Before Sustainable Development Goals (SDG): why Nigeria failed to achieve the Millennium Development Goals (MDGs).

World leaders adopted the UN Millennium Declaration in 2000, which committed the nations of the world to a new global partnership, aimed at reducing extreme poverty and other time-bound targets, with a stated deadline of 2015. Fifteen years later, although significant progress has been made worldwide, Nigeria is lagging behind for a variety of reasons, including bureaucracy, poor resource management in the healthcare system, sequential healthcare worker industrial action, Boko Haram insurgency in the north of Nigeria and kidnappings in the south of Nigeria. The country needs to tackle these problems to be able to significantly advance with the new sustainable development goals (SDGs) by the 2030 target date

Before Sustainable Development Goals (SDG): why Nigeria failed to achieve the Millennium Development Goals (MDGs).

World leaders adopted the UN Millennium Declaration in 2000, which committed the nations of the world to a new global partnership, aimed at reducing extreme poverty and other time-bound targets, with a stated deadline of 2015. Fifteen years later, although significant progress has been made worldwide, Nigeria is lagging behind for a variety of reasons, including bureaucracy, poor resource management in the healthcare system, sequential healthcare worker industrial action, Boko Haram insurgency in the north of Nigeria and kidnappings in the south of Nigeria. The country needs to tackle these problems to be able to significantly advance with the new sustainable development goals (SDGs) by the 2030 target date

Meta-analysis: the diagnostic accuracy of critical flicker frequency in minimal hepatic encephalopathy

BACKGROUND: Minimal hepatic encephalopathy (MHE) reduces quality of life, increases the risk of road traffic incidents and predicts progression to overt hepatic encephalopathy and death. Current psychometry-based diagnostic methods are effective, but time-consuming and a universal ‘gold standard’ test has yet to be agreed upon. Critical Flicker Frequency (CFF) is a proposed language-independent diagnostic tool for MHE, but its accuracy has yet to be confirmed. AIM: To assess the diagnostic accuracy of CFF for MHE by performing a systematic review and meta-analysis of all studies, which report on the diagnostic accuracy of this test. METHODS: A systematic literature search was performed to locate all publications reporting on the diagnostic accuracy of CFF for MHE. Data were extracted from 2 × 2 tables or calculated from reported accuracy data. Collated data were meta-analysed for sensitivity, specificity, diagnostic odds ratio (DOR) and summary receiver operator curve (sROC) analysis. Prespecified subgroup analysis and meta-regression were also performed. RESULTS: Nine studies with data for 622 patients were included. Summary sensitivity was 61% (95% CI: 55–67), specificity 79% (95% CI: 75–83) and DOR 10.9 (95% CI: 4.2–28.3). A symmetrical sROC gave an area under the receiver operator curve of 0.84 (SE = 0.06). The heterogeneity of the DOR was 74%. CONCLUSIONS: Critical Flicker Frequency has a high specificity and moderate sensitivity for diagnosing minimal hepatic encephalopathy. Given the advantages of language independence and being both simple to perform and interpret, we suggest the use of critical flicker frequency as an adjunct (but not replacement) to psychometric testing

Is the prevalence of HIV wrongly estimated in Nigeria? Some insights from a 2017 World AIDS day experience from a Nigerian Non-Governmental Organisation

Introduction: HIV is still a major public health challenge, especially in resource-limited settings. In Nigeria, it is estimated that over 50% of those infected with HIV do not know their status. With the recent Nigerian governmental approval of a "Test and Start Strategy", we embarked on HIV testing and services in four defined locations to mark 2017 World AIDS Day. The aim of this report is to document the process and outcome of the exercise. Methods: four teams led by senior clinical associates implemented the services and were mandated to test at least 100 persons per location. At each location, we carried out the following activities: (1) short advocacy to community leaders, (2) HIV testing and counselling, (3) disclosure of results, post-test counselling and healthy life-style education and (4) distribution of free male condoms and Information, Education and Communication (IEC) material. Results: a total of 237 people (male 195, female 42) were tested, the majority of whom were between 19 and 49 years (93.7%). Two people were found to be positive, giving a 0.84% positivity rate. Informal interactions between service providers and the people tested revealed that people were aware of HIV as a public health problem, and people positively received HIV services. Although there is a selection bias, as those tested will not be truly representative of the population, the current positively rate of less than 1% is low compared to previous Nigerian estimates, which are based on antenatal testing. However, the exercise showed a willingness to be tested and fair knowledge of HIV as a problem. Population-based data from across Nigeria should be aggregated to determine community prevalence pending the National population-based HIV survey in 2018. Such information will inform evidence-based decisions on the necessity of such large-scale surveys in future years. Conclusion: there is an urgent need to define the real prevalence of HIV in Nigeria through a well planned and executed community based survey

Hepatocellular carcinoma: Review of disease and tumor biomarkers.

© The Author(s) 2016.Hepatocellular carcinoma (HCC) is a common malignancy and now the second commonest global cause of cancer death. HCC tumorigenesis is relatively silent and patients experience late symptomatic presentation. As the option for curative treatments is limited to early stage cancers, diagnosis in non-symptomatic individuals is crucial. International guidelines advise regular surveillance of high-risk populations but the current tools lack sufficient sensitivity for early stage tumors on the background of a cirrhotic nodular liver. A number of novel biomarkers have now been suggested in the literature, which may reinforce the current surveillance methods. In addition, recent metabonomic and proteomic discoveries have established specific metabolite expressions in HCC, according to Warburgs phenomenon of altered energy metabolism. With clinical validation, a simple and non-invasive test from the serum or urine may be performed to diagnose HCC, particularly benefiting low resource regions where the burden of HCC is highest

Ebola virus disease epidemic in West Africa: Lessons learned and issues arising from West African countries

© Royal College of Physicians 2015. All rights reserved.The current Ebola virus disease (EVD) outbreak ravaging three nations in West Africa has affected more than 14,000 persons and killed over 5,000. It is the longest and most widely spread Ebola epidemic ever seen. At the time of this overview (written November 2014), having affected eight different nations, Nigeria and Senegal were able to control and eliminate the virus within a record time. Ghana has successfully, to date, kept the virus away from the country, despite economic and social relationships with affected nations. What lessons can we learn from Nigeria, Senegal and Ghana in the current epidemic? How can the world improve the health systems in low- and middle-income countries to effectively manage future outbreaks? Recently, the Royal College of Physicians launched a new partnership with the West African College of Physicians to curtail the effects of HIV/AIDS, malaria and tuberculosis in the region. We believe that strengthened health systems, skilled human resources for health and national ownership of problems are key to effective management of outbreaks such as EVD

Sustainable Health Development Goals (SHDG): breaking down the walls.

The worlds governments failed to achieve the Health for All 2000 goals from the Alma Ata Declaration of 1978. Although a lot of milestones have been covered since 2000, the worlds governing authorities are unlikely to achieve the current Millennium Development Goals (MDGs) which expire by the end of this year. The inability to achieve these goals may be linked to the multiplicity of health-related directives and fragmentation of health systems in many countries. However, with the proposed 17 sustainability development goals, health has only one universal aim: to ensure healthy lives and promote wellbeing for all at all ages. Accomplishing this will require a focus on health systems (system-thinking), commonization of services and full integration of services with total dismantling of vertical programs across the world

The Role of physical activity and nutrition in the sarcopenia of cirrhosis.

The aim of this review is to understand how physical activity and nutrition are involved in the improvement of sarcopenia in patients affected by liver cirrhosis. The pathogenesis of sarcopenia in cirrhosis involves three major factors: inadequate dietary intake, metabolic disturbances, and malabsorption. Although in the early stages muscles appear to be spared, sarcopenia progressively leads to mobility limitations and its consequences, such as propensity to falls and drastically reducing life quality. Several studies confirm the important role played by physical activity and balanced nutrition in this chronic condition. Exercise and nutritional intervention should be recommended in these patients in order to improve quality of life

Challenges of liver cancer: Future emerging tools in imaging and urinary biomarkers.

© The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.Chronic liver disease has become a global health problem as a result of the increasing incidence of viral hepatitis, obesity and alcohol misuse. Over the past three decades, in the United Kingdom alone, deaths from chronic liver disease have increased both in men and in women. Currently, 2.5% of deaths worldwide are attributed to liver disease and projected figures suggest a doubling in hospitalisation and associated mortality by 2020. Chronic liver diseases vary for clinical manifestations and natural history, with some individuals having relatively indolent disease and others with a rapidly progressive course. About 30% of patients affected by hepatitis C has a progressive disease and develop cirrhosis over a 20 years period from the infection, usually 5-10 years after initial medical presentation. The aim of the current therapeutic strategies is preventing the progression from hepatitis to fibrosis and subsequently, cirrhosis. Hepatic steatosis is a risk factor for chronic liver disease and is affecting about the half of patients who abuse alcohol. Moreover non-alcoholic fatty liver disease is part of the metabolic syndrome, associated with obesity, hypertension, type ? diabetes mellitus and dyslipidaemia, and a subgroup of patients develops non-alcoholic steatohepatitis and fibrosis with subsequent cirrhosis. The strengths and pitfalls of liver biopsy are discussed and a variety of new techniques to assess liver damage from transient elastography to experimental techniques, such as in vitro urinary nuclear magnetic resonance spectroscopy. Some of the techniques and tests described are already suitable for more widespread clinical application, as is the case with ultrasound-based liver diagnostics, but others, such as urinary metabonomics, requires a period of critical evaluation or development to take them from the research arena to clinical practice

Black Holes in Modified Gravity (MOG)

The field equations for Scalar-Tensor-Vector-Gravity (STVG) or modified gravity (MOG) have a static, spherically symmetric black hole solution determined by the mass $M$ with two horizons. The strength of the gravitational constant is $G=G_N(1+\alpha)$ where $\alpha$ is a parameter. A regular singularity-free MOG solution is derived using a nonlinear field dynamics for the repulsive gravitational field component and a reasonable physical energy-momentum tensor. The Kruskal-Szekeres completion of the MOG black hole solution is obtained. The Kerr-MOG black hole solution is determined by the mass $M$, the parameter $\alpha$ and the spin angular momentum $J=Ma$. The equations of motion and the stability condition of a test particle orbiting the MOG black hole are derived, and the radius of the black hole photosphere and the shadows cast by the Schwarzschild-MOG and Kerr-MOG black holes are calculated. A traversable wormhole solution is constructed with a throat stabilized by the repulsive component of the gravitational field.Comment: 14 pages, 3 figures. Upgraded version of paper to match published version in European Physics Journal