Spontaneous Perforation of the Bile Duct in Infants

Spontaneous perforation of the bile duct is a rare disease in children. To date, less than a hundred cases have been reported in English literature. A number of techniques have been applied to achieve preoperative diagnosis yet most cases are diagnosed at operation. A 3-month-old girl presented with fever, vomiting, progressive abdominal distension, jaundice and diarrhoea. Abdominal ultrasonography showed localized collection of fluid that displaced the small bowel to the right side of the abdomen. The fluid was found to be bilious on paracentesis. At laparotomy, biliary pseudocyst was found but the site of perforation was no longer identifiable. Excision of the containing wall and external drainage was carried out. 9 months after operation the child is well. A high index of suspicion should improve diagnosis and ensure early intervention.La perforation spontan\ue9e des canaux biliaires est une affection rare chez les enfants. A ce jour, moins de 100 cas ont \ue9t\ue9 rapport\ue9s dans la litt\ue9rature anglophone. Un certain nombre de techniques ont \ue9t\ue9 mises en oeuvre pour le diagnostic pr\ue9 op\ue9ratoire, n\ue9anmoins la plupart des cas sont de diagnostic per op\ue9ratoire. Une fille de 3 mois avait pr\ue9sent\ue9 de la fi\ue8vre, vomissements, distension progressive de l'abdomen, ict\ue8re et diarrh\ue9e. L'\ue9chographie de l'abdomen avait montr\ue9 une collection liquidienne localis\ue9e refoulant les anses gr\ueales vers le c\uf4t\ue9 droit de l'abdomen. La paracent\ue8se avait retrouv\ue9 un liquide bilieux. La laparotomie avait not\ue9 un pseudo kyste biliaire, mais le si\ue8ge de la perforation n'\ue9tait plus visible. La paroi du contenant a \ue9t\ue9 excis\ue9e et un drainage externe a \ue9t\ue9 r\ue9alis\ue9. Neuf mois apr\ue8s l'op\ue9ration, les suites \ue9taient simples. Une forte suspicion devrait mener au diagnostic et imposer une intervention pr\ue9coce

EVALUATION OF THE AGRONOMIC PERFORMANCE AND NUTRITIVE VALUES OF TEPHROSIA BRACTEOLATA GUILL. & PERR. AND GMELINA ARBOREA ROXB PRUNNINGS AT DIFFERENT STAGES OF GROWTH

This study was carried out to investigate the growth, dry matter yield and chemical composition of Tephrosia bracteolata and Gmelina arborea at Teaching and Research Farm, Federal University of Agriculture, Abeokuta, Nigeria. The objective of this study was to evaluate the effect of different stages of growth of T. bracteolata and G. arborea on their agronomic performance, herbage yield and nutritive value in the humid zone of Nigeria. Data were collected at 8, 12, 16 and 20 weeks after planting (WAP). Results showed that T. bracteolata attained the height of 161 cm at 20 WAP, though not significantly different from the height at 16 WAP. The leaf number (24), branch number (7) and dry matter yield of T. bracteolata were recorded highest at 16 WAP. The height of G. arborea was on constant increase throughout the experimental period. The crude protein (CP) and ether extract (EE) contents of the two browse plants were highest at 8 WAP and thereafter, declined throughout the experimental period. Fibre fractions, the neutral detergent fibre (NDF), acid detergent fibre (ADF) and acid detergent lignin (ADL) had a least value for both browse species at 8 WAP and highest values at 20 WAP. From the study, considering the dry matter yield and nutritive value, T. bracteolata being an annual species, can be harvested at 16 WAP when the quality and quantity will support livestock productivity and can be conserved to be fed to ruminant animals during dry season when feed availability and quality are extremely low. However, planting of G. arborea should be encouraged being a perennial browse plant that will support livestock productivity during the dry season in the tropics. In conclusion, T. bracteolata and G. arborea grow rapidly and are recommended as forage of high nutritive values that meet ruminant animal protein requirements especially during the dry season

MYC Overexpression Induces Prostatic Intraepithelial Neoplasia and Loss of Nkx3.1 in Mouse Luminal Epithelial Cells

Lo-MYC and Hi-MYC mice develop prostatic intraepithelial neoplasia (PIN) and prostatic adenocarcinoma as a result of MYC overexpression in the mouse prostate[1]. However, prior studies have not determined precisely when, and in which cell types, MYC is induced. Using immunohistochemistry (IHC) to localize MYC expression in Lo-MYC transgenic mice, we show that morphological and molecular alterations characteristic of high grade PIN arise in luminal epithelial cells as soon as MYC overexpression is detected. These changes include increased nuclear and nucleolar size and large scale chromatin remodeling. Mouse PIN cells retained a columnar architecture and abundant cytoplasm and appeared as either a single layer of neoplastic cells or as pseudo-stratified/multilayered structures with open glandular lumina—features highly analogous to human high grade PIN. Also using IHC, we show that the onset of MYC overexpression and PIN development coincided precisely with decreased expression of the homeodomain transcription factor and tumor suppressor, Nkx3.1. Virtually all normal appearing prostate luminal cells expressed high levels of Nkx3.1, but all cells expressing MYC in PIN lesions showed marked reductions in Nkx3.1, implicating MYC as a key factor that represses Nkx3.1 in PIN lesions. To determine the effects of less pronounced overexpression of MYC we generated a new line of mice expressing MYC in the prostate under the transcriptional control of the mouse Nkx3.1 control region. These “Super-Lo-MYC” mice also developed PIN, albeit a less aggressive form. We also identified a histologically defined intermediate step in the progression of mouse PIN into invasive adenocarcinoma. These lesions are characterized by a loss of cell polarity, multi-layering, and cribriform formation, and by a “paradoxical” increase in Nkx3.1 protein. Similar histopathological changes occurred in Hi-MYC mice, albeit with accelerated kinetics. Our results using IHC provide novel insights that support the contention that MYC overexpression is sufficient to transform prostate luminal epithelial cells into PIN cells in vivo. We also identified a novel histopathologically identifiable intermediate step prior to invasion that should facilitate studies of molecular pathway alterations occurring during early progression of prostatic adenocarcinomas

Breast cancer survival and survival gap apportionment in sub-Saharan Africa (ABC-DO): a prospective cohort study

Background: Breast cancer is the second leading cause of death from cancer in women in sub-Saharan Africa, yet there are few well characterised large-scale survival studies with complete follow-up data. We aimed to provide robust survival estimates in women in this setting and apportion the survival gaps. Methods: The African Breast Cancer-Disparities in Outcomes (ABC-DO) prospective cohort study was done at eight hospitals across five sub-Saharan African countries (Namibia, Nigeria, South Africa, Uganda, and Zambia). We prospectively recruited women (aged ≥18 years) who attended these hospitals with suspected breast cancer. Women were actively followed up by use of a telephone call once every 3 months, and a mobile health application was used to keep a dynamic record of follow-up calls due. We collected detailed sociodemographic, clinical, and treatment data. The primary outcome was 3-year overall survival, analysed by use of flexible proportional mortality models, and we predicted survival under scenarios of modified distributions of risk factors. Findings: Between Sept 8, 2014, and Dec 31, 2017, 2313 women were recruited from these eight hospitals, of whom 85 did not have breast cancer. Of the remaining 2228 women with breast cancer, 58 women with previous treatment or recurrence, and 14 women from small racial groups (white and Asian women in South Africa), were excluded. Of the 2156 women analysed, 1840 (85%) were histologically confirmed, 129 (6%) were cytologically confirmed, and 187 (9%) were clinically confirmed to have breast cancer. 2156 (97%) women were followed up for up to 3 years or up to Jan 1, 2019, whichever was earlier. Up to this date, 879 (41%) of these women had died, 1118 (52%) were alive, and 159 (7%) were censored early. 3-year overall survival was 50% (95% CI 48–53), but we observed variations in 3-year survival between different races in Namibia (from 90% in white women to 56% in Black women) and in South Africa (from 76% in mixed-race women to 59% in Black women), and between different countries (44–47% in Uganda and Zambia vs 36% in Nigeria). 215 (10%) of all women had died within 6 months of diagnosis, but 3-year overall survival remained low in women who survived to this timepoint (58%). Among survival determinants, improvements in early diagnosis and treatment were predicted to contribute to the largest increases in survival, with a combined absolute increase in survival of up to 22% in Nigeria, Zambia, and Uganda, when compared with the contributions of other factors (such as HIV or aggressive subtypes). Interpretation: Large variations in breast cancer survival in sub-Saharan African countries indicate that improvements are possible. At least a third of the projected 416 000 breast cancer deaths that will occur in this region in the next decade could be prevented through achievable downstaging and improvements in treatment. Improving survival in socially disadvantaged women warrants special attention. Funding: Susan G Komen and the International Agency for Research on Cancer

Few Losses to Follow-up in a Sub-Saharan African Cancer Cohort via Active Mobile Health Follow-up

Accurate survival estimates are needed for guiding cancer control efforts in sub-Saharan Africa, but previous studies have been hampered by unknown biases due to excessive loss to follow-up (LTFU). In the African Breast Cancer-Disparities in Outcomes Study, a prospective breast cancer cohort study, we implemented active mobile health follow-up, telephoning each woman or her next-of-kin (NOK) trimonthly on her mobile phone to update information on her vital status. Dates of every contact with women/NOK were analyzed from diagnosis in 2014-2017 to the earliest of September 1, 2018, death, or 3 years postdiagnosis. The cumulative incidence of being LTFU was calculated considering deaths as competing events. In all, 1,490 women were followed for a median of 24.2 (interquartile range (IQR), 14.2-34.5) months, corresponding to 8,529 successful contacts (77% of total contacts) with the women/NOK. Median time between successful contacts was 3.0 (IQR, 3.0-3.7) months. In all, 71 women (5.3%) were LTFU at 3 years: 0.8% in Nigeria, 2.2% in Namibia, and 5.6% in Uganda. Because of temporary discontinuity of active follow-up, 20.3% of women were LTFU after 2 years in Zambia. The median time to study notification of a death was 9.1 (IQR, 3.9-14.0) weeks. Although the present study was not a randomized controlled trial, in this cancer cohort with active mobile health follow-up, LTFU was much lower than in previous studies and enabled estimation of up-to-date and reliable cancer survival

Rapid epidemic expansion of the SARS-CoV-2 Omicron variant in southern Africa

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) epidemic in southern Africa has been characterised by three distinct waves. The first was associated with a mix of SARS-CoV-2 lineages, whilst the second and third waves were driven by the Beta and Delta variants, respectively1-3. In November 2021, genomic surveillance teams in South Africa and Botswana detected a new SARS-CoV-2 variant associated with a rapid resurgence of infections in Gauteng Province, South Africa. Within three days of the first genome being uploaded, it was designated a variant of concern (Omicron) by the World Health Organization and, within three weeks, had been identified in 87 countries. The Omicron variant is exceptional for carrying over 30 mutations in the spike glycoprotein, predicted to influence antibody neutralization and spike function4. Here, we describe the genomic profile and early transmission dynamics of Omicron, highlighting the rapid spread in regions with high levels of population immunity

PANC Study (Pancreatitis: A National Cohort Study): national cohort study examining the first 30 days from presentation of acute pancreatitis in the UK

Background Acute pancreatitis is a common, yet complex, emergency surgical presentation. Multiple guidelines exist and management can vary significantly. The aim of this first UK, multicentre, prospective cohort study was to assess the variation in management of acute pancreatitis to guide resource planning and optimize treatment. Methods All patients aged greater than or equal to 18 years presenting with acute pancreatitis, as per the Atlanta criteria, from March to April 2021 were eligible for inclusion and followed up for 30 days. Anonymized data were uploaded to a secure electronic database in line with local governance approvals. Results A total of 113 hospitals contributed data on 2580 patients, with an equal sex distribution and a mean age of 57 years. The aetiology was gallstones in 50.6 per cent, with idiopathic the next most common (22.4 per cent). In addition to the 7.6 per cent with a diagnosis of chronic pancreatitis, 20.1 per cent of patients had a previous episode of acute pancreatitis. One in 20 patients were classed as having severe pancreatitis, as per the Atlanta criteria. The overall mortality rate was 2.3 per cent at 30 days, but rose to one in three in the severe group. Predictors of death included male sex, increased age, and frailty; previous acute pancreatitis and gallstones as aetiologies were protective. Smoking status and body mass index did not affect death. Conclusion Most patients presenting with acute pancreatitis have a mild, self-limiting disease. Rates of patients with idiopathic pancreatitis are high. Recurrent attacks of pancreatitis are common, but are likely to have reduced risk of death on subsequent admissions

Effects of Interval Training Programme on Resting Heart Rate in Subjects with Hypertension: A Randomized Controlled Trial

Background: Heart rate (HR) is a determinant of cardiovascular event risk in patient with hypertension. The primary purpose of the present study was to investigate the effect of interval training program on HR in black African subjects with hypertension. Methods: Two hundred and forty five male patients with mild to moderate (Systolic Blood Pressure [SBP] between 140-179 & Diastolic Blood Pressure [DBP] between 90¬109 mmHg) essential hypertension were age- matched and grouped into interval and control groups. The interval (work: rest ratio of 1:1) groups involved in an 8-weeks interval training programs of between 45-60 minutes, at intensities of 60-79% of HR max, while the control group remained sedentary during this period. Blood pressure (SBP and DBP), V02max and HR were assessed. Student's t and Pearson correlation tests were used in data analysis. Results: Findings of the study revealed significant effect of exercise training program on HR. Also, changes in V02max negatively correlated with changes in HR (r= -.503) at p<0.05. Conclusion: It was concluded that moderate intensity interval training programs is effective in the non-pharmacological adjunct management of hypertension and may prevent cardiovascular event through the down regulation of HR in hypertension. Keywords: Hypertension; Interval exercise; cardiovascular risk factor; Heart Rat