Variability of the lateral ligamentous complex of the knee

The current study examined the prevalence and morphometric values of three extracapsular ligaments on the lateral aspect of the knee namely lateral collateral ligament, anterolateral and triradiate collateral ligaments in human cadavers. Twenty knees were used. The lateral collateral ligament, anterolateral and triradiate collateral ligaments were present in 70%, 5% and 25% of the cases respectively. The triradiate collateral ligament had three parts namely femoral, tibial and fibular arms with average lengths of 20.03mm, 18.14mm and 16.20mm respectively. The lateral collateral ligament was attached on the lateral condyle of femur and the apex of head of fibula. The anterolateral ligament was attached on the lateral epicondyle of femur anterior to the origin of the lateral collateral ligament and both posterior to the Gerdy’s tubercle and on the lateral meniscus. The triradiate collateral ligament attached on the lateral condyle of femur, descends as the femoral arm and divides at the joint line as the tibial arm (anteriorly) and fibular arm (posteriorly). The tibial arm was attached on the posterior aspect of the Gerdy’s tubercle while the fibular arm was attached on the anterior aspect of head of fibula. The triradiate collateral ligament and the anterolateral ligaments possessed internal attachment to the lateral meniscus and could potentiate meniscal damage. There are considerable ligament variations at the lateral side of knee which should be brought to the knowledge of surgeons and radiologists.Keywords: Knee, Lateral complex, lateral collateral ligament, anterolateral ligament, triradiate collateral ligamen

Evaluation of in vitro antimycobacterial activity of Nigerian plants used for treatment of respiratory diseases

The global threat of tuberculosis (TB) demands for search for alternative antimycobacterial drugs. Some Nigerian medicinal plants used in the treatment of TB and other respiratory diseases wereevaluated for activity against a clinical isolate of Mycobacterium tuberculosis and a strain of Mycobacterium bovis (BCG). The crude methanolic extracts of eight plant species were screened foractivity against a clinical isolate of M. tuberculosis using broth microdilution method. Four out of the eight plant extracts exhibited inhibitory activities against M. tuberculosis at 78 and 1250 µg/mL. Thecrude extracts of Entada africana, Hymenocardia acida, Sterculia setigera and Stereospermum kunthianum did not inhibit significantly even at high concentration of 1250 ìg/mL. The hexane fractionsobtained after fractionation were the most active fractions for all the plants tested against BCG, having Anogeissus leiocarpus and Terminalia avicennioides exhibiting the highest activity at 312 and 200µg/mL, respectively. Fractions Ta5 and Al4 obtained on further purification exhibited most significant activity (MIC of 4.7 and 7.8 g/mL, respectively). From the results of phytochemical analysis, terpenes and triterpenoid saponins are the most prominent compounds in these fractions and several reports earlier indicated that these metabolites are potential antimycobacterial agents. This class of metabolites presents interesting area for further investigation with special attention on the Combretaceae family from Nigeria flora

Inhibition of neuroinflammation in BV2 microglia by the biflavonoid kolaviron is dependent on the Nrf2/ARE antioxidant protective mechanism

Kolaviron is a mixture of bioflavonoids found in the nut of the West African edible seed Garcinia kola, and it has been reported to exhibit a wide range of pharmacological activities. In this study, we investigated the effects of kolaviron in neuroinflammation. The effects of kolaviron on the expression of nitric oxide/inducible nitric oxide synthase (iNOS), prostaglandin E2 (PGE2)/cyclooxygenase-2, cellular reactive oxygen species (ROS) and the pro-inflammatory cytokines were examined in lipopolysaccharide (LPS)-stimulated BV2 microglial cells. Molecular mechanisms of the effects of kolaviron on NF-B and Nrf2/ARE signalling pathways were analysed by immunoblotting, binding assay, and reporter assay. RNA interference was used to investigate the role of Nrf2 in the anti-inflammatory effect of kolaviron. Neuroprotective effect of kolaviron was assessed in a BV2 microglia/HT22 hippocampal neuron co-culture. Kolaviron inhibited the protein levels of NO/iNOS, PGE2/COX-2, cellular ROS and the proinflammatory cytokines (TNFα and IL-6) in LPS-stimulated microglia. Further mechanistic studies showed that kolaviron inhibited neuroinflammation by inhibiting IB/NF-B signalling pathway in LPS-activated BV2 microglia. Kolaviron produced antioxidant effect in BV2 microglia by increasing HO-1 via the Nrf2/ antioxidant response element (ARE) pathway. RNAi experiments revealed that Nrf2 is need for the anti-inflammatory effect of kolaviron. Kolaviron protected HT22 neurons from neuroinflammation-induced toxicity. Kolaviron inhibits neuroinflammation through Nrf2-dependent mechanisms. This compound may therefore be beneficial in neuroinflammation-related neurodegenerative disorders

Twelve-month observational study of children with cancer in 41 countries during the COVID-19 pandemic

Introduction Childhood cancer is a leading cause of death. It is unclear whether the COVID-19 pandemic has impacted childhood cancer mortality. In this study, we aimed to establish all-cause mortality rates for childhood cancers during the COVID-19 pandemic and determine the factors associated with mortality. Methods Prospective cohort study in 109 institutions in 41 countries. Inclusion criteria: children <18 years who were newly diagnosed with or undergoing active treatment for acute lymphoblastic leukaemia, non-Hodgkin's lymphoma, Hodgkin lymphoma, retinoblastoma, Wilms tumour, glioma, osteosarcoma, Ewing sarcoma, rhabdomyosarcoma, medulloblastoma and neuroblastoma. Of 2327 cases, 2118 patients were included in the study. The primary outcome measure was all-cause mortality at 30 days, 90 days and 12 months. Results All-cause mortality was 3.4% (n=71/2084) at 30-day follow-up, 5.7% (n=113/1969) at 90-day follow-up and 13.0% (n=206/1581) at 12-month follow-up. The median time from diagnosis to multidisciplinary team (MDT) plan was longest in low-income countries (7 days, IQR 3-11). Multivariable analysis revealed several factors associated with 12-month mortality, including low-income (OR 6.99 (95% CI 2.49 to 19.68); p<0.001), lower middle income (OR 3.32 (95% CI 1.96 to 5.61); p<0.001) and upper middle income (OR 3.49 (95% CI 2.02 to 6.03); p<0.001) country status and chemotherapy (OR 0.55 (95% CI 0.36 to 0.86); p=0.008) and immunotherapy (OR 0.27 (95% CI 0.08 to 0.91); p=0.035) within 30 days from MDT plan. Multivariable analysis revealed laboratory-confirmed SARS-CoV-2 infection (OR 5.33 (95% CI 1.19 to 23.84); p=0.029) was associated with 30-day mortality. Conclusions Children with cancer are more likely to die within 30 days if infected with SARS-CoV-2. However, timely treatment reduced odds of death. This report provides crucial information to balance the benefits of providing anticancer therapy against the risks of SARS-CoV-2 infection in children with cancer

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Background: Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. // Methods: We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung's disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. // Findings: We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung's disease) from 264 hospitals (89 in high-income countries, 166 in middle-income countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in low-income countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. // Interpretation: Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between low-income, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study

AIM: The SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery. METHODS: This was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin. RESULTS: Overall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P < 0.001). After adjustment, delay was not associated with a lower rate of complete resection (OR 1.18, 95% CI 0.90-1.55, P = 0.224), which was consistent in elective patients only (OR 0.94, 95% CI 0.69-1.27, P = 0.672). Longer delays were not associated with poorer outcomes. CONCLUSION: One in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease

Constraints to adequate dietary intake among women: Evidences from Ekiti State, Nigeria

Chronic vitamin and mineral deficiency, also known as ‘Hidden Hunger’, is one of the most serious health problems confronting developing nations, especially Nigeria. Successive governments have implemented several nutritional programs such as school feeding program, mineral fortification program and supplementation with vitamin A capsules to combat the level of child malnutrition. Despite these efforts, the level of malnutrition cases has not dropped below average in rural and urban households. FGDs were conducted with women who registered at the Primary Health Centers  (PHCs) in each of the communities selected for the study. The selection cut across rural and urban communities. In all, three FGDs were conducted in Ekiti State (Ado-Ekiti, Ikere-Ekiti and Ikoro-Ekiti). Each FGD included 10-12 discussants randomly selected from the list of weekly attendance at the PHCs. Results from the problem tree analysis revealed that constraints to the adequate dietary intake among women included income, cultural preference, nutritional knowledge and practice.Keywords: Dietary intake, Constraints, Primary health center

Some of the Effects of Aqueous Leaf Extract of Cnidoscolous aconitifolius (Euphorbiaceae) on the Morphology and Histology of the Kidney and Liver of Sprague Dawley Rat.

Cnidoscolus aconitifolius belongs to a group of arbrescent shrubs. It has continued to be used as food, medicine and ornamental plant till date.Awide variety of claims have been made for its medicinal efficacy as atreatment for numerous ailments ranging from its ability to strengthen fingernails and darken gray hair to curing alcoholism, insomnia, gout, and scorpion stings. This study was to elucidate the effect of aqueous leafextract of Cnidoscolus aconitifolius commonly used as food supplement on the kidney and liver of Sprague Dawley rats. Thirty-two Sprague Dawley rats of both sexes (with an average weight of 235g) were randomlyassigned into one control group (n=8) designated as A, while the extract treated groups consists of 3 subgroups and were designated as B, C, and D. the animals in the extract treated groups B, C and D were administered600mg/kg, 400mg/kg and 200mg/kg bwt of the extract respectively, while the control group received equal volume of phosphate buffered saline (PBS). The administration was done orally using an orogastric tubefor seven days (7d). Twenty-four hours after the last administration, all the animals were sacrificed by cervical dislocation. Laparatomy was performed and the liver and kidney excised, trimmed free of fat, rinsedin cold phosphate buffered saline solution. The liver was quickly fixed in 10% formolsaline, while the kidney was fixed in Bouin's fluid for histological processing. The histological findings after Hematoxylin and Eosin (H&E) staining showed that the extract treated sections the Kidney and Liver has no compromising effect on the cellular integrity of thestudied organs. There were no degenerative changes and no intercellular vacuolations in the renal cortex and liver parenchyma. These findings indicate that the administration of aqueous leaf extract of Cnidoscolusaconitifolius has no adverse effects on hepatic and renal morphology of the treated Sprague Dawley rats. It is therefore recommended that further studies at corroborating these observations be carried out

Some thermo-physical properties of yam cuts of two geometries

The effects of variation of temperature (-18 to 33°C) and geometries (slab and cylinder) on some thermo-physical properties of white yam were investigated. The measured parameters were density, specific heat, and thermal diffusivity at constant moisture level of 72.7% ± 0.69 (wet basis) using transient heat transfer method. Both the density and specific heat of the sample increased with increase in temperature to maximum levels after which further increase led to a reduction of the values of these parameters; however, they were independent of sample’s geometry. The rate of heat diffusion per second for the yam as measured was between 2.365 to 11.86 x 10-8 m2 and 2.676 to 8.062 x 10-8 m2 for slab and cylinder respectively. The thermal diffusivity and computed thermal conductivity were found to increase with increase in temperature. Conclusively, these thermo-physical properties were correlated with temperature using polynomials of the third order empirical model