Colonoscopy findings in lower gastrointestinal bleeding in Lagos: A comparative study based on age

Background

Lower gastrointestinal bleeding (LGIB) (hematochezia) is an important indication for colonoscopy, and may be caused by hemorrhoids, diverticulosis, and tumors.

Aims

The aim of this study was to compare the endoscopic findings in the young (<50 years) versus older subjects (≥50 years) with LGIB in Nigeria.

Subjects and Methods

This was a retrospective study of the endoscopic findings of all adults with LGIB from January 2017 to December 2019 in Lagos, Nigeria. The records of two centers that deliver outpatient gastrointestinal endoscopic services were ploughed for biodata, presenting complaints and findings in these individuals. These data were then analyzed and are thus presented.

Results

A total of 1,774 colonoscopies performed during this period, 793 were for LGIB. Of those with LGIB, 548 (69.1%) were males, 245 (30.9%) were female, mean age was 50.7 (±14) years, and 403 (50.8%) were younger than 50 years old. The most frequent findings in patients younger than 50 years were hemorrhoids (316, 78.4%), tumors (35, 8.7%), and polyps (27, 6.7%), while in the older patients, they were hemorrhoids (259, 66.4%), tumors (74, 19%) and diverticulosis (55, 14.1%). Younger age was significantly associated with the presence of hemorrhoids (P < 0.005), while older age was significantly associated with the presence of tumors (P < 0.005) and diverticulosis (P < 0.005).

Conclusion

Our study showed that hemorrhoids, tumors, and diverticulosis were the most common causes of LGIB in Nigerian patients - with younger age being significantly associated with hemorrhoids, and older age with tumors and diverticulosis. A third of the tumors in this study were found in younger patients. Unfortunately, this finding of such a high proportion of colorectal tumors being found in young Africans has been shown in previous reports - this work should help heighten concern and provoke further scientific probing into the phenomenon with a view to encouraging policy to help truncate its existence.

Phytobiological-facilitated Production of Silver Nanoparticles From Selected Non-cultivated Vegetables in Nigeria and Their Biological Potential

Objectives

Plant-mediated synthesis [silver (Ag) to form Ag nanoparticles (AgNPs)] is becoming progressively well accepted in many scientific and pharmaceutical fields. The aim of this study was to synthesize AgNPs using air-dried leaves of four neglected vegetables, i.e. Ceratotheca sesamoides, Ceiba pentandra, Crassocephalum crepidioides, and Launaea taraxacifolia.

Materials and Methods

Ultraviolet-visible (UV-Vis) spectroscopy, fourier transform infrared (FTIR) spectroscopy, and scanning electron microscopy (SEM) were used for characterization. Cell stabilization membrane and lipoxidase assays were used to determine used to assess the antiinflammatory activities while 2,2-diphenyl-1-picryl-hydrazyl-hydrate (DPPH) and 2,2'-azinobis(3-ethylbenzothiazoline-6-sulfonic acid (ABTS+) assays were used to assess the antioxidant activities of AgNPs [L. taraxacifolia-AgNPs, C. sesamoides Ag nanoparticles (CS-AgNPs), C. pentandra Ag nanoparticles (CP-AgNPs), and C. crepidioides AgNPs (CC-AgNPs)].

Results

The UV-Vis spectra of the synthesized NPs displayed absorption bands at around 360-440 nm, which is a characteristic band for AgNPs. The SEM image showed that the AgNPs formed were spherical in morphology. CC-AgNPs exhibited the most significant inhibitory activity against human red blood cell membrane stabilizasyonu [median inhibitory concentration (IC₅₀): 32.2 μg/mL] while CS-AgNPs displayed the most significant inhibitory activity against lipoxygenases (IC₅₀: 32.8 μg/mL). CP-AgNPs exhibited the most significant antioxidant effect against both ABTS and DPPH (IC₅₀: 5.5 and 6.4 μg/mL) when compared to ascorbic acid (IC₅₀: 4.7 μg/mL).

Conclusion

The synthesized AgNPs were found to be stable and the FTIR evidence suggested that the phytochemicals in the vegetables might have played an important role in the reduction and stabilization of AgNPs. This work showed that the synthesized AgNPs from non-cultivated vegetables can find relevance and application in health, drugs, food and environmental science. The evidences herein further confirmed their ethnopharmacological applications.

Dimensions of Electronic Fraud and Governance of Trust in Nigeria's Cashless Ecosystem

A negative outcome of the nascent cashless policy in Nigeria has been persistent electronic banking fraud (e-fraud). Fraud occurrence in any financial space indicates insecurity and loopholes being exploited by fraudsters. This underscores the importance of trust governance in electronic banking and its centrality in a transiting cashless economy like Nigeria. Against this background, we investigated e-banking fraud and the role trust governance plays in both the adoption and refusal to migrate and use electronic banking in Nigeria. Using qualitative methods (in-depth and key informant interviews) of data collection, 30 participants were purposively selected and in some instances reached through the snowball and referral methods. Findings showed internal, external, and collaborative dimensions of e-fraud. Experiences of fraud reportedly affected adoption and migration of bank customers to e-banking platforms. Although weak governance mechanism was reported, banks nonetheless are embracing security mechanisms such as sending SCAM alert messages to customers, while shaming and sack of compromised staff were employed as within-bank measures to secure the confidence of customers in the evolving financial ecosystem.

Estimation of CYP2D6*10 genotypes on citalopram disposition in Chinese subjects by population pharmacokinetic assay

WHAT IS KNOWN AND OBJECTIVE

There is great interindividual variability in citalopram (CIT) pharmacokinetics. We attempted to establish a population pharmacokinetic (PPK) model of CIT in Chinese healthy subjects, to evaluate the effect of genetic polymorphism on CIT pharmacokinetics and to compare the PPK and non-compartmental (NCA) assays in the estimation of CIT bioequivalence.

METHODS

Blood samples of 23 healthy subjects were collected after administration of CIT; plasma concentration of CIT was analysed using LC/MS-MS. CYP2C19 and CYP2D6*10 genotypes were determined. PPK model was established by using nonlinear mixed-effect modelling (NONMEM). The model was evaluated using goodness-of-fit plots and relative error measurements. Bioequivalence of CIT was evaluated by both PPK and NCA method.

RESULTS AND DISCUSSION

The estimated population absorption rate constant (ka ), clearance (CL/F) and volume of distribution (Vd/F) in Chinese healthy subjects are 0.64 L/h, 12.7 L/h and 705 L, respectively. Different CYP2C19 and CYP2D6 genotypes have impacts on CIT pharmacokinetics. There is about 5.5% decrement of CL/F for each CYP2C19*2 or CYP2D6*10 allele. The 90% confidence interval of CIT bioavailability obtained from NCA and PPK model were 96.4-105.4% and 92.5-103.4%, respectively.

WHAT IS NEW AND CONCLUSION

The PPK of CIT is best characterized by a one-compartment disposition model with first-order absorption. CYP2C19 and CYP2D6 genotypes have impacts on the CL/F of CIT. Bioequivalence of CIT can be estimated by both NCA and PPK model.

Severe proximal myopathy in advanced renal failure. Diagnosis and management

Myopathies encountered in uremic patients may have different pathogenetic mechanisms and treatment. Secondary hyperparathyroidism may cause uremic myopathy responding to specific treatment. This study aimed at presenting a case illustrative of the clinical features, diagnosis and management of uremic parathyroid myopathy. A 66-year old man with renal failure from membranous nephropathy developed sensory signs of uremic neuropathy and progressive painless weakness of the pelvic girdle muscles bilaterally. Motor nerve conduction velocity was normal, electromyogram was consistent with a myopathic pattern, while muscle biopsy showed a pattern of atrophy more consistent with a neuropathic pattern. Serological tests for collagen vascular diseases and hyperthyroidism were negative, while serum muscle enzymes were not elevated and serum phosphate levels were not low. Serum parathyroid hormone level was grossly elevated, while serum calcium was mildly elevated in a small fraction of the measurements, serum alkaline phosphatase showed a progressive rise and skeletal bone survey did not disclose osteopenia or signs of parathyroid bone disease. A course of calcitriol failed to improve the myopathy, which responded promptly and dramatically to parathyroidectomy. Uremic parathyroid myopathy, which has a characteristic clinical picture, must be differentiated from other neuropathic or myopathic conditions that require specific treatments. Progressive parathyroid myopathy is, by itself, an indication for parathyroidectomy, which is curative in this case.