1226 A MULTI-DISCIPLINARY APPROACH TO TRANSFORMING EYE CARE SERVICES FOR CARE HOME RESIDENTS

Introduction

Care home residents can have variable access to eye care services and treatments. We developed a collaborative approach between optometrists, care homes, and primary and secondary care to enable personalised patient-centred care.

Objective

To develop and evaluate an integrated model of eye care for care home residents.

Methods

Small scale plan-do-study-act (PDSA) service tests were completed in three care-homes in Southwark (2 residential, 1 nursing) between November 2021 to May 2022. Processes were compared to historical feedback and hospital-based ophthalmology clinic attendances (Mar 2019-2020). Hospital-like assessments were piloted at two care homes for feasibility and acceptability. Further piloting utilised usual domiciliary optometry-led assessment with multidisciplinary meeting access (including optometrist, GP, geriatrician, ophthalmologist and care home nurse) to reduce duplication of assessments and to evaluate MDM processes and referral rates.

Results

Examination was 100% successful at home (visual acuity and pressure measurement) compared to hospital outpatients (71.7% success visual acuity, 54.5% pressures). Examination was faster than in hospital settings (16 minutes vs 45 minutes-1 hour). Residents were away from usual activities for 32 minutes vs 6 hours for hospital visits including transport. Residents were less distressed with home-based assessments. Did-Not-Attend (DNA) rates reduced (26.7% to 0%), secondary care discharge rates improved (8.4% to 32%). Hospital eye service referral were indicated in 19% -23%, half of which were for consideration of cataract surgery. Alternative conservative plans were agreed at MDM for nursing home residents who were clinically too frail or would not have been able to comply with treatments avoiding 33% unnecessary referrals.

Conclusions

Home-based eye care assessments appear better tolerated and are more efficient for residents, health and care staff. Utilising an MDM for optometrists to discuss residents with ophthalmologists and wider MDT members enabled personalised patient-centred decision-making. Future work to test this borough wide is in progress.

Quality of stroke guidelines in low- and middle-income countries: a systematic review

OBJECTIVE

To identify gaps in national stroke guidelines that could be bridged to enhance the quality of stroke care services in low- and middle-income countries.

METHODS

We systematically searched medical databases and websites of medical societies and contacted international organizations. Country-specific guidelines on care and control of stroke in any language published from 2010 to 2020 were eligible for inclusion. We reviewed each included guideline for coverage of four key components of stroke services (surveillance, prevention, acute care and rehabilitation). We also assessed compliance with the eight Institute of Medicine standards for clinical practice guidelines, the ease of implementation of guidelines and plans for dissemination to target audiences.

FINDINGS

We reviewed 108 eligible guidelines from 47 countries, including four low-income, 24 middle-income and 19 high-income countries. Globally, fewer of the guidelines covered primary stroke prevention compared with other components of care, with none recommending surveillance. Guidelines on stroke in low- and middle-income countries fell short of the required standards for guideline development; breadth of target audience; coverage of the four components of stroke services; and adaptation to socioeconomic context. Fewer low- and middle-income country guidelines demonstrated transparency than those from high-income countries. Less than a quarter of guidelines encompassed detailed implementation plans and socioeconomic considerations.

CONCLUSION

Guidelines on stroke in low- and middle-income countries need to be developed in conjunction with a wider category of health-care providers and stakeholders, with a full spectrum of translatable, context-appropriate interventions.

Mn(II), Co(II), Ni(II), and Cu(II) complexes of amino acid derived Schiff base ligand: Synthesis, characterization and in-vitro antibacterial investigations

Four complexes of Mn(II), Co(II), Ni(II) and Cu(II) with Schiff base ligand (H3L) derived from 2-amino-3-methylbutanoic acid and acetylacetonate were synthesized. All complexes were characterized by elemental analysis, Fourier-transform infrared spectroscopy and electronic spectroscopy. The results confirmed the coordination of the ligand to metals in tridentate fashion via the hydroxyl oxygen, the azomethine nitrogen and the enolic acetylacetonate oxygen. Antimicrobial activities were established for all complexes, free ligand and ciprofloxacin for comparison. Both the ligand and its metal complexes were active against Gram-positive and negative bacterial strains. The Cu(II) complex, showed highest antibacterial activity among the complexes screened. Other complexes displayed considerable antibacterial activity. Octahedral geometry was proposed for the metal(II) complexes with the Schiff base.                     KEY WORDS: Schiff base, Amino acid, Metal Complexes, Antibacterial agents   Bull. Chem. Soc. Ethiop. 2021, 35(1), 97-106. DOI: https://dx.doi.org/10.4314/bcse.v35i1.8

Moringa oleifera and Musa sapientum ameliorated 7,12-Dimethylbenz[a]anthracene-induced upregulations of Ki67 and multidrug resistance 1 genes in rats

OBJECTIVES

Moringa oleifera (MO) and Musa sapientum (MS) are plants of ethnomedicinal importance. We evaluated the effects of MOF6 (extracted from MO leaves) and MSF1 (extracted from MS suckers) on immunomodulations of Ki67 (proliferation biomarker) and multidrug resistance 1 (MDR1) genes in the liver of rats in 7,12-Dimethylbenz[a]anthracene (DMBA)-induced hepatotoxicity and mutagenesis to determine their antiproliferation, anti-drug resistance, and anticancer potentials.

METHODS

Forty-five adult male rats were randomly divided into nine groups (n = 5). Groups 1 and 2 received physiological saline and 15 mg/kg bodyweight of DMBA, respectively. Groups 3 and 4 received 15 mg/kg bodyweight DMBA and were treated with 15 and 30 mg/kg bodyweight of MOF6, respectively. Group 5 received 15 mg/kg bodyweight DMBA and was treated with 10 mg/kg bodyweight of MSF1. Group 6 received 15 mg/kg bodyweight DMBA and was treated with 3.35 mg/kg bodyweight of doxorubicin and intravenous injection of 0.5 ml/200 g of cisplatin. Groups 7-9 received only 15 and 30 mg/kg bodyweight of MOF6 and 10 mg/kg bodyweight of MSF1, respectively. DMBA, doxorubicin, and extracts doses were administered orally. The duration of our experimental procedure was 8 weeks. Consequently, liver histopathology (hematoxylin and eosin technique) and enzyme-linked immunosorbent assay homogenates' concentrations of Ki67 and MDR1 were evaluated. Computed data were statistically analyzed (P ≤ 0.05).

RESULTS

Results showed normal histoarchitectures of the liver in all groups. Statistical analyses showed significant (P ≤ 0.05) and non-significant decreased concentrations (P ≥ 0.05) of Ki67 and MDR1 in Groups 3-9 compared with Group 2. Therefore, MOF6 and MSF1 ameliorated DMBA-induced hepatotoxicity, abnormal proliferation, and drug resistance.

CONCLUSION

MOF6 and MSF1 possess antiproliferation, anti-drug resistance, and anticancer potentials.

PATTERN OF LIVER CANCER ADMISSIONS AT THE UNIVERSITY COLLEGE HOSPITAL, IBADAN - A 4-YEAR REVIEW

BACKGROUND

Liver Cancer (LC) is a common malignancy globally, and it exacts an enormous toll on the health care system. Therefore, it is imperative to have an epidemiological profile for effective planning.

METHODS

This study examined the basic demographic, admission profile and outcome of this category of patients through a retrospective cross-sectional study. The study was carried out using data of clinical diagnoses of LC admitted into the Gastro-intestinal Unit (GLU), Department of Medicine, University College Hospital, Ibadan between 1st January 2011 and 31st December 2014.

RESULTS

Two hundred and six patients (16.8%) had diagnoses of LC out of the 1228 total cases admitted by the GLU. The total male patients were 147(71.4%) and female 59 (28.6%) while the most prominent age group for both genders and males were 41-50 years in the male group and 51-60 years among females. The mean ± SD and median hospital stay was 10.6±11.6 days and eight days for LC patients, respectively. The intrahospital fatality rate was 37.9% and occurred mainly within five days of admission.

CONCLUSION

Liver Cancer is an important disorder in gastrointestinal practice and had high fatality within a few days of admission; hence, efforts should be made to improve the care of the patients.

Care-seeking behavior for neonatal jaundice in rural northern Nigeria

Objective

This study determined the predictors of maternal knowledge and health-seeking behavior for neonatal jaundice in rural Kumbotso, northern Nigeria.

Study design

Cross-sectional survey.

Method

A total of 361 mothers were interviewed using structured questionnaires. Knowledge scores and care-seeking practices were determined. Adjusted odds ratios were generated from logistic regression models.

Results

The proportion of respondents with good, fair and poor knowledge of neonatal jaundice were (46.0%, n ​= ​166), (24.1%, n ​= ​87) and (30.0%, n ​= ​108), respectively. Of the 117 mothers with a jaundiced child, (67.5%, n ​= ​79) and (20.5%, n ​= ​24) received treatment from health facilities and traditional healers, respectively, whereas (12.0%, n ​= ​14) resorted to home remedies. Maternal education Adjusted Odds Ratio (AOR) ​= ​2.39; 95% Confidence Interval (CI): 1.16–4.91) (secondary school versus no formal), source of information on neonatal jaundice (AOR ​= ​11.3; 95%CI: 5.84–21.93) (health worker versus ‘others’), recent delivery in a health facility (AOR ​= ​1.83; 95%CI: 1.06–3.14) and having a previously jaundiced child (AOR ​= ​5.06; 95%CI: 2.76–9.27) predicted knowledge. Preference for health facility treatment was predicted by a previously jaundiced child (AOR ​= ​10.04; 95%CI: 5.73–17.60), antenatal care (AOR ​= ​2.97; 95%CI: 1.43–6.15) (≥4 versus 0 visits), source of information on neonatal jaundice (AOR ​= ​2.33; 95%CI: 1.30–4.17) (health worker versus ‘others’), and maternal ethnicity (AOR ​= ​0.36; 95%CI: 0.14–0.96) (Hausa-Fulani versus ‘others’).

Conclusion

Maternal knowledge of neonatal jaundice was sub-optimal. Being educated, health facility delivery, having had a jaundiced child, and receiving information from health workers predicted good knowledge. Having a previously jaundiced child, antenatal care, obtaining information from health workers and maternal ethnicity predicted preference for health facility treatment. Policies and programs should be strengthened to focus on prevention, early detection and prompt management of neonatal jaundice.

Open Laminectomy for Lumbar Spinal Canal Stenosis due to Prolapsed Lumbar Intervertebral Discs

BACKGROUND

Back pain due to prolapsed intervertebral disc accounts for two thirds of all visits to the orthopaedic clinic. The incidence of this disease is increasing with the increased sports activities in the young and due to degeneration in the elderly. Open lumbar microdiscectomy remains the gold standard amongst surgical procedures for herniated discs with or without instrumentation. However, percutaneous/ endoscopic microdiscectomy is gaining popularity. In our environment, high cost and paucity of instrumentation and skills militate against the use of such technique. In the western world, improvement in the mentioned skills and instrumentation and shorter rehabilitation time make minimal access surgeries more appealing than open microdiscectomy in recent times.

MATERIALS AND METHODS

Patients with clinical signs and symptoms of spinal canal stenosis secondary to isolated lumbar disc herniation were investigated with plain radiographs and magnetic resonance imaging (MRI). All those with definite canal stenosis as seen on the MRI that were not responsive to conservative therapy or those with rapidly deteriorating clinical outlook without instability were included to have open Laminectomy without instrumentation. Their preoperative and postoperative walking distance, their modified Roland-Morris disability indices, Their pain numeric score (NRS), their anteroposterior distance of the spinal canal at maximal site of stenosis and finally the absence or presence of preoperative and post operative anteroposterior/instability.

RESULTS

Twenty patients had open Laminectomy. There was significant improvement in the postoperative pain numeric score, the walking distance, the Roland Morris disability score. There was no evidence of postoperative instability on the plain radiograph.

CONCLUSION

Open Laminectomy remains a useful tool in the treatment of patients with lumbar spinal canal stenosis due to prolapsed intervertebral discs.

Impacts of Regulations on Air Quality and Emergency Department Visits in the Atlanta Metropolitan Area, 1999-2013

INTRODUCTION

The United States and Western Europe have seen great improvements in air quality, presumably in response to various regulations curtailing emissions from the broad range of sources that have contributed to local, regional, and global pollution. Such regulations, and the ensuing controls, however, have not come without costs, which are estimated at tens of billions of dollars per year. These costs motivate accountability-related questions such as, to what extent do regulations lead to emissions changes? More important, to what degree have the regulations provided the expected human health benefits?

Here, the impacts of specific regulations on both electricity generating unit (EGU) and on-road mobile sources are examined through the classical accountability process laid out in the 2003 Health Effects Institute report linking regulations to emissions to air quality to health effects, with a focus on the 1999-2013 period. This analysis centers on regulatory actions in the southeastern United States and their effects on health outcomes in the 5-county Atlanta metropolitan area. The regulations examined are largely driven by the 1990 Clean Air Act Amendments (C). This work investigates regulatory actions and controls promulgated on EGUs: the Acid Rain Program (ARP), the NOx Budget Trading Program (NBP), and the Clean Air Interstate Rule (CAIR) - and mobile sources: Tier 2 Gasoline Vehicle Standards and the 2007 Heavy Duty Diesel Rule.

METHODS

Each step in the classic accountability process was addressed using one or more methods. Linking regulations to emissions was accomplished by identifying major federal regulations and the associated state regulations, along with analysis of individual facility emissions and control technologies and emissions modeling (e.g., using the U.S. Environmental Protection Agency's [U.S. EPA's] MOtor Vehicle Emissions Simulator [MOVES] mobile-source model). Regulators, including those from state environmental and transportation agencies, along with the public service commissions, play an important role in implementing federal rules and were involved along with other regional stakeholders in the study. We used trend analysis, air quality modeling, satellite data, and a ratio-of-ratios technique to investigate a critical current issue, a potential large bias in mobile-source oxides of nitrogen (NOx) emissions estimates.

The second link, emissions-air quality relationships, was addressed using both empirical analyses as well as chemical transport modeling employing the Community Multiscale Air Quality (CMAQ) model. Kolmogorov-Zurbenko filtering accounting for day of the year was used to separate the air quality signal into long-term, seasonal, weekday-holiday, and short-term meteorological signals. Regression modeling was then used to link emissions and meteorology to ambient concentrations for each of the species examined (ozone [O3], particulate matter ≤ 2.5 μm in aerodynamic diameter [PM2.5], nitrogen dioxide [NO2], sulfur dioxide [SO2], carbon monoxide [CO], sulfate [SO4-2], nitrate [NO3-], ammonium [NH4+], organic carbon [OC], and elemental carbon [EC]). CMAQ modeling was likewise used to link emissions changes to air quality changes, as well as to further establish the relative roles of meteorology versus emissions change impacts on air quality trends. CMAQ and empirical modeling were used to investigate aerosol acidity trends, employing the ISORROPIA II thermodynamic equilibrium model to calculate pH based on aerosol composition. The relationships between emissions and meteorology were then used to construct estimated counterfactual air quality time series of daily pollutant concentrations that would have occurred in the absence of the regulations. Uncertainties in counterfactual air quality were captured by the construction of 5,000 pollutant time series using a Monte Carlo sampling technique, accounting for uncertainties in emissions and model parameters.

Health impacts of the regulatory actions were assessed using data on cardiorespiratory emergency department (ED) visits, using patient-level data in the Atlanta area for the 1999-2013 period. Four outcome groups were chosen based on previous studies identifying associations with ambient air pollution: a combined respiratory disease (RD) category; the subgroup of RD presenting with asthma; a combined cardiovascular disease (CVD) category; and the subgroup of CVD presenting with congestive heart failure (CHF).

Models were fit to estimate the joint effects of multiple pollutants on ED visits in a time-series framework, using Poisson generalized linear models accounting for overdispersion, with a priori model formulations for temporal and meteorological covariates and lag structures. Several parameterizations were considered for the joint-effects models, including different sets of pollutants and models with nonlinear pollutant terms and first-order interactions among pollutants. Use of different periods for parameter estimates was assessed, as associations between pollutant levels and ED visits varied over the study period. A 7-pollutant, nonlinear model with pollutant interaction terms was chosen as the baseline model and fitted using pollutant and outcome data from 1999-2005 before regulations might have substantially changed the toxicity of pollutant mixtures. In separate analyses, these models were fitted using pollutant and outcome data from the entire 1999-2013 study period. Daily counterfactual time series of pollutant concentrations were then input into the health models, and the differences between the observed and counterfactual concentrations were used to estimate the impacts of the regulations on daily counts of ED visits. To account for the uncertainty in both the estimation of the counterfactual time series of ambient pollutant levels and the estimation of the health model parameters, we simulated 5,000 sets of parameter estimates using a multivariate normal distribution based on the observed variance-covariance matrix, allowing for uncertainty at each step of the chain of accountability. Sensitivity tests were conducted to assess the robustness of the results.

RESULTS

EGU NOx and SO2 emissions in the Southeast decreased by 82% and 83%, respectively, between 1999 and 2013, while mobile-source emissions controls led to estimated decreases in Atlanta-area pollutant emissions of between 61% and 93%, depending on pollutant. While EGU emissions were measured, mobile-source emissions were modeled. Our results are supportive of a potential high bias in mobile-source NOx and CO emissions estimates. Air quality benefits from regulatory actions have increased as programs have been fully implemented and have had varying impacts over different seasons. In a scenario that accounted for all emissions reductions across the period, observed Atlanta central monitoring site maximum daily 8-hour (MDA8h) O3 was estimated to have been reduced by controls in the summertime and increased in the wintertime, with a change in mean annual MDA8h O3 from 39.7 ppb (counterfactual) to 38.4 ppb (observed). PM2.5 reductions were observed year-round, with average 2013 values at 8.9 μg/m3 (observed) versus 19.1 μg/m3 (counterfactual). Empirical and CMAQ analyses found that long-term meteorological trends across the Southeast over the period examined played little role in the distribution of species concentrations, while emissions changes explained the decreases observed. Aerosol pH, which plays a key role in aerosol formation and dynamics and may have health implications, was typically very low (on the order of 1-2, but sometimes much lower), with little trend over time despite the stringent SO2 controls and SO42- reductions.

Using health models fit from 1999-2005, emissions reductions from all selected pollution-control policies led to an estimated 55,794 cardiorespiratory disease ED visits prevented (i.e., fewer observed ED visits than would have been expected under counterfactual scenarios) - 52,717 RD visits, of which 38,038 were for asthma, and 3,057 CVD visits, of which 2,104 were for CHF - among the residents of the 5-county area over the 1999-2013 period, an area with approximately 3.5 million people in 2013. During the final two years of the study (2012-2013), when pollution-control policies were most fully implemented and the associated benefits realized, these policies were estimated to prevent 5.9% of the RD ED visits that would have occurred in the absence of the policies (95% interval estimate: -0.4% to 12.3%); 16.5% of the asthma ED visits (95% interval estimate: 7.5% to 25.1%); 2.3% of the CVD ED visits (95% interval estimate: -1.8% to 6.2%); and -.6% of the CHF ED visits (95% interval estimate: 26.3% to 10.4%). Estimates of ED visits prevented were generally lower when using health models fit for the entire 1999-2013 study period.

Sensitivity analyses were conducted to show the impact of the choice of parameterization of the health models and to assess alternative definitions of the study area. When impacts were assessed for separate policy interventions, policies affecting emissions from EGUs, especially the ARP and the NBP, appeared to have had the greatest effect on prevention of RD and asthma ED visits.

CONCLUSIONS

This study demonstrates the effectiveness of regulations on improving air quality and health in the southeastern United States. It also demonstrates the complexities of accountability assessments as uncertainties are introduced in each step of the classic accountability process. While accounting for uncertainties in emissions, air quality-emissions relationships, and health models does lead to relatively large uncertainties in the estimated outcomes due to specific regulations, overall the benefits of regulations have been substantial.

An Epidemiological Study of Needlestick Injury among Healthcare Workers in Ahmadu Bello University Teaching Hospital, Zaria, Nigeria

BACKGROUND

Occupationally acquired infections are leading causes of morbidity and mortality among health care workers. The study aimed to determine knowledge, attitude and preventive practices of health care workers on needle stick injuries in Ahmadu Bello University Teaching Hospital, Zaria.

METHODS

This was a cross sectional descriptive study in which stratified sampling technique was used to sample respondents. Data was collected using structured, close ended self-administered questionnaire.

RESULTS

A total of 166 respondents completed the questionnaires out of 250 distributed questionnaires. Forty-three (25.9%) were males, 123 (74.1%) were females. The combined mean age was 40.9 ± 9.8 years. All the respondents were aware and knew of transmission of blood borne pathogens. Majority 116 (70.7%) had ever sustained injury while at work and 14 (8.8%) sustained injury in the last 3 months. The incidence of injury increases with work duration (c2= 17.88, p=0.001) and length of practice (c2=10.38, p=0.001). Eighty percent of respondents had received training on universal precautions. The commonest place of exposure was in the wards (65.6%) and circumstances of exposure were respectively sudden patient movements 21(19.3%) and recapping needle 20 (18.3%). Only 52 (43.3%) of respondents took appropriate measure (rinsing and disinfecting) the site after injury.

CONCLUSION

This study revealed the high risk health care workers are exposed to at work. There is urgent need to improve the safety of health care workers through continuing education and strict adherence to universal precautions. There is need to establish a surveillance system to monitor such incidents and provision of post-exposure prophylaxis to those accidentally exposed.

Stages of delay in oral cancer care evaluated at a tertiary health centre

BACKGROUND

To examine the stages of delay in presentation and management of oral cancer patients at University College Hospital Ibadan and compare findings with previous studies.

METHODS

A 20-year retrospective analysis of the delay stages among oral cancer patients that utilized patient's biodata and clinical data.

RESULT

169 oral cancer cases consisting of 127 carcinomas, 25 sarcomas and 17 lymphomas were analyzed. There was significant difference in the mean evolution time (ET) according to histological type (oral carcinoma = 282.8 +/- 414, oral sarcomas = 219.2 +/- 247.3 and oral lymphomas 105.5 +/- 115 days; p = 0.001). Patient's delay was more than professional delay for all cancer types (65.9%, 59.1% and 60.1% for carcinomas, sarcomas and lymphomas respectively). There was a significant difference in the mean ET of the early stage cancers compared with the late stage cancers (mean = 137.2 +/- 99 and 266.4 +/- 355; p = 0.010).

CONCLUSION

A combination of patients and professional delay negatively influenced the management of oral cancer patients but the patient's delay formed the bulk of this combination in our center.

A New Approach to Simulation of Die Flow which Incorporates the Extruder and Rotating Screw Tips in the Analysis

The traditional method of mathematical modeling of the die flows treats the die as a stand alone tool which is independent of the extrusion conditions which feed the polymer melt into the die. Here, we demonstrate that especially under the conditions where a breaker plate is not used the flow and the deformation which occur in the die are dependent on the prevailing velocity and the stress conditions of the fluid at the extruder which feeds the die. A finite element method based technique is used to solve the conservation equations using a mesh which covers both the die and the rotating conical screw tips of the extruder. The presented methodologies provide a more realistic representation of the thermo-mechanical history experienced by the polymer melt or structured fluids including emulsions or suspensions in the die and thus provide better tools for die design and process optimization. The results also suggest that significant improvements in die design and hence die performance could ensue by using the geometry of the screw tips, the distance between the screw tips and the die and the rotational screw speed as additional parameters for design and optimization.

Compressive Squeeze Flow of Generalized Newtonian Fluids with Apparent Wall Slip

The compressive squeeze flow is encountered in various processes like compression molding and in rheometry. It involves a complex deformation field driven by both shear and normal stresses. Here the flow and deformation field generated during the compressive squeeze flow of generalized Newtonian fluids, subject to wall slip, was analyzed using both numerical simulation based on the 2-D Finite Element Method and the 1-D analytical model, which is based on the lubrication assumption. The agreement between the analytical and numerical solutions deteriorates with increasing Navier's wall slip coefficient and the increasing yield stress value of the viscoplastic fluid. The lubrication assumption is valid under various squeeze flow conditions but numerical analysis in conjunction with experimental studies are necessary to determine the ranges of material parameters and operating conditions for which the lubrication assumption is valid.

Social profile and habits of oral cancer patients in Ibadan

OBJECTIVES

The aim of this study was to compare the socioeconomic profile and social habits of oral cancer patients and those of control subjects in order to investigate the relative importance of these risk factors in the occurrence of oral cancer.

STUDY DESIGN

Thirty-two histologically diagnosed oral carcinoma patients and 30 normal patients were recruited at the dental centre University College Hospital, Ibadan. A 33-item questionnaire was administered to the two groups. The data obtained was analyzed using student t test and chi square as appropriate as well as odds ratio.

RESULTS

Incomes less than 50,000 naira per annum, absence of fruit in every diet and tobacco use, were associated with 5.7, 3.0 and 4.05 increased risk of oral cancer respectively.

CONCLUSION

Low income, fruit depleted diet and tobacco use seems to be the most important risk factors for oral cancer development in the studied environment.

Comparison of hepatitis C histological recurrence rates and patient survival between split and deceased donor liver transplantation

INTRODUCTION

Controversy exists as to whether there is an increased severity or frequency of recurrent hepatitis C viral (HCV) infection in recipients of adult living donor liver transplantation (LDLT) grafts. We sought to examine the time to histological recurrence and survival in HCV (+) patients who underwent split liver transplantation (SLT), which is technically similar to what occurs in the LDLT procedure.

METHODS

Twenty four HCV (+) adult recipients were identified through the UNOS database as having had SLT procedures at three centers: Mount Sinai Medical Center, University of Chicago, and University of California at Los Angeles. Of these, 17 patients with comprehensive data were matched to 32 HCV (+) patients who underwent whole deceased donor liver transplantation (DDLT) during the same time period. Outcome and time to initial HCV recurrence as documented by liver biopsy were assessed. Liver biopsy was performed when clinically indicated.

RESULTS

Patients who had SLT were significantly older (P=.01). There was no difference in number of rejection episodes (P=.40). Fifteen of 17 SLT (88%) versus 24/32 DDLT (75%) patients had documented HCV recurrence by biopsy (P=.46). The time to median cumulative incidence of recurrence of HCV post-liver transplantation was 12.6 months (SLT) versus 39.8 months (DDLT) patients. There was no difference in survival between SLT and DDLT patients (47 vs 70 months, P=.62) nor in cumulative incidence of histological HCV recurrence at 1, 2, and 3 years (P=.198, .919, and .806, respectively).

CONCLUSION

There is no difference in the cumulative incidence of histological recurrence of HCV post-liver transplant or in survival between recipients of deceased donor and split liver transplants.

Identification of Ultrastructural Changes in Liver Allografts of Patients Experiencing Primary Nonfunction

BACKGROUND

Primary nonfunction (PNF) after liver transplantation is fatal without timely retransplantation. PNF has been associated with many risk factors, but the etiology remains unknown in most cases. Using electron microscopy, we examined the hepatic ultrastructure of donor allografts in patients experiencing PNF and compared the findings with a well-matched group of other donor allografts.

MATERIALS AND METHODS

Archival paraffin-embedded pre- and post-reperfusion donor liver biopsies were examined by electron microscopy in 10 patients with PNF and in 10 controls, matched by donor age +/- 5 years, gender, cold ischemic time +/- 1 hour, and donor cause of death. Mitochondria, endoplasmic reticulum, sinusoidal endothelial cells, and the glycogen content of the cells were assessed. The donors' serum peak transaminases, bilirubin and sodium levels, as well as the recipient age and serum creatinine were compared.

RESULTS

There were no significant differences in recipient age at the time of transplantation, peak recipient serum creatinine, donor peak serum transaminase, sodium or bilirubin levels. In all cases, the endoplasmic reticulum and sinusoidal endothelial cells were ultrastructurally normal. Hepatocytes had variable degrees of glycogen pooling. Hepatic steatosis and intramitochondrial inclusions cells were present in 5/10 PNF compared to 0/10 controls patients on preperfusion liver biopsy (P = .17).

CONCLUSION

Liver allografts from patients suffering from PNF can have mitochondrial ultrastructural changes on preperfusion biopsies.

Late onset immune pancytopenia following bone marrow transplantation

A 17-year-old boy developed autoimmune pancytopenia in the absence of chronic graft-versus-host disease 170 d after allogeneic bone marrow transplantation (BMT) from his HLA identical brother. The anaemia and thrombocytopenia responded to conventional immunosuppressive treatment, but the neutropenia was refractory to this and to splenectomy and subsequent removal of splenic remnant. Following total lymphoid irradiation the neutrophil count rose to low normal levels but thrombocytopenia and anaemia secondary to marrow hypoplasia required transfusion support. Bone marrow function was finally normalized by an additional transfusion of donor marrow without prior immunosuppressive therapy. We conclude that late onset immune pancytopenia post BMT caused by antibodies of probable donor origin may be life threatening in the absence of chronic graft-versus-host disease.

Electrocardiographic hypertrophic patterns in hypertensive Nigerians

We studied hypertrophic patterns in the electrocardiograms of 60 Nigerian hypertensives. Thirty were in heart failure and 30 without failure (matched for age and sex). Combined left ventricular and left atrial hypertrophy was the commonest finding occurring in 58.3%, followed by left ventricular hypertrophy alone in 30%. 76.7% and 40% had combined left ventricular and left atrial hypertrophy in the heart failure and the non-heart failure groups, respectively (P less than 0.02). Though these changes increased with increased blood pressure, the latter is similarly severe in both groups. 100% of patients in Class IV failure had combined left ventricular and left atrial hypertrophy. The 3 patients who had additional right atrial hypertrophy were in Class IV failure, 2 of whom died during follow-up. These changes are much more marked at presentation than reprots in caucasians and even in previous reports in Africans. The changes reflect the long-standing nature and severity of the hypertensive process, and point to the fact that the majority of hypertensives in this environment present rather late.

Features of menopause and menopausal age in Nigerian women

The age of menopause and the clinical features of menopause were investigated by questionnaire survey in 563 Nigerian women of Yoruba descent who have been menopausal for at least 5 years. The mean and median ages of menopause were 48.4 and 48.0 years, respectively. No relationship could be established between menopausal age and various biosocial factors such as age of menarche, social class, parity, smoking and place of residence. The commonest menopause related symptoms were joint pains and hot flush and only 42% of them still practiced sexual intercourse. These findings when compared to those from other populations indicate that there is need for more work on menopause in Nigerian women.