Targeting Apoptosis Signal-Regulating Kinase-1 (ASK-1) As a Biomarker of Monocrotaline-Induced Pulmonary Hypertension following Administration of Antiretroviral Medications in Rat Model.

BACKGROUND: Apoptosis resistance is a recognized pathogenetic mechanism in pulmonary hypertension. However, the link between apoptosis signal-regulating kinase-1 (ASK-1) and pulmonary hypertension (PH) is unclear. This study was conducted to elucidate ASK-1 as a potential biomarker in PH. The study aimed to identify the role of ASK-1 in the mechanism of monocrotaline-induced PH in rats. METHODS: Forty adult male Sprague-Dawley rats (body weight: 200-250 g) were randomly divided into five groups (n=8 per group). The four treatment groups received a single intraperitoneal injection of monocrotaline (MCT) at a dose of 60 mg. kg-1 while the control group received an equivalent volume of intraperitoneal saline injection. Zidovudine (100mg. kg-1), ritonavir (30mg. kg-1), or combination of both drugs (zidovudine 100mg. kg-1 and ritonavir 30mg. kg-1) were administrated daily for the study period of 28 days to the rats in three of the four treatment groups with MCT for 28 days. On the twenty-eighth day of the study, rats were sacrificed, and organ harvested with the heart analyzed using RT-PCR for ASK-1. Antioxidant enzyme activities were determined using the colorimetric method. RESULTS: Animal survival rate was one hundred percent in the treated and control groups while the untreated group recorded 62% survival rate. There was significantly lower mRNA gene expression of ASK-1 in the heart tissues of the treated rats with zidovudine (2.67 ± 0.09, p < 0.0001), ritonavir (2.57 ±0.11, p < 0.0001) and a combination of both (2.75 ± 0.06, p < 0.0001) when compared to rats in the untreated group. An overexpressed mRNA gene of ASK-1 in the untreated rats was observed (12.0 ± 0.90, p < 0.0001) when compared to the controls. CONCLUSION: ASK-1 is a veritable biomarker for anti-apoptotic characteristics of PH. Our findings will spur new investigations on the role of ASK-1 in PH and the potential therapeutic benefits of antiretroviral medications in the prevention of PH. CONTEXTE: La résistance à l'apoptose est une pathogénétique reconnue mécanisme dans l'hypertension pulmonaire. Cependant, le lien entrekinase-1 régulatrice du signal d'apoptose (ASK-1) et pulmonaire l'hypertension (HTP) n'est pas claire. La présente étude a été menée pour :élucider ASK-1 comme biomarqueur potentiel de l'HTP. L'étude visait à :identifier le rôle de l'ASK-1 dans le mécanisme induit par la monocrotalinePH chez le rat. MÉTHODES: Quarante rats Sprague-Dawley mâles adultes (poids corporel:200 à 250 g) ont été divisés au hasard en cinq groupes (n = 8 par groupe).Les quatre groupes de traitement ont reçu une seule injection intrapéritonéalede monocrotaline (TCM) à une dose de 60 mg. kg­1 pendant que le témoina reçu un volume équivalent d'injection intrapéritonéale de solution saline.Zidovudine (100 mg kg­1), ritonavir (30 mg kg­1) ou combinaison deles deux médicaments (zidovudine 100 mg. Kg­1 et ritonavir 30 mg. kg­1) étaient administré quotidiennement pendant la période d'étude de 28 jours aux rats dans trois des quatre groupes de traitement avec MCT pendant 28 jours. Sur levingt-huitième jour de l'étude, des rats ont été sacrifiés et des organesrécolté avec le cœur analysé à l'aide de rt-PCR pour ASK-1. Les activités enzymatiques antioxydantes ont été déterminées à l'aide de la colorimétrieméthode. RÉSULTATS: Le taux de survie des animaux était de cent pour cent dans les groupes traités et témoins tandis que le groupe non traité a enregistré 62 %taux de survie. L'expression des gènes de l'ARNm était significativement plus faible d'ASK-1 dans les tissus cardiaques des rats traités par la zidovudine (2.67 ± 0.09, p < 0.0001), ritonavir (2.57 ±0.11, p < 0.0001) et acombinaison des deux (2.75 ± 0.06, p < 0.0001) par rapport aux rats dans le groupe non traité. Un gène d'ARNm surexprimé d'ASK-1 dans les rats non traités ont été observés (12.0 ± 0.90, p < 0.0001) lorsque par rapport aux contrôles. CONCLUSION: ASK-1 est un véritable biomarqueur antiapoptotique caractéristiques du pH. Nos conclusions donneront lieu à de nouvelles enquêtes sur le rôle de l'ASK-1 dans l'HTP et les avantages thérapeutiques potentiels demédicaments antirétroviraux dans la prévention de l'HTP. Mots-clés: Hypertension pulmonaire, régulation du signal d'apoptosekinase 1 (ASK-1), zidovudine, ritonavir, VIH/SIDA.

Increased Risk of Migraine among Students with Asthma: Results of Headache and Asthma Study among University Students.

BACKGROUND: Several studies in developed countries have investigated the relationship between migraine and asthma. OBJECTIVE: To examine the relationship between asthma and migraine among university students in a low middle-income country. METHODS: We conducted a cross-sectional study across three universities in the middle belt region of Nigeria. A self-administered questionnaire developed from the International Classification of Headache Disorders was used to screen for migraine. The European Community Respiratory Health Survey (ECRHS) survey tool screened for asthma and its related conditions. Migraine was diagnosed in subjects with recurrent, moderate to severe unilateral throbbing headaches associated with nausea, vomiting, or visual disturbances. Asthma was defined as reporting a previous asthma attack or currently taking asthma medication within the preceding 12 months. RESULTS: The frequency of asthma was significantly higher among those with migraine than those without migraine (28.6% vs. 9.0%). Conversely, migraine was significantly prevalent in participants with asthma (7.1%vs. 1.9%). On multivariate analysis, there were significant associations between migraine and asthma [aOR = 2.56 (95% CI 1.15-5.77)]. Other factors associated with migraine were female gender [aOR = 2.22 (95% CI 1.06-4.65)] and family history of recurrent headache in firstdegree relatives [aOR = 4.03 (95% CI 1.15-5.77)]. CONCLUSION: Our study shows an increased frequency and risk of migraine in participants diagnosed with asthma and vice versa. These results support the bidirectional association between migraine and asthma. Physicians, therefore, should be aware of the possibility of migraine in patients with asthma who complain of headaches.

CONTEXTE: Plusieurs études menées dans des pays développésvont étudié la relation entre la migraine et l'asthme. OBJECTIF: Examiner la relation entre l'asthme et la migraine chez les étudiants universitaires d'un pays à faible revenu intermédiaire. MÉTHODES: Nous avons mené une étude transversale à travers trois universités dans la région de la ceinture centrale du Nigéria. Un questionnaire auto-administré élaboré à partir de la Classification internationale des troubles de la céphalée a été utilisé pour dépister la migraine. L'enquête de la Communauté européenne sur la santé respiratoire (ECRHS) outil d'enquête dépisté pour l'asthme et ses affections connexes. La migraine a été diagnostiquée chez des sujets présentant des maux de tête lancinants unilatéraux récurrents, modérés à sévères associés à des nausées, des vomissements ou des troubles visuels. L'asthme était défini comme la déclaration d'une crise d'asthme antérieure ou en cours de prise médicaments contre l'asthme au cours des 12 mois précédents. RÉSULTATS: La fréquence de l'asthme était significativement plus élevée chez les personnes souffrant de migraine que chez celles sans migraine (28,6% vs 9,0%). Inversement, la migraine était significativement répandue chez participants asthmatiques (7,1 % contre 1,9 %). Sur l'analyse multivariée, il y avait des associations significatives entre la migraine et l'asthme [aOR = 2,56 (IC à 95 % 1,15-5,77)]. Autres facteurs associés à la migraine étaient le sexe féminin [aOR = 2,22 (95 %IC 1,06­4,65)] et antécédents familiaux de maux de tête récurrents chez les parents de premier degré [RA = 4,03 (IC à 95 % 1,15-5,77)]. CONCLUSION: Notre étude montre une augmentation de la fréquence etrisque de migraine chez les participants ayant reçu un diagnostic d'asthme et de viceVersa. Ces résultats soutiennent l'association bidirectionnelle entre migraine et asthme. Les médecins devraient donc: être conscient de la possibilité de migraine chez les patients asthmatiques qui se plaignent de maux de tête. Mots-clés: Migraine, Maux de tête, Asthme, Allergie, Association, Relation.

Preparedness and Perception on Virtual Learning during the COVID-19 Pandemic amongst Students of the Ekiti State University, Nigeria.

BACKGROUND: The advent of COVID-19 pandemic affected education which necessitated rapid adjustments and reorganizations in the approach to learning. This study examined undergraduate students' perception on the pandemic and its effect on medical education. METHODS AND MATERIALS: A cross-sectional online questionnaire-based survey of students in the College of Medicine, Ekiti State University, Ado-Ekiti, Nigeria. A google form, free open-source software survey tool, was used to collect data on different domains like socio-demographic characteristics, preparedness and disposition to virtual learning in pandemic, risk perception, and knowledge on COVID-19. RESULTS: A total of 568 participants took the survey with 311 (54.8%) females and a median age of 20 (IQR: 18-22) years. Four hundred and eighty-two (84.9%) of the students had regular access to the Internet, 57 (10%) have occasional access while 29 (5.1%) had no access. Three hundred and fifteen (56%) of the students agreed that their digital and online skills will be better after the pandemic. All the students were aware of the pandemic however, 441 (77.6%) students were aware of the pandemic through the social media, 79 (13.9%) through television and newspapers and 32(5.6%) through family and friends while only 4 (0.7%) became aware of the pandemic through healthcare workers. The median risk perception score for COVID-19 was 24 (IQR: 19-29). CONCLUSION: The study participants were ill-disposed to virtual learning recommended during the pandemics and had a low-risk perception of COVID-19. Hence, there is an urgent need for continuous education on the benefits of virtual learning beyond the COVID-19 pandemics and the need to adopt proactive measures in anticipation of future outbreaks of other infectious diseases.

CONTEXTE: L'avènement de la pandémie de COVID-19 a été affecté l'éducation qui nécessitait des ajustements rapides et réorganisations de l'approche de l'apprentissage. Cette étude a examiné la perception des étudiants de premier cycle sur la pandémie et ses effets sur l'éducation médicale. MÉTHODES ET MATÉRIAUX: Une coupe transversale en ligne enquête par questionnaire auprès des étudiants du Collège des Médecine, Université d'État d'Ekiti, Ado-Ekiti, Nigéria. Un googleform, outil d'enquête gratuit en logiciel open source, a été utilisé pour collecter données sur différents domaines comme la sociodémographique caractéristiques, préparation et disposition à l'apprentissage virtuel dans la pandémie, la perception des risques et les connaissances sur la COVID-19. RÉSULTATS: Un total de 568 participants ont répondu à l'enquête avec 311(54,8 %) femmes et âge médian de 20 ans (IQR : 18-22 ans). Quatre cent quatre-vingt-deux (84,9 %) des élèves avaient desaccès à Internet, 57 (10 %) y ont accès occasionnellement alors qu'ils29 (5,1%) n'y avaient pas accès. Trois cent quinze (56 %) des étudiants ont convenu que leurs compétences numériques et en ligne seront mieux après la pandémie. Tous les étudiants étaient au courant de la pandemie toutefois, 441 (77,6 %) élèves étaient au courant de la pandémie par les médias sociaux, 79 (13,9 %) par l'intermédiaire de la télévision et les journaux et 32 (5,6 %) par l'entremise de la famille et amis alors que seulement 4 (0,7 %) ont pris conscience de la pandémiempar l'intermédiaire des travailleurs de la santé. Le score médian de perception du risque pour la COVID-19 était de 24 (IQR: 19-29). CONCLUSION: Les participants à l'étude étaient mal disposés à apprentissage virtuel recommandé pendant les pandémies et a eu un perception à faible risque de la COVID-19. Par conséquent, il y a une urgencebesoin de formation continue sur les avantages de l'apprentissage virtuel au-delà des pandémies de COVID-19 et de la nécessité d'adopter des mesures proactives en prévision de futures flambées d'autres maladies infectieuses. Mots-clés: COVID-19, préparation, étudiants, apprentissage virtuel, perception, Nigéria.

Physical and socioeconomic impact of asthma in Nigeria: Experience of patients attending three tertiary hospitals.

BACKGROUND: Understanding the impact of asthma is the key to optimal care. OBJECTIVE: To determine the physical, economic, and social impact of asthma from the perspectives of individual patients in Nigeria. METHODS: This was a multicenter study of 172 adult asthma patients attending tertiary hospitals. We assessed the different impact of asthma in the preceding 12 months using a questionnaire. Physical impact (such as daily activity/chores, sport/exercise, and sleep quality), social impact (such as job loss, mental anguish, employer, and peers discrimination) and economic impact (like savings, indebtedness, mortgage/asset, and school or work absence). RESULTS: The physical, social and economic impacts were perceived by 59.3%, 47.7%, and 51.2% of patients, respectively. The physical impacts were poor sleep (44.2%), limitation of daily activity/chores (38.4%), and sporting/exercise (39.5%). The economic impacts were reduced savings (38.4%) and indebtedness (17.4%). Absence from school and work were respectively reported by 75% of students and 38.3% of workers. Socially, 34.9% reported mental torture, 10.5% changed job, 4.7% experienced discrimination and 3.5% lost their jobs due to asthma. Asthma-related emergency department visit was 42% and hospitalization was 32.6%. The physical impact was associated with non-adherence to ICS and persistent asthma symptoms. Economic impact was associated with asthma hospitalization, work absenteeism, comorbidity, and National Health Insurance (NHIS) coverage. Male sex and lack of post-secondary education were associated with social impact. CONCLUSION: Asthma causes broad and substantial physical and socioeconomic impacts in our sample of patients. Exploring these impacts and engaging the patient is imperative for holistic management and good health outcomes.

Factors affecting interest in respiratory medicine as a subspecialty of choice: survey of internal medicine residents in Nigeria.

AIMS AND OBJECTIVES: The objective of this study was to determine the factors that affect the interest in respiratory medicine (RM) as a subspecialty of choice among internal medicine residents in Nigeria. SUBJECTS, MATERIALS AND METHODS: This was a cross-sectional study of 136 internal medicine residents recruited from seven teaching hospitals from January 2011 to June 2011. A semi-structured questionnaire that was self administered by residents was used to obtain socio-demographic information and factors affecting residents' interest in respiratory medicine. RESULTS: Out of 136 residents that completed the study, 78 (57.4 %) were junior residents (PG year 1-3) and 58(42.6%) were senior residents (PG year >3). Thirty four (43.6%) junior residents and 21(36.2%) senior residents considered respiratory medicine as a sub-specialty of choice. Only 2(3.5%) of the senior residents were presently committed to RM. In the junior residents, interest in respiratory medicine was correlated with personal intelligence and ability (RR=2.58, ;95% confidence interval(CI): 1.16-7.07, p-0.01) , availability of respiratory physician (RR=2.42; 95% CI 1.07-7.63 ,p-0.02) and postgraduate examiners in RM in training institutions RR= (2.20; 95% CI 1.06-5.45,p-0.03), experience during rotation in medical school and residency (RR=2.11 ; 95% CI 1.11-4.21,p-0.03) and future annual income (RR=2.04;C:I1.03-4.68,p-0.04). In the senior residents, interest in RM was correlated with the availability of postgraduate examiners in RM in training institutions (RR- 6.36; 95% CI 1.16-66.80, P-<0.01), future opportunity for scholarships and travel grants (RR- 4.23; 95% CI 1.19-25.92,p-< 0.01), personal intelligence and ability (RR= 3.41; 95% CI.16-13.87,p-0.01) and prospect for rapid elevation in career (RR=2.92; 95% CI 1.03-11.91,p -0.04). Provisions of modern facilities in training institutions, mentoring by senior colleagues and promotion of subspecialty by respiratory physicians were rated by the senior residents as the most important ways of increasing interest in respiratory medicine and making it a specialty of choice. CONCLUSION: The interest in respiratory medicine among internal medicine residents is low and decline as their level of training advances. The factors affecting the interest in respiratory medicine have been highlighted and the policy makers need to understand, and if possible modify these factors by formulating appropriate changes to our training programs so as to increase future numbers of respiratory physician.