Propafenone is a class 1C antiarrhythmic with sodium channel and beta blocking properties. At toxic doses it causes wide range of arrhythmias including cardiac conduction abnormalities, AV block and prolongation of QRS complexes that may be fatal. In this paper we report a young female patient who had unstable hemodynamic condition due to propafenone ingestion estimated to be 6000 mgr and successfully treated with bicarbonate therapy. Bicarbonate therapy seems to be effective in propafenone intoxication and emergency physicians might be familiar to sodium channel blocking agent toxidromes and potential benefits of bicarbonate administration.
We present a case in which a pediatric cerebral palsy patient developed intraoperative myoglobinuria and rhabdomyolysis with elevated creatine kinase (CK) during prone scoliosis surgery. A diagnosis of rhabdomyolysis was established with the finding of tea-colored urine intraoperatively, and confirmed with elevated urine myoglobin and CK postoperatively. Cerebral palsy patients may develop anesthesia-induced rhabdomyolysis when inhalational anesthetics used.
Aims: The etiology of nail shedding in an 85-year-old man as well as predisposing and precipitating factors were evaluated, focusing on whether nail loss was secondary to infection or not. Presentation of Case: An 85-year-old man was examined for complete detachment and loss of the nail plates of the index and middle fingers of his right hand. There were no previous nail disorders or a recent traumatic injury. He was non-smoker and was not receiving any drug therapy before nail loss. Clinical symptoms and signs persisted after 10 days empirical use of antibiotics and local treatment. Culture samples by that time indicated an Enterobacter cloacae local infection. He was treated with topical application of the gentamycin injection solution on the nail beds. There was normal regrowth of the nails. No abnormality of the nail unit of both fingers was evident 2 years later. Discussion: The pathogenesis of nail shedding in our patient was assessed. Although a causal relation of nail loss and a primary Enterobacter cloacae infection was highly suggestive, other causes such as missed minor trauma, ischemia or idiopathic could not be excluded. Conclusion: A primary Enterobacter cloacae infection was the most likely cause of an acute nail shedding of the index and middle fingers of the right hand in an 85-year-old man. Treatment with local use of the gentamycin injection solution was proved a well-tolerated, safe and efficacious mode of treatment.
Aims: To compare the neonatal outcome in patients with PROM at and beyond 34 weeks, who had expectant management and progressed to spontaneous labour and those who had induction of labour. Study Design: Retrospective study of patients presenting with PROM at and beyond 34 weeks gestation over a 3 year period. Place and Duration of Study: Department of Obstetrics and Gynaecology, Ladoke Akintola University of Technology Teaching Hospital, Osogbo, Nigeria, between July 2007 and June 2010. Methodology: Case files of 92 patients with PROM and live, singleton fetuses, at and beyond 34 weeks gestation, in the study period, were retrieved from the hospital Health Records Department, collated and analyzed. Data collected included parity, estimated gestational age (EGA) at PROM, latency period (time interval from PROM to onset of labour), intervention following PROM, eventual mode of delivery and neonatal outcome. Results: A total of 2340 deliveries were recorded in the study period and 92 cases of PROM were on record for the period. However, only 74 PROM cases were included in the study, due to incomplete information. Incidence of PROM was therefore 3.9%. Length of latency period had a direct influence on the number of patients that went into spontaneous labour (P = 0.012) and subsequent vaginal delivery (P = 0.021). Induction of labour did not increase rate of caesarean section (P = 0.449) and had no effect on neonatal outcome (P = 0.239). Conclusion: Acceptable approach for the management of PROM at and beyond 34 weeks would be expectant management for the 1st 24 hours and induction of labor afterwards in patients who have not progressed into spontaneous labour. Expectant management in the extended latency period in the late preterm PROM group is associated with increased NICU admission (OR 7.33, 95% C.I 2.45 – 21.98); however, this did not affect duration of NICU stay or neonatal mortality.
We report the 1st case of severe, symptomatic hypocalcemia after denosumab (RANKL inhibitor) treatment in a peritoneal dialysis patient with secondary hyperparathyroidism and osteoporosis. A 58-year-old Caucasian female has been receiving chronic ambulatory peritoneal dialysis for four years secondary to polycystic kidney disease. Laboratory studies revealed: albumin-corrected calcium 9.0 mg/dL, phosphorus 5 mg/dL, alkaline phosphatase (ALP) 58 U/L [normal, 40-105], albumin 3.4 gm/dL [normal, 3.6-5.4] and intact parathyroid hormone (PTH) 315 pg/mL [normal, 40-72]. Marked osteoporosis was noted on the DXA scan, preventing her from renal transplantation considerations. She had failed conventional medical treatment, including per os calcium, monthly ergocalciferol (50,000 units/month), activated vitamin-D analog (doxercalciferol) and renal-failure adjusted alendronate (70 mg twice a month). She was started on subcutaneous denosumab 60 mg every 6 months. After her first dose, she developed a progressive drop of calcium, phosphorus, bicarbonate and magnesium, in spite of massive escalation of doxercalciferol and calcium supplementation. Hypocalcemia nadired at 6.3 mg/dL with symptomatic tetany, requiring a brief hospitalization approximately 7 weeks after denosumab treatment. Her elevated PTH rose further transiently (647 pg/mL), along with ALP (123 U/L). Bone-mineral parameters normalized approximately 3 months after denosumab administration. The observed phenomenon resembled the phenotype of “hungry bone syndrome” observed after surgical parathyroidectomy. Conclusion: Treatment decisions based on bone densitometry results alone are not transposable between patients with or without end-stage renal disease. Denosumab may lead to critical hypocalcemia in dialysis patients and further aggravate existing secondary hyperparathyroidism.
Aims: This article describes the results of a survey among dentists and dental technician regarding interdisciplinary teamwork. Interdisciplinary dental collaborations seem to be based on different conceptions with the consequence of various strengths but also weaknesses within teams. Study Design: International questionnaire (Germane, English, Russian). Place and Duration of Study: 250 questionnaires were handed out in paper form and 100 access codes for the Web-based version were sent. The survey was conducted between February and May 2011. Methodology: Dentists as well as dental technicians were permitted to participate in the survey. Candidates were recruited at postgraduate educational events. Previous participants of similar educational events were sent an access code via e-mail. Results: 132 questionnaires were evaluated (response rate of 37.7%). Of the surveyed persons, 60 were women (47%) and 72 were men (53%). The mean age of the respondents was 40.3 years +/-11.51 years. Associations with other specialties (n=84, 63.6%), solutions for unresolved problems (n=83, 62.9%), and expansion of one's own specialty (n=65, 49.2%) were the most frequently cited reasons to favor the use of interdisciplinary task groups. Difficult or ambiguous communication (n=73, 55.3%), conflicts within the team (n=70, 53.0%), and scheduling difficulties (n=63, 47.7%) were the most frequently cited reasons for not pursuing interdisciplinary cooperation, followed by rising costs and the expense of resources (n=62, 47.0%), the need to modify one's own concept (n=58, 43.2%), and the absence of a balance between workload and financial remuneration (n=52, 38.6%). Conclusion: Interdisciplinarity should not be regarded as the opposite of technological specialization. On the contrary, advancing technological developments in IDD will probably enforce a certain degree of specialization. Therefore, in the future it will become necessary not to lose contact with other specialties, keep open communication lines by means of a common language and common concepts, and also maintain communication with other medical specialties.
Aims: We present this case to improve medical knowledge about unusual presentation of leiomyomas and about the diagnostical findings of examinations settled down per rectal way. We provide images and stress the importance of differential diagnosis based on imaging. Presentation of the Case: We report a case of a 26 years old nulliparous, with a leiomyoma developed on the posterior upper third of the vagina surgically removed. The patient came to our Unit with dysmenorrhea and menorrhagia and underwent physical examination and ultrasound scan. Both exams were executed per transrectal way because of her being a virgo. A Computed Tomography scan has been executed too. All the results pointed out the presence of a round-shaped, well delimitated, solid mass in posterior vaginal wall. Magnetic Resonance confirmed this diagnosis. Discussion: We widely discuss the symptomathologic cortege, the diagnostic iter based on imaging we settled down, the possible differential diagnosis, and surgical therapy performed. Concordance of imaging, negativity of tumor markers and general well-being status of the patient led to the diagnostical hypotesis of vaginal benign neoformation. These data excluded other diagnosis as endometriosis, uterine fibroma, primitive vaginal malignant tumor and metastasis of other-site primitive malignant neoplasia. The patient has been treated by surgical transvaginal excission therapy. Conclusion: US imaging and MR gives us the possibility to recognize a mass and to discern his nature and localization, thus to choose the best therapy in each case. Hystopathology still represent the gold standard in making a diagnosis in gynaecological oncology.
Oesophageal Carcinoma presenting as symptoms of acute respiratory distress is extremely rare. Hence diagnosis may be difficult as all the initial investigations are focused towards finding a respiratory cause. In this paper the authors report a 62 year old Caucasian male who presented with acute dyspnoea with no respiratory history but was subsequently discovered to have an oesophageal carcinoma as the likely underlying cause. Subsequent investigations revealed it to be a stage IB squamous cell mid-oesophageal carcinoma that was treated by radiotherapy. It is important when evaluating a patient with acute respiratory symptoms but no previous respiratory history to consider alternative pathologies related to surrounding anatomical structures also.
Aim: To report a case of right-sided iatrogenic Horner's syndrome developed after branchial cleft cyst surgery. Presentation of the Scope: An 8 year-old boy presented with right-sided eyelid ptosis and enophthalmos, and diagnosed as having Horner’s syndrome. Discussion: Ophthalmic examination yielded miosis in the affected eye. Medical history revealed branchial cleft cyst surgery 4 years ago and mild ptosis was identified in the first postoperative day. Conclusion: Iatrogenic Horner syndrome may follow the cleft cyst surgery in on neck.
Introduction: Biphasic Pulmonary blastoma (BPB) is classified as one of the rare primary lung malignancies. It is composed of a mixture of epithelial and mesenchymal tissues resembling embryonic lung tissue. BPB is considered to be distinct from other lung tumors based on pathological features, clinical course and prognosis. Presentation of Case: The authors report an atypical case of BPB in a 27 -year-old man presented with complaints of dyspnea and left-sided chest pain for the previous four months. A chest radiograph showed the presence of an opaque left hemithorax, and the mediastinum was pushed toward the left. Computed tomography (CT) of the chest revealed a mixed solid and cystic process with variable contrast enhancement measuring 15,4 x 13,7 cm occupying the totality of the left hemithorax, pleural effusion, and a collapsed left lung, with contralateral mediastinal shift. A transthoracic needle pleural biopsy yielded a diagnosis of BPB.A general examination shows a peritoneal effusion. One month after diagnosis, the tumor grew rapidly, and therefore he was treated only by palliative care. He died from respiratory failure one month later. Although BPB is rare, this entity is increasingly described. Conclusion: The purpose of presenting this case report is to raise awareness among clinicians to consider this clinical entity as a differential diagnosis when a pleural mass is identified. Histological examination is the most reliable and conclusive method of diagnosing BPB and differentiating it from other primary or metastatic lung malignancies.
Aims: To present and discuss the etiology of three distinct episodes of thumb felon in a fur industry worker, in association with the required precautions. Case Presentation: A 61-year-old man working in a fur industry was treated for three distinct episodes of a felon of the right thumb within an 8-month period. He was treated successfully with surgical drainage and antibiotics following each episode. He was symptom-free and returned to work about two months following each episode. Felon formation, in all cases, was due to a Streptococcus constellatus infection secondary to mink hair penetration through the distal nail groove of his thumb. Using protective gloves, no further relapses have occurred during a 5-year follow-up. Discussion: A felon is an abscess of the pulp of a finger or thumb usually due to percutaneous trauma. Streptococcus constellatus, which is included in the Streptococcus milleri group, is often associated with various pyogenic infections. In the reported case, the lack of hand protection during fur processing was the cause of mink hair infiltration into the pulp of the patient’s thumb through the distal nail groove and of the three episodes of felon formation due to the secondary infection by Streptococcus constellatus. Conclusion: Lack of hand protection during fur processing could make hands vulnerable to micro-injuries and secondary infections.
Aims: To report a rare clinical case of gliomatosis cerebri, which presented with non-specific clinical, laboratory, and radiological findings. We provide images and stress the importance of differential diagnosis based on imaging, especially magnetic resonance (MR) spectroscopy. Case Presentation: A 73-year-old woman developed a right hemiplegia suggestive of ischemic stroke. Cerebral magnetic resonance imaging (MRI) highlighted a diffuse tumor-related infiltration involving several lobes without contrast enhancement, corresponding to the specific description and definition of gliomatosis cerebri type 1. With the aid of MR spectroscopy, we correctly diagnosed the disease preoperatively, which was finally confirmed pathologically by stereotactic biopsy. During radiological follow-up, a contrast enhancement occurred on cerebral MRI, suggestive of progression to a gliomatosis cerebri type 2. Given a poor performance status, this elderly patient received palliative treatment. Discussion: Gliomatosis cerebri is a relatively rare but well-known entity, which affects mostly middle aged patients. It often presents with confounding clinical and imaging features, thus additional examinations such as MR spectroscopy are almost always necessary before reaching the correct diagnosis before biopsy. Conclusion: Contrast enhancement on cerebral MRI, which is usually absent, is found in case of transformation from type 1 gliomatosis cerebri to type 2. Some features on MR spectroscopy are helpful for gliomatosis cerebri diagnosis: N-acetylaspartate levels are diminished, levels of myoinositol are significantly elevated, but Cho/Cr ratio may be normal.
Biologic agents have become important treatment options for the management of inflammatory bowel disease (IBD). With more than 10 years of experience behind us these agents have changed the natural history of the disease and have established themselves as a valid choice in the repertoire used in treating not only advanced patients but also newly diagnosed ones. We report two cases of ulcerative colitis who developed listeria meningitis after a single dose of infliximab therapy. We also examined the significance of the infection and the known details and morbidity about it. We assessed the close link between the use of biologics and the risk of serious infections in patients with IBD, as well as the published cases in the literature so far. Therefore, despite the excitement and hype surrounding their use we should not forget that these are agents that carry a substantial toll of side effects and this should be kept in mind when the choice of therapy is made.
Aim: The aim of this study is to describe an unusual case of an Epidermoid Cyst (EC) of the tongue treated by a Potassium Titanium Phosphate (KTP) laser. Presentation of Case: A 38 young male patient came to our attention since a little painless swelling, yellowish, on the lateral left side of the tongue. After an accurate clinical examination, a surgical excision with a KTP laser was performed. Control at 7 and 21 days showed a complete healing of lesion and the histological diagnosis was EC. Discussion: EC generally appear like a firm, usually painless swelling that sometimes raises the tongue. In the differential diagnosis of the EC the clinician has to consider a wide range of pathologic conditions that could be classified as development, neoplastic and infective pathologies. Surgical enucleation is the only effective treatment for these kinds of lesions and prognosis is very good, with a very low incidence of relapse. Conclusion: Several techniques are reported in the literature but the use of KTP laser for the excisional biopsy of ORAL EC is very effective, since the relative ease and speed of execution, the compliance of patience, the absence of bleeding and suture.
Aims: Tea (green, oolong, and black) is the second most widely consumed beverage worldwide, second only to water. Aside from a few reported adverse effects, tea, particularly green tea, appears to be beneficial for human health. In the case described herein, a male experienced several transient ischemic attack-like symptoms immediately following the consumption of a cup of high quality oolong tea. A thorough medical evaluation uncovered no evidence of such an attack and leads to the suggestion of a heretofore unreported response to oolong tea. Presentation of Case: A 72-year old male with hypertension and atrial fibrillation, who takes valsartan/hydrochlorothiazide to control hypertension and warfarin to reduce the risk of thrombosis and thromboembolism, presented at the emergency room of a local hospital describing several transient ischemic attack-like symptoms immediately after consuming a cup of oolong tea. His symptoms included presyncope, disequilibrium, bilateral hand parathesias, mild dysphasia, and visual problems (but apparently not presbyopia or amaurosis fugax), all of which had disappeared in approximately two hours after drinking the tea. (Mild presyncope was previously noted by the patient when ingesting a strong green tea.) No unusual features emerged from his physical examination, and his blood work was unremarkable except for elevation of his partial thromboplastin time (39 sec) and prothrombin time (22.5 sec), giving an international reference of 2.0, all consistent with the effects of warfarin. A battery of tests by the emergency room physician, a cardiologist, and a neurologist, e.g. electrocardiogram, brain computerized tomography, 2-dimensional transthoracic echocardiogram, brain magnetic resonance imaging, with and without 20 ml Gadolinium, and a magnetic resonance angiogram, confirmed the earlier diagnosis of atrial fibrillation but disclosed no additional malfunction in his heart. His brain showed no evidence of a prior hemorrhage, and his carotid arteries were clear. Methodology and Results: Analysis of the oolong tea by high performance liquid chromatography and mass spectrometry identified the major catechins and two methylxanthines, caffeine and theophylline, as well as other constituents, but there was no evidence of any extraneous chemicals that could lead to the symptoms. Conclusion: In view of the rapid onset of symptoms after the consumption of oolong tea, bilateral as opposed to unilateral parathesis, and the absence of any evidence of a hemorrhage or the presence of impurities in the tea, we suggest that the transient ischemic attack-like symptoms could possibly be attributable to one or more components of the oolong tea and was not an atypical magnetic resonance imaging-negative transient ischemic attack.
Aim: To see possible association between the chemotherapy, radiotherapy or both with the reactivation of Herpes simplex virus 1(HSV1) in brain which merits further dialogue in the field of current evidence based literature. Presentation of Case: We present a case of 46 years old male patient who developed herpes simplex encephalitis (HSE) while receiving radical chemo-radiation for locally advanced nasopharyngeal carcinoma. Full informed consent was obtained for publication of this case. He was treated with protracted course of anti-virals and is currently leading a healthy life. Study Design: The study is a case report of a rare but important side effect of a common chemoradiation procedure. Place and Duration of Study: The study took place at Comprehensive Cancer Center, King Fahad Medical City. It was reported during June 2013. Discussion: HSV1 causes several disseminated primary infections including herpes labialis, gingivostomatitis, and corneal infections. It is particularly notorious for causing potentially fatal encephalitis. Its reactivation is linked to several environmental factors including chemotherapy and radiotherapy. Conclusion: This case report emphasizes on the possible role of chemo-radiation as causation of this life threatening condition, its early detection, prompt and aggressive treatment.
Background: Prisoners endure some of the worst health outcomes of any population group in the community. Smoking rates among prisoners remain high despite a significant reduction in smoking rates among the general public. This protocol describes a study in which we will assess the effectiveness of a smoking cessation intervention conducted among male prisoners. Methods/Design: 425 male smoking prisoners will be recruited. After completion of a baseline assessment, participants will receive a multi-component smoking cessation intervention comprising two half hour individual sessions of cognitive behavioural therapy and nicotine replacement therapy with either active Nortriptyline or placebo. Blinded follow up assessments will be conducted at 3, 6 and 12 months. Discussion: This study will provide data on the efficacy of Nortriptyline as a smoking cessation aid for male prisoners in combination with a multi-component smoking cessation intervention. No other smoking cessation randomised controlled trials on male prisoners has been published. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR) identifier: #12606000229572. http://www.anzctr.org.au/trial_view.aspx?ID=1329
Aims: To assess the feasibility of using supportive interactive text messages to reduce repeat self-harm, and to reduce the frequency and intensity of suicidal ideation and suicidal behaviour in patients discharged from an Emergency Department (ED) after an episode of self-harm. Study Design: Prospective rater blinded randomised trial. Place and Duration of Study: Sample: ED of Beaumont Hospital, Dublin, Ireland. Methodology: 100 patients presenting with self-harm to the ED will be randomised to receive treatment as usual plus supportive and interactive text messages for three months or to receive treatment as usual. Patients in both groups will be followed up at 1, 3 and 6 months to ascertain frequency and intensity of thoughts of self-harm and self-harming behaviour. Data will be analysed on an intention-to-treat basis using SPSS version 20 for Windows with descriptive statistics, student’s t-test, ANOVA analysis and chi-square tests. Results: We hypothesize that supportive, informative and interactive text messages delivered to patients discharged from an ED after an episode of self-harm will significantly reduce the frequency and intensity of thoughts of self-harm and self-harming behaviour in patients compared with those receiving only follow-up treatment as usual. A secondary hypothesis is that patients receiving the text messages will report an overall satisfaction with the text messaging system. Conclusion: This is a low cost, simple strategy which, if shown to have a significant impact on reducing rates of self-harming thoughts and behaviours in patients who have self-harmed, will allow progress in an area of great clinical importance. Further larger studies could then progress to clarify the potential impact on suicide rates.
Aims: The purpose of this study was to investigate whether we can quickly, effectively, and with relatively low cost, heal long-standing (>8 months) diabetic foot ulcers using autologous skin fibroblasts. Place and Duration of Study: Immunology & National Histocompatibility Department and 2nd Department of Surgery, ‘G. Gennimatas’ General Hospital, ‘Demetrios Voyatzoglou’ Diabetic Foot Clinic, ‘A. Fleming’ General Hospital, Department of Biology, National and Kapodistrian University of Athens, Athens, Greece, between June 2011 and May 2012. Study Design and Methodology: Early, autologous skin fibroblasts arisen in large numbers from small split-thickness skin biopsies, cultured in high concentration of fetal bovine serum, and dispersed in patientsÎ„ own serum, were injected subcutaneously into the surrounding healthy tissue of uninfected diabetic foot ulcers of two type 2 diabetic patients without peripheral angiopathy. Results: There was complete healing in 11 and 27 weeks in patients 1 & 2, respectively. The early cultured fibroblasts showed impressive healing power for diabetic foot ulcers. On the contrary, the power of the prolonged cultured fibroblast diminished steadily, while the fibroblasts undergone the freezing-thawing procedure were not effective. Conclusion: The healing was complete, quick, safe, permanent, without scars or hyperkeratosis, and relatively inexpensive.
Aims: The aim of this study is to investigate the long-term efficacy of sitagliptin added to insulin in type 1 or type 2 diabetic patients with absolute insulin deficiency. Study Design: 48 weeks open-label, observational study. Place and Duration of Study: Department of Internal Medicine, Gyoda General Hospital, between June 2010 and December 2012. Methodology: Sitagliptin 25-100 mg/day was added to the ongoing insulin therapy in those without any detectable post-meal C-peptide levels. HbA1c and other parameters were followed for 48 weeks. Results: Effective reductions of HbA1c levels were already observed at 12 weeks and sustainable throughout the study period. However, 2 subjects had severe hypoglycemic evens. Post-meal C-peptide remained undetectable with all the subjects. Interestingly, significant increases of body weight were observed. Conclusion: Sitagliptin as an adjunct to insulin in patients with absolute insulin deficiency may be effective and sustainable for at least 48 weeks, allowing for less intense therapy. However, it should be noted that some patients may have severe hypoglycemic events. In spite of the significant glycemic effects of sitagliptin in the setting of this study, endogenous insulin secretory capacity remained absent, suggesting that the glucose lowering effect of this drug may be mediated through GLP-1 independent pathway as well.
Cervical cancer is one of the leading causes of death from cancer among women worldwide and is the most common female cancer in developing countries. In Jamaica, at 27.5 per 100, 000 it is second only to breast cancer as a cause of cancer death in women. Several studies have suggested an association between blood type A and cervical dysplasia/cancer. The aim of this study was to determine whether presence of cervical dysplasia/cancer is associated with blood type A in Jamaican women. Blood was collected from 319 women, 234 cases (abnormal Pap smears) and 85 controls (normal Pap smears). Blood type was determined by the determination of isoagglutinins (anti-A and anti-B). The frequency of types A, B, AB and O in the controls and cases was similar to the Jamaican population. There was a slightly association between blood group O and cervical dysplasia/ carcinoma in Jamaican women when compared with others blood groups. Cervical dysplasia/ carcinoma was strongly associated to the number of sexual partners, number of biological fathers, number of children and the use of hormonal contraceptive.
Aims: The hierarchy of evidence-based medicine determines the inferential powers of different clinical research designs. We want to address the difficult question if observational evidence under some circumstances can validate intervention effects. Methodology: Assessment of previous argumentation aiming at a clear conclusion for future decision-making. Results: We present five arguments demonstrating the fundamental need of randomized clinical trials to sufficiently validate intervention effects. Furthermore, we argue that hindrances to the conduct of randomized clinical trials can be lessened through education, collaboration, infrastructure, and other measures. Our arguments validate why the randomized clinical trial should and must be the study design evaluating interventions. By choosing the randomized clinical trial as the primary study design, effective preventive, prognostic, diagnostic, and therapeutic interventions will reach more patients earlier. Conclusion: Clinical experience or observational studies should never be used as the sole basis for assessment of intervention effects — randomized clinical trials are always needed. Therefore, always randomize the first patient as Thomas C Chalmers suggested in 1977. Observational studies should primarily be used for quality control after treatments are included in clinical practice.
Aims: To evaluate the symptomatic efficacy and safety of Lafaxid™ (lafutidine 10 mg) in Indian patients with Acid Peptic disorder (APD). Study Design: An observational, prospective, uncontrolled, open-label multi-centric study. Place and Duration of Study: Patients were recruited from 12 cities across India by 61 investigators, between October 2010 and December 2011. Methodology: We included 1500 patients (973 men, 527 women; age range 15-85 years) with Acid Peptic disorder. Lafutidine (10 mg tablets) was prescribed by the physicians as once daily dose (OD) for 28 days. The efficacy was analysed based on the change in the symptom baseline score on the 100 point Visual Analogue Scale (VAS) for individual symptoms, and the safety was determined based on adverse events reported during the study with the prescribed usage of lafutidine on day 14 and day 28 after start of the treatment. Results: Lafutidine monotherapy was given to 1378 patients. A very high reduction in the mean VAS score was observed from baseline for individual symptoms, viz. nausea, vomiting, belching, heart burn, epigastric pain, acid regurgitation, abdominal bloating & loss of appetite at the end of the study. The global mean VAS score (a sum of individual symptom VAS score) of these patients decreased from 120.34 ± 67.58 to 14.18 ± 26.97 at the end of the study (P < .001). There were 124 APD patients, previously treated but uncontrolled, with acid inhibitors like PPIs, H2RAs etc., also showed a significant reduction (157.42 ± 83.88 to 26.47 ± 46.34) in the VAS score on day 28 (P<.001). During the entire study, adverse events of mild and moderate nature were observed in 0.4% (6 patients) of the total patient population. Conclusion: The present study demonstrates that therapy with Lafaxid™ is symptomatically effective and well tolerated in patients with APDs.
Aims: To present the case of a patient with early-onset demyelinating neuropathy due to a MPZ-mutation, associated with deafness and inclusion-body-myopathy. Methods: Nerve conduction studies, electromyography, muscle biopsy, genetic testing. Results and Discussion: In a 46yo male with slowly progressive weakness and wasting since childhood initially of the lower and later also of the distal upper-limbs, ptosis, recurrent hyper-CK-emia, and progressive hearing impairment, nerve conduction studies revealed mixed demyelinating and axonal polyneuropathy and electromyography revealed neurogenic motor unit architecture. Nerve biopsy disclosed diffuse loss of myelinated fibers, reduced diameter of non-myelinated fibers, and fibers with hypomyelination and variable internodal myelination. Muscle biopsy revealed classical features of inclusion-body-myopathy. Upon genetic diagnostic work-up the MPZ-mutation c.320A>T, p.Glu107Val was detected. Since his son presented with a similar phenotype, inclusion-body-myopathy was interpreted as secondary to the neuropathy. Conclusions: CMT1B may show secondary axonal loss and mild clinical manifestations despite early onset. CMT1B may be associated with severe hearing impairment and collateral inclusion-body-myopathy.
Aims: Antiphospholipid syndrome (APS) is a systemic autoimmune disorder characterized by vascular thrombosis. Pulmonary changes regarding interstitium and airways have not been described in APS. Our aim was to determine the prevalence of nonthrombotic pulmonary CT manifestations in patients with APS. Study Design: Prospective study. Place and Duration of Study: Department of Pneumonology, First Department of Internal Medicine, Department of Cardiology, Department of Radiology Medicine, between June 2009 and May 2011. Methodology: Ten patients who met criteria for APS (5 primary and 5 secondary to systemic lupus erythematosus) were prospectively identified. All patients underwent chest high-resolution computed tomography (HRCT) and functional assessment including spirometry and 6-minute walking distance. Patients were free of respiratory symptoms. HRCT scans were evaluated for presence of air-trapping, subpleural reticular pattern, centrilobular nodules of ground-glass opacity, cysts, emphysema, atelectasis, consolidation and pleural effusion. Extent of air-trapping was estimated based on a HRCT scoring system. Results: All patients exhibited radiological and functional pattern compatible with small-airway disease, irrespective of smoking status. HRCT findings were negatively correlated with reduced levels of maximum midexepiratory flow (MMEF) 25/75%pred (r=-0.936, p<0.0001). Subpleural basal reticular pattern consistent with fibrosis was seen in 3 patients. Thin-walled cysts and upper-lobe hazy micronodular pattern were detected in 4 patients. Conclusion: CT findings of patients with APS may include air-trapping, subpleural reticular pattern, centrilobular nodules of ground-glass opacity and lung cysts irrespective of smoking history and SLE coexistence. HRCT and functional assessment may be valuable tools in evaluating APS patients.
Aims: Berberis lycium (Sumbal) is abundantly available in the northern areas of Pakistan and extensively used in local practice for the treatment of several human diseases. The objective of this study was to explore pharmacological basis for its use in gastrointestinal disorders. Materials and Methods: Crude aqueous (Bl.Aq) and methanolic (Bl.Meth) extracts of B. lycium were studied on isolated gut preparations of rabbit (jejunum) and guinea pig (ileum) by using in-vitro techniques. Tissues were mounted in tissue organ baths assembly containing physiological salt (Tyrode's) solution, maintained at 37ºC and aerated with carbogen, to assess the spasmogenic and spasmolytic effect and to find out the possible underlying mechanisms. Responses were measured on BioScience Powerlab data acquisition system by using isotonic transducers. Results: Phytochemical analysis indicates the presence of alkaloids, tannins and saponins in Bl.Aq and Bl.Meth. when tested on spontaneously contracting isolated rabbit jejunum, showed a dose-dependent spasmogenic effect at lower concentration (0.01-0.1 mg/mL) and (0.01-0.03 mg/mL), which was followed by spasmolytic effect at higher concentration (0.3-1.0 mg/mL) and (0.1-0.3 mg/mL) respectively. Pretreatment of the tissue with atropine (0.1 µM) partially suppressed the contractile effect. Bl.Aq and Bl.Meth caused complete inhibition of high K+ (80 mM)–induced contraction at 0.3 mg/mL and 0.1 mg/mL respectively and also produced a dose-dependent (0.01-0.03 mg/mL) rightward shift in the Ca++ concentration-response curve, similar to verapamil. When tested in bolus protocol on isolated guinea pig ileum, Bl.Aq and Bl.Meth caused a dose-dependent spasmogenic effect at 0.01-0.1 mg/mL. Pretreatment of tissue with atropine (0.1 µM) partially suppress the contractile effect. Conclusions: Results indicate that spasmogenic effect was partially mediated through cholinergic activity and spasmolytic effect was mediated through calcium channel blocking activity (CCB), explain its traditional uses in diarrhea, intestinal cramps and other gastrointestinal intestinal disorders.
Aims: To determine the 10-year overall survival (OS) in triple-negative (TN) and non-TN breast cancer (BC) patients, and to identify associated independent prognostic factors. Study Design: Descriptive and survival. Place and Duration of Study: Pathology Division at National Cancer Institute, Rio de Janeiro, Brazil, between 1992-1996. Methodology: Population: 348 women patients with invasive ductal carcinoma without lymph node metastasis. Analyzed variables: age, treatment, surgery type, tumor size, skin involvement, histological grade, vascular invasion, estrogen and progesterone receptors, HER-2, Ki-67 and p53. Statistical analysis performed: Kaplan-Meier survival curves, log rank test, and multivariate Cox models. Results: 27% of the studied women were categorized as TNBC and 73%, as non-TNBC. The former showed higher frequency of age <50yr, preoperative chemotherapy, tumors >5cm, high grade, vascular invasion, and positive p53, (P=.05). Ten-year OS among TNBC patients was 61.6%, and 70.1% for non-TNBC patients (P=.058). Survival was higher in TNBC patients treated with partial surgeries, tumors ≤5cm, without skin involvement, low grade, and Ki-67 negative (P=.05). Among non-TNBC patients, higher survival was observed in patients without skin involvement, low grade, no vascular invasion, and p53 negative, (P=.05). Cox modelization showed a 2-fold higher death risk for TNBC patients aged ≥50yr, about 2.5-fold higher risk related to preoperative chemotherapy, high grade tumor and skin involvement, and a 3.0-fold higher risk for Ki-67 positive patients (P=.05). For non-TNBC patients, a 2.0-fold increased death risk was verified in patients with skin involvement and vascular invasion (P=.05). Conclusion: TNBC patients showed a worse prognosis and survival when compared to non-TNBC patients. A worse 10-yr survival among TNBC patients was associated with age ≥50yr, preoperative chemotherapy, skin involvement, high histological grade, and Ki-67 positive tumors. For non-TNBC patients, the worst prognosis was related to skin involvement and vascular invasion. These predictors need to be further validating by other studies.
Aims: Few data exist on kidney dysfunction (KD) and glycoprotein IIb/IIIa inhibitors (GPI) in acute coronary syndrome (ACS) patients treated by percutaneous coronary intervention (PCI) and whether they impact on long-term outcome since most frequently patients with various degrees of KD are excluded. Study Design: Comparison of independent but concomitant arms of a randomized investigation on GPI. Place and Duration of Study: The Sant’ANna TIrofiban Safety study (SANTISS www.clinicaltrials.gov Identifier: NCT00566891) was an open-label investigator-initiated single centre registry at Sant’Anna Hospital, Catanzaro, during a 5-year enrollment period. Methodology: We considered 726 ACS patients with PCI under either triple (aspirin, clopidogrel including high-dose tirofiban) or double (aspirin and clopidogrel) anti-aggregating drugs (AAD). Serum creatinine levels, creatinine clearance (CrCl, using the Cockcroft-Gault formula) and estimated glomerular filtration rate (eGFR, using both MDRD and CKD_EPI formulas) were used as continuous co-variables. Cox’s proportional hazards model tested the multivariable contribution of covariates all fitted simultaneously (forced method) in order to predict the incidence of 1-year cumulative ischemic events (CIE). Results: There were 69 (9.5%) 1-year CIE. Incidences were 5.4, 9.8 and 13.4% (P=0.012) in CrCl tertiles 1 (96-216 ml/min), 2 (73-95 ml/min) and 3 (15-72 ml/min), respectively. Compared to CrCl, the percentile distributions of eGFR, by MDRD or CKD_EPI formulas were similar: all were comparable and significant predictors multivariately (p<0.001) of long-term CIE. The presence of diabetes (hazard ratios, HRs 1.84-1.91), intra aortic balloon pump (HRs 3.59-4.03), and thrombolysis (a protective factor) by tenecteplase (HRs 0.30-0.30) were further significant risk factors. With high-dose tirofiban there was a 20% lower but not statistically different incidence of 1-year CIE. Conclusion: KD assessed by CrCl or eGFR in ACS patients treated by PCI equally predicted and similarly impacted on 1-year CIE, independent of the formula adopted for eGFR calculation and the presence of GPI with high-dose tirofiban
Purpose: Injury rates and injury risk factors were examined for the first time among cadets undergoing Summer Warfare Annual Basic (SWAB) training at the U.S. Coast Guard Academy (USCGA). Methods: Participants were 778 men and 286 women from four years of SWAB training. Before SWAB training, the subjects were administered a Physical Fitness Assessment (PFA) (2-minute maximal effort sit-ups and 1.5 mile run) and functional movement screening (FMS) test. Height and weight were measured and, gender, age and ethnicity were obtained from administrative records. Training-related injuries were compiled from student medical records. The diagnosis, body part location, disposition, and limited duty days were recorded for each clinic visit. Results: During the 8 weeks of SWAB training, 23.8% of the women and 18.4% of the men were injured at least once. Compared to the men, the odds of an overall injury among women was 1.39 (95% confidence interval= 1.00-1.92). The odds of an overuse injury among women was 1.72 (95%confidence interval= 1.21-2.43) times higher than the men and the number of limited duty days for overuse injuries was also higher among the women (p <0.01). Independent risk factors for injuries among both men and women included lower aerobic fitness and lower functional movement screening scores. Conclusions: Female USCGA cadets were at higher risk of injuries, especially overuse-type injuries. Specific factors that put cadets at higher injury risk included lower aerobic capacity and inefficient movement strategies. Future injury studies should focus on females, aerobic fitness, and movement strategies. Prevention strategies should be tested to reduce injuries to limit lost training time.
Aims: The homeoprotein TGIFLX (transforming growth factor-β-induced factor 2-like, X-linked), which is essential in male reproduction and development and likely oncogenic when aberrantly expressed in prostate. We have previously shown an aberrant expression of TGIFLX in the majority of human prostate tumors. However, mechanism by which TGIFLX acts in prostate cancer is unknown. The aim of this study was to investigate the effects of overexpression of wild-type TGIFLX (wt-TGIFLX) on LNCaP, human prostate adenocarcinoma cells. Study Design: As a prospective study, we used adenovirus expression system for evaluation of TGIFLX expression effects on mammalian cells. Place and Duration of Study: Medical Genetics Department, Tehran University of Medical Sciences (TUMS), between December 2009 and July 2012. Methodology: We cloned entire coding sequence of TGIFLX gene into adenovirus and subsequently LNCaP cells were transfected with the recombinant virus harboring TGIFLX cDNA or control. The TGIFLX expression was confirmed by microscopic analysis and RT-PCR technique. Following molecular cloning and characterization of TGIFLX transcription factor, we then studied the effects of overexpression of TGIFLX in LNCaP cells on mRNA expression of BAX and BCL2 genes. Results: Our results showed that overexpression of TGIFLX downregulated BCL2 gene (P<0.05) and upregulated BAX gene (P<0.05) at transcript level. Our results suggested that TGIFLX could be a tumor suppressor gene and might be involved in initiation and/or development. Conclusion: TGIFLX can play a role as a transcriptional modulator of the genes involved in cell cycle pathway. But still more investigations are necessitated for clarifying this claim.
Aims: To assess the contribution of electron microscopy in the process of muscle biopsies evaluation for dermatomyositis. Study Design: Retrospective review of muscle biopsy cases. Place and Duration of Study: Pathology Department of King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia from January 2008 to January 2012. Methodology: Samples from cases suspected to have dermatomyositis were reviewed for light and ultrastructural morphological examination. Tubuloreticular inclusions (TRI) were considered present if these undulating tubules were detected in the endothelial cells of the capillaries. Results: Out of ten cases that were suspected for dermatomyositis, three cases showed classical light microscopic features of dermatomyositis, two of which showed TRI. Among four cases with non-specific light microscopic features that can be seen in dermatomyositis, TRI were detected in two of these four cases. Among three cases with non-contributory light microscopy, TRI were found in all of these three cases. Conclusion: Electron microscopy -if feasible- may be useful in the screening of muscle biopsies, when clinically or morphologically suspected inflammatory myopathies are considered. Further studies to assess the significance of TRI with a larger number of cases, clinical data correlation and immunostains are needed.
Aim: Detection of keratometric differences induced by daily wear of second generation silicone hydrogel (SiH) contact lens (CL) with hydraclear. Study Design: Prospective cross-sectional study. Methodology: The researchers investigated the difference between the keratometric values at equivalent spherical and cylindrical diopters of daily wearers of second generation SiH CL and those in an age-matched control group who wear only spectacles because of SiH CL’s stiffer moduli. The study also examined the effect of second generation SiH CLs on the corneal topography. Seventy asymptomatic, biomicroscopically normal eyes of SiH CL wearers and 70 eyes of non-lens wearer control subjects have been included in this study. The SiH CL wearers have been wearing lenses in the range of less than 6 months to 3 years. General Linear Models (GLM) with type III sum of squares was used (SPSS 15.0 for Windows). Results: Statistical analysis showed no significant difference between two groups regarding keratometric values (p > 0.05). Conclusion: Results suggest that daily wear of second generation SiH CL with hydraclear, which havemoderate modulus and higher oxygen permeability, does not affect the central keratometric readings.
Long QT Syndrome (LQTS), a disorder of the cardiac repolarization process with prolongation of the QT interval (QTc ≥0.46 seconds), is an ion-channelopathy. Mutations in either KCNQ1 or KCNE1 genes are susceptible to LQTS. Hence, screening of KCNQ1 and KCNE1 genes is taken up to evaluate the genetic correlation of these genes in Long QT patients of Indian origin. A total of 33 Long QT Syndrome patients and 100 healthy subjects were enrolled for the present study. PCR-SSCP protocol was utilised for screening of KCNQ1 and KCNE1 genes followed by In-silico and statistical analysis. The clinical profile of the Long QT syndrome patients in our study revealed a higher percentage of females with the mean age also being higher in females when compared to males. The two variations (S546S and IVS13+36A>G) in KCNQ1 and the S38G polymorphism in KCNE1 gene were identified and their association with Long QT syndrome is being reported for the first time in Indian population. S546S is located in the KCNQ1 C terminus close to this domain and IVS13+36A>G is located in the intronic region in close proximity to the coding region for C-terminal domain; these may therefore affect the functional protein through non-assembly. S38G leads to a substitution of serine to glycine at 38th amino acid position (S38G) in the transmembrane domain of KCNE1. Our study reports compound heterozygosity/genetic compound ofS546S and IVS13+36A>G of KCNQ1 gene. Haplotype frequencies and linkage disequilibrium analysis revealed a significant association between the three biomarkers. Compound heterozygosity of the polymorphisms influence downstream signalling and KCNQ1-KCNE1 interactions.
Background and Objectives: There is paucity of reliable information on knowledge about hypertension and cardiovascular disease (CVD) risk factors in rural southwestern Nigeria. This study assessed the level of awareness, basic knowledge and management of hypertension and CV risk factors among people living in rural south western Nigeria. Methods: A population based cross-sectional survey was conducted in Egbeda local government area of Oyo State, Nigeria. A structured questionnaire was used to interview 2000 subjects in order to assess knowledge of various aspects of modifiable CV risk factors. Results: The commonest source of medical information was the family/friend/opinion leaders of trusted groups in 1198(59.9%), the media (including radio, public enlightenment programmes, and newspapers) in 492(24.6%), and the doctor/nurse/health worker in 183(9.1%) of the respondents. The overall knowledge of CVD and its risk factors was poor. About 56% of the respondents could not identify a single risk factor. Of those who were able to, only a few could correctly identify the relationship between CV risk factors and CVD with some misconceptions. . We found that subjects who had more years of formal education, a positive family history of CVD, and self reported history of diabetes mellitus were more likely to have a good level of knowledge of hypertension and other CV risks when adjusted for age, gender and marital status. Conclusion: Our study confirms a limited knowledge and misconceptions of CVD and its risk factors in this population. Early detection and preventive practices were significantly lacking due to these gaps in Knowledge. There is an urgent need to design and implement culturally appropriate public awareness, health educational and health promotional programmes about CV risk factors and CVD for this community which can be adapted for other rural population in the country.
Aims: We studied the variability in telomere length in cord blood collected from newborns of different birth weights and gestational ages. Study Design: Prospective cohort study. Place and Duration of Study: Samples were collected from KK Women’s and Children’s Hospital between March 2011 and March 2012 and the terminal restriction fragment assays (TRF) were performed at the Department of Physiology, National University of Singapore. Methodology: Cord blood samples were prospectively collected in EDTA or heparin tubes for deliveries from Chinese parents. TRF assays were performed on genomic DNA extracted from whole blood. Data was collected for birth weight, gestational age, and maternal age. Variance analyses of telomere lengths and correlation coefficients were calculated using Statistical Package for the Social Sciences (SPSS). Results: The birth weight of the samples collected ranged from 0.61 kg to 5.18 kg with gestation age from 196 to 288 days. TRF results from 184 samples (96 males, 88 females) showed that there was a wide range from 6.6 kbp to 19.2 kbp. The mean TRF length was 12.64 kb (males: 12.33 kb ± 2.50; females: 12.99 kb ± 2.35). There was no statistically significant correlation of TRF with birth weight, gestation age or maternal age. There was highly significant correlation of birth weight with gestational age (P=0.00). Conclusion: Our results showed no correlation of either gestational age or birth weight with telomere length as measured by TRF assay.
Trichoepithelioma multiplex is a rare, benign cutaneous genodermatosis of disputed histogenesis, consisting of tumors of trichogenic origin. Aim: To explore the relationship between the anatomical location and the histopathological features of the trichoepitheliomas in a patient cohort with Trichoepitheliomamultiplex. Methods: The study was conducted over the period 1995-2008 at the tertiary Dermatology and Anatomical Pathology referral centers of the University of Pretoria. The clinical and pathological features of confirmed cases were assessed. Sixty four H&E stained sections from skin lesions distributed over different body areas were examined with regard to 16 histopathological parameters for the evidence of follicular differentiation and features useful in distinguishing trichoepithelioma from basal cell carcinoma. Special stains were employed for the demonstration of mucin (PAS, Alcian blue) amyloid (Congo red) calcium (Von Kossa) and epithelial structures (AE1/AE3-CK antibodies). Results:Trichoepithelioma multiplex was an uncommon diagnosis (20 patients). African patients were preponderant (16 vs.4 Caucasians) with slight male predominance (11 vs. 9 females). Sporadic cases prevailed (15 vs. 5 familial cases).A wide variation in the severity of the clinical presentation was observed, young black males and familial cases being more severely affected. The face was involved in all cases (30 biopsies), followed by the scalp and back (13 biopsies each) and the neck (8 biopsies). There were variations in histopathological patterns with considerable overlap between them. Special stains differentiated between the tumours from different body areas with the exception of AE1/AE3-CK antibodies. Foreign body reactions were common in lesions showing many keratinous cysts and follicular damage. Trichoepithelioma was seen in relation to a benign pigmented intradermal nevus in one biopsy and adjacent to a basal cell carcinoma in two cases Conclusion: A positive correlation could be established between the histopathological pattern of trichoepitheliomas and the body area from which the lesions were removed.
Background: Puberty is a developmental stage of increased insulin resistance that also is a critical period for bone mass accrual. Historically, African Americans (AA) have lesser risk for osteoporotic fractures compared to European Americans (EA). AA also have higher incidence of insulin resistance. The possibility that bone health and insulin secretion or concentrations are linked has not been investigated. Aims: We aimed to examine the associations of bone mineral density (BMD) and bone mineral apparent density (BMAD) with insulin sensitivity and secretion in healthy adolescent girls and healthy female adults and to evaluate ethnic differences in these associations. Study Design: Observational cohort design. Place and Duration of the Study: University of Alabama at Birmingham, between January 2010 and September 2011. Methodology: Healthy, female, non-smoking adolescents and young adults (14-55 years) were enrolled in this observational cohort study. Results: Adolescents had significantly higher fasting insulin (P=0.0002), insulin area under the curve [AUC] (P= 0.0004) and lower insulin sensitivity (P=0.0005) compared to adults. Among adolescents, AA race was significantly associated with BMD (β=0.086, P=0.01) and BMAD (β=0.0075, P=0.002); however, adjusting for insulin AUC explained this difference. Insulin AUC (β=0.0006, P=0.029) and fasting insulin (β=0.0005, P=0.01) were positively associated with BMAD only in AA adolescents. Insulin AUC and fasting insulin were not significant predictors of BMD for adults. Conclusion: The higher insulin concentration among AA adolescents is associated with increased BMD and higher BMAD.
Aims: The study was carried out to establish standard anthropometric values for stature estimation by using hand length in the three major ethnic groups in Nigeria. Study Design: Cross-sectional study. Place and Duration of Study: University of Maiduguri, Borno State, Nigeria between January - April 2010. Methodology: A total of 407 right hand dominant students (210 males and 197 females) aged 18 – 35 years who were purely of Hausa, Igbo and Yoruba origin by both parents and grandparents, are included in this study. Each person has been studied for measurements of stature, hand length and handbreadth. Results: No significant difference was observed in stature and hand dimensions between the Igbos and Hausas. However the Yorubas are significantly shorter and have shorter hands than the Igbos and the Hausas. The males are significantly taller than the females in all the three tribes and have longer hands than the females in the Hausas and Igbos. Both the sexes of Yorubas are significantly shorter than the Hausas and have significantly shorter hands than the Hausas and Igbos when comparison was made between same sexes. The Yoruba females have shorter but wider hands than the Hausa females. No significant difference was observed in stature and hand dimensions between the Hausas and Igbos when compared between same sexes. Regression equations for estimation of stature were formulated for each ethnic group and both sexes. Conclusion: The study supports the fact that variations are present not only between races but also among ethnic groups, thus formulae derived for one ethnic group and both sexes may not be applicable to other ethnic group and sex. This study therefore provides standard anthropometric values and regression equations for the three major ethnic groups in Nigeria.
Background: Nephrotic syndrome (NS) is a common childhood kidney disease caused by impaired glomerular function, characterized by protein leakage from the blood to the urine through the glomeruli, resulting in proteinuria, hypoalbuminemia, hypercholesterolemia and generalized edema. NS is descriptively classified upon the patients’ response to steroid treatment as steroid-sensitive NS (SSNS) or steroid-resistant NS (SRNS). Aim: describe and compare different management strategies for SRNS. Methods: This retrospective study included 53 SRNS who were attending the Nephrology Outpatient Clinic, Children's Hospital, and Cairo University for follow-up. Results: out of 53 SRNS patients, 29 (54.72%) patients showed complete response to immunosuppressive therapy, while 14 (25.42%) showed partial response and the remaining 10 (18.87%) showed no response. Conclusion: Partial response to steroids or to first line of immunosuppressive therapy predicts better response to further immunosuppressives in SRNS patient. Cyclophosphamide is a preferable line in MCNS as it gives good results (50% complete response) with the advantage of lower cost and shorter duration of use. In patients with non-minimal change lesions or those who failed to respond to cyclophosphamide, cyclosporine is used.
Aims: In view of significant role of osteocalcin and adiponectin in the onset of insulin resistance and diabetes in rat model and cell line studies we aimed to study the influence of family history for diabetes on osteocalcin and adiponectin levels and their role in initiating the changes in diabetic markers in healthy adult springs of diabetic parents, thus a hypothesis can be drawn on their role in developing diabetes in high risk population. Methodology: Age between 18 to 22 years was selected and divided into three groups. Group I: control group consists (n=81) with no family history of diabetes. Group II: (n=147) with one of their parents with history of type 2 diabetes. Group III: (n=47) with both parents having history of type 2 diabetes. In all the groups we estimated fasting plasma glucose, lipid profile, insulin and adiponectin and osteocalcin. Results: We observed significant lower levels of adiponectin 8.7 ± 1µg/ml in group-III and 9.5 ±1.3 µg/ml in group-II when compared to control 11.0 ± 1.2 µg/ml (p<0.01) and HOMA-IR in children of diabetic parents had a statistically significant correlation with plasma Adiponectin with Pearson’s coefficient -0.504. Through linear regression analysis parental diabetes influences plasma adiponectin p <0.01 (B -1.50, 95% CI -1.79 - -1.20) but not osteocalcin P>0.05 (B .313, 95% CI -.114 - .740) levels in children of diabetic parents. Conclusion: family history for diabetes does not influence osteocalcin levels but may influence adiponectin gene expression leading to a decrease in its plasma concentration, which might play a key role in developing diabetes in near future.
Aims: This study was carried out to evaluate the knowledge and use of disinfection policy in government hospitals in south-east geopolitical zone of Nigeria and to compare the three categories of government hospitals. Study Design: This was a descriptive, cross sectional study. Place and Duration of Study: Intensive Care Units and Special Care baby Units (SCBU), Departments of Pharmacy (Compounding/Storage Unit), Medical Laboratory Services, Surgery, Obstetrics and Gynecology, between February and May 2012. Methodology: A structured self administered and pre-tested questionnaires were administered to 200 randomly selected healthcare workers which included 40 Pharmacists, 59 Nurses, 55 Resident/General Practice Medical doctors and 46 Medical laboratory scientists, employed full-time in selected government hospitals in southeast geopolitical zone of Nigeria. Results: The sample size and the response rate were 200 and 100% respectively. About 53.3% of the respondents have heard of the policy, but only 24.5% of them actually know what it means. Only about 22% of all the respondents have applied the policy. The study also reveals that the level of knowledge of disinfection policy is not significantly related to the level of its application by the healthcare workers in the southeast (P-value 0.143, for chi-square and 0.49, for Pearson Correlation). Up to 78% of the healthcare workers have an idea about the different levels of disinfection. The University Teaching Hospitals seem to have better knowledge and use of the policy than the Federal Medical Centres and the General Hospitals. Conclusion: The knowledge of disinfection policy among the healthcare workers and its application is poor. This is worst in General Hospitals. There is therefore urgent need for a national policy on disinfection and health workers’ education or training on the policy and its application in all hospitals in the nation.
Background: The prevalence of Helicobacter pylori is typically higher in developing countries like Saudi Arabia. Aims: To estimate the prevalence of H. pylori among patients suffering from upper gastrointestinal (GI) symptoms, know the main risk factors leading to infection, and detect the clinical, endoscopic and pathological changes of the gastric mucosa of patients infected with H. pylori. Place and Duration of Study: This is a five-months prospective study conducted in King Fahd Hospital, Al-Madinah, Saudi Arabia. Methodology: H. pylori status in patients was determined by two biopsy based tests (histology and rapid urease test) as invasive tests and by a serological testing (ELISA IgG) as non-invasive test. Results: The age of the selected 68 patients ranged from 18-70 years with a mean age of 37.9 ± 14.15 years. H. pylori was more prevalent among males than females (70.5% vs 29.5%, p=0.020) and among age group (18-< 30) years. No significant difference was estimated between positive and negative HP cases in residency, work status, marital status, smoking, socioeconomic level and aspirin intake. The most common complaints in the selected patients having endoscopy were: epigastric pain, heart burn, and dyspepsia. A significant correlation was detected between H. pylori and each of age, sex and Diabetes Mellitus. The most prevalent endoscopic findings of the positive H. pylori cases were mild gastritis (84.1%). There was a significant difference in gastritis (p=0.003) and duodenitis (p=0.031) between positive and negative cases for H. pylori histopathology. The prevalence of H. pylori was 60.29% by rapid urease test, 64.7% by histopathological examination and 67.6% by serology among the studied cases. Conclusion:H. pylori-infected patients with upper GI symptoms were found to have more abnormal endoscopic and pathological findings than those without H. pylori infection.
Aim: It is highly intricate to categorize a solitary or prevailing factor for pathophysiology of varicocele. Herein, the basis of free radicals in the pathogenesis of varicocele was assessed. Study Design: Experimental using animal models. Place and Duration of Study: Department of Anatomy, College of Medicine, Lagos State University, Ikeja, Lagos, Nigeria, between April, 2012 and August, 2012. Methodology: Five (5) groups of rats were used, Group A animals served as the control, while Groups B, C, D and E animals were varicocelized. Groups C, E and E in addition, had intramuscular treatment of 25 mg/kg, 50 mg/kg and 75mg/kg body weight of α-tocopherol respectively. The models were sacrificed on 65th day and Testicular weights and volumes, sperm parameters, histology, morphometry, enzymatic and non enzymatic antioxidants were vastly estimated. Result: There was a significant (p<0.05) increase in activity level of SOD (5.92±4.1), CAT (380.2±7.1) and GPx (0.79±0.8) and a reduced lipid peroxidation evidenced by significant (p<0.05) reduction in level of MDA (18.2±6.1) of the varicocelized rat treated with Vitamin E (75mg/kg b.wt.) when compared to the activity of SOD (3.31±4.1), CAT (361.2±4.5), GPx (0.36±6.1) and MDA (0.36±6.1) of untreated varicocelized models. The geometric values, sperm characteristics and histological profiles threaded the same pattern as the oxidative status. Conclusion: These results confirmed and validated the important role of reactive oxygen in the pathogenesis of varicocelized.
Aims: To evaluate the advantage of full blood cell count as performed 48h post-delivery for the diagnosis of postpartum maternal anaemia. Study Design: Observational retrospective study. Methodology: According to the usual local protocol, haemoglobin assessment is made in all mothers at entry in the labour room (D0), and 2 days post-delivery (D2). The relationship between haemoglobin decrease, anaemia onset, and obstetrical anamnesis has been evaluated by multiple logistic regression analysis. Results: Four hundred and seven (407) parturient women were included. Of them 13.3% (n=54) had >2g haemoglobin loss and were considered having developed undiagnosed postpartum haemorrhage (UDPPH); 10.3% (n=42) had anaemia with <10g/dL haemoglobin at D2. The identified risk factors for postpartum anaemia onset were episiotomy (OR 11.8; 95%CI 4.71-17.5; P <0.001), foetal distress (OR 5.99; 95%CI 2.20-16.3; P <0.001), duration of labour (OR 1.21; 95%CI 1.05-1.40; P<0.008), and presence of perineal and/or vaginal tears (OR 2.9; 95%CI 1.18-7.13; P =0.02). Conclusion: Systematic haemoglobin control in all patients 2 days after vaginal delivery allows the detection and subsequent treatment of UDPPH-related anaemia.
Aims: To evaluate variables and factors linked to attempted suicide in psychiatric patients. Study Design: Case control study. Place and Duration: Psychiatric Department, S. Gerardo Health Care Trust (Italy), between January 2000 and July 2007. Methods: We recruited 32 patients (25 females and 7 males) admitted following a suicide attempt and patients with the same clinical diagnosis and no history of attempted suicide matched for socio-demographic characteristics. We administered 6 tests for the evaluation of personality traits (TCI-R), global psychopathology (SCL-90), quality of life (WHOQOL), Social adaptation (SASS), health (SF 36) and interpersonal relationships (IIP). Results: We obtained statistically significant differences between patients who attempted suicide and patients who did not in two subscales: harm avoidance (TCI-R, p=.021) and environmental area (WHOQOL, p=.036). Conclusion: This study suggests psychiatric patients less prone to inhibiting their behaviours and less afraid of the unknown, having a worse perception of their living environment safety and a poorer economic status may be at higher risk of suicide attempt.
This study was carried out to investigate ABO blood groups association with malaria parasitaemia among students of Igbinedion University, Okada located in Mid-Western Nigeria. Two milliliters (2ml) of venous blood was collected by venipuncture using 5ml hypodermic needles and syringes from 104 asymptomatic malaria students between March and June 2012. Blood samples were immediately dispensed into Ethylene Diamine Tetra-Acetic acid (EDTA) anticoagulated containers and mixed appropriately. ABO blood typing using monoclonal Antisera A, B and D was carried out on samples. The malaria Plasmodium falciparumrapid Test Device (whole blood) package insert kit (BDH, England) was used to test for the presence of malaria parasites in the specimens. The 104 samples analyzed were made up of 24(23.1%) rhesus positive males, 76(73.0%) rhesus positive females and 4(3.9%) rhesus negative females. In increasing order, 4(3.9%), 16(15.4%), 32(30.8%) and 52(50.0%) students occurred in blood groups AB, A, B and O respectively. Forty (38.4%) of total group O subjects were infected with various densities of malaria trophozoites. Out of 32 blood group B individuals representing 30.8% of the total sampled students, 24(23.1%) were infected. All sampled 4(3.9%) AB students were infected. On the whole, 80(76.8%) of total samples processed, were positive for malaria parasitaemia. Twelve (11.5%) and 68(65.4%) of total male and female subjects were infected. Malaria parasitaemia seemed to be relatively high across all blood groups with groups O and AB subjects apparently recording the highest and least infection rates respectively. There was statistical significant association between malaria parasitaemia and ABO blood groups of both male and female students (P < 0.05) and between malaria parasitaemia and ABO blood groups of female students only (P < 0.05). The association of malaria parasitaemia and ABO blood groups of male students was not significant (P > 0.05). There was a statistical significant association of malaria parasitaemia and ABO blood groups among all students sampled and this association may be due to the significant association that occurred among the female students as shown by statistics.
he aim of this study was to estimate the IMR in Fallujah General Hospital, Fallujah city/ Al –Anbar governorate/ Iraq, during the years 2007, 2008, 2009, 2010 and 2011 and to study the factors affecting it. This is a review of patient's records involving all live births and deaths occurring from the beginning of January 2007 to the end of December 2011 in FGH. The data were collected from the hospital records, the files of the patients admitted to the neonatal and children hospital wards during the mentioned years, and from birth and death certificates recorded in the hospital. Data collected included name, age, sex, residence, socioeconomic status and date of death .The IMR was 75/1000 live births in 2007, 53.8/1000 live births in 2008, 57.6/1000 live births in 2009 , 49.5/1000 live births in 2010 and 48.27/1000 live births in 2011. About 83.8% of deaths occur during the neonatal period & 16.2% in the post neonatal period. The average IMR was 57/1000 during the studied years, with an average male IMR=68.7/1000 and a female IMR= 44.37/1000. The studied dead infants were 52.8% in the rural and 47.2% in the urban areas. The 1st most common cause of death was the prematurity and RDS in the neonatal period and congenital malformation in the Post neonatal period. IMR was very high during the year 2007 and it didn't show much difference during the years 2008 and 2009, this may reflect the bad social, health, economic services in addition to the security situation during those years.
Aims: To assess the efficacy of lafutidine therapy versus rabeprazole in Indian patients with endoscopically and histologically proven gastritis and peptic ulcer. Study Design: A double blind, double dummy, randomized, comparative study. Place and Duration of Study: Global Liver and Gastroenterology Centre, Bhopal, India, between March 2010 and October 2010. Methodology: A total of 100 patients were enrolled, including 50 with endoscopically and histologically proven gastritis and other 50 with peptic ulcer (over 5 mm in diameter). Each group was randomized to receive either lafutidine or rabeprazole tablet and their corresponding competitor placebo dummy tablet, for a period of 4 weeks. Cure rate was confirmed endoscopically at the end of week 4 as compared to the baseline evaluation. Symptom response and Helicobacter pylori (H. Pylori) eradication were also compared among the two drugs at the end of the treatment period. Results: Complete cure of gastritis was observed in all the patients (100%) treated with lafutidine and 95.24% [20/21; 95% CI: 76.18 to 99.88%] patients treated with rabeprazole. Complete cure of ulcer was observed in 72.0 (18/25, 95% CI = 50.61 to 87.93%) and 79.16% (19/24, 95% CI = 57.85 to 92.87%) patients treated with lafutidine and rabeprazole respectively. There was no significant difference in gastritis/ulcer cure rate and symptom response rate between the two treatment groups at the end of the study. H pylori eradication rates was 82.61% (19/23) in lafutidine group vs 47.37% (9 /19) in rabeprazole group (âˆ†=35.2%, 95% CI = 3.2 to 67.3%; P= .023). Both, lafutidine and rabeprazole were well tolerated during the entire study. Conclusion: Endoscopically proven cure rate in patients suffering from gastritis and peptic ulcers is found to be comparable after 4 weeks treatment with Lafutidine and rabeprazole, but lafutidine showed better H. pylori eradication rate as compared to rabeprazole.
Background: Cutaneous diseases are common in patients with HIV/AIDS however there are few documented reports of these lesions from some parts of world such as Nigeria and West Africa. Objective: The aim of this study was to identify cutaneous pathologies in patients attending an adult outpatient (HIV/AIDS) clinic department in a rural/suburban centre in the south geopolitical zone of Nigeria. Additionally it also aims to determine if there are differences in the pattern of presentation as compared to patients seen in other parts of the country and the world. Methods/Design: This is a prospective observational study conducted in the adult antiretroviral (ART) clinic of Irrua Specialist Teaching Hospital Irrua Edo StateNigeria over a 12 month period involving HIV positive patients. All patients with skin complaints are included in the study while other patients without skin complaints are generally excluded. Results: A total of 9460 patients were seen during this period in the clinic including old, new and repeat visits. Four hundred and ninety patients had various dermatologic complaints at various times giving a 5.18% prevalence of the cutaneous pathology. The mean age of the patients was 38±10 years with a male: female ratio of 1:1.4(140:350). For easy of analysis these lesions were grouped into infective and non-infective pathologies. Infective pathologies dominated the main manifestation (viral- 37.1%, fungal 24.3% and bacterial 2.9%) and non-infective mainly neoplasms 5.7%, drug reactions 11.4% and others 18.6% (comprising post inflammatory hypopigmentation and hyperpigmention, pruritic eruptions of HIV, and papularurticaria (insect bite reactions). Lesions are generally more florid and widespread in these patients particularly at lower CD4 counts. Conclusion: Cutaneous manifestations of HIV infection are common even when not deliberately sought out for. They range from infections to neoplasms and drug reactions. They can be the main reason for initial presentation to the clinic and without prompt recognition and treatment patients care will be incomplete.
Aims: There is abundant evidence to suggest that health care staff are increasingly being exposed to violent incidents at their workplace. The purpose of our study was to identify the role of crowding in producing violence that occurs in emergency department as well as to outline the factors that affect the types of violence. Study Design: In this prospective study we collected incidents of violence against emergency staff by patients or their relatives. A survey with 20 questions about the event was completed by emergency staff just after the event. Also information about crowding at that time was recorded as well as the area of the event. Statistical analysis was done with SPSS 16.0. Place and Duration of Study: Department of Emergency Medicine, Marmara University Pendik Training and Research Hospital, Between April 1 and June 1, 2012. Methodology: A total of 116 acts of violence were reported during the 61 days of this study. 79 of 116 cases (68.1%) were verbal, 16 (13.8%) physical, and 21 (18.1%) were both verbal and physical. The information about each event was entered into a database and pooled for analysis. Results: The most common victims of violence were physicians (38.8%) and security personnel (31.0%). The presence of security personnel in the environment increases the risk of physical violence (P=.017). The average total number of patients waiting for examination or results of examinations was 24.9 ± 1.4 (95% CI, 22.3 – 27.5). It was observed that the violence increased when the number of people was close to this number and reduced when the crowding increased above this average. Conclusions: The existence of security personnel alone is not sufficient to prevent violence; new steps should be taken to prevent the entrance of the patients’ relatives to inside of the treatment areas of emergency departments.
Aims: Paradoxical vocal fold motion, especially during exercise, causes symptoms of dyspnea in patients experiencing this condition. At present, the standard means to diagnose this condition is invasive using a laryngoscope. The Airflow Perturbation Device (APD) could offer a simpler means of diagnosis and monitoring, but the APD must be validated with laryngoscopy. Both devices require access to the mouth, and so cannot be used simultaneously. The aim of this study was to determine if respiratory resistance of exercising subjects changes immediately after exercise begins and ends. Study Design: The study was conducted as a prospective study. Place and Duration of Study: All tests were conducted in the Human Performance Laboratory, Fischell Department of Bioengineering, University of Maryland, College Park, MD between August 2011 and August 2012. Methodology: Fifteen subjects exercised on a bicycle ergometer at 70% of maximum predicted heart rate while breathing through the APD. Results: Results show that APD measurements made just prior and after the cessation of exercise are comparable. Conclusion: APD measured inspiration and expiration resistances do not change immediately after exercise cessation.
Aim: To determine the effectiveness and compliance of Long Lasting Insecticide Nets (LLINs) on malaria parasitaemia among pregnant women attending antenatal clinics. Study Design: Cross sectional study. Place and Duration of Study: Rivers State, Nigeria, between April and September 2011. Methodology: Thick and thin blood films were made and stained using parasitological standard procedures to identify malaria parasites. Questionnaires were distributed to collect personal data of the pregnant women examined. Data gotten was analyzed with Chi-square test of significance. Results: A total of 400 pregnant women were examined, 317(79%) used LLINs with 29(9.1%) positive for malaria parasites while 83(21%) did not use LLINs with 75(90.4%) positive for malaria parasites (P<0.05). Pregnant women in their first, second and third trimesters that used LLINs had prevalence rates of 5.3%, 12.2% and 11.5% respectively while those that did not use LLINs had prevalence rates of 89.1%, 94.1% and 90.9% respectively (P<0.05). Primigraviidae, secundigraviidae and multiparous women who used LLINs had prevalence rates of 10.3%, 8.7% and 5.9% while those who did not use LLINs had prevalence rates of 95.8%, 89.5% and 75% respectively (P<0.05). Conclusion: The usage of LLINs in reducing malaria parasitaemia among pregnant women was statistically significant (P<0.05) irrespective of parity and gestation period.
Background: PTPN22 codifies for a protein-tyrosine-phosphatase (Lyp) involved in T cell receptor signaling regulation. p53 is involved in immune related inflammation regulating STAT 1 and pro-inflammatory cytokines. Possible interaction between the two systems concerning the susceptibility to immune related disorders are therefore biologically plausible. In the present note we have searched for such interaction in type 1 diabetes mellitus and reviewed previous data from our laboratory. Methods: We have studied 287 children with type 1 diabetes, 129 non diabetic adult subjects admitted to the Hospital for Coronary Artery Disease, 130 women with endometriosis and 256 healthy blood donors.PTPN22 and p53codon 72 genotypes were determined by DNA analysis. Results: In all diseases the proportion of PTPN22 *T allele is higher in p53 *Pro allele carriers than in p53*Arg/*Arg genotype. In *Arg/*Arg patients the proportion of *T allele carriers does not differ significantly from controls while in subjects carrying the *Pro allele is higher in patients than in controls. A significant increase of Odds Ratio is observed only in presence of both *T and *Pro alleles suggesting a cooperative interaction. Conclusion: It has been suggested that the susceptibility to autoimmune disorders in the presence of *T allele could be related to failure to delete auto reactive T cell during intrathymic selection. *Pro allele variant with its strong transcriptional activity could enhance the multiplication of such auto reactive T cell escaping intrathymic thus explaining a significant increase of Odds Ratio in the presence of both factors .The present observation could have relevance to identify individuals at high risk of clinical manifestations.
Background: Several randomized controlled trials (RCT) have reported no difference in long-term mortality between coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI). The purpose of this pooled observational analysis was to compare recent retrospective studies examining long-term survival of patients with multi-vessel coronary artery disease undergoing CABG and PCI. Methodology: We searched Medline for observational studies comparing long-term (>1 year) survival between CABG and PCI for the treatment of multi-vessel coronary artery disease over the past 10 years. Results: Eight studies met inclusion criteria. A total of 306,868 patients (155,502 CABG; 151,366 PCI) were identified. Follow-up ranged from 1 to 8 years. Mantel-Haenszel combined hazard ratios (HR) for mortality demonstrated a protective benefit of CABG compared with PCI (HR=0.77, 95%CI=0.75-0.79). Conclusion: These findings suggest a long-term survival advantage for CABG compared with PCI in patients with multi-vessel coronary artery disease.
Aims: This study aims to determine the antioxidant enzyme EC-SOD polymorphisms in Egyptian patients with type 2 diabetes mellitus with and without retinopathy, and its association with other biochemical changes to assess whether decreased SOD activity is associated with the development of diabetic complications. Study Design: Cross-sectional study. Place and Duration of Study: Department of Medicine Al-Hussein University Hospital, Cairo, Egypt, between May 2010 and April 2011. Methodology: The present study investigated the relationship among diabetes mellitus, lipid profiles, SOD activity, ESR, and CRP in the blood of 40 patients with type 2 diabetes with and without retinopathy and 20 healthy control subjects. The mean age of the diabetic patients was similar to that of control. The mean duration of the disease was 3.53 ± 1.17 years (1–5 years) in patients with type 2 diabetes without retinopathy and 18.7 ± 3.1 with retinopathy. Also we studied Arg213Gly dimorphism of the EC-SOD gene in type 2 diabetic patients with and without retinopathy and control persons using the PCR technique. Results: Superoxide dismutase (SOD) level was significantly decreased in diabetics and more markedly decrease in those with retinopathy. Total cholesterol (CHOL), triglyceride (TG) and low-density lipoprotein-cholesterol (LDL-c) levels were significantly increased in diabetics and more markedly increased in those with retinopathy compared with the control level. Genotype distribution of the EC-SOD in diabetic patients with and without retinopathy differed from normal individuals, as the argentines-to-glycine amino acid substitution was higher in diabetic patients compared with the normal individuals. Conclusion: The present study revealed that hyperglycemia produced marked oxidation impact as evidenced by a significant increase in lipid profile, lipid per oxidation products, as well as a significant decrease in the total SOD activity. Moreover, it showed that the genotype distribution of the EC-SOD was differed as the arginine-to-glycine amino acid substitution was higher in diabetic patients with and without retinopathy compared with the control individuals. This report emphasizes the important role of superoxide dismutase and its genotype distribution in diabetic patients with and without retinopathy, and hence the need for antioxidant supplements to delay the severity of diabetic retinopathy.
Objectives: We evaluated mid-term results of balloon angioplasty (BAP) of native coarctation of the aorta (CoA) in children. There is paucity of data on left ventricular hypertrophy (LVH) and left ventricular mass (LVM) post balloon dilatation of native CoA, hence we also assessed LVM regression. Study Design: Thirteen children were included (11 boys, 2 girls) with median age at intervention of 16 months (4-96 months) and all underwent BAP for native CoA. Patients were followed-up by transthoracic echocardiography assessment of left ventricular function, LVM, recoarctation, and other complications. Follow-up period ranged from 9–36 months (mean±SD, 24.38±8.22 months). Results: The mean peak systolic gradient decreased to ≤20 mmHg in 11 patients (84.6%), mean peak systolic gradient decreased from 61.15±12.44 mmHg before to 18.85±13.72 mmHg and 15.38±6.27 mmHg immediately after angioplasty and at last follow-up, respectively (P=0.00). There was recurrence of mean pressure gradient in two patients; the first patient was 4 months old and had a successful balloon angioplasty six months later and surgery was performed in the second patient. Ventricular function improved in all patients, mean left ventricular mass index (LVMI) during diastole significantly decreased from 142.27±131.22 before angioplasty to 69.55±54.38 g/cm2 at last follow-up (P=0.038). None of the patients developed aneurysms or any other complications at last follow-up. Conclusion: Considering its mid-term outcome, BAP is a successful and reliable procedure in the treatment of CoA. Follow-up by LVMI can be a noninvasive tool to assess mid and long term improvement.
Interstitial cystitis (IC) is a debilitating disease characterized by chronic inflammation of the urinary bladder. β-Adrenergic receptor blockers appear to have a beneficial clinical effect in IC. In this paper, we review the evidence of an association between β-adrenergic receptor blockade and IC. The information was obtained from MEDLINE. Genetic studies have provided the opportunity to determine which proteins link β-adrenergic receptor blockade to IC pathology. In particular, this link involves the major histocompatibility complex class II molecules, the renin-angiotensin system, the transcription factor nuclear factor-κB, the nerve growth factor, and the vascular endothelial growth factor. Β-Adrenergic receptor blockers also exert anti-IC effects through non-genomic factors, including stress, mitogen-activated protein kinase pathways, prostaglandins, cyclooxygenase-2, oxidative stress, and nitric oxide synthase. In conclusion, β-adrenergic receptor blockade may play a beneficial role in IC treatment. Additional investigations that examine β-adrenergic receptor blockers as IC therapeutics are required to further elucidate this role.
Aims: To evaluate the antitumor potential of metal silver and polyvinilpyrrolidone nanoparticle-encapsulated silver on L5178Y-R murine lymphoma cell growth and survival of tumor-bearing mice. Study Design: In vitro and in vivo (pre-clinical) study. Place and Duration of Study: Universidad Autónoma de Nuevo León, Facultad de Ciencias Biológicas, Departamento de Microbiología e Inmunología, San Nicolás de los Garza, N.L., México, from January 2009 to December 2011. Methodology: Concentration-response cell viability assay was performed in vitro and mice survival studies were done using a L5178Y-R tumor-bearing mouse model. The PROBIT regression analysis was performed to determine the in vitro LC50. In vivo survival distributions were calculated by Kaplan-Meier and Cutler-Ederer analysis, and survival curves comparisons and hypothesis testing was done using the log-rank method. Results: Metal silver induced up to 100% L5178Y-R cells cytotoxicity, with an LC50 of 1.8 X 10-8 M, whereas silver nanoparticles caused up to 78% cytotoxicity, with an LC50 of 14.4 X 10-8 M. In addition, Intramuscular administration of metal silver and silver nanoparticles administered at the time of tumor injection significantly (P = .05) increased mice survival, where 70% and 60% of mice survived at day 35 respectively, as compared with such treatments administered 7 days after tumor induction (55% and 25% survival respectively); vincristine treatment caused 50% mice survival and tumor-bearing control mice had 20% survival. These results open further approaches on treating several types of cancer using free and nanoparticle-encapsulated silver-based therapies.
Aims: To determine the tolerability of adding docetaxel to radiation therapy in patients with a rising PSA post prostatectomy for prostate cancer. Study design: Phase II study of the combination of docetaxel and radiation therapy. Place and duration of study: University and Veterans Association Hospital from 2007-2009. Methodology: Patients eligible to receive “salvage” radiation therapy were enrolled in a prospective study to receive concomitant weekly docetaxel (20 mg/m2) and then 4 cycles of full dose (75 mg/m2) docetaxel. Results: All 19 patients were able to complete the concomitant therapy, with just one patient not receiving all 7 cycles of weekly chemotherapy (missing one). Sixteen of 19 completed all four cycles, 2 completed 3 cycles and 1 completed 1 cycle of full dose docetaxel. During combined treatment, there were 3 transient grade 3 toxicities (diarrhea, hemoglobin decline, and hyperglycemia). There was no grade 4 toxicity. During full dose docetaxel, 3 patients suffered a grade 3 decline in WBC count and 2 went on to grade 4. Other single incidents of grade 3 toxicity were anxiety, fatigue, hyperglycemia, diarrhea, febrile neutropenia, port infection and abscess. All the toxicities were transient. By the end of treatment, 89% had a decline in PSA. Conclusion: This is the first report of combined docetaxel and radiation in the post prostatectomy setting. Patients tolerated the combined treatment very well. Toxicities of the full dose docetaxel are consistent with what’s reported in the literature and appear tolerable.
Primary health care as stated in the Alma Ata declaration underscores the importance of health education as one of the key methods of preventing and controlling prevailing health problems. This study seeks to test the effect of health education on perception and treatment seeking behaviour among care givers of under fives in a rural setting in Ogun State, Nigeria. The study design was a quasi-experimental study carried out in Ijebu North Local Government Area of Ogun State. A multistage random sampling technique was used in choosing the required samples for this study and a semi- structured questionnaire was used to collect relevant information. The intervention consisted of a structured educational programme based on a course content adapted from the national malaria control programme. A total of 400 respondents were recruited into the study with 200 each in both the experimental and control groups and were followed up for a period of 3 months when the knowledge and treatment seeking behaviour was reassessed. There was no statistically significant differences observed between the experimental and control groups in terms of socio-dermographic characteristics such as age [p=0.99], marital status [p=0.48], religion [p=0.1], and income [p=0.51]. The highest proportion of mothers reported malaria [45% & 47%] in experimental and control groups respectively, followed by Upper respiratory tract infection [22% & 25%], diarrhoea and vomiting [14% & 17%], measles [12% & 15%], convulsion [8% & 11%] and others [3% & 5%]. Only 52.1% (experimental) and 48% (control) groups of mothers believed that fever can kill a child. Furthermore, about 40% (experimental) and 44% (control) groups believed fever was not fatal while 8.0% of both groups were not sure. Post intervention, these differences were not statistically significant. The proportion of those who got their source of information about prevention of fever from health worker increased from 60.0% (pre-intervention) to 95.0% (post-intervention) (p<0.001) compared to the control group which increased from 62.0% (pre-intervention) to 62.5% (post-intervention) (p>0.001). Furthermore, 72.9% & 50.8% of respondents in the experimental and control group respectively commenced treatment at the right time (first day of fever). There was a significant increase of 24.6% [p=0.001] post intervention in the experimental group with no significant change in the control [p=0.64]. The study concludes that a systematic health education programme to caregivers should be a component of Roll back Malaria programme in Africa. Early diagnosis and prompt treatment is essential to control of infection and this can only be effectively carried out by those at the frontline of care at home.
Background: The in-hospital mortality is a major concern in Africa. The study is aimed at providing the determinants of in-hospital mortality of patients admitted in the gastroenterology and medicine unit (GMU) of the teaching hospital of Yopougon (Abidjan, Ivory Coast). Patients and Methods: A retrospective cohort of 341 patients (males: 53%, mean age: 43 years) admitted in the GMU during 2009 were studied. Socio-demographic, clinical, biological characteristics of patients were retrieved. Survival probability and determinants of in-hospital mortality were respectively determined by the Kaplan Meier curve and Cox model. Results: Among the 341 patients admitted, 79 (23.2%) died in the GMU. The in-hospital mortality rate was 4.3 (95%IC: 3.3-5.2) death per 100 patients-day. The main diagnoses were HIV/AIDS (15%), cirrhosis (14.4%), hepatocellular carcinoma (13.5%), tuberculosis (12.6%) and gastroenteritis (7.9%). Survival probabilities were higher in patients with Financial support (FS) to face medical fees (log rank test = 10.7, P=.001), with no comorbidities (log rank test= 4.5, P=.03) compared to those without, and when diagnoses were established than unknown (log rank test=11. 5, P=.001). In multivariate analysis, prothrombin time <65% (aHR=2.6, P=.02), creatinine level (aHR: 1.02, P=.02), HIV/AIDS or tuberculosis (aHR=0.44, P=.01), non malignant digestive diseases (aHR=0.34, P=.01) and FS (aHR=0.45, P<.02) were significantly associated with mortality in GMU. Conclusion: This study demonstrated that patients with HIV/AIDS or tuberculosis, non malignant digestive diseases or FS had a better outcome. However those with impairment of renal and liver functions had a high risk of death in the GMU.
Aims: The purpose of the study was to examine the effects of a moderate dose of commercially available fish oil on lipid variables in non-hemodialysis, chronic kidney disease patients. Study Design: The study utilized a double-blind, randomized, and placebo-controlled experimental design. The experimental intervention consisted of fish oil supplementation or a safflower oil control. Place and Duration of Study: Patients (N=31) from a family medicine center with Chronic Kidney Disease were eligible for the study and followed prospectively for eight weeks. Results: ANCOVA revealed a significant difference at post-test (p=0.02; Cohen’s d=-0.58) in HDL. No significant differences at post-test for triglycerides (p=0.66; Cohen’s d=0.16), total cholesterol (p=0.84; Cohen’s d=-0.04), LDL (p=0.39; Cohen’s d=0.25), total cholesterol/HDL ratio (p=0.34; Cohen’s d=0.20), and ApoB (p=0.52; Cohen’s d=0.11) were discovered. Conclusions: The results of our study suggest the consumption of 2.4 grams of combined EPA and DHA may be an effective over-the-counter nutritional intervention to increase HDL in individuals with CKD. The reasons for non-significant findings in all other cholesterol variables may be due to a dose-response relationship, the short duration of the study, the study population, or the supplements simply may not be effective in improving these variables.
Aims: This paper evaluates the use of percentage of micronucleus (MN), polychromatic erythrocytes (PCEs), chromosomal aberration (CA) and mitotic index (MI) frequencies in mice bone marrow smears as a method for assessing the ability of docosahexaenoic acid (DHA, is an omega-3 fatty acid) to reduce cyto-genotoxicity damage of cytosine arabinoside (ara-C). Ara-C is widely prescribed antineoplastic drug, especially for the treatment of acute myeloid leukemia. It is a pyrimidine analog, in which the ribose sugar of cytidine is replaced by arabinose moiety. Methodology: Positive control group of mice was only given intraperitoneal dose of ara-C of 75 mg/kg (every 12 h for 5 days); this dose was selected in accordance with its human therapeutic values. Negative control group of mice group only received 0.1 ml sterile distilled water every 12 hours for 5 days. Three treatment groups of mice were given same dose of ara-C in addition to three different doses of DHA (125, 250 and 500 mg/kg of mice). Experimental data were analyzed using (Mann–Whitney U-test) to compare values of positive and negative controls. However, Kruskal–Wallis test followed by Dunn’s multiple comparisons test were used to compare values of treatments with positive control. All values were accepted at p = 0.05. Results: When 75 mg/kg ara-C was applied, positive control group showed a significant increase in MN and CA, a high decrease in PCE, and a significant decrease in MI. When DHA was used with ara-C, the picture is changed, particularly at a medium dose of DHA of 250 mg/kg where a decrease MN and CA and an increase in PCEs in addition to an increase in MI were observed. Conclusion: DHA at 250 mg/kg was able to reduce cytogenotoxicity of ara-C, and lead to protecting the normal proliferating cells in bone marrow from the damaging effect of ara-C and hence improving therapy by ara-C.
Aims: To characterize gender differences in the ophthalmic findings and clinical outcomes of patients with open globe (OG) injuries. Study Design: Retrospective case series. Place and Duration of Study: Department of Ophthalmology, University Hospital, New Jersey Medical School between January 2001 and June 2010. Methodology: The medical records of all patients presenting with OG injuries to University Hospital, Newark, NJ from January 1, 2001 through June 30, 2010 were reviewed. Demographics, characteristics of the trauma, ophthalmic findings, and outcomes were compared in male and female patients. Results: A total 603 eyes (602 patients) with OG injuries were identified. Most of the patients (76.4%) were male. The mean patient age was 39.14 years which was significantly lower in males (35.66 years vs. 50.43 years in females; p<0.001). The vast majority of injuries were penetrating and/or work-related in men, whereas fall-related ruptures comprised the most common pattern of injury in women. Zone I was the most commonly injured zone in both genders, and Zone III wounds were more commonly seen in males (p=0.03). Although females were more likely to present with a worse visual acuity (VA, p=0.005), the final VA was not significantly different between males and females (p=0.06), and a statistically significant improvement in vision occurred in both genders (p<0.001 in both). Fifteen percent of patients had an unfavorable anatomic outcome and underwent either primary or secondary enucleation; the rate was not different among males and females (17% in both). Conclusion: Male and female victims of OG injuries follow different trends in terms of demographics, etiology, and type of injury. This highlights the importance of applying different prevention strategies in the genders.
Aims: To understand the exposure experiences of tea consumption in community male adult population of urban China and its potential beneficences in cardiovascular diseases and diabetes. Study Design: A cross-sectional study. Place and Duration of Study: Communities in Shanghai, Chengdu and Hangzhou, China between July to September, 2006. Methodology: Face-to-face questionnaire interviews through household visit were carried out to collect information on tea consumption and health conditions in Chinese men. The amount of tea-leaves consumed per time was weighed in grams using identical balances. Results: In this study, 73.7% (2156/2927) subjects met the criteria of present tea drinkers (PTDRs) at the time of interview, and the age-gender standardized proportion was 66.4%. Most of PTDRs drank tea every day and amounts of tea consumption did not vary over seasons. The average weekly amounts of tea consumption in grams for PTDRs varied from 55.2 grams green tea per week to 71.7 grams oolong tea per week. Also, green tea drinking was significantly inversely associated with cardiovascular disease and diabetes. Conclusion: This study provides an informative and comprehensive description of tea drinking in urban Chinese male population. Findings from this study also present the possibility of health benefits of green tea for male Chinese population.
Aim: To investigate the antioxidant and antimicrobial potential of Chloroform and Pet ether extracts of Manilkara zapota (MZCE, MZPE), Polyalthia longifolia (PLCE, PLPE), Abroma augusta (AACE, AAPE) Ficus hispida (FHCE, FHPE), Vitex negundo (VNCE, VNPE) plants. Study Design:In vitro antioxidant and antimicrobial study. Place and Duration of Study: Department of Pharmacy, School of Science & Engineering, Southeast University, Banani, Dhaka between June 2011 and March 2012. Methodology:In vitro antioxidant activity was performed using DPPH radical scavenging, nitric oxide (NO) scavenging, reducing power, total antioxidant capacity, total phenol and total flavonoid content determination assays. The antimicrobial assay was performed by disc diffusion method using kanamycin and Nystatin as the standard. Results: The most prominent antioxidant activity was observed with PLPE in DPPH radical scavenging test (IC50 =191.308 ± 28.450 μg/ml) as opposed to that of standard ascorbic acid (IC50= 43.129 ± 1.181μg/ml). In total antioxidant capacity method, FHCE showed the highest activity (837.558 ± 110.835 mg ascorbic acid/g). The total phenolic and flavonoids content were determined by Folin–Ciocalteu Reagent and aluminum chloride colorimetric method respectively. The highest total phenols & total flavonoids content were found in VNPE (180.434 ± 142.19 mg Gallic acid/g & 1265.255 ± 165.593 mg quercetin/g, respectively). The ferric reducing capacity of the extracts was strong and dose dependent manner. PLPE displayed the highest antimicrobial actions against Bacillus megaterium (40 mm). Conclusion: Comparison of different plant extracts used in the present study in various tested models showed wide variations in phenolic content and varying degrees of radical scavenging & reducing capacity. The obtained results indicate that investigated plants could be potential sources of natural antioxidants & antimicrobial agents and can be used for infectious diseases.
Background: Fractures of the clavicle are common especially among young adults who are the work force in many developing countries, including Ghana. The incidence of clavicular fracture varies and the methods of treatment which is determine by the classification, age, fracture characteristics and the patients preference also varies although clavicular fractures are traditionally treated non-operatively. In the northern part of Ghana fractures are very common yet there has not been any study on the incidence of clavicular fractures and the preferred mode of treatment. Aim: The aim of the present study is to retrospectively investigate the incidence of clavicular fracture and the preferred mode of management among fracture patients over a five year period. Study Design: Retrospective Place and Duration of Study: Tania specialist Orthopaedic Hospital, Tamale, Ghana. Methodology: Data regarding patient's age and sex, laterality involved, cause of injury and the mode of management of the fracture from January, 2007 to December, 2012 were analysed. Results: The incidence of clavicular fracture over the study period was 12.8% of all fractured cases. Majority of the subjects (71.4%) with clavicular fractures were aged 21 to 40 years. Old cases constituted 58.9% whiles only 41.1% of the cases were fresh fractures. About 70% of the old cases were people who had received management from traditional bonesetters. The fracture occurred on the clavicle of the right arm in 60.7% of the patients. Middle third fractures accounted for 78.6% with only 21.4% occurring on the distal third of the clavicle. The major cause of clavicular fractures in this study was road traffic accident constituting 83.0% followed by a fall from heights 11.6%. Conclusion: The incidence of clavicular fracture among the study subject was relatively high. Road traffic accidents were the most common cause of the injury and the preferred mode of management is the operative management using open reduction and internal fixation (ORIF).
Aims: To detect significant relationships between risk factors of cerebral stroke and the age of patients. Identify a number of exogenous factors among the geoheliomagnetic and meteorological ones which have a significant impact on the increase in the fatal outcome probability. Study Design: Main research field: cerebral strokes. Place and Duration of Study: The research is based on the results of retrospective analysis of the autopsy of people who died of cerebral stroke according to the data of the N.A. Semashko Municipal Hospital No 1 (Central Municipal Hospital) of Rostov-on-Don, Russia during the years of high (2000-2002) and low (2008-2010) solar activity. Methodology: The study involves 1135 patients who died of cerebral stroke. 5 observation groups were formed depending on the age: 1 group: 34 (3%) – less than 45 years old; 2 group: 200 (17.6%) - between 45-59 years old; 3 group: 540 (47.6%) - between 60-74 years old; 4 group: 356 (31.4%) - between 75-89 years old; 5 group: 5 (0.4%) - 90 and more years old. Nosological signs of disease and endogenous risk factors were recorded for each observation. To evaluate the complex impact of the environmental factors on the death rate of the vascular accidents, 44 exogenous risk factors were analyzed. Results: With the help of multivariate logistic regression method, after the construction of a mathematical model, nine endogenous and 8 exogenous factors, from amount participating in the analysis, which can be factors of immediate death risk for the patients belonging to various age groups, were detected. The coincidence of fact and calculations according to the gradations of the classification variable containing the meaning of number of age group, is ensured in 68.2% of cases (Concordant),coefficient of association Somers’D: .371. Model quality was evaluated according to the modeling sample. It is statistically proved, that death occurred with the patients of young and middle age because of diseases associated with hypertension, atherosclerosis of the 2-3 stage, alcohol. Characteristic CS type – hemorrhagic, especially hematoma class with blood breakthrough into the brain ventricles. Severe course of disease with frequent deaths in the 1st day are typical. In case of established combination of the pathogenic effect is mostly associated with high solar and geomagnetic activity. Among the patients of the elderly and the senile age appeared patients with secondary arterial hypertension, atherosclerosis of the 3-4 stage, heart diseases in the form of ciliary arrhythmia and coronary heart disease. Characteristic CS type – ischemic, especially non-atherothrombotic class. Death during the 1st day was statistically less likely. The maximum meteotropic reactions occur with contrasting weather patterns change, quick change of air masses with different thermal properties. Conclusion: Data about the discovered specific risk factors for the patients of different ages would allow choosing a more efficient individual approach to each patient aimed at improving the effectiveness of treatment and reducing the frequency of fatal outcomes.
Aims: 1) To identify a dietary pattern associated with plasma interleukin-6 (IL-6), tumor necrosis factor alpha (TNFα) and monocyte chemotactic protein-1 (MCP-1) in Latinos diagnosed with T2D. 2) To examine whether the “pro-inflammation” dietary pattern obtained is associated with additional cardiovascular disease risk in this Latino population. Methodology: Reduced rank regression was used to determine the cross-sectional relationship between food patterns and plasma inflammatory biomarkers in Latinos (26 men/77 women, 32-76 y) diagnosed with type-2 diabetes (T2D). Reduced rank regression was used to create 3 dietary patterns from 33 food groups. We included IL-6, TNFα, and MCP-1 as response variables to derive 3 dietary patterns. Study Design: Cross-sectional. Place and Duration of Study: University of Connecticut, Hartford Hospital, and the Hispanic Health Council, between January 2010 and May 2011. Results: The first dietary pattern characterized by low intake of fruits and yellow vegetables and high intake of refined grains and sugar-free beverages explained the largest proportion of variance in inflammation markers. After adjusting for confounding factors including energy intake, statin treatment, waist circumference, glycosylated hemoglobin and blood pressure, IL-6 (P< 0.0001) and TNFα (P =0.0004) were positively associated with the first dietary pattern. Food groups that were negatively associated with inflammation markers were fruits and dark yellow vegetables, explaining 10.2% and 4.6% of the variance, respectively. This dietary pattern was also significantly associated with higher number of large VLDL particles (P < 0.05) after adjusting for WC, statins use and systolic blood pressure as well as higher concentrations of apolipoprotein A-2 after adjusting for WC and energy (P< 0.05). Conclusion: This dietary pattern may increase heart disease risk in this already challenged population.
Aims: Hibiscus sabdariffa is a medicinal plant that is consumed for its health benefits in Africa. The study was designed to investigate the hepatoprotective potentials of Hibiscus polyphenolic rich extract (HPE), (a group of phenolic compounds occurring in the dried calyx of Hibiscus sabdariffa) against CCl4-induced damaged in rats. Place and Duration of Study: Department of Biochemistry, Ladoke Akintola University of Technology, Ogbomosho, Nigeria, between January 2011 and June 2012. Methodology: Liver injury was measured in serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), lactate dehydrogenase (LDH) and thiobarbituric acid reactive substances (TBARS) along with reduction of superoxide dismutase (SOD), catalase (CAT), and reduced glutathione (GSH). The antioxidant activity of HPE was evaluated using DPPH and ABTH radical scavenging assay in vitro. Results: The antioxidant investigation showed that HPE was able to scavenge the ABTS and DPPH radicals and these radicals scavenging abilities were found to be dose-dependent. Pretreatment of rats with different doses of HPE (50 and 100 mg/kg) significantly lowered serum ALT, AST, ALP, LDH and TBARS levels in CCl4 treated rats. GSH, SOD and CAT were significantly increased by pre-treatment with the HPE, in CCl4 treated rats. HPE was found to contain high level of total phenolic content (140.78mg/g in GAE/g dried weight). Hence, these data indicate that the dietary supplement of Hibiscus extract may inhibit liver damage in rats. Conclusion: The hepatoprotective activities observed in this study could be due to the ability of phenolic compounds to neutralize the free radicals produced from the metabolism of CCl4.
Aims: Some evidence has been reported on the increase in the rate of myocardial infarction, stroke and change in number cardiovascular parameters during geomagnetic storms. The aim of this study was to evaluate the risk of in-hospital lethal or major adverse cardiovascular events (myocardial infarction, stroke, and death) (MACE) in patients with myocardial infarction, depending on the patients’ clinical data and the heliophysical environment during hospital admission and on the first subsequent days. Place and Duration of Study: The study included 1,579 patients who in 2005-2006 were treated in the Hospital of Lithuanian University of Health Sciences and survived for more than one day. During hospitalization, 35 (2.2%) cases of death and 60 (3.8%) cases of MACE were registered. Methodology: The effect of geomagnetic storms, solar flares, and solar proton events was estimated by applying multivariate logistic regression, adjusting for clinical variables. Results: Geomagnetic storms occurring one day after hospital admission increased the risk of in-hospital death and MACE by over 2.9 times (respectively, OR=3.69, 95% CI 1.29-10.5; and OR=2.91, 95% CI 1.33-6.36). A dose-response relationship was observed between the daily geomagnetic level (quiet-unsettled, active, or stormy) on the day prior to hospitalization and the risk of mortality or MACE (respectively, 1; 1.98(0.75-5.19); 4.20(1.43-12.3), and 1; 2.41(1.19-4.91); 3.45(1.55-7.71)). Solar flares occurring 0-2 days before the admission increased the risk of MACE by over 1.9 times. Among high-risk patients admitted one day after active-stormy geomagnetic level, in-hospital death occurred in 10.8% and MACE – in 15.3% cases; among patients hospitalized one day after quiet-unsettled geomagnetic level, the respective percentage was 4.8 and 7.9. Conclusions: The heliophysical conditions during hospital admission affect the risk in-hospital lethal outcome and MACE, adjusting for clinical variables; these effects were stronger in high risk patients.
Aim: To assess the impact of diabetes mellitus (DM) on the cost of the tuberculosis (TB) treatment. Study Design: Prevalence based cohort Place and Duration of Study: Penang General Hospital, Hospital USM, and– Univesiti Malaya Medical Center; 2005 – 2008. Methods: Study patients were placed in the TB only, DM only, or DM-TB groups,with each group including 200 patients. Information related to demographics, chronic disease comorbidity, duration of hypertension (HTN) and DM, and economic variables were obtained from the patients’ medical files both at the beginning and end of the study period. The economic burden of DM-TB patients was assessed from hospitalization periods, frequency of clinic visits, and diagnostic requests. Results: Durations of DM and HTN were 9.2 and 5.6 years, respectively, for the DMonly group compared to 5.3 and 1.1 years, respectively, for DM-TB subjects. For both diabetic groups, diabetes preceded HTN, with onset of HTN occurring approximately 4 years after patients were diagnosed diabetic. Approximately 86% of DM only subjects suffered additional comorbidity, and 44.5% had three or more coexisting chronic diseases compared to 56% and 11.4%, respectively, in the DM-TB group. The hospitalization period was 10.2 days for the DM-TB group compared to 7 and 4 days for the TB only and DM only groups, respectively; however, 43% of TB only subjects needed surgical intervention compared to 17% in the DM-TB group. The total cost wasRM4530 (US$1234.3) for the DM-TB group compared to RM3082.8 (US$840) and RM6945.26 (US$1892.40) for theTB only and DM only groups, respectively. Conclusions: DM antedated HTN in our patients. Durations of both DM and HTNwere longer for the DM only group. The number of diagnosed chronic diseases and overall treatment cost was higher in the DM-TB group compared to TB only group, but lower compared to the DM only group. The TB only group required the most surgical intervention.
Background: Bile leak is a complication of hepatopancreatobiliary surgery and results from injury to the bile ducts. Treatment usually consists of percutaneous drainage combined with the placement of a biliary stent or a nasobiliary draining tube in the biliary tree via endoscopic retrograde cholangiopancreatography. Animal experiments and studies in humans have shown that somatostatin reduces bile secretion. Objective: To evaluate the efficacy of somatostatin as a conservative monotherapy for the successful management of mild to moderate post-operative bile leak. Place and Duration of Study: 2nd Department of at the University General Hospital of Alexandroupolis, during the period of 2010 and 2012. Patients and Methods: Fifteen patients (11male/4 female) with a mean age of 70.1±4.2 years who developed uncomplicated post-operative bile leak with a daily output ranging from 100ml to 800ml were included in the study. Eleven patients were operated for benign diseases of the liver and biliary tract, while the rest 4 patients for pancreatic or biliary tract malignancies. Somatostatin was administered intravenously to all patients in continuous infusions of 3000μg/12hours until complete recession of bile leak along with total parenteral nutrition. Results: Somatostatin treatment was successful in 14 patients (93.3%), with success being defined as the complete cessation of bile leak. Overall, mean duration of bile leak was 13.8±3.9 days. No major adverse reactions or complications were observed and no patients died. Conclusions: Somatostatin appears to be effective in the treatment of post-operative bile leak. The efficacy of somatostatin is observed both in patients with benign or malignant disease.
Aims: Health literacy among older people has received little attention in transitional countries of Southeast Europe. Our aim was to assess the level and socioeconomic correlates of health literacy among older people in Kosovo, a post-war country in the Western Balkans. Study Design: Cross-sectional study. Place and Duration of Study: Kosovo, between January-March 2011. Methods: This nationwide survey, conducted in Kosovo in 2011, included 1753 individuals aged ≥65 years (886 men, 867 women; mean age 73.4±6.3 years; response rate: 77%). Participants were asked to assess, on a scale from 1 to 5, their level of difficulty with regard to access, understanding, appraisal, and applicationof health information. Subscale scores and an overall health literacy score were calculated for each participant. Information on socioeconomic characteristics was also collected. Results: Subscale scores of health literacy were strongly correlated with each-other (range of Spearman’s rho: 0.8-0.9). Mean values of the overall health literacy scores were significantly higher in men, urban residents, married individuals, the highly educated, and the better off participants. Conclusions: This may be the first report from the Western Balkans addressing health literacy in a population-based sample. Future studies in Kosovo and other settings in the region should provide further insight into the magnitude and socioeconomic determinants of health literacy which is an under-researched topic in countries of Southeast Europe.
Aims: Learning disabilities represent the most significant cause of lifetime morbidity in neurofibromatosis type 1 (NF1) patients. The cognitive phenotype of NF1 pediatric patients is not well understood. The purpose of this study was to examine the cerebral glucose metabolic pattern in NF1 pediatric patients. Study Design: Retrospective. Place and Duration of Study: Saint Louis University Hospital, Saint Louis, Missouri, United States, between May 2011 and May 2012. Methodology: Six NF1 pediatric patients underwent FDG PET/CT including the brain, for evaluation of extracranial neoplasm. Their brain PET images were compared with a pediatric comparison set (21 subjects) using Statistical Parametric Mapping. Significant differences between groups were examined at p<0.001, uncorrected for voxel height and p<0.05, corrected for cluster extent. Results: Compared with the comparison set, the 6 NF1 patients showed the largest cluster of reduced FDG uptake (3966 voxels) in the medial dorsal nucleus of bilateral thalami. Additional clusters of metabolism in the range from 415 to 926 voxels were noticed in the right cingulate gyrus (Brodmann area (BA) 8 and 24), left occipital lobe (BA 17 and 18) and right fronto-parietal lobe (BA 43). Conclusion: The FDG reduction of the bilateral thalami is compelling and may be most pathognomonic for NF1. This and other areas of FDG reduction found within the brain may contribute to a better understanding of the NF1 cognitive phenotype.
Background: Detection of red blood cells antibodies is important for the diagnosis of autoimmune hemolytic anemia, hemolytic disease of newborn, pre-transfusion testing and other problems. The aim of this study was to use Staphylococcal protein A (SpA) and Streptococcal protein G (SpG) as reagents in immunological tests for detecting red blood cells (RBC) antibodies and to compare the method with other techniques. Study Design & Methods: Sera from 60 patients, comprising forty-four anti-D positive sera from pregnant women and 16 from healthy controls were, used for the study. The anti-globulin gel test and the standard Coombs’ test were used to determine RBC antibodies in these sera and the result were compared with that of protein A and protein G tests. Results: With various degree of agglutination all 4 techniques detected the presence of RBC antibodies (anti-D) in the sera from 44 pregnant women, and tested negative for the remaining 16 sera (from healthy controls). The sensitivity and the specificity of the 4 techniques was 100%. Conclusions: This preliminary study demonstrates that both SpA and SpG tests can be used for the detection of RBC antibodies and therefore requires more study and testing before they can become useful standard tests in transfusion medicine.
Background: Nitric oxide (NO) is a potent vasodilator synthesized by the vascular endothelium. It has been reported that endothelial nitric oxide synthase (eNOS) Glu298Asp gene polymorphism is associated with coronary artery disease (CAD). Methodology: In this study, we investigated Glu298Asp eNOS polymorphism and serum NO in a group of 146 age-matched male subjects; 77 patients with coronary artery disease (CAD) classified according to the severity of coronary insufficiency and 69 normal male controls. Results: The obtained frequencies of the eNOS Glu298Asp genotypes for the CAD subjects were GG (54.5%), GT (31.20%), and TT (14.3%). The allele distributions of G and T were 70.1 and 29.9%, respectively. In the control group, the genotype frequencies were 53.6% for GG, 36.2% for GT, and 10.2% for TT, and the frequencies of the G and T alleles were 71.7% and 28.3%, respectively. There were no significant differences in genotype and allele frequencies between the CAD patients and the control group. The mean serum NO levels in CAD patients was significantly higher than that of healthy subjects (p=0.0139). Conclusion: No significant association was detected when CAD severity, genotypes and NO serum levels were correlated.
Aim: We conducted a retrospective review of all brain imaging studies in the first year after allogeneic haematopoietic cell transplantation (HCT) to determine (a) the percentage of patients with CNS neurological complications based solely on undergoing brain imaging, (b) transplant-related risk factors of undergoing brain imaging, and (c) overall survival in the patients with neurological complications compared to those transplant patients who did not have brain imaging. Methods: Subjects were 543 consecutive recipients (August 2004-August 2007) of allogeneic HCT followed for overall survival for up to 6 years after HCT. Comparisons between patient groups with brain imaging and without brain imaging were tested using the Pearson chi-square test. Survival analyses with outcome time-to-brain-scan started at date of transplant and used Kaplan-Meier methods. Results: Of 543 HCT recipients, 128 patients (24%) underwent brain imaging during the first year after transplantation. There was a greater risk of brain imaging in unrelated donor transplants and in lymphoid as opposed to myeloid malignancies (respective hazard ratios 1.45 and 1.43, P=0.04). Overall survival was significantly worse in unrelated donor transplants (hazard ratio 1.42, P=0.003) and in cord blood transplants (hazard ratio 1.68, P=0.02). Landmark survival analysis of patients alive 1 year after HCT showed worse survival over the next 5 years in those who had brain imaging in the first post transplant year (P<0.0001). Conclusion: These results suggest that development of neurological symptoms or a sign sufficient to prompt clinicians to order brain imaging early after HCT identifies a poor prognosis in transplant population.
Aims: Liver steatosis is the most common benign form of non-alcoholic fatty liver disease. It might be a risk factor for hepatocellular carcinoma, either (i) by causing fibrosis, which highly predisposes to hepatoma, or (ii) by being an early precursor of carcinoma, although it is usually considered not to be pre-neoplastic. We investigated the genomic profile of liver samples from patients with fatty liver disease. Study Design & Methodology: Copy number variation was investigated by array-CGH, using the Human Genome 244K catalogue array (Agilent Technologies), and changes validated by quantitative polymerase chain reaction analysis. Results: The analysis of liver biopsies from 17 patients, 10 of whom had histological diagnosis of non-alcoholic fatty liver disease, showed differences in the type of variants in patients with steatosis compared to those without steatosis at several chromosome bands, including 3q29, 6p2, 11q11 and 22q11. Conclusion: The genomic copy number changes we have demonstrated suggest that genomic structural variations may be associated with the pathogenesis or the evolution of steatosis.
Background: Progressing from undergraduate education to post graduate training has been punctuated by a clinical examination which has not changed significantly in decades. This study investigated the feasibility of using a validated postgraduate assessment methodology in an undergraduate setting; The Toronto Patient Assessment & Management Exam (PAME). Methods: A standardised patient-centred multifaceted healthcare pathway examination consisting of 4 separate consecutive encounters was piloted in the final year of undergraduate training. The entire final year medical class was invited to participate. The final sample of 25 was selected on a consecutive, volunteer basis. Student’s experienced 2 standardised simulated cases; 1 medical, 1 surgical. Candidates were examined by 2 independent examiners (subject experts) and were ranked on a Global Rating Scale. Passing standard was set at 3/5 - ‘barely adequate for Intern/PGY1’ but with the addition of second pass criteria of avoidance of an egregious error. Results: 23 students completed the examination. Two arrived late and were excluded. 21/23 demonstrated knowledge and skills at least at minimum expected standard. 18/23 avoided an egregious error. Subgroup analysis identified better performance in the assessment and management of the medical case and the review encounter (encounter 4) was the lowest scoring in both cases. The format was well received by students and examiners. Conclusion: The use of an alternative certification examination ‘ACE’ based on a postgraduate format ‘PAME’ in undergraduate setting appears feasible and discriminatory. Inclusion in the pass criteria of avoidance of egregious error appears to improve the specificity of the examination. The ACE format reveals potential to replace elements of prepractice (PGY1) clinical barrier assessment.
Objective: To compare Routine Assessment of Patient Index Data 3 (RAPID3) on a Multidimensional Health Assessment Questionnaire (MDHAQ) with the Western Ontario and Mc-Master Universities Osteoarthritis Index (WOMAC) in patients with knee or hip osteoarthritis and to evaluate its reliability. Methods: 678 patients with hip or knee osteoarthritis were assessed in daily practice clinical care during 2009-2013. Patients completed an MDHAQ and so a RAPID3 was calculated (physical function, pain, patient global estimate). Pain, stiffness, and physical functions using the standard WOMAC indices for hip and knee osteoarthritis were assessed too; correlation between WOMAC total scores and RAPID3 scores were estimated with Spearman’s rho. Furthermore a linear regression model was developed with a coefficient of determination R2. Finally we evaluated validity and reliability of this index to evaluate that RAPID3 is not inferior to WOMAC. Results: RAPID3 and WOMAC were correlated significantly, with a global correlation Spearman’ rho index of 0.84 (P<0.01). Computing analysis for diagnosis the correlation index was 0.83 for hip osteoarthritis (p<0.01) and 0.87 for knee osteoarthritis. Conclusion: RAPID3 scores provide similar quantitative information to WOMAC in patients with hip or knee osteoarthritis.
Aims: This research was aimed at investigating both sensory and motor function of the rectum and anal canal in the patients with irritable bowel syndrome (IBS) and organic bowel disease. Methodology: There were examined 45 children with age of 11-13 years suffering from IBS and organic bowel disease. 20 healthy children of same age were examined as a control. All patients were examined with the use of general clinical blood and urine tests, biochemical blood tests including direct and indirect bilirubin, alanin aminotransferase, aspartame aminotransferase, alkaline phosphatase, gamma-glutamyl transpeptidase, urea, creatinine. Coprogram and fecal dysbiosis were also analysed. Digital rectal examination, ultrasonography of the abdomen, multiphase duodenal intubation, colonoscopy or sigmoidoscopy or irigography (by the indications) was also performed. Results: The average basal pressure was 6.5±0.6 mm Hg in the rectum and 44.5±1.5 mm Hg in the anal canal (mean ± s.e.m.). These indices were not dependent on the general health conditions and the clinical manifestations of IBS. However the threshold of reflective sensitivity was significantly greater (28.4±2.2 ml) in patients with chronic constipation associated with organic bowel disease compared with patients suffering from IBS with functional constipation (20.5±2.8 ml) and diarrhea (22.5 + 2.8 ml). Conclusion: Anorectal manometry is a sensitive and specific method to differentiate IBS from organic bowel disease. The most informative test is anorectal manometry using rectal balloon slowly filled with water.
Aims: Acute changes in the blood glucose concentration have a substantial effect on intestinal motility in both diabetic and healthy subjects. This research work was therefore designed to assess the effect of DM on GIT motor activity and the impact of treatment with OG on same. Methodology: The phytoconstituents and median lethal dose of the plant extract was determined before administration. Eighteen rats were used; the animals were divided into three groups of six rats each. Group 1 served as the control which was fed with normal feed. Group 2 was diabetic untreated rats (DM) while group 3 was OG treated diabetic rats (DMT). At the end of 28 days, the intestinal transit and motility were determined using graded doses of acetylcholine, adrenaline and atropine. Results: The DMT intestine showed greater increase in contraction with increase in concentration of acetylcholine, application of adrenaline showed that the ileum of the DMT had a significantly lower (P=.001) percentage change in relaxation when compared to control or DM groups but there was no significant difference between DM and control group. While atropine caused a significant increase (P=.001) in percentage change in relaxation in the DMT group when compared to control and DM groups. There was no significant difference between the DM and control group. DM and the DMT groups had significantly higher (P=.05) percentage transit than the control group. There were no significant differences between DM and DMT groups. Conclusion: These results demonstrate that impaired intestinal motor activity in type I STZ-induced diabetic rats is enhanced by treatment with OG, this may be possibly due to its hypoglycemic effect and its concomitant impact on related biochemical and neuroendocrine interplay that affect GI motor function.
Aims: To investigate whether there is an association between ethnicity and health-related quality of life in patients with type 2 diabetes and to analyze if the association remains after adjusting for possible confounders. Methodology: A 12-item Short-form Health Survey - SF-12 was used. The associations between health-related quality of life and ethnicity, sex, age, marital status, educational status, BMI and age of onset of diabetes, were evaluated using linear regression analyses (β-coefficient and 95% CI). Study Design: Cross-sectional. Place and Duration of Study: This study is based on health-survey conducted among patients with type 2 diabetes on four Primary Health Care Centers in town of Södertälje (Sweden) during 2006-2008. Results: Assyrians/Syrians reported significantly lower scores on six out of eight dimensions and two component summaries (physical and mental) of quality of life than Swedes (with exception of role limitation due to physical problems and vitality). After adjustment for sex, age, marital status, education, BMI and age of onset of diabetes Assyrians/Syrians scored statistically significant lower bodily pain dimension (β-coefficient = -16.0, 95 % CI = -24.7 – -7.2) and poorer mental health (β-coefficient = -12.1, 95% CI = -18.5 – -5.7) than Swedes. Conclusions: The present study shows that Assyrian/Syrian patients reported significantly lower health-related quality of life than Swedish-born patients. Measurement of health-related quality of life in patients with type 2 diabetes should be included into investigation and could be useful in guiding and evaluation of treatment intervention. The knowledge on self-reported quality of life could prevent early diabetes complications.
Background and Study Aims: Gene expression of biomarkers involved in hepatocarcinogensis could be used for the early diagnosis of hepatocellular carcinoma (HCC). Aim: To evaluate the hepatocyte expression of Glypican-3 (GPC-3), paternally expressed gene 10 (PEG-10), Midkine (MDK), Serpin peptidase inhibitor (SERPINI1), and Ubiquinol-cytochrome (QP-C) which can represent a possible genetic profile among hepatitis C virus (HCV)-related HCC patients. Patients and Methods: This prospective study was conducted on 70 Egyptian patients with HCV-related chronic liver disease and HCC patients. Patients were categorized into chronic HCV group (n=25), post-HCV cirrhosis group (n=24), HCC group (n=21) in addition to 7 healthy individuals who were candidates for living-donor related transplantation. Liver tissue obtained from all patients was subjected to total RNA extraction, reverse transcription of extracted RNA into cDNA and finally tissue expression of GPC-3, MDK, PEG-10, SERPINI1 and QP-C by qRT-PCR was assessed in each group. Results: A significant increase in hepatocyte expression of GPC-3, MDK, SERPINI1, and QP-C was detected in cancerous compared to non-cancerous liver tissue; in contrast, PEG-10 was significantly expressed in chronic HCV patients. The ROC curves was able to identify best cutoff values, sensitivity and specificity for GPC-3 (7.26, 81%, 58%), SERPINI1 (0.16, 80%, 70%), MDK (3.8, 60%, 70%) and QP-C (0.45, 65%, 79%) respectively. There was no significant correlation between the tissue expression of these biomarkers and the size of hepatic focal lesion or AFP levels. Conclusion: Hepatocyte expression of GPC-3, MDK, SERPINI1, and QP-C could represent a potential genetic profile for the early detection of HCC.
Aims: The prevalence of type 2 diabetes may be most likely linked to obesity and its prevalence appears to have increased as the prevalence of obesity increased. Dioscorea alata L. has been observed to possess flavonoids which induce antidiabetic effect and phenolic compounds which could help in weight management. It has been postulated that any therapeutic regimes that can limit weight gain while simultaneously controlling blood glucose levels will be effective in managing diabetes. This study was conducted to determine the effect of this rich plant on food intake, blood glucose and body weight in a normal non- diabetic state. Materials and Methods: The tuber was washed and the edible portion was dried at 50ºC, powdered, passed through 60 mesh sieve (BS), the powder was extracted with hot (70ºC) distilled water in a mechanical shaker for 24 h, filtered and freeze dried to yield aqueous extract. Twenty male wistar rats were used for this study; the rats were randomly assigned into five groups of five rats per group. Rats in group 1 served as control and were administered 0.3ml of 0.9% sodium chloride while Group 2, 3 and 4 received Dioscorea alata L. (DA) extract at 100mg/kg, 200mg/kg and 300mg/kg of body weight respectively for a period of 21 days. Food intake, Fasting blood glucose and body weight were measured. Results: The results showed that food intake, fasting blood glucose level and body weight were significantly (P=.05) reduced when compared with the control group. Conclusion: Therefore, we recommend that with further research into the extraction of the active constituent of Dioscorea alata L. that caused the reduced food intake, this plant could serve as a great therapeutic diet in the management of diabetes.
Aims: A post marketing study to assess the symptomatic efficacy and safety of Troxipide (TROXIPTM) 100mg in the management of acid peptic disorders (APDs) in Indian population. Study Design: An observational, prospective, uncontrolled, open-label, multicenter post marketing study. Place and Duration of Study: Patients were enrolled from 62 centers across 11 states of India, between October 2010 and March 2012. Methodology: Out of 1500 APD patients, 1486 (850 men, 636 women; age range 16-85 years) were prescribed Troxipide 100mg tablet orally thrice daily. The efficacy and safety assessments were performed on day 14 and day 28 after beginning the treatment and recorded in the case report forms. The efficacy of Troxipide was estimated based on the changes from the baseline in the symptom score on a 100 point visual analogue scale (VAS) for individual symptoms. Safety was assessed by adverse events reported with usage of Troxipide on day 14 and day 28 after start of the treatment. Results: Troxipide monotherapy (n=1427) significantly reduced the mean VAS score from baseline for all major symptoms, viz. nausea, vomiting, belching, heart burn, epigastric pain, acid regurgitation, abdominal bloating & loss of appetite at the end of the study. The global mean VAS score (a sum of individual symptom VAS score) of these patients decreased from 134.26 ± 75.31 to 21.88 ± 39.52 at the end of the study (P < .001). All the patients who were previously treated but uncontrolled, with acid inhibitors like proton pump inhibitors (PPIs), histamine 2 receptor antagonists (H2RAs) etc. had a significant reduction in the VAS score from 164.38 ± 64.54 to 35.56 ± 54.24 on day 28 (P<.001). Troxipide was well tolerated with overall incidence of adverse events being 1.05% (n=15) and all the events were resolved without any sequel. Conclusion: The present study demonstrates that Troxipide symptomatically controls APDs like gastritis, dyspepsia, gastro-esophageal reflux disease (GERD) and ulcers with good tolerability.
Aims: Acute rheumatic fever (ARF) is common between 5-15 years, uncommon with different presentation 25 in children below 5 years. The aim of this study is to assess the frequency and characterize the pattern of 26 presentation of rheumatic fever (RF) in Egyptian children younger than 5 years. Study Design: Retrospective study. Place and Duration of the Study: Pediatric department, cardiology division, Cairo University Children’s Hospital, 5 years follow up. Methodology: We retrospectively reviewed the pre-completed data of 766 patients following up in the rheumatic fever clinic. Those with incomplete medical records were excluded. We compared between children younger than 5 years and those who are 5 years or older as regards their demographic data, clinical presentations, laboratory findings and echocardiographic findings. Results: We enrolled 667 patients; 17 of them (2.5%) were younger than 5 years (mean age 3.82± SD 0.393 years). The group of patients younger than 5 years old; included 10 females (58.8%) and 7 males (41.2%). Positive family history was encountered in 6 patients (37.7%). The most common presentations of the younger age group of patients were arthritis in 12 patients (70.5%), followed by carditis in 5 patients (29.4%), chorea in 3 patients (17.6%), and skin manifestations in 2 patients in the form of erythema marginatum (11.7%). Subclinical carditis was more common in younger children than the older group, with more severe valve affection. None of the patients in the younger age group had recurrence of the RF during a period of 5 years follow up while recurrences were encountered in 16 patients (2.5%) of the older age group. Conclusion: ARF can occur in children younger than 5 years. The possibility of rheumatic fever should be adequately investigated in those young children presenting with arthritis, chorea, or skin rash especially in developing countries like Egypt. Echocardiography is an essential tool to diagnose cases with5 subclinical carditis.
Aims: This study estimated the prevalence of energy drink consumption among students at the University of the West Indies (UWI), and describes the frequency of consumption and associated adverse symptoms. Study Design: A cross-sectional survey was conducted using a sex-stratified random sample of students residing in the halls of residence at the UWI, in Jamaica. Place and Duration of Study: The study was conducted at the Mona campus of UWI, between October 2011 and January 2012. Methodology: A self-administered questionnaire was used to obtain demographic data, use of energy drinks, frequency of use, symptoms associated with use and perception of benefits. Results: There were 607 participants, consisting of 336 (55.4%) females and 271 (44.6 %) males. The mean age was 20.7 years. Jamaicans constituted 80% of responders. Energy drinks were used by 450 participants (74.1%), with 288 (64%) being once weekly users, consisting of 160 males (74.8%) and 128 females (54.2%). There were 20 students (4.4%) who used energy drinks 2-3 times/week, 11 (2.4%) 4-6 times weekly, 3 (0.7%) were daily users. Adverse symptoms experienced were: palpitation in 133 (29.6%), headache in 64 (14.2%), and nervousness in 58 (12.9%). Insomnia occurred in 236 (52.4%) with 129 (54.7%) females and 107 (50%) males. Chest pain was reported by 27 (6.0%) and fainting occurred in 2 respondents. Perceptions reported about the use of energy drinks included, enhanced sport performance, 38.9%, improved academic performance, 60%, and improved sexual performance, 21.8% and improvement in daily activities (both mental and physical), 22.3%. Conclusion: Energy drink use is common among students on the halls of residence at UWI in Jamaica. Insomnia, palpitation and headache were the most common adverse symptoms, but students perceived benefits in their academic and daily activities.
Aims: To screen cases of infantile cystinosis among different forms of proximal renal tubular acidosis (RTA). Study Design: Cross sectional. Place and Duration of Study: From a total of 25 families of RTA followed up in Nephrology unit of Mansoura University Children's Hospital (MUCH), Egypt, two unrelated families were diagnosed as infantile nephropathic cystinosis using clinical suspicion plus mutation analysis of CTNS gene in the period between January 2008 and November 2012. Methodology: Two families with multiple cases of infantile nephropathic cystinosis have been diagnosed. In absence of high-performance liquid chromatography and tandem mass spectrometry used for measuring intraleucocyte cystine, diagnostic tools for cystinosis used in the current work were clinical and laboratory evidences of PRTA, slit lamp detection of corneal cystine crystals and finally identification of CTNS gene mutations. All patients were subjected to routine echocardiography because of accidental discovery of heart malformation in one case. Rare mutant variant of the first family was subjected to RNA analysis which unfortunately failed, alternatively an in silico study was used to predict splice site. Results: All patients with cystinosis manifested a severe clinical course. Proband of family 1 showed two known mutations; deletion in the exon 3 (c.18_21 del GACT) and substitution in acceptor splice site of intron 11 (c.971 -12G>A). In silico study predicted an anticipated splice site that modified the open reading frame in carboxy-terminal region. Probands of family 2 were affected by ventricular and atrial septal defects in younger, and mild mitral and aortic incompetence in older patient; their DNA analysis revealed a novel nonsense mutation (c.734 G>A) which caused a premature stop codon in position 245 of protein. Conclusion: Nephropathic cystinosis has been diagnosed with ease in Egyptian population without need of sophisticated investigations. A novel mutation had been added to the list of CTNS gene variants.
Aim: Human Immunodeficiency Virus (HIV), Hepatitis B (HBV) and Hepatitis C (HCV) viruses are the major causes of chronic viral infections globally and their prevalence has been extensively reported in the literature in various study groups including general population, health care workers, sex workers, homosexuals, pregnant woman. There are only fewer reports of Seroprevalence in tertiary care centers. We aim to study the trends of such infections in a tertiary care teaching hospital located at South India. Study Design: This is a prospective study conducted over a 5 year period (2008-2012). Place and Duration of Study: Department of Microbiology, Prathima Institute of Medical Sciences, Karimnagar, Andhrapradesh, India from 2008-2012. Methodology: We performed a prospective study of patients presenting at the Prathima institute of medical Sciences, a rural tertiary care teaching hospital over a period of 5-years (Jan 2008 to Dec 2012). Screening for anti-HIV I and 2, HBsAg detection and anti-HCV antibodies test were carried out by commercially available enzyme linked immunosorbent assay (ELISA). Results: Of the 16796 individuals tested a total of 570 (3.3%) showed seropositivity to one of the three viral infections tested. Among the population tested 258(1.5%) were seropositive for antibodies against HIV-1, and none showed HIV-2 seroprevalence (0%). Prevalence of Hepatitis B and Hepatitis C were found as 305(1.8%) and 7(0.04%) respectively. Co-infection of HIV-1 with Hepatitis B was observed only in 10(0.06%) cases. Conclusion: The present study revealed that there was a slight increasing trend for Seroprevalence of HIV- 1 antibodies among the tested population. Hepatitis B surface antigen Seroprevalence has shown a gradual increase during the last five years. Seroprevalence rates of Hepatitis C viral infection also showed an increasing trend through a five year period.
Aims: To evaluate the immunomodulatory effect of using non-cholesterol lowering dose of atorvastatin (AS) on skin allograft survival and on tumor growth in mice. Study Design: Experimental Study. Place and Duration of Study: Department of Experimental Pathology, Immunology and Microbiology, Faculty of Medicine, American University of Beirut; 2011-2012. Methodology: BALB/c mice were transplanted with skin allografts from C57BL/6 mice and given either AS alone or in combination with immunosuppressive agents. Average survival days of skin allografts were recorded and serum levels of interleukin-1β (IL-1β) and interferon-γ (IFN-γ) were quantified. BALB/c mice and C57BL/6 mice were challenged intraperitoneally with B16F10 melanoma cancer cells (cancer cell line syngeneic to C57BL/6 mice) and were then treated with AS. They were observed regularly for tumor growth. Results: The results indicated that in transplant mice AS given alone or in combination with immunosuppressive agents prolonged allograft survival time through non-cholesterol lowering mechanisms in spite of a non-significant change in serum cytokine levels. Furthermore, AS treatment enhanced tumor growth in C57BL/6 mice and promoted tumor growth in BALB/C mice. Conclusion: It can be speculated that AS down expresses TLR and modifies MHC presentation resulting in hindering the generation of an innate and adaptive immune response.
Aims: Controlled clinical trials collect huge amounts of high quality data. It is a waste of information to evaluate these data only for the efficacy and safety of the investigational medication. We propose extended evaluations of large trials for scientific purposes, especially to find the most important risk factors of the disease or variables which are associated with risk to have the disease. Methodology: The SPICE study is a controlled, randomised, completely masked trial that has investigated the efficacy of the Crataegus product WS 1442 in 2681 randomised patients with congestive heart failure (CHF). It was initiated and sponsored by Dr. Willmar Schwabe Pharmaceuticals. Results have already been published. We asked the sponsor to send us the data for an extended evaluation which was performed with a multivariate Cox regression model to find risk factors for the composite endpoint cardiac death, non-fatal myocardial infarction or hospitalisation due to progressive heart failure. Results: Most important risk factors are lower New York Heart Association (NYHA) function class, younger age and higher left ventricular ejection fraction. Patients had less cardiac events when taking glycosides, antiarrhythmics, nitrates, diuretics, beta blockers and calcium antagonists, so patients with a high number of cardiovascular medication have a poorer prognosis. Three scenarios for the interpretation of cardioactive medications as “risk” are presented. We assume that symptoms leading to the indication of a specific cardioactive medication are the risk. This risk is only partly balanced by medication intake. In general, the intake of cardioactive medication is associated with the risk to have the disease. Conclusion: An extended evaluation of large clinical studies finds out what is important for the outcome besides specific efficacy of the investigational drug. This is usually not the scope of pharmaceutical companies, but useful for science, doctors and patients.
Aims: To ascertain the risk of pre-cancerous treatment failure considering selected genetic, environmental, and clinical characteristics among Brazilian women. Study Design: A prospective study developed in a cohort of women treated for Cervical Intraepithelial Neoplasia (CIN) lesion. Place and Duration of Study: Gynecology Oncology day clinic of Brazilian National Cancer Institute, between October 2004 and May 2006. Methodology: We included 285 women (age range 18-75 years) with CIN submitted to lesion excision. All patients were interviewed at admission to identify epidemiological and clinical characteristics, having blood samples collected, and a colposcopic examination performed. TP53 polymorphism was ascertained using PCR-RFLP. After treatment, the study population was followed up with Pap-tests during two years. Treatment failure was evaluated using histological confirmation of any altered tissue. Kaplan-Meyer curves and Cox Proportional Risk Model were used for data analysis. Results: Frequencies of TP53 polymorphisms were: Arg72Pro genotype(Arg/Pro)-177(62.1%); Arg72 genotype(Arg/Arg)-55(19.3%); Pro genotype (Pro/Pro)-53(18.6%). Women with endocervical margins involvement showed an HR 7.01(1.73-28.44). Current smoking was statistically related to CIN treatment failure (HR:3.90,95%CI:1.28-11.91). Comparatively to Arg/Arg, the risks for treatment failure were: HR 1.51(95%CI:0.23-9.80) for Arg/Pro women; and HR:1.41 (95%CI:0.31-6.52) for Pro/Pro. Conclusion: Surgical margins involvement and current tobacco smoking presented independent risks for CIN treatment failure among the studied population. Pro/Pro genotype seems to be associated with CIN treatment failure.
Aims: Magnesium hydroxide (Mg (OH)2) is an alkaline compound that is used as an anti-acid and laxative agent. The objective of the study was to find the effect of electrolyte concentration and polymers on the rheological behavior of Mg (OH)2 suspension. Place and Duration of Study: Department of Pharmaceutics, Faculty of Pharmacy and Nanotechnology Research Center Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. Methodology: To evaluate the effect of structural vehicle, some suspending agents such as carboxymethyl cellulose (CMC), polyvinyl pyrrolidone (PVP), tragacanth and magnesium aluminum silicate (Veegum) alone or in combination were utilized. NaCl (0.01 and 0.05 wt/vol %) was employed as flocculating agents. Physical stability parameters such as sedimentation volume, and the ease of redispersion of the suspensions were evaluated. After incorporation of structural vehicles, the rheological properties of formulations were also studied to find out their rheological behavior. Results: The results showed that the combination of suspending agents had the most physical stability and pseudoplastic behavior with some degree of thixotropy. NaCl as flocculating agent (0.01 wt/vol %) in formulations containing tragacanth and CMC improved the rheological behavior of suspensions and sedimentation volume, while the presence of PVP could not affect these properties. Conclusion: The results showed that viscosity and thixotropy measurement are a reliable factor to study suspension stability.
In addition to well-known analgesic action of tramadol, its potential antinflammatory effects have not been thoroughly evaluated. On the other hand, effectiveness of antioxidants is also reported against inflammation. It is known that glyceryl trinitrate, as a nitric oxide donor, enhance the antioxidative and anti-inflammatory effects. In the present study, the efficacy of the tramadol mixtue with glyceryl trinitrate on cytokines, NF-kappa B expression and oxidative stress marker was examined on the formalin-induced inflammation in rats (Tramadol 5, 10 and 30 mg/kg + nitroglycerine 1 mg/kg). Cytokines (TNF-α, IL-6 and IL-10) and oxidative/anti-oxidative stress markers (MDA, GSH) were measured in blood samples. NF-kappa B expression was assessed immunohistochemically in spleen and thymus. The results show that tramadol 30 mg/kg has both anti-inflammatory and anti-oxidative effects. Additionally, it was evidenced that glyceryl trinitrate improves the anti-inflammatory and anti-oxidative effects of Tramadol (30 mg/kg) on the formalin-induced inflammation in rats. In this framework, the present study provides a unique approach for the analysis of the efficacy of tramadol and additive effects of glyceryl trinitrate on the acute inflammations in rats.
Aims: We aimed to evaluate the effect of primary tumour resection in stage IV breast cancer on survival. Study Design: Retrospective data analysis. Place and Duration of Study: Hacettepe University Faculty of Medicine Departments of General Surgery and Medical Oncology between 2001 and 2008. Methodology: A total of 118 patients with breast cancer in whom metastasis was found at the time of diagnosis or within two months of operation were included in the present study and analysed retrospectively. Seventy-six patients (63.4%) underwent surgical treatment, while 42 (36.6%) underwent only diagnostic biopsy and were administered medical treatment. Results: The mean follow-up was 28 months. The median overal survival was 44 months in operation group and 34 months in non-operation group. The oestrogen and progesterone receptor status, and type of metastasis had a significant effect on survival. The median two-year survival was higher in operation group (23 months vs. 18 months, p=0.013). The survival was significantly higher in patients with only bone metastasis than those with other types of metastasis (p<0.001). Among patients with only bone metastasis, there was no survival difference between operation and non-operation groups (p=0.201). The median survival was significantly longer in operation group than non-operation group in patients with only visceral metastasis (p=0.006). Conclusion: The surgical treatment has favorable effect on survival in stage IV breast cancer, thus should be combined with systemic treatment to increase success rates.
Introduction: Recently there has been an increased association between environmental factors and male infertility. Aims: In the present study, the effect of changes in testicular biometric parameters (weight and volume) and testicular function (Sperm count, morphology, testosterone level) in Cadmium chloride administered Wistar rats was studied. Methodology: Twenty male albino Wistar rats were randomized into four groups (n=5). Group A (control) received rat chow and water, while Group B, C and D received 15mg/L, 20mg/L and 25mg/L of Cadmium chloride respectively for 6 weeks. Result: There was a significant (P=.05) and dose dependent decrease in testicular function parameters in the rats and a significant (P=.05) and positive correlation between the biometric parameters and testicular function. Conclusion: The findings showed that Cadmium chloride has a deleterious effect on testicular function and biometric parameters of the testes may be important in the assessment of testicular function.
Aims: Narghile smoking may be associated with a number of unconventional practices that need to be thoroughly investigated for their potential health problems. We investigated the prevalence and pattern of unconventional practices related to narghile smoking including the use of medications, fruits, and alcohol, among a sample of café patrons. Place and Duration of Study: A few cafés at Amman, Jordan during July 2011. Methodology: This was a cross-sectional survey whereby a pre-prepared questionnaire was distributed to a sample of café patrons. Questionnaire included demographic information, history of tobacco use, pattern of narghile smoking including unconventional practices and lastly health awareness and attitudes towards cessation. Results: Out of 96 café patrons, 61 (63.5%) agreed to participate with 42 males and 19 females. Age range was 16-64 years (mean=27.5±9.2). About 47.5% used fruits as the narghile head and 16.4% used fruits as water tank. Equal proportions (9.5%) of the sample added either milk/soft drinks to tank or added drugs to tobacco mix or the liquid contents of the tank. Conclusion: Narghile smoking may be associated with unconventional practices like the use of psychoactive drugs and alcohol. Further research is needed to explore the reasons behind this trend, and the associated potential health hazards.
Aims: To conduct an epidemiological study to establish the association between malnutrition, metabolic disorder and Onchocerciasis to Nodding Syndrome (NS) in Northern Uganda. Study Design: Case-control study design. Place and Duration of Study: Odek and Atiak sub counties in Gulu and Amuru districts between 10th to 20th June 2012. Methodology: We recruited consecutively 101 children with probable NS in the 2 sub counties in Gulu and Amuru districts. Controls were from the same population but without symptoms of NS and were matched by age, sex and residents. History and physical examinations were conducted; anthropometry, blood samples and skin snips were obtained from cases and controls. Researchers were pediatricians, psychiatrists, nurses, laboratory scientists and epidemiologists. The research proposal was approved by the Ministry of Health and the IRB of Gulu University. Results: There was a statistically significant association between NS with malnutrition (t=0.142; p=0.044), Onchocerciasis (Χ2 = 152.74, p<0.001; OR 7.025 95% CI 3.891, 12.682) and High Anion Gap (Χ2=146.752, p<0.001; OR 6.313 95%CI 4.027, 9.895). Conclusion: Nodding syndrome is associated with metabolic disorder in young children who are malnourished and infected with Onchocerciasis.
Background:KRAS mutation (KRM) is the earliest, most common mutation in pancreatic cancer. Accurate assessment of tumour KRM status in pancreatobiiary tumours is relevant in an era of targeted molecular therapies. Aim: To assess KRM in tumour and non-tumourous margin tissue in patients undergoing a pancreatic resection. Study Design: Original research, retrospective review of prospectively collected specimens. Place and Duration of Study: Patients who had undergone pancreaticoduodenectomy and distal pancreatic resection at the Royal Adelaide Hospital from 2011-2012 were consented for the study. Methods: Patient demographics, background history and tumour details were collated. Tumour tissue and margin areas were macrodissected from FFPE tissue sections following identification by a pathologist. DNA was prepared from the tissue using the QIAamp FFPE Tissue kit (Qiagen GmbH, Hilden Germany). KRM at codons 12 and 13 was assessed using SNaPShot TM (Applied Biosystems, Warrington UK) in tumour tissue and non-tumourous margin tissue. Fourteen patients were included in the study. The median age of the patients in the study was 68 (range 57-86) years. The M : F ratio was 8 : 6. Results: Twelve patients had adenocarcinomas (5 pancreatic; 4 ampullary, 3 biliary) and two had benign mucinous tumours. Six patients with adenocarcinomas had KRM (5@codon 12 and 1@codon 13). Margin tissue was negative for KRM in all the tested patients (p<0.016 Fisher) particularly, in those with tumour KRM. Tumours with KRM were associated with larger tumours 30(22-65) mm vs 20(15-35) mm [median(range)](p = .045 – MW-U). Nodal disease occurred in 6/6 with KRM vs 2/6 without KRM (p = .61 – Fisher). Conclusions: KRM is a local tumour event and not a field change. This suggests that testing for KRM should be reliant on tumour tissue and not surrounding normal margin tissue. KRM was associated with larger malignant tumours and a trend towards nodal disease.
Background: Sierra Leone started the Direct Observation Treatment Strategy (DOTS) for the treatment of pulmonary tuberculosis in 1992. The country’s pulmonary tuberculosis (PTB) treatment program is now standardized according to international scale. Under the national standardized PTB treatment system, the regimen for new PTB patients consists of a 2-month intensive treatment phase with isoniazid, rifampicin, pyrazinamide and ethambutol, followed by a 4-month continuation phase with rifampicin and isoniazid. Aims: To determine and analyse the annual PTB treatment success and incidence rates, treatment defaulters’ rate, and pulmonary tuberculosis mortality from 1992 to 2010 under the DOTS program at the Germany Leprosy Relief Association’s (GLRA) 13 regional diagnostic centers and chest clinics in Sierra Leone and to compare this data with the annual national tuberculosis data stored in WHO tuberculosis database covering the period 1992-2010. Study Design: The study retrospectively analysed pulmonary tuberculosis annual incidence rates for study subjects who registered for diagnosis and later for treatment at the GLRA 13 regional diagnostic centers and chest clinics from 1992 to 2002. From these data we were able to determine the treatment success and defaulters’ rates, and PTB mortality for these subjects. We also analysed data of the annual national tuberculosis incidence and success rates, and mortality rates retrieved from World Health Organisation (WHO) TB data for Sierra Leone for the period 1992-2010. Twenty six (26) healthcare service providers were also interviewed for additional information about the main cause of mortality among tuberculosis patient during the period under investigation. Study Subjects: A total of 2,958 (1,881 men and 1,077 females) mostly adults of age range 15-65 years were diagnosed and later treated for pulmonary tuberculosis from 1992 to 2002 at the various GLRA diagnostic and treatment centers in the country. Setting: The study was a multicenter study conducted at the Germany Leprosy Relief Association’s (GLRA) main referral diagnostic center and chest clinic at Lakka in Freetown and the Department of Environmental Health Sciences, Njala University in Bo, Sierra Leone. Pulmonary tuberculosis treatment outcomes data used in this study were obtained from TB patients who were admitted at various GLRA chest clinics in Sierra Leone from 1991-2001. Data analysis and literature reviews were done at the Department of Environmental Health Sciences, Njala University in Bo, Sierra Leone from 2011 to 2012. Results: The most important finding of this investigation was that the annual pulmonary tuberculosis incidence and treatment success rates (% cured rate and % completed treatment rate) rose significantly during the period under review for both the GLRA’s study subjects and the cases stored in the WHO tuberculosis database. Conclusion: The significantly high and growing number of annual PTB incidence rates during this HIV/AIDS epidemic reinforces the need for routine PTB treatment monitoring and supervision as well as compulsory HIV testing for tuberculosis patients seeking treatment.
Aims: To study effect of birth weight and mode of feeding during early infancy on clinical indicators of obesity and lipid profile in adulthood. Place and Duration of Study: The study was conducted on 260 adults aged 21-31 years censured in Yaoundé between February and March 2012. Methodology: The study was transversal and retrospective. Data such as birth weight, type of breastfeeding and duration of breastfeeding was collected. Participants also followed a food diary for a week. Anthropometric measurements and cardiovascular risk factors such as total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides and blood pressure were assessed. Results: There were no significant difference between LBW group and NBW. In HBW group weight, BMI and lean mass were significantly (p< .05) higher than in NBW group. Body fat was significantly (p < .05) high among NBW compare to HBW. These results were confirmed by binary regression for body fat .918 (.852-.988) and lean mass 1.100 (1.039-1.164). Relation between birth weight and body fat showed an inverse and significant (P<.05) correlation. Participants with low birth weight (LBW) had a concentration of total plasma cholesterol significantly higher than participants with normal birth weight (NBW) (p < .05) or High birth weight (HBW) (p < .05). Furthermore, a significant inverse correlation was noted between the total plasma cholesterol (P < .01), LDL cholesterol (P < .05) and the birth weight. The plasmatic total cholesterol (p < .05) and LDL cholesterol (p < .05) of participants who had mixed feeding was also higher compared to those who have been under exclusive breastfeeding for 6 months. Conclusion: birth weight and mode of feeding during early infancy have effects on clinical indicators of obesity and lipid profile in adulthood.
Aims: The aim of our study was to investigate the effects of continuous action of ultrasonic waves of variable frequencies on behavior of rats in "classical" tests used to reveal depression-like behavior, to evaluate the influence of different psychotropic drugs on rates of these tests and to analyze expression of several genes involved in pathogenesis of depression. Study Design: Rats in individual cages were exposed to ultrasonic irradiation for 21 days. Place and Duration of Study: V.P. Serbsky National Recearh Center For Social and Forensic Psychiatry, Department of Basic and Applied Neurobiology, Moscow, Russian Federation, between November 2012 and January 2013. Methodology: 48male non-pedigree albino rats were divided into 5 groups: non-ultrasound-saline, ultrasound-saline, ultrasound-fluoxetine, ultrasound-bupropion and ultrasound-tianeptine. After 21 days of irradiation social interaction test, forced swimming test and sucrose preference test (anhedonia test) were conducted. Than rats were decapitated and prefrontal cortex were taken for RT-qPCR gene expression analysis of 5-HT1A, 5-HT2A, 5HT1B, 5HT2B receptors and SERT. Results: Depression-like behavior manifests itself in reduced social activity in social interaction test, increased immobility in forced swimming test and lower sucrose consumption in anhedonia test. The administrated antidepressants demonstrated their effectiveness, except for bupropion in the social interaction test. RT-qPCR gene expression analysis showed reduced expression of 5HT2A receptor gene and increased expression of SERT gene in the prefrontal cortex of rats stressed with ultrasonic radiation. Conclusion: The obtained data allow to conclude that further investigations with lager number of animals, extended tests battery may allow to claim that this model meets the main requirements set to animal models (face, predictive and construct validity) and can be used in studies of depression-like disorders caused by a situation of informational uncertainty and in pre-clinical development of new antidepressants.
Aims: To study the prevalence of hypertension hemodynamic subtypes, prehypertension, hypertension (HTN) stages 1 and 2 as well as to evaluate the influence of overweight and obesity on those prevalences among untreated hypertensive Cameroonians. Study Design: This study was descriptive and cross-sectional. Place and Duration of the Study: Participants were randomly selected in Yaounde, Nkongsamba and Foumban from January 2009 to October 2012. Methodology: It involved 7042 Cameroonians of both sexes aged 18-85 years old. Blood pressure categories were defined using the 7th report of Joint National committee on hypertension. Hypertension subtypes were defined as Isolated Systolic Hypertension (ISH) [Systolic Blood Pressure (SBP)≥140 mmHg and Diastolic Blood Pressure (DBP) < 90 mm Hg]; Isolated Diastolic Hypertension (IDH) (SBP<140 and DBP≥90); Systodiastolic Hypertension (SDH) (SBP≥140 and (DBP) ≥ 90). Participants were classified based on their body mass index (BMI) as obese (BMI ≥30 kg/m2), overweight (25 ≤BMI≤ 29.9) and normal weight (18.5 ≤ BMI ≤ 24.9). Results: Close to 1/3 of individuals (2089) were pre-hypertensive (28.03% women vs 31.30% men, P<.001). 14.3% participants (14.28 % women and 14.32% men, P = .05) already suffering from hypertension stage 2, were diagnosed for the first time. IDH and SDH were the predominant subtypes: IDH (44.23% or 3115 participants), SDH (34.07%) vs ISH (21.7%) and varied with BMI classes. Distribution of frequencies (%) was the following for Normal weight: ISH (30.8%); IDH (41.3%), SDH (27.9%). Overweight: ISH (18.9%); IDH (46.8%), SDH (34.2%). Obese: ISH (15.3%); IDH (44.6%), SDH (40%). Fatness and waist circumference were predictors of IDH and ISH respectively. Conclusion: Obesity was associated with HTN in all age groups and both sexes. IDH and SDH in Cameroon are not only associated with increasing age, but also are prevalent in most cases of obesity induced HTN. This suggests that there is a need to improve prevention and surveillance measures, tailored towards specific subtypes.
Aims: To evaluate the effectiveness of a brief educational intervention and a predictive difficult airway (DA) checklist on performance of emergency endotracheal intubation by residents. Place and Duration of Study: The Emergency Department (ED) of Interim Louisiana State University Public Hospital, the level one trauma center in New Orleans, from September 2006 to June 2010. Methodology: We performed a retrospective chart review of patients intubated in the ED during the study period. Demographic, physiologic and procedural data had been previously recorded on a worksheet immediately following each intubation. In July 2008, residents received a lecture on management strategies for the DA and participated in simulation exercises based on DA scenarios. A detailed checklist of DA predictors was added to the standard intubation form, and completed by the resident prior to each intubation. Procedural outcomes were compared for number of attempts, time to successful intubation, faculty involvement and use of adjunct devices for the pre-and post-intervention periods using generalized estimating equations and z statistics. Results: There were 266 intubations in the pre-intervention period and 373 in the post-intervention period. 50.3% of post-intervention intubations met criteria for DA. Time to successful intubation did not vary between the two groups (11.6 minutes pre; 10.8 post, P=0.30). There was no significant difference in the number of attempts (1.4 pre; 1.3 post, P =0.44) or faculty interventions (1.5 v. 3.75%) or the number of successful intubations that were assisted by adjuncts (P =0.22). Success on the second attempt was more likely if an adjunct was used (P =0.24). Conclusion: A brief DA educational module and the application of a standard pre- intubation checklist resulted in few appreciable changes in EM resident intubations. Further research is needed to more clearly define the relationship between DA education and resident intubation performance.
Aims: To investigate in vitro antioxidant/radical scavenging activities and hepatoprotective ability of ethanolic leaf extracts of Cassia occidentalis (COLEX) in male Wistar rats treated with sodium arsenite (NaAsO2). Study Design/Methodologies: Using four different methodologies, the anti-oxidant/free radical scavenging activities of COLEX were determined in comparison with standard antioxidants, butylated hydroxyanisole (BHA) and butylated hydroxytoluene (BHT). For the hepatoprotection study, four groups of rats were used. Groups A: Control group given distilled water only; B: Given NaAsO2 at 2.5 mg•kg-1 bw/day (p.o.) for 2 weeks; C: Administered COLEX alone at 200 mg•kg-1 bw a day for 2 weeks (p.o.); D: Pre-treated with COLEX for 2 weeks followed by NaAsO2. The activities of the enzymes aspartate and alanine aminotransferases (AST and ALT), alkaline phosphatase (ALP) and γ-glutamyl transferase (γGT) were determined in the treated and control animals as indices of hepatotoxicity. Place and Duration of the Study: The animal treatment and analyses were carried out at Department of Biochemistry, University of Ibadan between February and June 2008. Results: At 25, 40 and 50 µg•ml-1 concentrations of the extracts or the antioxidants, the reducing power is of the order BHA > BHT > COLEX. At 50 µg•ml-1, the percentage inhibitions of peroxidation by COLEX, BHA and BHT were respectively 96.2%, 97.3% and 98.4% while percentage DPPH scavenging effect of COLEX, BHA and BHT were 62.5%, 67.5% and 61.3% respectively. The H2O2 scavenging activities were respectively 53.0%, 85.3% and 97.8% for COLEX, BHA and BHT. Pre-treatment with COLEX before administration of NaAsO2 led to significant (p < 0.05) reduction in the mean liver and serum γGT, and serum ALP and AST activities when compared with group administered only NaAsO2. Conclusion: COLEX exhibited hepatoprotective effects against NaAsO2 toxicity in male rats.
Objective: To investigate the demographic characteristics and dietary patterns of elderly adults (>60 years) in Ondo State, Nigeria. Methodology: This was a random sampling of 400 elderly individuals (>60 years) living in Ondo State, Nigeria. Data on demographic and non-demographic variable characteristics, including food habits, dietary patterns and food frequency, were collected using an open-ended and structured questionnaire. Most individuals aged 60–69 years were married, with fewer than 25% having primary education and the majority of the remainder having no formal education. Most were employed in farming and their income was low (<200 USD per month). About 80% ate three meals daily, 25% skipped meals, and 39% avoid certain foods and 87% had favorite food which relates significantly with gender (=7.2; p<0.05) marital status (=5.7; p<0.05) and health (rate of falling sick). Dietary pattern was significantly associated with body ailments (=51.9; p<0.05). Certain habits, such as alcohol ingestion, influenced the number of meals (=10; p<0.05). Memory loss was significantly associated with skipping meals (=7.2; p<0.05), whereas depression was significantly associated with the number of meals (=6.2; p<0.05). A logistic regression model found that educational level, occupation and gender were significant independent predictors of dietary pattern. Conclusion: Most elderly individuals in Ondo State, Nigeria, were of low socioeconomic level and illiterate, with dietary patterns influenced by age, education, occupation and gender. Age correlated inversely with bone mass, body mass index, body fat and body water.
Aims: Procalcitonin, the prohormone precursor of calcitonin rises in serum response to bacterial infections. Circulating PCT levels decrease when the infection is controlled by the host immune system or antibiotic therapy. The present study was conducted to measure the diagnostic and prognostic utility of procalcitonin in tuberculosis. Methodology: The study group consisted of forty patients with pulmonary tuberculosis (PTB) and forty normal controls (NC). Blood was collected from NC and PTB (labeled as PTB-0). Patients underwent the 4-drug chemotherapy for 2 months following which blood was collected again (labeled as PTB-2). They were continued into the next 4 months of the 2-drug regimen. Blood was collected thereafter and labeled as PTB-6. All blood samples were semiquantitatively analyzed for procalcitonin. Results: Serum PCT was < 0.5 ng/ml in thirty seven out of forty normal controls and > 2 ng/ml in three. The prohormone level was > 2ng/ml in fifteen and > 10 ng/ml in the rest of the PTB-0 subjects, thus indicating that PCT levels served as a useful marker of infection in PTB patients at diagnosis. After 2 months of intensive treatment the number of patients with PCT levels > 10 ng/ml increased to thirty two in PTB-2. Only 8 patients recorded plasma PCT levels > 2 ng/ml. At the end of 6 months of treatment, PCT values in all patients had decreased to < 2 ng/ml. Conclusion: Serum PCT seemed to show diagnostic and prognostic utility at the end of treatment however, PCT is not specific for tuberculosis alone and may be raised in other lung infections. Future studies with quantitative analysis of PCT in tuberculosis in comparison to other lung infections are needed for better understanding of the role of PCT in PTB.
The Human Papilloma Virus (HPV) and Human Immunodeficiency Virus (HIV) are both sexually transmitted infections, which have impacted the prevalence of cervical dysplasia and cancer in women. Infections with one of these viruses can facilitate infection with the other. In Jamaica cervical cancer is seen in 27.5 per 100, 000 women making it the second leading cause of cancer death in this population only to breast cancer as a cause of death in women with cancer. Our study investigates the seroprevalence of anti-HIV antibodies in women with abnormal pap smears in Jamaica to determine the influence of HIV on cervical dysplasia. Only patients with positive confirmatory tests were classified as HIV positive. Enzyme-Linked Immunosorbent Assay (ELISA) was used for screening while the Western blot was used for confirmation. Sero-prevalence of anti-HIV antibodies in women with abnormal pap smears was 0.85%. The preliminary results of HIV seroprevalence in women with abnormal pap smears may be low in Jamaica because of the success of the HIV/AIDS programme. A larger study can be done in the future and be representative of the Jamaica population, since the present study has as a limitation a smaller number of controls in comparison to cases. The findings reported do not support the hypothesis that HPV infection facilitates HIV infection in the studied population. It is the first study of its class reported in the Caribbean. It has been postulated that HPV infections may account for the cervical dysplasia despite the low prevalence of HIV association in the women with abnormal pap smears and that persistent HPV and to a lesser extent the HIV is responsible for the prevalence of abnormal pap smears in Jamaica. A limitation of the study was that the control group was smaller than that expected for 3 million’s population but a larger study can be done in the future.
Aims: Eggs are a good source of lutein and zeaxanthin, carotenoids known for their antioxidant properties. Mexican children have been shown to consume limited amounts of fruit and vegetables. The purpose of the current study is to determine whether the inclusion of eggs in the diet increases plasma carotenoids in this population. Study Design: This study is a follow up on the effects of high egg intake on plasma lipids and atherogenic lipoproteins in children. Fifty four Mexican children (25 boys/29 girls) aged 8-12 y were randomly assigned to consume either 2 eggs/d (518 mg additional dietary cholesterol) (EGG period) or the equivalent amount of egg whites (SUB Period) in a cross-over design for 4 wk. After a 3 wk washout, children were crossed over to the alternate treatment. Methodology: 3-day dietary records, plasma carotenoids and apolipoproteins were measured at the end of the EGG and SUB Periods. Results: In agreement with the lack of effects of eggs in increasing atherogenic lipoprotein profiles, plasma apolipoprotein B concentrations did not change between periods indicating that increases in plasma cholesterol were not associated with higher number of LDL particles. Although the values for apo C-III were high compared to other pediatric populations, they were not affected by egg intake. Dietary records indicated low intake of carotenoids, especially during the SUB period. Plasma lutein and zeaxanthin were increased during the EGG period from 0.235 ± 0.071 to 0.280 ± 0.147 μmol/L (P<0.001) and 0.044 ± 0.019 to 0.051 ± 0.031 μmol/L (P<0.001), respectively. Conclusions: These results suggest that the eggs are a good source of lutein and zeaxanthin in this population and that the increases in LDL size during the egg period may also be related to a better transport of these carotenoids in plasma.
Aims: The aim of this study was to evaluate the effect of honey on blood pressure and heart rate on healthy male and female subjects. Methodology: 20ml honey orally administered was evaluated in hundred healthy male and female subjects. Their basal systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) were taken as the control values. After measuring their basal SBP, DBP and HR, 20ml of honey was orally administered and the systolic blood pressure, Diastolic blood pressure and heart rate were measured at 15, 30, 60 minutes with a digital sphygmomanometer and analogue sphygmomanometer as a check. Results: The results of this study showed that mean SBP decreased (p=.05) significantly in female compared to male at control, after 15, 30 and 60 minutes of oral administration of 20ml of honey. DBP decreased (p=.05) significantly in female compared to male at control, after 15 minutes and 60 minutes of oral administration of 20ml of honey and HR decreased (p=.05) significantly in female compared to male at 60 minutes of oral administration of 20ml of honey. Conclusion: The effect of honey on systolic blood pressure, diastolic blood pressure and heart rate shows that it has a hypotensive effect in healthy male and female subjects.
Aim: Factor XIII is a transglutaminase that crosslinks fibrin in the last steps of the coagulation process. A few polymorphic sites have been identified in this gene, one of them being a point mutation (FXIII Val34Leu), leading to an amino acid change of valine to leucine. Several studies were published on the association between FXIII 34Leu allele and a decreased incidence of myocardial infarction (MI) with high controversy results dependent on the population. The aim of our study was to further investigate the possible protective role of the FXIII 34Leu allele polymorphism against acute MI in Egyptian patients. Study Design: Clinical examination by cardiologist specialists, blood test for biochemical markers and DNA genotyping using specific molecular sensing probes in Real Time PCR. Place and Duration of Study: Patients were recruited from consecutive admission to the coronary care unit, Suez Canal University Hospital, Ismailia, Egypt. Material and Methods: Total 107 subjects were recruited and subdivided into two main groups; patients (82) and control group (25). On admission, the following data were fulfilled: age, smoking, history of Diabetes Mellitus (DM) and Hypertension (HTN), family history of MI. Clinical examination: Blood pressure and Body Mass Index calculation were done and for patients a short outcome prognosis was done using left ventricular Ejection Fraction (EF). Routine laboratory investigations for recruited groups including fasting and postprandial glucose level, Triglycerides, total Cholesterol, HDL-C and LDL-C were carried out. Factor XIII Val34Leu was genotyped for all the recruited subjects using site specific molecular probes in real time PCR. Results: Obtained data were analyzed using OD and CI values, Pearson correlation coefficient Inter-correlations and Regression analysis model that showed insignificant association between FXIII Val34Leu polymorphism and MI patients. Conclusion: FXIII 34Leu variant has no association with reduced incidence of myocardial infarction in Egyptian patients.
Aims: To compare between the effectiveness of transcutaneous electrical acupoint stimulation versus Acupressure on post-operative nausea and vomiting in women scheduled for abdominal hysterectomy. Place and Duration of Study: Department of obstetrics and gynecology, Kasr El-Aini University Hospital, and outpatient clinic of faculty of Physical Therapy, Cairo University, between July 2012 and January 2013. Methodology: We included 150 patients (age ranged 45-65 years) with post-operative nausea and vomiting after abdominal hysterectomy, their body mass index was less than 30 kg/m2 without medical history of gastrointestinal diseases. Patients were equally divided into three groups. Group (A), received trancutaneous electrical acupoint stimulation (TEAS10Hz was applied on the P6 point of the dominant hand 30min before induction of anesthesia and continued for 8 h postoperatively) in addition to post operative anti-emetic drug. In group (B), acupressure (elastic wrist bands with a sphere to apply pressure on P6 point) was performed exactly in the same way as in group (A) in addition to post operative anti-emetic drug. Patients of group (C) received post operative anti-emetic drug only. Post-operative metoclopramid 10mg/iv was administrated for all patients in groups (A, B & C) as antiemetic. Assessment of all patients in all groups (A, B&C) was carried out after 4h and 8h of the treatment through Mc Gill assessment for postoperative nausea and vomiting. Results: Showed a statistically more significant decrease (P<.0001) in nausea and vomiting scales for group A than both groups B&C after 4 and 8 hours. Conclusion: Trancutaneous electrical acupoint stimulation of P6 point appears to be more effective than acupressure in alleviating post-operative nausea and vomiting after abdominal hysterectomy.
Aims: Literature is calling the attention to several risks for developing prostate cancer (Pca), and race is one of them. We performed an analysis of data of the charts of all unfavorable PCa (uPCa) treated with the combination of high-dose-rate brachytherapy (HDR) and external beam radiotherapy (EBRT). Study Design: Retrospective study. Place and Duration of Study: Department of Radiation Oncology (AC Camargo Vancer Center), São Paulo, Brazil, between 1997 and 2010. Methodology: The data of all uPCa treated between 1997 and 2010 were evaluated. Ethnicity definition was based on 3 categorizations: Black, White and Asiatic. We included 229 patients (age range 47-83 years). The median follow-up was 70.3 months (range, 36 –155 months). There were 7.4% (17) Asiatic, 79.0% (181) Whiten and 13.6% (31) Black patients. Results: EBRT and HDR doses ranged from 40 to 54 Gy and 16 to 30 Gy given in 4 fractions, respectively. Actuarial 5- and 10-year overall and disease free survical (DFS) rates were 87.6%, 61.3%, 90.9% and 54.2%, respectively. On univariate analysis prognostic factors related to improved DFS were White/Asiatic race (p<0.001), initial clinical stage p=0.004, HDR>20Gy (p<0.001) and Gleason-Score<7 (p<0.001). On multivariate analysis race (p=0.037), late clinical satge (p=0.038) and HDR<20Gy (p<0.001) were associated with biochemical failure. Conclusion: An association with aggressive PCa was observed in Black when compared to White/Asiatic patients. Already known predictive factors of biochemical failure were confirmed in our analysis. Improved DFS was related to HDR dose escalation. Further studies are still necessary to provide more information about clinical and genetic predictive factors of aggressiveness that can be used to guide a personalized treatment.
Aims: To evaluate salivary and serum IgG levels in patients with head and neck squamous cell carcinoma (HNSCC) and healthy control subjects and to assess the effect of treatment on IgG levels. Study Design: A cross sectional study. Place and Duration of Study: Department of Oral Pathology and Department of Radiotherapy, University College Hospital, Ibadan, Nigeria between January 2010 and December 2010. Methodology: Seventy eight subjects comprising 30 patients with untreated HNSCC, 18 patients with HNSCC receiving treatment and 30 healthy, age and gender-matched individuals were included. Serum and salivary samples from the participants were analysed for total IgG using ELISA technique. Results: The mean serum IgG in untreated and treated HNSCC patients was significantly lower compared with healthy controls (P=.001), while mean salivary IgG was significantly elevated (P=.001) in untreated HNSCC patients compared with treated and healthy controls. There was no significant correlation between serum and salivary IgG levels. Conclusion: In patients with head and neck squamous cell carcinoma, serum IgG was reduced while salivary IgG was elevated compared with healthy controls. Our finding suggests differential roles of immunoglobulin G in serum and saliva of patients with head and neck squamous cell carcinoma. Hence, salivary IgG may be a useful biomarker in patients with head and neck squamous cell carcinoma, while serum IgG levels may be useful in monitoring treatment in these individuals.
Aim:To determine possible factors associated with lethal outcome of pneumonia and to assess the accuracy of Pneumonia Severity Index (PSI) and Pediatric Risk of Mortality (PRISM) score in predicting mortality from pneumonia. Study Design: A retrospective analytical study Place and Duration of the Study: Pediatric Emergency Department (PED) of the pediatric hospital (Abu El-Reesh) Egypt, during a period from April 2010 to April 2012. Methodology: Children ≤5 years admitted to the PED diagnosed having pneumonia were included in the study (n=236). Data were retrieved from the electronic records and consisted of; hospital data, personal data, provisional and definite diagnosis, presenting clinical symptoms and signs, outcome and measurements of blood counts and serum biochemical markers. Results: Non-survivors constituted 26.7% of the studied group. Non-survivors significantly had a higher median PRISM score (18; IQR 11 for non-survivors compared to 8; IQR 6 for survivors, P =.000), have a longer median length of stay (8 days; IQR; 1 day for non-survivors compared to 4 days; IQR 2 days for survivors, P =.000), higher PSI score (61; IQR 39 for non-survivors compared to 41; IQR 20 for survivors, P=.000).Only longer LOS, higher PRISM score were independently associated with mortality. ROC curve analysis revealed area under the curve (AUC) of 0.857 for PRISM score (95% CI 0.80–0.91) and 0.73.6 for PSI score (95% CI 0.66–0.81). A PRISM score ≥ 12.5 is 81.4% sensitive and 73.3% specific in predicting mortality. Conclusion: Case fatality rate is quite high. PRISM scoring is accurate in predicting mortality among pneumonia pediatric patients and thus useful in decision making concerning management of these cases.
Background: Radiation protection in paediatric radiology requires special attention than in adult because children are more sensitive to radiation and at higher risk. This risk is explained by the longer life expectancy in children which allows for harmful effects of radiation to manifest and their developing organs and tissues being more sensitive to radiation. Hence, the need for determination of appropriate radiation dose for paediatric patients. Aims: To estimate entrance skin dose (ESD) received by paediatric patients during diagnostic x-ray examinations. Materials and Methods: A total of 253 paediatric patients undergoing various x-ray examinations between June 2011 and December, 2012 in a teaching hospital in the South West Nigeria were considered in this study. This hospital has no dedicated x-ray unit for paediatric radiology. The ESD received during x-ray examination was calculated using mathematical formula that incorporated the use of x-ray beam output and exposure parameters selected for the examination. Correlation coefficient (r) analysis was used to test the relationship between ESD, patient size (age and weight) and exposure parameters (kVp, mAs). Results: The ESD and ED received by paediatric patients from all the x-ray examinations considered in this study ranged from 10.29 ± 3.80 - 880.04 ± 89.44 µGy and 1.44 ± 0.53 - 66.74 ± 30.84 µSv respectively. The correlation coefficient analysis at 0.01 level of significant showed that there is a correlation between patient dose and exposure factors but there is no correlation between ESD, age and weight of patients. Conclusion: The ESD received by paediatric patients is higher than the internationally recommended reference dose. This is attributed to lack of dedicated x-ray unit and personnel for paediatric radiology.
Aims: This study was embarked upon to determine the effect of diabetes mellitus on food intake, water intake and body weight, and to ascertain the impact of treatment with crude Aloe vera gel on diabetic animals. Methodology: The phyto-constituents and median lethal dose of crude Aloe vera gel were determined before administration. 32 albino wistar rats were divided into four groups thus, control, diabetic untreated group (DM), diabetic group treated with crude Aloe vera gel (DMT) and crude Aloe vera gel treated control group. Food intake, water intake, body weight and fasting blood glucose levels were measured during the research work. Results: Food intake, water intake, and fasting blood glucose levels were significantly (P<0.001) increased in DM group compared to control, DMT and CT group. Body weight was significantly (P<0.001) increased in CT group compared to control. DM group had a significantly (P<0.001) lower body weight compared to control, DMT (P<0.001) and CT (P<0.001) group at the end of the research work. Consequently, the body weight change in DM group was significantly lower (P<0.001) compared to control, DMT and CT group. Conclusion: Crude Aloe vera gel reversed polyphagia, polydipsia and hyperglycemia in diabetic rats. Additionally, crude Aloe vera gel increased body weight in diabetic rats and can therefore be used to mitigate weight loss in type 1 diabetes mellitus.
Aims: To evaluate the effectiveness of topical 4% potassium hydroxide (KOH) solution in the treatment of pityriasis versicolor in comparison with topical 1% clotrimazole solution. Study Design: Single-blinded, comparative therapeutic study. Place of the Study: Department of Dermatology and Venereology – Baghdad Teaching Hospital-Baghdad, between June 2008 and August 2009. Methodology: We included 90 patients divided into 2 groups: group A (4% KOH), Includes 46 patients and group B (1% clotrimazole), and includes forty four patients. Skin scraping test was done for all patients. KOH was applied once daily, while clotrimazole solution twice daily for 2 or 4 weeks according to the response. Results: Eighty patients completed the study; forty in each group. In group A, 31 (77.5%), 8(20%) and 1 (2.5%) patients showed complete, partial and no response respectively after 2 weeks. After 4 weeks, 39 (97.5%) patients showed complete response and 1 (2.5%) patients showed partial response. In group B, 20 (50%), 18 (45%) and 2 (5%) patients showed complete, partial response and no response respectively after 2 weeks. After 4 weeks, 38 (95%) patients showed complete response and 2 (5%) patients showed partial response. There was a significant difference at 2 weeks of treatment. Group A showing a better response than group B (p=0.02). Itching, burning sensation, and erythema were detected in few patients of both groups. Conclusion: Topical 4% potassium hydroxide solution seems to act more rapidly than 1% clotrimazole solution for pityriasis versicolor.
Aims: A commercial rapid test kit for anti-Hepatitis C Virus (anti-HCV) detection was evaluated and compared for diagnosis of hepatitis C by detection of immunoglobulin G(IgG) antibodies against a third generation Enzyme Immunoassay(EIA) as gold standard. Methodology: A total of 560 patient serum samples were subjected to rapid screening with rapid test (immunochromatographic) strip supplied by Global Diagnostics and commercially prepared IgG capture EIA by DIA.PRO, Italy. Results: Of the 560 samples, anti HCV was detected in 31(5.54%) by ELISA, whereas only 17(3.04%) by strip method. This gives 100% specificity as no false positive was observed, but with 68.8% sensitivity. The number of false negative results was 14. The positive and negative predictive values were 100% and 97.42% respectively. Conclusion: The result pattern shows that sensitivity is compromised. It is therefore recommended that third generation ELISA is used for blood donors screening, to reduce transmission of hepatitis C virus through blood transfusion. When need arises to use strip for anti-HCV testing, such strip should be validated locally before its adoption because kits are directed against known range of strains of HCV and have minimum titer of antibody below which detection becomes impossible.
Recent investigations have highlighted various mechanisms of interaction between the Plasmodium falciparum (P. falciparum) parasite and the host, which are important for the understanding of the well-known protective effect by haemoglobinopathies like Sickle Cell Trait and α-Thalassemia against incidence and severity of malaria. Attention must therefore be given in the first place to the modifications induced in red blood cells (RBC) by the parasite in order to survive and display its pathogenic action: in this context, both the production of novel transport pathways able to support the development of the parasite during the erythrocytic cycle (in a cell which has lost transport activities during maturation process) and the changes induced to the RBC actin cyto-skeleton are discussed. As for the mechanisms involved in protection from P. falciparum infection, they can be of genetic, molecular, immunological character as well as interactive, due to the interplay of different factors. Some protection is afforded by genetic changes preventing P. falciparum to survive and proliferate within the red cell: such changes may include variants of the “basigin” receptor for the parasite antigens and inhibition by HbS of parasite-induced red cell remodelling. P. vivax infection may also be reduced in Duffy-negative heterozygotes. Genetic factors specifically interacting with the development of the infection are the sickle cell trait, the presence of foetal Haemoglobin (HbF), particularly in its pancellular distribution and genes associated with malaria resistance, identified by genome-wide linkage studies. Selective advantage of HbAS heterozygotes over HbS homozygotes in the clinical course of malaria can be explained by the so called “balanced polymorphism”. The presence of foetal haemoglobin (HbF) has also a protective effect, due to retardation of parasite growth in such situation: this is the rationale behind the attempts to reactivate HbF production in Sickle Cell Disease(SCD). Phagocytosis of infected red blood cells (RBC’s) has a significant protective effect by keeping a low level of parasitemia in HbAS subjects. Recent research also points to the role of modifications of RBC’s adherence to microvascular endothelium as an important factor in the pathogenesis of malaria and suggest that abnormal Hb’s like HbS and HbC as well as α-thalassemia can impair the adhesion of the parasite major ligand to host cells, thus limiting the sequestration of parasite –invaded red cells in many tissues and organs, like the brain. A special role in protection from malaria can be ascribed to molecular mediators, particularly a sequence involving haeme-oxygenase (HMO-1), which appears up-regulated in transgenic sickle cell mice: the action of HMO-1 prevents the cytotoxic effect of free heme and is in turn mediated by carbon monoxide, which inhibits Hb oxidation and further release of haeme from haemoglobin. Immunological factors are important, as shown by the development of children immunity to malaria, a rapid process in the early years of age (anti-disease immunity) and a slower one later (anti-parasite immunity); of remarkable interest are the antibodies to variant surface antigens (VSA) expressed by the parasite: an association was actually found between HbAS and the presence of IgG anti-VSA responses. Tolerance to parasite infection seems possible as the presence of β-chain mutations like in HbSAD mice provides a reduced incidence of experimental cerebral malaria. The possible role of various types of interferon is also under scrutiny. An example of interactions between different pathways comes from very recent studies, as it has been found that a mutation in the FAS gene promoter encoding the protein C- 95 results in a reduction of severe malaria incidence; as C-95 promotes apoptosis, an effect due to a C-95 – aided killing of immune cells, thus preventing an excessive immune response, is an interesting case of molecular-immunological interplay. Moreover, recent data on the mechanisms of malaria resistance, , show that during the intraerythrocytic life cycle of P. falciparum, two microRNA (miRNA),highly enriched in HbAS and HbSS erythrocytes, become integrated into the parasite messenger RNAs and cause translational inhibition, thus acting as negative regulators of parasite growth. It appears therefore that a very peculiar host defense strategy is working in sickle cell erythrocytes through miRNA activity.
The prefrontal lobe, which is more evolved in humans compared to other mammals, has extensive connections with many other areas of the brain including the thalamus, hypothalamus, hippocampus, and amygdala. The prefrontal lobe functions include ambition, cognition, emotions, information evaluation, mental integration, voluntary activity, and organized response. Violent behavior is related to aggression, with less serotonin, gamma-aminobutyric acid interaction, more dopamine, and more testosterone. Violent behavior is reinforced by negative experiences including viewing of violence in childhood and successful problem solving by violence. Every person has a natural and intrinsic need to establish the meaning of life, relative to ambition. Purpose in life (PIL)/ikigai means an attitude to establish the meaning of life. The term PIL/ikigai has been commonly used in daily life for many years in Japan. PIL/ikigai contributes to a greater ability to cope with stress, i.e., greater pleasure and comfort as well as less anxiety and confusion during stressful situations. This process leads to increasing serotonin and decreasing testosterone. PIL/ikigai is reinforced by positive experiences, including being moved by persons and events, success in challenging events, spending time in beautiful natural surroundings, and warm-hearted human relations. Moderate aerobic exercise, e.g., walking and running, causes pleasure. This process results in improvement of the autonomic nervous system, i.e., optimal balance between the sympathetic nervous system and parasympathetic nervous system, and optimally balanced secretions of dopamine, β-endorphin, and serotonin. PIL/ikigai, performing aerobic exercise and violent behavior are prefrontal lobe functions. Prefrontal lobe function develops even during adulthood as the result of experiences. Thus, PIL/ikigai and moderate aerobic exercise may prevent and improve violent behavior.
We selected the medicine research papers in English language published from the year 2005 to the date to determine the clinical significance of Takayasu’s arteritis (TA) and to review the literature available on this condition. TA is a world-wide, chronic inflammatory disease of unknown etiology. It is more prevalent in Asian countries. There are no specific laboratory tests to diagnose TA as it usually presents with non-specific symptoms such as fatigue, fever, arthralgia, weight loss, malaise, weakness and vision changes. Angiographic imaging is considered to be the gold standard investigation in diagnosing TA. Steroids with subsequent tapering doses are the mainstay of medical treatment; however, for addressing the refractory cases additional therapy becomes necessary. Reconstructive vascular surgery is limited to the severe and irreversible stenotic lesions where surgery becomes inevitable.
Lesions of the brachial plexus are most commonly caused by traumatic injuries. Other causes include infiltration by tumors, intrinsic or extrinsic compressions, damage from radiation therapy, or neuralgic amyotrophy (Parsonage-Turner syndrome). Less frequent causes of brachial plexus lesions include metabolic disease (e.g. diabetes), viral infections, immunological reactions to vaccination or infections, drugs, malignancies, paraneoplastic conditions, or hereditary disease (SEPT9 mutations, HNPP). The diagnosis of brachial plexus lesion is based upon history, clinical examination, and instrumental investigations, particularly, nerve conduction studies, electromyography, evoked potentials, magnetic stimulation, and the MRI. Treatment depends on the cause of the plexus lesion and includes prophylactic measures, physiotherapy, drugs, or surgery. Rarely applied measures include therapeutic magnetic stimulation or pulsed radiofrequency treatment. Outcome of plexus lesions depends on the underlying cause and the effectiveness of the treatment and ranges from favorable to deleterious. The outcome can be improved if diagnosis is made early and treatment is immediately applied after diagnosis.
It is now generally accepted that prostate cancer is the leading form of cancer in men. Current evidence indicates that countries including America and West Africa have more cases of aggressive progressive prostate cancer. Many treatment strategies have been used in management of prostate cancer. Since the discovery of androgen deprivation protocol seventy years ago, more treatment strategies have been reported which added more values to treatment outcome. However, death from this disease is due to resistance to androgen ablation therapy (AAT). Until recently, treatment of patients with disseminated prostate cancer was based on modalities that reduce AR signalling, either by direct androgen depletion (castration, e.g., surgical orchiectomy, luteinizing hormone-releasing hormone agonists), by blockage of the androgen receptor (AR) (e.g., flutamide, bicalutamide), or by combinations. In literature there is wide range of reports on diverse treatment strategies for prostate cancer; this often lead to serious confusion among clinicians and scientists, especially those new to the field. This study reviewed all the current available treatment strategies for androgen ablation therapy in management of hormone sensitive progressive prostate cancer, and highlights the merits and challenges involved in each of the treatments options. Thus, providing a summary of wide range of available literature on hormone management of prostate cancer and brings the scientists and clinicians to a focus using the best available evidence-based approach.
Aims: Predictive and prognostic features have served to allow prognostication for patients with early stage breast cancer. We sought to document our own outcomes for these features to see if our cohort corresponded to published reports. Study Design: Retrospective pilot cohort study. Place and Duration of Study: Department of Medical Oncology, Mid-Western Cancer Centre (MWCC), Mid-Western Regional Hospital (MWRH), Limerick, Ireland, between 1st January 2002 and 31st December 2002. Methodology: A retrospective analysis was designed to include with early stage breast cancer seen at our institution for the aforementioned period, information was derived from the patients’ records and indices were derived from prognostic tools. Information was analyzed using descriptive statistics and χ2 or Fisher’s exact test. Results: Seventy-seven (77) patients were found, with a median age of 52.2 years. Median overall survival of 84 months for the 10-year period of follow-up. The majority presented with moderately differentiated oestrogen receptor positive invasive ductal carcinoma and lymph node involvement (60%). 64% of patients underwent mastectomy as opposed to breast conservation. Adjuvant cytotoxic chemotherapy uptake was 61%, which was comparable to proportion of node positive disease. The predictive and prognostic features including axillary nodal status, tumour size, tumour grade, age at presentation and oestrogen receptor status were all significant indicators for outcome, but particularly within patients under 50 years of age. Conclusions: This report underscores that these predictive and prognostic factors were more significant within for patients under the age of 50 years.
Objective: The purpose of this article is to examine the main underlying social values that define health policy decisions. We focus on LMICs, many of which are at an early stage of implementation of these evidence-based policy processes. This review aimed at analyzing the ethical and procedural principles that underlie these social values, their potential conflict and the challenges of implementing a decision-making process according to these values in LMIC. Methods: Broad scoping search of international literature (December 2012) in PubMed, Cinahl, ISI Web of knowledge, Cochrane Library, and ProQuest. Search terms were “social values”, “healthcare/ health” and “low and middle income countries” (terms adapted according to each database). There was no pre-defined limit of year or language. We excluded “grey literature” documents only. From a total of 252 hits, we finally selected and fully read 51 of them. Results: The translation of health policy decisions from high-income countries to LMICs is complex, as they have differences that might affect the expected outcomes. Decisions should primarily aim at improving population health. The measurement of socioeconomic status and social inequalities in health, which is also context-specific, it is another primary objective in decisions about healthcare policies. Autonomy and equity might conflict in scenarios of limited budget. However, individual autonomy should be limited when affects other´s individuals autonomy and social welfare. Evidence and transparency in the decision process is highly valued, and expenditure in information for decision-making should be promoted since it increases population health. Conclusion: High-quality research evidence is paramount to implement health policies consistent with social values and the resources needed to produce relevant evidence can be considered a good use of public resources. A framework for decision-making should be anchored at least in three first order social values, improvement of population health, improving equity (in access to healthcare and health) and transparency.
Lymph node metastases to cervical group of nodes occur frequently in well-differentiated thyroid carcinoma. Metastasis to axillary lymph nodes however, is exceptional, leading to diagnostic and management dilemma. While presenting a case of thyroid malignancy with axillary lymph node metastasis, the literature is reviewed for similar cases to analyze their clinico-pathological features, investigations, management and outcome. Fifteen cases have been reported so far. Majority of these patients were female (male: female ratio 6:9) and their mean age was 54.5 years. Axillary lymph node metastases occurred concurrently or as recurrent disease after initial treatment of primary disease in about equal number of these patients. The predominant histological type was papillary carcinoma and 83.3% of these were poorly differentiated. Visceral metastases to lungs and bones were often seen. Despite treating these patients with thyroidectomy, lymph node clearance and adjuvant therapy, 40% of them died; some within one year and among the 60% who were alive, 30% still had active disease. Conclusion: Axillary lymph node metastasis from thyroid cancer, even though rare should be considered in the differential diagnosis in patients presenting with axillary mass and thyroid malignancy. Based on the limited number of cases reported in the literature it appears that it is generally a manifestation of the aggressive nature of this tumor with overall poor outcome.
Review Focus: General considerations on ablation procedure advocated in clinical contexts using electromagnetic (EM) energy are comprehensively reviewed. Relevant radiofrequency (RF) and/or microwave ablation techniques that have been in vogue and in traditional use across clinical procedures are revisited. Traditionally, RF/microwave ablations have been applied to a variety of pathological states, (in lieuof surgical methods and/or electrocautry procedures) so as to remove unwanted/cancerous tissue layers. Relevantly, new avenues of adopting unexplored electromagnetic (EM) energy falling in the spectral range of mm-wave/THz frequencies for such medical ablation purposes are studied. These higher frequencies for ablation can be considered either to supplant or used in parallel with the existing RF/microwave bands (at 915 MHz and 2.45 GHz). The motivation thereof is to identify certain improved ablation feasibility and derivable merits in clinical sense. Hence, the efficacy of the proposed scheme is identified for two exemplar ablation therapy procedures pertinent to Barrett’s esophagus and menorrhagia. Pertinent pros and cons are discussed and practical ablator designs are indicated. Study Details: Considering the strategy of using the proposed mm-wave/THz EM energy would amount to a shallow ablation via ‘thermal scouring’ of the tissue-linings intended for ablation and prevent otherwise undesirable hot-spots in deep-tissue media. This is conceivable because the advocated frequency bands would allow a very shallow skin-depth of penetration of EM energy; and hence, tissue-heating will be limited only to superficial linings. Further, the associated super-high frequency will heat the ablation site extremely fast reducing the procedure time considerably. In a Nut-shell: The study first offers a comprehensive review on classical and projects de novo aspects of EM ablation therapy with unexplored electromagnetic spectral resources of mm-Wave/THz band. Illustrated as examples are feasibility details concerning the ablation of the endometrium and Barrett’s esophagus. Design aspects of ablators are presented. Place and Duration of Study: The study reported is limited to a review on the subject-matter and provides analytical designs and computational models on the procedure performed (2012-2013) at: Department of Computer and Electrical Engineering and Computer Science, College of Engineering & Computer Science, Florida Atlantic University, Boca Raton, Florida 33431, USA.
Nanoparticles of fullerenes and their water-soluble derivatives have been firmly introduced into solution of medical problems. Although there are still debates about their toxicity and long-term consequences of their application in the clinic, the success of fullerenes application in some sections is undeniable, in particular, in photodynamic therapy (PDT) of cancer tumors. Besides there are interesting data on radiotherapy where fullerenes appear to be more transporters than drugs, but due to own cytoprotective properties, the fullerene adducts can also participate in the combined treatment. This review evaluates the status of these sections of fullerene chemistry in terms of development and recent trends.
Focus on cancer therapy is experiencing a major paradigm shift from ways of attacking tumor cells to a strategy for specifically targeting the tumor microenvironment (TME). This approach requires a comprehensive understanding of roles of each component of the tumor environment. A description of the tumor microenvironment and its impact on tumor progression is presented here. Available studies indicate that both tumor/epithelial and stroma characteristics play important roles in cancer progression. Details of this work show that different components of the tumor microenvironment contribute towards cancer progression and clearly suggest a role for use of combination therapies for tight tumor control.
Glioblastoma remains a poor"prognosis cancer. We review research showing evanescent opening of the blood"brain barrier, BBB, after electroconvulsive treatment, ECT. ECT as currently used in psychiatry for treatment"resistant depression has been in continuous use throughout the world since introduction in the late 1930’s. Post-ictal BBB opening phenomenon might be safe enough to use to deliver chemotherapeutic agents that would not otherwise cross the BBB. Although the main mass of tumor in glioblastoma has a relatively leaky BBB, the invasive paucicellular migratory microsatellite glioblastoma cells that become the origin of recurrent tumor are supplied by normal poorly"permeable capillaries, preventing ready access of potentially useful chemotherapy drugs like doxorubicin or methotrexate. These microsatellites go on to kill. Modern ECT uses deep neuromuscular blockade and cardiovascular stabilizing drugs such that muscular contractions and increases in intracranial pressure are minimized, yet the electroencephalogram shows a typical grand mal seizure. Post"ECT BBB opening allows transgression of > 4 kDa peptides, potentially comfortable enough to give free access to brain tissue of doxorubicin or methotrexate for example. Even drugs that are said to cross the BBB, such as temozolomide, the current mainstay chemotherapy drug in glioblastoma, do so only at ~20% of plasma levels. Many potentially useful drugs achieve brain tissue levels <1% of blood levels. We conclude that if careful step-wise study can establish safety, by delivering chemotherapy immediately after ECT we may open new and more effective treatment avenues for glioblastoma.