Common geriatric emergencies in a rural hospital in South‑Eastern Nigeria

Background: Geriatric population in rural Nigeria is often challenged by emergency health conditions that predispose them to higher risk of disability and mortality.Objective: This study was aimed at describing the common geriatric emergencies in a rural hospital in South‑Eastern Nigeria.Materials and Methods: This was a descriptive hospital‑based study of 216 geriatric patients who presented between June 2008 and June 2011 with emergency health conditions at St Vincent De Paul hospital, Amurie–Omanze, a rural Mission General Hospital in Imo state, South‑Eastern Nigeria. The geriatric patients seen within the study period who met the selection criteria were studied. Data extracted for analysis included biodata and diagnosis made.Results: A total of 216 geriatric emergencies were seen during the study period. The ages of the patients ranged from 65 years to 98 years with mean age of 72 ± 1.14 years. There were 94 males and 122 females with a male to female ratio of 1: 1.3. The three most common causes of geriatric emergencies were acute malaria (33.8%), hypertensive crises syndrome (19.0%), and acute hypertensive heart failure (18.1%).Conclusion: This study has shown that the three most common geriatric emergencies were medical emergencies (acute malaria, hypertensive crises syndrome, and acute hypertensive heart failure). Improving the quality of geriatric medical care will help in reduction of these emergency medical conditions. Similarly, health education of the geriatric population to embrace early health‑seeking behavior, health maintenance, and promotional practices that are needed to promote longevity is invariably advocated

Obesity in adult Nigerians: A study of its pattern and common primary co-morbidities in a rural Mission General Hospital in Imo state, south-eastern Nigeria

Objectives: This study was generally aimed at determining the prevalence and pattern of obesity using body mass index (BMI) criterion and specifically screening for its common primary co-morbidities among adult Nigerians attending a rural Mission General Hospital in Imo state, South-Eastern Nigeria.Materials and Methods: A descriptive study was carried out from June 2008 to May 2009. A total of 2156 consecutive new adult patients aged 18-90 years were screened for obesity using the BMI criterion, and 129 patients had BMI ≥30 kg/m2 and met the inclusion criteria. The data collected included age, sex, marital status, education, occupation, social class, weight, height and blood pressure, fasting blood sugar and lipid profile.Results: The prevalence of obesity was 6.0%, with class I obesity (86.1%) being the most common pattern. Hypertension (16.3%) was the most common primary co-morbidity; others included low high-density lipoprotein —cholesterol (21.7%), high low-density lipoprotein—cholesterol (9.3%), high total cholesterol (7.8%), high triglyceridemia (4.7%) and diabetes mellitus (3.9%).Conclusions: This study has shown that obesity and its primary co-morbidities are emerging as a serious health problem among the study population, with class I obesity being the most common pattern and hypertension being the most common primary co-morbidity. Anthropometric determination of obesity and screening for its common primary co-morbidities should be integrated as part of the clinic baseline assessment of adult Nigerians attending rural hospitals to facilitate their early detection and institutionalization of appropriate preventive and therapeutic measures

The magnitude of abdominal adiposity and atherogenic dyslipidemia among geriatric Nigerians with arterial hypertension in a rural hospital in South.eastern Nigeria

Background: As the case detection rate of arterial hypertension increases daily in rural Nigeria, screening for its associated abdominal obesity and dyslipidemia is an important healthcare challenge. Of great concern in rural Nigeria is that most geriatric hypertensives with abdominal obesity and dyslipidemia are not routinely diagnosed and therefore do not receive appropriate management.Objective: This study was aimed at describing the magnitude (prevalence and pattern) of abdominal adiposity using waist circumference (WC) index and dyslipidemia among geriatric Nigerians with arterial hypertension in a rural hospital in South.eastern Nigeria.Materials and Methods: A descriptive hospital.based study was carried out from June 2008 to June 2011 on 122 consecutive geriatric patients with systemic hypertension who met the selection criteria at St. Vincent De Paul Hospital, Amurie.Omanze, a rural Mission General Hospital in Imo state. Abdominal obesity was defined as WC .102 cm and .88 cm for men and women, respectively. Dyslipidemia was defined using the third report of National Cholesterol Education Panel in adult (ATP III). The data collected included basic demographic variables, blood pressure, waist circumference, fasting lipid profile, and blood sugar.Results: The prevalence of abdominal obesity was 50.8% and was the most common pattern of abdominal adiposity. Fifty.four (44.3%) out of 122 patients had at least one dyslipidemia with the most frequent being low high.density lipoprotein cholesterol (HDL.C, 38.5%). There was statistically significant difference between male and female genderbased on abdominal adiposity (X2 = 5.406, P value = 0.04) while their mean lipid differentials were not statistically significant.Conclusion: This study has shown that abdominal adiposity and dyslipidemia exist among geriatric hypertensives in the study area with abdominal obesity being the most common abdominal adiposity and low HDL.C being the most frequent lipid abnormality. This study therefore urges the necessity to consider abdominal obesity and dyslipidemia ingeriatric hypertensives in rural Nigeria alongside the complex of other cardiovascular risk factors

Evaluation of wheat-pigeon pea flour blends for noodle production in Nigeria

Inclusion of legume flours/starches in food formulations such as pastas, noodles, among others, assists in enhancing structure, texture and nutritional quality of the final products. Pigeon pea as a legume is still underutilized in Nigeria and most places in Africa. In this study, the effect of addition of pigeon pea (Cajanus cajan L.) flour (PPF) in various proportions into wheat flour (WF) for noodle production was evaluated with respect to selected chemical, cooking and sensory properties of the formulated products. Pigeon pea grains (1 kg) were cleaned and boiled in 3 L of tap water for 15 min. Boiled seeds were de-hulled and sun-dried for 3 days (average ambient temperature of 33.0 ± 2oC), milled and sieved (mesh size: 300 μm). Flour blends (WF: PPF) for noodle production were 90:10, 80:20, 70:30, 60:40 and 50:50; and 100% WF was used as control. Selected functional properties (Water absorption, swelling, oil absorption capacities and bulk density) of the flours were determined, while the noodles were subjected to chemical, cooking and sensory analyses using standard laboratory methods. Results indicated that more inclusion of the pigeon pea flour (PPF) gave rise to increasing water and oil absorption capacities. The 50:50 noodle had significantly (p<0.05) higher crude protein (15.68%); Magnesium (109.23 mg/100g) and iron (6.88 mg/100g) than the other noodle samples, while all the noodles had low fat contents. This could be an advantage to prevention of rancidity in the food products during storage and availability of noodles suitable for obese and diabetes Miletus Type 2 individuals. The 90:10 noodles had lower values of cooking time and yield but its cooking loss was higher than others. This underscores the benefit of PPF on improvement of texture of the noodles as the amount increased in the mixture. The 90:10 noodle blend was also more acceptable in all the sensory attributes than others. Therefore, utilization of PPF in composite noodle production in Nigeria and other developing countries can be recommended as this could support the effort towards food and nutrition security of households and communities.&nbsp

Gasoline fumes exposure and risk of respiratory disease among fuel pump attendants in Owerri Municipal Council, Nigeria

Gasoline fumes exposure and risk of respiratory disease was investigated in this cross-sectional study. The risk and factors influencing it were also assessed.  A total of 216 non-smoking subjects (108 fuel and 108 shop attendants) aged between 18-60 years and above who had worked for more than 1 year in fuel stations and shops located in Owerri Municipal, Imo state participated in the study. Their socio-demographic and occupational histories were recorded with questionnaire based on informed consent. Peak Expiratory Flow Rates (PEFRs) were recorded and analyzed separately for test and control group. Data collected were analyzed with Computer software SPSS Version 16, values of P less than 0.05 were considered significant. Results obtained showed that majority of the attendants were single-female adults, aged between 20-29 years, who had worked between 0-4 and 5-9 years in fuel stations and shops respectively. Odd Ratio (risk) of 3.2 was found in fuel pump attendants. Variations in PEFR of fuel attendants were found to be significantly associated with their years of gasoline exposure (0.000), age (p=0.000), sex (p=0.000), height (p=0.000) and work schedule (p=0.010). There was a statistical significant decrease in PEFR of fuel pump attendants (308.89±51.34), when compared with that of the shop attendants (350.46±46.41). The results revealed reduced respiratory/pulmonary function and risk of respiratory disease which worsen with years of exposure to gasoline fumes in fuel pump workers. Medical observations involving pre-employment and periodic post-medical check-ups like lung function tests and use of nose mask (respirator) were recommended for the protection of fuel pump workers

Autoimmune and autoinflammatory mechanisms in uveitis

The eye, as currently viewed, is neither immunologically ignorant nor sequestered from the systemic environment. The eye utilises distinct immunoregulatory mechanisms to preserve tissue and cellular function in the face of immune-mediated insult; clinically, inflammation following such an insult is termed uveitis. The intra-ocular inflammation in uveitis may be clinically obvious as a result of infection (e.g. toxoplasma, herpes), but in the main infection, if any, remains covert. We now recognise that healthy tissues including the retina have regulatory mechanisms imparted by control of myeloid cells through receptors (e.g. CD200R) and soluble inhibitory factors (e.g. alpha-MSH), regulation of the blood retinal barrier, and active immune surveillance. Once homoeostasis has been disrupted and inflammation ensues, the mechanisms to regulate inflammation, including T cell apoptosis, generation of Treg cells, and myeloid cell suppression in situ, are less successful. Why inflammation becomes persistent remains unknown, but extrapolating from animal models, possibilities include differential trafficking of T cells from the retina, residency of CD8(+) T cells, and alterations of myeloid cell phenotype and function. Translating lessons learned from animal models to humans has been helped by system biology approaches and informatics, which suggest that diseased animals and people share similar changes in T cell phenotypes and monocyte function to date. Together the data infer a possible cryptic infectious drive in uveitis that unlocks and drives persistent autoimmune responses, or promotes further innate immune responses. Thus there may be many mechanisms in common with those observed in autoinflammatory disorders

Inhibiting ex-vivo Th17 responses in Ankylosing Spondylitis by targeting Janus kinases

Treatment options for Ankylosing Spondylitis (AS) are still limited. The T helper cell 17 (Th17) pathway has emerged as a major driver of disease pathogenesis and a good treatment target. Janus kinases (JAK) are key transducers of cytokine signals in Th17 cells and therefore promising targets for the treatment of AS. Here we investigate the therapeutic potential of four different JAK inhibitors on cells derived from AS patients and healthy controls, cultured in-vitro under Th17-promoting conditions. Levels of IL-17A, IL-17F, IL-22, GM-CSF and IFN gamma were assessed by ELISA and inhibitory effects were investigated with Phosphoflow. JAK1/2/3 and TYK2 were silenced in CD4+ T cells with siRNA and effects analyzed by ELISA (IL-17A, IL-17F and IL-22), Western Blot, qPCR and Phosphoflow. In-vitro inhibition of CD4+ T lymphocyte production of multiple Th17 cytokines (IL-17A, IL-17F and IL-22) was achieved with JAK inhibitors of differing specificity, as well as by silencing of JAK1-3 and Tyk2, without impacting on cell viability or proliferation. Our preclinical data suggest JAK inhibitors as promising candidates for therapeutic trials in AS, since they can inhibit multiple Th17 cytokines simultaneously. Improved targeting of TYK2 or other JAK isoforms may confer tailored effects on Th17 responses in AS

Drug discovery in ophthalmology: past success, present challenges, and future opportunities

BACKGROUND: Drug discovery has undergone major transformations in the last century, progressing from the recognition and refinement of natural products with therapeutic benefit, to the systematic screening of molecular libraries on whole organisms or cell lines and more recently to a more target-based approach driven by greater knowledge of the physiological and pathological pathways involved. Despite this evolution increasing challenges within the drug discovery industry are causing escalating rates of failure of development pipelines. DISCUSSION: We review the challenges facing the drug discovery industry, and discuss what attempts are being made to increase the productivity of drug development, including a refocusing on the study of the basic biology of the disease, and an embracing of the concept of ‘translational research’. We consider what ophthalmic drug discovery can learn from the sector in general and discuss strategies to overcome the present limitations. This includes advances in the understanding of the pathogenesis of disease; improvements in animal models of human disease; improvements in ophthalmic drug delivery and attempts at patient stratification within clinical trials. SUMMARY: As we look to the future, we argue that investment in ophthalmic drug development must continue to cover the whole translational spectrum (from ‘bench to bedside and back again’) with recognition that both biological discovery and clinical understanding will drive drug discovery, providing safe and effective therapies for ocular disease