UPPER GASTROINTESTINAL TRACT ENDOSCOPY: A RETROSPECTIVE ANALYSIS OF INDICATIONS AND FINDINGS AT ATBUTH BAUCHI.

Introduction: Upper gastrointestinal (UGI) endoscopy is considered a safe procedure performed for diagnosis, monitoring the course of disease, early detection of complications, treatment, and responses to therapeutic intervention. The indications have increased over the years. This study aimed to analyse the indications, findings, and safety of UGI endoscopy in our environment. Methodology: A retrospective study of consecutive patients who had UGI endoscopy at ATBUTH over the period of two years (2014 -2016). Data extracted from the records of the patients including biodata, clinical presentation, indications, findings, and complications of the procedure was analyzed using SSPS version 26. The procedure was explained to each patient. After a spray of 10% xylocaine spray to the patient's pharynx, the procedure was carried out with an Olympus CV-170 machine using standard protocols and monitoring of vital signs throughout. Results: Two hundred and fifty-two patients were included, 148 (58.7%) males, 104 (41.3%) females, age range of 17-85 years (mean age ± SD = 44.1 ± 15.2). The commonest indications were dyspepsia 160 (63.5%). Hematemesis 32 (12.7%), suspicion for gastric 9(3.6%), and oesophageal tumours 6(2.4%) were also indications. The most common finding was gastritis 67 (26.6%). There was increased detection of gastric 11(4.4%) and oesophageal tumours 8(3.2%) more than clinical acumen and in elderly patients with troublesome symptoms. None of the patients developed complications from the procedure. Conclusions: UGI endoscopy is a safe procedure, and detects gastric and oesophageal tumours more accurately than clinical acumen and is recommended in all patients with troublesome upper GI symptoms.

Diagnostic usefulness of serum procalcitonin in patients with bacterial sepsis.

Background: The Sequential Organ Failure Assessment (SOFA) score is used for the diagnosis of sepsis and involves clinical and laboratory parameters that may not be readily and/or timely available in most resource-poor settings. Procalcitonin (PCT) has its level changed in response to bacterial sepsis and its measurement costs only a fraction of the total cost of investigations required to calculate SOFA score. This study aims to determine the diagnostic usefulness of PCT in bacterial sepsis. Materials and Methods: Ninety-nine participants were studied, divided into three groups: apparently healthy volunteers, those with bacterial infection without sepsis (SOFA score <2), and patients with bacterial sepsis (positive culture and SOFA ≥2). PCT level of each participant was measured and median group levels compared. Pearson's correlation was used to determine the correlation between serum PCT levels and SOFA scores in the sepsis group using a significance level of 5 percent (P < 0.05). Diagnostic usefulness of PCT was assessed using receiver operating characteristic (ROC). Result: Positive correlation was found between serum PCT levels and SOFA scores among patients with sepsis r = 0.42, P = 0.016. At a concentration of ≥4.25 ng/ml, serum PCT as a surrogate for SOFA score had a sensitivity and specificity of 57.60% and 84.80%, respectively, for indicating sepsis. The area under the ROC curve (AUC) was 0.74 (95% CI {0.62 to 0.86}, P = 0.001). Conclusion: Serum PCT concentration was significantly higher in bacterial sepsis compared to bacterial infection without sepsis and healthy state. PCT concentration demonstrated positive correlation with SOFA score in bacterial sepsis and can be used as surrogate for sepsis screening/monitoring in resource-poor settings.

Clinical indication-based diagnostic reference levels for paediatric head computed tomography examinations in Kano Metropolis, northwestern Nigeria.

INTRODUCTION: Paediatric patients are recognised to be at higher risk of developing radiation-induced cancer than adults because of rapidly growing organs and tissues which are vulnerable to cellular damage. The aim of the study was to determine indication based Diagnostic Reference Levels (DRLCI) for paediatric head computed tomography (CT) examinations within Kano metropolis, Nigeria. METHODS: CT dose index (CTDIvol), dose length product (DLP) and other scan parameters were recorded for 113 paediatric undergoing CT head examinations. Different clinical indications were recorded and categorised in addition to patient age. Third quartile values (75th percentile) of the median dose were considered as DRLCI. Analysis of Variance (ANOVA) was used to test for differences between DRLCI, for different age groups, and variations among institutions. The Statistical Package for Social Sciences version 23.0 was used for analysis. Statistical significance was set at p < 0.05. RESULTS: DRLCI for Hydrocephalus for <5 years and 5-10 years was 28.10 mGy and 28.11 mGy with DLP of 1623.20 mGy cm and 1623.21 mGy cm, respectively. The 11-15 year group recorded 29.10 mGy and 1625.20 mGy cm. Indications of haemorrhage/trauma and post-seizure imaging all had same values for <5 years and 5-10 years (28.10 mGy and 1623.20 mGy cm) while the 11 to 15-year group recorded 39.60 mGy and 1626 mGy cm. Intracranial Space Occupying lesion had the same DRLCI value for < 5years and 5-10 years (29.0 mGy and 1600 mGy cm, respectively) the 11 to 15-year group recorded values of 46.20 mGy and 1663.4 mGy cm. There was no statistically significant difference between DRLCI for <5 years and 5 to 10-year age groups (p = 0.199), while different centres showed some statistically significant relationships (p = 0.02). CONCLUSION: The study noted dose differences between age groups less than 10 years and above ten years, there were some statistically significant relationship with DRLCI. Dose optimisation techniques for paediatric examinations together with selection of the right protocol for paediatric head CT are necessary. IMPLICATIONS FOR PRACTICE: The study has provided DRLCI for paediatric head CT examinations. These values can be used for future comparisons and as a potential dose optimisation tool. Such data can also guide radiographers when selecting appropriate parameters for indication-based CT examination to help achieve a low dose with acceptable image quality.

Structural and binding studies of phosphopantetheine adenylyl transferase from Acinetobacter baumannii.

Phosphopantetheine adenylyltransferase (PPAT, EC. 2.7.7.3) catalyzes an essential step in the reaction that transfers an adenylyl group from adenosine tri phosphate (ATP) to 4'-phosphopantetheine (pPant) yielding 3'- dephospho-coenzyme A (dPCoA) and pyrophosphate (PP) in the coenzyme A (CoA) biosynthesis pathway. The enzyme PPAT from Acinetobacter baumannii (AbPPAT) was cloned, expressed and purified. The binding studies of AbPPAT were carried out with two compounds, tri­sodium citrate (TSC) and l-ascorbic acid (LAA, vitamin-C) using fluorescence spectroscopic (FS) and surface Plasmon resonance (SPR) methods. Both methods provided similar values of dissociation constants for TSC and LAA which were of the order of 10-8 M and 10-5 M respectively. The computer aided docking studies indicated fewer interactions of LAA with AbPPAT as compared to those of TSC. The freshly purified samples of AbPPAT were crystallized. The crystals of AbPPAT were soaked in the solutions containing TSC and LAA. However, the crystals of the complex of AbPPAT with LAA did not diffract well and hence the structure of the complex of AbPPAT with LAA could not be determined. On the other hand, the crystals of the complex of AbPPAT with TSC diffracted well and the structure was determined at 1.76 Šresolution. It showed that TSC bound to AbPPAT at the ATP binding site and formed several intermolecular contacts including 12 hydrogen bonds. The results of binding studies for both TSC and LAA and the structure of the complex of AbPPAT with TSC clearly indicated a potential role of TSC and LAA as antibacterial agents.