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Competing Interests: Declaration of Competing Interest The authors have no conflict of interest to declare.

Background: The Nigerian healthcare system, including medical laboratories, operates in a three-tiered structure across public and private sectors. Lessons from COVID-19 show the urgent need for a guideline to drive medical laboratory service integration., Problem: Lack of operational guideline to drive the integration of laboratory services has resulted in siloed operations across different medical laboratories causing duplication of resources, coordination issues, and inefficiencies., Aim: To highlight the development processes of medical laboratory service integration guideline and discuss its key provisions., Method: The Medical Laboratory Services Division (MLSD), Federal Ministry of Health (FMoH) initiated the development of a national guideline for integrating medical laboratory services. Partnering with stakeholders and engaging two consultants, a technical workshop was facilitated in January 2024. The Consultants garnered the initial inputs stakeholders made at the five-day meeting. The inputs were collated and organized to produce the guideline. The guideline was circulated to participants and other stakeholders for review and feedback received was used to finalize the document. The MLSD with support from partners further held a three-day stakeholders' meeting in May 2024 to validate the document before submitting it to the Health Minister for endorsement., Result: The guideline sets standards for achieving medical laboratory services and systems integration across different medical laboratories. The contents of the guideline are enumerated and respective recommendations made under each element are highlighted., Conclusion: The implementation of the guideline will help harmonize services, improve access to diagnostics, streamline processes, reduce redundancies, optimize resource utilization, enhance communication, data sharing, and pandemic preparedness., (Copyright © 2024 Instituto Mexicano del Seguro Social (IMSS). All rights reserved.)

Recent studies have indicated the significant involvement of the gut microbiome in both human physiology and pathology. Additionally, therapeutic interventions based on microbiome approaches have been employed to enhance overall health and address various diseases including aging and neurodegenerative disease (ND). Researchers have explored potential links between these areas, investigating the potential pathogenic or therapeutic effects of intestinal microbiota in diseases. This article provides a summary of established interactions between the gut microbiome and ND. Post-biotic is believed to mediate its neuroprotection by elevating the level of dopamine and reducing the level of α-synuclein in substantia nigra, protecting the loss of dopaminergic neurons, reducing the aggregation of NFT, reducing the deposition of amyloid β peptide plagues and ameliorating motor deficits. Moreover, mediates its neuroprotective activity by inhibiting the inflammatory response (decreasing the expression of TNFα, iNOS expression, free radical formation, overexpression of HIF-1α), apoptosis (i.e. active caspase-3, TNF-α, maintains the level of Bax/Bcl-2 ratio) and promoting BDNF secretion. It is also reported to have good antioxidant activity. This review offers an overview of the latest findings from both preclinical and clinical trials concerning the use of post-biotics in ND., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

The study was performed to evaluate the neuroprotective effects of Benfotiamine (BFT) in 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-induced Parkinson's disease (PD) in rats. The rats were given daily doses of BFT (100 mg/kg, 200 mg/kg) through oral administration for 42 days. The rats were given a single bilateral dosage of MPTP (0.1 mg/nostril) intranasally once before the drug treatment to induce PD. On day 42, the animals were subjected to various behavioral paradigms. Post-treatment with BFT for 42 days significantly improved the motor and nonmotor fluctuations of MPTP. The results demonstrated that treatment with BFT ameliorated MPTP-induced disorders in behavior, body balance, and dopamine levels in the mid-brain. Among the post-treated groups, a high dose of BFT was the most effective treatment. Mean values are indicated in ±SEM, n = 5***(p < 0.001) when compared with the vehicle control, n = 5 ### (p < 0.001) when compared with the disease control; (p < 0.001) when compared with the BFT per se; (p < 0.001) when compared with the low dose of BFT; (p < 0.001) when compared with the high dose of BFT. Our finding suggests that BFT contributed to superior antioxidant, and anti-inflammatory and could be a novel therapeutic method for PD management. In conclusion, BFT could be a potential drug candidate for curbing and preventing PD., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Background: Hesitancy to COVID-19 vaccine may worsen the burden of COVID-19 among people living with HIV (PLHIV), who are at a higher risk of COVID-19-related hospitalization and death, compared to HIV non-infected individuals. Therefore, we evaluate the predictors and reasons for COVID-19 vaccine hesitancy among unvaccinated PLHIV in six antiretroviral therapy (ART) clinics across northern Nigeria., Methodology: In this cross-sectional study, conducted between October 2021 and February 2022 in six hospitals across two geopolitical regions of Nigeria, we utilized interviewer-administered questionnaires to assess COVID-19 vaccine hesitancy among a convenience sample of 790 eligible adult PLHIV. Hesitancy was defined as answering 'no' or 'maybe' to a question asking participants their willingness to accept the COVID-19 vaccine. A multivariate logistic regression model was used to estimate the adjusted odds ratio (aOR) and 95% confidence interval (CI) of the factors associated with COVID-19 vaccine hesitancy among PLHIV., Results: Of the total 660 unvaccinated participants included in the analysis (61.82% female, mean age [SD] of 39.76 [10.75]), 381 (57.72%) were hesitant to COVID-19 vaccine. Being 50 years and older (aOR: 0.43; 95% CI: 0.21-0.89), being unemployed (aOR: 0.57; 95% CI: 0.34-0.95), experiencing the adverse effects of ART (aOR: 0.36; 95% CI: 0.15-0.86), and perception of being at high risk of contracting COVID-19 (aOR: 0.22; 95% CI: 0.13-0.37) were associated with significantly lower odds of hesitancy. Conversely, being female (aOR: 1.64; 95% CI: 1.02-2.61) and attending ART clinics at state administrative capital cities (IIDH Kano [aOR: 2.40; 95% CI: 1.10-5.25], MMSH Kano [aOR: 5.59; 95% CI: 1.97-10.66], YSSH Damaturu [aOR: 9.88; 95% CI: 4.02-24.29] vs. GH Gashua) were associated with significantly higher odds of hesitancy. The most common reasons for hesitancy include fear of potential adverse effects, skepticism about vaccine efficacy, the rapid development of the COVID-19 vaccine, and the perceived lack of effort to develop a cure or vaccine for HIV/AIDS., Conclusion: Interventions aimed at combating misperceptions and misinformation regarding the COVID-19 vaccination program may reduce the prevalence of COVID-19 vaccine hesitancy among unvaccinated PLHIV., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Mitochondria are the target sites for multiple disease manifestations, for which it is appealing to researchers' attention for advanced pharmacological interventions. Mitochondrial inhibitors from natural sources are of therapeutic interest due to their promising benefits on physiological complications. Mitochondrial complexes I, II, III, IV, and V are the most common sites for the induction of inhibition by drug candidates, henceforth alleviating the manifestations, prevalence, as well as severity of diseases. Though there are few therapeutic options currently available on the market. However, it is crucial to develop new candidates from natural resources, as mitochondria-targeting abnormalities are rising to a greater extent. Marine and terrestrial sources possess plenty of bioactive compounds that are appeared to be effective in this regard. Ample research investigations have been performed to appraise the potentiality of these compounds in terms of mitochondrial disorders. So, this review outlines the role of terrestrial and marine-derived compounds in mitochondrial inhibition as well as their clinical status too. Additionally, mitochondrial regulation and, therefore, the significance of mitochondrial inhibition by terrestrial and marine-derived compounds in drug discovery are also discussed., Competing Interests: Declaration of competing interest The authors declare that the research was conducted in the absence of any commercial or financial relationship that could be constructed as a potential conflict of interest., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Objective: To elucidate trends of prostate-cancer (PCa) screening in gay and bisexual men and assess the association of sexual orientation with PCa screening in the United States of America., Methods: Data for men ≥40 years-old with no history of PCa were collected from the National Health Interview Survey for the years 2013, 2015, and 2018. Multivariable logistic regression models were created to determine the associations between sexual orientation and PCa screening and the discussion of advantages and disadvantages prior to PCa screening., Results: Gay men screened for prostate cancer were younger than their straight counterparts with a median age (IQR) of 58 years (52-66) vs 64 years (56-71). Gay men were more likely to have undergone a screening PSA test (OR 1.56; 95% CI 1.20-2.02) and discuss the advantages of PSA testing with the physician prior to the test (OR 1.64; 95% CI 1.22-2.21) when compared to straight men. In yearly analysis, gay men were more likely to have undergone screening in 2013 (OR 1.65, 95% CI 1.01-2.68) and 2015 (OR 1.95, 95 CI% 1.30-2.91), however, there was no difference when compared to straight men in 2018 (OR 1.32, 95% CI 0.85-2.04)., Conclusion: Gay men were screened for PCa at a younger age comparted to straight men. They were also more likely to have undergone PCa cancer screening than straight men between 2013 and 2018. Further study is needed to better understand the role of sexual orientation in PCa screening and management., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Crocin (saffron bioactive) loaded protein nanoparticles were prepared from three underutilised cereal varieties viz., sorghum (SPCN), foxtail millet (FPCN) and pearl millet (PPCN) using ultrasonication technique. The particle size of crocin loaded protein complex was attained in the nano range with reduced polydispersity index and negative zeta potential. The encapsulation efficiency of crocin in protein nanoparticles was found to be 83.78% (FPCN), 78.74 % (SPCN) and 70.01% (PPCN). The topographical images of crocin loaded protein nano complex was revealed using field emission-scanning electron microscopy (FE-SEM). The attenuated total reflectance fourier transform infra-spectroscopy (ATR-FTIR) analysis showed the characteristic peaks of crocin at 956, 1700 and 3350 cm -1 in protein-crocin nanocomplex as a confirmatory test for nanoencapsulation. The antimicrobial activity of crocin loaded protein nanocomplex against three strains (Escherichia coli, Staphylococcus aureus and Fusarium oxysporium) were also evaluated. In vitro release studies showed higher content of crocin released in simulated intestinal conditions ensuring its controlled release at target site. Bioactivity (anti-cancerous and anti-hypertensive) of crocin upon in-vitro digestion were well retained indicating that protein nanoparticles can act as an effective wall material. Our results suggest that protein nanoparticles prepared in this study can act as an effective oral delivery vehicle for crocin that could be used for development of functional foods., (Copyright © 2022 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: This is a community-based, retrospective, observational study conducted to determine effectiveness of the BBIBP-CorV inactivated vaccine in the real-world setting against hospital admissions and death., Study Design: Study participants were selected from 214,940 PCR-positive cases of COVID-19 reported to the Department of Health, Abu Dhabi Emirate, United Arab Emirates (UAE) between September 01, 2020 and May 1, 2021. Of these, 176,640 individuals were included in the study who were aged ≥ 15 years with confirmed COVID-19 positive status who had records linked to their vaccination status. Those with incomplete or missing records were excluded (n = 38,300). Study participants were divided into three groups depending upon their vaccination status: fully vaccinated (two doses), partially vaccinated (single dose), and non-vaccinated. Study outcomes included COVID-19-related admissions to hospital general and critical care wards and death. Vaccine effectiveness for each outcome was based on the incidence density per 1000 person-years., Results: The fully-, partially- and non-vaccinated groups included 62,931, 21,768 and 91,941 individuals, respectively. Based on the incidence rate ratios, the vaccine effectiveness in fully vaccinated individuals was 80%, 92%, and 97% in preventing COVID-19-related hospital admissions, critical care admissions, and death, respectively, when compared to the non-vaccinated group. No protection was observed for critical and non-critical care hospital admissions for the partially vaccinated group, while some protection against death was apparent, although statistically insignificant., Conclusions: In a COVID-19 pandemic, use of the Sinopharm BBIBP-CorV inactivated vaccine is effective in preventing severe disease and death in a two-dose regimen. Lack of protection with the single dose may be explained by insufficient seroconversion and/or neutralizing antibody responses, behavioral factors (i.e., false sense of protection), and/or other biological factors (emergence of variants, possibility of reinfection, duration of vaccine protection, etc.)., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Secretoneurin is a novel prognostic biomarker that may predict mortality in heart failure and the occurrence of ventricular arrhythmias. This study reports the within subject variation (CV I ), between subject variation (CV G ), reference change values (RCV) and index of individuality (II) of secretoneurin., Methods: Thirty healthy volunteers were included. Non-fasting samples were obtained between 8 and 10 am once a week for ten weeks. Secretoneurin was analyzed in duplicate using ELISA. No outliers were present according to Burnett and Reeds' criteria. Simple linear regression did not identify significant trends. Variance homogeneity in the analytical variance and CV I were tested using Cochrane's and Bartlett's tests and four participants were excluded. Calculation of CV I , CV G and RCV were done on ln transformed data as described by Fokkema, the II was calculated using retransformed data., Results: The median age of the participants was 36 years and 53% were female. Non-fasting glucose, eGFR (CKD-EPI) , cTnT and NT-proBNP concentrations were within the normal range. Median secretoneurin concentrations were 38 pmol/L (women) and 33 pmol/L (men), p-value < 0.001. CV I and CV G were 9.8% (CI 8.7% to 11.0%) and 20.0 (CI 15.4% to 28.0%), respectively. RCV were 38.7% (CI 35.5% to 42.7%) and -27.9 (CI -29.9 to -26.2) and the II were 0.60 (CI 0.42-0.78). No gender differences were present., Conclusion: Secretoneurin has a fairly low CV I , CV G , RCV and II, indicating that it could be suitable as a diagnostic or prognostic biomarker and that delta values in serial samplings may be preferable for identifying clinical changes., (Copyright © 2021 The Author(s). Published by Elsevier Inc. All rights reserved.)

The existing finite natural resources have witnessed unsustainable usage in the past few years, especially for food production, with accompanying environmental devastation and ecosystem damage. Regrettably, the global population and consumption demands are increasing ceaselessly, leading to the need for more resources for food production, which could potentially aggravate the sustainability and ecosystem degradation issues, while stimulating drastic climate change. Meanwhile, the unexpected emergence of the COVID-19 pandemic and some implemented measures to combat its spread disrupted agricultural activities and the food supply chain, which also led to a reduction in ecosystem carbonization. This study sets out to explore policy framework and selected feasible actions that are being adopted during the COVID-19 pandemic, which could potentially reduce the emissions even after the pandemic to promote a resilient and sustainable agri-food system. In this study, we reviewed 27 articles that focus on the current state of the agri-food system in light of the COVID-19 pandemic and its impact on the decarbonization of the agroecosystem. This review has taken the form of a systematic methodology in analyzing the adoption and implementation of various measures to mitigate the spread of COVID-19 on the impact of the agri-food system and reduction in ecosystem degradation. Up to 0.3 Mt of CO 2 reduction from the agri-food system alone was reportedly achieved during the first 6 months of the pandemic in 23 European countries. The various adopted measures indicate that the circular economy approach is a panacea to achieve the needed sustainability in the agri-food system. Also, it dictates a need for a paradigm change towards improvement on localized food production that promotes sustainable production and consumption., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2021 Elsevier Ltd. All rights reserved.)

Gastric cancer (G.C) is one of the most lethal cancer types worldwide. Current treatment requires surgery along with chemotherapy, which causes obstacles for speedy recovery. The discovery of novel drugs is needed for better treatment of G.C with minimum side effects. Latcripin-7A (LP-7A) is a newly discovered peptide extracted from Lentinula edodes. It is recently studied for its anti-cancer activity. In this study, LP-7A was modeled using a phyre2 server. Anti-proliferation effects of LP-7A on G.C cells were examined via CCK-8, colony formation, and morphology assay. Apoptosis of LP-7A treated G.C cells was evaluated via Hoechst Stain, western blot and flow cytometry. Autophagy was assessed via acridine orange staining and western blot. The cell cycle was assessed via flow cytometry assay and western blot. Pathway was studied via western blot and STRING database. Anti-migratory effects of LP-7A treated G.C cells were analyzed via wound healing, western blot, and migration and invasion assay. LP-7A effectively inhibited the growth of G.C cells by inhibiting the PI3K/Akt/mTOR pathway. G.C cells treated with LP-7A arrested the cell cycle at the G1 phase, contributing to the inhibition of migration and invasion. Furthermore, LP-7A induced apoptosis and autophagy in gastric cancer cells. These results indicated that LP-7A is a promising anti-cancer agent. It affected the proliferation and growth of G.C cells (SGC-7901 and BGC-823) by inducing apoptosis, autophagy, and inhibiting cell cycle at the G1 phase in G.C cells., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Objective: To determine factors associated with performing inadvertent radical nephrectomy (RN) for upper tract urothelial carcinoma (UTUC), and to assess the impact of radical nephrectomy on overall survival (OS) compared to radical nephroureterectomy (NU)., Methods: Using the National Cancer Database (NCDB), patients with UTUC of the renal pelvis who were diagnosed with renal cortical tumors and underwent RN (n = 820) with subsequent surgical pathology demonstrating urothelial carcinoma were identified. These patients were compared to those diagnosed with renal pelvis tumors who appropriately underwent NU (n = 16,464) between 2005 and 2015. Multivariable logistic regression was used to determine patient, facility and tumor-related factors associated with undergoing RN. The impact of surgery (RN vs NU) on OS was determined by Cox-regression after propensity score matching., Results: A total of 4.7% patients with UTUC underwent inadvertent RN. Black race (adjusted odds ratio [aOR] 1.62, 95%CI 1.23-2.13), larger tumors, advanced tumor stage, and high-grade tumors (P < 0.0001) were associated with RN. However, surgery at a facility performing a higher volume of NU/year was associated with lower odds of having RN performed (aOR 0.85, 95%CI 0.75-0.97). After propensity score matching, the 5-year OS was 39.9% for those undergoing RN vs 49.9% for those undergoing NU (hazard ratio 1.45, 95%CI 1.30-1.62)., Conclusion: Inadvertent RN is not uncommon, occurring in almost 5% of patients with UTUC in the NCDB. Patients who underwent RN had significantly worse OS as compared to those treated with NU. These data highlight that accurate diagnosis of UTUC is paramount and clinicians should not hesitate to perform further workup when imaging findings are equivocal., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Objective: To assess the impact of neoadjuvant chemotherapy (NAC) on survival outcomes in a contemporary cohort of patients with in upper tract urothelial carcinoma (UTUC)., Methods: The National Cancer Database was queried from 2004 to 2015 to identify subjects who underwent nephroureterectomy for UTUC. Kaplan-Meier method with log-rank test was performed to compare all-cause mortality between patients who received preoperative chemotherapy to those who did not at each pathologic (p) TNM stage group: T1-4N0, N+, and M+ disease. Associations for all-cause mortality were identified using an adjusted Cox regression analysis., Results: A total of 10,315 chemoeligible subjects were included in the analysis. A total of 296 (2.9%) of patients received NAC prior to NU. Kaplan-Meier survival curves of the entire cohort demonstrated an overall survival advantage associated with administration of NAC (P = .017). Stratified by clinical staging, subjects with nonorgan-confined tumors had improved overall survival outcomes with NAC administration (P = .012). On multivariate analysis there was a statistically significant improvement in overall survival between in patients who received NAC. Of patients in the preoperative chemotherapy group who had clinically nonorgan-confined disease, 27.1% had organ-confined disease at time of surgery compared to 1.4% of those who underwent surgery as initial therapy., Conclusion: In a contemporary cohort of subjects who underwent nephroureterectomy for UTUC, administration of NAC in patients with high-grade nonorgan-confined disease led to higher rates of pathologic downstaging and was associated with improved overall survival., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Objective: To assess the qualitative and quantitative changes on prostate multiparametric magnetic resonance imaging (mpMRI) following partial gland ablation (PGA) with cryotherapy and correlate with histopathology., Methods: We used 3D Slicer to generate prostate models and segment ipsilateral (treated) and contralateral peripheral and transition zones in 10 men who underwent MRI/transrectal ultrasound fusion-guided PGA during 2017-2018. Pre- and post-PGA volumes of prostate segments were compared. Post-PGA mpMRI were categorized according to PI-RADS v2 and treatment response on mpMRI was assessed in a manner similar to the radiology evaluation framework following liver lesion ablation., Results: Median volume of ipsilateral peripheral and transition zones decreased from 10.9 mL and 13.0 mL to 7.2 mL and 10.8 mL (P = .005), respectively. Median volume of contralateral peripheral and transition zones also decreased from 12.1 mL and 12.5 mL to 9.9 mL to 10.4 mL (P = .005), respectively. Five men had clinically significant disease (Grade group ≥2) on post-PGA biopsy (3 within treatment field and 2 outside). Of the men with clinically significant prostate cancer, mpMRI revealed PI-RADS 3 lesions in 2. However, the treatment response framework did not detect residual disease., Conclusion: PGA results in asymmetrical and significant reductions in prostate volume. Our results highlight the need for a separate assessment framework to enable standardization of the interpretation and reporting of post-PGA surveillance mpMRI. Moreover, our findings have significant implications for MRI-targeted surveillance biopsy following PGA with cryotherapy., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Objective: To characterize the role of clinical and sociodemographic factors in the use of conservative management for localized prostate cancer in the US between 2010 and 2015, and to understand how those factors evolved in light of the recent national increase in conservative management rates., Methods: Data from the Surveillance, Epidemiology, and End Results Program "Prostate with Watchful Waiting Database," where conservative treatment was delineated by a distinct classifier, was used to evaluate factors associated with electing for conservative management at initial diagnosis (2010-2015). Men aged ≥40 years with cT1-T2a and T2NOS with Gleason score 3 + 3 and 3 + 4 were included (n = 118,415). Multivariable logistic regression was used to determine the association between clinical and sociodemographic factors and electing conservative management., Results: Between 2010 and 15, a total of 22,099 (18.6%) men were managed conservatively. Mean age of men managed conservatively decreased from 66.6 to 64.6 years, and median prostate-specific antigen (PSA) increased from 5.7 to 6.0 ng/mL, P <.0001. Men with lower income experienced a greater increase in conservative management rates compared to those with high income (152% vs 72% for third and fifth [richest] income quintiles, respectively). On multivariable analysis, Gleason score 3 + 3, older age, lower PSA, more recent year, treatment in the West, and higher levels of county income were significantly associated with conservative management., Conclusion: Characteristics of men undergoing conservative management are rapidly changing. Younger men, men with higher PSAs, and men of all incomes are increasingly being managed conservatively. Narrowing of income-based disparities with concurrent broadening of patients considered eligible for surveillance is encouraging., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Objectives: Evaluate the effect of functional endoscopic sinus surgery (FESS) for nasal polyposis on sleep efficiency and polysomnographic parameters., Subjects and Methods: This clinical trial was conducted on 15 patients with bilateral massive sinonasal polyposis who underwent FESS between August 2012 and September 2013. All participants were evaluated subjectively by employing the Pittsburgh Sleep Quality Index (PSQI) questionnaire and objectively (provided by polysomnographic parameters) before and 2 months after surgery., Results: The evaluation of subjective criteria of sleep quality assessed by PSQI showed significant improvement, particularly in nocturnal awakening (P = 0.002). However, Apnea Hypopnea Index (AHI) was not reduced significantly after surgery (P = 0.233). Among patients who had suffered from obstructive sleep apnea, AHI was improved in 7 patients, deteriorated in 3 patients, and did not change in 1 patient. Although the mean duration of REM sleep stage increased from 15.2 ± 10.7 to 18.9 ± 7.9, this change was not statistically significant. Furthermore, arousal index decreased dramatically from 31.6 to 17.1 (P = 0.02) and sleep efficiency index was improved after the surgery (P = 0.008)., Conclusions: This study documented the effect of resuming nasal cavity patency on improvement of sleep efficiency after FESS. In spite of insignificant effect of FESS on apnea index, alteration of other sleep parameters like arousal index following surgery may have a positive effect on sleep quality., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Introduction: In Kaduna State of Nigeria, the high influx of people from neighboring states with eligible children for polio vaccination represents a significant proportion of the target population. Many of these children are often missed by the vaccination team. The purpose of the study was to determine the contribution of targeted stakeholders in transit polio vaccination., Methods: We used the trends of vaccinated children at transit points, motor parks and markets, well as total children vaccinated by transit teams in Chikun, Igabi and Sabon Gari Local Government Areas (LGAs) of Kaduna State, Nigeria, four rounds before and after the introduction of transit polio vaccination with targeted stakeholders in Kaduna State., Results: A total of 87,502 under-5 children were vaccinated by the various transit teams in the three LGAs, which accounted for 3.2% of the total 2,781,162 children vaccinated by the three LGAs. For transit point vaccination, the number of vaccinated children increased from 1026 to 19,289 (302%), while motor park vaccination increased from 1289 to 4106 (318%) and market vaccination increased from 10,488 to 14,511 (138%), four rounds after the introduction of transit polio vaccination with targeted stakeholders., Conclusion: Engagement of targeted stakeholders significantly enhanced transit polio vaccination in Kaduna State, Nigeria., (Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objective: To examine trends in international medical graduate (IMG) representation within urology and compare these trends to those of other specialties., Methods: Urology match data were obtained from the American Urological Association from 1987 to 2015. IMG representation among residencies was extracted from reports on Graduate Medical Education published in Journal of the American Medical Association from 1978 to 2013. We analyzed trends in the number of IMG urology applicants, match rates in urology for IMGs vs US medical graduates, and the annual percentage of IMGs among all urology residents vs residents of other specialties., Results: Between 1987 and 2015, 6790 applicants matched into urology. The number of positions offered increased by 24% (224 to 295) between 1987 and 2015. However, the number of IMG urology applicants did not increase accordingly (r = -0.55, P = .78). Match rates for US students and IMGs ranged from 68% to 91% and 6% to 33%, respectively. From 1978 to 2013, the proportion of IMGs across all specialties remained relatively stable (25% to 27%), whereas the proportion of IMGs in urology decreased substantially (27% to 5%)., Conclusion: The proportion of IMGs in urology training has dramatically decreased over time and remains lower than most other specialties. IMGs are critical to urology as they can assist in meeting workforce demands, contribute diversity to the workplace, and help to propel the field forward through urologic research. Further efforts should be directed toward understanding the unique needs of IMG residents and helping them to navigate the challenges of practicing in a foreign country., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Objective: To investigate recent trends in mesh use for pelvic organ prolapse (POP)-related reconstruction procedures., Materials and Methods: Using the 2001-2011 5% Medicare claims database, we identified POP diagnoses and related procedures. Transvaginal mesh use and sacrocolpopexy were first reported in 2005 and 2004, respectively., Results: A total of 613,160 cases of vaginal and abdominal POP repair procedures were identified. The majority of procedures involved multiple compartments. The rate of mesh use increased dramatically from 2% of repairs in 2005 to 35% by 2008. After the Food and Drug Administration warning in 2008, mesh use plateaued and then decreased in 2011. Mesh was used more commonly in younger (odds ratio [OR] 0.722, P < .001), white (OR 0.712-0.791 for other races, P < .001) women in the South (OR 0.741-0.848 for non-South regions, P < .001). Starting in 2008, the rate of sacrocolpopexy procedures almost doubled yearly until 2011. Sacrocolpopexy was more common in younger patients (49% in women <70 years) and in white women (88%); the majority of sacrocolpopexies were performed in the South (60%) and laparoscopically (83%-98%)., Conclusion: The treatment of POP has changed over time. The use of mesh increased significantly until 2008, after which it plateaued following the Food and Drug Administration warning regarding mesh-related complications. Concurrently, the number of sacrocolpopexy procedures increased significantly starting in 2008 as the use of laparoscopic and/or robotic technique and concern regarding transvaginal mesh increased., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Background: Concerns remain whether robot-assisted radical cystectomy (RARC) compromises survival because of inadequate oncologic resection or alteration of recurrence patterns., Objective: To describe recurrence patterns following open radical cystectomy (ORC) and RARC., Design, Setting, and Participants: Retrospective review of 383 consecutive patients who underwent ORC (n=120) or RARC (n=263) at an academic institution from July 2001 to February 2014., Intervention: ORC and RARC., Outcome Measurements and Statistical Analysis: Recurrence-free survival estimates were illustrated using the Kaplan-Meier method. Recurrence patterns (local vs distant and anatomic locations) within 2 yr of surgery were tabulated. Cox regression models were built to evaluate the effect of surgical technique on the risk of recurrence., Results and Limitations: The median follow-up time for patients without recurrence was 30 mo (interquartile range [IQR] 5-72) for ORC and 23 mo (IQR 9-48) for RARC (p=0.6). Within 2 yr of surgery, there was no large difference in the number of local recurrences between ORC and RARC patients (15/65 [23%] vs 24/136 [18%]), and the distribution of local recurrences was similar between the two groups. Similarly, the number of distant recurrences did not differ between the groups (26/73 [36%] vs 43/147 [29%]). However, there were distinct patterns of distant recurrence. Extrapelvic lymph node locations were more frequent for RARC than ORC (10/43 [23%] vs 4/26 [15%]). Furthermore, peritoneal carcinomatosis was found in 9/43 (21%) RARC patients compared to 2/26 (8%) ORC patients. In multivariable analyses, RARC was not a predictor of recurrence. Limitations of the study include selection bias and a limited sample size., Conclusions: Within limitations, we found that RARC is not an independent predictor of recurrence after surgery. Interestingly, extrapelvic lymph node locations and peritoneal carcinomatosis were more frequent in RARC than in ORC patients. Further validation is warranted to better understand the oncologic implications of RARC., Patient Summary: In this study, the locations of bladder cancer recurrences following conventional and robotic techniques for removal of the bladder are described. Although the numbers are small, the results show that the distribution of distant recurrences differs between the two techniques., (Copyright © 2015 European Association of Urology. Published by Elsevier B.V. All rights reserved.)

Objective: To compare survival outcomes and diversion-related complications of patients with and without a history of pelvic irradiation who underwent radical cystectomy., Patients and Methods: Three hundred sixty-four patients underwent radical cystectomy for bladder cancer (BCa) from July 2001 to September 2013. Thirty-seven patients (10%) had a history of pelvic irradiation, and 327 (90%) did not. The Kaplan-Meier method and Cox regression models were applied to evaluate survival outcomes. Diversion-related complications were tabulated., Results: The proportion of non-organ-confined disease was numerically higher in irradiated than in nonirradiated patients (18 of 37 [49%] vs 117 of 327 [36%] patients, P = .1). The difference in the proportion of T4 disease between the 2 groups was statistically significant (13 of 37 [35%] irradiated vs 37 of 327 [11%] nonirradiated patients, P = .005). Pelvic lymph node dissection could not be performed in 7 of 37 irradiated patients. A nonurothelial carcinoma histology was more frequent in irradiated than in nonirradiated patients (5 of 37 [14%] vs 19 of 327 [6%], P = .003). At 3 years, BCa recurrence-free survival estimates were 70 ± 9% and 77 ± 3% (log-rank P = .5), and BCa-specific survival estimates were 64 ± 9% and 69 ± 3% (log-rank P = .4), for irradiated and nonirradiated patients, respectively. In multivariate analysis, a history of pelvic irradiation was not predictive of BCa recurrence or BCa-specific death. Rates of diversion-related complications did not differ between the 2 groups., Conclusion: BCa patients with a history of pelvic irradiation present with more advanced disease. Surgery remains difficult in this group of patients as pelvic lymph node dissection is omitted in approximately 1 of 5 patients. Within limitations, prior pelvic irradiation is not predictive of survival outcomes., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Objective: To examine the cost-effectiveness of endoscopic treatment of low-risk non-muscle-invasive bladder cancer (NMIBC) via office-based fulguration vs operating room-based transurethral resection of the bladder (TURB)., Methods: A Markov state-transition model was created to simulate and compare the economic burden of managing patients with office-based fulguration vs TURB. Direct procedural and hospitalization costs were queried from our institution. Patients were modeled as being followed up routinely with flexible cystoscopy, whereas tumor recurrences were treated with either fulguration or TURB., Results: A strategy of office-based fulguration was more cost-effective than TURB ($1171 per quality-adjusted life year [QALY] vs. $1208 per QALY) to treat recurrent NMIBC over a 5-year period. Fulguration was both more effective (14.94 vs. 14.91 QALYs) as well as less expensive ($17,494 vs. $18,005), thus dominating TURB. The incremental cost-effectiveness ratio was -$18,440 per QALY. Sensitivity analysis demonstrates that the relative costs of the procedures are more significant in determining cost-effectiveness than their respective utilities., Conclusion: Office-based cystoscopy and fulguration was more cost-effective than TURB for treating recurrent low-risk NMIBC. Adherence to an office-based treatment plan can lead to significant cost savings with a decreased therapeutic burden over the lifetime of a patient with NMIBC., (Copyright © 2015. Published by Elsevier Inc.)

Objective: To investigate the impact of cystectomy for the treatment of refractory benign disease secondary to radiation therapy on the health-related quality of life (HRQOL)., Methods: A retrospective review was performed on patients undergoing cystectomy for the management of treatment-refractory disease secondary to radiation therapy. Overall, 29 patients underwent cystectomy for refractory fistulas (n = 12, 41.4%), radiation cystitis (n = 12, 41.4%), pelvic pain (n = 4, 13.8%), or incontinence (n = 1, 3.4%) from 2004 to 2013. Preoperative and postoperative HRQOL were measured using a modified version of the Short Form version 2 (SF-36v2)., Results: A total of 19 patients (65.5%) reported a 30-day postoperative complication, of which 80% were Clavien grade I or II. Nineteen (65.5%) of the patients completed the SF-36v2 survey. Low scores were noted in the preoperative setting in the physical and mental health domains of these patients, especially in the role limitations due to health and emotional problems. Clinically meaningful improvements were noted in all the physical and mental health domains after cystectomy. Significant improvements were found in certain domains, namely in the level of pain control, general health, role limitations due to emotional problems, and social functioning (all P <.01)., Conclusion: Treatment-refractory disease from radiation therapy significantly impairs patients' HRQOL. Although cystectomy with urinary diversion is associated with perioperative complication risks, cystectomies can be safely performed in this high-risk population and significantly improve patients' physical and mental HRQOL. Further studies are needed to characterize the role of cystectomy in treatment-refractory disease from radiation therapy., (Copyright © 2015. Published by Elsevier Inc.)

Objective: To evaluate the effect of the tyrosine kinase inhibitor imatinib mesylate (Gleevec) on human corpus cavernosum (HCC) smooth muscle tone., Methods: HCC were obtained from 18 erectile dysfunction (ED) patients undergoing penile prosthesis surgery. The effects of imatinib in HCC strips were investigated in the presence of various inhibitors. The human phosphoreceptor protein tyrosine kinase (PTK) array (Proteome Profiler Array) detected changes in receptor phosphorylation before and after imatinib. Immunohistochemistry was used to localize phosphorylated c-kit (CD117/stem cell factor) in HCC smooth muscle cells., Results: Phenylephrine-induced contraction in HCC was significantly inhibited by imatinib (97.7% ± 2.3%). l-nitro-arginine methyl ester (l-NAME) or guanylyl cyclase inhibitor [1H-1,2,4] oxadiazolo [4,3-a]quinoxalin-1-one (ODQ) alone did not reverse the effect of imatinib, but suppressed this response in combination (18.0% ± 0.6%). The K(+) channel blockers (apamin and tetraethyl ammonium) decreased the imatinib-induced relaxation by 64% and 51%, respectively. PTK microarray analysis of 42 different phospho-receptor tyrosine kinases showed 14 were clearly activated in HCC. Imatinib treatment significantly inhibited phosphorylation of PTKs. A high level of CD117/c-kit-positive immunostaining was detected in untreated HCC smooth muscle, but not in treated HCC., Conclusion: Imatinib caused HCC smooth muscle relaxation in vitro mediated by nitric oxide/guanosine monophosphate signaling, involving the large-conductance Ca(2+)-activated K(+)-channels (BK(Ca)) or by inhibiting the upregulated PTK pathway. These results suggest that imatinib may also benefit erectile dysfunction patients who are not responsive to phosphodiesterase-5 inhibitors., (Copyright © 2013 Elsevier Inc. All rights reserved.)

This is a cross-sectional molecular epidemiological study on equine piroplasmosis (EP) affecting horses and donkeys in the Sudan. The study evaluated 499 samples from geographically distinct regions in eastern, central and western parts of the country. PCR amplification of the 18S rRNA gene of both Thelieria equi and Babesia caballi was carried out. Horses from all sampled areas were found positive to T. equi DNA but no B. caballi was detected. Absence of B. caballi infection was confirmed by another PCR targeting the B. caballi 48-kDa merozoite antigen. The overall prevalence was found to be 35.95%. The highest prevalence was detected in Showak 13 (81.3%) and the lowest was in Shearia locality in South Darfur 1 (5.6%). In another experiment, capillary electrophoresis was used to detect and differentiate between T. equi and B. caballi using one set of primers designed to amplify the 18S rRNA gene in a single PCR. Capillary electrophoresis method was found to be powerful in detecting mixed infections in artificially mixed controls samples. The data obtained in this study would contribute to the development of a national control strategy of EP in the Sudan., (Copyright © 2013 Elsevier B.V. All rights reserved.)

Background: Rapid diagnosis of HIV/AIDS enables the development of prevention and treatment programmes but accurate, reliable and cost effective testing strategies should be used for testing of HIV/AIDS from a large population., Objective: To evaluate the performance and effectiveness of three assays for the diagnosis of HIV in comparison with Western blot and to formulate an alternative cost-effective confirmatory approach for HIV diagnosis., Study Design: 472 specimens (serum) from a Pakistani population were evaluated. Two rapid HIV testing kits (Capillus, SD Bioline) and one ELISA (Vironostika Ag/Ab) kit were used to detect HIV. Results were compared with Western blot against which sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of all HIV assays were assessed., Results: 280/472 (59.3%) of the samples were positive for antibodies against purified HIV-1 viral proteins. The sensitivity of SD Bioline and Vironostika ELISA was 100% (95% CI; 98-100) while that of anti-HIV Capillus™ kit was 94.6% (95% CI; 91-96.8). The specificity of the Vironostika ELISA and anti-HIV Capillus™ kit was 100% (95% CI; 97-100) while specificity of SD Bioline was 98.4% (95% CI; 95-99). PPV was 100% (95% CI; 98-100%) for the anti-HIV Capillus™ and Vironostika ELISA and 98.9% (95% CI; 96-99%) for SD Bioline. NPV for SD Bioline and Vironostika ELISA was 100% (95% CI; 98-100%) and 92.7% for anti-HIV Capillus™ (95% CI; 88-96%)., Conclusion: The sensitivity and specificity of all three kits were satisfactory compared to Western blot and could be used for effective diagnosis of HIV/AIDS in Pakistani population., (Copyright © 2013 Elsevier B.V. All rights reserved.)

We report the population structure analysis of Theileria orientalis types (Ikeda, Buffeli and Chitose), the causative agent of theileriosis in cattle and its cohorts, using ITS1 and ITS2 spacers by fragment genotyping. We utilized primers flanking the two ribosomal RNA internal transcribed spacers (ITS1 and ITS2). Due to varying degrees of sequence polymorphism in the ITS regions found within and between species, we exploited the insertions and or deletions in these regions which resulted in different fragment sizes. On the basis of fragment size polymorphism, we could discriminate the three commonly found types of T. orientalis. ITS1 was capable of discriminating all three types (Ikeda-251 bp, Chitose-274 bp and Buffeli-269 bp) in one single reaction by fragment genotyping. In contrast, using ITS2, Ikeda (133-bp) a more pathogenic type was distinguishable from Buffeli/Chitose (139-bp). When compared with previous PCR detection method using, ITS1 and ITS2 genotyping was found to be more sensitive method with high specificity in population analysis and can be deployed in molecular epidemiology studies., (Copyright © 2010 Elsevier B.V. All rights reserved.)

This paper describes an algorithm that forms a retinal vessel graph by analysing the potential connectivity of segmented retinal vessels. Self organizing feature maps (SOFMs) are used to model implicit cost functions for the junction geometry. The algorithm uses these cost functions to resolve the configuration of local sets of segment ends, thus determining the network connectivity. The system includes specialized algorithms to handle overlapping vessels. The algorithm is tested on junctions drawn from the public-domain DRIVE database.

Background: Two parallel studies evaluated safety and immunogenicity of a prophylactic HIV-1 vaccine in 192 HIV-seronegative, low-risk volunteers. Modified vaccinia virus Ankara (MVA) and plasmid DNA (pTHr) expressed HIV-1 clade A gag p24 and p17 fused to a string of 25 overlapping CD8+ T cell epitopes (HIVA)., Methods: These studies compared intramuscular, subcutaneous, and intradermal MVA at dosage levels ranging from 5x10(6)-2.5x10(8) pfu. In Study IAVI-010, DNA vaccine was given as a prime at months 0 and 1, followed by MVA as a boost at months 5 and 8. In Study IAVI-011, MVA alone was given at months 0 and 2. Regular safety monitoring was performed. Immunogenicity was measured by the interferon (IFN)-gamma ELISPOT assay on peripheral blood mononuclear cells (PBMC)., Results: No serious adverse events were attributed to either vaccine; most adverse events were mild or moderate, although MVA resulted in some severe local reactions. Five vaccine recipients had at least one positive IFN-gamma ELISPOT response, but none were sustained., Conclusion: This HIV-1 vaccine candidate was in general safe and well-tolerated. Local reactions were common, but tolerable. Detectable immune responses were infrequent.

Purpose: To compare the efficacy and safety of once-daily (QD) bimatoprost, latanoprost, and timolol gel-forming solution in providing 24-hour intraocular pressure (IOP) control., Design: This was a randomized, multicenter, investigator-masked, prospective, parallel-group, clinical trial., Participants: Patients with open-angle glaucoma or ocular hypertension., Intervention: After washout of any previous ocular hypotensive medications, patients were randomly assigned to treatment with bimatoprost 0.03% ophthalmic solution QD (n=38) or latanoprost 0.005% ophthalmic solution QD (n=38) between 7 and 9 pm, or timolol maleate 0.5% gel-forming ophthalmic solution QD (n=39) between 7 and 9 am for 1 month., Main Outcome Measures: The primary outcome measure, circadian IOP, was measured at eight time points over the course of 24 hours beginning at 8 am on day 28 and with the last measurement at 8 am on day 29. IOP was also measured at 8 am and 10 am at baseline and at 8 am on day 14. Safety measures included adverse events, biomicroscopy, visual acuity, heart rate, and blood pressure., Results: At 10 am (peak drug effect) on day 28, the mean IOP reduction from baseline was significantly greater with bimatoprost (9.3 mm Hg, 40.3%) than with timolol gel (7.1 mm Hg, 31.1%; P=.024, Wilcoxon rank sum test) or latanoprost (7.4 mm Hg, 33.3%). In the overall analysis of IOP measured over the course of 24 hours, mean IOP was significantly lower with bimatoprost or latanoprost than with timolol gel (P<.001; analysis of repeated measures). The analysis of repeated measures also showed a significant difference between bimatoprost and latanoprost (P=.003). In the area-under-the-curve analysis, bimatoprost and latanoprost were superior to timolol gel (P< or =.018) but comparable to each other (P> or =.223). All treatment regimens were well tolerated, with few discontinuations due to adverse events. There were no significant effects on systemic safety parameters., Conclusion: Once-daily bimatoprost or latanoprost provided significantly better 24-hour IOP control than timolol gel in patients with glaucoma or ocular hypertension. Some measurements suggested a trend for greater efficacy of bimatoprost over latanoprost. All three treatments were well tolerated.

Thiol- or acid-promoted additions of silyl radicals to camptothecin are reported. At 105 degrees C, mixtures of 7-silyl (favored) and 12-silyl camptothecins are formed alongside substantial amounts of recovered camptothecin. At 160 degrees C, 12-silyl isomers are formed preferentially, but the total mass balance is substantially reduced. The silyl radical addition is featured in short semi-syntheses of DB-67 (7-tert-butyldimethylsilyl-10-hydroxy camptothecin) from both camptothecin and 10-hydroxycamptothecin.

Evidence exists to support the beneficial effects of superoxide dismutase on endothelial dysfunction induced by hyperglycemia in vitro. In vivo, however, studies of the effects of native superoxide dismutase preparations on the vascular complications accompanying diabetes are limited, and their therapeutic application potential has so far been disappointing. The objective of this study was to evaluate, for the first time in vivo, the effects of long-term administration of tempol, a stable superoxide dismutase-mimic compound, on diabetes-induced endothelial dysfunction in rats. Diabetes was induced by streptozotocin and rats were monitored for 8 weeks with or without treatment with tempol (100 mg/kg, s.c., b.i.d). Diabetic rats showed increased vascular levels of superoxide, which was accompanied by increased levels of the oxidative stress markers malondialdehyde and 8-epi-prostaglandin F(2alpha). In addition, the vasorelaxant as well as the cGMP-producing effects of acetylcholine and glyceryl trinitrate were reduced in diabetic rats. Treatment with tempol abolished not only the differences in the vascular content of superoxide, malondialdehyde and 8-epi-prostaglandin F(2alpha), but also the differences in the relaxation and cGMP responses of aortic rings to both acetylcholine and glyceryl trinitrate between control and diabetic rats. These results support the involvement of reactive oxygen species in mediation of hyperglycemia-induced endothelial dysfunction in vivo, and provide the rationale for potential utilization of stable superoxide dismutase-mimic nitroxides for the prevention of the vascular complications accompanying diabetes.