Educational Interventions for Antibiotics Misuse and Self-Medication in Africa: A Systematic Review and Meta-Analysis [Protocol].

BACKGROUND: Antibiotics misuse and self-medication remains one of the most serious public health challenges globally. Persistent rise in resistant bacterial infections has been attributed to high prevalence of antibiotics misuse and self-medication. Large volume of literature has emerged describing studies that evaluate the effectiveness of various types and combinations of educational and behavior-modification techniques to reduce antibiotics misuse and self-medication. No previous systemic review has attempted to assess the quality of evidence in public domains on educational strategies aiming to reduce prevalence and improve knowledge, attitude and practice on antibiotics misuse and self-medication in Africa. This study, therefore, intends to assess the quality of evidence presented and determine the effectiveness of health education as an intervention tool for reducing prevalence and improving knowledge and attitude on antibiotics misuse and self-medication among adults in Africa. METHODS: This study will include published papers on effectiveness of health education in reducing antibiotics misuse and self-medication from 2011-2021. Systematic search for literature will be conducted according to the Preferred Reporting Item for Systematic Reviews and Meat-analysis (PRISMA) guidelines to identify published studies based on our predetermined inclusion and exclusion criteria in PubMed, EMBASE, PsychINFO, CINAHL and Web of Sciences. Two independent reviewers will assess all identified studies and another set of reviewers will extract data for analysis and evidence synthesis.

CONTEXTE: Le mauvais usage des antibiotiques et l'automédication restent l'un des plus graves problèmes de santé publique dans le monde. L'augmentation persistante des infections bactériennes résistantes a été attribuée à la prévalence élevée de l'abus d'antibiotiques et de l'automédication. Un grand nombre de publications décrivent des études qui évaluent l'efficacité de divers types et combinaisons de techniques d'éducation et de modification du comportement pour réduire l'abus d'antibiotiques et l'automédication. Aucun examen systémique antérieur n'a tenté d'évaluer la qualité des preuves dans les domaines publics sur les stratégies éducatives visant à réduire la prévalence et à améliorer les connaissances, l'attitude et la pratique sur le mauvais usage des antibiotiques et l'automédication en Afrique. Cette étude a donc pour but d'évaluer la qualité des preuves présentées et de déterminer l'efficacité de l'éducation à la santé comme outil d'intervention pour réduire la prévalence et améliorer les connaissances et l'attitude sur le mauvais usage des antibiotiques et l'automédication chez les adultes en Afrique. MÉTHODES: Cette étude comprendra les articles publiés sur l'efficacité de l'éducation sanitaire dans la réduction de la mauvaise utilisation des antibiotiques et de l'automédication entre 2011 et 2021. Une recherche systématique de la littérature sera effectuée conformément aux directives PRISMA (Preferred Reporting Item for Systematic Reviews and Meat-analysis) afin d'identifier les études publiées en fonction de nos critères d'inclusion et d'exclusion prédéterminés dans PubMed, EMBASE, PsychINFO, CINAHL et Web of Sciences. Deux examinateurs indépendants évalueront toutes les études identifiées et un autre groupe d'examinateurs extraira les données pour l'analyse et la synthèse des preuves. Mots clés: Education à la santé, Mauvaise utilisation des antibiotiques, Automédication, Examen systématique et méta-analyse, Systématique et méta-analyse.

Bilateral absence: A rare anomaly of the gemelli muscles.

The superior and inferior gemelli are deep muscles of the gluteal region, that facilitate the maintenance of a dynamic stability of the hip joint. Their absence could increase the chances of failure in the management of total hip anthroplasty and column acetabular ring fractures. We present a case of an adult female cadaver, with bilateral absence of the superior and inferior gemelli muscles.

Effect of the COVID-19 pandemic on blood donations and transfusions in Nigeria - A multi-facility study of 34 tertiary hospitals.

Background: The coronavirus disease 2019 (COVID-19) pandemic affected blood supplies globally. Mobile blood drive campaigns halted, and voluntary blood donations reduced, challenging available blood supplies. Furthermore, fears of virus transmission led to deferrals of elective surgeries and non-urgent clinical procedures with noticeable declines in blood donations and transfusions. Aims: We aimed to assess the effect of the COVID-19 pandemic on the number of blood donations and transfusions across the country by blood product type across various hospital departments. Materials and Methods: A retrospective descriptive study was conducted to determine the impact of the COVID-19 pandemic on blood services in 34 tertiary hospitals in Nigeria, comparing January to July 2019 (pre-COVID-19) to January to July 2020 (peri-COVID-19). Data were collected from the country's web-based software District Health Information System, Version 2 (DHIS2). Results: A 17.1% decline in numbers of blood donations was observed over the study period, especially in April 2020 (44.3%), a 21.7% decline in numbers of blood transfusions, especially in April 2020 (44.3%). The largest declines in transfusion were noted in surgery department for fresh frozen plasma (80.1%) [p = 0.012] and accident and emergency department transfusion of platelets (78.3%) [p = 0.005]. The least decline of statistical significance was observed in internal medicine transfusions of whole blood (19.6%) [p = 0.011]. Conclusions: The COVID-19 pandemic significantly affected the numbers of blood donations and transfusions in Nigeria. Strengthening blood services to provide various blood components and secure safe blood supplies during public health emergencies is therefore critical.

Performance of cowpea as influenced by native strain of rhizobia, lime and phosphorus in Samaru, Nigeria.

The complimentary effects of a native rhizobia strain (SAMFIX 286), lime and single superphosphate (SSP) as components of ISFM were evaluated on the biomass, nodulation and N2 fixation of cowpea (Vigna unguiculata L.). Lime was applied at the rate of 250 kg (Ca(OH)2) ha-1, while SSP was applied at 30 kg P ha-1. The trial was carried out in a screen house with the treatments arranged in randomized complete block design. Results obtained show that the performance of SAMFIX 286 inoculated plants did not significantly (p < 0.05) differ from that of the un-inoculated treatment. Application of lime significantly increased root dry weight, shoot dry weight, nodule number and dry weight by 42.5%, 35.3%, 65.6% and 50%, respectively. Nodulation was significantly (p < 0.05) increased by SSP. The complimentary effect of lime with SSP significantly increased total shoot N concentration. Similarly, combined inoculation of SAMFIX 286 with lime and SSP increased N concentration by 31.9% and N derived from atmosphere (Ndfa) by 16.3% compared to the un-inoculated treatment. Inoculation of SAMFIX 286 with SSP was also effective on Ndfa by cowpea. It was concluded that lime and SSP were good combination with native rhizobia strain in improving cowpea nodulation and biological N2 fixation.

Antibacterial activity of Syzygium aromaticum seed: Studies on oxidative stress biomarkers and membrane permeability.

Oxidative stress and membrane permeability as mode of antibacterial activity of aqueous extract of Syzygium aromaticum seeds against Escherichia coli, Pseudomonas aeruginosa and Staphylococcus aureus was investigated. The concentration of phytochemical constituents of Syzygium aromaticum was determined using gas chromatography. Syzygium aromaticum seeds contain eugenol acetate > ß-carophyllene > eugenin > eugenol > methyl salicylate > ß-humulene > rhamnatin > fernesol > α-copeane > ß-ylangene > kaempferol > cinnamic acid > oleanolic acid > benzaldehyde > α-humulene > vanillin > α-cubebene > carvicol > benzoic acid. Syzygium aromaticum showed antimicrobial activity with minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) values as 0.06 and 0.10 mg/mL respectively. Time kill susceptibility by Syzygium aromaticum at MBC values showed significant decrease in the optical density and colony-forming unit (CFU) of Escherichia coli, Pseudomonas aeruginosa and Staphylococcus aureus. Superoxide anion radical content of the bacterial cells increased significantly following exposure to the extract. In a similar vein, superoxide dismutase and catalase activities increased significantly, while the level of reduced glutathione reduced, malondialdehyde increased significantly in bacterial cells exposed to the extract. The extract at MBC also enhanced the leakage of 260 nm absorbing materials and outer membrane permeability. It is evident from the data generated from this study that aqueous extract of Syzygium aromaticum seeds enhanced membrane permeability and oxidative stress in Escherichia coli, Pseudomonas aeruginosa and Staphylococcus aureus.

Involvement of oxidative stress in bactericidal activity of 2-(2-nitrovinyl) furan against Escherichia coli, Pseudomonas aeruginosa and Staphylococcus aureus.

The involvement of reactive oxygen species and oxidative stress in 2-(2-nitrovinyl) furan mediated bacterial cell death was investigated in Escherichia coli, Pseudomonas aeruginosa and Staphylococcus aureus. Time kill assay resulted in significant decrease in the optical density and colony-forming unit (CFU) of E. coli, P. aeruginosa and S. aureus. The level of superoxide anion radical and nitric oxide increased significantly in concentration dependent when compared with dimethyl sulfoxide (DMSO) treated bacteria. Similar concentration dependent increase in the activity of superoxide dismutase and catalase were recorded. The non-enzymatic antioxidant glutathione decreased significantly with a concomitant increase in glutathione disulfide. The level of malondialdehyde and fragmented DNA increased significantly in the bacterial cells treated with 2-(2-nitrovinyl) furan when compared with DMSO treated cells. The CFU of E. coli, P. aeruginosa and S. aureus following exposure to 2-(2-nitrovinyl) furan increased significantly (p < 0.05) in the presence of 2,2' bipyridyl, an Fe chelator, significantly when compared with only 2-(2-nitrovinyl) furan suggesting the involvement of hydroxyl radical in the cell death. The available data from this study showed that 2-(2-nitrovinyl) furan induced oxidative stress in E. coli, P. aeruginosa and S. aureus as evident from elevated levels of superoxide anion radical nitric oxides and antioxidant enzymes.

A Pathophysiological Insight into Sepsis and Its Correlation with Postmortem Diagnosis.

BACKGROUND: Sepsis is among the leading causes of death worldwide and is the focus of a great deal of attention from policymakers and caregivers. However, sepsis poses significant challenges from a clinical point of view regarding its early detection and the best organization of sepsis care. Furthermore, we do not yet have reliable tools for measuring the incidence of sepsis. Methods based on analyses of insurance claims are unreliable, and postmortem diagnosis is still challenging since autopsy findings are often nonspecific. AIM: The objective of this review is to assess the state of our knowledge of the molecular and biohumoral mechanisms of sepsis and to correlate them with our postmortem diagnosis ability. CONCLUSION: The diagnosis of sepsis-related deaths is an illustrative example of the reciprocal value of autopsy both for clinicians and for pathologists. A complete methodological approach, integrating clinical data by means of autopsy and histological and laboratory findings aiming to identify and demonstrate the host response to infectious insults, is mandatory to illuminate the exact cause of death. This would help clinicians to compare pre- and postmortem findings and to reliably measure the incidence of sepsis.

Erasmus syndrome in a marble worker.

Erasmus syndrome is defined as the association of silica exposure and subsequent development of systemic sclerosis. The limited number of cases reported in the literature mainly involves miners and only sporadically other professionals. We describe a case of Erasmus syndrome in a marble worker. A 68 year old man came to our observation complaining pelvic and scapular girdle pain, evening fever, intense weakness and emaciation for about 1 month. He also reported to have had Raynaud's phenomenon in his hands for the last 13 years. Also, his occupational history revealed a chronic exposure to silica dust. The patient presented pain in his shoulders and hips, moderate skin thickening and sclerosis in his hands and fingers extending proximally to his wrists. The diagnosis of systemic sclerosis was determined according to his clinical and medical history, the positivity of anti-Scl 70 antibodies, the nailfold capillaroscopy suggestive of an active scleroderma pattern and the detection of a mild restrictive pulmonary syndrome. The evaluation of the organbased complications excluded a gastroenterological and cardiovascular involvement, while the chest computed tomography (CT) detected multiple small nodules with a mantle distribution and enlarged lymph nodes with no signs of interstitial lung disease and fibrosis. Additional tests (positron emission tomography-CT, flexible bronchoscopy and broncho-alveolar lavage) excluded infectious diseases and cancer. However, given the pulmonary involvement, we performed a histological examination of the parenchyma and lymph nodes, which revealed a picture of pneumoconiosis. In the end, the occupational history and the findings from the diagnostic procedures led to the diagnosis of pulmonary silicosis. The precise definition of the pulmonary involvement was essential to the therapeutic approach to this patient.

Intra-articular therapy with tumor necrosis factor-α antagonists: an update.

The aim of the study was to review from the present literature the intra-articular (IA) use of the TNF-blocking drugs. A total of 28 papers about this topic were found through a search in PubMed; the first publication's date was July 2003. These studies include a total of 214 patients affected by 12 different joint diseases that reported a total of 1046 intra-articular therapies carried out in 10 different joint sites. Infliximab and etanercept were the most widely used medications. The safety of this treatment clearly emerges from our analysis, while more difficult was the evaluation of its efficacy. Nevertheless we deduced an ideal patient profile that may better respond to the IA anti-TNF treatment.

A Deep Learning System to Predict Epithelial Dysplasia in Oral Leukoplakia.

Oral leukoplakia (OL) has an inherent disposition to develop oral cancer. OL with epithelial dysplasia (OED) is significantly likely to undergo malignant transformation; however, routine OED assessment is invasive and challenging. This study investigated whether a deep learning (DL) model can predict dysplasia probability among patients with leukoplakia using oral photographs. In addition, we assessed the performance of the DL model in comparison with clinicians' ratings and in providing decision support on dysplasia assessment. Retrospective images of leukoplakia taken before biopsy/histopathology were obtained to construct the DL model (n = 2,073). OED status following histopathology was used as the gold standard for all images. We first developed, fine-tuned, and internally validated a DL architecture with an EfficientNet-B2 backbone that outputs the predicted probability of OED, OED status, and regions-of-interest heat maps. Then, we tested the performance of the DL model on a temporal cohort before geographical validation. We also assessed the model's performance at external validation with opinions provided by human raters on OED status. Performance evaluation included discrimination, calibration, and potential net benefit. The DL model achieved good Brier scores, areas under the curve, and balanced accuracies of 0.124 (0.079-0.169), 0.882 (0.838-0.926), and 81.8% (76.5-87.1) at testing and 0.146 (0.112-0.18), 0.828 (0.792-0.864), and 76.4% (72.3-80.5) at external validation, respectively. In addition, the model had a higher potential net benefit in selecting patients with OL for biopsy/histopathology during OED assessment than when biopsies were performed for all patients. External validation also showed that the DL model had better accuracy than 92.3% (24/26) of human raters in classifying the OED status of leukoplakia from oral images (balanced accuracy: 54.8%-79.7%). Overall, the photograph-based intelligent model can predict OED probability and status in leukoplakia with good calibration and discrimination, which shows potential for decision support to select patients for biopsy/histopathology, obviate unnecessary biopsy, and assist in patient self-monitoring.

JOB SATISFACTION AND PSYCHOLOGICAL HEALTH OF MEDICAL DOCTORS IN CALABAR, SOUTHERN NIGERIA.

BACKGROUND: Employees should be happy at their work, considering the amount of time they devote to it throughout their working life. There is paucity of data on the job satisfaction and psychological health of medical doctors in Nigeria. OBJECTIVE: To assess the level of job satisfaction and its relationship to psychological health among medical doctors in a southern city of Nigeria. DESIGN: A cross-sectional descriptive survey. SETTING: Three major public hospitals in Calabar, Nigeria. SUBJECTS: Medical doctors who had worked for at least six months in the hospitals. RESULTS: Response rate was 73.0%. More than half (56.7%) of the respondents expressed overall satisfaction with their job. Inadequate pay and work overload were the most commonly mentioned reasons for job dissatisfaction. About a fifth of the respondents were at increased likelihood of psychological disorder. There was a statistically significant negative correlation between job satisfaction scores and GHQ scores. Satisfied respondents were least likely to have psychological disorder. CONCLUSION: Causes of job dissatisfaction among medical doctors should be addressed to improve their psychological health.

Papular-purpuric gloves and socks syndrome due to parvovirus B19: a report of two simultaneous cases in cohabitant families.

The so-called papular-purpuric gloves and socks syndrome (PPGSS) is a condition characterized by acute onset of intense erythema, edema and petechiae with a typical localization on the hands and feet, besides mucosal lesions of the oral cavity. The syndrome has a favorable and self-limited course, requiring only a symptomatic therapy. In the 50% of the cases described in literature (ninety cases in 22 years), is documented an acute infection caused by parvovirus B19 and in only two cases the onset of PPGSS is reported among different members of the same family. The aim of the work is to describe two cases of PPGSS arisen during a short time period in two family members affected by an acute parvovirus B19 infection found by serum sampling. The peculiarity of the study was the infrequence of the syndrome and the rareness of the description of PPGSS in rheumatology. This syndrome is usually described in dermatology, but it is also interesting for the rheumatologist because it comes in differential diagnosis with various autoimmune diseases.

Severity and outcomes of hospitalised community-acquired pneumonia in COPD patients.

Chronic obstructive pulmonary disease (COPD) is a frequent comorbidity in patients with community-acquired pneumonia (CAP). We investigated the impact of COPD on outcomes of CAP patients. We prospectively studied the clinical presentation of 1,379 patients admitted with CAP during a 4-yr period. A comparative analysis of disease severity and course was performed between 212 patients with COPD, as confirmed by spirometry, and 1,167 non-COPD patients. COPD patients (mean forced expiratory volume in 1 s 47.7 ± 16.3% predicted) were older and more likely to have previously received antibiotics (37.1% versus 28.3%; p<0.01) than those without COPD. They presented with more severe respiratory failure (arterial oxygen tension/inspiratory oxygen fraction 270.4 versus 287.8; p<0.01) and more severe pneumonia (pneumonia severity index 118.3 versus 108.5; p<0.001) compared with non-COPD patients. However, COPD patients had less multilobar infiltration (44 (21%) versus 349 (30%); p<0.01) and fewer pulmonary complications (24 (14%) versus 241 (24%); p<0.01). A total of 89 (6.5%) patients died within 30 days. COPD patients had no significant difference in their 30-day mortality rate compared with non-COPD patients (nine (4.2%) patients versus 81 (7%); p = 0.14). Despite worse clinical presentation, COPD patients had a similar mortality rate compared to non-COPD patients. Previous antibiotic treatment and the decreased incidence of pulmonary complications in COPD may account for these findings.

Initial management of pneumonia and sepsis: factors associated with improved outcome.

Processes of care and adherence to guidelines have been associated with improved survival in community-acquired pneumonia (CAP). In sepsis, bundles of processes of care have also increased survival. We aimed to audit compliance with guideline-recommended processes of care and its impact on outcome in hospitalised CAP patients with sepsis. We prospectively studied 4,137 patients hospitalised with CAP in 13 hospitals. The processes of care evaluated were adherence to antibiotic prescription guidelines, first dose within 6 h and oxygen assessment. Outcome measures were mortality and length of stay (LOS). Oxygen assessment was measured in 3,745 (90.5%) patients; 3,024 (73.1%) patients received antibiotics according to guidelines and 3,053 (73.8%) received antibiotics within 6 h. In CAP patients with sepsis, the strongest independent factor for survival was antibiotic adherence (OR 0.4). In severe sepsis, only compliance to antibiotic adherence plus first dose within 6 h was associated with lower mortality (OR 0.60), adjusted for fine prognostic scale and hospital. Antibiotic adherence was related to shorter hospital stay. In sepsis, antibiotic adherence is the strongest protective factor of care associated with survival and LOS. In severe sepsis, combined antibiotic adherence and first dose within 6 h may reduce mortality.

Retrospective analysis of anaesthesia-related deaths during a 12-year period: looking at the data from a forensic point of view.

Anaesthesia-related death is one of the most complex events to be studied in forensic pathology because of its rarity and its doubtful presentation. Particularly, the difficulties in assessing the cause of deaths in such circumstances are underlined. A scale must be considered in order to determine the causal role of anaesthesia in the process leading to death. Indeed, beyond deaths exclusively explained by anaesthetic care, there are deaths that are not anaesthesia-related and deaths explained by surgery and co-morbidities in which the role of anaesthetic care has to be carefully investigated. A retrospective analysis of 3138 autopsies is presented with the aim of better understanding the patho-physiological process of anaesthesia-related mortality and to determine the causal role of anaesthesiological care in the process leading to death, thus assessing the real incidence of deaths due to anaesthesia (0.16%). In the present study, the number of deaths generically anaesthesia-related (33 cases) accounts for 2.06% of autopsies due to medical malpractice claims and 1.05% of all autopsies. The number of deaths totally related to anaesthesic care is rather low with 0.32% of autopsies due to medical malpractice claims and 0.16% of all autopsies. Anaesthesia-related deaths were due to lack of or delay in intubation (2 cases), acute cardio-respiratory failure (2 cases) and anaesthetic-induced hepatotoxicity (1 case). The importance of a careful forensic investigation (clinical and familial history, medical records, complete autopsy and toxicology), which can lead to a clear understanding of anaesthesia-related deaths, is also stressed.

Incidence of influenza-like illness into a cohort of patients affected by chronic inflammatory rheumatism and treated with biological agents.

This study aimed to evaluate the incidence of influenza-like illness (ILI), from October 2009 to May 2010, in a group of patients suffering from chronic inflammatory rheumatism and treated with biological therapies. At the end of 2009-2010 influenza season, 159 patients under biological therapies answered to a questionnaire distributed 8 months before and were deeply interviewed. The group included 69 men and 90 women (mean age 47.6); forty-nine suffering from rheumatoid arthritis, 61 with psoriatic arthritis, 32 with ankylosing spondylitis and 17 with other spondyloarthritis; 146 patients were treated with anti-TNF-α, 7 with rituximab and 6 with abatacept; 128 patients assumed DMARDs and 72 patients assumed low dose of steroids. A case of ILI was identified by anamnestic findings and according to the case definitions commonly used in Europe. Seventeen percent of the considered population reported at least one episode of ILI during the monitoring period; none of the patients during the acute influenza attack suffered particularly severe symptoms and no one was hospitalized due to complications. Despite the diversity among the considered subgroups, the statistical analysis did not show any significant difference when incidence of ILI was considered for different disease, different biological agent and different association therapy. None of the examined variables resulted statistically significant concerning the relative risk evaluation. The incidence of ILI into a cohort of 159 patients treated with biological agents during the influenza season 2009-2010 resulted higher than the value reported in a wide sample of Italian population in the same period. However, the pandemic impact was not heavy among the studied patients, considering that no important complications or hospitalizations have been reported.

Antifungal activity of Andrographis paniculata extracts and active principles against skin pathogenic fungal strains in vitro.

CONTEXT: Andrographis paniculata Nees. (Acanthaceae) is an annual herbaceous plant widely cultivated in southern Asia, China, and Europe. It is used in the treatment of skin infections in India, China, and Malaysia by folk medicine practitioners. OBJECTIVE: Antifungal activity of the whole plant extracts and isolation of active principles from A. paniculata were investigated. MATERIALS AND METHODS: Dichloromethane (DCM) and methanol (MEOH) extracts of A. paniculata whole plant were screened for their antifungal potential using broth microdilution method in vitro against seven pathogenic fungal species responsible for skin infections. Active principles were detected through bioguided assays and isolated using chromatography techniques. Structures of compounds were elucidated through spectroscopy techniques and comparisons were made with previously reported data for similar compounds. RESULTS: DCM extract revealed lowest minimum inhibitory concentration (MIC) value (100 µg/mL) against Microsporum canis, Candida albicans, and Candida tropicalis, whereas MEOH extract revealed lowest MIC (150 µg/mL) against C. tropicalis and Aspergillus niger. DCM extract showed lowest minimum fungicidal concentration (MFC) value (250 µg/mL) against M. canis, C. albicans, C. tropicalis and A. niger, whereas MEOH extract showed lowest MFC (250 µg/mL) against Trichophyton mentagrophytes, Trichophyton rubrum, M. canis, C. albicans, C. tropicalis and A. niger. Bioassay guided isolation from DCM and MEOH extract afforded 3-O-ß-d-glucosyl-14-deoxyandrographiside, 14-deoxyandrographolide, and 14-deoxy-11,12-didehydroandrographolide as antifungal compounds. The lowest MIC (50 µg/mL) and MFC (50 µg/mL) was exerted by 14-deoxyandrographolide on M. canis. DISCUSSION AND CONCLUSION: This is first report on the isolation of antifungal substances through bioassay-guided assay from A. paniculata. Our finding justifies the use of A. paniculata in folk medicines for the treatment of fungal skin infections.

The impact of non-closure of the platysma muscle layer on the cosmesis of thyroidectomy scar - a randomised double-blind controlled trial.

BACKGROUND: The relevance of closing the platysma muscle layer after open thyroidectomy has received little interest in terms of research. The objective was to determine whether non-closure of the platysma muscle layer after open thyroidectomy impacts significantly on the cosmetic outcome of the resulting collar scar. METHODS: In this prospective randomised controlled clinical trial, patients were assigned randomly to have the platysma muscle layer closed or not closed. The primary endpoint was the cosmesis of the collar scar six weeks after surgery assessed using the patient and observer scar assessment scale (POSAS). Additional endpoints included operation time and early postoperative wound complications. RESULTS: Ninety-two patients were recruited, with 46 randomised to each group. The patient scar assessment subscale(PSAS) of the POSAS showed no significant difference in the scar cosmesis between the two groups six weeks after surgery (median PSAS: 16.5 vs 17.5; p = 0.514). The observer scar assessment subscale (OSAS) showed that the platysma muscle layer closure group had marginally better scars (median OSAS: 15 vs 17; p = 0.045). The size of the goitre did not make any significant difference in the scar cosmesis. There was no significant difference in the incidence of early postoperative wound complications as well as the median operation time. CONCLUSION: Not closing the platysma muscle layer had no significant impact on the scar cosmesis six weeks after open thyroidectomy, with no significant difference in the incidence of early postoperative wound complications and the operation time.

Radiological consequence analysis for hypothetical accidental release from Nigerian Research Reactor-1.

Radiological dispersion study is a key element in safety analysis report (SAR) of every nuclear facility for the purpose of emergency response planning. In this work, computational approach was used to determine the total effective dose and ground deposition at critical positions onsite and offsite of the Nigerian Research Reactor-1 (NIRR-1) facility which will be useful in the ongoing development of final SAR for NIRR-1 Low Enriched Uranium (LEU) core. In the methodology used, NIRR-1 LEU core was depleted with TRITON module of SCALE 6.2.3 code and the fission inventory in the core was calculated after a continuous operation at full power of 231.931MWD/MTU for 918 Effective Full Power Days (EFPD) at an operation regime of 3 h per day, 3 days per week and 48 weeks per year. Hot Spot was employed for atmospheric transport and dose calculations with consideration of different accidental scenarios in which 20%, 30%, 60% and 100% gaseous inventory was hypothetically released into the atmosphere. From the results obtained, the total effective dose to maximum exposed workers at 10 m and maximum exposed members of public at 300 m from the reactor were 3.10mSvand0.43mSv respectively for the worst-case scenario with 100% release while the maximum ground deposition was 5.5×106Bq/m2 with corresponding maximum ground shine dose rate of 7.5×10-4mSv/hr. This results are at least one order of magnitude below the dose limits recommended by the International Commission on Radiological Protection (ICRP) and indicate that the present LEU core of NIRR-1 is unlikely to cause any detectable health effect on workers and members of public in the event that 100% of its gaseous inventory is released into air in the environment. Hence it could unequivocally be said that the population is safe from the operation of NIRR-1 in its present location.

Acute administration of 3,4-methylenedioxymethamphetamine (MDMA) induces oxidative stress, lipoperoxidation and TNFα-mediated apoptosis in rat liver.

Liver toxicity is one of the consequences of ecstasy (3,4-methylenedioxymethamphetamine MDMA) abuse and hepatocellular damage is reported after MDMA consumption. Various factors probably play a role in ecstasy-induced hepatotoxicity, namely its metabolism, the increased efflux of neurotransmitters, the oxidation of biogenic amines, and hyperthermia. MDMA undergoes extensive hepatic metabolism that involves the production of reactive metabolites which form adducts with intracellular nucleophilic sites. MDMA-induced-TNF-α can promote multiple mechanisms to initiate apoptosis in hepatocytes, activation of pro-apoptotic (BID, SMAC/DIABLO) and inhibition of anti-apoptotic (NF-κB, Bcl-2) proteins. The aim of the present study was to obtain evidence for the oxidative stress mechanism and apoptosis involved in ecstasy-induced hepatotoxicity in rat liver after a single 20 mg/kg, i.p. MDMA administration. Reduced and oxidized glutathione (GSH and GSSG), ascorbic acid (AA), superoxide dismutase (SOD), glutathione peroxidase (GPx), glutathione reductase (GR) and malondialdehyde (MDA), an indicator of lipid peroxidation, were determined in rat liver after 3 and 6h after MDMA treatment. The effect of a single MDMA treatment included decrease of GR and GPx activities (29% and 25%, respectively) and GSH/GSSG ratio (32%) with an increase of MDA (119%) after 3h from ecstasy administration compared to control rats. Liver cytosolic level of AA was increased (32%) after 6 h MDMA treatment. Our results demonstrate a strong positive reaction for TNFα (p<0.001) in hepatocytes and a diffuse apoptotic process in the liver specimens (p<0.001). There was correlation between immunohistochemical results and Western blotting which were quantitatively measured by densitometry, confirming the strong positivity for TNF-α (p<0.001) and NF-κB (p<0.001); weak and intense positivity reactions was confirmed for Bcl-2, SMAC/DIABLO (p<0.001) and BID reactions (p<0.001). The results obtained in the present study suggest that MDMA induces loss of GSH homeostasis, decreases antioxidant enzyme activities, and lipoperoxidation that causes an oxidative stress that accompaines the MDMA-induced apoptosis in liver cells.