A clinico-pathologicalanalysis of uterine leiomyomata in Maiduguri, Nigeria

Uterine leiomyoma (UL) is the commonest benign tumour of the female genital tract in the reproductive age group. There is little or no literature on the histopathological study of the disease in Nigeria. This may be the first study to serve as a baseline data in Maiduguri. Objective: To analyse the frequency of occurrence, age and parity of the patients, clinical presentation, degenerative changes, diseases associated with uterine leiomyomata and the treatment modalities of the tumour in Maiduguri. Methods: A retrospective analysis of all cases of uterine leiomyomata histologically diagnosed in the Histopathology Department of the University of Maiduguri Teaching Hospital, Nigeria between January 1994 and December 2003 inclusive. Results: A total of 501 cases of uterine leiomyomas were examined in this study, representing 4.5% of all disease conditions histopathologically diagnosed within the study period. The mean age of patients was 36.3 (±8.3SD) and the th peak age incidence was in the 4 decade of life. The symptoms are presented in the following order of frequency: lower abdominal pain, 187 (87.8%); menstrual pain and irregularity, 164 (77.0%); urinary frequency/hesitancy/urgency, 68 (31.9%); infertility/subfertility, 42 (19.7%) and constipation 24 (11.3%). Multiparous women accounted for 64.9% of all cases. There were 121 cases of uterine leiomyoma coexisting with adenomyosis (30), ovarian cysts [Non-neoplastic (41), Neoplastic [benign (12), malignant (8)] and cervical inflammatory diseases (30). The commonest mode of treatment was myomectomy in 367 (73%) and hysterectomy in 134 (27%) cases, with mean age of 33.9 and 46.7 years respectively There were 104 cases of degenerative changes: hyaline (92), cystic (12), calcification (9) and red degeneration(6) Conclusion: Uterine leiomyoma is common, especially in the reproductive age group and is often associated with degenerative changes, and coexistent with ovarian cysts, adenomyosis and chronic cervicitis. There is need to find the aetiological relationships of the disease in order to reduce its incidence as well as the frequent exposure of women to operations that are necessitated by the disease and its associated complications

The effects of metformin on maternal haemodynamics in gestational diabetes mellitus: A pilot study.

BACKGROUND: Gestational diabetes mellitus (GDM) is a major clinical challenge and is likely to remain so as the incidence of GDM continues to increase AIM: To assess longitudinal changes in maternal haemodynamics amongst women diagnosed with GDM requiring either metformin or dietary intervention in comparison to low-risk healthy controls. METHODOLOGY: Fifty-six pregnant women attending their first appointment at the GDM clinic and 60 low-risk healthy pregnant controls attending their routine antenatal clinics were recruited and assigned to three groups: GDM Metformin (GDM-M), GDM Diet (GDM-D) and Control. Non-invasive assessment of maternal haemodynamics, using recognised measures of arterial stiffness and central blood pressure (Arteriograph®), were undertaken under controlled conditions within four gestational windows: antenatal; AN1 (26-28 weeks), AN2 (32-34 weeks) and AN3 (37-40 weeks), and postnatal (PN) (6-8 weeks after delivery). Data were analysed using a linear mixed model incorporating gestational age and other relevant predictors, including age, blood pressure (BP), baseline bodyweight and pulse as fixed effects, and patient as a random effect. RESULTS: Fitted linear mixed models showed evidence of a two-way interaction effect between groups (GDM-D, GDM-M and Control) and stages of gestation (AN1, AN2, AN3 and PN) for maternal haemodynamic parameters: brachial artery augmentation index (AIx) (p=0.004), aortic AIx (p=0.008), and central systolic BP (p=0.001). However, differences in respect of aortic pulse wave velocity (p=0.001) and heart rate (p<0.001) were only significant for gestational stage. At AN2, we did not observe any evidence that the mean brachial Aix in the GDM-M was different from the control group (p=0.158). CONCLUSION: AIx and central systolic BP measures of arterial stiffness are adversely affected by GDM in comparison to controls during pregnancy. The possible beneficial effects of metformin therapy seen at 32 to 34 weeks of gestation require further exploration

A CLINICO-PATHOLOGICAL ANALYSIS OF UTERINE LEIOMYOMATA IN MAIDUGURI, NIGERIA

Background: Uterine leiomyoma (UL) is the commonest benign tumour of the female genital tract in the reproductive age group. There is little or no literature on the histopathological study of the disease in Nigeria. This may be the first study to serve as a baseline data in Maiduguri. Objective: To analyse the frequency of occurrence, age and parity of the patients, clinical presentation, degenerative changes, diseases associated with uterine leiomyomata and the treatment modalities of the tumour in Maiduguri. Methods: A retrospective analysis of all cases of uterine leiomyomata histologically diagnosed in the Histopathology Department of the University of Maiduguri Teaching Hospital, Nigeria between January 1994 and December 2003 inclusive. Results: A total of 501 cases of uterine leiomyomas were examined in this study, representing 4.5% of all disease conditions histopathologically diagnosed within the study period. The mean age of patients was 36.3 (+/-8.3SD) and the th peak age incidence was in the 4 decade of life. The symptoms are presented in the following order of frequency: lower abdominal pain, 187 (87.8%); menstrual pain and irregularity, 164 (77.0%); urinary frequency/hesitancy/urgency, 68 (31.9%); infertility/subfertility, 42 (19.7%) and constipation 24 (11.3%). Multiparous women accounted for 64.9% of all cases. There were 121 cases of uterine leiomyoma coexisting with adenomyosis (30), ovarian cysts [Non-neoplastic (41), Neoplastic [benign (12), malignant (8)] and cervical inflammatory diseases (30). The commonest mode of treatment was myomectomy in 367 (73%) and hysterectomy in 134 (27%) cases, with mean age of 33.9 and 46.7 years respectively There were 104 cases of degenerative changes: hyaline (92), cystic (12), calcification (9) and red (6). Conclusion: Uterine leiomyoma is common, especially in the reproductive age group and is often associated with degenerative changes, and coexistent with ovarian cysts, adenomyosis and chronic cervicitis. There is need to find the aetiological relationships of the disease in order to reduce its incidence as well as the frequent exposure of women to operations that are necessitated by the disease and its associated complications

Diurnal variation and repeatability of arterial stiffness and cardiac output measurements in the third trimester of uncomplicated pregnancy.

AIM: To investigate same day repeated measures and diurnal variation of arterial stiffness, cardiac output (CO), stroke volume (SV) and total peripheral resistance (TPR) during the third trimester of normal pregnancy. METHODOLOGY: Pulse wave velocity (PWV) and augmentation index (AIx) were recorded using the Arteriograph, while CO, SV and TPR were recorded using noninvasive cardiac output monitoring. The measurements were obtained in the third trimester of pregnancy from 21 healthy pregnant women at four time points (morning, afternoon, evening and midnight) over a 24-h period. Triplicate measurements of 67 women were obtained at 5-min intervals to assess repeatability between measurements within a patient. RESULTS: Diurnal measurements of arterial stiffness for brachial AIx, aortic AIx and PWV were not statistically significantly different at any of the four time points. Estimated means (SD) for PWV at the four stated time points were 7.81 (2.05), 8.45 (1.68), 7.87 (1.74) and 7.64 m/s (1.15), respectively (P = 0.267). Estimates for AIx at those time points were 10.22 (15.62), 4.44 (10.07), 6.49 (10.92) and 8.40% (8.16), respectively (P = 0.295). Similarly, mean arterial pressure, SV, SV index and TPR did not show any evidence of diurnal variation. However, we observed that the mean CO, cardiac index (CI) and heart rate (HR) varied from morning to midnight; the mean CO, HR and CI increased significantly in the afternoon compared with the corresponding mean morning measurements in a similar fashion to HR. Mean (SD) CO estimates at the four stated time points were 5.90 (1.33), 6.38 (1.49), 6.18 (1.43) and 5.80 ml/min (1.19), respectively, (P < 0.001), whereas mean CI estimates were 3.65 (0.58), 3.93 (0.68), 3.81 (0.65), and 3.57 (0.48), respectively, (P < 0.001), and mean HR estimates were 95 (12), 98 (13), 95 (12) and 88 (12.98), respectively (P < 0.001). Triplicate measurements of 61 women in our repeatability study showed moderate-to-high correlation between observations on the same woman for all Arteriograph and noninvasive cardiac output monitoring variables (estimates of intraclass correlation ranged from 0.49 to 0.91). CONCLUSION: With the exception of CO, CI and HR which showed a diurnal variation, measurements of most haemodynamic parameters did not change significantly from morning to midnight, suggesting there was no evidence of systematic differences in the mean values of these variables at these time points. Multiple consecutive noninvasive measurements of vascular stiffness, CO, SV and TPR were highly correlated confirming repeatability of measurements in the third trimester of uncomplicated pregnancy, so these haemodynamic measurements do not need to be undertaken at a specific time period of the day

Real-Time PCR Detection and Phylogenetic Relationships of \u3ci\u3eNeorickettsia\u3c/i\u3e In Digeneans From Egypt, Phillipines, Thailand, Vietnam and the United States

Neorickettsia (Rickettsiales, Anaplasmataceae) is a genus of obligate intracellular bacterial endosymbionts of digeneans (Platyhelminthes, Digenea). Some Neorickettsia are able to invade cells of the digenean\u27s vertebrate host and are known to cause diseases of domestic animals, wildlife, and humans. In this study we report the results of screening digenean samples for Neorickettsia collected from bats in Egypt and Mindoro Island, Philippines, snails and fishes from Thailand, and fishes from Vietnam and the USA. Neorickettsia were detected using a real-time PCR protocol targeting a 152bp fragment of the heat shock protein coding gene, GroEL, and verified with nested PCR and sequencing of a 1853bp long region of the GroESL operon and a 1371bp long region of 16S rRNA. Eight unique genotypes of Neorickettsia were obtained from digenean samples. Neorickettsia sp. 8 obtained from Lecithodendrium sp. from Egypt; Neorickettsia sp. 9 and 10 obtained from two species of Paralecithodendrium from Mindoro, Philippines; Neorickettsia sp. 11 from Lecithodendrium sp. and Neorickettsia sp. 4 (previously identified from Saccocoelioides lizae, from China) from Thailand; Neorickettsia sp. 12 from Dicrogaster sp. Florida, USA; Neorickettsia sp. 13 and SF agent from Vietnam. Sequence comparison and phylogenetic analysis demonstrated that the forms, provisionally named Neorickettsia sp. 8-13, represent new genotypes. We have for the first time detected Neorickettsia in a digenean from Egypt (and the African continent as a whole), the Philippines, Thailand and Vietnam based on PCR and sequencing evidence. Our findings suggest that further surveys from the African continent, SE Asia, and island countries are likely to reveal new Neorickettsia lineages as well as new digenean host associations

Does treatment modality affect measures of arterial stiffness in women with gestational diabetes?

OBJECTIVES: The incidence of gestational diabetes mellitus (GDM) is increasing and is associated with adverse maternal, fetal and neonatal outcomes. Arterial stiffness (AS) is raised in pregnancies complicated by placental-mediated diseases such as pre-eclampsia. We investigated if AS is different between healthy pregnancies and women with GDM on different treatment modalities. METHODS: We conducted a prospective longitudinal cohort study to assess and compare AS in pregnancies complicated by GDM with low-risk controls. AS, measured by pulse wave velocity (PWV) and brachial (BrAIx) and aortic (AoAIx) augmentation Index, was recorded using the Arteriograph® at four gestational windows: 24+0 to 27+6; 28+0 to 31+6; 32+0 to 35+6 and ≥36+0 weeks of gestation (windows W1-W4, respectively). Women with GDM were considered both as a single group, and as subgroups defined by treatment modality. Data were analyzed using a linear mixed model on each AS variable (log-transformed) with group, gestational windows, maternal age, ethnicity, parity, body mass index, mean arterial pressure and heart rate as fixed effects and individual as a random effect. We compared the group means including relevant contrasts and adjusted the p-values using the Bonferroni correction. RESULTS: The study population comprised 155 low-risk controls and 127 with GDM, of whom 59 were treated with dietary intervention, 47 with metformin alone and 21 with metformin plus insulin. The two-way interaction term of study group and gestational age was significant for BrAIx and AoAIx (p<0.001), though there was no evidence (p=0.729) that mean AoPWV was different between the study groups. Women in the control group demonstrated significantly lower BrAIx and AoAIX at gestational windows W1-3 compared to the combined GDM group, but not at W4. Mean (95% CI) difference in log adjusted BrAIx was -0.37 (-0.52, 0.22), -0.23 (-0.35, -0.12), and -0.29 (-0.40, -0.18) at W1, W2 and W3, respectively. Mean (95% CI) difference in log adjusted AoAIx was -0.49 (-0.69, -0.3), -0.32 (-0.47, -0.18) and -0.38 (-0.52, -0.24) at W1, W2 and W3, respectively. Similarly, women in the control group also demonstrated significantly lower BrAIx and AoAIx compared with each of the GDM treatment subgroups (diet, metformin and metformin plus insulin) at W1-3. The increase in mean BrAIx and AoAIx seen between W2 and W3 in the women with GDM treated with dietary management was attenuated in the metformin and metformin with insulin groups, however the mean differences in BrAIx and AoAIx between these treatment groups were not statistically significant at any gestational window. CONCLUSIONS: Pregnancies complicated by GDM demonstrate significantly higher AS compared to low-risk pregnancies regardless of treatment modality. Our data provides a basis for further investigation into the association of metformin therapy with changes in AS and risk of placental-mediated diseases. This article is protected by copyright. All rights reserved

A fabrication process for integrating polysilicon microstructures with post-processed CMOS circuits

A MEMS-first fabrication process for integrating CMOS circuits with polysilicon micromechanical structures is described in detail. The overall process uses 18 masks (22 lithography steps) to merge a p-well LOCOS CMOS process that has one metal and two polysilicon layers with a surface micromachining process that has three layers of polysilicon. The microstructures are formed within recesses on the surface of silicon wafers such that their uppermost surfaces are coplanar with the remainder of the substrate. No special planarization technique, such as chemical-mechanical polishing, is used in the work described here. Special aspects of the process include provisions to improve lithography within the recesses, to protect the microstructures during the circuit fabrication, and to implement an effective lead transfer between the microstructures and the on-chip circuitry. The process is validated using a test vehicle that includes accelerometers and gyroscopes interfaced with sensing circuits. Measured transistor parameters match those obtained in standard CMOS, with NMOS and PMOS thresholds at 0.76 V and -0.96 V, respectively.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/49027/2/jm0312.pd

Gravitational collapse with tachyon field and barotropic fluid

A particular class of space-time, with a tachyon field, \phi, and a barotropic fluid constituting the matter content, is considered herein as a model for gravitational collapse. For simplicity, the tachyon potential is assumed to be of inverse square form i.e., V(\phi) \sim \phi^{-2}. Our purpose, by making use of the specific kinematical features of the tachyon, which are rather different from a standard scalar field, is to establish the several types of asymptotic behavior that our matter content induces. Employing a dynamical system analysis, complemented by a thorough numerical study, we find classical solutions corresponding to a naked singularity or a black hole formation. In particular, there is a subset where the fluid and tachyon participate in an interesting tracking behaviour, depending sensitively on the initial conditions for the energy densities of the tachyon field and barotropic fluid. Two other classes of solutions are present, corresponding respectively, to either a tachyon or a barotropic fluid regime. Which of these emerges as dominant, will depend on the choice of the barotropic parameter, \gamma. Furthermore, these collapsing scenarios both have as final state the formation of a black hole.Comment: 18 pages, 7 figures. v3: minor changes. Final version to appear in GR

Spatio-temporal Models of Lymphangiogenesis in Wound Healing

Several studies suggest that one possible cause of impaired wound healing is failed or insufficient lymphangiogenesis, that is the formation of new lymphatic capillaries. Although many mathematical models have been developed to describe the formation of blood capillaries (angiogenesis), very few have been proposed for the regeneration of the lymphatic network. Lymphangiogenesis is a markedly different process from angiogenesis, occurring at different times and in response to different chemical stimuli. Two main hypotheses have been proposed: 1) lymphatic capillaries sprout from existing interrupted ones at the edge of the wound in analogy to the blood angiogenesis case; 2) lymphatic endothelial cells first pool in the wound region following the lymph flow and then, once sufficiently populated, start to form a network. Here we present two PDE models describing lymphangiogenesis according to these two different hypotheses. Further, we include the effect of advection due to interstitial flow and lymph flow coming from open capillaries. The variables represent different cell densities and growth factor concentrations, and where possible the parameters are estimated from biological data. The models are then solved numerically and the results are compared with the available biological literature.Comment: 29 pages, 9 Figures, 6 Tables (39 figure files in total