Clinical efficacy and safety of colistin treatment in patients with pulmonary infection caused by Pseudomonas aeruginosa or Acinetobacter baumannii: a meta-analysis

Introduction

The aim of this study was to evaluate the efficacy and safety of colistin treatment in patients with pulmonary infection caused by Pseudomonas aeruginosa or Acinetobacter baumannii.

Material and methods

The relevant studies were identified through a search of public databases including PubMed, MEDLINE and EMBASE up to December 2012. A meta-analysis was conducted to compare the clinical response, mortality and renal damage of colistin (colistin group) versus other effective antibiotics (control group). The odds ratio (OR) was chosen as the effect size.

Results

A total of 9 studies were eventually identified. The result of the meta-analysis showed that the pooled OR of clinical response was 1.24 (95% CI = 0.68–2.27, p > 0.05) for patients in the colistin group versus the control group, indicating no significant difference in efficacy between colistin and control groups. Similar results were obtained by the further subgroup meta-analyses by sample size, research year, ethnicity and study method. Treatment with colistin versus other agents did not affect hospital mortality (OR = 1.05, 95% CI = 0.58–1.89, p > 0.05) or renal damage (OR = 1.25, 95% CI = 0.78–2.00, p > 0.05). The combined estimate of our analysis was strong across multiple sensitivity analyses and without significant publication bias.

Conclusions

Our results suggest that colistin may be as efficacious and safe as standard antibiotics for the treatment of pulmonary infection.     

The effects of botulinum toxin type A on improvement and dynamic spastic equinus correction in children with cerebral palsy – preliminary results

Introduction

We evaluated the effects of botulinum toxin type A (BTA) with physical therapy on dynamic foot equinus correction and higher motor functional outcome in children with spastic type of cerebral palsy (CP).

Material and methods

Ankle joint active and passive movement, gastrocnemial muscle spasticity levels (Modified Ashworth Scale (MAS)), and higher motor functional status (Gross Motor Function Classification System (GMFCS) and Gross Motor Function Measure (GMFM) (GMFM-D – standing and GMFM-E – walking) were assessed before treatment and 3, 8, 16 weeks and 6 months after BTA administration in 12 children.

Results

There was a significant improvement of active (initial – (–)13.07 ±5.78; 6 months – (–)10.64 ±4.77; p < 0.001) and passive (initial – 4.21 ±2.29; 6 months – 4.71 ±2.16; p < 0.05) ankle joint foot dorsiflexion. GMFM-D and GMFM-E were significantly higher after 3, 8, 16 weeks (p < 0.001) and GMFM-D after 6 months (p < 0.001).

Conclusions

Botulinum toxin type A administration and physical therapy in patients with spastic CP improves the motion range of dynamic foot equinus after 3 weeks and higher motor functional outcome (standing and walking).     

The role of matrix metalloproteinase 14 polymorphisms in susceptibility to intervertebral disc degeneration in the Chinese Han population

Introduction

Matrix metalloproteinase 14 (MMP14) plays an important role in the pathophysiology of intervertebral disc degeneration (IVDD). The present study aimed to determine whether two single nucleotide polymorphisms (–378 T/C and –364 G/T) of MMP14 were associated with the risk and severity of IVDD in the Chinese Han population.

Material and methods

A total of 908 patients with IVDD and 906 healthy controls were enrolled in this study. The grade of disc degeneration was determined according to Schneiderman''s classification for magnetic resonance imaging. The polymorphisms of MMP14 were genotyped using polymerase chain reaction and direct sequencing.

Results

The genotype distribution of –364G/T did not show a significant difference between IVDD patients and healthy controls. The frequencies of the –378T/C and CC genotypes were significantly lower among IVDD patients compared with healthy controls (p < 0.001); unconditional logistic regression analysis revealed that the CT and CC genotypes were significantly associated with a decreased risk of IVDD compared with the TT genotype (p < 0.001). Patients with IVDD showed significantly higher frequencies of the T allele at –378T/C than healthy controls (p < 0.001). In addition, the –375 CC genotype, as well as the C allele, was associated with lower degenerative grades of IVDD compared with the TT genotype and the T allele, respectively (both p < 0.001).

Conclusions

The –378T/C polymorphism of MMP14 may be associated with the risk and severity of IVDD in the Chinese Han population. It shows potential to become a biomarker to predict risk and severity of IVDD.     

Associations of radiological features in Mycoplasma pneumoniae pneumonia

Introduction

The associations of radiological features with clinical and laboratory findings in Mycoplasma pneumoniae infection are poorly understood. The purpose of this study was to assess the associations.

Material and methods

A retrospective cohort study of 1230 patients with community-acquired pneumonia was carried out between January 2005 and December 2009. The diagnosis of M. pneumoniae infection was made using the indirect microparticle agglutinin assay and enzyme-linked immunosorbent assay.

Results

Females were more susceptible to M. pneumoniae infection. Ground-glass opacification on radiographs was positively associated with M. pneumoniae-IgM titres (rank correlation coefficient (r _s) = 0.141, p = 0.006). The left upper lobe was more susceptible to infection with M. pneumoniae compared with other pathogens. More increases in the risk of multilobar opacities were found among older or male patients with M. pneumoniae pneumonia (odds ratio, 1.065, 3.279; 95% confidence interval, 1.041–1.089, 1.812–5.934; p < 0.001, p < 0.001; respectively). Patients with M. pneumoniae pneumonia showing multilobar opacities or consolidation had a significantly longer hospital length of stay (r _s = 0.111, r _s = 0.275; p = 0.033, p < 0.001; respectively), incurring significantly higher costs (r _s = 0.119, r _s = 0.200; p = 0.022, p < 0.001; respectively).

Conclusions

Our study highlighted female susceptibility to M. pneumoniae pneumonia and the association of ground-glass opacification with higher M. pneumoniae-IgM titres. The left upper lobe might be more susceptible to M. pneumoniae infection. Older or male patients with M. pneumoniae pneumonia were more likely to show multilobar opacities. Multilobar opacities and consolidation were positively associated with hospital length of stay and costs.     

The effect of Helicobacter pylori eradication on proteinuria in patients with primary glomerulonephritis

Introduction

Glomerulonephritis is still the primary cause among the diseases causing end stage renal disease. Helicobacter pylori (HP), also having a local proinflammatory effect on gastric mucosa, can trigger a local and systemic inflammatory response, and consequently have a role in the development of extragastrointestinal defects.

Material and methods

The study was composed of patients diagnosed with primary glomerulonephritis who had dyspeptic complaints throughout the diagnosis. Patients who received endoscopic biopsy upon the determination of pathologic findings in their upper gastrointestinal endoscopy were HP positive in their biopsy material. A triple eradication therapy was initiated for HP.

Results

The study included 14 female and 19 male patients, 33 in total, whose biopsy material was determined to be HP positive. Before the eradication for HP, we found serum albumin to be 34.0 (19.0–51.0) g/l, serum total protein 58.6 ±12.9 g/l, serum creatinine 0.9 (0.5–1.2) and proteinuria 3069 (652–12392) mg/day in 24-hour urine. After the eradication, however, serum albumin was found to be 40 (20–52) g/l, serum total protein 62.3 ±11.1 g/l, serum creatinine 1.02 (0.6–1.29) mg/dl and proteinuria was 2850 (172–15181) mg/day in 24-hour urine. A comparison of the results showed that a statistically significant difference is established between the serum albumin, total protein and creatinine values (p = 0.001, p = 0.001 and p = 0.021, respectively), but not between proteinuria values in 24-hour urine (p = 0.990).

Conclusions

Patients with primary glomerulonephritis, HP eradication treatment has an effect on serum albumin levels.     

Obesity risk factors in a representative group of Polish prepubertal children

Introduction

The study aim was to evaluate risk factors of obesity in Polish children aged 7 to 9 years.

Material and methods

A representative group of 2571 children (1268 girls and 1303 boys) was randomly selected according to the European Childhood Obesity Group protocol. Weight and height were measured and body mass index (BMI) was calculated. A questionnaire was completed by the children''s parents with respect to behavioural and family-related risk factors of obesity. International Obesity Task Force criteria were used for classification of children''s obesity.

Results

Obesity was found in 3.7% of girls and 3.6% of boys. There was a statistically significant association between the prevalence of obesity in girls and their mother''s obesity: OR = 5.06 (1.96–13.05), p < 0.001, father''s obesity: OR = 5.19 (1.96–13.69), p < 0.001, and both parents’ obesity: OR = 5.43 (1.39–21.29), p = 0.01. Obesity in boys was significantly associated with mother''s obesity: OR = 5.6 (2.6–12.02), p < 0.001, father''s obesity: OR = 6.21 (2.89–13.37), p < 0.001, and both parents’ obesity: OR = 7.22 (2.44–31.33), p < 0.001. Skipping or irregular eating of breakfast was a risk factor for obesity in girls with OR = 2.71 (1.33–5.51), p = 0.005. Neither family income nor parents’ education level was related to their offspring''s obesity. TV watching, physical activity level and eating in fast food places were not significant risk factors for obesity.

Conclusions

Eating breakfast regularly seems to protect girls from obesity development while low physical activity is not a significant obesity risk factor in this age group for either boys or girls. This finding stresses the more important role of healthy diet than physical activity promotion in obesity prevention in prepubertal children.     

Cytoprotective and Antioxidant Effects of the Methanol Extract of Eremomastax Speciosa in Rats

Background

Ethno-botanical information shows that Eremomastax speciosa is used in the traditional management of various stomach complaints including gastro-duodenal ulcers.

Materials and Methods

In this study, we tested the cytoprotective potential of the whole plant methanol extract (100–200 mg/kg, p.o), against HCl/ethanol, absolute ethanol, cold/restraint stress rats, and pylorus legated rats pre-treated with indomethacin. The effects of the extract on gastric lesion inhibition, the volume of gastric juice, gastric pH, gastric acid output, mucus production and gastric peptic activity were recorded. Oxidative stress parameters were measured in blood and gastric tissue samples obtained from the animals in all the models tested.

Results

The extract significantly (p<0.05), reduced the formation of cold/restraint ulcers by (31–60%, inhibition), completely inhibited (100%) the formation of lesions induced by HCl/ethanol at the highest dose, but was less effective against absolute ethanol (22–46% inhibition). The extract (200 mg/kg), significantly reduced lesion formation (P<0.01), gastric acidity (P<0.01), and volume of gastric secretions (P<0.05), in the indomethacin/pylorus ligation model, and did not affect the activity of pepsin in gastric juice. Blood concentrations of antioxidant enzymes (catalase, SOD and GSH), increased significantly and MDA concentrations decreased in all models tested.

Conclusion

Cytoprotection by E. speciosa methanol extract was attributed to its ability to reduce acid secretion, and to enhance mucosal defence and in vivo antioxidant status.     

Serum p-cresyl sulfate predicts cardiovascular disease and mortality in elderly hemodialysis patients

Introduction

Previous studies have shown that serum p-cresyl sulfate (PCS) and indoxyl sulfate (IS) were significantly related to clinical outcomes in patients on hemodialysis (HD). However, evidence for the relationship in elderly HD patients remains scarce. We explore whether the two toxins can predict clinical outcomes in elderly HD patients.

Material and methods

Fifty stable HD patients more than 65 years old were enrolled from a single medical center. Serum total and free PCS, IS levels and biochemistry were measured concurrently. The clinical outcomes including cardiovascular events and all-cause mortality were analyzed after 38-month follow-up.

Results

Univariate Cox proportional hazard ratio analysis revealed that cardiovascular events were associated with gender (p = 0.02), diabetes (p < 0.01), calcium (p = 0.01), total PCS (p < 0.01), free PCS (p < 0.01) and total IS (p = 0.05). Multivariate analysis showed that diabetes (p = 0.01), total PCS (p = 0.01) and free PCS (p = 0.04) were related to cardiovascular events. For all-cause mortality, only total PCS (p = 0.01) reached significance after adjusting other confounding factors. However, Kaplan-Meier analysis indicated that free PCS (p = 0.02) and total PCS (p < 0.01) were significantly associated with cardiovascular events and total PCS (p = 0.048) was related to all-cause mortality during 38-month follow-up.

Conclusions

Our results indicate that total PCS is a valuable marker in predicting cardiovascular event and all-cause mortality in elderly HD patients.     

Clinical value of serum eosinophilic cationic protein assessment in children with inflammatory bowel disease

Introduction

Eosinophils contribute to the pathogenesis of inflammatory bowel disease (IBD) in the intestine. Eosinophilic cationic protein (ECP) is one of the most important eosinophilic specific mediators released during activation. The aim of the study was to evaluate the clinical value of serum ECP determination in children with active and inactive IBD and its correlation with disease activity.

Material and methods

There were 125 children with IBD (63 with Crohn''s disease – CD, 44 with ulcerative colitis – UC, 18 indeterminate colitis – IC) enrolled in the study. Among them 83 children were in the active phase of the disease, while the remaining 42 were in remission. The control group consisted of 56 healthy children. The ECP was assessed three times in children with active IBD, at baseline and after 2 and 6 weeks of treatment and once in children with inactive IBD and controls using fluoroenzymeimmunoassays.

Results

We found elevated ECP at baseline in the total active IBD group when compared to the inactive IBD and control groups, decreasing during treatment. Serum ECP was also elevated in the active UC and CD groups when compared to the inactive UC and CD groups, and correlated with clinical UC and CD activity (R = 0.57 and R = 0.52, p < 0.05, respectively) and duration of the clinical manifestation in UC (R = 0.62, p < 0.05) but not with the disease location in the gastrointestinal tract, or endoscopic and histopathological activity.

Conclusions

Evaluation of serum ECP in children with IBD may be useful in disease activity assessment at onset and during the treatment.     

The effects of L-thyroxin replacement therapy on bone minerals and body composition in hypothyroid children

Introduction

Prolonged treatment with levothyroxine 4 (L-T4) is a well known risk factor for osteoporosis. Patients on L-T4 replacement occasionally have a subnormal TSH, which carries a risk of development of bone loss. Thyroid hormones directly affect bone cells, stimulating osteoclastic and osteoblastic activity with a predominance of bone resorption and decrease of bone mineral density (BMD).

Material and methods

The study included 35 hypothyroid patients with mean age 11.57 ±5.06, while 26 age- and sex-matched children served as controls. Dual energy X-ray absorptiometry (DXA) was done to detect the bone mineral density (BMD), bone mineral content (BMC) and Z score in lumbar and femur neck regions. Body composition was also studied by DXA. Calcium, phosphorus, osteocalcin as a bone formation marker, osteoprotegerin as an indicator of osteoclast activity and urinary deoxypyridinoline as a bone collagen breakdown marker were assessed.

Results

No significant differences were detected in lumbar Z score (−0.12 ±0.66) and femur Z score (−0.17 ±0.58) compared to controls (−0.33 ±0.74 and −0.21 ±0.53 respectively). Bone mineral density and BMC were not significantly different from controls. No significant difference was detected between cases and controls in body composition. A positive correlation was detected between BMD and age (r=0.857, p<0.01), and with the period of treatment (r=0.766, p<0.01). A positive correlation was found between BMD and total body fat (r=0.693, p<0.01), and with abdominal fat (r=0.667, p<0.01).

Conclusions

Levothyroxine 4 treatment in hypothyroid children does not alter bone metabolism and body composition.     

Differential diagnostic CYFRA 21-1 level for benign and malignant pleural effusions: a meta-analysis in the Chinese population

Introduction

Many studies have investigated the usefulness of cytokeratin 19 fragments (CYFRA 21-1) in pleural fluid for the differential diagnosis of benign (BPE) and malignant pleural (MPE) effusions. In the present meta-analysis, the reported studies on the diagnosis between CYFRA 21-1 and pleural effusion were assessed to summarize the diagnostic characteristics of CYFRA 21-1 in Chinese patients.

Material and methods

The data sources from the creation of each database up to January 2011 included Medline, Chinese National Knowledge Infrastructure, EMBASE, Cochrane Library, and bibliographies of review and original articles. Through a systematic literature search for publications, the data from 22 studies were summarized based on their discussions on the result of the CYFRA 21-1 assay in pleural effusion and differential diagnosis evaluation in the Chinese population.

Results

A total of 22 studies were available for analysis, and the high CYFRA 21-1 level in MPE was significantly associated with risk for lung cancer (standardized mean difference [SMD] = 1.65, 95% confidence interval [CI] = 1.48–1.82, Z = 18.97, p < 0.00001) compared with BPE. The CYFRA 21-1 level in pleural effusion (13 studies) was significantly higher than that in serum (SMD = 1.10, 95% CI = 0.71–1.48, Z = 5.59, p < 0.00001). The risk for squamous cell carcinoma (SCC) for CYFRA 21-1 was 1.03 (95% CI = 0.64–1.42, Z = 5.15, p < 0.00001) compared with that of adenocarcinoma (8 studies). The sensitivity of CYFRA 21-1 reported in the articles ranged from 46% to 94%, and the specificity ranged from 57% to 100%. The summary measure of the test characteristics derived from the summary receiver operating characteristic curve was 81% for both sensitivity and specificity (17 studies).

Conclusions

The measurement of pleural CYFRA 21-1 is likely to be a useful diagnostic tool for the confirmation of MPE.     

Correlation between central venous pressure and peripheral venous pressure with passive leg raise in patients on mechanical ventilation

Background:

Central venous pressure (CVP) assesses the volume status of patients. However, this technique is not without complications. We, therefore, measured peripheral venous pressure (PVP) to see whether it can replace CVP.

Aims:

To evaluate the correlation and agreement between CVP and PVP after passive leg raise (PLR) in critically ill patients on mechanical ventilation.

Setting and Design:

Prospective observational study in Intensive Care Unit.

Methods:

Fifty critically ill patients on mechanical ventilation were included in the study. CVP and PVP measurements were taken using a water column manometer. Measurements were taken in the supine position and subsequently after a PLR of 45°.

Statistical Analysis:

Pearson''s correlation and Bland–Altman''s analysis.

Results:

This study showed a fair correlation between CVP and PVP after a PLR of 45° (correlation coefficient, r = 0.479; P = 0.0004) when the CVP was <10 cmH₂O. However, the correlation was good when the CVP was >10 cmH₂O. Bland–Altman analysis showed 95% limits of agreement to be −2.912–9.472.

Conclusion:

PVP can replace CVP for guiding fluid therapy in critically ill patients.     

Anti-epidermal growth factor receptor monoclonal antibody-based therapy for metastatic colorectal cancer: a meta-analysis of the effect of PIK3CA mutations in KRAS wild-type patients

Introduction

We conducted a meta-analysis to dissect the association between PIK3CA mutations (exon 9 and exon 20) and resistance to anti-epidermal growth factor receptor (EGFR) monoclonal antibodies (MoAbs) in KRAS wild-type metastatic colorectal cancer (mCRC) patients.

Material and methods

In 11 previously published studies, 864 cancer patients were treated with cetuximab or panitumumab-based therapy. Primary outcomes included objective response (complete response + partial response vs. stable disease + progressive disease), progression-free survival (PFS), and overall survival (OS). We calculated the odds ratio (OR) or hazard ratio (HR) with 95% confidence intervals (CIs) to estimate the risk or hazard. We found consistent and clinically substantial risk or hazard for objective response, PFS, and OS in the cetuximab or panitumumab-treated mCRC patients.

Results

PIK3CA mutations as a whole were associated with reduced response and poor PFS and OS in KRAS wild-type mCRC patients (objective response: OR = 0.42 and 95% CI 0.23–0.75; PFS: HR = 1.54 and 95% CI 1.13–2.09; and OS: HR = 1.4 and 95% CI 1.02–1.91). PIK3CA exon 9 mutations had no effect, whereas exon 20 mutations were associated with a worse outcome compared with wild types, with an OR of 0.21 (95% CI 0.05–0.93).

Conclusions

PIK3CA mutations as a whole might be useful prognostic factors for assessing clinical outcomes of anti-EGFR MoAb-based chemotherapies in KRAS wild-type mCRC patients. In particular, PIK3CA exon 20 mutations were significantly associated with lack of response.     

Low serum IgA and increased expression of CD23 on B lymphocytes in peripheral blood in children with regressive autism aged 3-6 years old

Introduction

Immune system dysfunction is considered to be one of many medical disorders found in children with autism. The primary objective of the study was to assess if blood tests reflecting humoral immunity (IgA, IgG, IgM, IgE) are useful in identifying children with regressive autism. The secondary objective was to evaluate a part of the cellular arm of immunity (CD4/CD25 Tregs, CD4/CD23 cells) in those children.

Material and methods

Using a clinical case-control design, the systemic levels of immunoglobulins and lymphocyte subpopulations analysed by flow cytometry were compared in children aged 3-6 years old with a new diagnosis of regressive autism (n = 24; mean age: 4.25 ±1.70 years; male 23/24) and in sex- and age-matched healthy children (n = 24; aged 4.25 ±2.20 years; male 23/24).

Results

The humoral immunity profile, described by three binary variables, IgA < 0.97 g/l, IgE > 36 IU/ml, and IgG > 6.3 g/l, with a sensitivity of 79% and a specificity of 83% (p < 0.0001), was able to identify children with autism. The highest risk of autism diagnosis was associated with IgA < 0.97g/l (OR – 23.0; p < 0.001). A higher number of CD19/CD23 was found in children diagnosed with autism than in the control group (36.82 ±6.72% vs. 18.20 ±3.95%; p < 0.02). No correlation between the number of CD23-positive cells and serum IgE levels was observed.

Conclusions

A subtle shift of serum immunoglobulins consisting of low-normal IgA and B cell activation expressed by an increase of CD23-positive cells may characterize children with regressive autism aged 3-6 years old.     

Ozone preconditioning and exposure to ketamine attenuates hepatic inflammation in septic rats

Introduction

The objective of this study was to evaluate the interaction between ozone oxidative preconditioning and the anesthetic ketamine on cytoplasmic nuclear factor κB (NF-κB) levels in a rat endotoxic shock model.

Material and methods

Forty Wistar rats were randomly divided into 5 groups: I – control group; II – rats intraperitoneally (i.p.) treated with LPS; III – rats treated with LPS and then treated with ketamine; IV – animals pre-treated with O₃/O₂ mixture for 5 days, then treated with LPS for 24 h followed by infusion with ketamine; V – O₃/O₂ pre-treatment, as described above for IV, followed by LPS infusion, and then 0.9% saline. In addition to histological examination of the liver, the levels of NF-κB were determined by SABC immunohistochemistry in each group.

Results

Histological damage was observed in the lipopolysaccharide (LPS) group. It was characterized by hepatic disarray, hepatic lobule distortion, congestion of liver sinusoids, hepatocyte swelling and necrosis, and granulocyte infiltration. These changes were not obvious in the O₃/O₂ + LPS + ketamine group. The normal control group had low activity of NF-κB, but that activity was markedly increased in the LPS group (p < 0.05). The NF-κB level was significantly decreased in the O₃/O₂ + LPS + ketamine group (p < 0.05) when compared with the ketamine-treated group, and was almost equal to the control group.

Conclusions

We confirmed that the preconditioning effect of ozone enhances the biological effectiveness of ketamine by altering NF-κB activity, which may play an important role in sepsis-induced liver injury in rats.     

Prevalence of Demodex spp. in eyelash follicles in different populations

Introduction

The pathologic relevance of Demodex infestation in blepharitis is still controversial. The aim of the study was to determine the prevalence of Demodex spp. in eyelash follicles and its relationship to eye symptoms.

Material and methods

A total of 290 individuals were studied for the presence of Demodex folliculorum and Demodex brevis within eyelash follicles. Participants belonged to one of four groups: inpatients, drug abusers, health professionals, and medical students. Ten eyelashes were epilated from each subject, placed on microscope slides and examined for parasites. The sample was defined as positive if at least one parasite or parasite''s ova were present. The presence of parasites was analyzed according to age, gender, place of living, reported eye problems, and use of contact lenses or glasses.

Results

The prevalence of Demodex spp. infestation among all studied subjects was 41%, with the highest infestation rate among inpatients (p < 0.01) and elderly people (p < 0.001). No difference regarding the presence of Demodex was found between women and men (p = 0.76). Demodex folliculorum was about 2.4 times more frequent than D. brevis. The prevalence of Demodex spp. in subjects with and without eye complaints suggesting blepharitis was similar (41.6% vs. 40.2%, respectively, p = 0.9). On the other hand, wearing glasses was linked to Demodex infestation (48.4% vs. 32.3%, p < 0.01).

Conclusions

Demodex is a common saprophyte found in human eyelash follicles. Its presence might be related to some ocular discomfort; however, in the vast majority of cases the infestation seems to be asymptomatic.     

Antiobesity,hypolipidemic, antioxidant and hepatoprotective effects of Achyranthes aspera seed saponins in high cholesterol fed albino rats

Introduction

Numerous herbal medicines have been recommended for the treatment of different diseases. Achyranthes aspera, Linn. (Family: Amaranthaceae), popularly known as Charchitta or Pitpapra, is commonly used by traditional healers for the treatment of fever, malaria, dysentery, asthma, arterial hypertension, pneumonia, and diabetes. The root extract is well reputed for its insect molting hormonal activity. This investigation was conducted to evaluate the effects of saponins from Achyranthes aspera seeds on the serum lipid profile of albino rats fed a high cholesterol diet.

Material and methods

Hypolipidemic, antioxidant and hepatoprotective activities of these saponins were tested as described previously. To determine the mechanism underlying the observed effects, serum antioxidant status was assessed according to ABTS (2,2’-azino-bis-3-ethylbenzo-thiazoline-6-sulfonic acid), superoxide dismutase and ferric ion reducing antioxidant power (FRAP) assays in saponin-treated hyperlipidemic animals. Liver enzyme levels were determined to reveal any possible hepatotoxicity.

Results

Four-week oral administration of A. aspera seed saponins produced a significant (p < 0.05) decrease of total cholesterol, total triglycerides and LDL-C and a significant increase of HDL-C level in hyperlipidemic rats. Treatment with A. aspera seed saponins also showed a significant (p < 0.01) improvement of serum antioxidant status in tested animals. No significant hepatotoxicity was produced by such treatment as the serum liver enzyme activity remained unaltered.

Conclusions

Saponins from A. aspera seeds possess antihyperlipidemic and antioxidant properties which might lead to improvement of serum lipid profile and blood antioxidant status. Our findings support the folkloric use of this indigenous plant in the treatment of hyperlipidemia. However, its exact mechanism of action remains to be elucidated.     

Tumor necrosis factor-α antibodies (infliximab,adalimumab and certolizumab) in Crohn's disease: systematic review and meta-analysis

Introduction

This meta-analysis compares the effectiveness and safety of tumor necrosis factor α (TNF-α) antibodies (infliximab, adalimumab and certolizumab) with either a placebo or each of them in the treatment of Crohn''s disease (CD).

Material and methods

A systematic review of literature published up to November 2012 was performed and a meta-analysis of identified studies was carried out. We searched the following databases: PubMed, EMBASE, The Cochrane Library and others. Only randomized or clinical controlled trials were included.

Results

Nineteen clinical trials fulfilled the established criteria (5 studies for infliximab vs. placebo, 6 for each adalimumab or certolizumab vs. placebo and 2 comparing infliximab with adalimumab). The results of meta-analysis showed that anti-TNF therapy in patients with CD is safe and statistically significantly more effective when compared with the placebo for induction of remission at week 4 (RB = 1.90, 95% CI: 1.55–2.33, p < 0.00001), maintenance of remission at weeks 20–30 (RB = 1.86, 95% CI: 1.61–2.15, p < 0.00001) and at weeks 48–56 (RB = 2.75, 95% CI: 2.13–3.54, p < 0.00001) in patients who responded to the induction therapy and patients randomized before the induction. Anti-TNF agents were also superior to the placebo in fistula healing (during short-term induction, as well as long-term maintenance) and inducing CR-70 but not CR-100 at week 4. Moreover, the anti-TNF therapy had a significant effect on achieving both CR-70 and CR-100 during long-term maintenance.

Conclusions

Infliximab, adalimumab and certolizumab are effective as both induction and maintenance therapy in moderate to severe Crohn''s disease in adults, including patients with fistulas. The safety profile was acceptable.     

Nodding syndrome: origins and natural history of a longstanding epileptic disorder in sub-Saharan Africa

Background

Repetitive involuntary head nodding was first reported in the 1960s in the Wapogoro tribe of Tanzania.

Objectives

We describe the natural history of head nodding in the Wapogoro tribe, with special reference to the earliest reported dates of onset.

Methods

We analyzed clinical data from 150 historical patients seen between 1960 and 1971.

Results

Head nodding with or without grand mal convulsions was present in 33/150 (∼20%) cases, was mostly familial and equally distributed by gender. Age at onset of head nodding ranged from 2–22 years (mean: ∼10 years) in the period 1934–1962. Head nodding preceded onset of grand mal convulsions by up to 12 months, and motor and psychomotor deficits indicative of brain damage developed with time. Fourteen of the 33 cases died at 13–39 years of age (mean: ∼20 years) while nineteen aged 16–28 years (mean: ∼16 years) were still alive.

Conclusion

Historical accounts of head nodding (amesinzia kichwa, Swahili) among the Wapogoro tribe fit the August 2012 World Health Organization (WHO) case definition of probable Nodding Syndrome. Reported to have existed in this population for at least 80 years, Nodding Syndrome is a progressive seizure disorder that leads to generalized convulsions (kifafa), brain damage and death.     

Prevalence of Chlamydia trachomatis infection among patients attending infertility and sexually transmitted diseases clinic (STD) in Kano,North Western Nigeria

Background

Chlamydia trachomatis is the most common bacterial sexually transmitted disease in the world with severe complications. The aim of this study was to determine the prevalence and possible risk factors of C. trachomatis in Kano. There is dearth of information on this subject in this locality.

Method

Urine samples, Endocervical swabs and Urethral swab were collected from consecutive patients attending the Infertility and STD clinics in Aminu Kano Teaching Hospital (AKTH) between June and December 2012, after administering a questionnaire by the attending physician and also obtaining an informed consent.Samples were analyzed using Diaspot Chlamydia kit, a rapid immunoassay test for the detection of genital chlamydial antigen in urinogenital samples.

Results

A total of 125 consecutive samples were collected, comprising 69 females and 56 males aged between 14 – 55 years. Twelve samples tested positive for C. trachomatis antigen giving a prevalence rate of 9.6%. The age group prevalence were as follows 25 – 29 yrs (17.1%), 20 – 24 (16.7%), 15 – 19 (12.5%), 30 – 34 (11.1%) and > 49 years (9.0%). Married patients were associated with higher infection rate than single (8.3%), and divorced patients (33.3%). A higher percentage of the patients (95.2%) were not aware of the existence of C. trachomatis infection and its complications. Previous STD exposure was associated with increased risk of Chlamydia infection.

Conclusion

C. trachomatis infection if unchecked will continue to pose a threat to reproductive life with its established complications. Since asymptomatic cases are common in the population regular screening should be encouraged for every adult especially before commencement of marital life.