The Effect of Music on Operative Anxiety markers in patients undergoing Cataract Surgery: Adual centre cross-sectional comparative study.

OBJECTIVE: To determine the effect of intraoperative music on various markers of anxiety among adult patients undergoing small incision cataract surgery. METHODS: This was a hospital-based, age-sex matched, comparative cross-sectional study of consenting 144 adult participants aged 46 years and above with operable, age-related cataracts undergoing small incision cataract surgery under local anaesthesia in two ophthalmic centres. All participants were allotted into two equal groups consisting of 72 participants in the experimental group (exposed to music of their choice) and 72 participants in the control group (no music exposure). Blood pressure, pulse rate and salivary cortisol assay levels were measured. Data obtained were analyzed using statistical package for social sciences (IBM SPSS version 23.0). RESULTS: One hundred and forty-four participants with total male-to-female ratio of 1:2.1 were studied. Gender ratio was 1:2.3 and 1:2.0 and the median age (Q1-Q3) of 65.00 (55.5-71.5) years and 65.50 (56.5-72.0) years for music and non-music groups respectively. Participants in the music group showed a statistically significant reduction in systolic blood pressure, diastolic blood pressure and pulse rate (p < 0.05) except at baseline. The mean value salivary cortisol level showed a statistically significant decrease in both groups from baseline for music (23.91ng/ml) and nonmusic (19.12ng/ml) group (p<0.001) respectively. Similarly, participants in the music group showed a statistically significant reduction of Spielberger State anxiety score after music intervention compared to control (p<0.001). CONCLUSIONS: This study demonstrated the effectiveness of music in decreasing anxiety indicators during cataract surgery with markers like salivary cortisol assay, pulse rate, systolic and diastolic blood pressure.

OBJECTIF: Déterminer l'effet de la musique intra-opératoire sur divers marqueurs d'anxiété chez les patients adultes subissant une chirurgie de la cataracte par petite incision. MÉTHODES: Il s'agissait d'une étude transversale comparative, basée à l'hôpital, appariée selon l'âge et le sexe, portant sur 144 participants adultes consentants âgés de 46 ans et plus, présentant des cataractes liées à l'âge opérables et subissant une chirurgie de la cataracte par petite incision sous anesthésie locale dans deux centres ophtalmologiques. Tous les participants ont été répartis en deux groupes égaux, soit 72 participants dans le groupe expérimental (exposé à de la musique de leur choix) et 72 participants dans le groupe témoin (pas d'exposition à la musique). La pression artérielle, la fréquence cardiaque et les taux de cortisol salivaire ont été mesurés. Les données obtenues ont été analysées à l'aid du logiciel statistique pour les sciences sociales (IBM SPSS version 23.0). RÉSULTATS: Cent quarante-quatre participants avec un rapport total d'hommes à femmes de 1:2,1 ont été étudiés. Le ratio hommes-femmes était de 1:2,3 et 1:2,0, avec un âge médian (Q1-Q3) de 65,00 (55,5-71,5) ans et 65,50 (56,5-72,0) ans pour les groupes musique et non-musique, respectivement. Les participants du groupe musique ont montré une réduction statistiquement significative de la pression artérielle systolique, de la pression artérielle diastolique et de la fréquence cardiaque (p < 0,05) sauf au départ. La valeur moyenne du taux de cortisol salivaire a montré une diminution statistiquement significative dans les deux groupes par rapport au départ pour le groupe musique (23,91 ng/ml) et le groupe non-musique (19,12 ng/ml) (p <0,001) respectivement. De même, les participants du groupe musique ont montré une réduction statistiquement significative du score d'anxiété à l'état de Spielberger après l'intervention musicale par rapport au groupe témoin (p <0,001). CONCLUSIONS: Cette étude a démontré l'efficacité de la musique dans la diminution des indicateurs d'anxiété pendant la chirurgie de la cataracte, avec des marqueurs tels que le dosage du cortisol salivaire, la fréquence cardiaque, la pression artérielle systolique et diastolique. Mots-clés: Musique binaurale, peur, anxiété, stress, chirurgie de la cataracte par petite incision, anxiolytique non pharmacologique.

Old unreduced elbow dislocation: Patients' perspectives on outcome of open reduction.

INTRODUCTION: Old unreduced elbow dislocation is not uncommon in developing countries. Many authors have reported outcome of open reduction in the management of this problem. However, we did not find any study that document patient reported outcome. OBJECTIVE: the objective of this study was to determine the patients' perspectives of outcome of open reduction in the management of old unreduced elbow dislocation. METHODS: This was a prospective interventional study of 49 consecutive patients with old unreduced simple elbow dislocation who were treated with open reduction at the National Orthopaedic Hospital, Dala - Kano, Nigeria and Albarka Clinic Kano, Nigeria between January 2015 and December 2019. RESULTS: Fourty nine patients were studied with median age of 31.0 years (range: 19-60 years). The majority of the patients were within 31-40 years age group. The male to female ratio was 6:1. Using the Mayor Elbow Performance Scale (MEPS) and Patients specific Functional scale (PSFS); there are significant improvements in postoperative functional capability of the patients (P = 0.000). With the short assessment for patient satisfaction (SAPS), 93.3% of patients were either satisfied or very satisfied with the outcome of open reduction. CONCLUSION: The outcome of open reduction for old unreduced elbow dislocation is good and is well accepted by the patients.

Implementation of multidrug-resistant tuberculosis (MDR-TB) treatment in Gabon: lessons learnt from the field.

PURPOSE: Since May 2016, WHO recommended a 9-12 month short-treatment regimen for multidrug-resistant tuberculosis (MDR-TB) treatment known as the 'Bangladesh Regimen'. However, limited data exist on the appropriateness thereof, and its implementation in low- and middle-income countries (LMIC). We report here on the pilot phase of the evaluation of the Bangladesh regimen in Gabon, prior to its endorsement by the WHO. METHODS: This ongoing observational study started in September 2015. Intensive training of hospital health workers as well as community information and education were conducted. GeneXpert-confirmed MDR-TB patients received the second-line anti-tuberculosis drugs (4KmMfxPtoHCfzEZ/5MfxCfzEZ). Sputum smears and cultures were done monthly. Adverse events were monitored daily. RESULTS: Eleven patients have been treated for MDR-TB piloting the short regimen. All were HIV-negative and presented in poor health with extensive pulmonary lesions. The overall sputum culture conversion rate was 64% after 4 months of treatment. Three patients developed marked hearing loss; one a transient cutaneous rash. Of 11 patients in our continuous care, 7 (63.6%) significantly improved clinically and bacteriologically. One (9.1%) patient experienced a treatment failure, two (18.2%) died, and one (9.1%) was lost to follow up. CONCLUSIONS: Our pioneering data on systematic MDR-TB treatment in Gabon, with currently almost total absence of resistance against the second-line drugs, demonstrate that a 9-month regimen has the capacity to facilitate early culture negativity and sustained clinical improvement. Close adverse events monitoring and continuous care are vital to success.

Low incidence of the immune reconstitution inflammatory syndrome among HIV-infected patients starting antiretroviral therapy in Gabon: a prospective cohort study.

There is a paucity of data on the immune reconstitution inflammatory syndrome (IRIS) in the Central African region. We followed ART-naive HIV-infected patients initiating antiretroviral therapy in an HIV clinic in Gabon, for 6 months. Among 101 patients, IRIS was diagnosed in five. All IRIS cases were mucocutaneous manifestations. There were no cases of tuberculosis (TB) IRIS, but active TB (n = 20) was associated with developing other forms of IRIS (p = 0.02). Six patients died. The incidence of IRIS is low in Gabon, with mild, mucocutaneous manifestations.

Genetic damage induced by electronic waste leachates and contaminated underground water in two prokaryotic systems.

The inappropriate and unsafe management practices related to disposal and recycling of electronic wastes in Nigeria has led to environmental and underground water contamination. Reports on the level and type of contamination as well as the possible DNA damage effects of this contamination are insufficient. This study evaluated the DNA damaging potential of e-waste simulated and raw leachates, and its contaminated underground water using the SOS chromotest on Escherichia coli PQ37 and the Ames Salmonella fluctuation test on Salmonella typhimurium strains TA98 and TA100, without and with metabolic activation. Physico-chemical parameters of the samples were also analyzed. The result of the Ames test showed induction of base pair substitution and frameshift mutation by the test samples. However, the TA100 was the more responsive strain for the three samples in terms of mutagenic index in the absence and presence of metabolic activation. The SOS chromotest results were in agreement with those of the Ames Salmonella fluctuation test. Nevertheless, the E. coli PQ37 system was slightly more sensitive than the Salmonella assay for detecting genotoxins in the tested samples. Lead, cadmium, manganese, copper, nickel, chromium, arsenic, and zinc contents analyzed in the samples were believed to play a significant role in the observed DNA damage in the microbial assays. The results of this study showed that e-waste simulated and raw leachates, and its contaminated underground water are of potential mutagenic and genotoxic risks to the exposed human populace.

Molecular epidemiology of Staphylococcus aureus from Lambaréné, Gabon.

While there is an abundance of data on the epidemiology and molecular typing of Staphylococcus aureus, especially those carrying Panton-Valentine leucocidin (PVL) genes or mecA from Western Europe, Northern America and Australia, comparably few studies target African strains. In this study, we characterised genes associated with virulence and resistance, as well the phylogenetic background of S. aureus from healthy carriers and outpatients in Gabon. In total, 103 isolates from 96 study participants were characterised. Seventy-nine isolates originated from throat swabs and 24 isolates from skin lesions. Three isolates carried mecA, although only one, belonging to CC8-MRSA-IV [PVL+] 'USA300', was found to be phenotypically oxacillin-resistant; two CC88-MRSA-IV isolates appeared to be oxacillin-susceptible. PVL genes were common, with a total of 44 isolates (43 %) found to be PVL-positive. CC15-MSSA [PVL+] (n = 29) and CC152-MSSA [PVL+] (n = 9) were the predominant clones among the PVL-positive isolates. Among PVL-negative isolates, CC5-MSSA (n = 12), CC101-MSSA (n = 10) and CC15 (n = 9) were the most frequent. A hitherto undescribed multilocus sequence type of S. schweitzeri was detected twice in unrelated patients. The data emphasise a need for further studies on the role of PVL in African populations and the clinical significance of S. schweitzeri.

Mutagenicity of automobile workshop soil leachate and tobacco industry wastewater using the Ames Salmonella fluctuation and the SOS chromotests.

Environmental management of industrial solid wastes and wastewater is an important economic and environmental health problem globally. This study evaluated the mutagenic potential of automobile workshop soil-simulated leachate and tobacco wastewater using the SOS chromotest on Escherichia coli PQ37 and the Ames Salmonella fluctuation test on Salmonella typhimurium strains TA98 and TA100 without metabolic activation. Physicochemical parameters of the samples were also analyzed. The result of the Ames test showed mutagenicity of the test samples. However, the TA100 was the more responsive strain for both the simulated leachate and tobacco wastewater in terms of mutagenic index in the absence of metabolic activation. The SOS chromotest results were in agreement with those of the Ames Salmonella fluctuation test. Nevertheless, the E. coli PQ37 system was slightly more sensitive than the Salmonella assay for detecting genotoxins in the tested samples. Iron, cadmium, manganese, copper, nickel, chromium, arsenic, zinc, and lead contents analyzed in the samples were believed to play significant role in the observed mutagenicity in the microbial assays. The results of this study showed that the simulated leachate and tobacco wastewater showed strong indication of a genotoxic risk. Further studies would be required in the analytical field in order to identify and quantify other compounds not analyzed for in this study, some of which could be responsible for the observed genotoxicity. This will be necessary in order to identify the sources of toxicants and thus to take preventive and/or curative measures to limit the toxicity of these types of wastes.

Pattern of prostate cancer among a Nigerian population: A study in a single tertiary care centre.

Background: Prostate cancer has become a global health challenge because of its rising morbidity and mortality in males. It is the second cause of cancer death following lung cancer in men. It is rare under the age of 40 and its incidence has been shown to increase exponentially with age. Previously, Prostate cancer was thought to be a disease rare in blacks owing to the fact that not so much was known of the disease. Aims and Objectives: The objective of the study was to review the prevalence, pattern of presentation and clinic-pathologic findings of prostate cancer in the Department of Radiotherapy, Lagos University Teaching Hospital (LUTH), between January 2001 to December 2010 in comparison to previous and recent studies globally. Methodology: Data collection for all patients histologically diagnosed with Prostate cancer at the Department of Radiotherapy, LUTH, from 1st of January 2001 to 31st of December 2010 was done. Results: A total of 144 cases with histologically confirmed Prostate cancer seen during the ten year study were analysed. The highest frequency was seen in the year 2010 with 34 cases. The age range was 41 to 81years with a mean of 66.19 ±7.30years.Adenocarcinoma was the commonest histological type with 98.6%.9(6.3%) patients had a positive family history of prostate cancer out of which 3(33.3%) had their brother affected the malignancy. 51(35.4%) patients presented with stage IV disease.18(12.5%) patients had a Gleason's score of 6,10(6.9%) patients had a Gleason's score of 7 and 2(1.4%) patients had a Gleason's score of 10. The most common presenting complaints were bone pains seen in 51(35.4%) patients, frequent night urine and difficulty with micturition seen in 50(34.7%) and 42(29.2%) patients respectively. Conclusion: This study showed that prostate cancer is not as rare as it used to be. Reasons attributed to its rarity then were lack of awareness, poor screening facilities and poor diagnosing technique.

Nucleus drop during small incision cataract surgery: A report of four cases.

Small incision cataract surgery (SICS) offers the benefits of a phacoemulsification (phaco) surgery without the attendant high cost, but it is not without certain risk such as nucleus drop into the vitreous as seen in phaco. A retrospective study of SICS and associated factors leading to nucleus drop during surgery, challenges of management and the visual outcomes. Of 793 eye surgeries performed during the study 586 were SICSs. Nucleus drop during SICS occurred in 0.68% of patients. Can-opener technique of capsulotomy, use of dispersive viscoelastic, diabetes mellitus, lack of anterior vitrectomy machine and poor access to immediate posterior vitrectomy were important problems in the management of the cases of nucleus drop in this study. The visual outcomes were poor in all the cases of nucleus drop. Careful patient selection for SICS and the use of continuous curvilinear capsulorhexis are advocated. An interior vitrectomy machine should be available to all cataract surgeons. It is good professional practice to be acquainted with the available vitreo-retina surgeons for urgent assistance in cases of nucleus drop.

Methicillin-resistant Staphylococcus aureus as a cause of invasive infections in Central Africa: a case report and review of the literature.

INTRODUCTION: Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) colonization and infection are increasingly being reported worldwide and are associated with severe illness. The vast majority of MRSA infections are skin and soft tissue infections, while invasive disease remains rare. In Western countries, the epidemiology of MRSA is well documented, but from Central Africa, reports on MRSA are very limited. METHODS: Case presentation and review of the literature. The clinical features, epidemiology, and characteristics of MRSA in Central Africa, as well as the treatment options, are discussed. We present a case of severe invasive CA-MRSA infection with pneumonia, pericarditis, and bacteremia in a previously healthy young woman in Gabon. Several virulence factors, like Panton-Valentine leukocidin and type I arginine catabolic mobile element, may play a role in the ability of CA-MRSA to cause severe invasive infections. Based on studies from Gabon and Cameroon (no reports were available from other countries), we find that the prevalence of MRSA is relatively low in this region. Treatment depends primarily on local prevalence and resistance profile of MRSA combined with clinical characteristics. CONCLUSION: Severe invasive infection with CA-MRSA is a rare disease presentation in Central Africa, where this pathogen is still relatively uncommon. However, cases of MRSA may be complicated by the human immunodeficiency virus (HIV) and tuberculosis epidemics, and also the limited availability of effective antibiotics.

Clonal structure of Staphylococcus aureus colonizing children with sickle cell anaemia and healthy controls.

Children with sickle cell anaemia (SCA) might carry hospital-associated bacterial lineages due to frequent hospital stays and antibiotic treatments. In this study we compared Staphylococcus aureus from SCA patients (n=73) and healthy children (n=143) in a cross-sectional study in Gabon. S. aureus carriage did not differ between children with SCA (n=34, 46∙6%) and controls matched for age, residence and sex (n=67, 46∙9%). Both groups shared similar S. aureus genotypes. This finding points towards a transmission of S. aureus between both groups in the community. We conclude that resistance rates from population-based studies with healthy participants could therefore also be used to guide treatment and prophylaxis of endogenous infections in children with SCA despite a different selection pressure.

Minimally invasive video-assisted parathyroidectomy is a safe procedure to treat primary hyperparathyroidism.

INTRODUCTION: Cervical exploration to identify the four parathyroid glands was considered to be the gold standard for management of primary hyperparathyroidism. In recent years, advances in preoperative localizing techniques have led to the use of more targeted, minimally invasive procedures to remove parathyroid glands. We present our series of patients who underwent Minimally Invasive Video-Assisted Parathyroidectomy (MIVAP) procedures and our results in treating primary hyperparathyroidism. METHODS: Patients who underwent video-assisted parathyroidectomy were identified from a prospectively maintained database. Clinico-pathological data including indications for surgery, complications, conversion to open procedure and success of surgery were obtained from clinical notes. RESULTS: A total of 56 patients underwent MIVAP between 2002 and 2010 at a district general hospital setup. The clinical indication was diagnosed primary hyperparathyroidism. Preoperative localization was attempted in all patients by sestamibi and high resolution ultrasound scans. The median age of patients was 65 years (32-82) and the median operating time was 78 min (20-168). Conversion to open procedure was done in 8/56 (14%) cases. The reason for conversion was failed exploration in 5 patients, inability to retrieve a very large friable adenoma in one patient, lipo-adenoma in one patient and very small parathyroid adenoma in one patient. Postoperative complications happened in one patient (2%) who developed postoperative sepsis resulting in temporary recurrent laryngeal nerve (RLN) palsy. All but 5 patients became normo-calcaemic following surgery. CONCLUSION: MIVAP is a safe and effective procedure for treating patients with primary hyperparathyroidism. It also allows classical 4 gland exploration, whenever necessary.

Mesh fixation techniques for inguinal hernia repair: an overview of systematic reviews of randomised controlled trials.

PURPOSE: Inguinal hernia repair using surgical mesh is a very common surgical operation. Currently, there is no consensus on the best technique for mesh fixation. We conducted an overview of existing systematic reviews (SRs) of randomised controlled trials to compare the risk of chronic pain and recurrence following open and laparoscopic inguinal hernia repairs using various mesh fixation techniques. METHODS: We searched major electronic databases in April 2020 and assessed the methodological quality of identified reviews using the AMSTAR-2 tool. RESULTS: We identified 20 SRs of variable quality assessing suture, self-gripping, glue, and mechanical fixation. Across reviews, the risk of chronic pain after open mesh repair was lower with glue fixation than with suture and comparable between self-gripping and suture. Incidence of chronic pain was lower with glue fixation than with mechanical fixation in laparoscopic repairs. There were no significant differences in recurrence rates between fixation techniques in open and laparoscopic mesh repairs, although fewer recurrences were reported with suture. Many reviews reported wide confidence intervals around summary estimates. Despite no clear evidence of differences among techniques, two network meta-analyses (one assessing open repairs and one laparoscopic repairs) ranked glue fixation as the best treatment for reducing pain and suture for reducing the risk of recurrence. CONCLUSION: Glue fixation may be effective in reducing the incidence of chronic pain without increasing the risk of recurrence. Future research should consider both the effectiveness and cost-effectiveness of fixation techniques alongside the type of mesh and the size and location of the hernia defect.

Non-communicable disease co-morbidity and associated factors in tuberculosis patients: A cross-sectional study in Gabon.

BACKGROUND: There are only limited data from resource-limited settings available on the prevalence of non-communicable diseases and associated risk factors of tuberculosis patients. This study investigated non-communicable disease co-morbidity in tuberculosis patients from Moyen Ogooué Province, Gabon. METHODS: All patients aged 18 years or older consulting for tuberculosis (TB) symptoms in Gabon's Moyen Ogooué province and neighbouring provinces from November 2018 to November 2020 were screened for diabetes mellitus, hypertension, and risk factors thereof (obesity, dyslipidaemia, smoking and alcohol consumption). Logistic regression was performed to identify factors associated with TB-diabetes and TB-hypertension co-morbidities. FINDINGS: Of 583 patients included, 227 (39%) were diagnosed with tuberculosis. In tuberculosis-confirmed patients, the prevalences of hypertension and diabetes were 16·3% and 12·8%, respectively. The prevalence of diabetes was twice as high in tuberculosis patients compared to non-tuberculosis patients. Factors independently associated with hypertension-tuberculosis co-morbidity were age >55 years (aOR=8·5, 95% CI 2·43, 32·6), age 45-54 years (aOR=4.9, 95%CI 1.3-19.8), and moderate alcohol consumption (aOR=2·4; 95% CI 1·02- 5·9), respectively. For diabetes-tuberculosis co-morbidity, age >55 years was positively (aOR=9·13; 95% CI 2·4-39·15), and moderate alcohol consumption inversely associated (aOR=0·26, 95% CI 0·08- 0·73). One-hundred-and-four (46%) of the tuberculosis patients had at least either dyslipidaemia, hypertension, diabetes, or obesity with a majority of newly-diagnosed hypertension and diabetes. INTERPRETATION: Integration of screening of non-communicable diseases and their risk factors during TB assessment for early diagnosis, treatment initiation and chronic care management for better health outcomes should be implemented in all tuberculosis healthcare facilities. FUNDING: This study was supported by WHO AFRO/TDR/EDCTP (2019/893,805) and Deutsches Zentrum für Infektiologie (DZIF/ TTU 02.812).

Datura stramonium abrogates depression- and anxiety-like disorders in mice: possible involvement of monoaminergic pathways in its antidepressant activity.

OBJECTIVES: Ethno-botanical surveys uncovered the use of Datura stramonium in the management of mental health abnormalities. Antidepressant- and anxiolytic-like activities of hydroethanol leaf extract of D. stramonium (HLDS) in mice and its possible mechanism of action were investigated in this study. METHODS: The hole-board test (HBT), open field test (OFT), elevated plus maze test (EPMT), and social interaction test (SIT) were used to investigate the anxiolytic-like activity while forced swim test (FST) and tail suspension test (TST) were employed for the antidepressant effect. Mice were pre-treated orally with purified water (10 mL/kg), bromazepam (1 mg/kg), fluoxetine (20 mg/kg) and D. stramonium (25, 50, 100 and 200 mg/kg). One hour post-treatment, mice were subjected to the various tests. RESULTS: In HBT, D. stramonium increased the head dips and sectional crossings turnover. D. stramonium increased the number of square crossed and rearings/assisted rearings in OFT. DS increased the time spent in open arms of EPM. In SIT, D. stramonium increased the frequency/duration of interactions. In FST and TST, D. stramonium decreased the duration of immobility which were reversed by doxazosin (α1 adrenoceptor antagonist) and ondasentron (5-HT3 receptor antagonist). CONCLUSIONS: HLDS has anxiolytic- and antidepressant-like activities through modulation of serotoninergic and adrenergic neurotransmissions.

Nutritional status of semi-urban Nigerian school children using the 2007 WHO reference population.

BACKGROUND: There is paucity of data on the nutritional status of school-age children in Sagamu town of Southwestern Nigeria. OBJECTIVE: To determine the nutritional status of primary school children in Sagamu Local Government Area, Nigeria. METHODS: A cross-sectional survey of primary school children aged 6 to 10 years in Sagamu, Southwestern Nigeria was done. Eight schools were selected using a multi-stage sampling technique. Children randomly selected proportionately from the schools were studied. The weight-for-age, height-for-age and BMI of these children were compared with the 2007 WHO reference values to diagnose underweight (WA <-2SD), stunting (HA <-2SD), thinness (BMI <-2SD), overweight (BMI > +1SD) and obesity (BMI > +2SD). RESULTS: A total of 1016 children comprising 479 (47.1%) boys and 537 (52.9%) girls were studied. The prevalence of malnutrition was 401(39.4%) and boys were more malnourished compared to girls (p =0.002). The overall prevalences of underweight, stunting and thinness were 260(25.5%), 144(14.2%) and 226(22.2%) respectively. Overweight and obesity were present in 31(3.0%) and 5(0.5%) of the population studied respectively. Boys were significantly more often underweight and stunted. CONCLUSION: The prevalence of under-nutrition among school children in Sagamu, Nigeria was high and the girls were generally better nourished than the boys. Efforts to reduce the burden of malnutrition in this population may include nutritional surveillance, food supplementation and free school meals.

Literacy, education and adherence to antiretroviral therapy in The Gambia.

We examined the relationship of patients' literacy and education to antiretroviral therapy (ART) adherence in an urban treatment centre in The Gambia. Information on education and literacy systematically collected before ART initiation was compared against selected adherence outcomes. Formally educated patients were significantly more likely to achieve virological suppression at both six and 12 months (87% vs. 67%, OR=3.13, P=0.03; 88% vs. 63%, OR=4.49, P=0.007, respectively). Literate patients had similar benefit at 12 months (OR=3.39 P=0.03), with improved virological outcomes associated with degree of literacy (P=0.003). A trend towards similar results was seen at 6 months for Koranically educated patients; however, this was no longer apparent at 12 months. No significant correlation was seen between socio-demographic characteristics and missed appointments. Our study suggests that literacy, formal education and possibly Koranic education may impact favourably on adherence to ART.

Genotoxicity assessment of a pharmaceutical effluent using four bioassays.

Pharmaceutical industries are among the major contributors to industrial waste. Their effluents when wrongly handled and disposed of endanger both human and environmental health. In this study, we investigated the potential genotoxicity of a pharmaceutical effluent, by using the Allium cepa, mouse- sperm morphology, bone marrow chromosome aberration (CA) and micronucleus (MN) assays. Some of the physico-chemical properties of the effluent were also determined. The A. cepa and the animal assays were respectively carried out at concentrations of 0.5, 1, 2.5, 5 and 10%; and 1, 5, 10, 25 and 50% of the effluent. There was a statistically different (p < 0.05), concentration-dependent inhibition of onion root growth and mitotic index, and induction of chromosomal aberrations in the onion and mouse CA test. Assessment of sperm shape showed that the fraction of the sperm that was abnormal in shape was significantly (p < 0.05) greater than the negative control value. MN analysis showed a dose-dependent induction of micronucleated polychromatic erythrocytes across the treatment groups. These observations were provoked by the toxic and genotoxic constituents present in test samples. The tested pharmaceutical effluent is a potentially genotoxic agent and germ cell mutagen, and may induce adverse health effects in exposed individuals.

Transanal endoscopic microsurgery in early rectal cancer: time for a trial?

OBJECTIVE: The optimal aim of oncological surgery is to balance cancer outcomes with preservation of function and quality of life. Radical resection (RR) offers the best curative procedure in colorectal cancer but at significant morbidity. Transanal endoscopic microsurgery (TEM) offers an alternative with less morbidity and better function. Its role remains unclear and needs to be established in the light of new emerging trends in rectal cancer. This review aims to evaluate the use of TEM and its limitations. METHOD: PubMed and MEDLINE search was performed. RESULTS: Strongest level of evidence (Level II) favoured TEM over RR and laparoscopic resection in term of mortality and morbidity. There was no difference in recurrence at follow-up of 41 and 56 months but neither study was adequately powered to detect a difference in recurrence/survival. Three retrospective case comparisons (Level III) also favoured TEM over RR but were subject to selection bias. Twenty eight published case series (Level IV) reported varying results due to different cancer stages, study population, full excision, adjuvant therapy and treatment indication. The oncological outcomes in TEM are similar to RR in highly selected cases but with far less mortality (near 0%), morbidity, blood loss, hospital stay and genitourinary/gastrointestinal dysfunction. TEM alone (+/- adjuvant therapy) appears sufficient for 'favourable' T1 tumours. 'Unfavourable' T1 or T2 tumours require adjuvant treatment. TEM should only be used for palliation in T3+ cancers. Seven functional studies reported significant transient dysfunction following TEM with full clinical recovery within a year. TEM is cost-effective providing sufficient cases are performed. CONCLUSION: Significant heterogeneity limits conclusions from current literature. A trial is required. Alternate end-points to local recurrence may be required in assessing the optimal surgical approach, which balances disease control with quality of life, and probability of noncancer related death.

Effects of Unripe Musa Paradisiaca on the Histochemistry of the Testis and Testosterone Levels in Adult Albino Rats.

This study was aimed at determining the effects of the unripe fruit of Musa paradisiaca on the testis andtestosterone levels in male Wistar rats. The animals were grouped into three, comprising a control, and 2 treatment groupsadministered with different doses (500 mg/kg and 1000 mg/kg) daily of the fruit flour over 28 days. Histochemical evaluationof the testes was done using Haematoxylin and Eosin, Periodic acid Schiff's (PAS) and Feulgen staining techniques, whilethe serum and homogenised testicular tissue were evaluated for testosterone levels using Accu-Bind ELISA Kit. The testisof the treated groups showed more rapidly dividing cells and more population of sperm cells compared to the control group,and also showed more positivity for Feulgen staining and PAS reaction. Both serum and testicular testosterone levels werehowever reduced. Serum testosterone was significantly lowered in the animals given the low dose (0.67 ± 0.03 ng/ml),compared to those given high dose (0.85 ± 0.02 ng/ml) and the control animals (1.88 ± 0.15 ng/ml) (p < 0.05). Changes intesticular testosterone were not statistically significant. The study suggests that M. paradisiaca fruit has reproductiveenhancing potential when consumed moderately, but this benefit may not be related to testosterone levels.