Pharmacotherapy of infertility in Ghana: Why do infertile patients discontinue their fertility treatment?

BACKGROUND: Globally, millions of people of reproductive age experience infertility. With that notwithstanding, most infertile patients undergoing pharmacotherapy withdraw from treatment before achieving the desired outcome. The reasons for their withdrawal, particularly in sub-Saharan Africa, have not been well examined, hence the need for this study. OBJECTIVES: The aim of the study was to examine why infertile patients discontinue pharmacotherapy prior to achieving conception. METHODS: The study employed an exploratory qualitative design. Purposive sampling technique was used to recruit subjects into the study. Twenty infertile patients (fourteen females and six males) who discontinued their treatment, and eight attending health professionals who provided direct care to these patients were interviewed. Telephone and face-to-face interviews were conducted using a semi-structured interview guide. The data collected were transcribed, coded, and generated into themes using thematic content analysis. RESULTS: The major reasons for discontinuation of infertility treatment included lack of support from male partners, seeking alternative treatment, unmet outcome, poor medical services, distance, stigmatization, and relocation. CONCLUSIONS: Patients and healthcare personnel shared both similar and diverse views on reasons for discontinuation of infertility treatment that reflect situations in a typical African setting, most of which are not reported in existing studies. The outcome of this study will provide insight for fertility therapists and policy makers in designing appropriate measures to facilitate maximum compliance and improvement in treatment outcome.

Characterizing the ZrC(111)/c-ZrO2(111) Hetero-Ceramic Interface: First Principles DFT and Atomistic Thermodynamic Modeling.

The mechanical and physical properties of zirconium carbide (ZrC) are limited to its ability to deteriorate in oxidizing environments. Low refractory oxides are typically formed as layers on ZrC surfaces when exposed to the slightest concentrations of oxygen. However, this carbide has a wide range of applications in nuclear reactor lines and nozzle flaps in the aerospace industry, just to name a few. To develop mechanically strong and oxygen-resistant ZrC materials, the need for studying and characterizing the oxidized layers, with emphasis on the interfacial structure between ZrC and the oxidized phases, cannot be understated. In this paper, the ZrC(111)//c-ZrO2 (111) interface was studied by both finite temperature molecular dynamic simulation and DFT. The interfacial mechanical properties were characterized by the work of adhesion which revealed a Zr|OO|Zr|OO//ZrC(111) interface model as the most stable with an oxygen layer from ZrO2 being deposited on the ZrC(111) surface. Further structural analysis at the interface showed a crack in the first ZrO2 layer at the interfacial region. Investigations of the electronic structure using the density of state calculations and Bader charge analysis revealed the interfacial properties as local effects with no significant impacts in the bulk regions of the interface slab.

COVID 19 meets changing traditional care systems for the elderly and a budding social work practice. Reflections for geriatric care in Ghana.

Starting in December 2019 in Wuhan China, the novel coronavirus (COVID 19) disease has reached 216 countries with 6, 140, 934 confirmed cases and 373, 548 deaths as at 2nd June, 2020 globally Ghana, with an estimated population of 31,014,508 has recorded 8, 297 confirmed cases, 2, 986 recoveries and 38 deaths with 5, 273 active cases as at the same date. All but one of the 16 administrative regions have recorded confirmed cases with the highest case numbers in the more urban regions of the country. Considering that one of the highest risk populations in the wake of the coronavirus outbreak is the elderly population, this brief essay examines the state of elderly care in Ghana in relation to this pandemic. The paper reflects on the state of care needs for the elderly, current elderly care systems, inadequacy of data on elderly population and social work practice in Ghana. It also raises questions on the preparedness of current elderly care systems and general social work practice in Ghana amidst COVID 19. The paper recommends professionalization of geriatric care and formalization of community-based care for the elderly in Ghana as the way forward.

Predictors of Poor Postoperative Outcomes in Pediatric Surgery Patients in Rural Ghana.

BACKGROUND/PURPOSE: Perioperative complications cause significant pediatric morbidity and mortality in low- and lower middle -income countries. This study investigates factors associated with prolonged length of stay, 90-day readmission and in-hospital mortality among pediatric patients at Eastern Regional Hospital (ERH) in Ghana. METHODS: This is a retrospective review of perioperative morbidity and mortality in children < 18 years at ERH in Koforidua, Ghana. All pediatric surgeries performed between January 2015 and December 2017 were included in this study. Univariate analysis was performed using Pearson's chi-square tests or Fisher's exact tests. Variables that were significant on univariate analysis were included in multivariable logistic regression models adjusted for age and gender. RESULTS: We analyzed 468 patients < 18 years of age with a median length of stay (LOS) of 3 days. The 90-day readmission and in-hospital mortality rates were 138 and 17 per 1000 patients, respectively. The most common procedures were herniorrhaphy (19 %) and appendectomy (15 %). Gastrointestinal surgery, surgical trauma, surgical infection and lack of insurance were significantly associated with prolonged LOS. Young age and female gender were significantly associated with in-hospital mortality. Malaria was significantly associated with 90-day readmission. CONCLUSIONS: Malaria infection is a significant risk factor for readmission, which should be investigated and treated in pediatric surgical patients in rural Ghana. Ensuring that all patients have insurance may result in shorter hospital stays. Provision of laparoscopic equipment may reduce hospital stays for patients undergoing gastrointestinal surgery. Expansion of the surgical work force, particularly pediatric surgeons, could improve perioperative survival in the very young population. LEVEL OF EVIDENCE: Retrospective comparative study.

Stability, equilibrium morphology and hydration of ZrC(111) and (110) surfaces with H2O: a combined periodic DFT and atomistic thermodynamic study.

ZrC is a non-oxide ultra-high temperature ceramic (UHTC) material with excellent physical and mechanical properties used in nuclear plants and jet propulsion engines. However, the mechanical properties can be lost because of the easy oxidation of its grain surfaces. One way of dealing with such a problem is to coat the surface with inert carbides like SiC which can be grafted onto the ZrC surface by first modifying the exposed surfaces with reactive molecules. The stability of different terminations of the (111) facet was studied and the most stable is the termination on both surface layers by Zr atoms as it has been observed experimentally. A DFT calculation study jointly with atomistic thermodynamic modelling has been used to study the reactivity of the (111) and (110) facets with H2O. H2O dissociates into surface hydroxyl groups with the release of H2 and the OH groups preferentially adsorb at high surface coverage (high adsorption energies at 1 ML coverage). The study of adsorption of H2O onto other low index surfaces allows the determination of the equilibrium morphology of the ZrC nanocrystallites in different environments. In vacuum, ZrC nanocrystallites reveal a cubic structure with much of the (100) surface and a small amount of the (111) facets at the corners. Hydration of the (111) surface was a strong process and hence water can be removed from the surface at temperatures above 1200 K and pressures lower than 10(-9) bar while higher pressures of H2 in the gas phase enhance the removal of water. The Wulff construction of the nanocrystallites after hydration indicates only the (111) surface at lower temperatures while revealing the (100) facets at higher temperatures. Thus whatever the experimental conditions be, the (110) facet does not have to be considered.