Infection Prevention and Control: Baseline Knowledge and Practices of TBAs in Rural Kano, Northwestern Nigeria

BACKGROUND

Maternal infections remain a significant contributor to maternal mortality worldwide. Majority of births in northern Nigeria occur at home and are attended by Traditional Birth Attendants (TBAs). Little has been documented about their knowledge and practice on infection prevention and control practices in Kano, northern Nigeria.

OBJECTIVES

This study evaluated the level as well as factors associated with TBAs' infection prevention and control knowledge and practices.

METHODS

The study is the baseline phase of a quasi-experimental study, conducted in a rural LGA in Kano State, Nigeria. Using an adapted tool, 163 eligible TBAs were surveyed. Knowledge and practice of IPC were scored, aggregated, and dichotomized into good or poor. Binary logistic regression analysis was used to predict knowledge and practice of IPC.

RESULTS

Majority (79.1%) of the TBAs exhibited poor IPC knowledge but many (78.5%) reported good practice. Good knowledge of IPC was predicted by the TBAs' age: a six-fold increased likelihood (AOR=6.25, 95% CI: 1.02- 38.53) and almost five-fold increased likelihood (AOR=4.75, 95% CI: 1.39- 16.24) for those in their second and fourth decades of life. TBAs who reported poor practice of IPC were 83% less likely (AOR=0.17, 95% CI: 0.03- 0.92) to have good knowledge of IPC. TBAs' practice was only linked to previous training (AOR=0.17, 95% CI: 0.04- 0.76).

CONCLUSION

TBAs knowledge of IPC was low although reported practice was good. The need for tailored training interventions to enhance knowledge and skills for safe delivery care is paramount to improve maternal and neonatal outcomes.

Drive for muscularity and tendencies of muscle dysmorphia among Pakistani bodybuilders: A prevalence study

OBJECTIVE

To assess the relationship between drive for muscularity and muscle dysmorphic tendencies in Pakistani bodybuilders.

METHODS

The cross-sectional study was conducted in Lahore, Pakistan, from June to September 2017, and comprised male bodybuilders in their early and middle adulthood. Data was collected using an indigenous Drive for Muscularity Inventory and the Body Dysmorphic Disorder factors of the Yale-Brown Obsessive Compulsive Scale. Data was analysed using SPSS 21.

RESULTS

There were 211 subjects with a mean age of 26.25±5.946 years. There was a positive relationship between drive for muscularity and tendencies of muscle dysmorphia (p<0.05). Of the total, 130(62%) bodybuilders had a moderate level of drive for muscularity. Unmarried bodybuilders aged 18-25 years had more drive for muscularity compared to married bodybuilders age 26 years and above (p<0.001).

CONCLUSIONS

The drive for muscularity and muscle dysmorphic tendencies were found prevalent in Pakistani culture.

COVID-19 survivors and neuropsychological issues: A way forward

Background: This brief article focuses on highlighting the importance of possible neuropsychological manifestations among the Coronavirus Disease 19 (COVID-19) survivors. Studies have evidenced that like other Coronaviruses, COVID-19 is highly contagious and also responsible for the development of mild to severe respiratory symptoms. As COVID-19 is a recently emerged pandemic that has resulted in more than six hundred thousand deaths around the globe as of July 2020 and most of the researches has focused on the physical manifestations. Purpose: The purpose of this review article was to highlight the importance of COVID-19 infection in perspective to mental health in those patients who are survived. Methodology: For this purpose, an intensive literature review was conducted through different scientific search engines including PubMed, Google Scholars, Science Direct, etc. Results and Conclusion: There is very limited data available on manifestations including psychological and neuropsychological. Studies have shown that viral infections including viruses from Coronaviridae have been implicated in the nervous system including the brain. So, it is important to investigate the post-COVID-19 infection in neuropsychological aspects. Such studies will highlight the importance of post-COVID-19 complications and will also help in redesigning the treatment plan for mental health. Keywords: COVID-19, neuropsychological issues, mental health, Coronavirus Disease 19 Survivors, depression, anxiety, stress Citation: Rafiq M, Bashir U, Hasnain J. COVID-19 survivors and neuropsychological issues: A way forward. Anaesth. pain intensive care 2020;24(5):

Development and Validation of Neuro-Cognitive Assessment Battery for Stroke Patients (NCABS) in Pakistan

Background & Objective:

Post Stroke Cognitive Impairments (PSCI) occur frequently in stroke survivors resulting in devastating consequences affecting daily living of survivors. Currently, there exists scarcity of sound assessment tools for the evaluation of PSCI as most of the commonly used scales offer a number of clinical (requires motor and linguistic skills) and cultural limitations (requires academic exposure). Therefore, current study was aimed at evaluating the efficacy of Neuro-Cognitive Assessment Battery for Stroke patients (N-CABS) in Pakistan.

Methods:

The participants were randomized in two groups including clinical and non-clinical group. N-CABS was administered on 61 clinical and 60 non-clinical participants (mean age=45 years; SD=5.55). Both groups were matched on all demographic variables including; age, gender, education and occupation. The psychometric properties of N-CABS were established through a number of robust measures of validity (construct, concurrent and discriminant validity) and reliability (internal consistency and test retest reliability).

Results:

The factor analysis suggested a two-factor solution (labeled as Verbal Cognitive Abilities and Visual Cognitive Abilities) for N-CABS explaining 67% of total variance. A significant test-retest reliability was found (α = 0.92, ^***p<0.001). The findings of concurrent validity recommended a significant correlation between N-CABS and Montreal Cognitive Assessment (MoCA) (α = 0.82, ^***p<0.001). Similarly, discriminant validity also revealed significant group differences to exist on N-CABS (^***p<0.001) suggesting N-CABS be able to discriminate between patients and healthy controls.

Conclusion:

The results of the current study favor N-CABS as a psychometrically strong screening instrument to screen PSCI in our culture.

First Report of Leaf Spot of Rice Caused by Alternaria arborescens in Pakistan

Rice (Oryza sativa) is one of the most profitable and popular cereal crops in Pakistan. In July 2012, symptoms consisting of circular, black, necrotic spots, 2 to 4 mm in diameter, were observed on leaves of a commonly grown rice cultivar, Basmati-198, in private rice fields at Lahore (Punjab). This disease was observed later on rice cultivar KSK-133 grown at Faisalabad (Punjab) during the same cropping season. Disease incidence was ~35% and 25% for Basmati-198 and KSK-133, respectively. To our knowledge, the pathogen was confined only in these areas and cultivars and was not present on other rice varieties or crops. Ten infected plants were selected randomly from each field of two rice cultivars and one infected leaf for each of the 10 infected plants was selected for the isolation of fungal pathogen. Necrotic lesions were cut into pieces of ~2 mm², surface-disinfected with 0.5% sodium hypochlorite, placed on 2% malt extract agar (MEA) (Sigma, Dorset, UK), and incubated at 25 ± 2°C for 4 to 5 days. Emerging fungal colonies were transferred aseptically to fresh MEA petri plates for purification. Alternaria spp. were consistently recovered from infected leaves. Three isolates per variety were selected for detailed morphological studies. Each isolate was grown at 25°C on MEA and potato carrot agar (PCA) for 7 days. All isolates displayed similar morphological features including black radiate, floccose colonies with irregular margins, 6 to 7 cm in diameter on MEA and 2 to 3 cm with 1 to 2 pairs of concentric growth rings on PCA. Conidial chains were not crowded with 1 to 10 conidia per branch and bearing several lateral branches. Conidiophores were tapering and narrow, 40 to 200 × 2 μm. Conidia were ovoid within a size range of 10 to 30 × 5 to 14 μm, with 1 to 5 transverse and 1 longitudinal septum. Conidial color darkens from a dull tan to a medium brown as the culture matures. Based on morphology, the pathogen was identified as Alternaria arborescens (1). A pure culture of the pathogen was deposited in First Fungal Culture Bank of Pakistan (FCBP) with accession FCBP1351. Identification based on morphology was verified by sequencing the internal transcribed spacer (ITS) region. For this, a DNA fragment of ~650 bp was amplified using total genomic DNA as template and ITS1 and ITS4 primers (2). The nucleotide sequence of the ITS region was submitted to GenBank under accession KF679683. Comparison of the sequence with those in GenBank revealed that the sequence was 99% identical with A. arborescens, isolate ALT-242 (KC415808), causing Eucalyptus leaf spot in India and strain STE-U4345 (AF404667), a causal pathogen of apple core rot in South Africa. Pathogenicity testing was performed on both cultivars. One-month-old plants grown in greenhouse were sprayed with 10 ml of spore suspension (2 × 10⁵ spores/ml) as well as 10 ml of this spore suspension in soil at the time of sowing. Control plants were sprayed with sterilized water. The plants were covered with plastic bags for 48 h and kept under observation for 2 weeks in a glasshouse at 30 ± 2°C. Lesions appeared on leaves after 10 days of inoculation whereas control plants remained healthy. Pathogenicity tests were repeated in triplicate. Similar disease symptoms and re-isolation of A. arborescens fulfilled Koch's postulates. To our knowledge, this is the first report of A. arborescens leaf spot of rice in Pakistan. At present, the distribution of this disease is limited to the fields where it was observed. References: (1) E. G. Simmons. Alternaria: An Identification Manual. CBS, Fungal Biodiversity Center Utrecht, The Netherlands, 2007. (2) T. J. White et al. Page 315 in: PCR Protocols: A Guide to Methods and Applications. Academic Press, San Diego, CA, 1990.

Response to the meningococcal meningitis epidemic (MME) at Aminu Kano Teaching Hospital, Kano (2008-2009)

In December 2008 an outbreak of Meningococcal Meningitis swept across sub Saharan Africa with Nigeria, especially its northern states worst affected. The management of Aminu Kano Teaching Hospital constituted an Emergency Preparedness & Response (EPR) committee. Over the course of 18 weeks from 5 January 2009 to 15 May 2009, AKTH managed 222 cases of suspected meningitis with 14 deaths (case fatality rate [CFR] of 6.3%). Twenty three per cent (23%) were microbiologically proven as meningococcal meningitis while 9% were confirmed to be pneumococcal meningitis. Male to female ratio was 1:1 with most patients (81%) aged below 14 years. The epidemic peaked in weeks 10 and 13 with 38 admissions in the respective weeks. Meningococcemia with purpura fulminans, post meningitic immune complex cutaneous vasculitis and polyarthritis were observed. Control measures instituted included provision of free ceftriaxone, chemoprophylaxis to contacts, vaccines to staff/families, and creation of dedicated isolation wards. Clinical management guidelines were developed and hospital staffs were also enlightened. Lessons learnt included the difficulty of discriminating between nosocomial transmission and community clusters; relative increase in pneumococcal meningitis during the epidemic; unreliability of penicillin/chloramphenicol; the utility of internet for communication; and the inadequacy of vaccines to meet staff & public demand.