Spectroscopy in Nanoscopic Cavities: Models and Recent Experiments.

The ability of nanophotonic cavities to confine and store light to nanoscale dimensions has important implications for enhancing molecular, excitonic, phononic, and plasmonic optical responses. Spectroscopic signatures of processes that are ordinarily exceedingly weak such as pure absorption and Raman scattering have been brought to the single-particle limit of detection, while new emergent polaritonic states of optical matter have been realized through coupling material and photonic cavity degrees of freedom across a wide range of experimentally accessible interaction strengths. In this review, we discuss both optical and electron beam spectroscopies of cavity-coupled material systems in weak, strong, and ultrastrong coupling regimes, providing a theoretical basis for understanding the physics inherent to each while highlighting recent experimental advances and exciting future directions.

Rosette-forming glioneuronal tumor: an update.

Rosette-forming glioneuronal tumor (RGNT) is a rare and distinct primary nervous system tumor. The literature on this novel neoplasm is sparse and limited to mostly case reports. Reviews on the characteristics of this tumor are fewer and far between with the latest up to a decade old. We thus provide a comprehensive review of recent literature to characterize presenting symptoms, radiological evidence, treatment options, and prognosis of this novel neoplasm. A Medline search for case reports detailing primary rosette-forming glioneuronal tumors was performed. RGNTs are a benign tumor of indolent course with mixed glial and neurocytic components. There is a slight female predominance with mean age of presentation at 23.57 years. Headaches, visual disturbances, and nausea and vomiting are the most common symptoms. Most RGNTs have solid and cystic components, arising most frequently in the fourth ventricle or cerebellum. Management is usually through surgery with gross total resection (GTR) providing better prognosis.

Clomiphene citrate ameliorated lead acetate-induced reproductive toxicity in male Wistar rats.

OBJECTIVE: The current study investigated the effects of clomiphene citrate on the hypothalamic-pituitary-testicular axis, steroidogenesis, sperm parameters, and testicular antioxidant enzyme activity of male Wistar rats submitted to lead acetate (Pb)-induced reproductive toxicity. METHODS: Twenty adult male Wistar rats were divided into four groups of equal size as follows: Control; Clomid (0.35 mg/kg); Pb (10 mg/kg); and Clomid + Pb. Serum levels of follicle stimulating hormone (FSH), luteinizing hormone (LH), testosterone, testicular 17-ß hydroxysteroid dehydrogenase (17-ß HSD) activity, androgen receptors, catalase activity, superoxide dismutase (SOD), malondialdehyde (MDA), sperm motility, viability, counts and morphology were estimated after oral administration of Clomid and/or lead acetate for 35 consecutive days. Data were analyzed using ANOVA at p<0.05. RESULTS: Lead acetate significantly decreased (p<0.05) serum LH and testosterone levels, testicular 17ß-HSD activity, androgen receptor expression, sperm motility, viability, counts, catalase activity, and SOD when compared with controls. Abnormal sperm morphology and MDA were significantly increased (p<0.05) in the Pb group compared with controls. Clomid co-administrated with lead acetate significantly increased (p<0.05) serum LH, testosterone levels, testicular 17ß-HSD, androgen receptor expression, sperm motility and viability when compared with the group given lead acetate. CONCLUSIONS: The present study suggests that clomiphene citrate may stimulate testicular testosterone synthesis, sperm motility and viability via luteinizing hormone in a context of lead acetate-induced reproductive toxicity.

The systemic management of cutaneous dermatomyositis: Results of a stepwise strategy.

Treatment of dermatomyositis (DM) is often achieved with a stepwise algorithm. However, the literature lacks quality evidence to support the use of this therapeutic strategy. The result of a stepwise therapeutic strategy in the management of skin-only DM is presented to better understand the clinical outcomes and allow for future studies. A cohort of 102 patients with DM, 41 of whom had skin-only disease, were seen between July 2009 and April 2013 at a referral-based connective tissue disease clinic. The Cutaneous Dermatomyositis Disease Area and Severity Index was used to prospectively assess disease severity and the outcomes in 41 adult patients with skin-only DM were analyzed. Of the 41 patients with skin-only DM, 23 patients (56.1%) received antimalarial medications alone and 18 patients (43.9%) received second- or third-line agents. Ten patients (24.4%) remained at the first level of the treatment algorithm and received only hydroxychloroquine. Prednisone was included in the treatment regimen for 11 patients with skin-only disease (26.8%). The results show that management of cutaneous DM often requires second-line agents because antimalarial medications alone are insufficient to treat most patients with skin-only disease.

The Role of Blood Lead, Cadmium, Zinc and Copper in Development and Severity of Acne Vulgaris in a Nigerian Population.

Acne vulgaris is a very common skin disorder affecting human beings. There is a paucity of report on the role of heavy metals-lead (Pb) and cadmium (Cd)-globally, and trace metals-zinc (Zn) and copper (Cd)-particularly in Nigeria in the development/severity of acne vulgaris. This study is aimed to determine the blood levels of some heavy metals-cadmium and lead-and trace metals-zinc and copper-in acne vulgaris sufferers in a Nigerian population. Venous blood samples were collected from a total number of 90 non-obese female subjects consisting of 30 mild, 30 moderate and 30 severe acne vulgaris sufferers for blood Cd, Pb, Cu and Zn determination. They were age-matched with 60 females without acne vulgaris who served as the control subjects. Acne sufferers had significantly higher blood Cd and Pb (P = 0.0143 and P = 0.0001 respectively) and non-significantly different blood levels of Cu and Zn (P = 0.910 and P = 0.2140 respectively) compared to controls. There were significant progressive increases in blood levels of Cd and Pb (P = 0.0330 and P = 0.0001 respectively) and non-significant differences in the mean blood level of Cu and Zn (P = 0.1821 and P = 0.2728 respectively) from mild to moderate and severe acne vulgaris sufferers. Increases in blood Cd and Pb may play critical roles in the pathogenesis/severity of acne vulgaris, while Cu and Zn seem to play less significant roles in the development of this disorder in this environment.

Validation of the Cutaneous Dermatomyositis Disease Area and Severity Index: characterizing disease severity and assessing responsiveness to clinical change.

BACKGROUND: The Cutaneous Dermatomyositis Disease Area and Severity Index (CDASI) was developed for use in clinical trials and longitudinal patient assessment. OBJECTIVES: To characterize disease severity using the CDASI and assess the responsiveness of this instrument to clinically meaningful changes in disease activity. METHODS: Patients with cutaneous dermatomyositis at the University of Pennsylvania (UPenn, n = 93) and Stanford University (Stanford, n = 106) were prospectively evaluated using the CDASI, physician global assessment (PGA) Likert scales and a visual analogue scale (VAS). Data was analysed using logistic regression models and receiver operating characteristic curves to select cut-offs. RESULTS: Baseline CDASI activity scores for the patients evaluated at UPenn ranged from 0 to 47 (median 17), and baseline PGA VAS scores ranged from 0 to 9·6 (median 1·1). At UPenn a CDASI activity score of 19 differentiated mild from moderate and severe disease. At Stanford baseline CDASI scores ranged from 0 to 48 (median 21), baseline PGA VAS scores ranged from 0 to 9·7 (median 4·2) and CDASI activity scores of 14 or less characterized mild disease. When a 2-cm change in the PGA VAS was regarded as a clinically significant improvement, a 4-point (UPenn) or 5-point (Stanford) change in CDASI reflected a minimal clinically significant response. CONCLUSIONS: The CDASI is a valid and responsive measure that can be used to characterize cutaneous dermatomyositis severity and detect improvement in disease activity. Variations in cut-offs may be due to differences in disease severity between the two populations or inter-rater variations in the use of the external gold measures.

The profile of chest injuries in a southeastern Nigeria teaching hospital, a 10-year experience.

BACKGROUND: Globally, major chest injuries have both high morbidity and mortality. A detailed study of chest injuries in south-eastern Nigeria is here presented. AIMS: To determine the incidence, the predisposing factors, the pattern of presentation and the outcome of management of chest injuries. MATERIALS AND METHODS: This is a retrospective study spanning a period of 10 years (2002-2011). The medical records of all patients with documented chest injuries that presented to our hospital within the period under review, were retrieved and analysed, by simple arithmetic percentages. RESULT: A total of 402 patients (average of 40/year) with the age ranges in the spectrum of 0-10 and 81-90 years, with a mean of 2.2 were found. Gender-wise, 301 males (74.9%) and 101 females (25.1%) were affected. The aetiological or the predisposing factors were blunt chest injuries (61.2%) and penetrating chest injuries (38.8%). In the pattern of presentation, haemothorax (20.9%), haemopneumothorax (16.2%), pneumothorax (17.4%) including simple, open and tension types as well as multiple ribs fractures (7.7%) constituted the majority. In the management strategies, conservative methods were mainly used. The outcome ranged from very good to fair. CONCLUSION: The management of chest injuries in our sub-region like any other developing countries is very much challenging. Concerted efforts are needed to overcome the burden it imposes.

The challenges facing the management of arterial aneurysm in UNTH, Enugu.

BACKGROUND: The management of arterial aneurysm either central or peripheral has undergone evolution over the past decades. We encounter both true and pseudo aneurysm on regular basis with its complications: OBJECTIVE: To assess the challenges of managing arterial aneurysm at UNTH, Enugu in view of the health complications of the condition. METHOD: Medical records of all patients with documented arterial aneurysm over a 5-year period (2007-2011) were reviewed. Data collected and documented included patients' demographics, type of vessels involved, investigative tools used in confirming the diagnosis, type of treatment, outcome and length of hospital stay. RESULT: Atotal of 37 patients were managed for arterial aneurysm during the period under review. These consisted of 24 males (64.9%) and 13 females (35.2%). Age range was 11-78 years with a mean of 2.4 years. Central aneurysms involved ascending, arch and descending aorta as well as abdominal aorta. Peripheral ones affected femoral, axillary, brachial, and popliteal artery. The central aneurysms with the exception of abdominal aortic aneurysms were managed conservatively. Those that failed conservative management were referred to centres with expertise and facilities for on pump surgery. The peripheral ones in addition to abdominal aortic aneurysms were managed operatively with good outcome. The challenges identified in the management included non-availability of on pump expertise and prosthesis, late presentation of patients, under utilisation of CT and or MRI, poor compliance to antihypertensive drugs and poor follow up. CONCLUSION: Intervention in arterial aneurysms is the gold standard but not yet easily available and affordable at this centre. The challenges that have been identified are real and need to be addressed in order to deliver optimal care to patients within our domain. Efforts are underway in tackiling them.

Audit of cardiothoracic diseases seen at the National Cardiothoracic Centre Enugu Nigeria.

BACKGROUND: The University of Nigeria Teaching Hospital, Enugu was designated the national centre of Excellence for Cardiothoracic diseases, because of the availability of skilled manpower. This study was therefore undertaken to see the pattern of cardiothoracic diseases managed in the surgical unit of the centre and to see if the objectives of its establishment are being achieved. METHOD: A retrospective analysis of in-patient admission records managed surgically or conservatively between 2000 and 2004 was made. RESULTS: A total of 704 cases were identified; 469 (55.6%) men, 121 (17.2%) women and 114 (16.2%) children. Majority, 163 (23.25%) were between the age range of 20-29 years. Enugu, the State where the hospital is domicile had the highest admission rate of 318 patients (45.15%) while the 19 Northern States had a total of 67 patients (9.51%). Chest wall disorder constituted the majority of cases (28.69%) of which chest trauma from road traffic accident was the majority 49.6%. Most patients were hospitalised for an average of 2-4 weeks (56%). CONCLUSION: The study revealed a low admission rate with a declining trend over the years and a skewed distribution of their origin. It also identifies militating factors and draws the attention of the relevant authorities to take necessary actions to stem this trend.

Blood transfusion in an emergency paediatric unit in Owerri, Nigeria: pattern and outcome.

The increasing number of patients presenting with severe anaemia and who invariably receive blood transfusion is of concern. This retrospective study reports the pattern of presentation and the outcome of management of patients who were transfused in the Emergency Paediatric Unit of Federal Medical Centre, Owerri, between September 2002 and August 2004.

Percutaneous needle pleural biopsies in pleural effusion of uncertain aetiology in a Nigerian teaching hospital.

Clinical observation shows that most of the patients with pleural effusion of undetermined aetiology in a Nigerian teaching hospital receive antiTB drug trials. This observation prompted the authors to evaluate the role of percutaneous needle pleural biopsy as a diagnostic tool in effusions of uncertain aetiology. Thirty-seven patients with pleural effusion of uncertain aetiology were investigated by percutaneous pleural biopsies using Abrams pleural biopsy needle over an 18-month period. In 34, the aetiology was established giving a sensitivity of 92%. Non-specific pleurisy/empyema remains the commonest cause of effusion (41%), followed closely by malignancies (29.4%) and TB pleurisy (22%), respectively. Percutaneous needle pleural biopsies establish diagnosis of malignancy in 91% of the cases with 72% of the malignancies originating from the lung. There is a significant association between malignancy and pleural effusion of uncertain aetiology in patients above 40 years of age (P = 0.022). The empirical use of antiTB drugs in the absence of investigative results suggestive of the diagnoses should be discouraged. Instead concerted effort should be made to establish the cause of such effusion.

A case of fractured internal jugular catheter.

We report a case of fractured internal jugular catheter, a rare but life threatening complication of the use of intravascular catheter in a 73 year-old man. He had an internal jugular catheter in-situ for nine months, much longer than the manufacturer's recommended duration.

Evaluation of the flow cytometric crossmatch. Preliminary results of a multicenter study.

The flow cytometric crossmatch is a technique that is increasingly being used by clinical transplant laboratories. In this multicenter study by the British Society for Histocompatibility and Immunogenetics Flow Cytometry Group, a series of crossmatches were carried out to determine whether different centers obtained same results when performing the same crossmatch. There was greater than 80% agreement among participating laboratories on the results of 35/54 tests. There was no clear agreement in the remaining 20 cases. Quantitative analysis, estimating the number of cell-bound fluorescein molecules, demonstrated that differences in the criteria used by each center to define a positive crossmatch were responsible for some discordant results. When applied, definition of positivity based on the molecules of fluorescein increased concordance from 57.5% to 81.4%.l. These results suggest that a criterion for the interpretation of results based on quantitative analysis of bound antibody may be more reliable than methods in current routine use.

Pericarditis: a persisting surgical problem.

A study of pericarditis treated surgically over a period of 14.5 years was conducted to evaluate the current pattern and management of this disease in a tropical environment. The series comprised 86 patients (58 males and 28 females) aged from 5 months to 60 years (mean 21.1 years). Pericarditis was effusive in 41 patients, calcific in 33 and fibrous in 12. Aetiological or associated factors were non-specific, pyogenic infection, rheumatic heart disease, endomyocardial fibrosis, tuberculosis and amoebiasis in 36, 21, eight, eight, six and four patients, respectively. All the patients were in New York Heart Association (NYHA) functional class III or IV. Operative treatment involved pericardiotomy with tube drainage in 32 patients, pericardiectomy in 49, and pericardiotomy with subsequent pericardiectomy in five. The total hospital mortality rate was 8.0%, and was largely a result of severe pre-operative cardiac decompensation and multiple organ failure. Of the 79 early survivors, 91% reverted to NYHA functional class I or II. Surgical treatment remains the most effective management of chronic pericarditis which still constitutes a major clinical problem in some countries.

Ventilatory pulmonary function study in healthy young Nigerian adults.

Ventilatory pulmonary function was studied in 108 healthy young Nigerian adults using an electronic spirometer, with a view to determining the normal values of function for healthy Nigerians. The measured values of forced vital capacity, forced expiratory volume in 1 sec, maximum voluntary ventilation, and peak flow rate were compared with those obtained from similar studies on Nigerians and the predicted values for Caucasians. Higher values of function were obtained in Nigerian males than in the females. Nigerian males, however, showed lower values when compared with Caucasians of similar anthropometric measurements; there was no difference between the females in this study and their Caucasian counterparts. There were also some similarities and differences between the values obtained in this study and those of similar studies in Nigerians of different socio-ethnic backgrounds. The results emphasize the necessity for a ventilatory normogram for each socio-economic or ethnic grouping of individuals.

A clinical evaluation of clavulanate-potentiated amoxycillin in the management of moderate to severe respiratory tract infections.

This study investigated the effects of clavulanate-potentiated amoxycillin in the management of moderate to severe respiratory tract infections. A total of 34 patients aged 10-70 years were studied to establish the clinical and bacterial efficacy of treatment and screened for unwanted effects and abnormal laboratory findings. Clavulanate-potentiated amoxycillin was given in dosages of 375 or 750 mg twice daily, orally, for a mean of 13 days (range 3-30 days). Patients were assessed at the end of 2 weeks and again on discharge from hospital (if later) for up to 6 months. Overall diminution in the number of symptoms was recorded at the end of the study; 78% of symptoms had disappeared after 2 weeks. The treatment proved highly effective in controlling respiratory tract infections in 94% of patients. The necessity for multiple drug therapy and parenteral administration was also avoided.

The technique of participatory research in community development.

PIP: The technique of participatory research in community development is based on the involvement of the beneficiaries of the research in the entire research process, including the formulation of the research design, the collection of data, interpretation of information collected, and the analysis of findings. Thus, research teams utilizing this approach are composed of villagers, farmers, unemployed people, local leaders, and educators. The research process thus offers an educational experience that helps to identify community needs and motivate community members to become committed to the solution of their own problems. Moreover, this approach challenges the prevalent notion that only professional researchers can generate knowledge for meaningful social reform. A participatory research technique, based on the concept of citizen enlightenment for community development, was adopted by the Department of Adult Education at the University of Ibadan in a study of rural poverty in Oyo State's Apasan villages. The research team, comprised of local leaders, peasant farmers, teachers, local students, and university students, identified the villages' isolation and food scarcity as major causes of poverty. 2 actions were taken in response to these findings: 1) the construction of a road linking the Apasan communities with the State capital, enabling villagers to travel to the town, sell their goods, and purchase needed items; and 2) formation of a primary cooperative society for multipurpose farming. These actions have solved the food problem, improved the villagers' earning capacity, and resulted in the return of numerous villagers who had migrated to towns to find wage employment. Because the villagers were directly involved in the study of their problems, they were able to become more aware of their social reality and make the changes needed to lift them out of poverty.^ieng

Management of traumatic rupture of the diaphragm.

Traumatic rupture of the diaphragm is a potentially serious injury which presents in different forms depending on the mechanism of the causative trauma. Over a 7 year period, 20 patients (17 male and 3 female) with traumatic rupture of the diaphragm were seen in our unit; their mean age was 25.6 years. Automobile accidents caused the diaphragmatic injuries in 65 per cent of cases while falls from trees were the cause of injury in 10 per cent. Ten patients (50 per cent) were seen within 7 days of the injury and 95 per cent within 3 months. The left hemidiaphragm was ruptured in 85 per cent and the right in 15 per cent of cases. Fifty ribs were fractured in fourteen patients (70 per cent) but there were no pelvic fractures. Fourteen patients (70 per cent) had gastrointestinal visceral herniation into the thorax, the stomach, omentum, colon and spleen being the commonest herniating organs. Successful surgical repair was achieved in 18 patients, 4 of whom also had splenectomy; 2 patients were treated conservatively. A high index of suspicion and early surgical treatment are the mainstay of successful management of traumatic rupture of the diaphragm with or without herniation of abdominal organs.