Cutaneous sarcoidosis in Nigeria

The study is a retrospective analysis of the cutaneous manifestations of sarcoidosis in patients seen during a 10-year period at the skin and chest clinics of the Lagos University Teaching Hospital. Of the 43 patients with sarcoidosis 30% had skin lesions. The most common was sarcoidal infiltration of scarification marks. Facial macropapular lesions also were frequently present.     

A Single-Blind,Parallel Design RCT to Assess the Effectiveness of SMS Reminders in Improving ART Adherence Among Adolescents Living with HIV (STARTA Trial)

PurposeThe study evaluated the feasibility, acceptability, and efficacy of interactive and tailored short message reminders on antiretroviral therapy adherence among adolescents (15–19 years) living with HIV in southwest Nigeria.MethodsThe study was a single-blind, parallel-design (ratio 1:1), and multicenter RCT of 209 medication-non-adherent adolescents living with HIV at HIV clinics in two states in southwest Nigeria. The research assessed ART adherence using the visual analog scale, viral suppression, pill count, and ACTG scores; the feasibility of the intervention by the SMS delivery and response (overall and individual) rates; and acceptability using self-report, willingness to continue receiving the intervention, and desire for its scale-up.ResultsA total of 17,690 text messages were sent while 10,119 (57.2%) got delivered to the participants. Out of 9,216 responses that were received from the study participants, 8,781 (95.3%) indicated acceptability of the intervention.The end-of-study log₁₀ of viral load values between control and intervention groups had a mean difference of 0.66 (95% CI 0.26–1.06) and p-value of .001. Also, the unadjusted odds ratio of undetected viral load (≤20 copies/ml) was 1.356 (1.039–1.771) with a p-value of .002. However, the intervention had no effect on subjective measures of antiretroviral therapy adherence.ConclusionsThe use of interactive and tailored short message reminders to enhance antiretroviral therapy adherence among adolescents has good potential. It seems feasible, highly acceptable, and possibly leads to improved viral load count. It is likely that the associated antiretroviral therapy adherence enhances viral suppression and, therefore, improves outcomes in adolescent HIV.     

Disclosure of Same-Sex Sexual Practices to Family and Healthcare Providers by Men Who Have Sex with Men and Transgender Women in Nigeria

Archives of Sexual Behavior - Disclosure of same-sex sexual practices by men who have sex with men (MSM) and transgender women (TGW) may facilitate appropriate healthcare engagement, including risk...     

Targeted Disruption of NF1 in Osteocytes Increases FGF23 and Osteoid With Osteomalacia‐like Bone Phenotype

Neurofibromatosis type 1 (NF1, OMIM 162200), caused by NF1 gene mutations, exhibits multi‐system abnormalities, including skeletal deformities in humans. Osteocytes play critical roles in controlling bone modeling and remodeling. However, the role of neurofibromin, the protein product of the NF1 gene, in osteocytes is largely unknown. This study investigated the role of neurofibromin in osteocytes by disrupting Nf1 under the Dmp1‐promoter. The conditional knockout (Nf1 cKO) mice displayed serum profile of a metabolic bone disorder with an osteomalacia‐like bone phenotype. Serum FGF23 levels were 4 times increased in cKO mice compared with age‐matched controls. In addition, calcium‐phosphorus metabolism was significantly altered (calcium reduced; phosphorus reduced; parathyroid hormone [PTH] increased; 1,25(OH)₂D decreased). Bone histomorphometry showed dramatically increased osteoid parameters, including osteoid volume, surface, and thickness. Dynamic bone histomorphometry revealed reduced bone formation rate and mineral apposition rate in the cKO mice. TRAP staining showed a reduced osteoclast number. Micro‐CT demonstrated thinner and porous cortical bones in the cKO mice, in which osteocyte dendrites were disorganized as assessed by electron microscopy. Interestingly, the cKO mice exhibited spontaneous fractures in long bones, as found in NF1 patients. Mechanical testing of femora revealed significantly reduced maximum force and stiffness. Immunohistochemistry showed significantly increased FGF23 protein in the cKO bones. Moreover, primary osteocytes from cKO femora showed about eightfold increase in FGF23 mRNA levels compared with control cells. The upregulation of FGF23 was specifically and significantly inhibited by PI3K inhibitor Ly294002, indicating upregulation of FGF23 through PI3K in Nf1‐deficient osteocytes. Taken together, these results indicate that Nf1 deficiency in osteocytes dramatically increases FGF23 production and causes a mineralization defect (ie, hyperosteoidosis) via the alteration of calcium‐phosphorus metabolism. This study demonstrates critical roles of neurofibromin in osteocytes for osteoid mineralization. © 2017 American Society for Bone and Mineral Research.     

Intimate partner violence among ever-married Afghan women: patterns,associations and attitudinal acceptance

Archives of Women's Mental Health - Intimate partner violence (IPV) is one of the most prevalent forms of violence that women suffer globally. Women in Afghanistan have been exposed to high...     

Microanatomical Effects of Ethanolic Extract of Cola Nitida on the Stomach Mucosa of Adult Wistar Rats

The study investigated the microanatomical effects of the extracts of Cola nitida on the stomach mucosa of adult male Wistar rats. Twenty adult male wistar rats were randomly divided into four equal groups of A, B, C and D (n=5). Animals in experimental groups B, C and D were given 600mg/kg body weight of crude extract of Cola nitida each by oral intubation for five, seven and nine consecutive days respectively, while group A (control) received equivalent volume of distilled water. Twenty four hrs after the last administration, the animals were sacrificed; tissues were harvested and fixed in 10% formol saline for histological analysis. The study revealed necrotized surface epithelium, degenerated gastric mucosa, and loss of glandular elements in the stomachs of experimental groups'' vis-à-vis the control group. These observations were days-dependent; as those groups which received the extract for higher number of days were seen to be adversely affected. In conclusion, Cola nitida at 600mg/kg body weight can cause gastric lesion in animals. This lesion may be pronounced if the administration continued for days. Cola nitida should, therefore, be taken with caution to avoid gastric complications.     

Impact of missed appointments for out-patient physiotherapy on cost,efficiency, and patients' recovery

Missed appointments (MAs) constitute a challenge for clinicians and clinical administrators. This study assessed the rates of MAs and their impact on cost, efficiency, and patients' recovery. A 3-year retrospective audit was conducted in a Nigerian outpatient physiotherapy clinic. Data were gleaned on socio-demographic and clinical variables related to MAs. Efficiency was calculated as current asset divided by current liability; while total revenue loss due to MAs was calculated as a product of the total of MAs and per treatment cost. Of 930 appointments, 79.2% were MAs. MAs for first, second and third treatment schedules were 26.1%, 34.1% and 32.3%, respectively. The proportion of MAs was higher among females (80.3%), the elderly (>65 years) (90.6%), patients with neurological conditions (91.3%) and appointments in the month of December (94.3%). If the per treatment schedule cost is $10, a 79.2% MAs rate will result in $7370 revenue loss and 737 lost opportunities to treat patients. MAs lowered efficiency by 79.0%, with an efficiency ratio of 0.21. If MAs slow a patient's recovery process by 2 days, then 79.2% of MAs could potentially impact patient recovery time by 1474 days. MAs for outpatient physiotherapy are a momentous challenge and signify important losses in terms of cost, efficiency and recovery time for patients.     

Arachnoiditis presenting as a cerebello-pontine angle tumour.

Two cases are reported in which arachnoiditis presented as tumours of the cerebello-pontine angle. The possible aetiological factors are briefly discussed.     

Gold–silica quantum rattles for multimodal imaging and therapy

Gold quantum dots exhibit distinctive optical and magnetic behaviors compared with larger gold nanoparticles. However, their unfavorable interaction with living systems and lack of stability in aqueous solvents has so far prevented their adoption in biology and medicine. Here, a simple synthetic pathway integrates gold quantum dots within a mesoporous silica shell, alongside larger gold nanoparticles within the shell’s central cavity. This “quantum rattle” structure is stable in aqueous solutions, does not elicit cell toxicity, preserves the attractive near-infrared photonics and paramagnetism of gold quantum dots, and enhances the drug-carrier performance of the silica shell. In vivo, the quantum rattles reduced tumor burden in a single course of photothermal therapy while coupling three complementary imaging modalities: near-infrared fluorescence, photoacoustic, and magnetic resonance imaging. The incorporation of gold within the quantum rattles significantly enhanced the drug-carrier performance of the silica shell. This innovative material design based on the mutually beneficial interaction of gold and silica introduces the use of gold quantum dots for imaging and therapeutic applications.Although gold’s potential in nanotechnology has been recognized for many decades (1, 2), new insights into the unique properties of gold nanoparticles (NPs) of less than 2 nm have just recently started to emerge (3, 4). Such extremely small gold NPs could be transformative for a broad set of applications ranging from energy production and storage to catalysis and health care (3). As the size of gold NPs decreases below 2 nm, the quantization of their conduction band leads to molecule-like properties (3). These quantum-sized gold NPs (or gold quantum dots, AuQDs) absorb light in the near-infrared (NIR) biological window (650–900 nm) (2) and convert it into photons and heat (5). Furthermore, whereas bulk gold is diamagnetic, some AuQDs exhibit magnetic properties (4, 6). However, the clear therapeutic and imaging potential of AuQDs in vivo has been undermined by their unfavorable biointeractions and lack of stability in aqueous solvents (5, 7). In biological environments AuQDs tend to aggregate rapidly, reverting to larger gold nanoparticles (AuNPs) (8) and/or bind to protein, which negatively affects their cytotoxicity (7). To retain their advantages, AuQDs require a protective, stabilizing framework that allows proficient biological interactions.Recently, new emphasis has been placed on hybrid NP systems, where multiple nanomaterials are assembled to create multimodal systems that exhibit the combined qualities of the component modules (9–11). These constructs promise to integrate various functionalities by incorporating different nanomaterials into a single, efficient, multimodal system (12, 13). However, these systems usually accumulate the specific functionalities of their component modules through multiple steps in their synthetic processes, thereby adding complexity at the expense of performance (11). Furthermore, certain functionalities are intrinsically difficult to combine, directing research efforts toward optimizing tradeoffs. Here, we propose taking a more holistic approach, whereby a simple, multifunctional design, centered on exploiting the advantages of AuQDs, induces a number of complementary emergent qualities for in vivo imaging and therapy.We present a gold–silica rattle (quantum rattle, QR), consisting of a hollow mesoporous silica shell (HS) with two size domains of hydrophobic gold NPs: AuQDs (<2 nm) and larger AuNPs (>2 nm). The HS can host bioactive molecules and stabilizes the AuQDs, allowing them to retain their photonic and magnetic properties in aqueous media. The AuQDs are paramagnetic and absorb and emit light in the NIR biological window, enabling photothermal therapy (PTT) as well as multimodal live imaging (NIR fluorescence, magnetic, and photoacoustic imaging). The large hydrophobic gold surface area presented by the QRs seems to enhance the drug-carrying performance of the system by increasing the loading content and loading efficiency and prolonging the release of a drug payload. Here, we present direct evidence of the unique in vitro and in vivo therapeutic and imaging efficacy of this innovative hybrid system.     

'It takes three to tango': a framework for understanding patient partnership in paediatric clinics

Since the late 1990s, the term 'partnership' has increasingly been inserted into the literature and rhetoric of the UK health-care system. In this paper, the assumptions and implications surrounding the usage of the term in relation to doctor-patient interaction are examined in the context of paediatric services. The paper considers recent ideas about partnership in medical encounters, especially those of Charles et al., and the extent to which they are applicable to children. The paper then goes on to develop a framework for understanding patient-partnership issues. It is argued that any investigation of partnership will need to take account of the organisational and legal setting, as well as the beliefs and agendas that all parties bring to the medical encounter. In the context of paediatrics, the perspectives of three actors--the child, parent and health service professional--need to be explored. Our framework allows for different sorts of 'coalition' to develop between these actors as they try to reconcile their perspectives in the clinic and offers a situationally contextualised view of partnership. We also argue that these matters require study outside as well as inside the clinic, through the use of a range of methods, including those that help children at home review their involvement in decision making in the clinic.