Anti-Interleukin-6 Therapy Decreases Hip Synovitis and Bone Resorption and Increases Bone Formation Following Ischemic Osteonecrosis of the Femoral Head

Legg-Calvé-Perthes disease (LCPD) is a juvenile form of ischemic femoral head osteonecrosis, which produces chronic hip synovitis, permanent femoral head deformity, and premature osteoarthritis. Currently, there is no medical therapy for LCPD. Interleukin-6 (IL-6) is significantly elevated in the synovial fluid of patients with LCPD. We hypothesize that IL-6 elevation promotes chronic hip synovitis and impairs bone healing after ischemic osteonecrosis. We set out to test if anti-IL-6 therapy using tocilizumab can decrease hip synovitis and improve bone healing in the piglet model of LCPD. Fourteen piglets were surgically induced with ischemic osteonecrosis and assigned to two groups: the no treatment group (n = 7) and the tocilizumab group (15 to 20 mg/kg, biweekly intravenous injection, n = 7). All animals were euthanized 8 weeks after the induction of osteonecrosis. Hip synovium and femoral heads were assessed for hip synovitis and bone healing using histology, micro-CT, and histomorphometry. The mean hip synovitis score and the number of synovial macrophages and vessels were significantly lower in the tocilizumab group compared with the no treatment group (p < .0001, p = .01, and p < .01, respectively). Micro-CT analysis of the femoral heads showed a significantly higher bone volume in the tocilizumab group compared with the no treatment group (p = .02). The histologic assessment revealed a significantly lower number of osteoclasts per bone surface (p < .001) in the tocilizumab group compared with the no treatment group. Moreover, fluorochrome labeling showed a significantly higher percent of mineralizing bone surface (p < .01), bone formation rate per bone surface (p < .01), and mineral apposition rate (p = .04) in the tocilizumab group. Taken together, tocilizumab therapy decreased hip synovitis and osteoclastic bone resorption and increased new bone formation after ischemic osteonecrosis. This study provides preclinical evidence that tocilizumab decreases synovitis and improves bone healing in a large animal model of LCPD. © 2020 American Society for Bone and Mineral Research (ASBMR).     

Outbreak of cholera in Ibadan, Nigeria

The changing epidemiology of cholera in Ibadan, Nigeria, has become a public health challenge, and outbreaks of the disease have been occurring with increasing frequency since the first outbreak in modern times in 1970. In this outbreak, 1384 persons were seen, diagnosed and treated for the disease at the cholera unit, Ibadan from January to December 1996. The outbreak lasted for a whole year. No child under one year was seen. The age adjusted case fatality rate was 5.3%. Diarrhoea and vomiting were the most common combination of symptoms present in 97.3% of all cases, followed by diarrhoea, vomiting and dehydration (84.3%). The median number of days spent on admission was only 2 days. Cholera cases were clustered within the densely populated and poorly planned areas of the city. Though significantly more cases were seen during the rainy season than during the dry season (p < 0.01), the deaths were not seasonally related (p = 0.67). Contamination of otherwise potable sources of water, late presentation to the cholera treatment unit and low levels of knowledge about diseases need to be addressed in order to effectively control this disease in the community. Progress should also be made towards developing a suitable vaccine for the control of this internationally important public health disease so that the responsibility of its control is not left entirely to individuals and communities, particularly in developing countries.     

Impact of the malaria parasite on reproductive indices of male mice

Aim:  To investigate the impact and possible mechanism of action of the rodent malarial parasite on reproduction.
Methods:  Male albino mice were infected with 15, 30 and 45% Plasmodium berghei berghei through inoculation with 10⁷ parasitized red blood cells. Each experiment had its own control that was not infected with P. berghei berghei . Mice infected with 15% P. berghei berghei were killed on days 0, 5, 10 and 15; those infected with 30% P. berghei berghei were killed on days 0, 3, 6 and 10; and those infected with 45% P. berghei berghei were killed on days 1–7 after infection. Caudal epididymal sperm motility, counts and morphology, body and wet organ weights and hematological indices were determined.
Results:  The results showed a progressive duration dependent decrease in sperm motility, sperm count and viability ( P  < 0.01) in parasitized mice. There were significant decreases in serum testosterone and increases in cortisol levels ( P  < 0.05) in the infected mice compared with the controls. There was also a progressive decrease ( P  < 0.05) in red blood cell count and packed cell volume. However, there was a progressive increase ( P  < 0.01) in white blood cell count and weight of the spleen and liver. There was no significant change in weight of the testis and epididymides.
Conclusion:  The results suggest that the malaria parasite could depress male fertility indices. (Reprod Med Biol 2006; 5 : 201–209)     

Legg‐Calvé‐Perthes Disease Produces Chronic Hip Synovitis and Elevation of Interleukin‐6 in the Synovial Fluid

Legg‐Calvé‐Perthes disease (LCPD) is a childhood hip disorder of ischemic osteonecrosis of the femoral head. Hip joint synovitis is a common feature of LCPD, but the nature and pathophysiology of the synovitis remain unknown. The purpose of this study was to determine the chronicity of the synovitis and the inflammatory cytokines present in the synovial fluid at an active stage of LCPD. Serial MRI was performed on 28 patients. T2‐weighted and gadolinium‐enhanced MR images were used to assess synovial effusion and synovial enhancement (hyperemia) over time. A multiple‐cytokine assay was used to determine the levels of 27 inflammatory cytokines and related factors present in the synovial fluid from 13 patients. MRI analysis showed fold increases of 5.0 ± 3.3 and 3.1 ± 2.1 in the synovial fluid volume in the affected hip compared to the unaffected hip at the initial and the last follow‐up MRI, respectively. The mean duration between the initial and the last MRI was 17.7 ± 8.3 months. The volume of enhanced synovium on the contrast MRI was increased 16.5 ± 8.5 fold and 6.3 ± 5.6 fold in the affected hip compared to the unaffected hip at the initial MRI and the last follow‐up MRI, respectively. In the synovial fluid of the affected hips, IL‐6 protein levels were significantly increased (LCPD: 509 ± 519 pg/mL, non‐LCPD: 19 ± 22 pg/mL; p = 0.0005) on the multi‐cytokine assay. Interestingly, IL‐1β and TNF‐α levels were not elevated. In the active stage of LCPD, chronic hip synovitis and significant elevation of IL‐6 are produced in the synovial fluid. Further studies are warranted to investigate the role of IL‐6 on the pathophysiology of synovitis in LCPD and how it affects bone healing. © 2015 American Society for Bone and Mineral Research     

Voluntary health workers' knowledge, attitude and practices regarding record keeping in Akinyele LGA of Oyo State, Nigeria

Lack of basic health data for monitoring and evaluation of health services continue to affect the planning, implementation and evaluation of health services in Nigeria. This has contributed to the poor health status and inefficient health services in the country. In the primary health care management information system (PHCMIS), Voluntary Village Health Workers (VHWs) and Traditional Birth Attendants (TBAs) are responsible for collecting information at the community/village level. Trained research assistants administered a pretested semi structured questionnaire and filled an observation checklist to all the voluntary health workers in Akinyele LGA of Oyo State in a cross-sectional survey conducted to assess their record keeping practices as well as their knowledge of and attitude towards it. Results showed that almost half of the respondents had no formal education and a similar proportion had been VHWs for between over 10 years. Over eighty per cent knew the uses of record keeping for monitoring and evaluation purposes. Their attitude towards it was positive and almost all felt it was easy to keep records. Ninety six percent keep records of their health activities and most forward them. It was observed that only 11 (10.8%) respondents had the VHW/TBA record of work produced and recommended by the Federal Ministry of Health because they were reportedly not supplied to them. The factors that were associated with record keeping practices were positive attitude towards record keeping, duration of work as a VHW/TBA, prior training on record keeping and receiving feedback on records kept. Recommendations made included periodic training and retraining of the VHWs on record keeping, ensuring consistent supply of record forms and providing regular feedback on records kept to the VHWs.     

The effect of training on the reporting of notifiable diseases among health workers in Yobe State, Nigeria

The generation of data through disease surveillance and notification system is critical to appropriate planning and implementation of disease control programmes, outbreak investigation, emergency preparedness and response. Health workers therefore need to be trained, retrained and updated on the principles and practice of disease surveillance and notification. This quasi-experimental study compared a study and control group "before and after" an intervention (training programme) in the study group. The Experimental and control LGA's were selected using a multistage, stratified random sampling technique. Overall, three LGA's were selected and enrolled in each of the groups. In each of the selected LGA's, all functional health facilities and personnel that fulfilled the inclusion criteria were then included in the study. The total number of participants in the experimental and control groups were 73 and 71 respectively at baseline. The proportion of personnel who were aware of the surveillance system increased from 35.6% to 91.9% (p=0.00) and the mean knowledge score increased from 0.85+/-1.38SD to 6.152.64SD (p=0.00) post intervention in the experimental group. The percentage completeness was 2.3% before and 52.0% after (p-0.00), while the percentage timeliness was 0.0% before and 42.9% after (p=0.00) in the experimental group. These statistically significant differences were however not demonstrated in the control group. Training therefore had a positive effect on health personnel knowledge, reporting requirement and the timeliness and completeness of the disease surveillance and notification system.     

Contact dermatitis in Nigeria

Nickel is the most important sensitizer in Lagos, with an incidence of 12.3% of 453 patients tested. There was no sex difference, as the wearing of necklaces and bracelets was equally fashionable among both sexes. Housewife eczema is not common, probably because of hardening. Dermatitis from additives in the processing of leather and rubber footwear was the next most common. Chromate sensitivity comes usually from leather or cement. Cultural and climatic factors are mainly responsible for differences in the incidence of contact dermatitis found in Lagos from other countries.