The prognostic significance of duodenal wall invasion in pancreatic adenocarcinoma.

OBJECTIVE: The most recent edition of the American Joint Committee on Cancer Staging Manual (AJCC, 8th edition) relies only on tumor size for staging resectable pancreatic adenocarcinoma, and the presence of duodenal wall invasion (DWI) no longer has an impact on staging. However, very few studies have evaluated its significance. In this study, we aim to evaluate the prognostic significance of DWI in pancreatic adenocarcinoma. METHODS: We reviewed 97 consecutive internal cases of resected pancreatic head ductal adenocarcinoma, and clinicopathologic parameters were recorded. All cases were staged according to the 8th edition of AJCC, and the patients were divided into two groups based on the presence or absence of DWI. RESULTS: Out of our 97 cases, 53 patients had DWI (55%). In univariate analysis, DWI was significantly associated with lymphovascular invasion and lymph node metastasis (AJCC 8th edition pN stage). In univariate analysis of overall survival, age > 60, absence of DWI, and African American race were associated with worse overall survival. In multivariate analysis, age > 60, absence of DWI, and African American race were associated with worse progression-free survival and overall survival. CONCLUSION: Although DWI is associated with lymph node metastasis, it is not associated with inferior disease-free/overall survival.

One Health risk challenges and preparedness regarding bovine tuberculosis at abattoirs in North-central Nigeria: Associated drivers and health belief.

BACKGROUND: Bovine tuberculosis (bTB) is a serious public health and neglected zoonotic disease responsible for 147,000 human cases and 12,500 deaths annually. This study assessed knowledge, risk perceptions, and preventive practices regarding bTB among occupationally exposed abattoir workers and drivers for transmission in slaughterhouses. METHODS: Using a pre-tested questionnaire, we surveyed a cross-section of workers in five main abattoirs in North-central Nigeria between 2018 and 2019. Data were analysed using descriptive statistics and univariable/multivariable logistic regression analyses at a 95% confidence level. RESULTS: All recruited respondents (n = 422: 77.7% meat processors and 22.3% meat and sanitary inspectors) participated and 10.4% had no formal education. About 44.0% and 27.0% of workers knew about bTB occurrence at the abattoirs and its transmission to humans, respectively. Less than one-third use personal protective equipment (PPE) during meat handling, only a few workers correctly practised routine handwashing, and 21.8% sterilized meat handling tools. A few participants (6.4%) had BCG vaccination against tuberculosis. Demographic characteristics (age, gender, occupation, and formal education) significantly influenced the perception and practices about bTB. A few workers perceived raw meat and milk, direct contact with infected carcasses, organs and contaminated fomites, contaminated environment through infected blood, dirty slaughtering floor, and aerosols of contaminated faeces as high-risk bTB transmission routes. Perceived drivers that influenced bTB transmission at abattoirs include unhygienic meat processing (OR = 5.4, 95%CI = 3.1-9.4, p < 0.001) and non-enforcement of abattoir standard operating systems (OR = 10.4, 95%CI = 6.0-18.5, p = 0.001). CONCLUSION: The workers have low knowledge levels, perceptions, and practices toward bTB emergence. These demand the workers' education on hygienic meat handling to mitigate the menace of the disease. Surveillance and preventive preparedness considering the identified drivers through the 'One Health' approach are recommended.

Rituximab Used for the Treatment of Nonuremic Calciphylaxis: A Complication of Prolonged Steroid Use in Lupus Nephritis.

Nonuremic calciphylaxis (NUC) is a rare and debilitating form of panniculitis. NUC is associated with a high mortality rate within the first year of diagnosis. Connective tissue diseases account for a small fraction of the reported cases. However, there have also been reported cases of patients developing NUC while on treatment with chronic corticosteroid immunosuppressive therapy. The pathophysiology of NUC is still not fully established. Several risk factors including underlying diseases, obesity, female gender, and medications have been associated with the development of NUC. The diagnosis remains challenging due to the condition's similarities with other forms of panniculitis. The gold standard for diagnosis is a tissue biopsy showing calcifications within the medial layer of arterioles and the presence of microthrombi with surrounding necrosis. The treatment for NUC has not advanced much in recent years and focuses on the management of the underlying condition, wound care, and treating any superimposed infection. Treating superimposed infections remains important as most of the associated mortality from NUC occurs due to sepsis. We describe a case of a young woman with lupus nephritis who developed NUC while on prolonged corticosteroid therapy. She did not respond to several immunosuppressive agents and was ultimately treated with rituximab, a monoclonal antibody against CD20 antigen, as salvage therapy.

Knowledge, Attitudes, and Risk Perception of Broiler Grow-Out Farmers on Antimicrobial Use and Resistance in Oyo State, Nigeria.

Assessing knowledge, attitudes, and risk perception of Nigerian broiler grow-out farmers (n = 152) to antimicrobial resistance (AMR) with a five sectional purposive-structured-questionnaire: demographics; knowledge; attitudes; risk-perception; and response to regulation of antimicrobial practices. Data were analyzed using descriptive statistics, chi-square test, and binary logistic regression. Respondents' knowledge score, in total, was lower than average, with all (100%) respondents having the understanding that antibiotics kill/reduce bacteria, most participants (>73%) believing that feeding antibiotics to broiler chickens is a necessity for weight gain, and many (>69%) thinking that no negative side-effects exist with the use of antibiotics. Poor attitude towards antimicrobial usage was prevalent (>63%) with unsatisfactory performance in most instruments: >60% of farmers reported using antimicrobials every week and still use antimicrobials when birds appear sick, and most (>84%) arbitrarily increase the drug dosages when used. However, a satisfactory performance score was reported (68%) in risk perception of AMR with >63% perceiving that inappropriate use of antibiotics is the main factor causing the emergence of resistant bacteria; >65.8% expressed that AMR in broiler chickens is not essential for public health, that AMR cannot develop from broiler bacteria diseases, that increasing the frequency of antimicrobial use cannot increase AMR in future, and that usage cannot lead to antibiotic residue in broiler-meat products leading to AMR development in human. None of the respondents were aware of any regulation for monitoring antimicrobial use. Significant factors associated with knowledge, attitudes, and risk perception of antimicrobial use and resistance among broiler grow-out farmers include marital status, farm category, education, educational specialization, sales target, growth duration/cycle, broiler stocking batch, and feed source. Identified gaps exist in AMR awareness among Nigerian broiler farmers and should be targeted through stakeholders' participation in combatting AMR threats.

Knowledge and self-reported food safety practices among meat consumers in Ilorin, Nigeria.

As an imperative source of protein to man, meat could also serve as a source of infections when processed poorly. This research studied consumers' knowledge and self-reported food safety practices among 869 meat consumers of different socioeconomic statuses. We summarized the data obtained using descriptive and inferential statistics. Two outcome variables were developed to determine satisfactory knowledge and practices. The knowledge and practice scores were determined through a numeric scoring system based on the respondents' correct responses to knowledge and practices questions. These outcome variables were further categorized into binary variables based on a cut-off point (mean + 1 SD of the scores) with scores greater and lower than the cut-off points considered satisfactory (acceptable/appropriate) and unsatisfactory, respectively. The respondents are predominantly female (54.9%) within the age range of 19-25 years (54.2%) and were unmarried (71.1%). Less than half (46.4% and 40.0%) of the respondents have adequate knowledge and practice levels of food safety. Most meat consumers have identified various challenges to food safety and hazards related to unsafe food safety practices. Important socioeconomic variables of the meat consumers such as occupation, age, and marital status, were significantly (p < 0.05) associated with food safety knowledge. Meat consumers with higher age categories and educational levels were more likely to have good food safety knowledge than those of the 15-18 years age category and primary educational level, respectively. Respondents with higher levels of education were more likely to demonstrate satisfactory food safety practices than those of primary education status, while males (OR = 1.34; 95% CI: 1.02, 1.76; p = 0.043) were significantly more likely to report satisfactory food safety practices. In conclusion, this study emphasized the need for an improvement in consumers' food safety practices.

Biphasic Hyalinizing Psammomatous Renal Cell Carcinoma: Another Provisional Entity Emerging From the Papillary Renal Cell Carcinoma Pandora's Box.

Papillary renal cell carcinoma (especially type 2) is a Pandora's box with many newly described renal cell carcinomas emerging from it as a result of enhanced molecular techniques. Biphasic hyalinizing psammomatous renal cell carcinoma (BHPRCC) is the latest addition, which was first described a few months ago. Here, we report a case of BHPRCC to supplement the very limited literature available about this entity, and to highlight the characteristic morphology as well as the recurring molecular alterations in the neurofibromatosis 2 gene.

Pitfalls in Morphologic Diagnosis of Pathogens: Lessons Learned From the Pseudo-Cystoisospora Epidemic.

Multiple groups have recently reported involvement of the gallbladder mucosa of immunocompetent patients by cystoisospora organisms. However, this has recently been disproved with the support of molecular and ultrastructural studies. Here we present a summary of these events, recounting how this pseudo-Cystoisospora epidemic began and ended. This review also highlights the important role played by ancillary techniques in supplementing the morphologic diagnosis of pathogens.

Serospatial epidemiology of zoonotic Coxiella burnetii in a cross section of cattle and small ruminants in northern Nigeria.

The persistent and highly transmissible Coxiella burnetii is a neglected infection that negatively affects reproductive parameters of livestock. It is also of zoonotic importance and has been reported to cause devastating human infections globally. Domestic ruminants represent the most frequent source of human infection. Data from Nigeria are very few and outdated. There is a significant gap in up-to-date information on the exposure, spatial distribution and risk factors of infection of this important disease. The exposure to C. burnetii was determined using sensitive serological assays in cattle and small ruminants. A total of 538 animals made up of 268 cattle and 270 small ruminants were sampled from three northern Nigerian states. The proportion of cattle sampled that were seropositive from the study locations were: Kwara 14/90 (15.6%; 95% CI: 8.8-24.7); Plateau 10/106 (9.43%; 95% CI: 4.6-16.7) and Borno 4/72 (5.56%; 95% CI: 1.5-13.6) states. Lower seroprevalence was recorded among the small ruminants sampled, with positives recorded from sheep and goat sampled from only Kwara state 6/184 (3.3%; 95% CI: 1.2-7.0); while none of the small ruminants sampled from Plateau were seropositive. The results of the bivariate analysis showed that none of the tested independent variables (village, age group, sex, breed of cattle, presence of ticks, reproductive status, and management system) were statistically significant factors associated with seropositivity of cattle for antibodies to C. burnetii. Stakeholders involved in animal husbandry should be duly educated on proper disposal of birth products as well as bodily fluids in order to reduce environmental contamination, persistence and human infection.

Prognostic significance of venous invasion in node-negative head and neck squamous cell carcinoma.

BACKGROUND: Venous invasion (VI) is not frequently evaluated on routine histologic examination of head and neck squamous cell carcinoma (HNSCC), and the prognostic significance is largely unknown. Studies have shown that extramural venous invasion is an adverse prognostic factor in colorectal carcinoma. To our knowledge, this is the first study evaluating the prognostic significance of venous invasion in node-negative (without clinical or pathologic evidence of lymph node involvement) HNSCC, utilizing the elastic stain. METHODS: A total of 105 consecutive lymph node-negative (N0) HNSCC were evaluated for the presence of venous channel invasion by tumor utilizing the elastin stain. Clinical, demographic, and follow-up data were recorded. RESULTS: Of 37 patients with venous invasion, 19% had loco-regional recurrence, as opposed to 12% of those without. Univariate analysis revealed statistically significant decreased recurrence-free survival in the presence of venous invasion (log-rank [Mantel-Cox] test P-value .025). CONCLUSION: Identification of VI is greatly aided by elastic stain. In patients with node-negative HNSCC, presence of VI resulted in decreased recurrence-free survival on univariate analysis. The impact of VI as a prognostic marker should be further evaluated.

Knowledge of Antimicrobial Resistance among Veterinary Students and Their Personal Antibiotic Use Practices: A National Cross-Sectional Survey.

The challenge of antimicrobial resistance (AMR) is grave in developing countries. Antimicrobials are misused yet stakeholders' contribution to antimicrobial stewardship is low. Veterinary students are future prescribers and their knowledge could influence progress in combating AMR; hence, there is a need to assess their knowledge, attitude, and awareness of AMR. A multi-institutional questionnaire was administered to undergraduates in Nigerian veterinary schools. It comprised demographics, own personal antibiotic usage, and knowledge, attitude, and awareness of AMR in humans and animals. Descriptive statistics and logistic regression were used for analyses. Of the 426 respondents, 39.2% reported personal antimicrobial use in the previous six months. Over 60% received knowledge scores lower than average and >87% requested more education on clinical use and prescriptions pre-graduation, monitored dispensing of antimicrobials, conducting AMR research, and confirmed link among human, animal, and environmental health. Less than 25% of respondents were aware of antimicrobial stewardship and global efforts/organizations for AMR. Final year students have 9-fold and 14-fold more satisfactory knowledge on antimicrobials in humans and animals compared with other students, respectively (p = 0.001). Final year students also have more knowledge (13×) and awareness of contributory factors (3×) on AMR (p = 0.001) than other students. Unsatisfactory knowledge on AMR issues exists among veterinary students yet willingness to improve was observed. Identified knowledge, attitude, and gaps in AMR awareness should be targeted by veterinary schools in Nigeria.

Neglected zoonotic diseases in Nigeria: role of the public health veterinarian.

Zoonotic diseases accounts for about 75% of emerging infectious disease and can be devastating to both human and animal health globally. A subset of zoonotic diseases is referred to as "neglected zoonotic diseases - NZDs" as they mainly affect poor populations who live in close proximity to domestic or wild animals often in areas where access to health and adequate sanitary facilities are not available. Furthermore, underestimation of the burden of NZD has continually led to its further neglect in least developed countries such as Nigeria. Controlling zoonotic infections including NZDs in animals is crucial in reducing human infections. Veterinarians provides an understanding of the epidemiology of infectious diseases in animal population and are therefore integral for the overall reduction in global burden of NZDs worldwide. Due to the current lack of and in some cases weak involvement of Veterinarians in policy issues related to zoonotic diseases, there is need to elucidate their importance in NZDs control in Nigeria. This review therefore summarises the neglected zoonotic diseases so far documented in Nigeria and also highlight the important role of the Veterinarian in their prevention and control within both human and animal population. Important recommendations to strengthen the role of the public health Veterinarian for sustainable control of NZDs were made.

Staphylococcus aureus in two municipal abattoirs in Nigeria: Risk perception, spread and public health implications.

Staphylococcus aureus is a zoonotic pathogen of significant public health concern. Information on the prevalence and risk factors facilitating bacterial colonization and spread under abattoir settings in Nigeria are scarce. This cross-sectional study was designed to determine prevalence of S. aureus as well as risk factors on knowledge and practices facilitating pathogen carriage among workers and slaughter animals in two municipal abattoirs of Ilorin and Ibadan, Nigeria. Swab samples (n = 1671) from nostrils of cattle, goats, pigs and abattoir workers, and from meat tables and abattoir walls were collected for detection of S. aureus. A questionnaire was administered to 275 workers to elucidate risk factors of pathogen carriage applying a logistic regression model. S. aureus prevalence was 6.5%. In total, MSSA and MRSA were detected at a frequency of 5.4% and 1.1%. Molecular analysis of the isolates revealed 19 different spa types, including a novel spa type (t16751). Gender, marital status, occupation and abattoir location were factors influencing worker's practices in relation to pathogen carriage and spread in the abattoir setting. This present study detected not only low MSSA and MRSA prevalence, in both abattoirs but also low risk perception and hygiene practices employed by abattoir workers. Good practices among workers at Nigerian abattoirs are needed to mitigate S. aureus carriage. Further studies expounding the antibiotic resistance and relationships of MSSA and MRSA strains detected in this study are needed to complement understanding of the spread of S. aureus in the abattoir food chain.

Erythrocyte sedimentation rate in stable patients on chronic hemodiaysis.

The objective of this study was to assess the value and determinants of erythrocyte sedimentation rate (ESR) in stable patients on regular hemodialysis (HD). Pre-dialysis and post-dialysis ESR was measured in a group of stable adult patients on regular HD and the results were compared. The results were also correlated with the patients' demographic and laboratory data. Only stable patents were included in the study. Patients with evidence of current infection, active inflammatory processor malignancy and severe anemia were excluded. We recruited 161 patients in the study of whom 44.1% were males, 53.4% had diabetes mellitus and 40.4% had an episode of sepsis previously. Only 15.5% of the patients had less than one year of dialysis and 54.3% were over the age of 60 years. The mean post-dialysis ESR was significantly higher than the pre-dialysis ESR (55.6 ± 30.4 and 49.8 ± 28.5, respectively; P = 0.003). Pre-dialysis, 79.5% of the patients had raised ESR. ESR was significantly correlated with C-reactive protein, serum ferritin, plasma albumin and fibrinogen (P <0.05). Patient factors (age, gender, duration of dialysis, previous renal transplantation, type of dialysis access and sepsis or thrombosis of dialysis access site) and blood laboratory parameters (hemoglobin, serum creatinine and serum parathormone) had no statistically significant correlation with ESR ( P ≥ 0.05). Post-dialysis the ESR was raised in most of the stable patients on regular HD and was significantly higher than the pre-dialysis ESR (by, on average, 5.8 mm/h). ESR had variable correlation with different blood factors.