Sero-prevalence and risk factors for cytomegalovirus infection among pregnant women in a teaching hospital in Ogun state, Nigeria

Background: Infection with cytomegalo virus is usually asymptomatic however in pregnant women the risk of congenital infection and foetal  abnormalities makes antenatal screening for CMV infection necessary. The aim of this study was to determine the sero-prevalence and risk factors for  CMV infection among pregnant women in Babcock University Teaching Hospital (BUTH), Ilishan Remo, Ogun State, Nigeria.Methods: The study was a cross-sectional descriptive study conducted between January and May, 2017 on patients attending the antenatal clinic of  Babcock University Teaching Hospital. Enzyme Linked Immunosorbent Assay (ELISA) Kits were used to determine IgM and IgG anti CMV antibody titresinvenous blood samples obtained from study participants.Results: A total of 80 patients were recruited into the study. The mean age was 30 years.All (100%) respondents were sero-positive for anti CMV IgG  antibodies while 28.75% of respondents were seropositive for anti CMV IgM antibodies.Conclusion: There was a highsero-prevalence rate of CMV infection in the study. Screening of pregnant women for CMV infection is necessary due to the  risk of congenital infection and fetal defects.

Association of Diabetes Mellitus with Coronavirus Disease 2019 Severity: A Retrospective Study from a Center in South Western Nigeria

BACKGROUND AND OBJECTIVES

Coronavirus Disease 2019 (COVID-19) is a novel viral infection, now a pandemic, caused by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). Diabetes mellitus (DM) has been associated with severe COVID-19 and poor glycaemic control is reportedly the link between these conditions. This study aimed to determine the association between DM and the severity of COVID-19.

METHODS

This was a retrospective study involving 86 patients with COVID-19 admitted to a tertiary hospital in South-Western Nigeria. Socio-demographic, clinical and laboratory data were extracted from their medical records. Ethical approval was obtained and descriptive and inferential statistics computed.

RESULTS

The mean age of the patients was 61 ± 16.1 years and 61.6% were males. Fever was noted in 67.4% of patients and, similarly, 67.4% of the patients had an SpO2<94% in ambient air when admitted. Thirty-six percent (36%) of the study patients had DM. Amongst patients with DM and those without DM, 72.2% and 62%, respectively, had severe or critical COVID-19 (p=0.323). Patients with DM were older than those without DM (65.8 years vs 57.3 years; p=0.015). The frequency of oxygen desaturation, respiratory failure, acute kidney injury (AKI) and multi-organ failure were significantly higher in COVID-19 patients with DM (p=0.037, 0.043, 0.004 and 0.016, respectively). Mortality was higher in COVID-19 patients with DM but this was not statistically significant (p=0.214). The odds of a patient with diabetes and COVID-19 developing respiratory failure and acute kidney injury were 1.395 (95%CI 1.154-6.913) and 1.125 (95%CI 1.025-1.621), respectively.

CONCLUSION

Diabetes mellitus was recorded in older patients with COVID-19 and associated with suboptimal oxygen saturation at presentation, respiratory failure, and acute kidney injury. There was no association found between DM and COVID-19 severity and mortality.

AB0968 ACUTE EFFECT OF A SINGLE BOUT OF BICYCLE ERGOMETRY EXERCISE ON AFFECT, MOOD AND PAIN IN INDIVIDUALS WITH KNEE OSTEOARTHRITIS

Background

Exercise provokes psychological responses that results in an increase in positive affect and mood, and a reduction in negative affect in patients with musculoskeletal problems including knee osteoarthritis (KOA) (Hoffman and Hoffman, 2007; Ekkekakis and Petruzzello, 1999). However, there is no consensus on the optimum duration of exercise that will bring about such positive effects among individuals with KOA.

Objectives

The objective of this study was to compare the acute effects of 10- and 15- minute bicycle ergometry exercise on affect, mood and pain in patients with KOA.

Methods

A quasi-experimental study with a follow-up arm. Forty-six participants with KOA were randomly assigned to either a 10-minute bicycle ergometer (10BE) exercise group or a 15-minute bicycle ergometer (10BE) exercise group. Participants’ affect, mood and pain were assessed at baseline, pre-exercise, immediately after the exercise, 10 minutes post-exercise, and 20 minutes post-exercise using the International Positive and Negative Affect Scale, Visual Analogue Mood Scale, and Visual Analogue Scale, respectively. Descriptive statistics, Friedman’s ANOVA, Mann-Whitney-U and generalised estimating equation were used to analyse the data with P-value at 0.05.

Results

Participants’ (94.23% females) age ranged from 40-79 years for the two groups. The mean age for 10BE and 15BE groups was 67.09±1.85 and 66.96±2.03 years, respectively. At baseline, the median scores for positive (19.00; interquartile range (IQR=18.00-20.00 vs. 20.00; IQR=18.00-21.00) and negative (8.00; IQR=7.00-11.00 vs. 9.00; 5.00-14.00) affect, mood (6.00; IQR= 3.00-8.00 vs. 7.00; IQR=4.75-8.00) and pain (5.00; IQR=5.00-8.00 vs. 5.50; IQR=5.00-7.00) were not significantly different between10BE and 15BE. Ten minutes of aerobic exercise significantly improved PA (P=0.001; Effect size (Es)=0.25)) and mood (P=0.001; Es=0.58), and reduced NA (P=0.001; Es=0.44) and pain (P=0.001; Es=0.73) of participants across the time points of the study. A 15-minute aerobic exercise also significantly improved PA (P=0.001; Es=0.25), mood (P=0.001; Es=0.45) and reduced NA (P=0.001; Es=0.49) and pain (P=0.001; Es=0.84) of participants across the time points of the study. There was no significant difference between groups and group-time interactions regarding effect of aerobic exercise on the outcomes (p>0.05).

Conclusion

Both 10- and 15-minutes single bouts of bicycle ergometry exercise had positive effects on affect and mood in individuals with KOA. Ten and 15- minutes single bout of bicycle ergometry exercise had comparable effects on affect and mood improvements in individuals with KOA.

References

[1]Ekkekakis P, Petruzzello SJ (1999). Acute Aerobic Exercise and Affect. Sports Medicine, 28(5):337–374. doi:10.2165/00007256-199928050-00005.

[2]Hoffman MD, Hoffman DR (2007). Does aerobic exercise improve pain perception and mood? A review of the evidence related to healthy and chronic pain subjects. Current Pain and Headache Reports, 11(2):93–97. doi:10.1007/s11916-007-0004-z

Disclosure of Interests

None declared

The ASOS Surgical Risk Calculator: development and validation of a tool for identifying African surgical patients at risk of severe postoperative complications

BACKGROUND

The African Surgical Outcomes Study (ASOS) showed that surgical patients in Africa have a mortality twice the global average. Existing risk assessment tools are not valid for use in this population because the pattern of risk for poor outcomes differs from high-income countries. The objective of this study was to derive and validate a simple, preoperative risk stratification tool to identify African surgical patients at risk for in-hospital postoperative mortality and severe complications.

METHODS

ASOS was a 7-day prospective cohort study of adult patients undergoing surgery in Africa. The ASOS Surgical Risk Calculator was constructed with a multivariable logistic regression model for the outcome of in-hospital mortality and severe postoperative complications. The following preoperative risk factors were entered into the model; age, sex, smoking status, ASA physical status, preoperative chronic comorbid conditions, indication for surgery, urgency, severity, and type of surgery.

RESULTS

The model was derived from 8799 patients from 168 African hospitals. The composite outcome of severe postoperative complications and death occurred in 423/8799 (4.8%) patients. The ASOS Surgical Risk Calculator includes the following risk factors: age, ASA physical status, indication for surgery, urgency, severity, and type of surgery. The model showed good discrimination with an area under the receiver operating characteristic curve of 0.805 and good calibration with c-statistic corrected for optimism of 0.784.

CONCLUSIONS

This simple preoperative risk calculator could be used to identify high-risk surgical patients in African hospitals and facilitate increased postoperative surveillance.

CLINICAL TRIAL REGISTRATION

NCT03044899.

Investigations into the Risk of Reproductive Toxicity Following Exposure to Highly Active Anti-Retroviral Drugs in Rodents

With the introduction of Highly Active Antiretroviral Therapy (HAART), there has been drastic decline in morbidity and mortality associated with HIV/AIDS. However, many patients experience adverse drug reactions perhaps due to the inherent toxic nature of HAART. The possible toxic effect of HAART (combination ARVs) on reproduction and sexual dysfunction in seropositive HIV patients remains a subject of intense research. This study was designed to investigate the toxic effects of HAART on the reproductive hormones and organs of male and female rats. Sexually mature adult male and female rats were administered therapeutic doses of single and combination antiretroviral drugs for 48 days and thereafter sacrificed under anaesthesia. Morphological and histopathological examination of the testes and ovaries were carried out. Serum biochemical assay, semen quality analysis and hormonal assays were also conducted using standard methods. Results show significant (p < 0.05) reductions in the weight of testes and epididymis across all groups versus control; sperm count and motility were also significantly reduced in the test groups while hormonal analysis in males revealed significant reductions in LH, FSH and Testosterone. In the females, there was a significant (p < 0.05) reduction in the number of ovarian follicles, prolactin, estrogen and progesterone. We thus conclude that the administration of single and combined antiretroviral drugs have potential reproductive toxic effects.

Colossal pilomatrixoma

We describe the largest reported case of pilomatrixoma in the literature. While pilomatrixomas typically present as small soft-tissue nodules of the head, neck and upper extremities, they can also present as much larger masses in atypical locations. When they present in their usual size, pilomatrixomas have typical imaging features and can be correctly diagnosed with imaging studies before histological confirmation. Their clinical and imaging diagnosis become challenging when they are very large, as in our case. A giant pilomatrixoma should also be considered for paediatric patients presenting with a large subcutaneous soft-tissue mass.

Non-trauma surgical emergencies in adults: Spectrum, challenges and outcome of care

Introduction

Significant deaths of between 21% and 38% occur from non-trauma surgical conditions in the accident and emergency room. Access to emergency surgical care is limited in many developing countries including Nigeria. We aimed to study the spectrum of non-trauma surgical emergencies, identify challenges in management and evaluate outcomes.

Methods

A one year prospective cohort study of all non-trauma emergencies in adults seen at the surgical emergency room of LASUTH from 1st October, 2011 to 30th September, 2012 was conducted. Data was analyzed using SPSS version 15.0.

Results

Of a total of 7536 patients seen, there were 7122 adults. Those with non-trauma conditions were 2065 representing 29% of adult emergencies. Age ranged between 15 and 97 years and male to female ratio was 1.7:1. Acute abdomen (30%), urological problems (18%) and malignancies (10%) were the most common. Among 985 patients requiring admission only 464 (47%) were admitted while the remaining 53% were referred to other centers. Emergency surgical intervention was carried out in 222 patients representing 48% of admitted patients. There were 12 (24%) non-trauma deaths in the emergency room. They were due to acute abdomen and malignancies in half of the cases.

Conclusion

Facilities for patients needing emergency care were inadequate with more than half of those requiring admission referred. Attention should be paid to the provision of emergency surgical services to the teeming number of patients seen on yearly basis in the Teaching Hospital.

•

Non-trauma conditions constitute a third of surgical emergencies and a quarter of deaths in the emergency room.

•

Acute abdomen, urological conditions and malignancies are the leading causes of non-trauma emergencies.

•

Available facilities could provide care for only half of the non-trauma patients requiring emergency room admission.

Pulmonary embolism in a patient with "isolated syncope", a diagnostic challenge

Syncope is a recognized presenting symptom in patients with pulmonary embolism (PE), and is more common in older patients and following a large embolus. Isolated syncope, in the absence of dyspnea or tachycardia, is uncommon in this setting, and may be misdiagnosed as cardiac in origin, leading to a delay in appropriate treatment. We present a case which illustrates the importance of consideration of pulmonary embolism in the differential diagnosis of patients presenting with syncope, and the value of echocardiography in its diagnosis.

CNS Complications of Systemic Malignancy amongst patients attending a Radiotherapy facility in Lagos

Introduction:  The Central nervous system (CNS) is a frequent a site of relapse of systemic cancer. There are few data available in literature about the frequency and nature of symptomatic histopathological variants of secondary brain/spinal tumours drawn against the gender/age distribution in our environment.  Objective: To study the frequency and manifestation of CNS involvement in patients with systemic cancer for a high index of suspicion so that practitioner will have highest index of suspicion to make early diagnosis and treatment in our environment.Material and methods: A total of 119 patients with histological confirmed cases of cancer with secondaries to the CNS, were analysed for this study.  Results: CNS metastasis were more common in female (67%) than male (33%) p=0.047. Spinal cord metastasis is the most common type of neurological manifestation (66.9%) with p=0.011. Breast (60.5%) and prostate (21%) were the most common site of primary tumour. Neurological manifestations were mostly associated with advanced Stage tumours (54.9%) (p=0.000). Approximately half of the cases, 56 (54.9%) were presented at late stage (4). Neurological manifestation occurred <6 months (43.1%) after initial diagnosis of the primary tumour. Spinal/radicular pain was the most prevalent among the patients (43%). CT scan/MRI Imaging in (52.6%) and mode of treatment was radiotherapy (99%) of patients. Conclusion:  Even though therapy is largely palliative, research should focus on enhancing the efficacy of whole brain radiotherapy and invest in the biosynthesis of synergistic new systemic agents that could also cross the BBB.DOI: http://dx.doi.org/10.3126/ajms.v6i4.11805 Asian Journal of Medical Sciences Vol.6(4) 2015 55-60

Genetic variation in glutathione metabolism and DNA repair genes predicts survival of small-cell lung cancer patients

BACKGROUND

Small-cell lung cancer (SCLC) carries the worst prognosis among lung cancer diagnoses. Combined radiation and chemotherapy is the standard of care; however, treatment outcomes vary. Variability in the rate at which chemotherapy agents are metabolized and in the capacity of repairing DNA damage has been hypothesized to be partly responsible for the treatment response variation. Genes in the glutathione metabolism and DNA repair pathways were tested through tag single-nucleotide polymorphisms (SNPs) to assess their association with survival in SCLC.

PATIENTS AND METHODS

Blood DNA from 248 patients with primary SCLC was genotyped for 419 tag SNPs from 49 genes in the glutathione and DNA repair pathways. Association analyses with patient survival were carried out at single-SNP, whole-gene, and haplotype levels after adjusting for age, gender, tumor stage, treatment modalities, and smoking history.

RESULTS

Among the 375 SNPs successfully genotyped, 21 SNPs, located on 11 genes, showed significant association with survival. Whole-gene analyses confirmed 3 of the 11 genes: GSS, ABCC2, and XRCC1. Haplotype analyses of these three genes identified haplotype combinations and genomic locations underlying the observed SNP associations.

CONCLUSION

Genetic variations in genes involved in the glutathione and DNA repair pathways are associated with SCLC survival.

S. K. Adesina, O. Idowu, A. O. Ogundaini, H. Oladimeji, T. A. Olugbade, G. O. Onawunmi and M. Pais, 'Antimicrobial constituents of the leaves of EAcalypha wilkesiana and acalypha hispida'. Phytotherapy research14(5) 2000, 371-374

The original article to which this Erratum refers was published in Phytotherapy Research 14(5) 2000, 371-374. Following publication of this paper in the August 2000 issue of Phytotherapy Research (14(5):371-374), it has come to our attention that the dates of receipt and acceptance were printed incorrectly. The corrected dates appear below. The publishers would like to apologise for any confusion caused. Received 28 August 1996 Accepted 15 June 1997

Antimicrobial constituents of the leaves of Acalypha wilkesiana and Aacalypha hispida

An activity directed fractionation of a 50% aqueous ethanol extract of A. wilkesiana and A. hispida leaves resulted in the isolation of gallic acid, corilagin and geraniin as the compounds responsible for the observed antimicrobial activity. Quercetin 3-O-rutinoside and kaempferol 3-O-rutinoside were also isolated from the inactive fraction of A. hispida. The structures were established by permethylation, 2D - NMR ((1)H and (13)C) and MS data.

Antimicrobial constituents of the leaves of Acalypha wilkesiana and Aacalypha hispida

An activity directed fractionation of a 50% aqueous ethanol extract of A. wilkesiana and A. hispida leaves resulted in the isolation of gallic acid, corilagin and geraniin as the compounds responsible for the observed antimicrobial activity. Quercetin 3-O-rutinoside and kaempferol 3-O-rutinoside were also isolated from the inactive fraction of A. hispida. The structures were established by permethylation, 2D - NMR ((1)H and (13)C) and MS data.

Antimicrobial constituents of the leaves of Acalypha wilkesiana and Aacalypha hispida

An activity directed fractionation of a 50% aqueous ethanol extract of A. wilkesiana and A. hispida leaves resulted in the isolation of gallic acid, corilagin and geraniin as the compounds responsible for the observed antimicrobial activity. Quercetin 3-O-rutinoside and kaempferol 3-O-rutinoside were also isolated from the inactive fraction of A. hispida. The structures were established by permethylation, 2D - NMR ((1)H and (13)C) and MS data.

Colonic atresia in monozygotic twins

We describe monozygotic twins with colonic atresia and discuss genetic causes of colonic atresia.

Clostridium difficile colitis associated with infant botulism: near-fatal case analogous to Hirschsprung's enterocolitis

We present the first five reported cases of Clostridium difficile-associated diarrhea (CDAD) in children with infant botulism caused by Clostridium botulinum. We compare two fulminant cases of colitis in children with colonic stasis, the first caused by infant botulism and the second caused by Hirschsprung's disease. In both children, colitis was accompanied by hypovolemia, hypotension, profuse ascites, pulmonary effusion, restrictive pulmonary disease, and femoral-caval thrombosis. Laboratory findings included pronounced leukocytosis, hypoalbuminemia, hyponatremia, coagulopathy, and, when examined in the child with infant botulism, detection of C. difficile toxin in ascites. CDAD recurred in both children, even though difficile cytotoxin was undetectable in stool after prolonged initial therapy. Four children who had both infant botulism and milder CDAD also are described. Colonic stasis, whether acquired, as in infant botulism, or congenital, as in Hirschsprung's disease, may contribute to the susceptibility to and the severity of CDAD.

Ectopic pancreas as the cause of gastric outlet obstruction in a newborn

This case of ectopic pancreas found in the pre-pyloric channel of a 2-day-old infant is unique. A review of the literature reveals no other cases of symptomatic ectopic pancreas in an infant of this age. In this patient, signs and symptoms were consistent with pyloric stenosis. Upper gastrointestinal study and esophagogastroduodenoscopy (EGD) revealed the diagnosis. This case is examined and the literature is reviewed.

Partial splenectomy in children under 4 years of age with hemoglobinopathy

BACKGROUND/PURPOSE

The risk of septicemia in postsplenectomy pediatric patients is approximately 2%. This risk is twice as great for children less than 4 years of age. In the first year of life this risk can be 30% or higher. Partial splenectomy is an alternative in patients with hemoglobinopathies. The authors attempt to assess the outcome of pediatric patients less than 4 years of age undergoing partial splenectomy using the Argon beam.

METHODS

In a tertiary care, university affiliated, dedicated children's hospital seven patients underwent partial splenectomy (PS) by the same surgeon from May 1993 to September 1995. The PS performed for trauma was excluded. Included were patients with hemoglobinopathies. Therefore, six patients were evaluated. Follow-up was from 6 months to 2 years. Pre- and postoperative blood transfusions, length of operation, estimated blood loss, length of hospital stay, postoperative complications, perfusion, and function of remnant spleen were evaluated.

RESULTS

Indications for splenectomy included sequestration crisis and hypersplenism. Percent splenectomy ranged from 65% to 75%. Average hospital stay was 6.3 days. Postoperative splenic function, measured by Pitt count and radionuclide spleen scan, was normal. Postoperatively there were no systemic infections, overwhelming postsplenectomy sepsis (OPSS), torsion of the splenic remnant, left upper quadrant fluid collections, or subphrenic abscesses. There were no deaths.

CONCLUSIONS

Partial splenectomy is a safe and effective procedure in children less than 4 years of age with hemoglobinopathies. The procedure as described yields minimal blood loss and retains immune competence. Partial splenectomy greatly reduces, and in some cases eliminates, the need for blood transfusions. PS should be considered the procedure of choice in children less than 4 years of age with sickle cell anemia or beta-thalassemia who require splenectomy.

Cholecystectomy in sickle cell anemia patients: perioperative outcome of 364 cases from the National Preoperative Transfusion Study. Preoperative Transfusion in Sickle Cell Disease Study Group

Cholecystectomy is the most common surgical procedure performed in sickle cell anemia (SCA) patients. We investigated the effects of transfusion and surgical method on perioperative outcome. A total of 364 patients underwent cholecystectomy: group 1 (randomized to aggressive transfusion) 110 patients; group 2 (randomized to conservative transfusion) 120 patients; group 3 (nonrandomized nontransfusion) 37 patients; and group 4 (nonrandomized transfusion) 97 patients. Patients were similar except group 3 patients were more likely to be female, over 20 years old, smokers, and more healthy by American Society of Anesthesiologists (ASA) physical status score. Total complication rate was 39%: sickle cell events 19%; intraoperative or recovery room events 11%; transfusion complications 10%; postoperative surgical events 4%; and death 1%. Group 3 patients had the highest incidence of sickle cell events (32%). Open cholecystectomies were performed in 58% and laparoscopic in 42%. Laparoscopic patients were younger and more healthy by ASA score. Laparoscopic patients had longer anesthesia time (3.2 v 2.9 hours), but shorter hospitalization time (6.4 days v 9.8). Complications were similar between these two groups. We conclude that SCA patients undergoing cholecystectomy have a high perioperative morbidity, and the incidence of sickle cell events may be higher in patients not preoperatively transfused. We recommend a conservative preoperative transfusion regimen, and we encourage the use of the laparoscopic technique for SCA patients undergoing elective cholecystectomy.

Sand aspiration: a case report

There have been few documented cases of sand aspiration. The authors report on a 3-year-old boy who suffered severe respiratory compromise secondary to sand aspiration. Emergency intubation and subsequent bronchoscopy were required to relieve airway obstruction. The patient did well and suffered no long-term sequelae.