Contribution Of Autopsy To Medical Practice In Cameroon: A 10 year review.

Of 12.000 bodies received at the mortuary of the Yaounde General Hospital, 126 were autopsied in this 10-year retrospective study from 1997 to 2007, giving a rate of 1 autopsy in 100 deaths. 72.2% of cases were males against 27.8% females. The predominant age group was 20-69 years (57.1%). The main causes of death include natural disease (32.5%), physical aggression (20.6%), road traffic accident (19.8%), poisoning (9.5%), asphyxia (7.1%) and firearm injury (6.4%). The indication for autopsy was mainly medico-legal (91.7%). The circumstances of death showed a predominance of natural causes (34.1%), murder (32.6%), and homicide (28.6%). Though the benefits of an autopsy to the family, medical practice and entire community are enormous, the rate of this procedure in our community is low. We recommend public education and advocate for a legislative framework thatregulates autopsy practice, at least, in teaching hospitals in our country

Ivermectin treatment of Loa loa hyper-microfilaraemic baboons (Papio anubis): Assessment of microfilarial loads, haematological and biochemical parameters and histopathological changes following treatment.

Individuals with high intensity of Loa loa are at risk of developing serious adverse events (SAEs) post treatment with ivermectin. These SAEs have remained unclear and a programmatic impediment to the advancement of community directed treatment with ivermectin. The pathogenesis of these SAEs following ivermectin has never been investigated experimentally. The Loa/baboon (Papio anubis) model can be used to investigate the pathogenesis of Loa-associated encephalopathy following ivermectin treatment in humans. 12 baboons with microfilarial loads > 8,000mf/mL of blood were randomised into four groups: Group 1 (control group receiving no drug), Group 2 receiving ivermectin (IVM) alone, Group 3 receiving ivermectin plus aspirin (IVM + ASA), and Group 4 receiving ivermectin plus prednisone (IVM + PSE). Blood samples collected before treatment and at Day 5, 7 or 10 post treatment, were analysed for parasitological, hematological and biochemical parameters using standard techniques. Clinical monitoring of animals for side effects took place every 6 hours post treatment until autopsy. At autopsy free fluids and a large number of standard organs were collected, examined and tissues fixed in 10% buffered formalin and processed for standard haematoxylin-eosin staining and specific immunocytochemical staining. Mf counts dropped significantly (p0.05). All animals became withdrawn 48 hours after IVM administration. All treated animals recorded clinical manifestations including rashes, itching, diarrhoea, conjunctival haemorrhages, lymph node enlargement, pinkish ears, swollen face and restlessness; one animal died 5 hours after IVM administration. Macroscopic changes in post-mortem tissues observed comprised haemorrhages in the brain, lungs, heart, which seen in all groups given ivermectin but not in the untreated animals. Microscopically, the major cellular changes seen, which were present in all the ivermectin treated animals included microfilariae in varying degrees of degeneration in small vessels. These were frequently associated with fibrin deposition, endothelial changes including damage to the integrity of the blood vessel and the presence of extravascular erythrocytes (haemorrhages). There was an increased presence of eosinophils and other chronic inflammatory types in certain tissues and organs, often in large numbers and associated with microfilarial destruction. Highly vascularized organs like the brain, heart, lungs and kidneys were observed to have more microfilariae in tissue sections. The number of mf seen in the brain and kidneys of animals administered IVM alone tripled that of control animals. Co-administration of IVM + PSE caused a greater increase in mf in the brain and kidneys while the reverse was noticed with the co-administration of IVM + ASA. The treatment of Loa hyper-microfilaraemic individuals with ivermectin produces a clinical spectrum that parallels that seen in Loa hyper-microfilaraemic humans treated with ivermectin. The utilization of this experimental model can contribute to the improved management of the adverse responses in humans

Evaluation of appendicitis risk prediction models in adults with suspected appendicitis

Background Appendicitis is the most common general surgical emergency worldwide, but its diagnosis remains challenging. The aim of this study was to determine whether existing risk prediction models can reliably identify patients presenting to hospital in the UK with acute right iliac fossa (RIF) pain who are at low risk of appendicitis. Methods A systematic search was completed to identify all existing appendicitis risk prediction models. Models were validated using UK data from an international prospective cohort study that captured consecutive patients aged 16–45 years presenting to hospital with acute RIF in March to June 2017. The main outcome was best achievable model specificity (proportion of patients who did not have appendicitis correctly classified as low risk) whilst maintaining a failure rate below 5 per cent (proportion of patients identified as low risk who actually had appendicitis). Results Some 5345 patients across 154 UK hospitals were identified, of which two‐thirds (3613 of 5345, 67·6 per cent) were women. Women were more than twice as likely to undergo surgery with removal of a histologically normal appendix (272 of 964, 28·2 per cent) than men (120 of 993, 12·1 per cent) (relative risk 2·33, 95 per cent c.i. 1·92 to 2·84; P < 0·001). Of 15 validated risk prediction models, the Adult Appendicitis Score performed best (cut‐off score 8 or less, specificity 63·1 per cent, failure rate 3·7 per cent). The Appendicitis Inflammatory Response Score performed best for men (cut‐off score 2 or less, specificity 24·7 per cent, failure rate 2·4 per cent). Conclusion Women in the UK had a disproportionate risk of admission without surgical intervention and had high rates of normal appendicectomy. Risk prediction models to support shared decision‐making by identifying adults in the UK at low risk of appendicitis were identified

Programming Actor-Based Collective Adaptive Systems

In recent years, we are witnessing a growing interest in large-scale situated systems, such as those falling under the umbrella of pervasive computing, Cyber-Physical Systems, and the Internet of Things. The actor model is a natural choice for designing and implementing such systems, thanks to the ability of actors to address distribution, autonomy of control, and asynchronous communication: namely, it is convenient to view the pervasive cyberspace as an environment densely inhabited by mobile situated actors. But how can an actor-centric development approach be fruitfully used to engineer a complex coordination strategy, where a myriad of devices/actors performs adaptive distributed sensing/processing/acting? Aggregate computing has been proposed as an emerging paradigm that faces this general problem by adopting a global, system-level stance, allowing to specify and functionally compose collective behaviours by operating on diffused data structures, known as “computational fields”. In this paper, we develop on the idea of integrating the actor model and aggregate computing, presenting a software framework where declarative global-level system specifications are automatically turned into an underlying system of Scala/Akka actors carrying complex coordination tasks involving large sets of devices spread over the pervasive computing system