Exploring Serum Vitamin D, Sex Hormones, and Lipid Profile Disparities in Women With and Without Polycystic Ovarian Syndrome: A Case-Control Study.

Background Polycystic ovarian syndrome (PCOS) is a common endocrine disorder affecting women of reproductive age. It is characterized by dyslipidemia, hormonal imbalances, and metabolic dysfunctions. Vitamin D deficiency may be implicated in the pathogenesis of PCOS, potentially exacerbating its metabolic syndrome. However, the exact interplay between these factors remains underexplored. Aim This study aimed to evaluate serum levels of vitamin D and its association with modalities of PCOS among women with PCOS and healthy controls.  Methods This was a hospital-based case-control study where 60 women newly diagnosed with PCOS and 56 non-PCOS controls were consecutively recruited within a 10-month period. The women aged 20-40 were recruited at the gynecology clinics of Lagos State University Teaching Hospital and Lagos Island Maternity Hospital. PCOS was diagnosed using the Rotterdam's criteria. The biodata, anthropometry, clinical features, serum vitamin D, cortisol, progesterone, testosterone, estradiol, prolactin, anti-Mullerian hormone (AMH), thyroid-stimulating hormone, follicle-stimulating hormone (FSH), luteinizing hormone (LH), insulin, fasting blood glucose (FBG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglyceride (TG), and very-low-density lipoprotein cholesterol (VLDL-C) levels of PCOS-diagnosed women were assessed and compared with those of women without PCOS. The exclusion criteria comprised known diabetics, women with gynecological pathologies such as fibroids, and women on medications affecting the study analytes or hormones. Statistical analyses included chi-square or Fisher's exact tests for categorical variables, student t-test for continuous variables, and Pearson's correlation for assessing relationships between continuous variables. The significance level was set at p<0.05 and a confidence interval of 95%. Results Individuals with PCOS exhibited a younger mean age (26.90±3.73 versus 29.95±5.00 years, p=0.001) and a higher prevalence of irregular menstrual patterns (46.7% versus 14.3%, p=0.0001) and acne (58.3% versus 37.5%, p=0.025). Moreover, PCOS was associated with elevated levels of TC (p = 0.03), TG (p = 0.03), LDL-C (p = 0.014), FBG (p = 0.001), LH:FSH ratio (p = 0.002), AMH (p = 0.0001), and testosterone (p = 0.003), but low progesterone (p = 0.001) and vitamin D (p = 0.033), alongside a higher incidence of vitamin D deficiency (33.3% versus 26.1%) and insufficiency (66.7% versus 56.5%). Additionally, significant but weak correlations were observed between serum vitamin D levels and waist-hip ratio (r = 0.4, p = 0.016) and FBG (r = -0.4, p = 0.036) in the PCOS group, suggesting potential metabolic implications. Conclusion The PCOS subjects in this study had decreased vitamin D and progesterone levels, with elevated concentrations of testosterone, AMH, lipid profile (TC, LDL, and TG), FBG, and LH:FSH ratio. Studies on the therapeutic effect of vitamin D administration in managing PCOS will need to be further evaluated.

Diagnostic capacity for invasive fungal infections in advanced HIV disease in Africa: a continent-wide survey.

BACKGROUND: Fungal infections are common causes of death and morbidity in those with advanced HIV infection. Data on access to diagnostic tests in Africa are scarce. We aimed to evaluate the diagnostic capacity for invasive fungal infections in advanced HIV disease in Africa. METHODS: We did a continent-wide survey by collecting data from 48 of 49 target countries across Africa with a population of more than 1 million; for Lesotho, only information on the provision of cryptococcal antigen testing was obtained. This survey covered 99·65% of the African population. We did the survey in six stages: first, questionnaire development, adaptation, and improvement; second, questionnaire completion by in-country respondents; third, questionnaire review and data analysis followed by video conference calls with respondents; fourth, external validation from public or private sources; fifth, country validation by video conference with senior figures in the Ministry of Health; and sixth, through five regional webinars led by the Africa Centres for Disease Control and Prevention with individual country profiles exchanged by email. Data was compiled and visualised using the Quantum Geographic Information System software and Natural Earth vectors to design maps showing access. FINDINGS: Data were collected between Oct 1, 2020, and Oct 31, 2022 in the 48 target countries. We found that cryptococcal antigen testing is frequently accessible to 358·39 million (25·5%) people in 14 African countries. Over 1031·49 million (73·3%) of 1·4 billion African people have access to a lumbar puncture. India ink microscopy is frequently accessible to 471·03 million (33·5%) people in 23 African countries. About 1041·62 million (74·0%) and 1105·11 million (78·5%) people in Africa do not have access to histoplasmosis and Pneumocystis pneumonia diagnostics in either private or public facilities, respectively. Fungal culture is available in 41 countries covering a population of 1·289 billion (94%) people in Africa. MRI is routinely accessible to 453·59 million (32·2%) people in Africa and occasionally to 390·58 million (27·8%) people. There was a moderate correlation between antiretroviral therapy usage and external expenditure on HIV care (R2=0·42) but almost none between external expenditure and AIDS death rate (R2=0·18), when analysed for 40 African countries. INTERPRETATION: This survey highlights the enormous challenges in the diagnosis of HIV-associated Pneumocystis pneumonia, cryptococcal disease, histoplasmosis, and other fungal infections in Africa. Urgent political and global health leadership could improve the diagnosis of fungal infections in Africa, reducing avoidable deaths. FUNDING: Global Action For Fungal Infections.

Comparative Analysis of Indoor and Outdoor Particulate Matter Concentrations and Air Quality in Ogbomoso, Nigeria.

BACKGROUND: Airborne particulates are an issue in many urban regions around the world and their detrimental impact on human health has increasingly become a public health concern. OBJECTIVES: The aim of the present study was to examine particle pollution in an urban settlement in Nigeria. This study examines the extent, spatial variation, and sources of indoor and outdoor particulate matter (PM) concentrations in Ogbomoso, Nigeria. METHODS: The survey research method was adopted. Sampling included 385 buildings across selected precincts and different residential zones in the town of Ogbomoso. Particulate matter analytes (PM1, PM2.5 and PM10) within/around each building were measured with a particle counter and details on domestic utilities/practices were obtained with a questionnaire. Analysis of variance was used to determine inter-zonal variations in PM levels and simple linear regression was used to analyze the relationship between indoor and outdoor air quality. RESULTS: Indoor and outdoor respirable particle (PM2.5) concentrations were lower than the World Health Organization (WHO) Interim Target limit of 75 µg/m3, while concentrations of inhalable particles (PM10) were higher than the set limit of 150 µg/m3 for daily averages. Coarse particles dominated, with an accumulative PM2.5/PM10 ratio of 0.24. The inter-zonal analysis of PM concentrations revealed that indoor and outdoor PM levels varied significantly by residential zone (p = 0.0005; p = 0.01, respectively). Regression analysis showed a significant but weak relationship between indoor and outdoor PM levels (r = +0.221), while the coefficient of determination (R2 = 0.049) showed that only about 5% of the variation in indoor air quality was associated with outdoor air quality. Particle pollution inducers were identified in the residents' waste disposal methods and adopted fuels/energy sources, with firewood and charcoal linked with increased concentrations of particulate matter. CONCLUSIONS: Air quality was relatively poor in the study area given observed particulate matter concentrations. Cleaner fuels, effective waste management systems and improved roads are needed to foster better air quality in the study area. COMPETING INTERESTS: The authors declare no competing financial interests.

MANAGING TEMPOROMANDIBULAR JOINT DISLOCATION IN IBADAN: A REVIEW OF 11 CASES.

AIM: The study presents a case series which evaluates the presentation, management and outcome of TMJ dislocation in a tertiary health centre in Nigeria. MATERIALS AND METHODS: Case review of 11 patients with TMJ dislocation seen in the University College Hospital (UCH) Ibadan over a period of 10 years. The criteria for the diagnosis of TMJ dislocation were based on history, clinical examination and radiologic findings. RESULTS: Mean age of patients was 44.4 years (SD +/-15.9years); age range was 25-65 years with 4 males and 7 females. Aetiology was trauma in 4 cases, wide mouth opening in 6 cases and unknown in a patient. There were 7 acute presentations, 2 recurrences and 2 chronic presentations; bilateral anterior presentation in 10 cases, unilateral (right) anterior presentation in 1 case. 4 of the acute cases were successfully managed using the Hippocrates manoeuvre, 1 had the manoeuvre under GA, and 2 had spontaneous reduction. All recurrent cases were successfully managed with the Hippocrates manoeuvre and IMF. Fifty percent of the chronic cases were successfully managed with the Hippocrates manoeuvre. Follow up was ≤ 2 weeks in 7 of the cases. CONCLUSION: The pattern of presentation of TMJ dislocation in the above named hospital was anterior dislocation, the female gender predominance, aetiology of wide mouth opening, as well as early presentation. A conservative method of management - the Hippocrates manoeuvre - was effective in most cases irrespective of duration of dislocation. Most patients had a poor attitude to follow up.

CLINICO-PATHOLOGIC REVIEW OF BIOPSIED TONGUE LESIONS IN A NIGERIAN TERTIARY HOSPITAL.

BACKGROUND: Varying pathologic conditions can affect the tongue for which the pattern of occurrence may differ. The aim of this study was to review the clinico-pathologic features of histologically diagnosed cases of tongue lesions that presented in our hospital over a 21 years period. MATERIALS AND METHODS: Data on habits, class of lesion, histological diagnosis, age, gender, and site distributions were analyzed using descriptive frequencies, ranges and means ± SD. Variables were compared using Chi square and ANOVA tests as appropriate. Sites of lesions were coded using the WHO ICD-O code on topography. RESULTS: Tongue lesions were seen in 43 males and 31 females. There was a bimodal peak age of occurrence at 40-49 and 60-69 years of age. Smoking and alcohol intake habits were recorded in 8 cases only. Neoplastic lesions constituted 78.4% of the cases. Using the WHO ICD-O code for topography of lesions, the tongue dorsum (ICD-O-2.0) was the most commonly affected site. Malignant lesions constituted 47.3% of the cases seen. Also, 8.6% of the malignant lesions were seen in younger patients (< 40 years). CONCLUSION: Tongue lesions showed a bimodal age of occurrence with neoplastic lesions as the most histologically diagnosed lesions in our study.

Cost-effectiveness of the Three I's for HIV/TB and ART to prevent TB among people living with HIV.

OBJECTIVE: To evaluate the cost-effectiveness of the Three I's for HIV/TB (human immunodeficiency virus/tuberculosis): antiretroviral therapy (ART), intensified TB case finding (ICF), isoniazid preventive treatment (IPT), and TB infection control (IC). METHODS: Using a 3-year decision-analytic model, we estimated the cost-effectiveness of a base scenario (55% ART coverage at CD4 count â©¿350 cells/mm(3)) and 19 strategies that included one or more of the following: 1) 90% ART coverage, 2) IC and 3) ICF using four-symptom screening and 6- or 36-month IPT. The TB diagnostic algorithm included 1) sputum smear microscopy with chest X-ray, and 2) Xpert® MTB/RIF. RESULTS: In resource-constrained settings with a high burden of HIV and TB, the most cost-effective strategies under both diagnostic algorithms included 1) 55% ART coverage and IC, 2) 55% ART coverage, IC and 36-month IPT, and 3) expanded ART at 90% coverage with IC and 36-month IPT. The latter averted more TB cases than other scenarios with increased ART coverage, IC, 6-month IPT and/or IPT for tuberculin skin test positive individuals. The cost-effectiveness results did not change significantly under the sensitivity analyses. CONCLUSION: Expanded ART to 90% coverage, IC and a 36-month IPT strategy averted most TB cases and is among the cost-effective strategies.