Principle and history of Natural Orifice Translumenal Endoscopic Surgery (NOTES)

The field of gastrointestinal endoscopy has been witnessing major advances over the last five decades. Developing from flexible endoscopy to endoscopic retrograde cholangiopancreatography (ERCP) in the 1950's and 70's to endoscopic ultrasound in the 80's, endoscopic technology has been transformed from serving purely diagnostic purposes to therapeutic applications. One recent major advance is the notion of using the flexible endoscope, taking it beyond the gastrointestinal lumen into what lies beyond the confines of the gastrointestinal tract. Natural orifice translumenal surgery offers the exciting potential to be safer, less invasive and possibly more cost‐effective than the traditional open surgical or laparoscopic approach. The history and principles of natural orifice translumenal endoscopic surgery (NOTES), along with future implications, are outlined in this article.     

Enhanced diagnostic yield with prolonged small bowel transit time during capsule endoscopy

Background: The effect of small bowel transit time (SBTT) on diagnostic yield during capsule endoscopy (CE) has not been previously evaluated. Our study aim was to assess the effect of SBTT on the likelihood of detecting intestinal pathology during CE. Methods: We reviewed collected data on CE studies performed at Johns Hopkins Hospital from January 2006 to June 2007. In patients investigated for anemia or obscure bleeding, the following lesions were considered relevant: ulcers, erosions, AVMs, red spots, varices, vascular ectasias, and presence of blood. In patients with diarrhea or abdominal pain, ulcers, erosions, and blood were considered relevant. Age, gender, study indication, hospital status, and quality of bowel preparation were identified as candidate risk factors affecting SBTT. Univariate logistic and linear regression analyses were performed to study the effect of SBTT on diagnostic yield. Results: Total of 212 CE studies were analyzed; most were in outpatients (n=175, 82.9%) and with excellent bowel preparation (n=177, 83.5%). Mean SBTT was 237.0min (3.9hrs). Age, gender, bowel prep, hospital status, and study indication did not significantly affect SBTT. However, increased SBTT was independently associated with increased diagnostic yield; OR=1.7 in SBTT=2-4hr (p=0.41), OR=1.8 in SBTT=4-6hrs (p=0.30), OR=9.6 in SBTT=6-8hrs (p=0.05). Conclusion: Prolonged SBTT during CE (>6 hr) is associated with an increased diagnostic yield. This may be due to a positive effect on image quality during a “slower” study. The use of promotility agents may adversely affect the ability of CE to detect significant intestinal pathology.     

An ethnobotanical study of medicinal plants used by the Zay people in Ethiopia

An ethnobotanical survey was carried out to collect information on the use of medicinal plants by the Zay people who live on islands as well as shore areas of Lake Ziway in the Ethiopian Rift Valley. A total of 33 medicinal plants were reported as being used locally for the treatment and/or control of human and livestock ailments. Results of the survey showed that leaf materials form the major component of plant parts harvested. The majority of the remedies are prepared in the form of juice from freshly collected plant parts. Most of the remedies are prepared from a single species, and are mainly taken orally. Most of the medicinal plants are collected from the wild. Of the total claimed medicinal plants, 10 were reported scarce locally. Environmental degradation and intense deforestation have been reported as the main causes for the depletion of medicinal plants in the area. As the Zay people are still partly dependent on medicinal plants, loss of these plants will, to a certain extent, hamper the existing health care system in the area. Measures for conservation of medicinal plants of the Zay people are urgently needed.     

Quantitative ethnobotany of medicinal plants used by Kara and Kwego semi-pastoralist people in lower Omo River Valley,Debub Omo Zone,Southern Nations,Nationalities and Peoples Regional State,Ethiopia

Aim of the study

The people in Ethiopia have been using medicinal plants over centuries and the traditional knowledge is passed verbally from generation to generation. Therefore, the aim of this study was to document the medicinal plants used by Kara and Kwego semi-pastoralist people and to establish association between the species richness and diversity, habit, parts used and administration of medicinal plants reported by the two people.

Materials and methods

Semi-structured interview was used in data collection; Chi-Square test, t-test and univariate analysis were used to compare medicinal plants knowledge between Kara and Kwego people. Informant consensus factor (ICF), fidelity level (FL), and preference ranking of medicinal plants were computed.

Results

Fifty-seven medicinal plant species were indicated that were distributed into 33 families and 52 genera. Thirty-four of them were common to both people whereas 12 were unique to Kara and 11 to Kwego. There was no significant difference (p > 0.05) between the two people in medicinal plant species richness and diversity. The growth forms, parts of medicinal plants and their conditions: fresh or dry used in the preparation of remedies and route of administration were not different (p > 0.05). Root was 55% of the plant parts used and oral was 61% of route of administration. The informant consensus factor was not significantly different (p > 0.05) between the two people. Solanum hastifolium Hochst. ex Dunal, Salvadora persica L. and Maeura sessiliflora Gilg were preferred more than the other medicinal plants reported to treat the prevalent diseases by both people.

Conclusions

The information documented on the medicinal plants of these people may be used as baseline data for future studies on semi-arid and arid pharmacologically important medicinal plants and for phytochemical investigations.     

Ovicidal and larvicidal activity of crude extracts of Maesa lanceolata and Plectranthus punctatus against Haemonchus contortus

The widespread development of anthelmintic resistance and high cost of the conventional anthelmintic drugs, has limited the control of gastrointestinal nematode parasites of sheep and goats and hence led to evaluation of medicinal plants as an alternative source of anthelmintics. In the current study, in vitro ovicidal and larvicidal activity of the leaves and fruits of the aqueous and hydro-alcoholic extracts of Maesa lanceolata and aerial parts of Plectranthus punctatus were evaluated on the egg and larvae of Haemonchus contortus using egg hatch assay and larval development test. All extracts of plants tested have shown complete inhibition of egg hatching at or below 1 mg/ml. ED₅₀ for egg hatch inhibition ranged from 0.11 to 0.29 mg/ml, for both the aqueous and hydro-alcoholic extracts of Plectranthus punctatus and Maesa lanceolata. All extracts have shown dose dependent inhibition of larval development with variable results. The complete inhibition (100%) at the maximum concentration tested (50 mg/ml) was obtained only for hydro-alcoholic extract of the fruits of Maesa lanceolata and the lowest inhibition (50.33%) was recorded for the hydro-alcoholic extract of the leaves of the same plant. The overall findings of the present study has shown that Plectranthus punctatus and Maesa lanceolata contain possible anthelmintic compounds and further evaluation of different extracts and fractions of these plants should be carried out.     

INAUGURAL ARTICLE by a Recently Elected Academy Member:The characteristics and chronology of the earliest Acheulean at Konso,Ethiopia

The Acheulean technological tradition, characterized by a large (>10 cm) flake-based component, represents a significant technological advance over the Oldowan. Although stone tool assemblages attributed to the Acheulean have been reported from as early as circa 1.6–1.75 Ma, the characteristics of these earliest occurrences and comparisons with later assemblages have not been reported in detail. Here, we provide a newly established chronometric calibration for the Acheulean assemblages of the Konso Formation, southern Ethiopia, which span the time period ∼1.75 to <1.0 Ma. The earliest Konso Acheulean is chronologically indistinguishable from the assemblage recently published as the world’s earliest with an age of ∼1.75 Ma at Kokiselei, west of Lake Turkana, Kenya. This Konso assemblage is characterized by a combination of large picks and crude bifaces/unifaces made predominantly on large flake blanks. An increase in the number of flake scars was observed within the Konso Formation handaxe assemblages through time, but this was less so with picks. The Konso evidence suggests that both picks and handaxes were essential components of the Acheulean from its initial stages and that the two probably differed in function. The temporal refinement seen, especially in the handaxe forms at Konso, implies enhanced function through time, perhaps in processing carcasses with long and stable cutting edges. The documentation of the earliest Acheulean at ∼1.75 Ma in both northern Kenya and southern Ethiopia suggests that behavioral novelties were being established in a regional scale at that time, paralleling the emergence of Homo erectus-like hominid morphology.