Evaluation of the potential pharmacokinetic interaction between almotriptan and fluoxetine in healthy volunteers

This study was designed to assess the pharmacokinetics of almotriptan, a 5HT1B/1D agonist used to treat migraine attacks, when administered in the presence and absence of fluoxetine. Healthy male (n = 3) and female (n = 11) volunteers received (1) 60 mg fluoxetine daily for 8 days and 12.5 mg almotriptan on Day 8 and (2) 12.5 mg almotriptan on Day 8, according to a two-way crossover design. Plasma and urinary almotriptan concentrations were measured by HPLC methods. Treatment effects on pharmacokinetic parameters were assessed by analysis of variance. Mean almotriptan Cmax was significantly higher following combination treatment with fluoxetine (52.5 +/- 11.9 ng/ml vs. 44.3 +/- 10.9 ng/ml, p = 0.023). Mean AUC0-infinity was not significantly affected by fluoxetine coadministration (353 +/- 55.7 ng.h/ml vs. 333 +/- 33.6 ng.h/ml, p = 0.059). Confidence interval analysis (90%) of log-transformed pharmacokinetic parameters showed that the confidence interval for AUC0-infinity was within the 80% to 125% limit for equivalence, but Cmax was not (90% CI 106%-134% of the reference mean). Adverse events were mild to moderate in intensity, and no clinically significant treatment effects on vital signs or ECGs were observed. The results show that fluoxetine has only a modest effect on almotriptan Cmax. Concomitant administration of the two drugs is well tolerated, and no adjustment of the almotriptan dose is warranted.     

Traditional healers and tuberculosis control in southern Nigeria

Traditional healers (THs) co-exist with orthodox medicine and offer options for the sick, especially cases with perceived supernatural causes. This study examined the role and capability of THs in the national tuberculosis control effort. Seventeen community leaders (CLs) and 20 THs were interviewed. Prolonged cough constituted one of the common health problems taken to THs in the communities studied. The THs manage such cases with herbs and are not inclined to referring cases to the orthodox health care facility because of the confidence in their ability to handle the cases which result from supernatural causes. The CLs attest to the acceptability of the THs in the communities, which they attribute to the efficacy of the traditional healing, uncomplicated treatment process, cause of the prolonged cough, as well as cost and secrecy. THs can be educated to make prompt referral of cases to Directly Observed Treatment Short-course (DOTS) clinics for prompt diagnosis and appropriate treatment.     

Challenges in the management of paediatric cataract in a developing country

AIM: To review the management of cataract in children in a tertiary hospital in a developing country, and to highlight the challenges therein. METHODS: The hospital records of children aged 15 years or less that had cataract surgery at University of Nigeria Teaching Hospital, Enugu from 2005 to 2008 were reviewed retrospectively. Information was obtained on bio-data, pre- and post-operative visual acuity (VA), biometry, and type of surgery, use of intraocular lens (IOL) and presence of co-morbidity. SPSS was used for data entry and analysis. RESULTS: The hospital records of 21 children (26 eyes) were analyzed. There were 12 males (57.1%) and 9 females (42.9%). Pre-operative VA could not be assessed in 11 eyes (42.3%), 14 eyes (53.9%) had VA <3/60 and 1 eye (3.8%) had VA 6/60. Biometry was done in only 5 eyes (19.2%). All eyes had standard extracapsular cataract extraction without primary posterior capsulectomy; 12 eyes (46.2%) had posterior chamber intraocular lens (PC-IOL) implant while 13 eyes (50.0%) had no IOL. After 12 weeks of follow up, vision assessment was available in only 15 eyes. With best correction, VA of 6/18 or better was achieved in only 5 eyes (33.3%). CONCLUSION: Inadequate facilities and inadequate follow up after surgery are some of the challenges in managing paediatric cataract in the developing countries. If these challenges are not addressed, cataract will remain a major cause of childhood blindness and low vision in Africa for many years. There should be collaboration between Paediatric Ophthalmology Centres in industrialized and developing countries to enhance skill transfer. Governmental and International Non-governmental Organizations can go a long way to facilitate this exchange.     

Rare consecutive femoral lesser trochanteric avulsion in an adolescent following sporting activities; a case report

Avulsion of the lesser trochanter is a rare but disturbing condition, which usually occurs in males between the ages of 7-16 years with significant physical activities or in athletes. Diagnosis is more often than not challenging, but with a good history, physical examination, and imaging modality, diagnosis can be clinched, and the prognosis is good even with a conservative management approach. This case report is that of a 12-year-old male who suddenly fell while participating in sporting activities in school. As a consequence of the fall, he felt severe pain in the left groin region with an associated inability to bear weight on the affected limb. A radiograph study of the hip revealed a fracture of the left lesser trochanter. Based on the diagnosis, a conservative approach, which entails the use of analgesics, and partial weight-bearing mobilization with axillary crutches to take the weight off the affected limb for a period, was the choice of management for this subject. Fifteen weeks following the conservative management for the avulsion of the left femoral lesser trochanter fracture, the subject sustained a similar injury to the contralateral groin, consequential to return to sporting activities. In conclusion, rare as avulsion of the lesser trochanter may be, a high index of suspicion must be raised in any adolescent with a painful limp following engagement in any sporting activities, and such individuals should have a radiograph study done to achieve prompt and effective care.     

Characteristics of Nigerian women taking sulfadoxine/pyrimethamine twice during pregnancy for the prevention of malaria

Objective

To investigate the characteristics of women in Nigeria who are likely to take sulfadoxine/pyrimethamine (SP) as recommended for the prevention of malaria in pregnancy to reduce maternal and child mortality rates.

Methods

A cross-sectional survey of 1380 women was conducted using a structured questionnaire. The women had given birth within 6 months prior to the survey and were drawn from 6 local government areas in Nigeria.

Results

Several demographic factors—older age bracket, ever attended school, currently living with a partner, ever married, and wealth—were significantly associated with compliance. Compliance was higher among respondents who had ever been married than among those who had never been married (χ² = 6.733; P = 0.006). Compliance was also higher among those in paid employment (χ² = 17.110; P < 0.001) and those in a higher wealth quintile (χ² = 34.861; P < 0.001). Knowledge of malaria, which included prevention of malaria in pregnancy through use of IPTp with 2 doses of SP, showed a positive association with compliance. Compliance with 2 doses of SP among those with good knowledge was higher (63.9%) than among those with poor knowledge (46.9%) (χ² = 26.981; P < 0.001).

Conclusion

The present findings could help in targeting health education programs to specific subgroups of women to increase compliance with the recommended 2 doses of SP for the prevention of malaria in pregnancy.     

Sleeping under Insecticide-treated Nets to Prevent Malaria in Nigeria: What Do We Know?

Malaria remains a public-health concern in Nigeria despite huge global investments in the production and distribution of insecticide-treated bednets (ITNs) to protect people from Plasmodium falciparum parasite. Information on the use of ITNs is needed for designing strategies for its effective use. Focus group discussions (FGDs) were conducted in communities from 3 geopolitical zones of Nigeria. The people had poor knowledge of malaria and mosquito bites, which resulted in wrong perception and misuse of the nets as door and window blinds to “protect entire household” since only two nets were given per household. The use of community structures (traditional leaders/village heads, youths, churches, and mosques) was suggested to ensure effective distribution of nets, sensitize, and monitor net-use in the communities. Health education would dispel misconceptions that ITNs could kill, curtail human fertility, and that local gin (Kai-Kai) would induce sleep and make one oblivious of mosquito nuisance.Key words: Insecticide-treated bednets, Malaria, Mosquito nets, Utilization, Nigeria     

Antifertility Properties of the Hot Aqueous Extract of Guaiacum officinale

The hot aqueous extract of the aerial part (leaves, flowers, fruits and tender branches) of Guaiacum officinale Linn (Zygophyllaceae) was evaluated for antifertility effects. In over 50 trials, the extract caused abortion in mice and rats. The extract caused abortion in the second and third trimesters only. The abortion ED 50 in pregnant mice was 320.50 ± 20.00 mg/kg, while the LD 50 was 1280.13 ± 9.03 mg/kg. At a dose of 480.75 mg/kg, the extract significantly reduced the litter size in mice when given during the first trimester (day 5) of pregnancy. The extract did not produce contraction of either the primed or gravid uteri derived from these animals. Similarly, the extract did not cause contraction of the guineapig ileum. However, it potentiated the contractions caused by acetylcholine. These findings tend to support the utility of the hot water extract of Guaiacum officinale in folk medicine for antifertility purposes.     

The PATH (Prospective Antifungal Therapy) Alliance® registry and invasive fungal infections: update 2012

The Prospective Antifungal Therapy Alliance (PATH Alliance®) performed prospective surveillance of invasive fungal infections (IFIs) among patients hospitalized at 25 medical centers in North America between 2004 and 2008, collecting information on the epidemiology, diagnosis, treatment, and mortality rates of IFIs. In total, 7526 IFIs were identified in 6845 patients. Candida spp. (73.4%) were the most common pathogens, followed by Aspergillus spp. (13.3%), and other yeasts (6.2%). Culture was the most frequently used diagnostic test in the majority of IFI categories. Most patients with invasive candidiasis were treated with fluconazole (48.3%) and the echinocandins (34.0%), while voriconazole (45.5%) was the main antifungal agent for invasive aspergillosis. The 12-week survival rate ranged from 37.5% for hematopoietic stem cell transplant recipients to ~ 75.0% for those with HIV/AIDS. In summary, the findings of the PATH Alliance® registry provide a better understanding of the epidemiology of a vast variety and large numbers of IFIs.     

Decreased clearance of von Willebrand factor in a patient with type 2B von Willebrand disease following development of immune thrombocytopenia

We report a case of concurrent type 2B von Willebrand disease (VWD) and immune thrombocytopenia (ITP). The patient had characteristic loss of von Willebrand factor (VWF) high molecular weight multimers (HMWM) but a normal platelet count in the initial 8 years after diagnosis of type 2B VWD. When he developed severe thrombocytopenia, however, both his VWD indices and VWF HMWM normalized. As his platelet count increased, he again lost the HMWM and his VWD indices decreased. These results suggest that the severe thrombocytopenia led to decreased clearance of VWF, especially the HMWM.