Adenoid and Tonsil Hypertrophy in Zaria, North Western Nigeria: Review of Clinical Presentation and Surgical Outcome.

Background: Adenotonsillar hypertrophy is one of the most common childhood disorder that necessitates presentation to the ear nose and throat specialist. The disorder may be managed conservatively or by surgery. Aim: To highlight the clinical presentation and surgical treatment outcome of patients managed for adenoid and tonsillar hypertrophy at Ahmadu Bello University Teaching Hospital Zaria, Nigeria. Materials and Methods: The case records of patients managed for adenoid and tonsil hypertrophy were reviewed from January 2013 to December 2017 at the Division of Otorhinolaryngology, Department of Surgery Ahmadu Bello University Teaching hospital Zaria, - Northwestern Nigeria. Case notes with incomplete information and /or missing pages were excluded. The data were analyzed using IBM SPSS (for windows, version 23). Results: There were 56 (55.4%) males and 45 (44.6%) females with male to female ratio of 1.2:1. Their ages ranged from 2-16 years with a mean and standard deviation of 4.0 and 3.2 respectively. The most common symptom at presentation was snoring 85 (84.2%) followed by rhinorrhea 81(80.2%). Findings from the radiologic investigations revealed that majority of the patients had severely narrowed nasopharyngeal air column 83(82,2%) Adenotonsillectomy was the most common surgery performed on most of the patients 63(62.4%) who presented with adenotonsillar hypertrophy. Majority of the patients 95(94.1%) had resolution of symptoms within the period of follow up. Four (4.0%) of them had recurrent adenoidal growth. Conclusion: Snoring, rhinorrhea and mouth breathing were the most common symptoms of adenotonsillar hypertrophy. The outcome of adenotonsillar surgeries in our patients is good, with the majority having resolution of symptoms.

Fibreoptic Laryngoscopic Assessment of Patients with Hoarseness: A Cross-sectional Analysis.

Background: Hoarseness is a common clinical manifestation of laryngeal diseases. The cause of hoarseness may not always be a simple inflammatory disease, but it can be from other serious life-threatening conditions such as laryngeal cancer, for which a delay in diagnosis of such condition may compromise treatment, resulting in poor prognosis and a decreased survival rate. Against this background, we evaluated the causes of hoarseness using fibreoptic laryngoscopy in our environment. Materials and Methods: This was a cross-sectional study of patients with hoarseness attending ENT clinic of our institution. Ethical clearance and consent were obtained. A questionnaire was used to collect relevant clinical data, fibreoptic laryngoscopy was carried out, and the data was analysed using the Statistical Products and Service Solution version 20.0. Results: The study recruited 90 patients with hoarseness. The age of the patients ranged between 18 and 70 years with a mean of 40.1 ± 14.8 years. There were 51 (56.7%) males and 39 (43.3%) females. About 46 (51.2%) of the patients had intermittent hoarseness, whereas 44 (48.8%) had persistent hoarseness. Most of the patients, 49 (54.4%), had hoarseness for less than 6 months before presentation. The fibreoptic laryngoscopic findings were non-specific laryngitis 49 (54.5%), laryngeal tumor 20 (22.2%), vocal cord polyp 7 (7.7%), laryngeal papilloma 6 (6.7%), vocal cord palsy 5 (5.6%), and others 3 (3.3%). Conclusion: Laryngeal tumour constituted a significant percentage of fibreoptic laryngoscopic findings in patients with hoarseness after nonspecific laryngitis. Therefore, fibreoptic laryngoscopy is recommended for all patients with hoarseness in order to detect sinister pathology early.

Epigenetic modifications associated with genes implicated in cytokine storm: The potential biotherapeutic effects of vitamins and minerals in COVID-19.

Cytokine storm is a phrase used to refer to an abrupt upsurge in the circulating levels of various pro-inflammatory cytokines, causing increased stimulation and activity of immune cells during disease conditions. The binding of pattern recognition receptors to pathogen-associated molecular patterns during COVID-19 infection recruits response machinery involving the activation of transcription factors and proteins required for a robust immune response by host cells. These immune responses could be influenced by epigenetic modifications as evidenced by significant variations in COVID-19 pathophysiology and response to therapy observed among patients across the globe. Considering that circulating levels of interleukin 1, tumor necrosis factor-α, and interleukin 6 are significantly elevated during cytokine storm in COVID-19 patients, genetic and epigenetic variations in the expression and function of these proteins could enhance our understanding of the disease pathogenesis. Treatment options that repress the transcription of specific cytokine genes during COVID-19 infection could serve as possible targets to counteract cytokine storm in COVID-19. Therefore, the present article reviews the roles of cytokines and associated genes in the COVID-19 cytokine storm, identifies epigenetic modifications associated with the disease progression, and possible ameliorative effects of some vitamins and minerals obtained as epigenetic modifiers for the control of cytokine storm and disease severity in COVID-19 patients. PRACTICAL APPLICATIONS: COVID-19 causes mortality and morbidity that adversely affect global economies. Despite a global vaccination campaign, side effects associated with vaccination, misconceptions, and a number of other factors have affected the expected successes. Cytokine storm in COVID-19 patients contributes to the disease pathogenesis and response to therapy. Epigenetic variations in the expression of various cytokines could be implicated in the different outcomes observed in COVID-19 patients. Certain vitamins and minerals have been shown to interfere with the expression and activity of cytokines implicated in cytokine storm, thereby counteracting observed pathologies. This review examines cytokines implicated in cytokine storm in COVID-19, epigenetic modifications that contribute to increased expression of identified cytokines, specific foods rich in the identified vitamins and minerals, and suggests their possible ameliorative benefits. The article will be beneficial to both scientists and the general public who are interested in the role of vitamins and minerals in ameliorating COVID-19.

Clinical profile and treatment outcome of laryngeal cancer in a Nigerian Tertiary hospital.

BACKGROUND: Laryngeal cancer is one of the most common malignancies of the upper aerodigestive tract worldwide, and its management may sometimes be challenging, especially in developing countries due to late presentation, poverty and limited resources. AIM: This study aims to highlight the clinical profile and treatment outcome of laryngeal cancer in our centre. PATIENTS AND METHODS: This was a retrospective review of patients who were managed for laryngeal cancer between January 2011 and December 2020. RESULTS: There were 90 (89.1%) males and 11 (10.9%) females, with a male-to-female ratio of 8.2:1. The age ranged from 22 to 82 years, with a mean age of 57.2 ± 12.7 years. Fifty patients (49.5%) presented more than 1 year after the onset of the symptoms. Squamous cell carcinoma (SCCA) was the only histological diagnosis observed in our patients. The laryngeal cancer was transglottic in location in 45 (44.6%) patients, while 50 (49.5%) patients presented with Stage III disease. Twenty-one (20.8%) patients had total laryngectomy. Amongst the patients managed, 17 (17.0%) were still on follow-up. Up to 37 (37.0%) were referred for radiotherapy elsewhere after chemotherapy. Forty-one of the patients (40.0%) died during the course of their management. There was a statistically significant association between having definitive surgical management and survival beyond 5 years (Chi-square test = 8.635, P = 0.003). CONCLUSION: Majority of the patients presented late with transglottic SCCA. Surgical extirpation of the lesion was associated with better prognosis in our patients.

Phytol suppresses parasitemia and ameliorates anaemia and oxidative brain damage in mice infected with Plasmodium berghei.

The quest for the development of a novel antimalarial drug informed the decision to subject phytol to in vivo trials following a demonstration of therapeutic potential against chloroquine sensitive strain of Plasmodium falciparum under in vitro condition. On this basis, the in vivo anti-Plasmodium berghei activity of phytol including the ameliorative effects of the compound on P. berghei-associated anaemia and organ damage were investigated. Mice were infected with chloroquine-sensitive strain of P. berghei and were treated with phytol at a dose of 10 and 20 mg/kg body weight (BW) for four days. The levels of parasitemia, packed cell volume and redox sensitive biomarkers of liver, brain and spleen tissues were determined. Our result revealed that phytol significantly (p < 0.05) suppressed the multiplication of P. berghei in a dose-dependent manner. Additionally, the phytol significantly (p < 0.05) ameliorated the P. berghei-induced anaemia and brain damage. Data from the present study demonstrated that phytol has suppressive effect on P. berghei and could ameliorate some P. berghei-induced pathological changes.

Plasmodium falciparum multidrug resistance gene-1 polymorphisms in Northern Nigeria: implications for the continued use of artemether-lumefantrine in the region.

BACKGROUND: The analysis of single nucleotide polymorphism (SNPs) in drug-resistance associated genes is a commonly used strategy for the surveillance of anti-malarial drug resistance in populations of parasites. The present study was designed and performed to provide genetic epidemiological data of the prevalence of N86Y-Y184F-D1246Y SNPs in Plasmodium falciparum multidrug resistance 1 (pfmdr1) in the malaria hotspot of Northern Nigeria. METHODS: Plasmodium falciparum-positive blood samples on Whatman-3MM filter papers were collected from 750 symptomatic patients from four states (Kano, Kaduna, Yobe and Adamawa) in Northern Nigeria, and genotyped via BigDye (v3.1) terminator cycle sequencing for the presence of three SNPs in pfmdr1. SNPs in pfmdr1 were used to construct NYD, NYY, NFY, NFD, YYY, YYD, YFD and YFY haplotypes, and all data were analysed using Pearson Chi square and Fisher's exact (FE) tests. RESULTS: The prevalence of the pfmdr1 86Y allele was highest in Kaduna (12.50%, 2 = 10.50, P = 0.02), whilst the 184F allele was highest in Kano (73.10%, 2 = 13.20, P = 0.00), and the pfmdr1 1246Y allele was highest in Yobe (5.26%, 2 = 9.20, P = 0.03). The NFD haplotype had the highest prevalence of 69.81% in Kano (2 = 36.10, P = 0.00), followed by NYD with a prevalence of 49.00% in Adamawa, then YFD with prevalence of 11.46% in Kaduna. The YYY haplotype was not observed in any of the studied states. CONCLUSION: The present study suggests that strains of P. falciparum with reduced sensitivity to the lumefantrine component of AL exist in Northern Nigeria and predominate in the North-West region.

Transient-evoked otoacoustic emission findings in children (1-12 years) with cerebral palsy in Kano, Nigeria.

BACKGROUND: Children with cerebral palsy (CP) suffer from multiple problems and potential disabilities. These range from musculoskeletal problems, mental retardation, epilepsy, ophthalmologic and hearing impairment among others. Consequences of hearing loss include problems with speech and language development. Early detection in this difficult-to-test population may prevent these consequences of hearing loss. An otoacoustic emission assessment is useful in this regard. This study assessed transient-evoked otoacoustic emissions (TEOAEs) in children with CP. MATERIALS AND METHODS: The study population were children with CP who presented at the paediatric neurology clinic during the study period. An equal number of control population matched for age and sex were also recruited using simple random sampling. An interviewer-administered questionnaire was used to obtain relevant clinical information. All participants selected underwent a detailed ear, nose and throat examination and TEOAE testing. RESULTS: There were 330 participants in this study, categorised into CP cases (165) and non-CP controls (165). The age range of the participants was 1-12 years, with a mean age of 4.44 ± 2.92 among CP patients and 4.47 ± 2.90 among the controls. The male-to-female ratio was 2:1. TEOAEs were 'failed' in 83.6% of the CP patients and in 28.5% of the controls. This study found a statistically significant difference in 'failed' TEOAE result between the CP patients and the controls (P = 0.0001). CONCLUSION: This study found a high prevalence of 'failed' TEOAEs in children with CP in Kano.

Penetrating Arrow Injuries of the Head-and-Neck Region: Case Series and Review of Literature.

Penetrating arrow injuries of the head-and-neck region are rare in the developed countries, but they are common in the rural communities of our country. Arrow shot to the head-and-neck region can be life-threatening due to the presence of major vessels and vital organs. Management of arrow injury to the head-and-neck region is seriously challenging, extraction of the arrows are usually difficult due to the proximity to vital structures, unskilled removal may worsen the existing injury or result in inadvertent damage to the vital structures. We presented the four cases of arrow shot to the head-and-neck region, three were managed successfully, and one was brought in dead probably due to attempt at the removal at home or poisonous nature of the arrow. Therefore, the aim of this report is to highlight our experience and challenges in the management of penetrating arrow injuries to head-and-neck region and to review some literature reports.

Relationship between Sinonasal Anatomical Variations and Symptom Severity in Patients with Chronic Rhinosinusitis.

Background: Anatomical variations are subtle structural abnormalities around the osteomeatal complex that might obstruct paranasal sinus drainage and ventilation. The role of these anatomical variants in chronic rhinosinusitis is still controversial and unclear. The aim of this study was to determine the prevalence of anatomical variations and their relationship with the severity of symptoms in patients with chronic rhinosinusitis. Materials and Methods: This was a cross-sectional study conducted among randomly selected patients with chronic rhinosinusitis. Sinonasal Outcome Test-20 (SNOT-20) was used to assess the patient's severity of symptoms. Computed tomographic scan was used to determine the presence of anatomical variations. The relationship between anatomical variations and symptom severity was determined using the Statistical Products and Service Solution (SPSS) version 20.0. Results: There were 70(58.3%) males and 50(41.7%) females within the age range of 17-60 years. SNOT-20 scoring showed 6(5.0%) of the patients with mild symptoms, 69(57.5%) with moderate, 37(30.8%) with severe, and 8(6.7%) with profound symptoms. The prevalence of sinonasal anatomical variants was 26.7%, which comprised of septal deviation (10.8%), agger nasi (6.7%), concha bullosa (4.2%), Haller cells (3.3%), and Onodi cells (1.7%). There was a statistically significant relationship between the anatomical variations and symptom severity (P = 0.000). Conclusion: This study found a significant relationship between anatomical variations and severity of chronic rhinosinusitis. The prevalence of anatomical variants was found to be 26.7%.

Contexte: Les variations anatomiques sont des anomalies structurelles subtiles autour du complexe ostéoméatal qui peuvent obstruer le drainage et la ventilation des sinus paranasaux. Le rôle de ces variantes anatomiques dans la rhinosinusite chronique est encore controversé et peu clair. Le but de cette étude était de déterminer la prévalence des variations anatomiques et leur relation avec la sévérité des symptômes chez les patients atteints de rhinosinusite chronique. Méthodologie: Il s'agissait d'une étude transversale menée auprès de patients sélectionnés au hasard et atteints de rhinosinusite chronique. Sinonasal Outcome Test-20 (SNOT-20) a été utilisé pour évaluer la gravité des symptômes du patient. La tomodensitométrie a été utilisée pour déterminer la présence de variations anatomiques. La relation entre les variations anatomiques et la gravité des symptômes a été déterminée à l'aide de la version 20 de la solution SPSS. Résultats: Il y avait 70 (58,3%) hommes et 50 (41,7%) femmes dans la tranche d'âge de 17 à 60 ans. Le score SNOT-20 a montré que 6 (5,0%) des patients présentaient des symptômes légers, 69 (57,5%) des symptômes modérés, 37 (30,8%) des symptômes graves et 8 (6,7%) des symptômes profonds. La prévalence des variantes anatomiques naso-sinusiennes était de 26,7%, comprenant la déviation septale (10,8%), l'agger nasi (6,7%), la concha bullosa (4,2%), les cellules de Haller (3,3%) et les cellules d'Onodi (1,7%). Il y avait une relation statistiquement significative entre les variations anatomiques et la sévérité des symptômes (P = 0,000). Conclusion: Cette étude a trouvé une relation significative entre les variations anatomiques et la sévérité de la rhinosinusite chronique. La prévalence des variantes anatomiques était de 26,7%.

Comparison of Flexible Nasopharyngoscopy with Plain Radiograph in the Assessment of Children with Adenoid Hypertrophy.

Background: Obstructive adenoid hypertrophy is one of the commonest disorder seen in paediatric otorhinolaryngology clinics. It has a wide range of complications that can lead to cardiopulmonary and developmental problems; hence, early diagnosis and treatment are paramount in preventing the complications. Several modalities for the assessment of adenoid hypertrophy have been described in the literature, of which plain radiograph and flexible nasopharyngoscopy are the most popular. In this study, traditional method of evaluating adenoid hypertrophy (plain radiograph) has been compared with newer flexible nasopharyngoscopy. Materials and Methods: This is a cross-sectional study of randomly selected children with clinical diagnosis of obstructive adenoid disease. All eligible participants underwent clinical examinations, flexible nasopharyngoscopy and postnasal space X-ray. The findings were compared using the chi-square test and Pearson's correlation test. Results: The age of the participants ranged between 2 and 10 years with mean of 4.5 ± 2.5 years. There were 79 (56.4%) males and 61 (43.6%) females. The adenoid hypertrophy observed using flexible nasopharyngoscopy among the participants ranged between 20 and 90% with mean of 67.4 ± 15.4%. The adenoid enlargement measured using adenoidal-nasopharyngeal ratio on plain radiograph ranged between 0.40 and 0.96 with mean of 0.7 ± 0.09. The Pearson's correlation test revealed strong correlation between flexible nasopharyngoscopy and plain radiograph (r = 0.858, P = .000), and there was statistically significant association between the two methods (χ 2 = 148.8, P = .000). Conclusion: There was a strong correlation between flexible nasopharyngoscopy and plain radiograph of the postnasal space in the assessment of obstructive adenoid disease in children.

Spices with Breast Cancer Chemopreventive and Therapeutic Potentials: A Functional Foods Based-Review.

BACKGROUND: Cancer is a multifaceted metabolic disease that affects sizeable dwellers of rural and urban areas. Among the various types of cancer, mammary cancer is one of the most frequently diagnosed cancers in women. Its menace can be curbed with locally consumed spices due to their multiple bioactive phytochemicals. AIMS: This review focuses on the breast cancer chemopreventive and therapeutic potentials of locally consumed spices. METHODS/RESULTS: The most commonly consumed spices with breast cancer chemopreventive and chemotherapeutic phytochemical include pepper, onions, ginger, garlic, curry and thyme containing many biologically active metabolites ranging from vitamins, fatty acids esters, polyphenols/phenolics, sulfurcontaining compounds and anthraquinones with proven antioxidant, anti-inflammatory, immuno-modulatory, antitumor and anticancer properties against breast cancer/carcinogenesis. Therefore, extracts and active principles of these spices could be explored in breast cancer chemoprevention and possibly therapeutically which may provide an avenue for reducing the risk and prevalence of breast cancer.

Modulation of sialic acid levels among some organs during insulin resistance or hyperglycemic states.

Previous studies have suggested a possible connection between insulin resistance and chronic hyperglycemia with membrane sialic acid content. In this study, the effects of high (20% ad libitum) fructose and glucose feeding on the sialic acid levels of some organs were investigated in rats. The blood glucose levels of the high fructose- and glucose-fed rats were consistently and significantly (P < 0.05) higher than the normal control throughout the experiment. Free serum sialic acid and total hepatic sialic acid levels were elevated in the high fructose- and glucose-fed rats compared to normal control, but only the data for the high glucose-fed group were significantly (P < 0.05) different from the normal control. Conversely, a significant (P < 0.05) decrease in the pancreatic sialic acid level was observed in high glucose-fed group compared to normal control. Also, the high fructose-fed rats had lower, but insignificant (P > 0.05), pancreatic sialic acid level than the normal control. On the other hand, high fructose and glucose feeding did not significantly (P > 0.05) affect the sialic acid levels of the skeletal muscle and heart, though a tendency to increase the sialic acid level was evident in the heart. In the kidney, the sialic acid level was significantly (P < 0.05) increased in both high fructose- and glucose-fed groups. It was concluded that the liver and kidney tend to stimulate sialic acid synthesis, while the pancreas downregulate sialic acids synthesis and/or promote sialic acid release from glycoconjugates. Also, these organs may contribute to high-serum sialic acid level observed during diabetes.