Community cervical cancer screening and precancer risk in women living with HIV in Jos Nigeria.

BACKGROUND: High HIV prevalence, and lack of organized screening for the indigent population receiving care and treatment within HIV clinics in low-resource settings increases cervical cancer incidence. We sought to determine predictors of cervical precancer in women living with HIV and receiving cervical cancer screening in Jos, Nigeria. METHODS: A cross-sectional study of women living with HIV and receiving care and treatment in adult HIV/AIDS clinics in Jos-Metropolis, Nigeria between June 2020 and April 2023. Ethical approvals were obtained from the ethics committee in Jos, Nigeria and Northwestern University IRB, USA. Informed consent was obtained from eligible participants, and data on socio-demographics, cancer risk factors, and cytology reports were collected. The outcome variables were cervical precancer lesions. The independent variables were prior Pap smear status, socio-demographics, income, educational, and other reproductive health factors. Descriptive statistics was done to obtain means ± sd, frequencies, and percentages for the variables. Univariate and bivariate analyses were done to determine predictors of cervical dysplasia. Analyses were performed using R software. RESULTS: Of 957 women screened, 570 were living with HIV and 566 women had cytology report and were included in the final analysis. The mean age was 45.08 ± 8.89 years and 81.6% had no prior evidence of Pap test (under-screened). Prevalence of cervical dysplasia was 24% (mild and severe dysplasia were 12.9% and 11.1%, respectively). Age above 45 years (aOR = 3.48, p = 0.009), postmenopausal status (aOR = 7.69, p = 0.000), and women with no history of prior IUCD use (aOR = 5.94, p = 0.0001), were predictors for severe dysplasia. Women who had history of STI (aOR = 0.17, p = 0.000), prior use of IUCD (aOR = 0.32, p = 0.004), prior use of condom (aOR = 2.50, p = 0.003) and had co-morbidities (aOR = 0.46, p = 0.009) were more likely to have had a Pap test in the past. CONCLUSIONS: The majority of indigent women receiving care at HIV clinics had their first Pap test screening, and lack of organized screening among older and post-menopausal women with HIV, puts women at a higher risk of developing severe cervical precancer lesions.

Glucocorticoid activation of anti-inflammatory macrophages protects against insulin resistance.

Insulin resistance (IR) during obesity is linked to adipose tissue macrophage (ATM)-driven inflammation of adipose tissue. Whether anti-inflammatory glucocorticoids (GCs) at physiological levels modulate IR is unclear. Here, we report that deletion of the GC receptor (GR) in myeloid cells, including macrophages in mice, aggravates obesity-related IR by enhancing adipose tissue inflammation due to decreased anti-inflammatory ATM leading to exaggerated adipose tissue lipolysis and severe hepatic steatosis. In contrast, GR deletion in Kupffer cells alone does not alter IR. Co-culture experiments show that the absence of GR in macrophages directly causes reduced phospho-AKT and glucose uptake in adipocytes, suggesting an important function of GR in ATM. GR-deficient macrophages are refractory to alternative ATM-inducing IL-4 signaling, due to reduced STAT6 chromatin loading and diminished anti-inflammatory enhancer activation. We demonstrate that GR has an important function in macrophages during obesity by limiting adipose tissue inflammation and lipolysis to promote insulin sensitivity.

Mechanical thrombectomy for the treatment of acute ischaemic stroke following pulmonary lobectomy.

Acute ischaemic stroke is a devastating postoperative complication that significantly impacts upon a patient's quality of life. Endovascular retrieval of thromboembolic material from proximal cerebral arteries by mechanical thrombectomy is the new standard of care for patients presenting with a proximal artery occlusion. We report the case of a patient developing an acute ischaemic stroke following pulmonary lobectomy, who was transferred to the regional neurosciences unit, despite the absence of an established referral pathway, to undergo mechanical thrombectomy, with significant prognostic neurological benefit. We would advocate all cardiothoracic centres identify their regional neurosciences unit and initiate discussion to establish a referral pathway.

Giant solitary fibrous tumour of the pleura an unpredictable entity: case series and literature review.

A small proportion of tumours can undergo malignant transformation. We report a case series of five patients diagnosed with giant solitary fibrous tumours of the pleura. These cases highlight the unpredictable nature of this disease process, with significant variability in clinical course observed, from indolence to aggressive progression. Three patients were found to have malignant disease on explant, with two of these having preoperative imaging and histology suggesting benign pathology. This finding emphasises that accurately differentiating between benign and malignant disease on imaging and/or biopsy has low specificity and sensitivity and cannot be relied upon in guiding the management of these tumours. Patients with solitary fibrous tumours of the pleura should be managed cautiously, owing to the unpredictable and potentially aggressive clinical course. We would advocate the position that all patients with solitary fibrous tumours of the pleura should be managed as if they have malignant disease. Prolonged follow-up is required due to the risk of disease recurrence, even in patients with benign disease.

Could Sentinel Skin Transplants Have Some Utility in Solid Organ Transplantation?

Accurate diagnosis of allograft rejection can be hazardous and challenging. A strategy that has emerged from experience with vascularized composite allografts (VCAs) is the use of sentinel skin transplants (SSTs)-portions of donor skin transplanted synchronously to an allograft. Work in nonhuman animal models and experience with VCAs suggest concordance between rejection occurring in the primary allograft and the SST, and that appearance of rejection in the SST may precede rejection in the primary allograft, permitting early therapeutic intervention that may improve outcomes with lower rates of chronic rejection. The encouraging findings reported in VCA transplantation raise the possibility that SST may also be useful in solid organ transplantation. Some evidence is provided by experience with abdominal wall transplantation in some intestinal and multivisceral transplant recipients. Results from those reports raise the possibility that rejection may manifest in the skin component before emergence in the intestinal allograft, providing a "lead time" during which treatment of rejection of the abdominal wall could prevent the emergence of intestinal rejection. It is plausible that these findings may be extrapolated to other solid organ allografts, especially those for which obtaining an accurate diagnosis of acute rejection can be hazardous and challenging, such as the lung or pancreas. However, more data are required to support widespread adoption of this technique.

Colonic transit in the empty colon after defunctioning ileostomy: do we really know what happens?

BACKGROUND: There is disagreement amongst surgeons about the use of oral mechanical bowel preparation (MBP) prior to low anterior resection with diverting ileostomy. Colonic transit in the early post-operative period is an important factor in determining the role of MBP, as propagation of any stool remaining in the defunctioned colon may exacerbate morbidity in the event of anastomotic leak. We studied colonic transit time in the first 7 days following low anterior resection with diverting ileostomy. METHODS: We conducted a prospective observational study of patients with rectal cancer undergoing elective low anterior resection with diverting ileostomy in a tertiary colorectal unit. Twenty radio-opaque markers were inserted into the caecum via the distal limb of the loop ileostomy at surgery. Plain abdominal radiographs were taken on post-operative days 1, 3 and 5. The primary endpoint was passage of the markers to the neorectum. Data were collected on treatment, return of gastrointestinal function and complications. RESULTS: Twenty-two patients (mean age 68.5 years; 18 males) participated in the study. In 20 patients, all markers remained in the right colon on day 7. Three markers were present in the left colon in one patient, and eight markers were present in the neorectum in another patient, on the seventh day. CONCLUSIONS: Colonic transit may be abolished by the presence of diverting ileostomy. It should now be established whether clearance of the left colon alone, using enemas, is sufficient for patients undergoing low anterior resection, thus avoiding the morbidity associated with oral MBP.

Aortic arch replacement with a beating heart: a simple method using continuous 3-way perfusion.

We describe a simplified 3-way perfusion strategy that could be used in complex aortic procedures, which ensures continuous end-organ perfusion and minimizes the potential risks of cardiac, cerebral and peripheral ischaemic complications.

Allograft biopsy in kidney transplant recipients in the medical city of Baghdad.

To determine the safety and efficacy of the practice of renal allograft biopsy and verify its impact on the management of kidney transplant patients presenting with graft dysfunction, we studied 50 renal allograft biopsies of 47 adult patients (38% males, mean age 32.4 ± 11 years) performed in the medical city complex from November 2008 to April 2011. All the biopsies were performed with a guidance of ultrasound. The procedure, complications, histological diagnoses and impact of the biopsy data on patients' management were recorded. Thirty percent of the biopsies were performed in the first 12 months post-transplantation and 24% were performed after the 60 th month. Adequate biopsy was achieved in 76% of the patients, with a 96% safety rate. Acute rejection was diagnosed in 38% of the biopsies and chronic allograft nephropathy in 38%, and they were the most common histological patterns in the study. The results of allograft biopsies positively impacted the management strategy in all study groups. Renal allograft biopsy was a useful and a relatively safe tool for the diagnosis of acute and chronic graft dysfunction in our experience.

Tissue expanders: early experience of a novel treatment option for perineal herniation.

PURPOSE: Acquired perineal hernias through the reconstructed pelvic floor can complicate radical pelvic operations including abdominoperineal resection of rectum. Operative intervention is indicated for symptomatic hernias. There is a lack of consensus as to the best operative technique. Here we present a novel method for repairing perineal herniation using saline-filled tissue expanders. METHODS: Perineal hernia repair may be affected either via an abdominal or via a perineal approach. After adhesiolysis to remove small bowel from the pelvis, a Natrelle™ 150SH tissue expander (Allergan Inc., California, USA) or Siltex™ Round Becker (Mentor Medical Systems, Holland) of appropriate size is inserted in the pelvis and the button placed in a subcutaneous pocket in the perineal skin. The tissue expander is then filled with saline until it fills the true anatomical pelvis without bladder compression. The volume may be increased or decreased postoperatively by accessing the subcutaneous button. RESULTS: We have performed this procedure in three patients with some success, all of whom have experienced symptomatic relief. The tissue expander may subsequently be removed without recurrence of symptoms, due to the fibrous capsule which forms. One patient required re-operation to elevate a herniating tissue expander. The tissue expander was removed earlier than anticipated to avoid deep pelvic infection in another. CONCLUSION: Our early experience suggests that using saline-filled tissue expanders to fill dead space in the pelvis after radical surgery may prove to be a valuable approach to perineal herniation, particularly if adjuvant radiotherapy is planned.

Treatment policy for psoriasis and eczema: a survey among dermatologists in the Netherlands and Belgian Flanders.

Today, many therapies are available for the treatment of psoriasis and eczema. One of the oldest topical therapies is coal tar. Coal tar has been used for decades, but over the past years, the use of coal tar has decreased for several reasons, including the supposed carcinogenicity of coal tar. We investigated the current and past treatment policies for psoriasis and eczema with special emphasis on the use of tar products; a postal survey was conducted among all dermatologists in two European countries: the Netherlands (n = 360) and the Flemish speaking part of Belgium (Flanders) (n = 328). This study was conducted as part of the ongoing LATER-study ("Late effects of coal tar treatment in eczema and psoriasis; the Radboud study"). All practising dermatologists received a questionnaire. Dermatologists were asked to describe their treatment policies in mild/moderate psoriasis, severe psoriasis, mild/moderate eczema and severe eczema. The response rate to the questionnaire was 62.5% for the Dutch dermatologists and 45.7% for the Flemish dermatologists. Almost all dermatologists prescribe topical corticosteroids. In eczema, most of the dermatologists prescribe the recently introduced calcineurin inhibitors (95%). Coal tar is a second choice topical therapy. Dutch dermatologists mainly use tar in the treatment of eczema (72% vs. 48% in Flanders), whereas in Flanders, tar is mainly prescribed in psoriasis (60% vs. 41% in Holland). Flemish dermatologists very frequently prescribe PUVA in psoriasis (93% vs. 63%). Topical treatment, especially topical corticosteroids, is the mainstay in psoriasis and eczema. Coal tar still is an important (second choice) therapy for the topical treatment of psoriasis and eczema, but its use varies from country to country. Despite the carcinogenicity of PUVA, this photochemotherapy is frequently prescribed by dermatologists, mainly in Flanders.