Psoralea forbesiae (Psoraleeae, Fabaceae), a new species from the Swartberg Mountains of South Africa

Psoralea forbesiae C.H.Stirt., A.Bello & Muasya is a new species of Psoraleeae, Fabaceae. Psoralea forbesiae is endemic to the Swartberg Mountains and is a tall densely branched re-sprouting shrub up to 2.5 m, with bluish-green stems and with most parts covered in small crater-like glands, leaves pinnately 3-foliolate, linear-oblong, pale bluish-green, semi-conduplicate, somewhat succulent, glabrous, crowded at the end of bare branches on older stems or distributed along short branches on young shoots, petiolate. A description of P. forbesiae, together with photographs and a distribution map are presented.

Assessment of nivolumab benefit-risk profile of a 240-mg flat dose relative to a 3-mg/kg dosing regimen in patients with advanced tumors

Background

Nivolumab 3 mg/kg every 2 weeks (Q2W) has shown benefit versus the standard of care in melanoma, non-small cell lung cancer (NSCLC), and renal cell carcinoma (RCC). However, flat dosing is expected to shorten preparation time and improve ease of administration. With knowledge of nivolumab safety, efficacy, and pharmacokinetics across a wide dose range in body weight (BW) dosing, assessment of the benefit–risk profile of a 240-mg flat dose relative to the approved 3-mg/kg dose was approached by quantitative clinical pharmacology.

Patients and methods

A flat dose of 240 mg was selected based on its equivalence to the 3-mg/kg dose at the median BW of ∼80 kg in patients in the nivolumab program. The benefit–risk profile of nivolumab 240 mg was evaluated by comparing exposures at 3 mg/kg Q2W and 240 mg Q2W across BW and tumor types; clinical safety at 3 mg/kg Q2W by BW and exposure quartiles in melanoma, NSCLC, and RCC; and safety and efficacy at 240 mg Q2W relative to 3 mg/kg Q2W in melanoma, NSCLC, and RCC.

Results

The median nivolumab exposure and its distribution at 240 mg Q2W were similar to 3 mg/kg Q2W in the simulated population. Safety analyses did not demonstrate a clinically meaningful relationship between BW or nivolumab exposure quartiles and frequency or severity of adverse events. The predicted safety and efficacy were similar across nivolumab exposure ranges achieved with 3 mg/kg Q2W or 240 mg Q2W flat dose.

Conclusion

Based on population pharmacokinetic modeling, established flat exposure–response relationships for efficacy and safety, and clinical safety, the benefit–risk profile of nivolumab 240 mg Q2W was comparable to 3 mg/kg Q2W. The quantitative clinical pharmacology approach provided evidence for regulatory decision-making on dose modification, obviating the need for an independent clinical study.

Investigation into diseases in free-ranging ring-necked pheasants (Phasianus colchicus) in northwestern Germany during population decline with special reference to infectious pathogens

The population of ring-necked pheasants (Phasianus colchicus) is decreasing all over Germany since the years 2008/2009. Besides impacts of habitat changes caused by current rates of land conversion, climatic influences or predators, a contribution of infectious pathogens needs also to be considered. Infectious and non-infectious diseases in free-living populations of ring-necked pheasants have been scarcely investigated so far. In the present study, carcasses of 258 deceased free-ranging pheasants of different age groups, predominantly adult pheasants, collected over a period of 4 years in the states of Lower Saxony, North Rhine–Westphalia and Schleswig-Holstein, were examined pathomorphologically, parasitologically, virologically and bacteriologically, with a focus set on infectious pathogens. A periocular and perinasal dermatitis of unknown origin was present in 62.3% of the pheasants. Additional alterations included protozoal cysts in the skeletal musculature (19.0%), hepatitis (21.7%), enteritis (18.7%), gastritis (12.6%), and pneumonia (11.7%). In single cases, neoplasms (2.6%) and mycobacteriosis (1.7%) occurred. Further findings included identification of coronaviral DNA from trachea or caecal tonsils (16.8%), siadenoviral DNA (7.6%), avian metapneumoviral RNA (6.6%), and infectious bursal disease viral RNA (3.7%). Polymerase chain reaction (PCR) on herpesvirus, avian influenza virus (AIV), paramyxovirus type 1 (PMV-1), avian encephalomyelitis virus (AEV), and chlamydia were negative. Based on the present results, there is no indication of a specific pathogen as a sole cause for population decline in adult pheasants. However, an infectious disease can still not be completely excluded as it may only affect reproduction effectivity or a certain age group of pheasants (e.g., chicks) which were not presented in the study.

Ultrasound guided percutaneous nephrostomy: Experience at ahmadu bello university teaching hospital, Zaria

BACKGROUND

Obstructive uropathy is a common problem in urologic practice; temporary relief of obstruction in the upper tract poses a significant challenge. Ultrasound-guided percutaneous nephrostomy (PCN) is an option for upper tract drainage; compared to fluoroscopic guidance, it is readily available, affordable, and not associated with radiation exposure. We present our experience with ultrasound-guided PCN.

PATIENTS AND METHODS

We studied all patients who had ultrasound-guided PCN in our center between January 2013 and January 2017. Information obtained included the patients' demographics, clinical details, primary pathology, indications, outcome, and complications within 30 days. Relevant data were extracted and analyzed using descriptive statistics.

RESULTS

A total number of 35 PCNs were performed in 26 patients within the period of study. The median age was 44.5 years. There were 17 females and 9 males. About 88.2% of the females had ureteric obstruction from advanced carcinoma of the cervix while the predominant cause of obstruction in the males was advanced carcinoma of the bladder. Kidney access under ultrasound guidance required well dilated collecting systems for success and ease of puncture. The most common complication was hematuria, which resolved within 24-48 h in all patients uneventfully.

CONCLUSION

PCN is an important and common procedure for temporary relief of upper urinary tract obstruction. While fluoroscopic guidance provides superior image guidance, ultrasound guidance is comparatively reliable, albeit with a longer learning curve. Adequate training, careful patients selection, and patience are key to success.

Self-perceived seizure precipitants among patients with epilepsy in Middle-belt of Nigeria

AIM

Patient's perception of seizure precipitant is crucial in epilepsy management, but it is often overlooked by physicians. This may be due to neglect and underestimation of its importance. This study looked at frequency and nature of self-perceived seizure precipitants among patients with epilepsy.

MATERIALS AND METHODS

A close-ended questionnaire-based study. Patients with active epilepsy (≥2 attacks/year) were recruited from the neurology clinic of the University of Ilorin Teaching Hospital (UITH), Ilorin.

RESULT

A total of 89 patients participated in the study and of these 41 (46.1%) were males. Their median age was 30 (21-52) years and median age at seizure onset was 22 (15-46) years. The median seizure duration was five (2-14) years. More patients (46.1%) had less than secondary school education and 12 (13.5) were uneducated. Generalized epilepsy was the predominant (68.6%) seizure type. A total of 33 (37.1%) subjects had ≥4 attacks/year, 29 (32.6%) had 5-12 attacks/year, and 27 (30.3%) >12 attacks/year. A total of 16 (18%) subjects did not mention any seizure precipitant, whereas 73 (82.2%) reported at least one specific seizure precipitant; of these, 62 (85%) patients reported ≥2 precipitants. Stress (41%), inadequate sleep (27%), and head trauma (26%) were the three leading seizure precipitants mentioned. Subject's age, sex, level of seizure control, and place of abode did not influence reported seizure precipitants. However, the more educated (>12 years education) patients significantly reported stress as seizure precipitant (P < 0.05). Most (80%) patients rightly indicated that antiepileptic drug was the best treatment for their seizure control.

CONCLUSION

The result of this study showed that the leading perceived seizure precipitants among epilepsy patients attending the neurology clinic of UITH were stress, inadequate sleep, head trauma, and demonic attacks and spells.

Testing the reliability of standard and complementary DNA barcodes for the monocot subfamily Alooideae from South Africa

Although a standard DNA barcode has been identified for plants, it does not always provide species-level specimen identifications for investigating important ecological questions. In this study, we assessed the species-level discriminatory power of standard (rbcLa + matK) and complementary barcodes (ITS1 and trnH-psbA) within the subfamily Alooideae (Asphodelaceae), a large and recent plant radiation, whose species are important in horticulture yet are threatened. Alooideae has its centre of endemism in southern Africa, with some outlier species occurring elsewhere in Africa and Madagascar. We sampled 360 specimens representing 235 species within all 11 genera of the subfamily. With three distance-based methods, all markers performed poorly for our combined data set, with the highest proportion of correct species-level specimen identifications (30%) found for ITS1. However, when performance was assessed across genera, the discriminatory power varied from 0% for all single markers and combinations in Gasteria to 63% in Haworthiopsis, again for ITS1, suggesting that DNA barcoding success may be related to the evolutionary history of the lineage considered. Although ITS1 could be a good barcode for Haworthiopsis, the generally poor performance of all markers suggests that Alooideae remains a challenge. As species boundaries within Alooideae remain controversial, we call for continued search for suitable markers or the use of genomics approaches to further explore species discrimination in the group.

Electrochemical performance of polypyrrole derived porous activated carbon-based symmetric supercapacitors in various electrolytes

The electrochemical performance of porous carbon prepared from the polymerization and carbonization of pyrrole is presented in this work.

A wafer-scale Bernal-stacked bilayer graphene film obtained on a dilute Cu (0.61 at% Ni) foil using atmospheric pressure chemical vapour deposition

A wafer-scale (scale of an entire foil) AB-stacked bilayer graphene film obtained on a dilute Cu(Ni) foil using AP-CVD.

Exploring the stability and electronic structure of beryllium and sulphur co-doped graphene: a first principles study

First principles density functional theory calculations have been performed to explore the stability, structural and electronic properties of Be and S co-doped graphene sheets.

DNA barcodes reveal microevolutionary signals in fire response trait in two legume genera

Large-scale DNA barcoding provides a new technique for species identification and evaluation of relationships across various levels (populations and species) and may reveal fundamental processes in recently diverged species. Here, we analysed DNA sequence variation in the recently diverged legumes from the Psoraleeae (Fabaceae) occurring in the Cape Floristic Region (CFR) of southern Africa to test the utility of DNA barcodes in species identification and discrimination. We further explored the phylogenetic signal on fire response trait (reseeding and resprouting) at species and generic levels. We showed that Psoraleoid legumes of the CFR exhibit a barcoding gap yielding the combination of matK and rbcLa (matK + rbcLa) data set as a better barcode than single regions. We found a high score (100 %) of correct identification of individuals to their respective genera but a very low score (<50 %) in identifying them to species. We found a considerable match (54 %) between genetic species and morphologically delimited species. We also found that different lineages showed a weak but significant phylogenetic conservatism in their response to fire as reseeders or resprouters, with more clustering of resprouters than would be expected by chance. These novel microevolutionary patterns might be acting continuously over time to produce multi-scale regularities of biodiversity. This study provides the first insight into the DNA barcoding campaign of land plants in species identification and detection of the phylogenetic signal in recently diverged lineages of the CFR.

The Impact of an educational intervention on knowledge of attention-deficit hyperactivity disorder among primary school teachers in Lagos Nigeria

Objective: Primary school teachers have been identified as important partners in the prompt recognition, referral and management of children with ADHD. However their capacity to function in these roles is hinged on their extent of knowledge about ADHD. Furthermore teachers' knowledge about ADHD may influence the education and clinical outcomes of children with ADHD. This study assessed the impact of an educational intervention program on knowledge about ADHD among primary school teachers in Lagos, Nigeria. Method: An experimental study of the impact of a brief educational intervention on ADHD literacy among primary school teachers (n=144) in Lagos, Nigeria. At baseline, knowledge about symptoms and treatment of ADHD was elicited with a vignette-based questionnaire. The intervention consisted of the administration of an educational leaflet about ADHD, designed by the American Academy of Child and Adolescent Psychiatry. One week post-intervention, the baseline assessments were repeated. Results: At baseline, 92.4% of the teachers could not recognise features of ADHD. The majority were also unaware of the role of teachers, medications and psychological interventions in the management of children with ADHD. Post-intervention, significantly greater number of respondents compared with baseline (88.0% vs. 7.6%) correctly identified symptoms of ADHD (p<0.005), and agreed that ADHD could be successfully managed with medications (63.2% vs. 9.0%; p<0.005) and psychological treatment (79.2% vs. 16.7%; p<0.005). Conclusion: A simple low-cost educational intervention is effective in improving knowledge about ADHD among primary school teachers in the shortterm. Further research is required to evaluate the impact of this intervention in the long term.

Psoraleaditurnerae and P.vanberkelae (Psoraleeae, Fabaceae): two new species restricted to the Core Cape Region of South Africa

Two new species of Psoralea L. are described: Psoraleaditurnerae A. Bello, C.H. Stirt. & Muasya, sp. nov. and Psoraleavanberkelae C.H. Stirt., A. Bello & Muasya, sp. nov. Psoraleaditurnerae is endemic to the Outeniqua mountains (Camferskloof) and is characterised by a mass of numerous basal shoots out of which emerge 2-3 woody stems up to 2 m tall, 3-foliolate needle-like leaflets at the base of the seasonally growing shoot reducing to one towards the apex and bearing numerous 1-3-flowered axillary inflorescences along its length; each mauve to purple and white flower subtended by a trifid cupulum. Psoraleavanberkelae is characterised by its spreading mounding habit, short tightly packed fleshy leaves, with large impressed papillae, densely glandular short broadly triangular stipules, pale to intense mauve to deep blue flowers, standard with a dark purple central blotch above a M-shaped white patch situated above claw, and khaki seeds with purple flecks.

Asymmetric supercapacitor based on an α-MoO3 cathode and porous activated carbon anode materials

Low cost porous carbon materials were produced from cheap polymer materials and graphene foam materials which were tested as a negative electrode material in an asymmetric cell configuration with α-MoO₃ as a positive electrode.

Investigation of different aqueous electrolytes on the electrochemical performance of activated carbon-based supercapacitors

Porous activated carbons was synthesized by an environmentally friendly technique, with an in-depth experimental study carried out to understand the electrochemical behaviour in different aqueous electrolytes (KOH, LiCl, and Na₂SO₄).

An additional strip of mesh minimizes hernia recurrence after laparoscopic totally extraperitoneal (TEP) inguinal hernia repair. An analysis of 490 cases over 10 years

AIM

The laparoscopic inguinal hernia repair has gained significant interest over the years as an alternative to the conventional open technique as a result of its faster recovery time, reduced postoperative pain and numbness. However the recurrence rates are in the order of 2.3% compared to the 1.3% quoted for the equivalent open approach. Much of these recurrences occur either caudal to the fold created in the mesh once in-situ or lateral to the border of the mesh. This technique aims to address both these areas of concern using an additional strip of mesh across the centre to brace the mesh and create a bolster to maintain mesh stability.

METHODS

The technique involves cutting a 2 cm strip from the 15x15 cm mesh which is laid length-ways over the remaining 13x15 cm mesh, keeping the longest dimension in the medial to lateral plane, and loosely tacked. The strip over hangs the lateral border of the mesh to control the lateral space. Recurrence rates were evaluated from a prospectively collected data series as well as outcomes collected from a questionnaire over a 10 year period between January 2001 and October 2011. Primary outcomes were confirmed hernia recurrence requiring surgical repair.

RESULTS

Four hundred ninety-one patients underwent laparoscopic totally extraperitoneal (TEP) hernia repair with outcomes including recurrence rates were retrospectively examined through a prospectively collected database. Subsequently 400 patients were sent a validated questionnaire. 246 responded (62% response rate). One recurrence (0.3%), which occurred 4 years after the original laparoscopic repair, was described across the series.

CONCLUSION

The use of the additional mesh strip potentially reduces TEP hernia recurrence rates beyond simply the benefits of the learning curve. Although, questionnaires are notoriously inaccurate, the value and consistency between both evaluation techniques suggests that this level of reduction is significant to warrant further prospective trials.

Nouns and predicates comprehension and production in children with Down syndrome

Our study investigated the lexical comprehension and production abilities as well as gestural production taking into account different lexical categories, namely nouns and predicates. Fourteen children with DS (34 months of developmental age) and a comparison group of 14 typically developing children (TD) matched for gender and developmental age were assessed through a test of lexical comprehension and production (PiNG) and the Italian MB-CDI. Children with DS showed a general weakness in lexical comprehension and production that appeared more evident when the lexicon was assessed through a structured test such as the PiNG that requires general cognitive skills that are impaired in children with DS. As for the composition of the lexical repertoire, for both groups of children, nouns are understood and produced in higher percentages compared to predicates. Children with DS produced more representational gestures than TD children in the comprehension tasks and above all with predicates; on the contrary, both groups of children exhibited the same number of gestures on the MB-CDI and during the subtests of PiNG production. Children with DS produced more unimodal gestural answers than the control group. Theoretical implications of these results are discussed.

Profiles and experiences of women undergoing genital fistula repair: findings from five countries

This article presents data from 1354 women from five countries who participated in a prospective cohort study conducted between 2007 and 2010. Women undergoing surgery for fistula repair were interviewed at the time of admission, discharge, and at a 3-month follow-up visit. While women's experiences differed across countries, a similar picture emerges across countries: women married young, most were married at the time of admission, had little education, and for many, the fistula occurred after the first pregnancy. Median age at the time of fistula occurrence was 20.0 years (interquartile range 17.3–26.8). Half of the women attended some antenatal care (ANC); among those who attended ANC, less than 50% recalled being told about signs of pregnancy complications. At follow-up, most women (even those who were not dry) reported improvements in many aspects of social life, however, reported improvements varied by repair outcome. Prevention and treatment programmes need to recognise the supportive role that husbands, partners, and families play as women prepare for safe delivery. Effective treatment and support programmes are needed for women who remain incontinent after surgery.

Rapid and complete decompression of chronic urinary retention: a safe and effective practice

We carried out a prospective study of consecutive patients who presented with chronic urinary retention over a period of 2 years in order to determine the safety and effectiveness of rapid and complete decompression of chronic urinary retention. A total of 22 patients met the inclusion criteria. Although slow decompression is thought to reduce complications, it harbours the disadvantages of impracticability, time and labour demands and an increased risk of infection. Post-obstructive diuresis, haematuria and hypotension are relatively frequent in rapid and complete decompression of chronic urinary retention. However, they are mild, transient and clinically insignificant. Rapid and complete decompression of the chronically obstructed urinary bladder not only saves time, it is safe and effective and should be adopted as the standard practice.

Assessing lexicon: validation and developmental data of the Picture Naming Game (PiNG), a new picture naming task for toddlers

BACKGROUND

Understanding lexical abilities in infants and toddlers is important, yet no single tool can be used.

AIMS

To perform a validation of a new tool (known as the Picture Naming Game, or 'PiNG') for assessing lexical comprehension and production in toddlers and to obtain developmental trends for Italian children.

METHODS & PROCEDURES

PiNG consists of four subtests: Noun Comprehension (NC), Noun Production (NP), Predicate Comprehension (PC) and Predicate Production (PP), each containing 20 lexical targets. It was administered to 388 children with typical development aged 19-37 months. The short form of the Italian version of the MacArthur-Bates Communicative Development Inventories (MB-CDI), previously completed by parents of participants, was used for the validation of PiNG.

OUTCOMES & RESULTS

For the validation study, reliability, internal consistency and concurrent validity were analysed. The reliability was optimal for NC, NP and PP, and satisfactory for PC. Split-half analysis showed a fair internal consistency for all of the subtests. Concurrent validity was verified through the correlation with MB-CDI using Pearson's correlation coefficient, which was significant even after having controlled for age. To describe the developmental trends, data are provided for 1-month age intervals. The comprehension subtests showed a rapid increase at younger ages, with children reaching a plateau slightly earlier for the NC (at 30 months versus 33 months for the PC). The increase in the production subtests was gradual; PP appeared to be the most difficult subtest, administrable starting at the age of 24 months. When we analysed, as potential confounders for developmental trends, gender, parents' educational level, and the way in which the subtests were administered, no differences were found, except for a better performance for girls in the NP subtest.

CONCLUSIONS & IMPLICATIONS

Overall, the results suggest that PiNG is suitable for children in the age range considered to evaluate language abilities. It can be used together with other tools with clinical and theoretical objectives also to describe lexical abilities in atypical populations, such as children with cognitive and/or language impairment, as well as with late-talking children. Finally, the four subtests can be administered separately or combined, which provides flexibility in clinical use, in that the individual child's linguistic and/or cognitive characteristics and level can be taken into consideration.

Factors influencing choice of surgical route of repair of genitourinary fistula, and the influence of route of repair on surgical outcomes: findings from a prospective cohort study

OBJECTIVE

The abdominal route of genitourinary fistula repair may be associated with longer term hospitalisation, hospital-associated infection and increased resource requirements. We examined: (1) the factors influencing the route of repair; (2) the influence of the route of repair on fistula closure 3 months following surgery; and (3) whether the influence of the route of repair on repair outcome varied by whether or not women met the published indications for abdominal repair.

DESIGN

Prospective cohort study.

SETTING

Eleven health facilities in sub-Saharan Africa and Asia.

POPULATION

The 1274 women with genitourinary fistula presenting for surgical repair services.

METHODS

Risk ratios (RRs) and 95% confidence intervals (95% CIs) were generated using log-binomial and Poisson (log-link) regression. Multivariable regression and propensity score matching were employed to adjust for confounding.

MAIN OUTCOME MEASURES

Abdominal route of repair and fistula closure at 3 months following fistula repair surgery.

RESULTS

Published indications for abdominal route of repair (extensive scarring or tissue loss, genital infibulation, ureteric involvement, trigonal, supratrigonal, vesico-uterine or intracervical location or other abdominal pathology) predicted the abdominal route [adjusted risk ratio (ARR), 15.56; 95% CI, 2.12-114.00]. A vaginal route of repair was associated with increased risk of failed closure (ARR, 1.41; 95% CI, 1.05-1.88); stratified analyses suggested elevated risk among women meeting indications for the abdominal route.

CONCLUSIONS

Additional studies powered to test effect modification hypotheses are warranted to confirm whether the abdominal route of repair is beneficial for certain women.

Laparoscopic management of small bowel obstruction with associated intestinal ischemia

Obstruction is the most common surgical disorder of the small bowel. Complete small bowel obstruction (SBO) is usually treated surgically because bowel strangulation cannot be excluded with certainty. Acute SBO has been previously considered a relative contraindication for laparoscopic management especially due to the laparotomy conversion rate. We present a case of SBO for which laparoscopic management resulted in earlier return of bowel function, shorter hospital stay, faster overall recovery, and decreased morbidity when compared to laparotomy.