A scoping review of risk-stratified bowel screening: current evidence, future directions

PURPOSE

In this scoping review, we examined the international literature on risk-stratified bowel screening to develop recommendations for future research, practice and policy.

METHODS

Six electronic databases were searched from inception to 18 October 2021: Medline, Embase, PsycINFO, CINAHL, Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Trials. Forward and backwards citation searches were also undertaken. All relevant literature were included.

RESULTS

After de-deduplication, 3,629 records remained. 3,416 were excluded at the title/abstract screening stage. A further 111 were excluded at full-text screening stage. In total, 102 unique studies were included. Results showed that risk-stratified bowel screening programmes can potentially improve diagnostic performance, but there is a lack of information on longer-term outcomes. Risk models do appear to show promise in refining existing risk stratification guidelines but most were not externally validated and less than half achieved good discriminatory power. Risk assessment tools in primary care have the potential for high levels of acceptability and uptake, and therefore, could form an important component of future risk-stratified bowel screening programmes, but sometimes the screening recommendations were not adhered to by the patient or healthcare provider. The review identified important knowledge gaps, most notably in the area of organisation of screening services due to few pilots, and what risk stratification might mean for inequalities.

CONCLUSION

We recommend that future research focuses on what organisational challenges risk-stratified bowel screening may face and a consideration of inequalities in any changes to organised bowel screening programmes.

The minimal invasive surfactant therapy: experience from a low resource setting

OBJECTIVE

To evaluate all cases managed with the Minimal Invasive Surfactant Therapy (MIST) and its effect on outcome.

BACKGROUND

Respiratory distress syndrome (RDS), a major cause of morbidity and mortality in preterm new-borns is common in sub-Saharan Africa. Surfactant replacement therapy (SRT) is less practiced and the new MIST is just introduced in Asaba, Nigeria.

METHODS

This descriptive survey recruited new-borns of consenting parents who provided for the surfactant and other commodities. Demographic characteristics were obtained. Intervention included MIST Surfactant, nasal bubble Continuous Positive Airway Pressure (n b-CPAP). Aminophylline or Caffeine, early breast milk feeding and Kangaroo mother care (KMC). Data were collected over a 1-year period and Standard statistical methods were used for data analysis.

RESULTS

From 1 May 2019 to 30 April 2020, there were 1801 live births, preterm birth rate of 10.72% (193/1801) at the FMC, Asaba. Admissions to the Neonatal Unit (NNU) comprised a total of 731 newborn: 270 preterms. Of these preterm; 52(19.26%) were extreme preterms; 122 (16.15%) very preterm. Of these 731 total admissions there were 104 (14.23%). Their gestational ages (GA) ranged from 24 to 38 weeks and birthweights from 600 to 3400 g. A total of 51 Newborns received surfactant. Their GA ranged from 24 to 38 Weeks; birth weights 600 to 3400 g. These comprised 48 preterm and 3 terms. All 51 infants with RDS who received MIST surfactant included 48 preterms and 3 terms with perinatal Asphyxia and Meconium Aspiration Syndrome. The obstetric management of five mothers of early preterm included two doses of antenatal cortico-steroids prior to delivery. MIST was successful in 47 of 51 (92.2%) cases. Age range at administration was one to 48 h. Duration of n-bCPAP post surfactant: ranged 6 h to 96 h: 4 babies were weaned off CPAP within 24 h; 12 babies at <48 h, another 9 at <72 h; and 20 beyond 96 h. Five babies received a second dose of MIST after 48 h of the first dose. Twelve of 51 (23.5%) babies died; 4 at 48 h, 2 at 72 h, 3at 96 h and 3 beyond 7 days. Prior to the MIST, respiratory distress (RD) and severity rating as indicated by the Silverman Anderson Score (SA) scores in the survivors ranged from 6/10 to 8/10.

CONCLUSIONS

The MIST, at FMC Asaba, improves outcome of the extreme preterm. Financial barriers remain a major constraint to its use.

Quercetin modulates granulosa cell mRNA androgen receptor gene expression in dehydroepiandrosterone-induced polycystic ovary in Wistar rats via metabolic and hormonal pathways

Background It is estimated that about 5-10% of women suffer from polycystic ovarian syndrome (PCOS) which is a major cause of female reproductive dysfunction. This study examined the role of quercetin on dehydroepiandrosterone (DHEA)-induced PCO in Wistar rats. Methods Twenty-eight pre-pubertal female Wistar rats that are 21 days old weighing 16-21 g were sorted into four groups (n = 7). Group I served as control and was given distilled water only, Group II were injected with 6 mg/100 g BW of DHEA in 0.2 mL of corn oil subcutaneously, Group III received 100 mg/kg BW of quercetin orally and Group IV received 6 mg/100 g BW of DHEA in 0.2 mL of corn oil subcutaneously and 100 mg/kg BW of quercetin orally. Rats were sacrificed after 15 days by cervical dislocation method. Blood samples and ovaries were collected for hormonal, biochemical, and histopathological analysis and expressions of mRNA androgen receptor gene were determined using RT-qPCR. All data were analysed using one-way ANOVA. Results A significant decrease (p < 0.05) in the antioxidant and metabolic enzyme activity in the DHEA treated group was observed when compared with control. DHEA co-administration with quercetin showed a significant decrease in malondialdehyde and cytokines when compared with DHEA treated group. Also a significant increase in progesterone, metabolic and antioxidant enzyme activity was observed. The histopathology demonstrates a reduction in cystic and atretic cells, improved expression of BCl2, E-Cadherin and a decrease in Bax. Conclusions Quercetin alleviated DHEA-induced PCO. These effects could be attributed to its antioxidant property.

Ovarian Metabolic activity in Dehydroepiandrosterone-Induced Polycystic Ovary in Wistar rats Treated with Aspirin

OBJECTIVES

Polycystic ovary syndrome (PCOS) represents 75% of the cases of anovulatory infertility. The aim of this study was to investigate the role of aspirin on dehydroepiandrosterone (DHEA) - induced polycystic ovary syndrome in Wistar rats.

METHODS

Twenty eight (28) pre-pubertal female Wistar rats of 21 days old weighing 16 - 21 g were divided into 4 groups (7 rats/group) and treated as follows; group I received distilled water and served as Control; Group II received 6 mg/100 g body weight DHEA in 0.2 ml of oil subcutaneously to induce PCOS. Group III received 7.5 mg/kg of aspirin orally; Group IV received 6 mg/100kg of body weight of DHEA in 0.2ml of oil subcutaneously and 7.5 mg/kg of aspirin orally. After 15 days of administration, the rats were slaughtered by cervical dislocation. Blood samples and ovaries were collected for reproductive hormonal analysis, biochemical and histopathological analysis. The expressions of mRNA androgen receptor (AR) gene in the ovary were determined by real time reverse transcriptase polymerase chain reaction (qPCR). All the data was analyzed using one way ANOVA with the Graph pad prism software version 6. A p<0.05 was considered significant.

RESULTS

The results obtained showed that dehydroepiandrosterone treatment caused significant decrease (p<0.05) in total protein, superoxide Dismutase (SOD), glutathione-s- transferase (GST), Ca2+ ATPase, and significant increase (p<0.05) in malondialdehyde, vascular endothelial growth factor, tumor necrosis factor and estrogen as compared to Controls. The group co-administered with DHEA and aspirin showed significant increases in SOD, GST, CAT, GSH, Progesterone, Ca2+ ATPase, Na+ ATPase, H+ ATPase and significant reduction (p<0.05) in malondialdehyde, VEGF, TNF-α and estrogen as compared with the DHEA group. The histopathological analysis showed reductions in cystic fibrosis, atretic ovaries, increased expression of Bcl-2 and E- Cadherin and reduced Bax expression in the group that received Aspirin and DHEA.

CONCLUSION

This study clearly demonstrates that Aspirin has ameliorating effects against polycystic ovary syndrome via anti-inflammatory and hormonal modulatory pathways.

On-station performance evaluation of improved tropically adapted chicken breeds for smallholder poultry production systems in Nigeria

Background

Availability of appropriate genetics is important for the development of smallholder poultry (SHP). The biological potential of improved dual purpose chicken germplasms was evaluated in Nigeria.

Methods

A total of six breeds (Fulani, FUNAAB Alpha, Kuroiler, Noiler, Sasso, and Shika-Brown) were tested on-station, in deep litter houses at two test centres (Public and private facility) for 504 days. Birds were fed ad libitum for the first 140 days after which restricted feeding was practised.

Result

Lowest and highest hatchability of eggs set was 55% (FUNAAB Alpha) and 89% (Sasso), respectively. At 140 days, male live weights were 200%–300 % higher than the local chickens (975 g) except Shika-Brown (152%) and Fulani (135%). Lowest (p < 0.05) age at first egg was 119 days for Shika-Brown and 120 days for FUNAAB Alpha and Kuroiler. Highest hen-housed egg production was 192 for Shika-Brown, and feed intake per dozen eggs was lowest (p < 0.05) for Shika-Brown (2.9 kg) and FUNAAB Alpha (2.9 kg). Mortality rate of the locally sourced breeds (Fulani, FUNAAB Alpha, Noiler, and Shika-Brown) was significantly lower (p < 0.05) than the foreign-sourced breeds (Kuroiler, Sasso) during brooding, growing and laying.

Conclusion

Results from this study identified FUNAAB Alpha and Noiler as being more suitable for dual-purpose functions (egg and meat), while Sasso and Kuroiler (meat) and Shika-Brown (egg) were observed to be better suited for single purpose functions. These findings could guide the introduction of smallholder poultry-specific hybrid germplasms for the development of the smallholder poultry production systems in Nigeria.

Vitamin C suppresses ovarian pathophysiology in experimental polycystic ovarian syndrome

BACKGROUND

Polycystic ovary syndrome (PCOS), also known as the Stein-Leventhal syndrome is one of the most common causes of anovulation, infertility and hyperandrogenism in women, affecting between 5-10 % of women of reproductive age (12-35 years) worldwide. Despite substantial effort to define the cause of PCOS, its pathophysiology remains poorly understood. Consequently, determining the mechanisms of PCOS and the possible treatment is the major goal of medical research in endocrine and reproductive physiology.

AIM

To investigate the mechanism of ovarian metabolic changes in dehydroepiandrosterone (DHEA)-induced polycystic ovary in Wistar rats treated with vitamin C.

METHODS

Twenty-eight immature female Wistar rats weighing (16-21 g) were randomly divided into four groups (n = 7/group): group I served as control and was given water, group II were injected with DHEA (6 mg/100 g in 0.2 ml corn oil subcutaneously to induce PCOS condition), group III received 150 mg/kg BW of Vitamin C orally, group IV were co-administered with 6 mg/kg BW DHEA in 0.2 ml of corn oil subcutaneously and 150 mg/kg BW of Vitamin C orally. All treatments lasted for 15 days. Twenty-four hours after the last administration, the rats were sacrificed by cervical dislocation. Blood samples and ovaries were collected for reproductive hormonal analysis, biochemical and histopathological analysis. The expressions of mRNA androgen receptor gene in the ovary were determined by real-time reverse transcriptase polymerase chain reaction. All data were analysed using one-way ANOVA.

RESULTS

There was a significant decrease (p < 0.05) in the antioxidant and metabolic enzyme activity in the DHEA treated group compared with the control group. DHEA co-administration with Vitamin C showed a significant decrease in Malondialdehyde, cytokines and Estrogen and a significant increase (p < 0.05) in antioxidant and metabolic enzymes compared with DHEA treated group only. The histopathological evaluation demonstrates a reduction in cystic and atretic ovaries, increased expression of Bcl₂ and E-Cadherin with a reduction in Bax expression in the group co-administered with DHEA and Vitamin C. The DHEA group showed overexpression of mRNA Androgen Receptor gene in the ovaries compared to the control group.

CONCLUSION

This study shows that Vitamin C plays a protective role against DHEA-Induced Polycystic Ovary in Wistar rats via its antioxidant and anti-apoptotic mechanisms.

Farmers' choice of genotypes and trait preferences in tropically adapted chickens in five agro-ecological zones in Nigeria

This study aimed at determining chicken genotypes of choice and traits preference in chicken by smallholder farmers in Nigeria. Data were obtained from a total of 2063 farmers using structured questionnaires in five agro-ecological zones in Nigeria. Chi square (χ²) statistics was used to explore relationships between categorical variables. The mean ranks of the six genotypes and twelve traits of preference were compared using the non-parametric Kruskal-Wallis H (with Mann-Whitney U test for post hoc separation of mean ranks), Friedman, and Wilcoxon signed-rank (with Bonferroni's adjustments) tests. Categorical principal component analysis (CATPCA) was used to assign farmers into groups. Gender distribution of farmers was found to be statistically significant (χ² = 16.599; P ≤ 0.002) across the zones. With the exception of Shika Brown, preferences for chicken genotypes were significantly (P ≤ 0.01) influenced by agro-ecological zone. However, gender differentiated response was only significant (P ≤ 0.01) in Sasso chicken with more preference by male farmers. Overall, FUNAAB Alpha, Sasso, and Noiler chicken were ranked 1st, followed by Kuroiler (4th), Shika Brown (5th), and Fulani birds (6th), respectively. Within genotypes, within and across zones and gender, preferences for traits varied significantly (P ≤ 0.005 and P ≤ 0.01). Traits of preference for selection of chicken breeding stock tended towards body size, egg number, egg size, and meat taste. Spearman's rank order correlation coefficients of traits of preference were significant (P ≤ 0.01) and ranged from 0.22 to 0.90. The two PCs extracted, which explained 65.3% of the variability in the dataset, were able to assign the farmers into two groups based on preference for body size of cock and hen and the other ten traits combined. The present findings may guide the choice of appropriate chicken genotypes while the traits of economic importance may be incorporated into future genetic improvement and conservation programs in Nigeria.

"…It might not have occurred to my husband that this woman, his wife who is taking care of him has some emotional needs as well…": the unheard voices of partners of Black African and Black Caribbean men with prostate cancer

PURPOSE

Evidence suggests that partners of men with prostate cancer (CaP) experience greater psychosocial distress compared with men themselves. However, the experiences of partners of high-risk (1 in 4) Black African (BA) and Black Caribbean (BC) men with CaP remain poorly understood as existing research has predominantly focused on Caucasian populations. This study aimed to address this gap by exploring partners' experience and support needs as influenced both by the specific impacts of CaP, treatment side effects and socio-cultural context.

METHODS

Using a constructivist grounded theory approach, eight face-to-face, two Skype and one telephone interviews were conducted with eligible partners (n = 11). The interviews were analysed using constant comparison following key stages of open, focused and theoretical coding.

RESULTS

Three broad categories emerged which described participants' experiences: 'partner in the passenger seat', 'care-giving on an isolating journey', and 'coping as a partner'. Findings showed that BA and BC cultural marital context influenced how partners experienced and traversed the CaP journey. Peripheral involvement in decision-making, communication restrictions, limited access to support and lack of recognition for their experiences and needs further contributed to partners' psychological and emotional distress.

CONCLUSIONS

Cultural beliefs, behaviours and values should be taken into account when developing psychosocial support for partners and their men with CaP. Specifically providing information focused on partners and including them in the CaP care pathway could help ensure that partners' needs are recognised and improve marital communications. This could potentially help partners and their men to identify acceptable ways of supporting each other throughout the CaP experience.

Molecular characterization of the leptin receptor gene as a candidate gene in the pulmonary hypertension syndrome in broiler chickens

Leptin Receptor Gene (LEPR) is a candidate gene in understanding the genetic basis of the Pulmonary Hypertension Syndrome (PHS) in broilers. Identification and evaluation of genetic polymorphisms in LEPR may provide a link between traits like Body Weight (BW) and Total Ventricle weight (TV) to the development of PHS. In this study, primers were designed in exons, upstream and downstream sequences to identify mutations in the LEPR on four broilers selected with respect to the PHS-related traits. About 77% of the 11,820 bp of the LEPR gene covered by the primers were sequenced. No mutations were found between the chickens associating the traits to the occurrence of PHS. However, 42 single nucleotide polymorphisms and four Indels were found between the reference sequences of the red jungle fowl and the experimental population. Ten of these mutations were not previously reported in LEPR at the genomic and transcript sequences (NP_989654.1, ENSGALT00000018009). The 10 mutations include six SNPs in intron regions, two Indels and two non-synonymous SNPs. The two new non-synonymous SNPs; G301A and A1637G, led to amino acid change A89T and N534S, respectively.