Tuberculosis and HIV co-infection: its impact on quality of life

Background-  

Very little is known about the quality of life of tuberculosis (TB) and HIV co-infected patients. In this study in Ethiopia, we compared the quality of life HIV positive patients with and without TB.     

Phenotypical characterization of α-galactosidase A gene mutations identified in a large Fabry disease screening program in stroke in the young

Objective

In the Belgian Fabry Study (BeFaS), the prevalence of Fabry disease was assessed in 1000 young patients presenting with stroke, unexplained white matter lesions or vertebrobasilar dolichoectasia. The results of the BeFaS suggested that Fabry disease may play a role in up to 1% of young patients presenting with cerebrovascular disease. However, the clinical relevance was unclear in all cases. We report on detailed phenotyping in subjects identified with α-galactosidase A (α-Gal A) enzyme deficiency or GLA mutations identified in the BeFaS (n = 10), and on the results of family screening in this population.

Methods

Family screening was performed to identify additional mutation carriers. Biochemical and/or clinical evaluation of all subjects (BeFaS index patients and relatives carrying a GLA mutation) was performed.

Results

Genetic family screening revealed 18 additional GLA mutation carriers. Bloodspot α-Gal A enzyme activity was normal in all GLA mutation carriers, even in 2 males with the p.A143T mutation. Plasma Gb3 and lyso-Gb3 levels were normal in all subjects. Elevated Gb3 in urine was detected in 2 subjects. Some classic clinical signs of Fabry disease, like angiokeratoma or cornea verticillata, could not be detected in our population. Cardiac symptoms of Fabry disease were found in 6 out of 10 p.A143T carriers. No signs of cerebrovascular disease were found in the relatives with a GLA mutation.

Conclusions

We could not identify mutations causing the classical clinical phenotype of Fabry disease in our cerebrovascular disease population. Enzyme activity analysis in bloodspots and plasma may fail to identify late-onset variants of Fabry disease. We recommend genetic testing when an atypical, late-onset variant of Fabry disease is suspected in a male cerebrovascular disease patient. However, this may lead to the identification of non-disease causing or controversial genetic variants.     

Implantable Gastric Stimulation (IGS™) as Therapy for Human Morbid Obesity: Report from the 2001 IFSO Symposium in Crete

This supplement contains reports from a symposium on a novel approach to treat obesity, gastric myo-electrical stimulation, that was held at the IFSO in Greece in 2001. There were four presentations. Xavier Pi-Sunyer from Columbia University in New York discussed medical risks of obesity. Karl Miller from Austria presented technical aspects of the surgery. Valerio Cigaina from Italy, the originator of the concept, reviewed his 7-year results with this therapy. Finally, Jerome D’Argent from France gave his preliminary results employing higher energy electrical stimulation parameters.Customarily weight loss data are presented as percent excess weight lost (%EWL), an antiquated measurement, eg. all subjects were purchasing life insurance, the poor and minorities were under-represented and those with heart disease, malignancies or diabetes were excluded. In this supplement weight loss data are presented in a novel manner: percent excess body mass index (BMI) lost %EBL.This innovation merits an explanation and justification. The NIH/NIDDK convened a panel, chaired by Professor Pi-Sunyer, that concluded that for adults a BMI of 25 should be considered the upper limit of normal. Accordingly, we have proposed that BMI units in excess of 25 be considered to represent 100% of the excess weight of an individual. The USA FDA has agreed to accept weight loss data presented as %EBL.The intriguing data presented justify further evaluation of this novel, potentially useful and relatively benign treatment of obesity.     

Outcomes of early relaparotomy in pediatric patients at Tikur Anbessa teaching hospital,Addis Ababa,Ethiopia: a five-year retrospective review

Background

Early relaparotomy is defined as relaparotomy within the first 30 days following surgery. The aim of this study is to explore the indications, outcomes and factors associated with relaparotomy in our pediatric population.

Methods

We performed a retrospective study of pediatric surgical patients (<?13 yrs.) who underwent relaparotomy at Tikur Anbessa Teaching Hospital between September 1, 2011 and August 31, 2016. All children who had relaparotomy within the first 30 days of the initial surgery were included. We collected patient data including demographics, operative indication, and postoperative outcomes. Data analysis was performed using SPSS Version 23. Chi-square and Fisher’s exact tests were used to report outcomes stratified by patient characteristics. Multivariable logistic regression was used to identify patient variables associated with relaparotomy and other outcomes.

Results

In our patient population, relaparotomy rate was 17.2%. Patient age ranged from 2 days to 12 years with mean age of 37.5 months. Male to female ratio was 1.2:1. Thirty-one (58.5%) relaparotomies were performed between the 5th and 8th postoperative days. The two most common indications for relaparotomy were postoperative intra-abdominal collection and anastomotic leak, accounting for 18 (34.0%) and 17 (32.1%) respectively. Mortality rate following relaparotomy was 26.4%. The most common cause of mortality was sepsis with multi-system organ failure (90.6%). Neonatal age was found to be the independent risk factors for death following relaparotomy, (AOR?=?27.59, 95% CI [2.0–379.9]).

Conclusion

Prevalence of relaparotomy in pediatric patients is high (17.2%) in our patient population. Neonatal age was associated with increased mortality following relaparotomy.

     

The role of alternative medicine in rhinology

Complementary and alternative medicine (CAM) includes treatments from traditional Chinese medicine, homeopathy, naturopathy, herbal medicine, Ayurvedic medicine, mind-body medicine, chiropractic or osteopathic manipulations, and massage. More than 40% of patients in the United States use CAM, with 17% of CAM use related to otolaryngology diagnoses, but nearly half of CAM users do not communicate their use of these medications to their physicians. Perioperative risk of bleeding is a particular concern in surgical specialties, and knowledge of these therapies and their potential adverse effects is critical.     

Laparoscopic adjustable silicone gastric banding in the treatment of morbid obesity

A first approach to laparoscopic placement of the adjustable silicone gastric band (ASGB) was begun in our institution in 1992. This work started on an animal model first. In the animal lab, details of laparoscopic dissection around the stomach have been defined. A new prototype of the adjustable silicone band for laparoscopic use has been devised. Four voluntary patients underwent this operation on the 1st, 2nd, and 3rd of September 1993. All the patients were female and the average weight was 116 kg (102–120 kg). The mean body mass index was 43 kg/m² (36–49 kg/m²). No major operative difficulty was encountered. Immediate postoperative outcome was uneventful.     

Pattern of widal agglutination reaction in apparently healthy population of Jimma town, southwest Ethiopia

BACKGROUND: Typhoid fever is leading cause of morbidity in developing countries including Ethiopia. Isolation of Salmonella Typhi by culturing, from blood or other source, is the surest way of making laboratory diagnosis. However, in resource-limited countries, the Widal agglutination test provides cheaper and easy alternatives, though inappropriate technique and interpretation continue to cast a shadow on its usefulness. METHODS AND MATERIALS: A cross-sectional study was carried out during the period of February to May 2004 to determine the baseline antibody tube titration and slide agglutination pattern to Widal antigen and the usefulness of rapid slide agglutination test for diagnostic purposes among apparently healthy population of Jimma town, southwest Ethiopia. Blood samples were collected from subjects who gave their consents after thorough explanation of the procedure and the purpose of the study. The study participants were selected by a systematic random sampling technique. The sera of subjects were tested for Widal agglutination by an experienced laboratory technologist according to the standard procedural protocol-using antigen from Chronolab AG, Switzerland Data were cleaned edited and entered in to a computer and analyzed using SPSS for window version 11.0. Major results were expressed as 95% probability limit, and validity scoring; agreement test (Kappa) was determined. RESULTS: The result indicated that among the apparently health population, almost all the blood tested showed some titer of the antibody and reactivity of agglutination slide tests. The 95% probability limit (mean + 2SD) for anti H and anti O antigen titration was 1:276.89 and 1:207.89, respectively. These figures are closer to a cut-off titer of 1.320. There was a fair agreement between slide agglutination test and tube titer for 0 antigen (Kappa=0.225) and a poor agreement for H antigen (Kappa=0.066). When agglutination test result of highly reactive (+4) and titration of 1:320 were used, few cases became reactive indicating the need to raise the cut-off value to these points respectively. CONCLUSION: It is recommended that if Widal test is to be used for the clinical work up of typhoid fever in adult population, a cut-off value highly reactive (+4),for rapid slide agglutination and a titer of 1.320 and above for tube titration test be used. At the cut-off values indicated above, Widal test has low sensitivity and positive predictive value and high specificity and negative predictive values. This makes the test useful support to clinical suspicion but unlikely means ofJscreening.