BackgroundBy September 2014, an outbreak of Ebola Viral Disease (EVD) in West African countries of Guinea, Liberia, Sierra Leone, Senegal and Nigeria, had recorded over 4500 and 2200 probable or confirmed cases and deaths respectively. EVD, an emerging infectious disease, can create fear and panic among patients, contacts and relatives, which could be a risk factor for psychological distress. Psychological distress among this subgroup could have public health implication for control of EVD, because of potential effects on patient management and contact tracing. We determined the Prevalence, pattern and factors associated with psychological distress among survivors and contacts of EVD and their relatives.MethodsIn a descriptive cross sectional study, we used General Health Questionnaire to assess psychological distress and Oslo Social Support Scale to assess social support among 117 participants who survived EVD, listed as EVD contacts or their relatives at Ebola Emergency Operation Center in Lagos, Nigeria. Factors associated with psychological distress were determined using chi square/odds ratio and adjusted odds ratio.ResultsThe mean age and standard deviation of participants was 34 +/ - 9.6 years. Of 117 participants, 78 (66.7 %) were females, 77 (65.8 %) had a tertiary education and 45 (38.5 %) were health workers. Most frequently occurring psychological distress were inability to concentrate (37.6 %) and loss of sleep over worry (33.3 %). Losing a relation to EVD outbreak (OR = 6.0, 95 % CI, 1.2–32.9) was significantly associated with feeling unhappy or depressed while being a health worker was protective (OR = 0.4, 95 % CI, 0.2–0.9). Adjusted Odds Ratio (AOR) showed losing a relation (AOR = 5.7, 95 % CI, 1.2–28.0) was a predictor of “feeling unhappy or depressed”, loss of a relation (AOR = 10.1, 95 % CI, 1.7–60.7) was a predictor of inability to concentrate.ConclusionsSurvivors and contacts of EVD and their relations develop psychological distress. Development of psychological distress could be predicted by loss of family member. It is recommended that psychiatrists and other mental health specialists be part of case management teams. The clinical teams managing EVD patients should be trained on recognition of common psychological distress among patients. A mental health specialist should review contacts being monitored for EVD for psychological distress or disorders.
Objectives Acute kidney injury (AKI) is common in very low birth weight infants (VLBW) and is associated with increased mortality. Serum creatinine (SCr) based AKI definitions have many limitations. Non-invasive urinary biomarkers may improve early identification, differentiate etiology, and predict outcomes with AKI. Study Design We performed 2 nested case-control studies to compare the ability of six urine biomarkers to predict AKI (rise in SCr of at least 0.3 mg/dl) and mortality (death before 36 weeks post-menstrual age). Results Compared to non-AKI subjects (N=21), those with AKI (N=9) had higher maximum neutrophil gelatinase-associated lipocalin (NGAL) [OR = 1.2 (1.0, 1.6) p< 0.01; ROC AUC = 0.80] and higher maxiumum osteopontin (OPN) [OR = 3.2 (1.5, 9.9); p< 0.01; ROC AUC = 0.83]. Compared to survivors (N=100), non-survivors (N=23) had higher maximum kidney injury molecule – 1 (KIM-1) [OR = 1.1 (1.0, 1.2); p<0.02; ROC AUC = 0.64]and higher maximum OPN [OR = 1.8 (1.2, 2.7); p<0.001; AUC of ROC = 0.78]. Combination of biomarkers improved predictability for both AKI and mortality. Controlling for gestational age and, birth weight did not considerably affect results. Conclusions Urinary biomarkers can predict AKI and mortality in VLBW infants independent of gestational age and birth weight.
Summaryobjective To investigate the association between birth outcomes and blood levels of aflatoxin B 1 (AFB1)-lysine adduct in pregnant women in Kumasi, Ghana.method A cross-sectional study of 785 pregnant women attending antenatal clinic was conducted. Aflatoxin B 1 (AFB 1 )-lysine adduct levels were determined by high performance liquid chromatography (HPLC) on blood taken after delivery. The birth outcomes considered were small for gestation age, low birthweight, preterm delivery and stillbirth. Participants were divided into quartiles based on the distribution of aflatoxin B 1 -lysine adducts in pg ⁄ mg albumin ('low': £2.67, 'moderate': >2.67 to £4.97, 'high': >4.97 to £11.34, 'very high': >11.34). Statistical analysis involved models that included sociodemographic variables and other potential confounders.results The average AFB 1 -lysine adduct level in maternal serum was 10.9 ± 19.00 pg ⁄ mg albumin (range = 0.44-268.73 pg ⁄ mg). After adjusting for socio-demographic variables and potential confounding factors, participants in the highest AFB 1 -lysine quartile with 'very high' AFB 1 -lysine level (>11.34 pg ⁄ mg) were more likely to have low birthweight babies (OR, 2.09; 95% CI, 1.19-3.68), and showed a trend of increasing risk for low birthweight (P trend = 0.007) compared to participants in the lowest quartile.conclusion This study adds to the growing body of evidence that aflatoxins may increase the risk of adverse birth outcomes. The findings have implications for targeted nutritional education of pregnant women in areas with high levels of aflatoxin contamination of foods.
International air travel has already spread Ebola virus disease (EVD) to major cities as part of the unprecedented epidemic that started in Guinea in December 2013. An infected airline passenger arrived in Nigeria on July 20, 2014 and caused an outbreak in Lagos and then Port Harcourt. After a total of 20 reported cases, including 8 deaths, Nigeria was declared EVD free on October 20, 2014. We quantified the impact of early control measures in preventing further spread of EVD in Nigeria and calculated the risk that a single undetected case will cause a new outbreak. We fitted an EVD transmission model to data from the outbreak in Nigeria and estimated the reproduction number of the index case at 9.0 (95% confidence interval [CI]: 5.2-15.6). We also found that the net reproduction number fell below unity 15 days (95% CI: 11-21 days) after the arrival of the index case. Hence, our study illustrates the time window for successful containment of EVD outbreaks caused by infected air travelers.
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