Current Trends in Medicine and Medical Research Vol. 3

Clinical Effects of Mixed Infection of Trypanosomes and Ancylostoma caninum in Dogs and Treatment with Diminazene and Mebendazole (Nigeria)

R. I. O. Nwoha, B. M. Anene — Mon, 24 Jun 2019 00:00:00 +0000

Trypanosomosis is one of the major diseases ravaging animals in Nigeria especially within Nsukka area in Enugu State. All species of trypanosomes, with the exception of some strains of T. vivax which produce a hyper acute and acute infection, are characterized by high parasitaemia, pyrexia, severe anaemia and haemorrhages on the mucosal and serosal surfaces. The socio-economic importance of trypanosomosis and ancylostomosis in both humans and animal necessitated the investigation of the clinical signs of single and conjunct infection of both parasites in dogs. Sixteen dogs grouped into 4 of 4 members each were used in the study. GROUP I was uninfected dogs (control), GROUP II was infected with Ancylostoma caninum GROUP III was infected with Trypanosoma brucei (T. brucei), GROUP IV was mixed infections of Trypanosoma brucei and Ancylostoma caninum (T. brucei/A. caninum). Post acclimatization, Ancylostoma caninum infection was done on GPII and GPIV. Two weeks later Trypanosoma brucei infections was done on GPIII and superimposed on GPIV. Three weeks post trypanosome infection; GPIII and GPIV were treated with 7 mg/kg diminazene aceturate (Veribin ® , CEVA Sante Animale- La Ballasteiére 33501 Libourne Cedex, France) x intramuscularly x once. Mebendazole (Vermin ® , Janssen-Cilag Ltd 50 - 100 Holmers Farm Way, High Wycombe, Bucks, HP12 4EG UK) at 100 mg x per os twice daily for 3 days was used only on GPII and GPIV and a repeat treatment given 2 weeks later. Prepatent period of T. brucei infection was 5.00±1.30 days in single infection and 3.00±1.40 days in conjunct infection of T. brucei and A. caninum. Persistent parasitaemia resulted in repeated treatment with diminazene aceturate at 7 mg/kg and mebendazole at 100 mg twice daily for 3 days. The predominant signs revealed include; fluctuation in weight, lethargy, vomition, enlargement of popliteal lymphnodes, pyrexia, oedema of lower jaw and ocular discharges, enlarged abdomen, anaemia, cornea opacity and slight emaciation. The clinical signs were most severe in GPIV compared to GPIII. The egg per gram of faeces (EPG) in GPII was significantly higher than the mixed infection (GPIV). Treatment only slightly improved clinical manifestations. In conclusion, most signs shown were consistent with trypanosomosis in dogs except abdominal enlargement which is a complication of A. caninum. Clinical signs therefore could serve as a diagnostic tool in the treatment of both conditions in dogs. The severity of the disease conditions was more in the conjunct group compared to the single infection. Treatment of the diseases with diminazene aceturate and mebendazole caused slight improvement in the clinical condition due to the resistant strain of T. brucei used in the study.

Prediction of Intrauterine Growth Restriction in High Pulsatility Index of Uterine Artery

Mon, 24 Jun 2019 00:00:00 +0000

Introduction: Intrauterine growth restriction is a significant cause of neonatal mortality. The uterine artery Doppler waveform becomes transformed into a high flow with low resistance at 22-24 weeks. The apt way to reduce intrauterine growth restriction is to identify the antenatal factors, which ascertain the uterine milieu and nutrient bioavailability. This chapter highlights the relation between abnormal uterine artery flow and resultant fetal growth restriction in a tertiary care center.

Presence of high pulsatility is a significant risk factor for early onset IUGR as compared to late onset IUGR. Abnormal Doppler waveforms within the uterine arteries are indicative of elevated resistance. The perfusion at the trophoblast-maternal interphase is high velocity, low volume and intermittent, resulting in intrauterine growth retardation. This subsequently leads to the damage of fetal tertiary stem villi floating in the intervillous space. The sensitivity is better for early onset IUGR. This chapter concludes that high pulsatility index in uterine arteries can lead to intrauterine growth restriction .The plausible explanation is reduced Vascular Endothelial Growth Factor (VEGF) from maternal decidual natural killer cells. This study concludes that high pulsatility index in uterine arteries is associated with intrauterine growth restriction. This occurs due to inadequate VEGF secretion from maternal decidua resulting in high velocity, low volume diastolic flow in the uterine artery supplying the spiral arterioles, that subsequently leads to the damage of fetal tertiary stem villi floating in the intervillous space. As resistance increases in uterine arteries, the velocity of blood flowing also increases from 10 cm/sec to 1-2 m/s. The uterine artery supplies both the trophoblast maternal interphase and the uterine arterial venous circulation. Most blood increases uterine arterial venous circulation and helps in the development of uterine musculature and local milieu of gestation and protects against post partum hemorrhage. Only a partial amount of blood flowing through uterine arteries is pumped into the dilated spiral arteries and sprinkled (cf shot) over tertiary fetal stem villi in the intervillous space. The damage to placental bed may be ischemic, hemodynamic, oxidative or immunological. The high velocity, low volume, intermittent perfusion by the uterine artery supplying the intervillous space at the trophoblast-maternal interphase can cause hemodynamic and oxidative damage resulting in intrauterine growth retardation. The sensitivity and negative predictive value are better for early onset IUGR.

Epidemiology of Mental Disorders in the Eastern Mediterranean Region

Nahla Khamis Ibrahim — Mon, 24 Jun 2019 00:00:00 +0000

Mental illnesses are complicated and multi-factorial disorders. This chapter of the book was done to determine the epidemiology of mental health problems in the Eastern Mediterranean Region (EMR). All electronic databases of studies done concerning mental disorders in the EMR (during the period from 1990 to 2019) were searched, scrutinized and summarized. Results revealed that EMR has higher rates of mental disorders compared to other regions of the world. This finding is mainly due to the unrest situation. The prevalence of mental illnesses in EMR ranged between 15.6% - 35.5% (with higher rates in nations with complex emergency circumstances). Mental disorders were associated with 11.9 million disability-adjusted life years (DALYs) during the period from 1990-2013. Palestine, Djibouti and Somalia reported the highest DALYs in the region during such period. Regarding mortality, depression and schizophrenia resulted in high mortality rates. Studies reported that vulnerable groups to mental illnesses including females, poor unmarried individuals, elderly, those suffering from chronic illnesses, individuals exposed to conflicts or violations of human rights, and the refugees. Cultures affect mental illnesses in the EMR as stigma attached to mental disorders is one of the commonest reasons for not looking for mental care. On the other hand, studies illustrated presence of inverse associations between religious level and some mental illnesses. Improving mental health promotion programs, with scaling up of mental health services and addressing the barriers against receiving mental care are recommended. Decreasing stigma attached to people with mental illnesses is recommended and can be done through mass media, schools, universities, etc. Conflict resolutions and building mental health capacity of the countries with conflicts are needed.

Predicting Contrast-Associated AKI for Intravenous Contrast Exposure and Non-coronary Angiography Procedures: A Review of the Literature

Ogochukwu Okoye — Mon, 24 Jun 2019 00:00:00 +0000

Introduction: Although cases of contrast associated AKI (CA-AKI) have been reported over the years and several studies exist on the subject, there has been little success in terms of developing a generally acceptable prediction model for this preventable disease. Majority of work done has been on patients under going coronary angiography and are not generalisable due to heterogeneity of patients and procedure related factors.

The aim of this chapter is to review the epidemiology and prediction models of CA-AKI in patients receiving intravenous contrast for non-coronary angiography procedures.

Conclusion: Although non-coronary procedures are more routinely performed in most institutions, very few prediction models exist for patients undergoing these procedures and this limits preventive efforts. Clearly, prediction models developed for PCI should not be adopted for non-coronary angiography procedures.

Atypical Post Partum Eclampsia and Posterior Reversible Encephalopathy Syndrome

Mon, 24 Jun 2019 00:00:00 +0000

Pregnancy induced Hypertension also called as “Gestosis” plural “Gestoses” has a heterogeneous etiology. A case of atypical eclampsia with seizures in the postpartum, that required intravenous Magnesium sulphate is described. The two proposed theories of etiopathogeniesis of cerebral edema, “Vasogenic Theory” and “Cytotoxic theory” are discussed. The concept of “delta hypertension” is emphasized. Impaired fluid mobilization, decreased sodium excretion and imbalance between angiopoietic factors in the post partum period is discussed as the likely cause of post partum eclampsia. It can be concluded that it is important to monitor blood pressure in the postpartum state. The patients of atypical postpartum eclampsia with PRES, are likely explained by hyper dynamic circulation, delta hypertension and vasogenic theory. PRES is reversible, has classical clinico-radiological features in MRI and has good prognosis with treatment.

Reported Experiences of Stalking Behavior from Patients towards Psychiatrists from the Atlantic Provinces of Canada

Amin A. Muhammad Gadit, Gerry Mugford, Terrence Callanan, Rana Aslanov — Mon, 24 Jun 2019 00:00:00 +0000

Introduction: Stalking is repeated acts, experienced as unpleasantly intrusive, that creates apprehension and can be understood by reasonably prudent persons as grounds for becoming fearful. Doctors and healthcare professionals are at greater risk than the general population of being stalked, particularly by their patients. Stalking behaviour is particularly significant among psychiatric patients that put mental health professionals at a greater risk of being victimized. Stalkers generally come from turbulent backgrounds, having experienced violent childhood, loss of caretaker, contact with criminal justice system, social isolation and significant losses a year prior to stalking behavior.
Aim: A study was conducted to assess the magnitude of stalking experienced by psychiatrists, its’ effects and actions taken to ameliorate the problem.
Methods: A cross sectional study to assess the magnitude of stalking the consequent effects on the psychological, social and occupational life of psychiatrists; and any preventative measure taken was conducted from July 2009-April 2010. A questionnaire was sent to 301 psychiatrists practicing in Atlantic Canada. Local Ethics approval was obtained.
Results: Of the 308 psychiatrists sent surveys, 116 responded (37.6%; 67 males and 47 females). One questionnaire was invalid. (Twenty-nine (15 males and 14 females) reported experiences of stalking. Fifty-eight (50.4%) were above age 50, 49(42.6%) were between ages 35-50 and (8) 7% were younger than 35. In the study cohort, 39(33.6%) psychiatrists were in pure clinical practice, 4(3.4%) were in academic practice and 71(61.2%) had combined clinical and academic practice. Among the subspecialties, 73(62.9%) psychiatrists were practicing general adult psychiatry, 19(16.4%) were child and adolescent psychiatrists, 6(5.2%) in geriatric psychiatry, 4(3.4%) in consultation-liaison, 5(4.3%) in forensic, 1(0.9%) in developmental disability and 7(6.0%) were in other psychiatric specialties. Of 115 psychiatrists, 53(46.1%) were in practice for more than 15 years, 16 (13.9%) were from 11–15 years, 29 (25.2%)-from 5 to 10 years and 17(14.8%) were in practice for less than 5 years. There was no significant differences [OR] (Odds Ratio values), p-values>0.05) in reported stalked for age or length of psychiatric practice. However, there was strong association of stalking with the distress experienced by the psychiatrists (p=0.00).
Conclusion: The problem of stalking does exist in the Atlantic Provinces of Canada and causes immense psychological, professional and social distress among psychiatrists who fall victim to stalking behavior. The majority of mental health professionals are unaware of any laws against stalking in Canada. There is a need for more effective education, support services and redress if we are to ameliorate the burden associated with stalking behaviours.

A Study of Scoliosis among Adolescent Female Patients at the National Orthopaedic Hospital, Enugu, Enugu State, Southeast Nigeria

A. C. Obi-Okaro, S. N. Ukibe, C. U. Nwadinigwe, Ekezie Jervas, N. R. Ukibe — Mon, 24 Jun 2019 00:00:00 +0000

Background: Scoliosis is a musculoskeletal disorder characterised by a lateral bending or curvature of the spine.

Aim of Study: To evaluate the prevalence, distribution and age of onset of adolescent scoliosis among female patients at the National Orthopaedic Hospital, Enugu, Southeast, Nigeria.

Study Design: This was a retrospective epidemiological study of female scoliosis patients treated between 2005 and 2014. Data were obtained from patients medical records after due permission had been sought for and obtained from the hospital management. A total of 16,027 orthopaedic cases were analysed.

Results: The prevalence of female adolescent scoliosis within the 10-year period was 0.27%. The peak age of presentation was 11-12 years, followed by 13-14 years. The prevalence rate varied from one year to the other. Thirty per cent (30%) of the presenting females were children of traders followed closely (20%) by children of teachers.

Conclusion: Female adolescent scoliosis was not common at the National Orthopaedic Hospital, Enugu within the study period. In view of the public health importance of scoliosis in adolescent girls, screening tests should be done periodically to detect cases in time for effective management and orthotic rehabilitation. Scoliosis among females was prevalent but not common at the National Orthopaedic Hospital, Enugu, Nigeria. It is suggested that periodic screening tests be performed to detect cases early. This will make for early diagnosis and proper treatment. Here lies the public health importance of adolescent scoliosis.

Physical Activity and Its Relationship with Body Weight in Older Adults

Mon, 24 Jun 2019 00:00:00 +0000

Purpose: To determine the relationship between calories intake, level of physical activity and overweight/obesity in adults over 60 years in Celaya, Mexico.

Study Design: It was a cross-sectional study.

Place and Duration of Study: Population: 754 adults between 60 and 70 years old from Day Care Centers for the elderly from Celaya, Guanajuato, México between August 2014 and July 2015.

Methodology: We included a sample of 100 of adults, both genders, who signed the consent form; the calories intake was measure with SNUT survey, physical activity with International Physical Activity Questionnaire and measuring of overweight/obesity with Body Mass Index. Statistical analysis was with Pearson’s r, and lineal regression equation between mean daily calories intake and Body Mass Index and between physical activity (METS/min/week) and Body Mass Index. The variables were categorized and it was calculated Chi squared test, p value, Odds Ratio and it was generated in a logistic multivariable model.

Results: The sample was 100 adults between 60 and 70 years old. There was not a correlation between caloric intake and Body Mass Index in males nor females (P>0.05). There was a good negative correlation between physical activity and body mass index (r=-0.56) and a negative lineal relationship (P<0.05). There was a relationship between physical activity and overweight/obesity (X²= 47.29, df 1 P=.00001) and OR=102.60. There was not a relationship between Mean Daily Caloric Intake and overweight/obesity (X²= 0.84 dg 1 P=.36).

Conclusion: There is a strong negative correlation and lineal relationship between physical activity and Body Mass Index. There is an relationship between physical activity and overweight/obesity in the elderly from Celaya, Mexico.

Potential of Physical Analgesia in the Complex Rehabilitation of Patients with Stump Pain and Phantom Pain After Lower Limb Amputation (A Double-blind Randomised Controlled Trial of Efficacy of Deep Oscillation, Laser Therapy and Paravertebral Infiltrations)

Ivet B. Koleva, Borislav R. Ioshinov, Radoslav D. Yoshinov — Mon, 24 Jun 2019 00:00:00 +0000

Introduction: Most of amputees feel residual limb (stump) pain, phantom sensations and phantom

pain. Our purpose was to remind the wide public of the impact of rehabilitation (including the modern

physical modalities Deep Oscillation – DO and Laser therapy - LTh) in the pain management of

amputees. According the medical definitions the amputation is ‘’the intentional surgical removal of a

limb or body part; performed for the following reasons: to remove malignant tumors, after severe

trauma, and to remove tissues without adequate blood supply, because of injury to the blood vessel,

hardening of the arteries, arterial embolism, impaired circulation, repeated severe infection that leads

to gangrene, severe frostbite, Raynaud's disease, or Buerger's disease’’.

Aims: Comparative evaluation of drug, physical (including DO and LTh) and combined analgesia in

the complex rehabilitation of patients after trans-femoral amputation suffering from stump pain and

phantom pain. In the current chapter, we tested the hypothesis that some modern preformed

modalities (Deep Oscillation and Laser therapy) in combination with paravertebral infiltrations have

the capacity to provide an analgesic effect, to relieve reactive depression and to ameliorate the quality

of life of amputees.

Materials and Methods: During last years a total of 105 amputees with stump pain and phantom pain

were observed and investigated. The investigation was conducted with consideration for the

protection of patients, as outlined in the Declaration of Helsinki, and was approved by the appropriate

institutional review boards and ethic commissions. All patients gave written informed consent before

undergoing any examination or study procedure.

A simple randomization was used. Patients were sequentially numbered and randomized into five

treatment groups of 21 each one.

All patients received a complex rehabilitation programme including physical therapy and patients’

education. In group 1 we applied too drug therapy – paravertebral infiltrations with steroids, lidocaine

and B vitamins. Patients of group 2 received a complex rehabilitation programme, including DO. In

group 3 we applied drug and physical analgesia techniques (infiltrations and DO). Patients of group 4

received a complex rehabilitation programme, including LaserTh. In group 5 we applied drug and

physical analgesia techniques (infiltrations and LTh).

For statistical evaluation we used t-test (ANOVA) and Wilcoxon rank test (non-parametrical correlation

analysis), performed using SPSS package. The treatment difference was considered as statistically

significant if the P value was < 0.05.

Results: The comparative analysis of results shows a significant improvement of the symptoms of the

patients, concerning: pain relief (visualized by the analysis of results of Visual analogue scale,

evaluation of stump tenderness), and depression (scales of Zung and McGill Quality of life

questionnaire). In all cases we detected reduction of pain sensation and depression; amelioration of

the independence in ADL. The drug analgesia in group 1 was fast, but short; the efficacy in

physiotherapy groups 2 & 4 was slow, but stable, and durable. We received best results in combined

groups 3 & 5.

Discussion: The drug therapy is efficient but with short duration. The physical analgesia with DO and

LTh initiates its effect slowly, but the results are stable. Best efficacy was observed in case of

combination of medication with physical modalities – in the beginning due to the steroid injection,

toward the moment of effective «input» of the physical modalities.

Current paper proposes personal opinions on some contemporaneous theories of pain and

therapeutic concepts of analgesia, including physical analgesia. We mentioned principal natural and

preformed physical modalities, with effectiveness in clinical practice. Authors suggest a conception of

mechanisms of physical analgesia, especially in case of application of Deep oscillation and Laser

therapy.

Conclusion: We consider most effective the combination of drug and non-drug analgesia in all

patients after lower limb amputation. We could recommend the complex program for treatment of the

pain in amputees. Pain management is an important part of the rehabilitation algorithms in amputated

patients with stump and phantom limb pain. The efficacy of Deep Oscillation is probably due to a

block of nociceptors. The application of Laser therapy is most effective in cases with trophic

alterations.

Vibrant Soundbridge and Bonebridge: Bilateral Application in a Child with Bilateral Congenital Ear Canal Atresia

Mon, 24 Jun 2019 00:00:00 +0000

A 12-year-old child with bilateral congenital microtia and ear canal atresia was bilaterally implanted with a Vibrant Soundbridge (VSB) on the right side and a Bonebridge on the left side. Prior to these surgeries the child was using percutaneous bone conduction devices (BCDs) on a headband for more than 9 years. No complications occurred during the surgeries. Sound field audiological testing showed cumulative benefit when both devices were used simultaneously. Directional hearing was tested in a sound-attenuated room. To ensure that the subject could only use acoustic information to localize sounds, the test was performed in complete darkness. The ability to localize sounds was poor when listening with either the VSB or Bonebridge, but increased significantly when both devices were used simultaneously. To our knowledge this is the first case report about the bilateral implantation of a VSB and Bonebridge. The VSB and Bonebridge were effectively combined in a teenager with aural atresia on both sides. It should be noted that from age 3 until the time of implant surgery, the patient had used bilateral BCDs on headbands, so he had almost 10 years of experience with bilateral auditory input. That might have been beneficial with respect to binaural hearing.

Effect of Cymbopogon citratus Stapf (DC) on Type 2 Diabetes Mellitus-induced Dyslipidemia: Current Knowledge

C. E. Ekpenyong, U. C. Inyang — Mon, 24 Jun 2019 00:00:00 +0000

Introduction: Diabetic dyslipidemia (DD) is a collection of quantitative, qualitative and kinetic lipid

abnormalities associated with diabetes mellitus that together caused the lipid profile to become more

atherogenic. It consists of elevated serum concentration of triglyceride-cholesterol (TG-C), a high

serum level of small dense low density lipoprotein-cholesterol (sd LDL-C), low level of high-density

lipoprotein-cholesterol (HDL-C) and normal to slightly elevated level of total low density lipoproteincholesterol

(LDL-C).

Aims:

Diabetic dyslipidemia is a recognized risk factor for coronary heart disease (CHD). Plant

medicinal agents such as Cymbopogon citratus (C. citratus) have shown potential as alternative

therapies for reducing cardiovascular risk factors. The aim of this study was to investigate the effect of

citratus leaf extract on the atherogenic index of plasma (AIP) in diabetic dyslipidemic rats (n=35).

Materials and Methods: A C. citratus extract was prepared by ethanol extraction of leaf material.

Rats were divided into seven groups (n=5) as follows: (a) Normal diet control, (b) Hyperlipidemic diet

(HLD) control, (c) HLD + 65 mg/kg streptozotocin (STZ) control (d) HLD + STZ + 250 mg/kg C.

citratus extract (CCE), (e) HLD + STZ + 500 mg/kg CCE, (f) HLD + STZ + 1000 mg/kg CCE, and (g)

HLD + STZ + 5 mg/kg atorvastatin + 600 µg/g glibenclamide. Animals were treated with HLD for 14

days and then injected intraperitoneally with 65 mg/kg STZ. Confirmed diabetic dyslipidemic animals

were treated intragastrically with CCE at doses of 250, 500, and 1000 mg/kg, with 5 mg/kg

atorvastatin, and with 600 µg/g glibenclamide for 30 days.

Results: The extract, which tested positive for tannins, saponins, alkaloids, flavonoids, etc. lowered

fasting blood glucose and glycosylated hemoglobin levels, and dose-dependently decreased the

serum levels of T-chol, LDL, VLDL, and b-HMG-CoA reductase, while simultaneously increasing HDL

levels. The AIP was lowered in a dose-dependent manner by 33, 43.7, and 52.4% in groups treated

with 250, 500, and 1000 mg/kg of CCE respectively.

Conclusion: The results indicate that the C. citratus extract had an ameliorative effect on

hyperglycemia, hyperlipidemia, obesity, and atherogenic index of plasma.

Maternal Risk Factors Predisposing to Congenital Heart Disease

Jayavelan Ramkumar, Benjamin M. Sagayaraj, Nidhi Sharma — Mon, 24 Jun 2019 00:00:00 +0000

Background: Congenital Heart Diseases (CHD) are defined as malformations of the heart and great vessels that develop in utero which may manifest at birth or later in childhood. They can be caused by numerous genetic and environmental factors. Genetic factors are nonmodifiable. However, identification of modifiable environmental risk factors is important to develop population based prevention strategies to reduce the incidence of CHD.

Objectives: The primary objective of the study was to find an association of the maternal lifestyles with CHD in new-borns. The secondary outcome of the study was to identify maternal factors that can be modified for the primary prevention of CHD.

Materials and Methods: This prospective study involved cardiovascular system examination of newborns after delivery in term gestations in 1394 singleton pregnancies. The maternal risk factors considered were age, prepregnancy Body Mass Index (BMI), consanguineous marriage, caffeine intake, diabetes, stress and intake of periconceptional Folic acid tablets.

Results: In this study, 22 (1.58%) out of 1394 pregnancies resulted in Congenital Heart Defects. Teenage pregnancy (p value= 0.0002), consanguineous marriage (p value=0.0004), overt diabetes mellitus (p value=0.0001), caffeine intake (p value=0.0031), prepregnancy BMI>24(p value=0.0001), maternal stress (p value<0.0001, history of previous congenital malformations (p value=0.004) and non intake of folic acid tablets in the first trimester (p value=0.0023 were found to be the most likely risk factor associated with CHD.

Conclusion: Community education programmes should be initiated in the high-risk population to prevent teenage pregnancies and consanguineous marriages. Maternal counseling for periconceptional control of blood glucose, adequate weight maintenance, intake of folic acid tablets, avoidance of stress and caffeine is needed to prevent CHD. The results of numerous studies suggest that in reducing the incidence of CHD, public health strategy needs to focus on avoidance of teenage pregnancy and consanguineous marriages. Pregnancy associated with stress should be monitored more closely. Prepregnancy maternal BMI, coffee intake and folic acid deficiency have to be corrected. Maternal overt diabetes and hyperglycemia during pregnancy needs to be screened and managed timely to reduce the incidence of CHD.

Cytology Services Utilisation Pattern in NorthCentral Nigeria

Mon, 24 Jun 2019 00:00:00 +0000

Introduction: Cytology is a simple, fast, low cost, minimally invasive and sensitive technique for evaluating cells sampled from lesions in the body. Cytology also has the peculiar advantages of minimal invasiveness, low cost and speed. It is an aspect of pathology service at its fledgling stage in most institutions in sub-Saharan African countries.
Aims: This study examined the pattern of the cytology samples received in the laboratory of a relatively new tertiary hospital in north-central Nigeria.
Materials and Methods: Three years archival slides and records of cytology samples were retrieved and analysed.
Results: Cytology specimens were 775 (27.5%) of 2,823 samples accessioned during the period. Most of the samples were cervical smears constituting 436 (56.3%) and an annual rate of 218 samples per year. This was followed by 134 (17.3%) breast fine needle aspiration (FNA) with an annual rate of 67 samples per year. The 48 (6.2%) lymph nodes FNA samples had an annual rate of 24 samples per year. Soft tissue and thyroid masses were 40 (5.2%) and 37 (4.8%), respectively. The sites of other less commonly requested cytology samples in this study included the liver, nose, eyes, testes, urine and peritoneal fluids. The patients’ age ranged from 14 months to 80 years.
Conclusions: This study shows a still very low utilisation of cytology services in management of patients. There remains the need of developing diagnostic cytology services in Nigeria, taking advantage of its low cost, accuracy and timeliness as a simple, yet highly useful diagnostic tool in a resource deficient environment. In the north – central region of Nigeria, cytology is still grossly underutilized as a diagnostic tool in the management of patients. Although mostly employed in routine cervical cancer screening, other patients need to benefit more from this simple, minimally invasive, cheap, highly sensitive and accurate investigative modality.

Low Dose Aspirin and Omega 3 Fatty Acids in the Pro Resolving Pathway of Cardiovascular Disorders

Jayavelan Ramkumar, Nidhi Sharma — Mon, 24 Jun 2019 00:00:00 +0000

Newer mechanisms of action of Acetyl Salicylic acid have been discovered in proresolving pathway of various disorders. Omega 3 fatty acids are also involved in the synthesis of resolvins via an aspirin triggered pathway. The present review aims to discuss the role of recently discovered aspirin triggered lipoxins, resolvins, protectins, maresins in understanding the pathophysiology of endothelial dysfunction in various cardiovascular disorders, especially hypertension. The concept of aspirin triggered lipoxins (15-epi-LXA₄and 15-epi-LX₄₎ counteracting the action of LTB₄.PGE₂, and TXA₂ is discussed. Aspirin triggered lipoxins also block the expression of IL-8 gene. Aspirin is the only known NSAID to induce NO in a dose dependent manner. In this chapter, we describe role of acetyl salicylic acid in the pro-resolution pathways that might prevent or reduce complications in patients with high blood pressure. Aspirin is a low cost intervention that can prevent the atherosclerosis of vessels by its anti-inflammatory, antiplatelet and proresolving abilities. Recent understanding of the pathophysiology of hypertension and proresolving pathways can help to understand the rational use of aspirin in prevention and reducing the complications of high blood pressure. A combination of aspirin and omega 3 fatty acids has potential benefits. DHA metabolites have been found to have potent role in the resolution pathway of inflammation. Future endeavors would focus on the identification of subset of high-risk hypertensive patients who will benefit most from aspirin, omega 3 fatty acids and DHA. Different dosage and time of initiation in various high-risk groups needs to be identified. Further research is also required to identify the correct time and the oral doses that will help in minimizing the long-term risk of future cardiovascular diseases.