Prevalence of non-communicable diseases among HIV positive patients on antiretroviral therapy at a tertiary health facility in Makurdi, north-central, Nigeria

Human immunodeficiency virus (HIV) treatment program has grown exponentially in Nigeria largely due to improved Antiretroviral therapy (ART) regimen which has changed the course of HIV/AIDs by enabling patients to live longer, raising concern of the co-existence of HIV with other chronic illnesses, notably non communicable diseases (NCDs). This study determined the prevalence of hypertension and diabetes mellitus among HIV positive patients in a tertiary institution in Makurdi, North-central Nigeria.Methods: A cross-sectional study was conducted at the ART clinic among clients ≥ aged 21 years old living with HIV /or enrolled between October 2022, and March 30, 2023. The clients' information was extracted from the register using a Proforma and all the clients who had attended their follow up clinic visit within the study period were included in the study. Data was analyzed using SPSS version 21.0. Categorical data were presented as frequencies and percentages. Results: Among the 491 patients, 404 (82.3%) had HIV only and 87 (17.7%) had HIV and at least one comorbidity, namely DM and/or HTN. Hypertension was the most prevalent comorbidity affecting 15.5% of the patients while 1.0% of them were diabetic. The middle aged (30-49) patients, females (63.2%) had the highest prevalence of comorbidities and some of those with normal weight (35.6%) also had the highest prevalence of NCDs.Conclusion: Non-communicable diseases are common among people living with HIV. There is need to encourage early diagnosis and treatment of non-communicable diseases in HIV positive patients in Nigeria.

Pediatric Inflammatory Bowel Disease: A Multicenter Study of Changing Trends in Argentina Over the Past 30 Years / 대한소아소화기영양학회지

Purpose@#To analyze the characteristics of pediatric inflammatory bowel disease (IBD) over the past three decades in Argentina and determine if there are differences between the first two decades and the past decade. @*Methods@#We conducted a retrospective multicenter analytical study in children with IBD between 0 and 18 years of age diagnosed between 1987 and 2017 in three tertiary health centers in Argentina. The evaluation included clinical characterization, endoscopy, histology, and imaging data together with therapeutic strategies. The patients were divided into two groups: Group 1, diagnosed between 1987 and 2007, and Group 2, diagnosed between 2008 and 2017. @*Results@#Of the 756 patients included, 409 (54%) had ulcerative colitis (UC), 250 (33%) had Crohn’s disease (CD), and 97 (13%) had IBD-unclassified (IBD-U). The positive family history was 3.8%, which was more frequent among children under two years of age (6.7%). There were no significant differences in clinical presentation and extraintestinal manifestations between periods, with hepatic manifestations being the most frequent. In the last decade, we found an upward trend in CD, a downward trend in UC/IBD-U, even after adjustment for socioeconomic status, and a decrease of 50% in surgical treatments coinciding with the advent of biological therapy. @*Conclusion@#This is the first multicenter cohort study in a Latin American country to describe clinical, endoscopic, and therapeutic data across the past 30-year period. Although CD was responsible for the overall increase in incidence, UC was still prevalent in this region.

Impact of medical school responses during the COVID-19 pandemic on student satisfaction: a nationwide survey of US medical students / 한국의학교육

Purpose@#Medical schools have faced various challenges in preparing their clinical students for the frontlines of a pandemic. This study investigated medical students’ satisfaction with their institutions during the coronavirus disease 2019 (COVID-19) pandemic with the intention of guiding educators in future public health crises. @*Methods@#In this cross-sectional study surveying students in clinical rotations, the primary outcome was overall satisfaction regarding medical schools’ responses to the pandemic, and the four secondary outcomes were school communication, exposure to COVID-19, availability of personal protective equipment, and access to COVID-19 testing. @*Results@#The survey was distributed to ten medical schools, of which 430 students responded for a response rate of 13.0%. While most students were satisfied (61.9%, n=266) with their schools’ response, more than one in five (21.9%, n=94) were dissatisfied. Among the four secondary outcomes, communication with students was most predictive of overall satisfaction. @*Conclusion@#In future crises, schools can best improve student satisfaction by prioritizing timely communication.

Dietary diversity score and its association with anemia status among selected nonpregnant women in Pasay City, Philippines

Background and Objective@#Iron deficiency anemia, the most common type of anemia, is a disease of public health significance that leads to negative economic and health implications. Dietary diversity is one of the recommended strategies in combating micronutrient deficiency such as anemia and may be measured through Dietary Diversity Score (DDS). The study aimed to determine whether DDS is associated with anemia status among nonpregnant women of reproductive age (WRA) in Pasay City, Philippines. Specifically, the study aimed to determine the: (1) prevalence of anemia, (2) mean DDS, and (3) association between DDS and anemia status among the study population. @*Methodology@#The study was analytic and cross-sectional that included 121 nonpregnant WRA who were selected using stratified random sampling with proportional allocation. Data collection methods included anthropometric assessment, hemoglobin determination, and 24-hour food recall as basis for calculating the dietary diversity score. @*Results and Conclusion@#Results of the study found that the prevalence of anemia was 21.49% and mean DDS was 4.46 (between low and moderate DDS). A statistical association was found between DDS and anemia status (p<0.001) such that the odds of having anemia was 25.47 times higher among women with low DDS compared to women with moderate/high DDS. Therefore, nutrition education and promotion awareness is needed on dietary diversity to prevent anemia among women of reproductive age.

Percepção do idoso frágil, do cuidador e do fisioterapeuta sobre a funcionalidade após tratamento fisioterapêutico ambulatorial / Perception of elderly, caregiver and physiotherapist about functionality after ambulatory physiotherapeutic treatment

O objetivo do estudo foi verificar a percepção do idoso frágil, do cuidador e do fisioterapeuta sobre a melhora funcional do idoso ao realizar atendimento fisioterapêutico ambulatorial. Trata-se de um estudo quase experimental, realizado no ambulatório de um Centro de Referência. O estado cognitivo foi avaliado pelo Mini Exame do Estado Mental, as atividades instrumentais de v ida diária (AIVD) p elo questionário de Pfeffer, as atividades básicas de vida diária (ABVD) pelo Índice de Barthel modificado, a fragilidade pela estratificação funcional e o risco de quedas pelo teste Tim ed Up a n d Go (TUG). Fo i elaborado pelos pesquisadores um questionário para avaliar a percepção de melhora dos idosos, cuidadores e fisioterapeutas sobre a função corporal e independência nas ABVD e AIVD. Participaram 23 idosos frágeis, 19 cuidadores e 6 fisioterapeutas. Os participantes possuíam declínio funcional parcial para as AIVD, desejavam melhorar a dor e mostraram-se satisfeitos com o resultado do tratamento. Idosos mais frágeis apresentaram uma melhor percepção sobre o desempenho para o uso do banheiro. A percepção de melhora dos cuidadores de idosos menos frágeis, com relação a atividades como higiene pessoal, vestir-se e deambulação, foi superior as dos demais. Não houve diferença significativa entre a percepção do ido so , cuidador e fisioterapeuta sobre a percepção de melhora na função corporal e nas ABVD e AIVD. Segundo a percepção do idoso, seu cuidador e fisioterapeuta o atendimento fisioterapêutico ambulatorial melhora as funções corporais de idosos frágeis auxiliando principalmente no desempenho das suas ABVD. Palavras-chaves: Idoso Fragilizado, Fisioterapia, Percepção, Assistência Ambulatorial...(AU)

The aim of this study was to verify the perception of frail elderly, t he caregiv er an d t he physiotherapist about the functional improvement of the elderly when performing outpatient physiotherapeutic care. It was developed an observational cross-sectional study, performed at an outpatient clinic of a Reference Center. The cognitive status was evaluated by Mini Men tal St at e Ex amination , instrumental activities of daily living (IADL) by Pfeffer questionnaire, the basic activities of daily liv in g (BADL) by modified Barthel Index, the fragility by functional stratification and the risk of falls by Timed Up and Go test. A questionnaire was developed by the researchers to evaluate the elderly p erceptio n o f improvement, caregivers and physiotherapists on body function and independence in BADL and IADL. A total of 23 frail elderly, 19 caregivers and 6 physiotherapists participated. The participants h ad p artial functional decline for AIDL, wished to improve pain and were satisfied with treatment's outcom e. More fragile elders presented a better perception of improvement for bathroom use. The perception of improvement for personal hygiene, dressing activity and ambulation of the caregiv ers o f less fragile elderly was superior to the others. There was no significant difference bet ween th e p erceptio n o f th e elderly, caregiver and physiotherapist about the improvement in body function an d BADL an d IADL. According to the perception of the elderly, their caregiver and physio therapist the outpatient physiotherapeutic care improves the body functions of fragile elderly assisting in the performance of their BADL...(AU)

Use of Antibiotics in early Childhood and Dental Enamel Defects in 6- to 12-year-old Children in Primary Health Care / Uso de antibióticos na primeira infância e defeitos de esmalte dentário em crianças de 6 a 12 anos na Atenção Primária à Saúde

ABSTRACT Dental enamel defects (DED) are lesions that occur due several factors. Proper care is needed to promote their treatment and prevention. The aim of this study was to evaluate the occurrence of DED in permanent teeth of children who used antimicrobial drugs in the first four years of life. This is a crosssectional study carried out in a Primary Health Care (PHC) service, which included children from six to 12 years of age. DED were evaluated by oral examination, and data on the use of antimicrobials in early childhood were collected based on medical records. Data were analyzed with the chisquare test and Fisher's exact test. The sample included 144 children. In relation to DED, 50% (72) and 20.1% (29) presented opacity and hypoplasia, respectively. Amoxicillin was the most frequently prescribed drug, followed by sulfamethoxazole + trimethoprim. Among the children, 78.5% (113) were prescribed antimicrobial drugs at least once during the first 4 years of life, and 55% (79) of them presented some type of DED. There was no statistically significant association between the variables analyzed. In conclusion, there was high prevalence of children with DED, and amoxicillin was the most commonly prescribed antibiotic.

RESUMO Os defeitos do esmalte dentário (DED) são lesões que ocorrem devido a vários fatores e é necessária atenção para promover seu tratamento e prevenção. O objetivo foi avaliar a ocorrência de DED em dentes permanentes de crianças que usaram antimicrobianos nos primeiros quatro anos de vida. Tratase de um estudo transversal realizado em um serviço de Atenção Primária à Saúde (APS), que incluiu crianças de seis a 12 anos de idade. A DED foi avaliada por dados de exames bucais, e os dados sobre o uso de antimicrobiano na primeira infância foram coletados com base em prontuários médicos. A análise foi realizada com o teste do quiquadrado e o teste exato de Fisher. A amostra foi composta por 144 crianças. Em relação ao DED, 50%(72) e 20,1%(29) apresentaram opacidade e hipoplasia, respectivamente. A amoxicilina foi o medicamento prescrito com mais freqüência, seguido pelo sulfametoxazol+ trimetoprim. Entre as crianças, 78,5%(113) receberam medica mentos antimicrobianos pelo menos uma vez nos primeiros 4 anos de vida e 55%(79) deles apresentaram algum tipo de DED. Não houve associação estatisticamente significante entre as variáveis analisadas. Em conclusão, houve uma alta prevalência de crianças com DED e a amoxicilina foi o antibiótico mais comumente prescrito.

Colon Cancer Risk of a Westernized Diet Is Reduced in Mice by Feeding Cruciferous or Apiaceous Vegetables at a Lower Dose of Carcinogen but Not a Higher Dose

Western-style diets (WD) are associated with greater risk of colon cancer. Exposure to 2-amino-1-methyl-6-phenylimidazo(4,5-b) pyridine (PhIP), a food-borne carcinogen, is linked to increased colon cancer risk. In contrast, intake of apiaceous and cruciferous vegetables (APIs and CRUs) is associated with reduced risk. Here we evaluated effects of a WD alone or a WD containing API or CRU, relative to a purified diet (basal), on colon cancer risk in mice. All diets were fed at one of two concentrations of PhIP (100 or 400 ppm). The activity of the hepatic PhIP-activating enzyme, cytochrome P450 (CYP) 1A2, was examined at week 4 and colonic precancerous lesions (aberrant crypt foci, ACF) were enumerated at week 12. In low PhIP-fed groups, CYP1A2 activity was greater for CRU than all other groups, which did not differ from one another. WD had a significantly greater effect on the formation of ACF than the basal diet. In groups fed API or CRU, the ACF number was reduced to the level observed in the basal diet-fed group. In high PhIP-fed groups, all WD-based diets had greater CYP1A2 activity than the basal diet-fed group. Surprisingly, the basal diet group had more ACF than the WD group, and API and CRU groups did not differ from the WD alone group. Thus, at the lower dose of PhIP, the WD increased colon cancer risk in mice, compared to a purified diet, and APIs and CRUs reduced the risk of the WD. However, at the higher dose of PhIP, the enhancement of colon cancer risk by the WD was not evident, nor was the chemopreventive effect of these vegetables.

Colon Cancer Risk of a Westernized Diet Is Reduced in Mice by Feeding Cruciferous or Apiaceous Vegetables at a Lower Dose of Carcinogen but Not a Higher Dose

Western-style diets (WD) are associated with greater risk of colon cancer. Exposure to 2-amino-1-methyl-6-phenylimidazo(4,5-b) pyridine (PhIP), a food-borne carcinogen, is linked to increased colon cancer risk. In contrast, intake of apiaceous and cruciferous vegetables (APIs and CRUs) is associated with reduced risk. Here we evaluated effects of a WD alone or a WD containing API or CRU, relative to a purified diet (basal), on colon cancer risk in mice. All diets were fed at one of two concentrations of PhIP (100 or 400 ppm). The activity of the hepatic PhIP-activating enzyme, cytochrome P450 (CYP) 1A2, was examined at week 4 and colonic precancerous lesions (aberrant crypt foci, ACF) were enumerated at week 12. In low PhIP-fed groups, CYP1A2 activity was greater for CRU than all other groups, which did not differ from one another. WD had a significantly greater effect on the formation of ACF than the basal diet. In groups fed API or CRU, the ACF number was reduced to the level observed in the basal diet-fed group. In high PhIP-fed groups, all WD-based diets had greater CYP1A2 activity than the basal diet-fed group. Surprisingly, the basal diet group had more ACF than the WD group, and API and CRU groups did not differ from the WD alone group. Thus, at the lower dose of PhIP, the WD increased colon cancer risk in mice, compared to a purified diet, and APIs and CRUs reduced the risk of the WD. However, at the higher dose of PhIP, the enhancement of colon cancer risk by the WD was not evident, nor was the chemopreventive effect of these vegetables.

Antibacterial Activity of Acacia nilotica Stem-Bark Fractions against Staphylococcus aureus and Escherichia coli

Aims:This research was carried out to determine the antibacterial activity of Acacia nilotica stem bark extract and bioactive fractions against the test bacteria (Staphylococcus aureusand Escherichia coli). Place and Duration of Study:Acacia niloticawas collected within Aliero town, Kebbi State, Nigeria between April and September, 2017. Methodology:The crude and bioactive fractions were obtained using soxhlet extraction and column chromatographic methodrespectively. The qualitative phytochemical screening was conducted to detect the presence of some phytochemical constituents in the crude extract and fractions. The antibacterial activity was determined at various concentrations (10, 50, 100, 150 and 200mg/ml) using disc diffusion method Results:The crude antibacterial activity indicated that ethanol extract showed higher activity than the n-hexane extract with 14.0±0.00 and 12.0±0.00 mm zones of inhibition compared with the control drug (10μg Ciprofloxacin drug), which showed 14.0±0.00 and 13.0±0.00 mm zone of inhibition against the test bacteria. The MIC and MBC values determined for ethanol extracts against the test bacteria was 12.5 mg/ml and 25 mg/ml, while the MIC and MBC values obtained for n-hexane extracts were 25 and 50 mg/ml against the test bacteria. The bioactive fractions (Yellow, Purple and Blue Black Fractions) tested against the test bacteria showed higher activity compared with the crude extract. The phytochemical properties of the plant crude extract and the bioactive fractions indicated the presence of phenol, tannins, alkaloids, saponins, flavonoids, terpenoids, steroids and glycosides and this attributed to the high antibacterial activities of 17.0±0.00and 16.0±0.00mm showed by the fractionsagainst Staphylococcus aureus and 15.67±and 14.0±0.00mm against Escherichia coli respectively. Conclusion:Acacia niloticacrude extract and fractions exhibited antibacterial activity which was comparable to the standard drug ciprofloxacin. This validates the folkloric medicinal use of this plant by the indigenous people of Aliero, Kebbi State

Apolipoprotein E and PAI-1 gene polymorphisms and no association with arterial ischemic stroke and peripheral arterial disease manifestations / Polimorfismos nos genes da apolipoproteína E e do PAI-1 e não associação com as manifestações de acidente vascular cerebral e doença arterial periférica

ABSTRACT Introduction: Arterial thrombosis is considered a multifactorial disease, resulting from the interaction of genetic and acquired risk factors. Objectives: The aim of this study was to investigate the presence of the polymorphism in inhibitor of plasminogen activator type 1 (PAI-1) and apolipoprotein E (ApoE) genes and its interactions with PAI-1 levels and lipids and apolipoprotein profiles, respectively, as well as the frequencies of these polymorphisms and their association with thrombosis. Methods: Ninety-seven patients [48 with arterial ischemic stroke (IS) and 49 with peripheral arterial disease (PAD)], treated at the hematology medical service were included in this study. Polymorphisms were also investigated in 201 control subjects. Polymorphisms were investigated by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). Results: For the PAI-1 polymorphism, there were 54.2% heterozygous (HT) genotypes and 12.5% homozygous (HM) genotypes in the patients' group, and 52.7% HT genotypes and 21.3% HM genotypes in the controls. For the ApoE polymorphism, there were 56.3% (ε3ε3), 6.3% (ε4ε4), 8.3% (ε2ε3), 4.2% (ε2ε4) and 24.9% (ε3ε4) in the patients, and 61.2% (ε3ε3), 4.5% (ε4ε4), 8% (ε2ε3), 4.5% (ε2ε4) and 21.8% (ε3ε4) in the controls. Conclusion: No significant difference was observed by comparing patients and controls. In this study, no association was found between the presence of the evaluated polymorphisms and the occurrence of thrombotic events.

RESUMO Introdução: A trombose arterial é considerada uma doença multifatorial, resultante da interação de fatores de risco genéticos e adquiridos. Objetivos: O objetivo deste estudo foi investigar a presença dos polimorfismos nos genes do inibidor da ativação do plasminogênio tipo 1 (PAI-1) e da apolipoproteína E (ApoE), bem como suas interações com níveis de PAI-1 e lipídios e perfis de apolipoproteína, respectivamente, além das frequências desses polimorfismos e sua associação com trombose. Métodos: Noventa e sete pacientes [48 com acidente vascular cerebral isquêmico arterial (AVC) e 49 com doença arterial periférica (DAP)], tratados no serviço médico de hematologia, foram incluídos neste estudo. Os polimorfismos também foram investigados em 201 indivíduos-controle. Os polimorfismos foram investigados por reação em cadeia da polimerase-fragmento de restrição polimorfismo (PCR-RFLP). Resultados: Para o polimorfismo PAI-1, havia 54,2% genótipos heterozigotos (HT) e 12,5% genótipos de homozigoto (HM) no grupo dos pacientes, e 52,7% genótipos HT e 21,3% genótipos HM nos grupos-controle. Para o polimorfismo da ApoE, havia 56,3% (ε3ε3), 6,3% (ε4ε4), 8,3% (ε2ε3), 4,2% (ε2ε4) e 24,9% (ε3ε4) nos pacientes, e 61,2% (ε3ε3), 4,5% (ε4ε4), 8% (ε2ε3), 4,5% (ε2ε4) e 21,8% (ε3ε4) nos controles. Conclusão: Nenhuma diferença significativa foi observada comparando pacientes e controles. Neste estudo, não foi encontrada associação entre a presença dos polimorfismos avaliados e a ocorrência de eventos trombóticos.

Antiedematogenic activity of the indole derivative N-salicyloyltryptamine in animal models

ABSTRACT The N-salicyloyltryptamine (NST) is an indole derivative compound analogue to the alkaloid N-benzoyltryptamine. In the present study, the antiedematogenic activity of NST was investigated in animal models. Firstly, the acute toxicity for NST was assessed according to the OECD Guideline no. 423. The potential NST-induced antiedematogenic activity was evaluated by carrageenan-induced paw edema in rats, as well as by dextran-, compound 48/80-, histamine-, serotonin-, capsaicine-, and prostaglandin E2-induced paw edema in mice. The effect of NST on compound 48/80-induced ex vivo mast cell degranulation on mice mesenteric bed was investigated. No death or alteration of behavioral parameters was observed after administration of NST (2000 mg/kg, i.p.) during the observation time of 14 days. The NST (100 and 200 mg/kg, i.p.) inhibited the carrageenan-induced edema from the 1st to the 5th hour (**p<0.01; ***p<0.001). The edematogenic activity induced by dextran, compound 48/80, histamine, serotonin, capsaicin, and prostaglandin E2 was inhibited by NST (100 mg/kg, i.p.) throughout the observation period (**p<0.01; ***p<0.001). The pretreatment with NST (50, 100 or 200 mg/kg, i.p) attenuates the compound 48/80-induced mast cell degranulation (**p<0.01; ***p<0.001). Thus, the inhibition of both mast cell degranulation and release of endogenous mediators are probably involved in the NST-induced antiedematogenic effect.

Serum tissue factor as a biomarker for renal clear cell carcinoma

ABSTRACT Purpose to determine the usefulness of serum TF as a potential marker for patients with clear cell RCC. Materials and Methods prospective study of 30 patients with clear cell RCC submitted to nephrectomy and 16 controls without clear cell RCC treated surgically for other conditions. TF is a endothelium marker that was correlated with worse prognosis in a variety of solid tumors including RCC. Serum TF was collected before surgery at the operating room and in the postoperative setting after at least four weeks. Serum samples were analyzed with a commercial ELISA kit for human TF (R&D Systems®). Results Mean preoperative serum TF levels in clear cell RCC patients and in controls were 66.8 pg/dL and 28.4 pg/dL, respectively (p<0.001). Mean postoperative serum TF levels in clear cell RCC patients were 26.3 pg/dL. In all patients with clear cell RCC postoperative serum levels of TF were lower, with a mean reduction of 41.6 pg/dL in the postoperative setting (p<0.001). Linear regression revealed that tumor size was correlated with the postoperative reduction of serum TF levels (p=0.037). Conclusions We have shown a 3-fold reduction in the median preoperative serum levels of TF in patients with clear cell RCC after surgery. We have also shown a difference of the same magnitude in the serum levels of TF compared with those of a control group of patients with benign diseases. TF appears to be a useful serum marker for the presence of clear cell RCC. Further studies are needed to validate these findings.

Visual impairment and amblyopia in Malaysian pre-school children - The SEGPAEDS study

Introduction: Little is known regarding the extent of visualimpairment amongst pre-school children in Malaysia.Objective: To determine the prevalence of visual impairmentand amblyopia in Malaysian preschool children.Methodology: A cross-sectional, population-based studywas conducted on children aged four to six years from 51participating kindergartens in the district of Segamat, Johor,Malaysia from 20 March 2016 to 6 April 2016. All subjects hadinitial eye screening consisting of LogMar visual acuity,orthoptics examination and Spot vision screenerassessment. Subjects who failed the initial eye screeningwere invited for a formal eye assessment consisting ofcycloplegic refraction and a comprehensive ocularexamination. Definitions of visual impairment and amblyopiawere based on the Multi-Ethnic Pediatric Eye Disease Studycriteria.Results: A total of 1287 children were recruited. Meansubject age was 5.03 (SD:0.77) and males represented 52.3%of subjects. Subjects by ethnicity were Malay (54.8%),Chinese (27.7%), Indian (15.6%) and Orang Asli (1.9%).Formal eye assessment was required for 221 subjects and88.8% required ophthalmic intervention. Refractive error,representing 95.4% of diagnosed ocular disorders,comprised of astigmatism (84%), myopia (9%) andhypermetropia (6.9%). With-the-rule astigmatism waspresent in 93.4% of the subjects with astigmatism. Visualimpairment was present in 12.5% of our subjects, with 61%having bilateral visual impairment. Of the subjects withvisual impairment, 59.1% had moderate visual impairment.The prevalence of amblyopia was 7.53%, and 66% of theamblyopic subjects had bilateral amblyopia.Conclusion: Our study highlights an urgent need forinitiation of preschool vision screening in Malaysia.

Endometrial cancer risk and survival by tumor MMR status / 부인종양

OBJECTIVE: The risk of developing endometrial cancer (EC) and/or survival following a diagnosis of EC might differ by tumor DNA mismatch repair (MMR) status. We assessed the association between tumor MMR status (classified as MMR-proficient, somatic MMR-deficient, germline MMR-deficient) and the risk of developing EC and survival following a diagnosis of EC. METHODS: We analyzed data from women who participated in the Australian National Endometrial Cancer Study (ANECS) conducted between 2005 and 2007. Risk analyses (698 cases/691 population controls) utilized sociodemographic and lifestyle information obtained from telephone interviews at recruitment. For survival analyses (728 cases), patients' clinical data was abstracted from medical records, and survival data were obtained via linkage with the Australian National Death Index. We used logistic regression analysis to evaluate the associations between tumor MMR status and EC risk, and proportional hazards models to perform survival analyses with adjustment of known prognostic factors. RESULTS: Established risk factors for EC did not differ significantly by tumor MMR status. In analyses including all EC subtypes, overall and EC-specific survival did not differ by tumor MMR status. Among women with the most common endometrioid subtype, EC-specific survival was worse for women with somatic MMR-deficient EC compared to women with MMR-proficient EC (hazard ratio [HR]=2.18; 95% confidence interval [CI]=1.19–4.01). CONCLUSION: The risk of EC is not associated with MMR status. Accurate separation of germline from somatic causes of MMR deficiency suggests that patients with endometrioid subtype somatic MMR-deficient tumors have poorer EC-specific survival than those with MMR-proficient tumors, after accounting for other prognostic factors.

Nephrometry scores and perioperative outcomes following robotic partial nephrectomy

ABSTRACT Objectives: Based on imaging features, nephrometry scoring systems have been conceived to create a standardized and reproducible way to characterize renal tumor anatomy. However, less is known about which of these individual measures are important with regard to clinically relevant perioperative outcomes such as ischemia time (IT), estimated blood loss (EBL), length of hospital stay (LOS), and change in estimated glomerular filtration rate (eGFR) after robotic partial nephrectomy (PN). We aimed to assess the utility of the RENAL and PADUA scores, their subscales, and C-index for predicting these outcomes. Materials and Methods: We analyzed imaging studies from 283 patients who underwent robotic PN between 2008 and 2014 to assign nephrometry scores (NS): PADUA, RENAL and C-index. Univariate linear regression was used to assess whether the NS or any of their subscales were associated with EBL or IT. Multivariable linear regression and linear regression models were created to assess LOS and eGFR. Results: The three NS were significantly associated with EBL, IT, LOS, and eGFR at 12 months after surgery. All subscales with the exception of anterior/posterior were significantly associated with EBL and IT. Collecting system, renal rim location, renal sinus, exophytic/endophytic, and nearness to collecting system were significant predictors for LOS. Only renal rim location, renal sinus invasion and polar location were significantly associated with eGFR at 12 months. Conclusions: Tumor size and depth are important characteristics for predicting robotic PN outcomes and thus could be used individually as a simplified way to report tumors features for research and patient counseling purposes.

Perfil de autoanticuerpos y asociación con patrones inmuno-electroforéticos en pacientes con esclerosis sistémica / Profile of autoantibodies and association with immunoelectrophoretic patterns in patients with systemic sclerosis

Contexto: la esclerodermia es una enfermedad autoinmune, sistémica y mediada por factores genéticos y ambientales; uno de sus marcadores es la presencia de autoanticuerpos con valor clínico, diagnóstico y pronóstico. Métodos: estudio descriptivo, observacional y relacional efectuado en pacientes con diagnóstico de esclerosis sistémica, atendidos en Unidad de Reumatología del Hospital Carlos Andrade Marín entre junio 2014 a mayo 2015. Los datos fueron procesados mediante análisis de correspondencia y cálculo de Chi cuadrado en el paquete estadístico SPSS 22. Resultados: de 80 pacientes estudiados se detectaron anticuerpos anti-topoisomerasa en 18 individuos (22,5%), anti centrómero (n=38, 47,5%), antinucleares (n=13, 16,3%), anti-ribonucleoproteína (n=7, 8,8%) y sin anticuerpos en 4 individuos (5%). Respecto a los patrones inmunoelectroforéticos se determinó el patrón centromérico en 23 sujetos (28,8%), moteado fino y grueso (n=17, 21,3% cada uno), homogéneo (n=8, 10%), nucleolar (n=7, 8,8%) y citoplasmático (n=1, 1,3%); fueron negativos 7 pacientes (8,8%). Mediante la prueba de chi cuadrado se obtuvo un valor de 116,3 de la relación auto-anticuerpos-patrones inmunofluorescencia, con un valor de p= 0,0000. El análisis de correspondencia demostró las siguientes asociaciones: a) anticuerpos antinucleares y patrón nucleolar (p=0,0021), anticuerpos antinucleares y patrón moteado grueso (p= 0,0123), anticuerpos anticentrómero y patrón centromérico (p= 0,0000), anticuerpos anticentrómero y patrón moteado fino (p= 0,0031), anticuerpos anti-topoisomerasa I y patrón homogéneo (p= 0,0001) y anticuerpos anti-ribonucleoproteína y patrón moteado grueso (p= 0,0000). Conclusiones: el perfil de autoanticuerpos en pacientes con esclerosis sistémica tiene una distribución similar a las publicaciones mundiales y relación es estadísticamente significativa con sus patrones inmunoelectroforéticos. (AU)

Introduction: Scleroderma is an autoimmune disease, systemic and mediated by genetic and environmental factors. One of its markers is the presence of autoantibodies with clinical value, diagnosis and prognosis. Subjects and methods: a descriptive, observational and relational study carried out in patients diagnosed with systemic sclerosis who were treated at the Rheumatology Unit of the Hospital Carlos Andrade Marín from June 2014 to May 2015. The data were processed by correspondence analysis and Chi square calculation in the package Statistic SPSS 22 version. Results: anti-topoisomerase antibodies were detected in 18 individuals (22.5%), anti-centromere (n=38, 47.5%), antinuclear antibodies (n=13, 16.3%), anti-ribonucleoprotein (n = 7, 8.8%) and without antibodies in 4 individuals (5%). As regards immune-electrophoretic patterns, the centromeric pattern was determined in 23 subjects (28.8%), fine and thick mottled (n = 17, 21.3% each), homogeneous (n = 8, 10%), nucleolar = 7, 8.8%) and cytoplasmic (n = 1, 1.3%); 7 patients (8.8%) were negative. The chi-square test yielded a value of 116.3 of the autoantibodies-immunofluorescence ratio, with a value of p=0.0000. Correspondence analysis showed the following associations: a) antinuclear antibodies and nucleolar pattern (p= 0.0021), antinuclear antibodies and thick speckle pattern (p=0.0123), anticentromere antibodies and centromeric pattern (p=0.0000) (p=0.0031), anti-topoisomerase I antibodies and homogeneous pattern (p=0.0001) and anti-ribonucleoprotein antibodies and thick speckle pattern (p=0.0000). Conclusion: The profile of autoantibodies in patients with systemic sclerosis has a similar distribution to global publications, and is statistically significant with his immune-electrophoretic patterns. (AU)

Otolaryngological presentations in times of terror: profile from a tertiary health center in north-central Nigeria

Objectives: To report the incidence, socio-demographic characteristics, otorhinolaryngological presentations and outcomes of management of patients at the Jos University Teaching Hospital following terror attacks

Methods: A prospective descriptive hospital based study of consecutive patients presenting with ear, nose and throat injuries as a result of bomb blasts and ethno-religious crises within a six-year period and managed at the Jos University Teaching Hospital were studied for age, gender, ear, nose and throat presentations, injury mechanism, interventions and outcome of interventions. A designed proforma was used for data collection

Results: There were 107 ear, nose and throat injuries from a total 468 terror-related injuries consisting of 66 [61.7%] males and 41 [38.3%] females [M:F ratio of 1.6:1], aged between 5 and 77 years [mean=36.7 years; SD= +/- 16.2]. Two peak age incidences of injuries in the first and third decades were recorded. The commonest source of injuries was bomb blasts in 47 [44%] patients. Multiple facial fractures with soft tissue injuries were the commonest seen in 78 [72.9%] patients. The commonest associated injuries were head injuries [n=36]. Ninety-four [87.9%] patients presented via the Accident and Emergency department, 16 [15%] received prehospital care. Patients with multiple injuries stayed longer in the hospital [p=0.028]. Complications were recorded in 19 [17.8%] patients. A case fatality rate of 5.6% was recorded

Conclusion: Bomb blasts were the major form of terror attacks in our region. The presence of multiple injuries is a significant negative predictor of patient outcomes

Medical education: Effectiveness of two simulation teaching methods in developing intubation skills of year level six medical students (clinical clerks)

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> To describe outcomes of two simulation teaching methods in developing intubation skills of year level six medical students (clinical clerks).<br /><strong>METHODS:</strong> Students were shown a 6-minute video on intubation. Students were exposed to video-assisted learning, video-assisted learning with instructor-guided simulation, and video-assisted learning with experiential learning. Each student was assessed by a non-graded 11 point objective structured clinical examination.<br /><strong>RESULTS AND DISCUSSION:</strong> The three learning strategies: 1. Video-assisted learning, 2. Video-assisted learning with instructor-guided simulation, 3. Video-assisted learning with experiential learning (self-discovery learning) simulation showed OSCE mean scores (standard deviations) of 5.76 (2.16), 7.21 (2.35) and 7.60 (1.72), respectively. Failure of intubation was 21% (8/38), 2% (1/40) and 0% (0/36), respectively. There is an absolute risk reduction of 27-30% in failure of intubation when either VGL or VEL is used. Students recognized the contribution of the simulation-based activities to the development of their intubation skills. They appreciated the opportunity to actually perform intubation in a rehearsal setting before doing the procedure on real patients.<br /><strong>CONCLUSION:</strong> Medical simulation enhanced student skills development. Experiential learning or self-discovery learning method may be as effective as instructor guided simulation.</p>

Medical education: Effectiveness of two simulation teaching methods in developing intubation skills of year level six medical students (clinical clerks)

OBJECTIVE: To describe outcomes of two simulation teaching methods in developing intubation skills of year level six medical students (clinical clerks).METHODS: Students were shown a 6-minute video on intubation. Students were exposed to video-assisted learning, video-assisted learning with instructor-guided simulation, and video-assisted learning with experiential learning. Each student was assessed by a non-graded 11 point objective structured clinical examination.RESULTS AND DISCUSSION: The three learning strategies: 1. Video-assisted learning, 2. Video-assisted learning with instructor-guided simulation, 3. Video-assisted learning with experiential learning (self-discovery learning) simulation showed OSCE mean scores (standard deviations) of 5.76 (2.16), 7.21 (2.35) and 7.60 (1.72), respectively. Failure of intubation was 21% (8/38), 2% (1/40) and 0% (0/36), respectively. There is an absolute risk reduction of 27-30% in failure of intubation when either VGL or VEL is used. Students recognized the contribution of the simulation-based activities to the development of their intubation skills. They appreciated the opportunity to actually perform intubation in a rehearsal setting before doing the procedure on real patients.CONCLUSION: Medical simulation enhanced student skills development. Experiential learning or self-discovery learning method may be as effective as instructor guided simulation.

Immunomodulatory and toxicological evaluation of the fruit seeds from Platonia insignis, a native species from Brazilian Amazon Rainforest

Abstract The “bacuri” (Platonia insignis Mart., Clusiaceae) is a native tropical fruit from the Brazilian Amazon and Northeast Regions. Its seeds are used to treat inflammatory diseases, diarrhea and skin problems in traditional medical practices. Regarding its widespread medicinal uses, it is important to evaluate the biological and toxicological potential of this species. This way, the aim of this study was to investigate the in vitro cytotoxic and immunomodulatory effects of the hexanic extract of P. insignis seeds, as well as its in vivo acute oral toxicity. The biological evaluation was performed by the determination of cytotoxic (MTT and hemolysis assay) and immunomodulatory (phagocytic capacity, lysosomal volume and nitrite production) activities of EHSB in murine peritoneal macrophages. In addition, the oral acute toxicity was evaluated using female Wistar rats treated with EHSB (2.0 g/kg), in accordance with the OECD 423 Guideline. The EHSB showed low toxicity for macrophages in the MTT test (CC50 value: 90.03 µg/ml), as well as for erythrocytes, which caused only 2.5% hemolysis at the highest concentration. A strong immunomodulatory activity was observed by a markedly increase of the NO production, phagocytic ability and lysosomal volume. On the other hand, it was not observed deaths or changes in the clinical and behavioral parameters in the toxicological evaluation. This manner, the present study contributes to the knowledge about the immunomodulatory and toxicological properties of the P. insignis. This may provide perspectives for the evaluation and development of effective and safe phytomedicines created from the Brazilian local biodiversity.