Building the resilience of smallholder farmers to climate variability: Using climate-smart agriculture in Bono East Region, Ghana.

The concept of climate-smart agriculture (CSA) emerges from a requirement to come up with advanced solutions towards the intricate and combined objectives of enhancing crop yields, ameliorating resilience, and encouraging a low-emissions agricultural sector. This study examines how smallholder farmers are building their resilience to climate variability using CSA practices in the Bono East Region, Ghana. Specifically, the study sought to: (i) assess the trends of temperature and rainfall for the period 2011 to 2021; (ii) identify and rank CSA practices used by the smallholder farmers for resilience building in agricultural systems; and; (iii) determine the barriers militating against smallholder farmers' implementation of the prioritized CSA practices. Standardized rainfall and temperature anomalies integrated with Sen's slope were used to determine the temperature and rainfall trends. One hundred and fifty random household surveys in five selected communities (Benkai, Fiaso, Traa, Awurano, and Bomini) accompanied by five key informant interviews were used to collect field data. The CSA practices identified by the farmers and the barriers opposing the implementation of these practices were ranked using the Relative Importance Index (RII) and Weighted Average Index (WAI) respectively. Results showed that rainfall was inconsistent and temperature rose from 2011 to 2021 in the study area. Results also revealed that the key CSA practices implemented by the farmers were appropriate fertilizer application (RII = 0.758), mixed farming (RII = 0.735), and crop diversification (RII = 0.717). However, in the implementation of these CSA practices, the farmers were confronted with key barriers including increased occurrences of diseases and pests (WAI = 1.173), restricted access to agricultural technologies (WAI = 1.100), and excessive price of improved crop varieties (WAI = 1.067). The study concludes that the resilience of smallholder farmers in Ghana can be built through the effective implementation of the aforementioned CSA practices.

Clinicopathologic characteristics of early-onset breast cancer: a comparative analysis of cases from across Ghana.

BACKGROUND: Breast cancer is the commonest cancer diagnosed globally and the second leading cause of cancer-related mortality among women younger than 40 years. This study comparatively reviewed the demographic, pathologic and molecular features of Early-Onset Breast Cancer (EOBC) reported in Ghana in relation to Late Onset Breast Cancer (LOBC). METHODS: A descriptive, cross-sectional design was used, with purposive sampling of retrospective histopathology data from 2019 to 2021. Reports of core or incision biopsy, Wide Local Excision or Mastectomy with or without axillary lymph node dissection specimen and matched immunohistochemistry reports were merged into a single file and analysed with SPSS v. 20.0. Descriptive statistics of frequencies and percentages were used to describe categorical variables. Cross-tabulation and chi-square test was done at a 95% confidence interval with significance established at p < 0.05. RESULTS: A total of 2418 cases were included in the study with 20.2% (488 cases) being EOBCs and 79.8% (1930 cases) being LOBCs. The median age at diagnosis was 34.66 (IQR: 5.55) in the EOBC group (< 40 years) and 54.29 (IQR: 16.86) in the LOBC group (≥ 40 years). Invasive carcinoma-No Special Type was the commonest tumour type with grade III tumours being the commonest in both categories of patients. Perineural invasion was the only statistically significant pathologic parameter with age. EOBC was associated with higher DCIS component (24.8% vs 21.6%), lower hormone-receptor-positive status (52.30% vs 55.70%), higher proliferation index (Ki-67 > 20: 82.40% vs 80.30%) and a higher number of involved lymph nodes (13.80% vs 9.00%). Triple-Negative Breast cancer (26.40% vs 24.30%) was the most predominant molecular subtype of EOBC. CONCLUSION: EOBCs in our setting are generally more aggressive with poorer prognostic histopathological and molecular features when compared with LOBCs. A larger study is recommended to identify the association between relevant pathological features and early onset breast cancer in Ghana. Again, further molecular and genetic studies to understand the molecular genetic drivers of the general poorer pathological features of EOBCs and its relation to patient outcome in our setting is needed.

Epidemiology of Autoimmune Hepatitis (AIH) in the United States Between 2014 and 2019: A Population-based National Study.

BACKGROUND AND AIMS: Autoimmune hepatitis (AIH) is a chronic, inflammatory disease of the liver with increasing prevalence. However, limited epidemiological data exist for the prevalence of AIH in the United States. We used a large database to describe the prevalence of AIH in the United States and the autoimmune diseases associated with it. APPROACH AND RESULTS: Data was collected from a commercial database (Explorys Inc., Cleveland, OH), an aggregate of Electronic Health Record data from 26 major integrated health care systems in the United States. We identified a cohort of patients with a diagnosis of AIH from April 2014 to April 2019 based on a Systemized Nomenclature of Medicine-Clinical Terms and calculated the prevalence of AIH. Of the 37,161,280 individuals active in the database from April 2014 to 2019, we identified 11,600 individuals with a diagnosis of AIH with an overall prevalence rate of 31.2/100,000. The prevalence of AIH was increased in females compared with males [odds ratio (OR)=3.21, P<0.0001], elderly (aged above 65 y) compared with adults (aged 18 to 65 y) and children (aged below 18 y) (OR=2.51, P<0.0001) and whites compared with African Americans, Asians, and Hispanics (OR=1.12, P<0.0001). Moreover, patients with AIH were more likely to have Sjögren syndrome, systemic lupus erythematosus, ulcerative colitis, celiac disease, rheumatoid arthritis, Crohn's disease, and autoimmune thyroiditis as compared with patients without AIH. CONCLUSIONS: We found that the estimated prevalence of AIH in the United States is 31.2/100,000, which is comparable to the reported prevalence of AIH in Europe. We confirmed that AIH has a strong association with other autoimmune diseases studied in the literature.

Technique for Fixation of Semitendinosus to the Patella in Patellar Tendon Reconstruction.

Chronic patellar tendon injuries are rare yet challenging to treat. Timing of surgery and graft choices are debatable. Many techniques and methods of fixation have been described with pros and cons. Functional impairment of the extensor mechanism and postoperative complications triggers the quest for finding the ideal technique. In this Technical Note, we use distally based semitendinosus (ST) looped over 2 ETHIBOND sutures. The ETHIBOND is passed through 2 vertical tunnels in the patella and retrieved proximally, docking the ST in a blind tunnel created in the lower pole of the patella. The whip-stitched free ST end is passed through a tunnel behind the tibial tubercle and sutured back to its base. A polyester tape is used to augment the repair in a circumferential manner. Postoperatively full weight bearing is allowed as tolerated in a hinged knee brace locked in extension with only passive range of motion of 0-90° allowed for 6 weeks.

Opportunistic Infections Are More Prevalent in Crohn's Disease and Ulcerative Colitis: A Large Population-Based Study.

BACKGROUND: Opportunistic infections (OIs) are more common in patients with inflammatory bowel disease (IBD); however, there have been limited large-scale studies of OIs in IBD. We investigated the epidemiological characteristics of OI in Crohn's disease (CD) and ulcerative colitis (UC) using a large population-based database. METHODS: Data were collected from a commercial database (Explorys Inc., Cleveland, OH, USA) that provided electronic health records from 26 major integrated US health care systems from 1999 to March 2018. In this data set, we identified all CD and UC patients, based on Systemized Nomenclature of Medicine-Clinical Terms. Within these cohorts, we identified a variety of OIs and compared the prevalence rate of OI in individuals with IBD with that of controls (patients in the database between March 2013 and March 2018 without the diagnosis of IBD). RESULTS: Explorys included 153,290 patients with CD and 128,540 patients with UC between March 2013 and March 2018. The prevalence of OIs was 17.8% in CD, 19.2% in UC, and 7% in non-IBD controls. When compared with non-IBD controls, all OIs were more common in CD (prevalence ratio [PR], 2.54; 95% confidence interval [CI], 2.51-2.57) and UC (PR, 2.74; 95% CI, 2.71-2.77). Overall, viral infections were numerically more common, whereas bacterial infections had the highest PRs in CD and UC when compared with controls without IBD. CONCLUSIONS: We found significantly higher rates of OI in IBD. Our study suggests the need for close follow-up of IBD patients to diagnose and provide vaccinations where applicable for prevention of infections.

Predictive performance of the estimating equations of renal function in Sri Lankan subjects.

OBJECTIVES: This study validates two popular predictive equations of renal function firstly, Modifications of Diet in Renal Disease and secondly, Chronic Kidney Disease Epidemiology Collaboration equations for Sri Lankan cohort. We used data of the patients referred to Renal Research lab of University of Colombo for creatinine clearance measurement. RESULTS: Predictive performances varied with the gender. Creatinine clearance and predicted renal functions were compared. Both fared unsatisfactorily with R2 ranging from 0.632 to 0.652, and overestimated renal function by 6-15%. The proportion chronic kidney disease staging 1 and 2 returned by Chronic Kidney Disease Epidemiology Collaboration equation showed significant difference, in females. Modifications of Diet in Renal Disease equation significantly under-estimated advanced chronic kidney disease in females. Chronic Kidney Disease Epidemiology Collaboration equation had better accuracy. The study sample had more females, Asian and lower body size and better renal functions than historic cohorts. Thai and Pakistani studies show both equations and their Asian adaptations fare poorly. Chronic kidney disease stages differ significantly with the equation used. Predictive equations have fared unsatisfactorily by overestimating renal functions. We recommend further studies using gold standards of measuring renal function.

Immediate Thrombolysis Followed by PCI for Left-Main Stem STEMI if Presenting Out of Hours: Should We Go "Back to the Future"?

A case of left-main stem STEMI presenting "out of hours" is discussed, wherein an excellent result was achieved with acute thrombolysis.

Dengue fever in renal transplant patients: a systematic review of literature.

BACKGROUND: Dengue fever in renal transplanted patients has not been studied well, and we review all the literature about episodes dengue fever in renal transplant patients. METHODS: The aim was to describe clinico-pathological characteristics, immunosuppressive protocols, need renal outcome and mortality. PubMed, LILACS, Google Scholar and Research Gate were searched for "Dengue" and "Renal/Kidney Transplantation" with no date limits. Hits were analyzed by two researchers separately. RESULTS: Fever, myalgia, arthralgia and headache was significantly lower than normal population, while pleural effusions and ascites were observed more. Incidence of severe dengue is significantly higher among transplant patients in this review, as well as they had a significantly higher mortality (8.9% vs 3.7%, p = 0.031). Age, period after transplantation and immunosuppressive profile had no effect on disease severity, mortality or graft out come. Presence of new bleeding complications and ascites was associated with more severe disease (p < 0.001 and p = 0.005), death (p = 0.033) or graft loss (p = 0.035). Use of tacrolimus was associated with new bleeding complications (p = 0.027), and with ascites (p = 0.021), but not with thrombocytopenia. 25% of patients with primary disease fail to mount an IgG response by 15 weeks of the illness. 58.9% had graft dysfunction during illness. Postoperative transplanted patients were at risk of severe disease and unfavorable outcome. CONCLUSIONS: The physical and laboratory findings in dengue fever in renal transplanted patients differ from the general population. Some degree of graft dysfunction is common during the illness, but only a minority develops graft failure.

Cardiac Magnetic Resonance Imaging Predictors of Short-Term Outcomes after High Risk Coronary Surgery.

BACKGROUND: The euroSCORE II is a widely used pre-coronary artery bypass graft surgery (CAGS) risk score, but its predictive power lacks the specificity to predict outcomes in high-risk patients (16) and left ventricular (LV) dysfunction (<40%) based on 2D-echocardiography who underwent CAGS and in whom CMRI (1.5T) was performed preoperatively were retrospectively studied. Cardiac magnetic resonance imaging parameters were assessed in patients who either had complications immediately post-surgery (n=35), six weeks post-surgery (n=20) or were uncomplicated. RESULTS: The average age of patients recruited was 69±5 years with high euroSCORE II (22±4) and low 2D-echocardiography LV ejection fraction (38%±2%). Cardiac magnetic resonance imaging results demonstrated that those with immediate complications had higher LV scar/infarct burden as a proportion of LV mass (17±3% vs 10±3%; p=0.04) with lower circumferential relaxation index (2.5±0.46 vs 2.8±0.56; p=0.05) compared to those with no complications. Early mortality from surgery was 17% (n=9) and was associated with lower RV stroke volume (55±12 vs 68±18; p=0.03) and higher LV infarct scar/burden (18±2% vs 10±2%, p=0.04). Cardiac magnetic resonance imaging showed patients with complications at six weeks post-surgery had higher LV scar/infarct burden (14.5±2% vs 6.8±2%, p=0.03) compared to those without complications. CONCLUSION: Cardiac magnetic resonance imaging preoperative LV and RV parameters are valuable in assessing the likelihood of successful outcomes from CAGS in high-risk patients with LV dysfunction.

Acute renal failure during immediate post transplant period due to a pericardial effusion.

BACKGROUND: Pericardial effusions and acute renal failure are common findings in clinical practice. However, acute renal failure resulting from pericardial effusions (without tamponade) is a rare finding. We report the first such case to occur in a transplanted kidney. CASE PRESENTATION: A 20-year-old Sri Lankan male presented with hypertensive crisis in the background of end stage renal failure. He was thoroughly investigated for secondary causes of hypertension to no avail. He was hemodialysed adequately for 6 months, while being worked up for transplantation. He received an ABO matched, living donor transplant. Immediate post-operative period his urine outputs were poor, soon to became anuric by 6 h post-transplant. Elevated liver enzymes and non-specific increase of resistivity indexes (0.84-0.88) at the Doppler scan raised the possibility of venous hypertension. An echocardiogram showed a moderately large pericardial effusion which was tapped, and found to be a transudate. He started producing urine within 6 h, entered polyuric phase by day 3, and by day 7 his creatinine dropped to reference levels. Vasculitis screen, anti nuclear factor, viral screen, and rickettsia serology were negative. Albumin levels on day 2 were 27 g/l and were replaced using human albumin. The exact cause of pericardial effusion is unclear but hypoalbuminemia, drug-induced and idiopathic are possible causes. He has excellent graft function, no recurrences or constrictive pericarditis after 2 years follow. CONCLUSION: We recommend any patient who has delayed graft function and raised central venous pressures to have an echocardiogram to exclude pericardial effusions. The response to pericardiocentesis had been universally good in reported cases.

Blockade of AT1 receptors in the rostral ventrolateral medulla increases sympathetic activity under hypoxic conditions.

The role of ANG type 1 (AT1) receptors in the rostral ventrolateral medulla (RVLM) in the maintenance of sympathetic vasomotor tone in normotensive animals is unclear. In this study, we tested the hypothesis that AT1 receptors make a significant contribution to the tonic activity of presympathetic neurons in the RVLM of normotensive rats under conditions where the excitatory input to these neurons is enhanced, such as during systemic hypoxia. In urethane-anesthetized rats, microinjections of the AT1 receptor antagonist candesartan in the RVLM during moderate hypoxia unexpectedly resulted in substantial increases in arterial pressure and renal sympathetic nerve activity (RSNA), whereas under normoxic conditions the same dose resulted in no significant change in arterial pressure and RSNA. Under hypoxic conditions, and after microinjection of the GABA(A) receptor antagonist bicuculline in the RVLM, subsequent microinjection of candesartan in the RVLM resulted in a significant decrease in RSNA. In control experiments, bilateral microinjections in the RVLM of the compound [Sar1,Thr8]ANG II (sarthran), which decreases sympathetic vasomotor activity via a mechanism that is independent of AT1 receptors, significantly reduced arterial pressure and RSNA under both normoxic and hypoxic conditions. The results indicate that, at least under some conditions, endogenous ANG II has a tonic sympathoinhibitory effect in the RVLM, which is dependent on GABA receptors. We suggest that the net effect of endogenous ANG II in this region depends on the balance of both tonic excitatory and inhibitory actions on presympathetic neurons and that this balance is altered in different physiological or pathophysiological conditions.