Laboratory and Field Evaluation of the Molluscicidal Properties of Phytolacca dodecandra

Dried berries of endod (Phytolacca dodecandra) (known also as soapberry) are widely used in Ethiopia instead of soap for laundering clothes. It was observed that in natural bodies of water where endod had been used there was a high mortality of snails. Subsequently, the molluscicidal potencies of various parts of male and female endod plants were determined and the berries were found to be the most potent. The potency of endod remained stable over a wide range of temperatures and pH values, in the presence of various concentrations of river-bed mud and after ultraviolet irradiation of solutions. The toxicity of endod to mammals and plants has been shown to be very low. Its toxicity to snail eggs also is low but it has been shown that this difficulty can be overcome in the field by repeated treatments. Endod kills leeches and schistosome cercariae and miracidia at very low concentrations. Comparative tests with endod and several standard molluscicides have given encouraging results.     

Attitudes of undergraduate medical students of Addis Ababa University towards medical practice and migration, Ethiopia

Background

Mobile technology is increasingly being used by clinicians to access up-to-date information for patient care. These offer learning opportunities in the clinical setting for medical students but the underlying pedagogic theories are not clear. A conceptual framework is needed to understand these further. Our initial questions were how the medical students used the technology, how it enabled them to learn and what theoretical underpinning supported the learning.

Methods

387 medical students were provided with a personal digital assistant (PDA) loaded with medical resources for the duration of their clinical studies. Outcomes were assessed by a mixed-methods triangulation approach using qualitative and quantitative analysis of surveys, focus groups and usage tracking data.

Results

Learning occurred in context with timely access to key facts and through consolidation of knowledge via repetition. The PDA was an important addition to the learning ecology rather than a replacement. Contextual factors impacted on use both positively and negatively. Barriers included concerns of interrupting the clinical interaction and of negative responses from teachers and patients. Students preferred a future involving smartphone platforms.

Conclusions

This is the first study to describe the learning ecology and pedagogic basis behind the use of mobile learning technologies in a large cohort of undergraduate medical students in the clinical environment. We have developed a model for mobile learning in the clinical setting that shows how different theories contribute to its use taking into account positive and negative contextual factors. The lessons from this study are transferable internationally, to other health care professions and to the development of similar initiatives with newer technology such as smartphones or tablet computers.     

The current landscape of locally advanced rectal cancer

Postoperative adjuvant chemoradiotherapy was recommended as the standard treatment for patients with rectal cancer because it reduces local recurrence. This paradigm shifted with the use of neoadjuvant chemoradiotherapy, which not only reduces local recurrence but also improves sphincter preservation and surgical outcomes. However, the treatment of rectal carcinoma remains complicated. The accuracy of tumor staging can be compromised depending on the imaging modality used. The addition of modern chemotherapeutics and biologics to 5-fluorouracil as radiation sensitizers is questionable. Oxaliplatin as a radiation sensitizer has minimal effects on the pathologic complete response, but improves the radiographical response at the expense of an increased risk of toxicities. The role of biologics in addition to radiation therapy continues to be explored. Attention has focused on improving diagnostic imaging, radiation oncology, and surgical techniques, treatment regimens, and on exploring a role of molecular markers for patients with rectal cancers. We review the pivotal trials that have led to the current treatment paradigm for locally advanced rectal cancer and discuss novel methodologies that are being developed for the treatment of this prevalent malignancy.     

Long-term survival in multiple myeloma is associated with a distinct immunological profile,which includes proliferative cytotoxic T-cell clones and a favourable Treg/Th17 balance

Despite improved outcomes in multiple myeloma (MM), a cure remains elusive. However, even before the current therapeutic era, 5% of patients survived >10 years and we propose that immune factors contribute to this longer survival. We identified patients attending our clinic, who had survived >10 years (n=20) and analysed their blood for the presence of T-cell clones, T-regulatory cells (Tregs) and T helper 17 (Th17) cells. These results were compared with MM patients with shorter follow-up and age-matched healthy control donors. The frequency of cytotoxic T-cell clonal expansions in patients with <10 years follow-up (MM patients) was 54% (n=144), whereas it was 100% (n=19/19) in the long-survivors (LTS-MM). T-cell clones from MM patients proliferated poorly in vitro, whereas those from LTS-MM patients proliferated readily (median proliferations 6.1% and 61.5%, respectively (P<0.0001)). In addition, we found significantly higher Th17 cells and lower Tregs in the LTS-MM group when compared with the MM group. These results indicate that long-term survival in MM is associated with a distinct immunological profile, which is consistent with decreased immune suppression.     

Evaluation of berries of Phytolacca dodecandra for growth inhibition of Histoplasma capsulatum var. farciminosum and treatment of cases of epizootic lymphangitis in Ethiopia

Objective:To evaluate the berries of Phytolacca dodecundra(P.dodecandra) for its effect on Histoplasma cupsulatum var.farciminosum(HCF) and for the treatment of cases of epizootic lymphangitis(ELi.Methods:Samples were collected from un-ruptured nodules of cases of EL at Debre Zeit and Akaki(central Ethiopia).Mycologieal culture and isolation of HCF were performed at the Akliln Lemma Institute of Pathobiology.Phytochemical screening was done for n-butanol extract of P.dodecandra to delect alkaloids,saponins,phenolic compounds and flavonoids.The minimum inhibitory concentrations(MICs) and minimum fungicidal concentrations(MFCs) ol aqueous and n-butanol extracts of P.dodecandra against FICF were determined by agar dilution assay.For the in vivo trial.5%simple ointment was prepared from n-butanol extract and applied topically to 24(twelve early and twelve moderate) cases of F.L.Results:Phytochemical screening showed that n-butanol extract ol P.dodecandra was positive lor alkaloids.saponins and phenolic compounds but negative for flavonoids.The MFCs of n-butanol and aqueous extracts of P.dodecandra were(0.039%-0.078%) and(0.625%-1.250%),respectively.The MFCs of n-butanol and aqueous extracts of P.dodecandra were(0.078%t-0.156%)and(1.250%-2.500%),respectively.The MIC and MFC of ketoconazole(positive control) was(1.200×10~(-5)%-2.500×10~(-5)%) and(5.000× 10~(-5)%-1.000×10~(-4)%),respectively while growth was observed on free medium(negative control).From the total of 24 treated cases of EL,14(58.3%) responded lo treatment;however,10(41.7%) did not respond to treatment.There was no significant difference in the degree of response to treatment between early and moderate cases(χ~2=0.086:P=0.408.Conclusions:It can be concluded that n-butanol extract of P.dodecandra demonstrates antifungal effects while the aqueous extract shows no antifungal activity.     

Developing scales to measure perceived HIV risk and vulnerability among Ethiopian women testing for HIV

HIV prevention services are increasingly being used by individuals in developing countries, but we know very little about how self-assessed HIV risk determines health-seeking behavior. People may feel they are at risk of HIV infection for many reasons, including both risky behavior and anxiety associated with heightened HIV awareness. In order to improve the measurement of perceived HIV risk, we developed scales measuring two constructs. Perceived risk is one's self-assessed likelihood of becoming HIV-infected based on HIV knowledge and behavior. Perceived vulnerability is felt susceptibility to HIV infection even in the absence of risk behavior. Items measuring these constructs were included in a voluntary HIV counseling and testing (VCT) client survey, conducted in mid-2008 with 2027 women attending eight Ethiopian VCT facilities. We also conducted in-depth interviews with 22 women in two of the facilities and added items to the scales based on findings from these interviews. All items were validated in a post-enumeration survey. Factor structures of both constructs were examined using exploratory factor analysis. We also calculated Pearson's correlations between the scales and comparable constructs and behaviors. Cronbach's alpha for the perceived risk scale was 0.87 in the initial survey and 0.89 in the validation survey. For the perceived vulnerability scale, Cronbach's alpha was only 0.66 in the initial survey but increased to 0.74 after adding items indicated by the in-depth interviews. The scales are moderately correlated, indicated by a Pearson's correlation of 0.65. Both scales have high construct validity. Perceived risk has a higher correlation with HIV status than does perceived vulnerability, at 39% vs 28%. Conversely, perceived vulnerability is more highly correlated with HIV salience than is perceived risk, at 39% compared to 25%. These findings suggest perceived HIV risk and perceived HIV vulnerability should be measured separately. More information is needed about how these constructs may motivate people to seek HIV prevention services.     

Targeted agents and esophageal cancer--the next step?

Esophageal cancer (EC) is an aggressive cancer and is a leading cause of cancer-related death worldwide. In the United States and Western Europe, there has been a decline in the incidence of squamous cell carcinomas coupled with a rapid rise in incidence of adenocarcinoma of the esophagus and gastroesophageal junction. Although the 5-year survival rates have slowly increased over time from 4% to 14%, the outcomes are still dismal. The lack of adequate preventative strategies, inadequate screening techniques, early lymphatic and hematogenous spread, and lack of truly effective therapeutic agents all contribute to the poor outcome. This review will highlight the current status of targeted therapies in EC. This will include a review of agents targeting the vascular endothelial growth factor and epidermal growth factor receptor pathways and trials planned or ongoing to incorporate these and other agents into therapy for advanced disease and into combined modality therapy for early-stage tumors. Further work is required regarding the rational integration of these targeted agents and the optimal selection of patients who will most likely benefit.