Diagnostic Utility of EMA, Vimentin and CD117 Immunohistochemical Markers in Subtyping Renal Cell Carcinoma in a Nigerian Tertiary Hospital: A 10-year Retrospective Study.

BACKGROUND: Renal cell carcinoma is the most lethal urological cancer and contributes significantly to morbidity and mortality due to cancers of the urogenital tract. In routine diagnostic surgical pathology practice of renal tumours, immunohistochemistry is a helpful ancillary technique after routine H & E. The role of renal immunohistochemistry is explored in this study. MATERIALS AND METHODS: The paraffin-embedded tissue blocks of all the confirmed cases of renal cell carcinoma seen at the University College Hospital (UCH), Ibadan, during the 10-year study period of 2007 to 2016 were retrieved, sectioned and immunohistochemistry done using monoclonal antibodies for EMA, Vimentin and CD117 following standard protocols. Frequency statistics and chi-square were applied to data to determine proportions and associations using the Statistical Package for the Social Sciences (SPSS) version 23. RESULTS: A total of 48 cases of renal cell carcinoma were seen within the study period that met the inclusion criteria for the study. The age range of the patients was between 3 to 76 years with an average age of 44.17 years. The male-to-female ratio was 1:1.3. Fuhrman Grade 2 nuclei were predominant (43.75%) while Fuhrman Grade 4 nuclei had the lowest frequency (6.25%). EMAstaining patterns for the different histological patterns of RCC showed no statistically significant difference while Vimentin and CD117 staining patterns showed a statistically significant difference. There was no statistically significant difference observed between the staining patterns of all three markers and the nuclear grades of the cases of RCC. CONCLUSION: This study demonstrated the usefulness of Vimentin and CD117 in differentiating chromophobe variant of renal cell carcinoma from other subtypes while EMA showed variable expression across the various subtypes.

CONTEXTE: Le carcinome à cellules rénales est le cancer urologique le plus mortel et contribue de manière significative à la morbidité et à la mortalité liées aux cancers du tractus urogénital. Dans la pratique courante de la pathologie chirurgicale diagnostique des tumeurs rénales, l'immunohistochimie est une technique auxiliaire utile après la coloration H & E (hématoxyline et éosine). Le rôle de l'immunohistochimie rénale est exploré dans cette étude. MATÉRIEL ET MÉTHODES: Les blocs de tissus inclus en paraffine de tous les cas confirmés de carcinome à cellules rénales observés à l'hôpital universitaire du collège (UCH) d'Ibadan, au cours de la période d'étude de 10 ans de 2007 à 2016, ont été récupérés, sectionnés et soumis à une immunohistochimie en utilisant des anticorps monoclonaux dirigés contre l'EMA, la vimentine et le CD117 suivant des protocoles standard.Des statistiques de fréquence et le test du chi-carré ont été appliqués aux données pour déterminer les proportions et les associations à l'aide du logiciel Statistical Package for the Social Sciences (SPSS) version 23. RÉSULTATS: Au cours de la période d'étude, un total de 48 cas de carcinome à cellules rénales répondant aux critères d'inclusion de l'étude ont été observés. L'âge des patients variait de 3 à 76 ans, avec un âge moyen de 44,17 ans. Le ratio hommes-femmes était de 1:1,3. Les noyaux de grade Fuhrman 2 étaient prédominants (43,75 %), tandis que les noyaux de grade Fuhrman 4 présentaient la fréquence la plus basse (6,25 %). Les schémas de coloration de l'EMA pour les différentes variantes histologiques du RCC n'ont montré aucune différence statistiquement significative, tandis que les schémas de coloration de la vimentine et du CD117 ont montré une différence statistiquement significative. Aucune différence statistiquement significative n'a été observée entre les schémas de coloration des trois marqueurs et les grades nucléaires des cas de RCC. CONCLUSION: Cette étude a démontré l'utilité de la vimentine et du CD117 pour différencier la variante chromophobe du carcinome à cellules rénales des autres sous-types, tandis que l'EMA a montré une expression variable dans les différents sous-types. Mots-clés: Carcinome à cellules rénales (CCR), antigène membranaire épithélial (EMA), vimentine, C-Kit (tyrosine kinase, CD 117), hématoxyline et éosine (H & E).

Understanding the risk of emerging bacterial resistance to over the counter antibiotics in topical sore throat medicines.

AIMS: The aims of this study were to explore the development of bacterial resistance and cross-resistance in four common human pathogens following realistic exposure to antibiotics found in over-the-counter (OTC) sore throat medicines: gramicidin, neomycin, bacitracin and tyrothricin. METHODS AND RESULTS: Bacterial exposure to in-use (concentration in the product before use) and diluted concentration (i.e. during use) of antibiotic where conducted in broth for 24 h or until growth was visible. The changes in bacterial susceptibility profile before and after exposure was determined using standardized ISO microdilution broth. Antibiotic testing was performed according to EUCAST guidelines. We demonstrated that test bacteria were able to survive exposure to the in-use concentrations of some antibiotics used in OTC medicines. Exposure to during use concentrations of bacitracin resulted in stable increase in minimal inhibitory concentration (MIC) (>8-fold) in Staphylococcus aureus and Acinetobacter baumannii. Exposure to tyrothricin resulted in a stable increase in MIC (2·4-fold) in Klebsiella pneumoniae, and exposure to neomycin resulted in a stable increase MIC (5000-fold higher than the baseline) in Streptococcus pyogenes. Clinical cross-resistance to other antibiotics (ciprofloxacin, fusidic acid, gentamicin, cefpodoxime, amoxicillin/clavulanic acid and cefotaxime) was also demonstrated following exposure to bacitracin or tyrothricin. Bacitracin exposure lead to a stable bacterial resistance after 10 passages. CONCLUSIONS: Our results indicate that OTC antibiotic medicines have the potential to drive resistance and cross-resistance in vitro. SIGNIFICANCE AND IMPACT OF THE STUDY: Tackling antibiotic resistance is a high worldwide priority. It is widely accepted that the overuse and misuse of antibiotics increase the risk of the development and spread of antibiotic resistance within communities. A number of OTC sore throat products, widely available across the world for topical use in respiratory indications, contain locally delivered antibiotics. Our findings showed that these antibiotics in OTC medicines present a risk for emerging cross-resistance in a number of bacterial respiratory pathogens.

Behavioural and anthropometric risk factors for diabetes mellitus among newly admitted undergraduates in a Nigerian University.

BACKGROUND: Type 2 diabetes mellitus (DM) is fast becoming a global epidemic, and its prevalence is increasing in children and young adults. The aim of the study was to identify young adults who had type 2 DM or impaired fasting glucose as well as those at risk of these conditions using anthropometric data and behavioral pattern. METHODOLOGY: Two hundred and twenty newly admitted undergraduates who were randomly selected during the registration process were involved in the study. Anthropometric parameters were measured while information on demographic details, medical history, and family history were obtained using a standard questionnaire. Fasting blood glucose was measured using the glucose oxidase method. RESULTS: Two hundred and seven (94%) participants had serum glucose within reference range, 10 (4.6%) had impaired fasting glucose, and 3 (1.4%) had serum glucose> 7.1 mmol/L, which is indicative of DM. A large number (91.4%) of individuals engaged in physical activity equivalent to a walk of at least 30 min/day. Most of them (93.2%) had body mass index <25.0 while 6.8% were overweight. One hundred and three participants (46.8%) indicated that they eat 3 or more servings of whole grain per day. CONCLUSION: Most of the participants are involved in healthy lifestyle. This has resulted in very low prevalence of impaired fasting glucose and type 2 DM among the group. It will be useful to follow up the group and note if they are able to maintain this trend since the risk of developing DM is known to increase with age.

Psychiatric Morbidity and Subjective Burden Among Carers of Outpatients of a Psychogeriatric Clinic in Southwestern Nigeria.

Few studies in Nigeria have investigated the burden of caring for elderly persons with mental illness. The aim of this study was to examine psychiatric morbidity and burden of care among caregivers of outpatients of a psychogeriatric clinic. Burden of care was evaluated with Zarit Burden Interview. A questionnaire was also used to elicit caregivers' sociodemographic and caregiving variables while psychological well-being was assessed with the General Health Questionnaire (GHQ). Overall, 52.3% had high care burden. High care burden was associated with financial difficulty (χ(2) = 9.37; df = 1; p = 0.002; OR = 3.1; 95% CI = 1.50-6.4), restrictions on caregivers' social activity (χ(2) = 4.87; df = 1; p = 0.027; OR = 2.4; 95% CI = 1.09-5.27), lack of support from relatives (χ(2) = 6.85; df = 1; p = 0.009; OR = 6.3; 95% CI = 1.35-29.6), physical health problems (χ(2) = 10.52; df = 1; p = 0.001; OR = 4.7; 95% CI = 1.75-12.7), and psychiatric morbidity (χ(2) = 4.05; df = 1; p = 0.044; OR = 2.62; 95% CI = 1.00-6.85). Psychiatric morbidity was predicted by physical health problems (OR = 3.0; 95% CI = 1.1-8.1), financial difficulty (OR = 17.2; 95% CI = 3.8-77.5), and job loss (OR = 5.3; 95% CI = 2.0-13.8). Care burden is a significant problem among caregivers of elderly persons with mental illness attending the clinic. This may have important implications for the mental well-being of the patients.

Fear of the perpetrator: a major reason why sexual assault victims delayed presenting at hospital.

OBJECTIVE: To identify the reasons for presentation of sexual assault more than 72 h after the incidents at Newcastle Hospital, South Africa. METHODS: A retrospective analysis of 534 medical records of victims seen between 2005 and 2009 at the hospital's sexual assault service centre. RESULTS: Overall, 219 (41%) of the victims presented at the hospital more than 72 h after the alleged sexual assault, mainly for fear of the perpetrator (37.4%). Females constituted 87%, and rape with vaginal penetration was the most common form of sexual assault reported (74%). Tests of significance showed a positive association between fear of the perpetrator and delayed presentation at hospital. Age under 9 years and being scared of what relatives would say about alleged sexual assault were also associated with delayed presentation. CONCLUSIONS: Attention needs to be focused on educating society on the importance of reporting sexual assault incidents promptly in order for victims to benefit from appropriate medical treatment.

Polyp prevalence at colonoscopy among Nigerians: A prospective observational study.

BACKGROUND: This study was aimed at identifying the prevalence, distribution, and clinicopathologic characteristic of colonic polyps among Nigerians undergoing colonoscopy at the Obafemi Awolowo University Teaching Hospitals complex, Ile-Ife, Nigeria. We also determined the polyp detection rate (PDR), polyps per colonoscopy (PPC) and adenoma detection rate (ADR). MATERIALS AND METHODS: This is a prospective study of all colonoscopy examinations performed at the endoscopy unit of our hospital from January, 2007 to December 2013. The patient demographics, indications for colonoscopy, colonoscopic findings, number of the polyps, their sizes, possible risk factors in the individual case histories, and histopathological characteristics of the polyps. RESULTS: During the study period, a total of 415 patients met the inclusion criteria and only 67 out of these had colonic polyps. The overall PDR was 16.1%. The age ranged was 2-87 years with a median of 57 years. Forty-three (64.2%) patients were 50 years or above and there were 40 (59.7%) males. Thirty-three (49.3%) patients were referred as a result of lower gastrointestinal bleeding, 14 (20.9%) for colorectal cancer (CRC) and 13 (19.4%) for routine screening. Thirty-nine (58.2%) patients had the polyps at the rectosigmoid region of the colon, 17 (25.4%) had the polyps located proximal to sigmoid colon and 11 (16.4%) patients had multiple polyps involving both segments. Adenomatous polyps was the most common (28 [47.5%]) histopathological finding of which two patients had adenomatous polyposis. Other findings include inflammatory polyps in 17 (18.8%) patients, 5 (8.5%) patients each had hyperplastic and malignant polyps, while 4 (6.8%) patients had juvenile polyps. The ADR was 6.8 and the PPC was 0.2. Statistically, patients 50 years and older were more likely to have adenomatous and hyperplastic polyps than those younger than this age (P = 0.010). CONCLUSION: We conclude that polyps are probably not as rare among black Africans especially when they are above 50 years. Our histopathological finding of adenomatous change in a good proportion of the detected polyps show that they are likely to be associated with CRCs in our compatriots and as such we would recommend a routine screening colonoscopy for Nigerians aged 50 and above.

Rapid-onset diarrhoea in HIV patient: The importance of suspecting cholera in non-endemic areas.

Cholera, a severe diarrhoeal disease caused by Vibrio cholerae is typically associated with inadequate potable water supply and poor sanitation. We report cholera disease presentation identified as a suspected case of acute diarrhoea (HIV/AIDS common condition) in a person living with HIV seen in a cholera non-endemic area. Contribution: We highlight the importance of recognizing cholera in cases of acute diarrhoea, especially among people with HIV, in resource-constraint areas that lack potable water supply.

Maximizing the Utility of Alzheimer's Disease Trial Data: Sharing of Baseline A4 and LEARN Data.

BACKGROUND: The Anti-Amyloid Treatment in Asymptomatic Alzheimer's Disease (A4) and Longitudinal Evaluation of Amyloid Risk and Neurodegeneration (LEARN) studies were conducted between 2014 and 2023, with enrollment completed in 2017 and final study results reported in 2023. The study screening process involved the collection of initial clinical, cognitive, neuroimaging, and genetic measures to determine eligibility. Once randomized, enrolled participants were assessed every four weeks over a 4.5-year follow-up period during which longitudinal clinical, cognitive, and neuroimaging measures were collected. A large number of longitudinal fluid biospecimens were also collected and banked. Consistent with the NIH data sharing policy and the principles of Open Science, the A4/LEARN investigators aimed to share data as broadly and early as possible while still protecting participant privacy and confidentiality and the scientific integrity of the studies. OBJECTIVES: We describe the approach, methods, and platforms used to share the A4 and LEARN pre-randomization study data for secondary research use. Preliminary results measuring the impact of these efforts are also summarized. We conclude with a discussion of lessons learned and next steps. DESIGN: The materials shared included de-identified quantitative and image data, analysis software, instruments, and documentation. SETTING: The A4 and LEARN Studies were conducted at 67 clinical trial sites in the United States, Canada, Japan, and Australia. PARTICIPANTS: The A4 study screened (n=6763), enrolled, and randomized (n=1169) participants between the ages of 65 and 85 with a blinded follow-up period of 240 weeks followed by an open-label period of variable length. The LEARN study screened and enrolled individuals (n=538) who were ineligible for the A4 study based on nonelevated measures of amyloid accumulation using positron emission tomography imaging (amyloid PET). MEASUREMENTS: We provide descriptive measures of the data shared and summarize the frequency, characteristics, and status of all data access requests submitted to date. We evaluate the scientific impact of the data-sharing effort by conducting a literature search to identify related publications. RESULTS: The A4 and LEARN pre-randomization study data were released in December 2018. As of May 8, 2024, 1506 requests have been submitted by investigators and citizen scientists from more than 50 countries. We identified 49 peer-reviewed publications that acknowledge the A4/LEARN study. CONCLUSIONS: Our initial results provide evidence supporting the feasibility and scientific utility of broad and timely sharing of Alzheimer's disease trial data.

Alexis O-ring wound retractor versus traditional metal retractors for the prevention of postcaesarean surgical site infections.

BACKGROUND: Postcaesarean surgical site infections (SSI) remain a burden globally. The Alexis® O C-Section Retractor, a plastic sheath retractor known to have decreased incidence of SSIs in gastrointestinal surgery, is yet to have its efficacy established during caesarean section (CS). This study aimed to compare the differences in the rate of postcaesarean surgical wound site infections between the Alexis® retractor and traditional metal retractors during CS at a large tertiary hospital in Pretoria. METHODS: Pregnant women scheduled for elective CS were prospectively randomised to either the Alexis® retractor group or the traditional metal retractor group at a tertiary hospital in Pretoria between August 2015 and July 2016. The defined primary outcome was development of SSI, and secondary outcomes comprised patients' peri-operative parameters. All participants' wound sites were observed in the hospital for 3 days before discharge and again at 30 days postpartum. Data were analysed using SPSS version 25 with p  0.05 considered significant. RESULTS: A total of 207 participants were involved, Alexis® (n = 102) and metal retractors (n = 105). None of the participants developed postsurgical site wound infection after 30 days, and there were no differences in time to delivery, total operative time, estimated blood loss or postoperative pain between the two arms of study. CONCLUSION: The study found no difference in participants' outcomes using the Alexis® retractor in comparison with the traditional metal wound retractors. We suggest that the use of Alexis® retractor be at the surgeon's discretion and its routine use not advised for now.Contribution: This research being the first of its kind in South Africa in which patients' clinical outcomes were compared post caesarean section from Alexis's plastic sheath group and metal retractors group in an attempt to proffer solution to the high burden of SSI. Although no difference was seen at this point, the research was pragmatic, as it was carried out in a setting with high burden of SSI. The study is going to serve as a baseline against which studies carried out in future can be compared.

Crystal structures of AKR1C3 containing an N-(aryl)amino-benzoate inhibitor and a bifunctional AKR1C3 inhibitor and androgen receptor antagonist. Therapeutic leads for castrate resistant prostate cancer.

Castrate resistant prostate cancer (CRPC) is associated with increased androgen receptor (AR) signaling often brought about by elevated intratumoral androgen biosynthesis and AR amplification. Inhibition of androgen biosynthesis and/or AR antagonism should be efficacious in the treatment of CRPC. AKR1C3 catalyzes the formation of potent AR ligands from inactive precursors and is one of the most upregulated genes in CRPC. AKR1C3 inhibitors should not inhibit the related isoforms, AKR1C1 and AKR1C2 that are involved in 5α-dihydrotestosterone inactivation in the prostate. We have previously developed a series of flufenamic acid analogs as potent and selective AKR1C3 inhibitors [Adeniji, A. O. et al., J. Med. Chem.2012, 55, 2311]. Here we report the X-ray crystal structure of one lead compound 3-((4-(trifluoromethyl)phenyl) amino)benzoic acid (1) in complex with AKR1C3. Compound 1 adopts a similar binding orientation as flufenamic acid, however, its phenylamino ring projects deeper into a subpocket and confers selectivity over the other AKR1C isoforms. We exploited the observation that some flufenamic acid analogs also act as AR antagonists and synthesized a second generation inhibitor, 3-((4-nitronaphthalen-1-yl)amino)benzoic acid (2). Compound 2 retained nanomolar potency and selective inhibition of AKR1C3 but also acted as an AR antagonist. It inhibited 5α-dihydrotestosterone stimulated AR reporter gene activity with an IC(50)=4.7 µM and produced a concentration dependent reduction in androgen receptor levels in prostate cancer cells. The in vitro and cell-based effects of compound 2 make it a promising lead for development of dual acting agent for CRPC. To illuminate the structural basis of AKR1C3 inhibition, we also report the crystal structure of the AKR1C3·NADP(+)·2 complex, which shows that compound 2 forms a unique double-decker structure with AKR1C3.

N-Benzoyl anthranilic acid derivatives as selective inhibitors of aldo-keto reductase AKR1C3.

Human aldo-keto reductases AKR1C1-AKR1C3 are involved in the biosynthesis and inactivation of steroid hormones and prostaglandins and thus represent attractive targets for the development of new drugs. We synthesized a series of N-benzoyl anthranilic acid derivatives and tested their inhibitory activity on AKR1C enzymes. Our data show that these derivatives inhibit AKR1C1-AKR1C3 isoforms with low micromolar potency. In addition, five selective inhibitors of AKR1C3 were identified. The most promising inhibitors were compounds 10 and 13, with IC(50) values of 0.31 µM and 0.35 µM for AKR1C3, respectively.

Voluntary physical activity and leucine correct impairments in muscle protein synthesis in partially pancreatectomised rats.

AIMS/HYPOTHESIS: Poorly controlled type 1 diabetes mellitus can cause reduced skeletal muscle mass and weakness during adolescence, which may affect long-term management of the disease. The aim of this study was to determine whether regular voluntary physical activity and leucine feeding restore rates of protein synthesis and deficits in skeletal muscle mass in a young, hypoinsulinaemic/hyperglycaemic rat model of diabetes. METHODS: Four-week-old male Sprague-Dawley rats were partially pancreatectomised (Px) to induce hypoinsulinaemia/hyperglycaemia and housed with/without access to running wheels for 3 weeks (n = 12-14/group). Sham surgery rats (shams) served as sedentary controls (n = 18). Protein synthesis and markers of protein anabolism were assessed in the fasted state and following leucine gavage. Fibre type and cross-sectional areas of the gastrocnemius muscle were measured using a metachromatic ATPase stain. RESULTS: Compared with sedentary behaviour, regular activity lowered fasting glycaemia and reduced fed hyperglycaemia in Px rats. Active-Px rats, which ran 2.2 ± 0.71 km/night, displayed greater muscle mass and fibre areas similar to shams, while sedentary-Px rats displayed a 20-30% loss in muscle fibre areas. Muscle protein synthesis (basal and in response to leucine gavage) was impaired in sedentary-Px (by ~65%), but not in active-Px rats, when compared with shams. Following leucine gavage, the phosphorylation status of eIF4E binding protein 1 (4E-BP1) and ribosomal S6 kinase 1 (S6K1), markers of mammalian target of rapamycin complex 1 (mTORC1) signalling, increased in shams (by two- and ninefold, respectively) and in active-Px (1.5- and fourfold, respectively) rats, but not in sedentary-Px rats. CONCLUSION/INTERPRETATION: Moderate physical activity in young Px rats normalises impairments in skeletal muscle growth and protein synthesis. These findings illustrate the critical compensatory role that modest physical activity and targeted nutrition can have on skeletal muscle growth during periods of hypoinsulinaemia in adolescent diabetes.

Discovery of substituted 3-(phenylamino)benzoic acids as potent and selective inhibitors of type 5 17ß-hydroxysteroid dehydrogenase (AKR1C3).

Aldo-keto reductase 1C3 (AKR1C3) also known as type 5 17ß-hydroxysteroid dehydrogenase has been implicated as one of the key enzymes driving the elevated intratumoral androgen levels observed in castrate resistant prostate cancer (CRPC). AKR1C3 inhibition therefore presents a rational approach to managing CRPC. Inhibitors should be selective for AKR1C3 over other AKR1C enzymes involved in androgen metabolism. We have synthesized 2-, 3-, and 4-(phenylamino)benzoic acids and identified 3-(phenylamino)benzoic acids that have nanomolar affinity and exhibit over 200-fold selectivity for AKR1C3 versus other AKR1C isoforms. The AKR1C3 inhibitory potency of the 4'-substituted 3-(phenylamino)benzoic acids shows a linear correlation with both electronic effects of substituents and the pK(a) of the carboxylic acid and secondary amine groups, which are interdependent. These compounds may be useful in treatment and/or prevention of CRPC as well as understanding the role of AKR1C3 in endocrinology.

ACCIDENTAL INTRAOPERATIVE FINDING OF PARASITIC FIBROIDS IN THE MESENTERY OF A MIDDLE-AGED WOMAN.

Fibroid (myoma) is the most common benign tumor of the female genital tract. The tumour may occur in the uterine corpus as intramural, submucous, subserous, cervical fibroid; or in the broad ligament as intraligamentary fibroid or outside of uterus as parasitic fibroid. Parasitic fibroid is rare as a primary or secondary tumour. It is commonly diagnosed as an incidental finding during radiologic or abdominal surgical procedures. This was a case report of histologically confirmed multiple parasitic fibroids in a 39-year-old woman coexisting with primary uterine fibroids. The woman presented with a history of progressive abdominal swelling and associated lower abdominal pain of 8 years duration. There was an antecedent history of exploratory laparotomy with excision of uterine mass. Abdominal ultrasonography revealed multiple uterine fibroid nodules in the submucous, intramural and subserous layers of the uterus with bilateral normal ovaries. She had abdominal myomectomy. The intraoperative findings revealed multiple uterine fibroid nodules with a total weight of 1670g. There were multiple parasitic fibroid nodules attached to the serosa of the colon with the largest measuring 3.5 x 2cm. We discussed the management and associated challenges of unanticipated parasitic fibroids at surgery. We highlighted the role of multi-disciplinary care and advocated for a high index of suspicion while preparing for surgical intervention in women with multiple uterine fibroids.

I-V Curves of an Apigenin Dye and Their Analysis by a New Parabolic Function.

A new parabolic function for I-V curves' analysis has been proposed. The new "analytical tool" provides a simple way to describe photophysical processes at an approximately monolayer surface of a dye-sensitized solar cell. It may now be possible to estimate factors such as hole-electron recombination, surface defects, and electron diffusion at the semiconductor layer. The theoretical approach that was previously reported by our group for predicting the photovoltaic performance of potential dye sensitizers has also been validated. The experimental photovoltaic and DFT/TD-DFT data of apigenin and those of the highly rated black dyes were used for the validation.

Hibiscus sabdariffa ethanolic extract protects against dyslipidemia and oxidative stress induced by chronic cholesterol administration in rabbits.

Excessive intake of cholesterol (CHOL) and induction of free radical production play a critical role in the pathophysiology of several human diseases. Dietary therapy with plant products rich in flavonoids has been shown to provide benefits without the adverse effects of agents used in clinical practice. Hibiscus sabdariffa (HS) has been used for various purposes due to myriads of flavonoids present in it. In this study, the chemopreventive property of HS ethanolic extract (HSE) was investigated in dyslipidemia and oxidant stress associated with prolonged CHOL administration in rabbits. Twenty-five (25) adult male rabbits weighing between 1.5 and 1.7 kg were used and randomly divided into five groups of five rabbits per group. The CHOL-fed rabbits received 1 g/kg/day of CHOL suspended in 1 ml of corn oil for 8 weeks. Group 1 received 1 ml of corn oil and served as control. Group 2 was fed with CHOL only while groups 3, 4 and 5 received daily doses ofcholestyramine (questran, 260 mg/kg), HSE 200 mg/kg and HSE 300 mg/kg respectively along with CHOL. Animals were sacrificed by cervical dislocation 24-hours after last dose. Enzymic and non-enzymic markers of oxidative stress and lipid profile were analysed in serum, liver, kidney and heart of rabbits. HSE significantly attenuated the alteration in lipid levels and antioxidant status induced by high CHOL intake in rabbits in this study. Both serum and tissue levels of low density lipoprotein-CHOL, triglycerides, phospholipids, and total CHOL decreased with increase in high density lipoprotein-CHOL except in the heart, following treatment with HSE in CHOL-fed rabbits when compared with the untreated group (p<0.05). Similarly, HSE prevented CHOL-induced depletion of enzymic (superoxide dismutase, catalase) and non-enzymic (reduced glutathione, vitamin C) antioxidants with the attendant increases in lipid peroxidation and xanthine oxidase activity in these animals. The effectiveness of HSE in this condition was comparable with that of cholestyramine but with greater in potency. Data from this study demonstrate the hypolipidaemic and antioxidant activities of HSE and suggest its therapeutic potential in disorders of lipid metabolism and cardiovascular events associated with hypercholesterolemia.

Epidemiology of inflammatory bowel disease in sub-Saharan Africa: A review of the current status.

While inflammatory bowel disease (IBD) has been well characterised in the West and other parts of the world, there are little data from sub-Saharan Africa (SSA). To throw light on the current status of IBD in SSA, we performed a systematic review of the literature, extracting relevant publications. We found only 210 documented IBD cases in SSA (excluding South Africa (SA)), which were reported in 34 publications until August 2019. The majority were cases of ulcerative colitis. Only three reports, all from SA, attempted to determine IBD incidence rates. The rest were mostly case reports or small case series; the largest from Nigeria comprised 32 patients. The paucity of documented cases possibly reflects under-diagnosis and under-reporting. Major deficiencies in diagnostic and clinical capacity were noted, which need to be addressed going forward.

Treatment outcomes of adults with new onset pulmonary tuberculosis in Pretoria, South Africa.

A persistently high burden of tuberculosis (TB) and low cure rates in South Africa call for frequent assessment of the effectiveness of the TB programme. We conducted a retrospective cohort study to evaluate treatment outcomes and associated factors among new TB patients taking standard regimen 1 TB treatment during 2010 in Pretoria, using the World Health Organization's six treatment outcomes classification. The 85 participants (of whom 59% were female) had co-infection with HIV in 70%. A total of 52% completed treatment, but only 15% were officially cured; 13% died and only 35% had an end-of-treatment sputum test. The treatment success rate (cured and complete treatment) was 67%. Completion of TB treatment was associated with HIV status (P = 0.02) and TB diagnosis using only sputum smear test (P = 0.02). Our results suggest non-compliance with standard TB guidelines by healthcare workers. We therefore advise future interventions should target both patients and healthcare workers.

Clients' reasons for prenatal ultrasonography in Ibadan, South West of Nigeria.

BACKGROUND: Prenatal ultrasonography has remained a universal tool but little is known especially from developing countries on clients' reasons for desiring it. Then aim was to determine the reasons why pregnant women will desire a prenatal ultrasound. METHODS: It was a cross-sectional survey of consecutive 222 women at 2 different ultrasonography facilities in Ibadan, South-west Nigeria. RESULTS: The mean age of the respondents was 30.1 +/- 4.5 years. The commonest reason for requesting for prenatal ultrasound scans was to check for fetal viability in 144 women (64.7%) of the respondents, followed by fetal gender determination in 50 women (22.6%. Other reasons were to check for number of fetuses, fetal age and placental location. Factors such as younger age, artisans profession and low level of education significantly influenced the decision to check for fetal viability on bivariate analysis but all were not significant on multivariate analysis. Concerning fetal gender determination, older age, Christianity, occupation and gravidity were significant on bivariate analysis, however, only gravidity and occupation remained significant independent predictor on logistic regression model. Women with less than 3 previous pregnancies were about 4 times more likely to request for fetal sex determination than women with more than 3 previous pregnancies, (OR 3.8 95%CI 1.52 - 9.44). The professionals were 7 times more likely than the artisans to request to find out about their fetal sex, (OR 7.0 95%CI 1.47 - 333.20). CONCLUSION: This study shows that Nigerian pregnant women desired prenatal ultrasonography mostly for fetal viability, followed by fetal gender determination. These preferences were influenced by their biosocial variables.

HELLP syndrome: the experience at Ile-Ife, Nigeria.

Between 1 January and 31 December, 2006, 34 consecutive cases of severe pre-eclampsia (12), imminent eclampsia (10) and eclampsia (12) who were admitted at the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife in the south-western part of Nigeria, were investigated for the development of HELLP (haemolysis, elevated liver enzymes and low platelet count) syndrome in a prospective study. The ages of the women ranged from 18 to 38 years, parity 0-5 and the estimated gestational age from 18-41 weeks at presentation. A total of 26 (76.5%) of the patients were unbooked, six (17.6%) of the 34 cases developed HELLP syndrome. Four (33%) of the 12 eclamptics developed HELLP syndrome, while only one (10%) of the cases of imminent eclampsia and 1 (8.3%) of severe pre-eclamptic cases developed the syndrome. Using the Mississippi Triple class system, none of the HELLP syndrome cases belonged to Class I; 4 were categorised in Class II while 2 were in Class III. All of the four eclamptic cases with HELLP syndrome died giving a 100% fatality rate while none of the imminent eclamptic and severe pre-eclamptic patients with the syndrome died. Furthermore, there were six (15.8%) perinatal deaths among the 38 infants delivered by the 34 mothers with severe pre-eclampsia/eclampsia. Our data suggest that the development of HELLP syndrome is more likely in eclamptic patients and when it occurs in them, it is highly fatal. Most of the cases in this study were unbooked. Substandard care may have contributed to the progression of the disease state and consequently, to maternal mortality. It is imperative to draw up an action plan for the identification of the risk factors for the development of pre-eclampsia/eclampsia at peripheral hospitals and maternity centres and for prompt referral of such cases afterwards. Efforts should also be geared towards the minimising of treatment delay in all phases, so as to minimise both perinatal and maternal morbidity and mortality.