The Aim: The management of obstructive coronary artery disease before the transcatheter aortic valve implantation (TAVI) is not yet well established. Presentation of Case: We describe a 68-year-old patient with severe aortic stenosis, multivessel coronary artery disease, severe left ventricle dysfunction and several co-morbidities, who was disqualified from aortic valve replacement concomitant to coronary artery by-pass grafting because of excessive operative risk (logistic EuroScore 27.62%, STS 13.3% risk of mortality). After careful assessment he was treated with staged percutaneous coronary intervention (PCI) of the left main and the left anterior descending artery and right coronary artery with drug-eluting stents implantation, followed by TAVI. In the postoperative period heart rhythm disturbances occurred and he required pacemaker implantation. At the 2 year follow-up he was doing well without angina and heart failure symptoms. An improvement in left ventricle contractility on echocardiography (EF-45%) with proper prosthesis function were noted. However, 25 months after the procedure he died from stroke. Discussion and Conclusion: Coronary artery disease is frequent in patients referred for TAVI and is associated with worse prognosis. The approach to the management of these patients is still unclear. We present and discuss several procedural strategies. The staged procedure with time interval appears to be a better alternative for patients with severe aortic stenosis with significant coronary artery disease and severe left ventricular dysfunction and co-morbidities. In doubtful cases, if symptoms of aortic stenosis and coronary artery disease are difficult to differentiate, PCI as a first step and clinical observation enable proper selection of an appropriate method for further treatment.
Chest pain frightens many people into thinking that they might be having a heart attack. There are many causes of chest pain, few of which are life-threatening. One of the causes of chest pain is vasospasms, which is transient in nature and prolonged episodes can lead to tissue necrosis. Therefore, a prompt diagnosis and treatment is vital to the management. We are reporting a case of a young female presented with chest pain with no history of drug use, previous episodes, palpitations, and hypertension being her only risk factor found to have elevated Troponin I and was diagnosed with non-ST elevation myocardial infarction (NSTEMI), later found to have coronary vasospasm.
Aims: Heterotaxy syndrome is a rare, complex, and confusing presentation in the realm of situs anomalies. The concurrence of heterotaxy syndrome with dextrocardia and Eisenmenger syndrome has never been reported in an adult. We described, for the first time, an adult patient who had heterotaxy syndrome with dextrocardia, complicated by Eisenmenger syndrome with large ventricular septal defect (VSD). Presentation of Case: A 43 year-old female presented to the emergency room with worsening exertional dyspnea. She carried past medical history of cyanotic congenital heart disease since birth. Her physical examination findings were significant for hypoxia and clubbing with cyanotic fingers and toes, dextrocardia, and a 3/6-holosystolic murmur over the right lower sternal border. Laboratory investigation showed polycythemia andher chest x-ray showed dextrocardia. Echocardiography showed dextrocardia with a dilated left ventricle and a large VSD with left-to-right shunting. Computed tomography (CT) angiogram of the chest showed bilateral bi-lobed lungs with both main stem hyparterial bronchi, right-sided polysplenia, right-sided stomach with left-sided dominant liver. Discussion and Conclusion: Heterotaxy syndrome has a complex variation in clinic presentation. We illustrate the occurrence of heterotaxy syndrome, polysplenia type with Eisenmenger syndrome and dextrocardia. Recognition of this rare anomaly is important for establishing a diagnosis in a patient with multiple organ displacement.
Objectives: Ureteral stenting is a common intervention in endourological procedures. Despite the usefulness of stents, patients may experience various stent-related symptoms. These symptoms can have a significant impact on patients’ health related quality of life. There are several medical modalities for symptom improvement and Phosphodiesterase 5 Inhibitors are recent therapeutic option. This study is designed to evaluate the effects of Tadalafil on alleviation of stent associated symptoms measured by Ureteral Stents Symptom Questionnaire. Design: In this Randomized Controlled Trail patients were randomly assigned to an intervention or Placebo group by a computer based random block design. Patients received encoded drug packages from a central call system. Physicians, patients and statistical analyzers were not aware of the designated intervention. Setting and Conduct: Patients received treatment with Tadalafil or placebo for four weeks after ureteral stent insertion and completed a follow up session four weeks after the intervention. Participants: Male patients who underwent unilateral ureteral stenting in Imam Reza hospital in Tabriz, Iran were enrolled in this study. Patients with history of hypertension, heart and/or respiratory disease, stroke, hypotension, renal failure, consumption of nitrate drugs and a positive urine culture or who had any allergic reaction to Tadalafil were excluded. Interventions: Patients were allocated to receive Tadalafil 10 mg or Placebo daily for four weeks. Outcome Variables: The primary outcome variables were stent related symptoms (urinary symptoms, pain, general health, sex and working status). Secondary outcomes included possible side effects such as cardiovascular, respiratory, gastrointestinal, musculoskeletal and central nervous system problems.
Aim: Many causative genes and susceptibility loci have been identified to be associated with Parkinson's disease (PD) in different ethnic populations. One of these genes is the Leucin-rich repeat kinase 2 (LRRK2) gene. The G2019S substitution in that gene is the most common mutation identified to co-segregates with PD. In the North part of Egypt (Alexandria and nearby region), an incidence of 9.7% of heterozygous mutation in LRRK2 G2019S was reported in a sample of Egyptians with sporadic PD. We investigated the same mutation in 69 Egyptian patients with sporadic PD and 96 ethnically matched controls who all were inhabitants of Upper Egypt to find out if it could be a susceptibility gene for PD among Egyptians. Place and Duration of Study: Departments of pharmacology, neurology, and clinical pathology, Assiut University (Egypt) and Department of Neurodegenerative Diseases, Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany between June 2010 and September 2011. Methodology: Sixty nine patients with PD of sporadic type and ninety six controls were included in the study and all were inhabitants of Assiut Governorate and nearby region in Upper Egypt. PCR-genotyping analysis for the point mutation G2019S in the exon 41 was performed and presence or absence of mutation was confirmed by direct sequencing of the probands identified of the DNA. Results: Genotyping analysis and sequencing of DNA showed only one patient who was carrier to the mutation G2019S (1/69; incidence: 1.45%) and it was of heterozygous style. The rest of subjects (patients and control) were not carrying the mutation. This rarity of this kind of mutation among the Egyptian sample studied suggests that it may be a rare cause of PD in Upper Egypt region. However, if it is observed, it may have a trend of heterozygosity genotyping style as previously defined in the Egyptians living in the North region of Egypt Conclusion: The very low incidence of G2019S mutation in Egyptians living in Upper Egypt compared to Egyptians inhabitants in North Egypt suggests a multicenter study on a large number of Egyptians with Parkinson’s disease to reach a real incidence of that mutation and if it has (or not) a correlation to causation and course of Parkinson’s disease among Egyptians.
Background: Viral hemorrhagic fevers are emergent and endemic in Africa and in South America. In Côte d’Ivoire, Yellow fever cases were reported yearly and the distribution of mosquitoes in the country are the main factors for high incidence of Flaviviruses. The poorly reporting of viral hemorrhagic fever cases in some regions, the lack of international interest land and the underestimation of molecular surveillance method contribute to increase the risk for public health. Objectives: To evaluate the performance of molecular diagnostic methods in national surveillance of two emergent Flaviviruses, Yellow fever virus and Dengue virus in Côte d’Ivoire. Study Design: 63 sera from suspected cases in 2010-2011 of viral hemorrhagic fevers were analyzed to detect viral RNA of Flaviviruses and to compare the results in three different methods. Results and Conclusion: The Flavivirus RT-PCR has showed the high molecular detection by12% and 6% for real time PCR. The methods are specific and high sensitive for the screening of tick and mosquito-borne Flaviviruses in clinical samples. This study confirms the high circulation of Flaviviruses and the introduction of Dengue virus in Côte d’Ivoire. The combination of real time PCR and the Flavivirus RT-PCR contribute to ameliorate the detection panel of molecular detection in Côte d’Ivoire and was a suitable method for the National Laboratory Reference.
Objective: lactate threshold and pH-threshold determination during cardiopulmonary testing (CPET) and evaluate their diagnostic and prognostic value in patients with chronic heart failure.
Methods: The study included 58 HF patients with NYHA class II-IV, who have performed CPET on treadmill using equipment «Oxycon PRO», Jaeger, Germany. Individual exercise test protocol (ramp protocol) was created for every participant. The cubital venous catheter was installed in all subjects before exercise test. Blood samples were taken at baseline and at 1-minute intervals during test. PH, lactate and HCO3- concentration were estimated using analyzer i-STAT, cartridge CG4 (Abbot, USA). Lactate threshold (LT) and pH-threshold (pH-T) were determined by changes in pH and lactate levels in correlation with dynamics of oxygen uptake (VO2), carbon dioxide output (VCO2), minute ventilation (VE), ventilatory equivalent of carbon dioxide (VE/VCO2), respiratory exchange ratio (RER). Respiratory compensation point (RCP) was determined, when ventilation dramatically increase relative VE/VCO2. Results: In HF patients with NYHA class II level of physical performance was significantly higher than in patients NYHA class III and IV. However, during exercise in all HF patients were observed similar physiological stages and compensatory mechanisms of regulation of homeostasis, but with varying of exercise intensity. In HF patient with NYHA class IV, exercise was stopped before reaching of RCP in connection with the development shortness of breath, weakness, tiredness, fatigue in the legs 8-9/10 Borg scale. Among HF patients with NYHA class III RCP reached 12 (36%) of people, among patients with class II - 14 (82%). The 95% confidence intervals (CI) for the VO2 peak, RCP, pH-T and LT in II, III and IV NYHA class are follows: in HF patients with NYHA class II - 17.4 to 18.2, 16.3 to 17.2, 14.7 to 15.3 and 9.7 to 10.1; NYHA class III - 13.5 to 14.3, 12.2 to 12.8, 11.4 to 11.8 and 8.2 to 8.6; NYHA class IV - 8.6 to 10.6 for VO2 peak, 8.1 to 9.7 for VO2 pH-T, 5.7 to 7.5 for VO2 LT. HF NYHA class correlated with VO2 LT, VO2 pH-T and VO2 RCP, r=-0.7, p<0.01, r=-0.5, p<0.01 and r=-0.4, p<0.01, respectively. Patients were observed in the average 21.4 of +/ - 1.5 months (6-48). For the specified period in the study group died 15 HF patients (25%) with III-IV FC. We observed the following correlations: the survival and VO2 LT - r=0.8, p<0.05; survival and VO2 Ñ€Ð-T - r=0.5, p<0.05; survival and VO2 RCP - r=0.2, p<0.07. Conclusion: In HF patients with NYHA class II-IV significant diagnostic and prognostic markers are content VO2 at lactate threshold and pH-threshold, especially at the lactate threshold.
Background: There is a high variability in chemical composition of essential oil from Artemisia herba-alba grown in different countries and different localities in the same country. This has led to the characterization of many oil-dependent chemotypes assigned to the plant. Only one report was published on the essential oil composition of Artemisia herba-alba grown in Jordan. Aim: The current study aims to determines the essential oil composition of Artemisia herba-alba grown wild in south Jordan and test their activity against clinical isolate antibiotics resistant bacteria. Methodology: The essential oils were isolated by hydrodistillation and analysed by Gas Chromatography-Mass Spectrometry (GC-MS). The screening for essential oil activity was carried out using disc diffusion method on methicillin-resistant Staphylococcus aureus, methicillin-sensitive Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus pyogenes, Escherichia coli, Klebsiella pneumonia, Proteus mirabilis, and Pseudomonas aeruginosa. Results: Fifty-eight components accounting for 98.8% of the oil were identified, with oxygenated monoterpenes accounting for about 75% of the total oil content. Major identified compounds were cis-chrysanthenol (13.83%), 1,8-cineole (12.84%), cis-limonene (12.57%), α-terpinenol (6.97%), and γ-muurolene (4.50%). The volatile fractions exhibited potent activity against all resistant strains except Pseudomonas aeruginosa. Conclusion: We report here a new chemotype of Artemisia herba-alba grown in Jordan characterized by the presence of chrysanthenol, 1, 8-cineole, cis-limonene, and α-terpinenol.
Uterine leiomyomas are the most common gynecologic tumors and though mostly asymptomatic, they may present with heavy or abnormal uterine bleeding, pelvic pain or pressure, subfertility, and recurrent pregnancy loss. Heavy bleeding is often a reason to prescribe iron supplements in a bid to maintain normal hemoglobin levels. These hematinics are also sometimes prescribed for several months prior to surgery even though menorrhagia may not be the complaint. These women tend to stay on these supplements for long periods of time often without any laboratory investigation follow ups. Therefore a possibility of them developing iron overload exists especially if bleeding is not the presenting complaint. The aim of the present study was to determine the hematological profile of women with fibroids in Ghana. Between May 2005 and March 2009, in a case-control study of premenopausal Ghanaian women aged 20–40 years at Komfo Anokye Teaching Hospital,(KATH) Kumasi, the hematologic profile of women with fibroid in Ghana was studied. Two hundred women with confirmed uterine fibroids and two hundred women with non-observable fibroids as controls were recruited for the study. Results of the study showed that women with fibroids had higher red cell counts and red cell indices compared to women who had no fibroids. The mean Hematocrit (HCT), Mean Cell Hemoglobin (MCH), Mean Cell Hemoglobin Concentration (MCHC), and Red Blood Cell Count (RBC) were all significantly higher among patients compared to controls. Mean Cell Volume (MCV), Platelet (PLT) and Total White Blood Cell (WBC) count did not differ significantly between the two groups. Total serum iron (FE) was significantly higher while total iron binding capacity was significantly lower among patients compared to the control group. The results of the study revealed that the number of the patients who were on hematinics was significantly higher than that of the control group. Findings of this study show that women with fibroids in Ghana had higher hemoglobin and serum iron levels compared to their compatriots who did not have the condition. Prescription of iron supplements should therefore be done with care and only after reviewing their hematology laboratory results so as to prevent the development of iron overload among these women.
Aims: To investigate the impact of war trauma On child mental health; the mediating role of different coping strategies. Methods: The sample was selected randomly from the five localities of the Gaza Strip that had been exposed to war16 months earlier. Children completed the Gaza Traumatic Events Checklist-20 items-War on Gaza, UCLA PTSD scale, Birleson Depression Scale, Child Revised Manifest Anxiety Scale, and Kidcope for children. Results: Children reported many traumatic events (mean = 4). One third (32.5%) had partial and 12.4% had full criteria of PTSD. Children living in families with low family monthly income reported more emotional problems. There was significant association between exposure to traumatic events and developing PTSD. The rates of significant anxiety and depressive symptoms were 20.5% and 22.3% respectively. Girls reported significantly more depressive symptoms than boys. Children commonly used the following coping strategies: wishful thinking, problem-solving, emotional regulation, and distraction. Trauma was negatively correlated with social support and wishful thinking, and positively correlated with self-criticism. Lack of social support and wishful thinking predicted all three types of mental health problems, while social withdrawal specifically predicted depression. Conclusions: Trauma can have long-standing impact on children’s mental health. Community-based intervention programmes could enhance children’s resilience. Parents, teachers, universal and specialist mental health practitioners have essential roles in the development and delivery of such programmes.
Aims: To ascertain the antidiabetic and antioxidative effects of ethanol-methanol extracts of leaf, stem bark and root of Jatropha curcas on the blood and liver tissue of streptozotocin-induced diabetic albino wistar rats Place and Duration of Study: Department of Medical Biochemistry, Cross River University of Technology, Okuku campus between August 2013 and March, 2014. Methodology: Fifty four (54) male albino wistar rats weighing 150- 200g were randomly assigned into nine study groups (n=6). Group I was the normal control, groups II–VI were induced with diabetes using streptozotocin. Group II was untreated, while groups III –VI were treated with leaf, stem bark, root extracts and Glibenclamide (standard drug) respectively. The remaining groups VII-IX were not induced with diabetes but were treated with leaf, stem bark and root extracts respectively. The administration of these extracts lasted for 14 days after which the animals were sacrificed. The liver tissue was collected and homogenized and the supernatant used for the estimation of SOD, CAT and MDA activities. Results: The result of blood glucose level on the fourteenth day of the plant extracts administration, showed further decrease in the groups treated with the plant extracts to the extent that group IV was significantly (P<0.05) decreased compared with the normal control. The blood glucose level of the standard drug (Glibenclamide) treated group (VI) was further decreased however it remained significantly (P<0.05) increased compared with the normal control and about three or more times that of the groups treated with the plant extracts. Result of the liver tissue SOD for the test groups showed significant (P<0.05) difference except for groups IV and VII when compared with the normal control. There was no significant (P≥0.05) difference in the SOD activities of test groups compared with the diabetic control. The liver tissue CAT showed general increase for the test groups, but group III produced a significant (P<0.05) increase compared with the normal control, while groups III and V showed significant (P<0.05) increase compared with the diabetic control. The liver tissue MDA showed significant (P<0.05) increase for groups II and IV but a significant (P<0.05) decrease for group V compared with the normal control. However, compared with group II (diabetic control) all the test groups showed a significant (P<0.05) decrease. Conclusion: The present research suggest that the leaf, stem bark and root of ethanol-methanol (1:1) extracts of Jatropha curcas possess anti-hyperglycemic and antioxidant activities but their response to the liver tissue enzyme systems of SOD and CAT vary in either to playing compensatory role or boosting the activities of the antioxidant enzymes. The plant parts also appear to possess the potential for reversing the tissue oxidative damage caused by diabetes as seen by their abilities to prevent lipid peroxidation.
Herein, both antidiabetic and hematoprotective effect of thymoquinone (TQ) therapy was investigated in rat model of streptozotocin (STZ)-induced diabetes. After disease induction, TQ (35 mg/kg/day) was given for 28 days and fasting blood glucose level was weekly measured. At day 29, blood samples, pancreatic and kidney specimens were prepared and screened for: (1) hematological parameters: counts of red blood cells (RBCs), white blood cells (WBCs) and platelets (PLTs), erythrocyte osmotic fragility, normal hemoglobin (Hb) and glycosylated hemoglobin (HbA1c), hematocrit (HCT), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH) and mean corpuscular hemoglobin concentration (MCHC), (2) serum insulin and serum and renal erythropoietin (EPO) levels, (3) serum creatinine and urea levels, (4) concentrations of glutathione (GSH), superoxide dismutase (SOD) and thiobarbituric acid reactive substances (TBARS) in serum, pancreatic and renal tissues, and (5) pancreas histopathology.STZ-injected rats showed injured pancreatic islets accompanied with persistent hyperglycemia, significant decreases in serum insulin, serum and renal EPO, RBCs counts and indices, PLTs counts, and increases in HbA1c, erythrocyte osmotic, WBCs counts, and serum creatinine and urea. However, therapy with TQ successfully protected the pancreatic islets and significantly improved the glycemic status, insulin and EPO production, and the hematological parameters that were deteriorated in STZ-diabetic untreated rats. TQ therapy also improved renal function and reversed the decreases in GSH and SOD, and the increases in TBARs that were induced in STZ-diabetic rats. In conclusion, these findings emphasize the antihyperglycemic, antianemic and hematoprotective potential of TQ in STZ-diabetic rats. Further studies are still needed to confirm the hematoprotective efficacy of TQ in different modalities of DM.
Aims: This paper describes the In vitro study of protein binding by sildenafil citrate (SC) in presence of bisoprololfumarate (BF) and metformin hydrochloride (MH). Study Design: Study was designed to assess In vitro of quenching of bovine serum albumin (BSA) by sildenafil citrate (SC) in presence of bisoprolol fumarate (BF) and metformin hydrochloride (MH) by fluorescence spectrophotometry. Place and Duration of Study: Drug Analysis and Research Laboratory, Centre for Advanced Research in Sciences, University of Dhaka, Dhaka-1000, Bangladesh between December 2013 and March 2014. Methodology: In the present work, the In vitro study of quenching of BSA by SC in presence of BF and MH have been studied by fluorescence emission spectroscopy under different conditions. At first, the BSA solution (20 µM) was prepared in phosphate buffer (pH =7.4) in eight test tubes and different amounts of sildenafil citrate was added to each BSA solution to obtain the final concentrations as 0, 20, 40, 80, 120, 160,240 and 320 × 10-6 molL-1, respectively. Then the fluorescence emission spectra of BSA-SC system were recorded for eight test tubes at two excitation wavelengths of BSA (λExmax= 280 nm and λExmax=293 nm) at 298 K and 308 K. Similarly, the fluorescence emission spectra of BSA-(SC+BF), BSA-(SC+MH) and BSA-(SC+BF+MH) systems were recorded at 280 nm and293 nm at 298 K and 308 K. Quenching constants were determined using the Stern-Volmer equation to provide a measure of the strength of quenching of BSA by SC in presence of BF and MH in all the systems. Results: The quenching of BSA by SC was increased in presence of BF and MH but remained close in presence of both BF and MH. Quenching constants were larger for the BSA-(SC+BF) system and ranked in the order as BSA-(SC+BF)>BSA-(SC+MH)>BSA-(SC+BF+MH)≈ BSA-SC at 280 nm at two different temperatures, respectively. But quenching at the excitation wavelength of 293 nm was ranked in order as BSA-(SC+BF) >BSA-(SC+MH) >BSA-(SC+BF+MH)>BSA-SC at 298 K and 308 K, respectively. Conclusion: It was found that BSA quenched by SC in presence of BF and MH, which indicated that the effectiveness of SC might be predominately influenced by these drugs.
Aims: This study explored the knowledge and attitude concerning Exclusive Breastfeeding (EBF) among young women who are apprenticed to learn hairdressing in Agbowo community, Ibadan, Nigeria. Study Design: The study was cross sectional in design. Place and Duration of Study: Study was carried out in Agbowo community in Ibadan-north local government area of Ibadan, south-western Nigeria between January 2012 and June 2012. Methodology: Through the hairdresser’s association in the study area, 164 apprentices were enumerated but only 116 met the criteria and consented to participate. Semi-structured interviewer-administered questionnaires were used to collect data on socio-demography, knowledge of EBF and attitudes towards breast feeding. Knowledge questions and attitude statements were scored and grouped as adequate or inadequate knowledge; positive or negative attitude. Association between knowledge and socio-demographic variables were explored by chi-square analysis. Results: Most apprentices were between 21-25yrs (49%), attained the senior secondary (SSS) level of education (55.2%) and majority were single (91.4%).While many (63.8%) of the respondents had inadequate knowledge of EBF, nearly all of them (96.4%) had positive attitude to breast feeding. Only 36.23% knew that infants should receive breast milk only, 68.1% would give water and 53.4%would give herbal teas in the first six months of life. Some misconceptions (e.g. colostrum is dirty) and negative attitudes (e.g. breast feeding inconvenient, embarrassing, sags breasts) existed. A significant association exist between age group of respondents (p=.001); level of education (p=.001) and knowledge of exclusive breast feeding. Conclusion: Relevant interventions about EBF should focus on young people especially those with low levels of education, who have gaps in EBF knowledge so that misconceptions and negative attitudes can be resolved.
Aims: To characterize the various clinical presentations of TB diagnosed in HIV/AIDS patients in the post-conflict Northern Uganda. Study Design and Setting: A prospective cohort study was conducted on 320 TB/HIV/AIDS co-infected patients at St. Mary’s Hospital, Lacor which is a specialist hospital in Gulu, Northern Uganda from July 2009 to July 2010. Methodology: Clinical features of confirmed 320 HIV sero-positive patients with confirmed TB co-infection (170 males and 150 females) recruited consecutively were studied and followed up for three months, their clinical presentations analyzed using SPSS version13.0. Ethics and Review Committee approved the study and those who did not meet the inclusion criteria were excluded. All patients gave an informed consent/Assent for the study. Results: The commonest clinical presentations were fever 316(98.8%), productive cough 268(83.7%), evening/night sweats 267(83.4%), general malaise 277(86.6%), wasting 228(71.3%), anaemia 220(68.8%) and lymphadenopathy 100(31.3%). The clinical features which were associated statistically and significantly with TB/HIV/AIDS co-infection were: Low grade fever (p=0.006); haemoptysis (p=0.001); Night sweats and evening fevers (p=0.043); Chest pain (p=0.041); General malaise (p=0.037) and wasting (p=0.047). Most patients 262(81.9%) improved and were discharged on Directly Observed Therapy Short-course (DOTS) while 58(18.1%) died. Conclusion: Clinical assessment is a very important adjuvant in TB/HIV/AIDS co-epidemic diagnosis. Early diagnosis and prompt management of TB co-infection ensured longer life and reduced morbidity and mortality.