Matrix metalloproteinase-induced cervical extracellular matrix remodelling in pregnancy and cervical cancer

The phenomenal extracellular matrix (ECM) remodelling of the cervix that precedes the myometrial contraction of labour at term or preterm appears to share some common mechanisms with the occurrence, growth, invasion and metastasis of cervical carcinoma. Matrix metalloproteinases (MMPs) are zinc-dependent endopeptidases that are pivotal to the complex extracellular tissue modulation that includes degradation, remodelling and exchange of ECM components, which contribute to homeostasis under normal physiological conditions such as cervical remodelling during pregnancy and puerperium. However, in cancer such as that of the uterine cervix, this extensive network of extracellular tissue modulation is altered leading to disrupted cell–cell and cell–basement membrane adhesion, abnormal tissue growth, neovascularization and metastasis that disrupt homeostasis. Cervical ECM remodelling during pregnancy and puerperium could be a physiological albeit benign neoplasm. In this review, we examined the pathophysiologic differences and similarities in the role of MMPs in cervical remodelling and cervical carcinoma

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Investigation of bioactive compounds and antimicrobial sensitivity of pawpaw (Carica papaya) leave extracts against morbific micro-organisms

Pawpaw (Carica papaya) is a notable plant due to its medicinal benefits used globally to treat diseases which include dengue, malaria, inflammation, and skin infections. This study was aimed at investigating the bioactive compounds and antimicrobial sensitivity of Pawpaw (Carica papaya) leave extracts against morbific micro-organisms. The bioactive compounds of C. papaya leaves were analyzed using Chemical Standard techniques as reported in literatures and antimicrobial assay was done using agar well diffusion techniques. Qualitative phytochemical screening results of pawpaw leaves shows the presence of glycosides, tannins, flavonoids, steroids, saponins and terpenoids. The antimicrobial sensitivity result reveals higher zones of inhibition of methanolic extract against Staphylococcus sp (11.4±0.3 mm), Vibrio sp (10.3±0.2 mm), E. coli (9.7±0.3 mm), Shigella sp (9.1±0.3 mm), Yeast (9.1±0.3 mm) and Penicillium sp (8.3±0.4 mm).  While aqueous extract shows higher zone of inhibition against Mould (8.0±0.5 mm). This study revealed pawpaw leaves contains secondary metabolites (bioactive compounds) while the antimicrobial sensitivity against the microorganisms explains the possibility of using the leaves as antibiotic substances (antimicrobial agents). Therefore, pawpaw leaves could be a significant source of medicine for the treatment of various fungal and bacterial infections

Generating evidence for health policy in challenging settings: lessons learned from four prevention of mother-to-child transmission of HIV implementation research studies in Nigeria

Abstract Background Implementation research (IR) facilitates health systems strengthening and optimal patient outcomes by generating evidence for scale-up of efficacious strategies in context. Thus, difficulties in generating IR evidence, particularly in limited-resource settings with wide disease prevention and treatment gaps, need to be anticipated and addressed. Nigeria is a priority country for the prevention of mother-to-child transmission of HIV (PMTCT). This paper analyses the experiences of four PMTCT IR studies in Nigeria, and proffers solutions to major challenges encountered during implementation. Studies included and findings Multicentre PMTCT IR studies conducted in Nigeria during the Global Plan’s assessment period (2011 to 2015) were included. Four studies were identified, namely The Baby Shower Trial, Optimizing PMTCT, MoMent and Lafiyan Jikin Mata. Major common challenges encountered were categorised as ‘External’ (beyond the control of study teams) and ‘Internal’ (amenable to rectification by study teams). External challenges included healthcare worker strikes and turnover, acts and threats of ethnic and political violence and terrorism, and multiplicity of required local ethical reviews. Internal challenges included limited research capacity among study staff, research staff turnover and travel restrictions hindering study site visits. Deliberate research capacity-building was provided to study staff through multiple opportunities before and during study implementation. Post-study employment opportunities and pathways for further research career-building are suggested as incentives for study staff retention. Engagement of study community-resident personnel minimised research staff turnover in violence-prone areas. Conclusions The IR environment in Nigeria is extremely diverse and challenging, yet, with local experience and anticipatory planning, innovative solutions can be implemented to modulate internal challenges. Issues still remain with healthcare worker strikes and often unpredictable insecurity. There is a dire need for cooperation between institutional review boards across Nigeria in order to minimise the multiplicity of reviews for multicentre studies. External challenges need to be addressed by high-level stakeholders, given Nigeria’s crucial regional and global position in the fight against the HIV epidemic

The prevalence of hydrocele in Nigeria and its implication on mapping of lymphatic filariasis

Informed by the public health and socio-economic burden of lymphatic filariasis (LF), the 50th World Health Assembly in May 1997 passed a resolution identifying as a priority the elimination of LF as a public health problem. Elimination programmes were based on the strategy of mass administration of ivermectin and albendazole to people living in endemic communities. The achievement of this strategy required collection of adequate epidemiological data in order to delineate the main LF zones that required priority mass community directed treatment and which was non-existent. The objective of the study was to fillin this gap. In the study, a total of 625 villages were selected from 25 states of the country and out of these, 89 villages (14.2%) were inaccessible at the time of the study. REM based on the rapid examination of 30-50 adult male resident (> 20 years) in selected villages for hydrocoele was carried out in 536 (85.8%) of the selected villages. Of these, 197 (36.8%) villages had males with hydrocoele, though the prevalence varied. Hydrocoele was apparently absent in 339 (63.2%) of the villages examined. These results were integrated into Geographical Information System (GIS) and remote sensing technologies, analyzed and interpreted. The results revealed spatial variation of the LF distribution. These were discussed in the context of the on-going plan to elimination LF in the country. Keywords: Lymphatic filariasis; hydrocoele; Rapid Epidemiological Mapping; Nigeria. Nigerian Journal of Parasitology Vol. 27 2006: pp. 29-3

Bacteria-produced ferric exopolysaccharide nanoparticles as iron delivery system for truffles (Tuber borchii)

Iron exopolysaccharide nanoparticles were biogenerated duringferric citrate fermentation by Klebsiella oxytoca DSM 29614. Before investigating their effects on Tuber borchii (Bianchetto^ truffle) mycelium growth and morphology, they were tested on human K562 cell line and Lentinula edodes pure culture and shown to be non-toxic. Using these nanoparticles as iron supplement, the truffles showed extremely efficient iron uptake of over 300 times that of a commercial product. This avoided morphological changes in T. borchii due to lack of iron during growth and, with optimum nanoparticle dosage, increased growth without cell wall disruption or alteration of protoplasmatic hyphal content, the nuclei, mitochondria, and rough endoplasmic reticula being preserved. No significant modifications in gene expression were observed. These advantages derive from the completely different mechanism of iron delivery to mycelia compared to commercial iron supplements. The present data, in fact, show the nanoparticles attached to the cell wall, then penetrating it non-destructively without damage to cell membrane, mitochondria, chromatin, or ribosome. Low dosage significantly improved mycelium growth, without affecting hyphal mor- phology. Increases in hyphal diameter and septal distance indicated a healthier state of the mycelia compared to those grown in the absence of iron or with a commercial iron supplement. These positive effects were confirmed by measuring fungal biomass as mycelium dry weight, total protein, and ergosterol content. This Bgreen^ method for biogenerating iron exopolysaccharide nanoparticles offers many advantages, including significant economic savings, without toxic effects on the ectomycorrhizal fungus, opening the possibility of using them as iron supplements in truffle plantations