Organoaxial partial rotation of duodenum with midgut malrotation in an adult

Midgut malrotation includes a range of developmental abnormalities that occur during fetal intestinal rotation. Manifestations of intestinal malrotation are generally seen in the paediatric population and are uncommon in adults. Symptomatic patients may present with either acute abdominal pain due to midgut volvulus, or chronic abdominal pain due to proximal midgut partial obstruction in the presence of congenital bands. A limited number of paediatric cases of duodenal occlusion due to duodenal malrotation has been previously reported in the medical literature. We herein report the case of a 57-year-old woman who presented with duodenal obstruction due to organoaxial partial rotation of the distal duodenum associated with midgut malrotation. This is probably the first of such a case diagnosed in adulthood reported in the medical literature. Our patient underwent Roux-en-Y duodenojejunostomy and had symptomatic relief following the successful surgery.     

Monitoring Microbicide Gel Use with Real-Time Notification of the Container’s Opening Events: Results of the CAPRISA Wisebag Study

Accurate estimation of the effectiveness of a microbicide for HIV prevention requires valid measurement of adherence to product use. A microbicide gel applicator container (Wisebag), fitted with cell phone technology to transmit opening events and text message reminders, was developed to monitor each opening event of the container as a proxy for gel use and adherence. Ten women were enrolled in a pilot study and followed for up to 4 months. Wisebag opening (WBO) dates and times were recorded and correlated with self-reported sex acts and gel applicator returns. During the 33 monthly follow-up visits, 47.8 % (77/161) of the recorded number of WBO events were concordant with the number of empty (used) applicators returned. The discrepancies were likely due to removal of more than one applicator during a single opening event. When the date and time of the WBO event data was assessed in relation to three different self-report adherence measures, agreement was fairly modest. The Wisebag was found to be acceptable as a storage container and the cell phone reminders generated were useful in supporting the dosing strategy. We recommend that the Wisebag be considered for larger scale and lengthier testing in microbicide trials.     

Low-density lipoprotein particles and risk of intracerebral haemorrhage in subjects with cerebrovascular disease.

BACKGROUND: Only limited data are available for risk factors for intracerebral haemorrhage (ICH) in subjects with established cerebrovascular disease. DESIGN: We performed a nested case-control study of participants of the Perindopril Protection Against Recurrent Stroke Study (PROGRESS). This was a randomized, placebo-controlled trial that established the beneficial effects of blood pressure lowering in 6105 patients with cerebrovascular disease. METHODS: Each of 41 subjects who experienced ICH during a mean follow-up of 3.9 years was matched to 1-3 control subjects. Lipoprotein particles and other plasma markers were measured in baseline blood samples from PROGRESS participants. RESULTS: In comparison with control subjects, ICH cases had increased mean low-density lipoprotein (LDL) diameter (P=0.04) and increased large LDL particle concentration (P=0.03). The odds ratio (adjusted for regression dilution bias) for ICH risk with 10 mmHg increase in systolic blood pressure (SBP) was 1.45 (95% confidence interval: 1.01-2.09, P=0.05), with a 1 nm increase in mean LDL diameter it was 2.15 (95% confidence interval: 0.97-4.77, P=0.06), and with 100 nmol/l increase in large LDL particle concentration it was 1.18 (95% confidence interval: 0.98-1.43, P=0.08). Plasma levels of C-reactive protein (CRP), soluble vascular cell adhesion molecule 1 (sVCAM-1), homocysteine, amino-terminal-pro-B-type natriuretic peptide (NT-proBNP), and renin were not associated with ICH risk. CONCLUSION: SBP predicted ICH risk in subjects with cerebrovascular disease, whereas CRP, sVCAM-1, homocysteine, NT-proBNP, and renin did not predict ICH risk. The trends for prediction of ICH risk by mean LDL particle diameter and large LDL particle concentration are hypothesis generating and require confirmation in larger studies.     

A quantitative ethnozoological assessment of traditionally used animal-based therapies in the tropical island of Mauritius

Ethnopharmacological relevance

There is currently a dearth of documentation on the use of animal-based therapies (ABT) in Mauritius. This study was therefore designed to gather primary folk knowledge on the different ABT used by Mauritians. Failure to document such knowledge can results in losses in both the use of such remedies and in the scientific documentation of the cultural traditions of animals used in the treatment and/or management of human diseases. The aim of the study is to collect, analyze, document and disseminate ABT from the tropical island of Mauritius used against common human ailments.

Methods

Data was collected following interviews from key informants (n=126) and reported diseases and health complications were classified in 14 categories. Eight quantitative indexes such as informant consensus factor (FIC), fidelity level (FL), relative frequency of citation (RFC), relative importance (RI), cultural importance index (CII), index of agreement on remedies (IAR), cultural agreement index (CAI) and ethnofaunistic index (EFI) were used to analyze the reported animal species.

Results

A total of 31 animal species belonging to 12 taxonomic groups were documented to be used in traditional medicine by Mauritians. ABT were prepared from whole animals or their body parts or products extracted from them such as: butter, meat, milk, bones, horn, musk, skin, fin, honey, mucus, eggs and legs. The most encountered taxonomic group was Actinopterygii (7 species). According to EFI, 3.34% of the indigenous fauna in Mauritius were used in the treatment and/or management of different ailments. The highest FIC value (0.98) was cited for endocrine, nutritional and metabolic disorders which included diabetes and gangrene. Rattus rattus scored the highest FL (100%) for the ailment category injury and poisons of external cause; Bos taurus had the highest RI value (2.00) due to its versatility, had the highest frequency of citation (RFC=0.49), the highest cultural importance (CII=0.84) and the highest CAI value (0.77). According to IAR, Salmo salar (IAR=1.00) had the highest agreement among the informants for being used for the same medicinal purpose. Furthermore, no side effects have been reported from the use of ABT.

Conclusions

Our study revealed that Mauritians possesses valuable knowledge on a plethora of ABT. It is believed that the present documentation will serve to record this vanishing knowledge before it is eroded completely from the island and to the scientific community. It is also anticipated that the present documentation will be fundamental to protect traditional knowledge, for the conservation and sustainable use of the rich biodiversity of Mauritius for future generations and to ensure Mauritius?s sovereign rights over its genetic resources and utilization by first documenting them. In addition, further experimental investigations are required to elucidate the pharmacological properties of the reported medicinal fauna of Mauritius     

Adherence challenges with drugs for pre-exposure prophylaxis to prevent HIV infection

Background There are 34 million people living with human immunodeficiency virus (HIV) worldwide and each year this number increases. Until a vaccine is discovered, the prevention of new HIV infections remains an urgent priority. Several trials studying the use of oral and topical agents for the prevention of HIV infection have already been completed. Adherence has proved to be a major challenge in achieving product efficacy. Aim of the review To provide the clinical pharmacist with an understanding of the oral pre-exposure prophylaxis (PrEP) and topical microbicide product pipeline whilst emphasizing the critical importance of adherence to these drugs to avert HIV infection. Methods PubMed/Medline and the web-based clinical trials registry (ClinTrials.gov) were searched using appropriate key words. For the time period 1992–2013—all phase II and phase III safety and effectiveness studies—testing agents for prevention of HIV infection were included in the review. Efficacy estimates, adherence estimates and reported challenges with adherence were extracted. Results Twenty-four phase II and III clinical trials were found during review. Of these, 20 trials have been completed, and six trials show effectiveness in preventing HIV infection. The majority of the successful trials were to oral PrEP and to date only one microbicide trial of a vaginal antiretroviral microbicide gel has showed effectiveness. Adherence to study product played a major role in trial outcomes and there are several reasons for non-adherence. These include high on-trial pregnancy rates, low trial retention rates, low participant perception of risk, participant characteristics such as age <25 years, single status, migratory partners and trial fatigue. Study product characteristics such as dosage form, dosing interval, as well as associated adverse events may also influence adherence. Conclusion Moderate to high adherence is critical to demonstrate efficacy of drugs for HIV prevention. For topical agents, intermittent use associated with coitus is more effective than daily use, particularly if sex is infrequent or partners migrant. For oral agents, daily use is effective but the motivation to use the drug and high risk perception is important. In serodiscordant couples, early initiation of highly active antiretroviral therapy in the infected partner affords almost complete protection to the negative partner. Drugs need to be tailored to the population at risk and availability of multiple drug options are important.     

Clinico-pathological study of cervical polyps

Objective  

To determine the incidence of malignancy in cervical polyps and determine the effect of age and parity on clinical presentation.