SPONTANEOUS TRANSVAGINAL INTESTINAL EVISCERATION IN AN ELDERLY WOMAN.

Introduction: Transvaginal intestinal evisceration is a rare surgical emergency that is associated with morbidity and mortality. Only a few cases of transvaginal evisceration have so far been described. The predisposing risk factors associated with this clinical condition are multifactorial. Case presentation: We report a case of an 85-year-old female that presented with spontaneous small bowel evisceration through the vagina. The loops of the small bowel appeared edematous and thickened but there was demonstrable visible peristalsis. She had no previous laparotomy or vaginal surgery. An emergency laparotomy was performed, and the small bowel was reduced into the abdomen through the vaginal defect. Afterward, a total abdominal hysterectomy was performed with the closure of the vaginal vault. The postoperative period was uneventful. Conclusion: The spontaneous evisceration of bowel loops can be successfully managed when patients with such cases present early and promptly managed. Prompt diagnosis and surgical management are crucial to prevent complications. If the eviscerated viscera are non-viable, resection and restoration of bowel continuity are imperative. Management should be individualized and multidisciplinary.

OBSTRUCTED CONGENITAL HERNIA OF UMBILICAL CORD IN A NIGERIAN NEWBORN AND ITS DIAGNOSTIC CONUNDRUM.

Background: Congenital Hernia of umbilical cord (CHUC) is a rare presentation. The failure of return of intestinal loops following physiological herniation has been postulated as the embryological basis of this condition. This is usually mistakenly termed as omphalocele minor. We aim to highlight this rare finding, the clinical features, diagnostic dilemma, and management of CHUC. Case Presentation: He is a 4-day old male with obstructed CHUC. He had an oedematous umbilical stump, with circumferential normal abdominal wall skin folds in the form of a collar wrapping round the proximal aspect of the protrusion. The umbilical defect measured about 4 cm in diameter. Subsequently, surgical reduction and repair of defect was done, with resolution of symptoms. Conclusion: CHUC though a rare entity and easily missed, accurate diagnosis and management offer good prognosis. Also, recognition will prevent iatrogenic bowel injury from careless clamping of the cord with associated morbidity and mortality. It also helps to prevent mis categorization and prevent unwarranted anxiety with misdiagnosis.

Design of a vibration damping robot and force evaluation in intraoperative robotic-assisted femoral shaft repair using a modified soft damper.

BACKGROUND: Closed intra-medullary nailing fixation is a method for treating fractured femurs with minimal invasiveness. However, this method lacks safety and precision. To avert prevailing problems such as extended cracks in the already broken bone, the design of a vibration damping robot and force evaluation system is essential. METHODS: This paper presents a sensor-based clamping robot system embedded with a regulated pressurised air balloon. Drilling forces were monitored by a force sensor attached to the end robot effector, while the reduced vibration result was measured by a non-contact laser displacement sensor. A 2 degree-of-freedom (2DOF) model was developed. RESULTS: Force and vibration data were obtained using a data acquisition module (EMS 309) and analysed using MATLAB software (Version R2015b). The results obtained show that both the frequencies and amplitudes of the vibration is reduced at 6 bar with effector's spindle speed of 1500 rpm. CONCLUSIONS: This proposed concept shows that drilling force and vibration can be reduced simultaneously using a robot effector coupled with a damper.

Comparative Analysis of Cutting Forces, Torques, and Vibration in Drilling of Bovine, Porcine, and Artificial Femur Bone with Considerations for Robot Effector Stiffness.

Bone drilling is known as one of the most sensitive milling processes in biomedical engineering field. Fracture behavior of this cortical bone during drilling has attracted the attention of many researchers; however, there are still impending concerns such as necrosis, tool breakage, and microcracks due to high cutting forces, torques, and high vibration while drilling. This paper presents a comparative analysis of the cutting forces, torques, and vibration resulted on different bone samples (bovine, porcine, and artificial femur) using a 6dof Robot arm effector with considerations of its stiffness effects. Experiments were conducted on two spindle speeds of 1000 and 1500 rpm with a drill bit diameter of 2.5 mm and 6 mm depth of cut. The results obtained from the specimens were processed and analyzed using MATLAB R2015b and Visio 2000 software; these results were then compared with a prior test using manual and conventional drilling methods. The results obtained show that there is a significant drop in the average values of maximum drilling force for all the bone specimens when the spindle speed changes from 1000 rev/min to 1500 rev/min, with a drop from (20.07 to 12.34 N), approximately 23.85% for bovine, (11.25 to 8.14 N) with 16.03% for porcine, and (5.62 to 3.86 N) with 33.99% for artificial femur. The maximum average values of torque also decrease from 41.2 to 24.2 N·mm (bovine), 37.0 to 21.6 N·mm (porcine), and 13.6 to 6.7 N·mm (artificial femur), respectively. At an increase in the spindle speed, the vibration amplitude on all the bone samples also increases considerably. The variation in drilling force, torque, and vibration in our result also confirm that the stiffness of the robot effector joint has negative effect on the bone precision during drilling process.

Enhancing the antimalarial activity of artesunate.

The global challenge to the treatment of malaria is mainly the occurrence of resistance of malaria parasites to conventionally used antimalarials. Artesunate, a semisynthetic artemisinin compound, and other artemisinin derivatives are currently used in combination with selected active antimalarial drugs in order to prevent or delay the emergence of resistance to artemisinin derivatives. Several methods, such as preparation of hybrid compounds, combination therapy, chemical modification and the use of synthetic materials to enhance solubility and delivery of artesunate, have been employed over the years to improve the antimalarial activity of artesunate. Each of these methods has advantages it bestows on the efficacy of artesunate. This review discussed the various methods employed in enhancing the antimalarial activity of artesunate and delaying the emergence of resistance of parasite to it.

OPHTHALMIC ARTERY AND CENTRAL RETINAL ARTERY DOPPLER PATTERNS IN PRIMARY OPEN ANGLE GLAUCOMA PATIENTS AT THE LAGOS UNIVERSITY TEACHING HOSPITAL, NIGERIA.

BACKGROUND: Circulatory abnormalities of retrobulbar vessels are increasingly being linked to the aetiopathogenesis of primary open angle glaucoma. These abnormalities can be assessed with a colour Doppler Imaging of retrobulbar vessels. AIMS AND OBJECTIVES: To compare the Doppler ultrasound patterns of central retinal artery and ophthalmic artery in new patients with primary open angle glaucoma (POAG) diagnosis with those of non-glaucomatous group. DESIGN OF THE STUDY: A hospital-based, comparative, cross-sectional study. SETTING: Department of Ophthalmology (Guinness Eye Centre) and Department of Radiology, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria. MATERIALS AND METHODS: End diastolic velocity (EDV), Peak systolic velocity (PSV) and resistivity index (RI) were measured in the central retinal artery (CRA) and ophthalmic artery (OA) of both eyes of newly diagnosed POAG patients. The CDI values of newly diagnosed POAG patients were compared with age-gender matched non-glaucomatous group. The Doppler values of the better and worse eye of patients with asymmetrical POAG were also compared. RESULTS: One hundred subjects (200 eyes) comprising of 50 POAG patients and 50 non-glaucomatous healthy subjects were recruited for this study. The male to female ratio was 1:1.1(24 males and 26 females) for POAG patients and 1:1 (25 males and 25 females) for non-glaucomatous subjects. The CRA and OA in both eyes of POAG patients had a significantly lower mean EDV and PSV compared with those of non-glaucomatous group (p< 0.001). The CRA and OA in both eyes of POAG patients had a significantly higher mean RI compared with those of non-glaucomatous group (p< 0.001). A significant positive Pearson correlation was seen between the IOP and the RI in the CRA and OA in both eyes. Also, statistically significant negative Pearson correlations were seen between the IOP and the PSV and EDV in the OA and CRA in both eyes. CONCLUSION: This study demonstrated a significant reduction in EDV and PSV as well as an increase in RI of the CRA and OA in both eyes among POAG patients compared to the non-glaucomatous group.

Psychosocial factors predicting severity of depression among treatment-seeking HIV/AIDS patients: A multi-site Nigerian study.

BACKGROUND AND OBJECTIVES: Depression as major psychological sequelea of the HIV/AIDS infection has continued to attract investigation. With few studies in Nigeria, it is unclear whether levels of perceived stigma, sexual risk behaviors, and anticipated discrimination are differentially associated with severity of depression. MATERIALS AND METHODS: The present study using a multivariate design investigated the role of stigma, anticipated discrimination, self-esteem, HIV-related factors (e.g., drug use combination, knowledge of duration of HIV diagnosis) and socio demographic factors (e.g., multiple spouse, age, gender, and ethnicity) in depression among people living with HIV/AIDS (PLWHA) on follow-up management in three tertiary hospitals in Nigeria. Five hundred and two (187 [37.3%] males and 315 [62.7%] females) HIV/AIDS patients participated in the study. RESULTS: Mean age and mean time in months since diagnosis were 36.73 ± 9.38 and 19.42 ± 23.12, respectively. Three variables: Ethnicity, anticipated discrimination, and HIV-related stigma were related to severity of depression at (P < 0.05). Multinomial logistic regression analyses showed that being from Yoruba (odds ratio [OR] = 0.25; 95% confidence interval [CI] = 0.145-0.441), or Igbo extraction (OR = 0.43; 95% CI = 0.214-0.873) reduces the risk of reporting severity of depression by 25% and 43%, respectively. Moreover, low perceived HIV-related stigma (OR = 0.59; 95% CI = 0.355-0.966) and low anticipated discrimination (OR = 0.54; 95% CI = 0.319-0.914) reduced the risk of reporting symptoms of severe depression by 59% and 54%, respectively. CONCLUSION: Intervention to reduce the severity of depression should consider cultural specificity in its design and also evolve educational programs that incorporate discrimination and stigma in managing depression among PLWHAs.

Caffeine plus nicotine improves motor function, spatial and non-spatial working memory and functional indices in BALB/c male mice.

There is a greater prevalence of cigarette smoking among caffeine dependent individuals. This study therefore sought to assess the effect of nicotine and/or caffeine on some key biochemical indices and neurobehavioural parameters associated with brain function in male mice. Forty male BALB/c mice were divided into 4 groups of 10 animals each; Group A serve as the control and received normal saline (s.c), Group B received 2mg/kg body weight of nicotine (s.c), Group C received 2mg/kg body weight of caffeine (s.c) and Group D received 2mg/kg of nicotine and 2mg/kg of caffeine (s.c). The experiment lasted for 21 days, and then the animals were subjected to behavioral test. Thereafter the animals were sacrificed and their brain isolated for the determination of endothelial nitric oxide (NO) level, acetylcholinesterase (AChE), arginase (Arg) and adenosine deaminase (ADA) activities; as well as some antioxidant indices. Administration of nicotine or caffeine caused a significant (P<0.05) inhibition on AChE, ADA and Arg activities as well as a significant increase in NO level when compared with the control. However, it was observed from this study that nicotine enhances caffeine cognitive properties through a significant increase in non-spatial working memory whereas; it was otherwise on the spatial working memory and motor coordination. Therefore, we can suggest from our present study that caffeine enhances the effect of nicotine either synergistically or additively on memory and motor function and some key biochemical indices associated with brain function in male mice.

Empirical evaluation of the Q-Genie tool: a protocol for assessment of effectiveness.

INTRODUCTION: Meta-analyses of genetic association studies are affected by biases and quality shortcomings of the individual studies. We previously developed and validated a risk of bias tool for use in systematic reviews of genetic association studies. The present study describes a larger empirical evaluation of the Q-Genie tool. METHODS AND ANALYSIS: MEDLINE, Embase, Global Health and the Human Genome Epidemiology Network will be searched for published meta-analyses of genetic association studies. Twelve reviewers in pairs will apply the Q-Genie tool to all studies in included meta-analyses. The Q-Genie will then be evaluated on its ability to (i) increase precision after exclusion of low quality studies, (ii) decrease heterogeneity after exclusion of low quality studies and (iii) good agreement with experts on quality rating by Q-Genie. A qualitative assessment of the tool will also be conducted using structured questionnaires. DISCUSSION: This systematic review will quantitatively and qualitatively assess the Q-Genie's ability to identify poor quality genetic association studies. This information will inform the selection of studies for inclusion in meta-analyses, conduct sensitivity analyses and perform metaregression. Results of this study will strengthen our confidence in estimates of the effect of a gene on an outcome from meta-analyses, ultimately bringing us closer to deliver on the promise of personalised medicine. ETHICS AND DISSEMINATION: An updated Q-Genie tool will be made available from the Population Genomics Program website and the results will be submitted for a peer-reviewed publication.

HIV-related stigma and self-disclosure: the mediating and moderating role of anticipated discrimination among people living with HIV/AIDS in Akure Nigeria.

Although links between HIV-related stigma and self-disclosure of HIV status among people living with HIV have been well established, it is unclear whether levels of perceived discrimination are differentially associated with self-disclosure. The present study using a multi-factorial survey design investigated the role of stigma and other self-related factors (e.g., anticipated discrimination, self-esteem, HIV-related factors [e.g., drug use combination; knowledge of duration of HIV diagnosis] and socio-demographic factors [e.g., multiple spouse; age, gender, educational level] and psychological distress [depression]) in self-disclosure among People living with HIV/AIDs has been added (PLWHA) on follow-up management in State Specialist Hospital Akure, Nigeria. One hundred and thirty nine HIV/AIDS patients (49 males and 90 females) participated in the study. Mean age and mean time in months since diagnosis were 39.56 ± 10.26 and 37.78 ± 48.34, respectively. Four variables: multiple spouse, anticipated discrimination, HIV-related stigma and self-esteem were related to self-disclosure at (p < .05). Product-term regression analyses demonstrated that perceived discrimination mediated the relationship between self-esteem (Sobel test: z = 2.09, Aroian = 2.06, p < .001), perceived stigma (Sobel test: z = 2.78, Aroaian = 2.75 p < .01) and self-disclosure. Interaction term analysis between HIV-related stigma t (5, 137) = 1.69, p > .05, self-esteem t (5, 137) = .59, p > .05 and anticipated discrimination were non-significant, suggesting a non-moderation effect of discrimination and disclosure. The results indicate that anticipated discrimination may impact HIV-related stigma to reduce self-disclosure among the PLWHAs in Akure, Nigeria. Interventions should incorporate anticipated discrimination in educational programs of HIV stigma in encouraging self-disclosure among PLWHAs.

The use of mobile phones to deliver acceptance and commitment therapy in the prevention of mother-child HIV transmission in Nigeria.

The objective of this study was to determine if introducing acceptance and commitment therapy in the prevention of mother to child HIV transmission (PMTCT) programme using weekly mobile phone messages would result in improved mental health status of HIV-positive, pregnant women in Nigeria. We used a Solomon four-group (two intervention and two control groups) randomised design. The study population was 144 randomly selected, HIV-positive pregnant women attending four randomly selected PMTCT centres in Nigeria. The intervention groups were exposed to one session of acceptance and commitment therapy with weekly value-based health messages sent by mobile phone for three months during pregnancy. The control groups received only post-HIV test counselling. A total of 132 participants (33 per site) were enrolled in the study from the two intervention and two control sites. In the pre-tests, the intervention and control groups did not differ significantly with regard to demographics. Evaluation of the pre- and post-tests of the intervention group indicated significantly higher Action and Acceptance Questionnaire (AAQ-II) scores. The introduction of a mobile phone acceptance and commitment therapy programme may result in greater psychological flexibility in women diagnosed with HIV.

Applications of calixarenes in cancer chemotherapy: facts and perspectives.

Research on the therapeutic applications of calixarene derivatives is an emerging area of interest. The anticancer activity of various functionalized calixarenes has been reported by several research groups. Due to their superior geometric shape, calixarenes can accommodate drug molecules by forming inclusion complexes. Controlled release of anticancer drugs by calixarenes might help in targeted chemotherapy. This review summarizes the anticancer potential of the calixarenes and their drug loading properties. The potential use of calixarenes in chemoradiotherapy is also highlighted in brief.

Association of hydrocarbon exposure with glomerulonephritis in nigerians: a case control study.

Glomerulonephritis (GN) is a major cause of CRF in Nigerians. Experimental evidence and clinical studies mostly in Caucasian subjects have associated hydrocarbon (HC) exposure with GN. We conducted a case-control study using a questionnaire-based quantitative HC exposure measurement to compare lifetime HC exposure levels between Nigerian patients with GN-induced CRF and matched healthy control subjects. Fifty consecutive patients with CRF from GN were compared with age and sex matched group of 45 healthy controls. A questionnaire designed to assess the sources, duration and intensity of HC exposure was used to compute an HC exposure score (HES) for each participant and the scores for the two groups were then compared. The HES was significantly higher in the patients (score +/- SEM) of 2307.5 +/- 698.8 vs. 53.4 +/- 16.5; p < 0.001. The HES was dichotomised by classifying all study subjects within the upper third of scores as a high-exposure sub-group. A significantly higher proportion of patients had high exposure (p<0.002). Logistic regression analysis excluded age and gender as confounding factors and determined a greater than four-fold risk of GN-induced CRF with high HC exposure (OR 4.3; 95% CI 1.7 - 11). In conclusion, our findings suggest that HC exposure is a significant risk factor for GN in Nigerians with CRF. Exposure limitation could help to reduce the burden of CRF in the country.

Rho-kinase inhibitors prevent agonist-induced vasospasm in human internal mammary artery.

1. Vasospasm of arterial conduits used for coronary artery surgery is an important cause of graft failure and is likely to result partly from raised levels of vasoconstrictor substances such as thromboxane A(2) and endothelin-1. Our aim was to find pharmacological agents that could prevent agonist-induced vasospasm. 2. Isometric tension was recorded from discarded segments of human left internal mammary artery (LIMA). Submaximal contraction evoked by the thromboxane A(2) mimetic U46619 (10 nM) was not inhibited by a blocker of store- and receptor-operated Ca(2+) channels (30 microM SKF96365) in the presence of diltiazem. Furthermore, contractions to < or =1 nM U46619 were preserved when extracellular Ca(2+) was reduced from 2.5 mM to 60 nM. Thus, sustained U46619-evoked contraction occurred without Ca(2+) influx. 3., We hypothesized that contraction might occur via Rho-kinase-mediated Ca(2+)-sensitization of myofilaments. Inhibitors of Rho-kinase (Y27632 and HA1077) were profound relaxants. If contraction was pre-evoked by 10 nM U46619, Y27632 and HA1077 caused full relaxation with EC(50)s of 1.67+/-0.22 microM and 3.58+/-0.35 microM respectively. Y27632 was also effective if applied before U46619, but was less potent. 4. Y27632 abolished contraction evoked by endothelin-1 and significantly reduced resting tone in the absence of a vasoconstrictor. 5. Rho-kinase-mediated Ca(2+)-sensitization appears to be a major mechanism of vasoconstriction in human LIMA. Rho-kinase inhibitors may have an important role in preventing vasospasm in arterial grafts used for coronary artery surgery.