Short-term COVID-19 vaccine adverse effects among adults in Ekiti State, Nigeria

BACKGROUND

The safety of the COVID-19 vaccines has been a topic of concern globally. This issue of safety is associated with vaccine hesitancy due to concerns about the adverse effects of the vaccines. Consequently, this study determined the short-term safety profile of the Oxford/AstraZeneca COVID-19 vaccine in Ekiti State, Nigeria.

METHODS

Descriptive cross-sectional study conducted between May and July 2021 among individuals who had received the first dose of the first batch of the Oxford/AstraZeneca COVID-19 vaccine at Ekiti State University Teaching Hospital (EKSUTH), Ado-Ekiti, Nigeria. A Google form was used to collect data on the adverse effects of the vaccine.

RESULTS

Out of over 1,000 individuals who were approached, 758 respondents completed the study. A large percentage (57.4%) of those who received the vaccines were healthcare workers. Adverse effects were reported in 70.8% of the participants with most manifesting on the first day of the vaccination. The predominant adverse effects were injection site soreness (28.5%), followed by fatigue (18.7%) and muscle pain (8.6%). There was no report of severe adverse effects such as anaphylactic reactions, thrombosis, myocarditis, transient myelitis, or Guillen-Barre syndrome.

CONCLUSION

This study found that self-reported adverse effects of the Oxford/AstraZeneca COVID-19 vaccine were mild and short in duration. This outcome has promising implications for improving COVID-19 vaccine uptake in the immediate environment and Nigeria.

Association between blood pressure dipping patterns and hypertension-mediated organ damage among Nigerians with newlydiagnosed hypertension

Introduction: Abnormal blood pressure (BP) dipping patterns are associated with increased cardiovascular risk among Africans. This study determined the association between BP dipping patterns and hypertension-mediated organ damage among patients with newly-diagnosed hypertension.Methods: Ambulatory BP monitoring and echocardiography were carried out on 120 participants. Participants were categorized based on the ratio of night-time to day-time systolic BP into 4 patterns: Normal dipper (≥ 10% but < 20%), non-dippers (≥ 0% but < 10%), reverse  dippers (<0%) and extreme dippers (≥ 20%).Result: Fifty-one (42.5%) were males, the mean age and body mass index were 44.2±9.8years and 27.1±4.4kg/m2 respectively. The non-dipping pattern was the most prevalent while the reverse dipping had the lowest mitral E/A ratio. Office systolic blood pressure was the only predictor of left ventricular hypertrophy (OR=1.050, 95% CI=1.004-1.098; p-value = 0.034).Conclusions: The non-dipping pattern was the most prevalent abnormal dipping pattern while the reverse dippers had the highest risk of hypertension-mediated organ damage. Office blood pressure was the only predictor of left ventricular hypertrophy. Hence, office BP measurement as well as ambulatory blood pressure measurements are potentially important tools in risk stratification in resource-poor settings of sub-Saharan Africa.

Parental monitoring and substance use among youths: A survey of high school adolescents in Lagos State, Nigeria

Background

Risk behaviours including marijuana use, alcohol consumption and cigarette smoking have a significant impact on the present and future health of adolescents. There are limited studies in sub-Saharan Africa to show evidence, if it exists, of the relationship between parental monitoring practices and the prevalence of substance use among adolescents. The aim of this study is to assess the relationship between parental monitoring practices and alcohol consumption, cigarette smoking and marijuana use among in-school adolescents in Mushin Local Government Area of Lagos State, South-Western Nigeria.

Methods

This was a cross-sectional survey of 437 in-school adolescents randomly selected from two schools in Mushin Local Government Area of Lagos State, Nigeria. Information on socio-demographic characteristics, the three domains of parental monitoring practices (Parental monitoring; negotiated unsupervised time and parental trust) and substance use were elicited using a modified version of parental monitoring practice scale and the Youth Risk Behaviour Surveillance System (YRBSS) questionnaire. Independent T tests and logistic regression models were used to assess relationship between parental monitoring practices and substance use.

Results

The overall prevalence of use of any of the substance was 21.7%. Negotiated unsupervised time was significantly associated with use of alcohol (P < 0.05), marijuana (P < 0.05) and cigarette smoking (P < 0.05). After controlling for age and gender, one unit increase in parental monitoring reduced the odds of engaging in any substance use by 10% (AOR = 0.90, 95% CI = 0.81-0.99) while a similar increase in negotiated unsupervised time significantly increases the odds of any substance use by 7% (AOR = 1.07, 95% CI = 1.01-1.14).

Conclusion

Of the three domains assessed, negotiated unsupervised time was consistently associated with substance use among these youth. Efforts to educate parents on the need to restrict unsupervised time of their wards may be warranted.

Health workforce and governance: the crisis in Nigeria

BACKGROUND

In Nigeria, several challenges have been reported within the health sector, especially in training, funding, employment, and deployment of the health workforce. We aimed to review recent health workforce crises in the Nigerian health sector to identify key underlying causes and provide recommendations toward preventing and/or managing potential future crises in Nigeria.

METHODS

We conducted a scoping literature search of PubMed to identify studies on health workforce and health governance in Nigeria. A critical analysis, with extended commentary, on recent health workforce crises (2010-2016) and the health system in Nigeria was conducted.

RESULTS

The Nigerian health system is relatively weak, and there is yet a coordinated response across the country. A number of health workforce crises have been reported in recent times due to several months' salaries owed, poor welfare, lack of appropriate health facilities and emerging factions among health workers. Poor administration and response across different levels of government have played contributory roles to further internal crises among health workers, with different factions engaged in protracted supremacy challenge. These crises have consequently prevented optimal healthcare delivery to the Nigerian population.

CONCLUSIONS

An encompassing stakeholders' forum in the Nigerian health sector remain essential. The national health system needs a solid administrative policy foundation that allows coordination of priorities and partnerships in the health workforce and among various stakeholders. It is hoped that this paper may prompt relevant reforms in health workforce and governance in Nigeria toward better health service delivery in the country.

Urinary cytologic findings in patients with benign and malignant adenomatous polyps of the prostatic urethra

CONTEXT

Urethral adenomatous polyps with prostatic epithelium (also known as benign prostatic epithelial polyps [BPEPs]) are a documented cause of hematuria, dysuria, and hematospermia, conditions that may prompt cytologic evaluation of urine.

DESIGN

The urine cytologic test findings in 5 cases of biopsy-proven BPEPs and in 1 case of prostatic ductal adenocarcinoma (PDA) that presented as a urethral polyp were retrospectively evaluated. Immunocytochemical stain for prostate-specific antigen (PSA), prostatic acid phosphatase (PAP), and high-molecular-weight cytokeratin (34betaE12) were used in evaluation of the lesions.

RESULTS

In 4 of 5 cases of BPEPs, clusters of bland columnar cells with uniform, oval nuclei were seen. Positive immunostaining for PSA and PAP confirmed the prostatic origin of the clusters in 2 cases. One urine sample contained abundant goblet cells and extracellular mucin, consistent with intestinal metaplasia coexisting in the bladder biopsy specimen. The urine sample in the fifth case of BPEPs contained no columnar cells. The last case had multiple urine cytologic evaluations that demonstrated PSA-positive, malignant-appearing clusters of columnar cells. A biopsy specimen of the polyps was described as a high-grade prostatic intraepithelial neoplasm in adenomatous polyp. However, in this patient, PDA was diagnosed on transurethral resection of the prostate specimen 4 years after the initial urine cytologic test.

CONCLUSION

Benign prostatic epithelial polyps should be considered in the differential diagnosis of clusters of columnar cells in urine cytologic testing. Cells with malignant nuclear features should instigate a careful search for a (prostatic) neoplasm, which may present as urethral polyps (e.g., PDA). Stains for PSA or PAP are useful adjuncts in differential diagnosis of this condition.

Pyogenic spondylodiskitis: a radiologic/pathologic and culture correlation study

BACKGROUND

Intervertebral disk tissue is resistant to hematogenous infection because of its avascularity. However, spondylodiskitis is being diagnosed with increasing frequency because of advancement in magnetic resonance imaging technology. There is a dearth of information regarding the bacteriology, histomorphologic features, and radiopathologic correlation of spondylodiskitis.

DESIGN

The study population consisted of 20 patients diagnosed as having spondylodiskitis by magnetic resonance imaging with and without gadolinium 67 enhancement and bone scans with technetium Tc 99m or gallium citrate Ga 67. Twenty-seven biopsy and debridement specimens were obtained from these patients. The specimens were cultured for microorganisms and also processed for histopathologic testing. Tissue sections were examined with hematoxylin-eosin and stains for infectious agents (Gomori's methenamine-silver, Gram, and Ziehl-Neelsen stains).

RESULTS

Where intervertebral disk tissue was present (23 of 27 cases), the morphologic changes included vascularization (with or without granulation tissue), myxoid degeneration, and necrosis. Chronic osteomyelitis was present in all 27 specimens and was associated with acute osteomyelitis in 7 cases (25%). Twenty-one of 27 cases had positive culture results (mostly pyogenic bacteria), but special stains revealed microorganisms in sections of the disk in only 4 cases (3 cases with gram-positive cocci and 1 with yeast consistent with Blastomyces). Florid acute inflammation was present in all the 4 cases.

CONCLUSION

Histopathologic features of acute spondylodiskitis include vascular proliferation, myxoid degeneration, and necrosis of the disk tissue with adjacent chronic osteomyelitis. Acute inflammation is variable and when florid is usually associated with identifiable organisms on histologic examination. At biopsy, tissue should be submitted for culture, since culture has a high sensitivity and specificity for detecting the etiologic organism.

Malignant ovarian sex cord tumor with annular tubules in a patient with Peutz-Jeghers syndrome: a case report

The majority of ovarian sex cord tumors with annular tubules (SCTAT) are benign neoplasms that arise sporadically. In patients who have Peutz-Jeghers syndrome (PJS), ovarian SCTAT is often an incidental finding. Malignant behavior in SCTAT has heretofore been reported only in sporadic cases. We report a case of bilateral, malignant SCTAT developing in a 47-year-old woman who had PJS, originally diagnosed as adenocarcinoma on cervicovaginal cytology. Cervicovaginal and peritoneal fluid cytologic preparations were characterized by pseudopapillary clusters and three-dimensional tubes of tumor cells with scanty cytoplasm and high nuclear: cytoplasmic ratio. Examination of surgical resection specimens revealed bilateral, solid ovarian tumors composed of simple and complex annular tubules with hyaline cores, typical of SCTAT. Tumor emboli were present within salpingeal lymphovascular spaces and in both right and left pelvic lymph nodes. Flow cytometry of tumor cells demonstrated a diploid phenotype. This case represents the first documented example of bilateral, malignant SCTAT arising in a patient who had PJS, presenting with an atypical cervicovaginal smear.

Investigations on human immunodeficiency virus type 1 integrase/DNA binding interactions via molecular dynamics and electrostatics calculations

The complete three-dimensional structure of the active site region of the human immunodeficiency virus type 1 (HIV-1) integrase (IN) is not unambiguously known. This region includes a flexible loop comprising residues 141-148 and the N-terminal portion of the helix alpha-4, which contains E152, the third catalytic residue, and Y143, which plays a secondary role in catalysis. Relatively high B-factors exist for most of the residues in the aforementioned region. The HIV-1 IN belongs to the polynucleotidyl transferase superfamily, whose members have been proposed to use two divalent metal ions for catalysis. Although only the position of the first metal ion has been determined crystallographically for the HIV-1 IN, we recently have proposed a binding site for the second metal ion. Based on this information, we have performed two 500-psec molecular dynamics simulations of the catalytic domain of the HIV-1 IN containing two Mg(2)+ ions. In one of the simulations, we included a dianionic phosphate group (HPO(4)(2)-) in the active site to mimic a portion of the DNA backbone of a substrate for the integration reaction. Electrostatics calculations and ionization state predictions were carried out on representative structures taken from the molecular dynamics simulations. Different conformational behaviors of the enzyme were observed, depending upon whether two Mg(2)+ ions were bound or two Mg(2)+ ions plus phosphate. The electrostatic calculations performed on the dynamical structures provide a further refinement about which regions of the catalytic domain of the HIV-1 IN may be involved in the DNA binding.

Acrometastasis in renal cell carcinoma

Acrometastasis is rare and may occur as the primary manifestation of an occult malignant tumor. Clinically, it may mimic benign osteoarthritic diseases, thus resulting in misdiagnosis and improper treatment. We describe a patient with renal cell carcinoma that presented itself as a case of chronic osteomyelitis after trauma to a finger. Such a lesion presents diagnostic challenges to both clinicians and histopathologists.

Tubulovillous adenoma of the urinary bladder

We report a case of vesical tubulovillous adenoma that occurred in a background of protracted chronic cystitis with intestinal-type glandular metaplasia and extensive cellular atypia (dysplasia) in the flat mucosa. Flow cytometry analysis showed DNA aneuploidy in the adenoma. Increased expression of the tumor suppresser gene, p53, and also of cellular proliferation markers (proliferating cell nuclear antigen and MIB-1) were detected in the villous adenoma and in the dysplastic regions of the flat metaplastic mucosa. These findings provide insight into the biology of intestinal metaplasia and also lend support to the theory of the chronic irritation-metaplasia-dysplasia-carcinoma sequence.

Blastomycosis of the lumbar spine: case report and review of the literature, with emphasis on diagnostic laboratory tools and management

We report on the conservative and surgical management of a patient with blastomycosis of the lumbar spine, causing severe and crippling deformity. The diagnosis was made through biopsy. Curative removal, reconstruction and realignment of the spine were achieved. Imaging modalities were highlighted, with a detailed discussion of the histology and conservative and surgical management. We emphasize the importance of early, aggressive treatment of blastomycosis to prevent deformity and disability, and to enable identification of the best management of a destructive lesion with deformity. This case demonstrates that empirical treatment should not be used in cases of unusual sinus and abscess locations. Specific diagnosis and early treatment are indicated to prevent dreadful complications and spinal deformity resulting from blastomycosis. Aggressive antifungal therapy can cure the disease but does not control complications related to deformity. The latter can only be addressed by surgical reconstruction. We review the literature of surgical treatment, focusing on abscess drainage, bone fusion and posterior instrumentation in the absence of addressing the deformity component.

Percutaneous transpedicular discectomy and drainage in pyogenic spondylodiscitis

Spondylodiscitis normally heals itself, but it can cause bone destruction leading to deformity and often pain. Debridement of these infections by percutaneous transpedicular discectomy with access from adjacent caudal pedicles can accelerate natural healing and prevent progression to bone destruction and deformity. We outline this technique and discuss a series of 28 patients treated using a percutaneous transpedicular approach to obtain culture and histopathology specimens, permit drainage and antibiotic irrigation, and provide a channel for granulation tissue to invade the infected space. This procedure is safe and effective, but it is contraindicated for epidural abscess or granulation tissue-induced neurocompression and it is ineffective against extensive bone destruction.

Testicular "tumor" of the adrenogenital syndrome: a case report of an unusual association with myelolipoma and seminoma in cryptorchidism

BACKGROUND

Males with congenital adrenal hyperplasia may develop bilateral testicular masses in early adult life. These are not malignant and generally regress with corticosteroid therapy. The authors report a case occurring in a 44-year-old man with associated seminoma and myelolipoma in an undescended testis.

METHODS

The testicular tumors were analyzed by histologic, flow cytometric, and ultrastructural techniques.

RESULTS

The tumors in both testes were comprised of polygonal cells with abundant granular eosinophilic cytoplasm, occasionally with brown (lipochrome) pigment and round nuclei of various sizes with prominent nucleoli. These cells were grouped into nodules by dense and sometimes thick fibrous trabeculae in the right testis. The areas corresponding to the fibrous trabeculae in the left (intraabdominal) testis were replaced by mixture of hematopoietic (myeloid) and fatty tissue in various proportions characteristic of myelolipoma. The left testis also had a well demarcated tumor that was diagnostic of seminoma. Electron microscopy demonstrated abundant smooth endoplasmic reticulum, a moderate number of mitochondria with tubulovesicular cristae, lipid droplets, and lipofuscin granules in the polygonal cells. No Reinke's crystals were observed. The patient received corticosteroids for his adrenocorticoid deficiency and also underwent external beam irradiation to the retroperitoneum for seminoma.

CONCLUSIONS

This case illustrates an unusual presentation of a testicular tumor in a patient with the adrenogenital syndrome as well as with myelolipoma and seminoma in a cryptorchid testis. The possibility of an associated neoplasm that could be potentially fatal should be considered whenever a testicular tumor of the adrenogenital syndrome continues to grow despite adequate hormonal treatment.

Sensitivity and specificity of triphenyl tetrazolium chloride in the gross diagnosis of acute myocardial infarcts

OBJECTIVE

Myocardial infarction is the most common cause of sudden death in the United States. However, the identification of early myocardial infarcts at necropsy is frequently difficult, since unequivocal gross changes of infarcts do not become apparent for 24 to 48 hours following myocardial ischemic injury. The use of dyes, such as nitro-blue tetrazolium and 2,3,5 triphenyl tetrazolium chloride (TTC), that identify the dehydrogenase-deficient infarcted myocardium has been shown, largely by animal studies, to be very helpful in the macroscopic diagnosis of such cases. Such animal studies could not be directly extrapolated to human autopsy studies, however, because of the assumption that autolysis may invalidate the histochemical assessment of myocardial enzymatic changes after death. This study was carried out to evaluate the sensitivity and specificity of TTC in the gross diagnosis of acute myocardial infarction in the human population.

DESIGN

The TTC stain reactions were correlated with histologic findings in the hearts of 638 consecutive adult autopsies.

RESULTS

Of the 638 hearts examined by TTC, 174 hearts stained positive for acute infarction; histology confirmed myocardial infarction in 140 hearts. Histologic examination revealed acute infarcts in 41 of the remaining 464 cases that had stained negatively with TTC. The use of TTC in the macroscopic diagnosis of acute myocardial infarcts in the human population was found to have a diagnostic sensitivity of 77.4% and a specificity of 92.6%. The predictive value of a positive test was 80.5%, and that of a negative test was 91.2%.

CONCLUSIONS

The overall diagnostic efficiency of the TTC test (ie, number of patients correctly identified) was 88%. These results show that the TTC test is a reliable, sensitive, and specific adjunct in the examination of the human heart at necropsy.

Recurrent massive hemothorax in Rendu-Osler-Weber syndrome

We report a case of Rendu-Osler-Weber syndrome, occurring as sudden death after two episodes of massive hemothorax. Autopsy revealed massive hemothorax resulting from spontaneous rupture of one of three subpleural arteriovenous malformations. Review of the patient's hospital records showed that she had had a massive spontaneous hemothorax 13 years earlier that was managed conservatively. This case emphasizes the importance of early therapeutic (surgical or radiologic) intervention in the treatment of pulmonary arteriovenous malformations.

Arterial bullet embolism resulting in delayed vascular insufficiency: a rationale for mandatory extraction

This paper reports a case of migrating intravascular bullet embolus that initially produced no symptoms but resulted in an above-knee amputation 14 months after its entry into a peripheral artery. The missile entered through a penetrating gunshot wound to the abdominal aorta and later became lodged in the left popliteal artery. However, the bullet fragment migrated further into the posterior tibial artery with consequent vascular insufficiency requiring a supracondylar amputation of the left lower extremity 14 months later. Emphasis is placed on the need for a high index of suspicion for bullet embolism, aggressive search for any bullets unaccounted for, and early surgical removal of all confirmed arterial emboli.

Healing response of the canine prostate to Nd:YAG laser radiation

The objective of the study was to characterize the healing response of the canine prostate to laser thermal injury. The study included 20 canine prostates that underwent transurethral laser radiation. The prostates were retrieved 1 hr after laser radiation in 7 dogs (acute group), and from 3 days to 9 weeks in 13 dogs (chronic group). Two distinct features were observed. First, reepithelialization of the prostate urethra resulted from mobilization of proliferating epithelial cells from acinar and ductal prostatic epithelium into the cavity surface, and not from the edges of the wound at the bladder neck. Squamous cell metaplasia was a prominent feature of reepithelialization. Second, the healing process in the canine prostate was relatively unimpeded. The large glandular component provided abundant germinal epithelial growth, and the absence of stromal elements allowed for complete sloughing of necrotic tissue without residual eschars. Further, the lesions in the chronic group had a tendency to be larger than those in the acute group, suggesting that extended delayed necrosis may occur at deep prostatic tissue layers.

The arthroscopic appearance of lipoma arborescens of the knee

Lipoma arborescens is a rare intra-articular lesion consisting of a villous lipomatous proliferation of the synovial lining. This case report draws attention to the history, physical findings, and arthroscopic appearance of lipoma arborescens, a rare lesion of the synovial lining of the knee. Arthroscopically, the lesion appears as a synovial lesion with numerous fatty-appearing globules and villous projections. In addition, magnetic resonance imaging is a valuable tool to differentiate the lesion from rheumatoid arthritis, pigmented villonodular synovitis, and synovial chondromatosis in those patients who present with a chronic, swollen, and painful joint.

Case report 871. Synovial sarcoma, monophasic type

A patient with a synovial sarcoma of the foot and several unusual radiographic findings has been reported. Radiographs demonstrated lamellated periosteal reaction in a metatarsal, a rare finding in cases of synovial sarcoma. Magnetic resonance scanning documented marrow invasion of multiple bones in the foot, when bony involvement has been reported as only erosive changes.

Diagnosis of systemic histoplasmosis in patients with AIDS

To compare various laboratory methods for diagnosis of systemic histoplasmosis, we retrospectively reviewed the charts of 165 patients with AIDS (acquired immunodeficiency syndrome). In eight of those patients, systemic histoplasmosis was confirmed by laboratory techniques. The laboratory methods used were histomorphology and microbiology. Tissues and fluids used for fungal cultures and histochemical stains included blood, bone marrow, lung, skin, pleura, esophagus and colon biopsy specimens, sputum, cerebrospinal fluid, bronchial washing/brushing, and pleural and peritoneal fluids. Results were positive in 83% of blood cultures and 71% of bone marrow cultures, making these tissues the best sources of Histoplasma organisms for microbiologic study. Similarly, Histoplasma sp could be demonstrated by fungal stains in 75% of bone marrow biopsy specimens as the main source for morphologic documentation of systemic histoplasmosis. The other tissues and fluids were only occasionally positive either microbiologically or morphologically. There was cross-positivity between morphologic and microbiologic methods in 80% of confirmed cases, making both methods equally reliable. However, the results were obtained within 48 hours by histomorphology, allowing prompt initiation of antifungal therapy. Although more specific results were produced by microbiologic methods, it took 18 to 35 days to grow the organism.