Association of Rhesus Blood Group (RhD) and Toxoplasmosis in Women with Miscarriage in Erbil

Background and objective: Toxoplasmosis has worldwide distribution and the incidence of the disease varies around the world. Human blood is categorized within two main systems: ABO and Rhesus factor blood group systems. The Rhesus factor protein which is the Rhesus factor gene product and a major component in the Rh blood group system carries the strongest blood group immunogen, This study aimed to estimate the sero-prevalence of toxoplasmosis and to investigate the distribution of ABO and Rhesus factor blood groups among women with toxoplasma infection. Methods: This cross-sectional study was carried out in Erbil from September 2017 to April 2018, in which 200 women with history of abortion were enrolled. Blood samples were collected and tested for anti-toxoplasma IgM antibody using direct agglutination and enzyme linked immunosorbent assay techniques. Results: the percentages of anti-toxoplasma IgM was 33.5% .and 65 (97%) of the seropositive women were RhD negative. Significant relationship between RhD blood group and Toxoplasma seropositive was observed while no significant relationship was found between toxoplasmosis and each ABO phenotype and demographic characteristics. Comparably, high sero-prevalence rate of anti-toxoplasma antibody was found among age group 21-40 years old (73.1%), however, it was statistically non- significant. Conclusion: Anti toxoplasma IgM antibodies was relatively high among women with history of abortion in Erbil and Rhesus factor positive was significant

Association between Vitamin D Deficiency and Bacterial Vaginosis among First Trimester Pregnant Women in Erbil Maternity Hospital

Background: Bacterial vaginosis (BV) is a polymicrobial clinical syndrome characterized by changes in vaginal flora, with replacement of normally abundant Lactobacillus species by high concentrations of anaerobic bacteria among reproductive age women. Studies have different aspects on the effect of vitamin D on BV. Objective: To find out the prevalence of BV, vitamin D deficiency in early pregnancy and to examine association between BV and vitamin D deficiency. Patients and Methods: A cross-sectional study was carried out during July 2017 till October 2018 among 100 pregnant women at first trimester pregnancy, aged 18-35 years old at Erbil Maternity Hospital. Results: At enrollment the prevalence of BV was (53%), about (73%) of our clients suffering from homogenous white greyish vaginal discharge, (57%) were with elevated vaginal PH and fishy odor, clue cells was found among (53%) of them. Vitamin D deficiency, defined as 25 (OH) D concentration below 20 ng/ml, was found in (67%) of women. Insufficiency of the vitamin D 25(OH) D concentration between 20-30ng/ml was present in (29%) of the women. Sufficient level of 25 (OH) over (30 ng/ml) was found in (4%). The incidence of Vitamin D pattern among women with BV were (49.3%), (62.1%) and (50%) respectively for each vitamin D deficiency, Insufficiency and sufficient vitamin D.  No significant association was found between Vitamin D deficiency and BV. Conclusion: High occurrence of BV and vitamin D deficiency were found. Vitamin D was not associated significantly with increased BV incidence. We suggested that pregnant women should check and manage their level of vitamin D and BV additionally they must not depend only on vitamin D for curing BV

Identification of aspirin analogues that repress NF-κB signalling and demonstrate anti-proliferative activity towards colorectal cancer in vitro and in vivo

Substantial evidence indicates that aspirin and related non-steroidal anti-inflammatory drugs (NSAIDs) have potential as chemopreventative/therapeutic agents. However, these agents cannot be universally recommended for prevention purposes due to their potential side-effect profiles. Here, we compared the growth inhibitory and mechanistic activity of aspirin to two novel analogues, diaspirin (DiA) and fumaryl diaspirin (F-DiA). We found that the aspirin analogues inhibited cell proliferation and induced apoptosis of colorectal cancer cells at significantly lower doses than aspirin. Similar to aspirin, we found that an early response to the analogues was a reduction in levels of cyclin D1 and stimulation of the NF-κB pathway. This stimulation was associated with a significant reduction in basal levels of NF-κB transcriptional activity, in keeping with previous data for aspirin. However, in contrast to aspirin, DiA and F-DiA activity was not associated with nucleolar accumulation of RelA. For all assays, F-DiA had a more rapid and significant effect than DiA, identifying this agent as particularly active against colorectal cancer. Using a syngeneic colorectal tumour model in mice, we found that, while both agents significantly inhibited tumour growth in vivo, this effect was particularly pronounced for F-DiA. These data identify two compounds that are active against colorectal cancer in vitro and in vivo. They also identify a potential mechanism of action of these agents and shed light on the chemical structures that may be important for the antitumour effects of aspirin

Pelvic organ prolapse managed at Usmanu Danfodiyo University Teaching Hospital, Sokoto: A 10-year review

Background: Pelvic organ prolapse can have a detrimental effect on woman's quality of life by limiting physical, social, psychological, and sexual functions. We determined the prevalence, predisposing factors, and complications of pelvic organ prolapse at the Usmanu Danfodiyo University Teaching Hospital (UDUTH), Sokoto. Materials and Methods: A retrospective study of the cases of pelvic organ prolapse managed at UDUTH, Sokoto, between January 1, 2003, and December 31, 2012. Results: The prevalence of pelvic organ prolapse was 1.4% of all gynecological admissions. The mean age of the patients was 45.3 ± 16.1 years. Majority of the patients, i.e., 63.7% were premenopausal. The grand multiparous women constituted 65.9% of the patients. The most common presenting symptom was a mass protruding through the vagina. The prolapsing organs included uterus 75.8%, bladder 12.1%, rectum 6.6%, and a combination of bladder and rectum 5.5%. The most common predisposing factor identified was unsupervised home delivery. Most of the patients had surgical intervention that included vaginal hysterectomy 59.3%, anterior colporrhaphy 7.7%, posterior colpoperineorrhaphy 6.6%, and combined anterior colporrhaphy and posterior colpoperineorrhaphy 5.5%. Hemorrhage was the most common intraoperative complication encountered in anemia 10.7% and wound infection 2.7% was most prevalent in the postoperative period. Conclusion: Multiparity, prolonged labor, and unsupervised deliveries were significant predisposing factors of pelvic organ prolapse antenatal care; skilled supervised deliveries and access to effective family planning methods will decrease the prevalence

Primary vaginismus: treatment with botulinum toxin

Background: Vaginismus is a rare condition. It may result in unconsummated marriages with subsequent marital disharmony. The most severe forms of these spasms of the vaginal muscles are often refractory to a variety of conventional treatment.Case Report: The index case was a 35-year old nulligravid, civil servant who presented to the gynaecological outpatient clinic with a complaint of inability to have coitus since she married 5years prior to presentation. She had several counselling sessions by both gynaecologists and psychiatrists, and had used several forms of treatment with improvement in her condition. She, subsequently, had successful treatment with intra-vaginal botulinum toxin injection.Conclusion: In cases of severe vaginismus, botulinum toxin injection can be considered as a first line option of treatment.Keywords: BotoxR, fear, penetration, spasm, vagina

Prevalence and pattern of sexual assault in Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria

Introduction: sexual violence is an important public health problem of growing concern all over the world. This study was conducted to determine the prevalence and pattern of sexual assault managed in Usmanu Danfodiyo University Teaching Hospital Sokoto, Nigeria. Methods: it was a retrospective study that looked into cases of sexual assault admitted into the hospital between January 2010 and December 2014. Information on patients’ biodata, and relevant details on the cases were extracted from the patients’ case files and analyzed. Results: out of the 5317 gynecological admissions during the period under study, 45 (0.84%) were cases of sexual assault. Of these, only 34 case files were available for data extraction. The patients’ age ranged from 2 to 37 years (mean = 12.6 + 8.3). About two thirds (61.8%) of those affected were young children (aged 12 years and below). In majority of cases (70.6%) the assault was penetrative, and in most of the cases (91.2%) only a single assailant was involved. In close to two thirds of cases, the assailant was either an acquaintance (38.2%) or a family member (20.6%). Although law enforcement agents were informed in majority (58.8%) of cases, arrests were made in less than half (41.2%). Conclusion: although the prevalence of sexual assault in this study appears to be low, a major cause for concern is the fact that those affected were predominantly young children. Parents should be more vigilant in monitoring their children’s movement, and stringent laws should be enacted and enforced to curb this heinous act.The Pan African Medical Journal 2016;2

Association of dementia with in-hospital outcomes in primary heart failure and acute myocardial infarction hospitalizations

Background: Dementia and cardiovascular diseases contribute to a significant disability and healthcare utilization in the elderly.Objective: The in-hospital treatment patterns and outcomes of heart failure (HF) and acute myocardial infarction (AMI) are not well-studied in this population.Methods: We used the National Inpatient Sample database to identify AMI and HF hospitalizations in adults ≥65 years between 2016 and 2018.Results: A total of 2,466,369 HF hospitalizations (277,900 with dementia [11.3%]) and 1,094,155 AMI hospitalizations (100,365 with dementia [9.2%]) were identified. Patients with dementia were older (mean age 83.8 vs 78.6 years for HF, and 83.0 vs 75.8 years for AMI) with female predominance (59.0% for HF and 56.0% for AMI) than those without dementia. In adjusted analysis, patients with dementia had higher in-hospital mortality (HF 4.7% vs 3.1%, aOR 1.33 [1.27-1.39] and AMI 9.9% vs 5.9%, aOR 1.23 [1.17-1.30]), p \u3c 0.001) and lower mechanical circulatory support utilization. Patients with AMI and dementia were less likely to receive revascularization (including percutaneous coronary intervention, coronary artery bypass grafting, and thrombolysis), vasopressors, and invasive mechanical ventilation. They had a longer mean length of stay (LOS) (5.5 vs 5.3 days for HF and 5.1 vs 4.8 days for AMI, p \u3c 0.001 for both), a lower inflation-adjusted cost of care for AMI ($15,486 vs$23,215, p \u3c 0.001), and higher rates of transfer to rehabilitation facilities.Conclusion: Patients with dementia admitted for HF or AMI had higher in-hospital mortality, a longer LOS, and were less likely to receive aggressive revascularization interventions after AMI

Prognostic significance of BIRC7/Livin, Bcl-2, p53, Annexin V, PD-L1, DARC, MSH2 and PMS2 in colorectal cancer treated with FOLFOX chemotherapy with or without aspirin.

Evasion of apoptosis is associated with treatment resistance and metastasis in colorectal cancer (CRC). Various cellular processes are associated with evasion of apoptosis. These include overexpression of pro-apoptotic proteins (including p53 and PD-L1), anti-apoptotic proteins (BIRC7/Livin and Bcl-2), chemokine receptors (including DARC), and dysregulation of DNA mismatch repair proteins (including MSH2 and PMS2). The aim of this study was to determine the effect of folinic acid, 5-FU and oxaliplatin (FOLFOX) as a single agent and aspirin plus FOLFOX in various combinations on the aforementioned proteins in human CRC, SW480 cell line and rat models of N-Methyl-N-Nitrosourea (NMU)-induced CRC. In addition, effects of the NMU-induced CRC and chemotherapeutic regimens on haematological and biochemical parameters in the rat models were studied. Immunohistochemistry, immunofluorescence and immunoblot techniques were used to study the expression pattern of the related proteins in the human CRC cells pre- and post-treatment. Double contrast barium enema, post-mortem examination and histological analyses were used to confirm tumour growth and the effect of the treatment in vivo in rat models. Notably, we found in human mucinous CRC, a significant increase in expression of the BIRC7/Livin post-FOLFOX treatment compared with pre-treatment (p = 0.0001). This increase provides new insights into the prognostic role of BIRC7/Livin in evasion of apoptosis and facilitation of treatment resistance, local recurrence and metastasis particularly among mucinous CRCs post-FOLFOX chemotherapy. These poor prognostic features in the CRC may be further compounded by the significant suppression of DARC, PD-L1, PMS2 and overexpression of MSH2 and anti-apoptotic Bcl-2 and p53 proteins observed in our study (p < 0.05). Importantly, we found a significant reduction in expression of BIRC7/Livin and reactivation of DARC and PD-L1 with a surge in Annexin V expression in rat models of CRC cells post-treatment with a sequential dose of aspirin plus FOLFOX compared with other treatments in vivo (p <0.05). The mechanistic rational of these effects underscores the importance of expanded concept of possible aspirin combination therapy with FOLFOX sequentially in future CRC management. Validation of our findings through randomized clinical trials of aspirin plus FOLFOX sequentially in patients with CRC is therefore warranted