Nnamdi Azikiwe University

The lifespan of people with severe mental illness (SMI) is shorter compared to the general population. This excess mortality is mainly due to physical illness. We report prevalence rates of different physical illnesses as well as important individual lifestyle choices, side effects of psychotropic treatment and disparities in health care access, utilization and provision that contribute to these poor physical health outcomes. We searched MEDLINE (1966 - August 2010) combining the MeSH terms of schizophrenia, bipolar disorder and major depressive disorder with the different MeSH terms of general physical disease categories to select pertinent reviews and additional relevant studies through cross-referencing to identify prevalence figures and factors contributing to the excess morbidity and mortality rates. Nutritional and metabolic diseases, cardiovascular diseases, viral diseases, respiratory tract diseases, musculoskeletal diseases, sexual dysfunction, pregnancy complications, stomatognathic diseases, and possibly obesity-related cancers are, compared to the general population, more prevalent among people with SMI. It seems that lifestyle as well as treatment specific factors account for much of the increased risk for most of these physical diseases. Moreover, there is sufficient evidence that people with SMI are less likely to receive standard levels of care for most of these diseases. Lifestyle factors, relatively easy to measure, are barely considered for screening; baseline testing of numerous important physical parameters is insufficiently performed. Besides modifiable lifestyle factors and side effects of psychotropic medications, access to and quality of health care remains to be improved for individuals with SMI.

OBJECTIVE: To evaluate the serum C-reactive protein (CRP) and lipid profile in women with pre-eclampsia. MATERIALS AND METHODS: Thirty-five women with and 35 women without pre-eclampsia, who were in the 3rd trimester of pregnancy, were enrolled in this study. Weight in kilogrammes and height in metres were measured to calculate the mean body mass index (BMI) for each group. The diastolic and systolic blood pressures were measured. Lipid profile tests and serum CRP assay were done for all patients. Total cholesterol, triglycerides (TG) and high-density lipoprotein cholesterol (HDL-C) were determined using enzymatic methods, while low-density lipoprotein cholesterol (LDL-C) was calculated using Friedewald's formula. RESULTS: The mean values of the BMI were 29.47 ± 6.90 versus 26.14 ± 2.92, of the diastolic blood pressure 109.14 ± 15.41 versus 72.29 ± 9.42 mm Hg and of the systolic blood pressure 170.57 ± 19.55 versus 120.86 ± 17.72 mm Hg for women with and without pre-eclampsia, respectively, and the differences were statistically significant (p = 0.012, p = 0.001 and p = 0.001, respectively). The biochemical analysis also indicated that the women with pre-eclampsia had a significantly higher mean serum CRP (8.57 ± 2.68 vs. 6.46 ± 2.46 mg/l, p = 0.001), TG (2.84 ± 0.45 vs. 1.87 ± 0.38 mmol/l, p = 0.001) and total cholesterol (5.59 ± 0.92 vs. 4.63 ± 0.78 mmol/l, p = 0.001) level but a lower mean HDL-C (1.10 ± 0.12 vs. 1.26 ± 0.15 mmol/l, p = 0.001) level than the controls. There was no statistical difference in the mean LDL-C values between the 2 groups (1.58 ± 0.8 vs. 1.45 ± 0.78 mmol/l, p > 0.05). CONCLUSION: Significant changes in CRP as well as TG, total cholesterol and HDL-C were associated with pre-eclampsia in these Southeastern Nigerian women.

BACKGROUND: Antibiotic resistance is currently the most serious global threat to the effective treatment of bacterial infections. Antibiotic resistance has been established to adversely affect both clinical and therapeutic outcomes, with consequences ranging from treatment failures and the need for expensive and safer alternative drugs to the cost of higher rates of morbidity and mortality, longer hospitalization, and high-healthcare costs. The search for new antibiotics and other antimicrobials continues to be a pressing need in humanity's battle against bacterial infections. Antibiotic resistance appears inevitable, and there is a continuous lack of interest in investing in new antibiotic research by pharmaceutical industries. This review summarized some new strategies for tackling antibiotic resistance in bacteria. METHODS: To provide an overview of the recent research, we look at some new strategies for preventing resistance and/or reviving bacteria's susceptibility to already existing antibiotics. RESULTS: Substantial pieces of evidence suggest that antimicrobials interact with host immunity, leading to potent indirect effects that improve antibacterial activities and may result in more swift and complete bactericidal effects. A new class of antibiotics referred to as immuno-antibiotics and the targeting of some biochemical resistance pathway components including inhibition of SOS response and hydrogen sulfide as biochemical underlying networks of bacteria can be considered as new emerging strategies to combat antibiotic resistance in bacteria. CONCLUSION: This review highlighted and discussed immuno-antibiotics and inhibition of SOS response and hydrogen sulfide as biochemical underlying networks of bacteria as new weapons against antibiotic resistance in bacteria.

As outlined in the first part of this bi-partite publication 1, individuals with severe mental illness (SMI) are at an increased risk for a large number of physical disorders that require clinical attention. People with SMI are entitled to the same standards of care as the rest of the population. However, rates of undiagnosed and untreated medical illnesses are higher in SMI individuals, compared to the general population. Despite the fact that the higher morbidity and mortality of physical illnesses in SMI patients are largely due to modifiable lifestyle risk factors 1, there is sufficient evidence that disparities not only in health care access and utilization, but also in health care provision, contribute to these poor physical health outcomes 2,3. According to one recent study, people with psychotic disorders, bipolar disorder, or major depressive disorder have greatly increased odds of reporting difficulties in accessing care (odds ratios, OR=2.5–7.0) 4. Although parity in access to and provision of health care should be conceived as a basic human right, a confluence of patient, provider, treatment and system factors has created a situation in which access to and quality of health care is problematic for individuals with SMI 5. Table 1 summarizes the barriers to the recognition and management of somatic illnesses in SMI patients. In many cases, the SMI patients’ only contact with the health service is through the mental health care team. Moreover, because of their SMI, these patients are less capable than other patients of interpreting physical signs, as well as solving their problems and caring for themselves, which places an increased responsibility on the part of mental care workers to be in the fore front for the physical health care of these patients 6. Two consensus conferences have called on mental health care providers to take responsibility for the physical health of their patients 7,8. However, despite data suggesting that the sensitization of psychiatrists to expand their tasks to include assessments of both mental and physical health in SMI patients can be improved by consensus guidelines 9, many psychiatrists still consider their primary or, even, sole function to provide clinical care in terms of psychiatric symptom control and are reluctant to monitor physical health 6. Although many barriers can be related to the patient and his/her illness, and/or to the clinician and his/her medical treatment, the reintegration of psychiatric care and general somatic services, with an ultimate goal of providing optimal services to this vulnerable patient population, seems to represent one of the most important challenges for psychiatric care today 7,10. However, this is only one part of the broader picture: 37% of 195 countries in the world do not even have a specified budget for mental health, and 25% of the countries (of the 101 countries that reported their mental health budget) spend less than 1% of their total health care budget on mental health 11. In some parts of the world, mental health resources are even poorer. In Africa and in the Western Pacific Regions, a mental health policy was found to be present in only half of the countries 12. Moreover, in developing as well as in developed countries, stigmatization, discrimination, erroneous beliefs and negative attitudes associated with SMI will have to be eliminated to achieve parity in health care access and provision. Due to differences between regions and countries (e.g., level of economic development, budgeting of health care, availability of mental health care personnel, etc.), the majority of actions should be adapted to the local needs and circumstances 7. The excess mortality rates in persons with SMI are largely due to modifiable health risk factors 1. Therefore, the monitoring and treatment of these factors should be a part of clinical routine care of the psychiatrist. Furthermore, to address the problem of suboptimal medical treatment for patients with SMI, changes need to be made in the health care system and delivery 48, wherein the psychiatrist, once again, can and should play a pivotal role. Physical health checks should focus on monitoring 49,50,51: - weight gain and obesity (body mass index, BMI; waist circumference, WC); - blood pressure; - dietary intake; - activity level and exercise; - use of tobacco and alcohol or other substances; - fasting blood levels of glucose; - fasting blood levels of lipids, especially triglycerides and high-density lipoprotein (HDL)-cholesterol; - prolactin levels (if indicated by reproductive system and/or sexual symptoms); - cardiovascular disease (CVD) risk and electrocardiographic (ECG) parameters; - dental health; - liver function tests, blood count, thyroid hormone, electrolytes (periodically, as indicated). Many of these physical health monitoring tests are simple, easy to perform and inexpensive 6,52,53,54, and therefore can/should be implemented in the health care systems of developed as well as developing countries. Moreover, even in developing countries, several of these simple and inexpensive measurements (e.g., body weight and blood pressure) can be routinely done by health workers other than doctors. Screening and assessment of physical health should begin with the patient's personal and family history, covering 40: diabetes mellitus (DM), hypertension, CVD (myocardial infarction or cerebrovascular accident, including age at onset), smoking, diet, physical activity. Secondly, as the individual components of the metabolic syndrome (MetS) (see 1) are critical in predicting the morbidity and mortality of CVD, DM, cancer and other related diseases, these, as well as some other non-metabolic parameters, should be checked at baseline and measured regularly thereafter 46,51. Concerning metabolic parameters, one should remember that drug-naïve, first-episode patients, as well as children and adolescents with psychotic disorders, are at higher risk for metabolic side effects of medications 55,56. Higher baseline values of weight and visceral fat distribution, as well as laboratory evidence of impaired glucose and lipid metabolism, have been, although not consistently, reported for these patients 57. Likewise, young drug-naïve patients of non-Caucasian ethnicity with a personal or family history of metabolic risk factors are more likely to develop metabolic side effects 57. Psychiatrists should, regardless of the medication prescribed, monitor and chart BMI and WC of every patient with SMI at every visit, and should encourage patients to monitor and chart their own weight 58. WC seems to be a more useful measurement than BMI. Prospective data in patients with impaired glucose tolerance revealed that central adiposity, having a strong correlation with insulin resistance 59, better predicted future type 2 DM than BMI 60. WC is also a stronger indicator than BMI for systolic blood pressure, HDL-cholesterol, or triglycerides 61, and has been proposed as the best single measure to identify individuals at high risk for CVD and the MetS 52. It is also a simple tool to assess the likelihood of insulin resistance: in one study, a WC <100 cm excluded insulin resistance in 98% of males and 94% of females 61. This assessment can easily be done with a simple and inexpensive waist tape measure. The International Diabetes Federation (IDF) definition (see 1) provides sex- and race-specific criteria for defining elevated WC to identify people with central obesity, thus adapting this criterion to make it also applicable to non-Caucasian populations. However, multiple studies found that WC is rarely measured 62,63,64. The other MetS criteria of blood pressure, fasting plasma glucose and fasting lipid profile should also be assessed, even if WC is normal. As the MetS components seem to cluster, the presence of one component often suggests the presence of the others. High blood pressure in SMI patients is often missed 65. As the cost for measuring blood pressure is low, and hypertension is a relevant CVD risk factor, blood pressure can/ought to be assessed routinely, even at every visit. Hypertension can be defined as a systolic blood pressure $130 mm Hg or a diastolic blood pressure $85 mm Hg 66. This diagnosis requires at least two separate, independent measurements that fall both within the range of hypertension 65. Individuals with a systolic blood pressure of 120 to 130 mm Hg or a diastolic blood pressure of 80 to 85 mm Hg should be considered as pre-hypertensive and require lifestyle modifications to prevent heart disease 67. A baseline measure of plasma glucose level should be collected for all patients before starting treatment 58. In patients starting antipsychotic (AP) treatment, finger prick tests should be carried out at baseline, 6 and 12 weeks to capture early cases of hyperglycemia and then, at minimum, yearly. Formal laboratory tests can be carried out blood glucose measurement should be in the fasting because this is the most measurement for the of developing glucose However, this can problematic to In cases patients present it is to a blood glucose than to the to 6. plasma glucose or suggests the of plasma glucose levels between and values of are of and should also assessment and However, the of need to be excluded by at least one measurement of fasting plasma the is the of fasting plasma glucose measurements needs to be increased to a to assess the of the Likewise, if fasting plasma glucose levels are or values are the of needs to be excluded by at least one measurement of fasting plasma the measurement the this should to a with an or other primary health care for assessment the glucose levels the This is as a goal for treatment but not to in early have risk factors for DM history, BMI WC critical should have their fasting plasma glucose level or at the same as other patients starting medication 6 and but thereafter need to be checked more every are or more of their baseline weight should also have their fasting plasma glucose level or more for every 58. of high should be to and often develop within and and poor weight of and in to metabolic and The of a patient with on the of the (e.g., or patients only of poor or In type 2 DM, and have been for weeks to of which can be through laboratory tests, blood glucose level and a of or triglycerides and should also be assessed at baseline and at with assessments is in of values for total are for patients DM and for patients with lipoprotein values for patients and with DM are and 65. However, the cost and of availability of this assessment not make it as a routine measure in all and patients. The patient's individual CVD risk should be his/her presence or of DM, systolic blood pressure and total or the of total to with to local or risk measurements are simple and easily In the psychiatric it is often to an as as in other medical In less well developed countries, an be even more In these cases, a is to patients should be heart as family history of early in males and in personal history of a heart of medications or or if has an of simple the measurement of as a baseline that the monitoring of patients with SMI has to be as a baseline in to assess the health As a general that every patient should have an measurement to the of on the by a monitoring can be A baseline assessment is especially important in patients with clinical risk factors for with a family history of early personal history of a heart hypertension or at heart and to have a prolactin levels should be measured in all patients at prolactin levels should only be measured in sexual or reproductive system are these need to be and system prolactin level measurement include or in and/or and in that should prolactin measurement include and/or that with antipsychotic treatment or including or problems with or In these cases, prolactin should be measured every especially the of Although the clinician needs to be that laboratory between in most prolactin values are at for and for A measurement of prolactin levels is the presence of which is but to high prolactin levels as measured by many that the presence of to in as many as of all reported of In cases measured prolactin is reporting of prolactin of can antipsychotic treatment, prolactin levels are most the of these levels is a of is the which has been associated with and The risk for cancer is less seems to be is that prolactin level that to should a treatment to a less prolactin antipsychotic (e.g., or, in patients, of the to out a should only be other for prolactin are excluded (e.g., by by thyroid hormone, and or if prolactin levels are and do not a to a risk or if are the of a Although considered by many as not health needs to be in the same as other physical health problems factors for a poor health (e.g., smoking, medication side and individual care needs should be assessed Physical and monitoring are well by patients and can be implemented in a of to general it is not to most patients to take part in the fasting blood and most are to and the of the Screening patients an monitoring 85 or risk chart is a than the more and guidelines recent both and have developed and monitoring guidelines these seem not to be routinely implemented in the clinical care of patients monitoring should be done at Physical health assessments should be on the and of the assessments compared with of treatment, it is important to measure weight to identify patients gain weight and of all patients on medication at baseline identify individuals and to early of changes in metabolic at the minimum, every guidelines and monitoring at baseline, 12 and patients gain at least of baseline body weight or are at increased risk for health outcomes (e.g., family history of DM or early personal history of or obesity, DM, the patient has central obesity, blood pressure mm plasma glucose or or DM plasma glucose or or triglycerides should be to primary care to these simple lifestyle or and/or to a risk medication can address these medical but not individuals with SMI are of the need to or do not the and to make lifestyle and other of the can and people with SMI to address their including smoking, and through the use of with SMI, as well as their family and should be and should to not need to be by a (e.g., a it require but should be by at the mental health and can be resources within the local service 6. should be and and treatment be to the individual needs of SMI patients dietary and physical activity in terms of weight gain in The on health, even with simple is A diet, physical activity and are the components of the and of modifiable risk However, if lifestyle do not including or be should be and as for the general and are well Moreover, to weight can be most evidence for to with or in Many patients with SMI do not the components of a It is that patients with have a higher in fat higher in in and poor in and Therefore, be should be to and even, as well as high high and poor as and The of as and and in a should be by Although patients well as their family and is patients need to that lifestyle changes should be people weight modifications will to their weight the likelihood of developing many are in fat and a weight in dietary can have has many that are of to SMI patients, including a in risk of DM and CVD, of triglycerides and in and in blood glucose and patients with type 2 However, that address weight management and physical activity have not a routine part of psychiatric care The can the individual with SMI in and that address the of health and which can medical in this population. as the and the for have been to be in people with SMI Table some of to the health of patients with Physical is one of the risk factors that can most easily be and in individuals with SMI People with are more than the general of these patients the health of a of at least physical activity According to the guidelines of the of and the physical activity between and a will provide weight and is in weight of physical activity a can be associated with weight Physical activity can metabolic health even in the of weight is evidence that physical activity with or is and in weight and risk profile in people with However, in patients are physical should be by to achieve weight if a patient for 1 are this is in terms of cardiovascular health, this will not in weight physical as be all these patients should be to in at least of activity least a on most of the 65. A of studies that patients, compared with the general population, have a higher of smoking, and high as well as of risk factors that make more vulnerable to to of individuals with SMI will and/or have a quality of because of a disease of is associated with a in the risk of heart disease and a in the risk of high cardiovascular Therefore, SMI patients should be to However, has important for the management of patients and of is associated with a risk of in patients levels can also found that the of patients with a plasma level increased to within the the despite Therefore, plasma levels be and made in if for at least Moreover, also the risk for In a study, an increased risk for DM that within of but was still 6 The increased risk seems to be by weight of to increased and excess Therefore, should consider (e.g., use of especially for tobacco is in patients with is evidence that people with SMI can Moreover, that in the general to be in SMI patients. The evidence also suggests that tobacco in SMI patients with psychiatric not mental although psychiatric often that a policy have a negative on the treatment this is not the Therefore, at a minimum, psychiatric should assess tobacco use in all patients, all tobacco to patients in developing a and and patients can be to a which can or other 65. blood pressure levels of less than are as smoking, weight and increased be sufficient to elevated blood pressure, although some patients are likely to require 65. guidelines the of best to the individual patient's needs health and should be to SMI patients, to their and treatment need to be to the individual needs of patients with and of mental should include dietary smoking, and side effects of and on the dietary control of and the of to the of a are to the side effects of some Psychiatrists should be made more of the of health Therefore, for in the of health risk factors as and of side effects of and on is patients with SMI need and to make use of dental are by dental care The should for do not patients and are to take care of this vulnerable population. the for of dental care should be Formal for the dental and of mental illness and medication side effects can be or to be associated with should not be for SMI patients with heart a personal history of a family history of at an early age if both or syndrome (see of and of are in patients with treatment, the SMI patient should be related to elevated as of and or patients are medications to be associated with prolactin these baseline should be at every starting the medication or the is sexual is management include the to a or sexual function by as or a should be considered prolactin is even a elevated level for more than or to a medication should be a has the of the and levels are or the patient has of a other than to an is psychiatrists should also be that even to can be the of a as a 58. there are more data on the of on and development, the clinician will to in a of individual clinical the of the is and should be made on a The and be for patient on an individual In the use of medication is indicated risk to the to this medication is by the of untreated or psychiatric illness in the require treatment should the and of with their if it is that treatment should be the will be of in this important on and should also be as part of routine mental health care Many psychiatrists are reluctant to despite the presence of physical health 6. should be to and/or medication a SMI patient of weight of or or other effects (e.g., side The should, consider the psychiatric and physical of the patient and the of both is to a to or prevent the (e.g., or to weight gain in patients DM or severe physical illness has been the SMI patient should be to services, including and to the health are at two levels of system level and health care and individual level patients, the with SMI as a health population. is still a of of the physical health and health care access problems for people with Therefore, and health care first have to identify and people with SMI as a health before the problem can be Psychiatrists can play an important in this of by the with policy and budget the health care and local should be implemented to physical health in persons with SMI and to encourage of the the health care In to mental health care also need to be in and measuring CVD health and other (e.g., health in SMI should be to primary care access to and care of physical health of the SMI population. and health care should access to and care of physical health of the SMI to and treatment of general health care have to to the physical health care needs of the SMI population. and is a and major access for people with It the of the health services and people with SMI to or to treatment and personal contact with persons with SMI can be to and should be and be implemented to access to health the between physical and mental health care and a policy of and mental and physical health care for persons with The reintegration of psychiatric care and general somatic services, with an ultimate goal of providing optimal services to this vulnerable patient population, seems to represent the most important for psychiatric care today for these service and provide for the health assessment and service In developing countries this to be or responsibility for the physical health of the SMI there is a provision of general somatic health care services for SMI patients, the should responsibility for the somatic health of his/her patients. has to a on the as SMI patients not the problem is or not be of physical monitoring and have been the patient's personal and family history at baseline to identify patients and to early of changes in critical patients with a personal or family history of obesity, high blood pressure, DM, heart disease or cerebrovascular accident, or with high or values on metabolic with risk of effects should be of the health of SMI patients should include monitoring of blood pressure, fasting plasma fasting lipids, smoking, physical diet, and sexual health, as well as effects of the an monitoring or risk chart the patient's This is a and better than the more and guidelines to monitor the physical health of the SMI weight gain of glucose or other effects consider to medications with risk higher to risk medications has been to cardiovascular and risk factors but needs to be done in a and monitoring to the primary care and services, including and that people with SMI have been to be at risk of developing CVD and/or DM be People with SMI have CVD and/or DM should be in primary stronger with these medical and other health care and physical care of patients with SMI has the of their physical health care outcomes should to develop at the of primary care SMI patients, to and erroneous as well as the of the psychiatrist, to better monitor and physical illness in SMI patients. care should be include of services a primary health care to mental health services, with between primary care and mental health is in the physical health of with having one service on a or to between services and the care for the a of health workers including medical as well as psychiatrists lifestyle modifications and treatment for SMI patients. and should be and to the SMI population. to encourage and the patient's to medical and personal and individual responsibility in patients with SMI, to make for and their individual (e.g., the and to people with SMI to more of their a range of and health including patient and likelihood of primary care medical services The of these in Table health care systems the world on local will contribute to a in the medical and related psychiatric health of patients with The improved physical health outcomes in SMI patients will both patients and This will and and physical health care that and patients with physical illnesses on the presence and effects of psychiatric changes in the monitoring and management of physical disorders that do not have to be can make a in this and patient The of this is part of the and has been by the the of and

Monkeypox is a zoonotic disease caused by monkeypox virus (MPXV), which is a member of orthopoxvirus genus. The reemergence of MPXV in 2017 (at Bayelsa state) after 39 years of no reported case in Nigeria, and the export of travelers' monkeypox (MPX) from Nigeria to other parts of the world, in 2018 and 2019, respectively, have raised concern that MPXV may have emerged to occupy the ecological and immunological niche vacated by smallpox virus. This review X-rays the current state of knowledge pertaining the infection biology, epidemiology, and evolution of MPXV in Nigeria and worldwide, especially with regard to the human, cellular, and viral factors that modulate the virus transmission dynamics, infection, and its maintenance in nature. This paper also elucidates the role of recombination, gene loss and gene gain in MPXV evolution, chronicles the role of signaling in MPXV infection, and reviews the current therapeutic options available for the treatment and prevention of MPX. Additionally, genome-wide phylogenetic analysis was undertaken, and we show that MPXV isolates from recent 2017 outbreak in Nigeria were monophyletic with the isolate exported to Israel from Nigeria but do not share the most recent common ancestor with isolates obtained from earlier outbreaks, in 1971 and 1978, respectively. Finally, the review highlighted gaps in knowledge particularly the non-identification of a definitive reservoir host animal for MPXV and proposed future research endeavors to address the unresolved questions.

Abstract Heavy metals are potential health risk, especially in mining sites where they deteriorate from sulfide-rich ore bodies. Lead, cadmium, arsenic and mercury are very carcinogenic, while others are toxic. The assessment of the levels of these metals in water resources of the lead–zinc mining communities of Enyigba, Mkpuma Akpatakpa, Ameka, Amorie, Amanchara and Alibaruhu was carried out, and the potential health risk has been investigated. These areas make up the main mining communities of Abakaliki, where active and abandoned mines are located. One hundred and six water samples were analyzed in two seasons using atomic absorption spectrophotometric and ultra-violet/visible spectroscopy. Result indicates levels of Pb 2+ &gt; Hg 2+ &gt; As 2+ &gt; Cd 2+ &gt; Mn 2+ &gt; Ag 2+ &gt; Se 2+ &gt; Ni 2+ &gt; Cr 2+ &gt; Cu 2+ in water sources. High levels of Mn 2+ (63.45 mg/L), Pb 2+ (11.42 mg/L), Cr 3+ (14.60 mg/L), Ni 2+ (1.260), Cd 2+ (15.67 mg/L), Ag + (6.06 mg/L), Hg 2+ (2.60 mg/L), As(4.13 mg/L), Se 2+ (2.68 mg/L), Zn 2+ (10.53 mg/L) and Co 2+ (0.9 mg/L) above the WHO recommended standard for drinking water were observed. Only Cu 2+ recorded safe concentrations in 100% samples analyzed. Levels of associated metals including Pb 2+ , As, Hg 2+ , Se 2+ and Cd 2+ are higher in groundwater especially in areas close to the active mines; this is due to mineralization in the area. Seasonal analysis shows a decreased concentration of chemical constituents in the rainy season relative to the dry season. Potential health risk is associated with accumulation of toxic heavy metals in tissues including Parkinson disease, arsenicosis, acrodynia, selenoises, Alzheimer’s disease, hair loss, mental imbalance and abortion in women abound in the areas. Alternative water supply sources and sensitization on the potential health risk are highly advocated in these communities.

BACKGROUND: For more than three decades, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) has provided a framework to quantify health loss due to diseases, injuries, and associated risk factors. This paper presents GBD 2023 findings on disease and injury burden and risk-attributable health loss, offering a global audit of the state of world health to inform public health priorities. This work captures the evolving landscape of health metrics across age groups, sexes, and locations, while reflecting on the remaining post-COVID-19 challenges to achieving our collective global health ambitions. METHODS: The GBD 2023 combined analysis estimated years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs) for 375 diseases and injuries, and risk-attributable burden associated with 88 modifiable risk factors. Of the more than 310 000 total data sources used for all GBD 2023 (about 30% of which were new to this estimation round), more than 120 000 sources were used for estimation of disease and injury burden and 59 000 for risk factor estimation, and included vital registration systems, surveys, disease registries, and published scientific literature. Data were analysed using previously established modelling approaches, such as disease modelling meta-regression version 2.1 (DisMod-MR 2.1) and comparative risk assessment methods. Diseases and injuries were categorised into four levels on the basis of the established GBD cause hierarchy, as were risk factors using the GBD risk hierarchy. Estimates stratified by age, sex, location, and year from 1990 to 2023 were focused on disease-specific time trends over the 2010-23 period and presented as counts (to three significant figures) and age-standardised rates per 100 000 person-years (to one decimal place). For each measure, 95% uncertainty intervals [UIs] were calculated with the 2·5th and 97·5th percentile ordered values from a 250-draw distribution. FINDINGS: Total numbers of global DALYs grew 6·1% (95% UI 4·0-8·1), from 2·64 billion (2·46-2·86) in 2010 to 2·80 billion (2·57-3·08) in 2023, but age-standardised DALY rates, which account for population growth and ageing, decreased by 12·6% (11·0-14·1), revealing large long-term health improvements. Non-communicable diseases (NCDs) contributed 1·45 billion (1·31-1·61) global DALYs in 2010, increasing to 1·80 billion (1·63-2·03) in 2023, alongside a concurrent 4·1% (1·9-6·3) reduction in age-standardised rates. Based on DALY counts, the leading level 3 NCDs in 2023 were ischaemic heart disease (193 million [176-209] DALYs), stroke (157 million [141-172]), and diabetes (90·2 million [75·2-107]), with the largest increases in age-standardised rates since 2010 occurring for anxiety disorders (62·8% [34·0-107·5]), depressive disorders (26·3% [11·6-42·9]), and diabetes (14·9% [7·5-25·6]). Remarkable health gains were made for communicable, maternal, neonatal, and nutritional (CMNN) diseases, with DALYs falling from 874 million (837-917) in 2010 to 681 million (642-736) in 2023, and a 25·8% (22·6-28·7) reduction in age-standardised DALY rates. During the COVID-19 pandemic, DALYs due to CMNN diseases rose but returned to pre-pandemic levels by 2023. From 2010 to 2023, decreases in age-standardised rates for CMNN diseases were led by rate decreases of 49·1% (32·7-61·0) for diarrhoeal diseases, 42·9% (38·0-48·0) for HIV/AIDS, and 42·2% (23·6-56·6) for tuberculosis. Neonatal disorders and lower respiratory infections remained the leading level 3 CMNN causes globally in 2023, although both showed notable rate decreases from 2010, declining by 16·5% (10·6-22·0) and 24·8% (7·4-36·7), respectively. Injury-related age-standardised DALY rates decreased by 15·6% (10·7-19·8) over the same period. Differences in burden due to NCDs, CMNN diseases, and injuries persisted across age, sex, time, and location. Based on our risk analysis, nearly 50% (1·27 billion [1·18-1·38]) of the roughly 2·80 billion total global DALYs in 2023 were attributable to the 88 risk factors analysed in GBD. Globally, the five level 3 risk factors contributing the highest proportion of risk-attributable DALYs were high systolic blood pressure (SBP), particulate matter pollution, high fasting plasma glucose (FPG), smoking, and low birthweight and short gestation-with high SBP accounting for 8·4% (6·9-10·0) of total DALYs. Of the three overarching level 1 GBD risk factor categories-behavioural, metabolic, and environmental and occupational-risk-attributable DALYs rose between 2010 and 2023 only for metabolic risks, increasing by 30·7% (24·8-37·3); however, age-standardised DALY rates attributable to metabolic risks decreased by 6·7% (2·0-11·0) over the same period. For all but three of the 25 leading level 3 risk factors, age-standardised rates dropped between 2010 and 2023-eg, declining by 54·4% (38·7-65·3) for unsafe sanitation, 50·5% (33·3-63·1) for unsafe water source, and 45·2% (25·6-72·0) for no access to handwashing facility, and by 44·9% (37·3-53·5) for child growth failure. The three leading level 3 risk factors for which age-standardised attributable DALY rates rose were high BMI (10·5% [0·1 to 20·9]), drug use (8·4% [2·6 to 15·3]), and high FPG (6·2% [-2·7 to 15·6]; non-significant). INTERPRETATION: Our findings underscore the complex and dynamic nature of global health challenges. Since 2010, there have been large decreases in burden due to CMNN diseases and many environmental and behavioural risk factors, juxtaposed with sizeable increases in DALYs attributable to metabolic risk factors and NCDs in growing and ageing populations. This long-observed consequence of the global epidemiological transition was only temporarily interrupted by the COVID-19 pandemic. The substantially decreasing CMNN disease burden, despite the 2008 global financial crisis and pandemic-related disruptions, is one of the greatest collective public health successes known. However, these achievements are at risk of being reversed due to major cuts to development assistance for health globally, the effects of which will hit low-income countries with high burden the hardest. Without sustained investment in evidence-based interventions and policies, progress could stall or reverse, leading to widespread human costs and geopolitical instability. Moreover, the rising NCD burden necessitates intensified efforts to mitigate exposure to leading risk factors-eg, air pollution, smoking, and metabolic risks, such as high SBP, BMI, and FPG-including policies that promote food security, healthier diets, physical activity, and equitable and expanded access to potential treatments, such as GLP-1 receptor agonists. Decisive, coordinated action is needed to address long-standing yet growing health challenges, including depressive and anxiety disorders. Yet this can be only part of the solution. Our response to the NCD syndemic-the complex interaction of multiple health risks, social determinants, and systemic challenges-will define the future landscape of global health. To ensure human wellbeing, economic stability, and social equity, global action to sustain and advance health gains must prioritise reducing disparities by addressing socioeconomic and demographic determinants, ensuring equitable health-care access, tackling malnutrition, strengthening health systems, and improving vaccination coverage. We live in times of great opportunity. FUNDING: Gates Foundation and Bloomberg Philanthropies.

Safety assessment of chemicals, pharmaceuticals, food and food ingredients, cosmetics, industrial products is very crucial prior to their approval for human uses. Since the commencement of toxicity testing (about 500 years ago, since 1520), significant advances have been made with respect to the 3Rs (reduction, refinement and replacement) alternative approaches. This review is focused on the update in acute systemic toxicity testing of chemicals. Merits and demerits of these advances were also highlighted. Traditional LD50 test methods are being suspended while new methods are developed and endorsed by the regulatory body. Based on the refinement and reduction approaches, the regulatory body has approved fixed dose procedure (FDP), acute toxic class (ATC) method and up and down procedure (UDP) which involves few numbers of animals. In terms of replacement approach, the regulatory body approved 3T3 neutral red uptake (NRU), the normal human keratinocyte (NHK), and the 3T3 neutral red uptake (NRU) phototoxicity test for acute phototoxicity. However, other promising replacement alternatives such as organ on chip seeded with human cells for acute systemic toxicity and 3T3 neutral red uptake (NRU) cytotoxicity test for identifying substances not requiring classification, as well as the in silico approaches are yet to receive regulatory approval. With this backdrop, a collaborative effort is required from the academia, industries, regulatory agencies, government and scientific organizations to ensure speedily regulatory approval of the prospective alternatives highlighted.

African traditional medicine is a form of holistic health care system organized into three levels of specialty, namely divination, spiritualism, and herbalism. The traditional healer provides health care services based on culture, religious background, knowledge, attitudes, and beliefs that are prevalent in his community. Illness is regarded as having both natural and supernatural causes and thus must be treated by both physical and spiritual means, using divination, incantations, animal sacrifice, exorcism, and herbs. Herbal medicine is the cornerstone of traditional medicine but may include minerals and animal parts. The adjustment is ok, but may be replaced with –‘ Herbal medicine was once termed primitive by western medicine but through scientific investigations there is a better understanding of its therapeutic activities such that many pharmaceuticals have been modeled on phytochemicals derived from it. Major obstacles to the use of African medicinal plants are their poor quality control and safety. Traditional medical practices are still shrouded with much secrecy, with few reports or documentations of adverse reactions. However, the future of African traditional medicine is bright if viewed in the context of service provision, increase of health care coverage, economic potential, and poverty reduction. Formal recognition and integration of traditional medicine into conventional medicine will hold much promise for the future.

The majority of mosquito-borne illness is spread by a few mosquito species that have evolved to specialize in biting humans, yet the precise causes of this behavioral shift are poorly understood. We address this gap in the arboviral vector Aedes aegypti. We first collect and characterize the behavior of mosquitoes from 27 sites scattered across the species' ancestral range in sub-Saharan Africa, revealing previously unrecognized variation in preference for human versus animal odor. We then use modeling to show that over 80% of this variation can be predicted by two ecological factors-dry season intensity and human population density. Finally, we integrate this information with whole-genome sequence data from 375 individual mosquitoes to identify a single underlying ancestry component linked to human preference. Genetic changes associated with human specialist ancestry were concentrated in a few chromosomal regions. Our findings suggest that human-biting in this important disease vector originally evolved as a by-product of breeding in human-stored water in areas where doing so provided the only means to survive the long, hot dry season. Our model also predicts that the rapid urbanization currently taking place in Africa will drive further mosquito evolution, causing a shift toward human-biting in many large cities by 2050.

To review studies on hypertension in Nigeria over the past five decades in terms of prevalence, awareness and treatment and complications. Following our search on Pubmed, African Journals Online and the World Health Organization Global cardiovascular infobase, 1060 related references were identified out of which 43 were found to be relevant for this review. The overall prevalence of hypertension in Nigeria ranges from 8%-46.4% depending on the study target population, type of measurement and cut-off value used for defining hypertension. The prevalence is similar in men and women (7.9%-50.2% vs 3.5%-68.8%, respectively) and in the urban (8.1%-42.0%) and rural setting (13.5%-46.4%).The pooled prevalence increased from 8.6% from the only study during the period from 1970-1979 to 22.5% (2000-2011). Awareness, treatment and control of hypertension were generally low with attendant high burden of hypertension related complications. In order to improve outcomes of cardiovascular disease in Africans, public health education to improve awareness of hypertension is required. Further epidemiological studies on hypertension are required to adequately understand and characterize the impact of hypertension in society.

AIM: This study examined the influence of toxic and transformational leadership practices on nurses' job satisfaction, psychological distress, absenteeism and intent to leave the organisation or the nursing profession. BACKGROUND: Transformational leadership is attributed to favourable nurse consequences; however, the nursing literature is silent regarding the causal association between toxic leadership and nurses' job outcomes. METHODS: This is a cross-sectional study involving 770 registered nurses from 15 hospitals in Central Philippines. Data were collected using seven self-report scales during the months of December 2019 to February 2020. RESULTS: The composite scores for the transformational leadership scale and toxic leadership scale were 4.22 and 1.59, respectively. Toxic leadership predicted job satisfaction, absenteeism, psychological distress and intention to leave the profession. Transformational leadership predicted job satisfaction and intent to leave the profession. CONCLUSION: Results suggest that nurses working with a transformational leader report higher job contentment and lower intent to leave the nursing profession. Nurses who work for a manager exhibiting toxic leadership behaviours demonstrated lower job contentment, higher stress levels, frequent absenteeism and higher intent to leave the nursing profession. IMPLICATION FOR NURSING MANAGEMENT: Nurse retention strategies should include measures to foster transformational leadership and derail toxic leadership practices in nurse managers through evidence-based education, training and professional development.

Adsorption as a technique is preferred to these other methods in the mitigation of methyl orange (MO) because of its simplicity in design and operation, indifferent sensitivity towards toxicants and low operational cost. This study is aimed at evaluating the performance of various adsorbent groups in the mitigation of MO from aqueous solutions. It will help reduce the arbitrary choice of adsorbent types for MO adsorption leading to a reduction in the amount of published literature with little/incremental contributions to the field. The study was based on an analysis of over 240 published works of literature on the subject within the last 5 years. The adsorbents were classified into the following seven groups based on their chemical composition; biosorbents, activated carbon, biochar, clays and minerals, polymers and resins, nanoparticles, and composites. In terms of frequency of utilisation of adsorbent group, composites were the most frequently used (>40%). It was observed that nanoparticles and polymers were the most frequently used constituents in the manufacture of composite adsorbents for MO. The choice of nanoparticles in composite adsorbents could be due to their flexibility in going into the matrices of other material types due to their small sizes. Polymers also act as good matrices for immobilising other composite constituents. Nanoparticles was the best adsorbent group for MO uptake. Clays and minerals had the greatest proportion of adsorbents with MO uptake capacity greater than the 1000 ​mg/g threshold.

Abstract Access to drinkable water is becoming more and more challenging due to worldwide pollution and the cost of water treatments. Water and wastewater treatment by adsorption on solid materials is usually cheap and effective in removing contaminants, yet classical adsorbents are not sustainable because they are derived from fossil fuels, and they can induce secondary pollution. Therefore, biological sorbents made of modern biomass are increasingly studied as promising alternatives. Indeed, such biosorbents utilize biological waste that would otherwise pollute water systems, and they promote the circular economy. Here we review biosorbents, magnetic sorbents, and other cost-effective sorbents with emphasis on preparation methods, adsorbents types, adsorption mechanisms, and regeneration of spent adsorbents. Biosorbents are prepared from a wide range of materials, including wood, bacteria, algae, herbaceous materials, agricultural waste, and animal waste. Commonly removed contaminants comprise dyes, heavy metals, radionuclides, pharmaceuticals, and personal care products. Preparation methods include coprecipitation, thermal decomposition, microwave irradiation, chemical reduction, micro-emulsion, and arc discharge. Adsorbents can be classified into activated carbon, biochar, lignocellulosic waste, clays, zeolites, peat, and humic soils. We detail adsorption isotherms and kinetics. Regeneration methods comprise thermal and chemical regeneration and supercritical fluid desorption. We also discuss exhausted adsorbent management and disposal. We found that agro-waste biosorbents can remove up to 68–100% of dyes, while wooden, herbaceous, bacterial, and marine-based biosorbents can remove up to 55–99% of heavy metals. Animal waste-based biosorbents can remove 1–99% of heavy metals. The average removal efficiency of modified biosorbents is around 90–95%, but some treatments, such as cross-linked beads, may negatively affect their efficiency.

• The cost of adsorbent preparation and usage was reviewed (2016 – 2022). • A quantitative metric the adsorbent cost performance, Ĉ (in $/mol) was developed. • Adsorbents at 〈 1 $/mol are relatively cheap while those 〉 200 $/mol are expensive. • Cost analysis can extend the practical relevance of routine adsorption studies . The cost of adsorbent preparation and usage is an important factor that determines its suitability for use in wastewater treatment in light of other competing technologies. Adsorbent cost can be determined via the cost of raw materials, discounted cash flow, cost indices, cost of adsorbent per gram of the adsorbate removed, Annual Capital Expenditure (CAPEX) and Operating Expenditures (OPEX), and the cost of adsorbent application in an adsorption operation. The need to unify the various concepts of adsorbent cost of different researchers and the evaluation of how the process efficiency affects the process cost prompted the need for this study. This paper aimed to review the cost of using different adsorbents for treating wastewater. It also developed a quantitative metric for comparing adsorbent costs known as the “adsorbent cost performance,” termed as Ĉ (and computed in $/mol). This was elucidated as the dollar cost of producing and using 1 g of an adsorbent for the removal of 1 mole of a chemical species in the aqueous phase, considered at the theoretical point of maximum uptake of the chemical species. There is a wide variation in adsorbent cost performance, but most adsorbents fall between 1 and 200 $/mol. Adsorbents at < 1 $/mol threshold can be considered very cheap for the intended application, while those at > 200 $/mol can be considered very expensive. More investigations into adsorbent cost analysis are encouraged, especially in routine adsorption studies, to help extend the practical relevance of these papers.

The use of vaccines have resulted in a remarkable improvement in global health. It has saved several lives, reduced treatment costs and raised the quality of animal and human lives. Current traditional vaccines came empirically with either vague or completely no knowledge of how they modulate our immune system. Even at the face of potential vaccine design advance, immune-related concerns (as seen with specific vulnerable populations, cases of emerging/re-emerging infectious disease, pathogens with complex lifecycle and antigenic variability, need for personalized vaccinations, and concerns for vaccines' immunological safety -specifically vaccine likelihood to trigger non-antigen-specific responses that may cause autoimmunity and vaccine allergy) are being raised. And these concerns have driven immunologists toward research for a better approach to vaccine design that will consider these challenges. Currently, immunoinformatics has paved the way for a better understanding of some infectious disease pathogenesis, diagnosis, immune system response and computational vaccinology. The importance of this immunoinformatics in the study of infectious diseases is diverse in terms of computational approaches used, but is united by common qualities related to host-pathogen relationship. Bioinformatics methods are also used to assign functions to uncharacterized genes which can be targeted as a candidate in vaccine design and can be a better approach toward the inclusion of women that are pregnant into vaccine trials and programs. The essence of this review is to give insight into the need to focus on novel computational, experimental and computation-driven experimental approaches for studying of host-pathogen interactions and thus making a case for its use in vaccine development.

Sugarcane (Saccharum officinarum) bagasse (SCB) is a biomass of agricultural waste obtained from sugarcane processing that has been found in abundance globally. Due to its abundance in nature, researchers have been harnessing this biomass for numerous applications such as in energy and environmental sustainability. However, before it could be optimally utilised, it has to be pre-treated using available methods. Different pre-treatment methods were reviewed for SCB, both alkaline and alkali-acid process reveal efficient and successful approaches for obtaining higher glucose production from hydrolysis. Procedures for hydrolysis were evaluated, and results indicate that pre-treated SCB was susceptible to acid and enzymatic hydrolysis as > 80% glucose yield was obtained in both cases. The SCB could achieve a bio-ethanol (a biofuel) yield of > 0.2 g/g at optimal conditions and xylitol (a bio-product) yield at > 0.4 g/g in most cases. Thermochemical processing of SCB also gave excellent biofuel yields. The plethora of products obtained in this regard have been catalogued and elucidated extensively. As found in this study, the SCB could be used in diverse applications such as adsorbent, ion exchange resin, briquettes, ceramics, concrete, cement and polymer composites. Consequently, the SCB is a biomass with great potential to meet global energy demand and encourage environmental sustainability.

Wastewaters from chemical industries are characterized by the presence of heavy metallic ions, chemical contaminant and turbidity. Exposure to lead (Pb), for example, is recognized as a major risk factor for several human diseases, and the structure of industrial ecological systems have made exposure to Pb unavoidable for most people alive today. The removal of these toxic metals and contaminants from industrial wastewater is a matter of great interest in the field of water pollution, which is a serious cause of water degradation. Coagulation-flocculation is a widely used method for wastewater treatment especially if the wastewater is discharged into surface water. Coagulation/flocculation is a commonly used process in water and wastewater treatment in which compounds such as ferric chloride and/or polymer are added to wastewater in order to destabilize the colloidal materials and cause the small particles to agglomerate into larger settle able flocs. Therefore, the futuristic use as well as the present demerits of this process is necessary for the treatment of effluents.

The application of artificial neural network (ANN), response surface methodology (RSM), and adaptive neuro-fuzzy inference system (ANFIS) in modeling the uptake of Eriochrome black-T (EBT) dye from aqueous solution using Nteje clay was the focus of this work. Acid activation with hydrochloric acid (HCl) was used to prepare the adsorbent while Fourier transform infrared spectroscopy (FTIR) and scanning electron microscopy (SEM) were utilized in the characterization of the adsorbent. The ANN, RSM, and ANFIS models were analyzed by considering the adsorbent dosage, contact time, solution temperature, and pH of the adsorption process. Sensitivity analyses involving six statistical error functions were further used to compare the acceptability of the models. Four mechanistic models (Weber and Morris, Film diffusion, Bangham, and Dummwald-Wagner models) were used to determine the mechanism of the EBT uptake. The result showed that the activation process enhanced the adsorption capacity of the clay. The ANFIS, ANN, and RSM models gave a high accuracy in predicting the adsorption of the EBT dye with correlation coefficients of 0.9920, 0.9910, and 0.9541, respectively. Further statistical indices lent credence to ANFIS as the best predictive model and RSM the least in adsorption of EBT dye. Process optimization using genetic algorithm gave optimum adsorption efficiency of 95.8%. Mechanistic modeling indicated film diffusion as the rate-limiting mechanism. The maximum amount of EBT adsorbed was 24.04 mg/g. The HCl-modified clay could be utilized as an efficient adsorbent in EBT uptake from wastewater.

Cellulose nanocrystals isolated from water hyacinth fiber (WHF) have been studied as a reinforcement for polyvinyl alcohol (PVA)-gelatin nanocomposite. Central composite design was used to study and optimize effects of the PVA, gelatin and cellulose nanocrystal (CNC) concentration on tensile strength and elongation of formed films. The results of this study showed that WHF CNC had a diameter range of 20–50 nm produced films reaching 13.8 MPa tensile strength. Thermal stability of the films was improved from 380 °C to 385 °C in addition of CNCs and maximum storage modulus of 3 GPa were observed when 5 wt% CNC was incorporated. However, water absorption, water vapour permeability (WVP) and moisture uptake of the films decreased in addition of CNC to the PVA-gelatin blends. Moisture uptake decreased from 22.50% to 19.05% while the least WVP when 10 wt% CNC added was 1.64 × 10–6 g/(m•h•Pa). These results show possibility for industrial application of WHF CNC and PVA-gelatin blends in biodegradable films for on-the-go food wrappers.