Purification and biochemical characterization of pullulanase produced from Bacillus sp. modified by ethyl-methyl sulfonate for improved applications.

Strain improvement via chemical mutagen could impart traits with better enzyme production or improved characteristics. The present study sought to investigate the physicochemical properties of pullulanase produced from the wild Bacillus sp and the mutant. The pullulanases produced from the wild and the mutant Bacillus sp. (obtained via induction with ethyl methyl sulfonate) were purified in a-three step purification procedure and were also characterized. The wild and mutant pullulanases, which have molecular masses of 40 and 43.23 kDa, showed yields of 2.3% with 6.0-fold purification and 2.0% with 5.0-fold purification, respectively, and were most active at 50 and 40 °C and pH 7 and 8, respectively. The highest stability of the wild and mutant was between 40 and 50 °C after 1 h, although the mutant retained greater enzymatic activity between pH 6 and 9 than the wild. The mutant had a decreased Km of 0.03 mM as opposed to the wild type of 1.6 mM. In comparison to the wild, the mutant demonstrated a better capacity for tolerating metal ions and chelating agents. These exceptional characteristics of the mutant pullulanase may have been caused by a single mutation, which could improve its utility in industrial and commercial applications.

A multi-state survey of farm-level preparedness towards African swine fever outbreak in Nigeria.

Outbreaks of African Swine Fever (ASF) have severe economic implications for Nigeria and result in significant loss of livelihoods. The non-availability of vaccines makes biosecurity the reliable key to reducing ASF outbreaks. This study evaluated preparedness for ASF outbreaks at the farm level among 247 pig farmers randomly selected from Abia, Akwa-Ibom, Edo, Kwara, and Oyo states. We categorized each pig farmer's ASF preparedness rating (ASF - PR) as "poor", "moderate", and "satisfactory" based on their score on an 11-item scale. Finally, a multivariable logistic regression analysis was conducted to assess the association between the socio-demographic variables and farm-level ASF preparedness. The awareness of ASF among pig farmers was very high (87.9%, n = 217). Most farmers knew the clinical signs of the disease, the modes of transmission of ASF, and correctly identified the risk factors. They also considered the need for thorough cleaning and disinfection of piggeries (87.1%, n = 189), tightened biosecurity (85.7%, n = 186), culling all ASF-affected pigs (77.9%, n = 169) as well as the ban on the transport of pigs and their products (49.8%, n = 108) as very important in ASF control. Conversely, 27.6%, (n = 60) of the farmers thought ASF could affect humans, 12% (n = 27) of them openly discarded the carcasses of dead pigs, and there was a high antibiotic usage. Most of the pig farmers used antibiotics as prophylaxis (63.6%, n = 157), chemotherapeutics (66.4%, n = 164), growth promoters (15.4%, n = 38), and wrongly so, 13% (n = 32) of them thought that antibiotics could be used to prevent and treat ASF. At the farm level, two-thirds (68.8%, n = 170) of the farmers had strict movement restrictions, and 48.6% (n = 120) routinely quarantine new pigs before introduction into their herd. Across the five states, 36% (n = 89) of the farmers had witnessed sudden death with signs consistent with ASF amongst their pigs and only 10.1% (n = 27) had confirmatory ASF diagnosis. The mean score for the farm-level ASF-PR was 6.95 ± 2.7. Approximately one-quarter of the 247 pig farmers had satisfactory ASF - PR that might help to prevent the incursion of ASF into their farms. Most farmers had moderate ASF - PR (59.5%, n = 147) whereas 17% (n = 42) had very poor ASF-PR and were most prone to an ASF outbreak. Of the sociodemographic variables, only age was significantly associated with farm-level ASF preparedness as older pig farmers especially those aged between 50 and 59 years (OR: 4.83; 95% CI: 1.10, 21.22; p = 0.037) were more likely to have satisfactory ASF - PR than the others. Our findings showed pig farmers were not adequately prepared and the next ASF outbreak could pose more significant threat to pig populations across Nigeria. Government should urgently establish minimum biosecurity measures and improve its ASF surveillance mechanisms for commercial and backyard pig production.

Parasitological and Bacteriological Evaluation of Common Raw Fruits Collected from Two Major Markets in Iwo, Osun State, South-West Nigeria.

Background: Fruits are a vital part of human nutrition because they contain the growth factors required to maintain normal health. Fruits are also known to harbour a wide range of parasites and bacteria. Consumption of unwashed raw fruits can lead to foodborne pathogens. This study was carried out to examine the presence of parasites and bacteria on fruits sold at two major markets in Iwo, Osun state, South-West Nigeria. Methods: Twelve different fresh fruits and seven different fresh fruits were purchased from different vendors from "Odo-ori" and "Adeeke" markets, respectively. The samples were transported to the microbiology laboratory of Bowen University, Iwo, Osun state for bacteriological and parasitological analysis. The parasites were concentrated by sedimentation and were examined using a light microscope, while for the microbial analysis, culturing and biochemical tests were also carried out on all the samples. Results: The parasites discovered include Fasciola hepatica eggs, Ascaris lumbricoides and Strongyloides stercoralis larvae, hookworm larvae, and Taenia and Trichuris trichiura eggs. Ascaris lumbricoides was most frequently detected (40.0%). Bacteria isolated from the sampled fruits include Klebsiella oxytoca, Klebsiella pneumoniae, Enterobacter aerogenes, Escherichia coli, Kluyvera ascorbata, Proteus mirabilis, Staphylococcus intermedius, Staphylococcus sp., Micrococcus sedentarius, Corynebacterium diphtheriae, and Streptococcus zooepidemicus. Conclusion: The presence of parasites and bacteria on the fruits observed indicates that public health diseases may arise from their consumption. Awareness and education among farmers, vendors, and consumers about the importance of personal and food hygiene through proper washing or disinfection of fruits could reduce the risk of parasites and bacterial fruit contamination.

Upper body push to pull ratios in law enforcement officer recruits.

BACKGROUND: Law enforcement recruits (LER) often encounter shoulder injuries, which may cause attrition from academies. Investigating required upper body muscular fitness may inform of muscular balance around shoulder joints through anterior and posterior ratios in LER. OBJECTIVE: To investigate push to pull ratios (P2P) and factors related with P2P in LER. METHODS: LER (95 males; 12 females) completed testing during a single session in the academy's first week: body mass, one-repetition maximum (1RM) bench press, push-up repetitions (reps) to failure, and pull-up reps to failure. Calculations were: estimated pull-up 1RM=body mass+0.033*(body mass x pull-ups); endurance P2P (eP2P)=push-ups / pull-ups; strength P2P (sP2P)=bench press 1RM / estimated pull-up 1RM. Pearson correlation coefficients assessed relationships among tests and P2P (p < 0.05). RESULTS: The sP2P was positively correlated with bench press 1RM and push-ups. The eP2P was negatively associated with pull-up reps and 1RM. Females had similar eP2P, but lower sP2P than male recruits (p < 0.05). CONCLUSION: Practitioners may benefit from examining eP2P and sP2P as they should not be used interchangeably. Future research should examine whether the P2P ratios are associated with injury and subsequent inability to successfully complete law enforcement training academies.

Prevalence of Laribacter hongkongensis in food and environmental matrices: A systematic review and meta-analysis.

Laribacter hongkongensis is a human pathogen harboured in food and environmental matrices. This present study aimed to meta-analysed the prevalence of L. hongkongensis in humans, aquatic products, food/non-food animals, and environmental waters to provide update information on the pathogen. Nine electronic databases were systematically searched for articles on L. hongkongensis and a random-effects-model meta-analysis on its prevalence was conducted. Assessment of heterogeneities and publication biases across the studies was determined by using the I2 statistic and Egger's regression/rank correlation tests of funnel plot, respectively. Furthermore, a meta-regression model was explored to unravel factors influencing the prevalence. A total of 39 documents were identified, of which, 33 articles were included as 98 sub-studies for the meta-analysis, and 87 sub-studies for subgroup-analysis. Overall, the prevalence of L. hongkongesis in human, aquatic products, food/non-food animals, and environmental waters was 8.5% (95% CI: 5.8-11.7). The leave-one-out influence analysis yielded a pooled prevalence of L. hongkongensis ranging from 8.1% (95% CI: 5.4-11.3) - 8.8% (95% CI: 5.8-12.3). Sub-group analysis found that the prevalence of L. hongkongensis was highest in Amphibian (54.6%, 95% CI: 41.3-67.6), followed by Pisces (7.9%, 95% CI: 5.3-10.9), Avian (0.5%, 95% CI: 0-5.8), and Mammal (0.5%, 95% CI: 0-3.6). In addition, Egger's regression-test of funnel plot suggests presence of publication (z = 4.2, p < 0.0001) in mammal subgroup. Multivariate meta-regression showed that the prevalence was significantly influenced by source type, class, and identification/detection method with the source type, class, and detection method specifically accounted for 25.49%, 11.28%, and 3.84% of the heterogeneity, respectively. Conclusively, the prevalence of L. hongkongensis decrease in order of Amphibian (54.6%), Pisces (7.9%), Avian (0.5%) and Mammal (0.5%). Aquatic products and environments are essential sources of the pathogen.

Human norovirus contamination in water sources: A systematic review and meta-analysis.

The human norovirus (HNoV), on a global scale, is the prevailing cause of contagious viral gastroenteritis outbreaks, with more than 200 000 deaths annually. This study aimed at assessing specific prevalence of HNoV pollution in different water sources and their roles in the dissemination of HNoV, with a view to refocus water sources and sewage management options for policy making towards public health safety. In this regard, we conducted a systematic review and meta-analysis (SR/MA) of the prevalence of HNoV in water sources. We searched PubMed, Google Scholar, Scopus and Web of Science for studies on HNoV prevalence in water sources without temporal restriction, till January 30, 2021. We conducted a random-effects meta-analysis of the HNoV prevalence and stratified the study by water type, continent, gross national income (GNI) group and genogroup. Further, a mixed-effects meta-regression model was performed for sensitivity analysis. The literature search identified 61 studies on water source-based HNoV (WsHNoV) prevalence. The pooled WsHNoV prevalence was 31.7% (95%CI: 25.1-38.5) but varied according to water sources types; river water showing the highest estimate at 43.5% (95%CI: 33.9-53.4), followed by estuarine water (30.6%, 95%CI: 12.5-52.2), composite water (27.9%, 95%CI: 13.5-44.9), marine water (25.9%, 95%CI: 10.0-45.6), groundwater (19.7%, 95%CI: 9.4-32.3) and lake water (2.2%, 95%CI: 0-25.8). Further, the findings indicated the highest WsHNoV prevalence in Africa as 55.9% (95% CI: 28.2-81.9), followed by Asia (31.6%, 95% CI: 22.3-41.6), Europe (29.8%, 95% CI: 17.9-43.2), North America (27.7%, 95% CI: 11.2-47.6) and South America (27.1%, 95%CI: 0.09-49.4). The WsHNoV prevalence stratified by GNI group was 40.6% (95%CI: 27.9-53.9) in middle-income countries and 28.7% (95%CI: 21.7-36.1) in high-income countries respectively. The prevalence of GI, GII and GI & GII genogroup in natural water was 16.4% (95%CI: 12.0-21.3), 20.6% (95%CI: 15.7-25.8) and 12.8% (95%CI: 6.9-20.6) respectively. Evidently, prevalence of the HNoV genogroup in water sources mirrors the pattern of HNoV gastroenteritis and GII genogroup dominance worldwide. In conclusion, public health efforts against waterborne diseases should prioritize water resource/sewage management options and policies towards ardent water sources pollution prevention.

Unintended Changes in Contralateral Limb as a Result of Acute Gait Modification.

Gait modification using real-time biofeedback is a conservative intervention associated with positive outcomes. Results from systematic reviews corroborate the effectiveness of various strategies employing real-time biofeedback for reducing estimated knee joint load. The effects on the nonmodified limb, however, remain unclear. Biomechanical changes to the nonmodified limb were investigated during unilaterally implemented medial knee thrust, lateral trunk lean, and toe-in foot progression. Nineteen healthy participants were recruited. Ten trials were completed for each gait condition including baseline. Assigned magnitude for each gait modification strategy was individualized based on the mean and SD of the gait parameter during baseline. Visual real-time biofeedback was provided. During medial knee thrust, participants' nonmodified limb presented with increased: first peak medial knee contact force, internal first peak knee extensor moment, as well as knee- and hip-flexion angles at internal first peak knee extensor moment. Observed biomechanical changes are elucidative of the body's attempt to attenuate increased external loads. These findings may carry significant implications for pathological populations. Load redistribution to the nonmodified side may result in unfavorable long-term outcomes particularly in patients with bilateral diagnosis. Future studies should explore acute and chronic changes in the nonmodified limb of individuals with knee osteoarthritis.

Storm time IRI-Plas model forecast for an African equatorial station.

The limitation of ionospheric models in describing short-term ionospheric events has led to the development of data assimilative models e.g. the International Reference Ionosphere extended to Plasmasphere (IRI-Plas) model. This paper compares the IRI-Plas derived total electron content (TEC), the peak height (hmF2) and critical frequency (foF2) of the F2-layer with those obtained from Global Positioning System (GPS) receiver's and Digisonde Precision Sounder (DPS-4) measurements over Ilorin (Geog. Lat. 8.50oN; Long. 4.50oE, dip: - 7.9o) during geomagnetic storm days. The model estimation was done by assimilation of Ionosonde foF2 and TEC derived from GPS (GPS-TEC) and Global Ionospheric Map (GIM-TEC) into the model code. In order to study the effect of data assimilation on the model's representation, the "no input" option of the model was used as reference. The result shows that with the exception of the foF2 assimilation mode, all the options generally reproduced TEC quite well for all the storm days considered. Overall, the model adjusted with GPS-TEC gives the best prediction of TEC as it reduced the prediction error of TEC by a multiple of up to three compared to using the GIM-TEC. Also, all the options failed to reproduce the storm induced prominent features in the storm-time features of foF2 and hmF2. In other word, assimilation with the TEC does not generally improve the storm-time predictions of foF2 and hmF2 at the station. Consequently, for storm-time estimation of the F2-layer peak parameters, the 'no input' representation of the model is more valid at this station.

Ecotoxicity of Mine Tailings: Unrehabilitated Versus Rehabilitated.

Earthworms are bioindicators of soil pollution. The ecotoxicity of tailings from selected gold mines in South Africa was investigated utilizing Eisenia andrei bioassays and biomarkers. Samples were obtained from unrehabilitated, rehabilitated and naturally vegetated sites. Biomass, neutral red retention time (NRRT), survival and reproduction were assessed using standardized protocols. Earthworm biomass, NRRT and reproductive success in rehabilitated tailings (comparable to naturally vegetated site) were significantly higher (p < 0.05) than in unrehabilitated tailings. In addition, significantly lower (p < 0.05) body tissue concentrations of As, Cd, Co, Cu and Ni contents were found in the rehabilitated tailings compared to the unrehabilitated. Further, significantly lower (p < 0.05) soil Mn and Zn concentrations were obtained in unrehabilitated tailings than the rehabilitated and naturally vegetated sites. Overall, reduced ecotoxicity effects were confirmed in rehabilitated compared to unrehabilitated tailings. This suggests that rehabilitation as a post-mining restorative strategy has strong positive influence on mine tailings.

Horizontal and Vertical Distribution of Heavy Metals in Farm Produce and Livestock around Lead-Contaminated Goldmine in Dareta and Abare, Zamfara State, Northern Nigeria.

Background. Hitherto studies in response to the June 2010 lead poisoning, Zamfara State, Nigeria, have focused on clinical interventions without information on livestock and other metals. Objective. This study has investigated the distribution of heavy metals in farm produce and livestock around lead-contaminated goldmine in Dareta and Abare, Zamfara State, Nigeria. Methods. Vegetables, soil, water, blood, and different meat samples were harvested from goat, sheep, cattle, and chicken from Dareta, Abare, and Gusau communities. The samples were digested with 10 mL of a mix of nitric and perchloric acids; the mixture was then heated to dryness. Lead, cadmium, zinc, chromium, copper, magnesium, and nickel were analysed using flame Atomic Absorption Spectrophotometer. The daily intake, bioaccumulation factor, and target hazard quotient (THQ) were calculated. Results. Chicken bone-muscles from Dareta had the highest concentrations of lead, zinc, and nickel (28.2750, 16.1650, and 4.2700 mg/kg, resp.), while chicken brain had the highest levels of cadmium, magnesium (0.3800 and 67.5400 mg/kg), and chromium (6.1650 mg/kg, kidney tissue inclusive). Conclusion. In addition to lead, cadmium may also be of concern in the contaminated mining communities of Zamfara State, Nigeria, given the high levels of cadmium in meat and vegetables samples from these areas.

Multicenter Pivotal Clinical Trial of Urine Malaria Test for Rapid Diagnosis of Plasmodium falciparum Malaria.

The need to expand malaria diagnosis capabilities alongside policy requirements for mandatory testing before treatment motivates exploration of noninvasive rapid diagnostic tests (RDTs). We report the outcome of the first cross-sectional, single-blind clinical performance evaluation of a urine malaria test (UMT) for diagnosis of Plasmodium falciparum malaria in febrile patients. Matched urine and finger-prick blood samples from participants ≥2 years of age with fever (axillary temperature of ≥37.5°C) or with a history of fever in the preceding 48 h were tested with UMT and microscopy (as the gold standard). BinaxNOW (Pf and Pan versions) blood RDTs were done to assess relative performance. Urinalysis and rheumatoid factor (RF) tests were conducted to evaluate possible interference. Diagnostic performance characteristics were computed at 95% confidence intervals (CIs). Of 1,800 participants screened, 1,691 were enrolled; of these 566 (34%) were febrile, and 1,125 (66%) were afebrile. Among enrolled participants, 341 (20%) tested positive by microscopy, 419 (25%) were positive by UMT, 676 (40%) were positive by BinaxNOW Pf, and 368 (22%) were positive by BinaxNow Pan. UMT sensitivity among febrile patients (for whom the test was indicated) was 85%, and specificity was 84%. Among febrile children ≤5 years of age, UMT sensitivity was 93%, and specificity was 83%. The area under the receiver-operator characteristic curve (AUC) of UMT (0.84) was not significantly different from that of BinaxNOW Pf (0.86) or of BinaxNOW Pan (0.87), indicating that the tests do not differ in overall performance. Gender, seasons, and RF did not impact UMT performance. Leukocytes, hematuria, and urobilinogen concentrations in urine were associated with lower UMT specificities. UMT performance was comparable to that of the BinaxNOW Pf/Pan tests, making UMT a promising tool to expand malaria testing in public and private health care settings where there are challenges to blood-based malaria diagnosis testing.

Prevalence, distribution and pattern of gastric lesions in slaughtered pigs in south-western Nigeria.

Gastric lesions, especially ulceration, cause significant economic losses in the swine industry worldwide. The study was designed to assess its prevalence, distribution and pattern in pigs in south-western Nigeria. Slaughter house surveys were conducted on three government-established abattoirs in Lagos, Ogun and Oyo states. Stomachs from 480 pigs were assessed for gross lesions, which were graded using a modification of a standard technique. Tissues from different regions of the stomach were routinely stained to assess histopathologic changes. Data were presented as frequency counts and analysed using analysis of variance and chi-square technique. Significance was determined at p ≤ 0.05. Gastric lesions were encountered across the four regions of the stomach with a point prevalence of 57.29%. The prevalence of lesions in the non-glandular region was 32.9%, with severe hyperkeratosis (13.13%) being most frequently observed (p < 0.05). Erosions were significantly higher in the cardia (8.54%) (p < 0.05), followed by fundus (8.33%). Gastric ulcers were significantly higher in the fundus (19.58%) (p < 0.05). Scars of healed ulcers and lacerations were also observed in the fundus (5.42%) (p < 0.05). The gastric lesion distribution across the four regions of the stomach and the occurrence of ulceration in the fundus showed an unusual pattern, which is rarely reported in other parts of the world. The reason for these findings in pigs in Nigeria is not fully understood; therefore, further studies are required to identify and manage these factors for increased productivity, improved animal welfare and enhanced food security.

Therapeutic and Safety Evaluation of Combined Aqueous Extracts of Azadirachta indica and Khaya senegalensis in Chickens Experimentally Infected with Eimeria Oocysts.

Coccidiosis is a disease of economic importance in poultry causing morbidity and mortality. Reports show that Azadirachta indica and Khaya senegalensis have been used individually in the treatment of avian coccidiosis. We thus investigated the efficacy and safety of the combined aqueous extracts of these plants for the treatment of experimentally induced coccidiosis in broiler chickens using oocyst count, oxidative stress biomarkers, serum biochemistry, histology, and haematological parameters. The phytochemical screening revealed the presence of tannins, saponins, cardiac glycosides, and steroids in both extracts. In addition, alkaloids and flavonoids were present in Azadirachta indica. There was significant (p < 0.05) dose dependent decrease in oocyst count across the treatment groups with 400 mg/kg of the combined extract being the most efficacious dose. Immunomodulatory and erythropoietic activity was observed. There were decreased intestinal lesions and enhanced antioxidant activity across the treatment groups compared to the negative control. Administration of the combined extract did not cause damage to the liver as ALT, AST, and ALP levels were significantly reduced in the uninfected chickens treated with the extracts compared to control suggesting safety at the doses used. The combined aqueous extracts of K. senegalensis stem bark and Azadirachta indica leaves were ameliorative in chickens infected with coccidiosis.

Caregivers' vector control methods and their impact on malaria outcome in under-five presenting in tertiary health institution in Nigeria.

BACKGROUND AND AIMS: Integrated vector control especially use of insecticide-treated bed nets have been reported as effective malaria preventive strategies. This study aimed at documenting factors that influence regular use of insecticide-treated nets in under-fives and impact of vector control methods on malaria outcome (severe malaria prevalence and mortality) in under-fives presenting in a tertiary health institution in Nigeria. METHODS: Cross-sectional study carried out from June 2012 and July 2013. Data was obtained by researcher-administered questionnaire and malaria was confirmed in each child by microscopy. RESULTS: 329 caregiver (31.2 ± 6.0 years) /child (20.7 ± 14.0 months) pair were recruited. Netting of doors/windows (80.0%) was the most practiced vector control method. 177 (53.8%) caregivers possessed insecticide-treated bed nets, and only a quarter of their under-5s regularly sleep in these nets. Children from lower social class statistically significantly sleep in the nets (p = 0.03), however, presence of 2 or more nets in a household independently predicted its regular use for the under-5s (ß = 1.09, OR = 3, p = 0.02). Prevalence of severe malaria was 36.2% and mortality was 52 per 1000. Combination of regular use of insecticide treated nets, environmental sanitation, indoor insecticide spray and netting of household doors/windows significantly predicted low prevalence of severe malaria compared to each of the malaria vector control methods used singly by the caregivers (ß = 1.66, OR =5.0, p = 0.04). CONCLUSIONS: Integrated vector control remains the most effective method of malaria vector control at the community.

Hypoglycaemia in Children Aged 1 Month to 10 Years Admitted to the Children's Emergency Centre of Lagos University Teaching Hospital; Nigeria

Background. Hypoglycaemia occurs in many disease states common in the tropics; and may also complicate treatment of malaria. It may contribute significantly to morbidity and mortality. Objectives. To determine the prevalence of and clinical conditions associated with hypoglycaemia. Methods. A total of 430 patients aged 1 month to 10 years were recruited consecutively from the Children's Emergency Centre of Lagos University Teaching Hospital. Clinical and demographic data were entered into a predesigned study proforma. Blood glucose was determined in the laboratory using the glucose oxidase method. Hypoglycaemia was defined as plasma glucose 2.5 mmol/L. Results. The median age of the study subjects was 24 months; with a range of 1.5 - 120 months. A total of 248 patients (57.6) were 24 months old. The mean (standard deviation) blood glucose of all the study subjects was 5.19 (2.05) mmol/L (median 4.9 mmol/L). Twenty-four patients (5.6) were hypoglycaemic. The predominant disease conditions in which hypoglycaemia occurred were severe malaria; multisystemic infections; marasmus; malignancies and gastroenteritis. Mortality was higher in hypoglycaemic patients than in those without hypoglycaemia (33.3 v. 5.4; p0.01). Conclusion. Hypoglycaemia complicates many common childhood illnesses seen in the emergency room and is associated with significant mortality. Hypoglycaemia should be suspected in severely ill children with severe malaria; multisystemic infections; marasmus; malignancies and gastroenteritis

Relationship between admission serum C-reactive protein and short term outcome following acute ischaemic stroke at a tertiary health institution in Nigeria.

BACKGROUND: There is evidence of an association between mediators of inflammation, particularly C-reactive protein (CRP), and outcome of acute ischaemic stroke. This provides a potential opportunity for interventions aimed at improving outcome. There is sparse data exploring the role of inflammatory markers such as CRP and stroke outcome in Africans. The study objective was to determine the association between admission serum CRP levels and short-term outcome in the Nigerian patient presenting with acute ischaemic stroke. MATERIALS AND METHODS: Consecutive patients hospitalized for first-ever acute ischaemic stroke at the Lagos University Teaching Hospital, Lagos, Nigeria, were prospectively enrolled between October 2007 and June 2008. Stroke severity was assessed using the National Institutes of Health Stroke Scale (NIHSS). Serum CRP was determined on samples obtained within 7 days of stroke onset. All stroke patients were followed up till day 30 post-stroke. Outcome measures were 30 day Glasgow outcome scale score and functional impairment on the modified Rankin Scale (mRS). An age- and gender-matched healthy control group had serum CRP determined at inclusion. Elevated CRP was defined as any level above the cutoff (mean +2 x standard deviation of CRP level of controls). RESULTS: Eighty patients with acute ischaemic stroke (47 men and 33 women) and 40 controls (27 male and 13 female) (P = 0.47) were studied. Mean age in cases was 59.1 ± 15.0 years. Mean CRP was significantly higher in stroke cases than controls (17.7 ± 14.4 mg/L versus 1.1 ± 1.7 mg/L respectively) (P < 0.00001). The frequency of elevated CRP (>4.5 mg/L) was 76.3% in stroke (N = 61) and 5% (N = 2) in controls (P < 0.0001). The case fatality rate in stroke with elevated CRP (32.8%) was significantly higher than stroke with normal admission CRP (0%; P = 0.015). The association of higher admission CRP with fatality () was statistically significant (P < 0.0001). Amongst survivors, mean CRP levels were markedly higher in the patients with unfavorable motor outcome (moderate/severe disability; n = 22; 21.5 ± 11.1) compared to those with favorable outcome (mild disability; n = 38; 6.5 ± 6.2) (P < 0.00001). In multivariate regression analysis, only high NIHSS score (P = 0.004) and admission CRP (P = 0.008) were independently associated with case fatality. CONCLUSIONS: Elevated admission CRP and high NIHSS score are independent predictors of short-term case fatality and adverse functional outcome following acute ischaemic stroke in Nigerians.

Diagnostic usefulness of N-terminal pro-brain natriuretic peptide among children with heart failure in a tertiary hospital in Lagos, Nigeria.

BACKGROUND: N-terminal pro-brain natriuretic peptide (NTproBNP) is useful in the diagnosis and management of adult patients with heart failure. OBJECTIVE: The objective of the study was to determine the usefulness of NT-proBNP in diagnosing congestive heart failure (CHF) in children and its correlation with left ventricular ejection fraction (LVEF) and clinical heart failure score. METHODS: Plasma NT-proBNP was measured in 28 children with CHF and age matched controls. Heart failure assessment was done using modified Ross score and all had echocardiography done. RESULTS: Mean plasma NT-proBNP of children with CHF (377.86±1026.49pg/mL) was significantly higher than that of controls (353.61±328.50 pg/mL) (p<0.001). A plasma NT-pro BNP of 951pg/mL was used as the cut off value for heart failure. The sensitivity, specificity, negative and positive predictive values were 57%, 96%, 69% and 94% respectively. NT-pro BNP levels showed a high positive correlation with the modified Ross score (r= 0.502; p<0.001) but low correlation with LVEF (r= -0.137; p>0.3). CONCLUSION: Our findings indicate that measuring NT-pro BNP may be useful as a diagnostic tool in congestive cardiac failure in children. The fact that its levels also correlated positively with modified Ross score thereby objectively determining severity of heart failure suggests that this biomarker may also be useful as an evaluation tool in congestive cardiac failure in children.

The expression and prognostic impact of CXC-chemokines in stage II and III colorectal cancer epithelial and stromal tissue.

BACKGROUND: The CXC-chemokine expression is linked with colorectal cancer (CRC) progression but their significance in resected CRC is unclear. We explored the prognostic impact of such expression in stage II and III CRC. METHODS: Tissue microarrays were constructed from stage II and III CRC biopsies (n=254), and the expression of CXCL1 and CXCL8, and their receptors CXCR1 and CXCR2, in malignant and adjacent normal tissue was graded by immunohistochemistry and was correlated with prognostic factors. RESULTS: Expression of CXCL1, CXCR1 and CXCR2 was elevated in tumour epithelium relative to normal adjacent tissue (P<0.001). CXCL8 expression was detectable in the peritumoural inflammatory infiltrate. There was no overall association between CXCL1, CXCR1 or CXCR2 expression and prognostic endpoints; however, univariate subgroup survival analysis demonstrated an inverse association between CXCL1 and recurrence-free survival (RFS) in stage III patients (P=0.041). The CXCL8 positivity in the tumour infiltrate, however, correlated with earlier disease stage (P<0.001) and improved relapse-free survival across the cohort (P<0.001). Disease stage (P<0.001) and tumour infiltrate CXCL8 positivity (P=0.007) were associated with enhanced RFS in multivariate Cox regression analysis. CONCLUSION: Autocrine CXC-chemokine signalling may have adverse prognostic effects in early CRC. Conversely, CXCL8 positivity within the immune infiltrate may have good prognostic significance.

Plasma homocysteine level and its relationship to clinical profile in Parkinson's disease patients at the Lagos University Teaching Hospital.

BACKGROUND: Hyperhomocysteinaemia (HHcy) is as a long-term sequelum of levodopa therapy in Parkinson's disease (PD). Information on its frequency and effects in Africans with PD is sparse. OBJECTIVE: To determine the frequency of HHcy and its relationship to clinical features of PD in African patients. METHODS: Using a case-control design, 40 consecutively attending PD patients and 40 age- and gender-matched healthy volunteering controls were studied. Parkinson's disease cases were evaluated for disease and treatment characteristics, using the Unified Parkinson Disease Rating Scale (UPDRS) motor and activities of daily living scores and disease stage (Hoehn and Yahr scale). Fasting total plasma homocysteine (Hcy) was determined in all subjects. Hyperhomocysteinaemia was defined as a Hcy level above the 90th percentile for the controls. RESULTS: Mean Hcy was 13.8 ± 5.4mmol/L in PD and 12.4±3mmol/L in controls (P>0.05). Hyperhomocysteinaemia (Hcy > 16.26umol/L) occurred in nine (22.5%) PD patients (all on levodopa) and 6 (15%) controls (P>0.05). Mean duration of levodopa use was 92 ± 105.3 months in PD with HHcy compared to PD patients with normal Hcy 33.9 ± 33.2 (p < 0.05). Disease severity and disability were similar regardless of Hcy levels. None of current age, disease duration, Hoehn and Yahr stage, UPDRS scores, total levodopa dose and duration was independent predictor of homocysteine level. CONCLUSION: There is increased occurrence of hyper-homocysteinaemia in Nigerian subjects with Parkinson's disease, receiving Levodopa. This hyperhomocysteinaemia is more common with prolonged use but appears to have no relationship with disease severity or disability.

'Pseudo Wine Glass' Radiological Appearance of Intracranial Haemorrhage as a Result of Chemotherapy-Induced Thrombocytopenia and Red Cell Sedimentation.

The radiological features of intracranial haemorrhage are well described in the literature, but atypical appearances can sometimes develop. We report a case of chemotherapy-induced thrombocytopenia resulting in fatal intracranial haemorrhage in a man undergoing autologous peripheral stem cell transplantation. The CT showed an unusual appearance, with separation of blood products and fluid within the haemorrhage leading to a wine-glass-shaped outline in the image. This case draws attention to this uncommon radiological finding and emphasises the risks of allosensitisation following chemotherapy and peripheral stem cell transplantation.