Head-to-head Intra-individual Comparison of [68Ga]-FAPI and [18F]-FDG PET/CT in Patients with Bladder Cancer.

AIM/PURPOSE: Fibroblast activation protein-(FAP)-ligands, a novel class of tracers for PET/CT imaging, demonstrated promising results in previous studies in various malignancies compared to standard [18F]FDG PET/CT. 68Ga-labeled fibroblast activation protein inhibitor-([68Ga]Ga-DOTA-FAPI)-PET/CT impresses with sharp contrasts in terms of high tumor uptake and low background noise leading to clear delineation. [18F]FDG PET/CT has limited accuracy in bladder cancer due to high background signal. Therefore, we sought to evaluate the diagnostic potential of [68Ga]FAPI in patients with bladder cancer. MATERIAL AND METHODS: This retrospective analysis consisted of 8 patients (median age 66), 7 of whom underwent both [68Ga]FAPI and [18F]FDG PET/CT scans with a median time interval of 5 days (range 1-20 days). Quantification of tracer uptake was determined with SUVmax and SUVmean. Furthermore, the tumor-to-background ratio (TBR) was derived by dividing the SUVmax of tumor lesions by the SUVmax of adipose tissue, skeletal muscle, and blood pool. RESULTS: Overall, 31 metastases were detected in five patients including lymph node metastases (n = 23), bone metastases (n = 4), lung metastases (n = 3), and a peritoneal metastasis (n = 1). In one patient, [68Ga]FAPI demonstrated significant uptake in the primary tumor located in the bladder wall. [68Ga]FAPI-PET/CT demonstrated significantly higher uptake compared to [18F]FDG PET/CT with higher mean SUVmax (8.2 vs. 4.6; p = 0.01). Furthermore, [68Ga]FAPI detected additional 30% (n = 9) lesions, missed by [18F]FDG. TBR demonstrated favorable uptake for [68Ga]FAPI in comparison to [18F]FDG. Significant differences were determined with regard to metastasis/blood pool ([68Ga]FAPI 5.3 vs [18F]FDG 1.9; p = 0.001). CONCLUSION: [68Ga]FAPI-PET/CT is a promising diagnostic radioligand for patients with bladder cancer. This first described analysis of FAP-ligand in bladder cancer revealed superiority over [18F]FDG in a small patient cohort. Thus, this so far assumed potential has to be confirmed and extended by larger and prospective studies.

Relative abundance and molecular identification of Culex pipiens complex (Diptera: Culicidae), in Kura Local Government Area, North-western Nigeria.

Culex species are the most widespread mosquito species across the world and are known to be highly opportunistic, feeding on humans and livestock. They are known to acquire the potential to transmit zoonotic diseases, including Rift Valley Fever (RVF). However, despite their public health significance, they remain understudied in North-western Nigeria, compared to Anophelines. This study was therefore aimed at determining the relative abundance and Multiplex polymerase chain reaction (Multiplex PCR) identification of members of the Culex pipiens complex, in Kura Local Government Area (LGA), North-western, Nigeria. Adult mosquitoes were collected using Center for Disease Control (CDC) miniature light traps from August to October 2019. Mosquitoes were identified using morphological identification keys. Members of the Culex pipiens complex were further identified using Multiplex PCR to assess the presence of sibling species. A total of 413 mosquitoes, belonging to 3 genera, Culex, Anopheles and Aedes were collected. Of this figure, 120 Culex spp. females were collected. Homes with livestock had the highest occurrence of mosquitoes, 123 (61.19%) compared to those without livestock, 78 (38.81%). There was no statistical difference among the two (2) categories of homes (P ≥ 0.005). Culicoides spp. were the most common with 130 collected (65.38%). Again, homes with livestock had the highest occurrence, 85 whilst homes without livestock had 45 of the other flies caught. Multiplex- PCR revealed no expected bands for Cx. quinquefasciatus and Cx. pipiens from the DNA obtained from field collected mosquitoes as confirmed by using genomic DNA of an insectary Culex quinquefasciatus as control. Cx. spp. is presently regarded as a biting nuisance having no significant epidemiological importance. Efforts at its control should be intensified before it is too late. This study provides useful information on the occurrence and multiplex PCR of Culex spp in Kura Local Government Area, North-western Nigeria. These results have implications for the control of Culex spp. mosquito populations and the spread of human, livestock and avian diseases.

Sequencing batch reactor technology for landfill leachate treatment: A state-of-the-art review.

Landfill has become an underlying source of surface and groundwater pollution if not efficiently managed, due to the risk of leachate infiltration into to land and aquifers. The generated leachate is considered a serious environmental threat for the public health, because of the toxic and recalcitrant nature of its constituents. Thus, it must be collected and appropriately treated before being discharged into the environment. At present, there is no single unit process available for proper leachate treatment as conventional wastewater treatment processes cannot achieve a satisfactory level for degrading toxic substances present. Therefore, there is a growing interest in examination of different leachate treatment processes for maximum operational flexibility. Based on leachate characteristics, discharge requirements, technical possibilities, regulatory requirements and financial considerations, several techniques have been applied for its degradation, presenting varying degrees of efficiency. Therefore, this article presents a comprehensive review of existing research articles on the pros and cons of various leachate degradation methods. In line with environmental sustainability, the article stressed on the application and efficiency of sequencing batch reactor (SBR) system treating landfill leachate due to its operational flexibility, resistance to shock loads and high biomass retention. Contributions of integrated leachate treatment technologies with SBR were also discussed. The article further analyzed the effect of different adopted materials, processes, strategies and configurations on leachate treatment. Environmental and operational parameters that affect SBR system were critically discussed. It is believed that information contained in this review will increase readers fundamental knowledge, guide future researchers and be incorporated into future works on experimentally-based SBR studies for leachate treatment.

Oral hygiene in stroke survivors undergoing rehabilitation: does upper extremity motor function matters?

Background: Traditionally, stroke rehabilitation outcomes are based on indicators of physical function, such measures may underrate the all-inclusive impact of stroke such as oral health.Objectives: To investigate the relationship between upper extremity motor function and oral hygiene status as well as the impact of stroke on Oral Health-Related Quality of Life (OHRQoL).Methods: Sixty stroke survivors were included in this cross-sectional survey. Spasticity and motor function/mobility of the affected upper extremity were assessed using the Modified Ashworth Scale and Action Research Arm Test, respectively. Oral hygiene was assessed using the Simplified Oral Hygiene Index and oral health impact was assessed using the 14-item Oral Health Impact Profile. Pearson's moment correlation coefficient was used to determine the relationship between oral hygiene and upper extremity motor function variables.Results: There were significant relationships between the oral hygiene index and Shoulder muscles spasticity (r = 0.374, p = .01), wrist muscles spasticity (r = 0.352, p = .01), as well as basic mobility (r = 0.423, p = .01). An estimated 8% (n = 5) of study participants have their QoL strongly impacted by their oral health.Conclusions: Upper extremity motor function variables such as spasticity and basic mobility matters in determining oral hygiene status after stroke. Stroke has little impact on oral health-related quality of life.

Sustaining tuberculosis preventive therapy scale-up through direct supportive supervision.

BACKGROUND: Tuberculosis preventive therapy (TPT) is recommended for tuberculosis (TB) prevention among people living with HIV (PLHIV) and other high-risk groups. The Nigerian Military HIV Program embarked on TPT-specific 'direct supportive supervision' (DSS) in May 2018 to increase TPT initiation and completion rates. METHODS: Interventional approaches included site visits to conduct root cause analysis, didactic teaching approach on the concepts of quality improvement and mentorship to address barriers. The DSS introduced TPT monitoring tools, sticker reminders on clients' folders, and bi-weekly data collection and review for decision making. RESULTS: TPT initiation increased from a monthly pre-intervention median of 323 clients to monthly medians of 2611 during the 'surge' and 1212 clients during the 'sustained' phases. Due to an isoniazid stock-out, a 'dip phase', with a median of 559 clients was recorded. Overall, 10 463 clients were started on TPT in fiscal year (FY) 2018 and 12 596 in FY2019, with an overall initiation rate of 79%. Completion rates were respectively 73% and 70% for FY2018 and FY2019. CONCLUSION: With the implementation of a tailored DSS, programmatic barriers to TPT were easily identified and quickly addressed to increase initiation and completion rates.

CONTEXTE: Le traitement préventif de la tuberculose (TPT) est recommandé pour la prévention de la tuberculose (TB) parmi les personnes vivant avec le VIH (PVVIH) et pour d'autres groupes à risque élevé. Le programme VIH de l'armée au Nigeria a rencontré de nombreux défis dans sa mise en œuvre. MÉTHODE: En mai 2018, le programme s'est lancé dans une « supervision directe de soutien ¼ spécifique du TPI (DSS) en vue de son expansion et de la réduction de la transmission de la TB chez les PVVIH. Les approches d'intervention mises en œuvre ont inclus des visites sur le terrain afin d'analyser les causes profondes, une approche didactique d'enseignement relatif aux concepts d'amélioration de la qualité et un tutorat afin de surmonter les obstacles. On a eu recours à l'introduction d'un outil de suivi du TPT, à des rappels sous forme de stickers sur les dossiers des clients et à un recueil de données et à une revue destinée à la prise de décisions bi hebdomadaire. RÉSULTATS: La mise en route du TPT a augmenté d'une médiane mensuelle avant l'intervention de 323 clients à 2611 et 1212 clients pendant les phases de lancement et de continuation respectivement. En raison d'une rupture de stock d'isoniazide, une phase de chute avec une médiane de 559 clients a été enregistrée. Au total, 10 463 et 12 596 clients ont débuté le TPT en FY2018 et FY2019 respectivement, avec un taux d'ensemble d'initiation de 79%. Les taux d'achèvement ont été de 73% et 70% respectivement pour FY2018 et FY2019. CONCLUSION: Grâce à une stratégie sur mesure de supervision et de soutien et en tenant compte des contextes particuliers du terrain, les obstacles programmatiques à la mise en œuvre du TPI ont été facilement identifiés et rapidement affrontés pour une meilleure prise en charge du patient.

South African guidelines for receptor radioligand therapy (RLT) with Lu-177-PSMA in prostate cancer.

BACKGROUND: Prostate cancer is an important cause of morbidity and mortality in South Africa, as it is in the rest of the world. In African men, however, prostate cancer tends to follow a more aggressive course when compared to their European counterparts. This is attributed to a plethora of diverse factors of which an underlying genetic component has been shown to be an important aspect. Such differences highlight the need for individualised therapy and for local guidelines. The aim of this guideline is to aid nuclear physicians and other clinicians who manage patients with prostate cancer in the correct identification and treatment of patients who are likely to benefit from receptor radioligand therapy. RECOMMENDATIONS: There are a multitude of treatment modalities available for the treatment of prostate cancer and these therapies may be required at various time points during the course of the disease in any individual patient. A multidisciplinary approach is crucial in deciding which therapy, or combination of therapies, would be most advantageous at particular time points. The multidisciplinary team should include a urologist, oncologist and nuclear medicine physician as a minimum, and should ideally also involve a palliative/pain specialist, a dietician and a psychologist. CONCLUSION: Treatment with 177Lu-PSMA has emerged as a promising systemic modality, which involves the delivery of targeted radiation therapy in the form of ß-particles to sites of tumour tissue. Therapy is provided on an outpatient basis, is well tolerated with relatively few side effects and has a positive effect on overall survival and quality of life. At present, it is used mostly in the setting of advanced, castrate-resistant cancer. Patients are selected (amongst other criteria) based on the prior PSMA-based SPECT/PET/CT imaging (99mTc-,68Ga- or 18F-PSMA), which should demonstrate sufficient receptor expression in order to consider PSMA-based targeted radionuclide therapy. Such imaging of an intended target prior to its therapeutic targeting is known as a theranostic approach.

Improving indicators of tuberculosis program cascades by leveraging HIV program strategies.

BACKGROUND: To improve rates of human immunodeficiency virus (HIV) case detection and treatment, the Nigerian Ministry of Defense Health Implementation Program and the US Army Medical Research Directorate-Africa/Nigeria introduced a HIV standard of care (SOC) package. Given the integration of tuberculosis (TB) and HIV programs and evolving policies, we evaluated the impact of this strategy on TB program indicators. METHODS: Routine, de-identified program data from 27 Nigerian military hospitals were analyzed. Using Wilcoxon signed-rank test, bivariate analyses were performed to compare data from 12 months before and after implementation of the SOC package. RESULTS: Our data showed improvements post-implementation as follows: the number of individuals receiving antiretroviral therapy (ART) screened for TB increased from 14 530 to 29 467 (P < 0.001); the number of individuals with presumptive TB identified increased from 803 to 1800 (P < 0.001); the number of ART clients bacteriologically tested for TB increased from 746 to 1717 (P < 0.001); and the number of ART clients treated for TB increased from 152 to 282 (P < 0.001). Newly registered or relapsed TB cases increased from 436 to 906 (P < 0.001), the number of TB cases with known HIV status increased from 437 to 837 (P < 0.001), the number of TB-HIV co-infected cases increased from 182 to 301 (P = 0.006), and the number of TB-HIV co-infected clients who started ART increased from 101 to 176 (P = 0.003). CONCLUSION: The implementation of the updated HIV SOC package led to the improvement in key TB diagnosis and treatment indicators. When emulated, this could help improve the performance of other TB programs in countries other than Nigeria.

The College of Nuclear Physicians of South Africa Practice Guidelines on Peptide Receptor Radionuclide Therapy in Neuroendocrine Tumours.

BACKGROUND: Peptide receptor radionuclide therapy (PRRT) for metastatic or inoperable neuroendocrine tumours (NETs) is a systemic therapy which targets somatostatin receptors overexpressed by differentiated NETs for endoradiotherapy. This guideline has been compiled by the College of Nuclear Physicians of the Colleges of Medicine of South Africa, with endorsement by the South African Society of Nuclear Medicine and the Association of Nuclear Physicians to guide Nuclear Medicine Physicians in its application during the management of these patients. RECOMMENDATIONS: Patients with well- to moderately-differentiated NETs should be comprehensively worked-up to determine their suitability for PRRT. Treatment should be administered by a Nuclear Medicine Physician in a licensed, appropriately equipped and fully staffed facility. Patient monitoring is mandatory during and after each therapy cycle to identify and treat therapy-related adverse events. Patients should also be followed-up after completion of therapy cycles for monitoring of long-term toxicities and response assessment. CONCLUSION: PRRT is a safe and effective therapy option in patients with differentiated NETs. Its use in appropriate patients is associated with a survival benefit.

First Results and Experience with PRRT in South Africa.

Neuroendocrine tumors (NETs) are a diverse group of tumors that often present late due to nonspecific symptoms. These tumors frequently express somatostatin receptors (SSRs), which allows for positron emission tomography/computed tomography (PET/CT) imaging with Ga-68-DOTATATE. In eligible patients, this may then be followed by peptide receptor radionuclide therapy (PRRT). Here, we report our initial results and experience with PRRT in a developing country, as one of the first groups to provide this therapy in South Africa. Eligible patients with confirmed inoperable NETs were recruited prospectively and treated with Lu-177-DOTATATE. Baseline imaging was performed with either single-photon emission CT- or PET-based SSR analogs, whereas follow-up was performed with 68Ga-DOTATATE PET/CT 6 months post treatment completion. Interim treatment response evaluation was based on post therapy imaging of Lu-177-DOTATATE. A total of 48 patients with a mean age of 58 years were treated with PRRT, of whom 22 (46%) demonstrated stable disease, 20 (42%) demonstrated a partial response, and 6 (12%) demonstrated progressive disease. The median progression-free survival (PFS) was 20 months with an interquartile range (IQR)25%-75% of 4.5-30 months. The median freedom from progression duration was 32 months with an IQR25%-75% of 25-40 months, and the median overall survival was 10 months with an (IQR)25%-75% of 5-24 months. Our subgroup analysis demonstrated an inverse association between metabolic tumor volume with PFS, which requires further validation. In conclusion, PRRT with Lu-177-DOTATATE resulted in a median PFS of 20 months in patients with inoperable NETs in the absence of significant side effects.

Cryptic Eimeria genotypes are common across the southern but not northern hemisphere.

The phylum Apicomplexa includes parasites of medical, zoonotic and veterinary significance. Understanding the global distribution and genetic diversity of these protozoa is of fundamental importance for efficient, robust and long-lasting methods of control. Eimeria spp. cause intestinal coccidiosis in all major livestock animals and are the most important parasites of domestic chickens in terms of both economic impact and animal welfare. Despite having significant negative impacts on the efficiency of food production, many fundamental questions relating to the global distribution and genetic variation of Eimeria spp. remain largely unanswered. Here, we provide the broadest map yet of Eimeria occurrence for domestic chickens, confirming that all the known species (Eimeria acervulina, Eimeria brunetti, Eimeria maxima, Eimeria mitis, Eimeria necatrix, Eimeria praecox, Eimeria tenella) are present in all six continents where chickens are found (including 21 countries). Analysis of 248 internal transcribed spacer sequences derived from 17 countries provided evidence of possible allopatric diversity for species such as E. tenella (FST values ⩽0.34) but not E. acervulina and E. mitis, and highlighted a trend towards widespread genetic variance. We found that three genetic variants described previously only in Australia and southern Africa (operational taxonomic units x, y and z) have a wide distribution across the southern, but not the northern hemisphere. While the drivers for such a polarised distribution of these operational taxonomic unit genotypes remains unclear, the occurrence of genetically variant Eimeria may pose a risk to food security and animal welfare in Europe and North America should these parasites spread to the northern hemisphere.

Phytotherapeutic information on plants used for the treatment of tuberculosis in eastern cape province, South Africa.

The current rate of deforestation in Africa constitutes a serious danger to the future of medicinal plants on this continent. Conservation of these medicinal plants in the field and the scientific documentation of our knowledge about them are therefore crucial. An ethnobotanical survey of plants used for the treatment of tuberculosis (TB) was carried out in selected areas of the Eastern Cape, South Africa. These areas were Hala, Ncera, Sheshegu, and Gquamashe, all within the Nkonkobe Municipality. One hundred informants were interviewed. The survey included the identification of scientific and vernacular names of the plants used for treatment of TB as well as the methods of preparation and administration, the part used, dosage, and duration of treatment. The survey revealed 30 plants belonging to 21 families which are commonly used by traditional healers for the treatment of TB and associated diseases. Of these plants Clausena anisata, Haemanthus albiflos, and Artemisia afra were the most cited. The leaves were the most common part used in the medicinal preparations. Our findings are discussed in relation to the importance of the documentation of medicinal plants.

Synthesis and validation of a weatherproof nursery design that eliminates tropical evening-Fever syndrome in neonates.

Neonatal thermal stabilisation can become challenging when uncontrollable factors result in excessive body temperature. Hyperthermia can rapidly slow down baby's progress and response to treatment. High sunlight intensity in tropical countries such as Nigeria manifests in incessant high neonatal temperatures towards early evenings. The ugly consequences of this neonatal evening-fever syndrome (EFS) can only be eradicated by the development of a controlled weatherproof nursery environment. Two laboratories and a 'control ward' were applied. Lab-2 was a renovation of an existing room in a manner that could correct an existing nursery. Lab-1 was an entirely new building idea. The laboratories were assessed based on comparative ability to maintain environmental coolness and neonatal thermal stability during hot days. Data collection continued for 12 full calendar months. On average, at evaluated out-wind peak temperature of 43°C (range: 41°C-46°C), the control-ward peak was at 39°C, Lab-2 peak at 36°C, and Lab-1 peak at 33°C. All incubators in the control overheated during the hot periods but there was no overheating in Lab-1. Forty-four (86%) of sampled babies were fever-quenched by water sponging 131 times in the control whilst only one baby received same treatment in Lab-1. Nursery designs patterned after Lab-1 can significantly reduce EFS-induced neonatal morbidity.

Morphometric Identification, Gross and Histopathological Lesions of Eimeria Species in Japanese Quails (Coturnix coturnix japonica) in Zaria, Nigeria.

The objective of the study was to identify the species, gross and histopathological lesions of Eimeria in Japanese quails in Zaria. A total of 400 fresh faecal samples were collected and 10 quail birds were purchased from a quail farm. The faecal samples were processed using simple floatation technique. Oocysts shape indices of sporulated oocysts were determined. The intestines were observed for gross lesions and segments were analyzed using Giemsa stain and Haematoxylin and Eosin stain and then observed microscopically for the developmental stages of the parasite. Four species of Eimeria were identified in the study. Eimeria bateri of shape index of 1.36 conformed to the guidelines used while the other three Eimeria species with shape indices of 1.48, 1.03, and 1.40 were not confirmed. The main gross lesion seen was nonhaemorrhagic ballooning of the caeca. Intestinal scrapping smear revealed a developmental stage of the parasite (merozoites) in the jejunum. Histopathology also revealed a developmental stage (schizont) of the parasite in the caecum and desquamation of the epithelial lining with areas of necrosis. Further study is required using molecular techniques to properly identify the unknown species of Eimeria that were detected in the study.

Reactive airway and anaesthesia: challenge to the anaesthetist and the way forward.

BACKGROUND: Patients with concurrent medical conditions such as Reactive airway disease presenting for anaesthesia, and surgery have potentially increased risk of perioperative morbidity and mortality if not well managed. OBJECTIVE: To highlight the need for adequate perioperative care and review the evidence for selection of techniques in the anesthesia for such cases" MATERIALS AND METHODS: An illustrative case is presented. CONCLUSION: The main goal of the anaesthetist is to administer safe and sufficient anaestheia without precipitating bronchospasm.

Anti-Retroviral Therapy Induced Diabetes in a Nigerian

Background:Anti-retroviral therapy (ART) using Highly Active Anti-retroviral Therapy (HAART) has led to considerable reduction in morbidity and mortality associated with human Immune deficiency virus (HIV) infection.This has led to increased life expectancy in HIV infected individuals on one hand; and side effects of chronic administration of these drugs on the other. One of such untoward effects is the association of anti-retroviral drugs especially the protease inhibitors (PI's) with metabolic derangements such as dyslipi- daemia; lipodystrophy; insulin resistance and rarely Diabetes mellitus. Although there is extensive literature on this dysmetabolic syndrome in the Western World; there is to our knowledge no previous report from Nigeria. Objective: to report a case of diabetes mellitus following the initiation of anti-retroviral therapy. Methods: a case report of diabetes mellitus induced by anti-retroviral therapy in a 48 year old Nigerian male. Conclusion: Awareness and high index of suspicion is required to identify the metabolic complications of ART

Babesia equi and Trypanosoma vivax infections in donkeys.

Six donkeys (Equus asinus) were purchased locally. To screen them before and during Trypanosoma vivax infection, thin and thick blood smears, temperature, haematocrit centrifuge technique (HCT), packed cell volume (PCV), white blood cell counts, and indirect immunofluorescent antibody test (IFAT) were done for Babesia equi. For the IFAT, an anti-horse conjugate was used. In spite of patent B. equi or T. vivax parasitaemia, the donkeys' temperatures remained below 38.5 degrees C; PCV was depressed more in B. equi infection than in T. vivax infection. Four out of the 6 donkeys had B. equi antibodies while 2 of them had detectable parasitaemia. Treatment with either Berenil or Imizol cleared the detectable B. equi parasitaemia, and IFAT was negative at 35-45 days post treatment. However, relapses occurred within 60-70 days after the treatment. In 2 circumstances serological titres were below 1:40 (negative) while there was detectable parasitaemia.

Onchocerciasis in Plateau State of Nigeria. II. The prevalence among residents around the Assob River area.

A study of the prevalence of human onchocerciasis in eight villages around the Assob River in Jos Plateau, Nigeria, was undertaken between October 1983 and March 1985 using the skin-snip method. A total of 1673 individuals were examined. One hundred and eighty five (11.06%) had microfilariae of Onchocerca volvulus in their skin biopsies, and of these infected people, five (2.7%) were blind. The highest prevalence rate recorded was in Ngwan Madaki, where 51 (26.3%) of the 194 people examined were infected. The lowest percentage prevalence was recorded in Dogon Fili with four (1.95%) of the 205 people examined being positive. The proportion of infected people increased with age; and onchocercal lesions were significantly more common in older than in younger persons (P less than 0.05). There was no significant difference between infection rates in males and females (P greater than 0.05), although the overall percentage infection and the numbers of onchocercal lesions were higher in males than in females.