Clinicopathologic Study of Sickle Cell-associated Kidney Disease: A Nigerian Experience.

BACKGROUND: Improvements in sickle cell disease (SCD) care have resulted in the survival of many patients into adulthood, although this is accompanied by the increased incidence of end-organ damage, including chronic kidney disease (CKD). OBJECTIVES: This study assessed the prevalence, pattern and predictors of renal dysfunction in SCD patients and investigated the associated renal histopathologic changes. METHODS: We evaluated 105 patients with SCD, for proteinuria, estimated glomerular filtration rate (eGFR), and tubular dysfunction. Renal biopsy was conducted on 22 patients who qualified. Data were analysed using SPSS package version 23. RESULTS: Thirty-seven (35.2%) of the 105 patients had CKD, as defined by an eGFR of 60 ml/min/1.73 m2 and/or proteinuria. The fractional excretion of potassium (FEK) was elevated in all patients, whereas the fractional excretion of sodium (FENa) was elevated in 98.1%. Glomerular filtration rate was negatively correlated with irreversible percentage sickle cell count (r = -0.616, P = 0.0001), FEK (r = -0.448, P = 0.0001) and FENa (r = -0.336, P = 0.004). Age, irreversible percentage sickle cell count, haemoglobin levels and FENa were the major predictors of CKD. The histological pattern in the 22 patients who had biopsies was consistent with mesangioproliferative glomerulonephritis 11 (50%), minimal change disease 6 (27.3%), focal segmental glomerulosclerosis 3 (13.6%) and interstitial nephritis 2 (9.1%). CONCLUSIONS: CKD was prevalent in SCD patients, and it was characterised by tubular dysfunction and mesangioproliferative glomerulonephritis. The main predictors of CKD were increased age, severity of vaso-occlusive crisis, worsening anaemia and tubular dysfunction.

Association Between Helicobacter pylori Infection and Migraine: A Systematic Review.

Migraine is a highly debilitating disease affecting humans worldwide. Despite having known this disease for a long time, not many studies have been done to search for a chronic infectious cause of migraine. The goal of this study was to look for an association between migraine and Helicobacter pylori infection. Following the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) standards, we conducted the analysis and literature search using PubMed, Google Scholar and Cochrane databases. After applying the inclusion and exclusion criteria, the search technique produced a total of 10 articles including one cross-sectional study, two randomized controlled trials (RCTs), one cohort study, five case-control studies and one meta-analysis. Analysis of these studies revealed that there could be an association between Helicobacter pylori infection and migraine, especially in the Asian population. However, the mechanism by which the infection could possibly cause this extra-gastric disorder needs further research and analysis.

Race/Ethnicity as a Risk Factor in the Development of Postpartum Hemorrhage: A Thorough Systematic Review of Disparity in the Relationship Between Pregnancy and the Rate of Postpartum Hemorrhage.

Postpartum hemorrhage (PPH) is a major cause of maternal death and morbidity worldwide. Throughout the years, there have not been many studies looking into the association of race and ethnicity with the occurrence of PPH. The goal of this study was to assess race and ethnicity as risk factors in the development of PPH in pregnant women. Following the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) standards, we conducted the analysis and conducted a literature search using Google Scholar and PubMed. After applying our inclusion and exclusion criteria, the search technique yielded a total of eight articles. The analysis included seven observational studies and one randomized controlled trial. The incidence of PPH was chosen as the major outcome measure. An evaluation of eight studies revealed that although Hispanics, Asians, Native Hawaiians, and other Pacific Islanders (NHOPI) have a higher chance of developing PPH caused by uterine atony, Caucasians had a greater rate of transfusion than the other groups. In addition, compared to Caucasians, African Americans or African descendants had a lower risk of atonic PPH but increased odds of atonic PPH requiring interventions. On the other hand, compared to non-native groups, Native Americans had increased odds of uterine atony. The results showed that, in contrast to other races/ethnicities, Caucasians had the lowest risk of PPH. Additionally, it was shown that African Americans or those descended from Africans had a higher chance of PPH but a lower risk of atonic PPH.

Radiofrequency Ablation as an Effective Long-Term Treatment for Chronic Sacroiliac Joint Pain: A Systematic Review of Randomized Controlled Trials.

Radiofrequency ablation (RFA) has emerged as a popular intervention for chronic pain management, including pain originating in the sacroiliac joint. It offers a less invasive option than surgery but with better results than the previous standard treatment with steroid and anesthetic injections. Procedure volumes have enjoyed significant growth in the market in recent years. The evidence supporting this intervention, in the form of randomized controlled trials, however, is both thin and mixed. The purpose of this systematic review is to evaluate the body of randomized controlled trials (RCTs) to determine the quality of support for and against the use of radiofrequency ablation to treat sacroiliac joint (SIJ) pain. Several important new papers have emerged since previous systematic reviews with similar objectives were published. The review was conducted according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, and three databases were used: PubMed, Google Scholar, and Scopus. Only RCTs were sought, and no other filters, such as a historical timeline cut-off, were used. Among 95 publications that returned in response to the query, 16 were ultimately accepted as meeting the inclusion/exclusion criteria. The Cochrane risk-of-bias tool was utilized as a quality assessment measure, and the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) framework was used to assess the certainty of the evidence. Among the included publications, 15 out of 16 publications featured positive results and conclusions that supported the use of RFA in treating chronic sacroiliac joint pain. The single negative study was also the largest trial (n=681), but it was identified as "High Risk" using the Cochrane risk-of-bias tool. It included several design flaws including neither operator nor patient blinding, missing information, use of inconsistent treatment modalities across groups, and disproportionate drop-out rates. Despite its flaws, we have included this study in the present review because of its sheer size. Taken in aggregate, the total body of research included in this review supports this intervention. Questions continue to exist around whether there are clinically significant benefits associated with different RFA modalities (for example, unipolar vs. bipolar), with convincing evidence supporting each of them. Finally, it can be concluded that while the benefits are reasonably and justifiably supported in this patient population for up to one year, there is a dearth of evidence beyond a 12-month post-intervention follow-up.

Diabetes, Polycystic Ovarian Syndrome, Obstructive Sleep Apnea, and Obesity: A Systematic Review and Important Emerging Themes.

Type 2 diabetes mellitus (DM), polycystic ovarian syndrome (PCOS), obstructive sleep apnea (OSA), and obesity represent four large and growing patient populations. A great deal of scientific and clinical knowledge has been developed for them individually, and significant advancements made. Taken as a group, however, the interrelationships are not as well understood. The purpose of this systematic review is to identify the body of existing research that ties them together and then to identify and discuss the prevailing themes, particularly for cause-and-effect mechanisms. PubMed, Google Scholar, and ScienceDirect were used to identify systematic reviews and meta-analysis articles to establish the broadest reach. Initially, 434 articles were carefully screened, out of which 22 most relevant studies were reviewed. Five important themes were distilled from these papers based on continued and consistent emphasis in the literature. These themes include topics such as the importance of considering visceral obesity rather than Body Mass Index (BMI), the most effective treatment approaches, including mounting support for melatonin and circadian rhythm management, the results of OSA in its feed-forward contribution to hormone imbalance, the role of non-obesity-related risk factors to PCOS and OSA such as age and genetic predisposition, and growing evidence to suggest the importance of mental health as a comorbidity in addition to the more traditional ones such as cardiovascular pathology. A new framework for investigating the interaction across these four disorders is offered that includes a revised perspective on the specific role of PCOS, perhaps being further upstream relative to the others. There currently exists a lack of well-designed randomized controlled trials in this particular area of medicine, an endeavor we believe could result in significant value, particularly as it relates to treatment approaches.

A Systematic Review of Sodium-Glucose Cotransporter 2 (SGLT2) Inhibitors and Sympathetic Nervous System Inhibition: An Underrated Mechanism of Cardiorenal Protection.

Sodium-glucose cotransporter 2 (SGLT2) inhibitors have many actions beyond glycemic control. The drug leads to favorable cardiovascular and renal outcomes. In this review, we focused on how SGLT2 inhibitors produce these outcomes and what role it plays in the inhibition of the sympathetic nervous system in diabetic patients. We searched PubMed, Google Scholar, and Biomed Central databases from January 2016 to February 2022. The authors used specific keywords and the Medical Subject Heading (MeSH) strategy. We identified a total of 3,961 records. Strict inclusion-exclusion criteria were followed to gather relevant data. From 3,961 results found through electronic databases, we finally selected 161 studies after the removal of duplicates, excluding irrelevant studies and those that did not fall into inclusion criteria. Forty-one studies underwent an extensive content search and quality appraisal using specific tools. It included a total of 12 best studies to conduct the systematic review supporting data from 17 other studies. Our review found that the SGLT2 inhibitors significantly reduced cardiovascular endpoints, including cardiovascular death, heart failure hospitalization, and all-cause mortality, with varying effects on major adverse cardiovascular (MACE). There were nominal improvements in renal outcomes (decline in renal disease progression, decreased albuminuria, less need for renal replacement therapy [RRT], and stable estimated glomerular filtration rate [eGFR]). Inhibition of the sympathetic nervous system (SNS) is an important and under-studied mechanism of SGLT2 inhibitors. This systematic review explores that SGLT2 inhibitors decrease the time to first cardiovascular event or death, less heart failure hospitalizations (HFH), and reduced MACE. Improvements in renal function preserved eGFR and reduction in RRT. Also, this drug inhibits SNS further by aiding in cardiorenal protection.

Hematopoietic stem and progenitor cells directly participate in host immune response.

The properties of hematopoietic stem and progenitor cells (HSPCs), including self-renewal and pluripotency, have been extensively studied. These features have been explored in the management of several haematological disorders and malignancies. Although their role as precursors of innate immune cells is well understood, little is known about their direct participation in host immune response. In this review, we explicate the direct role of HSPCs in the host immune response and highlight therapeutic options for the infectious disease burden that is currently ravaging the world, including COVID-19.

Osteogenic Sarcoma: A 21st Century Review.

Compared to other bone tumors, bone osteogenic sarcoma (BOS) continues to confer a much grimmer prognosis as the survival benefit of traditional chemotherapy treatment regimens is still unsatisfactory. Chemotherapy was demonstrated to be effective in eradicating both primary tumor and pulmonary metastases in the last century, with effective agents used in various combination regimens having changed the survival rate from less than 10% to 75%. The most common primary bone cancer, BOS is conventionally a primary intramedullary high-grade malignant tumor characterized by malignant cells forming immature bone or osteoid. BOS is a disease with diverse morphological presentations. The treatment of all morphological variants seem to have been the same for over 30 years. The introduction of antiproliferative agents such as insulin growth factor-binding protein 3 hold promise of a potentially veritable therapeutic target. In this review, we highlight recent data on osteosarcoma to consolidate a platform able to connect bench and bedside.

Comparison of the depth of tissue necrosis between double-freeze and single-freeze nitrous oxide-based cryotherapy.

BACKGROUND: Cryotherapy is one the methods of treating cervical premalignant lesions. It is particularly suitable for low-resource countries because of it is relative cheaper, has low cost of maintenance, ease of use and that does not require electricity which is in short supply in many rural areas of developing countries where the incidence and mortality from cervical cancer is very high. In this study we compared single and double freezing on the cervices of women admitted for hysterectomy for benign conditions using Nitrous-based cryotherapy. MATERIALS AND METHODS: Patients admitted for elective hysterectomy for benign gynaecological conditions were randomized into two arms. The first group had single freeze cryotherapy while the second arm received double freeze cryotherapy. The cervices were examined 24 hours later to determine the depth of tissue necrosis. RESULTS: In this comparative study, the depth of tissue necrosis was deeper with double freeze compared with single freeze. Also in both arms, the depth of necrosis was deeper on anterior lips than on posterior lips of the cervix. CONCLUSION: Double freeze technique achieve more depth of tissue necrosis than single-freeze on both anterior and posterior lips of the cervix.

Surgical outcome of abdominoperineal resection for low rectal cancer in a Nigerian tertiary institution.

BACKGROUND: Rectal cancer is a lifestyle-related illness with an increasing incidence in all developing countries in the last decade. Abdominoperineal resection (APR) offers a good oncologic clearance for low rectal cancer. The remaining controversies surrounding APR, as it is performed in a tertiary center in Nigeria, involve defining the role the operation plays in the management of existing rectal problems and determining what outcomes can be expected. The present study was aimed at examining the surgical outcomes of APR for low rectal cancers in a Nigerian tertiary institution. MATERIALS AND METHODS: This single-institution, retrospective, descriptive study analyzed APR rate, patient sex and age, subsite involvement, the diagnostic process, follow-up, and survival patterns after treatment of low rectal cancers. The study was conducted at Obafemi Awolowo University Teaching Hospital Complex Ile-Ife, Nigeria, between January 1989 and December 2007. RESULTS: During the 18-year period, 36 patients underwent APR. This accounts for 24.0% of all patients that had low rectal cancer. The age of the patients ranged from 29 years to 74 years (median: 58.9 years). Most of the patients were 60 years of age or older, and the majority were women (55.9%). The median duration of symptoms was 12 months, and all patients sought medical care for bleeding per rectum. Close to 80% of patients had advanced disease at presentation. Postoperatively, 17 patients (50%) had at least one complication and one patient (2.9%) died. Four (11.8%) patients had recurrence of the tumor, and in every case, recurrence occurred within the first year after operation. Operative blood loss (p = 0.006), degree of differentiation of the tumor (p = 0.011), distance from the anal verge (p = 0.033), and operative stage (p = 0.005) were found to significantly affect the outcome of treatment for the patients who underwent APR. The operative stage similarly affected the survival of patients (Mantel Cox = 0.026). CONCLUSIONS: Despite the advanced disease of our patients, the outcome of management appears to be comparable with results reported from other centers.

Focal segmental glomerulosclerosis and nephrotic syndrome in a child with embryonal rhabdomyosarcoma.

A case of nephrotic syndrome (NS) and acute renal failure (ARF) associated with embryonal rhabdomyosarcoma (RMS) in a 10-year-old boy is reported. Ultrasound revealed irregular, echogenic, circumferential urinary bladder base mass, bilateral hydroureter and hydronephrosis. Histopathology of percutaneous renal and urethrocystoscopic biopsy specimens, respectively, revealed focal segmental glomerulosclerosis (FSGS) and embryonal RMS. Tumour remission was induced with pulse doses of intravenous vincristine, cyclophosphamide, methotrexate and actinomycin D over a 15-month period. He has been followed-up for 28 months and has maintained a drug-free tumour and proteinuria remission for 1 year. While some malignancies have been reported in association with NS, its occurrence in association with RMS is quite exceptional. We conclude that RMS may be associated with FSGS and NS. Effective treatment of the RMS was associated with sustained remission of the nephrotic proteinuria.

Xanthogranulomatous orchitis in an adult Nigerian.

Xanthogranulomatous orchitis (XGO) is a rare benign disease of the testis which has not been previously documented in tropical Africa. We report a case of a 24-year-old Nigerian man who presented with a painless left hemiscrotal swelling. Our clinical diagnosis was left testicular cancer. Testicular tumor markers were normal. At surgical exploration, we found a left testicular tumor. Histopathological examination of the specimen showed XGO of the left testis. He had left radical orchiectomy and left inguinal node dissection. He has remained stable 8 months after the treatment. Xanthogranulomatous orchitis cannot be distinguished clinically from testicular cancer unless by histopathological examination. Orchiectomy is the treatment of choice. However, in all patients and particularly young patients and those with a single testis, histopathological confirmation is suggested to avoid unnecessary radical orchiectomy, useless irradiation and ill-timed chemotherapy.