Neonatal Tetanus: A Continuing Menace

Background: Tetanus especially that affecting the newborn has continued to contribute to morbidity and mortality in developing countries such as Nigeria despite the availability, for over 30 years of an effective vaccine. Its contributing factors include low immunization coverage, poor obstetric services and illiteracy. This study aims at reviewing the status of neonatal tetanus in UPTH with its characteristics and outcome while highlighting the need for instituting sustainable control measures.Methods: This is a retrospective analysis, involving the review of hospital records on neonatal tetanus cases treated at the University of Port Harcourt Teaching Hospital from 1995 to 2009. The case notes of all neonatal tetanus patients in the department of paediatrics from 1995-2009 were retrieved and reviewed for age, sex, presenting complaint, immunization status, examination finding, duration of hospitalization and outcome of illness.Results: Two hundred and ninety six neonates, comprising 174 (58.8%) males and 121(40.9%) females were treated 1(0.3%) of them did not have any record of his or her sex. Most of the mothers did not receive any doses of Tetanus Toxoid [TT] vaccine and delivered outside health facilities. Fifty percent of the cases died. The number and characteristics of the cases and deaths did not change significantly over the period.Conclusion: Essential obstetric care, strengthening of routine immunization, compulsory immunization of all women of childbearing age and school-age children should be adopted to reduce the incidence of neonatal tetanus in the country, while improved health care will reduce the associated high case fatality rate.Key Words: Neonatal tetanus, Outcome and trends; Port Harcourt; Nigeria

Bilateral Panner’s disease in sickle cell anaemia: Case report

Avascular necrosis is common in sickle cell disease in various vulnerable areas such as in the femoral or humeral heads. Panner’s disease however is described as avascular necrosis of the capitellum, which commonly occurs in a younger age group. It is a pathological process believed to be caused by interference in the blood supply to the growing capitellar epiphysis. A 17 year old boy with sickle cell disease presented with pain on pronation and supination of both elbows, particularly on the lateral side. These movements were restricted in both elbows. Plain radiograph of his elbows showed fragmentation of the capitellum with signs of revascularisation. We have performed a thorough literature search and have not found other reported cases of Panner’s avascular necrosis of the capitellum in association with sickle cell disease. We conclude that Panner’s disease is a possible complication of sickle cell anaemia

Anaesthesia for transvenous transcatheter tricuspid valve-in-valve implantation

The authors report and discuss the anaesthetic management of a transvenous transcatheter tricuspid valve replacement. The conduct of anaesthesia, the challenges encountered and the specific risks associated with the procedure will be discussed. Percutaneous tricuspid valve replacement may be safely performed under general anaesthesia, provided that the procedure is understood and all possible eventualities considered. As the quality of percutaneous prostheses improves, and if longterm follow-up confirms this as a safe option, anaesthesiologists will be expected to provide perioperative care for a growing number of these cases.Keywords: transvenous, transcatheter, tricuspid prosthesis, valve-in-valve implantatio

In situ non-invasive Raman spectroscopic characterisation of succinic acid polymorphism during segmented flow crystallisation

The kinetically regulated automated input crystalliser for Raman spectroscopy (KRAIC-R) combines highly controlled crystallisation environments, via tri segmented flow, with non-invasive confocal Raman spectroscopy. Taking advantage of the highly reproducible crystallisation environment within a segmented flow crystalliser and the non-invasive nature of confocal spectroscopy, we are able to shine light on the nucleation and growth of Raman active polymorphic materials without inducing unrepresentative crystallisation events through our analysis technique. Using the KRAIC-R we have probed the nucleation and subsequent growth of succinic acid. Succinic acid typically crystallises as β-SA from solution-based crystallisation although some examples of a small proportion of α-SA have been reported in the β-SA product. Here we show that α-SA and β-SA nucleate concomitantly but undergo Ostwald ripening to a predominantly β-SA product

Caracterizaci?n sociodemogr?fica y cl?nica de las intoxicaciones agudas por plaguicidas en el hospital Federico Lleras Acosta del municipio de Ibagu? desde 2013-2016

97 p. Recurso Electr?nicoEl presente trabajo, describe las caracter?sticas sociodemogr?ficas y cl?nicas de los pacientes diagnosticados con intoxicaciones agudas por plaguicidas que ingresaron al Hospital Federico Lleras Acosta del municipio de Ibagu? desde enero de 2013 a diciembre de 2016. El estudio fue de tipo observacional descriptivo, de corte transversal retrospectivo con historias cl?nicas seg?n los registros notificados tanto en el sistema de vigilancia en salud p?blica SIVIGILA como los registros Individuales de Prestaci?n de Servicios de Salud (RIPS) del Hospital, durante el periodo de tiempo mencionado. Se analizaron 137 casos, de los cuales se observ? que el 50% correspond?an a personas con una edad inferior a los 20 a?os; se observ? que el 81,5% presentaron alg?n nivel educativo hasta la secundaria; el 83% pertenec?a al r?gimen subsidiado, el 60% de los pacientes proced?an del municipio de Ibagu?; el 86,8% de las intoxicaciones se presentaron en el hogar. Principalmente, las intoxicaciones fueron con fines suicidas (79,6%) y de estos el 54,1% eran mujeres; la v?a oral fue la fama de exposici?n m?s frecuente (84%). Seg?n las variables cl?nicas, el 60,6% de los plaguicidas involucrados en las intoxicaciones pertenec?an a los inhibidores de la colinesterasa, cerca del 90% no presentaban antecedentes fisiol?gicos de enfermedades, lo cual es concordante con las edades j?venes registradas que no presentan enfermedades cr?nicas; se observ? adem?s que el 45% realiz? un intento de suicidio previo; el 30% de los pacientes requiri? atenci?n en alguna de las unidades de cuidado intensivo del hospital; el 3,6% de los pacientes fallecieron. Lo anterior evidencia la necesidad de cooperaci?n entre las autoridades competentes de la salud e instituciones p?blicas para implementar medidas efectivas que prevengan las intoxicaciones agudas con plaguicidas en particular la exposici?n voluntaria y dem?s estrategias empleadas para este fen?meno de crecimiento en el municipio. Palabras clave: caracter?sticas cl?nicas, datos de exposici?n, sociodemogr?ficas, suicidio, t?xico.The present study describes the sociodemographic and clinical characteristics of patients diagnosed with acute pesticide poisonings who entered the Federico Lleras Acosta Hospital in the municipality of Ibagu? from January 2013 to december 2016. The study was descriptive, cut-type observational retrospective cross section with clinical histories according to the Individual Health Service Delivery Records (RIPS) of the Hospital, during the aforementioned period of time. 137 cases were used, of which 50% corresponded to people under the age of 20; that 81.5% undergo an educational level up to secondary school; 83% belonged to the subsidized regime, 60% of the patients came from the municipality of Ibagu?; 86.8% of poisonings occur in the home. Mainly, intoxications were with suicides (79.6%) and of these 54.1% were women; the oral route was the most frequent exposure fame (84%). According to the clinical variables, 60.6% of the pesticides involved in the intoxications belong to the cholinesterase inhibitors, about 90% did not present a physiological background of diseases, which is consistent with the young ages registered that do not present chronic diseases; it is also recorded that 45% made a suicide attempt; 30% of the patients required attention in the intensive care units of the hospital; 3.6% of patients died. This demonstrates the need to implement programs to prevent suicide in the municipality, as well as the competent authorities of health and public institutions cooperate to implement effective measures, in addition to highlighting the importance of HFLLA to attend the subsidized regime. Keywords: clinical characteristics, exposure data, sociodemographic, suicide, toxic

Effects of senescence on the tumour microenvironment and response to therapy

Cellular senescence is a state of durable cell arrest that has been identified both in vitro and in vivo. It is associated with profound changes in gene expression and a specific secretory profile that includes pro-inflammatory cytokines, growth factors and matrix-remodelling enzymes, referred to as the senescence-associated secretory phenotype (SASP). In cancer, senescence can have anti- or pro-tumour effects. On one hand, it can inhibit tumour progression in a cell autonomous manner. On the other hand, senescence can also promote tumour initiation, progression, metastatic dissemination and resistance to therapy in a paracrine manner. Therefore, despite efforts to target senescence as a potential strategy to inhibit tumour growth, senescent cancer and microenvironmental cells can eventually lead to uncontrolled proliferation and aggressive tumour phenotypes. This can happen either through overcoming senescence growth arrest or through SASP-mediated effects in adjacent tumour cells. This review will discuss how senescence affects the tumour microenvironment, including extracellular matrix remodelling, the immune system and the vascular compartment, to promote tumourigenesis, metastasis and resistance to DNA-damaging therapies. It will also discuss current approaches used in the field to target senescence: senolytics, improving the immune clearance of senescent cells and targeting the SASP

Exposure to benzene at work and the risk of leukemia: a systematic review and meta-analysis

Background A substantial number of epidemiologic studies have provided estimates of the relation between exposure to benzene at work and the risk of leukemia, but the results have been heterogeneous. To bridge this gap in knowledge, we synthesized the existing epidemiologic evidence on the relation between occupational exposure to benzene and the risk of leukemia, including all types combined and the four main subgroups acute myeloid leukemia (AML), acute lymphocytic leukemia (ALL), chronic lymphocytic leukemia (CLL), and chronic myeloid leukemia (CML). Methods A systematic literature review was carried out using two databases 'Medline' and 'Embase' from 1950 through to July 2009. We selected articles which provided information that can be used to estimate the relation between benzene exposure and cancer risk (effect size). Results In total 15 studies were identified in the search, providing 16 effect estimates for the main analysis. The summary effect size for any leukemia from the fixed-effects model was 1.40 (95% CI, 1.23-1.57), but the study-specific estimates were strongly heterogeneous (I2 = 56.5%, Q stat = 34.47, p = 0.003). The random-effects model yielded a summary- effect size estimate of 1.72 (95% CI, 1.37-2.17). Effect estimates from 9 studies were based on cumulative exposures. In these studies the risk of leukemia increased with a dose-response pattern with a summary-effect estimate of 1.64 (95% CI, 1.13-2.39) for low (< 40 ppm-years), 1.90 (95% CI, 1.26-2.89) for medium (40-99.9 ppm-years), and 2.62 (95% CI, 1.57-4.39) for high exposure category (> 100 ppm-years). In a meta-regression, the trend was statistically significant (P = 0.015). Use of cumulative exposure eliminated heterogeneity. The risk of AML also increased from low (1.94, 95% CI, 0.95-3.95), medium (2.32, 95% CI, 0.91-5.94) to high exposure category (3.20, 95% CI, 1.09-9.45), but the trend was not statistically significant. Conclusions Our study provides consistent evidence that exposure to benzene at work increases the risk of leukemia with a dose-response pattern. There was some evidence of an increased risk of AML and CLL. The meta-analysis indicated a lack of association between benzene exposure and the risk of CML

Interactive effects of inbreeding and endocrine disruption on reproduction in a model laboratory fish

This is the final version of the article. Available from Wiley via the DOI in this record.Inbreeding depression is expected to be more severe in stressful environments. However, the extent to which inbreeding affects the vulnerability of populations to environmental stressors, such as chemical exposure, remains unresolved. Here we report on the combined impacts of inbreeding and exposure to an endocrine disrupting chemical (the fungicide clotrimazole) on zebrafish (Danio rerio). We show that whilst inbreeding can negatively affect reproductive traits, not all traits are affected equally. Inbreeding depression frequently only became apparent when fish were additionally stressed by chemical exposure. Embryo viability was significantly reduced in inbred exposed fish and there was a tendency for inbred males to sire fewer offspring when in direct competition with outbred individuals. Levels of plasma 11-ketotestosterone, a key male sex hormone, showed substantial inbreeding depression that was unaffected by addition of the fungicide. In contrast, there was no effect of inbreeding or clotrimazole exposure on egg production. Overall, our data provide evidence that stress may amplify the effects of inbreeding on key reproductive traits, particularly those associated with male fitness. This may have important implications when considering the consequences of exposure to chemical pollutants on the fitness of wild populations.Thanks to NERC's Post Genomics & Proteomics Programme NE/F0077871/1 and AstraZeneca's Safety, Health and Environment Research Programme for funding this work. We thank Alexander Scott (11-ketotestosterone radioimmunoassay) at the Centre for Environment, Fisheries and Aquaculture Science, Jan Shears and Luanne Wilkes at University of Exeter, Gareth Readman, Vicki Cammack, Kate Hurd and Yohanna Glennon at Brixham Environmental Laboratory for their assistance