Cognizance and mitigation of falsified immunization documentation: Analyzing the consequences for public health in Nigeria, with a focus on counterfeited COVID-19 vaccination cards: A case report.

Background and Aims: The global immunization campaign against COVID-19 has mandated vaccination certificates, leading to a surge in fake documentation. In Nigeria, the proliferation of counterfeit COVID-19 vaccination cards, facilitated by unscrupulous health workers, raises critical public health concerns. This research spotlights various forms of this malpractice, analyzes the factors contributing to the circulation of fake vaccination cards, their implications on public health, and provides recommendations for addressing the issue. Methods: Extensive literature review and analysis were conducted to investigate the emergence of fake COVID-19 vaccination cards in Nigeria. Perspectives from health workers and reports from reputable undercover investigations were examined to identify factors contributing to the circulation of fraudulent records. The research also delved into corruption within the health sector and the impact of low salaries on healthcare workers. Additionally, global instances of fake vaccination cards were explored to provide a comprehensive understanding of the issue. Results: Healthcare workers' vaccine hesitancy, corruption, and inadequate salaries were identified as key contributors to the circulation of fake vaccination cards in Nigeria. Instances of health workers accepting bribes to issue cards without administering vaccines were uncovered. The implications on public health included threats to herd immunity, compromised disease surveillance, erosion of public trust, and reinforcement of vaccine hesitancy. The research also highlighted global challenges with fake vaccination cards, emphasizing the need for international cooperation. Conclusion: Fake vaccination cards in Nigeria poses challenges to public health, affecting the reliability of immunization data and jeopardizing disease control efforts. It is crucial to strengthen healthcare worker engagement, tackle corruption through increased transparency and improved policies, and implement digital vaccination verification systems. International collaboration is essential to establish standardized security measures and verification checkpoints. Addressing flawed vaccination records requires urgent action to enhance vaccination efforts, and safeguard the population from the resurgence of vaccine-preventable diseases.

Do pregnancy rates differ with intra-uterine insemination when different combinations of semen analysis parameters are abnormal?

OBJECTIVE: To evaluate the relationship of one or a combination of semen analysis parameter results on insemination outcomes. MATERIAL AND METHODS: A retrospective analysis was performed to evaluate the effect on pregnancy rates in relation to one or more abnormal semen analysis parameters based on the 2010 World Health Organization semen analysis guidelines. RESULTS: Nine hundred eighty-one couples underwent 2231 intrauterine insemination cycles at the Stanford Fertility and Reproductive Medicine Center. In our study, the pregnancy rates ranged from 11-25% when an individual or combined semen analysis parameters were analyzed. Similar pregnancy rates were found when one, two, and in most cases three parameters were abnormal. When a single parameter was abnormal among volume, concentration, and motility, pregnancy rates were mainly unaffected. There was the exception of total sperm count where pregnancy rates were diminished when counts were below 39 million (p=0.04). CONCLUSIONS: Clearly, total sperm in the specimen and not the concentration of sperm per milliliter was the critical factor for predicting pregnancy. Therefore, a reorganization of semen analysis reports should be done emphasizing the total amount of sperm present and de-emphasizing concentration of sperm.

The impact of semen processing on sperm parameters and pregnancy rates after intrauterine insemination.

BACKGROUND: The objective of this retrospective study was to evaluate the effect of semen processing on computer analyzed semen parameters and pregnancy rates after intrauterine insemination (IUI). METHODS: Over a two-year period, a total of 981 couples undergoing 2231 IUI cycles were evaluated and the freshly collected non-donor semen was analyzed before and after density gradient centrifugation (DGC). RESULTS: DGC led to significant increases in sperm concentration by 66±74 ×106/mL (P=0.0001), percentage of motile sperm by 24±22% (P=0.0001), concentration motile by 27±58 ×106/mL (P=0.0001), and forward sperm progression by 18±14 µ/s (P=0.0001). In 95% of cases, there was a decrease in the total motile sperm count (TMSC), with an average decrease of 50±124% compared to pre-processed samples (P=0.0001). Importantly, the decrease in TMSC did not negatively affect pregnancy rates (P=0.45). CONCLUSIONS: This study proves that DGC leads to significant increases in most sperm parameters, with the exception of TMSC. Remarkably, the decrease in TMSC did not affect the pregnancy rate. This should reassure clinicians when the TMSC is negatively affected by processing.

Pregnancy rates unaffected by sperm count in intrauterine insemination: a retrospective cohort study.

BACKGROUND: The aim of this study was to elucidate the impact of both pre and postprocessing total motile sperm count (TMSC) on pregnancy rates in a subfertile population undergoing intrauterine insemination (IUI). METHODS: Subfertile couples presenting to the Stanford University Fertility Center during a two-year period were retrospectively enrolled. Eligible couples consisted of women with good ovarian reserve, proven tubal patency, normal anatomy and inducible ovulation. Ovulation induction was administered per standard protocols. IUI was performed using only fresh semen; samples were analyzed pre and post-processing. Pregnancy was established using ß-HCG assays performed 15-17 days after IUI. Pregnancy rates for subgroups of pre and postprocessing TMSC were compared. RESULTS: A total of 981 couples underwent 2231 IUI cycles. Overall, the pregnancy rate was 20.2%. Pregnancy rates did not differ and remained rather stable for the pre (P=0.12) and post (P=0.66) processing semen analysis when stratified for TMSC. CONCLUSIONS: In the absence of teratospermia, TMSC does not appear to impact pregnancy rates in subfertile couples undergoing IUI.

Comparison of pregnancy rates in pre-treatment male infertility and low total motile sperm count at insemination.

PURPOSE: In intrauterine insemination (IUI), total motile sperm count (TMSC) is an important predictor of pregnancy. However, the clinical significance of a poor TMSC on the day of IUI in a patient with prior normal semen analysis (SA) is unclear. We performed this study to determine if these patients perform as poorly as those who had male factor infertility diagnosed prior to commencing treatment. METHODS: 147 males with two abnormal SA based on the 2010 World Health Organization criteria underwent 356 IUI with controlled ovarian hyper-stimulation (COH). Their pregnancy rates were compared to 120 males who had abnormal TMSC at the time of 265 IUI with COH, in a retrospective university-based study. RESULTS: The two groups were comparable in female age (p = 0.11), duration of infertility (p = 0.17), previous pregnancies (p = 0.13), female basal serum FSH level (p = 0.54) and number of mature follicles on the day of ovulation trigger (p = 0.27). Despite better semen parameters on the day of IUI in the pre-treatment male factor infertility group (TMSC mean ± SD: 61 ± 30 million vs. 3.5 ± 2 million, p < 0.001), pregnancy rates were much higher in the group with low TMSC on the day of IUI (5 % vs. 17 %, p < 0.001). CONCLUSION: A patient with a recent (within 6 months) normal pre-treatment SA but low TMSC on the day of IUI likely has a reasonable chance to achieve pregnancy, and does not perform as poorly as subjects previously diagnosed with male factor infertility. More studies should be performed to confirm these findings.

The evaluation of pre and post processing semen analysis parameters at the time of intrauterine insemination in couples diagnosed with male factor infertility and pregnancy rates based on stimulation agent. A retrospective cohort study.

OBJECTIVE: To identify pre or post processing semen analysis parameters that may be predictive of successful pregnancy in couples with male factor infertility undergoing intra uterine insemination (IUI). To evaluate the pregnancy rate based on ovulation inducing agent in couples with male factor infertility per the 2010 world health organization criteria treated with IUI. STUDY DESIGN: This retrospective study was performed at Stanford University medical center. All couples with male factor infertility fitting inclusion criteria were included over a 2 year period of time. 147 couples with male factor infertility were included and 356 IUIs were analyzed. All subjects in this study had Kruger strict analysis >4% normal forms. Logistic regression analysis was used to control for confounding effects and multiplicity. RESULTS: The overall pregnancy rate was 5.3%. No parameter in either the pre or post analysis predicted pregnancy. Furthermore, it was found that natural cycle and letrazole treatment had similar pregnancy rates (3% and 3%) p=ns. Similar outcomes were also observed between clomiphene citrate and gonadotropin stimulated cycles (7.5% and 6.0%) p=ns. CONCLUSIONS: Total motile sperm count which has been found to be a predictor of pregnancy when evaluated in isolation, may be due to a confounding effect. These low pregnancy rates should be considered when deciding whether to suggest IUI and when selecting a protocol for ovulation induction for couples with male factor infertility.

Management of pneumothoraces detected on chest computed tomography: can anatomical location identify patients who can be managed expectantly?

BACKGROUND: Pneumothorax (PTX) can be readily detected by computed tomography (CT) or ultrasound. However, management of PTX in hemodynamically stable patients remains controversial. STUDY OBJECTIVES: We sought to investigate whether a distinct anatomical distribution of PTX along prespecified chest zones as detected by CT can be described in patients with or without subsequent chest tube thoracotomy (CTT), thus potentially allowing the extended focused assessment with sonography for trauma (EFAST) ultrasound examination to guide PTX management. METHODS: We performed a retrospective review of chest CT scans performed in the emergency department (ED) of a Level I trauma center. CT scans were analyzed for PTX distribution according to a chest zone model. Medical records of subjects with PTX were reviewed for subsequent CTT. RESULTS: Of 3636 chest CT scans performed, 183 PTX (156 patients) were detected without CTT at the time of CT scan (69% male, mean age 42 years). Of these, 66 subjects (40%) underwent CTT; 43 chest tubes (63%) were placed in the ED, 9 (13%) during hospitalization and 9 (13%) in the operating room. Median time to CTT was 140 min (interquartile range 52-199). Initial hemodynamic parameters, need for surgery, and need for mechanical ventilation were similar in both groups (p > 0.05 for all). Anatomical distribution and size of PTX were similar in the two groups. CONCLUSION: Although the majority of patients with traumatic PTX could be managed conservatively, we did not identify a characteristic anatomical PTX pattern, which could identify subjects who may not require CTT.

Magnet-related injury rates in children: a single hospital experience.

BACKGROUND AND OBJECTIVE: The ingestion of multiple magnets simultaneously or the placement of magnets in both nares can lead to serious injury resulting from the attraction of the magnets across the tissues. The impact of mandatory standards for toys containing magnets has not been thoroughly investigated. The aim of the present study was to describe the emergency department (ED) visit rate for magnet-related injuries. METHODS: We performed a retrospective study of children evaluated for magnet-related injuries from 1995 to 2012 in an urban tertiary care pediatric ED. We identified cases using a computerized text-search methodology followed by manual chart review. We included children evaluated for magnet ingestion or impaction in the ears, nose, vagina, or rectum. We assessed the type and number of magnets as well as management and required interventions. A Poisson regression model was used to analyze rates of injury over time. RESULTS: We identified 112 cases of magnet injuries. The median patient age was 6 years (IQR 3.5, 10), and 54% were male. Compared to before 2006, the rate for all magnet-related injuries in 2007-2012 (incidence rate ratio 3.44; 95% confidence interval 2.3-5.11) as well as multiple magnet-related injuries (incidence rate ratio 7.54; 95% confidence interval 3.51-16.19) increased. Swallowed magnets accounted for 86% of the injuries. Thirteen patients had endoscopy performed for magnet removal (12%), and 4 (4%) had a surgical intervention. Magnets from toys account for the majority of the injuries. CONCLUSIONS: The number of ED visits for magnet-related injuries in children may be rising and are underreported, with an increase in the proportion of multiple magnets involvement. In our case series, mandatory standard for toys had no mitigating effect.

Utility of lung ultrasound in predicting pulmonary and cardiac pressures.

AIMS: Quantification of linear lung ultrasound (LUS) artefacts (B-lines) represents a novel, non-invasive approach to assess pulmonary congestion. We investigated the relationship between the number of B-lines (vertical artefacts arising from the pleural line) and intracardiac pressures. METHODS AND RESULTS: Prior to scheduled right heart catheterization (RHC), 100 subjects underwent LUS of eight zones. A reviewer blinded to the haemodynamic data quantified the number of sonographic B-lines. Of 92 subjects who completed RHC, 79 had adequate LUS data of all zones [median age 61 years, 26 women, median left ventricular ejection fraction (LVEF) 58%, 35 with history of heart failure; 22 postcardiac transplantation]. The number of B-lines correlated with measured right atrial (r = 0.32), pulmonary artery diastolic (PADP) (r = 0.34), mean pulmonary artery (mPAP) (r = 0.43), pulmonary artery systolic (PASP) (r = 0.48) pressures, and pulmonary vascular resistance (PVR) (r = 0.51) (P < 0.005 for all), but not with pulmonary capillary wedge pressure. There was a graded association between tertiles of B-line number and increasing PADP, mPAP, PASP, and PVR (P for trend ≤0.001 for all). Each additional B-line was associated with an increase in PASP of 1 mmHg and an increase in PVR of 0.1 Wood units. These associations remained robust after multivariable adjustment (P = 0.002). Assessment of two inferior lateral zones resulted in similar correlations to the eight-zone method. CONCLUSIONS: Easily obtainable, LUS may be useful in the estimation of right-sided cardiac pressures and PVR. Further evaluation of lung ultrasound as an adjunct to heart failure diagnosis, monitoring, and prognosis is warranted.

Short-term (90 min) diagnostic performance for acute non-ST segment elevation myocardial infarction and 30-day prognostic evaluation of a novel third-generation high sensitivity troponin I assay.

OBJECTIVES: We evaluated a third-generation high sensitivity "guidelines acceptable" troponin I assay (hs-cTnI) against a contemporary "clinically usable" troponin assay (cTnI). DESIGN AND METHODS: Remnant samples of undifferentiated emergency department (ED) patients with suspected acute coronary syndrome were enrolled. Baseline and 90-minute samples were analyzed for cTnI and hs-cTnI. Sensitivity, specificity, positive and negative predictive values for AMI and 30-day adverse cardiac events (ACE) were compared. RESULTS: Of 486 ED patients, there were 465 patients who had blood remaining at the presentation for the hs-cTnI assays, with 12 AMIs. At presentation, the clinical sensitivity and specificity for AMI was 75% and 97% for cTnI and 83.3 and 82.1% for hs-cTnI. There were 407 patients who had paired baseline and 90-minute blood samples for cTnI and hs-cTnI including 9 of the 12 AMI patients. The sensitivity and specificity was 77.7% and 96.5% for cTnI and 100% and 81.9% for hs-cTnI at 90 min. A Δ change of 30% increase from baseline to 90 min improved the specificity to 94.5% (95% CI 92%-96%) without lowering the sensitivity. When AMI was defined as a Δ30% change of hs-cTnI at t=0 and 90 min and one hs-cTnI result >99th percentile cutoff, more than 3 times as many patients met the diagnostic criteria for AMI compared to results from the normal sensitive troponin assay; 28 (6.9%) for hs-cTnI vs. 9 (2.2%) with cTnI. There were 37 in-hospital or 30-day events, producing an OR of 3.03, 95% CI: 0.86-9.59 for cTnI, and 2.54, 95% CI: 1.27-5.10 for hs-cTnI, which detected 11 more cases. CONCLUSIONS: The hs-cTnI assay achieved a 90-minute rule out for AMI and detected more 3 times as many AMI cases. The specificity increased with the Δ30% criteria. The hs-cTnI assay also detected more cases of patient at risk for adverse cardiac events at 30 days.

Strategies for endogenous spinal cord repair: HPMA hydrogel to recruit migrating endogenous stem cells.

Injury to the spinal cord disrupts ascending and descending axonal pathways and causes tissue damage with a subsequent limited cellular regeneration. Successful treatment would encompass the restoration of the cytoarchitecture, homeostasis and function all in dear need. Transplantation-based treatments using exogenous cells are the most favoured approach. Yet, with the advent of the stem cell concept and continuous progress in the field it became clear that the endogenous potential for repair is greater than previously thought. As an alternative to neural grafting, we and other researchers have aimed at understanding what are the elements needed for a successful repair with self progenitors that would give rise to the cell types needed to restore function of the central nervous system. Some studies involve both scaffolds and cell grafts. Here we describe studies on spinal cord repair using what we call "endogenous tissue engineering for regenerative medicine". The approach involves a hydrogel that mimics the natural milieu where endogenous pre-existing and newly formed cells populate the gel progressively allowing for the integration of CNS self populations leading to a successful recovery of function. Highlight aspects learned from this type of studies are that: Endogenous reconstruction of the injured spinal cord is possible by using the adequate support. The contribution of nestin-expressing progenitors to spinal cord regeneration is continuous and substantial both, in the reconstructed segment as well as, along the distal and caudal segments of the reconstructed spinal cord. Most of these cells appear to have been in a quiescent state until the injury occurred and only a small fraction of these neural progenitors was produced via cell proliferation. The hydrogel combined with exercise was necessary and sufficient to restore locomotor function in cats that underwent spinal transaction followed by reconstructive surgery. This recovery of function was first seen 28 days after surgery and continued to improve for at least 21 months. Therefore, endogenous pre-existing and newly formed cells populated the gel scaffold established contact with the non injured tissue and lead to recovery of function.

Expression of heat shock protein (HSP)-25 and HSP-32 in the rat spinal cord reconstructed with Neurogel.

We recently showed a successful reconstruction of the cat spinal cord using NeuroGel a polymer hydrogel bridge between the two spinal stumps. The polymer graft supports axonal elongation, myelination and angiogenesis up to 21 months, Wallerian degeneration was diminished and gliotic scarring was prevented. In the present study, we report the expression patterns of two stress proteins, (HSPs) HSP-25 and HSP-32 after spinal cord hemisection with and without reparative surgery with NeuroGel. Double immunofluorescence using cell specific markers for neurons, astrocytes and oligodendrocytes (OL), in combination with antibodies for HSP-25 and 32 showed that mainly neurons express both proteins. Both HSPs displayed different temporal expression patterns in the reconstructed spinal cords with a concomitant reduction of secondary damage. In conclusion, Neurogel reconstruction of the spine during the acute phase considerably reduces secondary damage resulting in a rapid and stable regenerative response.