Search

Background: Pleural effusion is an abnormal accumulation of fluid in the pleural cavity which present with spectrum of clinico-aetiological manifestations often requiring multidisciplinary approach. Objectives: This study set out to determine the prevalence, aetiology, clinical presentation, treatment modalities and outcome of pleural effusion in children. Materials and Methods: This was a retrospective study where records of children with diagnosis of pleural effusion admitted at UDUTH, Sokoto were obtained between January 2017 and December 2022 and reviewed. Diagnosis was based on clinical presentation and radiological confirmation of pleural effusion. Data was analyzed with SPSS version 20.0. Results: A total of 49 cases were retrieved. The prevalence of pleural effusion was 0.54% (9,056). It was more prevalent in males with ratio of 2.5:1 (χ² = 9.833, P = 0.007). The median age was 9 years (IQR 7). The most common cause of pleural effusion was pneumonia 26 (53.1%) followed by tuberculosis 16 (32.6%), malignancy 3 (6.1%), cardiac and renal causes accounted for 2 (4.1%) each. Cough (100.0%), difficulty in breathing (100.0%), tachypnea (100.0%), respiratory distress (100.0%), and desaturation (98.0%) were the common presentations. Most (77.5%) of them presented with right sided pleural effusion. The majority (93.9%) had closed thoracostomy tube drainage. The outcome showed majority (83.7%) of the cases been discharged, with a median duration of hospital stay of 22days (IQR 17). However, mortality rate for the malignant causes was 100.0%. Conclusion: Infections were the major cause of paediatric pleural effusion with relatively good outcome. Surgical intervention and multidisciplinary team approach are needed to reduce the morbidity and mortality in patients with pleural effusion especially for the malignant causes.

Introduction: Echinococcosis is a widespread zoonotic disease caused by tapeworms of the Echinococcus genus, manifesting in mature or larval forms. Cystic echinococcosis (CE) and alveolar echinococcosis (AE) are the primary types affecting humans, linked, respectively, to Echinococcus granulosus and Echinococcus multilocularis . This study is a systematic review and meta-analysis of the risk factors associated with CE and AE in humans., Methods: Relevant English publications were found through a thorough search of eligible databases. The inclusion criteria focused on cross-sectional and case-control studies investigating risk factors for human echinococcosis. Collected data included author, country, study design, demographics, sample size, literacy, occupation, drinking water source, dog ownership, and hand hygiene., Results: A total of 1,594 studies were found in the initial search, with only 36 papers (involving 1,207,436 cases) meeting the inclusion criteria. Most of the study population (99.35%) showed no echinococcosis infection, while 0.65% were infected. Of the infected cases, 77.92% had CE, while 22.08% had AE. Among 629,996 (52.18%) females, 4,830 (0.76%) were infected, compared to 2,968 (0.52%) infections among 565,872 (46.86%) males ( p  < 0.001). Rural areas, low education levels, agricultural/livestock workers, dog owners, water sources, and poor hand hygiene were all significantly associated with the infection ( p  < 0.05)., Conclusion: Echinococcosis remains a global health concern, particularly among rural residents, those with lower education, agricultural workers, and dog owners. Targeted public health measures, including improved hygiene practices and access to clean water, are essential to reducing its impact., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Kakamad, Anwar, Ahmed, Habibullah, Kaka Ali, Nasralla, Abdullah, Tahir, Kareem, Hasan, Gharib, Asaad, Mohammed, Abdalla, Esmaeil, Rashid and Hamahussein.)

Objectives: Wake-up stroke (WUPS) patients can be selected to intravenous thrombolysis (IVT) treatment based on the Magnetic Resonance Imaging (MRI) mismatch concept. However, recent studies suggest the introduction of modified MRI mismatch criteria, allowing IVT in WUPS patients with a partial mismatch., Material and Methods: WUPS patients treated with IVT in the NOR-TEST trial and consecutively thereafter at Stavanger University Hospital were included in this study. Patient selection for treatment was performed based on the clinical presentation and the MRI DWI/FLAIR mismatch criteria. MRI examinations were reassessed according to the modified DWI-FLAIR mismatch criteria, allowing partial mismatch. Improvement in NIHSS and mRS at 3 months were used to analyze clinical outcome, and the rate of intracranial hemorrhage (ICH) to analyze safety., Results: 78 WUPS patients were treated with IVT. Only 68 of these patients were independent pre-stroke and included in the clinical analysis. When reassessing the MRI examinations, 41 (60 %) were rated as DWI/ FLAIR mismatch, 14 (21 %) as partial mismatch and 13 (19 %) as match. The results show that the patient groups had a mRS score 0-1 at 3 months measured as primary outcome to respectively 27 (65.9 %), 11 (78.6 %) and 8 (61.5 %); (P = 0.629). The mismatch group showed the best clinical improvement (3-points NIHSS reduction, p = 0.005). No ICH was seen in any of the groups., Conclusion: Our study extended the mismatch concept in clinical praxis to treat WUPS patients with partial mismatch, showing the best clinical outcome in the mismatch group., Competing Interests: Declaration of competing interest Declaration of competing interest none to disclose., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Abstract: Prolonged air leak (PAL) represents the most commonly encountered complication following pulmonary resection. This review aims to show the role of autologous blood pleurodesis (ABPP) in the management of PAL. A search was conducted on the Web of Science, PubMed, MEDLINE, and Google Scholar for English-language articles until September 15, 2023, with titles containing the related phrase "autologous blood patch pleurodesis (ABPP), and prolonged air leaks." Included studies comprised four randomised controlled trials, ten cohort studies, a case series, and nine case reports from various countries. Patients undergoing ABPP had a mean age of 52.7 years. Autologous blood volumes for pleurodesis varied (50 mL to 250 mL). Approximately 73.8% of cases responded to ABPP in 1 to 30 days (mean 3.75 days), and in-hospital complications were infrequent (3.9%). Follow-up durations post pleurodesis were up to 20 months. The evidence presented in this systematic review supports the role of ABPP as an effective and safe intervention for managing PAL, particularly after pulmonary resection., (Copyright © 2024 Copyright: © 2024 Indian Chest Society.)

We have reported that the microtubule (MT) network in β cells attenuates this function by withdrawing insulin secretory granules (ISGs) away from the plasma membrane. Thus, high glucose-induced MT remodeling is required for robust glucose-stimulated insulin secretion (GSIS). We now show that α-cell secreted hormones, Gcg and/or Glp1, regulate the MT stability in β cells. Activating the receptors of Gcg or Glp1 (GcgR or Glp1R) with chemical agonists induces MT destabilization in β ells in the absence of high glucose. In contrast, inhibiting these receptors with antagonists attenuates high glucose-induced MT destabilization. Supporting the significance of this regulation, the MT networks in β cells of islets with higher α/β cell ratio are less stable than those with lower α/β cell ratio. Within each individual islet, β cells that are located close to α cells show faster MTs remodeling upon glucose stimulation than those away. Consequently, islets with higher α/β cell ratio secrete more insulin in response to high glucose and plasma membrane depolarization, which is recapitulated by direct Gcg stimulation. These combined results reveal a new MT-dependent pathway by which α cells, using Gcg and or Glp1-mediated paracrine signaling, tune β-cell secretion. In addition, the different α-β cell ratios in individual islets lead to their heterogeneous secretory responses, which may be important for handling secretory function needs under different physiological conditions., Highlights: Gcg sensitizes glucose-induced MT remodeling in mouse and human β cellsMT density in single islets anti-correlates with α/β cell ratioGSIS levels in single islets positively correlate with α/β cell ratioDifferent α/β cell ratio contributes to heterogeneity of single islet GSIS.

Crohn's disease (CD) is a granulomatous inflammatory bowel disease. Around 25% of CD patients exhibit extraintestinal manifestations, though pulmonary involvement is rare. This study presents a case of CD causing pleural effusion. A 43-year-old man visited the pulmonology clinic with a dry cough for one-month, right-side pleuritic chest pain, and exertional dyspnea. He was treated with antihistamines and antitussive syrup, with incomplete relief. A chest CT scan showed bilateral mild pleural effusion. Given his occasional black stools and high serum calprotectin, a colonoscopy confirmed CD. Pulmonary manifestations may involve airway, parenchymal, and interstitial pathologies, but no distinctive pathological findings differentiate CD's pulmonary manifestations from other causes. In conclusion, isolated bilateral pleural effusion and the underlying pleuritis as a pulmonary manifestation of CD-characterized by dry cough and pleuritic chest pain, particularly preceding the diagnosis of CD-is extremely rare but possible., Competing Interests: The authors declare that they have no competing interests., (© The Author(s) 2024. Published by Oxford University Press.)

Background: It is estimated that over 75.0% of households in sub-Saharan Africa are involved in agriculture, and the majority of the poor in rural areas rely on agriculture for their livelihoods. One billion people living with disabilities in low- and middle-income countries are argued to make up the poorest of the poor, yet to our knowledge, no literature has captured the livelihood of people living with disabilities in the context of farming in Nigeria, specifically northern Nigeria where most of the households are involved in agriculture and related activities., Objectives: This article reports on findings from a study that sought to understand disability in the context of northern Nigerian farming, with a particular focus on the role and lived experiences of people living with disabilities working in the agricultural sector., Method: A survey questionnaire was developed and captured the experiences of 1067 people living with disabilities working in the agricultural sector across five states (Adamawa, Bauchi, Jigawa, Kaduna and Yobe) in northern Nigeria., Results: Findings indicate that people with disabilities are actively participating in agricultural activities for several reasons, which specifically included 'forced to and for survival'. When participants reported needing care, this was predominantly provided by family members. Findings also showed that participants with disabilities experienced several economic and sociocultural challenges because of their impairments., Conclusion: This study adds to the very limited literature on farmers living with disabilities in sub-Saharan Africa and so highlights the need for more research to be conducted with farmers living with disabilities in Nigeria, particularly female farmers living with disabilities. These will provide more evidence pertaining to the experiences of farmers living with disabilities in order to provide effective disability- and gender-inclusive agricultural and entrepreneurship programmes in Nigeria., Contribution: The results of this research reveal important insights relating to the experiences of farmers living with disabilities in northern Nigeria, which can contribute to informing future developmental projects to achieve effective inclusion and actively benefit people living with disabilities., Competing Interests: The authors declare that they have no financial or personal relationships that may have inappropriately influenced them in writing this article., (© 2022. The Authors.)

Background: Tenecteplase has probably pharmacological and clinical advantages in the treatment of acute ischemic stroke. There are lacking data about safety and efficacy of tenecteplase in wake-up stroke (WUPS)., Aims: To investigate safety and efficacy of tenecteplase compared to alteplase in WUPS patients included in NOR-TEST., Methods: WUPS patients in NOR-TEST were included in the study based on DWI-FLAIR mismatch. Included patients randomly assigned (1:1) to receive intravenous tenecteplase 0.4 mg/kg (to a maximum of 40 mg) or alteplase 0.9 mg/kg (to a maximum of 90 mg). Neurological improvement was defined as 1) favorable functional outcome at 90 days modified Rankin Scale (mRS) of 0 or 1 and 2) neurological improvement measured with the National Institutes of Health Stroke Scale (NIHSS) of 4 points within 24 hours as compared to admission NIHSS or NIHSS 0 at 24 hours., Results: Of 1100 patients from 13 stroke centers included in NOR-TEST, 45 were WUPS patients. Of these, 5 patients were stroke mimics and excluded. Of the remaining 40 patients (3.6%), 24 were treated with alteplase (60%). There was no difference in the number of patients achieving a good clinical outcome (mRS 0-1) in either treatment group. Patients treated with tenecteplase showed a better early neurological improvement (87.5% vs 54.2%, P = 0.027). No ICH was detected on MRI/CT 24-28 hours after thrombolysis., Conclusions: In WUPS patients treated in NOR-TEST, there was no difference in clinical outcomes at 90 days and no ICH events or deaths were observed in either alteplase- or tenecteplase-treated patients. Clinical Trial Registration-URL: https://www.clinicaltrials.gov. Unique identifier: NCT01949948., (© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Introduction: Renal cell carcinoma (RCC) is known to metastasize to almost every organ. A well-recognized phenomenon in RCC is late metastatic recurrence after nephrectomy which is arbitrarily defined as more than 10 years. The incidence of solitary ipsilateral and contralateral adrenal metastasis is 3% and 0.7% respectively in patients who have underwent radical nephrectomy., Case Report: A57-year-old female presented with an incidental ultrasonic finding of a right adrenal mass 15 years after radical nephrectomy for left side renal cell carcinoma. Further evaluation with abdominal contrast enhanced CT scan revealed a right adrenal mass suggestive of metastatic lesion. The results of laboratory examinations showed the mass to be nonfunctional. Open right adrenalectomy was performed. She was discharged home on 4 th postoperative day. Pathological examination revealed morphological and immunohistochemical findings in line with metastatic renal cell carcinoma of the left kidney. During the last 2 years she has being on regular follow up, neither local recurrence nor distant metastasis anywhere have been detected by whole body Positron Emission Tomography(PET) scan., Discussion: Late metastatic contralateral adrenal recurrence from RCC is very rare and to the best of our knowledge, 5 similar cases have been reported 10 years after radical nephrectomy. Early diagnosis of adrenal metastasis is challenging because they are usually silent both anatomically and functionally., Conclusion: Solitary contralateral adrenal metastatic recurrence of RCC is extremely rare event. Surgical removal is a wise option in these cases that may improve survival., (Copyright © 2019 The Authors. Published by Elsevier Ltd.. All rights reserved.)

The present study aimed to empirically examine the demographic variables that determine women's economic empowerment. A sample of 500 married women between 21 and 49 years old (M age  = 35.49, SD = 7.66) was conveniently selected from district Multan (Pakistan). Control over economic resources was used as a proxy for women's economic empowerment. Ordered probit regression was run to assess the demographic determinants (i.e., age, education, paid job, income, and property) of economic empowerment of the least empowered, moderately empowered, and highly empowered women. Paid job, age, income, and property appeared as positive and significant predictors of women's economic empowerment. Implications of the study were also discussed.

Introduction: Avian mycoplasmas impose a significant economic burden to the poultry industry. In recent years, macrolide-resistant Mycoplasma gallisepticum have occasionally been encountered in Egypt., Methodology: This study was designed to document the involvement of macrolide-resistant M. gallisepticum in respiratory organs of chickens suffering respiratory problems. Concurrently, an exhaustive molecular characterization of the intrinsic resistance of recovered isolates to macrolides was done., Results: Of 120 chickens showing respiratory problems, 14 (11.67%) M. gallisepticum were isolated and genetically identified; 8 of them were recovered from air sacs, 4 from lungs, and 2 from tracheas. Broth microdilution of all M. gallisepticum isolates showed various degrees of minimum inhibitory concentrations (MICs) against macrolides: erythromycin (0.25-32 µg/mL), tylosin (0.0625-4 µg/mL), and tiamulin (0.031-2 µg/mL). Nucleotide sequencing of domain V (peptidyl transferase region) of the 23S rRNA gene of macrolide-resistant M. gallisepticum isolates revealed transition mutations at positions 2068 and 2069 (corresponding to 2058 and 2059 in Escherichia coli numbering) in an isolate and at position 2067 (corresponding to 2057 in E. coli numbering) in three isolates as hot spots for macrolide resistance. Surprisingly, a transversion mutation at position 2621 (corresponding to 2611 in E. coli numbering) was reported in one of the recovered isolates as a first report., Conclusion: Generation of new mutations is evidence for persistence of M. gallisepticum despite macrolide treatment. Periodic surveys to monitor for the possible appearance of resistant strains are recommended.

Aim: To investigate the number of hypertensive patients, the optometrist is able to identify by routinely taking blood pressure (BP) measurements for patients in "at-risk" groups, and to sample patients' opinions regarding in-office BP measurement. Many of the optometrists in Saudi Arabia practice in optical stores. These stores are wide spread, easily accessible and seldom need appointments. The expanding role of the optometrist as a primary health care provider (PHCP) and the increasing global prevalence of hypertension, highlight the need for an integrated approach towards detecting and monitoring hypertension., Methods: Automated BP measurements were made twice (during the same session) at five selected optometry practices using a validated BP monitor (Omron M6) to assess the number of patients with high BP (HBP) -in at-risk groups-visiting the eye clinic routinely. Prior to data collection, practitioners underwent a two-day training workshop by a cardiologist on hypertension and how to obtain accurate BP readings. A protocol for BP measurement was distributed and retained in all participating clinics. The general attitude towards cardiovascular health of 480 patients aged 37.2 (±12.4)y and their opinion towards in-office BP measurement was assessed using a self-administered questionnaire., Results: A response rate of 83.6% was obtained for the survey. Ninety-three of the 443 patients (21.0%) tested for BP in this study had HBP. Of these, (62 subjects) 66.7% were unaware of their HBP status. Thirty of the 105 subjects (28.6%) who had previously been diagnosed with HBP, still had HBP at the time of this study, and only 22 (73.3%) of these patients were on medication. Also, only 25% of the diagnosed hypertensive patients owned a BP monitor., Conclusion: Taking BP measurements in optometry practices, we were able to identify one previously undiagnosed patient with HBP for every 8 adults tested. We also identified 30 of 105 previously diagnosed patients whose BP was poorly controlled, twenty-two of whom were on medication. The patients who participated in this study were positively disposed toward the routine measurement of BP by optometrists.

Ration power plants, to generate power, have become common worldwide. One such one is the steam power plant. In such plants, various moving parts of heavy machines generate a lot of noise. Operators are subjected to high levels of noise. High noise level exposure leads to psychological as well physiological problems; different kinds of ill effects. It results in deteriorated work efficiency, although the exact nature of work performance is still unknown. To predict work efficiency deterioration, neuro-fuzzy tools are being used in research. It has been established that a neuro-fuzzy computing system helps in identification and analysis of fuzzy models. The last decade has seen substantial growth in development of various neuro-fuzzy systems. Among them, adaptive neuro-fuzzy inference system provides a systematic and directed approach for model building and gives the best possible design parameters in minimum possible time. This study aims to develop a neuro-fuzzy model to predict the effects of noise pollution on human work efficiency as a function of noise level, exposure time, and age of the operators doing complex type of task.

Background: Even though functional lateralization is a common feature of many nervous systems, it is poorly understood how lateralized neural function is linked to lateralized gene activity. A bilaterally symmetric pair of C. elegans gustatory neurons, ASEL and ASER, senses a number of chemicals in a left/right asymmetric manner and therefore serves as a model to study the genetic basis of functional lateralization. The extent of functional lateralization of the ASE neurons and genes responsible for the left/right asymmetric activity of ASEL and ASER is unknown., Results: We show here that a substantial number of salt ions are sensed in a left/right asymmetric manner and that lateralized salt responses allow the worm to discriminate between distinct salt cues. To identify molecules that may be involved in sensing salt ions and/or transmitting such sensory information, we examined the chemotaxis behavior of animals harboring mutations in eight different receptor-type, transmembrane guanylyl cyclases (encoded by gcy genes), which are expressed in either ASEL (gcy-6, gcy-7, gcy-14), ASER (gcy-1, gcy-4, gcy-5, gcy-22), or ASEL and ASER (gcy-19). Disruption of a particular ASER-expressed gcy gene, gcy-22, results in a broad chemotaxis defect to nearly all salts sensed by ASER, as well as to a left/right asymmetrically sensed amino acid. In contrast, disruption of other gcy genes resulted in highly salt ion-specific chemosensory defects., Conclusions: Our findings broaden our understanding of lateralities in neural function, provide insights into how this laterality is molecularly encoded, and reveal an unusual multitude of molecules involved in gustatory signal transduction.

Pseudoaneurysm formation is a serious vascular complication of pancreatitis. It most commonly affects splenic and gastroduodenal arteries. We report a rare case of superior mesenteric artery pseudoaneurysm in a child with hereditary pancreatitis. Multidetector CT angiography allowed the comprehensive assessment of the aneurysm and allowed accurate surgical planning obviating the need for catheter angiography.

Primary aortic angiosarcomas are extremely rare. Clinically and radiographically, they mimic atherosclerosis and atheroembolic disease. For a definitive diagnosis, histologic evaluation of the tumor or of peripheral emboli is required. The imaging findings are frequently nonspecific and in most published cases did not allow a definitive preoperative diagnosis. This is the first report of the computed tomographic angiographic findings of a primary intimal abdominal aortic sarcoma and a review of previously described imaging findings in these tumors.

The objective of this series was to describe the findings in 2 types of iliac vein compression syndrome on intravascular ultrasonography. We conducted a retrospective review of the intravascular ultrasonographic findings in 2 patients with iliac vein compression syndrome due to 2 different types of venous spur and correlated those findings with the contrast-enhanced venographic findings. Intravascular ultrasonography allowed differentiation of the 2 different types of iliac vein compression syndrome in analogy to the venographic classification. Both cases had compression of the left common iliac vein between the right common iliac artery and the vertebral bodies. In addition, hyperechogenic eccentric wall thickening, the presence of multiple vascular channels separated by hyperechogenic structures, and the presence of sequelae of deep venous thrombosis such as synechiae and organized thrombus can be seen on intravascular ultrasonography. The ability to perform exact measurements of the venous dimensions is an added benefit of intravascular ultrasonography. Intravascular ultrasonography can assist in the diagnosis and classification of iliac vein compression syndrome, allows assessment of its complications, and can be potentially helpful for planning endovascular treatment.

β-Galactosidase gene fusions have been used to monitor the progress of mosquito-larvicidal-toxin gene expression in Bacillus sphaericus strain 2362. β-Galactosidase estimation in cells from late-growth-phase batch cultures was compared with larvicidal toxicity after incubation for 48 h. Conditions which promoted efficient sporulation, such as plentiful trace elements and relatively crude protein sources (soybean or cottonseed flours), enhanced reporter gene expression and provided high toxicity. However, acetate, which repressed sporulation, similarly repressed binary toxin yield. Gene fusions to the binary and 100-kDa toxin genes of B. sphaericus could be useful for the rapid screening of fermentation conditions for the local production of this larvicidal bacterium but, in view of the poor correlation with toxicity at high toxicity levels, such experiments should be confirmed with bioassays.

Translational lacZ fusions to the promoters of the parasporal, crystal protein (binary toxin) and 100-kDa ADP-ribosylating mosquitocidal toxin genes of Bacillus sphaericus were prepared and expression of the toxin genes monitored as beta-galactosidase activity. Transcription of the crystal protein gene fusion began immediately before the end of exponential growth and continued into stationary phase in both B. sphaericus and Bacillus subtilis but accompanied exponential-phase growth in Escherichia coli. Expression of this fusion was severely delayed in a B. subtilis spo0A mutant and decreased relative to the wild type in a B. subtilis spoIIAC background. beta-Galactosidase activity from the 100-kDa toxin gene fusion was restricted to early exponential phase in B. sphaericus, but in B.subtilis it continued into late exponential phase. Expression was about eightfold lower in B. sphaericus than B. subtilis suggesting an element of negative control in the native host.

When analyzed within seventy-two hours of admission to the coronary care unit, the mean values of serum copper and magnesium were lower in patients with acute myocardial infarction than in noncardiac patients. Zinc values showed no difference. Because the reduction of serum copper in males was statistically significant, the authors suggest that a lowering of serum copper, especially in males, can be useful in the diagnosis of recent infarction and could possibly have other implications. Significant elevations of serum calcium and of serum potassium were also demonstrated.