Jaundice in malaria

Jaundice is not an unusual accompaniment of malaria. It can occur due to intravascular hemolysis, disseminated intravascular coagulation, and, rarely, 'malarial hepatitis'. Although the primary schizogony of the malarial parasite always leads to the rupture of the infected hepatocyte, alteration of the hepatic functions is uncommonly recorded due to this event. Histologically, the hepatitis or the actual inflammation in the liver has never been demonstrated. Nonetheless, the term 'malarial hepatitis' (MH) has been used in the literature to describe the occurrence of hepatocellular jaundice in patients with Plasmodium falciparum infection. The authors' own data and review of the literature indicate that it is not an uncommon entity. In endemic areas, jaundice is seen in approximately 2.5% of patients with falciparum malaria. It also appears to be a heterogeneous syndrome and one can recognize two clinical subsets. In one group there was an acute, virulent presentation with coma, renal failure and in some cases even hemorrhagic manifestations. It is only in this setting that jaundice signified a 'severe' disease as noted by the World Health Organization action program. This presentation is often confused with acute viral hepatitis and acute hepatic failure in non-endemic areas, but can be clinically differentiated.     

Idiopathic cholestasis associated with bloody diarrhea as the first manifestation of Hodgkin's lymphoma

Jaundice in Hodgkin's disease occurs in 3-13% of the cases reported in the medical literature and can be due to several causes. Cholestatic jaundice associated with ductopenia may be a consequence of an associated paraneoplastic process and can occur several months before the development of Hodgkin's disease. When there is a finding of jaundice of unknown etiology associated with ductopenia, the possible existence of Hodgkin's disease should be investigated. We describe a case of cholestatic jaundice associated with Hodgkin's disease. The first clinical and laboratory manifestations were symptoms of bloody diarrhea months before the development of Hodgkin's disease. We discuss the differential diagnoses considered, given the complexity of the case.     

Herbal Interventions in Asthma and Allergy

This paper reviews the role of herbal-based medicines in the treatment of asthma and allergic rhinitis. A comprehensive literature search was performed of relevant English-language papers and abstracts were identified through a MEDLINE search and from bibliographies of the identified papers. Papers and studies pertaining to the use of medicinal plants in the treatment of asthma and allergic rhinitis were identified. They were then analyzed according to design, inclusion and exclusion criteria, population studied, variables tested, method of treatment (i.e., specific medicinal plants or herbal combinations), and results. The data have been reviewed and divided on the basis of culture and the effects of medicinal plants in asthma and allergy. A number of studies were found that support the use of some herbal medicines in asthma and allergy. Various derivatives from specific medicinal plants were identified as the antiasthma components and some mechanisms of action were explored. The results show positive effects of these herbs on bronchodilation, pulmonary function tests, and antagonism of asthma mediators such as histamine and platelet activating factor, corticosteroid levels, and clearance of mucus. Improved symptoms were also seen in patients with allergic rhinitis specifically on histamine-induced reactions, e.g., rhinorrhea, sneezing, and itching. From the review, there has been a role for some herbal medicines in the treatment of asthma and allergic rhinitis. Usage of herbal medicines has increased in recent years. Many of these medicinal plants provided relief of symptoms equal to allopathic medicines used. Specific chemical derivatives have been isolated from many of these plant products which act on the mechanisms and mediators that cause asthma and allergies. The amount of research on these products, especially in the United States, is limited. There is a lack of control of quantity and quality of the components in these remedies. Yet, many have fewer side effects than current therapy. Throughout the history of medicine, drugs have been developed from traditional medicine. By continuing to investigate how some of these herbal interventions work, we may be able to find additional effective medicines to treat asthma and allergies.     

Herbal medicines and nonalcoholic fatty liver disease

Nonalcoholic fatty liver disease(NAFLD), which is characterized by excessive fat accumulation in the liver of patients who consume little or no alcohol, becomes increasingly common with rapid economic development. Long-term excess fat accumulation leads to NAFLD and represents a global health problem with no effective therapeutic approach. NAFLD is considered to be a series of complex, multifaceted pathological processes involving oxidative stress, inflammation, apoptosis, and metabolism. Over the past decades, herbal medicines have garnered growing attention as potential therapeutic agents to prevent and treat NAFLD, due to their high efficacy and low risk of side effects. In this review, we evaluate the use of herbal medicines(including traditional Chinese herbal formulas, crude extracts from medicinal plants, and pure natural products) to treat NAFLD. These herbal medicines are natural resources that can inform innovative drug research and the development of treatments for NAFLD in the future.     

Unusual complication of amebic liver abscess: Hepatogastric fistula

Amebic liver abscess is a parasitic disease which is often encountered in tropical countries. A hepatogastric fistula secondary to an amebic liver abscess is a rare complication of this disease and there are only a handful of reported cases in literature. Here we present a case of an amebic liver abscess which was complicated with the development of a hepatogastric fistula. The patient presented with the Jaundice, pain and distension of abdomen. The Jaundice and pain improved partially after he had an episode of brownish black colored increase in frequency of stools for 5 to 6 d. Patient also had ascites and anemia. He was a chronic alcohol drinker. Esophagogastroduodenoscopy performed in view of the above findings. It showed a fistulous opening with bilious secretions along the lesser curvature of the stomach. On imaging multiple liver abscesses seen including one in sub capsular location. The patient was managed conservatively with antiamebic medications along with proton pump inhibitors. The pigtail drainage of the sub capsular abscess was done. The patient improved significantly. The repeat endoscopy performed after about two months showed reduction in fistula size. A review of the literature shows that hepatogastric fistulas can be managed conservatively with medications and drainage, endoscopically with biliary stenting or with surgical excision.     

A review of five traditionally used anti-diabetic plants of Bangladesh and their pharmacological activities

Plants are used traditionally throughout the globe to treat various diseases.Traditionally used medicinal plants are an essential part of the health sector in Bangladesh due to its abundance of a vast source of ethno-medicine.Rural people from developing country like Bangladesh are greatly dependent on traditional source of medicine.The prevalence of diabetes mellitus is increasing from recent years; therefore various researches are going on to discover better medicine to treat this disease.This study has focused on five plants which are Andrographis paniculata, Ageratum conyzoides, Swertia chirata, Terminalia arjuna, and Azadirachta indica to find out their traditional formulation as anti-diabetic medicine and their pharmacological activity has also been explored through literature search.The available information about traditional anti-diabetic uses of these plants and their pharmacological activities were collected from various electronic sources like Pubmed, Sci Finder, Elsevier, Springer, Scopus, Scirus, Science Direct, Google Scholar and Web of Science apart from these locally available books and peer reviewed journal were also used to collect information.This study will help to strengthen the relation between traditional medicine, pharmacology and drug development.A clue may be found from the information provided this review to discover new and better anti-diabetic drugs.     

Traditional medicines and their in-vitro proof against Staphylococcus aureus in Pakistan

Objective:To gather the fragmented literature on ethnobotany,phytochemistry and in-vitro activities of medicinal plants of Pakistan being used against common infections caused by Staphylococcus aureus(S.aureus).Methods: A large number of published and unpublished research studies related to the ethnomedicinal,phytochemical and anti-S.aureus activity of medicinal flora of Pakistan published from 1990-2018 were reviewed using online bibliographic databases such as PubMed,Web of Science,Science Direct,ResearchGate and libraries.Results: S.aureus can cause many human ailments including endocarditis,staphylococcal scalded skin syndrome,septic arthritis,respiratory problems with an estimated infection rate of 25%-35% across the globe.This review comprised of 86 medicinal plants.Data showed that people mostly used leaves(50%) for the preparation of traditional medicines.Correlation analysis on the reviewed data revealed that methanolic extract concentrations of medicinal plants was highly significantly positive correlated(r=0.8;P0.01) with the S.aureus zone of inhibitions.S.aureus reportedly showed complete resistant to the commonly used antibiotic erythromycin.Isolated compounds like altheahexacosanyl lactone,cinnamaldehyde,niloticane,gobicusin A,asparacosin A,muzanzagenin,isoagatharesinol,friedelin,inophynone and eugenol were active against S.aureus.This study provided in-vitro proof for the flora of Pakistan used against different infections caused by S.aureus.Conclusions: Antibacterial agents from natural sources could be more effective against bacterial pathogens and will be helpful in minimizing the adverse effects of synthetic drugs,and hence provides a base for the pharmaceutical industries.     

A review on most important herbal and synthetic antihelmintic drugs

Parasites and parasitic diseases are widely spread in the world. Their adverse effects on health and social-economic society cause tremendous public health problems. Parasitic infections in different ways (water, soil, food and vegetables) can affect humans and induce other complications such as gastrointestinal disorders, malnutrition, anemia and allergies and sometimes even life threatening. Medicinal plants are being widely used, either as a single drug or in combination with synthetic drugs. These medicinal plants are considered as a valuable source of unique natural products and drugs for development of medicines against various disorders and diseases. In this article the recently published papers about medicinal plants and parasites were reviewed, using scientific sites such as Medline, PubMed and Google Scholar. The used terms included: herbal medicine, medicinal plants, and antihelmintic drugs, antinematoda, anticestoda, antitrematoda. From the above collected literature it might be concluded that these plants are promising potential sources for preparation of new drugs or for pharmacological and therapeutic applications.     

Parasitic liver disease in travelers

Liver disease is an important source of morbidity among ill returning travelers. Jaundice is one of the most common and obvious symptoms of liver disease, the differential diagnosis of which is extensive, especially in travelers. Jaundice in travelers can arise from both infectious and noninfectious causes. We herein summarize the most common parasitic etiologies that may lead to jaundice in the returned traveler, visitors of friends and relatives, or new immigrants, and describe the etiology, epidemiology, and pathogenesis of clinical features of each.     

Traditional effects of medicinal plants in the treatment of respiratory diseases and disorders: an ethnobotanical study in the Urmia

ObjectiveTo identify, present and review the respiratoty medicinal plants which used by Urmian herbalists.MethodsThe list of traditional healers of West Azarbaijan Province was prepared and data were obtained by direct observation, interviews and the questionnaires After that, herbarium samples were collected from the desired area and deposited in herbarium unit of the Faculty of Agriculture, Urmia University, Urmia, Iran.ResultsOur results demonstrated that 20 medicinal plants from 10 plant families are used to treat respiratory disorders. Also, the most plant part that used for treating of respiratory disorders was seed (27%) and the most traditional form prescribed by herbalists was boiled (54%). Forty three percentage of Urmia herbalists have used herbs for the treatment of cough.ConclusionsPeople in this area have a strong belief that plants have a positive impact in the treatment of respiratory disorders and they have used medicinal plants since ancient times to treat these disorders. Our study revealed the importance of herbal medicines and traditional medicine in this area as medicinal resource for drug discovery in future.     

Herbal medicines for liver diseases in India

The use of natural remedies for the treatment of liver diseases has a long history, starting with the Ayurvedhic treatment, and extending to the Chinese, European and other systems of traditional medicines. The 21st century has seen a paradigm shift towards therapeutic evaluation of herbal products in liver diseases by carefully synergizing the strengths of the traditional systems of medicine with that of the modern concept of evidence-based medicinal evaluation, standardization of herbal products and randomized placebo controlled clinical trials to support clinical efficacy. The present review provides the status report on the scientific approaches made to herbal preparations used in Indian systems of medicine for the treatment of liver diseases. In spite of the availability of more than 300 preparations for the treatment of jaundice and chronic liver diseases in Indian systems of medicine using more than 87 Indian medicinal plants, only four terrestrial plants have been scientifically elucidated while adhering to the internationally acceptable scientific protocols. In-depth studies have proved Sylibum marianum to be anti-oxidative, antilipidperoxidative, antifibrotic, anti-inflammatory, immunomodulating and liver regenerative. Glycyrrhiza glabra has been shown to be hepatoprotective and capable of inducing an indigenous interferon. Picrorhiza kurroa is proved to be anti-inflammatory, hepatoprotective and immunomodulatory. Extensive studies on Phyllanthus amarus have confirmed this plant preparation as being anti-viral against hepatitis B and C viruses, hepatoprotective and immunomodulating, as well as possessing anti-inflammatory properties. For the first time in the Indian systems of medicine, a chemo-biological fingerprinting methodology for standardization of P. amarus preparation has been patented.     

Case Report: Severe cholestatic jaundice induced by Epstein-Barr virus infection in the elderly

Infectious mononucleosis due to Epstein-Barr virus (EBV) is almost always a self-limited disease, most commonly seen in young adults. Hepatitis is a well-recognized complication of EBV infection that usually resolves spontaneously. Jaundice occasionally results from the unusual complication of autoimmune haemolytic anaemia rather than hepatitis. We report a 60-year-old man with severe cholestatic jaundice whose history, liver histology and laboratory findings suggested EBV infection. He also developed significant jaundice related to his hepatitis, but not to autoimmune haemolysis, a situation that led to diagnostic delay. Costly diagnostic laboratory tests and invasive procedures were performed to rule out a malignant extrahepatic biliary obstruction. Physicians need to be aware of this complication and EBV infection should be included in the differential diagnosis of cholestatic jaundice in the elderly.     

Differential diagnosis of jaundice

Jaundice a frequent diagnostic problem and in many cases difficult to resolve, despite of current advances in exploration techniques, echography specially. In this review the significance of each method is discussed. The significance of clinical data as a first diagnostic stage is analyzed. Afterwards, according to biochemical data, the different jaundice types are distinguished and the diagnostic tests are chosen. Lastly, the main diagnostic invasive and noninvasive methods are evaluated.     

Obstructive jaundice associated Burkitt's lymphoma mimicking pancreatic carcinoma

The primary compromise of the pancreas in lymphomas is uncommon. However, in advanced stages of Non-Hodgkin's lymphomas (LNH) the secondary invasion of the pancreas is observed more frequently. Jaundice due to extrahepatic cholestasis as a presentation form is extremely rare, with only few cases described in the literature. The aim is to present a case of an obstructive jaundice as an expression of Burkitt's lymphoma probably due to a diffuse pancreatic infiltration in an adult without immunodeficiency with a rapid response of cholestasis to low dose of hydrocortisone. Skin tumor simultaneously present with jaundice allowed the histologic diagnosis with skin biopsies. After a unique dose of 100 mg hydrocortisone, jaundice improved and cholestatic enzymes decreased, pancreas became smaller and common bile duct diameter became normal at ultrasound and CT scan, also skin tumors turn pale and diminished in size. There are isolated reports of Burkitt's lymphoma cases with associated obstructive jaundice due to pancreatic infiltration or by compression by lymph nodes of the bile ducts, many of them are pediatric cases or immunodepressed HIV patients. In the case presented, surgical resection of the pancreatic infiltration and biliary drainage, either surgical or endoscopic during the same procedure was not necessary for the histopathologic diagnosis of the illness like is described in the literature. The diagnosis was suspected by the rapid decrease of cholestatic features after a single dose of hydrocortisone and the histology was easy done by a skin biopsy. We think the interest in this case is the quick response to low doses of corticoids, which avoided the necessity of surgical procedure for the diagnosis of the biliary tree obstruction, allowing a quick implementation of the specific chemotherapeutic treatment of the lymphoma without any surgical or endoscopic procedures to heal the jaundice.     

Colon carcinoma metastasis to the intrapancreatic tract of the common biliary duct: A first case report

Jaundice, a common feature of advanced colon cancer, is usually due to liver parenchyma metastasis, but it can sometimes be caused by extrahepatic biliary obstruction. This rare event is related to metastasis to the lymph nodes placed behind the duodenum, along the choledochus or the vena porta, extrinsically compressing the common duct. Stenosis of the common bile duct secondary to parietal metastatic involvement is extremely rare. We report on a case of colon carcinoma metastasis to the intrapancreatic tract of the common bile duct, with a review of the literature.     

Colon carcinoma metastasis to the intrapancreatic tract of the common biliary duct: a first case report

Jaundice, a common feature of advanced colon cancer, is usually due to liver parenchyma metastasis, but it can sometimes be caused by extrahepatic biliary obstruction. This rare event is related to metastasis to the lymph nodes placed behind the duodenum, along the choledochus or the vena porta, extrinsically compressing the common duct. Stenosis of the common bile duct secondary to parietal metastatic involvement is extremely rare. We report on a case of colon carcinoma metastasis to the intrapancreatic tract of the common bile duct, with a review of the literature.     

Ethnomedicinal plants used by Chorei tribes of Southern Assam,North Eastern India

ObjectiveTo explore and enumerate the medicinal plants used by the Chorei tribe residing in Sourthern Assam part of North Eastern India in the treatment of various ailments.MethodsSystematic and intensive field surveys were conducted in Chorei inhabited parts of Southern Assam part of North East India to collect information on medicinal plants used by them in treatment of various ailments. Data was collected through structured questionnaires and personal observations made during the field visit.ResultsA total of 53 different medicinal plants were recorded along with their vernacular names, parts used and mode of utilization by the Chorei tribes. Each of the plants was categorized according to their use in treatment of particular disease.ConclusionsThe present study revealed that the Chorei tribe is primarily dependent of medicinal plant for treatment of various ailments.     

Jaundice: an important,poorly recognized risk factor for diminished survival in patients with adenocarcinoma of the head of the pancreas

Objectives: Jaundice impairs cellular immunity, an important defence against the dissemination of cancer. Jaundice is a common mode of presentation in pancreatic head adenocarcinoma. The purpose of this study was to determine whether there is an association between preoperative jaundice and survival in patients who have undergone resection of such tumours.Methods: Thirty possible survival risk factors were evaluated in a database of over 400 resected patients. Univariate analysis was used to determine odds ratio for death. All factors for which a P-value of <0.30 was obtained were entered into a multivariate analysis using the Cox model with backward selection.Results: Preoperative jaundice, age, positive node status, poor differentiation and lymphatic invasion were significant indicators of poor outcome in multivariate analysis. Absence of jaundice was a highly favourable prognostic factor. Interaction emerged between jaundice and nodal status. The benefit conferred by the absence of jaundice was restricted to patients in whom negative node status was present. Five-year overall survival in this group was 66%. Jaundiced patients who underwent preoperative stenting had a survival advantage.Conclusions: Preoperative jaundice is a negative risk factor in adenocarcinoma of the pancreas. Additional studies are required to determine the exact mechanism for this effect.     

Toxoplasmosis and anti-Toxoplasma effects of medicinal plant extracts-A mini-review

Toxoplasmosis is a globally diwstributed parasitic protozoan disease,caused by Toxoplasma gondii.The infection can result in more severe symptoms with potentially life-threatening in case of immunocompromised individuals.Sulfadiazine and pyrimethamine are the two drugs used as a part of standard therapy for toxoplasmosis.Researchers have demonstrated the therapeutic effects of medicinal plants for toxoplasmosis,which can be used as an alternative to standard drug therapy with reduced side effects.Traditional herbal plants are used by people to cure a large number of parasitic disorders.This review provides new insights into various medicinal plants that are used traditionally for the treatment of toxoplasmosis and other parasitic infections,which can be useful as an alternative treatment option for Toxoplasma gondii infections.