The Excess Preterm Birth Rate Among US-Born (Compared to Foreign-Born) Black Women: The Role of Father’s Education

Maternal and Child Health Journal - To ascertain the component of the excess preterm birth (<?37 weeks, PTB) rate among US-born (compared to foreign-born) Black women...     

Early Distant Recurrence in Patients With Resected Stage I Lung Cancer: A Case Series of “Blast Metastasis”

BackgroundThe standard of care in the management of stage I non–small-cell lung cancer (NSCLC) has been anatomic lung resection with multistation lymph node sampling of ≥ 10 lymph nodes. The 5-year survival for NSCLC has ranged from 73% to 93% (for stage IB and stage IA, respectively) and will be more favorable for patients with fewer comorbidities and those with a higher state of premorbid functioning and who undergo surgical resection. Despite the positive prognosis for operable stage I NSCLC, a subset of patients will develop metastatic disease within as few as 12 months after resection. Using an institutional database, we have presented the data from 68 patients who had developed distant metastatic recurrence after resection of pathologic stage I NSCLC within 1 year after surgery.Patients and MethodsA retrospective study was conducted of a prospectively maintained intuitional database. The final cohort included patients with pathologic stage I NSCLC who had undergone anatomic resection but had subsequently presented with multiple sites of distant recurrence within 1 year. The study period extended from 2003 to 2020. Patients with broad local recurrence or recurrence at a single distant site were excluded. Kaplan-Meier analysis was used to estimate the 5-year survival.ResultsA total of 2827 patients had undergone surgical resection for stage I NSCLC during the 17-year period and 68 met the criteria for inclusion. Most of the patients (n = 48) were smokers, and the dominant histologic type was adenocarcinoma (n = 37). After recurrence, 22 patients (33%) had undergone chemoradiotherapy and 19 (28%) had received chemotherapy alone. The mean and median overall survival were 23.7 and 14 months, respectively. The 5-year survival from recurrence and surgery were both 13.2%.ConclusionsLimited data are available on the risk factors for early metastasis after resected stage I NSCLC. The results from our cohort have demonstrated poor survival after recurrence. These data might be the basis for determining a phenotype for patients prone to early widespread metastasis despite seemingly curative surgical resection.     

Magnetisable solid-phase separation fluoroimmunoassay for total oestriol in pregnancy serum

A rapid separation fluoroimmunoassay for serum or plasma levels of total oestriol in pregnancy was established, based on the use of fluorescein-labelled oestriol and sheep anti-oestriol serum covalently linked to magnetisable particles. Equilibrium was attained within 10 min, and the fluorescence of the bound fraction of labelled ligand was quantitated fluorimetrically after elution from the magnetisable particles. Results for pregnancy serum samples correlated well with an established radioimmunoassay technique and the sensitivity, precision and accuracy were appropriate for clinical use. Advantages of this system as compared with radioimmunoassay include the speed and-simplicity of end-point detection, prolonged shelf-life of the labelled reactant and absence of any health hazard. The separation step enabled the removal of any endogenous fluorophores or other interfering factors present in biological samples.     

Node-Positive Segmentectomy for Non–Small-Cell Lung Cancer: Risk Factors and Outcomes

BackgroundSegmentectomy for well-selected early stage non–small-cell lung carcinoma (NSCLC) has been shown to have similar oncologic outcomes and survival to lobectomy. However, these data are based on the presumption that the disease is node negative. Few data exist regarding the risk factors for and the outcomes of patients with disease treated with segmentectomy that is found to be node positive. We sought to determine the risk factors for and outcomes of clinical stage I NSCLC patients who are treated with segmentectomy but are determined to be node positive.Patients and MethodsWe queried patients with clinical stage I NSCLC ≤ 3 cm within the National Cancer Data Base between 2004 and 2014 who were treated with segmentectomy or lobectomy and found to have positive nodes. Kaplan-Meier curves with log-rank tests were used to compare overall survival (OS) between segmentectomy and lobectomy. For comparison only, segmentectomy patients with pathologically node-negative disease were identified to determine predictors of node positivity after segmentectomy via multivariable logistic regression.ResultsA total of 4556 patients with node-positive disease were identified, comprising 115 segmentectomy patients and 4441 lobectomy patients. Multivariable analysis identified increasing tumor size, squamous-cell histology, and increasing number lymph nodes sampled as significant predictors of node positivity after segmentectomy. There was no difference in OS between segmentectomy and lobectomy, with 3-year OS rates of 66.3% and 68.1%, respectively (P = .723).ConclusionThere are discrete risk factors for discovering positive nodes after segmentectomy. Segmentectomy is associated with similar OS compared to lobectomy for clinical stage I NSCLC found to be node positive.     

Phenylalanine is the predominant antisickling agent in Cajanus cajan seed extract

Amino acid analysis showed that solvent extracts of Cajanus cajan L. Millsp. (Fabaceae) seeds (white species) contain, as free amino acid, as much as 26.3% phenylalanine. Antisickling experiments based on the estimated amount of free phenylalanine in the methanol (water-soluble) extract of the seeds showed that the presence of this amino acid alone could account for about 70% of the antisickling potency of Cajanus cajan seed extract.     

Support and unmet needs of patients undergoing multidrug-resistant tuberculosis (MDR-TB) treatment in southern Nigeria

Multidrug-resistant tuberculosis (MDR-TB) is presently a major public health threat. MDR-TB patients face diverse financial and psychosocial difficulties. Researchers conducted in-depth interviews based on interview guides with 42 participants. Data were analyzed using categorization, coding, generation of themes, and thematic memo writing. The key findings were as follows: Out of the 42 patients, 30 (71.4%) were males and 12 (28.6%) were females. All patients received financial stipends for transport and monthly social support. The patients however needed more financial support than they received (suggesting high unmet financial needs). Patients suffered depressive mood before and during treatment but received inadequate mental health/psychosocial care and treatment. Patients developed hearing impairment as a major adverse drug reaction, but the care and treatment they received were inadequate. In conclusion, the programmatic support provided for MDR-TB patients' financial and mental health/psychosocial needs and auditory drug side effects fell short of their need. Programmes for control of MDR-TB should increase budgetary allocations and ramp up mechanisms for provision of mental health/psychosocial support and care/treatment for drug side effects.     

Management of Priapism in Adult Men

This study aims to present the management of priapism in adult men in Port Harcourt, Nigeria. All patients who presented with priapism in 2 hospitals in Port Harcourt from July 2007 to April 2014 were prospectively studied. Treatment was assigned based on clinical presentation. Data analyzed included: age on clinical presentation, risk factor, mode, and outcome of management. There were 18 patients aged 17 to 60 years (median age: 30 years). Three patients (16.7%) presented with stuttering priapism. Most of the patients presented after 24 hours of onset. Sixteen patients (89.9%) had hematological disorders. Five patients (27.8%) took suspected aphrodisiac medications. Seven patients (38.9%) were managed conservatively. The rest achieved detumescence following glandulo-cavernous shunting. Erectile function after treatment was satisfactory in 5 patients (27.8%). The commonest cause of priapism in Port Harcourt was hematological disorder. Most of the patients presented late. Prevalence of erectile dysfunction after treatment was high.Key words: Priapism, Sickle cell anemia, TumescencePriapism is a potentially painful medical condition in which the erect penis or clitoris does not return to its flaccid state, despite the absence of both physical and psychological stimulation, within 4 hours.¹ Priapism has been described as a genuine erectile dysfunction in which erection persists without sexual stimulation.² It is a rare condition with overall incidence of 1.5 cases per 100,000 person-years.³ However, it is an important urologic emergency because erectile tissue damage may occur leading to loss of functional erections.⁴ The time interval between the onset of symptoms and presentation for medical intervention impacts on the outcome of management.Priapism is associated with various risk factors such as: antipsychotics drugs, local aphrodisiacs; hematologic malignancies, and congenital vascular disorders. Hemoglibinopathies constitute the major cause in countries where sickle cell disease (SCD) is endemic.⁵Depending on the predisposing factor, priapism may be ischemic, nonischemic, or stuttering. Ischemic priapism is also referred to as veno-occlusive or low flow priapism. Ischemic priapism is characterized by painful persistent erection, reduced or absent cavernosal blood flow, and abnormal cavernous blood gases. The corpora cavernosa are rigid and painful.^2,3Nonischemic priapism is of arterial origin and is said to be a high-flow type. It is due to unregulated cavernous arterial inflow. The phallus in this case may not be rigid or painful and may not require emergency surgical intervention.²In stuttering priapism, the patient has an unwanted painful erection which occurs repeatedly with periods of detumescence. These patients are thought to have recurrent ischemic priapism.^4,5Studies on priapism in the African populations focused on risk factors. This article is to present the results of a 7-year prospective study of priapism in 2 institutions in Port Harcourt, Nigeria, with the aim of documenting the relationship between the outcome of treatment and interval between onset of priapism and intervention in an African population.     

Analysis of Prospective Trauma Registry Data in Francophone Africa: A Pilot Study from Cameroon

Introduction

Injury rates in sub-Saharan Africa are among the highest in the world, but prospective, registry-based reports from Cameroon are limited. We aimed to create a prospective trauma registry to expand the data elements collected on injury at a busy tertiary center in Yaoundé Cameroon.

Methods

Details of the injury context, presentation, care, cost, and disposition from the emergency department (ED) were gathered over a 6-month period, by trained research assistants using a structured questionnaire. Bivariate and multivariate models were built to explore variable relationships and outcomes.

Results

There were 2,855 injured patients in 6 months, comprising almost half of all ED visits. Mean age was 30 years; 73 % were male. Injury mechanism was road traffic injury in 59 %, fall in 7 %, penetrating trauma in 6 %, and animal bites in 4 %. Of these, 1,974 (69 %) were discharged home, 517 (18 %) taken to the operating room, and 14 (1 %) to the intensive care unit. The body areas most severely injured were pelvis and extremity in 43 %, head in 30 %, chest in 4 %, and abdomen in 3 %. The estimated injury severity score (eISS) was <9 in 60 %, 9–24 in 35 %, and >25 in 2 %. Mortality was 0.7 %. In the multivariate analysis, independent predictors of mortality were eISS ≥9 and Glasgow Coma Score ≤12. Road traffic injury was an independent predictor for the need to have surgery. Trauma registry results were presented to the Ministry of Health in Cameroon, prompting the formation of a National Injury Committee.

Conclusions

Injuries comprise a significant proportion of ED visits and utilization of surgical services in Yaoundé. A prospective approach allows for more extensive information. Thorough data from a prospective trauma registry can be used successfully to advocate for policy towards prevention and treatment of injuries.