First report of successful treatment of multidrug-resistant cytomegalovirus disease with the novel anti-CMV compound AIC246

We report the first case of cytomegalovirus (CMV) disease treated with AIC246, a novel anti-CMV compound which targets the viral terminase complex and remains active against virus resistant to DNA polymerase inhibitors. A lung transplant recipient developed refractory multidrug-resistant CMV disease involving the lungs, gastrointestinal tract and retina. His disease progressed despite treatment with all DNA polymerase inhibitors; multiple agents reported to have activity against CMV in case series, and reduction in his immunosuppressive medications. AIC246 which is in clinical development was obtained for emergency use, and combined with additional reduction in immunosuppression resulted in rapid clinical, virological and radiological resolution of disease. The patient has remained free of CMV disease or viremia off treatment for greater than 3 months. In summary AIC246, while still in development, may be a promising alternative to current therapies.

Echocardiographic Assessment of Cardiac Changes During Normal Pregnancy Among Nigerians

BACKGROUND

Pregnancy is a physiological process associated with an increased hemodynamic load and cardiac structural remodeling. Limited echocardiographic information exists on cardiac chambers, left ventricular (LV) systolic and diastolic functions, and LV mass during trimesters of normal pregnancy among African women.

MATERIALS AND METHODS

Echocardiography was done at the beginning of the second trimester, beginning of the third trimester, and middle of the third trimester for 100 normal pregnant women and at one visit for age-matched 100 nonpregnant women. The data were analyzed using the Statistical Package for Social Sciences (SPSS) version 17 software. Analysis of variance was used to compare within trimesters, and a P value of <0.05 was considered significant.

RESULTS

The mean (SD) ages of the patients and controls were 28.20 (±5.91) and 28.35 (±6.06) years, respectively (age range = 19–44 years, P = 0.86). Cardiac chambers, LV systolic function, and LV mass and its index increased significantly during pregnancy. A significant increase in A-wave velocity but slight increase in E-wave velocity and a reduction in tissue e′ velocity at the septal margin but a progressive increase in a′ velocity were also observed (P < 0.05).

CONCLUSION

Cardiac chamber dimensions, LV wall thickness, and mass, most indices of LV systolic and diastolic function, though within normal range, were significantly higher in pregnant than in nonpregnant Nigerian women.

Understanding the determinants of climate change adaptation strategies among smallholder maize farmers in South-west, Nigeria

Climate is one of the most important factors in agricultural productivity, which could directly or indirectly influence productivity since the climate is linked to physiological processes. It is, therefore, essential to understanding the various strategies used by farmers to mitigate the adverse impact of climate change and the factors that influence maize farmers' adoption and intensity of climate change adaptation strategies among smallholder maize farmers in South-west Nigeria. In all, a sample of three hundred and thirty (311) smallholder maize farmers were interviewed. A double-hurdle count data model was employed to estimate the factors influencing farmers' adoption of adaptation strategies while accounting for selection bias with the plugging of inverse mill ratio (IMR) as a regressor. Significant variables such as household size, depreciation ratio, frequency of extension visits, access to extension, and non-farm income were factors influencing the adoption of climate change adaptation strategies among maize farmers. Age of the respondent, age square, household size, farm-based organization (FBO), non-farm income, climate information, access to credit, farmers residing in Osun State (location_Osun), distance to market significantly influenced the intensity of climate change adaptation strategies. This study, therefore, concluded that farm-level policy efforts that aim to improve rural development should focus on farmers' membership in FBO, increase the visits of extension agents, encourage non-farm income and access to climate change information, particularly during the off-cropping season. Policies and investment strategies of the government should be geared towards supporting improved extension service, providing on-farm demonstration training, and disseminating information about climate change adaptation strategies, particularly for smallholder farmers in Nigeria.

Impact of climate change adaptation strategies on rice productivity in South-west, Nigeria: An endogeneity corrected stochastic frontier model

The study assessed the impact of climate change adaptation strategies on technical efficiency of smallholder rice farmers in South-west Nigeria. An endogeneity corrected stochastic frontier model which account for the endogeneity of adoption of adaptation strategies that is likely to depend on inefficiency was employed for the study. The result of the study revealed that adoption of adaption strategies is endogenously determined with rice productivity and hence, failure to account for endogeneity, the parameter efficiency estimates would be inconsistent. The empirical results from the model show that quantity of labour, herbicides and the interaction of labour with both farm size and insecticides were statistically significant in explaining the variations in the efficiency of rice production in the study area. In addition, the study identified the combined effects of climate change adaptation strategies and some socioeconomic characteristics such as age, gender, education, farming experience, access to credit, access to information, membership of farmers in agricultural based cooperative and location of rice farmers as sources of technical inefficiencies. The study concluded that increase implementation of climate change adaptation strategies could enhance rice productivity and technical efficiency of rice farmers through timely access to climate change information and other related institutional support. Based on farmers' knowledge and understanding of changes in climatic conditions and the adaptation strategies to mitigate its effect, it is therefore important for the government, stakeholders and donor agencies to involve farmers in the climate change adaptation planning process.

Quantifying the determinants of climate change adaptation strategies and farmers' access to credit in South Africa

The damaging effects of climate change on agricultural productivity are on the increase. Relevant adaptation strategies are important to cope with climate change risks and sustain agricultural productivity. This study employed descriptive statistics, multivariate probit (MVP) model and endogenous switching regression model (ESRM), to analyze the data collected using a survey questionnaire from four provinces in South Africa. The study estimated the determining factors influencing the adoption of climate change adaptation strategies and credit access among smallholder farmers in the study areas. The empirical results of the multivariate probit model showed that location, access to extension, non-farm income, farming experience, crop and livestock production, susceptibility, agricultural training and access to credit variables influenced the smallholder decision to adopt climate change adaptation strategies. On the other hand, the ESRM showed that location, age, marital status, gender among others, influenced the decision to adopt climate change adaptation strategies. The variables such as location, education, drought experience affected the smallholder farmers' access to credit. Thus, to improve the adaptive capacity of farmers, stakeholders and government must cooperate and collaborate to improve the conditions under which farmers can gain access to climate change information and suitable agricultural credit as well as policy incentives to ensure overall sustainability of the agricultural sector.

Sociodemographic factors associated with female genital cutting among women of reproductive age in Nigeria

OBJECTIVES

The aims of the study were to determine the prevalence of female genital cutting (FGC) among women of reproductive age in Nigeria and identify the sociodemographic factors associated with the practice.

METHODS

A secondary analysis of the 2013 Nigeria Demographic and Health Survey was carried out in 38,948 women of reproductive age (15-49 years).

RESULTS

The prevalence of FGC among respondents was almost 25%, most of whom (82%) had undergone the procedure when they were under 5 years of age. Traditional circumcisers performed 72.2% of all procedures. Type 2 was the common form (62.6%) of FGC. Almost a quarter of respondents (23.1%) wanted the practice to continue. Women aged 45-49 years were approximately twice as likely to have undergone FGC compared with women aged 15-19 years (odds ratio [OR] 2.41; 95% confidence interval [CI] 1.99, 2.92; p < .001). Women from parts of Nigeria other than the North East zone were significantly more likely to have experienced FGC (p < .001). Women of Yoruba ethnicity were significantly more likely to have experienced FGC compared with women of Hausa/Fulani ethnicity (OR 4.86; 95% CI 3.03, 8.12; p < .001).

CONCLUSIONS

Our findings have programmatic implications for ending the practice of FGC in Nigeria. Elimination efforts should be intensified among women of Yoruba ethnicity. To instigate behavioural change, communication interventions should particularly target residents in parts of Nigeria other than the North East zone.

Making a case for community screening services: findings from a medical outreach in ibadan, Nigeria

Background:

Currently, population based medical check up is yet to be explored as a veritable tool for assessing the burden of non-communicable diseases in Nigeria.

Objectives:

This study aimed to assess the prevalence of selected lifestyle related diseases during a free medical rally in an urban community.

Methods:

General medical examinations of all participants at a free medical rally in a middle class community in Ibadan, Oyo State was conducted. Body Mass Index (BMI), blood pressure and random blood sugar measurements were done using standardised instruments. BMI classification for children was done using the CDC guidelines for males and females aged 2-20 years.

Results:

Of the 302 participants examined, 33.1% were males and 32.1% were less than 18 years. Of those aged 2 to 20 years, 22.9% were underweight, while 5.2% were overweight/ obese. In adults 3.6% were underweight and 43.2% were overweight/ obese. Adults were significantly more likely to be overweight/obese (P<0.001). Prevalence of high blood pressure was 29.3% and 9.4% of adults had elevated random blood glucose levels. A higher proportion of obese people (P=0.259), males (P= 0.327) and those older than 40 years (P<0.001) had elevated blood pressure. A weak correlation (spearman rho= 0.3) was found between blood pressure and BMI (P<0.001) and also between BMI and blood sugar level (spearman rho= 0.2) P=0.05.

Conclusion:

There is a need for greater emphasis on community based screening programmes to aid early diagnosis and treatment of non communicable diseases in the country.

Unsafe abortion in lagos, Nigeria: a continuing tragedy

OBJECTIVES

To assess the incidence, pattern of presentation and management of complications resulting from unsafe abortion as well as the associated demographic variables at the Lagos Island Maternity Hospital.

PATIENTS AND METHODS

A cross sectional survey of all cases with complicated induced abortion was carried out between 1st August 2005 and 31st January 2007.

RESULTS

The majority of the patients were young 21.7% were teenagers between 14 and 19 years while 32.6% were in the 20-24 year age group. The majority (64.0%) were single while 30.9% were married, 1.7% were divorced, while 3.4% were separated. Teenagers and single women were more likely to obtain their abortion late (above 12 weeks gestation). 81.2% of the patients knew about modern methods of contraception but only 34.5% had ever used contraception and only 8.6% were using contraception when they became pregnant. Medical doctors were the abortionists in 46.9% of the cases, followed by nurses (17.7%) and traditional practitioners. Retained products of conception was the commonest complication (77.1%) followed by anaemia (48.6%) and sepsis (44.6%). Evacuation of the uterus was the commonest surgical procedure done. There were 16 maternal deaths giving a case fatality rate of 9.14%. Sepsis was the commonest cause of death.

CONCLUSION

Unsafe abortion remains a serious concern to the health of women. Efforts need to be maximised at preventing unwanted pregnancy by making contraceptive services easily accessible to women. Effective post abortion care services need to be put in place.

Clinical Profile and Outcome of COVID-19 Cases Admitted at a Tertiary Health Facility In South-West Nigeria

BACKGROUND

Coronavirus Disease 2019 (COVID-19) is anemerging disease with a global spread that has affected millions of lives. In Nigeria, the third wave of the outbreak is being experienced with many patients requiring hospitalization. Being a novel disease, we characterized the clinical profile and outcomes of patients admitted into our isolation centre.

METHODS

A case series of 65 COVID-19 patients admitted at theIsolation Centre of Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, from June 2020 to March 2021 is presented. Information on demographic characteristics, medical history, symptoms, treatment and outcomes was obtained. Data were analysed using SPSS version 25.

RESULTS

Most (47; 72.3%) patients were less than 65 years old and 39 (60.0%) were males. The commonest symptoms were cough (42; 64.6%), breathlessness (41; 63.1%), fever (40; 61.5%), muscle aches (40; 61.5%), and anosmia (16; 24.6%). Hypertension (41; 63.1%) and diabetes (18; 27.7%) were the most predominant comorbidities. Forty-three patients (66.2%) had supplemental oxygen therapy. The majority (44; 70%) of patients were admitted for 10 days or less and 58 (89.3%) patients were discharged home. However, 6 deaths (9.2%) were recorded among patients with advanced comorbidities and severe sepsis with all deaths occuring within 5 days of admission.

CONCLUSION

There was a male predominance among patients admitted at the Isolation Centre and all mortalities occurred within five days of admission. Early detection, prompt management of cases with hypoxaemia and optimal treatment of comorbidities are recommended for good outcomes in COVID-19 patients.

Microbial burden of some herbal antimalarials marketed at Elele, Rivers State

Herbal antimalarials still remain an alternative to our traditional communities who can not afford orthodox antimalarials. This study was aimed at investigating the microbial quality of six herbal antimalarials using standard microbiological methods. Of the six preparations analyzed, "schnapps", palm wine and water were the media of preparation; the water base preparations recorded higher microbial load. The mean microbial load was 159.5 × 10(5) cfu/ml and 217.4 × 10(2)cfu/ml in water and alcohol base preparations respectively. The microbial profile of the preparations showed that the schnapps base preparations were predominantly contaminated with Bacillus sp (Aerobic spore bearers) and Mucor spp. The palm wine preparation harboured Bacillus sp, yeasts and Mucor spp while the water base preparations had several isolates such as Staphylococcus epidermidis, Pseudomonas aeruginosa, Escherichia coli 0157H7, Proteus mirabilis, Enterococcus feacalis, Serratia marcensces, Staph. aureus, Bacillus spp and Mucor spp. Conclusively, this study underlines the public health importance of these preparations given the high burden of such human pathogen as Ecoli O157H7, Ps aeruginosa, Stahp aureus, etc. in the preparations.

Genetic analysis of the impact of heat stress on fertility traits in dairy cows in the Netherlands

This study aimed to use temperature-humidity index (THI) as an indicator for assessing heat stress conditions for fertility traits in the Holstein dairy cattle breed in the Netherlands. Data from AI and calving events of 416,814 first-parity cows from the Netherlands were used, considering different THI definitions based on different numbers of days before and after artificial insemination events. To achieve our aim, we investigated first, at population level, the relationship between different THI definitions and 4 fertility traits: conception rate, interval calving to first insemination, interval first to last insemination, and calving interval. Second, to investigate individual variation in the relationship between THI and fertility, variance components were estimated for each trait using the so-called broken stick model. This model assumes that breeding values are dependent on THI above but not below a THI threshold identified at the population level and explores the presence of genetic variation associated with fertility decline during heat stress. This study revealed considerable changes in fertility traits during periods of heat stress, with a THI threshold of 60 for conception rate and interval first to last insemination and 50 for interval calving to first insemination and calving interval. Interestingly, as THI levels increased, genetic variance and heritability also increased, indicating that at higher THI levels associated with reduced fertility, the genetic variation of fertility traits is greater. Furthermore, significant genotype-by-environment interactions were observed for all 4 fertility traits, suggesting changes in sire rankings between THI levels below and above the threshold. This study provides insights that may help breeding programs and farmers breed animals resilient to heat stress conditions.

Treatment compliance and challenges among tuberculosis patients across selected health facilities in Osun State Nigeria

BACKGROUND

Tuberculosis (TB) is a major public health problem in the world and Africa has approximately one quarter of the world's cases. One of the greatest challenges facing most TB programmes is the non-compliance to TB treatment among TB patients.

AIM

This study aimed at determining the challenges of management of tuberculosis (TB) across selected Osun State health facilities. The study employed a descriptive cross-sectional design. A semi-structured questionnaire was used to collect data from 102 TB patients in the health facilities. The instrument measured socio-demographic variables, patient related factors, socio-economic variables, health care system related factors to TB disease and treatment.

METHODS

Data were analysed and summarized using descriptive and inferential statistics. Statistical significance was placed at p < 0.05.

RESULTS

TB patients who had no formal education (χ2 = 12.941, p < 0.05), who were smoking during treatment (χ2 = 13.194, p < 0.001), who consumed alcohol during TB treatment (χ2 = 6.371, p < 0.05) and those who were HIV positive (χ2 = 23.039, p < 0.001) significantly failed to comply with TB treatment. TB patients who waited for one hour or more at heath facilities (χ2 = 21.761, p < 0.001), who reported that TB treatment should be stopped before six month (χ2 = 9.804, p < 0.05) or when patient felt better (χ2 = 35.185, p < 0.001) and travelled for 10 km or more (χ2 = 13.610, p < 0.001) significantly failed to comply with TB treatment.

CONCLUSION

This study concluded that non-compliance rate to tuberculosis treatment among TB patients in this study is high. Both health facility and patient-related factors were largely responsible.

Antimicrobial potentials of silver colloidal (nanorods) on clinical isolates in Bayelsa state, Nigeria

Antimicrobial resistance in developing countries has long been an issue of major concern. Nanotechnology has become an eye opener for the intervention on multiple drug resistance organisms. In this study we investigated the antimicrobial potentials of Silver Nitrate (nanorods) solution used in managing infectious diseases, the Minimum Inhibitory Concentration (MIC) and Minimum Bactericidal Concentration (MBC) of the product against microbial isolates were determined using standard microbiological techniques. The mean MIC and MBC of silver nitrate solution on fungi (0.16 µg/ml and 0.29 µg/ml respectively) was significantly lower than that of Gram positive organisms (2.35µg/ml and 2.62µg/ml) and Gram negative organisms (2.05 µg/ml and 2.10 µg/ml). Of all the Gram positive organisms, Staphylococcus spp recorded the lowest mean MIC and MBC while in the Gram negative organisms group, E. coli isolates showed the lowest mean MIC and MBC of the silver nitrate solution, though not significantly different from the other isolates. In conclusion, results from this study revealed that Silver Nitrate(nanorods) may have be broad spectrum in activity, but with higher antifungal potentials.