Demographics of tonsillar hypertrophy among sickle cell disease patients in calabar.

Background: Sickle cell disease (SCD) is the most common genetic disorder, with Africa bearing the highest burden. In this cohort study, sickle cell subjects are immunocompromised and predisposed to recurrent infections and tonsillar hypertrophy, especially in children. Subsequently, tonsillar hypertrophy leads to sleep-disordered breathing (SDB) with resulting hypoxemia, hypercapnia, and acidosis, raising the risk of HbS polymerization and, consequently, vaso-occlusive phenomena and other complications. Aims: This study aimed to compare tonsillar hypertrophy between sickle cell patients and controls. Materials and Methods: A cross-sectional descriptive study was conducted at, University of Calabar Teaching Hospital, Calabar from September 2019 to September 2021. The cohort of the study was an SCD patient confirmed using hemoglobin electrophoresis at the hematology laboratory of University of Calaabr teaching hospital and recruited via the adult and pediatric hematology unit of University of Calabar teaching hospital, and Calabar sickle cell club. The data were analyzed using Microsoft Excel and IBM Statistical Package and Service Solution (SPSS) version 22. Results: Using Brodsky's grading, the prevalence of grade 3 and 4 hypertrophic tonsils in sickle cell subjects was 41.6% but 17.3% in control. The age range of 0-25 years was the most frequently affected with the peak at 0-5 years. The males among the sickle cell subjects were slightly more affected than the females (M: F =1.2:1), while the females were slightly more in the control (M: F =1:1.1). Conclusions: Hypertrophic tonsils affect control and SCD, but the obstructive grades are commoner in genotypes SCD- Sickle cell disease Haemoglobin SS, SC and AA.

Guía de práctica clínica para el manejo de lesiones premalignas del cuello del útero / Clinical practice guide for the management of premalignant lesions of the cervix

Incluye recomendaciones sobre la prevención y manejo de lesiones premalignas y reducir la incidencia y mortalidad por cáncer cervicouterino.

Cervical necrotizing fasciitis: management challenges in poor resource environment.

Necrotizing fasciitis of the head and neck is a rare and potentially fatal disease. It is a bacterial infection characterized by spreading along fascia planes and subcutaneous tissue resulting in tissue necrosis and likely death. It is commonly of dental or pharyngeal origin. Factors affecting the success of the treatment are early diagnosis, appropriate antibiotics and surgical debridement. Our study showed eight patients, five males and three females with mean age of 49.25 years (range 20-71 years). Clinical presentations were a rapidly progressing painful neck swelling, fever, dysphagia and trismus. The aetiology varied from idiopathic, pharyngeal/tonsillar infection, trauma and nasal malignancy. There were associated variable comorbidities (diabetes mellitus, HIV infection, hypertension and congestive cardiac failure). All the patients received early and aggressive medical treatment. The earliest time of surgery was 12 h after admission because of the poor financial status of patients. Three cases came in with complications of the disease and were not fit for extensive debridement under general anaesthesia. For them limited and reasonable bed side debridement was done. Mortality was 50 % from multiple organ failure, HIV encephalopathy, aspiration pneumonitis and septicemia. The duration of hospital stay for the patients that died ranged from 1 to 16 days and 4 to 34 days for the survivor. Our study heightens awareness and outlines the management challenges of necrotizing fasciitis of the head and neck in a poor resource setting.

Are significant numbers of abnormal cells lost on the discarded ThinPrep® broom when used for cervical cytology?

UNLABELLED: Are significant numbers of abnormal cells lost on the discarded ThinPrep® broom when used for cervical cytology? BACKGROUND: In view of a study with SurePath® showing that cells were lost on the broom if it was discarded, we decided to investigate whether cells were lost on the ThinPrep® (TP) broom, which is discarded according to the manufacturer's protocol. AIM: To determine whether significant amounts of cellular material are lost on the discarded TP broom, and whether the loss is operator dependent. METHODS: Three hundred and six women attending the Guy's Hospital Colposcopy Unit gave their consent for TP liquid-based cytology samples to be taken and the broom immersed in a second vial instead of being discarded. The cellularity of the first and second vials was compared by counting cells in 10 ×40 high-power fields (HPFs). The significance of cell loss was ascertained by correlating the likelihood of abnormal cells and transformation zone (TZ) material being present with the degree of cellularity of the two vials. RESULTS: More than 10 cells per HPF were seen in 3.2%, 19.4% and 35.8% of slides from the second vial taken by three experienced colposcopists, which was significantly different between them (P < 0.001); cellularity of the first vial was not significantly different between colposcopists but the one with highest cellularity in the first vial discarded most in the second. Abnormal cells were more likely to be seen in slides with more than 10 cells per HPF (P < 0.001) and with evidence of TZ sampling (P < 0.001), but there was no preferential loss of TZ material in the second vial. Of 126 slides with abnormal cells on the slides from the second vial, 113 (89.7%) were also present on the significantly more cellular first vial (P < 0.001). CONCLUSION: Abnormal cells were potentially lost on the broom, but were usually represented in the first vial. The likelihood of abnormal cells being discarded was operator dependent in this small study, but this did not affect the quality of the initial preparation. The likelihood of abnormal cells being seen on TP slides was dependent on their cellularity, which provided our laboratory with a criterion for the assessment of sample adequacy.

Balance hídrico y uso de drogas vasoactivas como predictores de mortalidad en pacientes con lesión pulmonar aguda y síndrome de distress respiratorio agudo: Estudio multicéntrico / Water balance and drug use vasoactive as predictors of mortality in patients with acute lung injury and respiratory distress syndrome acute: Multicentric study

Introducción. Desde la década de 1990, la mortalidad por el síndrome de distress respiratorio agudo ha disminuido. Sin embargo, no hay datos concluyentes acerca de que una nueva estrategia sea responsable de esta evolución (p. ej., el manejo de los fluidos). Aún no se ha dilucidado cuál es la cantidad óptima de fluidos para tratar a estos pacientes. Clásicamente la discusión se basa en estrategias liberales o conservadoras. Objetivo. El objetivo principal fue conocer cómo impacta el balance de fluidos asociado con el uso de noradrenalina en la evolución. Materiales y métodos. Se llevó a cabo un estudio observacional en 87 pacientes con síndrome de distress respiratorio agudo entre agosto y diciembre de 2007, en tres hospitales universitarios. Se utilizó el protocolo de tratamiento estándar de las Unidades de Cuidados Intensivos permitiendo la expansión en forma liberal cuando se sospechaba hipovolemia no resuelta. Resultados. Se detectaron tres situaciones de mayor riesgo y mala evolución: a) la asociación de noradrenalina y balance positivo de fluidos <2500 ml en las primeras 24 h (OR: 5,4; IC95%: 2,1-13,9; p = 0,0004), b) la asociación de noradrenalina y balance acumulativo >5500 ml en las primeras 72 h (OR: 2,7; IC95%: 1,1-6,5; p = 0,032) y c) pacientes con puntaje APACHE II >21, noradrenalina y balance positivo <2500 ml en las primeras 24 h (OR: 8,4; IC95%: 1,8-39; p = 0,008). Conclusión. La utilización de noradrenalina y escaso fluido en estrategias de reanimación que intentan "proteger" al pulmón con lesión parece no ser adecuada, según este estudio observacional(AU)

Introduction. Recent studies have shown an important decline in mortality due to acute respiratory distress syndrome since 1990. However, to date, there is no definitive evidence to demonstrate that any mode of specific therapeutic approach (i.e., fluid management) make a difference in survival or other outcome measures. The optimal fluid management of acute lung injury is not established. Classically there are two arguments: the wet or dry strategy. Objective. The main goal was to know the impact on outcome of fluid balance and the use of noradrenaline as a vasoactive drug. Materials and methods. In this observational study, 87 ventilated patients with acute respiratory distress syndrome were included from August to December 2007 in three University Critical Care Units. A standard protocol of resuscitation was used, fluid intake was liberal only in hypovolemic patients. Results. Three categories of risk and poor outcome were detected: a) noradrenaline plus positive fluid balance <2500 mL in first day (OR: 5.4; IC95%: 2.1-13.9; p = 0.0004), b) noradrenaline plus a cumulative positive balance >550 mL in first 72 hours (OR: 2.7; IC95%: 1.1-6.5; p = 0.032), c) APACHE II >21 and noradrenaline plus positive fluid balance <2500 mL in the first day (OR: 8.4; IC95%: 1.8-39; p = 0.008). Conclusion. The use of noradrenaline and conservative resuscitation with fluid in critically ill patients with acute respiratory distress syndrome in order to minimize the risk of excessive fluid therapy was associated with poor outcome and higher mortality(AU)

[Pumpless extracorporeal pulmonary care: an alternative in the treatment of persistent acute respiratory distress syndrome]. / Asistencia pulmonar extracorpórea sin bomba: una alternativa en el tratamiento del síndrome de distrés respiratorio agudo grave persistente.

A 34-year old woman who developed persistent and severe acute respiratory distress syndrome with underlying myelomonocytic leukemia (M4FAB) is described. After ruling out the most common causes of pulmonary infiltration in this type of patient and one week of broad spectrum antibiotics and steroids therapy, we proposed leukemic pulmonary infiltration as etiological diagnosis. Despite using a protective ventilatory strategy, recruitment maneuvers, prone position and high frequency oscillatory ventilation, her gas exchange became worse. Under this condition we used a Pumpless-Extracorporeal life assist (PELA) and begun chemotherapy. The method, arterial blood gases, hemodynamic parameters and ventilatory mechanics before and after its use are described. The patient remained on P-ELA for nine days; one week later she was extubated and ten days after she was discharged from the Intensive Care Unit the patient left the hospital in good health condition.

Endoplasmic reticulum stress prolongs GH-induced Janus kinase (JAK2)/signal transducer and activator of transcription (STAT5) signaling pathway.

The desensitization of the GH-induced Janus kinase 2 (JAK2) and signal transducer and activator of transcription 5 (STAT5) signaling pathway plays a crucial role in GH regulation of hepatic genes. Previous studies have demonstrated that the inactivation of the GH-induced JAK2/STAT5 pathway is regulated by protein translation and suppressors of cytokine signaling (SOCS). In this study we sought to explore the relationships between endoplasmic reticulum stress, GH-induced JAK2/STAT5 activity and SOCS expression. 1,2-bis(o-Aminophenoxy)ethane-N,N,N,N-tetraacetic acid (acetoxymethyl)ester (BAPTA-AM), used to provoke endoplasmic reticulum stress, caused a drastic inhibition of protein translation that correlated with the phosphorylation of the eukaryotic translation initiation factor 2alpha. Both GH and BAPTA-AM caused a rapid induction of the transcription factor C/EBP homology protein (CHOP) and an additive effect was observed with combined treatment, which suggests a regulatory role of GH on endoplasmic reticulum stress. Endoplasmic reticulum stress did not interfere with the rapid GH activation of STAT5 DNA binding activity. However, BAPTA-AM prolonged the DNA binding activity of STAT5 without affecting STAT5 or JAK2 protein levels. GH-induced phosphorylation of JAK2 and STAT5 DNA binding activity were prolonged in the presence of BAPTA-AM, suggesting that endoplasmic reticulum stress prevents the inactivation of STAT5 DNA binding activity by modulating the rate of JAK2/STAT5 dephosphorylation. Like BAPTA-AM, the endoplasmic reticulum stressors dithiothreitol and A23187 also prolonged the GH-induced STAT5 DNA binding activity. We were not able to correlate BAPTA-AM effects to the GH-dependent expression of SOCS proteins or SOCS mRNA, suggesting that endoplasmic reticulum stress modulates the rate of JAK2/STAT5 dephosphorylation through mechanisms other than inhibition of SOCS expression. This study indicates that cellular stress may modulate transcription through the JAK/STAT pathway.

HLA antigens in Ameridian groups of two different linguistic families from Colombia.

Serological HLA types (A, B, C, DR and DQ loci) were studied in five different Indian tribes (Cubeo, Tucano, Coreguaje, Embera and Noanama) belonging to two distinct linguistic families. For all the MHC loci, the range of variation among the five tribes was enormous. Two tribes, Cubeo and Tucano, showed a wide spectrum of antigenic specificities which seemed to be due to admixture from non-tribal groups, while in the other three tribes the polymorphisms of various HLA loci showed restricted distributions. The gene frequency data, when converted to a kinship matrix and a two-dimensional eigenvector plot, indicated that members of the same linguistic family tend to have greater genetic affinity.

Primates no humanos para investigación biomédica: establecimiento, adaptación y mantenimiento de Aotus lemurinus griseimembra / Nonhuman primates for biomedical research: establishing, adapting and maintaining Aotus lemurinus griseimembra

Los primates forman parte importante de la fauna tropical y han sido objeto de estudios especiales que contribuirán a la solución de problemas de salud humana y animal. Con el fin de lograr avances en el terreno de la inmunología de la malaria se estableció una colonia de primates del género Aotus y se analizaron los factores sanitarios y las variables biológicas que permitirán conocer mejor los métodos de conservación de los simios en ambientes cerrados (AU)

[Abortion in Colombia. Medical, legal and socioeconomic aspects]. / El aborto en Colombia. Aspectos médicos legales y socio-económicos

PIP: Abortion is a social problem and criminal sanctions are very ineffective in limiting it and are seldom applied (133 legal actions vs. 65,600 cases of induced abortion in 1965). Abortion is a social disease, as are prostitution, juvenile delinquency, drug abuse, and so far has been an insoluble problem. Colombian laws should be modified to reflect reality. Sex education must be emphasized, because ignorance is one of the main causes of abortion. Leniency should be applied toward women who cooperate with the authorities in identifying the person who performed an abortion. Legalization of abortion and enforcement of strict laws against it are considered as possible solutions, but both are rejected. The former is regarded as morally unacceptable and as imposing an excessive burden on scarce health services, the latter as even worse, imposing an equivalent burden on the court system, without s olving either health or social problems. The best and probably only solution is to improve education in family planning, to promote knowledge and motivation to enable the population to make sound and responsible decisions.^ieng

Primates no humanos para investigación biomédica: establecimiento, adaptación y mantenimiento de Aotus lemurinus griseimembra / Nonhuman primates for biomedical research: establishing, adapting and maintaining Aotus lemurinus griseimembra

Los primates forman parte importante de la fauna tropical y han sido objeto de estudios especiales que contribuirán a la solución de problemas de salud humana y animal. Con el fin de lograr avances en el terreno de la inmunología de la malaria se estableció una colonia de primates del género Aotus y se analizaron los factores sanitarios y las variables biológicas que permitirán conocer mejor los métodos de conservación de los simios en ambientes cerrados (AU)