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Background: Breast's Invasive Ductal Carcinoma (IDC), which is the commonest type of malignancy in females worldwide, can be characterized using immunohistochemistry in view of personalized cancer therapy. In this study, we aimed to determine the pattern of immunohistochemical profiles of IDC using oestrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor 2 receptor (HER2) and proliferative index (Ki-67) biomarkers in our tertiary healthcare facility in Uyo, Akwa Ibom State, Nigeria given the dearth of its data in our environment. Materials and methods: We carried out a retrospective hospital-based immunohistochemical study of archival IDC tissue blocks over a four- and half-year period. Using systematic random sampling method, 64 formalin fixed paraffin embedded (FFPE) IDC tissue blocks were selected for this study. We carried out immunohistochemical evaluation using ER, PR, HER2 and Ki-67 biomarkers. Subsequently, we presented the results and classification schemes as text, tables, graphs, and photomicrographs. Results: We found that the proportion of expressions were ER-negative (88.7%), PR-negative (87.3%), HER2-negative (68.3%) and Ki-67 (<20%) being 83.6% respectively. The immunohistochemical-based classification which was done using combined immunohistochemical profiles of ER/PR/HER2 and ER/PR/HER2/Ki-67 biomarkers respectively, revealed five immunohistochemical-based subtypes. These subtypes were ER-positive luminal A (ER+/±PR+/HER2-) [5.56%], ER-positive luminal B (ER+/±PR+/HER2+) [5.56%], HER2-overexpression (ER-/±PR+/HER2+) [16.66%], Triple negative (ER-/PR-/HER2-) [66.67%] and Unclassified subtypes (ER-/PR+/HER2-) [5.56%]. Furthermore, these five subtypes were further subcategorized into low (Ki-67 <20%) and high (Ki-67 ≥20%) proliferation subtypes accordingly. Conclusion: The commonest pattern of immunohistochemical profile expression of IDC in Uyo was found to be the Triple negative subtype.
Subject(s)
Humans , Breast Neoplasms , Immunohistochemistry , Carcinoma, Ductal , Carcinoma , Flow Profiles , Triple Negative Breast NeoplasmsABSTRACT
Background: Non-communicable diseases (NCDs), including type-2 diabetes and hypertension, have been associated with increased morbidity and mortality rates because of coronavirus disease 2019 (COVID-19). Maintaining quality care for these conditions is important but data on the impact of COVID-19 on NCD care in South Africa are sparse. Aim: This study aimed to assess the impact of COVID-19 on facility and community-based NCD care and management during the first COVID-19 wave. Setting: Two public health sector primary care sites in the Cape Town Metro, including a Community Orientated Primary Care (COPC) learning site. Methods: A rapid appraisal with convergent mixed-methods design, including semi-structured interviews with facility and community health workers (CHWs) (n = 20) and patients living with NCDs (n = 8), was used. Interviews were conducted in English and Afrikaans by qualified interviewers. Transcripts were analysed by thematic content analysis. Quantitative data of health facility attendance, chronic dispensing unit (CDU) prescriptions and routine diabetes control were sourced from the Provincial Health Data Centre and analysed descriptively. Results: Qualitative analysis revealed three themes: disruption (cancellation of services, fear of infection, stress and anxiety), service reorganisation (communication, home delivery of medication, CHW scope of work, risk stratification and change management) and outcomes (workload and morale, stigma, appreciation and impact on NCD control). There was a drop in primary care attendance and an increase in CDU prescriptions and uncontrolled diabetes. Conclusion: This study described the service disruption together with rapid reorganisation and change management at primary care level during the first COVID-19 wave. The changes were strengthened by the COPC foundation in one of the study sites. The impact of COVID-19 on primary-level NCD care and management requires more investigation.
Subject(s)
Quality of Health Care , Delivery of Health Care , Noncommunicable Diseases , COVID-19 , Disease Management , Diabetes Mellitus, Type 2 , HypertensionABSTRACT
Background@#and purpose In acute stroke patients, plasma concentrations of direct oral anticoagulants (DOAC) at hospital admission only poorly mirror DOAC exposure or the coagulation status at the time of the event. Here, we evaluated whether DOAC exposure and DOAC plasma concentration at the time of transient ischemic attacks (TIA) and ischemic strokes correlate with their likelihood of occurrence. @*Methods@#Prospectively, consecutive DOAC patients with acute ischemic stroke or TIA were included. Admission DOAC plasma concentrations were measured by ultraperformance liquid chromatography– tandem mass spectrometry. Individual DOAC exposure (area under the curve) and DOAC concentrations at event onset were derived from population pharmacokinetic analyses. @*Results@#DOAC exposure was successfully modeled in 211 patients (ischemic stroke 74.4%, TIA 25.6%). Compared to published values, 63.0% had relatively lower DOAC exposure and they more often received lower DOAC doses than recommended (odds ratio [OR], 2.125; 95% confidence interval [CI], 1.039 to 4.560; P=0.044). These patients more likely suffered ischemic strokes than TIA (OR, 2.411; 95% CI, 1.254 to 4.638; P=0.008) and their strokes were more severe (slope, 3.161; 95% CI, 0.741 to 5.58; P=0.011). Low relative DOAC concentrations at event onset were likewise associated with ischemic strokes (OR, 4.123; 95% CI, 1.834 to 9.268; P=0.001), but not to stroke severity (P=0.272). DOAC exposure had a higher explanatory value for stroke severity than concentrations at event. @*Conclusions@#Low DOAC exposure is strongly associated to ischemic stroke and its severity. By monitoring DOAC plasma concentrations, patients prone to ischemic stroke might be identified.
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Objective@#The consensus is that life expectancy for individuals with Parkinson’s disease (PD) is reduced, but estimations vary. We aimed to provide an overview of 20 years of mortality and risk factor data from the Queensland Parkinson’s Project. @*Methods@#The analysis included 1,334 PD and 1,127 control participants. Preliminary analysis of baseline characteristics (sex, age at onset, family history, smoking status, pesticide exposure, depression and neurosurgery) was conducted, and Kaplan–Meier curves were generated for each potential risk factor. Standardized mortality ratios (SMRs) were calculated comparing this cohort to the general Australian population. Cox proportional hazards regression modeling was used to analyze potential predictors of mortality. @*Results@#In total, 625 (46.8%) PD and 237 (21.0%) control participants were deceased. Mean disease duration until death was 15.3 ± 7.84 years. Average ages at death were 78.0 ± 7.4 years and 80.4 ± 8.4 years for the deceased PD and control participants, respectively. Mortality was significantly increased for PD in general {SMR = 2.75 [95% confidence interval (CI): 2.53–2.96]; p = 0.001}. SMRs were slightly higher for women and those with an age of onset before 60 years. Multivariate analysis showed that deep brain stimulation (DBS) treatment was associated with lower mortality [hazard ratio (HR) = 0.76; 95% CI: 0.59–0.98], while occasional pesticide exposure increased mortality risk (HR = 1.48; 95% CI: 1.17–1.88). Family history of PD, smoking and depression were not independent predictors of mortality. @*Conclusion@#Mortality in PD is increased. Sex, age at onset and occasional pesticide exposure were independent determinants of increased mortality, while DBS treatment was associated with reduced mortality.
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Purpose@#Recombinant rotavirus A vaccines are being developed as an alternative to existing live oral attenuated vaccines. One of the main problems in the production of such vaccines is the genetic diversity of the strains that are in circulation. The goal of this study was to create an antigen panel for modern broad-spectrum recombinant rotavirus A vaccine. @*Materials and Methods@#The antigens of rotavirus were cloned and expressed in Escherichia coli. Antigenic specificity was investigated by Western blot analysis, which was performed using commercial polyclonal antisera to several RVA strains. Phylogenetic analysis was based on the amino acid sequences of the VP8* protein fragment of human RVA isolates representing genotypes P[4], P[6], and P[8]. @*Results@#A universal panel of antigens was established, including consensus and conserved sequences of structural proteins VP8*, VP5*, and VP7, which are the main targets of neutralizing antibodies. For the first time, a consensus approach was used in the design of extended antigens based on VP8* (genotypes P[4], P[6], and P[8]) and VP5* (genotype P[8]) proteins' fragments. In addition, a gene coding the protein (ep-875) containing several copies of conserved short neutralizing epitopes of VP8*, VP7, and VP5* was created. Western blot analysis demonstrated that three synthetic VP8*-based antigens were not recognized by commercial antiserum against rotavirus strains isolated more than 35 years ago, but the specific activity of the VP5* and ep-875 antigens was confirmed. The problems of serological mismatch of vaccine strains and antigens with currently circulating strains are discussed. @*Conclusion@#Five antigens representing sequences of structural proteins belonging to different genotypes can be used in various combinations (from mono- to pentavalent mixtures) for the development of an effective broad-spectrum rotavirus vaccine.
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Background@#Anti-parasitics are frequently used in research animal facilities to treat a multitude of common infections, with pinworms and fur mites being amongst the most common. Ivermectin and selamectin are common oral and topical treatments for these infections, respectively. Although commonly thought to be innocuous to both the research animals and any transgenic elements that the animals may carry, evidence exists that ivermectin is capable of activating the recombinase activity of at least one CreER . The goal of the current study was to determine if there was an effect of either anti-parasitic agent on the activity of CreER proteins in transgenic mice.Case presentation: We analyzed the offspring of transgenic mice exposed to either ivermectin or selamectin during pregnancy and nursing. Through analysis of reporter genes co-expressed with multiple, independently generated transgenic CreER drivers, we report here that ivermectin and selamectin both alter recombinase activity and thus may have unintended consequences on gene inactivation studies in mice. @*Conclusions@#Although the mechanisms by which ivermectin and selamectin affect CreER activity in the offspring of treated dams remain unclear, the implications are important nonetheless. Treatment of pregnant transgenic mice with these anti-parasitics has the potential to alter transgene activity in the offspring. Special considerations should be made when planning treatment of transgenic mice with either of these pharmacologics.
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Background@#and PurposeResponses to oral appliances (OAs) in obstructive sleep apnea (OSA) vary, and have not been fully evaluated in Korean patients. In this study we aimed to determine the efficacy of OAs for the first-line treatment of Korean patients with moderate or severe OSA. @*Methods@#This multicenter prospective observational study included 45 patients with moderate or severe OSA that had been newly diagnosed between March 2017 and May 2018 and who underwent OA treatment for 1 month. Questionnaires were completed and polysomnography (PSG) was performed before and after OA treatment. The primary outcome measures were improvement in the absolute apnea-hypopnea index (AHI) and the percentage reduction in the AHI. The secondary outcomes were improvements in the questionnaire scores related to sleep-associated symptoms and PSG parameters. @*Results@#The patients were aged 47.4±12.1 years (mean±SD), only two of them were female, and their AHI at baseline was 29.7±10.9/h. After OA treatment the AHI had reduced by 63.9±25.8%, with the reduction was similar between the patients with moderate OSA and those with severe OSA. Overall 31.1% of the patients achieved a normal AHI (<5/h), and 64.4% had an AHI of ≤10/h after the treatment. The body mass index (BMI) was the most reliable factor for predicting the percentage reduction in the AHI. The OAs also improved the sleep architecture and subjective sleep-related symptoms. @*Conclusions@#The OAs were effective in patients with moderate or severe OSA. The OAs reduced the mean AHI to 63.9% of the baseline value, and this reduction was influenced by the BMI.
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Background@#Anti-parasitics are frequently used in research animal facilities to treat a multitude of common infections, with pinworms and fur mites being amongst the most common. Ivermectin and selamectin are common oral and topical treatments for these infections, respectively. Although commonly thought to be innocuous to both the research animals and any transgenic elements that the animals may carry, evidence exists that ivermectin is capable of activating the recombinase activity of at least one CreER . The goal of the current study was to determine if there was an effect of either anti-parasitic agent on the activity of CreER proteins in transgenic mice.Case presentation: We analyzed the offspring of transgenic mice exposed to either ivermectin or selamectin during pregnancy and nursing. Through analysis of reporter genes co-expressed with multiple, independently generated transgenic CreER drivers, we report here that ivermectin and selamectin both alter recombinase activity and thus may have unintended consequences on gene inactivation studies in mice. @*Conclusions@#Although the mechanisms by which ivermectin and selamectin affect CreER activity in the offspring of treated dams remain unclear, the implications are important nonetheless. Treatment of pregnant transgenic mice with these anti-parasitics has the potential to alter transgene activity in the offspring. Special considerations should be made when planning treatment of transgenic mice with either of these pharmacologics.
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Background: The high maternal and perinatal mortality rates in Nigeria continue to be issues of concern. That antenatal care improves both perinatal and maternal outcomes is now well established. The study seeks to identify the predictors of poor maternal and perinatal outcome among singleton maternal delivery cases referred to Rivers State University Teaching Hospital (RSUTH).Methods: A longitudinal study was employed; the patients referred to RSUTH were followed up to ascertain maternal and neonatal outcomes. A sample size of 460 was used. Selection of cases was done by systematic sampling. Data obtained in the study were demographic, obstetric and perinatal findings. Maternal and perinatal outcome were dichotomized into poor and good outcomes. Bivariate and multivariate analyses were performed using SPSS version 20.0.Results: A total of 460 cases were recruited. The mean age±SD was 28.7±4.6 years. There was poor maternal outcome in 65 (14.1%) and poor perinatal outcome in 291 (63.3%). There was one maternal death (rate 0.2%), perinatal mortality rate was 26.5%, low birth-weight rate was 6.3% and asphyxia rate was 23.3%. There is an association of multiparity and unbooked status with poor maternal outcome, while poor perinatal outcome was influenced by unbooked status.Conclusions: Perinatal and maternal mortality were high amongst all referral cases. There is a positive correlation of multiparity with poor maternal outcome and between unbooked status and an increased risk of both maternal and perinatal adverse outcomes.
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Background: Cervical cancer remains a leading cause of death among women in the developing world, with poor prognosis attributed to lack of awareness about the disease and its prevention. Hospital workers’ attitude and practice to such an issue might positively or negatively influence people they come into contact with. This study is to assess the determinants of cervical cancer screening via Pap smear among Female Staff in a Tertiary Hospital in Nigeria.Methods: A hospital-based cross-sectional study was conducted between September and November 2015. A structured self-administered questionnaire was used to collect data from 265 female hospital workers on socio-demographic characteristics (age, parity, educational level and occupational category) and awareness and utilization of Pap smear test. The data obtained were analyzed using SPSS version 20.0.Results: Of the 265 respondents, only 40 (15.1%) had Pap smear test done at least once previously. Bivariate analysis of socio-demographic factors and Pap smear test uptake among the respondents was statistically significant for younger maternal age ≤35 years, not being married, higher educational level, professional occupation category and awareness of Pap smear. However, only maternal age, marital status and awareness of Pap smear remain statistically significant after multivariate analysis.Conclusions: Uptake of Pap smear test as a screening test for cervical cancer is low among female hospital workers. Identified determinants of cervical cancer screening via Pap smear test were younger age ≤35 years, not being married, higher educational level, professional occupational category and awareness of Pap smear.
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An increasingly blurred understanding of the conditions under which clinicians may withhold HIV seropositive status from partners of patients who are sexually active and who do not intend to disclose suggests a critical need to revisit the relationship between the principle of confidentiality, the moral and legal duties to warn at-risk third parties, and the organisational ethics surrounding licit cooperation with wrongdoing in the effort to uphold professional moral responsibility. This essay grounds its argument in two, straightforward premises: (i) the ethical principle of cooperation is an indispensable measure of the moral licitness of instances of complicity with wrongdoing; (ii) some instances of material organisational complicity vis-à-vis confidential withholdings of HIV seropositive status from partners of sexually active patients both meet and successfully employ the standards of the ethical principle of cooperation. Drawing from this syllogism, the essay argues that, in Type II cases, healthcare organisations may (initially and on certain conditions) materially cooperate in withholding the HIV seropositive status of patients from partners with whom patients are sexually active, and to whom patients do not intend to disclose HIV seropositive status, in the effort to honour professional obligations of privacy, confidentiality, and fidelity in a manner that is both legally licit and morally justifiable.
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There are several million hairdressers worldwide who are chronically exposed to various chemicals used in hairdressing business. This study aimed at determining the occupational health problems and work practices of hairdressers in Uyo, Nigeria. This was a cross-sectional descriptive study carried out in March 2017.The study participants consisted of all consenting hairdressers in Uyo metropolis, Nigeria who had been working for at least 6 months prior to the study. Data obtained was analyzed using STATA 12.1 software. Level of significance was set at 5%. A total of 429 hairdressers participated in the study. The mean age of respondents was 28.5 �7.5 years. Majority, (88.3%) were females and 63.9% were single. Ninety percent had at least secondary education, while 47.6% had worked for > 3years. Health problems reported included back pain 61.5%, tiredness 57.1%, Itching/ redness of hands 43.1%, eye itching 26.1%, catarrh 22.8% and hearing difficulty 17.7%. Injuries included needle pricks 59.0% and cuts 46.9%. Standing for > 8 hours was reported by 33% of respondents. Use of any personal protective equipment (PPE) was 67.6%. The most commonly used was glove 42.7%. Awareness about PPE increased with respondent's level of education (p<0.05).Hand lesions were significantly less among those who used gloves as 95.6% had no chemical burns and rashes, 95.1% experienced no dryness and 63.4% had no itching/redness (p<0.05). The respondents reported several health problems. Work practices included poor use of PPE and prolonged standing. Regular workplace safety training, shift duty and use of ergonomically suitable chairs are advocated for hairdressers
Subject(s)
Barbering/instrumentation , Cross-Sectional Studies , Hazardous Substances , Nigeria , Occupational Health , Professional PracticeABSTRACT
The burden of atrial fibrillation (AF) is projected to increase substantially over the next decade in parallel with the aging of the population. The increasing age, level of comorbidity, and polypharmacy will complicate the treatment of older adults with AF. For instance, advanced age and chronic kidney disease have been shown to increase the risk of both thromboembolism and bleeding in patients with AF. Frailty, recurrent falls and polypharmacy, while very common among elderly patients with AF, are often overlooked in the clinical decision making despite their significant interaction with oral anticoagulant (OAC) and profound impact on the patient's clinical outcomes. Such factors should be recognized, evaluated and considered in a comprehensive decision-making process. The introduction of non-vitamin K oral anticoagulants has radically changed the management of AF allowing for a more individualized selection of OAC. An understanding of the available data regarding the performance of each of the available OAC in a variety of at risk patient populations is paramount for the safe and effective management of this patient population. The aim of this review is to appraise the current evidence, point out the gaps in knowledge, and provide recommendations regarding stroke prevention in older adults with AF and comorbid conditions.
Subject(s)
Adult , Aged , Humans , Accidental Falls , Aging , Anticoagulants , Atrial Fibrillation , Clinical Decision-Making , Comorbidity , Hemorrhage , Polypharmacy , Renal Insufficiency, Chronic , Stroke , Thromboembolism , WarfarinABSTRACT
The burden of atrial fibrillation (AF) is projected to increase substantially over the next decade in parallel with the aging of the population. The increasing age, level of comorbidity, and polypharmacy will complicate the treatment of older adults with AF. For instance, advanced age and chronic kidney disease have been shown to increase the risk of both thromboembolism and bleeding in patients with AF. Frailty, recurrent falls and polypharmacy, while very common among elderly patients with AF, are often overlooked in the clinical decision making despite their significant interaction with oral anticoagulant (OAC) and profound impact on the patient's clinical outcomes. Such factors should be recognized, evaluated and considered in a comprehensive decision-making process. The introduction of non-vitamin K oral anticoagulants has radically changed the management of AF allowing for a more individualized selection of OAC. An understanding of the available data regarding the performance of each of the available OAC in a variety of at risk patient populations is paramount for the safe and effective management of this patient population. The aim of this review is to appraise the current evidence, point out the gaps in knowledge, and provide recommendations regarding stroke prevention in older adults with AF and comorbid conditions.
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ABSTRACT We studied the effects of particulate and dissolved optically active components on the attenuation of photosynthetic active radiation (PAR) in a tropical lake. The temporal and spatial distribution of tripton, Chl-a and aCDOM(440) and their relative contribution to the diffuse PAR attenuation coefficient (Kd) was investigated at 21 sites (dry and wet seasons and two intermediate periods) and at monthly interval at 1 pelagic site. Higher values of Kd were observed during the mixing period, characterized by a higher concentration of tripton and Chl-a compared to the stratified rainy season. In the spatial sampling PAR attenuation was dominated by tripton absorption/scattering (average relative contribution of 79%), followed by Chl-a (average 11.6%). In the monthly sampling tripton and Chl-a accounted for most of the Kd with relative contributions of 47.8% and 35.6%, respectively. Multiple linear regression analysis showed that Chl-a and tripton in combination explained 97% of the monthly variation in Kd (p<0.001), but Chl-a had more influence (higher regression coefficient). Thus, although most of light attenuation was due to tripton, seasonal variations in phytoplankton abundance were responsible for most of the temporal fluctuations in Kd.
Subject(s)
Photosynthesis/physiology , Light , Phytoplankton/radiation effects , Polyurethanes , Seasons , Lakes , Chlorophyll/radiation effects , Environmental Monitoring , Spatio-Temporal Analysis , Chlorophyll A , Methacrylates , Models, BiologicalABSTRACT
Synovial osteochondromatosis (SO) can occur idiopathic or secondary to osteoarthritis. SO can be easily diagnosed with plain film radiography and clinical findings. In case of disabling osteoarthritis, total knee arthroplasty and removal of all corpora libra are indicated. We present a 71-year-old woman with significant osteoarthritis and severe SO intra-articular and in the suprapatellar bursa of the right knee. Total knee arthroplasty, extraction of the loose bodies, and partial synovectomy were performed. During a 2.5-year follow-up, the patient regained full function of her affected knee and there was no recurrence of SO. We choose to present this case to show the extensiveness SO can occur in. Our advice is to remove all the loose bodies carefully to prevent damage to the prosthesis. During follow-up, special attention should be paid to prevent recurrence of SO. When recurrence is associated with rapid growth or destruction of joints, malignant reoccurrence must be considered.