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Pasha Y, Taylor-Robinson S, Leech R, et al., 2018, L-ORNITHINE L-ASPARTATE IN MINIMAL HEPATIC ENCEPHALOPATHY: POSSIBLE EFFECTS ON THE BRAIN-MUSCLE AXIS?, Annual General Meeting of the British-Society-of-Gastroenterology, Publisher: BMJ PUBLISHING GROUP, Pages: A117-A118, ISSN: 0017-5749
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Atzori S, Garvey L, Hoogenboom T, et al., 2018, SPLEEN STIFFNESS VIA ACOUSTIC RADIATION FORCE IMPULSE IN HIV PATIENTS WITH NON CIRRHOTIC PORTAL HYPERTENSION, Annual General Meeting of the British-Society-of-Gastroenterology, Publisher: BMJ PUBLISHING GROUP, Pages: A108-A109, ISSN: 0017-5749
Forlano R, Mullish BH, Katertsidis N, et al., 2018, SAT-476 A mobile application for the management and follow-up of patients with Non-Alcoholic Fatty Liver Disease, International Liver Congress 2018, Paris, France
Forlano R, Mullish BH, Katertsidis N, et al., 2018, A mobile application for the management and follow-up of patients with Non-Alcoholic Fatty Liver Disease, International Liver Congress (ILC), Publisher: ELSEVIER SCIENCE BV, Pages: S819-S819, ISSN: 0168-8278
Garvey L, Atzori S, Williamson M, et al., 2018, A cross-sectional study to investigate spleen stiffness via acoustic radiation force impulse (arfi) elastography in HIV-infected patients with non cirrhotic portal hypertension, Publisher: WILEY, Pages: S71-S72, ISSN: 1464-2662
Carbone M, Nardi A, Carpino G, et al., 2018, Pre-treatment risk stratification in primary biliary cholangitis: a predictive model to guide first-line combination therapy, International Liver Congress (ILC) of the European-Association-for-the-Study-of-the-Liver (EASL), Publisher: ELSEVIER SCIENCE BV, Pages: S225-S226, ISSN: 0168-8278
Forlano R, Mullish BH, Katertsidis N, et al., 2018, A mobile application for the management and follow-up of patients with Non-Alcoholic Fatty Liver Disease, Journal of Hepatology, Vol: 68, Pages: S819-S819, ISSN: 0168-8278
Abellona U, Mark DP, Oleribe O, et al., 2018, Towards elucidating a universal panel of diagnostic biomarkers for early hepatocellular carcinoma, International Liver Congress (ILC), Publisher: ELSEVIER SCIENCE BV, Pages: S433-S433, ISSN: 0168-8278
Atzori S, Hoogenboom T, Taylor-Robinson S, et al., 2018, Non invasive assessment of liver fibrosis by three different Shear Wave Techniques: Head-to-Head Performance, International Liver Congress (ILC), Publisher: ELSEVIER SCIENCE BV, Pages: S643-S644, ISSN: 0168-8278
Oleribe OO, Aliyu S, Taylor-Robinson SD, 2018, Is the prevalence of HIV wrongly estimated in Nigeria? Some insights from a 2017 World AIDS day experience from a Nigerian Non-Governmental Organisation, PAN AFRICAN MEDICAL JOURNAL, Vol: 29, ISSN: 1937-8688
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 planne
Carbone M, Nardi A, Carpino G, et al., 2018, Pre-treatment risk stratification in primary biliary cholangitis: A predictive model to guide first-line combination therapy, Publisher: ELSEVIER SCIENCE INC, Pages: 21-22, ISSN: 1590-8658
Oleribe OO, Salako BL, Akpalu A, et al., 2018, Public private partnership in in-service training of physicians: the millennium development goal 6-partnership for African clinical training (M-PACT) approach, PAN AFRICAN MEDICAL JOURNAL, Vol: 29, ISSN: 1937-8688
Introduction: in-service training of healthcare workers is essential for improving healthcare services and outcome. Methods: the Millennium Development Goal (MDG) 6 Partnership for African Clinical Training (M-PACT) program was an innovative in-service training approach designed and implemented by the Royal College of Physicians (RCP) and West African College of Physicians (WACP) with funding from Eco Bank Foundation. The goal was to develop sustainable capacity to tackle MDG 6 targets in West Africa through better postgraduate medical education. Five training centres were establised: Nigeria (Abuja, Ibadan), Ghana (Accra), Senegal (Dakar) and Sierra Leone (Freetown) for training 681 physicians from across West Africa. A curriculum jointly designed by the RCP-WACP team was used to deliver biannual 5-day training courses over a 3-year period. Results: of 602 trained in clinical medicine, 358 (59.5%) were males and 535 (88.9%) were from hosting countries. 472 (78.4%) of participants received travel bursaries to participate, while 318 (52.8%) were residents in Internal Medicine in the respective institutions. Accra had the highest number of participants (29.7%) followed by Ibadan, (28.7%), Dakar, (24.9%), Abuja, (11.0%) and Freetown, (5.6%). Pre-course clinical knowledge scores ranged from 35.1% in the Freetown Course to 63.8% in Accra Course 1; whereas post-course scores ranged from 50.5% in the Freetown course to 73.8% in Accra course 1. Conclusion: M-PACT made a positive impact to quality and outcome of healthcare services in the region and is a model for continued improvement for healthcare outcomes, e.g malaria, HIV and TB incidence and mortality in West Africa.
Oleribe OO, Osita-Oleribe P, Nwachukwu C, et al., 2018, A Comprehensive HIV Program by an Indigenous Organization in Nigeria: A 5 Year Progress Report, Annals of Medical and Health Sciences Research, Vol: 7, Pages: 101-105, ISSN: 2141-9248
Background: Nigeria has a high HIV burden with over 3,500,000 infected and more than 200,000 deaths annually. Since 2004, international donor agencies and implementing partners managed HIV programs in Nigeria. Excellence and Friends Management Care Centre (EFMC) was the first local organization to be funded to provide comprehensive HIV services in Nigeria. Aim: To document the need, processes and products of five years of indigenous HIV programming in Nigeria. Materials and Methods: PEPFAR funded EFMC from 2011 to provide comprehensive HIV services in Nasarawa State and Abuja, the Federal Capital Territory (FCT). EFMC engaged staff, assessed and activated sites, trained and empowered healthcare workers, provided consumables, enrolled clients and provided preventive, treatment and support services. EFMC also strengthened healthcare systems and refurbished and equipped facilities for integrated HIV services. Results: EFMC decentralized, commonized and integrated HIV services in over 120 service delivery points with an average cost per target of US$ 273.12. We tested 623,148 people for HIV. The positivity rate was 3.3% (annual range 1.9–4.5%). We placed 10,150 on Highly Active Antiretroviral Therapy. In addition, we tested 164,746 pregnant women for HIV with 5,442 (3.3%) positive and provided 4,189 (77.0%) positive pregnant women with ARV prophylaxis. More than 500 healthcare workers in HIV program management. Conclusions: EFMC’s “commonization” model is cost-effective and efficient. Progressively funding local partners will ensure sustainability of HIV programs. Using program results as national figures will save cost from periodic sentinel studies. Government should support local NGOs to control the HIV epidemic in Nigeria.
Cobbold JFL, Atkinson S, Marchesi JR, et al., 2018, Rifaximin in non-alcoholic steatohepatitis: An open-label pilot study, HEPATOLOGY RESEARCH, Vol: 48, Pages: 69-77, ISSN: 1386-6346
AimGut microbial dysbiosis is implicated in the pathogenesis of non‐alcoholic steatohepatitis (NASH). We investigated downstream effects of gut microbiota modulation on markers of hepatic inflammation, steatosis, and hepatic and peripheral insulin sensitivity in patients with NASH using rifaximin therapy.MethodsPatients with biopsy‐proven NASH and elevated aminotransferase values were included in this open‐label pilot study, all receiving 6 weeks rifaximin 400 mg twice daily, followed by a 6‐week observation period. The primary endpoint was change in alanine aminotransferase (ALT) after 6 weeks of rifaximin. Secondary endpoints were change in hepatic lipid content and insulin sensitivity measured with a hyperinsulinemic–euglycemic clamp.ResultsFifteen patients (13 men and 2 women) with a median (range) age of 46 (32–63) years were included. Seven had diabetes on oral hypoglycemic medications and 8 had no diabetes. After 6 weeks of therapy, no differences were seen in ALT (55 [33–191] vs. 63 [41–218] IU/L, P = 0.41), peripheral glucose uptake (28.9 [19.4–48.3] to 25.5 [17.7–47.9] μmol/kg/min, P = 0.30), hepatic insulin sensitivity (35.2 [15.3–51.7]% vs. 30.0 [10.8–50.5]%, P = 0.47), or hepatic lipid content (21.6 [2.2–46.2]% vs. 24.8 [1.7–59.3]%, P = 0.59) before and after rifaximin treatment. After 12 weeks from baseline, serum ALT increased to 83 (30–217) IU/L, P = 0.02. There was a significant increase in the homeostasis model assessment–estimated insulin resistance index (P = 0.05). The urinary metabolic profile indicated a significant reduction in urinary hippurate with treatment, which reverted to baseline after cessation of rifaximin, although there was no consistent difference in relative abundance of fecal microbiota with treatment.ConclusionThese data do not indicate a beneficial effect of rifaximin i
Oleribe OO, Osita-Oleribe P, Ekom E, et al., 2017, Is malaria over-diagnosed? A world malaria day 2017 experience by Excellence and Friends Management Care Centre (EFMC) and partners, Abuja Nigeria, Pan African Medical Journal, Vol: 28, Pages: 273-273, ISSN: 1937-8688
Malaria remains a major cause of mortality across the world, but particularly in sub-Saharan Africa. WHO-sponsored World Malaria Day activity has helped to improve education and has contributed to a reduction in mortality globally in the past decade. However, much needs to be done still in Africa. We report on a World Malaria Day scheme in three primary Healthcare Facilities in and around the Abuja Federal Capital Territory in Nigeria in 2017. Activity included educational talks to pregnant women and nursing mothers of young children, with malarial testing, distribution of free mosquito nets and also medical treatment if needed. We found a large clinical over-diagnosis of malaria with simple fevers of any cause being reported as malaria. None of these cases were found to be due to malaria on formal malarial testing. We conclude that efforts should continue into education and prevention of malaria with insecticide-impregnated mosquito nets a key factor. However, over-diagnosis of malaria and the use of unnecessary antimalarial treatment may lead to parasite resistance to antimalarial treatment, morbidity from drug side-effects and potential mortality from not receiving the right treatment for other febrile illnesses. We recommend that malarial testing, particularly with simple blood film microscopy is implemented more widely across Africa, as it is simple to perform and allows effective management plans to be drawn up for individual patients.
Cartlidge C, U AMR, Alkhatib A, et al., 2017, The utility of biomarkers in hepatocellular carcinoma: review of urine-based 1H-NMR studies – what the clinician needs to know, International Journal of General Medicine, Vol: 2017, Pages: 431-442, ISSN: 1178-7074
Hepatocellular carcinoma (HCC) is the fifth most common malignancy, the third most common cause of cancer death, and the most common primary liver cancer. Overall, there is a need for more reliable biomarkers for HCC, as those currently available lack sensitivity and specificity. For example, the current gold-standard biomarker, serum alpha-fetoprotein, has a sensitivity of roughly only 70%. Cancer cells have different characteristic metabolic signatures in biofluids, compared to healthy cells; therefore, metabolite analysis in blood or urine should lead to the detection of suitable candidates for the detection of HCC. With the advent of metabonomics, this has increased the potential for new biomarker discovery. In this article, we look at approaches used to identify biomarkers of HCC using proton nuclear magnetic resonance (1H-NMR) spectroscopy of urine samples. The various multivariate statistical analysis techniques used are explained, and the process of biomarker identification is discussed, with a view to simplifying the knowledge base for the average clinician.
Heffernan A, Barber E, Cook NA, et al., 2017, Aiming at the Global Elimination of Viral Hepatitis: Challenges along the Care Continuum, Open Forum Infectious Diseases, Vol: 5, ISSN: 2328-8957
A recent international workshop, organised by the authors, analysed the obstacles facing the ambitious goal of eliminating viral hepatitis globally. We identified several policy areas critical to reaching elimination targets. These include: providing hepatitis B birth-dose vaccination to all infants within 24 hours of birth; preventing the transmission of blood-borne viruses through the expansion of national haemovigilance schemes; implementing the lessons learnt from the HIV epidemic regarding safe medical practices to eliminate iatrogenic infection; adopting point-of-care testing to improve coverage of diagnosis; and providing free or affordable hepatitis C treatment to all. We introduce Egypt as a case study for rapid testing and treatment scale-up: this country offers valuable insights to policy makers internationally, not only regarding how hepatitis C interventions can be expeditiously scaled-up, but also as a guide for how to tackle the problems encountered with such ambitious testing and treatment programmes.
U MRA, Taylor-Robinson SD, 2017, Comments on Gabbani, et al. Metabolomic analysis with (1)H NMR for non-invasive diagnosis of hepatic fibrosis degree in patients with chronic hepatitis C., Digestive and Liver Disease, Vol: 50, Pages: 209-210, ISSN: 1590-8658
We read with great interest the recent publication by Gabbani et al. reporting their assessment of the severity of liver fibrosis in patients with chronic hepatitis C using 1H NMR spectroscopy [1]. However, we would like to comment on the design of the study, the analysis of the data and the interpretation and reporting of the results.
Kim JU, Oleribe O, Njie R, et al., 2017, A TIME FOR NEW NORTH - SOUTH RELATIONSHIPS IN GLOBAL HEALTH, International Journal of General Medicine, Vol: 2017, Pages: 401-408, ISSN: 1178-7074
The modern concept of globalization in health care and clinical research often carries a positive message for the “Global South” nations of Africa, South America and Southeast Asia. However, bioethical abuse of participants in clinical trials still exists in the Global South. Unethical studies directed by the “Global North”, formed by the medically advanced nations in North America, Western Europe and Japan, have been hugely concerning. The issue between the Global North and South is a well-recognized socioeconomic phenomenon of globalization. Medical exploitation has its roots in the socioeconomic interactions of a postcolonial world, and solutions to reducing exploitation require a deeper understanding of these societal models of globalization. We explore the fundamental causes of imbalance and suggest solutions. Reflecting on the globalization model, there must be an effort to empower the Global South nations to direct and govern their own health care systems efficiently on the basis of equality.
Oleribe OO, Akpalu A, Ayegua-Hagan N, et al., 2017, Use of mosquito nets: Is it time to think differently?, Malaria Chemotherapy, Control & Elimination, Vol: 6, ISSN: 2090-276X
While the Millennium Development Goal 6 has concentrated on malaria elimination strategies with some degree ofsuccess, reflected in falling morbidity and mortality over the past 15 years, the situation in Africa is not as promising asthe rest of the world. We wondered how effective the message to use insecticide-treated mosquito nets was and withthis in mind, in September 2016, we undertook a survey of highly-trained doctors from Nigeria and Ghana, attendingMillennium Development Goal 6 postgraduate training courses in Ibadan and Accra to assess whether they practicedantimalarial personal protection policies themselves. Surprisingly, over 40% of the doctors in the Accra survey did noteven own a mosquito net with 20% in Ibadan. Only 7% of those in Ghana used their nets daily, rising to 20% in theNigerian respondents. We conclude that further public health measures are needed to bring home the message thatmosquito nets should be used on a daily basis in endemic areas and that no section of society is exempt.
Forlano R, Manousou P, Mullish BH, et al., 2017, Assessment of non invasive markers of fibrosis against collagen quantitation and NASH-CRN scoring in liver biopsies of NAFLD patients, The AASLD Liver Meeting 2017, Publisher: Wiley, Pages: 334A-334A, ISSN: 0270-9139
Mullish BH, Forlano R, Yee M, et al., 2017, Development of an algorithm for the prediction of cardiovascular events in patients with NAFLD: the role of mean platelet volume, The AASLD Liver Meeting 2017, Publisher: Wiley, Pages: 1175A-1176A, ISSN: 0270-9139
Hegade VS, Pechlivanis A, McDonald JA, et al., 2017, Serum Metabonomic and Gut Microbial Profile in Patients with Primary Biliary Cholangitis with Pruritus and the Effect of Ileal Bile Acid Transporter Inhibition, 68th Annual Meeting of the American-Association-for-the-Study-of-Liver-Diseases (AASLD) / Liver Meeting, Publisher: WILEY, Pages: 171A-171A, ISSN: 0270-9139
Bajaj JS, Kakiyama G, Cox IJ, et al., 2017, Gut microbial functional changes after liver transplant can modulate infection risk and increase atherogenic metabolites, The 68th Annual Meeting of the American Association for the Study of Liver Diseases: The Liver Meeting 2017, Publisher: Wiley, Pages: 52A-53A, ISSN: 0270-9139
Morement H, Harrison RH, Taylor-Robinson SD, 2017, The Multidisciplinary Team Meeting (MDT) in the United Kingdom: From the Patients’ Perspective Comments and observations from cholangiocarcinoma patients and their families, International Journal of General Medicine, Vol: 2017, Pages: 305-310, ISSN: 1178-7074
Syms RRA, Kardoulaki E, Rea M, et al., 2017, Magneto-inductive magnetic resonance imaging duodenoscope, Progress in Electromagnetics Research (PIER), Vol: 159, Pages: 125-138, ISSN: 1070-4698
A magnetic resonance imaging (MRI) duodenoscope is demonstrated, by combining non-magnetic endoscope components with a thin-film receiver based on a magneto-inductive waveguide.The waveguide elements consist of figure-of-eight shaped inductors formed on either side of a flexiblesubstrate and parallel plate capacitors that use the substrate as a dielectric. Operation is simulatedusing equivalent circuit models and by computation of two- and three-dimensional sensitivity patterns.Circuits are fabricated for operation at 127.7 MHz by double-sided patterning of copper-clad Kaptonand assembled onto non-magnetic flexible endoscope insertion tubes. Operation is verified by benchtesting and by1H MRI at 3T using phantoms. The receiver can form a segmented coaxial image alongthe length of the endoscope, even when bent, and shows a signal-to-noise-ratio advantage over a surfacearray coil up to three times the tube diameter at the tip. Initial immersion imaging experiments havebeen carried out and confirm an encouraging lack of sensitivity to RF heating.
Mohamed Z, Mbwambo J, Shimakawa Y, et al., 2017, Clinical utility of HCV core antigen detection and quantification using serum samples and dried blood spots in people who inject drugs in Dar-es-Salaam, Tanzania, Journal of the International AIDS Society, Vol: 20, ISSN: 1758-2652
Introduction: A lack of access to hepatitis C virus (HCV) diagnostics is a significant barrier to achieving the World HealthOrganization 2030 global elimination goal. HCV core antigen (HCVcAg) quantification and dried blood spot (DBS) areappealing alternatives to conventional HCV serology and nucleic acid testing (NAT) for resource-constraint settings, particu-larly in difficult-to-reach populations. We assessed the accuracy of serum and DBS HCVcAg testing in people who inject drugsin Tanzania using HCV NAT as a reference.Method: Between May and July 2015, consecutive HCV-seropositive patients enrolled in the local opioid substitutiontreatment centre were invited to participate in the study. All had HCV RNA detection (Roche Molecular Systems,Pleasanton, CA, USA), genotyping (NS5B gene phylogenetic analysis) and HCVcAg on blood samples and DBS (Architectassay; Abbott Diagnostics, Chicago, IL, USA).Results: Out of 153 HCV-seropositive individuals, 65 (42.5%) and 15 (9.8%) were co-infected with HIV (41 (63%) were on anti-retroviral therapy (ARVs)) and hepatitis B respectively. In total, 116 were viraemic, median viral load of 5.7 (Interquartilerange (IQR); 4.0–6.3) log iU/ml (75 (68.2%) were genotype 1a, 35 (31.8%) genotype 4a). The median alanine transaminase(ALT) (iU/l), aspartate transaminase (AST) (iU/l) and gamma-glutamyl transferase (GGT) (iU/l) were 35 (IQR; 23–51), 46 (32–57) and 69 (35–151) respectively. For the quantification of HCV RNA, serum HCVcAg had a sensitivity at 99.1% and aspecificity at 94.1%, with an area under the receiver operating curve (AUROC) at 0.99 (95% CI 0.98–1.00). DBS HCVcAg had asensitivity of 76.1% and a specificity of 97.3%, with an AUROC of 0.87 (95% CI 0.83–0.92). HCVcAg performance did not differby HIV co-infection or HCV genotype.Conclusions: Our study suggests that HCVcAg testing in serum is an excellent alternative to HCV polymerase chain reaction inAfrica. Although HCVcAg detection and quanti
Cook NA, Kim JU, Crossey MM, et al., 2017, A pilot evaluation of a computer-based psychometric test battery designed to detect impairment in patients with cirrhosis, International Journal of General Medicine, Vol: 2017, Pages: 281-289, ISSN: 1178-7074
Background: Psychometric testing is used to identify patients with cirrhosis who have developed hepatic encephalopathy (HE). Most batteries consist of a series of paper-and-pencil tests, which are cumbersome for most clinicians. A modern, easy-to-use, computer-based battery would be a helpful clinical tool, given that in its minimal form, HE has an impact on both patients’ quality of life and the ability to drive and operate machinery (with societal consequences).Aim: We compared the Cogstate™ computer battery testing with the Psychometric Hepatic Encephalopathy Score (PHES) tests, with a view to simplify the diagnosis.Methods: This was a prospective study of 27 patients with histologically proven cirrhosis. An analysis of psychometric testing was performed using accuracy of task performance and speed of completion as primary variables to create a correlation matrix. A stepwise linear regression analysis was performed with backward elimination, using analysis of variance.Results: Strong correlations were found between the international shopping list, international shopping list delayed recall of Cogstate and the PHES digit symbol test. The Shopping List Tasks were the only tasks that consistently had P values of <0.05 in the linear regression analysis.Conclusion: Subtests of the Cogstate battery correlated very strongly with the digit symbol component of PHES in discriminating severity of HE. These findings would indicate that components of the current PHES battery with the international shopping list tasks of Cogstate would be discriminant and have the potential to be used easily in clinical practice.
Oleribe OO, Kirby K, Oladipo O, et al., 2017, The Millennium Development goal 6 Partnership for African Clinical Training (M-PACT) Clinical Course: a six months' post training impact survey, Annals of Medical and Health Sciences Research, Vol: 7, Pages: 284-288, ISSN: 2141-9248
Context: The Royal College of Physicians of London and the West African College of Physicians have a long history of collaboration with a focus on postgraduate education. The Millennium Development Goal 6 Partnership for African Clinical Training (M-PACT) Clinical Course project was undertaken to improve the theoretical and practical knowledge base in the pertinent diseases of the Millennium Developments Goals (MDG 6): Tuberculosis, HIV/AIDS, Malaria, and medical leadership. Aim: To assess the impact of the training on everyday practice of the participants at least six months’ post training. Material and methods: A cross-sectional descriptive survey was used to execute this study between April to May 2016. A self-administered questionnaire was used for this study. Questionnaires were distributed using SurveyMonkey®. Data were analyzed using SurveyMonkey® Analysis Tool and Microsoft Excel Sheet. Results: A total of 73 trainees from six different courses responded to the survey. Majority (76.06%) of all respondents were from tertiary facilities. The survey revealed a positive influence on the clinical practice of participants, on prescription patterns, diagnostic approaches, and case findings in the community. A number of new concepts such as “Doctors as Leaders” were learned by the participants with over 80% of respondents desiring further trainings in leadership. Conclusion: The M-PACT courses had changed the knowledge base of the participants with more confident diagnosis, management and prescribing reported as a result. We suggest that this format for postgraduate teaching is important not only in West Africa, but throughout sub-Saharan Africa.
Syms RRA, Kardoulaki E, Rea M, et al., 2017, Metamaterial Magnetic Resonance Imaging Endoscope, 2017 11th International Congress on Engineered Material Platforms for Novel Wave Phenomena (METAMATERIALS), Publisher: IEEE, Pages: 337-339
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