Factors that predict development of chronic kidney disease in patients with rheumatoid arthritis receiving biologic DMARDs and mortality rates.

OBJECTIVES: We aimed to determine the choice of biologic/targeted synthetic disease-modifying anti-rheumatic drugs (b/ts-DMARDs), factors associated with the development of chronic kidney disease (CKD), and mortality in RA patients with CKD receiving b/ts-DMARDs. METHODS: Two thousand one hundred forty-one RA (79.4% female) patients were included in the analysis from the HUR-BIO prospective registry. Patients were divided into the CKD group and the non-CKD group. Age and gender-matched patients were selected from the non-CKD group, and then three main groups were determined. CKD was staged according to the glomerular filtration rate criteria. The clinical characteristics of the patients, disease activities, treatment choices, drug retention rate, and mortality rates were compared between the groups. RESULTS: CKD was detected in 90/2141 (4.2%) RA patients on b/ts-DMARDs. Forty patients (2.3%) developed CKD during follow-up after the initiation of b/ts-DMARDs. In the CKD group, anti-TNF agents were chosen as the first-line b/ts-DMARDs therapy in 64.4% of patients, with etanercept leading in 31 (34.4%) patients. In multivariate analysis, age at the start of treatment, DAS-28-ESR at last visit, amyloidosis, hypertension, and history of smoking were the factors associated with the development of CKD in RA patients receiving b/ts-DMARDs. The mortality rate in RA-CKD patients until the onset of the pandemic was 15.41 per 1000 patient years, whereas it was 85.9 per 1000 patient years after the pandemic. CONCLUSION: Comorbidities and control of disease activity are critical in the development of CKD in RA patients receiving b/ts-DMARDs. While there was no significant difference in mortality rate between CKD and non-CKD patients, the overall mortality rate increased after the COVID-19 pandemic duration in both groups.

Drug therapy and medication adherence in type 2 diabetes in a care facility: A cross sectional survey.

Background: Adherence to medications improves glycaemic control and reduces diabetes-related morbidity and mortality. Objectives: The study assessed drug therapy for type 2 diabetes, glycaemic control and association of medication adherence with socio-demographic and clinical data, among adult diabetic patients attending a healthcare facility. Methods: Cross-sectional survey and hospital records were used to obtain data. The study included 200 adults with type 2 diabetes mellitus in a Nigerian healthcare facility. Data on patients clinical characteristics, diabetes drug therapy and medication adherence were collected, entered and anlaysed using SPSS version 24 (P < 0.05). Primary outcome measure was medication adherence among the patients, while secondary outcome measures was glycaemic control. Results: A total of 200 (100%) respondents participated in the study and the majority 141(70.5%) were over 60 years old. Oral medications were mostly used 187(93.5%), particularly, metformin 199(99.5%) and pioglitazone 100(50.0%), while dipeptidyl peptidase-4 inhibitors were not used at all. Patients mostly had poor glycaemic control 159 (79.5%) and majority 152(76.0%) did not practice self-blood glucose monitoring. Moderate medication adherence was predominant in the population. Class of medicine and socio-demographics were not significantly associated with medication adherence (P > 0.05), unlike results of blood glucose self-tests (p = 0.001). Conclusion: Oral antidiabetics, particularly metformin and pioglitazone were mostly used. Poor glycaemic control and moderate adherence were found in the patients, and medication adherence was associated with self-glucose monitoring. This emphasises the need for regular diabetes education on medication adherence.

Pharmacy students' perceptions on the health and pharmaceutical care needs of older adults.

INTRODUCTION: Perceptions of pharmacy students as future health care providers can enhance the health and pharmaceutical care (PC) needs of older adults. The objective of this study was to investigate pharmacy students' awareness and perceptions of the health and PC needs of older adults. METHODS: A cross-sectional survey was conducted among pharmacy students in Southwest, Nigeria for four weeks using a 39-item structured questionnaire. Unpaired t-tests and one-way analysis of variance were performed. A P < .05 was considered significant. RESULTS: Based on 422 completed questionnaires, 299 (70.9%) were females, 283 (67.1%) were 20 to 24 years, 123 (29.2%) were in 200 Level, 402 (95.3%) had heard of PC with their first source of information being pharmacy school, 352 (83.4%). Reliability of the instrument was 0.92 (Cronbach's alpha). Mean + SD of pharmacy students' perceived health and PC needs of older adults were 3.73 ±â€¯1.176 and 4.21 ±â€¯1.031, respectively. The majority, 355 (84.2%), agreed on the importance of health care providers understanding their geriatric patients' family circumstances and social environment and 381 (90.3%) perceived that such will strengthen their professional relationship with older adults. CONCLUSIONS: Pharmacy students were aware of PC and indicated positive attitudes towards caring for older adults but few had provided care. Reinforcement of PC training and emphasis on geriatric topics in pharmacy curriculum are reiterated.

Comparative pathology, molecular pathogenicity, immunological features, and genetic characterization of three highly pathogenic human coronaviruses (MERS-CoV, SARS-CoV, and SARS-CoV-2).

The last two decades have witnessed the emergence of three deadly coronaviruses (CoVs) in humans: severe acute respiratory syndrome coronavirus (SARS-CoV), Middle East respiratory syndrome coronavirus (MERS-CoV), and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). There are still no reliable and efficient therapeutics to manage the devastating consequences of these CoVs. Of these, SARS-CoV-2, the cause of the currently ongoing coronavirus disease 2019 (COVID-19) pandemic, has posed great global health concerns. The COVID-19 pandemic has resulted in an unprecedented crisis with devastating socio-economic and health impacts worldwide. This highlights the fact that CoVs continue to evolve and have the genetic flexibility to become highly pathogenic in humans and other mammals. SARS-CoV-2 carries a high genetic homology to the previously identified CoV (SARS-CoV), and the immunological and pathogenic characteristics of SARS-CoV-2, SARS-CoV, and MERS contain key similarities and differences that can guide therapy and management. This review presents salient and updated information on comparative pathology, molecular pathogenicity, immunological features, and genetic characterization of SARS-CoV, MERS-CoV, and SARS-CoV-2; this can help in the design of more effective vaccines and therapeutics for countering these pathogenic CoVs.

Pharmacy graduates' perceptions of competency, integration, and social accountability in the undergraduate curriculum of pharmacy schools in Nigeria.

INTRODUCTION: An integrated, competency-based curriculum that fosters social accountability including cultural sensitivity among graduates is an educational strategy towards producing practice-ready professionals. This study aimed to evaluate pharmacy graduates' perceptions of competency, integration, and social accountability in the undergraduate curriculum of Nigerian schools of pharmacy. METHODS: A cross-sectional online survey consisting of a 42-item questionnaire was administered to 467 purposively selected pharmacy graduates who completed their undergraduate training between January 2012 and February 2020 from 20 accredited Nigerian pharmacy schools. Mann-Whitney U test was used to determine the differences in the participants' responses on a Likert scale. RESULTS: Of 467 participants, 54.4% felt that the Nigerian undergraduate pharmacy curriculum was not adequate in content, while 54.2% felt the courses in the curriculum were not well integrated to facilitate easy learning by students. About half (50.6%) strongly agreed or agreed that "the basic pharmacy courses are well synchronized with the clinical components" but 28.9% strongly disagreed or disagreed. The majority (88%), with no significant difference between gender (z = -1.615, P = .11), strongly agreed or agreed that they apply knowledge of clients' culture and disparity to deliver pharmaceutical services. CONCLUSIONS: Marginally above half of the graduates perceived the Nigerian undergraduate pharmacy curriculum to be deficient in course content. There is evidence of limited integration and social accountability in the curriculum. Cultural sensitivity appears to be a component of the curriculum but this needs to be properly structured. The pedagogy strategy for learning cultural sensitivity should be further interrogated.

Racial disparities in COVID-19 hospitalizations do not lead to disparities in outcomes.

OBJECTIVES: The objective of the study is the identification of racial differences in characteristics and comorbidities in patients hospitalized for COVID-19 and the impact on outcomes. STUDY DESIGN: The study design is a retrospective observational study. METHODS: Data for all patients admitted to seven community hospitals in Michigan, United States, with polymerase chain reaction confirmed diagnosis of COVID-19 from March 10 to April 15, 2020 were analyzed. The primary outcomes of racial disparity in inpatient mortality and intubation were analyzed using descriptive statistics and multivariate regression models. RESULTS: The study included 336 Black and 408 White patients. Black patients were younger (62.9 ± 15.0 years vs 71.8 ± 16.4, P < .001), had a higher mean body mass index (32.4 ± 8.6 kg/m2 vs 28.8 ± 7.5, P < .001), had higher prevalence of diabetes (136/336 vs 130/408, P = .02), and presented later (6.6 ± 5.3 days after symptom onset vs. 5.4 ± 5.4, P = .006) compared with White patients. Younger Black patients had a higher prevalence of obesity (age <65 years, 69.9%) than older Black patients (age >65 years, 39.2%) and younger White patients (age < 65, 55.1%). Intubation did not reach statistical significance for racial difference (Black patients 61/335 vs. 54/406, P = .08). Mortality was not higher in Black patients (65/335 vs. 142/406 in White patients, odds ratio 0.61, 95% confidence interval: 0.37 to 0.99, 2-sided P = .05) in multivariate analysis, accounting for other risk factors associated with mortality. CONCLUSIONS: Higher prevalence of obesity and diabetes in young Black populations may be the critical factor driving disproportionate COVID-19 hospitalizations in Black populations. Hospitalized Black patients do not have worse outcomes compared with White patients.

Determinants of health-related quality of life among human immunodeficiency virus positive (HIV-positive) patients at Ahmadu Bello University teaching hospital, Zaria, Nigeria- 2015.

BACKGROUND: The advent of Highly Active Antiretroviral Therapy (HAART) is associated with improved clinical and laboratory outcomes resulting in prolonged life and well-being of people living with Human Immunodeficiency Virus (PLHIV). However, the needs for life-long therapy, medications' side effects and stigma have raised concerns about their quality of life (QOL). This study assessed the determinants of Health-related quality of life (HRQOL) among HIV-positive patients at Ahmadu Bello University Teaching Hospital (ABUTH) Zaria. METHODS: We conducted a cross-sectional study of 353 HIV-positive adults on HAART attending the HIV clinic of ABUTH, Zaria. The participants were recruited into the study using a systematic sampling technique. Data on socio-demographics, medical parameters, QOL and family functionality were collected using structured, interviewer-administered questionnaire. The World Health Organization (WHO) Quality of Life HIV short form instrument (WHOQOL-HIV BREF) item and Family APGAR tool were respectively used in assessing the QOL and family functionality of the participants. We performed univariate, bivariate and multivariate analysis. RESULTS: Mean age was 39.1(±10.9) years, 239 (67.7%) were females, 208 (58.9%) were Hausa-Fulani, 240 (68.2%) married and up to 210 (59.4%) had at least a secondary education. The overall mean scores on the scale of 4-20 for HRQOL were similar in three domains: environment domain 14.5(±2.8); social relationship 14.4(±3.1) and level of independence 14.4(±2.5). Lower scores were recorded in spirituality/religion/personal beliefs 12.3(±4.3). Identified determinants of HRQOL were spousal HIV- positive status (AOR = 3.37; CI; 1.46-7.74) and high family function (AOR = 2.57; CI: 1.51-4.39). CONCLUSION: Having highly functional family and having HIV-positive partner were the major determinants of HRQOL. Routine family counselling and strengthening the HIV social-support network should be incorporated into the routine patients' care in HIV treatment centers.

Effects of oxytocin administration on salivary sex hormone levels in autistic and neurotypical women.

BACKGROUND: Oxytocin administration, which may be of therapeutic value for individuals with social difficulties, is likely to affect endogenous levels of other socially relevant hormones. However, to date, the effects of oxytocin administration on endogenous hormones have only been examined in neurotypical individuals. The need to consider multi-hormone interactions is particularly warranted in oxytocin trials for autism due to evidence of irregularities in both oxytocin and sex steroid systems. METHODS: In this double-blind cross-over study, saliva samples were collected from 16 autistic and 29 neurotypical women before and after intranasal administration of 24 IU oxytocin or placebo. Oestradiol, testosterone, and oxytocin levels were quantified in saliva samples. Participants also completed the Autism-Spectrum Quotient (AQ) and Empathy Quotient (EQ) questionnaires. RESULTS: Distinct patterns of change in testosterone and oestradiol levels pre- to-post-administration were observed in autistic relative to neurotypical women (ANCOVA, p < 0.05 main effect of Group), controlling for sample collection time. The mean percent change oestradiol was + 8.8% for the autism group and - 13.0% for the neurotypical group (t = 1.81, p = 0.08), while the mean percent change testosterone was + 1.1% in the autism group and - 12.6% in the neurotypical group (t = 1.26, p = 0.22). In the oxytocin condition, the mean percent change oestradiol was + 12.6% in the autism group and - 6.9% in the neurotypical group (t = 1.78, p = 0.08), while the mean percent change testosterone was + 14.4% in the autism group and - 15.2% in the neurotypical group (t = 3.00, p = 0.006). Robust regression confirmed that group differences in percent change hormone levels were not driven by a small number of influential individuals. Baseline hormone levels did not differ between groups when considered individually. However, baseline testosterone relative to oestradiol (T:E2 ratio) was higher in autistic women (p = 0.023, Cohen's d = 0.63), and this ratio correlated positively and negatively with AQ and EQ scores, respectively, in the combined sample. LIMITATIONS: Further studies with larger and more diverse autistic sample are warranted to confirm these effects. CONCLUSIONS: This study provides the first evidence that oxytocin influences endogenous testosterone levels in autistic individuals, with autistic women showing increases similar to previous reports of neurotypical men. These findings highlight the need to consider sex steroid hormones as a variable in future oxytocin trials.

Avascular necrosis less frequently found in systemic lupus erythematosus patients with the use of alternate day corticosteroid

Background/aim: Avascular necrosis (AVN) is the death of bone due to compromise of blood flow. The etiology of AVN is multifactorial; corticosteroid usage is the second most significant factor after trauma, and systemic lupus erythematosus (SLE) is the most common underlying disease. The objective of this study was to assess the factors of AVN in SLE patients. Materials and methods: The study included 127 patients with SLE who fulfilled 1997 American College of Rheumatology (ACR) revised criteria. Demographic data, age at SLE diagnosis, disease duration, disease activity, body mass index, clinical findings, antiphospholipid syndrome, steroid usage, dose and duration, comorbid diseases, and smoking history were recorded. Results: AVN was found in 11 of 127 (8.7%) SLE patients. Hyperlipidemia (P < 0.001), cushingoid body habitus (P < 0.001), and proteinuria (P = 0.013) were found at higher rates in the AVN group. All of the 11 AVN cases had osteoporosis (P < 0.02). In multivariate regression analysis, daily steroid usage was the only factor for development of AVN in SLE. Conclusion: The hypothesis of our study was that an alternate day steroid regimen may decrease AVN frequency in SLE patients.

The knowledge, awareness, and perception of healthcare professionals about appropriate prescribing in the elderly: Findings from Nigeria and South Africa.

RATIONALE, AIMS, AND OBJECTIVES: Inappropriate prescribing is associated with preventable morbidity and mortality in the elderly. The American Geriatrics-Beers (AGS-Beers) Criteria was developed to guide healthcare professionals (HCPs) to prescribe medications appropriately in the elderly. However, there is a dearth of information about the knowledge and awareness of HCPs of these criteria, and their perceptions of appropriate prescribing in the elderly. This study aimed to evaluate the knowledge and perceptions of Nigerian and South African HCPs about appropriate prescribing in the elderly. METHOD: A 32-item questionnaire was self-administered among consecutively selected HCPs (physicians, nurses, and pharmacists) in one teaching hospital each in Nigeria and South Africa. Seven questions including six clinical vignettes from the 2015 AGS-Beers Criteria were used to assess the participants' knowledge.The participants' knowledge was classified based on the total score as poor (0-3), fair (4, 5), and good (6, 7). The HCPs' perceptions of appropriate prescribing in the elderly were evaluated using a 5-point Likert scale. Mann-Whitney U test was used to evaluate ranked variables at P < .05. RESULTS: A total of 369 participants, 62.9% (232/369) mean age 42.75(9.35) years in Nigeria and 37.1% (137/369), mean age 38.66 (7.76) years, (CI = 2.32-5.87, P < .001) in South Africa were evaluated. Many participants in Nigeria (52.6%) and 48.2% in South Africa had scores (4, 5).The majority of the participants (57.3%) in Nigeria and 67.2% in South Africa were not aware of any explicit criteria for prescribing to the elderly while 45.8% of the total participants with no significant difference between the groups (P = .332) "strongly agreed" or "agreed" that the basic professional training is adequate for prescribing medicines to the elderly. CONCLUSIONS: Many HCPs in Nigeria and South Africa had a fair knowledge of appropriate prescribing to the elderly and considered basic professional training as adequate for appropriate prescribing to the elderly.

Predictors of drug retention and treatment response in axial spondyloarthritis patients treated with certolizumab: real-life results from the HURBIO registry.

OBJECTIVES: To assess the real-life retention rate of certolizumab and factors related to retention of certolizumab. METHODS: We analysed all patients who received at least 1 dose of certolizumab and were registered in the HURBIO database. Patients with at least 1 control visit were included in efficacy analysis. Drug retention rates were calculated using the Kaplan-Meier method and predictors of drug retention was determined by Cox proportional hazard model. Factors predicting BASDAI50 response at first visit were analysed by the logistic regression analysis. Reasons of switching and discontinuation were also determined. RESULTS: A total of 325 (AS (76%), female 55%) patients were recruited. Median follow-up while receiving certolizumab was 13 (4.7-22.7) months. At 1 year, overall certolizumab retention rate was 72.5%. Predictors of poor certolizumab retention were: Current or ex-smoker [HR 1.11 (0.70-1.76), p=0.65], high CRP levels [HR 0.72 (0.45-1.16), p=0.18], biologic-naïve [HR 0.81 (0.49-1.32), p=0.39] and good BASDAI50 response at first control visit [HR 0.54 (0.30-0.96), p=0.04]. Mean duration from starting certolizumab to the first control visit was 3 (3-6) months. Predictors of poor BASDAI50 response: Presence of nr-axSpa [RR 2.12 (1.01-4.51), p=0.05], female gender [RR 2.14 (1.20-3.82), p=0.01] and history of biologic therapy [RR 3.52 (1.95-6.33), p<0.001]. The most common causes of drug switch were primary failure and drug side-effects. CONCLUSIONS: In this study, good BASDAI50 response at first visit seems to be a strong predictor of higher retention of certolizumab in patients with axial spondyloarthritis.

Medico-social characteristics of patients with eclampsia in a metropolitan hospital in North western Nigeria: is there a changing pattern?

Background: Eclampsia is a recognized cause of maternal and neonatal morbidity and mortality in North western Nigeria. It's a preventable obstetrics calamity were adequate antenatal care services are provided. Objective: To review medico-social characteristics of patients with eclampsia at a metropolitan Specialist Hospital in North-western Nigeria. Methodology: Eighty consecutive patients that presented with eclampsia at Murtala Mohammed Specialist Hospital were recruited for the study from 1st December, 2016 to 28th February, 2017. Data were collected using structured questionnaire, administered by research assistants. Information obtained included sociodemographic data, duration of fits before presentation and maternal-fetal outcome. Results: A total of 1931 patients delivered within the study period, among them 80 had eclampsia. This gives an incidence of 4.0%. Teenage pregnancy accounted for 35%. Forty-nine patients (61.2%) were primigravidae and up to 95% were booked. Majority of the patients 40(50%) had antepartum eclampsia while only 10(12.5%) had postpartum eclampsia. Most of the patients (73.8%) presented within 12 hours of convulsions and (87%) had vaginal delivery. There were 3 maternal deaths with case fatality rate of 3.8%. Live birth was achieved in 65%. Fresh still birth and Macerated still births were recorded in 20% and 12.5% respectively. Conclusion: The incidence of eclampsia is still high despite introduction of free maternity care services. Socio medical factors and poor quality of Antenatal Care services may be the contributing factors to development of eclampsia. There is need to review and improve the quality of antenatal care services offered at the primary health care centers

Inguinal hernia repair in Nigeria: a survey of surgical trainees.

PURPOSE: Africa's inguinal hernia burden is high with large numbers of untreated hernias. Mesh repair is recommended in developed countries, but the best repair in developing countries is unknown. Little is known about knowledge and practice of surgeons in Nigeria performing inguinal hernia repair. Surgical trainees can provide this information. METHODS: A questionnaire-based survey was administered to surgical trainees from all over Nigeria who had attended the West African College of Surgeons' integrated revision course in Jos, on their practice and recommendations concerning elective inguinal hernia repair. RESULTS: One hundred and nine surgical trainees (90.8%) consisting of 78 (71.6%) registrars and 30 (27.5%) senior registrars responded. Thirty-two (29.4%) used antibiotics routinely for inguinal hernia surgery. Ceftriaxone was the most widely used antibiotic (45%). Ninety-two (84.4%) respondents will perform this surgery as day case. Forty (36.7%) respondents stated modified Bassini repair as their preferred method of repair. Mesh repair was recommended by 93 (85.3%) respondents while 65 of 100 respondents (65%) recommended laparoscopic surgery. Of 103 respondents, 93 (90.3%) had performed inguinal hernia repair and 34 (33%), mesh repair. For 56 (51.4%) respondents, the most difficult part of open hernia surgery was sac dissection. CONCLUSIONS: Surgical trainees in Nigeria perform more tissue-based inguinal hernia repair than mesh but majority would recommend both mesh repair and laparoscopic surgery. Majority found sac dissection as the most difficult part of open hernia surgery.

COMPLETE OESOPHAGEAL STRICTURE FOLLOWING THYROIDECTOMY FOR BENIGN GOITRE: A CASE REPORT.

Oesophageal injury leading to stricture is a dreaded disease with clinical course and prognosis that are dependent on the etiology, early recognition, and prompt and effective treatment. Commonly, iatrogenic oesophageal injury occurs during endoscopic procedures, and often in a diseased oesophagus. Though uncommon, injury can occur during thyroidectomy. We therefore present the case of a Nigerian woman with complete oesophageal stricture resulting from oesophageal injury sustained during thyroidectomy.

Intranasal oxytocin enhances intrinsic corticostriatal functional connectivity in women.

Oxytocin may influence various human behaviors and the connectivity across subcortical and cortical networks. Previous oxytocin studies are male biased and often constrained by task-based inferences. Here, we investigate the impact of oxytocin on resting-state connectivity between subcortical and cortical networks in women. We collected resting-state functional magnetic resonance imaging (fMRI) data on 26 typically developing women 40 min following intranasal oxytocin administration using a double-blind placebo-controlled crossover design. Independent components analysis (ICA) was applied to examine connectivity between networks. An independent analysis of oxytocin receptor (OXTR) gene expression in human subcortical and cortical areas was carried out to determine plausibility of direct oxytocin effects on OXTR. In women, OXTR was highly expressed in striatal and other subcortical regions, but showed modest expression in cortical areas. Oxytocin increased connectivity between corticostriatal circuitry typically involved in reward, emotion, social communication, language and pain processing. This effect was 1.39 standard deviations above the null effect of no difference between oxytocin and placebo. This oxytocin-related effect on corticostriatal connectivity covaried with autistic traits, such that oxytocin-related increase in connectivity was stronger in individuals with higher autistic traits. In sum, oxytocin strengthened corticostriatal connectivity in women, particularly with cortical networks that are involved in social-communicative, motivational and affective processes. This effect may be important for future work on neurological and psychiatric conditions (for example, autism), particularly through highlighting how oxytocin may operate differently for subsets of individuals.

Epidemiological study of bovine brucellosis in three senatorial zones of Bauchi State, Nigeria.

AIM: To determine the seroepidemiological patterns of bovine brucellosis in three senatorial zones of Bauchi State, Nigeria. MATERIALS AND METHODS: Blood samples were aseptically collected from the anterior jugular vein of 336 slaughtered cattle, between September 2013 and March 2014 in three senatorial zones of Bauchi State, Nigeria. The sera obtained were screened for brucellosis using rose Bengal plate test (RBPT) and serum agglutination test (SAT) in parallel. The data generated was subjected to Chi-square and Fishers exact test analysis to establish whether there is a relationship between the breeds, sex, and location of the animals sampled. RESULTS: Of the 336 cattle screened, 18 (5.4%) and 13 (3.9%) were positive by RBPT and SAT, respectively. There was no statistically significant association (p>0.05) between the sex, age, and location of cattle with seropositivity of brucellosis in the state. It was concluded that brucellosis is prevalent in Bauchi State. Further study is recommended in other abattoirs and herds of cattle in Bauchi State for confirmation of the status of the disease among cattle slaughtered in the state. CONCLUSION: A high seroprevalence of brucellosis among the cattle in Bauchi state indicates that the disease is endemic and cattle are one of the animals that perpetuate and sustain the disease.

Divergent subcortical activity for distinct executive functions: stopping and shifting in obsessive compulsive disorder.

BACKGROUND: There is evidence of executive function impairment in obsessive compulsive disorder (OCD) that potentially contributes to symptom development and maintenance. Nevertheless, the precise nature of these executive impairments and their neural basis remains to be defined. METHOD: We compared stopping and shifting, two key executive functions previously implicated in OCD, in the same task using functional magnetic resonance imaging, in patients with virtually no co-morbidities and age-, verbal IQ- and gender-matched healthy volunteers. The combined task allowed direct comparison of neural activity in stopping and shifting independent of patient sample characteristics and state variables such as arousal, learning, or current symptom expression. RESULTS: Both OCD patients and controls exhibited right inferior frontal cortex activation during stopping, and left inferior parietal cortex activation during shifting. However, widespread under-activation across frontal-parietal areas was found in OCD patients compared to controls for shifting but not stopping. Conservative, whole-brain analyses also indicated marked divergent abnormal activation in OCD in the caudate and thalamus for these two cognitive functions, with stopping-related over-activation contrasting with shift-related under-activation. CONCLUSIONS: OCD is associated with selective components of executive function, which engage similar common elements of cortico-striatal regions in different abnormal ways. The results implicate altered neural activation of subcortical origin in executive function abnormalities in OCD that are dependent on the precise cognitive and contextual requirements, informing current theories of symptom expression.

Oxytocin increases eye contact during a real-time, naturalistic social interaction in males with and without autism.

Autism spectrum conditions (autism) affect ~1% of the population and are characterized by deficits in social communication. Oxytocin has been widely reported to affect social-communicative function and its neural underpinnings. Here we report the first evidence that intranasal oxytocin administration improves a core problem that individuals with autism have in using eye contact appropriately in real-world social settings. A randomized double-blind, placebo-controlled, within-subjects design is used to examine how intranasal administration of 24 IU of oxytocin affects gaze behavior for 32 adult males with autism and 34 controls in a real-time interaction with a researcher. This interactive paradigm bypasses many of the limitations encountered with conventional static or computer-based stimuli. Eye movements are recorded using eye tracking, providing an objective measurement of looking patterns. The measure is shown to be sensitive to the reduced eye contact commonly reported in autism, with the autism group spending less time looking to the eye region of the face than controls. Oxytocin administration selectively enhanced gaze to the eyes in both the autism and control groups (transformed mean eye-fixation difference per second=0.082; 95% CI:0.025-0.14, P=0.006). Within the autism group, oxytocin has the most effect on fixation duration in individuals with impaired levels of eye contact at baseline (Cohen's d=0.86). These findings demonstrate that the potential benefits of oxytocin in autism extend to a real-time interaction, providing evidence of a therapeutic effect in a key aspect of social communication.

Aortic dissection in children and adolescents with Turner syndrome: risk factors and management recommendations.

There is a general lack of awareness of the risk of aortic dissection in Turner syndrome (TS) from both patients with TS and their physicians. Patients often ignore symptoms for up to 24 h before seeking medical advice, significantly increasing their risk of death. A clinical profile of those at risk of dissection is emerging and includes the presence of congenital heart defects, aortic dilatation and hypertension. MRI has revolutionised the visualisation of cardiovascular anatomy in TS but remains underutilised, especially in children and adolescents, and there is currently little guidance on blood pressure (BP) assessment or hypertension management. Children and adolescents with TS at risk of dissection could be easily identified by timely imaging and BP assessment. This would allow medical management or surgical intervention to be put in place to reduce the risk of this major, and often fatal, complication. Since guidance is lacking, we have reviewed the literature on the risk factors for dissection in TS during childhood and adolescence, and make recommendations on the assessment and management of these patients.

Pattern of computerized tomography of the brain findings in stroke patients in Sokoto, northwestern Nigeria.

BACKGROUND: Stroke is a common cause of morbidity and mortality worldwide. Therapeutic decision regarding its management requires prompt and accurate diagnosis as well as exclusion of other conditions mimicking this condition. Computerized tomography (CT) scan has been found to be the gold standard in distinguishing primary intracerebral hemorrhage (ICH) from cerebral infarction (CI). METHODS: A retrospective review of CT findings in 128 patients who presented in the Radiology Department of Usmanu Danfodiyo University Teaching Hospital with clinical diagnosis of stroke was undertaken over a period of 1 year (from December 2008 to November 2009). The following data were recorded; age, sex, clinical diagnosis, and CT findings. All the CT examinations were performed on a Neusoft C3000 multidetector spiral CT. Evaluation was done by consultant radiologists in the department. RESULTS: Of the 128 patients seen within the period under review, 84 (65.6%) were males while 44 (34.4%) were females. Age range was 4-85 years (mean 49.52, standard deviation (SD) 15.11), while 61 (47.7%) of the patients were in the age group of 41-60 years. Eighty-six patients (67.1%) had cerebral infarction, 38 (29.7%) had intracerebral hemorrhage, while one (0.01%) had subarachnoid hemorrhage. Three patients (0.02%) had normal brain CT findings. CONCLUSION: Cerebral infarction is the most common form of stroke in this study. CT is essential in establishing the type of stroke, which subsequently determines the type of intervention as well as follow-up evaluation the patient may require.