node status or tumor grade. However a positive association was found with oestrogen and progesterone receptor status.

The Cutaneous Manifestations Associated with COVID-19: A review.

IMPORTANCE: As the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic spreads, increasing cases of dermatologic manifestations of the disease continue to be reported. OBSERVATIONS: In this general review of the case reports, case series, and other systematic reviews on this subject, several patterns of cutaneous lesions have been compiled. These include viral exanthems, papulovesicular, pernio-like, vasculopathy-related, and other miscellaneous rashes. CONCLUSIONS AND RELEVANCE: While clinical observations and subjective cases of rashes associated with SARS-CoV-2 are important to furthering our research and study of this viral disease, we as clinicians must be cautious in attributing causation with correlation. Continued research and study are needed before we can attribute a source for these dermatologic manifestations.

Vaccine implementation factors affecting maternal tetanus immunization in low- and middle-income countries: Results of the Maternal Immunization and Antenatal Care Situational Analysis (MIACSA) project.

OBJECTIVES: To examine the characteristics of existing maternal tetanus immunization programmes for pregnant women in low- and middle-income countries (LMICs) and to identify and understand the challenges, barriers and facilitators associated with maternal vaccine service delivery that may impact the introduction and implementation of new maternal vaccines in the future. DESIGN: A mixed methods, cross sectional study with four data collection phases including a desk review, online survey, telephone and face-to-face interviews and in country visits. SETTING: LMICs. RESULTS: The majority of countries (84/95; 88%) had a maternal tetanus immunization policy. Countries with high protection at birth (PAB) were more likely to report tetanus toxoid-containing vaccine (TTCV) coverage targets > 90%. Less than half the countries included in this study had a TTCV coverage target of > 90%. Procurement and distribution of TTCV was nearly always the responsibility of the Expanded Programme on Immunization (EPI), however planning and management of maternal immunization was often shared between EPI and Maternal, Newborn and Child Health (MNCH) programmes. Receipt of TTCV at the same time as the antenatal care visit correlated with high PAB. Most countries (81/95; 85%) had an immunization safety surveillance system in place although only 11% could differentiate an adverse event following immunization (AEFI) in pregnant and non-pregnant women. CONCLUSIONS: Recommendations arising from the MIACSA project to strengthen existing services currently delivering maternal tetanus immunization in LMICs include establishing and maintaining vaccination targets, clearly defining responsibilities and fostering collaborations between EPI and MNCH, investing in strengthening the health workforce, improving the design and use of existing record keeping for immunization, adjusting current AEFI reporting to differentiate pregnant women and endeavoring to integrate the provision of TTCV within ANC services where appropriate.

Effects of Pollination by the Indo-Malaya Stingless Bee (Hymenoptera: Apidae) on the Quality of Greenhouse-Produced Rockmelon.

Rockmelon (Cucumis melo Linnaeus (Cucurbitales: Cucurbitaceae)) is a novel commercialized fruit in Malaysia and has great potential to become an important horticultural crop for the international market. In this study, we investigated the effects of pollination by the Indo-Malaya stingless bee Heterotrigona itama Smith (Hymenoptera: Apidae) on measures of yield and quality of rockmelon cultivated in the greenhouse, compared with hand cross-pollination and self-pollination. Results showed that rockmelon produced from plants pollinated by stingless bees and hand cross-pollination had higher fruit set, were heavier and larger, and contained higher numbers of seed per fruit compared with those produced by self-pollination. Pollination by stingless bees produced fruit with greater sweetness than either hand cross-pollination or self-pollination. This study demonstrated that stingless bee pollination produced rockmelon fruit of similar quality, but better yields compared to the other pollination treatments. We showed that stingless bees should be considered as an alternative, effective pollinator for the improved production of high quality rockmelon in commercial greenhouse cultivation.

Undergraduate Students' Understanding of Physiology Subject, Opinions and Perception: The Case of Bayero University, Kano, Nigeria.

Human Physiology courses are compulsory in medical education but many students encounter challenges instudying them. This study investigates understandings, opinions and perceptions of students about physiology subject andthe challenges they encounter in their study. Two hundred and eighty (280) students were interviewed using structuredquestionnaire. The data were analyzed using IBM SPSS statistics 22. The mean age of the students was 22.8 ± 4.1 years.Males constituted 174(62.1%), while females were 106 (37.9%). Majority of the respondents were in 300 level of study inthe university 178(63.6%) as of the time of conducting this research. Most of the participants 257(91.8%) claimed to havegood to excellent understanding of the physiology subjects. One hundred and nine (39.1%) alleged that academic staff hadunfriendly attitude like rushing lectures, commencing lectures late and fixing tests and other continuous assessment close toexaminations, and that lecturers have poor communication/ teaching skills. Less than one-third (28.7%) believed that thesubjects have bulky course contents, and 56(20.1%) were of the opinion that the students' lack of seriousness or interest isamong the reasons for failing physiology courses. On binary logistic regression, being of female sex, and in 300 level ofstudy emerged as the independent predictors of the students' perception of physiology. Improving the pedagogy 102(36.4%),good attitude of staff towards students and teaching 73(26.1%), improving infrastructure and equipment 35(12.5%); andinstituting guidance and counseling unit for both staff and student 31(11.1%) were the ways suggested by the students forimproving performance in physiology subject. Most of the students had poor and negative perception about physiologysubjects (83.2%). Guidance and counseling for students, through the level coordinators and the mentor-mentee programshould be strengthened in all departments. Basic infrastructure and equipment, and teaching techniques should also beupgraded.

Antidiarrheal and Antioxidant Activities of Methanol Extract of Bryophyllum pinnatum Leaf Harvested from South-Eastern Nigeria in Mice.

Bryophyllum pinnatum belongs to the family Crassulaceae and it is commonly used in the ethnomedical practices. This study investigated the antidiarrheal and antioxidant properties of methanol extract of Bryophyllum pinnatum leaf harvested from South-Eastern Nigeria in mice. Cold maceration method in 80% methanol was adopted in the extract preparation. The 2,2-diphenyl-1-picrylhydrazyl (DPPH) and ferric reducing antioxidant power (FRAP) assays were used to evaluate the antioxidant property while castor oil-induced diarrhea, small intestinal transit, and enteropooling models were used for the antidiarrheal investigation. The effects of the extract (50, 100, and 200 mg/kg) were compared to distilled water (10 ml/kg) and loperamide (5 mg/kg). The extract produced concentration dependent increase in antioxidant effect in both DPPH and FRAP assay. The extract caused a significant (p < 0.05) reduction in mean stool output, percentage of wet stools, small intestinal transit, and intestinal fluid accumulation in the treated mice when compared to the distilled water treated mice. The study validates the use of Bryophyllum pinnatum in the ethnomedical management of diarrhea.

Diabetes insipidus: a postpartum complication.

Sheehan's syndrome and diabetes insipidus were diagnosed in a 31-year-old woman seven months after postpartum bleeding with a short duration of hypotension. The diagnosis of diabetes insipidus was established by the inability to concentrate urine during water deprivation and the marked increase in urinary osmolality after administration of 1-Desamino-8-D-arginine-vasopressin (DDAVP). Obstetricians should be aware of diabetes insipidus as a postpartum complication.

Serum ascorbic acid and protein calorie malnutrition in continuous ambulatory peritoneal dialysis patients.

Protein calorie malnutrition (PCM) is a major predictor of morbidity and mortality in continuous ambulatory peritoneal dialysis (CAPD) patients. Oxidative stress has been implicated as a contributory cause. The relative lack of ascorbic acid, a plasma antioxidant, has been reported in CAPD patients. We therefore examined the correlation between serum ascorbic acid (SAA) and parameters of PCM in a cross-sectional study of 50 clinically stable adult CAPD patients. The mean age of the study group was 61 +/- 11 years; 48% of the patients were male; and 64% had diabetes. The parameters assessed were SAA, serum albumin (S Alb), body mass index (BMI), subjective global assessment (SGA), and lean body mass (LBM). The results (mean +/- standard deviation) were: SAA, 9.44 +/- 8.79 mg/L; S Alb, 31.6 +/- 4.9 g/L; BMI, 24.4 +/- 3.4; LBM, 0.66 +/- 0.14 kg/kg body weight; SGA, 9 of 50 were considered mildly-to-moderately malnourished (the rest were well-nourished). A significant correlation (p < 0.001) was found between SAA and S Alb only with SAA < or = 9 mg/L. No correlation was seen between SAA (at any level) and BMI or LBM. The SAA was not significantly different between the groups as graded by SGA. The data suggest that the mechanisms for low serum albumin in these patients may be related to the role of ascorbic acid as a plasma antioxidant.

Oral intake and serum levels of ascorbic acid in continuous ambulatory peritoneal dialysis patients.

Oral intake of ascorbic acid is essential for optimum health in human beings. Continuous ambulatory peritoneal dialysis (CAPD) patients have an increased need for ascorbic acid, because of increased loss through dialysate, reduced intake owing to nausea and loss of appetite, and increased oxidative stress. However, optimum intake is still controversial. We studied 50 clinically stable patients to determine the relationship between oral ascorbic acid intake and serum ascorbic acid (SAA) level. Total oral intake ranged from 28 mg daily to 412 mg daily. Only one patient had an oral intake of ascorbic acid below 60 mg per day. The SAA levels ranged from 1 mg/L to 36.17 mg/L. Although a strong correlation existed between intake and SAA (p < 0.001, R2 = 0.47), the variation in SAA at any given intake level was wide. Of the studied patients, 62% had an SAA < 8.7 mg/L, 40% had an SAA < 5.1 mg/L (below the level in a healthy population), and 12% had a level below 2 mg/L (scorbutic). None of the patients demonstrated clinical manifestations of scurvy. Our results show that, in CAPD patients, ascorbic acid deficiency can be reliably detected only with SAA measurements, and oral intake may influence SAA level. To maintain ascorbic acid in the normal range for healthy adults, daily oral intake needs to be increased above the U.S. recommended dietary allowance to 80-140 mg.

An immunofluorescence study of renal lesions in diabetes mellitus.

Percutaneous renal biopsies were performed in 30 diabetic patients who presented with proteinuria. Tissues were studied for evidence of an immune lesion using immunofluorescence techniques. No consistent pattern of binding of FITC labelled polyvalent, monospecific IgG, IgA, IgM and labelled bovine insulin antisera in various diabetic renal lesions could be demonstrated. The binding of labelled insulin was observed even in biopsies of patients who had never received exogenous insulin therapy. It was therefore concluded that there is no evidence to support an immune pathogenesis in the morphogenesis of the diabetic renal lesions, nor do these lesions occur as a result of insulin therapy.

Benign ovarian cysts--a retrospective evaluation over two years.

Histological analysis of 89 "benign" ovarian cysts received over a period of 2-1/2 years (January, 1991 to July, 1993) at the department of Pathology, Fatima Jinnah Medical College, Lahore showed that 44 were neoplastic, 22 dysfunctional, 19 simple and 4 endometriotic. Clinical presentation and gross features could not serve to differentiate these types. Routine histological examination had to be supplemented with ample blocking and deeper sections for a more specific typing. With this procedure the original diagnosis was altered in 11.2% cases, 7 cases originally labelled as "simple cysts", were categorized as dysfunctional (N = 2), neoplastic (N = 1) and endometriotic cysts (N = 3). Similarly in 3 cases the primary diagnosis of endometriotic cysts was altered in favour of dysfunctional (N = 2) and neoplastic (N = 1) cysts. The neoplastic and dysfunctional cysts have different clinical implications. It is proposed that the clinical diagnosis of benign ovarian cyst should be supported by a careful histological evaluation.

Fine needle aspiration of unilocular ovarian cysts--a cytohistological correlation.

OBJECTIVE: To assess the diagnostic efficacy of Fine Needle Aspiration Cytology in differentiating neoplastic and non-neoplastic dysfunctional ovarian cysts--cytological findings to be verified with histology of excised cyst. METHODS: In this prospective study fifty-three cases with unilocular nonseptate ovarian cystic masses,detected on ultrasound examination were subjected to ultrasound guided fine needle aspiration of the cyst contents at Department of Pathology, Allama Iqbal Medical College Lahore, from January 1999 - January 2000. Aspirated fluid was examined cytologicaly using Giemsa stain on the smears prepared from centrifuged deposit. The same cyst removed surgically was examined histologicaly and cytohistological correlation was carried out. RESULTS: In this series of 53 cases, histologically confirmed break up of various types of cysts was follicular cysts (n=25), leuteal cysts (n=6), serous cysts (n=15), mucous cysts (N=4) and Endometriotic cysts (n=3). Non-diagnostic fine needle aspirate was obtained in 19/53 cases, majority being the follicular cysts. The cytohistological correlation revealed no false positive but 40% false negative results for follicular cysts on cytological examination of the aspirate. Hence the specificity and sensitivity for cytological diagnosis of follicular cyst was 100% and 60% respectively. For leuteal cysts, false positive and false negative results on cytological examination were 0% and 16.6% respectively with a specificity and sensitivity value of 100% and 83% respectively. For neoplastic serous cysts cytologically false positive and false negative diagnosis was 0% and 46.6% respectively with specificity and sensitivity of 100% and 53%. For mucinous cystadenomas sensitivity and specificity of cytological diagnosis was 100%. For endometriotic cysts a sensitivity of 67% and specificity of 100% was procured with cytological evaluation. CONCLUSION: Guided fine needle aspiration cytology may prove to be one of the most valuable and acceptable tools in the differential diagnosis of ovarian cystic lesions.

Spinal tuberculosis: a five-year review of cases at the National Tuberculosis Centre.

We reviewed 31 cases (19 males and 12 females) of spinal tuberculosis seen at the National Tuberculosis Centre from 1985 to 1989. The mean age was 35.4 years. The predominant clinical feature was backache (90.3%), while neurological features were found in 30.9%. An elevated erythrocyte sedimentation rate (in 80.0%) and a positive Mantoux test (in 70.9%) served as useful investigations. Spinal x-ray was abnormal in all cases, the lumbar spine being most commonly involved. Bacteriological or histopathological confirmation was obtained in only 29.0% of cases. The mainstay of treatment was anti-tuberculous chemotherapy with surgery being performed in 41.9% of patients.

Bio-ethical and legal issues in relation to HIV/AIDS: the Uganda experience.

In Uganda, as in many other countries, there is a vacuum regarding an appropriate legal and ethical response to the HIV/AIDS pandemic. Whereas much has been done to address the HIV/AIDS pandemic in a multidisciplinary way, very little has been done regarding legal and ethical issues. Hence, cases of claimants to have cures for AIDS, spiritual healers and sale of fake drugs plus unauthorized vaccine and drug trials are on the increase. The rights and needs of people infected with HIV/AIDS are not adequately addressed. The property rights of those affected by the pandemic continue to be abused. Therefore there is need to mobilize doctors, lawyers and human rights activists who should advocate and address these issues. This paper therefore highlights the critical bio-ethical and legal issues in relation to HIV/AIDS.

Hypolipidaemic and haematological evaluation of the hydromethanolic extract of Ficus glumosa stem bark in alloxan-induced diabetic rats.

BACKGROUND: Diabetes mellitus is associated with dyslipidaemia and haematological disorders which lead to cardiovascular complications and anaemia respectively. In this study, hydromethanolic extract of Ficus glumosa was evaluated for its hypolipidaemic and haematological effects in alloxan-induced diabetic rats. METHODS: Treatment was done orally using 62.5, 125 and 250 mg/kg of F. glumosa extract (FGE) with glibenclamide (2 mg/kg) as standard reference drug for 21 days. At the end of the treatment, blood collected through direct heart puncture was used for evaluation of serum lipid profile and determination of haematological parameters. Organosomatic index evaluation of the liver, spleen and kidney was also done using standard procedures. RESULTS: All doses of the extract and glibenclamide (2 mg/kg) caused dose-dependent and significant (p<0.05) reduction in serum levels of total cholesterol and low-density lipoprotein cholesterol (LDL-C) of the treated rats when compared with the control group. The extract and glibenclamide produced significant (p<0.05) increase in the serum levels of high-density lipoprotein cholesterol (HDL-C) in the treated rats. The extract (62.5 mg/kg) and glibenclamide (2 mg/kg) caused a significant (p<0.05) increase in red blood cell (RBC), haemoglobin (Hb), packed cell volume (PCV) and mean corpuscular haemoglobin concentration (MCHC) in the treated rats when compared to the negative control group. However, FGE (62.5 mg/kg) and glibenclamide (2 mg/kg) produced a significant (p<0.05) decrease in mean corpuscular volume (MCV) value of the treated rats. FGE (125 and 250 mg/kg) produced a significant (p<0.05) increase in the organosomatic index of kidney in treated rats. CONCLUSIONS: The results suggest that F. glumosa may be of help in diabetes-induced anaemia and dyslipidaemia associated with diabetes mellitus.

Salmonella infections complicating inflammatory bowel disease.

One hundred and five of 267 patients with inflammatory bowel disease at a community hospital had recorded diarrhea, but only one had Salmonella (0.9%). Two additional patients, one from another institution, are also reported. A literature review disclosed only 37 cases, 18 of which were adequately defined clinically. Patients with IBD may not be at an increased risk for Salmonella infection. Salmonella infection may increase the severity of IBD, and therefore antibiotics may be necessary.