Outcomes of Coronary Artery Bypass Graft Surgery in Africa: A Systematic Review and Meta-Analysis.

Coronary artery bypass graft (CABG) surgery has been in practice for many decades, and it is one of the most commonly performed cardiac surgeries worldwide. While there are several studies reporting data on perioperative outcomes following CABG in developed countries, there is a staggering paucity of data and evidence reporting the outcomes in developing areas such as Africa. Thus, it is important to study the practice and outcome of CABG in Africa to establish its clinical efficacy and safety in this region and identify factors that might be limiting its practice. The overall aim of this study is to identify all relevant clinical data on CABG in Africa and report on the perioperative outcomes and practice of CABG in the African population. Electronic search was performed using three online databases, PubMed, African Journal Online, and Research Gate, from inception to June 2023. The preferred reporting items for systematic reviews and meta-analysis (PRISMA) guideline was utilised for this study. Relevant studies fulfilling predefined eligibility criteria were included in the study. Intraoperative details, such as the number of grafts performed, operative, bypass, and cross-clamp time, were reported. The primary endpoint assessed were early mortality and overall mortality. The secondary endpoints included length of hospital stay, intensive care unit stay, and postoperative complications, such as renal impairment, atrial fibrillation, and surgical site infection. The data were pooled together and meta-analyzed using a random effect model for proportions and mean for meta-analysis with R software (version 4.3.1 (2023-06-16); R Development Core Team, Vienna, Austria). This systematic review identified 42 studies that fulfilled the study eligibility criteria, including 21 randomised controlled trials, 20 observational studies, and one cross-sectional study. Only four out of the 54 countries in Africa had studies carried out that met the criteria for this review; they included Algeria, Egypt, Nigeria, and South Africa, with a majority from Egypt. Meta-analysis reported a pooled early mortality and pooled overall mortality of 3.51% and 3.73%, respectively, for the total cohort of patients. The result of this meta-analysis suggests that mortality outcomes following CABG in Africa are relatively higher than those in developed nations. Several issues, such as lack of financial resources and poor infrastructure, continue to hinder the optimal practice of CABG procedures in many parts of Africa. Further studies focused on finding factors associated with outcomes following CABG should be done. Though there were a few limitations to the study largely from a lack of data from several regions and countries in Africa, the result from this meta-analysis can serve as a benchmark for future studies until more relevant data are reported.

Anticancer effects of Morinda lucida and Annona muricata on immunomodulations of Melatonin, tumor necrosis factor-alpha and p53 concentrations in lead acetate-induced toxicity in rats.

OBJECTIVES: Lead poisoning accounts for about 0.6% of global burden of disease. Lead-induced toxicity is through confinement of oxidative stress in affected organs. We evaluated the effects of MLF1 (extracted from Morinda lucida leaves) and AMF1 (extracted from Annona muricata leaves) on lipid peroxidation and immunomodulations of Melatonin, tumor necrosis factor-alpha (TNF-α), and p53 proteins in lead acetate (LA)-induced toxicity in rats. METHODS: Sixty adult female rats were randomly divided into 12 groups (n = 5). Groups 1 and 2 received physiological saline and 100 mg/kg bodyweight of LA, respectively, for 5 weeks. Groups 3-6 received 100 mg/kg bodyweight LA for 2 weeks, followed by treatments with 7.5 and 15 mg/kg bodyweight of MLF1, and 7.5 and 10 mg/kg bodyweight of AMF1, respectively, for 3 weeks. Groups 7-10 received 7.5 and 15 mg/kg bodyweight of MLF1, 7.5 and 10 mg/kg bodyweight of AMF1, respectively, for 5 weeks. Groups 11-12 received co-administrations of 100 mg/kg bodyweight LA with 15 mg/kg bodyweight MLF1 and 10 mg/kg bodyweight of AMF1, respectively, for 5 weeks. Drugs and extracts were administered orally. Consequently, liver histopathology (Hematoxylin and Eosin), sera Melatonin, and TNF-α (enzyme-linked immunosorbent assay [ELISA]) levels were evaluated. Malondialdehyde (MDA) (thiobarbituric acid assay) and p53 (ELISA) levels were evaluated in liver homogenates. Data were statistically analyzed (P ≤ 0.05). RESULTS: Results showed normal liver histology in all Groups. Statistical analyses showed significant (P ≤ 0.05) and non-significant decreased levels (P ≥ 0.05) of MDA, TNF-α and p53 in Groups 3-12, compared with Group 2. Furthermore, results showed significant (P ≤ 0.05) and non-significant increased Melatonin levels (P ≥ 0.05) in Groups 4-12 compared with Group 2. CONCLUSION: This study confirmed that MLF1 and AMF1 confer a degree of antioxidant, anticancer and hepato-protetive potentials against LA-induced toxicity in rats.

Robot-Assisted Laparoscopic Urachal Excision Using Hidden Incision Endoscopic Surgery Technique in Pediatric Patients.

Introduction: Although laparoscopic urachal excision in children has been well reported, there are limited data on a robot-assisted surgery (RAS) approach. The hidden incision endoscopic surgery (HIdES) technique is an established method of eliminating visible scars following a number of RAS urologic procedures. We report our experience of using a robotic approach to treat urachal anomalies in children, and we present the first description of utilizing the HIdES port configuration for this procedure. Materials and Methods: We retrospectively reviewed pediatric patients who underwent resection of a urachal remnant at our institution from 2013 to 2018. Surgical techniques were either the traditional open approach (OA) or RAS. HIdES trocar placement configuration was employed in all robotic cases. Patient demographics, perioperative data, pathology reports, and outcomes were abstracted and compared. Results: Twenty-three patients underwent a urachal remnant resection in the study period (RAS: 14 patients vs OA: 9 patients). RAS patients were older (8.5 vs 2.0 years, p = 0.031) and weighed more than OA patients (36.1 vs 13.9 kg, p = 0.063). Median operative time for RAS was longer than OA operative time (136 vs 33 minutes, p < 0.01). Fewer RAS patients were outpatient compared with OA (7.1% vs 66.7%, p < 0.01), but with a median length of stay of 1 day (0-1 day). Two patients (14.3%) in the RAS group experienced postoperative complications within 1 week of the procedure compared with 1 (11.1%) in the OA group. There was no significant difference in blood loss, postoperative narcotic requirements, or duration of follow-up between both groups. Conclusion: RAS is a safe and feasible alternative to open surgery for urachal anomalies. Complete excision can be achieved by using HIdES port configuration, allowing for excellent cosmetic outcomes that are superior to traditional surgical scars without limitation to essential surgical ergonomics.

Discrepancies in Self-Reported and Actual Conflicts of Interest for Robotic Pediatric Urological Surgery.

PURPOSE: Transparency of conflicts of interest is essential when assessing publications that address the benefits of robotic surgery over traditional laparoscopic and open operations. We assessed discrepancies between self-reported and actual conflicts of interest as well as whether conflicts of interest are associated with favorable endorsement of robotic surgery. MATERIALS AND METHODS: We searched the Embase® and MEDLINE® databases for articles on robotic surgery within pediatric urology. We included English language articles published since 2013, when data in the Open Payments program (Centers for Medicare and Medicaid Services, Baltimore, Maryland) became available. For all United States based authors Open Payments was used to identify the total amount of financial payment received from Intuitive Surgical®. Chi-square test was used to assess the association between conflicts of interest and favorable endorsement of robotic surgery. RESULTS: A total of 191 articles were initially identified. After exclusion criteria were applied 107 articles remained (267 distinct authors). Of the articles 86 (80.4%) had at least 1 author with a history of payment from Intuitive Surgical, with 79 (91.9%) having at least 1 author who did not declare a conflict of interest despite history of payment. A total of 44 authors (16.5%) had a history of payment from Intuitive Surgical, with an average payment of $3,594.15. Articles with a first and/or last author with a history of payment were more likely to contain a favorable endorsement of robotic surgery compared to articles without a history of payment (85.1% vs 63.6%, p = 0.0124). CONCLUSIONS: Nondisclosure of conflict of interest with Intuitive Surgical is extremely common within pediatric urology. Steps to ensure accurate reporting of conflicts of interest are essential. There appears to be an association between a history of payment and favorable endorsement of robotic surgery.

Shielding of beta and bremsstrahlung radiation with transparent Bi2O3-B2O3-TeO2 glasses in therapeutic nuclear medicine.

High-energy beta emitters (yttrium-90, strontium-89 and phosphorus-32) are nowadays increasingly used in therapeutic nuclear medicine. Beta particles and bremsstrahlung (photons produced when beta particles interact with materials) are harmful and should be shielded in order to protect the personnel and public from their harmful effects. This work determined the radiation yield, effective atomic number and range associated with the interaction of beta particles with a transparent xBi2O3-30B2O3-(70-x)TeO2 glass system (where x = 40, 50, 60 and 70 mol%) using the ESTAR database and programme; and other relevant equations. The properties of the studied glass systems were compared with transparent lead glass, which is unwanted in the medical settings because of lead's toxicity. The result of this work showed that the studied glasses are suitable for use in making vials, syringes and other transparent materials, necessary for shielding high-energy beta particles. All the studied glass systems can replace lead glass.

Immunohistochemical characterization of endometrial leucocytes in endometritis.

AIMS: Leucocytes are a normal and variable component of the endometrial stromal cell population. The aim of this study was to characterize endometrial leucocytes in established cases of endometritis in order to determine whether there are objective characteristics of the leucocyte infiltrate which would allow its identification as part of an inflammatory process rather then the normal physiological leucocyte infiltrate. METHODS AND RESULTS: We examined endometrial tissue from 79 cases of endometritis and 22 histologically normal controls. Leucocytes were characterized immunohistochemically for CD45, CD20, CD68, CD3 and CD56 and numbers were analysed semiquantitatively on a scale of 0-4. In many endometritis cases the overall number of leucocytes was increased. Furthermore, leucocytes were unusually distributed with a tendency to accumulate superficially beneath the endometrial surface. Whilst numbers of macrophages, T lymphocytes and endometrial granulated lymphocytes (uterine natural killer cells) did not differ between endometritis samples and controls, most endometritis cases contained a substantially increased number of B cells, which normally represent 1% or less of the endometrial leucocyte population. B lymphocytes were also observed in unusual locations such as intraepithelially and within glandular lumina. CONCLUSIONS: These results suggest that immunohistochemical characterization of endometrial leucocytes may be helpful in establishing a diagnosis of endometritis in equivocal cases.

Effect of prior steroid treatment on temporal artery biopsy findings in giant cell arteritis.

AIM: To examine the effect of up to 6 weeks of corticosteroid treatment on the positive temporal artery biopsy rate in giant cell arteritis (GCA). METHODS: Prospective comparative clinical study of 11 patients meeting the American College of Rheumatology criteria for diagnosis of GCA. Patients underwent temporal artery biopsy within 1 week, at 2-3 weeks, or after 4 weeks of corticosteroid treatment. RESULTS: Overall, nine of 11 (82%) patients had positive temporal artery biopsies. Six of seven (86%) biopsies performed after 4 or more weeks of steroid treatment were positive. CONCLUSION: Temporal artery biopsy is useful several weeks after institution of steroids.

Morphological patterns of paediatric solid cancer in Lagos, Nigeria.

With successful implementation of the Expanded Programme on Immunisation (E.P.I.), many Nigerian children are protected against the common infections of childhood which claim their lives within the first decade of existence. Recent observations tend to show that paediatric cancer may start to play a significant role in childhood morbidity and mortality. Therefore, this study analyses 372 cases of paediatric solid malignant tumours received at the Department of Morbid Anatomy, Lagos University Teaching Hospital (L.U.T.H) from 1974 to 1988. Considering all the age groups together, the commonest malignant tumour is lymphoma (32.8%), of which Burkitt's lymphoma accounts for 19.6%. Retinoblastoma and Wilms' tumour represent second and third commonest solid cancers respectively. There is, however, slight variation in the different age groups. For example, in the age group 1-4 years, malignant lymphoma is an uncommon disease representing only 11.0% of all cancers whilst retinoblastoma (34.5%) and nephroblastoma (24.0%) together account for 58.6%. Epithelial cancer although rare in children, represents 12.6% in the 10-14 year age group. There is a higher incidence of this tumour when compared to the other age groups (less than 1 year, 1-4 years and 5-9 years). Intracranial neoplasia are uncommon, representing only 2.0%. The overall incidence of solid malignant tumours in children aged 0-14 years in Lagos is estimated to be 22 per million person years.