First and Second Waves of Covid-19: A Comparative Study of the Clinical Presentation and Outcome among Hospitalized Patients in Lagos Nigeria.

OBJECTIVE: Nigeria experienced many waves of the COVID-19 pandemic. This study compared the clinical presentations and mortality among hospitalized patients during the first and second waves of the pandemic in Lagos State, Nigeria. METHODS: A retrospective cohort study was conducted. Deidentified medical records of laboratory-confirmed COVID-19 patients admitted into 15 isolation centers in Lagos, Nigeria between February 27, 2020, and September 30, 2020 (first wave) and October 1, 2020, and April 30, 2021 (second wave) were reviewed. IBM Statistics version 25 was used for data analysis. RESULTS: More patients were hospitalized during the first wave of the pandemic. The mean age of patients was higher during the second wave (54.5±15.8 years vs. 42.2±15.5 years, p <0.001). More patients admitted during the second wave had comorbidities (56.0% vs 28.6%, p <0.001), were symptomatic (90.8% vs 52.0%, p <0.001), had severe COVID-19 disease (58.9% vs 25%, p <0.001) and died (14.9% vs 6.4%, p<0.001) compared with the first wave. The odds of death increased with age and severity of COVID-19 disease during the first and second waves. CONCLUSION: A higher proportion of the patients admitted in Lagos, Nigeria during the second wave were older, had comorbidities, and had severe COVID-19 disease than the first wave. Despite the fewer hospitalized patients, there were more deaths during the second wave.

OBJECTIF: Le Nigeria a connu plusieurs vagues de la pandémie de la COVID-19. Cette étude a comparé les présentations cliniques et la mortalité chez les patients hospitalisés lors des première et deuxième vagues de la pandémie dans l'État de Lagos, Nigeria. MÉTHODES: Une étude de cohorte rétrospective a été réalisée. Les dossiers médicaux déidentifiés des patients atteints de la COVID-19 confirmée par laboratoire, admis dans 15 centres d'isolement à Lagos, Nigeria, entre le 27 février 2020 et le 30 septembre 2020 (première vague) et entre le 1er octobre 2020 et le 30 avril 2021 (deuxième vague), ont été examinés. IBM Statistics version 25 a été utilisé pour l'analyse des données. RÉSULTATS: Un plus grand nombre de patients ont été hospitalisés lors de la première vague de la pandémie. L'âge moyen des patients était plus élevé lors de la deuxième vague (54,5±15,8 ans vs. 42,2±15,5 ans, p <0,001). Un plus grand nombre de patients admis lors de la deuxième vague avaient des comorbidités (56,0% vs. 28,6%, p <0,001), étaient symptomatiques (90,8% vs. 52,0%, p <0,001), avaient une forme grave de la maladie à la COVID-19 (58,9% vs. 25%, p <0,001) et sont décédés (14,9% vs. 6,4%, p<0,001) par rapport à la première vague. Les chances de décès ont augmenté avec l'âge et la gravité de la maladie à la COVID-19 lors des première et deuxième vagues. CONCLUSION: Une proportion plus élevée des patients admis à Lagos, Nigeria, lors de la deuxième vague étaient plus âgés, avaient des comorbidités et présentaient une forme grave de la maladie à la COVID-19 par rapport à la première vague. Malgré un nombre moindre de patients hospitalisés, il y a eu plus de décès lors de la deuxième vague. MOTS-CLÉS: Présentation Clinique, Covid-19, Première Vague, Mortalité, Nigeria, Deuxième Vague.

Correction: New cyclic glycolipids from Silene succulenta promote in vitro MCF-7 breast carcinoma cell apoptosis by cell cycle arrest and in silico mitotic Mps1/TTK inhibition.

[This corrects the article DOI: 10.1039/D3RA01793A.].

New cyclic glycolipids from Silene succulenta promote in vitro MCF-7 breast carcinoma cell apoptosis by cell cycle arrest and in silico mitotic Mps1/TTK inhibition.

In vitro anticancer screening of Silene succulenta Forssk. aerial parts (Caryophyllaceae) showed that the n-hexane fraction was a highly effective fraction against breast carcinoma cell lines (MCF-7) with IC50 = 15.5 µg mL-1. The bioactive-guided approach led to the isolation of two new cyclic glucolipids from the n-hexane fraction, identified as a 1,2'-cyclic ester of 11-oxy-(6'-O-acetyl-ß-d-glucopyranosyl) behenic acid (1) as a C-11 epimeric mixture and 11(R)-oxy-(ß-d-glucopyranosyl)-1,2'-cyclic ester of behenic acid (2). An in vitro cytotoxicity study showed the potential suppression of MCF-7 cells with IC50 values of 11.7 ± 0.04 and 6.6 ± 0.01 µg mL-1 for compounds 1 and 2, respectively, compared to doxorubicin (IC50 = 3.83 ± 0.01 µg mL-1). Accordingly, only cell cycle tracking for the most active compound (2) was assessed. The cell cycle investigation showed that compound 2 altered the cell cycle at G0/G1, S, and G2/M phases in MCF-7 treated cells. In addition, its powerful apoptotic ability resulted in a significant increase in the early and late stages of apoptosis. Moreover, molecular docking analysis, which was performed against the anticancer mitotic (or spindle assembly) checkpoint target Mps1 kinase, showed that the two new cyclic glycolipids (1 and 2) possess high binding affinity of -7.7 and - 7.6 kcal mol-1, respectively, compared to its ATP ligand. Overall, this report emphasizes that natural cyclic glycolipids can be used as potential antitumour breast cancer agents.

Length of Hospital Stay of COVID-19 Patients managed at the Lagos State Isolation Centres during the First Wave of the Pandemic.

BACKGROUND: Lagos State has the highest number of COVID-19 cases in Nigeria. We assessed the factors predicting the length of hospital stay of COVID-19 patients admitted in 15 isolation centres across the state. METHODS: We reviewed the electronic medical records of all COVID-19 patients admitted and discharged between February 27, 2020, and September 30, 2020. Logistic and linear regressions were used to assess factors predicting the length of hospital stay. RESULTS: A total of 3153 records were reviewed, of which 2623 (83.2%) met the inclusion criteria. The mean age of patients admitted was 40.5 (Sd 14.8) years. The age range was four days-97 years. A total of 1258 (48.0%) were symptomatic, while 2056 (78.4%) and 567 (21.6%) presented with mild and severe disease, respectively. Cough (22.0%), fever (17.3%) and breathlessness (12.3%) were the most common symptoms at presentation. Generally, the median length of hospital stay was 11 (IQR 9, 14) days. A total of 1609 (61.3%) had a prolonged length of hospital stay. The odds for prolonged hospital stay was higher among elderly patients (AOR 12.1 95%CI 7.6-19.4, p<0.001), male (AOR 1.2 95%CI 1.0-1.4, p=0.031) and patients with severe disease (AOR 1.3 95% CI 1.0-1.7, p=0.042). Age, hypertension and shortness of breath made the most significant contribution to predicting the length of hospital stay (P<0.05). CONCLUSION: Age, gender, hypertension and breathlessness predicted the length of hospital stay. Proactive measures should be instituted in managing COVID-19 patients.

CONTEXTE: L'État de Lagos a le plus grand nombre de cas de COVID-19 au Nigeria. Nous avons évalué les facteurs predisan la durée du séjour à l'hôpital des patients atteints de la COVID-19 admis en 15 centres d'isolement à travers l'État. MÉTHODES: Nous avons examiné les dossiers médicaux électroniques de tous les Patients atteints de la COVID-19 admis et sortis de l'hôpital entre février27, 2020 et 30 septembre 2020. Régressions logistiques et linéaire sont été utilisés pour évaluer les facteurs prédisant la durée de l'hôpital rester. RÉSULTATS: Un total de 3153 dossiers ont été examinés, don't 2623 (83,2 %) répondaient aux critères d'inclusion. L'âge moyen des patients admis était de 40,5 ans (Sd 14,8). La gamme d'âge était de quatre jours­97 ans. Au total, 1258 (48,0 %) étaient symptomatiques, tandis qu'en 2056(78,4 %) et 567 (21,6 %) ont présenté une maladie bénigne et grave,respectivement. Toux (22,0 %), fièvre (17,3 %) et essoufflement(12,3 %) étaient les symptômes les plus courants à la présentation.En général, la durée médiane du séjour à l'hôpital était de 11 (IQR 9, 14)Jours. Au total, 1609 (61,3 %) ont eu une durée prolongée d'hospitalisation rester. Les chances de séjour prolongé à l'hôpital étaient plus élevées chezpatients âgés (AOR 12,1 IC à 95 % 7,6­19,4, p<0,001), hommes (AOR1,2 IC à 95 % 1,0 à 1,4, p = 0,031) et patients atteints d'une maladie grave(AOR 1,3 IC à 95 % 1,0­1,7, p = 0,042). Âge, hypertension et l'essoufflement a apporté la contribution la plus significative à prédire la durée du séjour à l'hôpital (P<0,05). CONCLUSION: Âge, sexe, hypertension et essoufflement prédit la durée du séjour à l'hôpital. Des mesures proactives devraient être institués dans la prise en charge des patients atteints de LA COVID-19. Mots-clés: COVID-19, présentation clinique, durée de l'hôpitalrester, Lagos.

Isolation, Characterization, Complete Structural Assignment, and Anticancer Activities of the Methoxylated Flavonoids from Rhamnus disperma Roots.

Different chromatographic methods including reversed-phase HPLC led to the isolation and purification of three O-methylated flavonoids; 5,4'-dihydroxy-3,6,7-tri-O-methyl flavone (penduletin) (1), 5,3'-dihydroxy-3,6,7,4',5'-penta-O-methyl flavone (2), and 5-hydroxy-3,6,7,3',4',5'-hexa-O-methyl flavone (3) from Rhamnus disperma roots. Additionlly, four flavonoid glycosides; kampferol 7-O-α-L-rhamnopyranoside (4), isorhamnetin-3-O-ß-D-glucopyranoside (5), quercetin 7-O-α-L-rhamnopyranoside (6), and kampferol 3, 7-di-O-α-L-rhamnopyranoside (7) along with benzyl-O-ß-D-glucopyranoside (8) were successfully isolated. Complete structure characterization of these compounds was assigned based on NMR spectroscopic data, MS analyses, and comparison with the literature. The O-methyl protons and carbons of the three O-methylated flavonoids (1-3) were unambiguously assigned based on 2D NMR data. The occurrence of compounds 1, 4, 5, and 8 in Rhamnus disperma is was reported here for the first time. Compound 3 was acetylated at 5-OH position to give 5-O-acetyl-3,6,7,3',4',5'-hexa-O-methyl flavone (9). Compound 1 exhibited the highest cytotoxic activity against MCF 7, A2780, and HT29 cancer cell lines with IC50 values at 2.17 µM, 0.53 µM, and 2.16 µM, respectively, and was 2-9 folds more selective against tested cancer cell lines compared to the normal human fetal lung fibroblasts (MRC5). It also doubled MCF 7 apoptotic populations and caused G1 cell cycle arrest. The acetylated compound 9 exhibited cytotoxic activity against MCF 7 and HT29 cancer cell lines with IC50 values at 2.19 µM and 3.18 µM, respectively, and was 6-8 folds more cytotoxic to tested cancer cell lines compared to the MRC5 cells.

Inhibition of cell-intrinsic NF-κB activity and metastatic abilities of breast cancer by aloe-emodin and emodic-acid isolated from Asphodelus microcarpus.

Anthraquinones are a major class of compounds naturally occurring in Asphodelus microcarpus. The pharmacological actions of anthraquinones in cancer cells are known to induce apoptosis or autophagy, and revert multidrug resistance. In this study, five anthraquinone-type analogs were isolated from the methanol extract of A. microcarpus leaves and identified as, emodin, rhein, physcion, aloe-emodin, and emodic acid. Among them, aloe-emodin and emodic-acid strongly inhibited the proliferation, cells-intrinsic NF-κB activity and metastatic ability of breast cancer. Although aloe-emodin inhibited p38 and ERK phosphorylation, emodic-acid more markedly inhibited JNK, in addition to p38 and ERK phosphorylation. Both aloe-emodin and emodic-acid inhibited the secretion of the pro-tumorigenic cytokines IL-1ß and IL-6, and VEGF and MMP expression, and subsequently inhibited the invasive and migratory potential of 4T1 cells. Thus, our study demonstrated the effects of aloe-emodin and emodin-acid in controlling the migratory and invasive ability of 4T1 breast cancer cells, in addition to inhibiting NF-κB activity and the expression of its downstream target molecules.

Descriptive epidemiology of coronavirus disease 2019 in Nigeria, 27 February-6 June 2020.

The objective of this study was to describe the epidemiology of COVID-19 in Nigeria with a view of generating evidence to enhance planning and response strategies. A national surveillance dataset between 27 February and 6 June 2020 was retrospectively analysed, with confirmatory testing for COVID-19 done by real-time polymerase chain reaction (RT-PCR). The primary outcomes were cumulative incidence (CI) and case fatality (CF). A total of 40 926 persons (67% of total 60 839) had complete records of RT-PCR test across 35 states and the Federal Capital Territory, 12 289 (30.0%) of whom were confirmed COVID-19 cases. Of those confirmed cases, 3467 (28.2%) had complete records of clinical outcome (alive or dead), 342 (9.9%) of which died. The overall CI and CF were 5.6 per 100 000 population and 2.8%, respectively. The highest proportion of COVID-19 cases and deaths were recorded in persons aged 31-40 years (25.5%) and 61-70 years (26.6%), respectively; and males accounted for a higher proportion of confirmed cases (65.8%) and deaths (79.0%). Sixty-six per cent of confirmed COVID-19 cases were asymptomatic at diagnosis. In conclusion, this paper has provided an insight into the early epidemiology of COVID-19 in Nigeria, which could be useful for contextualising public health planning.

Prevalence of prediabetes in secondary school students in Port Harcourt, Nigeria

This study aimed to assess the prevalence of prediabetes using impaired fasting glucose (IFG) in secondary school students aged 10 to 19 years in Port Harcourt; Nigeria; and to determine associated risk factors. Fasting blood glucose (FBG); blood pressure (BP); and body mass index (BMI) was measured. All students who had a FBG of 5.6 - 6.9mmol/l were asked to undergo an oral glucose tolerance test (OGTT). A total of 880 students were studied. The prevalence of IFG using the International Society for Paediatric and Adolescent Diabetes (ISPAD) criteria was 17% and prevalence was comparatively higher in subjects who were obese; had systolic prehypertension or diastolic hypertension; as well as a family history of diabetes. There was; however; no statistical association between the BMI percentile categories; BP category; sex and age category; or family history of diabetes and occurrence of IFG. The prevalence of IFG was 4% using the World Health Organization (WHO) criteria. Only one child had diabetes. Sixty-six (42%) students who had IFG had an OGTT; of which 10(15%) had IGT. We conclude that prediabetes is common in this population; and screening should be considered; at least in those with obesity or a family history in diabetes

A new flavan-3-ol dimer from Ficus spragueana leaves and its cytotoxic activity.

BACKGROUND: Isolation and structure elucidation of flavan-3-ol constituents from the leaves of Ficus spragueana and their cytotoxic activity. MATERIALS AND METHODS: Different open silica gel column chromatographic techniques with different solvent systems were used for the separation of the constituents of the ethyl acetate-soluble fraction of the alcoholic extract of Ficus spragueana leaves. The structures of these compounds were assigned on the basis of spectroscopic analyses and comparison with literature data. MTT colorimetric assay method (Viability assay) was used for the evaluation of cytotoxic activity of compound 1 against human breast cancer (MCF-7) and human liver cancer (HepG2) cell lines. RESULTS: The isolation of one flavan-3-ol dimer and was identified as (-)-afzelechin-(4α→8)-epicatechin 1, and two flavan-3-ol monomers and were identified as (-)-epiafzelechin 2 and (-)-epicatechin 3. Compound 1 was relatively inactive against human breast cancer (MCF-7) cell line at the tested concentrations as compared with the standard. However, at a concentration (50 ΅g) it was found to give inhibition upon the proliferation of examined human liver (HepG2) tumor cell line. CONCLUSIONS: Compound 1 is a new flavan-3-ol dimer and it showed a potent cytotoxic activity against human liver (HepG2) tumor cell line.

Follicular turnover and hormonal association in postpartum goats during early and late lactation.

To clarify the effect of lactation period on ovarian follicular activity and associated hormonal levels in goats, six goats were monitored daily by ultrasonographic examination with blood sampling during early (Days 5 to 25; Day 0 was the day of kidding) and late (Days 40 to 60) lactation. While the presence of a corpus luteum of pregnancy retarded follicular growth in the ipsilateral ovary until Days 11-13 postpartum, the total follicular number (TFN) and area (TFA) increased during late lactation due to the significant increase in the number of medium- and large-sized follicles and decrease in the number of small follicles. Four goats showed a similar pattern of follicular development during the period studied characterized by the emergence of five and six waves during the early and late lactation, respectively. The largest follicle diameter of the first three waves monitored during early lactation was significantly smaller as compared with the diameter of those existing during late lactation. TFN showed a positive correlation with FSH but showed a negative correlation with immunoreactive (ir-) inhibin and estradiol during the postpartum period. TFA was positively correlated with ir-inhibin, estradiol and PRL and negatively correlated with FSH during the monitored periods. The plasma levels of ir-inhibin and progesterone were significantly higher during late lactation compared with the levels recorded during early lactation. Ir-inhibin levels showed a significant positive correlation with LH and estradiol during early and late lactation but showed a negative correlation with FSH during the whole lactation period. LH was positively correlated with estradiol and PRL during early and late lactation, respectively. These results suggest that the lactation period has a detrimental effect on ovarian activity during the early postpartum period in goats.

Eculizumab induces long-term remission in recurrent post-transplant HUS associated with C3 gene mutation.

A 15-year-old male patient developed atypical hemolytic uremic syndrome (aHUS) at 16 months of age leading to end-stage renal disease. The family history was suggestive of autosomal dominant aHUS, and he was more recently found to have a C3 heterozygous gene mutation (1835C>T mutation in exon 14, which determines the amino-acidic substitution R570W) with no other complement abnormalities. He had two renal transplants, the first at 2.5 years, and the second at 8 years of age, but allograft dysfunction developed in both transplants leading to graft failure due to recurrent HUS at 5 years and 18 months post-transplantation respectively. At 15 years of age he received a third transplant from a deceased donor with pre-emptive plasmapheresis. He had immediate graft function and nadir serum creatinine was 1.3-1.4 mg/dl. Severe allograft dysfunction and hypertension developed 2 months after transplantation following influenza infection. Renal allograft biopsy showed thrombotic microangiopathy. He received plasmapheresis followed by eculizumab therapy. Allograft function returned to baseline 3 weeks after starting therapy, and post-treatment allograft biopsies showed improvement in thrombotic microangiopathy. He continues to receive eculizumab every 2 weeks with stable graft function 13 months after transplantation.

Ovarian follicular dynamics and hormonal changes in goats during early pregnancy.

The present study was conducted to characterize follicular development and its hormonal control during early pregnancy in goats. The ovaries of goats (n=8) were scanned daily for follicles (> or = 2 mm in diameter) and corpora lutea by transrectal ultrasound with blood sampling from the jugular vein for monitoring the hormonal changes during the first thirty-five days after mating. During early pregnancy, three (37.5%), four (50%) and one (12.5%) goat showed nine, eight and seven waves of follicular development, respectively. The corpora lutea were detected as early as Day 3.61 ± 0.45 (7.47 ± 0.43 mm) of pregnancy (Day 0=day of mating) and attained their maximal cross-sectional diameter (10.64 ± 0.37 mm) on Day 25.7 ± 0.8 of pregnancy, respectively. A transient rise in FSH levels was temporally associated with the day of follicular wave emergence (up to three days prior to wave emergence). The plasma LH and estradiol levels were negatively correlated with the progesterone concentration. The rise in plasma immunoreactive (ir) inhibin levels was negatively correlated with the FSH concentration and positively correlated with the number of large-sized follicles. Alternatively, the mean plasma ir-inhibin levels showed a noticeable decline with the progression of pregnancy. The present results demonstrated that follicular development during early pregnancy shows a wave-like pattern, with seven to nine waves developing until Day 35 after breeding, and that the number of follicular waves can be predicted by the number of FSH peaks. The current study also demonstrated that the role of inhibin as an FSH regulator is maintained throughout early pregnancy.

Profiles of circulating steroid hormones, gonadotropins, immunoreactive inhibin and prolactin during pregnancy in goats and immunolocalization of inhibin subunits, steroidogenic enzymes and prolactin in the corpus luteum and placenta.

The current study was performed to follow up the circulating hormonal changes and to correlate the findings with the physiological activity of the corpus luteum (CL) and placenta during pregnancy in goats. Blood samples were collected weekly from five goats during pregnancy for measuring steroid and protein hormones. A gradual increase was observed in immunoreactive (ir-) inhibin, with maximal levels at the 17th week. The plasma concentrations of estradiol and prolactin (PRL) showed nearly similar patterns during pregnancy, where they declined to basal levels during the first 4 weeks post-breeding and then increased significantly, with the maximal concentration during late pregnancy. The plasma FSH and LH concentrations were maintained at basal levels throughout the gestation period. The plasma progesterone concentration abruptly increased in the first week post-breeding and remained at high values throughout the pregnancy period. Immunohistochemical localization of inhibin alpha, beta(A), beta(B) and steroidogenic enzymes cytochrome P450 aromatase, 3alpha-hydroxysteroid dehydrogenase (3betaHSD), cytochrome 17alpha-hydroxylase P450 and cholesterol side-chain cleavage cytochrome P450 in the cyclic and pregnant goat CL revealed positive immunoreactivity without affinity differences between the luteal and pregnancy stages. The placental syncytiotrophoblasts also showed positive staining, except for inhibin beta(A) and 3betaHSD. The giant binucleate cells of the placenta showed positive immunoreactions to PRL. These results suggest that the high concentrations of ir-inhibin, estradiol and PRL during late pregnancy are of placental origin and that the placenta may have a vital role in the maintenance of pregnancy, regulation of mammary growth and preparation for kidding and lactation in goats.

Serum levels of epidermal growth factor and HER-2 neu in non small-cell lung cancer: prognostic correlation.

Lung cancer is still a leading cause of cancer related mortality all over the world with the majority of cases are discovered at a late stage. Various panels of molecular prognostic markers are being studied to map the association of these markers with response and survival. The aim of this study is to study levels of epidermal growth factor receptor (EGFR), HER-2 neu in both serum and bronchoalveolar lavage (BAL) in patients with non small-cell lung cancer (NSCLC), correlate their levels with clinical, pathological characters as well as prognosis. A total of 30 patients with pathologically proven NSCLC were enrolled in this study in addition to ten normal controls subjects and ten cases with benign pulmonary diseases as broncheicatsis, chronic obstructive pulmonary disease. Results revealed significantly increased levels of EGFR and HER-2 neu in both serum and bronco-alveolar lavage compared with controls. The levels were significantly higher in those with stages III, IV compared with I, II, and in those with higher grades of the tumor. There was no statistically significant correlation with performance status or survival. In conclusion, serum measurement of these markers is a promising noninvasive technique which needs correlation with other methods of determination, measurement at different chronological points during disease evolution to explore its full potential. Standardization of techniques for determination of EGFR and HER-2 neu over-expression must become a priority in future studies that should also include larger number of patients, conducted in a prospective manner together with comparisons of various methods and correlation of protein expression with gene copy numbers.

Infliximab therapy for HIV positive Crohn's disease: A case report.

Anti-TNF-alpha is now established as a major player in the treatment of Crohn's disease, however the use of anti-TNF-alpha therapy in patients concomitantly having HIV infection and Crohn's disease is a relatively unexplored subject. There is generally some apprehension and anxiety to use infliximab in patients with HIV. One case has been reported in literature of usage of anti-TNF-alpha in HIV positive patient with Crohn's disease who was on anti-retroviral therapy. We report for the first time the successful usage of infliximab in treating Crohn's disease in an HIV positive patient who is not on any anti-retroviral treatment.

Physiological roles of inhibin in regulation of FSH secretion and follicular development during early pregnancy in goats.

The aim of the current study was to clarify the physiological role of inhibin in controlling FSH secretion and follicular development during the early pregnancy in goats. Eight goats investigated sonographically on Days 19-21 (Day 0=day of mating) for pregnancy were assigned into control (n=3) and treated (n=5) groups. The ovaries of all animals were daily scanned with ultrasound for follicles 2mm or more in diameter from 1 day before to 5 days after treatment. On Day 25 postbreeding; animals received either 10 ml, of normal goat serum or antiserum against [Tyr (30)]-inhibin alpha (1-30). Jugular blood samples were collected every 6 h starting 24 h before and until 120 h after treatment. The plasma concentration of FSH increased at 6 h and remained at significantly high levels until 120 h in treated vs. control group. The plasma concentrations of estradiol showed a marked increased at 66 h, with peak levels at 120 h after treatment of antiserum. The basal concentrations of LH and the pattern of plasma concentrations of progesterone were not significantly different between the two groups. The number of medium size (3.5-5.0 mm) follicles increased considerably from Day 2, whereas small (3.5 mm or less) and large (5 mm or more) follicles increased noticeably from Day 3, as compared with pre-treatment and controls. These results clearly indicated that inhibin is a key hormone in regulation of follicular development through regulation of endogenous FSH secretion during early pregnancy in goats.

Lipoblastoma in a four-year-old African child.

A four-year old Sudanese child presented with a growing mass in the medial aspect of the right thigh. The mass appeared during the neonatal period. On clinical examination a diagnosis of lipoblastoma was entertained on the basis of the patient's age and the clinical features of the mass. The tumor was completely excised surgically. The clinical diagnosis of lipoblastoma was confirmed pathologically. Follow-up of the patient for 6 months postoperatively showed no evidence of recurrence.

Laparoscopic cholecystectomy in the Academy Medical Centre, Khartoum, Sudan.

OBJECTIVE: To highlight the results of minimum access surgery in Sudanese patients. DESIGN: Prospective audit of laparoscopic cholecystectomies. SETTING: The Academy Medical center (Yastabshiroon), Teaching University Hospital. SUBJECTS: All the patients who had this type of surgery were included in the study. Clinical and operative data were evacuated from March 2002 to March 2004. MAIN OUTCOME MEASURES: One hundred and twenty patients had laparoscopic cholecystectomy at the center. There were 97 females and 23 males; age range was 22-90 years with a mean of 52 years. Indications for surgery were repeated attacks of biliary colic in 38, chronic cholecystitis in 60, acute cholecystis in 10 and mucocele in 12 patients. RESULTS: Three patients with chronic cholecystitis had peri-portal fibrosis due to bilharzial infestations, in spite of which laparoscopic surgery was successful. Operating time was 25-120 minutes with a mean of 47 minutes. Conversion was performed in six (2%) patients because of bleeding and four for extensive dense adhesions. There was one mortality case of a 75-year-old female who had pulmonary embolus. Hospital stay was 16-24 hours with a mean of 22 hours. Two patients had port site discharge. CONCLUSION: In general, patients were satisfied with the results of surgery and this encourages us to popularise this procedure to take off in the Sudan.

Cephalosporin-induced nonconvulsive status epilepticus in a uremic child.

The temporal relationship between convulsive seizures and the administration of beta-lactams has long been recognized. A specific form of seizures, nonconvulsive status epilepticus, is less common and is often manifested by alterations in mental status without associated seizures. It is most commonly encountered in uremic patients and poses a diagnostic challenge because of its nonspecific clinical manifestations. In this report, we describe a child with chronic renal failure who developed nonconvulsive status epilepticus on two separate occasions after administration of a third-generation cephalosporin. Awareness of this potentially treatable condition is crucial to ensure appropriate and prompt medical therapy. To our knowledge, this is the first report of cephalosporin-induced nonconvulsive status epilepticus in a child with chronic renal failure.

Regression of primary high-grade gastric B-cell lymphoma following Helicobacter pylori eradication.

The causative association between Helicobacter pylori and gastric mucosal inflammation is well established. The inflammatory process leads to the acquisition of mucosa-associated lymphoid tissue (MALT) by the stomach. Evidence links H. pylori gastritis with the development of low-grade primary gastric lymphoma with a phenotype specific for lymphoma of MALT type. It is now accepted that primary low-grade MALT lymphomas regress with H. pylori eradication therapy. However, the response of primary, diffuse, large-cell gastric lymphoma to H. pylori eradication therapy is still not established. We report a case of a primary high-grade gastric lymphoma regressing after H. pylori eradication therapy.