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   2010| November  | Volume 2 | Issue 11  
    Online since November 9, 2011

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Anti-plasmodial effects of Azadirachta indica in experimental cerebral malaria: Apoptosis of cerebellar Purkinje cells of mice as a marker
Mohammed Farahna, Selma Bedri, Sami Khalid, Mustafa Idris, C Radhakrishna Pillai, Eltahir A Khalil
November 2010, 2(11):518-525
Background: Malaria is a major public health problem in the world, but treatment of malaria is becoming more difficult due to increasing drug resistance. Therefore, the need for alternative drugs is acute. Aims: This study investigated the antiplasmodial and protective effect of an ethanolic extract of the leaves from a traditionally used medicinal plant, Azadirachta indica (Neem) in a mouse model of malaria. Materials and Methods: Swiss albino mice were intraperitoneally infected with 10x10 6 Plasmodium berghei ANKA, a rodent malaria parasite. The presence of parasites was checked by microscopic examination of blood samples daily. Ethanolic extracts of Neem at 300, 500 and 1000 mg/kg were administered intraperitoneally daily for five days from the day parasitaemia reach 5% of parasite inoculation. Intraperitoneal chloroquine and artemether were used as standard drug treatment controls. Symptoms of neurological or respiratory disorder, mortality, weight and temperature were recorded. Histological sections of brain were prepared and examined after staining with hematoxylin-eosin and immunohistochemistry for apoptotic cells. Results: All Neem treatment groups displayed parasitaemia that gradually increased during treatment, and showed signs of terminal illness (i.e. hypothermia, ptosis and convulsions) within 2-4 days post-treatment. In contrast, the chloroquine and artemether groups showed no cerebral malaria symptoms and no deaths. Apoptosis in Purkinje cells, cerebral haemorrhage and oedema were found in some of the mice treated with Neem and chloroquine. Conclusions: Azadirachta indica (Neem) extract was not protective against malaria symptoms and signs in this mouse model. However, a difference in the number of apoptotic Purkinje cells between the untreated control group and Neem treatment at 500 mg/kg suggests that Neem may have some neuronal protective effect.
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Management of acute gastroenteritis in healthy children in Lebanon - A national survey
Aouni Alameddine, Sawsan Mourad, Nahida Rifai
November 2010, 2(11):512-517
Background: Acute gastroenteritis remains a common condition among infants and children throughout the world. In 1996, The American Academy of Pediatrics (AAP) revised its recommendations for the treatment of infants and children with acute gastroenteritis. Aim: The purpose of this survey was to determine how closely current treatment among Lebanese pediatricians compares with the AAP recommendations and to determine the impact of such management on the healthcare system. Patients and Methods: The outline of the study was based on a telephone questionnaire that addressed the management of healthy infants and children below five years of age with acute gastroenteritis complicated by mild to moderate dehydration. In addition, the costs of medical treatment and requested laboratory studies were calculated. Results: A total of 238 pediatricians completed the questionnaire. Most pediatricians prescribed Oral Rehydration Solutions (ORS) for rehydration (92.4%), advised breastfeeding during acute gastroenteritis (81.5%), and avoided parenteral rehydration for mild to moderate dehydration (89.1%). In addition to ORS, oral fluids such as soda, juices, and rice water were allowed for rehydration by 43.7% of pediatricians. Thirty-one percent of pediatricians delayed re-feeding for more than 6 hours after initiation of rehydration. Only 32.8% of pediatricians kept their patients on regular full-strength formulas, and only 21.8% permitted full-calorie meals for their patients. 75.4% of pediatricians did not order any laboratory studies in cases of mild dehydration and 50.4% did not order any laboratory studies for moderate dehydration. Stool analysis and culture were ordered by almost half of the pediatricians surveyed. Seventy-seven percent prescribed anti-emetics, 61% prescribed probiotics, 26.3% prescribed antibiotics systematically and local antiseptic agents, 16.9% prescribed zinc supplements, and 11% percent prescribed antidiarrheal agents. Conclusion: Pediatricians in Lebanon are aware of the importance of ORS and the positive role of breastfeeding in acute gastroenteritis. However, they do not follow optimal recommendations from the AAP concerning nutrition, laboratory examinations and drug prescriptions. Consequently, this poses significant financial losses and economic burden.
  2,477 267 -
Contribution of malnutrition and malaria to anemia in children in rural communities of Edo state, Nigeria
Favour Osazuwa, Oguntade Michael Ayo
November 2010, 2(11):532-536
Background : The most common cause of anemia is an iron deficiency; however, the condition may also be caused by deficiencies in folate, vitamin B 12 and protein. Some anemia is not caused by nutritional factors, but by congenital factors and parasitic diseases such as malaria. Aim: This study attempted to estimate the prevalence of anemia among children in three rural communities of the Ovia North East Local government area, and to determine whether its cause was nutritional or could be attributed to malaria. Patients and Methods: A total of 316 children between the ages of 1 and 15 years were included in the study. Children were examined for malaria parasites by microscopy. The World Health Organization (WHO) age-adjusted cut-off for hemoglobin was used to classify anemia. Results: 38.6% of the children were anemic, with hemoglobin levels lower than 11g/dL, although parasite prevalence and density were low. Malnutrition was patent; 37.0% of the children were stunted, 19.3% wasted and 44.0% underweight. Serum ferritin was more sensitive than hemoglobin concentration in detecting anemic children. Anemia was also significantly higher in the Evbuomore village school than in the Ekosodin and Isiohor villages (P<</i>0.001). Conclusion: Anemia detected in this population may be due more to malnutrition than to malaria.
  2,157 270 -
Report of two cases of non-union of clavicle treated with nonsurgical management
Anupama Gupta, Rajinder Pal Singal, Rikki Singal, Pradeep Sahu, Shashi Singal, Raman Gupta, Samita Gupta
November 2010, 2(11):544-546
Context : Fractures of the clavicle usually occur at the junction of the medial two third with the lateral one third and usually heal by nonsurgical measures. Radiographs and MRI of the shoulder provide helpful investigations for diagnosis and treatment. In the following cases, an anterior-posterior view revealed non-union of the clavicle on the right side, which is atypical in children. Case Report : Non-union of a clavicular fracture is an extremely rare condition, especially in children. We are reporting two cases in this paper; in the first case; an 8-year-old male child visited the hospital with a history of fracture of the right clavicle one year ago. In the second case, a 26-year-old male patient presented with a history of fracture of the right clavicle six years ago. Conclusion : Careful attention should be paid when obtaining a detailed history and physical examinations, as traumatic arthritis at either clavicular joint may mimic non-union. The explicable evidence of osseous non-union on radiographs may be minor and may not correlate with the clinical symptoms.
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Surgical management of endoscopically unresectable duodenal gangliocytic paraganglioma in a patient with partial upper gastrointestinal obstruction
Iswanto Sucandy, Gary Ayers, David J Bertsch
November 2010, 2(11):547-551
Context: Gangliocytic paragangliomas are unusual and often misunderstood tumors that occur almost exclusively in the second portion of the duodenum, although they have been described in other sites such as the urinary bladder, spermatic cord, prostate, urethra, uterus and scalp. We describe our experience with the surgical management of an endoscopically unresectable gangliocytic paraganglioma located in the third part of the duodenum causing a partial upper gastrointestinal obstruction. Case Report: A fifty-two-year-old male presented to the Geisinger clinic with a four-year history of postprandial projectile vomiting associated with epigastric discomfort. Computed tomography scan revealed an oval-shaped filling defect in the third part of the duodenum. Endoscopic ultrasonography showed a 22 x 16 x 35 mm submucosal mass that was not amenable to an endoscopic resection. Exploratory laparotomy revealed an absence of extraduodenal involvement. A long-stalked tumor was successfully excised and extruded through a longitudinal duodenotomy. The pathology report showed a gangliocytic paraganglioma with negative lymph nodes. Conclusions: In patients presenting with prolonged recurrent attacks of vomiting, diagnostic workup to exclude anatomic causes is mandatory. Gangliocytic paraganglioma must be considered in the differential diagnosis of an intraduodenal tumor.
  2,132 204 -
IgG/IgE bullous pemphigoid with CD45 lymphocytic reactivity to dermal blood vessels, nerves and eccrine sweat glands
Ana Maria Abreu-Velez, J Graham Smith, Michael S Howard
November 2010, 2(11):540-543
Context: Bullous pemphigoid (BP), the most common autoimmune blistering disease, is mediated by autoantibodies. BP primarily affects the elderly and is characterized by the development of urticarial plaques surmounted by subepidermal blisters, and the deposition of immunoglobulins and complement at the basement membrane zone (BMZ) of the skin. BP is immunologically characterized by the development of autoantibodies targeting two structural proteins of the hemidesmosomes, BP180 (collagen XVII) and BP230 (BPAG1). Case Report: A 63 -year-old Caucasian female patient was evaluated for a 4 day history of several itching, erythematous blisters on her extremities. Biopsies for hematoxylin and eosin (H&E) examination, as well as Periodic acid-Schiff (PAS), immunohistochemistry (IHC) and direct immunofluorescence (DIF) analysis were performed. Results: H&E demonstrated a subepidermal blister, with partial re-epithelialization of the blister floor. Within the blister lumen, numerous neutrophils were present, with occasional eosinophils and lymphocytes also noted. Within the dermis, a mild, superficial, perivascular and periadnexal infiltrate of lymphocytes, histiocytes and occasional eosinophils was identified, with mild perivascular leukocytoclastic debris. The PAS stain was positive at the BMZ, and around selected blood vessels, nerves and sweat glands. DIF revealed linear deposits of IgG and Complement/C3 and fibrinogen at the BMZ, and around selected dermal nerves, blood vessels and sweat glands. Strong granular deposits of IgE were also observed, colocalizing with monoclonal antibodies to Collagen IV (CIV). By IHC, positive CD45 staining of lymphocytes was seen surrounding selected dermal blood vessels, eccrine sweat glands, and nerves. Conclusion : The patient displayed IgG, IgE, and fibrinogen autoantibodies against the BMZ, as well as around some dermal nerves and sweat glands; their binding in the skin could trigger complement activation. In addition, the role of the dermal CD45 positive lymphocytes warrants further investigation.
  1,926 336 -
Awareness and knowledge of ocular cancers in a resource-limited economy
Abdulkabir A Ayanniyi, Abubakar A Jamda, Kabir B Badmos, Rabi S Adelaiye, Abdulraheem O Mahmoud, Fatima Kyari, Edmund J Nwana
November 2010, 2(11):526-531
Aims: To determine awareness and knowledge of ocular cancers in a resource-limited setting. Material and Methods: A descriptive cross-sectional survey (2009) of 1,887 Nigerians using interviewer-administered questionnaire. Results: Respondents were 55.6% males, and mean age was 30 years, SD 9.5. Most respondents (77.8%) had at least secondary education. Fewer respondents were aware of eye cancers (57.1%) compared to cancers in general (73.7%) (P<.001). Despite the male preponderance there were no associations between gender and awareness of ocular cancers (P=0.07) and cancers in general (P=0.85). However, education was associated with awareness of ocular cancers (P<.001) and cancers in general (P<.001). Ocular cancers were thought to be caused by corrosives 33.2%, trauma 21.4%, witchcraft 18.6%, genetic transmission 15.7%, sunlight 8.0%, radiations 2.5% and infections 0.6% (n = 883). Of 280 respondents, 41.1% based their knowledge of patients having ocular cancers on sources other than hospital diagnosis. Of 148 respondents, 16.2% were related to 'patients' they knew had ocular cancers. There were 202 respondents who indicated challenges to accessing orthodox medical eye care services by ocular cancer patients as high cost 55.5%, long waiting period 23.3%, long distance 15.4% and poor attitude of health workers 5.9%. Conclusion: Awareness of ocular cancers compared to other cancers is low. Misconceptions on the causes of ocular cancers exist. Public ocular cancers health education can enhance awareness. The need to address barriers to accessing eye care is underscored.
  1,966 213 -
Unusual complication of percutaneous nephrostomy in a renal transplant recipient
Martin Nitschke, Martina Paetzel, Christian S Haas
November 2010, 2(11):537-539
Context: Ureteral obstruction, resulting in impaired graft function, is a well-known problem following renal transplantation. Management of ureteral complications includes percutaneous nephrostomy, which is considered to be a safe and effective measure. Case Report: Here, we demonstrate a case of a 35-year old renal allograft recipient with primary graft function but stagnating serum creatinine following extraction of the double-J catheter. Ureteral stenosis was suspected by ultrasound imaging and magnetic resonance tomography, and urinary flow was preserved with a percutaneous nephrostomy. However, early displacement of the percutaneous nephrostomy catheter resulted in distinct clinical discomfort. CT imaging suggested an intra-abdominal position of the catheter's tip, requiring immediate surgical action. Conclusion: The present case demonstrates that performing PCN following renal transplantation may have unexpected risks.
  1,728 202 -
Clinical pancreatology I: Pancreatic medical history
Ĺke Andrén-Sandberg
November 2010, 2(11):502-509
The present article and subsequent reviews will not be to report all what has been published, but rather to give an introduction samples that hopefully make the reader eager to read the whole article or articles with "a taste of clinical pancreatology in 2010". The main sources of literatures were PubMed, and the additional Journals such as Pancreas, Pancreatology and Journal of the Pancreas were also scrutinized. Only some full articles in almost all languages were included in the review, other articles, however, that were too superficial or too poor in other ways, were omitted, and the publications of non-human study were excluded.
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Pancreatic transplantation
Ĺke Andrén-Sandberg
November 2010, 2(11):510-511
A pancreas transplant is a surgical procedure to place a healthy pancreas from a donor into a patient whose pancreas no longer functions properly. Exocrine pancreas transplantation remains the standard treatment of choice for patients with diabetes mellitus complicated by end-stage renal disease. The use of pancreas transplantation for type 2 diabetes mellitus is an emerging concept. A pancreas transplant is often done in conjunction with a kidney transplant. Even if pancreas transplantation provides the best glycemic control option for diabetes mellitus, it is associated with significant morbidities related to infectious disease. The present article provides with a review of pancreatic transplantation.
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