Electronic Structures of an Annulated meso-Tetraphenylchlorin and a Related Chlorin Analogue Incorporating an 8-Membered Ring through MCD Spectroscopy and DFT Calculations.

Herein, we compare the electronic structures of the metal-free and nickel(II) derivatives of an annulated meso-tetraphenyldihydroxychlorin with those of the (metallo)chlorin analogues derived by pyrroline ß,ß'-ring cleavage of the annulated (metallo)chlorins. These (metallo)chlorin analogues incorporate 8-membered heterocycles in place of the pyrroline, carry oxo-functionalities on the former pyrroline ß-carbon atoms, and were previously shown to possess drastically ruffled (twisted) nonplanar conformations. The magnetic circular dichroism spectra of all chromophores investigated feature chlorin-like UV-vis spectra and correspondingly reversed (positive-to-negative in ascending energy) sign sequences in the Q-band region, indicative of ΔHOMO < ΔLUMO relationships. Density functional theory (DFT) calculations indicate that the HOMOs in all compounds are a1u-type molecular orbitals (in traditional for the porphyrin spectroscopy D4h point group). Time-dependent DFT calculations correlate well with the experimental spectra and indicate that Gouterman's four-orbital model can be applied to these chromophores. This work highlights to which degree synthetic chlorin analogues can deviate from the structural parameters of natural chlorins without losing their electronic chlorin characteristics.

Atorvastatin improves sputum conversion and chest X-ray severity score.

BACKGROUND: We report the results of a phase IIB study investigating the safety and effectiveness of atorvastatin use with standard anti-TB drugs.METHODS: In this multicentre, open-labelled study, we recruited treatment-naÏve patients with uncomplicated pulmonary TB aged at least 18 years. Participants were randomly assigned to standard-of-care or standard-of-care plus oral dose of atorvastatin (40 mg) daily for 2 months. Primary end points were safety measured by the number of participants with severe adverse events and effectiveness measured by the number of participants with negative sputum culture. Secondary endpoint was chest X-ray (CXR) severity score.RESULTS: Of the 185 participants screened, 150 were enrolled and equally assigned to the standard-of-care and atorvastatin groups. Adverse event severity was similar in the two groups. There was increased frequency of muscle pain in the trial group (12/75, 16% vs. 4/75, 5%). For efficacy analysis, respectively 64 (97%) and 57 (85.1%) patients in the trial and control groups had culture-negative results (P = 0.02) and experienced a reduction in CXR severity score of respectively 37% and 22%, with a mean difference of 1.4-4.9%.CONCLUSION: Atorvastatin is safe and associated with improved microbiological and radiological outcomes in TB.

The value of standards for health datasets in artificial intelligence-based applications.

Artificial intelligence as a medical device is increasingly being applied to healthcare for diagnosis, risk stratification and resource allocation. However, a growing body of evidence has highlighted the risk of algorithmic bias, which may perpetuate existing health inequity. This problem arises in part because of systemic inequalities in dataset curation, unequal opportunity to participate in research and inequalities of access. This study aims to explore existing standards, frameworks and best practices for ensuring adequate data diversity in health datasets. Exploring the body of existing literature and expert views is an important step towards the development of consensus-based guidelines. The study comprises two parts: a systematic review of existing standards, frameworks and best practices for healthcare datasets; and a survey and thematic analysis of stakeholder views of bias, health equity and best practices for artificial intelligence as a medical device. We found that the need for dataset diversity was well described in literature, and experts generally favored the development of a robust set of guidelines, but there were mixed views about how these could be implemented practically. The outputs of this study will be used to inform the development of standards for transparency of data diversity in health datasets (the STANDING Together initiative).

Effect of Chronic Obstructive Pulmonary Disease Severity on Inspiratory Flow Rates via Inhaler Devices.

INTRODUCTION: Chronic obstructive pulmonary disease (COPD) is a chronic respiratory disorder that affects millions of people worldwide and inhalation therapy is central to the symptomatic management of the disease. Therefore, knowledge of the minimum Peak inspiratory flow (PIF) requirements for specific inhalers especially dry powder inhalers (DPI's) is necessary when prescribing inhalation therapy. The purpose of this study is to assess the effect of COPD severity on PIF in patients with COPD. METHODOLOGY: A total of 150 subjects (75 patients with stable COPD, and 75 apparently healthy subjects) participated in the study. PIF was assessed using the In-check Inhaler Assessment Kit (manufactured by Clement Clarke International Ltd, Harlow, UK). Lung function was assessed by spirometry with subjects divided into four groups based on the severity of their airway obstruction using the GOLD criteria. The Modified Medical Research Council (MMRC) dyspnea scale was used to assess dyspnea severity. Exercise capacity was assessed using the 6-minute walk test. Statistical analysis was performed with SPSS 23.0 software. In all the statistical tests, a p value of <0.05 was considered significant. RESULTS: The mean age for the COPD patient and control population are 72.48 ± 8.01 and 70.69 ± 5.82 respectively. The control group had higher PIF than COPD group; however, only the clickhler and pMDI had statistically significant difference between the mean PIF of the patients compared with the control group. Generally, there was an observed trend of a decrease in mean PIF as the COPD stage progresses with a statistically significant difference observed for Easibreathe (F= 3.52, p= 0.019) and pressurized Metered dose inhaler (pMDI) (F= 4.26, p= 0.008). There was a significant positive correlation between FEV1%, FVC, Exercise capacity (6-minute walk distance) and PIF for Clickhaler, Autohaler, Easybreathe and pMDI. For pMDI, there was a statistically significant difference between means of PIF across the MMRC dyspnea scale with PIF decreasing with increasing severity of dyspnea (F= 2.85, p= 0.033). CONCLUSION: COPD patients have slightly lower PIF than controls. Poor exercise tolerance and lower spirometric pulmonary function parameters may contribute to low PIF.

INTRODUCTION: La bronchopneumopathie chronique obstructive (BPCO) est un trouble respiratoire chronique qui touche des millions de personnes dans le monde et la thérapie par inhalation est essentielle à la gestion symptomatique de la maladie. Par conséquent, il est nécessaire de connaître les exigences minimales en matière de débit inspiratoire de pointe (DIP) pour certains inhalateurs, en particulier les inhalateurs de poudre sèche (IPS), lors de la prescription d'un traitement par inhalation. L'objectif de cette étude est d'évaluer l'effet de la gravité de la BPCO sur le débit de pointe inspiratoire chez les patients atteints de BPCO. MÉTHODOLOGIES: Un total de 150 sujets (75 patients atteints de BPCO stable et 75 sujets apparemment sains) ont participé à l'étude. Le PIF a été évalué à l'aide du kit d'évaluation In-check Inhaler (fabriqué par Clement Clarke International Ltd, Harlow, UK). La fonction pulmonaire a été évaluée par spirométrie, les sujets étant répartis en quatre groupes en fonction de la gravité de l'obstruction des voies respiratoires selon les critères GOLD. L'échelle de dyspnée modifiée du Medical Research Council (MMRC) a été utilisée pour évaluer la sévérité de la dyspnée. La capacité d'exercice a été évaluée à l'aide du test de marche de 6 minutes. L'analyse statistique a été réalisée avec le logiciel SPSS 23.0. Dans tous les tests statistiques, une valeur p de <0,05 a été considérée comme significative. RÉSULTATS: L'âge moyen des patients atteints de BPCO et de la population de contrôle est respectivement de 72,48 ± 8,01 et 70,69 ± 5,82. Le groupe de contrôle avait un PIF plus élevé que le groupe BPCO; cependant, seuls le clickhler et le pMDI présentaient une différence statistiquement significative entre le PIF moyen des patients et celui du groupe de contrôle. D'une manière générale, on a observé une tendance à la diminution du FRP moyen au fur et à mesure de l'évolution de la BPCO, avec une différence statistiquement significative pour l'Easibreathe (F= 3,52, p= 0,019) et l'aérosol-doseur pressurisé (pMDI) (F= 4,26, p= 0,008). Il existe une corrélation positive significative entre le VEMS, la CVF, la capacité d'exercice (distance de marche de 6 minutes) et le PIF pour Clickhaler, Autohaler, Easybreathe et pMDI. Pour le pMDI, il y avait une différence statistiquement significative entre les moyennes de PIF sur l'échelle de dyspnée du MMRC, le PIF diminuant avec l'augmentation de la sévérité de la dyspnée (F= 2,85, p= 0,033). CONCLUSION: Les patients atteints de BPCO ont un PIF légèrement inférieur à celui des témoins. Une mauvaise tolérance à l'exercice et des paramètres spirométriques de la fonction pulmonaire plus faibles peuvent contribuer à la faiblesse du PIF. Mots clés: Maladie pulmonaire obstructive chronique, Inhalateurs de poudre sèche, Débit inspiratoire de pointe, Aérosol-doseur pressurisé.

Determinants of Suboptimal Peak Inspiratory Flow Rates among Patients with Chronic Obstructive Pulmonary Disease in Southwest, Nigeria.

BACKGROUND: Inhalational therapy is the cornerstone in the management of chronic obstructive pulmonary disease (COPD) patients. Patients' peak inspiratory flow impacts effective dry powder inhaler (DPI) delivery and management outcome. OBJECTIVE: This study assessed peak inspiratory flow rates (PIFR) and determined the factors associated with suboptimal inspiratory flow rates among COPD patients. METHODS: A descriptive cross-sectional study was conducted among 60 participants (30 stable COPD patients and 30 age-and-sex matched controls). Socio-demographic characteristics was obtained and spirometry was done for all participants. PIFR assessment was done using the In-Check Dial Meter and was categorized as suboptimal (< 60L/min) or optimal (≥ 60L/min). P values less than 0.05 were taken as statistically significant. RESULTS: Mean age of the COPD patients and healthy controls were both 67.8 ± 10.3 years, with 53.3% being females. Post-bronchodilation FEV 1/FVC% for COPD patients was 54.15 ± 11.27%. The mean PIFR among COPD patients was significantly lower than that of healthy controls, in all DPIs simulated, especially for Clickhaler (46.2±13.4 vs 60.5±11.4L/min, p<0.001). A significant proportion of COPD patients had suboptimal PIFR, in the simulated resistances against Clickhaler and Turbuhaler (70% vs 80%; p<0.001). Older age, shorter height and low BMI were associated with suboptimal PIFR among COPD patients. However, independent predictors of suboptimal PIFR were BMI, PEFR, FEV1% and FVC%. CONCLUSION: Suboptimal PIFR was found in a significant number of COPD patients when compared with healthy respondents. Routine assessment using In-Check Dial meter should be done to determine the suitability of dry powder inhalers for patients with COPD.

CONTEXTE: Le traitement par inhalation est la pierre angulaire de la prise en charge des patients atteints de bronchopneumopathie chronique obstructive (BPCO). Le débit inspiratoire de pointe des patients a une incidence sur l'efficacité de l'inhalateur de poudre sèche et sur les résultats de la prise en charge. OBJECTIF DE L'ÉTUDE: Cette étude a évalué les débits inspiratoires de pointe et déterminé les facteurs associés aux débits inspiratoires sousoptimaux chez les patients atteints de BPCO. MÉTHODES: Une étude transversale descriptive a été menée auprès de 60 participants (30 patients atteints de BPCO stable et 30 témoins appariés selon l'âge et le sexe). Les caractéristiques socio-démographiques ont été recueillies et une spirométrie a été effectuée pour tous les participants. L'évaluation du PIFR a été réalisée à l'aide du Dial Meter In-Check et a été catégorisée comme suboptimale (< 60L/min) ou optimale (≥ 60L/min). Les valeurs P inférieures à 0,05 ont été considérées comme statistiquement significatives. RÉSULTATS: L'âge moyen des patients atteints de BPCO et des témoins sains était de 67,8 ± 10,3 ans, avec 53,3 % de femmes. Le pourcentage de VEMS/FVC après bronchodilatation chez les patients atteints de BPCO était de 54,15 ± 11,27 %. Le PIFR moyen des patients atteints de BPCO était significativement plus faible que celui des témoins sains, pour tous les DPI simulés, en particulier pour le Clickhaler (46,2±13,4 vs 60,5±11,4L/min, p<0,001). Une proportion significative de patients atteints de BPCO avait un PIFR sous-optimal, dans les résistances simulées contre Clickhaler et Turbuhaler (70% vs 80% ; p<0.001). L'âge avancé, la petite taille et un faible IMC étaient associés à une PIFR sous-optimale chez les patients atteints de BPCO. Cependant, les prédicteurs indépendants du PIFR suboptimal étaient l'IMC, le DEP, le VEMS et la CVF. CONCLUSION: Un nombre significatif de patients atteints de BPCO présente un PIFR sous-optimal par rapport aux personnes interrogées en bonne santé. Une évaluation de routine à l'aide de l'appareil de mesure In-Check Dial devrait être effectuée pour déterminer si les inhalateurs de poudre sèche conviennent aux patients atteints de BPCO. Mots clés: Inhalateur de poudre sèche, Débit inspiratoire maximal, Fonction pulmonaire.

Frequency of Osteoporosis in Black Nigerian Women Aged 50 and above with Degenerative Musculoskeletal Diseases and Fractures.

BACKGROUND AND OBJECTIVES: Osteoporosis is a bone disease characterized by reduced bone density (and microarchitecture damage) prevalent in post-menopausal women, who are prone to fragility fractures. There is paucity of data regarding the prevalence of osteoporosis in Nigerian women. This study was carried out to evaluate the frequency of osteoporosis among Nigerian women with degenerative skeletal diseases and fractures who visited our hospital so as to suggest prevention and early treatment in order to reduce the occurrence of fragility fractures. METHODS: Women aged 50 years and older, who visited the hospital with degenerative skeletal diseases and fractures during the study period were recruited. Their ages, diagnosis, Bone Mineral Density (BMD), T-score and interpretation were recorded in an anonymous database. RESULTS: The ages of the 173 patients evaluated ranged between 51 and 89 years, of which 111 (64.1%) were aged between 61 and 80 years. The most common diagnosis was degenerative lumbar spine disease in 37.0% of patients, but only 13.9% had fractures. Knee and hip osteoarthritis (OA) accounted for fewer cases (22.5% and 3.5% respectively). Using WHO criteria for diagnosing osteoporosis, 35 (20.2%) of the patients had osteoporosis, while 82 (47.4%) had low BMD, 52 (30.1%) were normal and 4 (2.3%) had high BMD. CONCLUSIONS: In this study, the frequency of osteoporosis increased with age and was higher among patients with a combination of cervical and lumbar degenerative disease, followed by fractures. We, therefore, recommend routine screening of women aged 50 and above with degenerative spine disease and fractures.

CONTEXTE ET OBJECTIFS: L'ostéoporose est une maladie osseuse caractérisée par une réduction de la densité osseuse (et des dommages à la microarchitecture) fréquente chez les femmes ménopausées, sujettes aux fractures de fragilité. Il y a peu de données sur la prévalence de l'ostéoporose chez les femmes nigérianes. Cette étude a été réalisée pour évaluer la fréquence de l'ostéoporose chez les femmes nigérianes atteintes de maladies dégénératives du squelette et de fractures qui ont visité notre hôpital afin de suggérer une prévention et un traitement précoce afin de réduire la survenue de fractures de fragilité. MÉTHODES: Des femmes âgées de 50 ans et plus, qui ont visité l'hôpital avec des maladies dégénératives du squelette et des fractures au cours de la période d'étude ont été recrutées. Leur âge, leur diagnostic, leur densité minérale osseuse (DMO), leur score T et leur interprétation ont été enregistrés dans une base de données anonyme. RÉSULTATS: L'âge des 173 patients évalués variait entre 51 et 89 ans, dont 111 (64,1%) étaient âgés de 61 à 80 ans. Le diagnostic le plus courant était la maladie dégénérative de la colonne lombaire chez 37,0% des patients, mais seulement 13,9% avaient des fractures. L'arthrose du genou et de la hanche (OA) représentait moins de cas (22,5% et 3,5% respectivement). En utilisant les critères de l'OMS pour le diagnostic de l'ostéoporose, 35 (20,2%) des patients souffraient d'ostéoporose, tandis que 82 (47,4%) avaient une faible DMO, 52 (30,1%) étaient normales et 4 (2,3%) avaient une DMO élevée. CONCLUSIONS: Dans cette étude, la fréquence de l'ostéoporose augmentait avec l'âge et était plus élevée chez les patients présentant une combinaison de maladies dégénératives cervicales et lombaires, suivies de fractures. Nous recommandons donc un dépistage systématique des femmes âgées de 50 ans et plus souffrant de maladie dégénérative de la colonne vertébrale et de fractures. MOTS CLÉS: femmes nigérianes, ostéoporose, densité minérale osseuse, fractures de fragilité.

Pyrrole-Modified Porphyrins Containing Eight-Membered Heterocycles Using a Reversal of the "Breaking and Mending" Strategy.

The conversion of meso-aryl-porphyrins/chlorins to porphyrinoids containing nonpyrrolic heterocycles (so-called pyrrole-modified porphyrins, PMPs) along an approach we dubbed "the breaking and mending of porphyrins" is well known. However, examples are limited to the synthesis of PMPs containing up to six-membered heterocycles; the syntheses of larger rings failed. We report here hitherto unavailable eight-membered chlorin-type PMPs using an inverted "mending and breaking" approach. All examples are based on the addition of N,N'-dimethylurea derivatives to a meso-phenyl-ß,ß'-dioxoporphyrin, followed by oxidative cleavage of the intermediate diol adduct. We correlate the extremely nonplanar solid-state structures of three crystallographically characterized PMPs containing an eight-membered ring with their solution-state optical properties. The first examples of bis-modified, bacteriochlorin-type PMPs containing either two eight-membered rings or an eight-membered ring and an imidazolone ring are also detailed. Using other N,N'-nucleophiles failed to either generate chlorins containing a ß,ß'-dihydroxypyrroline, a prerequisite for the "breaking step," or the cleavage of those substrates that did generate a diol underwent subsequent reactions that thwarted the generation of the desired PMPs. This contribution adds novel PMPs containing eight-membered rings, highlights the effects these derivatizations have on the macrocycle conformation, and how that affects their optical properties.

Ultrasonographic Volumetric Assessment of Achilles Tendons in Unilateral Congenital Clubfoot in Lagos, Nigeria.

PURPOSE: To assess cases of unilateral congenital talipes equinovarus (CTEV) and compare both Achilles tendons using [MSK USS]. METHODS: Twenty-two patients (44 feet) with unilateral CTEV presenting at the clubfoot clinic who met the inclusion criteria were recruited for the study. Biographic data was collected from the patients and both Achilles tendons scanned using high frequency ultrasound scan probe. The length, width, thickness were measured and area of the tendons estimated. RESULTS: The median age of the patients was 32.5days with a male to female ratio of 1.2:1. The right foot was involved in 15 patients while the left was affected in 7 cases giving a ratio 2.1:1. The Achilles tendons in Clubfeet with mean length of 2.44(±0.3) cm were consistently longer than in the normal feet with mean length of 2.25(±0.3) cm. The width, thickness and area of the Achilles tendons in normal feet with mean values of 0.52(±0.01) cm, 0.22(±0.03) cm and 0.030(±0.01) cm2 respectively were consistently more than in clubfeet with mean values of 0.43(±0.1) cm, 0.20(±0.03) cm and 0.020(±0.01) cm2 respectively. The disparity in length between the normal and clubfeet when compared with the Pirani scores of the affected feet revealed no statistically significant difference. This was also noted when the disparity in width, thickness and area of Achilles tendons were similarly compared with Pirani scores. CONCLUSION: The Achilles tendon of unilateral CTEV is longer but thinner and narrower than in the contralateral normal foot. The disparity in sizes of the tendon has no significant correlation with severity of the clubfeet.

Hibiscus sabdariffa renews pancreatic ß-cells in experimental type 1 diabetic model rats.

This study evaluated the antidiabetic potentials of flavonoid-rich aqueous fraction of methanolic extract of Hibiscus sabdariffa calyx (HSCE) on the pancreatic ß-cells of experimental type I diabetic model rats. Type 1 diabetes mellitus was induced in Wistar rats by a single intraperitoneal injection of 80mg/kg b/w streptozotocin (STZ) dissolved in 0.1M citrate buffer (pH 6.3). The rats were divided into five groups (n=12) including normal control group, test group I, diabetic negative control, test group II, and diabetic positive control. The test groups received 1.75g/kg b/w of HSCE by gavage for 15 days. Animals were sacrificed; the splenic portion of their pancreas and serum were evaluated for histopathological and biochemical parameters respectively. The regenerative effects of the extract on STZ-diabetes ß-cells damage was evident from the results of the histopathological analysis and the biochemical parameters evaluated in the serum. Reduced levels of glutathione, catalase and superoxide dismutase in the serum of diabetic rats were significantly improved in the H. sabdariffa-treated rats (P<0.05). Histological examination of pancreatic islet sections revealed degenerative and necrotic changes (D) in the pancreatic islet of Langerhans, ß-cell degranulation, pyknotic ß-cell nuclei, decreased islet cellular density, and severe vacuolation (V) in the islet of STZ-diabetic negative control group. The morphology of the pancreas of HSCE-treated diabetic rats (test group II) revealed remarkable improvements in the islet of Langerhans. Stereological studies also revealed that HSCE-treatment remarkably improved volume of the pancreatic islets and the numerical density of ß-cell (number of ß-cells per unit area of islet) depleted by STZ diabetes. The study concluded that possible antidiabetic mechanism of Hibiscus sabdariffa in STZ diabetes is through induction of ß-cell regeneration and its strong antioxidant potential.

Observations on the Mechanochemical Insertion of Zinc(II), Copper(II), Magnesium(II), and Select Other Metal(II) Ions into Porphyrins.

Building on a proof of concept study that showed the possibility of the mechanochemical insertion of some M(II) metals into meso-tetraphenylporphyrin using a ball mill as an alternative to traditional solution-based methods, we present here a detailed study of the influence of the many experimental variables on the reaction outcome performed in a planetary mill. Using primarily the mechanochemical zinc, copper, and magnesium insertion reactions, the scope and limits of the type of porphyrins (electron-rich or electron-poor meso-tetraarylporphyrins, synthetic or naturally occurring octaalkylporphyrins, and meso-triphenylcorrole) and metal ion sources suitable for this metal insertion modality were determined. We demonstrate the influence of the experimental metal insertion parameters, such as ball mill speed and reaction time, and investigated the often surprising roles of a variety of grinding agents. Also, the mechanochemical reaction conditions that remove zinc from a zinc porphyrin complex or exchange it for copper were studied. Using some standardized conditions, we also screened the feasibility of a number of other metal(II) insertion reactions (VO, Ni, Fe, Co, Ag, Cd, Pd, Pt, Pb). The underlying factors determining the rates of the insertion reactions were found to be complex and not always readily predictable. Some findings of fundamental significance for the mechanistic understanding of the mechanochemical insertion of metal ions into porphyrins are highlighted. Particularly the mechanochemical insertion of Mg(II) is a mild alternative to established solution methods. The work provides a baseline from which the practitioner may start to evaluate the mechanochemical metal insertion into porphyrins using a planetary ball mill.

Impact of Sleep Quality on the Health-Related Quality of Life of Patients with Chronic Obstructive Pulmonary Disease.

BACKGROUND: Impaired sleep is reportedly common in chronic obstructive pulmonary disease (COPD) and the impact of quality of sleep on health-related quality of life (HRQL) has been documented. Although factors affecting HRQL have been investigated in various studies, the impact of sleep quality on HRQL has not been previously investigated among patients with COPD in Nigeria. The purpose of this study was to determine the contribution of sleep quality as a factor affecting HRQL. We hypothesized that sleep quality is a determinant of HRQL. METHODOLOGY: Sixty patients with COPD were evaluated. HRQL was assessed using COPD Assessment Test (CAT). Subjective sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). Lung function was assessed by spirometry, severity of dyspnea by the Modified Medical Research Council (MMRC) scale, and functional exercise capacity by the Six-Minute Walk Test (6MWT). In all the statistical tests, a p value of <0.05 was considered significant. RESULTS: The mean age of the study population was 70±8years. Forty-nine patients (81.7%) had poor quality of sleep (PSQI > 5). The mean CAT score of the study population was 19.40±7.5. Bivariate correlation shows that HRQL reduces with worsening sleep quality (r=0.705, p=<0.001). HRQL was also associated with COPD severity (P = 0.001), severity of dyspnea, exercise capacity and frequency of exacerbation (P = <0.001). Multiple regression analysis showed that quality of sleep was the best independent predictor of HRQL in our patients (p= <0.001). CONCLUSION: Results from this study suggest that health status is generally poor in patients with COPD and quality of sleep is a significant determinant of their HRQL.

Flexible fiberoptic bronchoscopy in respiratory care: Diagnostic yield, complications, and challenges in a Nigerian Tertiary Center.

INTRODUCTION: Flexible fiberoptic bronchoscopy (FOB) is a key diagnostic and therapeutic procedure in pulmonology. Experience with fiberoptic bronchoscopy is scanty in most developing countries. OBJECTIVES: The goal of this study was to report our experience and clinical utility of fiberoptic bronchoscopy. METHODS: A review of bronchoscopy requests, services, and reports performed over a 5-year period was performed. Demographic characteristics were extracted. Indications for the procedures, type of bronchoscopic sampling done, final diagnosis, and complications were reported. Sensitivities, specificities, and overall diagnostic yield of the procedures were determined. RESULTS: About 163 diagnostic bronchoscopies were performed during the study. Ninety-nine patients with complete data were analyzed. Mean age was 54.8 ± 19.2 years, with males constituting the majority, 56.6%. Suspected bronchial cancer and pleural effusion were the main indications for bronchoscopy (33% and 19.1%, respectively). A total of 80, 39, and 99 bronchial washings, brushings, and bronchial biopsies were performed, respectively. Bronchial cancer was confirmed in 51.5% and was diagnostic in 57% of suspected pleural effusion. Pulmonary tuberculosis was confirmed in 50% of suspected cases and additional 8 cases were diagnosed. The overall diagnostic yield of bronchoscopy was 62%. Specificities of bronchial brushing and washing cytology for excluding bronchial cancer were 90.9 and 83%, respectively, and sensitivities of detecting bronchial cancer were 64.3% and 59%, respectively, P< 0.05 each. Serious complication occurred in about 1%. There was no mortality. CONCLUSIONS: These results show that FOB is a useful and safe procedure with a low complication rate in our setting.

Heavy metal burdens of public primary school children related to playground soils and classroom dusts in Ibadan North-West local government area, Nigeria.

Information about heavy metal burden of children in Nigeria related to playground soils and classroom dusts is lacking. Playground soil, classroom dust, blood and spot urine samples (n=253) were collected from 6 urban and 2 semi-rural public schools in Ibadan North-West, Nigeria. Samples were analysed for Pb, Cu, Zn, Fe and Mn. Mean blood Pb levels in urban area (male, 41.66±8.78µg/dl vs. female, 40.64±5.46µg/dl) were twice as high as those in semi-rural area (male, 19.71±3.73µg/dl vs. female, 20.65±2.26µg/dl). Concentrations of Pb, Cu, Zn, and Fe in soil and dust samples in the urban schools were between 2- to 4-fold greater than that of semi-rural schools. No correlation was observed between blood and dust metals. A positive correlation (r=0.168, p=0.008) was observed between blood Pb and playground soil Pb. Pb burden in the children might be from their schools' playgrounds and other yet unidentified sources.

EXPERIENCE WITH MANAGING COMPLICATED FRACTURES USING ILIZAROV PRINCIPLE IN LAGOS, NIGERIA.

BACKGROUND: Management of complicated bone fractures in our environment is very challenging. The Ilizarov principle has been found to be a viable management option worldwide, but the use of this method in our environment has been sparsely reported. AIM: To document our use of Ilizarov method to manage patients with complicated long bone fractures and the outcome. DESIGN OF STUDY: Prospective observational study. SETTING: Lagos State University Teaching Hospital, Ikeja, Nigeria. METHODOLOGY: All the patients were treated between June 2009 and December 2012 using the Linear Rail-fixator System (LRS) according to Ilizarov principle. They were followed up for at least two years and data on demography, indications, procedure and outcome were collected and subjected to statistical analysis. RESULTS: Thirty patients whose procedures had been concluded were recruited. The age range was 4 - 57 years with a mean of 38 years ; 17 were male while 13 were female with a male/female ratio of 1.3:1. Specific indications for treatment included infected non-union, failed implant with limb length discrepancy and mal-union. They all had bone defects ranging from 4cm to 12cm and the pre-operative period of morbidity ranged from 2 months to 8 years. Seventeen patients had acute docking and lengthening, 10 had bone transport while 3 had simple limb lengthening. Using the Association for the Study and Application of the Method of Ilizarov (ASAMI) criteria, bone outcome was excellent in 7 patients, good in 20 and poor in 3. Functional outcome was excellent in 8, good in 19 and poor in 3. Complications included pin site infection (grades I & II) in 14 patients, knee stiffness in 6 and regenerate fracture in 1. CONCLUSION: Ilizarov surgery is a good method of limb reconstruction in our environment. Our major complications are the high rate of pin site infection and knee stiffness. Good pin site care and early physiotherapy is essential.

Ultrastructural and immunohistochemical effects of aqueous leave extract of Xylopia aethiopica on the stomach in streptozotocin-induced diabetic rats / Efectos ultraestructurales e inmunohistoquímicos del extracto acuoso de la hoja Xylopia aethiopica en el estómago de ratas diabéticas inducidas por estreptozotocina

Gastrointestinal pathology in diabetic patients has become a source of concern in recent times. The aim of this study was to investigate the ultrastructural and immunohistochemical effects of aqueous leaf extract of Xylopia aethiopica on the stomach in streptozotocin-induced diabetic rats. This study was conducted using thirty adult Wistar rats. The animals were divided into three groups (n= 10). Group A was the control animals (administered with equivalent volume of citrate buffer), group B was diabetic animals induced by a single intraperitoneal injection of streptozotocin dissolved in citrate buffer (65 mg/kg) and group C was diabetic animals treated with 200 mg/kg body weight of aqueous leave extract of X. aethiopica for twenty five days. At the expiration of the study, all the animals in each of the groups were sacrificed and the stomach excised and fixed in both 10 % formol and karnovsky fixatives immunohistochemical, light microscopic and electron microscopic studies respectively. The results showed a gradual decline (P<0.05) in the blood glucose level in the extract treated group as against the increment in untreated diabetic group. There was a distortion of the glandular mucosa and epithelium in the untreated diabetic group vis-à-vis the extract treated and control groups. The immunohistochemical staining and percentage immunoreactivity of the stomach of untreated diabetic group showed that the immunoexpression of H+/K+-ATPase were sparse and significantly (p<0.000) lower compared with the control group. There was a better staining pattern for H+/K+-ATPase gastric proton pump in the group treated with aqueous leaf extract of X. aethiopica as compared with the untreated diabetic group. The ultrastructural studies of untreated diabetic group revealed a reduction in the density of mitochondria as compared with the control group. Treatment with leaf extract of X. aethiopica increased the mitochondrial density as well as uniform dispersal of chromatin. It is concluded that diabetes causes gastric pathology thus resulting in morphological changes in the gastric histo-architecture and parietal cells. The aqueous leaf extract of X. aethiopica enhances the recovery/restoration of these defects in streptozotocin induced diabetic rats and as such, may play a significant role in the management of complications associated with diabetes mellitus.

La enfermedad gastrointestinal en pacientes diabéticos se ha convertido en una fuente de preocupación en los últimos tiempos. El objetivo fue investigar los efectos ultraestructurales e inmunohistoquímicos de extracto acuoso de la hoja de Xylopia aethiopica en el estómago de ratas con diabetes inducida por estreptozotocina. Se utilizaron 30 ratas Wistar adultas, divididas en tres grupos (n= 10). El Grupo A, control (se le administró un volumen equivalente de tampón de citrato); el Grupo B, animales diabéticos inducidos por una sola inyección intraperitoneal de estreptozotocina disuelta en tampón de citrato (65 mg/kg) y el Grupo C, animales diabéticos con 200 mg/kg peso corporal tratados con extracto acuoso de X. aethiopica durante 25 d. Luego, todos los animales fueron sacrificados, se les extirpó el estómago y fijó en formol al 10 % y en fijador Karnovsky para anticuerpos monoclonales contra la bomba de protones gátrica H+/K+-ATPasa; las muestras se observaron mediante microscopías óptica y electrónica. Los resultados mostraron una disminución gradual (P<0,05) en el nivel de glucosa en sangre del grupo tratado con el extracto, contra un incremento en el grupo diabético no tratado. Hubo una distorsión de la mucosa glandular y el epitelio en el grupo diabético no tratado vis-à-vis los grupos tratados con extracto y el de control. La tinción inmunohistoquímica del estómago del grupo diabético no tratado, mostró escasas células parietales inmunorreactivas en el grupo diabético no tratado comparado con el grupo control. Hubo un mejor patrón de tinción en la bomba de protones gátrica H+/K+-ATPasa en el grupo tratado con el extracto de hoja acuosa de X. aethiopica, en comparación con el grupo diabético no tratado. Los estudios ultraestructurales del grupo diabético no tratado revelaron una reducción en la densidad de las mitocondrias en comparación con el grupo control. El tratamiento con extracto de hoja de X. aethiopica aumentó la densidad mitocondrial, así como la dispersión uniforme de la cromatina. Se concluye que la diabetes causa una enfermedad gástrica que genera cambios morfológicos en la histoarquitectura de las células parietales gástricas. El extracto de hoja acuosa de X. aethiopica mejora la recuperación/restauración de estos defectos en ratas diabéticas inducidas por estreptozotocina y, como tal, puede jugar un rol significativo en el tratamiento de las complicaciones asociadas con la diabetes mellitus.

Haemodynamic Changes during Awake Fibreoptic Bronchoscopy in Nigeria.

INTRODUCTION: There are no reports on haemodynamic changes on West African patients undergoing fibreoptic bronchoscopy (FOB). The aim of this study was to document these changes in West African patients undergoing awake FOB. MATERIALS AND METHODS: All consenting patients considered for awake FOB had their pulse rates, blood pressures and oxygen saturations documented at various phases of FOB, during procedures and up to 30 minutes after FOB to monitor any changes from pre-procedure levels. The values were analysed using SPSS version 16. RESULTS: One hundred and sixty FOB were performed on 145 patients. In non- sedated patients, the maximum oxygen saturation fall was 6% at the level of the vocal cord while the pulse rate rose as high as 13% at the carina. Bronchial washings exerted the most changes in sedated patients (SPO2 fell by 4.9%, and pulse rate rose by 11.9%). The mean arterial pressure increased occurred during bronchial washing for both groups (18.7% for non-sedated and 15.7% for sedated patients) CONCLUSION: Tachycardia, elevations in blood pressure and hypoxaemia are more pronounced and occur earlier during FOB in non-sedated patients. Traversing the vocal cords and bronchial washing evoke the most cardivascular changes during FOB.

Histological studies on the retina and cerebellum of Wistar rats treated with ArteetherTM

Introduction: Arteether TM, a derivative of artemisinin, is among the recent drugs that have given renewed hope for combating malarial menace. The present study investigated the effects of arteetherTM on the histology of the retina and cerebellum of Wistar rats. Materials and Methods: Twenty adult albino Wistar rats weighing 150-200 g, were randomly divided into four groups (A, B, C and D) of five animals each and used for this study. Group A rats were given intramuscular (i.m.) arteetherTM (3 mg/kg b.w.) daily for 3 days. Group B rats were given i.m. arteetherTM (6 mg/kg b.w.) daily for 3 days. Group C rats were also given i. m. of arteetherTM (3 mg/kg b. w.) daily for 3 days, and the same dose was repeated at two-weekly intervals for 4 further weeks; while Group D rats which received normal saline (0.9 % w/v, 3 ml/kg b.w.), served as controls. At the end of the experiment, the rats were sacrificed by cervical dislocation. The retina and cerebellum were excised and processed routinely for histopathology changes, using haematoxylin and eosin stain (H & E), as well as Nissl stain. Results: Results obtained showed normal cellular components of the retina and cerebellum in all groups, and no cyto-pathological changes were observed. Conclusion: Thus, this study showed that under light microscopic examination, therapeutic doses of arteetherTM caused no significant cyto-pathologic changes in the retina and cerebellum of Wistar rats.(AU)