Cancer of the cervix in Zaria, Northern Nigeria

Objective:

Carcinoma of the cervix is still the most common gynecological malignancy among women in the developing nations. The purpose of this study is to review the pattern of carcinoma of the cervix in Zaria, Northern Nigeria.

Method:

This is a retrospective study of patients seen at the Gynecologic oncology unit of Ahmadu Bello University Teaching Hospital, Zaria, Nigeria between November 2005 and November 2009.

Results:

A total of 406 gynecological cancers were identified during the period under review. Carcinoma of the cervix accounted for 65.7 % (267) of histologically confirmed gynecological cancers. Most of the patients were married 265 (99.2 %) and 40% were in the second order of marriage; 57.1% of these women were in a polygamous setting. Two hundred and two (75.6 %) patients fell in the 40Œ69 year age bracket, with a mean age of 44.5 years. The disease appears to be associated with high parity (range of 0Œ14); grand multiparous patients constituted 145 (68.3%) of the cases. Abnormal vaginal bleeding (219 patients: 82 %), offensive vaginal discharge (120 patients: 44.9%) and post-coital bleeding (56 patients: 20.9%) were the most common symptoms. About 78% of the patients had advanced disease, stage III disease being the commonest stage accounting for 159 (59.5 %). Fifty-six (21%) of these patients presented with vesico-vaginal fistula.

Conclusion:

This study demonstrates that in the northern part of Nigeria 65.7% of all gynecological cancers are carcinoma of the cervix. This high percentage appears to be connected with some detrimental sociocultural practices, such as early onset of sexual activity, which should be addressed. More emphasis should be given to screening programs for women in under-developed countries.

Evaluation of the level of micronutrients in fortified foods in Alexandria, Egypt

Food fortification is an effective, low-cost way to eliminate dietary micronutrient deficiencies in developing countries. This study in Egypt aimed to evaluate the levels of and variations in fortification with iron, iodine and vitamin A in food products from different manufacturers. Almost all iodized salt samples contained iodine concentrations within Egyptian standards. The iron content of iron-fortified biscuits supplied to schools and of vitamin-A-fortified margarine, infant formula milk powder and infant cereal food were highly variable and many samples were not within Egyptian standards. Monitoring of fortification levels of key products is required at the factory, retail and household levels.

Exploiting LIBS as a spectrochemical analytical technique in diagnosis of some types of human malignancies

In the present work we are presenting a detailed in vitro study of using laser-induced breakdown spectroscopy (LIBS) as a quick and simple method for spectrochemical analysis to identify and characterize some types of human malignancies. This has been performed via detection of the abundance of certain elements namely calcium and magnesium in malignant tissues with respect to the non-neoplastic ones. In order to improve the performance of the LIBS technique - in particular its sensitivity, reproducibility and limit of detection - the measurements have been performed under vacuum (10(-2) Torr) and the samples were frozen down to -196 degrees C in a specially designed vacuum chamber. Under such experimental arrangements a pronounced enhancement has been achieved in the signal to noise (S/N) ratio of different spectral lines. Significant discriminating results have been obtained in case of breast and colorectal cancers indicating the possibility of adopting LIBS in the early detection of the malignancy as well as the identification of the severity and the grade of the disease. The present work demonstrated that future in vivo measurements are also feasible and reliable using especial endoscopic systems for delivery of laser beam and collection of the emitted plasma light.

Kidney transplantation in children with bladder augmentation or ileal conduit diversion

INTRODUCTION

Various congenital and acquired diseases of the lower urinary tract can lead to chronic renal failure requiring renal replacement therapy.

AIM

The aim of the study was to assess problems and results of kidney transplantation in children with significant lower urinary tract dysfunction.

MATERIALS AND METHODS

Between 1984 and 2007, there were 33 kidney transplantations in children with end-stage renal disease and severe lower tract dysfunction out of 539 kidney transplantations performed in our department. The patients were 23 males and 10 females. Thirty patients received a kidney from a deceased donor, the remaining 3 from a living related donor. The age at transplantation ranged from 2.25 years to 19 years. In 26 patients an ileal conduit modo Bricker was created (in 21 patients at transplant operation). Bladder augmentation was performed in 6 patients and a continent urinary reservoir was created in 1.

RESULTS

Post-transplant follow-up ranged from 7 to 88 months (mean 32 months). Overall patient survival is 100% and graft survival is 97%. Creatinine concentrations ranged from 0.3 to 3.4 mg% (mean 0.92 mg%). Surgical complications were diagnosed in 16 patients. All surgical complications were treated successfully and none of them caused graft loss. Urinary tract infections (UTI) were the most commonly observed complication, occurring in 26/33 (78%) patients, but the majority of these UTI were asymptomatic and had no influence on graft function.

CONCLUSIONS

Kidney transplantation in children with lower urinary tract dysfunction and end-stage renal failure offers excellent medium term results in our experience, despite the creation of non-standard urinary drainage. Recurrent urinary tract infections are the most common complications in these patients, but in the majority of cases this does not lead to impairment of graft function.

Liver transplantation in children with hepatocellular carcinoma. Do Milan criteria apply to pediatric patients?

HCC constitutes 25-30% of primary malignant liver tumors in children. Conventional surgical excision is not possible in more than 50% of patients. LTx has recently become an important therapeutic option for adults and children with primary liver tumors. The aim of this study was a retrospective analysis of the clinical and pathological data of children with HCC treated with LTx in relation to Milan criteria assessed at diagnosis and then immediately before transplantation, in comparison with a group of patients treated conventionally. Between 1990 and 2007 we have treated 21 children diagnosed with HCC. Patients were divided into two groups: group I, 10 children treated conventionally and group II, 11 children treated with LTx regardless of previous therapy. The outcome of our patients treated conventionally with resection and chemotherapy is very poor--the disease-free survival rate is 30%. In contrast, despite that only 3 children having fulfilled adult Milan criteria, early clinical results of LTx are much superior. Total hepatectomy followed by LTx is the main treatment option for the majority of children with HCC. Decisions on the type of surgical treatment is made individually, but very early in the course of treatment.

Ethylenediaminetetraacetate and lysozyme improves antimicrobial activities of ovotransferrin against Escherichia coli O157:H7

The aim of this study was to evaluate the effect of EDTA, lysozyme, or the combination of EDTA and lysozyme on the antibacterial activity of ovotransferrin against Escherichia coli O157:H7. Ovotransferrin solutions (20 mg/mL) containing 100 mM NaHCO3 (OS) with added EDTA (2.0 or 2.5 mg/mL), lysozyme (1.0, 1.5, or 2.0 mg/mL), or both were prepared. The antibacterial activities of OS, OSE (OS+EDTA), or OSL (OS+lysozyme) against E. coli O157:H7 in model systems were investigated by turbidity and viability tests. In addition, OSE, OSL, or OSEL (OS+EDTA+lysozyme) was applied to irradiated pork chops and commercial hams to determine whether the solutions had antibacterial activity on meat products. The effect of the initial cell population on the antibacterial activity of OSE, OSL, and OSEL was determined. Ethylenediaminetetraacetate at 2 mg/mL plus OS induced a reduction of approximately 3 to 4 log in viable E. coli O157:H7 cells in brain heart infusion broth media, and 1 mg/mL of lysozyme plus OS resulted in a reduction of approximately 0.5 to 1.0 log during a 36-h incubation at 35 degrees C. However, neither OSE nor OSEL showed a significant antibacterial effect on pork chops and hams during storage at 10 degrees C. The initial cell number in media did not affect the antibacterial activity of OSE or OSEL against E. coli O157:H7. This study demonstrates that combinations of ovotransferrin, NaHCO3, and EDTA have the potential to control E. coli O157:H7.

Use of Intrathecal Midazolam to Improve Perioperative Analgesia: A Meta-Analysis

Intrathecal midazolam binds with gamma aminobutyric acid-A receptors in the spinal cord leading to an analgesic effect. Clinical studies suggested that intrathecal midazolam may also reduce nausea and vomiting when used as an adjunct to other spinal medications. However, the potential neurotoxic effect of intrathecal midazolam remains a concern. This meta-analysis aims to evaluate the effectiveness and side-effects of intrathecal midazolam in the perioperative and peripartum settings. Thirteen randomised controlled studies from MEDLINE (from 1966 to July 1 2007), EMBASE and Cochrane Controlled Trials Register databases, involving a total of 672 patients, were considered. Volunteer, animal and chronic pain studies were excluded. Adding intrathecal midazolam to other spinal medications reduced the incidence of nausea and vomiting (odds ratio 0.50, 95% confidence interval [CI] 0.27 to 0.90, P=0.02; I 2 =4%) and delayed the time to request for rescue analgesia (weighted-mean-difference=98.7 min, 95% CI: 76.1 to 121.4, P <0.00001; I=98.5%). Intrathecal midazolam did not affect the duration of motor blockade (weighted-mean-difference =25.1 min, 95% CI -7.6 to 57.8, P=0.13, I 2 =94.8%). The incidence of neurological symptoms after intrathecal midazolam was uncommon (1.8%) and did not differ from placebo (odds ratio 1.20, 95% CI 0.22 to 6.68, P=0.84). Based on the limited data available, intrathecal midazolam appears to improve perioperative analgesia and reduce nausea and vomiting during caesarean delivery. A multicentre registry or large randomised controlled study with a prolonged follow-up period would be useful to confirm the clinical safety of intrathecal midazolam.

Lipid, Carbohydrate Metabolism, and Antioxidant Status in Children After Liver Transplantation

Organ transplantation is a risk factor for atherogenesis that may be related to immunosuppressive therapy. Increased free radical generation may even aggravate atherogenesis. The aim of the study was to assess lipid metabolism in relation to risk factors for atherogenesis as well as carbohydrate metabolism and antioxidant status among children after liver transplantation. We studied 35 children at 3 to 5 years after liver transplant in whom the following parameters were assessed: total cholesterol; triglyceride; high-density lipoprotein cholesterol; low-density lipoprotein cholesterol (LDL-C); very low-density lipoprotein cholesterol; apolipoproteins B, AI, E, lipoprotein (a); vitamin E; glutathione; glucose; insulin; and glutathione peroxidase activity. Three subgroups of patients were assessed according to the immunosuppressive therapy: cyclosporine (CsA), tacrolimus (Tac), or mycophenolate mofetil (MMF) in combination with low-dose CsA or Tac. We observed differences among the subgroups only in total cholesterol (CsA: 131.6 to 285.6; Tac: 144.0 to 181.61; MMF: 132.1 to 181.2) and LDL-C (CsA: 79.4 to 126.9; Tac: 42.2 to 118.8; MMF: 74.2 to 117.3). Lipid metabolism was not significantly disturbed among children after liver transplantation, an observation that does not point to a high risk of atherogenesis. CsA seems to have the strongest untoward effect on cholesterol metabolism. Decreased GSH concentration after liver transplantation may be related to slightly impaired liver function, but GPx activity and vitamin E concentrations remained normal.