Evaluating binding and interaction of selected pesticides with serum albumin proteins by Raman, 1H NMR, mass spectrometry and molecular dynamics simulation.

Addressing the acute pesticide poisoning and toxicity to humans, is a global challenge of top priority. Serum albumin is the most abundant plasma protein, capable of binding with herbicide and pesticide residues. This study reports multifaceted approaches for in-depth and robust investigation of the molecular interactions of selected pesticides, including propanil (PPL), bromoxynil (BXL), metolachlor (MLR) and glyphosate (GPE) with bovine serum albumin (BSA) proteins using experimental (Raman and FTIR spectroscopy, native mass spectrometry and high field 1H NMR), molecular dynamics (MD) simulation and principal component analysis (PCA). The binding of pesticides with BSA resulted in BSA amide I and amide II Raman spectral shifts. PCA of Raman spectra of serum-pesticide complexes showed the grouping of pesticides on the score plot based on the similarities and differences in pesticides' chemical structures. Native mass spectrometry results revealed strong adduct formation of the pesticides with the protein. The observed changes in chemical shifts, peak broadening or peak disappearance of characteristic proton signals of the pesticides, indicated altered chemical environments due to binding BSA-pesticides interactions. The results of MD simulation conducted for over 500 ns revealed strong pesticides interaction with LEU197, LEU218, LEU237, TRP213, SER286 and ILE289 residues to the site I of BSA. Free energy landscapes provided insights into the conformational changes in BSA on the binding of pesticides. Overall, the experimental and computational results are in consonant and indicate the binding of pesticides into the site I and site II (sub-domain IIA) of the BSA via hydrogen bonding, non-covalent and hydrophobic interactions.Communicated by Ramaswamy H. Sarma.

Restoring non-COVID-19 clinical research and surveillance in Oyo state, Nigeria during the SARS-CoV-2pandemic.

Background: Many sub-Saharan African patients receive clinical care from extramurally-supported research and surveillance. Dur- ing the COVID-19 pandemic, pausing these activities reduces pa- tient care, surveillance, and research staff employment, increasing pandemic losses. In Oyo State, Nigeria, we paused a multi-country invasive salmonellosis surveillance initiative and a rural clinical bac- teriology project. Objective: Working with research partners raises health facility con- cerns about SARS-CoV-2 transmission risks and incurs infection pre- vention costs, so we developed and implemented re-opening plans to protect staff and patients and help health facilities deliver care. Methods: Our reopening plan included appointing safety and per- sonal protective equipment (PPE) managers from existing project staff cadres, writing new standard operating procedures, implement- ing extensive assessed training, COVID-19 testing for staff, procuring and managing PPE, and providing secondary bacteraemia blood culture support for COVID-19 patients in State isolation facilities. Results: Surveillance data showed that the pandemic reduced care access and negatively affected patient unsupervised antibacterial use. The re-opening plan repurposed human and material resources from national and international extramurally-supported programs to mitigate these effects on public health. Conclusions: A structured reopening plan restarted care, surveil- lance, and infection prevention and control.

Economic costs of terminal care for selected non-communicable diseases from a healthcare perspective: a review of mortality records from a tertiary hospital in Nigeria.

INTRODUCTION: WHO revealed that morbidity and mortality from non-communicable diseases (NCDs) are on the increase and NCDs accounted for approximately 29% of all deaths in Nigeria in 2016. This study was conducted to estimate the economic cost of selected NCDs-lung cancer, liver cancer and liver cirrhosis. These diseases are known to be associated with key modifiable health risk behaviours (smoking and alcohol use), which are prevalent in Nigeria and often commence during the adolescent years. METHODS: Data were obtained between 2016 and 2017, from mortality records of patients managed for the selected diseases in the University College Hospital, a major referral centre in Nigeria. Information on costs of treatment, clinic visits, admission and transportation was obtained. Average costs of terminal in-patient care and transportation costs (in 2020 prices) were computed per patient. Costs were converted to the US dollar equivalent using the current official rate of US$1: ₦360.50. RESULTS: Twenty-two (out of 90 cases recorded) could be retrieved and all the patients had been diagnosed in the terminal stages of the disease. The average direct costs were ₦510 152.62 (US$1415.13) for an average of 49.2 days of terminal care for lung cancer; ₦308 950.27 (US$857.00) and ₦238 121.83 (US$660.53) for an average of 16.6 and 21.7 days of terminal care for patients managed for liver cancer and liver cirrhosis, respectively. CONCLUSION: The economic costs of each of the diseases were very high. Findings emphasise the need for aggressive efforts to promote primary prevention, improve early diagnosis and provide affordable treatment in view of the fact that the monthly minimum wage is less than US$85.00 and treatment costs are borne out-of-pocket by the generality of the population in Nigeria.

Association of the ABO blood group with SARS-CoV-2 infection in a community with low infection rate.

BACKGROUND AND OBJECTIVES: Reports on the association of the ABO phenotypes with infection by the SARS-CoV-2 virus have mostly come from countries with high infection rates. This study examined the possible association between SARS-CoV-2 infection and the ABO phenotype in Black Africa. MATERIALS AND METHODS: This report is from a single centre where both asymptomatic and symptomatic patients were quarantined. At the time of this report, Oyo State, Nigeria had carried out 15 733 tests of which 3119 were positive for the virus with 1952 recoveries and 37 deaths. The ABO distribution of patients was compared with that of a blood donor population. RESULTS: Of the 302 participants, 297 (98%) had their blood group determined, asymptomatic and symptomatic individuals were 123 (40·7%) and 179 (59·3%) respectively. Blood group O was significantly less represented among the patients (P < 0·01) while blood groups B and AB were significantly more represented (P < 0·01, P = 0·03 respectively). Patients with anti-B (groups A and O) were significantly less represented than those without anti-B (B and/or AB): B and AB (P < 0·001), B (P = 0·002), AB (P = 0·01). There was no difference in the blood group distribution of symptomatic and asymptomatic patients (χ2 (3, N = 302) = 2·29; P = 0·51), but symptomatic patients with anti-A (groups B and O) were more represented than asymptomatic patients with anti-A (χ2 4·89; P = 0·03). CONCLUSION: The higher prevalence of blood group O and more potent beta haemolysins (anti-B antibodies) are likely reasons for the lower infectivity by the SARS-CoV-2 virus and severity of COVID-19 disease in the community.

Changes in Selected Renal Function Parameters of Newly Admitted COVID-19 Patients from One Infectious Diseases Center in Ibadan, Nigeria: Indication for Immunopathology.

COVID-19 caused by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) enters the host cells through attachment to the Angiotensin Converting Enzyme-2 receptors (ACE-2) on the host cells. ACE-2 is known to affect renal functions, vasoconstriction and fluid homeostasis. Thus, the impact of SARS-CoV-2 infection on renal functional parameters is worth investigating. Plasma obtained from whole blood samples collected from newly diagnosed COVID-19 patients were analysed for albumin, urea, creatinine, Na, K, Cl and HCO3 using auto analysers. All newly diagnosed patients were immediately admitted for managed at the Infectious Disease Center, Olodo in Ibadan the capital of Oyo State, South Western Nigeria. The results obtained were evaluated to determine the frequency of derangements in the renal parameters of patients with the COVID-19 disease. It was observed that 57.1%, 37.8%, 32.7%, 28.1%, 18.7%, 17.8% and 3.4% of newly diagnosed COVID-19 patients had values of Cl, creatinine, albumin, Na, K, HCO3 and urea respectively outside the reference ranges. While 43.3%, 4.7%, 2.5%, 2.5%, 2.0%, 1.7% and 1.0% of COVID-19 patients had values of Cl, creatinine, Na, K, albumin, Urea and HCO3 respectively above the reference ranges. Of all admitted patients, 33.1%, 30.7%, 25.6%, 16.8%, 16.3%, 13.8% and 1.7% had creatinine, albumin, Na, HCO3, K, Cl and urea values respectively below reference ranges. The changes in renal function parameters of newly diagnosed COVID-19 patients portend that renal failure is imminent in poorly managed COVID-19 patients and this has immunopathology implications during SAR-COV-2 infection.

Computer Navigation-Assisted Knee Replacement Demonstrates Improved Outcome Compared with Conventional Knee Replacement at Mid-Term Follow-up: A Systematic Review and Meta-analysis.

The study is a systematic review and meta-analysis of prospective randomised control studies and prospective cohort studies of mid-term functional outcome of total knee replacement undertaken using imageless computer navigation compared with conventional instrumented total knee replacement. The literature search strategy included a search of the electronic databases, visual scanning of reference lists, hand searching of key journals and conference proceedings, and abstracts, citations, and trial registers. In total, 440 papers were retrieved after removal of duplicates, and with further screening, 11 papers were included in the systematic review and 6 papers were considered appropriate for meta-analysis. Analysis of the data showed evidence of a modest improvement in functional outcome at mid-term follow-up with use of imageless computer navigation assistance compared with conventional instrumented total knee replacement with a total score point estimate of 3.36 confidence interval (CI) (- 0.583, 7.298), objective score point estimate of 1.45 CI (0.11, 2.799), and functional score point estimate of 2.4, CI (- 1.174, 5.977). The predominant risk of bias was from random allocation and attrition. There is evidence of a modest improvement in functional outcome with the use of imageless computer navigation assistance compared with conventional instrumented total knee replacement at mid-term follow-up.

Sars-Cov-2 Infection Screening Using Two Serological Testing Methods.

The challenges associated with adequate deployment of nucleic acid amplification tests (NAATs) in developing countries underscores the important role of simple but sensitive and specific serological testing kits in COVID-19 diagnosis. Presently, there are a number of point-of-care tests for Severe Acute Respiratory Syndrome Corona Virus-2 (SARS-CoV-2) screening. However, the reliability of these test kits is poorly documented and hence, needs to be ascertained. This study was therefore designed to determine the sensitivity and specificity of two serological test kits for COVID-19 screening with the view to providing necessary information on the suitability of their deployment as routine test kits for SARS-CoV-2 in Nigeria. Forty-seven (47) asymptomatic adults who had been tested for SARS-CoV-2 with the real-time reverse-transcriptase polymerase-chain reaction (RT-PCR) were enrolled into this study. Blood samples were obtained for qualitative determination of serum IgM and IgG antibodies to the S-antigen of SARS-CoV-2 using a commercially available IgM and IgG Rapid Diagnostic Test (RDT) and enzyme linked immunosorbent assay (ELISA). The association between the test kits (ELISA and RDT) and PCR in diagnosing COVID-19 was determined using the Fisher's Exact test at P<0.05. The sensitivity and specificity of the test kits were determined using ROC while the Positive Predictive Value (PPV), Negative Predictive Value (NPV), Positive Likelihood Ratio (PLR), Negative Likelihood Ratio (NLR), Diagnostic Odds Ratio (DOR) and accuracy were calculated as appropriate. Twenty-eight (59.6%) of the study participants had positive PCR result. ELISA and RDT identified 20 (42.6%) and 13 (27.7%) participants respectively as having anti- SARS COV-2 specific antibodies. ELISA had a better sensitivity performance, NPV, PLR, DOR and accuracy than the RDT while the RDT had a better specificity performance than ELISA. The proportion of participants with anti-SARS-CoV-2 IgM antibody identified using ELISA was significantly higher compared with RDT. In contrast, the proportion of participants with positive anti- SARS COV-2 IgG antibody identified using RDT was significantly higher compared with ELISA. ELISA has a better sensitivity for detecting anti-SARS-CoV-2 Spike-protein specific antibodies than the RDT. However, combination of RDT and ELISA for the detection of anti-SARS-COV-2 antibodies might be useful for population COVID-19 screening.

Older persons' perceptions about advanced directives and end of life issues in a geriatric care setting in Southwestern Nigeria.

INTRODUCTION: Advanced directives enable the planning of care and support services independent of the older person's ability to make the decision. There is a paucity of information regarding the views and preferences regarding advanced directives and other end of life issues among older persons in low and middle-income countries such as Nigeria. The study aimed to explore the knowledge, attitude and belief of older persons regarding decision making surrounding end of life and advance directives. METHODS: Data were collected through focus group discussions at a monthly social gathering of outpatients in a geriatric center in Oyo State, Nigeria. Discussions were audiotaped, transcribed and analyzed manually using a thematic approach. RESULTS: Respondents' knowledge about the end of life care and advanced directives as prescribed in high income settings were sparse and did not include choices about treatment options or any medical directives. The predominant perceptions among the participants bordered mainly on the arrangements for place of death, burial and property sharing. Participants listed in order of preference the major decision makers in the advanced directive process mainly, the oldest male child, religious leaders and legal practitioners. CONCLUSION: Our findings imply the need for improving knowledge and awareness about the benefits of advanced directives among older persons with a focus on opportunities for their active participation.

Epidemiology of road traffic crashes among long distance drivers in Ibadan, Nigeria.

BACKGROUND: Road Traffic Crashes (RTCs) are major causes of morbidity and mortality in Nigeria. Few studies in Ibadan have focused on the distribution and determinants of RTC among long distance drivers. OBJECTIVE: To describe the distribution of crashes by place, times of occurrence, characteristics of persons involved and identify associated factors. METHODS: A cross-sectional study was carried out among consenting long distance drivers within selected parks in Ibadan. RESULTS: Respondents (592) were males, with median age of 42.0 years (range 22.0-73.0 years). Secondary education was the highest level of education attained by 38.0%. About 34.0% reported current use of alcohol. The life-time prevalence of crashes was 35.3% (95% CI= 31.5-39.2%) and 15.9% (95% CI=13.1-19.0%) reported having had at least one episode of crash in the last one year preceding the study. The crash occurred mainly on narrow roads [32/94 (34.0%,)] and bad portions of tarred roads [35/94 (37.2%,)] with peak of occurrence on Saturdays 18/94 (19.1%,). Significantly higher proportions of drivers aged ≤39years (23.4%) versus >39years (11.7%), those with no education (29.9%) versus the educated (13.8%) and those who reported alcohol use (21.9%) versus non users (12.8%) were involved in crashes in the year preceding the study. Significant predictor of the last episode of crashes in the last one year were age (OR=2.2, 95% CI=1.4-3.5), education (OR=2.7, 95% CI=1.5-4.6) and alcohol use (OR=1.8, 95% CI=1.2-3.0). CONCLUSION: Road traffic crashes occurred commonly on bad roads, in the afternoon and during weekends, among young and uneducated long-distance drivers studied. Reconstruction of bad roads and implementation of road safety education programmes aimed at discouraging the use of alcohol and targeting the identified groups at risk are recommended.

Operative stabilization of open long bone fractures: A tropical tertiary hospital experience.

BACKGROUND: Operative treatment of open fractures in our environment is fraught with problems of availability of theater space, appropriate hardware, and instrumentation such that high complication rates may be expected. MATERIALS AND METHODS: We evaluated all open long bone fractures operatively stabilized at our center to determine the outcome of the various treatment modalities as well as the determinant factors. RESULT: A total of 160 patients with 171 fractures treated between December 1995 and December 2008 were studied. There were twice as many males; mean age was 35.0 years. About half were open tibia fractures. Gustilo IIIa and IIIb fractures each accounted for 56 cases (45.2%). Fifty-three percent were stabilized within the first week of injury. Interval between injury and operative fixation averaged 11.1 days. Anderson-Hutchin's technique was employed in 27 cases (21.8%), external fixation in 21 (16.9%), plate osteosynthesis in 50 (40.3%), and intramedullary nail 15 cases (12.1%). Mean time to union was 24.7 weeks. Fifty-two complications occurred in 50 fractures (40.3%) with joint stiffness and chronic osteomyelitis each accounting for a quarter of the complications. Union was delayed in grade IIIb open fractures and those fractures treated with external fixation. CONCLUSION: A significant proportion of open long bone fractures we operatively treated were severe. Severe open fractures (type IIIb) with concomitant stabilization using external fixation delayed fracture union. While we recommend intramedullary devices for open fractures, in our setting where locking nails are not readily available, external fixation remains the safest choice of skeletal stabilization particularly when contamination is high.

Blood lead, calcium, and phosphorus in women with preeclampsia in Edo State, Nigeria.

The authors investigated the effect of blood lead (BPb) and its relationship with calcium and phosphorus in the development of preeclampsia in Nigeria. Blood samples were collected from 59 preclamptics, 150 normal pregnant, and 122 nonpregnant women. Blood lead and serum Ca and P were determined. Blood lead was significantly higher (p < .001), whereas serum Ca and P were significantly lower (p < .001) in preclamptics than in normal pregnant women (60.2 ± 12.8 vs 26.3 ± 8.0 µg/dL for Pb, 1.39 ± 0.33 vs 2.03 ± 0.22 mmol/L for Ca, and 0.76 ± 0.10 vs 0.99 ± 0.13 mmol/L for P, respectively). There was significant increase (p < .05) in BPb and decreases (p < .01) in serum Ca and P in pregnant women than in nonpregnant women (35.7 ± 18.0 vs 13.1 ± 6.4 µg/dL for Pb, 1.85 ± 0.33 vs 2.33 ± 0.20 mmol/L for Ca, and 0.93 ± 0.38 vs 1.24 ± 0.26 mmol/L for P). Also, BPb was negatively correlated with serum Ca and, P, and positively correlated with systolic and diastolic blood pressures in pregnancy (r = -.804 for Ca, r = -.728 for P, r = .908 for SBP, and r = .842 for DBP) and preeclampsia (p < .01). It appears that increase in blood lead, which parallels decreases in serum calcium and phosphorus, may be related to the development and progression of preeclampsia in this environment.

Spinal anesthesia in children: no longer an anathema!

BACKGROUND: Spinal anesthesia is underutilized for surgery in children in Nigeria. Until recently, only caudal and general anesthesia are employed in the pediatric age group, and the thought of spinal anesthesia was an anathema. This study evaluated cardiovascular changes, duration of spinal block, the length of surgery, length of spinal needle to establish lumbar puncture, and the incidence of complications associated with this procedure. METHODS: Thirty-two children ASA 1 and 2 between the ages of 2 and 12 had spinal block from August 1, 2008 to February 28, 2010 for orthopedic and plastic surgical procedures. Spinal block was carried out at L5/S1 interspace, and the dose of bupivacaine was 0.5 mg·kg(-1). RESULT: Satisfactory surgical anesthesia was achieved in 31 of 32 children. There was no sensory or motor block within 10 min in one child, despite an easy lumbar puncture necessitating the use of general anesthesia. No patient showed oxygen desaturation, bradycardia, or hypotension. Two (6.5%) children aged 5 and 8 reported mild, position-dependent headaches, 3 (9.7%) had nausea and vomiting, and 5 (16.1%) had postspinal shivering. There was a positive correlation between the size of the child and the needle length to establish spinal anesthesia (r = 0.7, P = 0.0001). CONCLUSION: This study demonstrates that spinal anesthesia in children causes minimal hemodynamic disruption and therefore is a safe technique for lower extremity surgeries. This technique that hitherto has not been popular with children in our environment has been found to be safe and equally effective.

Changing pattern of pediatric maxillofacial injuries at the Accident and Emergency Department of the University Teaching Hospital, Ibadan--a four-year experience.

INTRODUCTION: Maxillofacial injuries are common among polytraumatized patients, and in Nigeria, the incidence seems to be on the increase. This probably is related to the drive of industrialization and the increase in the number of road traffic accidents. Delays in attending to severe maxillofacial injuries can be grave because of concomitant injuries that can be life threatening. METHODS: This is a prospective review of maxillofacial injuries in patients less than or equal to 16 years of age who were seen at the Accident and Emergency Department between October 2002 and December 2006. In all the patients, the accident and emergency physicians carried out initial resuscitation, and thereafter, they were referred to the maxillofacial unit on call. RESULTS: A total of 611 patients with maxillofacial injuries were seen during the study period and of this, 134 (22%) were less than or equal to 16 years old. The male:female ratio was 1.1:1.0. Road traffic accident (RTA) was the most common etiological factor in 73 (54.5%) cases, while gunshot injuries accounted for 6 (4.4%) cases. Soft tissue lacerations were the most common maxillofacial injuries occurring in 90 (55.9%) cases; mandibular fractures were the most common bony injury in 17 (13.4%). CONCLUSIONS: The upsurge in maxillofacial gunshot injuries in the pediatric age group is alarming and this may be a reflection of the global changes (westernization and drug-related offenses like armed robberies) and the harsh economic conditions in this community.

Unintentional injury outcomes secondary to pedestrian traffic crashes: a descriptive analysis from a major medical center.

INTRODUCTION: An environment in which traffic regulations are not strictly enforced often is characterized by carnage from motor vehicular crashes resulting in severe injuries with unacceptably high mortality. The descriptive demographics and injury characteristics of pedestrian road crash victims presenting to a tertiary medical center in southwestern Nigeria are presented in order to provide baseline epidemiology as a first step in determining areas of potential mitigation for care of unintentional injuries. METHODS: Consecutive pedestrian road traffic crash patients treated in the Accident and Emergency Department of a tertiary hospital were prospectively reviewed from March 2007 to February 2008 to determine baseline demographics and clinical outcomes. RESULTS: A total of 184 patients with a mean value of the ages of 31.4 years were studied; 27% of the patients were <11 years of age. The male to female ratio was 1.6:1. Fifty-four percent of the victims were struck by automobiles and 29% were struck by motorcycles. Sixty-five percent were struck while crossing common thoroughfares. Head injury was sustained in 61% of patients. The mortality rate was 31.0% (n = 57). The clinical course leading to death showed 22.8% of the patients who died initially experienced hemorrhagic shock, 17.5% suffered a severe head injury, and 17.5% suffered aspiration. Autopsy confirmed brainstem herniation in 28.1% of the patients who died. The average interval between injury and death was 5.5 +/-13.6 days (range: 0-77 days). In this setting, three out of every ten patients experiencing pedestrian vehicular trauma will die before leaving the hospital. The elderly are most at risk, with two-thirds of victims dying from injuries sustained. CONCLUSIONS: This raises serious questions about the prehospital- and hospital-based emergency services for vehicular road crash victims in this environment, and confirms the World Health Organization findings that Africa has the highest rate overall for unintentional injury deaths. A system-wide program must be put in place that addresses proven prevention measures across all sectors of the community.

Extraosseous osteosarcoma in Ibadan: case series over a 20-year period.

Extraosseous osteosarcoma (EOO) is a rare form of sarcoma. There have been few reports of cases and outcome from an African population.Out of 112 cases of sarcomas seen at the UCH, Ibadan between 1986-2005, 5 were EOO. All presented late on account of initial excision without histology and outcomes were poor. EOO occurs in the black population of Sub-Saharan Africa. The outlook for these patients is still bleak.

Plating of Femoral Shaft Fractures: the Experience in an African Teaching Hospital.

BACKGROUND: Femoral shaft fractures are common presentation in our trauma units. It is obvious that all these fractures cannot be treated conservatively due to the pressure on trauma beds and thus a suitable method of internal fixation that is feasible in the environment has had to be adopted. OBJECTIVE: This study is a report of our experience with plate fixation of femoral shaft fracture in our environment. DESIGN: A retrospective hospital based study. PATIENT AND METHOD: All patients with femoral shaft fractures stabilized with plates and screws between 1997 and 2004 at the University College Hospital were reviewed. The case notes were retrieved and data extracted from them; all case notes entry gave sufficient information. RESULTS: The fracture pattern showed 56 cases (35.4%) of Type 32-A, 45 cases (28.5%) of Type 32-B and 57 cases (36.1%) of Type 32-C using AO classification. The outcome of treatment was excellent to good in 125 fractures (77.2%). The average time of healing was 20 weeks (range 16-48). Fracture related complications occurred in nine fractures (5.7%) which included deep infection in four fractures (2.5%) and implant failure in five fractures (3.2%). CONCLUSION: Femoral shaft plating gives good result if the principles of fixation is carefully followed and in developing countries where initial cost of procurement of equipments for closed nailing may not be forth coming, it thus provide a safe efficient and low cost method of fixation of femoral shaft fracture.

On-site physicians at a major sporting event in Nigeria.

INTRODUCTION: Although the need for on-site physicians at mass gatherings has been investigated in developed countries, it has not been studied in a developing country, where resources are limited, paramedical services are unavailable, and transportation and other facilities are inadequate. HYPOTHESIS: The presence of on-site physicians would result in the effective management and prehospital care of casualties at mass gatherings or major sporting events in a developing country. METHODS: A retrospective review of the planning procedures and medical records of the 19th Nigerian University games was conducted. Data from demographic profiles of visitors presenting to the on-site, secondary, and tertiary medical centers and the treatments used were extracted from log-books and processed and interpreted. RESULTS: The Games hosted 6000 accredited athletes and officials, and an estimated 80,000 spectators. Medical coverage was provided by 54 doctors and other healthcare staff at on-site, secondary, and tertiary medical centers. No trained paramedics were available. A total of 494 visits were made to the medical centers (medical usage rate of 2.1/1000, patient presentation rate of 0.08). Forty-six percent of the visitors were evaluated by a physician on-site. Ninety percent of the visits were managed on-site, while 5% and 3% were referred to secondary and tertiary medical centers, respectively. CONCLUSION: The presence of on-site physicians at a major sporting event resulted in the majority of injuries and complaints being effectively treated on-scene. This reduced the number of hospital referrals and saved time and money for treatment.

Osteophytes--an alternative source of chondrocytes for transplantation?

OBJECTIVE: The aim of this research was to evaluate the possibility of using osteophyte-derived chondrocytes for autologous chondrocyte implantation by comparing the behaviour of these chondrocytes with that of normal articular cartilage-derived chondrocytes in monolayer culture. MATERIALS AND METHODS: The scrapings from the cartilage mantle of osteophytes harvested during routine total knee replacement for osteoarthritis were enzymatically digested and grown in monolayer culture. Articular cartilage scrapings obtained from visually normal area of the femoral condyle (usually from the posterior cuts) were also enzymatically digested as for the cartilage from the osteophytes. The behaviours of these two sets of chondrocytes were evaluated in monolayer culture, by their gross appearance, matrix protein elaborated and collagen types with the articular cartilage-derived chondrocytes acting as controls. RESULTS: Osteophyte-derived chondrocytes confluenced earlier than normal articular cartilage-derived chondrocytes. The osteophyte-derived chondrocytes elaborated cartilaginous matrix as evidenced by positive staining for Toluidine blue and the cells were immunoreactive positive for collagen types I, II and III. CONCLUSION: Osteophyte-derived chondrocytes are similar to normal articular cartilage-derived chondrocytes in monolayer culture. Since osteophytes are expendable tissues and often found in association with full thickness articular cartilage defects, they may provide an alternative source of chondrocytes for transplantation in cases where autologous chondrocyte transplantation (implantation) is embarked upon.

Oncogene expression in the peri-articular osteophytes.

OBJECTIVE: The aim of this study was to ascertain the proliferative and probably reparative potentials of the periarticular osteophytes by evaluating the sites of expression of c-myc, c-jun and c-fos oncogenes in this neoplastic repair tissue. MATERIALS AND METHODS: Sections of osteophytes were obtained from knees of patients undergoing total knee arthroplasty for osteoarthritis. Decalcified sections of osteophytes were stained for c-myc and c-jun oncogenes using the avidin HRP technique. Sections of breast carcinoma were used as positive controls. Undecalcified or frozen sections of osteophytes were stained for c-fos oncogene using the avidin alkaline phosphatase technique. Sections of the human skin were used as positive control. For both techniques, sections of normal articular cartilage were used as negative controls. RESULTS: The chondrocytes of the entire cartilage mantle of the peri-articular osteophyte had positive staining for c-myc oncogene but no staining for c-jun oncogene. The basal chondrocytes of the deep layer of the cartilage mantle of the peri-articular osteophyte had positive staining for c-fos oncogene. The normal articular cartilage sections had no staining for any of the oncogenes evaluated. CONCLUSION: The expression of c-myc oncogene in the osteophytic chondrocytes suggests that these cells are actively proliferating. However, c-fos expression in the basal chondrocytes implies that these cells are capable of transformation. This result confirms the proliferative ability of the peri-articular osteophytes and this may suggest that this osteochondral repair tissue, which is apparently wrongly sited, may be a source of tissue for osteochondral grafting for full thickness articular cartilage defects.

Biochemical observations in Blount's disease (infantile tibia vara).

Blount's disease or congenital tibia vara is a clinical entity characterized by tibia bowing, tibia torsion, and beaking of the medial tibia metaphysis on plain radiograph. In our environment, burnt-out rickets patients with biochemical and radiological diagnosis of rickets who after treatment still have residual bone changes despite normal bone biochemistry) can also present with similar clinical and radiological features as Blount's disease. However, certain biochemical variations, including antioxidants, may serve as a basis for differentiation between these two disorders. The serum levels of calcium, inorganic phosphate, zinc, copper, and alkaline phosphatase in 15 patients (10 females and five males) aged between two- and five years (mean 3.8 +/- 1.1 (SD)) with clinical and radiological features of Blount's disease were determined. The mean weight of the patients with Blount's disease was 14.0 +/- 2.4 kg (range: 11.5-16.3 kg). Fifteen subjects (nine females and six males) matched for age and sex without clinical features of any metabolic bone and/or nutritional diseases who were attending the surgical outpatient clinic served as control subjects. The serum concentrations of inorganic phosphate and calcium, though lower in patients with Blount's disease compared with controls, did not reach statistical significance. Alkaline phosphatase activity was increased in the serum of all patients with Blount's disease. In addition, there was an observed significant reduction in serum concentration of zinc (P < 0.03) compared to the control subjects. As for calcium level, the concentration of serum copper in Blount's patients was reduced, but this was not statistically significant. These biochemical observations, especially those of the antioxidant micronuent zinc, may serve as a basis for the differentiaion of the sometimes clinically inseparable disorders of Blount's and rckets and may aid in early differential diagnosis, appropriate treatment as well as prevention of complications.