UNHEALTHIEST HABITS FOR YOUR HEART

UNHEALTHIEST HABITS FOR YOUR HEART

 

UNHEALTHIEST HABITS FOR YOUR HEART

Emilia Paluszek

“One Love! One Heart! Let’s get together and feel all right,” sang Bob Marley. But without a heart, one can forget about love or frankly — anything else. The good news is that if you manage to avoid certain mistakes and adopt a couple of simple rules you can keep your heart in mint condition for years. Love your heart and you will feel all right. Read on, and to ensure your health and the health of others, don’t miss these Sure Signs You’ve Already Had Coronavirus.

1 You’re Not Making Muscle Health a Priority

“Not making muscle health a priority is a major issue for your health. Make sure that you treat your heart with the respect it deserves,” says Dr. Neerav Dilip Padliya, Ph.D., PMP, Vice President, Research for MYOS RENS Technology. If you don’t know which heart risk factors you have, ask your healthcare provider to conduct or request screening tests during regular visits.

Here are the key screening tests for monitoring cardiovascular health recommended by the American Heart Association:

  • Blood pressure. The American Heart Association recommends checking your blood pressure during each regular healthcare visit or at least once per year if blood pressure is less than 120/80 mm Hg.
  • Cholesterol. The recommendation is to check it every 4-6 years for normal-risk adults; more often if any you have elevated risk for heart disease and stroke.
  • Weight/Body Mass Index (BMI). The American Heart Association recommends checking both during your regular healthcare visit.
  • Waist circumference. The recommendation is to check it as needed to help evaluate cardiovascular risk if your BMI is greater than or equal to 25 kg/m2.
  • Blood glucose test. The American Heart Association recommends testing it at least every 3 years.

Discuss smoking, physical activity, diet. Each regular healthcare visit

  1. 2. You’re Not Exercising Regularly

“The most unhealthy heart habit is a sedentary lifestyle. With the COVID pandemic and everyone stuck at home, it has been hard to keep an active lifestyle for most people,” says Dr. Paris Sabo. “The best thing you can do for your heart is to keep it pumping by being active regularly. The best activity is walking to get your heart rate up. Try to walk outside if you can, a minimum of three days a week for 30 minutes each.”

  1. 3. You’re Smoking

“Do not smoke — it’s by far and away the biggest risk factor for coronary artery disease. It does not matter how good your cholesterol is or how far you can run if you smoke one pack per day,” says Christopher Drumm, MD. “Put the Newports down. A pack a day over 5 years costs around 12,000 dollars and many years of your life.”

  1. 4. You’re Drinking Too Much

According to Hopkins Medicine, “Heavy drinking is linked to a number of poor health outcomes, including heart conditions. Excessive alcohol intake can lead to high blood pressure, heart failure or stroke. Excessive drinking can also contribute to cardiomyopathy, a disorder that affects the heart muscle.”

  1. 5. You’re Stressed

“Stress increases cortisol levels, a hormone that is pumped out in excess during times of stress,” says Leann Poston, MD. “Stress can also lead to avoiding exercise and enjoyable activities, unhealthy eating habits, insomnia, and abuse of drugs or alcohol. All of which further stress the heart.”

  1. 6. You’re Snoring

“Heavy snoring can sound funny to your sleep partner, but the condition is no joke,” says Michigan Health. “Snoring is often the sign of a condition called obstructive sleep apnea, which raises the risk for diabetes, obesity, hypertension, stroke, heart attack and other cardiovascular problems.”

  1. 7. You Have Diabetes

“Over time, high blood glucose from diabetes can damage your blood vessels and the nerves that control your heart and blood vessels,” says the NIH. “The longer you have diabetes, the higher the chances that you will develop heart disease. People with diabetes tend to develop heart disease at a younger age than people without diabetes.”

  1. 8. You’re Obese

“Obesity changes in the structure and function of the heart. It increases your risk of heart disease,” says Summit Medical Group. “The more you weigh, the more blood you have flowing through your body. The heart has to work harder to pump the extra blood.”

  1. 9. You’re Not Eating High-Quality Protein

“One of the most common mistakes that people make is not consuming enough high-quality protein. Sufficient high-quality protein, or protein with leucine, in your diet, is integral to maintaining good cardiovascular health,” says Dr. Padliya. Some of the best examples of natural protein are eggs, almonds, chicken breast, cottage cheese, and Greek yogurt. Some protein to avoid is sugary yogurt, fried meats, and protein bars.

  1. 10. You’re Not Thinking About the Future

“Muscle loss can also begin as early as 35-40 years old, so people should be cognizant of their muscle health, exercise, and good diet intake much earlier in life,” says Dr. Padliya.

According to Medical News Today, “People can prevent and minimize this loss by staying active. If they do not, it may contribute to poor health and well-being. Some past studies have suggested that people with cardiovascular disease who experience higher loss of muscle mass also have a higher risk of premature death.”

  1. 11. You’re Over 70 And Don’t Take Protein Supplements

“People in their senior years should also be exceeding the daily recommended allowance since they are at greater risk of muscle atrophy or muscle loss which can result in an increased risk of injuries, leading to lessened vitality. According to a recent study, requirements change for people as they grow older so sticking to the general recommended allowance is not sufficient for those over the age of 70,” says Dr. Padliya. “That said, the majority of people 70+ don’t eat enough protein to even meet the general recommended daily allowance. It is recommended that a 40-50-year-old person should ingest .8 grams per kilogram of protein per day for optimal muscle health, but someone who is 70+ should really be over 1.2 grams per kilogram per day. The quality of protein makes a difference as well. You want to make sure the protein you consume has enough leucine as it is very important for building muscle, particularly in older people,” states Dr. Padliya.

  1. 12. You’re Avoiding Egg Yolks

“Many people avoid the egg yolks opting for the egg whites only as the seemingly “healthier’ option, but the majority of the essential nutrients for muscle health are found in the yolks. Egg yolks are a great source of protein. A major study released in The American Journal of Clinical Nutrition, concluded that consuming one egg including the yolk per day is safe for cardiovascular health, too,” says Dr. Padliya.

  1. 13. You’re Eating Too Much Salt

“Salt is a common flavour enhancer that is in almost every food. Salt can cause problems such as increased blood pressure,” says Dr. Sabo. “When eating out, ask to leave the salt out of dishes, or when cooking at home use salt alternatives such as herbs and spices that are salt-free to flavour up your food. Always look at the sodium count on packaged foods to make sure that you’re not getting too much of the unhealthy flavour additives.”

  1. 14. You’re Ignoring the Doctor’s Orders

“When it comes to heart disease, not following your doctor’s advice is the biggest mistake,” says Dr. Rashmi Byakodi. “Heart treatment goals fail due to poor adherence to the medication regimen. Be aware of the medications you are taking and its side effects’’

  1. 4. Use PPE Accessories

I assess if PPE—personal protective equipment—such as masks, gloves, eyewear fits properly and comfortably and wear it consistently.

  1. 5. Study Data

I study available data and studies in small segments to not become overwhelmed. I know that data is continually evolving and may not be complete. I disaggregate the data by human factors such as age, race/ethnicity, sex/gender, SES to assess how it applies to the individual. I am aware that COVID-19 is a multi-system disease just like adaptation to space. As for yourself: To get through this pandemic at your healthiest, don’t miss these 35 Places You’re Most Likely to Catch COVID.

ROHSI CREATES AWARENESS ON SALIENT ILLNESSES – Dispatch News Online

ROHSI CREATES AWARENESS ON SALIENT ILLNESSES – Dispatch News Online

ROHSI CREATES AWARENESS ON SALIENT ILLNESSES

By Canice Opara

The Rays of Hope Support Initiative (ROHSI) has been creating awareness on salient sicknesses in the country, such as hypertension and diabetes through education on their health implications.

According to Mr. Benjamin Olorunfemi, founder of the organization, these ailments have been causing a lot of problems in the country, and unfortunately people are not always taking them seriously, hence his organization has embarked on an awareness campaign to education citizens.

Olorunfemi, who narrated how he almost died through these sickness, said he later researched on them only to discover that high blood pressure and diabetes are among other non-communicable diseases millions of Nigerians are battling with without knowing what they are, that this has led to his desire to raise awareness, provide health education, get people screened for hypertension and diabetes with the vision to reducing the untimely death resulting from complications caused by these ailments. Hence, Rays of Hope Support Initiative (ROHSI) was born in March 2017.

“We found out that if people had access to information and medical services early, deaths and other health complications arising from these ailments could be prevented. Then we decided to fight against these diseases with one-on-one talk Initiative, which was later extended to our communities because of the increasing number of people who need information and treatment”, he said.

Olorunfemi, quoting the World Health Organisation (WHO), said hypertension and diabetes are responsible for an estimated 45 percent of adults’ death due to heart diseases, and 51 percent of deaths due to stroke globally, with studies blaming the increasing prevalence of the condition on lifestyle and dietary factors such as physical inactivity, alcohol and tobacco use, and a diet high in sodium usually from processed and fatty foods. That unfortunately, the control of hypertension and diabetes has become a priority in many countries of the world, but remains a crisis in Nigeria in terms of awareness and management as the condition continues unabated.

He stated that studies continue to show from experts that more Nigerians are daily battling with these ailments without laid down measures, and asked why?

The ROHSI founder believes that economic downturn and the astronomical increase in managing these ailments are forcing many people to go on compulsory “drug holiday’’, as they found it hard to get funds in getting medical screening and medication on real-time. And that it could be why today people are seeking an alternative to orthodox drugs and treatment, as the economic situation has not allowed the majority of them to be able to cope with continuing medication.

He wondered why government, whose responsibility it is to create awareness and help pharmaceutical companies in curbing these sicknesses, is not doing much in that regard.

“Our government that was supposed to help in terms of awareness, providing relief and subsidies to pharmaceutical companies and the people with hypertension and diabetes to ameliorates their health conditions are not doing much even; our primary healthcare centres that supposed to be the first point of call for screening, detecting and helping in alleviating these ailments are not functioning to their name. Today, many of these patients are going back to alternative medicine or ‘’drug holiday’’ as I have said earlier, which often worsens the condition resulting in more health complications”, Olorunfemi lamented.

He said based on this, they are coming in to bridge that gap by coming in today as an organization to provide means by which more of people with these ailments could be reached through programmes like community outreaches, where they have provided free screening and medication to over 3,000 Nigerians.

“We all know there are significant health and economic gains attached to early detection, adequate treatment and good control of hypertension and diabetes than treating the complications of these ailments”, he reminded.

While saying that his organisation has the vision of supporting the health and well-being of people through health education and enlightenment, Olorunfemi said “but it’s not what we can do alone as an organisation; we need like minded people like you to help us with your time, network, resources among others in achieving the following:

“To create awareness on the effects and management of hypertension and diabetes among our people with special interest among the low income and the less privileged members of our society.

“To help increase the understanding among the communities, especially the less privileged members of the communities battling with these ailments about its impact on their health.

“To reduce the percentage of people with these diseases significantly through our awareness, health education and community outreaches respectively with follow-up on a great percentage of the people.

“To provide people living with hypertension or diabetes with comprehensive information on the causes and management.

“To provide our targeted audience with ongoing follow-up information on hypertension and diabetes.

“To reach a larger number of the communities with pamphlets, handbill, lecture in local dialects for clear and better understanding of what hypertension and diabetes are all about, and how deadly they could become if not discovered and managed on time”.

Olorunfemi advised that Nigerians should discourage people from resorting to self – medication, but instead seek for proper medical attention.

He added that all of the above cannot be achieved without Nigerians’ efforts and contributions, and that is why his organisation is asking people to join them with all that they have in achieving these.

First Published By Dispatch News Online http://dispatchnews.com.ng/2020/09/19/rohsi-creates-awareness-on-salient-illnesses/

 

MY STORY WITH RAYS OF HOPE SUPPORT INITIATIVE

MY STORY WITH RAYS OF HOPE SUPPORT INITIATIVE

 

 

 

 

  Awareness 

MY STORY WITH RAYS OF HOPE SUPPORT INITIATIVE-ROHSI

BY: Benjamin Olorunfemi

 In July 2016, after being away for weeks I came home to observe some off-duty days with my family. I knew I was having symptoms of not being in good health but I cannot say precisely what was wrong with me. My wife and I was a bit worry because I hardly fell sick.

I took some medication (just as we like to do in this part of the world without consulting a doctor; or any medical personnel). I was a bit ok as I went back to my place of work after observing the few days off. But by the time I resumed back, it became an issue as I couldn’t comprehend or coordinate myself. I was advised to visit a hospital to see a doctor. I went as advise, and the doctor that attended to me raised an eyebrow about my blood pressure numbers (to me it was nothing because I did not know the health implications of the numbers).

I was given medication for few days with advice to come back in a matter of days but within two days my blood pressure numbers rose from 140/100 mmHg  to 198/125mmHg  (at this stage, all was happening to me as I could not see, the headache, the heartbeats among others). I was rushed back to the hospital by my colleagues, where I was admitted and put under observation for over 12 hours (Their actions saved my life from some health complications I got to know later).

I got advised of my life through the medical doctor that attended to me on what was happening to me, the prevalence in Nigeria and the health implications it could cause me if I did not get to manage it on time. He made me understand that it has led to many dying at their prime but; I wondered why with all my education and exposure I did not get to know this

With that, consultations were made within the circle of friends, family, and community members among others. Books and Journals were read researching on what is high blood pressure, diabetes among other non-communicable diseases and what I found out (that millions of Nigerians are battling with these diseases without in knowing of what it is) led to the desire to raise awareness, provide health education, get people screened for hypertension and diabetes with the vision of reducing the untimely death resulting from complications caused by these ailments

We found out that if people had access to information and medical services early, deaths and other health complications arising from these ailments could be prevented. Then we decided to fight against these diseases with one on one talk Initiative, which was later extended to our communities but because of the increasing number of people who need information and treatment, Rays of Hope Support Initiative (ROHSI) was born in March 2017

According to the World Health Organization (WHO), hypertension and diabetes are responsible for an estimated 45% of adults’ death due to heart diseases and 51% of deaths due to stroke globally with studies blaming the increasing prevalence of the condition on lifestyle and dietary factors such as physical inactivity, alcohol and tobacco use, and a diet high in sodium usually from processed and fatty foods. Unfortunately, the control of hypertension and diabetes has become a priority in many countries of the world, but remain a crisis in Nigeria in terms of awareness and management as the condition continues unabated.

 Studies continue to show from experts that more Nigerians are daily battling with these ailments without laid down measures why? The economic downturn and the astronomical increase in managing these ailments are forcing many of our people to go on compulsory ‘’ drug holiday’’ as they found it hard to get funds in getting medical screening and medication on real-time.

Today people are seeking an alternative to orthodox drugs and treatment as the economic situation has not allowed the majority of them to be able to cope with continuing medication.

Our government that was supposed to help in terms of awareness, providing relief and subsidies to pharmaceutical companies and the people with hypertension and diabetes to ameliorates their health conditions are not doing much even; our primary healthcare centres that supposed to be the first point of call for screening, detecting and help in alleviating these ailments are not functioning to their name. Today, many of these patients are going back to alternative medicine or ‘’ drug holiday’’ as I have said earlier which often worsens the condition resulting in more health complications.

Today we are coming in as an organization to provide means by which more of our people with these ailments can be reached through programmes like our community outreaches where we have provided free screening and medication to over 3000 Nigerians. 

We all know there are significant health and economic gains attached to early detection, adequate treatment and good control of hypertension and diabetes than treating the complications of these ailments. 

Through my organization, we have the vision of supporting the health and well being of our people through health education and enlightenment but it’s not what we can do alone as an organization we need like minded people like you to help us with your time, network, resources among others in achieving the following:

  • To create awareness on the effect and management of hypertension and diabetes among our people with special interest among the low income/ less privileged members of our society
  • To help increase the understanding among the communities especially the less privileged member of the communities battling with these ailments about its impact on their health
  • To reduce the percentage of people with this disease significantly through our awareness, health education and community outreaches respectively with follow up on a great percentage of the people
  • To provide people living with hypertension or diabetes with comprehensive information on the causes and management
  • To provide our targeted audience with ongoing follow up information on hypertension and diabetes
  • To reach a larger number of the communities with pamphlets, handbill, lecture in local dialect for clear and better understanding of what hypertension and diabetes are all about and how deadly it can become if not discovered and Managed on time.
  • Discouraging people restoring to self –medication instead of seeking proper medical attention.

All of the above cannot be achieved without your efforts and contributions and that is why we are asking you to join us with all that you have in achieving these.

I am asking for whatever assistance you are ready to give as an individual and organization. Be your brother’s keeper; let us put an end to curtail the effects of these ailments among our people

 

 

MANAGING HIGH BLOOD SUGAR IS KEY TO REDUCING COVID-19 COMPLICATIONS: STUDY

MANAGING HIGH BLOOD SUGAR IS KEY TO REDUCING COVID-19 COMPLICATIONS: STUDY

By: Kara-Marie Hall, RN, BSN, CCRN

Key Takeaways:

  • Researchers at Michigan Medicine are using a targeted algorithm to help manage blood sugar levels in COVID-19 patients.
  • High blood sugar (hyperglycemia) is linked to severe illness in those with COVID-19. 
  • Having a severe case of COVID-19 can also cause high blood sugar in people who do not have diabetes.
  • Aggressive management of high blood sugar in patients with COVID-19 appears to reduce their risk of long-term health consequences associated with the virus.

Researchers at Michigan Medicine have created a management tool that could improve outcomes for patients with high blood sugar (hyperglycemia) and COVID-19. The research, which was published ahead of print on August 11 in the journal Diabetes, shows a two-way relationship between blood sugar levels and COVID-19.

According to the researchers, having high blood sugar can put patients at risk for more severe illness if they contract COVID-19. The reverse also appears to be true: patients with COVID-19 also are at risk for high blood sugar levels, even if they do not have diabetes.1

“Based on current evidence, it’s fair to say that the COVID-19 virus, particularly in its most severe forms, leads to much higher blood glucose levels,” study senior author Rodica Pop-Busui, MD, PhD, tells Verywell. Pop-Busui adds that having high blood glucose levels can also lead to worse outcomes for patients with COVID-19.

If left uncontrolled, the inflammation from COVID-19—often called a “cytokine storm”—can cause complications when coupled with inflammation caused by hyperglycemia.1 It also increases the likelihood of needing mechanical ventilation.

What Is Hyperglycemia?

Sugar (glucose) is necessary for proper organ function. Glucose enters your organs’ cells through a hormone called insulin. If the amount of glucose in your body exceeds the amount of insulin available, the glucose builds up in your blood and causes high blood sugar levels, known as hyperglycemia.

Hyperglycemia is typically defined as a blood sugar level of at least 180 mg/dl or greater when measured one to two hours after eating.2 However, the defined range varies among health organizations. Diabetes mellitus (type 1, type 2, and gestational) is the most common cause.

Michigan Medicine Introduces Hyperglycemia Management Teams

The researchers at Michigan Medicine designed a personalized, targeted clinical algorithm—a set of guidelines that helps healthcare providers make decisions—to help frontline healthcare workers without adding to their already heavy workload.

To put the guidelines into practice, the researchers launched several hyperglycemia management teams that were tasked with:

  • Checking patients’ glucose values through venous and arterial blood specimens rather than bedside glucose checks (because it’s more convenient)
  • Creating timely insulin dose adjustments multiple times a day
  • Reducing the number of glucose checks for most patients to every six hours

Not only did the algorithm lower patients’ glucose levels to an acceptable target range (generally 150-180 mg/dL), it also lessened the burden on frontline health care workers.

“We developed this early in the course of the pandemic, and we have continued to adapt and improve it based on lessons learned daily on the frontlines,” Pop-Busui says. “Others have started to use variations of this algorithm as well.”

What This Means For You:

If you have diabetes or even prediabetes, keeping your blood sugar levels well-controlled can help you reduce the risk of complications if you contract COVID-19.

COVID-19 Can Trigger Hyperglycemia

The Michigan Medicine researchers also found that some of the COVID-19 patients who had been referred to them for treatment developed high blood sugar levels even though they did not have diabetes.

“The severe inflammatory reaction triggers insulin resistance and high blood sugar even in people who may not have had known diabetes, but could have been in a prediabetic state,” Pop-Busui says.

A recent study published in the Journal of Medical Virology corroborates this idea, showing that out of 184 patients hospitalized with COVID-19, about 24% of patients were prediabetic.3

What is Prediabetes?

Prediabetes is a precursor to type 2 diabetes. According to the Centers for Disease Control and Prevention, more than 1 in 3 Americans have prediabetes. Over 84% of people with prediabetes are unaware that they have it.4

However, factors beyond diabetes and prediabetes can contribute to high blood sugar.

“[Patients with hyperglycemia] may also simply have stress hyperglycemia, which can occur from the stress of illness,” Roma Gianchandani, MD, another author of the Michigan Medicine study, tells Verywell,

Regardless of whether patients have prediabetes, diabetes, or stress hyperglycemia, Pop-Busui says their high blood sugar levels need immediate and sustained treatment.

Risks of Untreated Hyperglycemia

Romy Block, MD, an endocrinologist and co-founder of Vous Vitamin, tells Verywell that long-term, high blood sugars can directly injure blood vessels. Several health problems can result from this damage, including:

“In many medical conditions, tightly controlled sugars can decrease the duration of illness and decrease the [number of] days spent in the hospital,” Block says.

Treatment for hyperglycemia usually includes the administration of insulin—either given intravenously (directly into your vein) or under the skin—to bring down high blood sugar levels. 

BENIGN PROSTATE ENLARGEMENT

An enlarged prostate means the gland has grown bigger. Prostate enlargement happens to almost all men as they get older. An enlarged prostate is often called benign prostatic hyperplasia (BPH). It is not cancer, and it does not raise your risk for prostate cancer.

Age-associated prostate gland enlargement that can cause urination difficulty.

This type of prostate enlargement isn’t thought to be a precursor to prostate cancer.

With this condition, the urinary stream may be weak or stop and start. In some cases, it can lead to infection, bladder stones and reduced kidney function.

Treatments include medication that relaxes the bladder or shrinks the prostate, surgery and minimally invasive surgery.

Note:

  • Very common
  • More than 1.5 million cases per year (Nigeria)
  • Treatable by a medical professional
  • Requires a medical diagnosis
  • Lab tests or imaging often required
  • Chronic: can last for years or be lifelong

SYMPTOMS:

  • Frequent or urgent need to urinate.
  • Increased frequency of urination at night (nocturia)
  • Difficulty starting urination.
  • Weak urine stream or a stream that stops and starts.
  • Dribbling at the end of urination.
  • Inability to empty the bladder.

How do you check if your prostate is enlarged?

Diagnosis?

  • Digital rectal exam. The doctor inserts a finger into the rectum to check your prostate for enlargement.
  • Urine test. Analysing a sample of your urine can help rule out an infection or other conditions that can cause similar symptoms.
  • Blood test. …
  • Prostate-specific antigen (PSA) blood test.

 

TREATMENTS:

Treatment consists of supportive care and urinary retention medications

Treatments include medication that relaxes the bladder or shrinks the prostate, surgery and minimally invasive surgery.

Don’t resign yourself to living with BPH. Addressing your symptoms now can help you avoid problems later. Untreated BPH may lead to urinary tract infections, acute urinary retention (you can’t go at all), and kidney and bladder stones. In severe cases, it can lead to kidney damage.

Treatment options include medications and surgery. You and your doctor will consider several factors when you evaluate these choices. These factors include:

  • how much your symptoms interfere with your life
  • the size of your prostate
  • your age
  • your overall health
  • any other medical conditions

Can enlarged prostate Be Cured?

These are tablets that relax the muscles in the prostate and around the opening of the bladder, making it easier to urinate. They don’t cure an enlarged prostate, but they can help to relieve symptoms. Alpha-blockers are usually the first type of medicine you will be offered unless your prostate is very large.

Note Also:

If you have BPH or prostatitis, make an effort to reduce your caffeine intake by cutting back on coffee, soda or energy drinks. Avoiding caffeine can make a big difference in your urinary health. Another important drink for your prostate is water. Stay hydrated, and do not try to drink less to reduce your urine.

Various types of exercises can be helpful for men with prostate problems or OAB. Kegel exercises can strengthen and train your pelvic floor muscles to help control urination. Exercises such as walking, jogging, swimming, and tennis are also beneficial.

What foods hurt your prostate?

  • Red meat and processed meat. A diet high in meat, particularly if it’s cooked well-done, may be associated with an increased risk of developing prostate cancer. …
  • Dairy. Consuming large amounts of dairy products may increase your risk of developing prostate cancer. …
  • Alcohol. …
  • Saturated fats.

Green leafy vegetables are especially important because they are rich in antioxidants. Cruciferous vegetables such as broccoli also reduce the risk of prostate problems, including BPH and prostate cancer. People who eat onion and garlic regularly may also benefit from a lower risk of BPH.

Sources: Rays of Hope Support Initiative; College of Medicine, University of Ibadan and others

 

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