HostSeq: a Canadian whole genome sequencing and clinical data resource.

HostSeq was launched in April 2020 as a national initiative to integrate whole genome sequencing data from 10,000 Canadians infected with SARS-CoV-2 with clinical information related to their disease experience. The mandate of HostSeq is to support the Canadian and international research communities in their efforts to understand the risk factors for disease and associated health outcomes and support the development of interventions such as vaccines and therapeutics. HostSeq is a collaboration among 13 independent epidemiological studies of SARS-CoV-2 across five provinces in Canada. Aggregated data collected by HostSeq are made available to the public through two data portals: a phenotype portal showing summaries of major variables and their distributions, and a variant search portal enabling queries in a genomic region. Individual-level data is available to the global research community for health research through a Data Access Agreement and Data Access Compliance Office approval. Here we provide an overview of the collective project design along with summary level information for HostSeq. We highlight several statistical considerations for researchers using the HostSeq platform regarding data aggregation, sampling mechanism, covariate adjustment, and X chromosome analysis. In addition to serving as a rich data source, the diversity of study designs, sample sizes, and research objectives among the participating studies provides unique opportunities for the research community.

A multi-species direct-fed microbial supplement alters the milk lipidome of dairy cows.

The study evaluated the effects of supplementing a multi-species direct-fed microbial (DFM) on the milk lipidome of lactating dairy cows. Twenty-four multiparous Holstein cows (41 ± 7 d in milk) were used in a randomized complete block design with experimental duration of 91 d. Cows were blocked based on energy-corrected milk yield from a 14-d pretreatment period, and were assigned randomly within each block to the following treatments: (1) control (CON): corn silage-based total mixed ration without DFM; or (2) BOV+: basal diet top-dressed with a DFM containing a mixture of Lactobacillus animalis (LA-51), Propionibacterium freudenreichii (PF-24), Bacillus subtilis (CH201), and Bacillus licheniformis (CH200) at 11.8 × 109 cfu/d. Milk samples were taken from morning and evening milkings on 2 consecutive days of each week of the pretreatment and treatment periods. Separate composites of pretreatment period and treatment period samples were prepared for individual cows and used for lipidome analysis. Lipidome analysis of the milk samples was performed using an ultra-high-performance liquid chromatograph linked to a quadrupole time-of-flight mass spectrometer in both positive and negative ionizations. The relative concentrations of 14 lipid species, including long-chain polyunsaturated fatty acids (LC-PUFA) such as FA 20:8 and FA 28:7 and triacylglycerides (TG) such as TG 40:3 and TG 54:2, were increased [false discovery rate (FDR) ≤0.05], whereas 13 lipid species, including saturated FA 24:0 and TG 40:0 were decreased (FDR ≤0.05) by supplemental BOV+. The relative concentration of de novo FA in milk was greater, whereas that of preformed FA was lower in dairy cows supplemented with BOV+. Results from this study demonstrate the potential of a DFM containing L. animalis, P. freudenreichii, Bacillus subtilis, and B. licheniformis to alter the milk lipidome in lactating dairy cows toward increased relative concentration of LC-PUFA, which might offer a healthier profile of FA to consumers with its associated health benefits.

Clinical Profile and Outcome of COVID-19 Cases Admitted at a Tertiary Health Facility In South-West Nigeria.

BACKGROUND: Coronavirus Disease 2019 (COVID-19) is anemerging disease with a global spread that has affected millions of lives. In Nigeria, the third wave of the outbreak is being experienced with many patients requiring hospitalization. Being a novel disease, we characterized the clinical profile and outcomes of patients admitted into our isolation centre. METHODS: A case series of 65 COVID-19 patients admitted at theIsolation Centre of Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, from June 2020 to March 2021 is presented. Information on demographic characteristics, medical history, symptoms, treatment and outcomes was obtained. Data were analysed using SPSS version 25. RESULTS: Most (47; 72.3%) patients were less than 65 years old and 39 (60.0%) were males. The commonest symptoms were cough (42; 64.6%), breathlessness (41; 63.1%), fever (40; 61.5%), muscle aches (40; 61.5%), and anosmia (16; 24.6%). Hypertension (41; 63.1%) and diabetes (18; 27.7%) were the most predominant comorbidities. Forty-three patients (66.2%) had supplemental oxygen therapy. The majority (44; 70%) of patients were admitted for 10 days or less and 58 (89.3%) patients were discharged home. However, 6 deaths (9.2%) were recorded among patients with advanced comorbidities and severe sepsis with all deaths occuring within 5 days of admission. CONCLUSION: There was a male predominance among patients admitted at the Isolation Centre and all mortalities occurred within five days of admission. Early detection, prompt management of cases with hypoxaemia and optimal treatment of comorbidities are recommended for good outcomes in COVID-19 patients.

CONTEXTE: La maladie de la coronavirus 2019 (COVID-19) est une maladie émergente dont la propagation mondiale a affecté des millions de vies. Au Nigéria, la troisième vague de l'épidémie est en train de se produire avec de nombreux patients nécessitant une hospitalisation. S'agissant d'une nouvelle maladie, nous avons caractérisé le profil clinique et les résultats des patients admis dans notre centre d'isolement. MÉTHODES: Une série de cas de 65 patients atteints de COVID-19 au Centre d'isolement de l'Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, de juin 2020 à mars 2021 est présentée. Des informations sur les caractéristiques démographiques, les antécédents médicaux, symptômes, le traitement et les résultats ont été obtenus. Les données ont été à l'aide de SPSS version 25. RÉSULTATS: La plupart des patients (47 ; 72,3 %) étaient âgés de moins de 65 ans et 39 (60,0 %) étaient des hommes. Les symptômes les plus fréquents étaient la toux (42 ; 64,6%), l'essoufflement (41 ; 63,1%), la fièvre (40 ; 61,5%), les douleurs musculaires (40; 61,5%) et l'anosmie (16 ; 24,6 %). L'hypertension artérielle (41; 63,1%) et le diabète (18 ; 27,7%) étaient les comorbidités les plus prédominantes. Quarante-trois patients (66,2 %) avaient une oxygénothérapie complémentaire. La majorité (44 ; 70%) des patients ont été admis pour 10 jours ou moins et 58 (89,3%) ont été renvoyés chez eux. Cependant, 6 décès (9,2 %) ont été enregistrés parmi les patients présentant des comorbidités avancées et une septicémie grave, tous les décès étant survenus dans les 5 jours suivant l'admission. CONCLUSION: Il y avait une prédominance masculine parmi les patients admis au centre d'isolement et tous les décès sont survenus dans les cinq jours cinq jours après l'admission. La détection précoce, la prise en charge rapide des cas l'hypoxémie et le traitement optimal des comorbidités sont recommandées recommandés pour obtenir de bons résultats chez les patients atteints de COVID-19. Mots clés: COVID-19, Profil clinique, Résultat, Gestion des cas, Centre d'isolement.

Regulatory effects of quercetin on testicular histopathology induced by cyanide in Wistar rats.

Several causes of infertility have been identified, and several papers have documented some compounds that cause infertility. One of the compounds reported to be toxic to the reproductive system is cyanide. In the management of infertility, various mechanisms ranging from synthetic drugs, natural products and supplements have been employed. Quercetin is an antioxidant supplement that has been used in the treatment of a variety of ailments. This work is aimed at investigating the role of quercetin in attenuating spermato-toxicity and testicular-histopathology induced by cyanide. Seventy-two (72) male wistar rat (weight 190 g ± 10 g) were divided into nine groups (n = 8) except for groups 4 and 5 with (n = 16). Group 1 (control) received physiological saline while Groups 2 and 3 received 0.5 and 1 mg/kg body weight (bwt) cyanide respectively for 56 days, groups 4 and 5 received 0.5 and 1 mg/kg bwt cyanide respectively for 30 days. At day 30, eight animals were sacrificed from Groups 4 and 5 and the remaining eight (8) rats were subdivided into groups (6 and 7) and were given 20 and 40 mg/kg bwt of quercetin respectively for twenty-six days. Co-administration of cyanide and quercetin at a dose of 0.5 mg/kg cyanide +20 mg/kg quercetin and 1 mg/kg cyanide +40 mg/kg quercetin were given to group 8 and 9 respectively for 56 days. Significant decreases in sperm parameters (count, motile and normal sperm) and increases in malondiadehyde concentration were observed in the cyanide treated groups. Testicular histoarchitecture showed few to no spermatozoa in the lumen of rats treated with cyanide. All these effects were attenuated by quercetin. In conclusion, quercetin regulates testicular histopathology induced by cyanide in Wistar rats. Data from this work suggests potential preventive or therapeutic applications of quercetin for individuals subjected to cyanide environmental pollution.

Hibiscus sabdariffa extract protects against cadmium-induced ovarian toxicity in adult Wistar rats.

Hibiscus sabdariffa (HS) is native to tropical and subtropical regions, and its enrichment as a source of antioxidants and phytoestrogen has been documented. The present study investigated effects of HS on ovarian toxicity induced by cadmium. Adult female Wistar rats were grouped into 4 (n=5/group): Group A received HS (100 mg/kg), group B received cadmium sulphate (5 mg/kg), group C received cadmium sulphate and HS, and group D (control) received 1 ml of distilled water. Cadmium sulphate was administered for five days (i.p) followed by oral administration of HS for 28 days. Results showed distortion in the cytoarchitecture of the follicular cells in the ovary of cadmium-treated rats while there was mild or no distortion recorded for the ovary of the rats treated with cadmium and HS. There was also a significant reduction in the serum level of Luteinizing and follicle stimulating hormone of the rats treated with cadmium (group B) when compared with control rats. However, these alterations were attenuated when treated with HS. We concluded that HS has an ovarian protective effect in cadmium-treated adult female rats. Hence the present results suggest that HS extract would be a potential therapeutic agent in ovarian dysfunction.

Exposure to Atrazine Elicits Morpho-Physiological and Testicular Dysfuntions in adult male rats

@#Some of the environmental toxicants acting as endocrine disruptors have been associated with health hazards in human and wildlife by modulating hormonal actions. The widely used herbicide; atrazine (ATZ) is a potent endocrine and testicular disruptor. However, studies on it remain largely inconclusive especially whether the effects are reversible or permanent. We therefore designed this study to evaluate the histological and hormonal changes associated with differential ATZ exposure. Twenty (20) adult male Wistar rats were divided into 4 groups (5 rats per group) control and three experimental groups. Control received the vehicle; the 3 groups received ATZ, 38.5, 77.0 and 154.0 mg/kg bw/day for 30 days respectively. The effects of Atrazine were assessed through histopathological observation, spermatozoa quality examination and reproductive hormone levels. Results showed that irrespective of the ATZ dose, there was significant decrease in weight, severe pathological changes in testicular tissue, decrease in the quality of semen and altered luteinizing hormone (LH) of the rats. Taken together, our findings showed that ATZ exposure could lead to poor reproductive ability in male Wistar rats

Women, Culture and Africa's Land Reform Agenda.

Pre-colonial Africa prides itself on adherence to diverse cultural affinity and traditional belief systems, which defines the place of women in respect to land access, use and ownership. Land resources continue to play important roles in both agrarian and industrial societies; thus the absence of effective land management and gender construction in land allocations has deepened gender inequality, restricted women's capacity building and agricultural development in Africa. This article explores the impact of traditional African practices and cultural beliefs on women's land ownership and use, and also reconciles women's land rights (access and control) with the realities of land reform in post-colonial Africa. It explores how gender inequalities, in terms of land ownership and rights, have jeopardized attempts at agricultural productivity and sustainable development in Africa. However, it is tasking to 'universalize' African culture and locate it in a center, due to the diverse cultural values found in Africa. However, there are certain belief systems that run through most African communities, such as the denial of women's land rights and the patriarchal nature of societies. Thus, the article found that, despite the development of legal frameworks that expand women's property rights, cases of cultural impediments to the exercise of land rights abound in Africa.

Age, Sex, and Racial Differences in Neuroimaging Use in Acute Stroke: A Population-Based Study.

BACKGROUND AND PURPOSE: Limited information is available regarding differences in neuroimaging use for acute stroke work-up. Our objective was to assess whether race, sex, or age differences exist in neuroimaging use and whether these differences depend on the care center type in a population-based study. MATERIALS AND METHODS: Patients with stroke (ischemic and hemorrhagic) and transient ischemic attack were identified in a metropolitan, biracial population using the Greater Cincinnati/Northern Kentucky Stroke Study in 2005 and 2010. Multivariable regression was used to determine the odds of advanced imaging use (CT angiography/MR imaging/MR angiography) for race, sex, and age. RESULTS: In 2005 and 2010, there were 3471 and 3431 stroke/TIA events, respectively. If one adjusted for covariates, the odds of advanced imaging were higher for younger (55 years or younger) compared with older patients, blacks compared with whites, and patients presenting to an academic center and those seen by a stroke team or neurologist. The observed association between race and advanced imaging depended on age; in the older age group, blacks had higher odds of advanced imaging compared with whites (odds ratio, 1.34; 95% CI, 1.12-1.61; P < .01), and in the younger group, the association between race and advanced imaging was not statistically significant. Age by race interaction persisted in the academic center subgroup (P < .01), but not in the nonacademic center subgroup (P = .58). No significant association was found between sex and advanced imaging. CONCLUSIONS: Within a large, biracial stroke/TIA population, there is variation in the use of advanced neuroimaging by age and race, depending on the care center type.

Histological Features and Tissue Microarray Taxonomy of Nigerian Breast Cancer Reveal Predominance of the High-Grade Triple-Negative Phenotype.

INTRODUCTION: Little is known about the biology, molecular profile and hence optimal treatment of African Nigerian breast cancer. The aim of this work, therefore, was to characterize the histology and molecular profile of Nigerian breast cancer. METHODS: Breast carcinomas from women at 6 centres of similar tribal origin in Nigeria were reviewed and assembled into tissue microarrays (TMAs), and sections were stained for hormone receptors, i.e. estrogen receptor (ER)α, ERß1, ERß progesterone receptor (PR) and androgen receptor, cyclin D, HER2, Ki67 and cytokeratins (CKs), i.e. CK5/6 and CK14 (basal) and CK18 and 19 (luminal). RESULTS: A total of 835 tumours were analysed. The mean age at diagnosis was 48.62 ± 12.41 years. The most common histological subtype was ductal NST (no-special-type) carcinoma (87.3%). Over 90% of the tumours were grade 2 or 3. The predominant molecular phenotype was the non-basal, triple-negative type (47.65%) followed by the HER2-positive group (19.6%). The percentage of ER-, PR- and HER2-positive tumours was 22.4, 18.9 and 18.8%, respectively. CONCLUSION: Nigerian breast cancer predominantly has a high-grade, triple-negative profile. It occurs at a younger age and bears similarities at the molecular level to pre-menopausal breast cancer in white women, with remarkably lower levels of ERß expression. The early presentation and histological and molecular phenotype may explain the poor prognosis, and tailoring treatment strategies to target this unique profile are required.

Hygiene Practices among Workers in Local Eateries of Orolu Community in South Western Nigeria.

BACKGROUND: Activities of local food premises and monitoring of food handlers are usually not regulated. AIM: The objective of this study was to determine food hygiene (FH) practices among food handlers in rural communities in South Western Nigeria. SUBJECTS AND METHODS: Descriptive cross-sectional study was carried out among 235 food handlers; data collection was by interviewer administered questionnaires. Using the SPSS software, multivariate analysis in two separate models was done to explore the predictors of correct knowledge and good hygiene practices. The model fit was assessed as good using the Hosmer and Lemeshow test. RESULTS: Mean age of respondents was 31.8 (10.8) years. Of the respondents (134) that had training, 17.2% (23/134) had formal training, and 82.8% (111/134) had apprenticeship; about 31.5% (74/235) of respondents maintained a good level of hygiene in their practices. Significant predictors of correct knowledge were found to be being trained (significant 0.01, odds ratio [OR] 2.4, 95% confidence interval [CI] 1.2-4.8) and receiving the training as an apprentice (significant 0.01, OR - referent group); or in a formal setting (significant 0.01, OR 3.3, 95% CI 1.6-7.0) and having no formal education (significant 0.04, OR - reference group). CONCLUSION: Good knowledge and attitude but low level of good practices toward FH characterized food handlers under study.

Prevalence and Predictors of Erectile Dysfunctions among Men on Antiretroviral Therapy in South-western Nigeria.

BACKGROUND: Erectile dysfunctions (EDs) are common presentations among men on anti-retroviral therapy, many of who had a course to discontinue anti-retroviral drugs or search for alternative treatments. AIM: This study assessed the prevalence and predictors of ED among men on anti-retro viral therapies (ART) in a Nigerian population. SUBJECTS AND METHODS: It was a descriptive cross-sectional survey among 234 HIV-positive men on anti-retroviral therapy selected using stratified sampling method after excluding for co-morbidities. Research instrument was semi-structured interviewer administered questionnaire, and data were analyzed using the SPSS software version 17.0 (Chicago IL, USA), while binary logistic regression and Chi-square test were used to demonstrate association between selected categorical variable. RESULTS: Mean age of respondents was 37.1 (1.6) years, 85.6% have not missed their medications, self-reported adherence was reported as good among 213 [(90.8%) 213/234], though calculated adherence was 90% among as many as 201 [(85.6%) 201/234]. Pattern of EDs revealed weak erection among 42 [(37.8%) 42/111], 15 [(13.5%) 15/111] said they could no longer achieve erection, 33 [(29.7%) 33/111] said they could not maintain erections, while 27 [(24.3%) 27/111] presented with loss of libido. Delayed and premature ejaculations were reported among 24 [(21.6%) 24/111] and 8 [(7.2%) 8/111] respectively. About 14% (33/234) of respondents said that anti-retroviral drugs could have caused their ED while 78% (183/234) said it should not. A statistically significant association exists between having weak erections and age above 65 years and calculated the adherence <95%, while none exists between having weak erections and missing pills. CONCLUSION: Anti-retroviral drugs are common causes of EDs. Concerns of clients should always be addressed most especially issues that may compromise adherence.

Surveillance and Outbreak Response Management System (SORMAS) to support the control of the Ebola virus disease outbreak in West Africa.

In the context of controlling the current outbreak of Ebola virus disease (EVD), the World Health Organization claimed that 'critical determinant of epidemic size appears to be the speed of implementation of rigorous control measures', i.e. immediate follow-up of contact persons during 21 days after exposure, isolation and treatment of cases, decontamination, and safe burials. We developed the Surveillance and Outbreak Response Management System (SORMAS) to improve efficiency and timeliness of these measures. We used the Design Thinking methodology to systematically analyse experiences from field workers and the Ebola Emergency Operations Centre (EOC) after successful control of the EVD outbreak in Nigeria. We developed a process model with seven personas representing the procedures of EVD outbreak control. The SORMAS system architecture combines latest In-Memory Database (IMDB) technology via SAP HANA (in-memory, relational database management system), enabling interactive data analyses, and established SAP cloud tools, such as SAP Afaria (a mobile device management software). The user interface consists of specific front-ends for smartphones and tablet devices, which are independent from physical configurations. SORMAS allows real-time, bidirectional information exchange between field workers and the EOC, ensures supervision of contact follow-up, automated status reports, and GPS tracking. SORMAS may become a platform for outbreak management and improved routine surveillance of any infectious disease. Furthermore, the SORMAS process model may serve as framework for EVD outbreak modeling.

Testicular histomorphometry and semen quality of adult Wistar rats following juvenile oral lead intoxication

Empirical evidence has shown that childhood lead (Pb) intoxication impairs cognitive function and heightens the risk of dementia in young adult humans. However, the effects of juvenile Pb toxicity on testicular morphometry and semen quality in young adulthood require further studies. Using a rodent model, juvenile (4 weeks old) Wistar rats were randomized to receive either normal saline or lead acetate in their drinking water at 0.5% (5000 ppm), 1.5% (15000 ppm) and 2.5% (25000 ppm) for 7 weeks. At 11 weeks postnatal, young adult rats were anaesthetized and their cauda epididymides excised for sperm analysis. The left testicles were homogenized in phosphate buffer and the supernatants assayed for testosterone by the enzyme immunoassay technique. The right testicles were processed for photomicroscopy by the haematoxylin and eosin technique. Using ImageJ software, testicular sections were subjected to morphometric analysis. Our findings showed that juvenile Pb intoxication alters testicular histomorphometry in young adulthood as indicated by significant (P<0.05) reductions in seminiferous tubule diameters and lumen, and marked attenuation of the germinal epithelium in the Pb-exposed rats compared with the non-exposed age-matched controls. Furthermore, findings from sperm analysis showed significantly low sperm density and motility following oral Pb exposure, while the percentage of deformed and dead sperm cells had increased significantly (P<0.05). Meanwhile, testicular interstitial compartment and the associated Leydig cells were unperturbed, and testicular testosterone levels were not significantly different between the control and Pb-treated groups (P>0.05). These findings show that Pb intoxication initiated prior to pubescence alters testicular histomorphometry and lowers semen quality in young adult Wistar rats, and these changes were unconnected with testicular testosterone levels

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The adverse effect of spasticity on 3-month poststroke outcome using a population-based model.

Several devices and medications have been used to address poststroke spasticity. Yet, spasticity's impact on outcomes remains controversial. Using data from a cohort of 460 ischemic stroke patients, we previously published a validated multivariable regression model for predicting 3-month modified Rankin Score (mRS) as an indicator of functional outcome. Here, we tested whether including spasticity improved model fit and estimated the effect spasticity had on the outcome. Spasticity was defined by a positive response to the question "Did you have spasticity following your stroke?" on direct interview at 3 months from stroke onset. Patients who had expired by 90 days (n = 30) or did not have spasticity data available (n = 102) were excluded. Spasticity affected the 3-month functional status (ß = 0.420, 95 CI = 0.194 to 0.645) after accounting for age, diabetes, leukoaraiosis, and retrospective NIHSS. Using spasticity as a covariable, the model's R (2) changed from 0.599 to 0.622. In our model, the presence of spasticity in the cohort was associated with a worsened 3-month mRS by an average of 0.4 after adjusting for known covariables. This significant adverse effect on functional outcomes adds predictive value beyond previously established factors.

Prevalence of erectile dysfunction (ED) and its risk factors among adult men in a Nigerian community.

AIMS AND OBJECTIVES: This study assesses the prevalence of erectile dysfunction as well as its risk factors. MATERIALS AND METHODS: This is a descriptive cross-sectional study among 650 adult males, aged between 18 and 70 years selected by multi-stage sampling technique. Data were obtained from respondents selected from 4 wards in Olorunda local government area of Osogbo in Osun state, Southwest, Nigeria, using pre-tested semi-structured questionnaires. RESULTS: Majority of the respondents were between ages 20-29 years with mean age of 33.6 ± 13.4 years. Most of the respondents [547(91.2%)] were aware of ED and 63.4% of them said it can be treated. The prevalence of ED was 43.8% and factors such as increasing age (p=0.00), hypertension (p=0.000), diabetes mellitus (p=0.000), perineal surgery (p=0.000), alcohol consumption (p=0.000), and smoking (p=0.000) were found to be significantly associated with developing ED. CONCLUSION AND RECOMMENDATION: The level of awareness about erectile dysfunction was high among respondents and the prevalence from this study was 43.8%. Factors associated with ED from this study included increasing age, alcohol consumption, hypertension, perineal injury and surgery. Hence, the risk of developing ED can be significantly reduced by educating men about life style modifications such as reduction in alcohol intake and smoking, as well as regular exercises.

Assessment of the reproductive health status of adult prison inmates in osun state, Nigeria.

Introduction. All over the world, numbers of prisoners have being increasing with majority in the sexually active age group; hence diseases such as HIV, Tuberculosis and Hepatitis are more prevalent in prisons than in the community. This study thus aims to provide an overview of the reproductive health status of adult prison inmates in Osun State. Methodology. This is a cross-sectional study among adult inmates in Osun State prison. Data was obtained from 209 selected respondents using pre-tested semi structured questionnaire. Result. Majority of the respondents were in the age group 20-39 years with mean age of 30.9 + 7.5. 73.2% are aware of STIs, 93.3% HIV/AIDS and 81.3% contraception. 54.6% had multiple sexual partners before incarceration and 23.3% of them used condom always. 89.5% were not involved in any sexual practice inside the prison, 9.1% masturbated and 1.4% had homosexual partners. Less than 6% had access to male condoms gotten from prison staffs and prison clinics. Conclusion and recommendation. No comprehensive reproductive health care system to address reproductive health services in prisons. Respondents' knowledge about STIs, HIV/AIDS and contraception is good, but their condom usage is low compared with the knowledge. Government should put in place specific reproductive health programmes in prisons.

Population-based study of wake-up strokes.

OBJECTIVE: Previous studies have estimated that wake-up strokes comprise 8%to 28% of all ischemic strokes, but these studies were either small or not population-based. We sought to establish the proportion and event rate of wake-up strokes in a large population-based study and to compare patients who awoke with stroke symptoms with those who were awake at time of onset. METHODS: First-time and recurrent ischemic strokes among residents of the Greater Cincinnati/Northern Kentucky region (population 1.3 million) in 2005 were identified using International Classification of Diseases-9 codes 430-436 and verified via study physician review. Ischemic strokes in patients aged 18 years and older presenting to an emergency department were included. Baseline characteristics were ascertained, along with discharge modified Rankin Scale scores and 90-day mortality. RESULTS: We identified 1,854 ischemic strokes presenting to an emergency department, of which 273 (14.3%) were wake-up strokes. There were no differences between wake-up strokes and all other strokes with regard to clinical features or outcomes except for minor differences in age and baseline retrospective NIH Stroke Scale score. The adjusted wake-up stroke event rate was 26.0/100,000. Of the wake-up strokes, at least 98 (35.9%) would have been eligible for thrombolysis if arrival time were not a factor. CONCLUSIONS: Within our population, approximately 14% of ischemic strokes presenting to an emergency department were wake-up strokes. Wake-up strokes cannot be distinguished from other strokes by clinical features or outcome. We estimate that approximately 58,000 patients with wake-up strokes presented to an emergency department in the United States in 2005.

Warfarin use leads to larger intracerebral hematomas.

BACKGROUND: Among patients with intracerebral hemorrhage (ICH), warfarin use before onset leads to greater mortality. In a retrospective study, we sought to determine whether warfarin use is associated with larger initial hematoma volume, one determinant of mortality after ICH. METHODS: We identified all patients hospitalized with ICH in the Greater Cincinnati region from January through December 2005. ICH volumes were measured on the first available brain scan by using the abc/2 method. Univariable analyses and a multivariable generalized linear model were used to determine whether international normalized ratio (INR) influenced initial ICH volume after adjusting for other factors, including age, race, sex, antiplatelet use, hemorrhage location, and time from stroke onset to scan. RESULTS: There were 258 patients with ICH, including 51 patients taking warfarin. In univariable comparison, when INR was stratified, there was a trend toward a difference in hematoma volume by INR category (INR <1.2, 13.4 mL; INR 1.2-2.0, 9.3 mL; INR 2.1-3.0, 14.0 mL; INR >3.0, 33.2 mL; p = 0.10). In the model, compared with patients with INR <1.2, there was no difference in hematoma size for patients with INR 1.2-2.0 (p = 0.25) or INR 2.1-3.0 (p = 0.36), but patients with INR >3.0 had greater hematoma volume (p = 0.02). Other predictors of larger hematoma size were ICH location (lobar compared with deep cerebral, p = 0.02) and shorter time from stroke onset to scan (p < 0.001). CONCLUSION: Warfarin use was associated with larger initial intracerebral hemorrhage (ICH) volume, but this effect was only observed for INR values >3.0. Larger ICH volume among warfarin users likely accounts for part of the excess mortality in this group.

Effect of breastfeeding during venepuncture in neonates.

BACKGROUND: Evidence suggests that infants feel pain, and painful experiences may lead to subsequent increased pain sensitivity. Owing to concerns regarding the potential adverse effects of pharmacological interventions in newborns, effective alternatives for pain control are being sought. AIM: The Neonatal Infant Pain Scale (NIPS) was used to determine the analgesic effect of breastfeeding during venepuncture. METHODS: The study was of cross-over design where each neonate served as his/her own control. Median pain scores during venepuncture when neonates were being breastfed (BF) were compared with those when neonates were not being breastfed (NBF). The site of venepuncture and number of previous venepunctures were noted. Pain was assessed using NIPS. RESULTS: In all, 38 term neonates (25 male, 13 female) were recruited. Mean (SD) age and weight were 8.42 (8.74) days and 2.89 (0.67) kg, respectively. The median pain score (interquartile range) of the neonates when breastfed was 1.50 (1-2), and 4.00 (2-6) when not breastfed (p=0.0001). The Kruskal-Wallis H-test did not show statistically significant differences between the BF and NBF groups when the number of previous punctures (p=0.57, p=0.27) and site of venepuncture (p=0.71, p=0.77) were considered. CONCLUSION: Using NIPS, it has been demonstrated that breastfeeding is analgesic in neonates during venepuncture and previous venepuncture/s and site of venepuncture do not seem to affect pain scores. Breastfeeding should be the first-choice analgesic during painful procedures in neonates.