The Prevalence and Pattern of Admission Mortality among Acute Stroke Patients Managed at a Tertiary Hospital in Abakaliki, Nigeria: A Retrospective Study.

BACKGROUND: Stroke ranks as the second leading cause of mortality worldwide, following ischemic heart disease, and is expected to maintain this position through 2030. This neurological ailment is profoundly impactful, imposing a significant burden on health and the economy. In 2019 alone, it was responsible for 6.6 million fatalities and the loss of 143 million disability-adjusted life years (DALYs) across the globe. OBJECTIVES: This study highlighted the prevalence and pattern of admission mortality among acute stroke patients managed over 9 years in a private tertiary hospital in Abakaliki, Nigeria. METHODOLOGY: This was a retrospective hospital-based study conducted at a tertiary hospital in Abakaliki, Nigeria from January 2014 to December 2022. Relevant data were extracted from the patients' case notes and the sociodemographic, clinical and laboratory parameters of acute stroke survivors were compared with those of their dead counterparts. RESULTS: Out of the 172 (males - 57%; females - 43%) patients that fulfilled the inclusion criteria, 53 (30.81%) had haemorrhagic stroke while 119 (69.19%) had ischaemic stroke. The overall admission mortality rate was 15.12%, and it was more common in patients with haemorrhagic stroke, advancing age, severe hypertension, severe stroke, impairment of consciousness, renal dysfunction, hypernatremia, neutrophilic leucocytosis, and short admission duration. CONCLUSIONS: High mortality rates are linked to acute stroke admissions, particularly in cases involving haemorrhagic stroke, increasing age, severe hypertension, substantial stroke severity, impaired consciousness, renal dysfunction, hypernatremia, neutrophilic leukocytosis, and brief admission duration.

CONTEXTE: L'accident vasculaire cérébral (AVC) est la deuxième cause de mortalité dans le monde, après la cardiopathie ischémique, et devrait conserver cette position jusqu'en 2030. Cette affection neurologique a un impact profond, imposant une charge significative sur la santé et l'économie. En 2019 seulement, elle a été responsable de 6,6 millions de décès et de la perte de 143 millions d'années de vie ajustées sur l'incapacité (DALYs) dans le monde. OBJECTIFS: Cette étude a mis en évidence la prévalence et le modèle de la mortalité à l'admission chez les patients victimes d'AVC aigu gérés pendant 9 ans dans un hôpital privé tertiaire à Abakaliki, Nigéria. MÉTHODOLOGIE: Il s'agissait d'une étude rétrospective en milieu hospitalier menée dans un hôpital tertiaire à Abakaliki, Nigéria, de janvier 2014 à décembre 2022. Les données pertinentes ont été extraites des dossiers des patients et les paramètres sociodémographiques, cliniques et de laboratoire des survivants d'un AVC aigu ont été comparés à ceux de leurs homologues décédés. RÉSULTATS: Parmi les 172 patients (hommes - 57 % ; femmes - 43 %) qui remplissaient les critères d'inclusion, 53 (30,81 %) avaient un AVC hémorragique tandis que 119 (69,19 %) avaient un AVC ischémique. Le taux global de mortalité à l'admission était de 15,12 % et était plus fréquent chez les patients ayant un AVC hémorragique, un âge avancé, une hypertension sévère, un AVC sévère, une altération de la conscience, une dysfoncti on rénal e, une hyper natrémie, une l eucocytose neutrophilique et une courte durée d'admission. CONCLUSIONS: Les taux de mortalité élevés sont liés aux admissions pour AVC aigu, en particulier dans les cas d'AVC hémorragique, d'âge avancé, d'hypertension sévère, de sévérité importante de l'AVC, d'altération de la conscience, de dysfonction rénale, d'hypernatrémie, de leucocytose neutrophilique et de courte durée d'admission. MOTS-CLÉS: Facteurs de risque, Mortalité à l'admission, AVC aigu, Étude rétrospective.

Spatiotemporal and seasonal transmission dynamics of Schistosoma haematobium and snail infectivity in Ase River catchment, Delta State, Nigeria.

Bulinus are intermediate snail hosts of Schistosoma haematobium. Despite their vectorial role, the transmission dynamics and infectivity of these intermediate snail hosts remain understudied in the Ase River. This longitudinal study evaluated the geospatial and seasonal transmission patterns and infectivity of three S. haematobium vectors between November 2020 and October 2022 in the Ase River catchment, Delta State, Nigeria. Eleven (11) geospatial water contact coordinates were mapped for monthly spatiotemporal collection of Bulinus species along the Ase River and its catchment, for two years. Snail sampling was performed for 45 min at each study site using scooping/hand-picking techniques and subsequently counted, identified and recorded. Snails of the Bulinus genus were individually placed in a beaker containing distilled water and exposed to light to shed cercariae which were identified to be human schistosome type. The number of infected snails for each month and season was also documented to analyze the spatiotemporal and seasonal transmission dynamics of infectivity. Out of the 2345 Bulinus snails collected, a total of 41.45% were found to be infected with S. haematobium. The monthly infectivity of Bulinus snails varied significantly (P < 0.05) throughout the study period (P = < 0.0001; F = 23.11; df = 11). Further analysis showed a strong significant association (χ2 = 23.57; df = 11; p = 0.015) between the study years. The Principal Component Analysis (PCA) results suggest that Bulinus infectivity within the Ase River catchment area was primarily associated with the months of February and January. B. truncatus consistently had the highest transmission potential, followed by B. globosus and B. senegalensis. ANOVA confirms that the monthly/study site infectivity and transmission potential in B. truncates, B. globosus and S. senegalensis were statistically, significant (P < 0.05). These results demonstrated a clear distinction in the patterns and relationships between the different months in terms of snail infectivity and seasonal transmission potential. This understanding will help in the continuous monitoring and targeted interventions to control schistosomiasis transmission in Ase River.

Evaluation of the antimalarial and CD4+ T-cell modulatory effects of leaf methanol extract of Phyllanthus muellerianus (Kuntze) Exell (Phyllanthaceae) in Plasmodium berghei-infected mice.

ETHNOPHARMACOLOGICAL RELEVANCE: Phyllanthus muellerianus (Kunze) Exell, a member of the Phyllanthaceae family, is a medicinal plant widely distributed in Africa. Decoctions from the leaves are used in Nigeria to treat fevers, convulsions, some neurological disorders and malaria. AIM OF THE STUDY: This study is to evaluate the anti-malarial properties of methanol extract of Phyllanthus muellerianus (MEPM) leaves and its ethyl acetate fraction using a murine malaria model infected with Plasmodium berghei. Additionally, we seek to investigate the potential modulatory effects of this extract and fraction on CD4+ T-cell populations in the context of malaria infection. MATERIALS AND METHODS: The anti-malarial effects of the leaf methanol extract of Phyllanthus muellerianus (MEPM) were screened using three established in vivo models of anti-plasmodial screening namely the curative, suppressive and prophylactic models. The methanol extract (MEPM) was afterwards fractionated into hexane (HFPM), ethyl acetate (EAFPM), and methanol (MFPM) fractions. In the pilot anti-malarial screening of the fractions, EAFPM exhibited the best antiparasitic activity. Subsequently, EAFPM was screened for anti-malarial activity using the three models above. The effects of the MEPM and EAFPM on haematological indices (Hb and PCV) of the inoculated animals were further screened and the mean survival time (MST) of the animals was monitored. CD4+ T cells of various groups were counted before and after treatment using a flow cytometer. The EAFPM was further subjected to HPLC analysis for identification of its major compounds. RESULTS: The EAFPM (100 and 200 mg/kg) elicited 88% and 93% cure respectively in the curative model, while artesunate (5 mg/kg,- the positive control) gave 87% protection. The MEPM and EAFPM also gave significant suppression of parasitemia in the suppressive model. The treated groups survived beyond 28 days as against 11 days by the control group (infected but not treated). The treated groups also prevented anaemia seen in the negative control. The EAFPM group significantly modulated the CD4+ T cell. Compounds identified were Gallocatechin, Quercetin -3-O-gallate, Ellagic acid, and Methylellagic acid rhamnoside). CONCLUSION: The study established that the leaf of Phyllanthus muellerianus possesses antimalarial activity, thus lending support to its use in the folkloric treatment of malaria.

HLA-DRB1*15:01 and the MERTK Gene Interact to Selectively Influence the Profile of MERTK-Expressing Monocytes in Both Health and MS.

BACKGROUND AND OBJECTIVES: HLA-DRB1*15:01 (DR15) and MERTK are 2 risk genes for multiple sclerosis (MS). The variant rs7422195 is an expression quantitative trait locus for MERTK in CD14+ monocytes; cells with phagocytic and immunomodulatory potential. We aimed to understand how drivers of disease risk and pathogenesis vary with HLA and MERTK genotype and disease activity. METHODS: We investigated how proportions of monocytes vary with HLA and MERTK genotype and disease activity in MS. CD14+ monocytes were isolated from patients with MS at relapse (n = 40) and 3 months later (n = 23). Healthy controls (HCs) underwent 2 blood collections 3 months apart. Immunophenotypic profiling of monocytes was performed by flow cytometry. Methylation of 35 CpG sites within and near the MERTK gene was assessed in whole blood samples of individuals experiencing their first episode of clinical CNS demyelination (n = 204) and matched HCs (n = 345) using an Illumina EPIC array. RESULTS: DR15-positive patients had lower proportions of CD14+ MERTK+ monocytes than DR15-negative patients, independent of genotype at the MERTK SNP rs7422195. Proportions of CD14+ MERTK+ monocytes were further reduced during relapse in DR15-positive but not DR15-negative patients. Patients homozygous for the major G allele at rs7422195 exhibited higher proportions of CD14+ MERTK+ monocytes at both relapse and remission compared with controls. We observed that increased methylation of the MERTK gene was significantly associated with the presence of DR15. DISCUSSION: DR15 and MERTK genotype independently influence proportions of CD14+ MERTK+ monocytes in MS. We confirmed previous observations that the MERTK risk SNP rs7422195 is associated with altered MERTK expression in monocytes. We identified that expression of MERTK is stratified by disease in people homozygous for the major G allele of rs7422195. The finding that the proportion of CD14+ MERTK+ monocytes is reduced in DR15-positive individuals supports prior data identifying genetic links between these 2 loci in influencing MS risk. DR15 genotype-dependent alterations in methylation of the MERTK gene provides a molecular link between these loci and identifies a potential mechanism by which MERTK expression is influenced by DR15. This links DR15 haplotype to MS susceptibility beyond direct influence on antigen presentation and suggests the need for HLA-based stratification of approaches to MERTK as a therapeutic target.

Sleep Health amongst Patients Attending Adult Neurology Clinic in Abakaliki, Nigeria.

BACKGROUND: Sleep health indicates how well an individual or population sleeps. Good sleep health is characterized by subjective satisfaction, sustained alertness during waking hours, appropriate timing, high efficiency, and adequate duration. Poor sleep health is associated with many short-term and long-term health consequences. There are limited data on the pattern of sleep health in Nigeria. Against this backdrop, we embarked on this study to determine the Pattern of Sleep Health among patients attending the Adult Neurology clinic in a Federal Teaching Hospital, in Abakaliki, Nigeria. METHODS: This is a cross-sectional observational hospital-based study undertaken at the Adult Neurology clinic of the Alex Ekwueme Federal University Teaching Hospital Abakaliki, Nigeria from July to September 2022. RESULTS: Out of the 267 patients recruited for the study, 19% had good sleep health with SATED scores of 8 to 10 while 81% had poor sleep health. The absence of alcohol abuse, cigarette smoking, and neurological diagnosis were statistically associated with poor sleep health with no sex and age predilection. The mean sleep duration was 7.5± 1.5 hours (male = 7.6 hours, female = 7.3 hours, 18- 64 years= 7.4 hours, ≥ 65 years =7.9 hours). Timing of sleep (mean= 0.97) was the least rated while sleep satisfaction (mean= 1.54) was the best-rated sleep dimension. CONCLUSION: Sleep health is very poor amongst patients attending the adult Neurology clinic at Abakaliki Nigeria and it is associated with smoking, absence of alcohol abuse, and neurological diagnosis. CONTEXTE: La santé du sommeil indique à quel point un individu ou une population dort. Une bonne santé du sommeil se caractérise par une satisfaction subjective, une vigilance soutenue pendant les heures d'éveil, un timing approprié, une efficacité élevée et une durée adéquate. Une mauvaise santé du sommeil est associée à de nombreuses conséquences sanitaires à court et à long terme. Il existe des données limitées sur le schéma de santé du sommeil au Nigéria. Dans ce contexte, nous avons entrepris cette étude pour déterminer le schéma de santé du sommeil parmi les patients fréquentant la clinique de neurologie pour adultes dans un hôpital d'enseignement fédéral à Abakaliki, Nigeria. MÉTHODES: Il s'agissait d'une étude observationnelle transversale réalisée à la clinique de neurologie pour adultes de l'hôpital universitaire fédéral Alex Ekwueme àAbakaliki, Nigeria, de juillet à septembre 2022. RÉSULTATS: Sur les 267 patients recrutés pour l'étude, 19 % avaient une bonne santé du sommeil avec des scores SATED de 8 à 10, tandis que 81 % avaient une mauvaise santé du sommeil. L'absence d'abus d'alcool, de tabagisme et de diagnostic neurologique était statistiquement associée à une mauvaise santé du sommeil, sans prédilection pour le sexe et l'âge. La durée moyenne du sommeil était de 7,5 ± 1,5 heures (homme = 7,6 heures, femme = 7,3 heures, 18-64 ans = 7,4 heures, ≥ 65 ans = 7,9 heures). Le timing du sommeil (moyenne = 0,97) était la dimension la moins bien notée, tandis que la satisfaction du sommeil (moyenne = 1,54) était la dimension la mieux notée. CONCLUSION: La santé du sommeil est très mauvaise chez les patients fréquentant la clinique de neurologie pour adultes à Abakaliki, au Nigéria, et elle est associée au tabagisme, à l'absence d'abus d'alcool et au diagnostic neurologique. Mots-clés: :Santé du sommeil, Clinique de neurologie,Abakaliki, Nigeria.

Stroke Hexagon; Protocol for Reduction of Stroke Burden in Resource-Poor Settings.

BACKGROUND: Stroke is a neurological emergency, with high prevalence, especially in developing countries where it assumes an epidemic proportion. It is globally the second most common cause of death after ischemic heart disease. The poor indices reported in developing countries are multifactorial and related to late case presentation, ignorance, poverty, and unavailability of comprehensive and well-coordinated stroke care. OBJECTIVES: This manuscript identified and highlighted the available and cheap stroke management pillars in developing countries and recommended measures to strengthen the system to maximize the benefits in the reduction of morbidity and mortality from stroke. RESULTS: The identified stroke management pillars include stroke prevention, hyperacute stroke management, acute stroke management, stroke rehabilitation, stroke research, and stroke support. CONCLUSIONS: A coordinated and concerted stroke management protocol involving the stroke hexagon will reduce stroke morbidity and mortality in resource-poor settings. There is a need to sensitize the stakeholders in stroke management to assume more responsibility.

CONTEXTE: L'AVC est une urgence neurologique, avec une prévalence élevée, en particulier dans les pays en développement où il prend une ampleur épidémique. Il est mondialement la deuxième cause de décès la plus fréquente après la maladie cardiaque ischémique. Les mauvais indices rapportés dans les pays en développement sont multifactoriels et liés à une présentation tardive des cas, à l'ignorance, à la pauvreté et à l'absence de soins coordonnés et complets pour l'AVC. OBJECTIFS: Ce manuscrit a identifié et mis en évidence les piliers bon marché de la prise en charge de l'AVC dans les pays en développement et recommandé des mesures pour renforcer le système afin de maximiser les avantages dans la réduction de la morbidité et de la mortalité dues à l'AVC. RÉSULTATS: Les piliers identifiés de la prise en charge de l'AVC comprennent la prévention de l'AVC, la prise en charge hyperaiguë de l'AVC, la prise en charge aiguë de l'AVC, la rééducation post-AVC, la recherche sur l'AVC et le soutien aux personnes touchées par l'AVC. CONCLUSIONS: Un protocole de prise en charge de l'AVC coordonné et concerté impliquant l'hexagone de l'AVC réduira la morbidité et la mortalité liées à l'AVC dans les milieux à ressources limitées. Il est nécessaire de sensibiliser les parties prenantes à la prise en charge de l'AVC pour qu'elles assument davantage de responsabilités. Mots-clés: Hexagone de l'AVC, Protocole, Fardeau de l'AVC, Milieux à ressources limitées.

HAEMATOLOGICAL PARAMETERS AMONGST ACUTE STROKE PATIENTS MANAGED AT A TERTIARY HOSPITAL IN ABAKALIKI NIGERIA: A CASE-CONTROL STUDY.

Introduction: Changes in the haematological indices could have implications for stroke risk, management plan, and outcome. There are limited data on the pattern of haematological parameters of acute stroke patients in Nigeria despite its impact on stroke risk, management, and outcome. Objectives: To determine the pattern and the prognostic implications of the haematological parameters in acute stroke patients managed over a nine-year period at a Tertiary Hospital in Abakaliki Nigeria. Methodology: This was a retrospective hospital-based case-control study of the haematological parameters of acute stroke patients seen over a nine-year period at a tertiary hospital in Abakaliki Nigeria. Results: The mean total white blood cell count and percentage neutrophil in the case group were significantly higher than the control group while the mean packed cell volume did not show any significant difference. Further analysis of the case group revealed that the mean PCV was significantly lower among female folks, elderly age group, those with low education attainment, impaired renal status, short admission duration, haemorrhagic stroke, and admitting hypertension. On the other hand, mean total WBC count and differential neutrophils were significantly elevated among female folks, working-class age group, low educational status, longer admission duration, mortality, and haemorrhagic stroke. Conclusions: Elevated total white blood cell count and differential neutrophilia were significantly associated with acute stroke. Changes in haematological parameters have implications for stroke risk and outcome.

PREVALENCE OF RENAL DYSFUNCTION IN ACUTE STROKE PATIENTS AT ABAKALIKI NIGERIA: AN OBSERVATIONAL STUDY.

Introduction: Renal dysfunction is commonly seen in hospitalized stroke patients. It serves both as a risk factor for stroke and as a complication of stroke. Renal dysfunction is a poor prognostic factor for stroke and increases the risk of recurrence. Despite the above poor indices, there is a paucity of data on the prevalence of renal dysfunction in acute stroke patients in Nigeria. Objective: It is against this background that this study was conducted to identify the prevalence and pattern of renal dysfunction among acute stroke patients who were managed at a Federal Teaching Hospital in Abakaliki Nigeria. Methodology: This is a cross-sectional observational hospital-based study undertaken at the Emergency unit of the Alex Ekwueme Federal University Teaching Hospital Abakaliki, Nigeria from October 2021 to April 2022 (7-month period). Result: Amongst the 210 acute stroke patients enrolled in the study, 51 (24%) had renal dysfunction with no age and sex predilection. Haemorrhagic stroke, alteration in consciousness, and anaemia were significantly associated with renal dysfunction. Conclusion: The prevalence of renal dysfunction following acute stroke is high and there is a need for assessment of renal functions in every acute stroke patient and institute prompt multi-disciplinary treatment.

DEMOGRAPHICS OF COLLABORATORS INVESTIGATING THE NIGERIAN MEDICAL AND DENTAL INTERNS: A MEDICAL INTERNSHIP TRAINING IN NIGERIA (MINTING) STUDY COLLABORATION.

Introduction: The internship period is a peculiar time in a doctor's career, and some have described it as a "nuisance year" during which the junior doctor assumes many roles at the same time. Junior doctors especially house officers are faced with many unique challenges; this is even more pronounced in poor resource settings like Nigeria. This study aimed to unravel and improve understanding of the challenges faced by medical and dental interns in Nigeria. Methodology: A nine-member House officers Research and Statistics Committee (HRSC) was immediately set up to include three senior colleagues - Senior Registrars and Registrar. To carry out her responsibility efficiently the committee created the House Officers Research Collaboration Network (HRCN), a 103- member team comprising medical and dental interns from across Nigeria under a collaborative - Medical INternship Training in Nigeria (MINTING) study. Results: Out of a total of the 103 House Officers Research Collaboration Network, 80 of them participated in this survey giving a 78% response rate. Ten of the intern Collaborators had additional qualification and seven of them had BSc as an initial degree. About 66 % of the Collaborators have never authored any publication. Of the 27 that have published an article; three collaborators are said to have published 15, 13, 16 articles respectively. Male collaborators where more likely to have published at least one article in the past. Thirty one of the 80 Collaborators have never been in a research collaborative group prior to this MINTING collaborative. Conclusion: This commentary is set out to describe in detail Nigerian House Officers initiative in terms of the structure, functions, operational modalities, and to investigate the demographics of the HRCN collaborators which showed that over two third of collaborators have never authored any publication and about a third of them have never been involved in collaborative research. We also believe the findings will serve as policy guide and benchmark in training the critical medical health force.

Prevalence of Hyponatremia in Acute Stroke Patients in a Federal Teaching Hospital, Abakaliki, Nigeria.

BACKGROUND: Hyponatremia is a common electrolyte imbalance which is readily observed in patients with neurological disorders such as stroke. It is associated with increased morbidity and mortality during and after hospitalization. There has not been any study to demonstrate the frequency of admission hyponatremia in acute stroke patients in Nigeria. It is against this backdrop that we embarked on this study to determine the frequency and pattern of admission hyponatremia in acute stroke patients in a Federal Teaching Hospital, Abakaliki, Nigeria. METHODS: This was a cross-sectional observational hospitalbased study undertaken at the Emergency unit of the Alex Ekwueme Federal University Teaching Hospital Abakaliki, Nigeria from November 2021 to April 2022. RESULTS: Amongst the 177 acute stroke patients enrolled in the study, 58 (32.8%) had hyponatremia. Advanced age, alteration in consciousness, and haemorrhagic (intracerebral and subarachnoid haemorrhage) stroke were significantly associated with presence of hyponatremia. CONCLUSION: Admission hyponatremia is prevalent amongst acute stroke patients in Abakaliki, Nigeria and commonly associated with advanced age, alteration in consciousness and haemorrhagic stroke.

CONTEXTE: L'hyponatrémie est un déséquilibre électrolytique commun qui est facilement observé chez les patients atteints de troubles neurologiques tels que l'AVC. Elle est associée à une morbidité et une mortalité accrues pendant et après l'hospitalisation. Aucune étude n'a été menée pour démontrer la fréquence de l'hyponatrémie à l'admission chez les patients victimes d'un AVC aigu au Nigeria. C'est dans ce contexte que nous avons entrepris cette étude pour déterminer la fréquence et les caractéristiques de l'hyponatrémie à l'admission chez les patients victimes d'un AVC aigu dans un hôpital universitaire fédéral à Abakaliki, au Nigeria. MÉTHODES: Il s'agissait d'une étude transversale d'observation en milieu hospitalier entreprise au service des urgences de l'Alex Ekwueme Federal University Teaching Hospital d'Abakaliki, au Nigeria, de novembre 2021 à avril 2022. RÉSULTATS: Parmi les 177 patients victimes d'un AVC aigu inscrits à l'étude, 58 (32,8 %) présentaient une hyponatrémie. L'âge avancé, l'altération de la conscience et l'AVC hémorragique (hémorragie intracérébrale et subarachnoïde) étaient significativement associés à la présence d'une hyponatrémie. CONCLUSION: L'hyponatrémie à l'admission est prévalente chez les patients victimes d'un accident vasculaire cérébral aigu à Abakaliki, au Nigeria, et est souvent associée à un âge avancé, à une altération de la conscience et à un accident vasculaire cérébral hémorragique. Mots clés: Accident vasculaire cérébral aigu, hyponatrémie, urgence médicale, Abakaliki, Nigeria.

White matter tract conductivity is resistant to wide variations in paranodal structure and myelin thickness accompanying the loss of Tyro3: an experimental and simulated analysis.

Myelination within the central nervous system (CNS) is crucial for the conduction of action potentials by neurons. Variation in compact myelin morphology and the structure of the paranode are hypothesised to have significant impact on the speed of action potentials. There are, however, limited experimental data investigating the impact of changes in myelin structure upon conductivity in the central nervous system. We have used a genetic model in which myelin thickness is reduced to investigate the effect of myelin alterations upon action potential velocity. A detailed examination of the myelin ultrastructure of mice in which the receptor tyrosine kinase Tyro3 has been deleted showed that, in addition to thinner myelin, these mice have significantly disrupted paranodes. Despite these alterations to myelin and paranodal structure, we did not identify a reduction in conductivity in either the corpus callosum or the optic nerve. Exploration of these results using a mathematical model of neuronal conductivity predicts that the absence of Tyro3 would lead to reduced conductivity in single fibres, but would not affect the compound action potential of multiple myelinated neurons as seen in neuronal tracts. Our data highlight the importance of experimental assessment of conductivity and suggests that simple assessment of structural changes to myelin is a poor predictor of neural functional outcomes.

Longitudinal changes of blood parameters and weight in inoperable stage III NSCLC patients treated with concurrent chemoradiotherapy followed by maintenance treatment with durvalumab.

BACKGROUND: Investigating dynamic changes in blood-parameters and weight in patients with locally advanced non-small cell lung cancer (NSCLC) receiving durvalumab maintenance therapy after chemoradiotherapy (cCRT). Laboratory outcomes were determined based on the number of durvalumab administrations received. METHODS: Twenty-two patients completed platinum-based cCRT followed by maintenance treatment with durvalumab. Different parameters such as hemoglobin (Hb), leukocytes, Lactate dehydrogenase (LDH), C-reactive protein (CRP), body weight and albumin were analyzed before cCRT, after cCRT, 3, 6, 9 and 12 months after starting durvalumab maintenance. RESULTS: Sixteen (72.7%) patients were male; twelve (54.5%) and fifteen (68.2%) patients had non-squamous histology and Union for International Cancer Control (UICC) stage IIIB-C disease, respectively. Median follow-up time was 24.4 months; 12- and 18-months- progression-free and overall-survival rates were 55.0% and 45.0 as well as 90.2 and 85.0%, respectively. During maintenance treatment Hb increased by 1.93 mg/dl (17.53%) after 9 months (p < 0.001) and 2.02 mg/dl (18.46%) after 12 months compared to the start of durvalumab (p < 0.001). LDH decreased by 29.86 U/l (- 11.74%) after 3 months (p = 0.022). Receipt of at least 12 cycles of durvalumab was beneficial in terms of Hb-recovery (Hb 6 months: 12.64 vs. 10.86 [mg/dl]; Hb 9 months: 13.33 vs 11.74 [mg/dl]; (p = 0.03)). Median weight change [kilogram (kg)] was + 6.06% (range: - 8.89 - + 18.75%) after 12 months. The number of durvalumab cycles significantly correlated with total weight gain [kg] (Spearman-Rho-correlation: r = 0.502*). CONCLUSION: In the investigated cohort, no severe hematologic toxicity occurred by laboratory blood tests within 1 year of durvalumab maintenance therapy after cCRT for unresectable stage III NSCLC. Receiving at least 12 cycles of durvalumab appears to have a significant effect on recovery of hemoglobin levels and body weight.

The Efficacy of Local Infiltration Analgesia in the Control of Post-Operative Pain after Total Joint Replacement Surgeries.

BACKGROUND: Total joint replacement surgeries can produce severe pain in the post-operative period that can prolong the duration of hospital stay. The aim of the study, was to determine the efficacy of Local Infiltration Analgesia in the management of post-operative pain after total joint replacement. METHOD: This was a prospective study with patients recruited for the study divided into group A and B. Group A received intra-operative analgesic cocktail while those in group B (control group) received an equal volume of normal saline. Both groups received the same post-operative pain management protocol. Pain assessment in the post-operative period was done using the visual analogue scale, at 4 hours, 8 hours, 24 hours and 48 hours post surgery. Time to achieving assisted ambulation, occurrence of adverse events, and the number of times analgesic was administered for breakthrough pain were assessed. RESULTS: A total number of 50 patients who had either total joint arthroplasty (25 in each group) were recruited for the study. The Normal saline group had significantly higher VAS scores in the first 8 hours after surgery (p values 0.016 at 4 hours and 0.037 at 8 hours post-operation) while both groups had similar pain scores thereafter. Mobilization times were not significantly different between both groups and adverse events occurred with almost equal frequency in both groups. CONCLUSION: Periarticular local infiltration analgesia as part of multimodal pain control protocol is effective in the control of early post-operative pain after total joint replacement.

CONTEXTE: Les chirurgies de remplacement total de l'articulation peuvent produire une douleur intense pendant la période postopératoire qui peut prolonger la durée du séjour à l'hôpital. Le but de l'étude était de déterminer l'efficacité de l'analgésie locale par infiltration dans la gestion de la douleur postopératoire après une arthroplastie totale. MÉTHODES: Il s'agissait d'une étude prospective avec des patients recrutés pour l'étude ont été divisés en groupes A et B. Le groupe A a reçu un cocktail analgésique intra-op¼ratoire. tandis que les patients du groupe B (groupe témoin ont reçu un volume égal de solution saline normale. Les deux groupes ont reçu le même protocole de gestion de la douleur post-opératoire. L'évaluation de la douleur dans la période postopératoire a été réalisée à l'aide de l'échelle visuelle analogique, à 4 heures, 8 heures, 24 heures et 48 heures après l'opération après l'opération. Le temps nécessaire à l'obtention d'une l'ambulance assistée, la survenue d'événements indésirables et le nombre de fois où un analgésique a été administré en cas de percée de la évalués. RÉSULTATS: 50 patients ayant subi une arthroplastie totale (25 dans chaque groupe) ont été recrutés pour l'étude. Le groupe recevant du sérum physiologique présentait des scores VAS significativement plus élevés dans les 8 heures après l'opération (valeurs p de 0,016 à 4 heures et 0,037 à 8 heures après l'opération), alors que les deux groupes avaient des scores de douleur similaires par la suite. Les temps de mobilisation n'étaient pas significativement différents entre les deux groupes et les événements indésirables sont survenus à une fréquence presque égale dans les deux groupes. CONCLUSION: L'analgésie périarticulaire par infiltration locale dansle cadre d'un d'un protocole multimodal de contrôle de la douleur est efficace dans le contrôle de la douleur postopératoire précoce après une arthroplastie totale. Mots clés: Analgésie par infiltration locale; arthroplastie totale; arthroplastie; douleur postopératoire.

Forensic radiography services: The experiences of radiographers and forensic pathologists in Nigeria.

INTRODUCTION: Radiographers can play an essential role within forensic teams and contribute by producing high quality images. There are several aspects of forensic imaging, these commonly include but are not limited to imaging as part of post-mortem investigations, evaluation of non-accidental injuries and the identification of the presence of illicit drugs. In some countries radiographers perform post-mortem imaging before conventional autopsy, a practice that needs to be advanced in less developed countries. In this study, we explored experiences, attitudes and knowledge of radiographers' and forensic pathologists' in delivering forensic radiography services in Nigeria. METHOD: A qualitative exploratory descriptive study was undertaken. Three focus group interviews were conducted with 14 radiographers and five forensic pathologists. Participants were recruited through purposive sampling from two government owned tertiary hospitals in Lagos-State, Nigeria. Focus groups were audio recorded and lasted approximately 1 h. Data were thematically analysed and managed using the Atlas Ti computer software. RESULTS: Forensic pathologists and radiographers perceived forensic radiography differently. Radiographers reported a reluctance to take images of deceased people and were generally not aware of medicolegal issues involved in performing forensic examinations. Three themes emerged in the study, namely participants' experiences in forensic radiography, participants' knowledge of forensic radiography principles and guidelines, and participants' attitude towards forensic radiography services. CONCLUSION: Improving forensic radiography services is likely to require development of postgraduate curricula in forensic radiography and a fellowship curriculum in radiography for forensic pathologists. IMPLICATION FOR PRACTICE: This paper argues that, for radiographers to produce high quality diagnostic images that can assist the forensic team in medico-legal investigations subspecialisation in the field of forensic radiography would be advantageous.

GENDER DIFFERENCES IN THE CLINICAL PROFILE AND SOCIODEMOGRAPHIC CHARACTERISTICS OF DILATED CARDIOMYOPATHY IN IBADAN, NIGERIA.

Background: Cardiomyopathies contribute about 18.2-40.2% (average- 21.4%) to the global burden of heart failure of which dilated cardiomyopathy (DCM) is a major cause. DCM is the second commonest cause of heart failure in Ibadan. The gender differences in the clinical profile has not been described in our setting. Objective: In this study, we set out to describe the gender differences in the pattern and presentation of DCM at the University College Hospital, Ibadan, Nigeria. Methods: This was an analysis of a prospectively collected data over a period of 5 years (August 1, 2016 to July 31, 2021). Results: A total of 117 subjects, 88 males (75.3%) and 29 females (24.8%) aged 50.30 ± 14.7 years (range, 17 to 86 years). Males had significantly achieved a higher educational level than females (p = 0.004). Males were more likely to be employed and had more monthly income compared to females. Males were significantly more likely to use alcohol and smoke cigarette (p = 0.0001 and 0.001 respectively). Females were more likely to be in NYHA class III/IV. There was no statistically significant difference in the relationship between any medication and gender of participants (p > 0.05). Conclusions: DCM is a disease of young and middle-aged adults in our population. The commonest age group was 20-39 years and there was male preponderance. There were some gender differences in the clinical profile of the disease in our environment.

Effectiveness and tolerability of radiotherapy for patients with indolent non-Hodgkin's lymphoma: a monocenter analysis.

To analyze the effectiveness and toxicities of radiotherapy in indolent non-Hodgkin's lymphoma (iNHL) patients treated in our institution. Patients with iNHL treated with radiotherapy between 1999 and 2016 were included. The primary endpoint was progression-free survival (PFS). Secondary endpoints were local control (LC), overall survival (OS) and toxicities. PFS, LC, and OS were analyzed using Kaplan-Meier method. Log-rank test was used to investigate the differences between subgroups. Cox proportional hazard model was used for univariate continuous analysis. Seventy-five patients were identified in our institutional database between 1999 and 2016. Fifty-eight (77.3%) had stage I after Ann-Arbor and 17 patients (22.7%) had stage II. The median follow-up was 87 months (95% CI 72-102 months). Median single dose per fraction was 2.0 Gy (range 1.5-2 Gy) and median total dose was 30.6 Gy (range 16-45 Gy). Radiotherapy was performed in 2D (n = 10; 13.3%), 3D (n = 63; 84.0%) and VMAT (n = 2; 2.7%) techniques, respectively. The median PFS was 14.0 years (95% CI 8.3-19.7 years). The estimated PFS after 5 and 10 years were 73.0% and 65.5% in Kaplan-Meier analysis, respectively. The 5- and 10-year LC were 94.9% and 92.3%, respectively. The 5- and 10-year OS were 88.6% and 73.9%. In univariate analyses of PFS, younger patients (≤ 60 years old) had significantly superior PFS to those older than 60 years old (5-year PFS 81.9% vs. 65.1%, p = 0.021). Dose escalation > 36.0 Gy had no prognostic influence in term of PFS (p = 0.425). Extranodal involvement, stage and histology had no prognostic impact on PFS. Depending on the site of lymphomas, the most common acute side effects were: dermatitis CTCAE° I-II (8.0%), xerostomia CTC° I (8.0%), cataract CTC° I (12.0%) and dry eyes CTC° I-II (14.6%). No adverse event CTC° III was reported. Most acute side effects recovered at 3 to 6 months after radiotherapy except for CTC° I cataract and xerostomia. Local Radiotherapy was highly effective for treatment of early stage iNHL with no serious side effects in our cohort. The most acute CTCAE° I-II side effects recovered 3 to 6 months later. Technique advances seem to have further improved effectiveness and tolerability of radiotherapy.Trial registration: Local ethics committee of Ludwig-Maximilian-University (LMU) Munich approved this retrospective analysis on the May 7th, 2019 (Nr. 19-137).

Recent advances of PET imaging in clinical radiation oncology.

Radiotherapy and radiation oncology play a key role in the clinical management of patients suffering from oncological diseases. In clinical routine, anatomic imaging such as contrast-enhanced CT and MRI are widely available and are usually used to improve the target volume delineation for subsequent radiotherapy. Moreover, these modalities are also used for treatment monitoring after radiotherapy. However, some diagnostic questions cannot be sufficiently addressed by the mere use standard morphological imaging. Therefore, positron emission tomography (PET) imaging gains increasing clinical significance in the management of oncological patients undergoing radiotherapy, as PET allows the visualization and quantification of tumoral features on a molecular level beyond the mere morphological extent shown by conventional imaging, such as tumor metabolism or receptor expression. The tumor metabolism or receptor expression information derived from PET can be used as tool for visualization of tumor extent, for assessing response during and after therapy, for prediction of patterns of failure and for definition of the volume in need of dose-escalation. This review focuses on recent and current advances of PET imaging within the field of clinical radiotherapy / radiation oncology in several oncological entities (neuro-oncology, head & neck cancer, lung cancer, gastrointestinal tumors and prostate cancer) with particular emphasis on radiotherapy planning, response assessment after radiotherapy and prognostication.

COVID radiology preparedness in Nigeria: How ready are we?

The novel human coronavirus (COVID-19) began in Wuhan China as an interstitial pneumonia of unidentifiable origin in December 2019 and thereafter spread its tentacles all over the world.There is a need for radiology departments in both government and private facilities to be prepared to meet this crisis. Their efforts should be geared not only toward diagnosis, but also to preventing patient-to-patient, staff-to-patient, and staff-to-staff transmission of infection by utilizing social distancing measures and personal protective equipment (PPE).Aim: To evaluate the preparedness of radiologic departments of government hospitals and private centers, by assessing the outlay of the facility and likelihood to attend to COVID patients, type of equipment in the centers, and plans in place for protection of staff and the public.Materials and Methods: The radiology departments of government and private facilities in each geopolitical zone of the country were randomly selected to discuss radiology preparedness in Nigeria using preset guidelines which were sent to radiologists at the facilities. Written informed consent was obtained from the radiologists at the participating centers. Ethical approval was also obtained from the Lagos University Teaching Hospital Health Research Ethics Committee.Results: A total of twelve centers were included in the study, comprising eight government and four private centers. All had plans in place to attend to COVID patients; majority were in the process of developing standard operating procedures (SOPs). Majority of the government facilities lacked mobile equipment and adequate PPEs, with only one computed tomography machine and no holding area in some of the facilities for symptomatic patients unlike the private facilities. They, however, had infection control teams in place.Conclusion: Private radiological centers appear better prepared and more equipped to cope with the crisis than government hospitals. Adequate PPEs, mobile equipment, and isolation rooms need to be provided for the government facilities. Radiology information systems should be installed for remote viewing. Training and retraining on COVID management and decontamination should be conducted periodically. SOPs should be drafted universally and modified for each facility

Relationship between corneal biomechanical properties among pregnant women in a tertiary hospital in Nigeria.

OBJECTIVE: In Nigeria, many pregnant women as well as health-care providers are unaware of the effect of pregnancy on the eye. The present study investigated the changes in central corneal thickness (CCT), corneal sensitivity (CS), and intraocular pressure (IOP) among pregnant women in a tertiary hospital in Nigeria and the relationship between them. MATERIALS AND METHODS: A prospective longitudinal study was used. One hundred and thirty-four pregnant women attending the Obstetric Clinic of the University of Nigeria Teaching Hospital, Enugu, were consecutively recruited in their second trimester for the study. Changes in CCT, CS, and IOP were monitored at the second and third trimesters and 6-week postpartum. Data obtained were analyzed using Statistical Package for the Social Sciences version 20. The effect of duration of pregnancy on these variables was determined using simple linear regression and further analysis was done using Bonferroni's post hoc test. RESULTS: The women were aged 18-48 years, with a mean age of 30.81(±5.49) years and majority of them (61.2%) were multigravida. The duration of pregnancy varied inversely and significantly with CS (P < 0.05) and IOP (P < 0.000) with the least values recorded in the third trimester, while it varied directly and also significantly with CCT (P < 0.000) with the highest value obtained in the third trimester. A negative correlation that was significant only in third trimester was found between CCT and IOP (P < 0.02) and CS (P < 0.03). CONCLUSION: There was a progressive increase in CCT with a corresponding decrease in CS and IOP across the trimesters of pregnancy, but these changes reversed 6-week postpartum.