Probable HTLV-I/II Tropical Spastic Paraparesis Patient from Ethiopia: A Case Report

BackgroundAvailable data on the burden of Human T-cell lymphotropic virus type I/II infection for eastern Africa, limited to Ethiopia, Mozambique, and Rwanda, show prevalence lower than elsewhere in Africa (0% – 1.8%). Even if Tropical Spastic Paraparesis occurs in an endemic form in Ethiopia, its seroprevalence is low. Over a lifetime, it is estimated that 1–2% of Human T-cell lymphotropic virus type I/ II -infected individuals will develop progressive and disabling inflammatory clinical manifestations. We are reporting this case since it signifies the existence of seropositive Tropical Spastic Paraparesis in our setting and the need to properly diagnose this condition.Case PresentationWe are reporting a 45 years old female patient from Addis Ababa, Ethiopia, who presented with progressive weakness of the lower limbs and urinary urge incontinence of five years duration. Serology for Human T-cell lymphotropic virus type I/ II antibody was positive. She was diagnosed to have probable tropical spastic paraparesis after fulfilling World Health Organization diagnostic criteria for tropical spastic paraparesis with the level of ascertainment. Symptoms showed transient improvements after providing five days of Methylprednisolone followed by low doses of corticosteroids and Azathioprine. The patient is now significantly disabled and wheelchair-bound.ConclusionsThe patient described here signifies a probable Human T-cell lymphotropic virus type I/ II - associated myelopathy/tropical spastic paraparesis in Ethiopian women. This case highlights the existence of Human T-cell lymphotropic virus type I/II - associated myelopathy/ tropical spastic paraparesis within our setting and the need to properly diagnose this condition.     

Research progress of in-situ gelling ophthalmic drug delivery system

 Blindness and vision impairment are the most devastating global health problems resulting in a substantial economic and social burden. Delivery of drug to particular parts of the anterior or posterior segment has been a major challenge due to various protective barriers and elimination mechanisms associated with the unique anatomical and physiological nature of the ocular system. Drug administration to the eye by conventional delivery systems results in poor ocular bioavailability (<5%). The designing of a novel approach for a safe, simple, and effective ocular drug delivery is a major concern and requires innovative strategies to combat the problem. Over the past decades, several novel approaches involving different strategies have been developed to improve the ocular delivery system. Among these, the ophthalmic in-situ gel has attained a great attention over the past few years. This review discussed and summarized the recent and the promising research progress of in-situ gelling in ocular drug delivery system.     

The quality of care provided to patients with chronic non-communicable diseases: a retrospective multi-setup study in jimma zone, southwest ethiopia

Background

Chronic Non-Communicable Diseases are among the major causes of morbidity and mortality worldwide. However, access to and quality of health care for patients is very low in developing countries including Ethiopia. Hospitals and Health Centers are the main sources of health care for such patients in Ethiopia. In this study we assessed the quality of care patients with Chronic Non-Communicable Diseases received in hospital and health center setups.

Methods

A retrospective multi-setup study was conducted in Jimma University Specialized Hospital and four Health Centers in Jimma Zone from February to March 2010. A total of 52 process indicators of quality covering three disease conditions: Diabetes, Hypertension and Epilepsy were measured by reviewing randomly selected medical records. Quality of care was measured as a proportion of recommended components of care actually provided to patients. And also outcome and structural measures were assessed to supplement process measures of quality.

Results

Six hundred seventy four medical records were reviewed. Recommended care components were actually provided to patients in 35.1% (95% CI:34.1%, 36.0%), 38.5% (95% CI:37.5%, 39.5%) and 60.1% (95% CI:59.3%, 61.0%) of times on which patients were eligible, among patients with Diabetes, Hypertension and Epilepsy, respectively. After case mix adjustment, it was found that 45.9% (95% CI:45.4%, 46.5%) of recommended components of care was actually provided to patients. This was 45.1% (95% CI:44.4%, 45.8%) in the hospital and 30.5% (95% CI:29.7%, 31.3%) in the health centers. Among patients for whom outcome data was available, optimal level of disease control was achieved only for 47 (30.5%), 40 (38.5%) and 193 (52.9%) of patients with Diabetes, Hypertension and Epilepsy, respectively.

Conclusion

The quality of care provided to patients with Chronic Non-Communicable Diseases is very low in both settings though it is relatively better in Jimma University Specialized Hospital. Therefore, a continuous process of quality improvement is recommended in both settings.     

Reaction of Medical Students to Experiences in Dissection Room

Background

As preclinical medical students start and/or enter the course, they go through the anatomy curriculum, which involves interaction with cadavers and cadaveric material. The objective of this study was to determine the reactions of preclinical medical students from year two and year three to the dissecting room.

Methods

Questionnaire was distributed to all second and third year medical students. The questionnaire was designed with the objective of identifying specific patterns of attitudes held and problems faced by the students in their first exposure to the human cadaver. The results are analyzed statistically using the SPSS 16.0 software and P< 0.05 was considered statistically significant.

Results

The commonest symptoms experienced were loss of appetite (43.29% year 2 and 34.86 % third year students). The commonest cause of their symptoms was studied and the result shows that it was the smell of the dissection room, as reported by 67.01% of year two students; and 54.12% for year 3 students.

Conclusion

The present study findings show that smell of the dissection room, touch and fear of cadaver were the commonest cause of their symptoms experienced while study in dissection room for the majority of students. Thus, instructors are should give awareness raising education before the commencement of the dissection session to the students both mentally and emotionally ready to do their work enthusiastically and confidently. Moreover, it is necessary to make the laboratory tidy for the students so that they develop a love for the dissection room.     

Seasonal influence on some blood and biochemical parameters of pigeons (Columba livia) in Rajasthan, India

This study was undertaken to investigate the effect of season on some haematological and biochemical parameters in pigeons (Columba livia) in Rajasthan, India. Blood samples of 80 pigeons were collected in four different seasons (20 from each season) for analysing haematological and biochemical parameters. In the haematological parameters, haemoglobin, packed cell volume and total erythrocyte count were significantly lower (p?<?0.05) in summer compared with winter season. Whereas, no significant difference (p?<?0.05) was observed in the values of total leucocyte count in different seasons. Albumin, total protein, serum alanine amino transaminase and aspartate amino transaminase were significantly increased (p?<?0.05) in summer compared with winter season, whereas alkaline phosphatase values in summer were significantly low when compared to winter. In conclusion, heat stress during summer caused deterioration in some haematological and serum biochemical constituents of pigeons (C. livia). This study highlights the relevance of seasonal variations when monitoring the health and physiological state of pigeons     

Child sexual abuse and its outcomes among high school students in southwest Ethiopia

Child sexual abuse (CSA) is a major contributing factor to the burden of disease among children and adolescents. The aim of this study is to determine the prevalence of CSA and its outcomes among female high school students in Ethiopia. A cross-sectional study was conducted among Jirren high school female students in April 2005. A total of 323 female students from grade 9 were selected by systematic random sampling and they completed a self-administered questionnaire on experiences of sexual abuse. Data were cleaned and analysed by SPSS/PC statistical package. The results revealed that the prevalence of CSA was 68.7%. Among the different forms of sexual abuses, verbal harassment was the most common (51.4%) followed by sexual intercourse, 18.0% and unwelcome kissing, 17.1%. The commonly indicated abusers in this study were unknown persons (36%) followed by school-mates (31.5%). Among victims of sexual abuse, 7.2% had an unwanted pregnancy and 5.9% had sexually transmitted diseases. The rate of other psychological effects of CSA, such as suicide ideation, suicide attempt, and sexual dysfunction, was high. The overwhelming majority (86.4%) considered sexual abuse to be a major social problem. The study revealed that the prevalence of CSA is high. Reproductive health education should be provided to students. Parents, police, and the public in general should be made aware of the problem before it endangers the lives of children and adolescents.     

Immunological Markers and Hematological Parameters among Newly Diagnosed Tuberculosis Patients at Jimma University Specialized Hospital

Background

Tuberculosis (TB) is a cause of 1.2–1.5 million deaths worldwide, including deaths from TB among HIV positive people. Determining the extent of immune cells belonging to cell mediated immunity and haematological parameters is critical to maximize the potential benefit of anti-tubercular treatment and case management.

Materials and Methods

Comparative cross sectional study was conducted to determine the white blood cell (WBC) count, CD₄, CD₈, haemoglobin (Hgb), red blood cell (RBC) count, mean corpuscular haemoglobin (MCHC), mean corpuscular volume (MCV) between newly diagnosed TB patients and apparently healthy controls (HCs).

Results

From consecutively enrolled 108 TB patients, pulmonary TB (PTB) accounted for 48(44.4%), TB lymphadenitis accounted for 48(44.4%), and disseminated/miliary TB accounted for 12(11.1%). Analysis of variance revealed that mean ± SD of CD₄ count of male TB patients (650 ± 224cells/µl) was significantly lower than male control group (883 ± 256 cells/µl) (p= 0.001). In a similar manner, the mean CD₄ count of female TB patients (793 ± 332cells/µl) was lower than female control group (975 ± 300 cells/µl) (p=0.001). There was no statistically significant difference in CD₈ counts between cases and controls for both genders. Forty (37.0%) TB patients had developed anaemia of whom 22(55%) were among PTB, 13(32.5%) from tuberculous lymphadenitis and 5(20%) from disseminated TB. Morphologically, from all anaemia among TB patients, normocytic normochromic anaemia accounted for 15(37.5%) followed by normocytic hypochromic anaemia 13(30.4%).

Conclusion

CD₄ lymphopenia was significant among TB patients. Granulocyte count was increased. Mild anaemia was found major haematological abnormality among newly diagnosed TB patients.     

Removal of Nitrite from Aqueous Solution Using Sugarcane Bagasse and Wheat Straw

Sugarcane bagasse and wheat straw were applied for the removal of nitrite ions from water samples. Batch experiments were conducted to establish optimum pH (5), initial nitrite concentration (5 mg/L), adsorbent dose (3 mg/L) and contact time (90 min). Under the optimized conditions, raw sugarcane bagasse was found to be a more effective (removal efficiency 90 %) adsorbent in removing nitrite ions than wheat straw (removal efficiency 63 %). Adsorption isotherms and kinetic parameters were also studied. The correlation coefficient values for Langmuir and Freundlich isotherm models were 0.9625 and 0.9590, respectively. The results showed that the adsorption of nitrite fairly fits both Langmuir and Freundlich adsorption isotherms for both adsorbents. The kinetics of the adsorption process follows the pseudo second-order kinetic model.