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Human Papilloma Virus, Risk Factors and Sequelae: How much do Female Adolescents in Port Harcourt Metropolis know?
No full textBackground: Human Papilloma virus (HPV) infection is the most common viral infection of the genital tract; is sexually transmitted with the highest rates observed in young women. This study assessed the level of knowledge of HPV and cervical cancer among adolescent girls in Port Harcourt metropolis, Nigeria.
Methodology: A cross-sectional survey among 328 in-school female secondary school students aged 9 - 19 years, selected via multi-stage sampling. Information on socio-demographics, knowledge of HPV and cervical cancer and sexual history were collected using a self-administered, semi-structured questionnaire. Data was analyzed using SPSS version 23 and Chi square test was used to establish associations.
Results: Only 38.2% and 30% had heard of cervical cancer and HPV respectively; the media being the most common source. Knowledge of transmission, risk factors, sequelae and prevention of infection was poor (75%). About 20.2% were aware of the causal association between HPV infection and cervical cancer. Some (3.1%) were sexually exposed and practiced unprotected sexual intercourse. Median age at sexual debut was 11 years. Older and private school students (15- 19years) had better knowledge.
Conclusion: The level of knowledge of HPV, cervical cancer, their association and risk factors, among adolescent girls in Port Harcourt metropolis is poor. Some adolescents engage in sexual practices that put them at risk for HPV infection. Social media and upper primary and secondary school-based approach to HPV health promotion should be explored to provide detailed adolescent-friendly information to guide in prevention of HPV infection and cervical cancer 
Inclusion of licuri cake in high-grain diets for steers: Intake, digestibility, carcass characteristics, and meat quality
No full textA high-grain diet is essential to maximize growth and yield as well as to provide high-quality meat in beef cattle. This study evaluated the effects of including licuri cake in high-grain diets for steers on performance and carcass and meat quality. Forty-four crossbred (1/2 Bos taurus × 1/2 Bos indicus) castrated steers at 24 months of age, with an initial weight of 358.19 ± 41.57 kg, were used. The animals were distributed into four treatments that consisted of diets including licuri cake (0, 85, 170, or 255 g/kg, dry matter basis). Dry matter intake and digestibility decreased with the inclusion of licuri cake in the diet. However, the addition of the ingredient did not influence the intakes of total digestible nutrients (6.7 ± 0.5 kg/day) or crude protein. Licuri cake inclusion did not influence weight gain (1.5 ± 0.2 kg/day) or hot carcass weight (255.1 ± 24.9 kg). There was also no effect on carcass fat thickness, whereas the cholesterol content in the meat decreased with the addition of the cake. We recommend the inclusion of up to 255 g/kg licuri cake in the diet of feedlot steers fed high-concentrate diets
Influence of feeding on different types of pasture on the fatty acid profile and health indices of goat milk
No full textThe main objective of the present research was to study the change in fatty acid (FA) composition of milk fat in a Carpathian local breed during grazing on two plots characterized by a different cover with herbaceous species and woody (only herbaceous species: H and high woody species cover: W) allowances with or without concentrate supplementation (Cs: 500 g concentrate/head/d). Thus, four treatments resulted: H-U: only herbaceous species-unsupplemented, H-Cs: only herbaceous species-concentrate supplementation, W-U: high woody species-unsupplemented, W-Cs: high woody species-concentrate supplementation. Individual milk production (n = 10) was recorded daily, and milk samples were collected weekly for a seven-week period (June to August) and analysed for fat, protein, lactose, urea-N, and FAs. Milk production was not influenced by the type of pasture. The daily production of milk, 3.5% fat-corrected milk, and protein level increased and the content of fat and urea-N reduced with concentrate supplementation, whereas the content of lactose was similar. The botanical composition of pasture markedly influenced the FA profile of goat milk fat. The goats grazing in scrubland (W group) produced milk fat with higher concentrations of monounsaturated FA (C18:1 t11, vaccenic acid, VA) and polyunsaturated FA (omega 3 and conjugated linoleic acid, CLA) and lower concentrations of hypercholesterolaemic FA (HFA; C12:0 + C14:0 + C16:0). Regardless of the botanical composition of the pasture, milk fat of unsupplemented grazed goats had the lowest proportion of HFA, as well as the highest proportions of C18:1 c9, VA, RA (rumenic acid, C18:2 c9,t11), and total n-3 FA compared to the Cs groups (supplemented with concentrate). Concentrate supplementation increased short-chain FA and saturated FA content. In contrast, percentages of the nutritionally desirable FA (C18:3 c9, c12, c15; C18:2 c9, t11, C18:1 t11; C20:5n-3; C22:5n-3, and total n-3 FA) were substantially lower, whereas levels of total n-6 FA, n-6:n-3 ratio, atherogenicity index (AI), and thrombogenicity index (TI) were substantially higher in milk from Cs groups. No interactions occurred between pasture type and concentrate supplementation for milk FA composition. It is concluded that the milk from goats kept unsupplemented on the natural pasture were better in terms of nutraceutical parameters advantageous to human nutrition than the milk produced by concentrate supplementation
Predictors of mortality and survival probability distribution among patients on tuberculosis treatment in Vihiga County, Kenya
No full textBackground: Tuberculosis (TB) related mortality remains a serious impediment in ending TB epidemic.
Objective: To estimate survival probability and identify predictors, causes and conditions contributing to mortality among TB patients in Vihiga County.
Methods: A cohort of 291 patients from 20 purposively selected health facilities were prospectively considered. Data was obtained by validated questionnaires through face-to-face interviews. Survival probabilities were estimated using Kaplan-Meier method while Cox proportional hazard model identified predictors of TB mortality through calculation of hazard ratios at 95% confidence intervals. Mortality audit data was qualitatively categorized to elicit causes and conditions contributing to mortality.
Results: 209 (72%) were male, median age was 40 (IQR=32-53) years while TB/HIV coinfection rate was 35%. Overall, 45 (15%) patients died, majority (78% (log rank<0.001)) during intensive phase. The overall mortality rate was 32.2 (95% CI 23.5 - 43.1) deaths per 1000 person months and six months’ survival probability was 0.838 (95% CI, 0.796-0.883). Mortality was higher (27%) among HIV positive than HIV negative (9%) TB patients. Independent predictors of mortality included; comorbidities (HR = 2.72, 95% CI,1.36–5.44, p< 0.005), severe illness (HR=5.06, 95% CI,1.59–16.1, p=0.006), HIV infection (HR=2.56, 95%CI,1.28–5.12, p=0.008) and smoking (HR=2.79, 95% CI,1.01–7.75, p=0.049). Independent predictors of mortality among HIV negative patients included; comorbidities (HR = 4.25, 95% CI; 1.15-15.7, p = 0.03) and being clinically diagnosed (HR = 4.8, 95% CI; 1.43-16, P = 0.01) while among HIV positive; they included smoking (HR = 4.05, 95% CI;1.03-16.0, P = 0.04), severe illness (HR = 5.84, 95% CI; 1.08-31.6, P = 0.04), severe malnutrition (HR = 4.56, 95% CI; 1.33-15.6, P = 0.01) and comorbidities (HR = 3.04, 95% CI; 1.03-8.97, p = 0.04). More than a half (52%) of mortality among HIV positive were ascribed to advancedHIV diseases while majority of (72%) of HIV negative patients died to TB related lung disease. Conditions contributing to mortality were largely patient and health system related.
Conclusion: Risk of TB mortality is high and is attributable to comorbidities, severe illness, HIV and smoking. Causes and conditions contributing to TB mortality are multifaceted but modifiable. Improving TB/HIV care could reduce mortality in this setting.
Keywords: TB mortality; survival distributions; treatment outcomes; Vihiga
The influence of delayed sample processing time on PO2 values in critically ill patients with sepsis-induced leucocytosis
Full text linkBackground: The extent of error, from collection to processing, when measuring PO2, PCO2 and pH in arterial blood samples drawn from critically ill patients with sepsis and leucocytosis, is unknown.Methods: Twenty-nine patients with sepsis and a leucocyte count > 12 000/mm3, who had routine arterial blood analysis were included in the study. Blood was drawn into two 1 ml heparinised glass syringes. One syringe was cooled on ice and tested at 60 minutes. The other syringe was used for analysis at 0, 10, 30 and 60 minutes. Differences in measurements, from the Time-0 results, were described. For PO2, linear mixed models estimated the impact of time to processing, controlling for the potentially confounding and moderating effects of Time-0 leucocyte count and fractional inspired oxygen concentration respectively.Results: PO2 exhibited the most pronounced changes over time at ambient temperature: The mean (SD) relative differences at 10, 30 and 60 minutes were -4.72 (8.82), -13.66 (10.25), and -25.12 (15.55)% respectively; and mean (SD) absolute differences -0.88 (1.49), -2.37 (1.89) and -4.32 (3.06) kPa. For pH, at 60 minutes, the mean (SD) relative and absolute differences were -0.27 (0.45)% and -0.02 (0.03) respectively; for PCO2, 6.16 (7.80)% and 0.25 (0.35) kPa. The median differences for the on-ice 60-minute sample for pH and PCO2 were 0.019 and -0.12 (both P < 0.001), and for PO2 0.100 (P: 0.216). The model estimated that average PO2 decreased by 5% per 10 minute delay in processing (95% CI for effect: 0.94 to 0.96; P < 0.001) at the average leucocyte count, with more rapid declines at higher counts, though with substantial inter-patient variation.Conclusion: Delayed blood gas analysis in samples stored at ambient temperature results in a statistically and clinically significant progressive decrease in arterial PO2, which may alter clinical decision-making in septic patients
Risk factors and interventions associated with mortality or survival in adult COVID-19 patients admitted to critical care: a systematic review and meta-analysis
Full text linkBackground: Patients with confirmed COVID-19 admitted to intensive care units have a high mortality rate, which appears to be associated with increasing age, male sex, smoking history, hypertension and diabetes mellitus.Methods: A systematic review to determine risk factors and interventions associated with mortality/survival in adult patients admitted to an intensive care unit (ICU) with confirmed COVID-19/SARS-CoV-2 infection. The protocol was registered with PROSPERO (CRD42020181185).Results: The search identified 483 abstracts between 1 January and 7 April 2020, of which nine studies were included in the final review. Only one study was of low bias. Advanced age (odds ratio [OR] 11.99, 95% confidence interval [CI] 5.35–18.62) and a history of hypertension were associated with mortality (OR 4.17, 95% CI 2.90–5.99). Sex was not associated with mortality. There was insufficient data to assess the association between other comorbidities, laboratory results or critical care risk indices and mortality. The critical care interventions of mechanical ventilation (OR 6.25, 95% CI 0.75–51.93), prone positioning during ventilation (OR 2.06, 95% CI 0.20–21.72), and extracorporeal membrane oxygenation (ECMO) (OR 8.00, 95% CI 0.69, 92.33) were not associated with mortality. The sample size was insufficient to conclusively determine the association between these interventions and ICU mortality. The need for inotropes or vasopressors was associated with mortality (OR 6.36, 95% CI 1.89–21.36).Conclusion: The studies provided little granular data to inform risk stratification or prognostication of patients requiring intensive care admission. Larger collaborative research is needed to address this limitation
