Economic burden of non-communicable diseases on households in Nigeria: evidence from the Nigeria living standard survey 2018-19.

BACKGROUND: The importance of non-communicable diseases (NCDs) in Nigeria is reflected in their growing burden that is fast overtaking that of infectious diseases. As most NCD care is paid for through out-of-pocket (OOP) expenses, and NCDs tend to cause substantial income losses through chronic disabilities, the rising NCD-related health burden may also be economically detrimental. Given the lack of updated national-level evidence on the economic burden of NCDs in Nigeria, this study aims to produce new evidence on the extent of financial hardship experienced by households with NCDs in Nigeria due to OOP expenditure and productivity loss. METHODS: This study analysed cross-sectional data from the most recent round (2018-19) of the Nigeria Living Standard Survey (NLSS). Household-level health and consumption data were used to estimate catastrophic health expenditure (CHE) and impoverishing effects due to OOP health spending, using a more equitable method recently developed by the World Health Organization European region in 2018. The productivity loss by individuals with NCDs was also estimated from income and work-time loss data, applying the input-based human capital approach. RESULTS: On average, a household with NCDs spent ₦ 122,313.60 or $ 398.52 per year on NCD care, representing 24% of household food expenditure. The study found that OOP on cancer treatment, mental problems, and renal diseases significantly contribute to the cost of NCD care. The OOP expenditure led to catastrophic and impoverishing outcomes for households. The estimations showed that about 30% of households with NCDs experienced CHE in 2018, using the WHO Europe method at the 40% threshold. The study also found that the cost of NCD medications was a significant driver of CHE among NCD-affected households. The results showed heterogeneity in CHE and impoverishment across states and geographical regions in Nigeria, with a higher concentration in rural and North East geopolitical locations. The study also found that 20% of NCD-affected households were impoverished or further impoverished by OOP payment, and another 10% were on the verge of impoverishment. The results showed a negligible rate of unmet needs among households with NCDs. CONCLUSIONS: The study highlights the significant effect of NCDs on Nigerian households and the need for effective policy interventions to address this challenge, particularly among the poor and vulnerable.

Effect of drill quality on biological damage in bone drilling.

Bone drilling is a universal procedure in orthopaedics for fracture fixation, installing implants, or reconstructive surgery. Surgical drills are subjected to wear caused by their repeated use, thermal fatigue, irrigation with saline solution, and sterilization process. Wear of the cutting edges of a drill bit (worn drill) is detrimental for bone tissues and can seriously affect its performance. The aim of this study is to move closer to minimally invasive surgical procedures in bones by investigating the effect of wear of surgical drill bits on their performance. The surface quality of the drill was found to influence the bone temperature, the axial force, the torque and the extent of biological damage around the drilling region. Worn drill produced heat above the threshold level related to thermal necrosis at a depth equal to the wall thickness of an adult human bone. Statistical analysis showed that a sharp drill bit, in combination with a medium drilling speed and drilling at shallow depth, was favourable for safe drilling in bone. This study also suggests the further research on establishing a relationship between surface integrity of a surgical drill bit and irreversible damage that it can induce in delicate tissues of bone using different drill sizes as well as drilling parameters and conditions.

Selective anti-cancer activity against melanoma cells using 3-O-acetyl-ß-boswellic acid-loaded 3D-Printed scaffold.

This study aimed to develop a local 3 D-printed bioactive graft using poly-caprolacton (PCL) as a drug carrier and 3-O-acetyl-ß-boswellic acid (ß-ABA) as an anticancer compound. ß-ABA-loaded 3 D-printed scaffold was fabricated and physically characterized. The results indicated more desirable mechanical and physical properties of the ß-ABA-loaded PCL mat in comparison with the PCL scaffold. Following sustained release of ß-ABA, the ß-ABA-loaded PCL scaffold revealed selective cytotoxic activity against melanoma cells, while the PCL + ABA with the bolus delivery of ß-ABA was toxic against fibroblast cells. Followed by the induction of apoptosis in melanoma cells at the gene level, the result of the western blot showed that the ß-ABA-loaded scaffold significantly up-regulated P53 and down-regulated BCL2, with an increment in the ratio of Bax/BCL2. The selective anti-cancer properties of ß-ABA-loaded 3 D printed scaffold against melanoma cells indicated that this scaffold could be potentially used as a bioactive graft to improve the melanoma treatment.

Comparative study of the cytotoxicity, apoptotic, and epigenetic effects of Boswellic acid derivatives on breast cancer.

This study aimed to compare the effect of Boswellic acid derivatives on the viability, apoptosis, and epigenomic profiling of breast cancer. According to the viability assays, 3-O-acetyl-11-keto-ß-Boswellic acid (AKBA) showed more toxicity against MDA-MB-231 cells when compared with the 3-O-acetyl-ß-Boswellic acid (ABA). In contrast, ABA revealed less toxicity against MCF-10A. Cell cycle and apoptosis assays determined the maximum apoptotic effect of AKBA on MCF-7, and MDA-MB-231 cells. Interestingly, ß-Boswellic acid (BA) and ABA did not promote the apoptosis in MCF-10A cells. Transwell migration assay indicated the greatest normalized inhibition (around 160%) in the migration of MDA-MB-231 cells induced by AKBA. The expression of P53, BAX, and BCL2 genes in cancerous cell lines has affirmed that both AKBA and ABA could induce the maximal apoptosis. Western-blot investigation demonstrated that the maximum over-expression of P53 protein (1.96 times) was caused by AKBA in MDA-MB-231 cells, followed by ABA in MCF-7 cells. The BCL2 protein expression was in agreement with the previously reported results. The global DNA methylation in both cancerous cells was reduced by ABA. These results suggest that ABA represented more epigenetic modulatory effect while AKBA shows more cytotoxic and apoptotic effect against breast cancer cell lines.

An engineered microfluidic blood-brain barrier model to evaluate the anti-metastatic activity of ß-boswellic acid.

BACKGROUND: The development of anti-cancer drugs with the ability to inhibit brain metastasis through the blood-brain barrier (BBB) is substantially limited due to the lack of reliable in vitro models. MAIN METHODS: In this study, the Geltrex-based Transwell and microfluidic BBB models were applied to screen the effect of ß-boswellic acid (ß-BA) on the metastasis of MDA-MB-231 cells through the BBB in static and dynamic conditions, respectively. MAJOR RESULTS: The toxicity assay revealed that ß-BA deteriorates MDA-MB-231 cells, while ß-BA had no detectable toxic effects on human umbilical vein endothelial cells (HUVECs) and astrocytes. Trans-endothelial electrical resistance evaluation showed sustainable barrier integrity upon treatment with ß-BA. Vimentin expression in HUVECs, evaluated using western blot, confirmed superior barrier integrity in the presence of ß-BA. The obtained results were confirmed using an invasion study with a cell tracker and a scanning electron microscope. ß-BA significantly inhibited metastasis by 85%, while cisplatin (Cis), a positive control, inhibited cancer cell migration by 12% under static conditions. Upon applying a dynamic BBB model, it was revealed that ß-BA-mediated metastasis inhibition was significantly higher than that mediated by Cis. CONCLUSIONS AND IMPLICATIONS:  In summary, the current study proved the anti-metastatic potential of ß-BA in both static and dynamic BBB models.

Gelatin-methacryloyl hydrogel based in vitro blood-brain barrier model for studying breast cancer-associated brain metastasis.

Breast cancer is one of the leading causes of brain metastasis. Metastasis to the brain occurs if cancer cells manage to traverse the 'blood-brain barrier' (BBB), which is a barrier with a very tight junction (TJ) of endothelial cells between blood circulation and brain tissue. It is highly important to develop novel in vitro BBB models to investigate breast cancer metastasis to the brain to facilitate the screening of chemotherapeutic agents against it. We herein report the development of gelatin methacryloyl (GelMA) modified transwell insert based BBB model composed of endothelial and astrocyte cell layers for testing the efficacy of anti-metastatic agents against breast cancer metastasis to the brain. We characterized the developed model for the morphology and in vitro breast cancer cell migration. Furthermore, we investigated the effect of cisplatin, a widely used chemotherapeutic agent, on the migration of metastatic breast cancer cells using the model. Our results showed that breast cancer cells migrate across the developed BBB model. Cisplatin treatment inhibited the migration of cancer cells across the model. Findings of this study suggest that our BBB model can be used as a suitable tool to investigate breast cancer-associated brain metastasis and to identify suitable therapeutic agents against this.

Experimental study on biological damage in bone in vibrational drilling.

BACKGROUND: Drilling is a well-known mechanical operation performed for fixing fracture at required locations in bone. The process may produce mechanical and thermal alterations in the structure of the bone and surrounding tissues leading to irreversible damage known as osteonecrosis. OBJECTIVE: The main purpose of this study was to measure the level of biological damage in bone when a drill assisted by low and high levels of vibrations is penetrated into bone tissue. METHODS: Histopathology examination of sections of bones has been performed after drilling the bone using a range of vibrational frequency and rotational speed imposed on the drill with and without supply of saline for cooling. RESULTS: Cell damage in bone was caused by the combined effect of drill speed and frequency of vibrations. Histopathology examination revealed more damage to bone cells when a frequency higher than 20 kHz was used in the absence of cooling. Cooling the drilling region helped minimize cell damage more at a shallow depth of drilling compared to deep drilling in the cortex of cortical bone. The contribution of cooling in minimizing cell damage was higher with a lower drill speed and frequency compared to a higher drill speed and frequency. CONCLUSION: Vibrational drilling using a lower drill speed and frequency below 25 kHz in the presence of cooling was found to be favorable for safe and efficient drilling in bone.

Secondary metabolites from acridocarpus orientalis inhibits 4T1 cells and promotes mesenchymal stem cells (MSCs) proliferation.

Among medicinal plants, Acridocarpus orientalis (AO) possesses a remarkable anti-cancer potential, possibly because of its anti-oxidant property. In this study, the leaf and stem extracts from AO were assessed to find the bioactive compound with selective anti-cancer properties. The MTT viability and live and dead assays revealed that around 80% and 98% of 4T1 cells survival were declined after 48 h incubation with leaf and stem extracts, respectively. The leaf extract increased stem cell proliferation by 20% whereas the stem extract inhibited around 22% of stem cells proliferation after 48 h treatment. The live and dead assay of MSCs confirmed that 40% of the MSCs died when treated with AO stem extract. On the other hand, there were no dead cells after two days of treatment with the leaf extract. Followed by the induction of cell cycle arrest in G0/G1-phase, the real-time PCR demonstrated apoptosis properties in 4T1 cells through overexpression of Bax and down-regulation of BCL2 genes. Interestingly, within the pure compounds isolated from AO leaf extract, Morin was responsible for the inhibition of 4T1 cells proliferation as well as MSCs expansion, predicting to play an essential role in the treatment of cancer. The promising in vitro anti-cancer and stem cell-inductive properties of morin isolated from AO extract may provide a great potential to produce selective herbal derived drugs.

Experimental investigation on the effect of drill quality on the performance of bone drilling.

Bone drilling is a well-known process in operative fracture treatment and reconstructive surgery. The cutting ability of the drill is lost when used for multiple times. In this study, the effect of different levels of drill wear on bone temperature, drilling force, torque, delamination around the drilling region and surface roughness of the hole was investigated using a series of experiments. Experimental results demonstrated that the wear of the drill is strongly related to the drilling force, torque, temperature and surface roughness of the drilled hole. Statistical analysis was performed to find the effect of various factors on multiple response variables in the bone drilling process. The favorable conditions for bone drilling are obtained when feed rate, drill speed and the roughness of the cutting edge of the drill were fixed at 30 mm, 2000 rpm and up to 2 mm, respectively. Further, analysis of variance (ANOVA) was performed to determine the factor with a significant impact on the response variables. F-test and p-value indicated that the feed rate had the highest effect on grey relational grade followed by the roughness of the drill. This study suggests that the sharp drill along with controlled drilling speed and feed rate may be used for safe and efficient surgical drilling in bone.

Glycaemic Control for People with Type 2 Diabetes Mellitus in Bangladesh - An urgent need for optimization of management plan.

AIMS: The objective of this study was to identify the determinants of glycaemic control among people with type 2 diabetes mellitus in Bangladesh. A cross-sectional study was carried out during March to September 2017, and 1253 adult patients with type 2 diabetes mellitus were recruited from six hospitals. Data were collected from patients via face-to-face interview, and their medical records were reviewed. Multiple logistic regression analysis was performed. Among the participants, 53.2% were male. Mean (±SD) age was 54.1 (±12.1) years and mean (±SD) duration of diabetes was 9.9 (±7.2) years. About 82% participants had inadequate glycaemic control (HbA1c ≥ 7%) and 54.7% had very poor control (HbA1c ≥ 9%). Low education level, rural residence, unhealthy eating habits, insulin use, infrequent follow up check-ups and history of coronary artery diseases found associated with inadequate and very poor controls. Being female and smokeless tobacco consumer appeared to be associated with inadequate control however cognitive impairment was associated with very poor control only. Prevalence of inadequate glycaemic level was very high in Bangladesh. Having understood relatable lifestyle modification factors, demographics and co-morbidities among people with type 2 diabetes, health care providers in conjunction with patients should work together to address the glycaemic control.

In-vitro experimental study of histopathology of bone in vibrational drilling.

Drilling is a common surgical procedure for fracture treatment and reconstruction in multiple surgical fields, including orthopaedics, neurology, and dentistry. Drilling delicate tissue (such as bone) with a hard metallic tool is considered notorious for inducing mechanical and thermal damage, which can adversely affect osseointegration and may weaken the bond between the bone and implant, or other fixative devices anchoring the bone. The aim of this study is to explore the benefits of vibrational drilling (VD) in overcoming the complications associated with conventional drilling (CD). Drilling tests were performed on fresh cortical bone with the intention of investigating the effect of a range of frequencies, in combination with drilling speed and feed rate, on biological damage around the drilling region using histological sections of skeletally mature bone. The study examined the most influential factors and optimal combination of parameters for safe and efficient drilling in bone. Results from Taguchi grey relational analysis showed that a lower drilling speed and feed rate combined with a frequency of 20 kHz were favourable parameters for safe drilling in bone. Accordingly, VD using controlled parameters may be an alternative to CD in bone surgical procedures.

The Burden of Cardiovascular Diseases Among US States, 1990-2016.

Importance: Cardiovascular disease (CVD) is the leading cause of death in the United States, but regional variation within the United States is large. Comparable and consistent state-level measures of total CVD burden and risk factors have not been produced previously. Objective: To quantify and describe levels and trends of lost health due to CVD within the United States from 1990 to 2016 as well as risk factors driving these changes. Design, Setting, and Participants: Using the Global Burden of Disease methodology, cardiovascular disease mortality, nonfatal health outcomes, and associated risk factors were analyzed by age group, sex, and year from 1990 to 2016 for all residents in the United States using standardized approaches for data processing and statistical modeling. Burden of disease was estimated for 10 groupings of CVD, and comparative risk analysis was performed. Data were analyzed from August 2016 to July 2017. Exposures: Residing in the United States. Main Outcomes and Measures: Cardiovascular disease disability-adjusted life-years (DALYs). Results: Between 1990 and 2016, age-standardized CVD DALYs for all states decreased. Several states had large rises in their relative rank ordering for total CVD DALYs among states, including Arkansas, Oklahoma, Alabama, Kentucky, Missouri, Indiana, Kansas, Alaska, and Iowa. The rate of decline varied widely across states, and CVD burden increased for a small number of states in the most recent years. Cardiovascular disease DALYs remained twice as large among men compared with women. Ischemic heart disease was the leading cause of CVD DALYs in all states, but the second most common varied by state. Trends were driven by 12 groups of risk factors, with the largest attributable CVD burden due to dietary risk exposures followed by high systolic blood pressure, high body mass index, high total cholesterol level, high fasting plasma glucose level, tobacco smoking, and low levels of physical activity. Increases in risk-deleted CVD DALY rates between 2006 and 2016 in 16 states suggest additional unmeasured risks beyond these traditional factors. Conclusions and Relevance: Large disparities in total burden of CVD persist between US states despite marked improvements in CVD burden. Differences in CVD burden are largely attributable to modifiable risk exposures.

Cost-effectiveness of massively parallel sequencing for diagnosis of paediatric muscle diseases.

Childhood-onset muscle disorders are genetically heterogeneous. Diagnostic workup has traditionally included muscle biopsy, protein-based studies of muscle specimens, and candidate gene sequencing. High throughput or massively parallel sequencing is transforming the approach to diagnosis of rare diseases; however, evidence for cost-effectiveness is lacking. Patients presenting with suspected congenital muscular dystrophy or nemaline myopathy were ascertained over a 15-year period. Patients were investigated using traditional diagnostic approaches. Undiagnosed patients were investigated using either massively parallel sequencing of a panel of neuromuscular disease genes panel, or whole exome sequencing. Cost data were collected for all diagnostic investigations. The diagnostic yield and cost effectiveness of a molecular approach to diagnosis, prior to muscle biopsy, were compared with the traditional approach. Fifty-six patients were analysed. Compared with the traditional invasive muscle biopsy approach, both the neuromuscular disease panel and whole exome sequencing had significantly increased diagnostic yields (from 46 to 75% for the neuromuscular disease panel, and 79% for whole exome sequencing), and reduced the cost per diagnosis from USD$16,495 (95% CI: $12,413-$22,994) to USD$3706 (95% CI: $3086-$4453) for the neuromuscular disease panel and USD $5646 (95% CI: $4501-$7078) for whole exome sequencing. The neuromuscular disease panel was the most cost-effective, saving USD$17,075 (95% CI: $10,654-$30,064) per additional diagnosis, over the traditional diagnostic pathway. Whole exome sequencing saved USD$10,024 (95% CI: $5795-$17,135) per additional diagnosis. This study demonstrates the cost-effectiveness of investigation using massively parallel sequencing technologies in paediatric muscle disease. The findings emphasise the value of implementing these technologies in clinical practice, with particular application for diagnosis of Mendelian diseases, and provide evidence crucial for government subsidy and equitable access.

Exploring thermal anisotropy of cortical bone using temperature measurements in drilling.

BACKGROUND: Bone drilling is widely used in orthopaedics for fracture treatment, reconstructive surgery and bone biopsy. Heat generation in bone drilling can cause rise in bone temperature resulting in prolonged healing time or loosening of fixation. OBJECTIVE: The purpose of this study was to investigate thermal anisotropy of bone by measuring the level of temperature in bone drilling with and without cooling conditions in two anatomical directions. METHODS: Drilling tests were performed on bovine cortical bone. A total of fifteen specimens were used to obtain data for statistical analysis. Temperature near the cutting zone was measured in two anatomical directions. i.e. along the longitudinal and circumferential direction. Temperature distribution was also found in the two prescribed directions. Analysis of variance (ANOVA) was used to identify significant drilling parameter affecting bone temperature. RESULTS: Drilling speed, feed rate and drill size were found influential parameters affecting bone temperature. Higher drilling speed, feed rate, and large drill size were found to cause elevated temperature in bone. Much lower temperature was measured in bone when cooling fluid was supplied to the drilling region. Experimental results revealed lower temperatures in the circumferential direction compared to the longitudinal direction. CONCLUSIONS: Thermal anisotropy for heat transport was found in the bone. This study recommends lower drilling speed and feed rate and cooling for controlling rise in bone temperature.

In-vitro experimental analysis and numerical study of temperature in bone drilling.

BACKGROUND: Bone drilling is a common practice of surgical treatments in orthopaedics and traumatology. Penetration of a high-speed drill into bone tissue is accompanied by generation of a significant amount of heat. Cooling of the drilling region is necessary to avoid potential risk of thermal damage to bone. OBJECTIVE: The purpose of this study was to measure and predict bone temperature by conducting experiments and numerical simulations using cooling by means of irrigation at two different temperatures. METHODS: A series of experiments and numerical studies were performed to investigate the effect of cooling conditions on the rise in bone temperature in drilling. The temperature increase in bone was assessed for different drilling speeds and feed rates in the presence irrigation at 5 °C and 25 °C. RESULTS: Bone temperature was found to be strongly affected by the drilling parameters and cooling conditions. Irrigation with water at 5 °C kept bone temperature well below the thermal threshold level. CONCLUSION: This study strongly recommends the use of irrigation at lower temperature for safe surgical incision.

Diagnosis and management of laryngo-pharyngeal reflux.

The aim of the present paper was to analyze laryngo-pharyngeal reflux (LPR) manifestations in ENT patients, and present a diagnostic and treatment algorithm for appropriate management. Retrospective chart review of 150 patients, who had initially presented with symptoms suggestive of LPR. Treatment included the administration of omeprazole 20 mg twice daily for at least 4 weeks. Unresponsive patients were also given metoclopramide 10 mg twice daily for four additional weeks, and the dose of omeprazole was increased to 40 mg twice daily, if they did not achieve complete symptom resolution. Only patients who became completely asymptomatic after LPR treatment were included in the study. As many as 18 % of patients attending an ENT outpatient department benefited from anti-reflux treatment. A need to clear the throat represented the most common symptom, whereas interarytenoid oedema/congestion was the most common finding on flexible naso-endoscopy (62.67 and 72.7 % of patients, respectively). The vast majority of patients responded after 4 weeks of treatment with omeprazole, however, as many as 32 % of LPR patients achieved complete symptom control after the initial 4 week trial period. LPR seems to be more common than previously reported in the literature. Appropriate management of LPR can prevent the symptomatic use of various medical treatments for related manifestations, and even surgical interventions, thus decreasing the overall patient morbidity.

Coexistent Papillary Carcinoma of Thyroid and Hashimoto's Thyroiditis - Diagnosis on Fine Needle Aspiration Cytology.

Hashimoto's thyroiditis is associated with an increased risk of developing papillary carcinoma of thyroid. We hereby report a case of Hashimoto's thyroiditis with papillary carcinoma in a 45-year-old ear old female diagnosed on fine needle aspiration cytology (FNAC) which was later confirmed on histopathological examination .Such an occurrence, when both lesions are picked up on FNAC in a patient with no palpable thyroid nodule is rare. The case is presented here for its rarity.

Analysis of forces in conventional and ultrasonically assisted plane cutting of cortical bone.

Bone cutting is a well accepted but technically demanding surgical procedure in orthopaedics. A level of tool penetration force during cutting of bones has been the prime concern to surgeons, since it can produce unnecessary mechanical damage to surrounding tissues. Research in this area has been undertaken for many decades to find ways to minimise the cutting force. Cutting of bone with ultrasonic tools is a relatively new technique replacing conventional procedures in neuro-, dental and orthopaedic surgeries, due to its precision and safety. In this article, the level of forces produced during a chisel-like tool penetration in a fresh cortical bone is studied. The obtained force data are analysed for both conventional cutting and ultrasonically assisted cutting. Through a series of experiments, it was demonstrated that the depth of cut and parameters of ultrasonic oscillations affected the level of cutting force, the former being the main factor in both types of cutting. It was found that the tool penetration force was decreased with an increase in the ultrasonic frequency or amplitude and was not affected by the cutting speed. The rise in bone temperature was measured and was found to be insensitive to the level of cutting speed within the range used in this study.