Secondary fibrosarcoma of the brain stem treated with cyclophosphamide and Imatinib

Radiation-induced midbrain fibrosarcoma is a rare, highly aggressive tumor, which is associated with poor prognosis. We present the case of a 48-year old man with brainstem fibrosarcoma 20 years following radiation therapy received for a pituitary tumor. We discuss this case in the context of the diagnostic criteria for these tumors, and previous reports of secondary and primary sarcomas of the central nervous system

Maternal and child health interventions in Nigeria: a systematic review of published studies from 1990 to 2014

BACKGROUND: Poor maternal and child health indicators have been reported in Nigeria since the 1990s. Many interventions have been instituted to reverse the trend and ensure that Nigeria is on track to achieve the Millennium Development Goals. This systematic review aims at describing and indirectly measuring the effect of the Maternal, Newborn, and Child Health (MNCH) interventions implemented in Nigeria from 1990 to 2014. METHODS: PubMed and ISI Web of Knowledge were searched from 1990 to April 2014 whereas POPLINE® was searched until 16 February 2015 to identify reports of interventions targeting Maternal, Newborn, and Child Health in Nigeria. Narrative and graphical synthesis was done by integrating the results of extracted studies with trends of maternal mortality ratio (MMR) and under five mortality (U5MR) derived from a joint point regression analysis using Nigeria Demographic and Health Survey data (1990-2013). This was supplemented by document analysis of policies, guidelines and strategies of the Federal Ministry of Health developed for Nigeria during the same period. RESULTS: We identified 66 eligible studies from 2,662 studies. Three interventions were deployed nationwide and the remainder at the regional level. Multiple study designs were employed in the enrolled studies: pre- and post-intervention or quasi-experimental (n = 40; 61%); clinical trials (n = 6;9%); cohort study or longitudinal evaluation (n = 3;5%); process/output/outcome evaluation (n = 17;26%). The national MMR shows a consistent reduction (Annual Percentage Change (APC) = -3.10%, 95% CI: -5.20 to -1.00 %) with marked decrease in the slope observed in the period with a cluster of published studies (2004-2014). Fifteen intervention studies specifically targeting under-five children were published during the 24 years of observation. A statistically insignificant downward trend in the U5MR was observed (APC = -1.25%, 95% CI: -4.70 to 2.40%) coinciding with publication of most of the studies and development of MNCH policies. CONCLUSIONS: The development of MNCH policies, implementation and publication of interventions corresponds with the downward trend of maternal and child mortality in Nigeria. This systematic review has also shown that more MNCH intervention research and publications of findings is required to generate local and relevant evidence

Records of caesarean sections in bitches presented to the veterinary teaching hospital, Federal university of agriculture, Abeokuta, Nigeria

Case records at the Veterinary Teaching Hospital, Federal University of Agriculture, Abeokuta were reviewed between January, 2012 and December, 2014 to determine the frequency of caesarean sections (CS) performed in dogs. Data recorded include breed and age of dogs, indication for CS and method of anaesthesia used. Other records obtained were ultrasound information regarding fetal viability prior to surgery, and surgical outcome three days post operation. Data were presented using descriptive statistics. Association between the time of presentation of bitches for CS, method of anaesthesia and surgical outcome was determined using chi square test. A p value ≤ 0.05 was considered significant. Sixteen (16) CS were performed during the study period. Breeds involved were Boerboel, Rottweiler, Alsatian, bulldog, Lhasa apso and mongrel dogs, with the highest record in Boerboel. Mean age of the dogs was 3.1 ± 1.2 years. Eleven (11) of the dogs were nulliparous; while five (5) had previous normal parturitions. Fifteen (15) dogs had emergency CS, while one (1) had elective CS. Indication for CS in the dogs included uterine inertia (13), uterine torsion (1) and vaginal prolapse (1). Mean time of presentation of the bitches for CS was 48.6 ± 28.6 hours. Epidural anaesthesia, general anaesthesia with either Diazepam + Propofol combinations or Xylazine+ Ketamine+ Diazepam were used. Surgical outcome were good in thirteen (13) bitches and poor in three (3) bitches, while the outcome on the puppies was good in eight (8) of the caesarean section. Time of presentation of the bitches for CS and anaesthesia type were significantly (p< 0.05) associated with surgical outcome in both the bitches and the puppies. It was concluded that CS in dogs are seldomly performed and most cases involved emergency management of dystocia. Duration of labour and type of anaesthesia used are important risk factors for the outcome of CS in both the dam and the puppies

Anesthetic and surgical predictors of treatment outcome in re-do craniotomy

Introduction: Craniotomy is a neurosurgical operation done to remove brain tumor, repair vascular lesion, and relieve intracranial pressure. Complications can arise which may necessitate re-do craniotomy. The study is planned to find out the relationship between variables such as age, American Society of Anaesthesiologist (ASA), Glasgow coma score (GCS), frequency of re-do craniotomy, and surgical outcome of re-do craniotomy. Materials and Methods: This is a retrospective study of all the patients who had re-do craniotomy over a 4-year period. The data that were collected included age, sex, ASA classification, indication for re-do craniotomy, GCS, frequency of re-do craniotomy, postoperative complications, and outcome. Results: Twenty-five patients had indication for re-do craniotomy within the study period. Forty percent were male and 60% were female, and their mean age was 38.56 ± 17.38 years. The indications for re-do craniotomy were removal of residual tumor, evacuation of clot, and cerebrospinal fluid leakage. Seventy-six percent had good outcome, while 24% had poor outcome. Outcome was good for patients who had re-do craniotomy done once, while poor outcome was for patients with second and third craniotomies. Ninety percent of patients with ASA 2 had good outcome, while 9.1% had poor outcome; but 64.3% had good outcome with ASA 3, while 37.7% had poor outcome with a P-value of 0.18. Seventy-five percent had poor outcome in patients with GCS of less than 9, while 25% had good outcome; but 14.3% had poor outcome in patients with GCS above 9, while 85.7% had good outcome with a P-value of 0.031. Conclusions: Increasing frequency of re-do craniotomy and lower GCS were major factors affecting outcome in re-do craniotomy in our center. The outcome of these patients is valuable in the management of other patients with re-do craniotomy in future

Expression and regulation of the pattern recognition receptors Toll-like receptor-2 and Toll-like receptor-4 in the human placenta

The placenta constitutes a physical and immunological barrier against invading infectious agents and has been suggested to be a pregnancy-specific component of the innate immune system. The aim of this study was to investigate the presence and regulation of Toll-like receptors-2 and -4 (TLR2 and TLR4) in the human placenta, because these receptors are believed to be important for immune responses against pathogens. Twenty-eight placentas from normal term pregnancies were analysed with immunohistochemistry, which showed a strong immunoreactivity for TLR2 and TLR4 in the villous and the intermediate trophoblasts. The regulation of TLR2 and TLR4 by microbial stimulus was assessed by incubating explants of term chorionic villi with zymosan or lipopolysaccharide (LPS) and analysed with real-time reverse transcriptase–polymerase chain reaction. Stimulation with zymosan and LPS readily induced interleukin (IL)-6 and IL-8 cytokine production in the placenta cultures, whereas TLR2 and TLR4 mRNA and protein expression remained at the same high level as in unstimulated explants. These data suggests a novel mechanism for the fetoplacental unit to interact with micro-organisms

Nitrotyrosine formation after activation of murine macrophages with mycobacteria and mycobacterial lipoarabinomannan

Murine peritoneal macrophages, elicited with thioglycollate, were stimulated in vitro with lipopolysaccharide (LPS). The production of nitrite, superoxide anion (SOA), and the accumulation of nitrotyrosine in the cells increased after treatment, and all were inhibitable by the NO synthase inhibitor NG-monomethyl-l-arginine monoacetate (l-NMMA). This effect suggests a direct correlation between the accumulation of those metabolites and NO synthase activity. Lipoarabinomannan (LAM) purified from Mycobacterium tuberculosis was added to peritoneal macrophages in the presence of interferon-gamma (IFN-γ); the cells produced nitrite and SOA, both inhibitable by l-NMMA. There was, as well, accumulation of nitrotyrosine in the macrophage proteins. Strikingly, the amount of nitrotyrosine measured after LAM plus IFN-γ, or LAM plus the low molecular weight adjuvant glutamylmuramyl dipeptide (GMDP), increased significantly in the presence of l-NMMA. These results suggest that murine macrophages, upon LAM stimulation, might generate reactive nitrogen metabolites by a route other than NO synthase. Nitrotyrosine accumulation after infection of macrophages in vitro, with either live bacille Calmette–Guérin (BCG) or live M. tuberculosis, in the presence or absence of IFN-γ, showed no correlation with nitrite production, suggesting a low superoxide production