Patterns of chronic illness among older patients attending a university hospital in Nigeria

Background: The rising burden of chronic diseases has attracted the attention of public health researchers and policymakers worldwide. Objectives: To assess the demographic, morbidity and outcome patterns of chronic illness among the older patients at Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria. Design: Retrospective study Setting: Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria. Participants: Seven hundred and eighty-eight (788) adults (60 years and over) hospitalized between 2010 and 2014 in the hospital. Interventions: None Results: The age of the selected study population ranged from 60 to 99 years with a mean of 76.08(±10.42). More than half (53.0%) were between 60–69 years, with a subsequent decline. Male patients accounted for 64.0%, but females were more frequent among patients 80 years and older. The most common health conditions were heart diseases (22.5%), neoplasm (13.2%), cerebrovascular accident (12.4%), and gastrointestinal diseases (14.5%). The records showed that 14.9% were referred to other institution for various reasons (including further management, lack of space, industrial action by workers, discharged against medical advice or dead). Conclusion: Heart diseases were the major chronic illnesses among the older adults followed by neoplasm conditions, while musculoskeletal conditions were the least. It also found that there was a poor outcome of conditions amongolder adults in this setting. Therefore, efforts should be made towards the prevention and reduction of chronic illnesses, as well as improving the outcome of care. Keywords: chronic diseases, older adults, health care, retrospective, demographic Funding: Doctoral Fellowship from Consortium for Advanced Research Training in Afric

Managing breast cancer in younger women: Challenges and solutions

Breast cancer in young women is relatively rare compared to breast cancer occurring in older women. Younger women diagnosed with breast cancer also tend to have a more aggressive biology and consequently a poorer prognosis than older women. In addition, they face unique challenges such as diminished fertility from premature ovarian failure, extended survivorship periods and its attendant problems, and the psychosocial impact of diagnosis, while still raising families. It is therefore imperative to recognize the unique issues that younger women face, and plan management in a multidisciplinary fashion to optimize clinical outcomes. This paper discusses the challenges of breast cancer management for young women, as well as specific issues to consider in diagnosis, treatment, and follow-up of such patients

GENDER-RELATED ALTERATIONS IN FREE FATTY ACIDS AND OXIDATIVE STRESS IN HYPERTENSION CO-MORBIDLY OCCURRING WITH TYPE 2 DIABETES MELLITUS

Increase in plasma free fatty acids (FFAs) concentrations may cause cellular damage via the induction of oxidative stress. The aim of this present study was to investigate FFAs and oxidative stress in hypertension co-morbidly occurring with Type 2 Diabetes Mellitus (T2DM). Age and sex matched control subjects (n=150) and patients (n=470) [hypertensive nondiabetics (HND, n=179), normotensive diabetics (ND, n=132), hypertensive diabetics (HD, n=159)] presenting at the Medical Out-Patient Clinic of the State Hospital, Abeokuta, Nigeria were recruited. Fasting plasma glucose, creatinine, urea, FFAs, thiobarbituric acid reactive substances (TBARS) were determined spectrophotometrically. The presence of either or both diseases resulted in significant increase (p<0.05) in the plasma FFAs and oxidative stress marker-TBARS in different compartments (plasma, erythrocytes andlipoproteins) for both male and female patients when compared with their control counterparts. The increase in FFAs was more marked in comorbidity female when compared with other female patients. There was significant (p<0.05) difference in gender FFAs concentrations. In both controls and patients, FFAs in plasma are significantly (p<0.05) higher in male when compared with their female counterparts. This research revealed biochemical variations in hypertension co-morbidly occurring with T2DMcharacterised by gender-related elevation in FFAs and enhanced oxidative stress. Plasma FFAs might be a good biomarker predicting the occurrence and development of hypertension and/or T2DM. &nbsp

The Effects of Cymbopogon citratus (Lemon grass) on the Blood Sugar Level, Lipid Profiles and Hormonal Profiles of Wistar Albino Rats

The present study was undertaken to investigate the effect of extracts of Cymbopogon citratus on the blood sugar level, lipid profiles and hormonal profiles of normal rats. Oral administration of ethanolic and aqueous extract of C. citratus at a doses of 200 mg/kg body weight, for a period of 30 days, caused a significant (p0.05) reduction in blood glucose levels. Effect on hormonal profile (TSH, T3, and T4) was also determined, and was found to be significantly higher in all the administered groups when compared with control. Lipid profiles levels; Total cholesterols, triglycerides, high density lipoprotein-cholesterol and low density lipoprotein-cholesterol were significantly (p0.05) higher for all treated rats as compared against control. Findings in this study showed that this plant has hypoglycemic properties and did not exert oxidative damage to the heart and the various hormonal profiles as well as its relative safety and possible use for weight gain. 

Beneficial effects of omega-3 fatty acid on dyslipidemia in organs of alloxan-induced diabetic rats

Diabetes Mellitus is one of the heterogeneous metabolic disorders associated with dyslipidemia, a major risk factor contributing to cardiovascular disease. This metabolic abnormality affects virtually all organs. Over the years, antidiabetic drugs which majorly aim at the hyperglycemic aspect of the disease have been used. Therefore, to address this dyslipidemia, omega-3 fatty acid (O3FA) supplement was employed. Its effects on lipid metabolism in the organs (heart, liver, kidney, pancreas, spleen and brain) of alloxan-induced (150mg/kg body weight, intraperitoneally) diabetic male rats were investigated. O3FA (0.4g/kg b.wt/day) was administered as pre- and posttreatment for 2 weeks. The lipid levels were significantly increased (p<0.05) in diabetic rats. O3FA administration significantly reduced (p<0.05) the levels of cholesterol, phospholipids, triacylglycerol by varying extents, in the examined organs without affecting hyperglycemia in the diabetic rats. The ratio of HMG CoA/mevalonate decreased in the liver of the diabetic rats by 28% indicating increased activity of HMG-CoA reductase. This diabetes-induced dyslipidemia was accompanied by a 28% increase in the activity of hepatic HMG-CoA reductase. Administration of O3FA to the diabetic rats however resulted in 10% and 17% decrease in the activity of this enzyme in the pre- and post-treated groups respectively. Also, lipid peroxidation was significantly reduced (p<0.05) by O3FA suggesting that it has protective effect against oxidative damage. This study reveals that O3FAsupplement has beneficial effects in attenuating dyslipidemia observed in diabetes mellitus and could be beneficial as an adjunct in the management of diabetes mellitus

Circulating tumour DNA characterisation of invasive lobular carcinoma in patients with metastatic breast cancer

BACKGROUND: Limited data exist to characterise molecular differences in circulating tumour DNA (ctDNA) for patients with invasive lobular carcinoma (ILC). We analysed metastatic breast cancer patients with ctDNA testing to assess genomic differences among patients with ILC, invasive ductal carcinoma (IDC), and mixed histology. METHODS: We retrospectively analysed 980 clinically annotated patients (121 ILC, 792 IDC, and 67 mixed histology) from three academic centers with ctDNA evaluation by Guardant360™. Single nucleotide variations (SNVs), copy number variations (CNVs), and oncogenic pathways were compared across histologies. FINDINGS: ILC was significantly associated with HR+ HER2 negative and HER2 low. SNVs were higher in patients with ILC compared to IDC or mixed histology (Mann Whitney U test, P \u3c 0.05). In multivariable analysis, HR+ HER2 negative ILC was significantly associated with mutations in CDH1 (odds ratio (OR) 9.4, [95% CI 3.3-27.2]), ERBB2 (OR 3.6, [95% confidence interval (CI) 1.6-8.2]), and PTEN (OR 2.5, [95% CI 1.05-5.8]) genes. CDH1 mutations were not present in the mixed histology cohort. Mutations in the PI3K pathway genes (OR 1.76 95% CI [1.18-2.64]) were more common in patients with ILC. In an independent cohort of nearly 7000 metastatic breast cancer patients, CDH1 was significantly co-mutated with targetable alterations (PIK3CA, ERBB2) and mutations associated with endocrine resistance (ARID1A, NF1, RB1, ESR1, FGFR2) (Benjamini-Hochberg Procedure, all q \u3c 0.05). INTERPRETATION: Evaluation of ctDNA revealed differences in pathogenic alterations and oncogenic pathways across breast cancer histologies with implications for histologic classification and precision medicine treatment. FUNDING: Lynn Sage Cancer Research Foundation, OncoSET Precision Medicine Program, and UL1TR001422

Surface Protection of Carbon Steel with ZrO2 Composite Induced Zinc Based Electrolytic cell via Electrodeposition Technique

The effect of Zirconium dioxide (ZrO2) as additive to Zn-MgO electrolytic chemical bath coating by co-deposition on carbon steel was investigated. Weight loss was conducted on the electrodeposited mild steel and it was inspected. The anti corrosion properties were assessed by linear polarization procedure in 1 mole of HCl medium. From the results gotten, all deposited coatings displayed significant improvement. An amazing improvement was accomplished in every one of the coatings as against the as-received sample. Zn-MgO-ZrO2 (0.8V) with the best performing coating showing an upgrade indicates enhanced anti-wear and friction qualities displaying wear resistance improvement

Management and outcomes of gastrointestinal congenital anomalies in low, middle and high income countries: Protocol for a multicentre, international, prospective cohort study

Introduction: Congenital anomalies are the fifth leading cause of death in children globally, contributing an estimated half a million deaths per year. Very limited literature exists from low and middle income countries (LMICs) where most of these deaths occur. The Global PaedSurg Research Collaboration aims to undertake the first multicentre, international, prospective cohort study of a selection of common congenital anomalies comparing management and outcomes between low, middle and high income countries (HICs) globally.Methods and Analysis: The Global PaedSurg Research Collaboration consists of surgeons, paediatricians, anaesthetists and allied healthcare professionals involved in the surgical care of children globally. Collaborators will prospectively collect observational data on consecutive patients presenting for the first time, with one of seven common congenital anomalies (oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation and Hirschsprung\u27s disease).Patient recruitment will be for a minimum of 1 month from October 2018 to April 2019 with a 30-day post-primary intervention follow-up period. Anonymous data will be collected on patient demographics, clinical status, interventions and outcomes using REDCap. Collaborators will complete a survey regarding the resources and facilities for neonatal and paediatric surgery at their centre.The primary outcome is all-cause in-hospital mortality. Secondary outcomes include the occurrence of post-operative complications. Chi-squared analysis will be used to compare mortality between LMICs and HICs. Multilevel, multivariate logistic regression analysis will be undertaken to identify patient-level and hospital-level factors affecting outcomes with adjustment for confounding factors.Ethics and Dissemination: At the host centre, this study is classified as an audit not requiring ethical approval. All participating collaborators have gained local approval in accordance with their institutional ethical regulations. Collaborators will be encouraged to present the results locally, nationally and internationally. The results will be submitted for open access publication in a peer reviewed journal.Trial Registration Number: NCT03666767

Prognostic performance of pretreatment systemic immune-inflammation index in women with epithelial ovarian cancer

Purpose: This study investigated the prognostic performance of the systemic immune-inflammation index (SII) in patients with epithelial ovarian cancer (EOC) in Lagos, Nigeria. Methods: We performed a secondary analysis of the data of 91 women who had treatment for EOC between 2009 and 2018. The associations between pretreatment SII and survivals were tested. Results: Pretreatment SII more than 610.2 was a significant independent predictor of reduced progression-free survival (HR = 2.68; 95% CI, 1.17 to 6.09) while SII greater than 649.0 was a significant independent predictor of reduced 3-year overall survival (HR = 2.01; 95% CI, 1.01 to 3.99). Conclusion: These findings suggest that high SII may be a potential prognostic indicator and useful marker for more intensive surveillance and design of personalized treatment in patients with EOC