Legal framework in aid of biological diversity and statutory deficiencies in Pakistan

Abstract The traditional perception of mutual rights and obligations in the developing world was practically confined to human beings only. Fortunately, this conventional understanding is growing to include all living beings in the scope of certain basic rights. It is also addressing those creatures which are co-existing with human societies naturally or are associated for their subsistence and interdependence. It means that there should be prescribed body of rules and regulations to regulate human conduct in the society. In Pakistan social awakening for animal rights supported by international campaigns have urged state institutions to make adequate body of rules and regulations for protection of animal rights. Purpose of developing required understanding, at the first place is to clarify what is a right and what is an obligation? Secondly what should be the nature of these rights and obligations. Should these be only specific to human beings or there are other beings who also possess certain rights? If other living beings, species have rights, how these rights are to be conferred and regulated? Who is under obligation to provide these rights? Who is liable and responsible to ensure observance of such obligations? It is becoming clearer that like human beings’ animals do have certain rights as living beings. All most all religions of the world have prescribed certain rights to them which are encrypted in their holy books. Most of the people are aware of basic concept of observing mild and kind behavior towards pet animals only. Today we scientifically know that humanity and animals have co-existing inevitability. By observing mutual behavior and sensation, the world has provided special rights to the animals by making laws and Acts. Implementation of those rights can only be made through mutual understanding of the citizens under the supervision of law enforcing agencies. It is the responsibility of state and citizens of the states jointly to protect the animals when their rights are being violated.

Exploring the perspectives of underrepresented voices: Perceptions and experiences of uterine cancer for black African, Caribbean, black British, and mixed-black women in the UK to develop strategies for early symptom presentation

OBJECTIVES

The uterine cancer (UC) mortality rate in the UK is significantly higher for women who belong to a Black ethnic group compared to those from other ethnic groups. This study aimed to understand the views and experiences of UC amongst Black ethnic minority women in the UK, with a focus on awareness and presentation of red-flag symptoms.

METHODS

Women of Black African, Caribbean, Black British and Mixed-Black ethnicity were purposefully recruited to participate in focus groups and individual semi-structured interviews.

RESULTS

Twenty women from different regions in England participated in the study. Reflexive thematic analysis of the data led to the identification of three main themes: 1) Healthcare inequities; 2) Support and sense making with other Black women; and 3) Knowledge dissemination, mobilisation, and empowerment. Perceptions of inequitable healthcare provision and distrust influenced how participants, and their peer networks, approached seeking assistance from healthcare professionals. Concerns were also raised about culturally insensitive information resources, including issues of language, literacy, and representation, all of which served as potential barriers for women within Black ethnic minority groups.

CONCLUSIONS

The deficiency of targeted knowledge mobilisation and specific UC information aimed at Black ethnicity women living in the UK, reportedly contributes to the dissemination of misconceptions and an atmosphere of apprehension around a UC diagnosis. The insights from this study highlight the significance of designing culturally sensitive strategies to promote informed decision-making and empower the dissemination of accurate health knowledge amongst Black women.

Determinants and Outcomes for Neonatal Septicaemia at the Federal Medical Centre Bida, North Central Nigeria

BACKGROUND

Neonatal septicaemia (NNS) occurs during the first 28 days of life and is characterized by systemic bacterial infection proven by blood culture. It is a leading cause of morbidity and mortality in neonates. Determinants of NNS vary between locations forming the basis for this study.

OBJECTIVE

To determine the prevalence and the predisposing factors to neonatal septicaemia among neonates admitted to the neonatal intensive care unit (NICU) of Federal Medical Centre, Bida (FMC Bida).

METHODS

This was a one-year prospective observational study, 167 neonates admitted to the neonatal intensive care unit (NICU) of FMC Bida, were selected by purposive sampling method to participate in the study from 13th May, 2015 to 30th April, 2016. A structured questionnaire was filled out by consenting parents and blood samples were collected for laboratory analysis. The data was analyzed using SPSS version 20 (2016). The data were summarized using frequency distributions, means, standard deviation, charts and tables while statistical significance was determined using the chisquare test and Fisher's exact test at a 5% level of significance as well as Odd's Ratio (OR) as appropriate.

RESULTS

Of the 167 neonates recruited, 97(58.1%) were males, 70(41.9%) were females and a male: female ratio of 1.4:1. Outborns were 100 (60%), inborns were 67(40%). Mean age was 4.3 ± 1.5 days and the mean weight of 2589 ± 743.9g. The overall prevalence of neonatal sepsis was 2.33% while the blood culture's positive rate was 9.58%. Risk factors identified in the neonates in this study were prolonged rupture of membranes (PROM), chorioamnionitis, meconium-stained liquor, foul-smelling vaginal discharge, being an outborn, having a low birth weight, inability to cry at birth and prematurity but, PROM was the only risk factor significantly associated with septicaemia (OR 5.4; 95% CI 2.2-13.5) while Escherichia coli was the leading bacterial isolate.

CONCLUSION

In conclusion, prolonged rupture of membrane was mostly responsible for neonatal septicaemia in this study.

Prevalence, Risk Factors, Maternal and Perinatal Outcome of Patients with Eclampsia in University of Maiduguri Teaching Hospital, Maiduguri, Nigeria: A 15-Year Retrospective Review

BACKGROUND

Eclampsia, defined as the occurrence of generalised, tonic-clonic convulsions or coma that is unrelated to other medical conditions in a woman with hypertensive disorder of pregnancy, is a leading cause of maternal and perinatal morbidity and mortality.

METHODS

Retrospective review of cases of eclampsia managed over 15 years (2006 to 2020) at the University of Maiduguri Teaching Hospital, Borno State, Nigeria. Factors associated with adverse maternal and perinatal outcomes were determined using appropriate bivariate analysis. Statistical significance was set at P < 0.05.

RESULTS

The prevalence of eclampsia was 2.96%. Most of the patients, 55.2% (420/761) were >35 years, 76% (579/761) were primigravidae and 80.4% (612/761) were unbooked. In 59.1% (450/761) of the cases, the eclampsia was antepartum and 40.3% (301/761) were delivered through a caesarean section. The commonest risk factor was previous eclampsia. There were 58(7.6%) maternal deaths, and the perinatal mortality was 18.1% (138/761). There was a statistically significant association between adverse maternal outcomes and having no formal education (P<0.001), being unemployed (P<0.001), being in coma for >10 hours(P=0.029), caesarean delivery (P<0.001), SBP >160mmHg (P<0.001) and DBP >110mmHg (P<0.001). Adverse perinatal outcome was significantly associated with having no formal education (P<0.001), being unemployed (P=0.004), unbooked status (P=0.015), multiple pregnancy (P=0.021), preterm delivery(P<0.001), caesarean delivery (P=0.012) and Systolic BP >160mmHg (P<0.001).

CONCLUSION

The prevalence of eclampsia is high. Having no formal education, unemployment, coma of 10 hours or more, vaginal delivery and severe hypertension, unbooked status, and multiple gestation are significantly associated with poor maternal or fetal outcomes.

Intelligent Anti-Money Laundering Fraud Control Using Graph-Based Machine Learning Model for the Financial Domain

Financial domains are suffering from organized fraudulent activities that are inflicting the world on a larger scale. Basel Anti-Money Laundering (AML) index enlists 146 countries, which are impacted by criminal acts like money laundering, and represents the country's risk level with a notable deteriorating trend over the last five years. Despite AML being a substantially focused area, only a fraction of such activities has been prevented. Because financial data related to this field is concealed, access is limited and protected by regulatory authorities. This paper aims to study a graph-based machine-learning model to identify fraudulent transactions using the financial domain's synthetic dataset (100K nodes, 5.3M edges). Graph-based machine learning with financial datasets resulted in promising 77-79% accuracy with a limited feature set. Even better results can be achieved by enriching the feature vector. This exploration further leads to pattern detection in the graph, which is a step toward AML detection.

990 ADVANCE CARE PLANS IN UK CARE HOME RESIDENTS: AN IMPLEMENTATION STUDY

Introduction

Research shows delivery of advance care planning (ACP) in care homes is highly acceptable, increases the proportion of residents dying in their preferred place, and reduces hospital admissions. We examined whether implementation of a service delivering ACP to care homes in Lincoln (UK) realised the research outcomes in routine practice.

Method

Implementation of a service undertaking ACP in care homes was evaluated using routine data. Outcomes included proportion of care homes agreeing to participate; proportion of residents agreeing to put ACPs in place; characteristics of residents with and without ACPs, and place of death of those dying with or without ACPs. Effect on hospital admissions was examined comparing pre- and post-implementation admissions in participating homes.

Results

Fifteen (63%) of 24 eligible care homes participated. ACPs were prepared for 404/516 (78%) residents. Those with ACPs were older, frailer, more cognitively impaired, and malnourished than those without. For those with ACPs (384/404; 95%), care homes were the preferred place of death. 219/248 (88%) of residents with ACPs who died did so in their care home compared to 33/49 who died without ACPs (33/49, (67%) (relative risk 1.35, 95%CI 1.1–1.6, p &lt; 0.01). In the 15 participating homes, there were 717 hospital admissions over 360 pre-intervention care home months (mean 2.11 admissions per care home month). In the post intervention phase, there were 789 admissions over 341 care home months (mean 2.29 admissions per care home month).

Conclusion

Most residents wished to have ACPs, which appeared to have influenced place of death. However, the population value of the service was limited because not all care homes participated. Hospital admissions were not reduced. Future work should aim to ensure services are universally available to residents, and to identify why reductions in hospital admissions seen in research studies may not be replicated in clinical practice.

Effects of Se nanoparticles supplementation on growth performance, hematological parameters and nutrient digestibility of Labeo rohita fingerling fed sunflower meal based diet

The aim of the present study is to assess the effects of selenium nanoparticles on the growth, hematology and nutrients digestibility of Labeorohita fingerlings. Fingerlings were fed with seven isocaloric sunflower meal-based diet supplemented with different concentrations of nanoparticles naming T1 to T7 (0, 0.5, 1, 1.5, 2, 2.5, and 3 mg/kg), with 5% wet body weight while chromic oxide was used as an indigestible marker. After experimentation for 90 days T3 treated group (1mg/kg -1Se-nano level) showed the best result in hematological parameters (WBC's 7.97 ×103mm-3, RBC's 2.98 ×106 mm-3 and Platelet count 67), nutrient digestibility (crude protein: 74%, ether extract: 76%, gross energy: 70%) and growth performance (weight gain 13.24 g, weight gain% 198, feed conversion ratio 1.5, survival rate 100%) as compared to the other treatment groups. Specific growth rates were found significantly higher in T5 than in other groups. The present study indicated positive effect of 1 mg/kg Se-nanoparticles on growth advancement, hematological parameters, and nutrients digestibility of L. rohita fingerlings.

Mapping the role of pH-adjusted potassium in diabetic ketoacidosis: Hypokalemia and the patient outcomes

BACKGROUND

Incidence of hypokalemia during the management of diabetic ketoacidosis (DKA) is high despite detailed potassium replacement guidelines in its treatment.

AIM

We aimed to find the role of pH-adjusted potassium (pH_K ) in the development of hypokalemia, and their mutual impact on patient outcomes during DKA management.

METHODOLOGY

Adult DKA patient's admission data of preceding 3 years (2015-2017) were retrospectively clerked. Outcomes of interest were time to develop hypokalemia and to terminate emergency department (ED) care (hours), severity of hypokalemia and hospitalisation length (days). Linear regression was used to determine significant associations/predictors.

RESULTS

The study was concluded on 85 patients. Hypokalemia was observed in nearly 3/4^th of all admissions and occurred by the time of ED care termination. Each 1 mmol/L increase in pH_K significantly (a) reduced the degree of hypokalemia by 0.07 mmol/L, (b) delayed time to develop hypokalemia by 4.58 hours, (c) and reduced the ED care time by 1.28 hours. Arterial pH was the other factor significantly delaying time to develop hypokalemia (36.25 hours) and facilitating early discharge from ED (13.86 hours). Moreover, each 1 mmol/L reduction in the degree of hypokalemia increased hospitalisation length by 1.86 days. Though significant, acute kidney injury negligibly increased hospitalisation length by 0.01 days.

CONCLUSION

pH-adjusted potassium shall be used as a marker for hypokalemia and to initiate potassium replacement instead of measured serum potassium in DKA. Utilising pH_K will help to avoid hypokalemia, reduce its severity and shorten ED care which will subsequently reduce hospitalisation length. We expect pH_K to improve pharmacoeconomics in the future.

Re-visiting pH-adjusted potassium to avoid hypokalemic crisis during management of diabetic ketoacidosis: A conceptual framework

BACKGROUND AND AIMS

Diabetic ketoacidosis (DKA) treatment guidelines recommend to initiate potassium-replacement when serum potassium (S_K) drops within normal range, and to withhold insulin if S_K is below normal. Despite strict recommendations, hypokalemia is frequently observed in DKA.

METHODS

Scientific literature was thoroughly searched to find 1) DKA treatment guidelines, 2) studies reporting hypokalemia in DKA, 3) and literature elaborating mechanisms involved in hypokalemia.

RESULTS

Acidosis affects S_K and its regulators including insulin, catecholamines and aldosterone. Current conceptual framework is an argument to gauge the degree of hypokalemia before it strikes DKA patients utilizing S_K level after adjusting it with pH. Suggested approach will reduce hypokalemia risk and its associated complications. The nomogram calculates pH-adjusted potassium and expected potassium loss. It also ranks hypokalemia associated risk, and proposes the potassium-replacement rate over given time period. The differences between current DKA treatment guidelines and proposed strategy are also discussed. Moreover, reasons and risk of hyperkalemia due to early initiation of potassium replacement and remedial actions are debated.

CONCLUSION

In light of proposed strategy, utilizing the nomogram ensures reduced incidence of hypokalemia in DKA resulting in improved clinical and patient outcomes. Pharmacoeconomic benefits can also be expected when avoiding hypokalemia ensures early discharge.

Bougainvillea glabra (choisy): A comprehensive review on botany, traditional uses, phytochemistry, pharmacology and toxicity

ETHNOPHARMACOLOGICAL RELEVANCE

Bougainvillea glabra (Choisy). (Family: Nyctinaginacea) is a valuable ornamental plant with culinary uses and also utilized in traditional medicine for treating common ailments. It is traditionally employed against several diseases such as diarrhoea, hypotension, intestinal disorders, stomachache, nausea, inflammation-related ailments, and in pain management. Though widely validated via in vitro and in vivo models, to date no endeavour has been made to compile in a single review the traditional, phytochemistry and pharmacological properties of B. glabra.

AIMS

To provide an up-to-date, authoritative review with respect to the traditional uses, chemical composition, in vitro and in vivo pharmacological properties, and toxicological estimations accomplished either utilizing the crude extracts or, wherever applicable, the bioactive compounds isolated from B. glabra. Besides, a critical evaluation of the published literature has been undertaken with regards to the current biochemical and toxicological data.

MATERIALS AND METHODS

Key databases per se, Ovid, Pubmed, Science Direct, Scopus, and Google scholar amongst others were probed for a systematic search using keywords to retrieve relevant publications on this plant. A total of 52 articles were included for the review depending on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

RESULTS

The studies conducted on either crude extracts, solvent fractions or isolated pure compounds from B. glabra had reported a varied range of biological effects comprising antibacterial, antifungal, antidiabetic, cytotoxic, analgesic, antipyretic, anti-inflammatory, and antioxidant activities. Phytochemical analysis of different parts of B. glabra unveiled 105 phytochemicals, belonging to phenolic, flavonoid, betacyanin, terpenoid, glycoside and essential oils classes of secondary metabolites.

CONCLUSION

Most of the pharmacological activities of crude extracts from this plant have been reported. A very few studies have reported the isolation of compounds responsible for observed biological potential of this plant. Moreover, the toxicity studies of this plant still need to be explored comprehensively to ensure its safety parameters. Additional investigations are recommended to transmute the ethnopharmacological claims of this plant species in folklore medicines into scientific rationale-based information.

Clinical management protocol of an acute contagious bovine pleuropnuemonia in a 6- year-old Bunaji cow in Sakaru village of Soba local government area, Kaduna state, Nigeria

The test and slaughter policy of the federal government of Nigeria on contagious bovine pleuropneumonia (CBPP) in cattle is no longer feasible because it lacked the political will as a result, farmers tend to treat their cattle of the disease most which has been ineffective. herefore, the quest for a supportive clinical management protocol for CBPP in cattle aimed at enabling the cow regain its body condition in order to allow the farmer sell the cow for slaughter at a profit was the aim of this case report. A 6-year-old Bunaji cow weighing 350kg with history of not feeding well, lagging behind during grazing, difficulty in breathing, intermittent cough and bloat was presented. Physical examination was carried out and differential diagnoses which included contagious bovine pleuropneumonia, mango choke, Pasteurellosis and tuberculosis were considered. After a careful scrutiny of the differentials, a tentative diagnosis of contagious bovine pleuropneumonia which was confirmed by the Latex agglutination test (LAT) was arrived at. A supportive clinical management protocol was instituted with the sole aim of enabling the cow regain its body condition in order to allow the farmer sell the cow for slaughter at a profit. The protocol involved isolation of the cow and administration of 20% tetracycline long acting through a combination of conventional (intra-muscular) and non-conventional (intra-venous) routes of administration along with an anti-inflammatory agent and an appetite stimulant. Six days after the commencement of therapy, the observed clinical signs subsided greatly and the cow became apparently healthy. The study showed that, the protocol of administering 20%tetracycline long acting through a combination of conventional (intra-muscular) and nonconventional (intra-venous) routes along with an anti-inflammatory agent (dexamethasone) and an appetite stimulant (vit. B. complex) was effective and profitable to the farmer. The client was advised to sell the cow for slaughter after observing the 21- day withdrawal period of the drugs. 

Trends in measles cases in Bayelsa state, Nigeria: a five-year review of case-based surveillance data (2014-2018)

BACKGROUND

Measles is a vaccine preventable, highly transmissible viral infection that affects mostly children under five years. It has been ear marked for elimination and Nigeria adopted the measles elimination strategies of the World Health Organization (WHO) African region to reduce cases and deaths. This study was done to determine trends in measles cases in Bayelsa state, to describe cases in terms of person and place, identify gaps in the case-based surveillance data collection system and identify risk factors for measles infection.

METHODS

We carried out a secondary data analysis of measles case-based surveillance data for the period of January 2014 to December 2018 obtained in Microsoft Excel from the State Ministry of Health. Cases were defined according to WHO standard case definitions. We calculated frequencies, proportions, estimated odds ratios (OR), 95% confidence intervals (CI) and multivariate analysis.

RESULTS

A total of 449 cases of measles were reported. There were 245(54.6%) males and the most affected age group was 1-4 years with 288(64.1%) cases. Of all cases, 289(9.35%) were confirmed and 70 (48.27%) had received at least one dose of measles vaccine. There was an all-year transmission with increased cases in the 4th quarter of the year. Yenegoa local government area had the highest number of cases. Timeliness of specimen reaching the laboratory and the proportion of specimens received at the laboratory with results sent to the national level timely were below WHO recommended 80% respectively. Predictors of measles infection were, age less than 5 years (AOR: 0.57, 95% CI: 0.36-0.91) and residing in an urban area (AOR: 1.55, 95% CI:1.02-2.34).

CONCLUSIONS

Measles infection occurred all-year round, with children less than 5 years being more affected. Measles case-based surveillance system showed high levels of case investigation with poor data quality and poor but improving indicators. Being less than 5 years was protective of measles while living in urban areas increased risk for infection. We recommended to the state government to prioritize immunization activities in the urban centers, start campaigns by the 4th quarter and continue to support measles surveillance activities and the federal government to strengthen regional laboratory capacities.

Correlation of acidosis-adjusted potassium level and cardiovascular outcomes in diabetic ketoacidosis: a systematic review

BACKGROUND

During the progress and resolution of a diabetic ketoacidosis (DKA) episode, potassium levels are significantly affected by the extent of acidosis. However, none of the current guidelines take into account acidosis during resuscitation of potassium level in DKA management, which may increase the risk of cardiovascular adverse events.

OBJECTIVE

To assess literature regarding the adjustment of potassium level using pH to calculate pH-adjusted corrected potassium level, and to observe the relationship of cardiovascular outcomes with reported potassium level and pH-adjusted corrected potassium in DKA.

METHODOLOGY

Seven databases were searched from inception to January 2018 for studies which had reported people with diabetes developing diabetic ketoacidosis, in relation to prevalence or incidence, fluid resuscitation or potassium supplementation treatment, treatment or cardiovascular outcomes, and experimentation with DKA management or insulin. Quality of studies was evaluated using Cochrane Risk of Bias and Newcastle Ottawa Scale.

RESULTS

Forty-seven studies were included in qualitative synthesis out of a total of 10,292 retrieved studies. Forty-one studies discussed the potassium level and blood pH at the time of admission, ten studies discussed cardiovascular outcomes, and only four studies concurrently discussed potassium level, pH, and cardiovascular outcomes. Only two studies were graded as good on the Newcastle Ottawa Scale. The reported potassium level was well within normal range (5.8 mmol/L), whereas pH rendered patients to be moderately acidotic (7.13). Surprisingly, none of the included studies mentioned pH-adjusted corrected potassium level and, hence, this was calculated later. Although mean corrected potassium was within the normal range (3.56 mmol/L), 13 studies had corrected potassium below 3.5 mmol/L and five had it below 3.0 mmol/L. Nevertheless, with the exception of one study, none discussed cardiovascular outcomes in the context of potassium or pH-adjusted potassium level.

CONCLUSION

The evidence surrounding cardiovascular outcomes during DKA episodes in light of a pH-adjusted corrected potassium level is scarce. A prospective observational, or preferably, an experimental study in this regard will ensure we can modify and enhance safety of existing DKA treatment protocols.

Imaging Carotid Atherosclerosis Plaque Ulceration: Comparison of Advanced Imaging Modalities and Recent Developments

Atherosclerosis remains the leading cause of long-term mortality and morbidity worldwide, despite remarkable advancement in its management. Vulnerable atherosclerotic plaques are principally responsible for thromboembolic events in various arterial territories such as carotid, coronary, and lower limb vessels. Carotid plaque ulceration is one of the key features associated with plaque vulnerability and is considered a notable indicator of previous plaque rupture and possible future cerebrovascular events. Multiple imaging modalities have been used to assess the degree of carotid plaque ulceration for diagnostic and research purposes. Early diagnosis and management of carotid artery disease could prevent further cerebrovascular events. In this review, we highlight the merits and limitations of various imaging techniques for identifying plaque ulceration.

Adipocytokines and aging: adiponectin and leptin

Adipose tissue is an active metabolic organ secreting adipocytokines which are involved in the energy homeostasis and regulation of glucose and lipid metabolism. Aging is associated with fat redistribution, which is characterized by loss of peripheral subcutaneous fat and accumulation of visceral fat. Visceral adipose tissue is more involved in the developement of metabolic diseases than subcutaneous adipose tissue. Aging also alters the function, proliferation, size, and number of adipose cells which leads to alterations in the secretion, synthesis and function of the adipocytokines. Adiponectin is an insulin sensitizing, anti-inflammatory, and antiathoregenic adipokine. Centarians have higher adiponectin levels associated with longevity. However, in older individuals ‑ age 65 or more ‑ adiponectin is associated with higher mortality. Dysregulation of adiponectin in older individuals may be due to loss of function of circulating adiponectin or a response to increased inflammatory process. Longitidunal increase in adiponectin levels 5with aging rather than genetically high adiponectin levels may translate to increased mortality in older patients. The adipocytokine leptin is traditionally viewed as a product of adipocytes that can exert endocrine effects. There have been conflicting reports of not only the effects of aging on leptin, but also the effects of leptin on age-related diseases including sarcopenia, Alzheimer's disease and cardiovascular diseases. Aging is also associated with resistance to leptin and/or to a decrease of receptors for this hormone. In this review, we briefly discuss the role of two major adipocytokines adiponectin and leptin in the aging process and age-related diseases.

Pattern of oncologic emergencies seen in adult cancer patients attending the Radiotherapy and Oncology Centre, Ahmadu Bello University Teaching Hospital, Zaria - Nigeria

AIMS AND OBJECTIVES

To evaluate the Pattern of Oncologic Emergencies seen in Adult cancer patients and the treatment modalities used.

MATERIALS AND METHODS

Between January 2004 and December 2008, a total of 1824 (M:F = 1:1.8) new patients were seen. 196 (M:F = 1:1.4) consecutive patients with histologically confirmed malignancies presenting with or having oncologic emergencies were treated and have been reviewed. Patients' folders were reviewed retrospectively with a structured pro forma. Results were analysed using Epi Info soft ware Version 3.4.1; 2007 Edition.

RESULTS

The median age was 49 years and mean age of 42 years (range, 15 - 82 years). M: F = 1:1.4. 162 patients had oncologic emergencies at presentation while 21 during treatments and 13 during follow up. At the time of diagnosis of oncologic emergency, 126 were not on any treatment, 42 patients on hormonal therapy and 28 patients were on diverse chemotherapy. All the patients presented late with 108 patients presenting with metastatic disease and 88 patients with locally advanced disease. Only 35 patients were treated within 1 week of onset of emergency. 59 patients had cervical cancer, 31 patients with breast cancer and 28 patients with prostate cancer. Tumour haemorrhage wass the commonest oncologic emergency seen in 107 patients followed by bone pain with imminent cord compression from bone metastases in 59 patients. Of 107 patients with tumour haemorrhage, 54 patients had cardiovascular collapse with 7 having acute renal failure. Similarly, of the 107 with tumour haemorrhage, 56 patients bled from cervical cancer, 12 patients from breast cancer and 8 patients from urinary bladder. 129 patients were treated with teletherapy, 31 patients had chemotherapy, 27 patients had emergency surgery and 5 patients had chemoradiation. Oncologic emergencies were corrected in 126 patients.

CONCLUSION

Tumour haemorrhage is the commonest oncologic emergency in this environment and teletherapy is the commonest therapy used. More radiotherapy centres are needed for prompt treatment and their usefulness in managing emergencies should be made known. Oncologic emergencies are commonly seen in metastatic and locally advanced disease.

Verapamil stimulation test in hyperprolactinemia: loss of prolactin response in anatomic or functional stalk effect

AIM

Verapamil stimulation test was previously investigated as a tool for differential diagnosis of hyperprolactinemia, but with conflicting results. Macroprolactinemia was never considered in those previous studies. Here, we aimed to re-investigate the diagnostic value of verapamil in a population who were all screened for macroprolactinemia. Prolactin responses to verapamil in 65 female patients (age: 29.9 +/- 8.1 years) with hyperprolactinemia were tested in a descriptive, matched case-control study.

METHODS

Verapamil 80 mg, p.o. was administered, and then PRL levels were measured at 8th and 16th hours, by immunometric chemiluminescence. Verapamil responsiveness was determined by peak percent change in basal prolactin levels (PRL).

RESULTS

Verapamil significantly increased PRL levels in healthy controls (N. 8, PRL: 183%), macroprolactinoma (N. 8, PRL: 7%), microprolactinoma (N. 19, PRL: 21%), macroprolactinemia (N. 23, PRL: 126%), but not in pseudoprolactinoma (N. 8, PRL: 0.8%), and risperidone-induced hyperprolactinemia (N. 7, PRL: 3%). ROC curve analysis revealed that unresponsiveness to verapamil defined as PRL <7%, discriminated anatomical or functional stalk effect (sensitivity: 74%, specificity: 73%, AUC: 0.855+/-0.04, P <0.001, CI: 0.768-0.942) associated with pseudoprolactinoma or risperidone-induced hyperprolactinemia, respectively.

CONCLUSION

Verapamil responsiveness is not a reliable finding for the differential diagnosis of hyperprolactinemia. However, verapamil unresponsiveness discriminates stalk effect (i.e., anatomically or functionally inhibited dopaminergic tonus) from other causes of hyperprolactinemia with varying degrees of responsiveness.

Qualitative phytochemical screening and in vitro antimicrobial effects of methanol stem bark extract of Ficus thonningii (Moraceae)

The methanolic stem bark extract of Ficus thonningii (Moraceae) was subjected to preliminary phytochemical screening and in vitro antimicrobial tests. The phytochemical tests was carried out using standard methods of analysis and these investigations revealed the presence of alkaloids, anthraquinones, carbohydrates, flavonoids, saponins and tannins. The antimicrobial activity of the plant extract was assayed using the agar plate disc diffusion and nutrient broth dilution techniques. Test micro organisms were: Escherichia coli, Klebsiella spp, Pseudomonas aeruginosa, Salmonella typhi (gram-negative), Staphylococcus aureus and Streptococcus spp. (gram-positive). The extracts inhibited the growth of all the test organisms at different concentrations especially against Pseudomonas aeruginosa and Streptococcus spp. which had mean inhibition zone of 33.33+/-7.33 mm and 32.33+/-2.51 mm respectively. The results showed the MIC of 10 mg ml(-1) against pseudomonas and 1.25 against remaining organisms tested. The MBC against Staphylococcus aureus was 2.5 mg ml(-1) and that of Streptococcus spp. was found to be 0.625 mg ml(-1). The extracts showed varied inhibitory activity against the organisms studied.

Continuing communicable disease burden in Eritrea

BACKGROUND AND METHODS

A retrospective study of the national health profile of Eritreans, focusing on acute respiratory tract infection (ARTI), tuberculosis (TB), diarrhoea, sexually transmitted diseases (STDs) and HIV/AIDS, was done on data from 1998 to 2003 through a health information management system. Records were included for patients of all ages receiving outpatient and inpatient hospital services during the study period. All incidence rates were given as cases per 100,000 population.

RESULTS

The incidence of ARTI increased from 6,500 cases per annum in 1998 to 8 500 in 2003, representing a 30% increase. Diarrhoea rates remained unchanged, averaging 3,000 cases. For both ARTI and diarrhoea, rates were at least 3 times higher in children under 5 years of age than in those over 5 years of age. The incidences of TB and STDs decreased from 370 and 220 in 1998 to 170 and 80 in 2003, respectively. HIV/AIDS incidence increased from 40 in 1998 to 65 in 2003, reflecting a 60% increase. The case fatality rates (CFRs) for HIV/AIDS and TB were 12% and 2% in 1998, increasing to 14% and 3%, respectively, in 2001. The CFR for ARTI and diarrhea remained low at 0.3%. CFRs were higher in children under 5 years than in those over 5 years for all the diseases but rates declined consistently, probably reflecting the positive impact of the introduction of the integrated management of childhood illness (IMCI). Although the incidence rate of HIV/AIDS was relatively low compared with rates for TB, ARTI and diarrhoea, the HIV/AIDS CFR was relatively high, posing a threat to the gains made in control of infectious diseases. The disease burden from TB and STDs declined over the 6-year study period, while that from ARTI and HIV/AIDS increased. Consequently the overall disease burden from communicable diseases remained unchanged over the study period.

The prevalence of hypertension and its relationship with obesity: results from a national blood pressure survey in Eritrea

The prevalence of cardiovascular diseases has been shown to be on the increase in Africa based on hospital-based information and limited national surveys. A recent report on analysis of data from Health Information Management Systems (HIMS) highlighted an increasing burden of noncommunicable diseases (NCDs) in Eritrea, with the incidence of hypertension doubling in a space of 6 years. HMIS data are only a proxy of national prevalence rates, necessitating the conduct of national surveys. The WHO STEPwise approach to surveillance of NCDs was used for the national NCD risk factor survey in 2004. This report focuses on blood pressure (BP) and obesity (body mass index (BMI) > 30 kg/m2) as NCD risk factors in Eritrea. A total of 2352 people in age groups 15 to 64 years participated in the survey. The prevalence of hypertension defined as BP > 140/90 mmHg was 15.9% in the general population, with 16.4% in urban and 14.5% in rural areas, 17% of whom were males while 15% were females. BMI was positively associated with systolic (SBP), diastolic and mean arterial pressure. Although the prevalence of obesity (3.3%) was higher in females, the effect of BMI on BP was higher in males than in females (regression coefficient 0.64 and 0.38, respectively, P < or = 0.05), especially in those >45 years. BMI did not have a significant effect on BP in lean people (BMI < 19) and in those with high BMI, but was positively correlated to SBP in those with normal BMI (P < or = 0.02). BMI and age appear to play a synergistic role in creating a strong association with BP.

Recurrent cholera epidemics in Kano--northern Nigeria

OBJECTIVES

The study examined the factors associated with recurrent cholera epidemics in Kano State of Northern Nigeria, the management of the epidemics and health outcomes.

METHODS

Using epidemiological data from the Public Health Department of the Kano State Ministry of Health, the study examined the frequency and geographical distribution of the epidemics for the period 1995 to 2001; procedures for detection; control measures as well as results of biological and bacteriological testing of water from different sources. Mapping and testing for significance of faecal contamination of water sources were done.

RESULTS

The number of cholera cases in the city was 2 630; 847 and 2 347 in 1995/6, 1997 and 1999 respectively. The State Epidemiological Unit which is responsible for surveillance detected epidemics using set thresholds and activated multi-sectoral emergency responses. Control measures encompassed accurate diagnosis at the reference laboratory, Kaduna; registration of cases; case management and public health measures targeting personal hygiene and water treatment. The cholera epidemics attracted worldwide attention with emergency responses from many agencies including WHO, UNICEF and Medicens Sand Frontiers (MSF). Case fatality rates decreased from 15% in 1995/6 to 5% in 1997 and 2% in 1999. The organism responsible for all the outbreaks was Vibrio cholerae, el-tor of inaba serotype. Water contamination of all sources was the principal cause of the epidemics. There were statistically significant differences in levels of faecal contamination of water sources, wells being most affected, followed by piped water, chi2 = 11.556, (p < 0.02). Bore holes were relatively safer sources of water. Point source epidemics always started from Kano City before fanning out to the rest of the State.

CONCLUSION

Multi-sectoral Epidemic Preparedness and Response (EPR) approaches have contributed to the reduction in case fatality rates over the years and should be sustained. However, in order to prevent future cholera epidemics, there is need to introduce intervention measures that address the root problems of poor sanitation and unsafe water supplies.

Magneto−Structural Correlations: Synthesis of a Family of End-On Azido-Bridged Manganese(II) Dinuclear Compounds with S = 5 Spin Ground State

The preparation of a series of multidentate pyridyl-imine ligands, L1-L3, and their reactivity with the Mn(II)/N3- system is described (L1 = [N,N-bis(pyridine-2-yl)benzylidene]ethane-1,2-diamine; L2 = [N,N-bis(pyridine-2-yl)benzylidene]propane-1,3-diamine, and L3 = [N,N-bis(pyridine-2-yl)benzylidene]butane-1,4-diamine). Complexes comprising dinuclear end-on bis(mu-azido)-bridged manganese(II) units of formulas [Mn2(L1)2(N3)4][Mn2(L1)2(N3)2(CH3OH)2](ClO4)2 (two cocrystallized dinuclear units, 1.2), [Mn2(L2)2(N3)2](ClO4)2 (3), and [Mn2(L3)2(N3)2](ClO4)2 (4) have been synthesized. The crystal structures of complexes 1-4 as well as their magnetic properties are presented. Each manganese atom of cocrystallized complexes in compound 1.2 is heptacoordinated, displaying Mn-N-Mn angles, theta, of 102.53(12) and 101.70(12) degrees and Mn...Mn distances of 3.5091(7) and 3.4680(7) A. On the other hand, each manganese center in compounds 3 and 4 is located within an octahedral coordination environment, the complexes displaying theta angles of 104.29(11) and 103.60(18) degrees , respectively, and Mn...Mn vectors of 3.5371(7) and 3.5338(10) A, respectively. Magnetic susceptibility studies revealed the presence of intramolecular ferromagnetic superexchange, yielding an S = 5 spin ground state in all complexes. Fitting of the experimental data led to coupling constants, intermolecular exchange values, and g factors (in the J/zJ'/g format) of 0.77 cm(-1)/0.01 cm(-1)/2.20 (1.2), 2.04 cm(-1)/0.01 cm(-1)/1.99 (3), and 1.75 cm(-1)/-0.05 cm(-1)/2.04 (4), respectively (using H = -2JS1S2 as the convention for the Heisenberg spin-Hamiltonian). These results are consistent with predictions from recent DFT calculations performed on end-on bis(mu-N3-)-bridged Mn(II) dinuclear complexes. A plot of experimental J vs theta, including data from the only preexisting compound of this kind, reveals a linear relationship, which could be the first evidence of a possible magneto-structural correlation between these two parameters.

Crystal structure, spectroscopic studies, and nonlinear optical (NLO) properties of Schiff base metal complexes containing an N, S donor ligand

A new ligand, 4-dipropylaminobenzaldehyde thiosemicarbazone (abbreviated as HL), and its complexes ML2 (M = Ni, Pd, and Cu) have been synthesized and fully characterized by elemental analyses, EI-MS, IR and UV–vis spectroscopy, and photoluminescence measurements. All of the compounds exhibit a blue–green color with dual fluorescence in DMF solution. The quantum yield ratio (Φ′(CT)/Φ(LE)) decreases in the order NiL2 > HL > PdL2 > CuL2. The ligand HL crystallizes in the monoclinic system, space group P21/n, with a = 15.1680, b = 8.5573, and c = 25.3920 Å, β = 100.3457°, and V = 3242.2 Å3. The nickel complex (NiL2) crystallizes in the triclinic system, space group Pī, with a = 8.3093, b = 9.7540, and c = 10.2802 Å, α = 101.383°, β = 107.693°, γ = 96.703°, and V = 764.12 Å3. In these complexes, HL has lost a proton from its tautometric thiol form and acts as a single negatively charged bidentate ligand coordinating to the nickel ion via the mercapto sulfur and β-nitrogen atoms. The geometry around Ni(II) is almost square-planar with two equivalent Ni—N and two equivalent Ni—S bonds. The monomeric structure of HL or NiL2 is extended into an infinite two-dimensional network via hydrogen bonds. The two-photon absorption of HL and ML2 solutions (in DMF) was measured at 532 nm by the open-aperture Z-scan technique. Key words: crystal structure, metal complex, dual fluorescence, NLO.

Orbital embryonal rhabdomyosarcoma in Karachi (1998-2002)

OBJECTIVE

To study the epidemiology of ocular Rhabdomyosarcoma (ORMS) in Karachi.

METHODS

Incident ORMS cases resident of Karachi, registered at Karachi Cancer Registry (KCR) during 1st January 1998 to 31st December 2002 were included in the study. The data were classified using ICD-O2; computerized with Canreg-3, and analyzed using SPSS 10.0.

RESULTS

Ten cases of ORMS were reported to KCR during 1998-2002. RMS originated in the orbit in eight cases, conjunctiva in one and eyelid in one. Nine cases presented with proptosis, associated with conjunctivitis in four cases. One case presented with eyelid swelling. The crude annual incidence rate was 0.13/100,000, the age standardized rate was 0.3/100,000. The mean age of childhood cases was 10.4 years (95% CI 4.0; 16.7); and adult cases was 24.8 years (95% CI 12.8; 36.7). At presentation, eight patients were older than 10 years and three were older than 20 years. Five cases were categorized as childhood malignancies. Tumors were a TNM stage III disease at presentation in eight cases; survival at the end of one year was 70%, and at the end of two years 20%. There were no survivors at the end of three years.

CONCLUSION

ORMS in Karachi is a disease with a dismal survival. It may reflect a late presentation, or shorter adult ORMS survival or a manifestation of a different genetic pattern, associated with rapid evolution and poor prognosis. Health education for the population, especially parents and health providers is essential for early ORMS diagnosis. Pediatricians, ophthalmologists and health professionals, can play a vital role. Healthcare planning should focus on capacity building for ophthalmologic screening. Cytogenetic studies are advised to determine the genetic pattern.

Cancer esophagus Karachi 1995-2002: epidemiology, risk factors and trends

OBJECTIVE

To study the trends of cancer esophagus in Karachi South during 1995-2002 and identify risk factors.

METHODS

Incident esophageal cancer cases recorded at the Karachi Cancer Registry for Karachi South, during 1st January 1995 to 31st December 2003 were reviewed. For maximum completion of data, incident cases registered from 1st January 1995 to 31st December 2002 were included for final analyses.

RESULTS

The Age Standardized Incidence Rates (ASIRs) of cancer esophagus in Karachi South for males were 6.5/100,000 (1995-1997) and 6.4/100,000 (1998-2002). In females the observed rates were 7.0/100,000 (1995-1997) and 8.6/100,000 (1998-2002).

CONCLUSION

In the moderately high incidence, cancer esophagus zone of Karachi, the ASIRs in males remained stable during the last decade, but in females, an upward trend was observed suggesting a progressively higher exposure to risk factors in the latter. The potential risk factors in Karachi are use of all forms of tobacco, areca nut, infrequent consumption of raw fruits and vegetables and diet deficiencies. There is a necessity to actively control the proven risk factors and address the existence of other risk factors. The primary recommended strategy for the control of cancer esophagus would therefore be legislation against tobacco and areca nut in Pakistan and public health education. The risk factors of cancer esophagus identified in this article need to be further confirmed.