AbobotulinumtoxinA Doses in Upper and Lower Limb Spasticity: A Systematic Literature Review

Disabling limb spasticity can result from stroke, traumatic brain injury or other disorders causing upper motor neuron lesions such as multiple sclerosis. Clinical studies have shown that abobotulinumtoxinA (AboBoNT-A) therapy reduces upper and lower limb spasticity in adults. However, physicians may administer potentially inadequate doses, given the lack of consensus on adjusting dose according to muscle volume, the wide dose ranges in the summary of product characteristics or cited in the published literature, and/or the high quantity of toxin available for injection. Against this background, a systematic literature review based on searches of MEDLINE and Embase (via Ovid SP) and three relevant conferences (2018 to 2020) was conducted in November 2020 to examine AboBoNT-A doses given to adults for upper or lower limb muscles affected by spasticity of any etiology in clinical and real-world evidence studies. From the 1781 unique records identified from the electronic databases and conference proceedings screened, 49 unique studies represented across 56 publications (53 full-text articles, 3 conference abstracts) were eligible for inclusion. Evidence from these studies suggested that AboBoNT-A dose given per muscle in clinical practice varies considerably, with only a slight trend toward a relationship between dose and muscle volume. Expert-based consensus is needed to inform recommendations for standardizing AboBoNT-A treatment initiation doses based on muscle volume.     

Prevalence of pathogens of abnormal vaginal discharges in a Nigerian tertiary hospital

ObjectiveTo investigate the prevalence of pathogens of abnormal vaginal discharges and to improve the current syndromic management of abnormal vaginal discharge.MethodsA prospective study of pathogens of abnormal vaginal discharge was carried out from December 2007 to December 2008. Samples of female genital swabs were collected from Obstetrics and Gynecology Units of Aminu Kano Teaching Hospital, Kano, Nigeria, and analyzed by microscopy, culture and sensitivity test in Medical Microbiology Laboratory of Aminu Kano Teaching Hospital.ResultsMicroorganisms were detected in 70% (1 400) of a total 2 000 female genital swabs studied. Candida species peaked with 42.0% (840), followed by Gardnerella vaginalis, a pathogen of bacteria vaginosis with 26.0%. The distribution of abnormal vaginal discharge was highest in young adults aged from 21 to 30 years.ConclusionsThe commonest Microorganisms of infective vaginal discharge were Candida species, followed by Gardnerella vaginalis, a pathogen of bacterial vaginosis. Vaginal discharge was prevalent among young adults. We recommend prevention, early diagnosis and prompt treatment of infected female, especially among the young, sexually active group in order to reduce the menace of HIV transmission.     

Is renal medullary carcinoma the seventh nephropathy in sickle cell disease? A multi-center Nigerian survey

IntroductionPrevious studies had enlisted renal medullary carcinoma (RMC) as the seventh nephropathy in sickle cell disease (SCD). Clinical experience has contradicted this claim and this study is targeted at refuting or supporting this assumption.ObjectiveTo estimate the prevalence of RMC and describe other renal complications in SCD.ResultsOf the 3,596 registered sickle patients, 2 (0.056%) had been diagnosed with RMC over a ten year period, thereby giving an estimated prevalence rate of 5.6 per 100,000. The most common renal complication reported by the attending physicians was chronic kidney disease (CKD). The frequency of routine renal screening for SCD patients varied widely between centres — most were done at diagnosis, annually or bi-annually.ConclusionThe ten year prevalence of RMC in Nigerian SCD patients was determined to be 5.6 (estimated incidence of 0.56). RMC is not more common in SCD patients and therefore cannot be regarded as a “Seventh Sickle nephropathy”. Most of the managing physicians reported that the commonest nephropathy observed in their SCD patients was chronic kidney disease.     

Growth inhibition of drug-resistant species of Plasmodium falciparum by domain structured N1,N2-derivatized hydrazines: denticity effects, redox switches, and reductant-driven redox-cycling

Six analogs of bidentate 1-[pyridoxylidene]-2-phenyl]hydrazine, twelve analogs of N2O-tridentate 1-[pyridoxylidene]-2-[heteroaryl]hydrazine, and four O2N-tridentate analogs of 1-[pyridoxylidene]-2-[heteroaroyl] hydrazines were synthesized and characterized. Their solutions in water and DMSO were assayed in vitro for activity against a chloroquine-resistant species of P. falciparum obtained from Hadassah Hospital Blood Bank in Jerusalem. The O2N-tridentate group was essentially inactive, whereas the bidentate group, with N and O liganding atoms, exhibited slight activity against late-stage trophozoites and schizonts of P. falciparum. The N2O-tridentate group, by contrast, was remarkably active against resistant P. falciparum, highlighting the importance of the Denticity Effect in this system. It is assumed that the pyridoxal-based chelator acts as an iron redox mediator, controlling the first coordination sphere and, therefore, the immediate chemical environment of the iron. Chelation of iron-(II) presumably facilitates its oxidation..The Fe(II) --> Fe(III) intra-electron transfer, may be viewed as a switch ("redox switch"), controlling the thermodynamic stability and kinetic lability of the coordination shell. The redox-switch is accompanied by the appearance of a carbon-based Fe-(III)-chelate radical, capable of donating its free electron to the parasite-DNA, thus causing death. The antimalarial N2O-tridentate Fe(III)-chelates appear to be prone to redox-switch, and tend to be converted into their Fe(II) species, whereas the inactive O2N-tridentate analogs apparently cannot do so.     

A study of female genital swabs in a Nigerian Tertiary Hospital

ObjectiveTo detect some common microbial agents of vaginal discharge and improve the current syndromic management of abnormal vaginal discharge.MethodsA prospective study of female genital swabs collected from obstetrics and gynecology units of Aminu Kano Teaching Hospital, Kano, Nigeria and an analysed of microscopy, culture and sensitivity in the medical microbiology and parasitology laboratory of this hospital were conducted from December 2007 to December 2008. Data on epidemiologic indices were collected from the patients, using structured interviewer-administered questionnaires.ResultsEight hundred and forty Candida species were detected, constituting 60% (n=840) of 1 400 female genital discharge samples of microbial etiology in a total of 2 000 female genital samples received. The distribution of vaginal candidiasis was the highest in young adults aged 21 to 30 years with 43%(n=360) of the total 840 cases. Pregnant women that presented with vaginal candidiasis constituted 40% (n=360) of the total 840 cases. Other risk groups included the immuno-suppression with 24% (n=202), group on hormonal therapy with 15% (n=126) and broad spectrum antibiotics users with 16% (n=134).ConclusionsThe results show that Candida is the most common cause of vaginitis and vulvo-vaginal candidiasis followed by C. albicans in the young adults aged 21 to 30 years, pregnant mothers, immuno-suppression, contraceptive and broad spectrum antibiotic users. Proper management of vaginal candidiasis and vulvo-vaginal candidiasis is recommended especially among the risk groups in order to avoid complications and reduce HIV transmission.     

Management of asymptomatic silicone-injected breast with reduction mammoplasty

Even though Silicone injection for breast augmentation has been related to disastrous long-term effects and complications, some patients do not develop significant symptoms at all (asymptomatic). Unfortunately, the management of asymptomatic Silicone-injected breast is still unclear and has never been reported exclusively. We present two cases of asymptomatic patients with a history of liquid Silicone injections who refused to have a mastectomy. They were concerned with the breast ptosis and chose to undergo reduction mammoplasty to improve the appearance of the breasts. Magnetic resonance imaging may be useful as an additional screening tool to confirm the diagnosis and exclude the presence of malignancy in breasts with injected Silicone. We believe that breast reduction may be the alternative option for women with a history of liquid Silicone injection who have no symptoms but desire to preserve their breasts and improve their aesthetics.KEY WORDS: Breast, magnetic resonance imaging, mammaplasty, mastectomy, Silicone     

Hereditary Gingivo-Alveolar Hyperplasia: A Report of Two Siblings

Gingival hyperplasia is characterized by fibrotic gingival overgrowth. The lesion may bury all the crown of the teeth and lead to impairment in masticatory functions and aesthetic disfigurement. This inherited disease is considered rare. We presented two cases of gingival hyperplasia in two siblings: an 11-year-old girl and an 8-year-old boy, whose mother had also suffered from the disease. The two siblings presented with generalized gingival overgrowth involving the maxillary and mandibular arches and covering almost all of the teeth. We performed surgery to reduce the excessive gingivo-alveolar tissue and disclosed most of the teeth. The patients showed functional and aesthetic improvement. The last follow-up through a phone call, which was conducted 12 months after the surgery, revealed no recurrent hyperplasia.Key words: Gingiva, Gingival hyperplasia, Gingivectomy, MasticationGingival hyperplasia is a rare disease which affects one in 750,000 people.¹ It is characterized by localized or generalized enlargement of the gingiva¹ and causes impairment of speech function, mastication, occlusion, and aesthetics.¹⁻⁴ Gap between two teeth, malposition of the teeth, prolonged retention of primary dentition, and delayed eruption of permanent dentition have also been reported.^1,5We conducted a literature search in PubMed on March 15, 2013, using Boolean operator OR, the field of title, under the keywords “gingival hyperplasia,” “drug induced gingival hyperplasia,” “gingival overgrowth,” “gingival fibromatosis,” “hereditary gingival fibromatosis,” and “idiopathic gingival fibromatosis.” Only publications in English were retrieved to have the number of cases that have been reported. Our unpublished study showed there were 1096 cases reported. This number was very low compared to the total world population, which was 6.8 billion people in 2010.⁶ When we compared it to other rare craniofacial syndromes such as Crouzon syndrome (1:65,000),⁷ that number was still 10 times lower. Considering that fact, we were keen to report our cases of gingival hyperplasia in two siblings whose mother had also suffered from the disease. This was intended to enrich the cases reported in the literature.     

A preliminary observation on interdomal suture through bilateral reverse-J incisions to repair cleft lip nose deformity in the setting of traveling charity programs

Background

Nasal appearance is one of the most important factors in determining the success of a cleft repair. This preliminary study aimed to evaluate a simple variant of primary nose repair technique to achieve an optimal nasal esthetic outcome along with the lip repair in the setting of traveling charity programs, where time is an obvious limitation.

Methods

A cross-sectional study on the outcome of nose repair was conducted within the setting of traveling cleft charity programs. Nasal repair was done during primary cleft lip repair by bilateral reverse-J incisions inside the nostril followed by an interdomal suture, without postoperative nasal retainer. Pre- and postoperative photographs were evaluated based on two variables: (1) alar facial symmetry ratio and (2) columellar angle. The significance of improvements was assessed using Wilcoxon or paired samples t test. Postoperative esthetic outcome was also evaluated based on the Fujimoto–Imai method.

Results

From January 2007 to February 2012, there were 68 unilateral and 19 bilateral cleft cases, among which 44 unilateral and 3 bilateral cleft cases were eligible. The bilateral group was discarded from this study for being too small. In the unilateral group, the improvement in both variables was significant (p value?<?0.05). Esthetic outcome was found to be excellent in 21 unilateral cleft patients and good in 23.

Conclusions

This preliminary study showed that interdomal suture via bilateral reverse-J incisions is a potentially effective method to repair unilateral cleft lip nose deformity in the setting of traveling charity programs. Level of evidence: Level IV, therapeutic study.