The synergism of hepatitis B and aflatoxicosis in hepatocellular carcinoma development: A mini-review

Hepatocellular carcinoma (HCC) is the twelfth most common cancer and the fifth leading cause of worldwide cancer related death. Chronic hepatitis B infection, caused by the hepatitis B virus (HBV) and exposure to aflatoxins is fundamental in the formation of HCC in developing countries. This review of scientific publications aims to establish the detrimental effects of aflatoxin-contaminated foods and highlights the correlation between aflatoxin and hepatitis B viral-associated hepatocellular carcinoma. Research has shown a significant increase in the occurrence of HCC in HBV-infected individuals exposed to fungal toxins. HBV demonstrates the ability to integrate and bind to p53 protein in the host DNA and propagate hepatocyte vulnerability through carcinogenic aflatoxin B1 (AFB1) damage. Although there has been clear evidence about the synergistic interaction of exposure to AFB1 and HBV infection in the induction of HCC, other literature has shown otherwise, mainly because incomplete and vague findings and hypotheses were made in regions where AFB1 and HBV pose a public health risk. Vaccination against hepatitis B and measures such as robust food safety systems to avoid hepatotoxicity and hepatocellular carcinogenesis induced by AFB1 is the most effective methods in the prevention of HCC induced by HBV and AFB1

Long-term survival after head and neck cancer surgery with immediate free flap reconstruction.

BACKGROUND: Head and neck cancer is one of the most frequent cancers worldwide. A combination treatment including surgery is known to have a better survival rate than exclusive radiotherapy-chemotherapy. In extreme cases of non-metastatic patients who have voluminous tumor, or complex location, surgery with immediate reconstruction by free flap could be an option to improve long term survival. PURPOSE: To share experience of long-term survival of patients with head and neck cancer who underwent oncologic surgery with immediate free flap reconstruction, and to analyze influencing factors. METHODS: All consecutive patients treated with free flaps for reconstruction of extensive defects after resection of head and neck cancer in our center (Nancy, France) were retrieved from the hospital database. Data was recorded in a systematic way. Bivariate and multivariate Cox proportional hazards models were used for statistical analysis. RESULTS: Between 1997 and December 2007, 70 patients underwent surgical resection of head and neck tumor with free flap reconstruction. 11 patients were excluded because of missing data. Follow-up time was 7.4 years, IQR from 4.3 to 11.3. Overall survival was 53.8%, 95% CI [39.9%; 65.8%] at 5 years and 38.6% [24.8%; 52.3%] at 10 years. Age>60 years at the surgery HR 2,373 (1,143; 4,927) and TNM score 3-4 HR 2,524 (1,093; 5,828) were statistically associated to a lesser survival rate. CONCLUSION: The ability to successfully and safely perform free flaps increases treatment options for patients with advanced head and neck cancer in a selected population. it seems worthwhile to perform these microvascular reconstructions.

Maternal understanding of fetal movement in third trimester: a means for fetal monitoring and reducing stillbirth.

BACKGROUND: Fetal movement, a sign of life, is widely considered as an indicator of fetal health status. Therefore, perceived alteration in regular fetal movement after the age of viability may signify impending adverse perinatal outcome. AIMS: This study aimed to determine maternal knowledge, behavior, and concerns about abnormal fetal movement in the third trimester of pregnancy. MATERIALS AND METHODS: A total of 225 women were surveyed using a self-administered questionnaire at the out-patient prenatal clinics of two tertiary health facilities in Nigeria between December 1, 2012 through January 31, 2013. Questions addressed knowledge, perception behavior, and concerns about experience of abnormal fetal movement. RESULTS: Correct Knowledge of excessive and decreased fetal movement was found in 47% and 31.1% of respondents, respectively. Majority of women (87.6%) either had no knowledge of normal parameters of fetal activity or did not recall being told that movement frequency and strength should increase in the third trimester. The proportion of women who expressed concern over excessive and decreased fetal movement was 31.1% and 21.8%, respectively. Maternal education was significantly associated with correct knowledge of decreased fetal movement ( P = 0.026). Almost 36% of respondents had knowledge of at least one potential consequence of abnormal fetal movement. CONCLUSION: Maternal educational level is an important factor in the early identification of abnormality of fetal movement. The unsatisfactory knowledge and poor perception behavior among respondents reflect the need for a guideline, particularly during antenatal care, on information and management of abnormal fetal movement in our setting to prevent avoidable stillbirth.

Underweight, overweight and obesity in adults Nigerians living in rural and urban communities of Benue State.

OBJECTIVE: To assess the prevalence of underweight, overweight and obesity among Nigerians aged 18-45 years, living in urban and rural settlements in one state in Nigeria. MATERIALS AND METHODS: Four hundred and thirty-five subjects between 18 and 45 years of age were recruited for height, weight and waist circumference (WC) measurements. Body mass index (BMI) was calculated (weight/height 2, kg/m 2 ); WHO criteria determined BMI and WC categories. RESULTS: Based on BMI, about 2% of the study population was underweight, 22% was overweight and 4% was obese. There were more normal weight persons in rural than in urban settlement. About 40 and 30% of females in urban and rural settlement, respectively, were either overweight or obese. Based on WC of the sample population, 10.34% had increased risk for metabolic syndrome [action level I (defi ned as WC ≥94 cm in men and ≥80 cm in women)] and 2.8% had substantially increased risk [action level II (defi ned as WC ≥102 cm in men and ≥88 cm in women)]. At action level II, there was no obese male. CONCLUSION: This study revealed that underweight, overweight and obesity exist in young adults, but overweight and obesity are more prevalent. Therefore, concerted efforts should be made to control this in young adults for their present well-being and to possibly avoid the risk of disease later in life.

Bacterial isolates in blood cultures of children with suspected septicaemia in Kano: a two-year study.

AIMS AND OBJECTIVE: Septicaemia is a common condition in children with a resultant high morbidity and mortality. The gold standard for diagnosis of septicaemia is the isolation of bacterial agents from blood cultures. The study was done to determine the common aetiology of septicaemia in children and their antibiotic susceptibility pattern in Kano, Nigeria. MATERIALS AND METHODS: A retrospective study with a review of blood culture reports of paediatric patients aged 0-15 years, suspected of septicaemia, from October 2006 to October 2008 in the Medical Microbiology department of Aminu Kano Teaching Hospital Kano. Kano. Nigeria was carried out. RESULTS: Out of a total of 3840 blood culture samples, only 18.2% (n=700) was culture positive. Gram-negative and gram - positive bacteria constituted 69.3% (n=2661) and 30.7% (n=1179) respectively. The most prevalent bacterial isolates were Escherichia coli with 44.3% (n=310/700) and Staphylococcus aureus 30.7% (n=215/700). Escherichia coli were sensitive to ceftriaxone, ciprofloxacin, gentamicin and clavulinate - amoxyl. CONCLUSION: The commonest bacterial isolate from blood culture of children with suspected septicaemia in Kano is Escherichia coli. The most sensitive and preferable among the tested antibiotics is ceftriaxone. Rational use of antibiotics with regular antibiotic susceptibility surveillance studies is recommended to maintain high antibiotic therapeutic profile.

Effects of methanolic and chloroform extracts of leaves of Alstonei boonei on rat liver mitochondrial membrane permeability transition pore.

The effects of methanolic and chloroform extracts of the leaves of Alstonei boonei, a medicinal plant with anti-malarial, anti-inflammatory and analgesic properties, were assessed on liver mitochondrial membrane permeability transition (MMPT) pore were assessed in experimental animals in vitro and in vivo. The results obtained showed that calcium ions induced the opening of MMPT pore significantly (P< 0.05) in rat liver mitochondria, while spermine (0.1mM) inhibited calcium-induced opening of MMPT pore of these mitochondria thus, indicating that the mitochondria were intact, ab initio. The results further revealed the inhibitory effects of different concentrations of the various extracts of leaves of Alstonei boonei (200 microg/ml, 600 microg/ml, 1000 microg/ml, 1400 microg/ml) compared with spermine. Specifically, the data revealed that methanolic and chloroform extracts of leaves of Alstonei boonei reversed calcium-induced opening of MMPT pore in a concentration-dependent manner (26.5%, 27.4%, 56.4%, 69.3%) for methanolic extract of Alstonei boonei and (9.6%, 34.9%, 51.5% and 82.1%) for chloroform extract of Alstonei boonei, respectively. Although, the MMPT pore was not affected by low concentrations of the methanolic extract of Alstonei boonei (200 microg/ml and 600 microg/ml) in the absence of calcium, the extract at higher concentrations (1000 microg/ ml and 1400 microg/ml) induced the opening of the pore in a concentration-dependent manner. Mitochondria isolated from Wistar strain albino rats orally exposed to various doses of the methanolic extract of Alstonei boonei exhibited pore opening in the absence of calcium. In this respect, maximum (112%) induction of pore opening was obtained at 250mg/kg body weight, while minimum (31%) induction of pore opening was obtained at 200mg/kg body weight. Calcium further increased the extent of opening of the MMPT pore in animals previously exposed to methanolic extract of Alstonei boonei. These findings suggest that certain bioactive components of Alstonei boonei may be involved in inhibiting the opening of the MMPT pore in-vitro and in the induction of the opening of the pore at high doses of the extract with the eventual release of cytochrome C which is a prelude to the progression of programmed cell death.

Effect of demographic variables on cytomegalovirus antibody seropositivity among prospective blood donors in Jos, Nigeria.

BACKGROUND: Cytomegalovirus, otherwise called human herpes virus type 5, is a transfusion transmissible pathogen responsible for significant morbidity and mortality among various groups of individuals with damaged or impaired host immunity. Although it has a worldwide distribution, the infection is thought to be more widespread in developing countries where certain demographic factors and living conditions are thought to be responsible for the observed increased prevalence of this infection. OBJECTIVES: The aim of this study is to evaluate the effect of living conditions, using certain selected demographic parameters, on CMV seropositivity, among blood donors in Jos. PATIENTS AND METHODS: A total of 200 prospective blood donors who presented for bleeding were recruited consecutively into the study. Questionnaire was used to obtain the personal, educational, social and demographic data of donors. Screening for CMV antibodies was performed on each serum sample using ELISA kit ("DIALAB", Austria) (www.dialab.at). RESULTS: The relationship between the extent of crowding and CMV status of donors was statistically significant, p<0.05. Other studied donor demographic parameters (source of drinking water, place of abode and type of toilet facility) did not statistically influence donor CMV status, p>0.05. CONCLUSION: Our study showed that overcrowding was the most significant factor that statistically influenced donor CMV status in Jos, Nigeria. There is, therefore, an urgent need for concerted effort to handle the problem of overcrowding in developing countries and Nigeria in particular.

Effect of Demographic Variables on Cytomegalovirus Antibody Seropositivity among Prospective Blood Donors in Jos, Nigeria.

BACKGROUND: Cytomegalovirus, otherwise called human herpes virus type 5, is a transfusion transmissible pathogen responsible for significant morbidity and mortality among various groups of individuals with damaged or impaired host immunity. Although it has a worldwide distribution, the infection is thought to be more widespread in developing countries where certain demographic factors and living conditions are thought to be responsible for the observed increased prevalence of this infection. OBJECTIVES: The aim of this study is to evaluate the effect of living conditions, using certain selected demographic parameters, on CMV seropositivity, among blood donors in Jos. PATIENTS AND METHODS: A total of 200 prospective blood donors who presented for bleeding were recruited consecutively into the study. Questionnaire was used to obtain the personal, educational, social and demographic data of donors. Screening for CMV antibodies was performed on each serum sample using ELISA kit ("DIALAB", Austria) (www.dialab.at). RESULTS: The relationship between the extent of crowding and CMV status of donors was statistically significant, p<0.05. Other studied donor demographic parameters (source of drinking water, place of abode and type of toilet facility) did not statistically influence donor CMV status, p>0.05. CONCLUSION: Our study showed that overcrowding was the most significant factor that statistically influenced donor CMV status in Jos, Nigeria. There is, therefore, an urgent need for concerted effort to handle the problem of overcrowding in developing countries and Nigeria in particular.

Cataract surgery: limitations and barriers in Makurdi, Benue State.

BACKGROUND: Cataract is amenable to surgery; despite this affected patients do not always embrace or accept cataract surgical intervention. The study aims to ascertain the factors responsible for this negative attitude towards cataract surgery by affected patients. METHODS: A prospective study was carried out with an interview assisted questionnaire, parameters assessed were duration of blindness before presentation, insight into the cause of cataract, awareness of the available treatment, knowledge of where to go for treatment and possible barriers to surgical treatment was administered to all consecutive patients aged 40 years and above whose cause of visual impairment and blindness is principally due to cataract for a period of one year (January 2007 December 2007). RESULTS: Senile cataract constituted 2.6% (180) of all the patients aged 40 years and above. Duration of blindness before presentation ranged from 6 to 84 months. Majority of the patients (65%) were aware that surgical intervention was the answer to their visual dysfunction. CONCLUSION: Although, affected patients are knowledgeable that surgical intervention was the answer to their visual dysfunction, they do not readily embrace surgical intervention for diverse reasons.

Knowledge of sickle cell disease and haemoglobin electrophoresis: a survey of students of a tertiary institution.

BACKGROUND: Sickle Cell Disease (SCD) is the commonest genetic disease worldwide. Of the sickle cell control strategies, premarital genetic counselling is increasingly practised in many countries of the world. Knowledge of the citizenry of a nation about SCD constitutes an important variable that influences the acceptability, practice and success of premarital genetic counselling. A study of students of Benue State University, Makurdi was carried out to determine their current level of knowledge. METHOD: A cross sectional study involving 300 students of Benue State University, Makurdi; selected by a multistage stratified sampling technique, using self administered structured questionnaire, was carried out. RESULTS: Virtually all study respondents had at one time or the other heard about sickle cell disease. Based on the criteria used for knowledge scoring, less than half of the students (48%) demonstrated good knowledge. Overall Mean Score Knowledge (MSK) was 4.65 +/- 1.65. MSK was 4.58 +/- 1.66 and 4.74 +/- 1.64 for males and females respectively; there was no statistically significant difference (P > 0.05). However, having an affected relative suffering from sickle cell disease significantly influenced level of knowledge among study respondents (P < 0.05), but was not significantly associated with respondents knowing their haemoglobin phenotype. Only 141 students (47%) knew their haemoglobin phenotype. Level of knowledge about SCD did not significantly increase with age. Also, sex and religion did not significantly influence level of knowledge. CONCLUSION: The knowledge about SCD was poor and only a few knew their haemoglobin phenotype. If sickle cell disease control strategies must yield any significant results, more education about SCD, especially among students in tertiary institutions in Nigeria is recommended. The use of persons with SCD as peer educators/counsellors should be explored.

A Review of the Impact of Cost and Quality of HIV Kits on HIV Testing in a Nigerian Teaching Hospital

Background: When HIV antibodies testing was introduced in Aminu Kano Teaching Hospital; Kano a couple of years ago; Double ELISA was used to test blood samples before a particular specimen was diagnosed as reactive or non-reactive. A time came when immunoconfirmatory test was introduced into HIV antibodies testing for confirmations of the presence of HIV. Objectives: This present retospective study is to review the impact of cost and quality of HIV reagent kits in the two periods A and B on the patients and confidence on the health care provider. Methods: We collated and compared laboratory records for both periods of HIV antibodies testing at Aminu Kano Teaching Hospital Kano consisting of period A from November 1997 to May 1998 (7 months) and period B from November 1998 to May 1999 (7months). In period A; double ELISA was used (Genie II and Immunocomb Bispot) while in period B; Immunocomb Bispot and Immunoconfirm II were used Results: The results show that the cost per test increased from two hundred and fifty Naira($2) to five hundred Naira($4). There was a reduction on the number of patients from 289 to 258 within the two periods. But the prevalence of reactive HIV antibodies decreased from 43.6to 36.8. Conclusion: The period when Immunoconfirmatory technique was introduced brought assurance; reliability and confidence to HIV diagnosis test in the centre

The seroprevalence of cytomegalovirus antibodies among prospective blood donors in Jos.

BACKGROUND: Human cytomegalovirus, otherwise called human herpes virus type 5, is a significant cause of morbidity and mortality in pregnancy, and among immunocompromised patients like recipients of organ transplants. Cytomegalovirus is transmissible via blood transfusion, among other parenteral routes. This study therefore aims at establishing the seroprevalence of CMV antibodies among prospective blood donors in Jos. This is with a view to making recommendations on donor screening and transfusion protocols among susceptible patients. METHODS: A total of 200 prospective blood donors were recruited into the study. Screening for CMV antibodies was done using ELISA kit, manufactured by "DIALAB", Austria (www.dialb.at). RESULTS: Of the 200 prospective blood donors analysed, 184 donors were found to be positive for cytomegalovirus antibodies, representing a prevalence rate of 92%. The peak age prevalence was in the 25-29 years age range, representing 30.4%. Cytomegalovirus prevalence was lowest in the 15-19 years age range and above 50 years (1.6% each). CONCLUSION: A cytomegalovirus antibody prevalence rate of 92% indicates that screening for CMV should be included in screening algorithm for potentially susceptible recipients of blood and its products. Non infected susceptible persons should be transfused CMV negative orleucocyte depleted blood and blood products.

Osteonecrosis complicating chronic myeloid leukaemia.

BACKGROUND: There are previous reports of osteonecrosis among Nigerians with sickle cell diseases and some other medical conditions. To the best of the authors' knowledge there is, however, no known such report attributed to chronic myeloid leukaemia, especially in Nigeria. Apart from presenting this as the first report, it is also to emphasize the need for early full blood count in persons presenting with otherwise non-haematological condition. METHOD: The case note of the patient and the available literature on the subject were used. RESULT: The 15-year-old girl who presented with a fifteen-month history of right hip joint pain and progressive abdominal swelling with weight loss for five months was found to have chronic myeloid leukaemia and avascular necrosis of the right femoral head. Her gait and walk improved remarkably within two weeks of commencing cytoreductive therapy. However, she still uses crutches due to the extensive bone damage from the prolonged impaired blood supply caused by chronic myeloid leukaemia before presentation. CONCLUSION: Osteonecrosis of the femoral head can complicate chronic myeloid leukaemia from hyperviscosity-induced leucostasis. Early simple peripheral blood examination in diseases presenting with otherwise non-haematological symptoms will reduce, if not prevent, severe complications of diseases.

A rapid usability assessment methodology to support the choice of clinical information systems: a case study.

We present here an adapted methodology integrating usability engineering and early evaluation procedures to support the choice of a Clinical Information System in the context of a standard Call for Tender. We illustrate the application of this methodology with a case study. We integrated a standard 'contextual task and activity analysis' into the choice process and then drew up usability recommendations for the choice of an application. We organized a one-week on-site exhibition and test for each candidate company. During the test sessions, we performed a rapid usability assessment. The final choice of the application is strongly and positively influenced by the results of the usability assessment.