4 research outputs found
Comparative Evaluation of Conventional Cytology, Liquid-Based Cytology and Cell Block Technique for Cytopathological Analysis of Pleural Aspirates : Comparative evaluation of cytological methods
No full textObjective: To compare the diagnostic accuracy, practicality, and utility of conventional cytology (CC), liquid-based cytology (LBC), and cell block (CB) techniques in the cytopathological evaluation of pleural aspirates, aiming to determine the most effective method for diagnosing pleural effusion (PE), particularly in distinguishing between benign and malignant conditions.
Methods: A cross-sectional descriptive study involving sixty-eight patients aged over 18 years with non-traumatic pleural effusion confirmed by clinical evaluation and chest X-ray was conducted at Nnamdi Azikiwe University Teaching Hospital from January 31, 2020, to January 31, 2022. Pleural fluid samples were processed using three cytological techniques: CC, LBC, and CB. The slides were evaluated and categorized into five diagnostic categories: non-diagnostic, negative for malignancy, atypia of undetermined significance, suspicious for malignancy, and malignant. Statistical analysis was performed using SPSS version 22.
Results: The study included 40 males (58.8%) and 28 females (41.2%), with a mean age of 51.6 ± 17.12 years. Malignant effusions were observed in 23 patients (33.8%). The CB technique demonstrated superior performance with a sensitivity of 82.6%, specificity of 88.9%, and an accuracy of 1. In contrast, LBC showed a sensitivity of 65.2% and specificity of 55.6%, while CC had the lowest sensitivity (17.4%) and specificity (51.1%). The CB method also achieved the highest negative predictive value (NPV = 1), outperforming LBC (NPV = 0.956) and CC (NPV = 0.852).
Conclusion: The CB technique was found to be the most reliable method for the cytopathological evaluation of pleural aspirates, exhibiting the highest sensitivity, specificity, and diagnostic accuracy. The study highlights the importance of selecting advanced cytological methods such as CB to enhance diagnostic precision in clinical practice, particularly in the differentiation of malignant from benign pleural effusions
Effectiveness of Treatment Outcomes of Public Private Mix Tuberculosis Control Program in Eastern Nigeria
No full textEffective tuberculosis treatment has been shown to have significant effect on the control of tuberculosis. Completion of treatment of active cases is therefore the most important priority of tuberculosis control programmes. Descriptive statistics with a retrospective cohort study design used to analyze secondary data set (2007-2010) of patients accessing TB-DOTS treatment in two facilities (Nnamdi Azikiwe University Teaching Hospital, NAUTH and Department of Health Services Tuberculosis and Leprosy Control Unit Nnewi North Local Government Area (L.G.A.) Secretariat, DHSTLCU ) as public health facilities and other two facilities ( Immaculate Heart of Catholic Church Hospital, IHCCH and Diocesan Anglican Communion Hospital, DACH) as private health facilities in Nnewi North L.G.A., Anambra State. Gender of patients were male: female 54%(1016 patients) : 46% (883 patients) and 53%(63 patients) : 47%(56 patients) in public and private health facilities respectively . Using WHO (1996) standards the health facilities adjudged as efficient were: in 2007, private facilities using the indicator of treatment failure rate; private facilities using the indicator of death rate; public facilities and private facilities using the indicator of transfer-out rate ; public facilities using the indicator of treatment completion rate. In 2008, effective health facilities were: private health facilities using the indicator of failure rate; public and private health facilities using the indicator of transfer-out rate; private facilities using the indicator of treatment completion rate. In 2009, effective health facilities were public and private health facilities using indicator of treatment failure rate; public and private health facilities using the indicator of death rate; public and private facilities using the indicator of transfer out; public and private facilities using the indicator of treatment completion rate. In 2010, effective health facilities were: private health facilities using the indicator of cure rate; private facilities using the indicator of death rate ; public and private facilities using the indicator of transfer-out; public facilities using the indicator of treatment completion rate. In conclusion, private health facilities were more effective than public health facilities by the several indicators over the four year period. Future research is needful to use primary and secondary data sets in assessment of TB control program effectiveness; technical efficiency assessment using non-parametric statistics will assess the validity of assessing effectiveness using only the WHO standards; identify centre-specific factors associated with poor treatment outcome; institutionalizing a reward system for effective TB-DOTS facilities will engender healthy competition in the Public Private Mix for sustained effectiveness; the Monitoring and Evaluation tools especially the treatment card for data capture should be improved upon for comprehensiveness of patients socio-economic history. Keywords: Tuberculosis, Effectiveness, Treatments Outcomes, Public Private Mi
A New Form of Authoritarianism? Rethinking Military Politics in Post-1999 Nigeria
No full textDespite the vast research that has been done on the Nigerian military, virtually all of these studies have failed to critically examine the accepted role of the military in the democratising phase. This is important because the relationship between the political elite and the military in post-military authoritarian states guarantees either democratic consolidation, or its reversal. In Nigeria, despite an appearance of significant progress in subordinating the military institution to democratic civilian authority, the military remains a crucial political actor in the polity. It appears that the military has yet to accept the core democratic principles of civilian oversight of the institution. This thesis, therefore, explores whether a new form of military authoritarianism is emerging in Nigeria, with the aim of understanding Nigeria’s military behaviour in a transitional phase, from prolonged military authoritarianism to democratisation. To examine this military behaviour, Alfred Stepan’s concept of military prerogatives that was used to understand the military’s behaviour in a transitional phase in Latin America is applied to Nigeria.
A crucial understanding of authoritarianism in Nigeria is initially discussed in this study using mainly document analysis strategy to examine whether multi-ethnic states, such as Nigeria, tend to have authoritarian systems. Six hypotheses form the core analysis of this thesis: first, that the military has retained significant military prerogatives; second, that retired military officers are gaining influential political and economic positions; third, autonomous military involvement in human rights abuses since 1999; and fourth, that civilian government oversight remains weak, and facilitates military authoritarianism. These hypotheses are primarily analysed using the elite interview technique. During the first half of 2011, the author conducted field research where serving and retired military officers were interviewed. The fifth hypothesis is that the military has intervened in politics post-1999. The examination of this hypothesis relies primarily on key security-related media reports (mostly newspaper editorials) on the military after 1999. The examination of the final hypothesis, that increases in military expenditures might facilitate a new form of military authoritarianism, relies primarily on descriptive statistical analysis. In addition, this study collated relevant historical materials that relate to the military, utilising national archival collections.
The empirical findings of this research did not identify a new form of military authoritarianism in Nigeria. The study, however, argues that the unrestricted institutional framework accorded the military has contributed significantly to authoritarian practices in the post-military era in Nigeria. This study discovered that there were similarities between the Brazilian and Nigerian militaries in regard to their military spending during their period in power. Both countries had lower defence budgets. Just as in Brazil, it appears that part of the reason the Nigerian military decided to relinquish power in 1999 had to do with its desire to gain a higher budget, something that was precluded in a military government struggling to retain a sense of legitimacy. The military needed a higher budget to modernise and re-professionalise its institution after more than a decade in power. This feature, which the Nigerian military shares with the Brazilian military, appears to justify the application to Nigeria of Alfred Stepan’s concept of military prerogatives.
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Global, regional, and national incidence and mortality burden of non-COVID-19 lower respiratory infections and aetiologies, 1990-2021: a systematic analysis from the Global Burden of Disease Study 2021
No full textBackground Lower respiratory infections (LRIs) are a major global contributor to morbidity and mortality. In 2020-21, non-pharmaceutical interventions associated with the COVID-19 pandemic reduced not only the transmission of SARS-CoV-2, but also the transmission of other LRI pathogens. Tracking LRI incidence and mortality, as well as the pathogens responsible, can guide health-system responses and funding priorities to reduce future burden. We present estimates from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 of the burden of non-COVID-19 LRIs and corresponding aetiologies from 1990 to 2021, inclusive of pandemic effects on the incidence and mortality of select respiratory viruses, globally, regionally, and for 204 countries and territories.
Methods We estimated mortality, incidence, and aetiology attribution for LRI, defined by the GBD as pneumonia or bronchiolitis, not inclusive of COVID-19. We analysed 26 259 site-years of mortality data using the Cause of Death Ensemble model to estimate LRI mortality rates. We analysed all available age-specific and sex-specific data sources, including published literature identified by a systematic review, as well as household surveys, hospital admissions, health insurance claims, and LRI mortality estimates, to generate internally consistent estimates of incidence and prevalence using DisMod-MR 2.1. For aetiology estimation, we analysed multiple causes of death, vital registration, hospital discharge, microbial laboratory, and literature data using a network analysis model to produce the proportion of LRI deaths and episodes attributable to the following pathogens: Acinetobacter baumannii, Chlamydia spp, Enterobacter spp, Escherichia coli, fungi, group B streptococcus, Haemophilus influenzae, influenza viruses, Klebsiella pneumoniae, Legionella spp, Mycoplasma spp, polymicrobial infections, Pseudomonas aeruginosa, respiratory syncytial virus (RSV), Staphylococcus aureus, Streptococcus pneumoniae, and other viruses (ie, the aggregate of all viruses studied except influenza and RSV), as well as a residual category of other bacterial pathogens.
Findings Globally, in 2021, we estimated 344 million (95% uncertainty interval [UI] 325-364) incident episodes of LRI, or 4350 episodes (4120-4610) per 100 000 population, and 2.18 million deaths (1.98-2.36), or 27.7 deaths (25.1-29.9) per 100 000. 502 000 deaths (406 000-611 000) were in children younger than 5 years, among which 254 000 deaths (197 000-320 000) occurred in countries with a low Socio-demographic Index. Of the 18 modelled pathogen categories in 2021, S pneumoniae was responsible for the highest proportions of LRI episodes and deaths, with an estimated 97.9 million (92.1-104.0) episodes and 505 000 deaths (454 000-555 000) globally. The pathogens responsible for the second and third highest episode counts globally were other viral aetiologies (46.4 million [43.6-49.3] episodes) and Mycoplasma spp (25.3 million [23.5-27.2]), while those responsible for the second and third highest death counts were S aureus (424 000 [380 000-459 000]) and K pneumoniae (176 000 [158 000-194 000]). From 1990 to 2019, the global all-age non-COVID-19 LRI mortality rate declined by 41.7% (35.9-46.9), from 56.5 deaths (51.3-61.9) to 32.9 deaths (29.9-35.4) per 100 000. From 2019 to 2021, during the COVID-19 pandemic and implementation of associated nonpharmaceutical interventions, we estimated a 16.0% (13.1-18.6) decline in the global all-age non-COVID-19 LRI mortality rate, largely accounted for by a 71.8% (63.8-78.9) decline in the number of influenza deaths and a 66.7% (56.6-75.3) decline in the number of RSV deaths.
Interpretation Substantial progress has been made in reducing LRI mortality, but the burden remains high, especially in low-income and middle-income countries. During the COVID-19 pandemic, with its associated non-pharmaceutical interventions, global incident LRI cases and mortality attributable to influenza and RSV declined substantially. Expanding access to health-care services and vaccines, including S pneumoniae, H influenzae type B, and novel RSV vaccines, along with new low-cost interventions against S aureus, could mitigate the LRI burden and prevent transmission of LRI-causing pathogens. Copyright (c) 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license
