Current status of peptic ulcer disease in Port Harcourt metropolis,Nigeria

BackgroundEpidemiological studies on peptic ulcer disease (PUD) have shown a recent decrease in hospital admissions in Western countries.ObjectiveThis paper aimed to study the current status and risk factors of PUD in a Nigerian metropolis.MethodsA cross-sectional study of symptomatic patients at upper gastrointestinal (GI) endoscopy diagnosed with PUD from February 2014 to September 2019 at a referral endoscopy facility in Port Harcourt, Niger delta region of Nigeria. The variables studied included demographics, symptoms and duration, blood group, chronic non-steroidal anti-inflammatory (NSAID) use, smoking, endoscopic and histology findings. Statistical analysis was performed using SPSS version 20.ResultsA total of 434 upper GI endoscopies were performed during the study period with thirty-one diagnosis of PUD made. The mean age of gastric ulcer (GU) and duodenal ulcer (DU) cases were 54.4 ± 20.2yrs and 48.1 ± 14.5yrs respectively (p = 0.367). GU to DU ratio was 1.4:1. H. pylori infection, chronic NSAID use and blood group O were seen in 7(22.5%), 8(25.8%) and 18(72.0%) respectively. Major indication in 21(67.7%) cases was gastrointestinal bleeding.ConclusionThere is a low diagnostic rate of PUD (6.7%) with pre-pyloric antral gastric ulcers as most common type and multifactorial aetiology.     

A right hemisphere dominance for bimanual grasps

To find points on the surface of an object that ensure a stable grasp, it would be most effective to employ one area in one cortical hemisphere. But grasping the object with both hands requires control through both hemispheres. To better understand the control mechanisms underlying this “bimanual grasping”, here we examined how the two hemispheres coordinate their control processes for bimanual grasping depending on visual field. We asked if bimanual grasping involves both visual fields equally or one more than the other. To test this, participants fixated either to the left or right of an object and then grasped or pushed it off a pedestal. We found that when participants grasped the object in the right visual field, maximum grip aperture (MGA) was larger and more variable, and participants were slower to react and to show MGA compared to when they grasped the object in the left visual field. In contrast, when participants pushed the object we observed no comparable visual field effects. These results suggest that grasping with both hands, specifically the computation of grasp points on the object, predominantly involves the right hemisphere. Our study provides new insights into the interactions of the two hemispheres for grasping.     

Citrin deficiency,a perplexing global disorder

Citrin deficiency, caused by mutations in SLC25A13, can present with neonatal intrahepatic cholestasis or with adult onset neuropsychiatric, hepatic and pancreatic disease. Until recently, it had been thought to be found mostly in individuals of East Asian ancestry. A key diagnostic feature has been the deficient argininosuccinate synthetase (ASS) activity (E.C. 6.3.4.5) in liver, with normal activity in skin fibroblasts. In this series we describe the clinical presentation of 10 patients referred to our laboratories for sequence analysis of the SCL25A13 gene, including several patients who presented with elevated citrulline on newborn screening. In addition to sequence analysis performed on all patients, ASS enzyme activity, citrulline incorporation and Western blot analysis for ASS and citrin were performed on skin fibroblasts if available. We have found 5 unreported mutations including two apparent founder mutations in three unrelated French-Canadian patients. In marked contrast to previous cases, these patients have a markedly reduced ASS activity in skin fibroblasts. The presence of citrin protein on Western blot in three of our cases reduces the sensitivity of a screening test based on protein immunoblotting. The finding of citrin mutations in patients of Arabic, Pakistani, French Canadian and Northern European origins supports the concept that citrin deficiency is a panethnic disease.     

Human microglia and astrocytes constitutively express the neurokinin-1 receptor and functionally respond to substance P

Background

The tachykinin substance P (SP) is recognized to exacerbate inflammation at peripheral sites via its target receptor, neurokinin 1 receptor (NK-1R), expressed by leukocytes. More recently, SP/NK-1R interactions have been associated with severe neuroinflammation and neuronal damage. We have previously demonstrated that NK-1R antagonists can limit neuroinflammatory damage in a mouse model of bacterial meningitis. Furthermore, we have since shown that these agents can attenuate bacteria-induced neuronal and glial inflammatory mediator production in nonhuman primate (NHP) brain explants and isolated neuronal cells, and following in vivo infection.

Methods

In the present study, we have assessed the ability of NHP brain explants, primary human microglia and astrocytes, and immortalized human glial cell lines to express NK-1R isoforms. We have utilized RT-PCR, immunoblot analysis, immunofluorescent microscopy, and/or flow cytometric analysis, to quantify NK-1R expression in each, at rest, or following bacterial challenge. Furthermore, we have assessed the ability of human microglia to respond to SP by immunoblot analysis of NF-kB nuclear translocation and determined the ability of this neuropeptide to augment inflammatory cytokine release and neurotoxic mediator production by human astrocytes using an ELISA and a neuronal cell toxicity assay, respectively.

Results

We demonstrate that human microglial and astrocytic cells as well as NHP brain tissue constitutively express robust levels of the full-length NK-1R isoform. In addition, we demonstrate that the expression of NK-1R by human astrocytes can be further elevated following exposure to disparate bacterial pathogens or their components. Importantly, we have demonstrated that NK-1R is functional in both human microglia and astrocytes and show that SP can augment the inflammatory and/or neurotoxic immune responses of glial cells to disparate and clinically relevant bacterial pathogens.

Conclusions

The robust constitutive and functional expression of the full-length NK-1R isoform by human microglia and astrocytes, and the ability of SP to augment inflammatory signaling pathways and mediator production by these cells, support the contention that SP/NK-1R interactions play a significant role in the damaging neuroinflammation associated with conditions such as bacterial meningitis.

     

Iron as the malignant spirit in successful ageing

Iron enhances the production of the highly reactive and toxic hydroxyl radical, thus stimulating oxidative damage. Iron has been associated with a number of oxidative injury-dependent, age-related conditions and diseases. Indeed, oxidative injury is a major factor of (accelerated) ageing. This commentary reviews part of the existing literature on iron's deleterious effects, particularly in the context of ischemia-reperfusion injury and cardiovascular, brain and muscle diseases as well as skin ageing. Furthermore, the advantages of iron chelation are presented. Indeed, iron chelation or deprivation has been shown to act as a potent anti-oxidant in a variety of animal models of human diseases, preventing oxidative stress to tissues and organs. Iron chelators favor successful ageing in general, and when applied topically, successful skin ageing. It has also been proposed that gender-related differences in iron status are responsible for the increased longevity of women as compared to men. Despite this evidence, the role of iron in ageing and the possibilities of pharmacologically targeting iron have remained essentially unexplored. Iron thus appears as the "malignant spirit" in successful ageing.     

Intracerebroventricular injection of the terminal complement complex causes inflammatory reaction in the rat brain

To investigate the effect of the terminal complement complex (TCC) on the central nervous system, we injected both the cytolytically active and the inactive complexes into the lateral ventricle of rats. Both complexes promoted accumulation of leukocytes into the cerebrospinal fluid at 4-6 h post-injection. The cells recovered at this time were mostly polymorphonuclear leukocytes (PMN) that were partially replaced by mononuclear cells at 12 h. A direct contribution of the complexes to the in-vivo migration of leukocytes was ruled out by their inability to be chemotactic for rat PMN. Contaminating C5a is unlikely to be responsible for the effect of TCC because it failed to mobilize leukocytes when injected into the lateral ventricle. Histological analysis of rat brains 6 hours after injection of TCC revealed marked leukocyte infiltration of the choroid plexus, increased expression of intercellular adhesion molecule-1 and egression of leukocytes out of the meningeal vessels. The cerebrospinal fluid of rats treated with TCC exhibited chemotactic activity for rat PMN and increased levels of growth related oncogene/cytokine-induced neutrophil chemoattractant-1 and monocyte chemoattractant protein-1 preceding the accumulation of leukocytes. Elevated concentration of IL-1 beta was also found in the cerebrospinal fluid and in periventricular areas of rats treated with TCC.     

Age-related differences in neural activities during risk taking as revealed by functional MRI

Previous research has clearly documented that risky decisionmaking is different in young and older adults. Yet, there hasbeen a relative dearth of research that seeks to understandsuch age-related changes in the neural activities associatedwith risk taking. To address this research issue, 21 men (12young men, mean age 29.9 ± 6.2 years and 9 older men,mean age 65.2 ± 4.2 years) performed a risky-gains taskwhile their brain activities were monitored by an fMRI scanner.The older adults, relative to their younger peers, presentedwith contralateral prefrontal activity, particularly at theorbitofrontal cortex. Furthermore, stronger activation of theright insula was observed for the older-aged participants comparedto the younger-aged adults. The findings of this study are consistentwith the a priori speculations established in accordance withthe HAROLD model as well as previous findings. Findings of thisstudy suggest that when making risky decisions, there may bepossible neuropsychological mechanisms underlying the changein impulsive and risk-taking behaviors during the course ofnatural ageing.     

MRI of the prostate: clinical relevance and emerging applications

MRI of the prostate can aid in many aspects of prostate cancer management, from initial detection to treatment planning and follow-up. This review describes the current strengths and limitations of conventional anatomic and molecular MR imaging techniques (including MR spectroscopic imaging and dynamic contrast-enhanced imaging) for aiding prostate cancer management. It also describes promising emerging approaches for acquiring, analyzing, and applying MR imaging data, and the major research and educational efforts that will be required to realize the potential of prostate MR imaging in routine clinical practice.     

Solid splenic masses: evaluation with 18F-FDG PET/CT.

Our objective was to assess the role of (18)F-FDG PET/CT in the evaluation of solid splenic masses in patients with a known malignancy and in incidentally found lesions in patients without known malignancy. METHODS: Two groups of patients were assessed: (a) 68 patients with known malignancy and a focal lesion on PET or a solid mass on CT portions of the PET/CT study; and (b) 20 patients with solid splenic masses on conventional imaging without known malignancy. The standard of reference was histology (n = 16) or imaging and clinical follow-up (n = 72). The lesion size, the presence of a single versus multiple splenic lesions, and the intensity of (18)F-FDG uptake expressed as a standardized uptake value (SUV) were recorded. The ratio of the SUV in the splenic lesion to the background normal splenic uptake was also calculated. These parameters were compared between benign and malignant lesions within each of the 2 groups of patients and between the 2 groups. RESULTS: The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of (18)F-FDG PET/CT in differentiating benign from malignant solid splenic lesions in patients with and without malignant disease were 100%, 100%, 100%, and 100% versus 100%, 83%, 80%, and 100%, respectively. In patients with known malignant disease, an SUV threshold of 2.3 correctly differentiated benign from malignant lesions with the sensitivity, specificity, PPV, and NPV of 100%, 100%, 100%, and 100%, respectively. In patients without known malignant disease, false-positive results were due to granulomatous diseases (n = 2). CONCLUSION: (18)F-FDG PET can reliably discriminate between benign and malignant solid splenic masses in patients with known (18)F-FDG-avid malignancy. It also appears to have a high NPV in patients with solid splenic masses, without known malignant disease. (18)F-FDG-avid splenic masses in patients without a known malignancy should be further evaluated as, in our series, 80% of them were malignant.     

Custom designed radial forearm free flap for reconstruction of nasomaxillary defects: Report of two cases

Nasal amputation and nasomaxillary defects, need to reconstruct the internal lining, osteochondral structure, and external coating of the nose. Authors report a 70-year-old male and a 65-year-old female treated for nasomaxillary defects (Brown JS, Shaw RJ. The Lancet Oncology 2010;11:1001–1008) due to squamous cell carcinoma (SCC) where the tip of the nose was preserved. A new custom design of the radial forearm free flap (RFFF) consisting on a subcutaneous tissue (SCT) component, a skin paddle for the internal nasal vault lining, and a skin paddle for the external nasal skin coating was raised to treat both total thickness nasal defects. The dimension of each skin paddle corresponds to the defect measurements. The skin incisions of the custom design correspond to those of a conventional RFFF. The SCT component was harvested in a subcutaneous plane continuously with the skin island for the internal nasal lining which is drawn on the ulnar skin of the forearm. The component for the external nasal coating was drawn on the radial skin area of the flap. No postoperative complications and a satisfactory outcome was reported after 1 year of follow-up. This new custom design of the RFFF is described for reconstruction of nasomaxillary defects when the tip of the nose is preserved.