Search

PURPOSE This study was designed to investigate the clinicopathologic predictors of progression-free survival (PFS) and overall survival (OS) in patients with epithelial ovarian cancer (EOC) following primary treatment in Lagos, Nigeria. MATERIALS AND METHODS Using data from a retrospective cohort of 126 patients who received treatment for EOC between 2010 and 2018, we identified 83 patients with a complete clinical record for subsequent data analysis. Patients' demographics and updated 2-year follow-up status were abstracted from medical records. Kaplan-Meier survival curves were compared using the log-rank test, and Cox proportional hazard models were used for multivariate analysis to identify independent predictors of survivals following treatment in EOC patients. RESULTS The median PFS and OS were 12 and 24 months, respectively. After adjusting for covariates in the multivariate analysis, younger age ≤ 55 years (hazard ratio [HR] = 0.40; 95% CI, 0.22 to 0.74; P = .01) and International Federation of Gynecology and Obstetrics (FIGO) stage I/II (HR = 0.02; 95% CI, 0.01 to 0.08; P = .01) were independent predictors of improved PFS, whereas being premenopausal (HR = 2.34; 95% CI, 1.16 to 4.75; P = .02) was an independent predictor of reduced OS after 2-year follow-up. CONCLUSION PFS could be predicted by the age and FIGO stage of the disease, whereas menopausal status was predictive of OS in patients with EOC. This knowledge should form the basis for counseling patients with ovarian cancer during their primary treatment and lend support to the importance of aggressive follow-up and monitoring for the older, premenopausal patients and those with an advanced stage of epithelial ovarian cancer. However, robust longitudinal research should be carried out to provide additional reliable insight to this information.

Steroid hormones are one of the presumed modulators of Lactobacillus abundance in the vaginal epithelium. We set out to characterize the vaginal microbiome (VMB) and also provide an in-depth understanding of the relative contribution of estradiol (E2) and progesterone (P1) in shaping the vaginal microbiome of Nigerian women (n = 38) who experienced both uncomplicated term delivery and preterm delivery using samples longitudinally collected during pregnancy (17–21, 27–31, 36–41 weeks gestation) and 6 weeks postpartum. Vaginal swabs and blood samples were aseptically collected. Vaginal swabs were used for microbiome assessment using 16S ribosomal RNA (rRNA) gene sequencing. Blood samples were used for hormonal measurement using a competitive-based enzyme-linked immunosorbent assay (ELISA). Across several maternal covariates, maternal age, pregnancy status and delivery mode were not significantly associated with the vaginal microbiota whereas maternal E2 level (pE2 = 0.006, Omnibus), and P1 level (pP1 = 0.001, Omnibus) were significantly associated with the vaginal microbiome. E2 and P1 concentrations increased throughout pregnancy commensurately with increasing proportions of L. crispatus (pE2 = 0.036, pP1 = 0.034, Linear Mixed Model). An increasing trend of α-diversity was also observed as pregnancy progressed (pobserved ASV = 0.006, LMM). A compositional microbiome shift from Lactobacillus profile to non-Lactobacillus profile was observed in most postnatal women (pCST IV L. crispatus abundance.

Purpose: The study aimed at presenting a comparative appraisal of the trends of the two most prevalent infectious diseases bedeviling the region: human immunodeficiency virus (HIV) and tuberculosis (TB). Subject & Methods: Data on fourteen ECOWAS member countries and also fourteen member countries of the SADC bloc. This represents about 93.3% and 87.5% membership of the ECOWAS and SADC blocs respectively. Although the choice of sample size is determined largely by the availability of data, the choices were carefully made to maximize available observation. The data were sourced from World Development Indicators online database published by the World Bank. We use two measures of infectious diseases: the prevalence rate of human immunodeficiency virus and the incidence of tuberculosis. Results: The HIV prevalence rates and incidence of TB were uneven in the two selected trade blocs. The magnitude and the severity of the diseases varied. The burden of both diseases was higher for SADC and lesser for ECOWAS. The average prevalence rate of HIV in the SADC bloc over the study period was 600% of the prevalence rate in ECOWAS (SADC = 12.5%, ECOWAS = 2.1%). Likewise, in the same period, the average TB incidence per 100,000 people was 578.8 and 181.7 respectively in the SADC and ECOWAS blocs. Conclusions: The study finds that the magnitude and severity of the diseases vary widely between the Economic Community of West Africa States (ECOWAS) and the Southern Africa Development Community (SADC) trade blocs. And, while concerted efforts at curbing the diseases have yielded results, there is still much to be done in both blocs.

Introduction: The global population is aging, creating challenges for health systems. The mean age of patients with major trauma has increased over time, posing some challenges for trauma system designs. Elderly trauma patients are said to have higher mortality rates and longer hospital and intensive care unit stays. This study is aimed at assessing the pattern of injuries in elderly population in a dedicated trauma centre of a developing economy. Methods: This is a retrospective study of all patients aged 60 years and above seen in the trauma centre of a West African tertiary hospital over a three year period from January 2017 to December 2019. Relevant parameters including Sociodemographic data, injury pattern and injury scores were derived from the trauma registry. Data analysis was done using statistical package for social sciences (SPSS) version 24. Results were presented using tables and a figure. Results: A total of 183 patients aged 60 years and above were enrolled out of 4549 general trauma patients, representing 4% of the trauma patient population seen. Male to female ratio was 2.3 with the mean age of 65 ± 6.3. The most frequent mechanisms of injury were motor vehicular crash (MVC) (48.4%), followed by falls (16.5%). More proportion of females (21.8%) were significantly found to suffer falls compared to their males (14.2%) counterparts (p

Primary cutaneous γδ T-cell lymphoma (PCGD-TCL) is an extremely rare and aggressive T-cell neoplasm with complex heterogeneity. We present a series of two patients who presented with firm, subcutaneous nodules and were diagnosed with PCGD-TCL. In both cases, biopsies demonstrated a both superficial and deep adnexotropic infiltrate comprised of angiocentric, medium- to large-sized atypical lymphocytes. The infiltrate extended into the panniculus. Immuno–histochemical stains highlighted atypical lymphocytes that expressed CD3, CD8 and CD56 but were negative for EBV ISH. A brisk histiocytic response with focal aggregation into granulomas was highlighted with a PG-M1 stain. The atypical lymphocytes were positive for gene rearrangements on a TCR delta stain and negative for βF-1. CT and PET scan in one of the two patients demonstrated diffuse, subcutaneous, ground-glass foci; hypermetabolic soft tissue nodules; and lymphadenopathy in the lungs, as well as splenomegaly. A diagnosis of histiocyte-rich PCGD-TCL was rendered. A histiocyte-rich, granulomatous variant of γδ T-cell lymphoma is extremely rare. Its potentially misleading resemblance to inflammatory granulomatous conditions could pose a diagnostic pitfall in this already challenging condition. This variant may resemble granulomatous mycosis fungoides and granulomatous slack skin syndrome, but it has a distinct, aggressive clinical outcome.

We aimed to study the maternal characteristics and obstetric and neonatal outcomes in pregnant mothers with pre-eclampsia (PE) compared to normotensive.This was a population-based retrospective data analysis. Data were obtained from the PEARL-Peristat Study perinatal registry (Perinatal Neonatal Outcomes Research Study in the Arabian Gulf) Qatar. The birth periods ranged from January to December 2017 in the main Women's Hospital (now named Women's Wellness Research Center) and March to December 2017 in other hospitals. This study examined 19762 singleton births at 24 weeks of gestation and above. This analysis included only 19,194 births with complete data in the registry database at the time of this analysis, divided into normotensive women (The prevalence of hypertensive disorders among the 19,762 singleton pregnancies was 1027/19,762 (5.1%). The incidence of pre-eclampsia was 459/19,762 (2.3%) while gestational (341/19,762 (1.7%) and chronic hypertension 219/19,762 (1.1%)). A history of PE or eclampsia in past pregnancies was reported in 12.9% vs 0.9%Women with pre-eclampsia when compared to the normotensive women, they are older, nulliparous, diabetic and obese with an increased risk of preterm birth and cesarean deliveries. It was noted that PE was significantly associated with acute maternal morbidity, still births, cesarean section and preterm births. By taking preventive measures, prompt delivery and appropriate care we can reduce the risks associated with it or prolong the pregnancy to a gestational period which is considered safe for the neonatal survival. Therefore it's imperative to be aware of the population-based risk factors and its mode of presentation in order to give a timely appropriate care and to prevent severe maternal and fetal morbidities and mortalities.

Introduction A Trauma System or its components has been shown to improve trauma services and outcome of seriously injured patients. These organised services are non0existent or the components operate in isolation in most African countries. This study was done to identify the observed advances in trauma care service delivery, brought about by the beginning of operation of a trauma centre in the capital city of a West African country. Methodology The operation of the trauma centre was reviewed for progress in terms of organisation of care, in-hospital care, training, and referral system and injury prevention. In addition, the challenges facing the trauma centre were also reviewed and discussed. Results The trauma centre has brought about better organisation of care and specialist availability, various training in trauma surgery, advances in referral and injury prevention. Funding is an identified threat to the function of the centre. Discussion The trauma centre provided the drive for specialist training in trauma and changes in the process of care. Funding is a threat to optimal function, as was poor inter-relatedness with other local hospitals, pre-hospital services and rescue providers.

Objectives: The usefulness of biomarkers in community acquired pneumonia (CAP) has been under the research light with limited reports from Africa. This study aimed at evaluating the clinical usefulness of serum procalcitonin (PCT) in patients admitted with CAP in a tertiary hospital in Ilorin, Nigeria. Materials and Methods: This was prospective single center observational study of 102 admitted patients with clinical and radiologic features of CAP. All the patients had serum PCT assay, complete blood count, blood culture, sputum microbiology, and serological evaluation for atypical pathogens. Repeat PCT assay was done following 1 week of antibiotic therapy. The patients were classified into one of two diagnostic groups: Those with microbiologically confirmed bacterial CAP and those without bacterial CAP. Results: Over half (58/102; 56.8%) of the patients had microbiologically confirmed bacterial CAP. The baseline serum PCT concentrations were significantly higher in patients with bacterial CAP when compared to the non-bacterial CAP group (2.55 ± 0.14 vs. 0.94 ± 0.61 ng/ml; P < 0.001). There was also a statistically significant difference between the pre- and post-treatment serum PCT concentrations in the bacterial CAP group (P < 0.001) and the non-bacterial CAP group (P = 0.006). The area under the receiver operating characteristic (AUC) for pre-treatment PCT in diagnosing bacterial CAP was 0.795 (95% confidence level [CI]: 0.709–0.881) with a sensitivity of 67.2% and specificity of 79.5% at an optimal cutoff of 1.5 ng/ml. Overall, the biomarker was independently associated with white cell counts >10 × 109/L (AOR = 6.28; 95% CI: 1.30–30.32, P = 0.02). The baseline mean serum PCT levels were also significantly higher in patients admitted for 7 or more days (P = 0.010). Conclusion: Serum PCT had good diagnostic strength in patients admitted with bacterial CAP in Ilorin. The biomarker can also assist clinicians with predicting the pathogenic group and monitoring clinical progress of CAP.

Supplemental Digital Content is Available in the Text., Background: With the highest rates of HIV/AIDS in the United States, Black Americans are still underrepresented in HIV medical research. Setting: BRAAVE (NCT03631732) is a randomized, phase 3b, multicenter, open-label US study. Methods: Adults identifying as Black or African American and virologically suppressed on 2 nucleoside reverse transcriptase inhibitors (NRTIs) plus third agent were randomized (2:1) to switch to open-label bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) once daily or stay on baseline regimen (SBR) for 24 weeks, after which SBR had delayed switch to B/F/TAF. Resistance to non-NRTIs, protease inhibitors, and/or NRTIs was permitted; integrase strand transfer inhibitor resistance was exclusionary. Primary endpoint was proportion of participants with HIV-1 RNA ≥50 copies/mL at week 24 (snapshot algorithm; noninferiority margin of 6%). Results: Of 558 screened, 495 were randomized/treated (B/F/TAF n = 330; SBR n = 165). Overall, 32% were ciswomen, 2% transwomen, and 10% had an M184V/I mutation. At week 24, 0.6% on B/F/TAF vs 1.8% on SBR had HIV-1 RNA ≥50 copies/mL (difference −1.2%; 95% confidence interval −4.8% to 0.9%), demonstrating noninferiority of B/F/TAF vs SBR. Proportions with HIV-1 RNA

In 2018, an estimated 1.8 million persons living in Nigeria had HIV infection (1.3% of the total population), including 1.1 million (64%) who were receiving antiretroviral therapy (ART) (1). Effective ART reduces morbidity and mortality rates among persons with HIV infection and prevents HIV transmission once viral load is suppressed to undetectable levels (2,3). In April 2019, through the U.S. President's Emergency Plan for AIDS Relief (PEPFAR),* CDC launched an 18-month ART Surge program in nine Nigerian states to rapidly increase the number of persons with HIV infection receiving ART. CDC analyzed programmatic data gathered during March 31, 2019-September 30, 2020, to describe the ART Surge program's progress on case finding, ART initiation, patient retention, and ART Surge program growth. Overall, the weekly number of newly identified persons with HIV infection who initiated ART increased approximately eightfold, from 587 (week ending May 4, 2019) to 5,329 (week ending September 26, 2020). The ART Surge program resulted in 208,202 more HIV-infected persons receiving PEPFAR-supported ART despite the COVID-19 pandemic (97,387 more persons during March 31, 2019-March 31, 2020 and an additional 110,815 persons during April 2020-September 2020). Comprehensive, data-guided, locally adapted interventions and the use of incident command structures can help increase the number of persons with HIV infection who receive ART, reducing HIV-related morbidity and mortality as well as decreasing HIV transmission.

Objective The aim of this study was to describe and evaluate the impact of the programme intervention of the Rivers State Antiretroviral Treatment (ART) Surge, a collaboration between the US President's Emergency Plan for AIDS Relief (PEPFAR) and the State Ministry of Health, to increase HIV case-finding and ART access in Rivers State, the state with the largest ART gap among people living with HIV (PWH) in Nigeria. Design During April 2019-September 2020, the intervention included six specific strategies: using local government area-level ART gap analysis to guide case-finding; expanding targeted community testing; tailoring comprehensive key population HIV services; engaging HIV treatment programme stakeholders; synchronizing team efforts; and using near real-time data for programme action. Methods Weekly reported facility and community data on tests conducted, PWH diagnosed, and PWH initiated on ART were aggregated. The total number of PWH maintained on ART was reported quarterly. Results During May 2019-September 2020, the weekly number of newly diagnosed PWH initiated on ART supported by PEPFAR in Rivers State increased from 82 to 1723. During October 2019-September 2020, the monthly number of people screened for HIV testing eligibility in the community increased from 44 000 to 360 000. During April 2019-September 2020, the total number of PWH on ART supported by PEPFAR statewide increased by 3.8 times, from 26 041 to 99 733. Conclusion The strategies applied by HIV program stakeholders contributed to scale-up of PWH identification and ART linkage within the Rivers State ART Surge. Continued gains through time indicate the importance of the application of a quality improvement approach to maintain programme flexibility and effectiveness.

Hypertensive disorders in pregnancy pose a huge challenge to the socioeconomic stability of a community; being a major cause of maternal and neonatal morbidity and mortality during delivery. Although there have been recent improvements in management strategies, still, the diversified nature of the underlying pathogenesis undermines their effectiveness. Generally, these disorders are categorized into two; hypertensive disorders of pregnancy with proteinuria (pre-eclampsia and eclampsia) and hypertensive disorders of pregnancy without proteinuria (gestational and chronic hypertension). Each of these conditions may present with unique characteristics that have interwoven symptoms. However, the tendency of occurrence heightens in the presence of any pre-existing life-threatening condition(s), environmental, and/or other genetic factors. Investigations into the cerebrovascular system demonstrate changes in the histoarchitectural organization of neurons, the proliferation of glial cells with an associated increase in inflammatory cytokines. These are oxidative stress indicators which impose a deteriorating impact on the structures that form the neurovascular unit and the blood-brain barrier (BBB). Such a pathologic state distorts the homeostatic supply of blood into the brain, and enhances the permeability of toxins/pathogens through a process called hyperperfusion at the BBB. Furthermore, a notable aspect of the pathogenesis of hypertensive disorders of pregnancy is endothelial dysfunction aggravated when signaling of the vasoprotective molecule, nitric oxide, amongst other neurotransmitter regulatory activities are impaired. This review aims to discuss the alterations in cerebrovascular regulation that determine the incidence of hypertension in pregnancy.

Solid organ and hematopoietic stem cell transplantation may be complicated by development of post-transplant lymphoproliferative disorders (PTLDs). The World Health Organization categorizes PTLDs into four entities including non-destructive, monomorphic, polymorphic, and classical Hodgkin lymphoma types. The most common PTLDs are B-cell lymphomas, with T-cell lymphomas accounting for only a few cases. Cutaneous T-cell lymphomas are rarer still in post-transplant patients with primary cutaneous peripheral T-cell lymphoma being an extraordinarily rare subtype in this population. PTLDs may be aggressive and are often associated with high morbidity and mortality. Advances in medicine have led to increased awareness of PTLDs and improved diagnostic tools which assist in diagnosis of these conditions. However, the clinical and histopathologic heterogeneity of PTLDs may make diagnosis a challenge. In the transplant patient population, the cutaneous manifestations of lymphoproliferative disease may mimic other conditions such as eczematous dermatitis and graft-versus-host disease. Herein, we report a case of post-transplant primary cutaneous peripheral T-cell lymphoma not otherwise specified (PTCL-NOS) in a pediatric heart transplant patient and describe the clinical presentation and diagnostic histopathologic features. This article is protected by copyright. All rights reserved.

Purpose: This study investigates the effectiveness of health-aid in Nigeria, with focus on child health outcomes. In particular, the study aims to examine whether health aid has yielded significant gains in child health in Nigeria. Methodology/Approach/Design: Secondary data on neonatal, infant and under 5 mortality as well as measles and DPT immunization were used. The stationarity of the variables was ascertained using the augmented Dickey-Fuller and Philip-Perron unit root tests. In order to confirm the presence or otherwise of long-run relationship among the selected variables, Johansen cointegration test was carried out and the obtained coefficients and p-values indicate evidences of long-run relationship. Finally, the study used the fully modified ordinary least square (FMOLS) estimator to examine the effects of aid targeted at children health on the various child health outcomes. Results: The results suggest the existence of long-run relationships between health aid and child health indicators, with aid having reducing impacts on the mortality indicators and a positive correlation with child immunization coverage. Also, public health expenditure, literacy rate and urbanization rate are negatively correlated with measures of children mortality and positively correlated with the measures of immunization coverage. Except for infant mortality, economic growth proxy by GDP growth rate has insignificant effect on child health. Practical Implications: Sustained improvement in children health is the core objective of aids aimed at children’s health, and findings of this research will serve as a framework for health policymakers in understanding the contributions of health aid inflow to specific indicators of child health in Nigeria. Originality/Value: This study makes a number of contributions to the ongoing discussion on the effectiveness of health-specific ODA in Nigeria. Despite the inconclusiveness of the health aid-health outcomes literature, this study has shown that children health aid has led to improvement in children health in Nigeria. While previous studies have focused on child mortality indicators, this study examined the effect on various measures of children health including children immunization coverage.

Abdominal myomectomy is a common modality of treatment for large and symptomatic uterine fibroids in women who wish to retain their fertility. Black women have higher rates and larger sizes of uterine fibroids. We aimed to determine the presentation patterns, peri-operative complications, and determinants of complications in patients who underwent abdominal myomectomy. This was a retrospective review of women who had abdominal myomectomy between July 2016 and June 2019. There were intra-operative complications and post-operative complications in 25% and 29.3% of patients respectively. There were higher odds for developing intra-operative complications among those who had general anaesthesia [OR = 3.514, 95%CI (1.951-6.331)], more than 10 fibroid nodules enucleated [OR = 4.917, 95%CI (2.600-9.298)], pre-operative Packed cell volume (PCV) < 30% [OR = 4.831, 95%CI (2.370-9.880)], presence of adhesions [OR = 2.680, 95%CI (1.510-4.730)], fibroids larger than 10 centimetres [OR = 1.98, 95%CI (1.13-3.49)], previous pelvic surgery [OR = 2.68, 95%CI (1.52-4.63)]. Post-operative complications were higher in those who had general anaesthesia or pre-existing medical conditions.IMPACT STATEMENTWhat is already known on this subject? Abdominal myomectomy is a major surgical procedure globally with a significant morbidity rate. Sufficient evidence relating to the determinants of peri-operative complications are lacking.What do the results of this study add? Our results highlight the factors associated with increased odds of developing complications following abdominal myomectomy.What are the implications of these findings for clinical practice and/or further research? Our study complements existing data on the peri-operative complications following abdominal myomectomy. It also reflects the possibility of mortality albeit a rarerity. A retrospective multivariate analysis like this, while classifying morbidities into intra-operative and post-operative complications, is required to start an audit cycle. Knowing these determinants will help improve patient optimisation for surgery, identify high risk women and enhance more directed counselling. The results from this pilot study will also be used to design a prospective study to be undertaken by the authors.

The hallmarks of Alzheimer’s disease (AD) pathology include senile plaques accumulation and neurofibrillary tangles, which is thought to underlie synaptic failure. Recent evidence however supports that synaptic failure in AD may instead be instigated by enhanced N-methyl-D-aspartate (NMDA) activity, via a reciprocal relationship between soluble amyloid-β (Aβ) accumulation and increased glutamate agonist. While previous studies have shown Aβ-mediated alterations to the glutamatergic system during AD, the underlying etiology of excitotoxic glutamate-induced changes has not been explored. Here, we investigated the acute effects of stereotaxic dentate gyrus (DG) glutamate injection on behavior and molecular expression of specific proteins and neurochemicals modulating hippocampal functions. Dependence of glutamate-mediated effects on NMDA receptor (NMDAR) hyperactivation was tested using NMDARs antagonist memantine. DG of Wistar rats (12-weeks-old) were bilaterally microinjected with glutamate (500 mM) with or without daily intraperitoneal (i.p.) memantine injection (20 mg/kg) for 14 days, while controls received either intrahippocampal/i.p. PBS or i.p. memantine. Behavioral characterization in open field and Y-maze revealed that glutamate evoked anxiogenic responses and perturbed spatial memory were inhibited by memantine. In glutamate-treated rats, increased NO expression was accompanied by marked reduction in profiles of glutathione-s-transferase and glutathione peroxidase. Similarly, glutamate-mediated increase in acetylcholinesterase expression corroborated downregulation of synaptophysin and PSD-95, coupled with initiation of reactive astrogliosis (GFAP). While neurofilament immunolocalization/immunoexpression was unperturbed, we found glutamate-mediated reduction in neurogenic markers Ki67 and PCNA immunoexpression, with a decrease in NR2B protein expression, whereas mGluR1 remains unchanged. In addition, increased expression of apoptotic regulatory proteins p53 and Bax was seen in glutamate infused rats, corroborating chromatolytic degeneration of granule neurons in the DG. Interestingly, memantine abrogated most of the degenerative changes associated with glutamate excitotoxicity in this study. Taken together, our findings causally link acute glutamate dyshomeostasis in the DG with development of AD-related behavioral impairment and molecular neurodegeneration.

Moving forward from 2020, Africa faces an eminent challenge of food safety and security in the coming years. The World Food Programme (WFP) of the United Nations (UN) estimates that 20% of Africa's population of 1.2 billion people face the highest level of undernourishment in the world, likely to worsen due to COVID-19 pandemic that has brought the entire world to its knees. Factors such as insecurity and conflict, poverty, climate change and population growth have been identified as critical contributors to the food security challenges on the continent. Biotechnological research on Genetically Modified Organisms (GMOs) provides a range of opportunities (such as increased crop yields, resistance to pests and diseases, enhanced nutrient composition and food quality) in addressing the hunger, malnutrition and food security issues on the continent. However, the acceptance and adoption of GMOs on the continent has been remarkably slow, perhaps due to contrasting views about the benefits and safety concerns associated with them. With the reality of food insecurity and the booming population in Africa, there is an eminent need for a more pragmatic position to this debate. The present review presents an overview of the current situation of food safety and security and attempts to reconcile major viewpoints on GMOs research considering the current food safety and security crisis in the African continent.

Continuous globalization and industrialization have ensured metals are an increasing aspect of daily life. Their usefulness in manufacturing has made them vital to national commerce, security and global economy. However, excess exposure to metals, particularly as a result of environmental contamination or occupational exposures, has been detrimental to overall health. Excess exposure to several metals is considered environmental risk in the aetiology of several neurological and neurodegenerative diseases. Metal-induced neurotoxicity has been a major health concern globally with intensive research to unravel the mechanisms associated with it. Recently, greater focus has been directed at epigenetics to better characterize the underlying mechanisms of metal-induced neurotoxicity. Epigenetic changes are those modifications on the DNA that can turn genes on or off without altering the DNA sequence. This review discusses how epigenetic changes such as DNA methylation, post translational histone modification and noncoding RNA- mediated gene silencing mediate the neurotoxic effects of several metals, focusing on manganese, arsenic, nickel, cadmium, lead, and mercury.

This work is aimed at formulating a mathematical model for the control of zika virus infection using Sterile Insect Technology (SIT). The model is extended to incorporate optimal control strategy by introducing three control measures. The optimal control is aimed at minimizing the number of Exposed human, Infected human and the total number of Mosquitoes in a population and as such reducing contacts between mosquitoes and human, human to human and above all, eliminates the population of Mosquitoes. The Pontryagin’s maximum principle was used to obtain the necessary conditions, find the optimality system of our model and to obtain solution to the control problem. Numerical simulations result shows that; reduction in the number of Exposed human population, Infected human population and reduction in the entire population of Mosquito population is best achieved using the optimal control strategy.

Background: There is limited evidence about effective strategies for promoting culturally congruent diabetes education in low-resourced primary-care settings. Objectives: This project, conducted in Central Kenya, examined the effect of an intervention on provider practices and patients’ knowledge of diabetes self-care management. Methods: The intervention consisted of short (30-minute) sessions that offered providers evidenced-based, culturally con- gruent diabetes education and teaching materials to use with patients. A checklist was used to assess providers’ diabetes care practices at baseline and post intervention. Data from semi-structured patient interviews assessed patients’ diabetes knowledge at baseline and post intervention. Providers and patients also completed post-intervention satisfaction surveys. Results: Six providers and 74 patients participated in the project. Statistical analysis was completed using SPSS. Significant increases were noted in patients’ post-intervention overall diabetes knowledge score (p=.05) and the foot care knowledge subscale (p=.02). No significant differences were noted between patients’ baseline and post-intervention scores in the gen- eral diabetes (p=.86) or nutrition knowledge (p=.32) subscales. Conclusion: These findings suggest supporting providers with culturally congruent tools and resources about diabetes care guidelines can improve knowledge of self-care practices in patients with diabetes. Keywords: Type II diabetes mellitus; foot care; diabetes self-care; diabetes education; culturally congruent; Swahili; Kikuyu; central Kenya.

Background: Drug repositioning is becoming popular due to the development of resistance to almost all the recommended antimalarials. Pregabalin and gabapentin are chemical analogs of gamma- aminobutyric acid (GABA) approved for the treatment of epilepsy and neuropathic pain. Objective: This study investigates acute toxicities and antimalarial activities of pregabalin and gabapentin in the murine malarial model. Methods: Acute toxicities were assessed using the method of Lorke, while curative activities were assessed by the administration of serial doses of pregabalin and gabapentin to Plasmodium berghei infected mice. Pregabalin was further investigated for its prophylactic activity, and curative potential when combined with either artesunate or amodiaquine. All drugs were freshly prepared and administered orally. Thin films were collected, stained, and observed under the microscope for the estimation of parasitemia and calculation of percentage chemoinhibition or chemoprevention. In pregabalin –artesunate or -amodiaquine combination aspect of this study, survival day post-infection (SDPI) was recorded, while parasitemia was re-estimated for animals that survived till day 28. Results: The oral LD50 of gabapentin, as well as pregabalin, was >5,000 mg/kg. Gabapentin at 100 and 200 mg/Kg demonstrated 35.64% and -12.78% chemoinhibition, respectively, while pregabalin demonstrated 75.60% and 100.00% chemoinhibition at doses of 12.5 and 25 mg/Kg, respectively. Moreover, pregabalin at individual doses of 25, 50 mg/Kg, and in combination with either artesunate or amodiaquine demonstrated 100.00% chemoinhibition. In its prophylactic study, pregabalin was found to be 100% chemopreventive at individual doses of 12.5 and 25 mg/Kg. Conclusion: Both GABA analogs have antimalarial properties, but pregabalin proved to be more efficacious.

Cymbopogon citratus is a tropical phytomedicinal plant that is widely known for its hypoglycemic, hypolipidemic, anxiolytic, sedative, antioxidative and anti-inflammatory properties. In this study, we have examined the neuroprotective effects of the essential oil (ESO) of Cymbopogon citratus, following aluminum chloride (AlCl3)-induced neurotoxicity within the cerebellum of Wistar rats. A total of 40 adult male Wistar rats were assigned into five groups and treated orally as follows: A-phosphate-buffered saline (1 ml daily for 15 days); B-ESO (50 mg/kg daily for 15 days); C-AlCl3 (100 mg/kg daily for 15 days); D-AlCl3 then ESO (100 mg/kg AlCl3 daily for 15 days followed by 50 mg/kg ESO daily for subsequent 15 days); E-ESO then AlCl3 (50 mg/kg ESO daily for 15 days followed by 100 mg/kg AlCl3 daily for following 15 days). To address our questions, we observed the locomotion and exploratory behavior of the rats in the open field apparatus and subsequently evaluated cerebellar oxidative redox parameters, neural bioenergetics, acetylcholinesterase levels, transferrin receptor protein, and total protein profiles by biochemical assays. Furthermore, we investigated cerebellar histomorphology and Nissl profile by H&E and Cresyl violet Nissl staining procedures. ESO treatment markedly attenuated deficits in exploratory activities and rearing behavior following AlCl3 toxicity, indicating its anxiolytic potentials. Additionally, AlCl3 evokedincrease in malondialdehyde and nitric oxide levels, as well as repressed cerebellar catalase, glutathione peroxidase, and superoxide dismutase profiles were normalised to baseline levels by ESO treatment. Treatment with ESO, ergo, exhibits substantial neuroprotective and modulatory potentials in response to AlCl3 toxicity.

Women with a history of pre-eclampsia (PE) tend to have a higher risk of developing cardiovascular and neurological diseases later in life. Imbalance in oxidative markers and purinergic enzymes have been implicated in the pathogenesis of neurological disease. This study investigated the effect of PE on oxidative imbalance, purinergic enzyme inhibitory activity, acetylcholinesterase and chymotrypsin activities in the brain of PE rat model at post-partum/post-natal day (PP/PND) 60. Pregnant rats divided into early-onset and late-onset groups were administered with Nω-nitro-l-arginine methyl through drinking water at gestational days 8–17. Rats were allowed free access to water throughout the pregnancy and allowed to deliver on their own. The mother and the pups were euthanized at PP and PND 60, respectively, the cortex and the cerebellum excised, homogenized and stored for analyses of the enzymes. Results showed an increase in nitric oxide and malondialdehyde with a concomitant decrease in reduced glutathione and superoxide dismutase, an indication of oxidative damage. Also, there was an increase in acetylcholinesterase activity with a decrease in chymotrypsin, adenylpyrophosphatase and ecto-nucleoside triphosphate diphosphohydrolase activities in both the cortex and the cerebellum of the mother and the pups at PND 60. These results indicate the involvement of oxidative stress, increased cholinergic activity and depleted proteolytic and purinergic activities in PE-induced neurotoxicity.

Background Folliculotropic mycosis fungoides (FMF) is a variant of cutaneous T-cell lymphoma that has clinical overlap with a variety of inflammatory follicular unit disorders. However, we describe distinctive presentations of FMF with acneiform features that can be diagnostically challenging, leading to diagnostic delay. Objective To highlight the importance of histopathologic and immunohistochemical evaluation for diagnostic confirmation of presumed inflammatory follicular unit-based disorders that are unusual in presentation or unresponsive to standard therapies. Methods A cross-sectional retrospective study of 5 consecutive patients with a histopathologic diagnosis of FMF was conducted. The clinical, histopathologic, immunophenotypic, and molecular genetic features of cases are presented. Results We describe 5 patients with clinical and histopathologic presentations of FMF masquerading as hidradenitis suppurativa, furunculosis, or acne vulgaris (age range 34-66 years, 4:1 female to male). Clinical morphologies included open and closed comedones, inflammatory pustules, papules and nodules, follicular papules with keratotic plugging, cysts, and scarring involving the face, trunk, and intertriginous areas. All patients failed to respond to standard therapies, including topical and oral antibiotics, topical and oral retinoids, or topical corticosteroids, before receiving the diagnosis of FMF. Lesional skin biopsies showed a perifollicular CD4-positive T-lymphocytic infiltrate with pilotropism, intrafollicular mucin deposition, foreign-body granulomatous inflammation, acute inflammation, and follicular epithelial necrosis. None had concurrent systemic mycosis fungoides. Limitations Small retrospective cohort study. Conclusion We present these cases to expand the clinical and histopathologic spectrum of FMF that may strikingly resemble acneiform disorders and to highlight the importance of diagnostic reconsideration with histopathologic evaluation.

Morphea is an autoimmune skin disease with protean clinical manifestations. Histologic features are similarly variable, and skin biopsies may be nondiagnostic. A single-institution retrospective cohort study was conducted. Morphea patients who had a biopsy in 2005-2015 were included, and a histopathological review was conducted by 2 pathologists. There were 51 biopsy specimens from 40 subjects. The most common histologic features were dermal sclerosis (90%), dermal thickening (78%), collagen homogenization (86%), a superficial and deep infiltrate (76%), a moderate-abundant inflammatory infiltrate (73%), and periadnexal fat loss/decreased skin appendages (71%). Twenty-four specimens were not diagnostic of morphea. In these specimens, the main clues to diagnosis included the presence of dermal sclerosis (79%), subtle collagen homogenization (75%), dermal thickening (58%), moderate-to-abundant plasma cells (50%), and perineural inflammation (50%). There were no statistically significant differences between active and inactive lesions, nor untreated and treated lesions. The histopathologic features of morphea are variable and a high proportion of biopsies are not diagnostic. Clinicians and pathologists should have a high degree of suspicion to correctly make the diagnosis of morphea.

Introduction: Early detection of drug resistant tuberculosis with more sensitive and accessible method together with appropriate control measures among other factors are keys to interruption of transmission and mortality rate. Study Design: This study conducted a retrospective review of presumptive TB register of patients screened for Mycobacterium tuberculosis (MTB) and rifampicin resistant tuberculosis (RR-TB) using Xpert MTB/RIF assay at General Hospital Offa in Kwara State Nigeria between January to December 2018 in order to access the on-going efforts such as quarterly surveillance, improved infrastructural facilities and intense media advocacy on Tuberculosis by Kwara state government on prevention of Tuberculosis in Kwara State. Results: Overall, 63 (10.6%) of the sputum samples collected were positive for Mycobacterium tuberculosis while 4 (6.3%) showed rifampicin resistance out 63 (10%) of patients positive for Mycobacterium tuberculosis. There is high recovery rate of Mycobacterium tuberculosis among women than men as this study recovers 52.4% and 47.6% in male and female respectively. Adults appear to be more vulnerable to TB and the vulnerability tends to increase with age. Conclusion: This study documents low frequency of rifampicin resistance tuberculosis particularly within female population using highly sensitive and specific Xpert MTB/RIF in Kwara State.

PURPOSE To determine the correlation and agreement between intraocular pressure (IOP) parameters evaluated by the modified diurnal tension curve (mDTC) and the water drinking test (WDT) in primary open-angle glaucoma (POAG) in an indigenous African population. MATERIALS AND METHODS This was a prospective, interventional, comparative study of 50 newly diagnosed, previously untreated primary open-angle glaucoma patients at the out-patient clinic of the Eleta Eye Institute, Ibadan. A series of IOP measurements were taken 2 hourly (from 7:00 AM to 3:00 PM) for the mDTC, using Goldmann applanation tonometer. The WDT was performed thereafter. The patients drank 800 mL of water within 5 minutes, and another series of IOP measurements were taken every 15 minutes for a duration of 1 hour from the moment water was fully ingested. Both the mDTC and the WDT were performed on the same day. IOP peak, mean, and IOP fluctuations were estimated from the data collected. Comparison between the mDTC and the WDT was performed using the paired Student T test for means, Pearson correlation analysis for correlation, and Bland-Altman analysis for agreement. RESULTS Estimated IOP parameters were significantly higher for the WDT than for the mDTC. The average peak IOP was 27.8±4.0 mm Hg during the WDT and 24.9±3.1 mm Hg during the mDTC (P

Water is very crucial for the survival and maintenance of most living organisms. The quality of water available for plant, animal or human use cannot therefore be compromised. This study therefore examined the physicochemical and microbiological characteristics of water samples in Okomu National Park, Edo State, Nigeria. Water samples were collected from four waterholes (three rivers and one stream) for two seasons (dry and wet) using grab sampling technique. These water samples were analysed for physicochemical [temperature, pH, total dissolved solid, electrical conductivity, total suspended solids, dissolved oxygen (DO), nitrate, chloride, phosphate, sulphate, biological oxygen demand (BOD) and chemical oxygen demand (COD)] and microbiological (total coliform and fungal counts) analyses using standard methods. Data collected were subjected to descriptive statistics and T-test at α0.05 and compared with WHO permissible limits. The result showed that the mean COD (both seasons) and BOD (dry season) were above the comparable WHO permissible limit while there was no significant difference in the values of all the physicochemical parameters across the seasons of sampling. Salmonella / Shigella and Staphylococcus aureus were observed to be absent while the total coliform and fungi counts were observed to be higher than the WHO permissible limit for drinking water. The detection of Escherichia coli in the water samples (except Arakhuan stream) is an indication of faecal contamination either of animal or human origin. There was significant difference in total heterotrophic bacteria (t=-4.936) and total coliform counts (t=-2.417) in the waters sampled. Constant monitoring of the waterholes and intensified sensitization of the surrounding communities on ecosystem conservation is needed to protect the park’s ecosystems.

Pre-eclampsia (PE) is a pregnancy complicated syndrome that affects multiple organs including the brain that continue post- delivery in both mother and the offspring. We evaluated the expression of oligodendrocytes in the brain of PE rat model through development as well as the cognitive changes and other behavioural modifications that may occur later in the life of offspring of PE-like rat model. Pregnant rats divided into early-onset and late-onset groups were administered with N-nitro- L-arginine methyl (L-NAME) through drinking water at gestational days (GD) 8-17. Rats were allowed free access to water throughout the pregnancy. At GD 19, post-natal day (PND) 1 and 60, rats were sacrificed and brain excised for further analysis. The offspring were subjected to behavioural studies for cognitive and sensorimotor impairments before sacrificed at PND 60. Results showed significant down-regulation in the expression of OLIG2 in PE at GD 19 brain which persists till PND 60. Likewise, there was a significant increase in the latency to locate the platform in Morris water maze, time to traverse the balance beam and reduced hanging time on the wire test between the control and the PE treated. PE could lead to impaired neuronal signalling through demyelination which may contributes significantly to long-term sensorimotor and cognitive deficit.

Background: The optimal management of community acquired pneumonia (CAP) depends on the clinical and microbio- logical profile in the locality. Objectives: To determine the clinical and microbiological profile of patients admitted with CAP in Ilorin, Nigeria. Methods: One hundred and two consenting consecutively selected patients with clinical and radiologic confirmation of CAP were recruited in 12 months. The socio-demographic, physical examination and laboratory/radiologic parameters were documented in a questionnaire. Microbiological evaluation of their sputum was done and blood samples were taken for complete blood count, culture, serum urea and serological evaluation for atypical bacteria and some viral pathogens. Results: CAP constituted 5.9% of the total medical admissions during the one-year study period. The mean age of the pa- tients was 49 ± 22 years with the largest frequency in those aged 65 years and above. The commonest symptoms were short- ness of breath (96.1%) and cough (94.1%), with a median duration of 3 days from symptom onset to admission. Systemic hypertension was the commonest comorbid illness (25/102; 24.5%). Klebsiella pneumoniae was the predominant pathogen iso- lated (20/102; 28.1%). The susceptible antibiotics were Imipenem, Ceftazidime and Ceftriaxone. Intra-hospital mortality was 17.6%. CURB – 65 score of ≥ 2 and the presence of complications of CAP were the independent predictors of mortality. Conclusion: CAP constitutes a significant disease burden in Ilorin, Nigeria. Typical bacteria accounted for over half of the pathogens isolated from the patients with gram negative agents predominating. This highlights a possible shift in the micro- biological profile which could guide empirical treatment. Keywords: Community acquired pneumonia; microbiological profile; Nigeria.

Background: Alloxan is widely used to induce experimental diabetes mellitus (DM) in animals with different grades of disease severity by varying the dose of Alloxan used. This method has however be questioned by recent research work as an appropriate technique for the induction of diabetes. Objective: To provide a simple, yet concise and reproducible experimental procedure and model for Alloxan-induced DM in rats. Methods: The study was divided into 2 separate experiments. Experiment 1: Alloxan was administered, into four subgroups each (group 1- 100 mg of Alloxan /kg of rat body weight, group 2- 120 mg/kg, group 3- 150 mg/kg, and group 4- 170 mg/kg); in each subgroup, the dose of Alloxan was administered at different concentrations (20 mg/ml, 10 mg/ml, 5 mg/ml and 4 mg/ml) in groups of 10 rats each. The pre-induction fasting period was also varied between groups. Experiment 2:Following a pre-induction fasting period of 36 hours, animals received 150 mg Alloxan /kg body weight and at a concentration of 20 mg Alloxan/ ml. Result:Alloxan administered intraperitoneally at 150 mg/kg of rat body weight, at 20 mg/ml and following a pre-induction fast period of 36 hours yielded the most favorably conditions with the least recorded mortality. Conclusion: From the results of this study, it can be concluded that alloxan is a diabetogenic drug with a strict protocol of use in inducing a predictable DM in rats and as such, this model is a standard and reproducible technique for the induction of DM in experimental rats. J Bangladesh Soc Physiol. 2019, December; 14(2): 56-62

Aims:This study was aimed at investigating the prognostic impact of pretreatment thrombocytosis in epithelial ovarian cancer (EOC) patients in Lagos, Nigeria.Methods:This was a retrospective cohort study involving the review of the clinical record of 72 patients with histologically confirmed EOC who were managed at the Lagos University Teaching Hospital, Lagos, Nigeria over a 7-year period from January 2010 to December 2016. Information on the sociodemographic data and platelet counts at diagnosis of EOC were retrieved from the patients' medical records. Descriptive statistics were then computed for all baseline patients' characteristics. Survival analyses were carried out using the Kaplan-Meier estimates. Multivariate analysis of these data was performed with the Cox proportional hazards model.Results:This study revealed that the prevalence of pretreatment thrombocytosis was 41.7% among the women with EOC. Fifty-three (73.6%) of the women had the advanced-stage disease (FIGO stage III-IV) while 52 (72.2%) had high-grade disease (II-III). The majority (66.7%) of the women had a serous histological type of EOC while 76.4% had documented recurrence. Pretreatment thrombocytosis was significantly associated with the women's parity (P= 0.009), serum carbohydrate antigen 125 levels (P= 0.018), median progression-free survival (PFS) (P< 0.001), 3-year median overall survival (OS) (P< 0.001), type of primary treatment (P= 0.002), extent of cytoreduction (P< 0.001), presence of ascites (P= 0.002), International Federation of Gynecology and Obstetrics (FIGO) stage (P= 0.008), and histological type (P= 0.011). Pretreatment thrombocytosis was negatively associated with PFS (hazard ratio [HR] = 0.25; 95% CI 0.83, 0.75;P= 0.014) and 3-year OS (HR = 0.03; 95% CI 0.03, 0.27;P= 0.002).Conclusions:The study suggests that pretreatment thrombocytosis may be a useful predictor of survivals in EOC patients.

Background: Breast cancer in African women differs from the Caucasian. Understanding the profile of Nigerian women with breast cancer will help with preventive measures and treatment. This study focused on the clinico-pathological characteristics, with risk factors of breast cancer patients in Nigeria. Methods: Newly diagnosed female patients with breast cancer were assessed over 12 months. Patients were reviewed using a predesigned proforma which focused on socio-demographic information, clinical information, risk factors and tumor biology. Results: A total of 251 women were identified; their mean age was 46 years. More than half (62.5%) are premenopausal at presentation, 37.8% with Eastern Cooperative Oncology Group (ECOG) score of 0 and right side (50.2%) as the most common primary site of disease. Less than half of them (43.0%) are estrogen receptor (ER) positive, 27.9% are progesterone receptor (PR) positive, 43.8% and 47.4% are hormone receptor positive and triple negative, respectively. Most patients presented at the latter stage of the disease, stage III (66.9%) and stage IV (18.3%). Only 15.9% are well differentiated and almost all (92.8%) had invasive ductal histological type. Obesity (66.2%) and physical inactivity (41.9%) are the most common risk factors for the disease. A significant relationship was found between immunohistochemistry status and family history of breast cancer, tumor site, previous breast surgery, previous lump and alcohol intake. Conclusion: Findings from this study showed that Nigerian breast cancer patients differ from their counterparts in the high human development index (H-HDI) countries in terms of the patients and disease characteristics. In view of this, prevention and treatment options should consider this uniqueness to ensure better outcome. World J Oncol. 2020;11(4):165-172 doi: https://doi.org/10.14740/wjon1303

Predicting the trend of non-seasonal data is a difficult task in Social Science. In this research work, we used time series analysis of 144 observations on monthly basis for record of reported cases of tuberculosis patients in Minna General Hospital, Niger State from the period of 2007-2018. Exploratory Data Analysis (EDA: Time Plot and Descriptive Statistics), Stationarity Test (ADF), Trend estimation (Tt), Normality Test, and Forecast evaluation were carried out. The Augmented Dickey Fuller test for stationarity was conducted and the result revealed that the series are not stationary but became stationary after first difference. The correlogram established that the ARIMA (2, 1, 3) was the best model this was further confirmed from the result of L-jung Box. Equation for ARIMA (2, 1, 3) was given as Xt + 0.6867Xt-1 – 0.8859Xt-2 = Et + 1.3077Et-1 - 1.2328Et-2 + 0.5788Et-3. Which was used to predict five years likely cases of tuberculosis in Minna for the period of 2019-2023. It was clearly shown from the projection that the reported cases of tuberculosis reduce year by year by 7% over the period under consideration which could be as a result of intervention from government, health worker, and individuals. In line with these findings, we recommend that the management of general hospital to increase awareness campaign to the public on the causes and dangers of tuberculosis.

Human epidermal growth factor receptor 2 (HER2) is a member of epidermal growth factor receptors with tyrosine kinase functionality. The dimerization of HER2 leads to the autophosphorylation of tyr...

Background Receptor tyrosine kinases (RTKs) are single-pass transmembrane proteins that play significant roles in regulating cellular processes, including cell division and growth. Overexpression and mutations of RTKs have been found in clinical manifestations of different forms of cancer. Therefore, RTKs have received considerable interest as a therapeutic biomarker in the treatment of cancer cells. Main body of the abstract Comprehensive data on RTKs, pharmacological and biological properties of natural compounds were systematically searched up to 2021 using relevant keywords from various databases, such as Google Scholar, PubMed, Web of Science, and Scopus. The scientific search by various standard electronic resources and databases unveils the effectiveness of medicinal plants in the treatment of various cancers. In vitro and in vivo studies suggested that bioactive compounds such as flavonoids, phenols, alkaloids, and many others can be used pharmacologically as RTKs inhibitors (RTKI) either by competing with ATP at the ATP binding site of the tyrosine kinase domain or competing for the receptor extracellular domain. Additionally, studies conducted on animal models indicated that inhibition of RTKs catalytic activity by natural compounds is one of the most effective ways to block the activation of RTKs signaling cascades, thereby hampering the proliferation of cancer cells. Furthermore, various pharmacological experiments, transcriptomic, and proteomic data also reported that cancer cells treated with different plants extracts or isolated phytochemicals exhibited better anticancer properties with minimal side effects than synthetic drugs. Clinically, natural compounds have demonstrated significant anti-proliferative effect via induction of cell apoptosis in cancer cell lines. Short conclusion An in-depth knowledge of the mechanism of inhibition and structural characterization of RTKs is important to the design of novel and selective RTKIs. This review focuses on the molecular mechanisms and structures of natural compounds RTKI targeting vascular endothelial growth factor, epidermal growth factor receptor, insulin receptor, and platelet-derived growth factor while also giving future directions to ameliorate the scientific burden of cancer. Graphic abstract

Background and Purpose: To identify the qualitative and quantitative contributions of conventional risk factors for occurrence of ischemic stroke and its key pathophysiologic subtypes among West Africans. Methods: The SIREN (Stroke Investigative Research and Educational Network) is a multicenter, case-control study involving 15 sites in Ghana and Nigeria. Cases include adults aged ≥18 years with ischemic stroke who were etiologically subtyped using the A-S-C-O-D classification into atherosclerosis, small-vessel occlusion, cardiac pathology, other causes, and dissection. Controls were age- and gender-matched stroke-free adults. Detailed evaluations for vascular, lifestyle, and psychosocial factors were performed. We used conditional logistic regression to estimate adjusted odds ratios with 95% CI. Results: There were 2431 ischemic stroke case and stroke-free control pairs with respective mean ages of 62.2±14.0 versus 60.9±13.7 years. There were 1024 (42.1%) small vessel occlusions, 427 (17.6%) large-artery atherosclerosis, 258 (10.6%) cardio-embolic, 3 (0.1%) carotid dissections, and 719 (29.6%) undetermined/other causes. The adjusted odds ratio (95% CI) for the 8 dominant risk factors for ischemic stroke were hypertension, 10.34 (6.91–15.45); dyslipidemia, 5.16 (3.78–7.03); diabetes, 3.44 (2.60–4.56); low green vegetable consumption, 1.89 (1.45–2.46); red meat consumption, 1.89 (1.45–2.46); cardiac disease, 1.88 (1.22–2.90); monthly income $100 or more, 1.72 (1.24–2.39); and psychosocial stress, 1.62 (1.18–2.21). Hypertension, dyslipidemia, diabetes were confluent factors shared by small-vessel, large-vessel and cardio-embolic subtypes. Stroke cases and stroke-free controls had a mean of 5.3±1.5 versus 3.2±1.0 adverse cardio-metabolic risk factors respectively ( P Conclusions: Traditional vascular risk factors demonstrate important differential effect sizes with pathophysiologic, clinical and preventative implications on the occurrence of ischemic stroke among indigenous West Africans.

Basal cell carcinoma (BCC) is the most commonly diagnosed cutaneous cancer in the United States with more than 2.5 million treated annually. Genetic studies have revealed that approximately 90% of BCCs have a mutation in the hedgehog-signaling pathway. Patients with BCC usually have an excellent prognosis with surgical modalities, however, patients with locally advanced BCC may potentially experience significant cosmetic or functional impairment, with only surgical intervention. Vismodegib is a hedgehog pathway inhibitor that has been successful in treating patients with locally advanced BCC. We report a patient with BCC with a good response to vismodegib and a novel xanthomatous change in the excision specimen.

Prostate cancer is the second leading cancer in men, according to the WHO world cancer report. Its prevention and treatment demand proper attention. Despite numerous attempts for disease prevention, prostate tumours can still become metastatic by blood circulation to other organs. Several treatments have been adopted. However, findings show that the docetaxel treatment induces adverse reactions in patients. Particle Swarm Optimized Gaussian Process Classifier (PSO-GPC) is proposed to determine when to discontinue treatment. Based on three cohorts of prostate cancer patients, we propose and compare several classifiers for the best performance in determining treatment discontinuation. Given the data skewness and class imbalance, the models are evaluated based on both the area under receiver operating characteristics curve (AUC) and area under precision recall curve (AUPRC). With the AUCs ranging between 0.6717 - 0.8499, and AUPRCs ranging between 0.1392 - 0.5423, PSO-GPC performs better than the state-of-the-art. We have carried out statistical analysis for ranking methods and analyzed independent cohort data with PSO-GPC, demonstrating its unbiased performance. A proper determination of treatment discontinuation in metastatic castration-resistant prostate cancer patients will reduce the mortality rate in cancer patients.

Active surveillance (AS) is an important strategy to avoid overtreatment of prostate cancer (PCa) and has become the standard of care for low-risk patients. The role of magnetic resonance imaging (MRI) in AS has expanded due to its ability to risk stratify patients with suspected or known PCa, and MRI has become an integral part of the AS protocols at various institutions. A negative pre-biopsy MRI result is associated with a very high negative predictive value for a Gleason score ≥ 3+4. A positive MRI result in men who are otherwise eligible for AS has been shown to be associated with the presence of high-grade PCa and therefore with ineligibility. In addition, MRI can be used to guide and determine the timing of per-protocol biopsy during AS. However, there are several MRI-related issues that remain unresolved, including the lack of a consensus and guidelines; concerns about gadolinium deposition in various tissues; and increased demand for higher efficiency and productivity. Similarly, the need for the combined use of targeted and systematic sampling is still a matter of debate when lesions are visible on MRI. Here, we review the current AS guidelines, as well as the accepted roles of MRI in patient selection and monitoring, the potential uses of MRI that are still in question, and the limitations of the method.A vigilância ativa (VA) é uma estratégia importante para evitar o tratamento excessivo do câncer de próstata (CaP) e tornou-se o padrão de atendimento a pacientes de baixo risco. O papel da ressonância magnética (RM) na VA tem se expandido, devido à sua capacidade de estratificar o risco pacientes com CaP suspeito ou diagnosticado, tornando-se parte integrante dos protocolos de VA em várias instituições. Uma RM pré-biópsia negativa está associada a um valor preditivo negativo muito alto para o diagnóstico de Gleason ≥ 3+4. Um exame positivo em homens que são elegíveis para VA tem se mostrado associado à presença de CaP de alto grau e inelegibilidade para VA. A RM também pode ser usada para orientar e determinar o tempo ideal de uma biópsia, ou por protocolo, durante a VA. Há, no entanto, várias questões relacionadas à RM que permanecem não resolvidas. Estas incluem a falta de consenso ou diretrizes, preocupações com o depósito de gadolínio em vários tecidos e aumento da pressão por maior eficiência e produção. Da mesma forma, a necessidade de biópsia sistemática combinada à dirigida continua a ser uma questão controversa, quando as lesões são visíveis na RM. Revisaremos as atuais diretrizes de VA, os papéis consensualmente aceitos da RM na seleção e monitoramento dos pacientes, potenciais usos, ainda discutíveis, e as limitações do método.

Introduction Inflammatory bowel disease (IBD) is increasingly common among patients with other comorbid chronic conditions, particularly diabetes mellitus (DM). Yet, studies that explored the impact of comorbid diabetes on the outcomes of IBD are scanty. Therefore, this study aims to examine the outcomes of inflammatory bowel disease among hospitalized patients with diabetes mellitus. Methods Using the Nationwide Inpatient Sampling (NIS) database from 2016 to 2018, we identified patients' records with a diagnosis of IBD using the International Classification of Diseases, Tenth Revision codes (ICD-10). The overall study population was further stratified by diabetes mellitus status. We matched patients with IBD and diabetes mellitus (IBD DM) with IBD cohorts using a greedy propensity score matching (PSM) ratio of 1:1 and compared in-hospital outcomes between the two cohorts. Conditional logistic regression was performed to estimate the odds of outcomes. Results Out of the 192,456 hospitalizations for IBD, 34,073 (7.7%) had comorbid IBD DM and 158,383 (92.3%) had no diabetes mellitus (IBD only). Patients with IBD DM are likely to be older. They have higher rates of hypertension, hyperlipidemia, coronary artery disease, obesity, peripheral vascular disease, congestive heart failure, chronic kidney disease, chronic lung disease, chronic liver disease, and stroke than the IBD cohort. After propensity score matching, IBD DM was associated with a lower adverse outcome [odds ratio (OR): 0.96, confidence interval (CI): 0.93 - 0.99, p < 0.01], IBD-related complications (intestinal or rectal fistula, intra-abdominal abscess, toxic colitis, intestinal perforation, intestinal obstruction, toxic megacolon, abscess of the abdomen, and perianal abscess), (OR: 0.76, CI: 0.72 - 0.80, P

A 40-year-old previously healthy, non-atopic woman was referred for evaluation of a possible immunodeficiency disorder in the setting of an unusual erosive cheilitis and history of recurrent methicillin-resistant Staphylococcus aureus (MRSA) infection. Extensive work-up was non-diagnostic, including screening for immunologic disorders. She had failed multiple therapeutic modalities, including corticosteroid and immunosuppressive therapy. Tissue biopsy from the lip proved pivotal in demonstrating changes suggestive of factitial disease. This led to further detailed history-taking, yielding evidence of considerable psychologic distress. The patient was diagnosed with exfoliative cheilitis related to factitial disease in association with underlying untreated anxiety and psychologic trauma.

Background Observations highlighting the "unmasking" of cutaneous T-cell lymphoma after treatment with dupilumab for atopic dermatitis (AD) have been recently reported. However, there remains a paucity of literature describing the evolution of clinical and histopathological features that characterizes this phenomenon. Objective To define the clinical and histopathologic evolution of atypical lymphoid infiltrates after the administration of dupilumab for AD. Methods A cross-sectional study of clinical and histopathologic features in 7 consecutive patients with a diagnosis of "atypical lymphoid infiltrate" or mycosis fungoides (MF) on dupilumab for AD was performed. Results Seven patients with atypical lymphoid infiltrates or MF in evolution after dupilumab therapy (age range 27-74 years) were reviewed. Average duration of AD before MF diagnosis was 5.7 years, and the average duration on dupilumab treatment was 9.8 months. Notable histopathologic features across predupilumab and postdupilumab biopsies included progressive increase in the densities of the atypical lymphoid infiltrates (7/7), presence of atypical epidermotropic lymphocytes (6/7), and papillary dermal fibrosis (6/7). Limitations Small retrospective cohort study. Conclusion These cases highlight the transformation of lymphoid infiltrates after dupilumab treatment for AD and emphasize the importance of clinical and histopathologic evaluation before and during treatment with dupilumab for treatment-refractory presumed AD.

Introduction:the burden of HIV and tuberculosis co-infection is a global public health challenge. Despite the benefit of isoniazid preventive therapy (IPT) in reducing the rate of co-infection, the uptake is generally limited in developing countries. This study aimed to determine the prevalence of IPT use and the factors affecting the uptake among HIV-infected patients attending our Teaching Hospital. Methods:this cross-sectional survey involved 300 HIV-infected individuals attending the AIDS prevention initiatives in Nigeria clinic of the Lagos University Teaching Hospital. A self-designed and well-structured questionnaire was used to document the demographic data, patients’ exposure to tuberculosis, and IPT uptake. Clinical data of eligible patients were also extracted from their case notes. The main outcome measure was the prevalence of IPT use and non-use. Results:out of the respondents evaluated, (72.7%, n = 218) were females. Tuberculosis was the predominant comorbidity (15.7%, n = 47) and majority (53.0%, n = 159) had a CD4 count of < 500 cells/ml. Overall prevalence of IPT uptake was very low (7.1%, n = 18) among HIV-infected patients. Major factors affecting uptake were lack of awareness of benefit (44.4%, n = 8) and lack of fear of contracting tuberculosis (22.2%, n = 4). However, lack of awareness of IPT benefit was the only independent factor associated with poor IPT uptake (adjusted odds 1168.75, 95% confidence interval: 85.05-16060.33; p = 0.001). Conclusion:isoniazid preventive therapy uptake was found to be very low in this study. Increased awareness and policy implementation of IPT by the healthcare provider is necessary.

BACKGROUND: Post-stroke seizures (PSS) are associated with significant morbidity and mortality across the globe. There is a paucity of data on PSS in Africa. PURPOSE: To assess the frequency and factors associated with PSS by stroke types across 15 hospitals in Nigeria and Ghana. METHODS: We analyzed data on all stroke cases recruited into the Stroke Investigative Research and Educational Network (SIREN). We included adults aged ≥18 years with radiologically confirmed ischemic stroke (IS) or intracerebral hemorrhage (ICH). PSS were defined as acute symptomatic seizures occurring at stroke onset and/or during acute hospitalization up until discharge. We used logistic regression to estimate adjusted odds ratios (aOR) with 95% Confidence Interval. RESULTS: Among 3,344 stroke patients, 499 (14.9%) had PSS (95% CI: 13.7 – 16.2%). The mean duration of admission in days for those with PSS vs no PSS was 17.4 ± 28.6 vs 15.9 ± 24.7, p=0.72. There were 294(14.1%) PSS among 2091 ischemic strokes and 159(17.7%) among 897 with ICH, p=0.01. The factors associated with PSS occurrence were age

Orofacial granulomatosis (OFG) is an uncommon chronic granulomatous condition presenting as perioral inflammation in the absence of systemic disease. There is continued debate regarding whether OFG is a distinct clinical disorder or a manifestation of orofacial Crohn's disease. Our retrospective review identified 7 patients diagnosed with OFG between 2000 and 2018 at a tertiary pediatric hospital. Four of the 7 patients subsequently developed Crohn's disease with a median delay of 3.1 years (range 0.4-6.9 years). This indicates that gastroenterology evaluation with long-term monitoring for intestinal Crohn's disease is warranted.

Hyperemesis gravidarum (HG) complicated by acute kidney injury (AKI) is not commonly encountered in practice. Despite the extreme rarity of HG as a cause of AKI, health-care providers should be aware of the likelihood of such a complication. The aim of the study was to report a case of HG complicated by AKI. A 35-year-old G2P1+0 (one alive) female presented with progressively worsening nausea and vomiting with associated weight loss and reduced urinary output at the gestational age of 17 weeks. Serum creatinine and urea values at presentation were 883 μmol/L and 56 mmol/L, respectively. She, however, responded to intravenous fluid therapy/replacement with subsequent normalization of serum urea and creatinine values and restoration of renal function. AKI can be a complication of HG. Individualized care of affected women will improve the prognosis.

Primary cutaneous follicle center cell lymphoma is the most prevalent type of primary cutaneous B-cell lymphoma and usually portends a favorable prognosis. Typically, the diagnosis can be rendered based on characteristic histopathologic features and immunohistochemical profile. Rarely, a diagnostically challenging variant with a predominant spindle morphology mimicking other malignant spindle cell neoplasms may be encountered. Even more unusual is the presence of a prominent myxoid stroma in this rare sarcomatoid variant of follicle center cell lymphoma. Herein, we present a case of a 52-year-old man with a slowly enlarging cyst-like lesion on the chin with histopathologic examination revealing a malignant, predominantly spindled neoplasm within an abundant myxoid stroma. Following a broad panel of immunohistochemical stains, the strong positive staining of the spindle cells for LCA (CD45), CD20, and Bcl-6 confirmed the diagnosis of follicle center cell lymphoma. We present this distinctive rare subtype of cutaneous follicle center cell lymphoma to increase awareness of this variant and to discuss challenging histopathologic mimics to consider while highlighting the utility of immunohistochemistry stains to avoid misdiagnosis.