Evaluation of extracts of the root of Landolphia owerrience for antibacterial activity.

Ethanolic and aqueous (cold and hot) extracts of Landolphia owerrience root parts (whole-root, root-bark and root-wood) were tested for activity against ten bacterial strains using agar-well diffusion and macro-broth dilution methods, respectively. The ethanolic extracts of the whole-root and root-wood were active against 100 and 80% of the test organisms, respectively. Ethanolic and aqueous extracts of the root-bark were moderately active while the aqueous (cold and hot) extracts of the root-wood exhibited little or no activity. Out of the nine extracts prepared, 66.7% were active against Staphylococcus aureus ATCC 12600, 55.6% variously against each of Pseudomonas aeruginosa ATCC 10145 and local clinical isolates of P. aeruginosa, S. aureus, Escherichia coli and Salmonella typhi, 44.4% against Proteus sp., 33.3% against Bacillus subtilis ATCC 6051 and 22.2% against E. coli ATCC 11775. The agar-well-determined MIC values for the ethanolic whole-root extract (0.78-50 mg/ml) were higher (indicating lower activity) than the corresponding macro-broth-determined values (0.39-50 mg/ml) probably because of slow diffusion rates of the active constituents of the extract in agar. On the other hand, the differences could be due to the effects of DMSO used to dissolve the ethanolic extracts in the agar-well diffusion tests. Similar discrepancies in the MIC values detectable with the two test methods were apparent in the root-wood extract and the control drug, Gentamycin, except that in the latter the agar-well-determined MIC values (0.125-8.0 microg/ml) were lower than the macro-broth-determined values (0.125-64 microg/ml). The strong activity of the ethanolic extracts against known etiologic agents of diseases traditionally treated with L. owerrience root of similar preparations provides scientific justification for the use of the herb in ethnomedical practice in Nigeria.     

Diagnosis and treatment of bbstetrics disseminated intravascular coagulation in resource limited settings

BackgroundDisseminated intravascular coagulation (DIC) is one of the commonest causes of abnormal bleeding during pregnancy and puerperium. Its successful management is a challenging feat in resource limited settings (RLS).AimTo determine Obstetricians'' approach in diagnosing and treating obstetrics DIC in a RLSMethodA semi-structured pre-tested 4-sectioned questionnaire was used to collect demographic data of Nigerian obstetricians and data on their practice in the diagnosis and treatment of obstetrics DIC.ResultsA total of 171 obstetricians responded. Preeclampsia was the most frequent cause identified (70.2%) followed by postpartum haemorrahge (58.3%). Platelet count determination was the test mostly used (95.9%) to make a diagnosis of DIC whereas, antithrombin assay was the least (20.6%) requested investigation. While about two-third would monitor the evolution of DIC, a little less than half of the obstetricians would not repeat laboratory testing more than every 2 days, reason mainly (61.8%) due to patient''s financial constraint. Almost three-quarter of them preferred fresh whole blood as the first line of treatment of DIC.ConclusionDIC remains a challenge in the obstetrics practice in RLS especially in investigations, monitoring and index of suspicion for non-overt DIC.     

Forensic Investigation of mass disasters in Nigeria: A review

This paper is to establish the present state of things in the country in terms of legal framework and the availability of personnel with a view to presenting an overview of proper mass disaster investigations. This is a retrospective review of mass disasters in Nigeria that occurred within the last 20 years. The study therefore reviews the state of the forensic investigation of the mass disasters as well as the efforts made to identify the victims of the disaster. The process of proper forensic investigation from the stage of evaluation of the scene and recovery process to the final identification of victims are presented to serve as a protocol for the country. The assessment of the present state of preparedness in Nigeria is also examined with a view to improving the practice to international standards. Data were retrieved from official documents from the aviation industry as well as Nigeria news reports. The standard protocols for disaster victim identification were retrieved from the guide released by the INTERPOL. The state of preparedness of the country and recommendations for improvement are presented. The Federal government and the states of the federation should without further delay put in place the process of reviewing the law of Coroner''s system and provide the enabling environment for the proper forensic investigation. The training curriculum of the first responders should incorporate mass disaster investigations in order to produce efficient officers and personnel. A functional disaster victim identification (DVI) team is strongly advocated to incorporate different professionals involved in mass disaster management.     

How much primary tumor metabolic volume reduction is required to improve outcome in stage III NSCLC after chemoradiotherapy? A single-centre experience

Purpose

We analysed a correlation between pre- to post-treatment primary tumour metabolic volume (PT-MV) reduction on 18F-FDG-PET/CT and survival in non-small cell lung cancer (NSCLC) patients treated with chemoradiotherapy (CRT).

Methods

Sixty consecutive patients with NSCLC stage IIIA-B (UICC 7th edition), treated with chemoradiotherapy, who underwent 18F-FDG-PET/CT at the same institution before and 6 weeks after treatment, were analysed. Different metabolic response values were investigated on their correlation with survival parameters: complete response (100% PT-MV reduction); major response (80–99% PT-MV reduction); moderate response (50–79% PT-MV reduction); minor response (1–49% PT-MV reduction) and non-response (no change or increase in uptake).

Results

From 60 patients, 52 (87%) had repeat PET/CT scans 6 weeks after completion of CRT. Complete metabolic response (CR) was reached in ten (17%), whereas major and moderate metabolic responses occurred in 16 (27%) and 15 (25%) patients, respectively. Four patients (7%) had minor metabolic response. Non-response was documented in seven patients (12%). Median overall survival (MS) for the entire cohort was 17 months (95% CI: 11.9–22.1 months). MS according to the different metabolic response values was as follows: 34 months (95% CI: 0–84.1); 22 months (95% CI: 14.2–29.8); 12 months (95% CI: 0.4–23.6); 11 months (95% CI: 0.2–21.8) and 17 months in patients with complete, major, moderate, minor and non-response (95% CI: 6.7–27.3), respectively (p?=?0.008).On multivariate analysis, significant predictors of survival included ECOG performance status (p?=?0.035, HR 0.49, 95% CI: 0.25–0.95) as well as complete and major metabolic response as a continuous variable with PT-MV reduction of at least 80% (p?=?0.021, HR 0.36, 95% CI: 0.15–0.86). Moderate metabolic response did not correlate with improved outcome (p?=?0.522).

Conclusions

In this homogeneous locally-advanced NSCLC single-centre patient cohort, a PT-MV reduction of at least 80% (complete and major metabolic response) following CRT was necessary to significantly improve patient outcome.

     

Analysis of primary tumor metabolic volume during chemoradiotherapy in locally advanced non-small cell lung cancer

Purpose

Positron emission tomography with 2?deoxy-2-[fluorine-18] fluoro-d-glucose integrated with computed tomography (18F-FDG-PET/CT) has an established role in the initial diagnosis and staging of lung cancer. However, a prognostic value of PET/CT during multimodality treatment has not yet been fully clarified. This study evaluated the role of primary tumor metabolic volume (PT-MV) changes on PET/CT before, during, and after chemoradiotherapy (CRT).

Methods

A total of 65 patients with non-small-cell lung cancer (NSCLC) UICC stage IIIA/B (TNM 7th Edition) were treated with definitive chemoradiotherapy (sequential or concurrent setting). PET/CT was acquired before the start, at the end of the third week, and 6 weeks following CRT.

Results

Median overall survival (OS) for the entire cohort was 16 months (95% confidence interval [CI]: 12–20). In all, 60 (92.3%) patients were eligible for pre-treatment (pre-PT-MV), 28 (43%) for mid-treatment (mid-PT-MV), and 53 (81.5%) for post-treatment (post-PT-MV) volume analysis. Patients with pre-PT-MV >63?cm³ had worse OS (p < 0.0001). A reduction from mid-PT-MV to post-PT-MV of >15% improved OS (p = 0.001). In addition, patients with post-PT-MV > 25?cm³ had significantly worse outcome (p = 0.001). On multivariate analysis, performance status (p = 0.002, hazard ratio [HR] 0.007; 95% CI 0.00–0.158), pre-PT-MV1 < 63?cm³ (p = 0.027, HR 3.98; 95% CI 1.17–13.49), post-PT-MV < 25?cm³ (p = 0.013, HR 11.90; 95% CI 1.70–83.27), and a reduction from mid-PT-MV to post-PT-MV > 15% (p = 0.004, HR 0.25; 95% CI 0.02–0.31) correlated with improved OS.

Conclusions

Our results demonstrated that pre- and post-treatment PT-MV, as well as an at least 15% reduction in mid- to post-PT-MV, significantly correlates with OS in patients with inoperable locally advanced NSCLC.

     

Correlates of neutrophil/lymphocyte,platelet/lymphocyte,and platelet/neutrophil ratios of neonates of women with hypertensive disease of pregnancy with neonatal birth outcomes

Background: Studies have indicated neutrophil/lymphocyte ratio (NLR), Platelet/Lymphocyte ratio (PLR), and platelet/neutrophils ratio (PNR) to be inflammatory markers. The correlation of these values in infants of hypertensive mothers has not been investigated.

Aim: To investigate the relationship between NLR, PLR, and PNR of neonates of women with hypertensive disease of pregnancy and neonatal APGAR scores and birth weight.

Methodology: Cord blood samples of 200 neonates collected and the blood counts and ratios obtained.

Results: NLR in the babies of the hypertensive mothers was 0.865 and 1.42 in the control group (p = 0.0001). PLR was 34.7 in the neonates of the hypertensive mothers and 62.4 in the control group (p = 0.0001). PNR did not differ significantly between the two groups,p = 0.418. Degree of hypertension had a direct relationship with NLR; SBP had a p value of 0.001 while the DBP had p = 0.002. The PLR had an inverse relationship with the degree of hypertension; SBP p value of 0.0001, while DBP was p = 0.0001. No significant association was observed between the ratios and neonatal birth weight (p ≥ 0.05); however, PNR and PLR were found to be significantly associated with the 1st (p = 0.045 and 0.030) and 5th (0.049 and 0.037) minute APGAR scores in the newborns.

Conclusion: PLR and NLR in neonates of hypertensive mothers are found to be markedly lower than those of controls, the degree of which is affected by the severity of hypertension. Also, lower PLR is associated with lower APGAR scores. Therefore, severity of high blood pressure and lower PLR may be determinants of poor birth outcome.     

Validity of common ultrasound methods of fetal weight estimation in late pregnancy among women in Kwale,Niger Delta region,Nigeria

BackgroundAccuracy of some ultrasound equations used in our locality for fetal weight estimation is doubtful.ObjectiveTo assess the accuracy of common ultrasound equations used for fetal weight estimation.ResultsThe highest intraclass correlation coefficient was generated by the Hadlock 5 and Hsieh 2 equations. The least mean absolute percent error was obtained with Hsieh 2 equation, followed by Woo 3, and Hadlock 5. These equations also had the least percentage error and the least range of limits of agreement in the same order with no significant difference between their mean fetal weight estimates and that of the actual birth weight (p > 0.05). All twelve equations had strong positive correlation with the actual birth weight with Nzeh 2 equation the least.ConclusionHsieh 2 equation has the best accuracy in fetal weight estimation studied.