Recent advances in the diagnostic evaluation of pancreatic cystic lesions

Pancreatic cystic lesions (PCLs) are becoming more prevalent due to more frequent abdominal imaging and the increasing age of the general population. It has become crucial to identify these PCLs and subsequently risk stratify them to guide management. Given the high morbidity associated with pancreatic surgery, only those PCLs at high risk for malignancy should undergo such treatment. However, current diagnostic testing is suboptimal at accurately diagnosing and risk stratifying PCLs. Therefore, research has focused on developing new techniques for differentiating mucinous from non-mucinous PCLs and identifying high risk lesions for malignancy. Cross sectional imaging radiomics can potentially improve the predictive accuracy of primary risk stratification of PCLs at the time of detection to guide invasive testing. While cyst fluid glucose has reemerged as a potential biomarker, cyst fluid molecular markers have improved accuracy for identifying specific types of PCLs. Endoscopic ultrasound guided approaches such as confocal laser endomicroscopy and through the needle microforceps biopsy have shown a good correlation with histopathological findings and are evolving techniques for identifying and risk stratifying PCLs. While most of these recent diagnostics are only practiced at selective tertiary care centers, they hold a promise that management of PCLs will only get better in the future.     

Variations in the prevalence of point (pre)hypertension in a Nigerian school-going adolescent population living in a semi-urban and an urban area

Background  

Hypertension has been shown to start in early life and to track into adulthood. Detecting adolescents with hypertension and prehypertension will aid early intervention and reduce morbidity and mortality from the disorders. This study reports the point-prevalence of the two disorders in a semi-urban and an urban population of school-going adolescents in Nigeria.     

Correlation between maternal weight and insulin resistance in second half of pregnancy

Background:

In pregnancy, routine measurement of maternal weight gives a crude assessment of maternal and foetal well-being. Excess weight gain in pregnancy is related to increased risk for gestational diabetes mellitus (GDM), hypertension in pregnancy and foetal macrosomia. In the Nigerian context, lack of knowledge of pre-pregnancy weight coupled with late booking of women in pregnancy hinders accurate assessment of weight gain in pregnancy. The absolute maternal weight is often used as surrogate. This study evaluates the relationship between absolute weight in the second half of pregnancy and insulin resistance.

Patients and Methods:

The weight of hundred pregnant women was measured between 24 to 32 weeks of pregnancy and their insulin resistance was measured using Homeostatic Model Assessment (HOMA-IR) from fasting serum glucose and fasting serum insulin.

Results:

Twenty-six women had weight ≥95 kg and 74 women had weight of <95 kg. There was a significant positive correlation between weight and HOMA-IR (r = 0.248), fasting glucose (r = 0.198), and fasting insulin (r = 0.228), (P < 0.05). The mean weight, HOMA-IR, fasting glucose and fasting insulin were higher in women with weight ≥95 kg compared to those with less weight. Also maternal weight ≥ 95 kg was associated with severe insulin resistance, (Odds Ratio = 3.1).

Conclusion:

Absolute weight in pregnancy correlates well with insulin resistance. Women having weight ≥95 kg between 24-32 weeks of gestation were more likely to have severe insulin resistance with implications for increased risk of GDM and other complications.     

Improving work-life balance among administrative officers in Catholic primary schools: Assessing the effect of a Christian religious rational emotive behavior therapy

Objective:Work-life balance (WLB) is an essential precursor of workers’ mental health. The theory of rational emotive behaviour therapy proposes that an imbalance in work and family life may result from people''s dysfunctional perceptions of their work and other aspects of their personal life. Also, the constructive philosophies of rational emotive behavior therapy are said to be congruent with most religious belief systems of Christian clients. Therefore, our research examined the efficacy of Christian religious rational emotive behaviour therapy (CRREBT) on WLB among administrative officers in Catholic primary schools.Methods:This is a group randomized trial involving 162 administrative officers from Catholic primary schools in Southeast Nigeria. The treatment process involved an 8-session CRREBT programme.Results:The scores for WLB of the administrative officers enrolled in the CRREBT programme were significantly improved compared to those in the control group at the end of the study. At the follow-up phase, the CRREBT programme proved to be effective over a 3-month period.Conclusion:CRREBT is an effective therapeutic strategy for managing WLB among Catholic school administrative officers.     

Rural-Urban Differentials in Access to Behaviour Change Communication and Use of Long-Lasting Insecticide-Treated Nets and Artemisinin-Based Combination Therapy in Southeast Nigeria

BackgroundAs Malaria continues to take a heavy toll on the life and economy of Nigerians, The National Malaria Elimination Programme uses behaviour change communication (BCC) to promote the use of Long-Lasting Insecticide-treated Nets (LLIN) and Artemisinin-based Combination Therapy (ACT) to combat malaria. This study examined the impact of BCC on the use of LLIN and ACT in Southeast Nigeria.MethodsA structured questionnaire was used to gather data from 480 respondents in urban and rural communities across five states. Analysis of data was done using percentages, chi-square and logistic regression.ResultsFindings showed weak effect of BCC on LLIN and ACT use despite achieving high (93.75%) exposure. Only 45.1% and 45.7% of the respondents used LLIN and ACT respectively. Urban residents were found to sleep under LLINs and use ACTs more than rural dwellers. Regression results showed that newspapers (OR=1.341) and the Internet (OR=3.216) increased the odds of LLIN use in the rural areas and magazines (OR=1.837) in the urban areas. Television (OR=2.375; P=0.002) and the Internet (OR=6.063; P=0.001) increased the odds of ACT use in the urban areas. Education was found to be a positive predictor of LLIN use in the rural (OR=4.645; P=0.011) and urban areas (OR=6.102) as well as ACT use in the rural (OR=7.268; p=0.002) and urban areas (0R=6.145; P=0.009).ConclusionAccess to behaviour change communication though very high has not achieved the desired behaviour change. The National Malaria Elimination Programme should produce appropriate messages to address barriers to LLIN and ACT use.     

Repeated but Not Single Administration of Ketamine Prolongs Increases of the Firing Activity of Norepinephrine and Dopamine Neurons

BackgroundClinical studies have shown that the rapid antidepressant effect of the glutamate N-methyl-D-aspartate receptor antagonist ketamine generally disappears within 1 week but can be maintained by repeated administration. Preclinical studies showed that a single ketamine injection immediately increases the firing and burst activity of norepinephrine (NE) neurons, but not that of serotonin (5-HT) neurons. It also enhances the population activity of dopamine (DA) neurons. In the present study, we investigated whether such alterations of monoamine neuronal firing are still present 1 day after a single injection, and whether they can be maintained by repeated injections.MethodsRats received a single ketamine injection or 6 over 2 weeks and the firing activity of dorsal raphe nucleus 5-HT, locus coeruleus NE, and ventral tegmental area DA neurons was assessed.ResultsOne day following a single injection of ketamine, there was no change in the firing activity of 5-HT, NE, or DA neurons. One day after repeated ketamine administration, however, there was a robust increase of the firing activity of NE neurons and an enhancement of burst and population activities of DA neurons, but still no change in firing parameters of 5-HT neurons. The increased activity of NE neurons was no longer present 3 days after the last injection, whereas that of DA neurons was still present. DA neurons were firing normally 7 days after repeated injections.ConclusionThese results imply that the enhanced activity of NE and DA neurons may play a significant role in the maintenance of the antidepressant action of ketamine.     

Serogroup W135 Meningococcal Disease,The Gambia, 2012

In 2012, an outbreak of Neisseria meningitidis serogroup W135 occurred in The Gambia. The attack rate was highest among young children. The associated risk factors were male sex, contact with meningitis patients, and difficult breathing. Enhanced surveillance facilitates early epidemic detection, and multiserogroup conjugate vaccine could reduce meningococcal epidemics in The Gambia.     

Intervention for stress management among skilled construction workers

Objective:Previous studies have demonstrated the need for a stress management intervention among construction workers. Construction workers, despite their degree of stress, are expected to contribute to the accomplishment of projects on construction sites. This study aimed to ascertain the effect of a group rational emotive behavior therapy (group REBT) on stress management among a select sample of skilled construction workers in construction industry in Nigeria.Methods:With a randomized controlled trial design, 160 skilled construction workers completed the study and responded to the perceived stress scale-14 and work-related irrational beliefs questionnaire. Participants were randomly allocated to either the intervention group (n = 80) or the control group (n = 80). The main method of data analysis used in the study was repeated measures within-between subjects analysis of variance statistic.Results:Results show that group REBT significantly improved stress and work-related irrational beliefs scores of the skilled construction workers after they were exposed to the intervention and compared with their colleagues in the control group. The significant reduction in stress and work-related irrational beliefs scores of the treatment group were also sustained at follow-up.Conclusion:Group REBT was significant in reducing stress and work-related irrational beliefs among the skilled construction workers.     

Review of prostate cancer research in Nigeria

Prostate cancer (CaP) disparities in the black man calls for concerted research efforts. This review explores the trend and focus of CaP research activities in Nigeria, one of the ancestral nations for black men. It seeks to locate the place of the Nigerian research environment in the global progress on CaP disparities. Literature was reviewed mainly through a Pubmed search with the terms "prostate cancer"and "Nigeria", as well as from internet and hard copies of journal pages.Findings: One of the earliest publications about CaP in Nigeria was in 1973 from the nation's 1st tertiary hospital in Ibadan, reporting low incidence, followed by a lull of nearly one decade. In 1980, the incidence rate of CaP was reported as almost similar for black men in Ibadan and Washington and from then on, research work from surgeons and pathologists, from the south to the north, east to west, continued to report increasing prevalence of CaP. Apart from epidemiology, other areas of research include KAP (knowledge attitude and practice) studies (poor education of caregivers and population), histopathology (mostly adenocarcinoma), diagnosis (digital rectal examination [DRE], prostate specific antigen [PSA], ultrasound), clinical features (late presentation and high mortality), and prevention (lifestyle, education and screening). As of today there is a gaping dearth of molecular and genetic studies. Conclusion: The global focus on CaP disparities in black men calls for more efforts from Africa, in all areas of research, along with international collaborations for capacity building.