Pattern of Adult Mechanical Intestinal Obstruction in Delta State University Teaching Hospital

Introduction: Adult mechanical intestinal obstruction(AMIO) is a frequent challenge to most practicing generalsurgeons, Contemporary literature review suggests a changein the pattern of causes with bands and adhesions now beingthe commonest cause in some reports. Delta state universityteaching hospital (DELSUTH) is a state-owned tertiary healthfacility in Delta State, Nigeria.This study aims to highlight theaetiological pattern of AMIO in DELSUTH and its associatedmorbidity and mortality.Material and Methods: All adult patients with clinical andradiological evidence of mechanical intestinal obstructionwere prospectively studied over a 32 months period.Result: 65 consecutive adult patients with AMIO were studiedwhich constitutes 22% of all admitted surgical emergenciesseen in our services. Female: Male ratio 1.8:1, Age range was16 to 100 years and mean age 42.5 years. Post operative bandsand adhesions was the commonest cause of AMIO (46.1%).The commonest clinical presentation was abdominal pain(95.4%) and 56.9% of patients had a previous abdominalsurgical scar. Obstetric and gynaecological operations werethe most common cause of bands and adhesions (46.7%) nextwas appendectomies (23.3%). Non operative managementfor band and adhesions was successful in 53.3% and meanduration for symptom resolution was 4 days. Commonestcomplication was superficial surgical site infection (16%).mortality rate was 15.3%.Conclusion: Bands and adhesions are the commonestcause of AMIO in DELSUTH and are related to Obstetric/gynaecological operations and open appendectomies. Thisdiffers from previous studies in developing countries whereobstructed hernia was the dominant cause.

Concordance of multiparameteric MRI and MRI ultrasound fusion-guided prostate biopsy

@#Multiparametric MRI (mpMRI) of the prostate is recently becoming more and more utilized in the detection of prostate cancer. Studies have shown that a higher PIRADS score correlated to a higher chance of obtaining a clinically significant prostate cancer but few studies have correlated PIRADS score to a specific Gleason score.@*OBJECTIVE@#This study aimed to determine the concordance of PIRADS score to the Gleason score result of MRI ultrasound fusion-guided prostate biopsy.@*METHODS@#All patients who had at least a PIRADS 2 lesion on mpMRI and underwent MRI ultrasound fusion-guided biopsy of the prostate from August 2018 up to November 2019 at St. Luke’s Medical Center, Global City were included in the study. An ambispective collection of data was done until the ideal sample size of greater than 100 positive lesions was obtained, in order to derive concordance rate.@*RESULTS@#One hundred and sixty-two patients were included in the study with a total of 212 lesions analyzed. Forty three percent were benign while 57% were found to be malignant. PIRADS 2 lesions had zero high grade cancers, and the percentage steadily increased with 37.8% of PIRADS lesions considered high grade. Concordance was computed to be 0.38 showing a fair, direct concordance between PIRADS and Gleason score with significant result (p<0.05).@*CONCLUSION@#A result of PIRADS 4 or 5 lesion on mpMRI will have a higher urgency of doing a prostate biopsy and subsequent management to prevent unfavorable outcomes as opposed to PIRADS 3 lesions.

Pattern of Neonatal Mortality in a Teritiary Health Facility in Umuahia, South East, Nigeria.

Background: Neonatal mortality rates are highest in Sub-Saharan Africa, with Nigeria inclusive. And so the aim of the current study was to audit the pattern of neonatal deaths. Study Design: A cross sectional retrospective descriptive study was undertaken. Place and Duration of Study: The study was carried out at the Newborn Special Care Unit (NBSCU) of Federal Medical Centre (FMC), Umuahia with a review of the admissions and mortality register between 2000 and 2010. Methods: A review of the admissions and mortality register of the NBSCU between 2000 and 2010 was undertaken. Data extracted from the register included socio-demographic variables, birth weight, diagnosis/cause of death, duration of hospitalization, place of delivery (inborn/out-born), source of referral. Results: Total admission over the period was 2,756 comprising 1541 (55.9%) males and 1215 (44.1%) females. Total deaths was 440, comprising 235 (53.4%) males and 205 (46.6%) females.An overall case fatality rate of 16.0% was reported in the current study with mean age at death being 4.7± 6.0 days (0.01- 28 days). Majority of the dead cases were out-born, 263/440 (59.8%) compared to in-born, 177/440 (40.2%). Forty two percent (185 cases) of the deaths occurred with 24 hours of hospitalization while 25.9% (114 cases) passed on after 72 hours of admission. The leading probable direct causes of neonatal deaths were birth asphyxia (141), preterm delivery (133), neonatal sepsis (58), severe neonatal Jaundice (41), and neonatal tetanus (14). Most deaths (42.0%) occurred in the first 24hours irrespective of the cause of death. Conclusion: High rate of neonatal mortality, most of which are largely preventable as observed in the index study still abound in our locale. High cost effective maternal and newborn interventions could be applied even at community levels where most of the deliveries occur to save lives of the newborns.

Evidence on delay in sexual initiation, multiple partnerships and condom use among young people: review of Caribbean HIV behavioural studies / Evidencias sobre la demora en la iniciación sexual, las parejas múltiples, y el uso del condón entre los jóvenes: revisión de estudios de conducta en relación con el VIH en el Caribe

OBJECTIVE: To develop a Caribbean regional profile of youth sexual behaviour associated with risk of HIV. DESIGN AND METHODS: A review of sexual behaviour surveys with youth aged 15-24 years was conducted as part of the Pan American Health Organization (PAHO) HIV Caribbean Office's Review and Gender Analysis of Caribbean HIV Behavioural and Seroprevalence Studies. Studies with internationally recommended indicators were prioritized. Studies were sought via database searches and contact with researchers and National AIDS Programmes. RESULTS: Inter-country comparisons and longitudinal analyses were limited by lack of uniformity in study age groups and indicators. Data were sufficient to identify the following among 15-24-year olds: * More males than females report sexual intercourse before the age of 15 years. * More than half of sexually active youth report sex before age 16 years. * First sexual encounter is usually with someone older, with age differences larger for females. * More males than females report multiple partnerships, with 20%-76% of males reporting this in the past year. * Condom use varies widely, with no clear pattern by gender. CONCLUSION: There are substantial levels of early sexual initiation, intergenerational sex among females and multiple partnerships among males, while condom use is inconsistent. Efforts to promote delay in sexual initiation, partner reduction and consistent condom use should be supplemented with initiatives against harmful gender norms, child abuse and transactional sex and skills to negotiate safe sex. Standardization of survey methods to facilitate cross-study comparisons should continue and encompass additional risk factors such as transactional sex, gender-based violence, drug use and HIV treatment adherence.

OBJETIVO: Desarrollar un perfil regional caribeño del comportamiento sexual de la juventud en relación con el riesgo de VIH. DISEÑO Y MÉTODOS: Se realizó una revisión de los estudios del comportamiento sexual de jóvenes entre 15 y 24 años, como parte del Estudio de la Oficina de VIH de la Organización Panamericana de la Salud (OPS) para el Caribe, y el Análisis de Género de los Estudios de Seroprevalencia y Conducta en relación con el VIH en el Caribe. Se le dio prioridad a los estudios con indicadores recomendados internacionalmente. Se obtuvieron estudios mediante búsquedas de bases de datos y contactos con los investigadores y los programas nacionales de SIDA. RESULTADOS: Los análisis longitudinales y las comparaciones entre países estuvieron limitados por la falta de uniformidad en los grupos etarios y los indicadores de los estudios. Los datos fueron suficientes para identificar lo siguiente entre los jóvenes de 15 a 24 años de edad: * Más varones que hembras reportaron relaciones sexuales antes de los 15 años de edad. * Más de la mitad de los jóvenes sexualmente activos reportaron relaciones sexuales antes de los 16 años. * El primer encuentro sexual suele ser con alguien de más edad, siendo las diferencias de edad mayores para las mujeres. * Más varones que hembras reportaron relaciones de parejas múltiples; 20%-76% de los hombres reportaron este tipo de relación en el último año. * El uso del condón varía ampliamente, sin un patrón claro por género. CONCLUSIÓN: Hay niveles considerables de iniciación sexual temprana, sexo intergeneracional entre las hembras, y múltiples parejas entre los varones, mientras que el uso del preservativo es inconsistente. Los esfuerzos por promover la demora en la iniciación sexual, la reducción de parejas, y el uso sistemático del condón deberían complementarse con las iniciativas contra las normas de género perjudiciales, el abuso infantil, el sexo transaccional, y las habilidades para negociar sexo seguro. La estandarización de los métodos de encuesta para facilitar las comparaciones transversales debe continuar y abarcar otros factores de riesgo, tales como el sexo transaccional, la violencia de género, el uso de drogas, y el cumplimiento con el tratamiento del VIH.

Diagnostic accuracy of breast specific gamma imaging in the detection of breast cancer in high risk women: A meta-analysis

Mammography remains the mainstay of screening for primary breast cancer, however, some limitations persists in women with dense breast, in its inability to differentiate a benign from a malignant lesion, and in its heavy reliance on the radiologists' skill. Breast specific gamma imaging, which evaluates the functional images rather than anatomic images seen in mammography, addresses these limitations and can be a potential adjunct in screening for breast cancer. This meta-analysis aims to determine the diagnostic accuracy of breast specific gamma imaging for diagnosing breast cancer in women who are high risk. We searched PUBMED (1999-2009) and Google Scholar (1999-2009) for diagnostic accuracy studies that compared breast specific gamma imaging with histopathologic diagnosis of breast cancer in high risk women. Citation searches and screening of references of included studies were conducted. Two authors searched citations that correlated with the criteria using a data collection form. The methodological quality was then assessed by three authors using the QUADAS method. HSROC meta-analytical tool was used to estimate summary ROC curves. Four studies with 360 participants and 411 lesions were included. Breast specific gamma imaging has a high sensitivity (84%-97%) and specificity (60%-86%). SROC shows the included studies have high overall accuracy. Breast specific gamma imaging has high diagnostic accuracy in detecting breast cancer in women at high risk.

Complement activation by phospholipids: the interplay of factor H and C1q

Complement proteins in blood recognize charged particles. The anionic phospholipid (aPL) cardiolipin binds both complement proteins C1q and factor H. C1q is an activator of the complement classical pathway, while factor H is an inhibitor of the alternative pathway. To examine opposing effects of C1q and factor H on complement activation by aPL, we surveyed C1q and factor H binding, and complement activation by aPL, either coated on microtitre plates or in liposomes. Both C1q and factor H bound to all aPL tested, and competed directly with each other for binding. All the aPL activated the complement classical pathway, but negligibly the alternative pathway, consistent with accepted roles of C1q and factor H. However, in this system, factor H, by competing directly with C1q for binding to aPL, acts as a direct regulator of the complement classical pathway. This regulatory mechanism is distinct from its action on the alternative pathway. Regulation of classical pathway activation by factor H was confirmed by measuring C4 activation by aPL in human sera in which the C1q:factor H molar ratio was adjusted over a wide range. Thus factor H, which is regarded as a down-regulator only of the alternative pathway, has a distinct role in downregulating activation of the classical complement pathway by aPL. A factor H homologue, β2-glycoprotein-1, also strongly inhibits C1q binding to cardiolipin. Recombinant globular domains of C1q A, B and C chains bound aPL similarly to native C1q, confirming that C1q binds aPL via its globular heads.

MYCOBACTERIUM TUBERCULOSIS AND gyrA VARIATION IN ZAMBIA

<I>M. tuberculosis</I> strains were isolated from clinically and bacteriologically confirmed patients to evaluate the susceptibility of clinical <I>M. tuberculosis</I> isolates to fluoroquinolone and to obtain molecular epidemiological information in Zambia,. The pathogens were subjected to susceptibility testing with isoniazid, rifampicin, ethambutol and streptomycin. The minimum inhibitory concentrations to ciprofloxacin, sparfloxacin and levofloxacin were also evaluated. The <I>gyrA</I>, fluoroquinolone resistance-determining region (QRDR), was sequenced and analysed. As a result, three of the 16 strains examined were resistant to isoniazid, rifampicin and⁄or streptomycin. All of the strains were susceptible to ciprofloxacin, levofloxacin and sparfloxacin. However, a unique <I>gyrA</I> gene variation of<I> M. tuberculosis</I> was identified in the isolates. One strain had a mutation (T73A) in QRDR. Additionally, 81.25% (13⁄16) of the strains tested had Thr at codon 88. Several variations of <I>gyrA</I> gene have been reported in relation to drug resistance. The <I>gyrA</I> variation data will be useful as epidemiological information. It may be important to monitor fluoroquinolone susceptibility even in developing countries for use against resistant <I>M. tuberculosis</I> infection, even though no fluoroquinolone resistance was observed in this study.

Aspectos bioéticos e jurídicos do transexualismo / Bioethical and juridical aspects of transsexualism

O transsexualismo tem sido muito discutido atualmente, tanto na área médica como jurídica. Diferentes aspectos relativos à readequação sexual dos portadores de transsexualismo estão envolvidos nesta discussão, enfatizando-se, sobretudo, o direito fundamental à identidade sexual. Em 1997, o Conselho Federal de Medicina editou uma resolução que estabelece critérios diagnósticos de transsexualismo e critérios para a realização da cirurgia de trangenitalização, uma das etapas do processo de readequação sexual

Effect of 2,4-dichlorophenoxy acetic acid on rabbit duodenum.

2,4-dichlorophenoxy acetic acid (2,4-D) produces myotonia in healthy animals. The action of this drug was studied on smooth muscles in vitro using isolated strips of rabbit's duodenum. The drug was found to have a stimulant action on the smooth muscle. The action seems to be a direct one.

Age of puberty in the Burmese male and female

A total of 1,510 school boys (ages ranging from 9 to 18 years) and 1,770 school girls (ages ranging from 10 to 19 years) were examined to determine the age of puberty in the Burmese. The median age of adolescence for Burmese boys was found to be 4.67 years. The mean age of menstruation in girls was found to be 12.4 years (S.D. 1.71). Results were compared with those obtained by researchers in other countries. That onset of puberty in tropical climate occurs two years later than in temperate climate, as popularly held by many medical authorities, is still open to criticism.