Notes

The result associated with few months aerobic exercise in the course of dialysis upon liver enzymes, cystatin chemical and quality of time of hemodialysis people.
Modular construction of an autonomous and programmable multi-functional heterogeneous biochemical circuit that can identify, transform, translate, and amplify biological signals into physicochemical signals based on logic design principles can be a powerful means for the development of a variety of biotechnologies. To explore the conceptual validity, we design a CRISPR-array-mediated primer-exchange-reaction-based biochemical circuit cascade, which probes a specific biomolecular input, transform the input into a structurally accessible form for circuit wiring, translate the input information into an arbitrary sequence, and finally amplify the prescribed sequence through autonomous formation of a signaling concatemer. This upstream biochemical circuit is further wired with a downstream electrochemical interface, delivering an integrated bioanalytical platform. We program this platform to directly analyze the genome of SARS-CoV-2 in human cell lysate, demonstrating the capability and the utility of this unique integrated system.
Embryo chicken egg is a nutritional supplement that has been used to enhance physical fitness and promote wound healing according to traditional Chinese medicine for many years. In this study, we evaluated the effects of embryo chicken egg extract (ECE) on the exercise performance and fatigue in mice and the underlying mechanisms.

The results indicated that ECE can prolong the exhaustive swimming time, decrease lactic acid, blood urea nitrogen, creatine kinase, and malondialdehyde levels, and increase superoxide dismutase, glutathione peroxidase, and glycogen levels. Additionally, ECE can also regulate the balance of oxidative stress via the adenosine monophosphate activated protein kinase/mammalian target of rapamycin signalling pathway.

Taken together, these results showed that ECE can improve exercise performance and reduce physical fatigue in mice, which indicates that ECE can be used as a potential supplement to reduce physical fatigue. © 2020 Society of Chemical Industry.
Taken together, these results showed that ECE can improve exercise performance and reduce physical fatigue in mice, which indicates that ECE can be used as a potential supplement to reduce physical fatigue. © 2020 Society of Chemical Industry.
The single high-wire system is a free canopy trellis system suitable for warm to hot climates. In a global warming scenario, it arouses as a technological solution since it prevents berry overheating and sunburn. Canopy management practices manipulate leaf-to-fruit ratios, affecting berry and wine composition. We aimed to evaluate the phenolic and sensory profiles of Malbec wines from single high-wire trellised vineyards in a hot region in Mendoza (Argentina) and to assess the effect of varying leaf-to-fruit ratios on these attributes. We manipulated leaf-to-fruit ratios by varying shoot trimming (experiment 1 0.45 m, 0.80 m, and untrimmed) and winter pruning severity (experiment 2 16, 24, 32, and >32 countable buds per meter). We characterized wine attributes by a descriptive analysis, color by the CIELAB space, and global phenolics compounds and anthocyanins by high-performance liquid chromatography with diode array detection.

We found that wines where shoots were trimmed to 0.80 m or left untrimmed had similar and greater intensity of color, violet hue, astringency, and alcohol and a richer aroma profile than wines where shoots were trimmed to 0.45 m. Meanwhile, wines from 16 and >32 buds/m treatments (the latter simulating a box pruning) were similar to each other and had higher color intensity, violet hue, acidity, alcohol, and astringency and a more complex aroma profile than the other pruning treatments.

The best quality wines were achieved by leaving 16 or >32 buds/m and by trimming shoots to 0.80 m or leaving them untrimmed. The modulation of cultural practices in sprawling canopies offers the potential to produce wines with different styles in hot regions. © 2020 Society of Chemical Industry.
32 buds/m and by trimming shoots to 0.80 m or leaving them untrimmed. The modulation of cultural practices in sprawling canopies offers the potential to produce wines with different styles in hot regions. © 2020 Society of Chemical Industry.Mycosis fungoides is an extra-nodal indolent non-Hodgkin lymphoma of T- cell origin that is characterized by skin involvement. The course of the disease is typically slowly progressive with non-specific clinical and histopathologic features which may evade diagnosis for years. Chemo-therapeutic agents to control the disease are effective if employed early, but the prognosis and therapy is dependent on the stage of the disease at presentation. We report a case of a 25-year old man with a clinical diagnosis of Tinea incognito and histologic features of non-specific dermatitis at first presentation. With poor hospital attendance and inconsistent therapy, his clinical features and histology reports over the next couple of years were consistent with psoriasis, then mycosis fungoides. He is currently stable on chemotherapeutic agents. With different histopathology results over a three- year span, it is possible that the patient had both diseases occurring separately. It is also possible that psoriasis was a harbinger of mycosis fungoides and the change in clinical presentation which necessitated repeated biopsies eventually revealed the picture.
Preeclampsia is a significant public health problem associated with increased risk of hypertension for offsprings. We compared the blood pressure and presence of hypertension between neonates born to women with preeclampsia and those with normal pregnancy as well as its relationship to anthropometric indices.

This is a comparative cross-sectional study of 40 neonates born to women with preeclampsia and those born following normal pregnancy in four tertiary health facilities located in Jos, Nigeria. Anthropometric and blood pressure values were measured within 6-12 hours of delivery using standard protocols. SPSS version 25 was used in all analyses. Statistical significance was taken at p <0.05.

The mean birth weight for neonates of preeclamptic women was 2,476.1±810.8 grams, compared with 2,994.2±529.6 grams in babies of normal pregnancy (p=0.002). The mean birth length for neonates of preeclamptic women was 45.4±6.2 cm compared with 49.8±3.1 cm in babies of normal pregnancy (p<0.001). The mean pothweight, length or ponderal index. Early infant blood pressure surveillance is advocated in order to monitor and hence prevent complications ensuing in later life.
Newborns of women with preeclampsia have associated higher odds of elevated blood pressure. Elevated blood pressure has no significant relationship to birthweight, length or ponderal index. Early infant blood pressure surveillance is advocated in order to monitor and hence prevent complications ensuing in later life.
Several stroke studies in West Africans have demonstrated a high proportion of haemorrhagic stroke and poor outcomes. This may be due to the socioeconomic status of patients and inadequate clinical care. Outcomes may well be different if more informed patients treated in better facilities are studied.

To study the pattern of stroke and stroke outcomes in African patients attending a private hospital in Sierra Leone METHODS 150 consecutive African stroke patients admitted to a private hospital in Sierra Leone were studied. Demographic details, risk factors, clinical features including blood pressure were recorded. CT scans, ECG, serum cholesterol, and blood sugar were done. Patients were reviewed at day 30 and Rankin scores allocated. Two sample independent t-test was used to compare means, and chi square to compare variables.

Hypertension was the most common risk factor present in 77.6% of patients prior to admission with diabetes in 29.5%. Other risk factors include previous stroke (11.7%), smoking (6. determinants of stroke types and outcomes in African patients. . More detailed studies to confirm the effects of socioeconomic factors on stroke pattern and outcomes in Africa are needed.
Sickle cell anaemia (SCA), one of the causes of morbidity and mortality in children is associated with a large spectrum of systemic complications including sickle cell nephropathy (SCN). Microalbuminuria has been used as a marker of preclinical glomerular damage in these patients. This study aimed at detecting early, renal injury in children with SCA aged 1-17 years, highlighting associations and predictors of microalbuminuria in these children.

102 known HbSS children aged 1-17yrears in steady state were recruited into a cross-sectional study. Socio-demographic and clinical findings were recorded. Albuminuria was assayed with spot urine using a quantitative method. Urine creatinine concentration was estimated using the Roche reflotron test strips for quantitative determination of creatinine in blood, serum, plasma and urine. Albumin to creatinine ratio (ACR) was then calculated. Microalbuminuria was defined as ACR of 30-300mg/g.

Microalbuminuria was detected in 22.5% of SCA patients in our cohort. Age (p=0.001), gender (p=0.000), packed cell volume (p=0.047) showed a significant relationship with the occurrence of microalbuminuria in this study. Increasing age (OR=1.72, CI=1.22-2.44, p=0.002), female gender (OR=0.09, CI=0.01-0.95, p=0.04) and lower packed cell volume (OR=0.49, CI=0.26-0.90, p=0.02) emerged as independent risk factors associated with the occurrence of microalbuminuria in the study population.

Renal injury occurs in a high proportion of patients with SCA. Routine screening of all patients with SCA as part of their follow up is therefore recommended to identify patients with early renal injury for proper management.
Renal injury occurs in a high proportion of patients with SCA. Routine screening of all patients with SCA as part of their follow up is therefore recommended to identify patients with early renal injury for proper management.
Adolescence is a vulnerable period of transition and a time for establishing healthy or risky behaviours. Adolescents constitute the strategic link between a nation's past and the future. Adolescent obesity is an epidemic of global proportions which has affected both industrialized and developing countries. Identifying factors that influence adolescent obesity in our environment would help to strengthen preventive measures, reduce the disease burden, and ultimately improve adult health.

A cross-sectional study conducted in secondary schools in Kaduna metropolis, North-West Nigeria. The participants were selected using systematic sampling method. Data were collected using a structured interviewer-administered questionnaire. The data were analyzed using SPSS version 20.

One hundred and fifty adolescents were recruited into the study. This consisted of 85(56.7%) girls and 65(43.3%) boys. The mean age of the participants was 14.1 ± 2.3 years. The prevalence of overweight and obesity was 21.3% and 14.0% respectively. Factors identified to be associated with the development of obesity included lack of sporting activities (c2 = 8.18, p= 0.04) and the number of hours of sleep daily (c2 = 17.91, p= 0.01). All except one of the obese adolescents consumed snacks/soft drinks, though the relationship between adolescent obesity and consumption of snacks/soft drinks was not statistically significant (c2 = 5.58, p= 0.13).

Addressing the risk factors associated with adolescent obesity is a key to reversing this global epidemic. Health education on appropriate sleep pattern and engaging in sporting activities should be emphasized in secondary schools.
Addressing the risk factors associated with adolescent obesity is a key to reversing this global epidemic. Health education on appropriate sleep pattern and engaging in sporting activities should be emphasized in secondary schools.
Preterm babies have constituted a major constraints on human and material resources due to early mortality and long term disability among survivors. Rates of disability among survivors have increased over the period, with high rates of broncho-pulmonary dysplasia.

To determine the survival and management challenges of preterm babies in University of Maiduguri Teaching Hospital, Maiduguri Borno State REUSLTS Of the 1129 preterm babies managed in the Special Care Baby Unit (SCBU), 714 cases notes were retrieved and analyzed giving a retrieval rate of 63%. There were 256 (35.9%) preterm babies as in-born, while 458 (64.1%) were out-born. Male preterm babies were 372 (52.1%), while female preterm babies were 342 (47.9%); with female to male ratio of 1.081. Extreme low birth weight (<1000grams) were 17 (2.3%), very low birth weight (1000-1499 grams) were 288 (40.3%) while low birth weight (1500-2499 grams) were 406 (56.9%). We also documented 3 preterm babies whose weights >2500 grams were large for gestational age weight. Duration of oxygen therapy (p = 0.620), duration of phototherapy (p = 0.474), and EBT (p = 0.466) showed no association with their survival while only duration of incubator care (p = 0.005) demonstrated significant association with outcome.

The population of preterm babies studied is 32.70% and their survival has remarkably improved. However, this improved survival of preterm babies especially the extreme and very low birth weight categories has posed a big challenge due to limited access to incubator care, use of caffeine and surfactant which might influence the outcome.
The population of preterm babies studied is 32.70% and their survival has remarkably improved. However, this improved survival of preterm babies especially the extreme and very low birth weight categories has posed a big challenge due to limited access to incubator care, use of caffeine and surfactant which might influence the outcome.
The incidence and outcomes of acute kidney injury (AKI) are worse in developing countries due to late diagnosis, poor access and high cost of care. Surgical patients may have up to 10 fold increased risk for AKI due to complications arising from the primary surgical illness, peri-operative complications and treatment.

This study was a retrospective cross-sectional study of the epidemiology of AKI in two Nigerian tertiary institutions. Patients who had surgery during a 1year period were included. Patients' identification were obtained from the theatre registers, and relevant data collected from their hospital files. AKI was defined using the Kidney Disease Improving Global Outcomes (KDIGO) serum creatinine criteria.

Two hundred and twenty patients were studied, and the majority were males (60.9%). Forty patients developed AKI (18.2%), with the majority in KDIGO stage 1 (12.7%). Mean age was 43.7±17.6 years compared to 37.2±21.7 years among those without AKI (mean difference=6.489, p=0.079). More males th79). More males than females developed AKI (19.4% vs 16.3%, p=0.558). AKI was diagnosed in 38.5% of patients with sepsis compared to 16.9% of non-septic patients (p=0.061); in 23.9% of patients who had significant blood loss compared to 15.4% of patients without significant blood loss (p=0.128). Intensive care unit (ICU) admission was significantly commoner among patients with AKI (20% vs 7.8% p = 0.023). Mortality was 25% among patients who developed AKI compared to 7.2% in those without AKI (p=0.005) CONCLUSION Patients diagnosed with AKI had a higher mean age. Perisurgical AKI was commoner in males, patients with sepsis, and those who lost significant blood intra-operatively. ICU admission and mortality were significantly higher among patients with AKI.
Version describes the angle in the axial plane subtended by the femoral neck and the femoral shaft. Femoral version varies among various major geographic and racial populations. Femoral version plays a role in some orthopaedic operations. This study documented femoral version among Nigerians comparing two methods on dry femoral bones.

This was a prospective descriptive study that involved measurements of femoral anteversion and retroversion angles on dry femoral bones using the Kingsley Olmsted (KO) method and digital measurement using a free software, IC Measure® from imaging source (The imaging source, Europe GmbH, Uberseetor 18, 28217 Bremen. Germany) Forty-eight (48) adult dry femoral bones were measured. The results obtained from these measurements were analyzed using Stata 13 (StataCorp, Texas, USA) RESULTS The average value of anteversion angle using the Kingsley Olmsted (KO) method was 20.50 ± 5.50. The average anteversion angle using IC measure was 21.30 ± 6.00. The observed agreement was 16.67%.asty and total hip replacement in Africans.
An understanding of the natural history of colorectal polyps is relevant to the management of colorectal cancer.

To study the frequency, morphology, and histopathology of colorectal polyps in a metropolis of Niger Delta region, Nigeria.

A cross-sectional retrospective study of consecutive cases of colonoscopy performed at a referral endoscopy facility in Port Harcourt metropolis, Niger Delta region of Nigeria, from March 2014 to March 2020. Variables collated included demographics, primary indication, site, morphology and histopathology of colorectal polyps. Statistical analysis was performed using IBM SPSS version 20, Armonk. NY, USA.

A total of 496 colonoscopies were performed during the study period. The age range of patients was 4 years to 92 years (mean 54.7± 13.0). There were 357 males and 139 females. The leading primary indications for colonoscopy were gastrointestinal bleeding, routine screening for colorectal cancer and abdominal pain/discomfort in 220 (44.4%), 89 (17.9%) and 66 (13.3%) cases respectively. Colorectal polyps were recorded in 111 (22.4%) patients with a M F of 2.71 and peak incidence in the 6th decade of life 53 (47.7%) cases. Majority of the polyps were seen in the colon segments extending from rectum to splenic flexure 59 (63.4%). Inflammatory, adenomatous and hyperplastic polyps were seen in 51(50.0%), 39(38.2%) and 10(9.8%) cases respectively and a sole case of malignant polyp was recorded.

Adult colorectal polyps are seen predominantly in males above 50 years of age, and in the left colon. Tubular adenoma with low grade dysplasia is the most prevalent neoplastic polyp.
Adult colorectal polyps are seen predominantly in males above 50 years of age, and in the left colon. Tubular adenoma with low grade dysplasia is the most prevalent neoplastic polyp.
Gastric cancer develops from chronic gastritis through distinct precancerous lesions which include atrophic gastritis (AG), intestinal metaplasia (IM) and dysplasia in a sequential manner, all of which are related to Helicobacter pylori (H. pylori) infection. We determined the prevalence of H. pylori infection and the gastric premalignant conditions in a Southwestern Nigerian population with chronic gastritis.

A prospective cross-sectional study conducted on 252 adult patients with dyspepsia at a faith-based tertiary health facility in Nigeria. Gastroscopy was performed on all the participants and five gastric biopsies were taken from each of them. Standard histological examination for H. pylori, gastritis and the precancerous lesions was performed on the specimens. The biopsy sampling and histological examination were performed in line with the Updated Sydney System recommendations. We summarized data by Means ± Standard Deviation, frequencies and percentages. Associations between categorical variables were tested by means of Chi-square test or Fisher exact test as appropriate. The cutoff for statistical significance was P-value < 0.05.

A total of 78 (31.0%) subjects tested positive by histology for H. pylori infection. Of all the gastric precancerous lesions, AG had the highest prevalence [54 (21.4%)], followed by dysplasia [6 (2.4%)] and IM [3 (1.2%)]. Regarding the severity of the precancerous lesions, 47 (87.0%) subjects had mild AG while 7 (13.0%) had moderate AG. All the subjects with IM and dysplasia had mild or low-grade lesions.

The prevalence rates of gastric precancerous lesions in our study population were low.
The prevalence rates of gastric precancerous lesions in our study population were low.The global burden of chronic kidney disease (CKD) is rapidly increasing with a projection of becoming the 5th most common cause of years of life lost globally by 2040. Aggravatingly, CKD is a major cause of catastrophic health expenditure. The costs of dialysis and transplant consume up to 3% of the annual healthcare budget in high-income countries. However, the onset and progression of CKD is often preventable. In 2020, the World Kidney Day campaign highlights the importance of preventive interventions - be they primary, secondary or tertiary. This complementing article focuses on outlining and analyzing measures that can be implemented in every country to promote and advance CKD prevention. Primary prevention of kidney disease should focus on the modification of risk factors and addressing structural abnormalities of the kidney, urinary tracts, as well as the exposure to environmental risk factors and nephrotoxins. In persons with pre-existing kidney disease, secondary prevention, including blood pressure optimization and glycaemic control, should be the main goal of education and clinical interventions. In patients with advanced CKD, the management of co-morbidities such as uraemia and cardiovascular disease is a highly recommended preventive intervention to avoid or delay dialysis or kidney transplantation. Political efforts are needed to proliferate this preventive approach. While national policies and strategies for non-communicable diseases might be in place in all or every country. Also, specific policies directed toward education and awareness about CKD screening, management and treatment are often lacking. Hence, there is an urgent need to increase the awareness and importance of preventive measures among populations, professionals and policy makers.
Gastrointestinal diseases account for significant morbidity and mortality across the world. The study aims at establishing the epidemiological profile of gastrointestinal diseases in a Nigerian tertiary care center.

This is a descriptive retrospective study of all gastrointestinal specimens, submitted to the histopathology department of Delta State University Teaching Hospital (DELSUTH) for diagnosis. The age, sex, and histological diagnosis were extracted from the archives of the department. These were re-reclassified into diagnostic groups, analyzed using Excel spread sheet 2007 and summarized in tables.

The study involves 570 patients (290 males and 280 females) with gastrointestinal tract (GIT) diseases within the age range of 10 days to 99 years, and of a mean age of 48.4 years. Congenital, inflammatory, benign neoplasms, malignant neoplasms and vascular diseases accounted for 1.6%, 77.5%, 2.6%, 18.1% and 0.18% of the cases respectively. These lesions were domiciled in the esophagus (1.4%), stomachGIT cancers (colorectal and gastric cancer) being the next most common. The preponderance of GIT lesions among the productive age calls for action to ameliorate the trend. Preventive public enlightenment campaign on GIT cancer risk factors and population-based screening programmes especially for Helicobacter pylori infection and colorectal cancer is highly recommended.
To understand factors related to cervical cancer screening behaviors and factors that influence these behaviors among women living in Eswatini.

Data from the World Health Organization STEP's data - A household cross sectional survey in Eswatini in 2014 for 1217 eligible women aged 15 and above. The dependent variable was binary categorized, into two levels With or without cervical cancer screening experience and independent variables were factors related to cervical cancer screening. The binary logistic regression models were used to analyze the factors related to cervical cancer screening.

Women with cervical cancer screening experience were 15.2%. The multiple logistic regression analysis revealed that women's age, education, employment status, history of cardiovascular disease and community environment were significantly correlated with the cervical cancer screening behavior.

Screening for cervical cancer is still low among women living in Eswatini. Our findings provide a greater understanding of African women's factors related to cervical cancer screening among African countries which are age, education, employment status and environmental issues. This can particularly be attributed to the limited availability and accessibility of cervical cancer screening services among socio-economically disadvantaged populations.
Screening for cervical cancer is still low among women living in Eswatini. Our findings provide a greater understanding of African women's factors related to cervical cancer screening among African countries which are age, education, employment status and environmental issues. This can particularly be attributed to the limited availability and accessibility of cervical cancer screening services among socio-economically disadvantaged populations.
Failure of radioactive iodine therapy (RAI) in patients with hyperthyroidism is not uncommon. A Second dose is usually needed if the first one failed. The purpose of this audit was to determine the efficacy of RAI in patients with hyperthyroidism at Groote Schuur Hospital (GSH).

This was a retrospective study. A single observer reviewed the records of all patients who received I131 therapy for hyperthyroidism between 23rd April, 2010 and 23rd November, 2017 in conjunction with their pre- and post-treatment thyroid function tests. Results of their thyroid ultrasound were retrieved and documented. The images of their Tc99m sodium per-technetate thyroid scans were also retrieved and reprocessed. Cure was determined by three consecutive thyroid function tests by euthyroid or hypothyroid status 6 months after therapy.

Of the 353 patients with complete records, 310 (88%) of our patients were females and 43 (12%) were male patients. Majority (200 patients) of the patients were older than 45 years of age, 148 poiodine therapy be considered before second RAI.
Our audit showed cure rate was 68% at 6 month and 89% at a year. A second dose was indicated in 32% of patients. Patients presenting with severe thyrotoxicity are likely to require more than one RAI therapy. Further researches are suggested to find out if pre-treatment with antithyroid drugs would influence efficacy of RAI in patients with severe thyrotoxicity and would a one year follow up after radioiodine therapy be considered before second RAI.
Due to the prevailing socio-cultural and religious affiliations, Paediatricians in sub-Saharan Africa face unique ethical dilemmas. An understanding and application of the ethical principles can help prevent and resolve these dilemmas, and improve child health indices. The objective is to determine the knowledge, attitude and practical applications of non-maleficence and beneficence by child-care doctors at a Teaching Hospital.

This is a questionnaire-based study. Socio-demographics, knowledge and attitude towards the ethical principles, and its utilisation by doctors in childcare was sought. Data were analyzed using descriptive statistics.

294 doctors participated. The mean percentage knowledge score of nonmaleficence and beneficence was 31.00±21.14, significantly higher among doctors in Paediatrics (39.35±23.44, p=0.0001). For every decrease in professional rank, knowledge score decreased by 3.8224 (95% CI -5.824 - -1.819; p=0.0001). The doctors had a high mean percentage score on attitude towards ethics of 74.79±16.34, and for every increase in years of practice, attitude towards ethics score would increase by 2.922 (95% CI 1.133 to 4.711, p=0.001). There was a low practice score of 34.27±20.07. Majority (69%) encountered less than one dilemma a month. More than 90% of doctors had encountered dilemmas involving the principle of non-maleficence [184 (90.6%)], while 154 (75.9%) involved beneficence.

Most respondents have a low level of knowledge and practice of the principles of nonmaleficence and beneficence. Their excellent attitude implies their willingness at improving their knowledge and practice.
Most respondents have a low level of knowledge and practice of the principles of nonmaleficence and beneficence. Their excellent attitude implies their willingness at improving their knowledge and practice.
The successful outcome of any pregnancy depends on a well formulated and implemented ANC, which to a larger extent also depends on its functional and operational continuum of care, that is affordable, accessible and of high quality during and after pregnancy and childbirth. Defective ANC, in terms of coverage and quality, has been shown to be associated with unfavourable pregnancy outcome.

To determine the maternal and perinatal outcome(Obstetric performance) of booked and referred pregnant women who though, booked for ANC in lower health care facilities but were delivered at our facility.

The is a retrospective and cross-sectional study conducted at Olabisi Onabanjo University Teaching Hospital (OOUTH), Sagamu, Nigeria from the 1st of January 2017 to 31st of December 2018.

The booked were significantly older than the unbooked (29.4±5.0 vs 28.5±5.5; P=0.001), while 47.6% and 35.3 % were nulliparous in the study and control groups respectively. Majority of the booked (69.3%) and the unbooked (59.3%) wee mean Apgar scores at one minute were 7.0±2.0 and 4.7±3.1(P less then 0.001) for the booked and unbooked respectively while at five minutes they were 8.6±1.9 and 6.4±3.6 (P less then 0.001) for the booked and unbooked respectively and the differences were statistically significant at one and five minutes. The proportion of maternal deaths were higher among the unbooked than the booked (2.6% vs 0.4%; P less then 0.001), maternal morbidity ( 8.1% vs 2.5%; P less then 0.001) and fetal deaths (40.6% vs 6.3%; P less then 0.001) CONCLUSION In all the indices and parameters compared between the two groups the unbooked patients (control) performed poorly and this is surprising despite the huge resources extended to secondary and primary health care delivery services in Nigeria.
Bilateral primary total knee replacements (TKRs) can be performed simultaneously (under the same anaesthetic) or staged (on separate occasions). Patients who undergo simultaneous biltateral TKRs only have one anaesthetic, operation and hospital stay. This reduces overall time in pain, rehabilitation time and total days in hospital with cost-saving implications. Despite the benefits, simultaneous bilateral TKRs are not routinely performed due to fear of worse outcomes.

This paper assesses the long-term functional and general health outcomes between the two approaches.

We undertook a retrospective cohort study. Patients who underwent a bilateral TKR in our centre from 2012-2014 were included. The validated Oxford Knee and EuroQol scores were used to assess function and general health outcomes. These were assessed at baseline and 1-year along with satisfaction scores.

41 simultaneous bilateral TKRs and 43 staged bilateral TKRs met the inclusion criteria. Patients were age and sex matched. The Oxford Knee Score increase at one year was equivalent in both groups (20.1 vs. 18.1, p=0.170), suggesting no difference in long-term function. The EuroQol Score increase at one year was equivalent in both groups (0.41 vs. 0.48, p=0.350), suggesting no difference in long-term general health. Satisfaction was comparable between the two groups (88.8 vs. 86.2, p=0.52).

There is no difference in functional and general health outcomes between staged and simultaneous bilateral knee replacements. In patients with bilateral knee arthritis, simultaneous bilateral TKRs should be considered.
There is no difference in functional and general health outcomes between staged and simultaneous bilateral knee replacements. In patients with bilateral knee arthritis, simultaneous bilateral TKRs should be considered.EDITORIAL.EDITORIAL.EDITORIAL.EDITORIAL.
Instability is one of the most common complications after total hip arthroplasty (THA), particularly when using the posterior approach. Repair of the posterior capsule has proven to significantly decrease the incidence of posterior hip dislocation. The purpose of the present study is to evaluate if a racking hitch knot utilizing a 2mm braided polyblend suture provides a stronger repair of the posterior soft tissues when compared to a traditional repair utilizing a non-absorbable suture after a posterior approach to the hip.

Ten cadaveric hips from donors, who were at a mean age of 80 ± 9 years old at the time of death, were evaluated after posterior soft tissue repair utilizing two different techniques. Five specimens were repaired utilizing a racking hitch knot with a 2mm braided polyblend suture (FiberTape®, Arthrex GmbH, Naples, Florida) and five other specimens were repaired with a traditional repair using a no. 2 non-absorable suture (FiberWire®, Arthrex GmbH, Naples, Florida). Cadaveric specimens weposterior soft tissues when compared to non-absorbable suture repair following a posterior approach to the hip joint.Acute heart failure (AHF) is a complex and heterogeneous syndrome not only associated with a concerning rise in incidence, but also with still unacceptably high rates of mortality and morbidity. As this dismal outcome is at least in part due to a mismatch between the severity of AHF and the intensity of its management, both in-hospital and immediately after discharge, early and accurate risk prediction could contribute to more effective, risk-adjusted management. Biomarkers are noninvasive and highly reproducible quantitative tools that have improved the understanding of AHF pathophysiology. They can help guide the intensity of AHF management. In addition, using a statistical model to estimate risk from a combination of several predictor variables such as vital signs or demographics has gained more and more attention over recent years. In this context, the aim of a statistical model, which gives a so-called risk score, is to help clinicians to make more standardised decisions. This review highlights recent advances and remaining uncertainties regarding risk stratification in AHF by characterising and comparing the potential of biomarkers and risk scores. .
To assess neonatal transport activities by the neonatal transport teams of the University Children&rsquo;s Hospital Zurich in order to identify opportunities for improvement in the organisation of these transports.

Retrospective analysis of prospectively collected data on neonatal transports by the neonatal transport teams of the University Children&rsquo;s Hospital Zurich between January 2014 and December 2018. Data on transports affecting neonates with a corrected gestational age of up to 44 weeks and a weight less than 5 kg were extracted from registration forms, transport forms, transport reports and the neonates&rsquo; medical charts. Transport data were assessed separately for urgent, non-urgent and re-transfers.

During the study period, 1110 transport runs, including 883 (79.5%) urgent, 105 (9.5%) non-urgent and 122 (11.0%) re-transfers were performed. Ground transport accounted for 90.7% of the cases. The majority (77.7%) of the transported neonates were born at term and 59.1% were trocesses to improve preparation time should be defined and implemented in order to reduce it to less than 30 min so as to guarantee efficient care. Further studies are needed to assess the quality and efficacy of neonatal transports in Switzerland. National guidelines on the standard of neonatal transport and quality metrics should be established in order to set benchmarks and to improve the quality of the transports.
The European Society of Cardiology recommends beta-blocker prescription after ST-segment elevation myocardial infarction (STEMI). Evidence for beta-blocker indication depends on the presence of left ventricular dysfunction (left ventricular ejection fraction [LVEF] &lt;40%, class I level A; LVEF &ge;40%, class IIa level B). In clinical practice, beta-blockers should be up-titrated to target doses as long as patients tolerate them. The aim of this study was to assess the patterns of beta-blocker prescription and up-titration after STEMI for one year after hospital discharge.

This observational study included patients admitted to a tertiary hospital for STEMI between April 2014 and April 2016. Patients with beta-blocker contraindications were excluded from the study. The primary outcomes were the patterns of beta-blocker prescription at discharge and at one year post-PCI, and the evolution of beta-blocker doses over the year. Beta-blocker doses were classified as low (&lt;50% of the target dose)-blocker prescription at discharge in both LVEF groups. Finally, patients without any beta-blocker prescription at one year were more likely to have had a short university hospital stay during the index event.

Beta-blocker prescription after STEMI remains prevalent, but most doses are low and up-titration within one year is rare. This raises concern, particularly for patients with LVEFs &lt;40%. Our findings highlight the changes in clinical practice over the last few decades, which corroborate with the latest evidence-based findings.
Beta-blocker prescription after STEMI remains prevalent, but most doses are low and up-titration within one year is rare. This raises concern, particularly for patients with LVEFs <40%. Our findings highlight the changes in clinical practice over the last few decades, which corroborate with the latest evidence-based findings.
Obstructive sleep apnea (OSA) is associated with cardiovascular and cerebrovascular morbidity. Patients with sickle cell disease (SCD) are at increased risk for both neurologic complications (NC) and OSA. However, the relationship between OSA and SCD complications is unclear. We hypothesized that there would be an association between OSA diagnosis and SCD complications.

Hospital discharge records of patients with SCD aged < 19 years were obtained for the years 1997, 2000, 2003, 2006, 2009, and 2012 from the Kid's Inpatient Database. The primary outcome, NC, a composite of stroke, transient ischemic attack, and seizures. Secondary outcomes included acute chest syndrome (ACS), vaso-occlusive crisis, length of hospital stay, and inflation-adjusted cost of hospitalization. Multivariable regression was conducted to ascertain the association of OSA with primary and secondary outcomes. Analyses were adjusted for the use of noninvasive mechanical ventilation (NIMV) to determine its role as NC risk modifier.

There were 203,705 SCD discharges included in the analysis, of which 2,820 (1.4%) and 4,447 (2.2%) also included OSA and NC diagnoses. Multivariable logistic regression indicated that OSA was associated with NC (adjusted odds ratio [OR], 1.50 [95% CI 1.02-2.21], p = 0.039) and ACS (OR, 1.34 [95% CI 1.08-1.67], p = 0.009) in children with SCD. In the multivariable analysis adjusted for NIMV, the significant association between OSA and NC was no longer observed (OR, 1.39 [95% CI 0.94-2.05], p = 0.100).

OSA is associated with a 50% increase of odds of NC in children with SCD in this nationwide dataset. The use of NIMV to treat OSA may modify the risk of OSA-associated NC.
OSA is associated with a 50% increase of odds of NC in children with SCD in this nationwide dataset. The use of NIMV to treat OSA may modify the risk of OSA-associated NC.
To the best of our knowledge, we describe the first evidence in Europe of an MDR, blaNDM-4-positive Escherichia coli isolated from a food-producing animal, harboured by a novel IncFII plasmid of which we report the complete sequence.

One blaNDM-4-positive E. coli isolated in 2019 from the caecal contents of a fattening pig in Italy was in-depth characterized by combined bioinformatic analysis of Oxford Nanopore long reads and Illumina short reads, for in silico typing, determination of the blaNDM-4 genetic context and full reconstruction of the blaNDM-4-carrying plasmid.

The isolate belonged to ST641 and to the genoserotype O108H23 and tested positive for different virulence genes and plasmid replicons. The MDR phenotype of resistance to all β-lactams, carbapenems, sulfamethoxazole and trimethoprim was mediated by blaTEM-1B, blaNDM-4, sul1/sul3 and dfrA12, respectively. The blaNDM-4 gene was harboured by a novel 53 043 bp IncFII plasmid (pMOL412_FII) composed of four main genetic regions, including an Mng genomic data from different sources and geographical areas, may help to trace back and control possible plasmid-borne carbapenemase gene transmission between animals and humans and along the food chain at international level.Converting an acrylic resin removable complete prosthesis into a fixed implant-supported prosthesis to immediately load the implants can be a challenging procedure. Using acrylic resin to secure titanium interim copings intraorally may be a difficult task, and any process to facilitate this procedure may be advantageous for the clinician and the patient. This report describes a technique for facilitating the fabrication of an interim immediately loaded implant-supported fixed complete prosthesis. This technique and the materials used enabled the efficient fabrication and delivery of the prosthesis with an appropriate soft tissue surface and acrylic resin thickness without irritating newly sutured soft tissues.RNA silencing is a major mechanism of constitutive antiviral defense in plants, mediated by a number of proteins, including the Dicer-like (DCL) and Argonaute (AGO) endoribonucleases. Both DCL and AGO protein families comprise multiple members. In particular, the AGO protein family has expanded considerably in different plant lineages, with different family members having specialized functions. Although the general mode of action of AGO proteins is well established, the properties that make different AGO proteins more or less efficient at targeting viruses are less well understood. In this report, we review methodologies used to study AGO antiviral activity and current knowledge about which AGO family members are involved in antiviral defense. In addition, we discuss what is known about the different properties of AGO proteins thought to be associated with this function.
Bardet-Biedl syndrome (BBS) is a ciliopathy with a wide spectrum of symptoms due to primary cilia dysfunction, including genitourinary developmental anomalies as well as impaired reproduction, particularly in males. Primary cilia are known to be required at the following steps of reproduction function (i) genitourinary organogenesis, (ii) in fetal firing of hypothalamo-pituitary axe, (iii) sperm flagellum structure, and (iv) first zygotic mitosis conducted by proximal sperm centriole. BBS phenotype is not fully understood.

This study explored all steps of reproduction in 11 French male patients with identified BBS mutations.

BBS patients frequently presented with genitourinary malformations, such as cryptorchidism (5/11), short scrotum (5/8), and micropenis (5/8), but unexpectedly, with normal testis size (7/8). Ultrasonography highlighted epididymal cysts or agenesis of one seminal vesicle in some cases. Sexual hormones levels were normal in all patients except one. Sperm numeration was normal in 8 out of the 10 obtained samples. Five to 45% of sperm presented a progressive motility. Electron microscopy analysis of spermatozoa did not reveal any homogeneous abnormality. Moreover, a psychological approach pointed to a decreased self-confidence linked to blindness and obesity explaining why so few BBS patients express a child wish.

Primary cilia dysfunction in BBS impacts the embryology of the male genital tract, especially epididymis, penis, and scrotum through an insufficient fetal androgen production. However, in adults, sperm structure does not seem to be impacted. These results should be confirmed in a greater BBS patient cohort, focusing on fertility.
Primary cilia dysfunction in BBS impacts the embryology of the male genital tract, especially epididymis, penis, and scrotum through an insufficient fetal androgen production. However, in adults, sperm structure does not seem to be impacted. These results should be confirmed in a greater BBS patient cohort, focusing on fertility.
Physiological alterations challenge the assessment of maternal thyroid function in pregnancy. It remains uncertain how the reference ranges vary by week of pregnancy, and how the classification of disease varies by analytical method and type of thyroid function test.

Serum samples from Danish pregnant women (n = 6282) were used for the measurement of thyrotropin (TSH), total and free thyroxine (T4), total and free 3,5,3'-triiodothyronine (T3), and T-uptake using "Method A" (Cobas 8000, Roche Diagnostics). TSH and free T4 were also measured using "Method B" (ADVIA Centaur XP, Siemens Healthineers).

Pregnancy week- and method-specific reference ranges were established among thyroid antibody-negative women (n = 4612). The reference ranges were used to classify maternal thyroid function, and results were compared by analytical method and type of thyroid function test.

The reference ranges for TSH showed a gradual decrease during pregnancy weeks 4 to 14, a gradual increase was observed for total T4, total T3, and T-uptake, whereas free T4 and free T3 showed less variation. When TSH and free T4 were used, Method A classified 935 (14.9%) with abnormal thyroid function, Method B a total of 903 (14.4%), and the methods agreed on 554 individuals. When TSH and total T4 were used, 947 (15.1%) were classified with abnormal thyroid function, and classifications by either total T4 or free T4 agreed on 584 individuals.

Even when pregnancy week- and method-specific reference ranges were established, the classification of maternal thyroid dysfunction varied considerably by analytical method and type of thyroid function test.
Even when pregnancy week- and method-specific reference ranges were established, the classification of maternal thyroid dysfunction varied considerably by analytical method and type of thyroid function test.In the mammalian glutamate transporters, countertransported intracellular K+ is essential for relocating the glutamate binding site to the extracellular side of the membrane. This K+-dependent process is believed to be rate limiting for the transport cycle. In contrast, extracellular K+ induces glutamate release upon transporter reversal. Here, we analyzed potential K+ binding sites using molecular dynamics (MD) simulations and site-directed mutagenesis. Two candidate sites were identified by spontaneous K+ binding in MD simulations, one site (K1 site) overlapping with the Na1 Na+ binding site and the K2 site being localized under hairpin loop 2 (HP2). Mutations to conserved amino acid residues in these sites resulted in several transporters that were defective in K+-induced reverse transport and which bound K+ with reduced apparent affinity compared with the wild-type transporter. However, external K+ interaction was abolished in only one mutant transporter EAAC1D454A in the K1 site. Our results, for the first time, directly demonstrate effects of K1-site mutations on K+ binding, in contrast to previous reports on K+ binding sites based on indirect evidence. We propose that K+ binding to the K1 site is responsible for catalyzing the relocation step, whereas binding to the K2 site may have an as-of-yet unidentified regulatory function.Capybara (Hydrochoerus hydrochaeri) is the largest species among the extant rodents. The draft genome of capybara was sequenced with the estimated genome size of 2.6 Gb. Although capybara is about 60 times larger than guinea pig, comparative analyses revealed that the neutral evolutionary rates of the two species were not substantially different. However, analyses of 39 mammalian genomes revealed very heterogeneous evolutionary rates. The highest evolutionary rate, 8.5 times higher than the human rate, was found in the Cricetidae-Muridae common ancestor after the divergence of Spalacidae. Muridae, the family with the highest number of species among mammals, emerged after the rate acceleration. Factors responsible for the evolutionary rate heterogeneity were investigated through correlations between the evolutionary rate and longevity, gestation length, litter frequency, litter size, body weight, generation interval, age at maturity, and taxonomic order. The regression analysis of these factors showed that the model with three factors (taxonomic order, generation interval, and litter size) had the highest predictive power (R2 = 0.74). These three factors determine the number of meiosis per unit time. We also conducted transcriptome analysis and found that the evolutionary rate dynamics affects the evolution of gene expression patterns.Colorectal cancer (CRC) remains one of the leading causes of cancer-related mortality in the USA. As much as 50-60% of CRC patients develop resistance to 5-fluorouracil (5FU)-based chemotherapeutic regimens, attributing the increased overall morbidity and mortality. In view of the growing evidence that active principles in various naturally occurring botanicals can facilitate chemosensitization in cancer cells, herein, we undertook a comprehensive effort in interrogating the activity of one such botanical-andrographis-by analyzing its activity in CRC cell lines [both sensitive and 5FU resistant (5FUR)], a xenograft animal model and patient-derived tumor organoids. We observed that combined treatment with andrographis was synergistic and resulted in a significant and dose-dependent increase in the efficacy of 5FU in HCT116 and SW480 5FUR cells (P less then 0.05), reduced clonogenic formation (P less then 0.01) and increased rates of caspase-9-mediated apoptosis (P less then 0.05). The genomewide expression analysis in cell lines led us to uncover that activation of ferroptosis and suppression of β-catenin/Wnt-signaling pathways were the key mediators for the anti-cancer and chemosensitizing effects of andrographis. Subsequently, we validated our findings in a xenograft animal model, as well as two independent CRC patient-derived organoids-which confirmed that combined treatment with andrographis was significantly more effective than 5FU and andrographis alone and that these effects were in part orchestrated through dysregulated expression of key genes (including HMOX1, GCLC, GCLM and TCF7L2) within the ferroptosis and Wnt-signaling pathways. Collectively, our data highlight that andrographis might offer a safe and inexpensive adjunctive therapeutic option in the management of CRC patients.
Physical activity (PA) has been linked to a reduced risk of type 2 diabetes by reducing weight and improving insulin sensitivity. We investigated whether PA is associated with a lower incidence of latent autoimmune diabetes in adults (LADA) and whether the association is modified by genotypes of human leukocyte antigen (HLA), transcription factor 7-like 2 (TCF7L2)-rs7903146, or the fat mass and obesity-associated gene, FTO-rs9939609.

We combined data from a Swedish case-control study and a Norwegian prospective study including 621 incident cases of LADA and 3596 cases of type 2 diabetes. We estimated adjusted pooled relative risks (RRs) and 95% CI of diabetes in relation to high (≥ 30 minutes of moderate activity 3 times/week) self-reported leisure time PA, compared to sedentariness.

High PA was associated with a reduced risk of LADA (RR 0.61; CI, 0.43-0.86), which was attenuated after adjustment for body mass index (BMI) (RR 0.90; CI, 0.63-1.29). The reduced risk applied only to noncarriers of HLA-DQB1 and -DRB1 (RR 0.
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