The Use of Intralipid Infusions in the Prevention of Embryo Implantation Failure.

Intralipids have been suggested to suppress uterine natural killer cell activity, which could potentially improve implantation rates in women with recurrent loss. We report a case of a 41-year-old African woman with recurrent pregnancy loss who had elevated uterine killer cell activity and for whom intralipid infusion was used to achieve pregnancy. We recommend routine uterine natural killer cell testing for women with recurrent pregnancy loss and further research on newer intravenous lipid emulsions in fertility medicine.

Prolonged complete response after neoadjuvant capecitabine-gemcitabine for a locally advanced pancreatic adenocarcinoma: A case report.

Background: Pancreatic duct adenocarcinoma is increasing in incidence without appreciable decrease in overall survival despite decades of heightened research. Its mortality rate approaches its incidence rate. We report a case of carcinoma of the pancreas that had complete response from adjuvant chemotherapy. Case Presentation: A 39-year old male radiographer presented with a 3-month history of progressively worsening epigastric pain radiating to the back, associated with history of weight loss, anorexia, and jaundice. Abdominal CT scan showed a mass in the head of pancreas. A Whipple's operation was planned for the patient. However, intraoperatively, the head and body of the pancreas were found to have been taken over by the tumor, which encased the portal vein as well. Multiple core needle biopsies of the pancreas were taken. Cholecystojejunostomy, gastrojejunostomy, and jejunojejunostomy were then done. Histopathologic analysis of the specimen revealed a well-differentiated adenocarcinoma of the pancreas. He was commenced on 28-day cycle of gemcitabine 1000 mg/m2 on Days 1, 8, and 15 plus capecitabine 830 mg/m2 on Days 1-14. Repeat CT scan done after the 4th cycle showed no residual tumor in the pancreas. He has been in good health after 36 months follow-up, having received eight cycles of chemotherapy. He was counseled on resection of the pancreas, but he declined. Conclusion: Complete radiologic response may rarely occur after adjuvant chemotherapy for locally advanced adenocarcinoma of the pancreas. This does not, however, imply a cure of the disease.

Pregnancy-associated Acute Myocardial Infarction (PAMI): Case Report.

Cardiovascular diseases are recognised complications of pregnancy, however, pregnancy-associated acute myocardial infarction (PAMI) is uncommon. Pregnancy is known to increase risk of myocardial infarction even in the absence of traditional risk factors for atherosclerotic vascular disease. Our patient presented with acute chest pain two weeks after delivery and her electrocardiogram was in keeping with STelevation myocardial infarction (STEMI). Coronary angiography revealed coronary artery dissection and she was managed conservatively. Various pathophysiological mechanisms of PAMI have been described in literature including spontaneous coronary artery dissection (SCAD) found in our case. The diagnosis is often missed and earlier reported cases were diagnosed at autopsy. Therefore, we report this case as a learning tool. Also, there is a need for a high index of suspicion in pregnant patients presenting with features suggestive of aortic dissection, and its diagnosis should be thought of in peripartum women presenting with acute chest pain.

Les maladies cardiovasculaires sont des complications reconnues de la grossesse, cependant, l'infarctus aigu du myocarde associé à la grossesse (IPAM) est rare. La grossesse est connue pour augmenter le risque d'infarctus du myocarde même en l'absence de facteurs de risque traditionnels de maladie vasculaire athéroscléreuse. Notre patiente s'est présentée avec une douleur thoracique aiguë deux semaines après l'accouchement et son électrocardiogramme était conforme à l'infarctus du myocarde avec élévation de l'échelle (STEMI). La coronarographie a révélé une dissection de l'artère coronaire et elle a été gérée de manière conservatrice. Divers mécanismes physiopathologiques de PAMI ont été décrits dans la littérature, y compris la dissection spontanée des artères coronaires (SCAD) trouvée dans notre cas. Le diagnostic est souvent manqué et les cas signalés antérieurement ont été diagnostiqués à l'autopsie. Par conséquent, nous rapportons ce cas comme un outil d'apprentissage. En outre, il existe un besoin d'un indice de suspicion élevé chez les patientes enceintes présentant des caractéristiques suggérant une dissection aortique, et son diagnostic doit être envisagé chez les femmes en péripartum présentant une douleur thoracique aiguë.

Hesperidin ameliorates hepatic dysfunction and dyslipidemia in male Wistar rats exposed to cadmium chloride.

The ever-increasing human population with attendant industrialization poses serious global health challenge. Cadmium (Cd) with other heavy metals contribute greatly to environmental pollutions and humans are daily exposed to them, leading to diverse ailments. We explored whether Hesperidin (HSP) could protect against hepatic damage and dyslipidemia in Wistar rats exposed to Cd. Forty wistar rats were randomly assigned into five groups (n = 8). Group 1 received 2 mL/kg body weight of normal saline; Group 2 received 100 mg/kg body weight of HSP while Group 3 received 5 mg/kg body weight of Cadmium Chloride (CdCl2) for 28 days. Group 4 received 100 mg/kg body weight of HSP and after 90 min, CdCl2 (5 mg/kg) body weight was administered for 28 days. Group 5 received 50 mg/kg body weight of HSP and after 90 min, CdCl2 (5 mg/kg) body weight was administered for 28 days. The serum lipid profiles, hepatic dysfunction and oxidative stress markers were determined using standard methods. Cd toxicity in rats prominently elevated serum activities of AST, ALT, ALP and levels of total bilirubin, direct bilirubin, cholesterol, LDL-C and malondialdehyde with decreased levels of HDL-C, triglycerides, superoxide dismutase, catalase, glutathione and body weights. The pre-treatment of HSP before Cd intoxication prevented the dysregulated activities of liver enzymes and levels of lipid profiles, enzymatic and non-enzymatic antioxidants and other biomarkers investigated, thus suggesting anti-hyperlipidemic and hepato-protective potentials. HSP may have great potentials for development of therapeutics that could enhance the management of dyslipidemia and liver disorders associated with heavy metal exposure.

Cancellation of elective surgical cases in a nigerian teaching hospital: Frequency and reasons.

BACKGROUND: Dwindling economic resources and reduced manpower in the health sector require efficient use of the available resources. Day of surgery cancellation has far reaching consequences on the patients and the theatre staff involved. Full use of the theatre space should be pursued by every theatre user. OBJECTIVE: The study aimed to report on the rates and causes of day of surgery cancellation of elective surgical cases in our hospital as a means towards proffering solutions. MATERIALS AND METHODS: It was a retrospective study of all elective cases that were booked over a 15-month period from January 2016 to March 2017. Cancellation was said to have occurred when the planned surgery did not take place on the proposed day of surgery. Cancellations were categorized into patient-related, surgeon-related, hospital-related and anesthetist-related. Reasons for the cancellations were documented. Data were analyzed using Statistical Package for the Social Sciences (SPSS) software program, version 22. Variables were compared using Chi-square tests. A value of P < 0.05 was considered statistically significant. RESULTS: During the 15-month period, a total of 1296 elective surgeries were booked. Of this, 118 (9.1%) cases were cancelled. Patient-related factor was the most common reason (47.5%) followed by surgeon-related factor (28%). Lack of funds was the most common patient related-reason for cancellation. Majority of the cancelled cases were general surgical cases (36.4%) followed by orthopedics (25.4%) and urology (11%). Seventy percent of the cancelled cases were first and second on the elective list. CONCLUSION: The cancellation rate in this study is high. The reasons for these cancellations are preventable. To ensure effective use of the theatre, efforts should be made to tackle these reasons.

Postintubation tracheal stenosis: Surgical management.

Postintubation tracheal stenosis (PITS) is a known complication of endotracheal intubation or tracheostomy. It is the most common indication for tracheal resection/reconstructive surgery. Despite technological improvement and skilled patient care in the ICU, PITS still constitutes an important group of iatrogenic sequela after intubation. With increasing number of patients requiring ICU admission and mechanical ventilation in Nigeria, it is important that this complication is prevented from occurring. The care of such patients often is technically challenging. The successful management by resection and end-to-end anastomosis of a 37-year-old man presenting with 2 cm length of severe tracheal stenosis of 4 mm luminal diameter following prolonged endotracheal intubation and who had had repeated bronchial dilatation is presented.

Assessment of some indicators of oxidative stress in nigerian sickle cell anemic patients.

BACKGROUND: Oxidative stress, the imbalance between the productive of reactive species and antioxidant defences notably plays an important role in the pathogenesis of sickle cell disease. Generating the necessary data about oxidative stress in patients with sickle cell anemia (SCA) would help in developing cost-effective and accessible treatment interventions of SCA in resource-poor countries. AIM: The aim of this study is to evaluate the levels plasma lipid peroxidation product, malondialdehyde (MDA), serum nitric oxide (NO), and total antioxidant activity (TAOA) as indicators of oxidative stress in sickle cell individuals. MATERIALS AND METHODS: In this pilot study, 52 patients; homozygous (Hb SS) sickle cell patients confirmed by cellulose electrophoresis and 20 age- and sex-matched healthy (Hb AA) controls were subjected to analysis of NO, MDA, and TAOA. The plasma MDA was measured by a thiobarbituric reaction, (NO) was evaluated by the method described by Guevara et al. using Griess reagent and the TAOA of serum was determined by the method of Koracevic et al. RESULTS: The results showed a statistically significant decrease and increase in baseline levels of NO and MDA, respectively, in Hb SS group when compared with the control Hb AA (P = 0.000 and 95% confidence interval [CI] of 0.10-0.18 and -9.67--5.57, respectively). A slight decrease in the TAOA level between the groups was observed although not statistically significant (P = 0.15 95% CI was -0.28-2.90). CONCLUSION: The results showed of imbalance between oxidant and antioxidant status in patients with SCA. Antioxidant supplementation may be a cheap assessable intervention for in sickle cell individuals (in the steady state or in crisis) to prevent further oxidative damage to the erythrocytes.

Responses to glycemic control therapy according to age, gender, level of adiposity, and duration of diabetes in type 2 diabetic patients.

CONTEXT: It is established that glycemic control measures involving diet and oral medication reduces glycated hemoglobin concentration (HbA1c) in type 2 diabetic patients. AIMS: To determine whether glycemic levels after diabetic treatment is affected by age, gender, obesity, and diabetic duration in type 2 diabetic patients. SETTINGS AND DESIGN: A total of 52 type 2 diabetic patients participated in a 12-week diabetic management therapy involving oral medication (metformin) and lifestyle intervention (diet). MATERIALS AND METHODS: We compared the glycated hemoglobin reduction after treatment between the elderly and non-elderly; males and females; obese and non-obese; and newly diagnosed and long-standing diabetics. RESULTS: After the diabetic treatment, participants' mean HbA1c level indicated a reduction of 1.1 ± 1.31%, weight loss of 2.46 ± 1.79 kg, and BMI reduction of 0.94 ± 0.69 kg/m 2 . A total of 23 (44.2%) patients had an acceptable HbA1c level of <6.5%. Significantly greater HbA1c reduction was observed in non-elderly, non-overweight/obese, and newly diagnosed diabetic patients compared to the elderly, overweight/obese, and long-standing diabetic patients respectively (P < 0.05 or P < 0.01). HbA1c reduction did not indicate sex differences. CONCLUSION: The present findings suggest lower responses to glycemic control therapy in elderly, overweight/obese, and long-standing diabetic patients when compared to the non-elderly, non-overweight/obese, and newly diagnosed diabetic patients. It is recommended that treatment criteria for type 2 diabetes should account for the age, level of adiposity, and diabetic duration of the patient in order to make optimal therapeutic decisions for the treatment of diabetes mellitus in adults.

Salt (sodium chloride) content of retail samples of Nigerian white bread: implications for the daily salt intake of normotensive and hypertensive adults.

BACKGROUND: Bread has been identified as a major contributor to the excessive salt (sodium chloride) intake of consumers in many countries, some of which have very high incidences of hypertension and related cardiovascular complications, such as stroke. This has prompted a global rise in interest in the salt content of breads produced and consumed in many other countries. METHODS: The sodium contents of retail samples of 100 brands of Nigerian white bread were determined by photometry with a view to estimating the relative contribution of bread to the recommended daily sodium intake of both normotensive and hypertensive adults in the country. RESULTS: The salt content of the bread samples varied extensively, ranging from 0.51 g per 100 g (0.51%) to 1.8 g per 100 g (1.8%). The average salt content was 1.36 g per 100 g. Based on an estimated consumption of six slices of bread (about 180 g) per meal of bread, this equates to a daily intake of between 0.99 g and 3.33 g of salt from bread alone. This represents between 19.8% and 66.6% of the recommended daily allowance of 5 g for normotensive adults, and between 24.75% and 83.25% of the recommended daily allowance of 4 g for hypertensive adults. CONCLUSIONS: The consumption of some brands of bread by normotensive and hypertensive adults puts them at great risk of exceeding their recommended daily allowance for salt. Thus, there is an urgent need to regulate the amount of salt added to bread. In the interim, compelling bakers to declare the salt content of their products on the packaging could help consumers, especially hypertensive adults, avoid brands with a high salt content.

Epidemiology of intestinal helminth parasites in stray dogs from markets in south-eastern Nigeria.

A survey of gastrointestinal helminth parasites of stray dogs (Canis familiaris) was conducted at Obollo-Afor and Ekwulobia markets, in Enugu and Anambra States, south-eastern Nigeria, respectively, to determine the patterns of infection among dogs in different parts of south-eastern Nigeria. Faecal samples collected, using long forceps, from every dog encountered in the markets between June 2007 and December 2008 were analysed by the Kato-Katz technique. Out of 413 dogs examined in both markets, 217 (52.6%) were infected with at least one of five parasites (Toxocara spp., Dipylidium caninum, Ancylostoma caninum, Taenia spp. and Trichuris vulpis). Overall faecal egg intensity of infection was 49.9 ± 58.7 eggs/g (epg). The prevalence of infection was comparable between the markets and between the male and female dogs, but varied significantly (P < 0.05) by age, decreasing from 78.9% in pups to 36.0% in adult dogs. The mean intensity pattern was similar to that of prevalence, decreasing from 86.7 ± 63.0 epg in pups to 22.1 ± 34.4 in adults. The most important individual parasite infection was Ancylostoma spp. (39.2%; 30.0 ± 41.2 epg) while T. vulpis was the least important (1.9%; 0.7 ± 5.4 epg). Generally, prevalence and intensity patterns of each parasite were also comparable between the markets and between sexes, but significantly (P < 0.05) age-dependent. The implications of these findings to public health in Nigeria and other endemic countries are discussed in relation to options for cost-effective control design and implementation.

Antinociceptive; anti-inflammatory and cytotoxic activities of Pentaclethra macrophylla aqueous extracts in mice

The aqueous leaf; stem - bark; seed and fruit pericarp extracts of Pentaclethra macrophylla were examined for their cytotoxicity; while only the leaves and seeds were tested for analgesic and anti-inflammatory activities using in-vivo and in-vitro experimental models. Cytotoxicity haemagglutination assay revealed the following order of toxicity among the plant parts: fruit pericarp stem - bark seed leaf with 71.4; 25.6; 5.3; and 0.5 haemagglutination titre values respectively. The extracts at 30 and 60 mg/kg exhibited analgesic activity and anti-inflammatory property using the flick and hot plate tests; acetic acid induced writhing test; and leucocyte counts; pulmonary oedema and oedema paw of mice in a dose-dependent manner. These findings therefore explain and justify ethnomedical uses of Pentaclethra macrophylla in the treatment of itching (inflammatory response) and pain in animals and in man

Clinical predictors of malaria in Gambian children with fever or a history of fever.

Diagnosis of malaria in children is difficult without laboratory support because the symptoms and signs of malaria overlap with those of other febrile illnesses such as pneumonia. Nevertheless, in many parts of Africa diagnosis of malaria must be made without laboratory investigation. Therefore, a scoring system has been developed to assist peripheral health care workers in making this diagnosis. Four hundred and seven Gambian children aged 6 months to 9 years who presented to a rural clinic with fever or a recent history of fever were investigated. A diagnosis of malaria was made in 159 children who had a fever of 38 degrees C or more and malaria parasitaemia of 5000 parasites/microL or more. Symptoms and signs in children with malaria were compared with those in children with other febrile illnesses to identify features which predicted malaria. Symptoms and signs were incorporated into various logistic regression models to test which were best independent predictors of malaria and these regression models were used to construct simple scoring systems which predicted malaria. A nine terms model predicted clinical malaria with a sensitivity of 89% and a specificity of 61%, values comparable to those obtained by an experienced paediatrician without laboratory support. The ability of peripheral health care workers to diagnose malaria using this approach is now being investigated in a prospective study.

A randomized trial of chloroquine, amodiaquine and pyrimethamine-sulphadoxine in Gambian children with uncomplicated malaria.

The increasing occurrence of chloroquine-resistant Plasmodium falciparum in sub-Saharan Africa makes it essential to reconsider current recommendations for the treatment of uncomplicated P.falciparum malaria. In an open, randomized trial, we have compared chloroquine (CQ), amodiaquine (AQ), and pyrimethamine-sulphadoxine (PS) in rural Gambian children with uncomplicated P.falciparum malaria. Three hundred children were randomly assigned at the time of consultation (Do) to oral treatment with 25 mg/kg CQ, 25 mg/kg AQ (both given over 3 days), or 1.25/25 mg/kg PS. They were reviewed on day 7 (D7) and day 28 (D28) for symptoms, malaria parasitaemia, and packed cell volume (PCV). Significantly more children treated with PS compared to CQ (17 vs 7%, P = 0.03) or AQ (17 vs 3%, P = 0.001) returned with clinical complaints during the first 3 days after treatment. Five of these patients had a generalized convulsion (1 from the AQ group, 4 from the PS group), of whom 4 developed cerebral malaria. At D7, significantly more patients treated with CQ compared to AQ (25 vs 7%, P = 0.0009) or PS (25 vs 4%, P = 0.0001) were parasitaemic. By D28, the cumulative number of parasitological failures was significantly higher in the CQ group compared to the AQ group (65 vs 35%, P = 0.0001), and significantly higher in the AQ group compared to the PS group (35 vs 14%, P = 0.001). Overall, 91% of parasitological failures observed during the study period were symptomatic and were consequently treated with an alternative antimalarial drug. Over the 28-day study period the mean PCV increased significantly less in the CQ group than in the PS group (1.2 vs 3.8%, P = 0.016) and was lower in the CQ group than in the AQ group (1.2 vs 2.7%, P = 0.12, not significant). These results suggest that PS acts more slowly than 4-aminoquinolines in controlling the clinical features of malaria, and that AQ can be considered as an interim alternative to CQ in the first-line therapy of uncomplicated malaria in African areas of high CQ resistance.