Gastro-duodenal disease in Africa: Literature review and clinical data from Accra, Ghana.

Gastroduodenal disease (GDD) was initially thought to be uncommon in Africa. Amongst others, lack of access to optimal health infrastructure and suspicion of conventional medicine resulted in the reported prevalence of GDD being significantly lower than that in other areas of the world. Following the increasing availability of flexible upper gastro-intestinal endoscopy, it has now become apparent that GDD, especially peptic ulcer disease (PUD), is prevalent across the continent of Africa. Recognised risk factors for gastric cancer (GCA) include Helicobater pylori (H. pylori), diet, Epstein-Barr virus infection and industrial chemical exposure, while those for PUD are H. pylori, non-steroidal anti-inflammatory drug (NSAID)-use, smoking and alcohol consumption. Of these, H. pylori is generally accepted to be causally related to the development of atrophic gastritis (AG), intestinal metaplasia (IM), PUD and distal GCA. Here, we perform a systematic review of the patterns of GDD across Africa obtained with endoscopy, and complement the analysis with new data obtained on pre-malignant gastric his-topathological lesions in Accra, Ghana which was compared with previous data from Maputo, Mozambique. As there is a general lack of structured cohort studies in Africa, we also considered endoscopy-based hospital or tertiary centre studies of symptomatic individuals. In Africa, there is considerable heterogeneity in the prevalence of PUD with no clear geographical patterns. Furthermore, there are differences in PUD within-country despite universally endemic H. pylori infection. PUD is not uncommon in Africa. Most of the African tertiary-centre studies had higher prevalence of PUD when compared with similar studies in western countries. An additional intriguing observation is a recent, ongoing decline in PUD in some African countries where H. pylori infection is still high. One possible reason for the high, sustained prevalence of PUD may be the significant use of NSAIDs in local or over-the-counter preparations. The prevalence of AG and IM, were similar or modestly higher over rates in western countries but lower than those seen in Asia. . In our new data, sampling of 136 patients in Accra detected evidence of pre-malignant lesions (AG and/or IM) in 20 individuals (14.7%). Likewise, the prevalence of pre-malignant lesions, in a sample of 109 patients from Maputo, were 8.3% AG and 8.3% IM. While H. pylori is endemic in Africa, the observed prevalence for GCA is rather low. However, cancer data is drawn from country cancer registries that are not comprehensive due to considerable variation in the availability of efficient local cancer reporting systems, diagnostic health facilities and expertise. Validation of cases and their source as well as specificity of outcome definitions are not explicit in most studies further contributing to uncertainty about the precise incidence rates of GCA on the continent. We conclude that evidence is still lacking to support (or not) the African enigma theory due to inconsistencies in the data that indicate a particularly low incidence of GDD in African countries.

Immunocytochemically defined populations of neurons progressively increase in size through embryogenesis of Hydra vulgaris.

The hydra nervous system shares many features with nervous systems of more complex organisms but serves as a unique model system due to its simplicity and constant regeneration. Development of neuron populations during and after hydra embryogenesis is not well understood. In this study, neurons were identified at prehatching and posthatching stages with RFamide or JD1 antisera. These populations were further subdivided into ganglion, sensory, or unclassifiable neurons, and all identified populations were statistically analyzed over developmental time. RFamide-positive neurons appeared 20 days after the cuticle formed around the embryo. The JD1-positive neuron population appeared just after hatching, but by adulthood it had surpassed the size of the RFamide-positive population. All neuron populations progressively increased through their adult levels. Density of most of the populations, however, did not. For instance, during the 5-fold increase in size that the hydra experienced between 5 days posthatching and adulthood, the number of RFamide-positive neurons rose approximately 2-fold and the number of JD1-positive neurons 4-fold. However, the density of neurons in each of these populations fell. These data do not support the hypothesis that large-scale culling of neurons during development, frequently found in other animals, occurs in hydra.

Ultrastructure of the retinal synapses in cubozoans.

Cubomedusae (box jellyfish) are well known for strong directional swimming, rapid responses to visual stimuli, and complex lensed eyes comparable to those of more advanced multicellular animals. They possess a total of 24 eyes that are of four morphologically different types, yet little is known about the neural organization of their eyes. The eyes are located on ganglion-like structures called rhopalia. Each of the four rhopalia contains an upper and a lower lensed eye (with a cornea, lens, and retina), two pit ocelli, and two slit ocelli. Transmission electron microscopy was used to examine the synaptic morphology of the eyes and pacemaker region of four species of cubozoans (Tamoya haplonema, Carybdea marsupialis, Tripedalia cystophora, and Chiropsalmus quadrumanus). Invaginated synapses were found in all four species, but only in the upper and lower lensed eyes. Density measurements indicated that the invaginated synapses were located close to the basal region of photoreceptor cells, and size differences of invaginated synapses were observed between the upper and lower lensed eyes, as well as between species. Four additional types of chemical synapses-clear unidirectional, dense-core unidirectional, clear bidirectional, and clear and dense-core bidirectional-were also observed in the rhopalia. The invaginated synapses of the lensed eyes may be useful as markers to help sort out the neural circuitry in the retinal region of these complex cubomedusan eyes.

Evidence of a microtrabecular cytoskeletal lattice in glandular cells of hydrozoan planulae.

Hydrozoan planulae of Pennaria tiarella and Podocoryne carnea were processed for transmission electron microscopy using diethylene glycol distearate (DGD). The DGD functions as a removable embedding medium to produce embedment-free sections of intact planulae. Images of glandular cells obtained using embedment-free sections were compared with those from conventional Spurr-embedded sections. In unembedded sections a large number of thin anastomosing fibers were observed throughout the cytoplasm of the glandular cell. The fibers appeared to coalesce in certain areas to form thick bundles of fibers that partitioned the glandular cytoplasm into spherical compartments. The meshwork of fibers is three-dimensional and resembles a microtrabecular lattice. Mitochondria are suspended within and attached to the network of fibers, thus suggesting a cytoskeletal role of the fibers. This study documents the presence of a cytoplasmic fiber system within cells of intact invertebrate larvae.