Feasibility of extracts of common Philippine succulents as ultrasound acoustic gel alternatives

@#<p style="text-align: justify;"><strong>Background.</strong> Ultrasound remains to be an ideal imaging tool for the diagnosis of various conditions in the body. However, the cost and unavailability of the commercial acoustic gel continue to hamper the tool's diagnostic value in low-resource communities.</p><p style="text-align: justify;"><strong>Objectives.</strong> The study aims to investigate the feasibility of extracts of common Philippine succulents as ultrasound acoustic gel, based on image quality parameters, organoleptic characteristics, spreadability, pH, and viscosity.</p><p style="text-align: justify;"><strong>Methods.</strong> Aloe Vera, common houseleek, burro's tail, snake plant, echeveria, crown of thorns, panda plant, and jade plant were extracted and filtered before subjecting them for a physical evaluation. The evaluation analyzed the organoleptic characteristics, spreadability, pH, and viscosity of the formulated gels. The commercial acoustic gel was used as the reference gel. Three experienced ultrasonographers blindly evaluated a total of 243 images obtained using the formulated gels based on four image quality parameters.</p><p style="text-align: justify;"><strong>Results.</strong> The formulated gels had optimal appearance, texture, homogeneity, and pH value. However, all of the extracts had a lower viscosity than the commercial reference gel. The extract obtained from the burro's tail exhibited the highest viscosity among the tested extracts. There was no significant difference in the image quality parameters among the commercial and formulated gels.</p><p style="text-align: justify;"><strong>Conclusion.</strong> The extracts obtained from the succulents are feasible as an acoustic gel for ultrasound imaging based on the physical and image quality analyses. The tested plants are readily available and easy to produce compared to commercial acoustic gel.</p>

Identification of Cryptosporidium parvum Oocysts among Hospitalized Children under-5years in Northeastern Nigeria

Cryptosporidium parvumis among the major pathogens causing diarrheal diseases in children. It is of major public health significance due to its low infectious dose and its oocysts are highly resistant to chlorination, common household disinfectants and survive long periods in the environment. This study was designed to evaluate the occurrence of Cryptosporidium parvum oocysts in stool of hospitalized children under-5years. One hundred and fifty (150) stool samples were collected from one hundred and fifty children (Male:Female= 1:1.08, Mean Age±S.D=22.08 months ± 21.02) and were processed using the modified Ziehl-Nelson method for identification of protozoan oocysts. Out of the one hundred and fifty (150) stool samples analyzed, 16 tested positive to oocysts of C. parvum, which gives a parasite prevalence rate of 10.7%. This was observed to be higher among male patients (52.0%) and children between the age 32-41months (31.3%). Parasite prevalence in relation to age of patients was statistically not significant (X2=0.105, DF=1, P-value= 0.74591, p<0.05). Other intestinal protozoan parasites identified include Entamoeba histolytica(1.33%) and Giardia lamblia (2.60%

Solid tumors after chronic lymphocytic leukemia patients: report of six cases and review of the literature

Introduction: Malignancies have been reported to occur with increased frequency in chronic lymphocytic Leukemia [CLL] patients. The aim of this study was to describe which second malignancies occur in patients with CLL, whether these malignancies are related to CLL, its treatment, or both. We also attempt to study factors predicting the development of other malignancies

Patients and methods: Between 1995 and 2009, six cases of CLL associated with solid tumor were diagnosed in Hematology Department of Military Hospital of Tunis. The diagnosis of CLL was made by immunophenotyping of peripheral blood circulating B cells, and the diagnosis of solid tumors was made by biopsy with anatomopathological exam and immunohistochemical study

Results: The mean age of patients was 71 years. Five patients were male. The CLL was classified Stage A in one case, Stage B in three cases and Stage C in two cases. Two patients had abnormal karyotype. Three patients have not received specific treatment for their CLL. Solid tumors were represented by skin cancer in three cases, lung cancer in two cases and breast cancer in one case. The median time between diagnosis of CLL and that of solid tumor was 53 months

Conclusion: Patients with CLL have an increased risk of developing a second cancer. Awareness of risk factors could permit early detection

Arrhythmogenic right ventricular dysplasia: a sudanese experience

Arrhythmogenic right ventricular dysplasia cardiomyopathy [ARVDC] is a genetic cardiomyopathy characterized by ventricular arrhythmias and structural abnormalities of the right ventricle [RV].There were no reported studies on the presentation of Sudanese patients with ARVDC. This study aimed to describe patient characteristics and various manifestations of ARVDC among 4 patients seen at Shaab Teaching Hospital [STH] during the period from 2006-2010. This study was carried out in STH. STH is the central reference cardiology hospital in Sudan with the final diagnosis of ARVDC. Initially, none of those patients was diagnosed as having ARVDC. The first patient was treated as myocardial infarction and epilepsy. The second patient was diagnosed as Epilepsy. Both the third and fourth patients were treated for palpitations and the fourth patient was diagnosed as having heart failure as well. The first Patient died suddenly while the others stayed alive and have come for follow-up. They were prescribed anti-arrhythmic drugs, and showed remarkable improvement. The diagnosis of these cases based primarily on findings obtained from clinical assessment and simple laboratory tests, as neither MRI nor endomyocardial biopsy were available. Awareness of the protean presentations of ARVDC shouldn't be overlooked. Palpitation isn't always benign. Big heart shadows in X-rays may have many causes. T-wave changes not necessarily ischemia and Loss of consciousness isn't synonymous with epilepsy only. A national registry is a necessity

Pattern of liver diseases in Sudanese children

We aimed at determining the pattern and the incidence of liver disease in the Sudanese children referred to the Gastroenterology unit as Gaafar Ibn Oaf Specialized Children Hospital, which has not been studied before. In a cross-sectional study conducted over 5 years, 450 liver needle biopsies were sent to the pathology laboratory of our center. Slides were prepared from paraffin-embedded blocks, stained by routine H and E and special stains and were then reviewed. The frequency of each disorder, separately and in combination with the age group or gender of the patient were compared with other similar studies. The male to female ration was 1.5:1. The age range between 1 month and 15 years old and 42% were less than 1 year old. The most common histological diagnosis was liver cirrhosis where no specific cause could be found [26%] followed by neonatal hepatitis [20%], fatty liver [12%], billary Atresia [10%], chornic hepatitis [8%], metabolic liver disease [6%], Progressive Intrahepatic Cholestasis [5.5], non specific pathological changes [4.4%] and Hepato Cellular Carcinoma in [4%]. A liver biopsy is a useful and practical tool for the appropriate diagnosis of pediatric liver diseases. We found that Idiopathic Liver Cirrhosis, Neonatal Hepatitis, Fatty Liver, Billary Atresia and Chronic Hepatitis in the stated order are the most prevalent histological diagnosis in Sudanese children. Hepatocellular Carcinoma is significantly high in our pediatrics population

Result of eradication of esophageal varices in children with extra hepatic portal venous obstruction in Sudan

Extra hepatic Portal Vein Thrombosis is the main cause of Portal hypertension in children in Sudan, which is responsible for almost 30% of heamatemsis in children in Sudan. Treatment is targeted at the complications and includes primary and secondary prophylaxis against upper gastrointestinal bleeding [which results from the rupture of esophageal varices] which is usually a combination of endoscopic sclerotherapy and/or band ligation to eradicate the varices, Porto systemic shunting in selected cases, medical prophylaxis, and to support the child growth and development. In this study we looked beyond the eradications of the varices in these children to help us providing a better long term care plan for such an important problem. The Objectives are to find out the recurrence of esophageal varices, evolution of gastric varices, portal hypertensive gastropathy [PHG] and risk of rebleeding following esophageal variceal eradication in children with Extra hepatic Portal Vein Obstruction [EHPVO]. Between March 2005 and March 2010, children with extra hepatic portal venous obstruction [EHPVO] and bleeding from esophageal varices who referred to the Gastroentrology unit at Gafaar In Oaf Specialized Children Hospital, Khartoum, Sudan, and the Endoscopic unit of the Military hospital, Omderman, Sudan received endoscopic injection sclerotherapy [EIS] and /or Esophageal Varices Band Ligation [EVBL] until eradication. Surveillance endoscopy was performed initially at 3 months and subsequently at intervals of 6 months to one year to detect esophageal and gastric varices, and PHG. Gastric varices were classified as gastroesophageal [GOV] or isolated gastric varices [IGV]. Gastroesophageal varices included types GOV1 and GOV2 that extend along lesser and greater curvatures respectively. Patients who had recurrence of bleeding were evaluated by emergency upper gastrointestinal endoscopy. The therapeutic endoscopy procedures were done by the two authors. 113 of 133 children who achieved esophageal varices eradication were evaluated. Esophageal varices recurred in 40% cases. Primary gastric varices [before EIS/EVBL] were seen in 61% cases [GOV98% [83% GOV1, 15%GOV2] and IGV2%] and secondary gastric varices [after EIS/EVBL] in 28% [GOV 71% [47% GOV1, 24% GOV2] and IGV 29%]. Secondary gastric varices were distributes as 20% GOV1, 42% GOV2 and 87% IGV. Frequency of gastric varices before sclerotherapy or/and banding, at the last follow up showed decrease in GOV1 from 57to 39 [P=0.01], increase in GOV2 from 10 to 16 and increase in IGV from 1 to 10 [P<0.001]. PHG increased in frequency from 12% to 41% [P<0.001] and severity from one patient to 12 [P<0.001]. Eight cases had rebleeding from gastric varices [4 GOV1, 3 GOV2 and 1 IGV]. It was conclude that following esophageal variceal eradication in children with EHPVO a significant decrease in Gastroesophageal Varices, increase in Isolated Gastric Varices and increased frequency and severity of Portal hypertensive Gastropathy takes place. Small rebleeding risk persists from gastric varices irrespective of the type

Pattern of liver diseases in Sudanese children

We aimed at determining the pattern and the incidence of liver disease in the Sudanese children referred to the Gastroenterology unit as Gaafar Ibn Oaf Specialized Children Hospital, which has not been studied before. In a cross-sectional study conducted over 5 years, 450 liver needle biopsies were sent to the pathology laboratory of our center. Slides were prepared from paraffin-embedded blocks, stained by routine H and E and special stains and were then reviewed. The frequency of each disorder, separately and in combination with the age group or gender of the patient were compared with other similar studies. The male to female ratio was 1.5:1. The age range between 1 month and 15 years old and 42% were less than 1 year old. The most common histological diagnosis was liver cirrhosis where no specific cause could be found [26%] followed by neonatal hepatitis [20%], fatty liver [12%], Billary Atresia [10%], chronic hepatitis [8%], metabolic liver disease [6%], Progressive Intrahepatic Cholestasis [5.5%], non specific pathological changes [4.4%] and Hepato Cellular Carcinoma in[4%]. A liver biopsy is a useful and practical tool for the appropriate diagnosis of pediatric liver diseases. We found that Idiopathic Liver Cirrhosis, Neonatal Hepatitis, Fatty Liver, Billary Atresia and Chronic Hepatitis in the stated order are the most prevalent histological diagnosis in Sudanese children. Hepatocellular Carcinam is significantly high in our pediatrics population

Calciphylaxis: a diagnosis to be considered

Calciphylaxis, Calcific uremic artteriolopathy [CUA] is a rare but serious complication of end-stage renal disease [ESRD], though it can occur in non uremic. Its main presentation is skin changes and digital gangrene. We present a case of a 70 years old male who had a previous big toe amputation. He presented with acute heart failure syndrome, with fingers and toes gangrene which was mistakenly diagnosed as cyanosis. Following comprehensive assessment patient was diagnosed as having Calciphylaxis. Histological findings have shown intimal hypertrophy and diffuse calcification of the small arteries which further supported the diagnosis of CUA, calciphylaxis, complicating CRF

Causes of portal hypertension in Sudanese children

The etiological profile of Pediatric Portal hypertension in our hospital, Gafaar Ibn Oaf Specialized Children Hospital a tertiary referral children hospital for the whole of Sudan, showed that the commonest causes were extra hepatic portal venous obstruction [EHPVO] and liver cirrhosis. Cryptogenic liver cirrhosis was the most common cause of cirrhosis

Liver biopsy: is it safe in children?

The blind liver biopsy technique has been widely used in Sudan as the availability of the ultra sound machines and the committed Pediatrics Radiologist were not always at hands. Liver biopsy is an essential tool in the diagnosis of liver diseases and subsequently, initiating the appropriate treatment. The aim of the study was to observe the safety of blind liver biopsy in our children. One hundred fifty consecutive liver biopsies in hospitalized children were evaluated retrospectively. Using a standard percussion technique biopsy sites were chosen and through intercostals space blind liver biopsies were performed by TruCut biopsy needle. The study was conducted at Gafaar Ibn Oaf Specialized Children Hospital ,Khartoum Sudan, over the last five years, between January 2005-January 2010. The first biopsy sample was considered macroscopically adequate in 94.8% of cases. A definitive histological diagnosis was possible in 99.1% of cases. seventy children were more than 5 years of age and of these 8 [11.4%] complained of pain at the biopsy site, external hemorrhage from the biopsy site was seen in 1 [0.6%] case but no sign of internal hemorrhage was detected during the 24 hours follow up period. No child died following the procedure. Blind liver biopsy in the studied hospitalized children was found to be a safe procedure

Eitology of chidhood diarrhea in Zliten, Libya

To determine the etiological agents of diarrhea in children from a small semi-urban city in Libya and the association of age, gender, seasonal variation, breast-feeding, source of water for drinking, or antibiotic use with the isolation of enteropathogens and whether such agents are community or hospital acquired. Using standard microbiological techniques we examined stool samples from 169 children [70 females] aged a few days to 12 years with acute diarrhea for viral, bacterial and parasitological agents. We used the disc diffusion method to determine the susceptibility of bacterial pathogens to antimicrobial agents. We carried out the study between April 2000 to March 2001. We detected a single agent in 44.4%, rotavirus in 26.6%, Salmonella in 13.6%, and Cryptosporidium in 13% of patients and other enteric pathogens, Shigella in 3.6%, Aeromonas in 5.5%, Entamoeba histolytica/dispar in 11.8, and Giardia lamblia in 1.2%. Serotyping of isolated Salmonella resulted in 21 being Salmonella enteric serotype heidelberg and 3 Salmonella enteritidis. We detected both serotypes in one child. More than 75% of the isolated Salmonella were resistant to 6 different commonly used antimicrobial agents. We found rotavirus, non-typhoid Salmonella and Cryptosporidium to be the most important enteric agents associated with childhood diarrhea in Zliten. The isolated bacterial pathogens showed high resistant rates, particularly among the Salmonella, to the commonly used antimicrobial agents. The ease of which one can obtain these drugs in Zliten may play a role in such resistance

Sequential intravesical immunochemotherapy for stages Ta And T1 transitional cell carcinoma of the bladder: an update

Objectives: To present an update of our experience with sequential immuno-chemotherapy using bacillus Calmette-Guerin [BCG] and epirubicin in superficial bladder tumors. In addition, the question of whether to start with BCG or epirubicin is answered

Methods: Between January 1993 and December 2001, 156 patients with histologically proven Ta and T1 bladder transitional cell carcinoma were included in a prospective randomized study. Following transurethral resection of the bladder tumor [TURBT], patients were randomly assigned to 1 of 2 groups. Patients in group 1 received weekly doses of 150 mg BCG alternating with 50 mg epirubicin for 6 weeks. Maintenance was carried out by a monthly dose of BCG alternating with epirubicin, to complete 1 year of treatment. Patients in group 2 received the same protocol, but with a reversed order with epirubicin being used initially

Results: 149 patients, 114 men and 35 women with a mean age of 55 years, were evaluable. 7 patients were excluded due to severe side effects. Mean and median follow-up was 42.8 and 43 months, respectively. In the whole series recurrence rate was 18.1%, recurrence rate per year was 0.06, mean interval to first recurrence was 29 months and progression rate was 12%. Side effects developed in 40 patients [25.6%] and were mostly in the form of mild cystitis [26 patients]. The 2 groups of therapy were comparable regarding recurrence rate, recurrence rate per year, progression rate and side effects

Conclusions: The sequential therapy is effective in recurrence prophylaxis of superficial bladder tumors. The side effects were less frequent than in our historical controls treated with BCG alone. It does not matter to start with epirubicin or BCG in this regimen

Post-operative bile duct strictures: Management of eight patients

Management of eight patients with benign bile duct stricture following cholecystectomy is discussed. Seven patients had been operated for gall stones while one had undergone cholecystectomy and repair of hepatic duct confluence after blunt abdominal trauma. Five patients had undergone multiple operations before referral to this hospital on admission, all the patients had abnormal liver function tests. Three patients had low serum albumin, 4 had a history of previous major infection and one patient had associated cirrhosis and portal hypertension. Five patients had an external biliary fistula. All the patients were operated upon: 4 by mucosal graft operation [Bismuth type-IV], 3 by hepatico-jejunostomy by direct suture [Bismuth type-III and II] and one by choledocho-duodenostomy [Bismuth type-I]. There were no post-operative deaths in patients treated by hepaticojejunostomy. One of the 4 patients treated by mucosal apposition died in the immediate postoperative period; he had associated cirrhosis and portal hypertension. Six patients [75%] have a good result with a mean follow up of 3.5 years [range 2-8 years]. One patient has occasional attacks of jaundice and fever and persistently raised serum alkaline phosphatase. Factors influencing outcome were prolonged jaundice, site of stricture, number of previous attempts at stricture repair, associated cirrhosis and portal hypertension

Psychiatric morbidity: prevalence, associated factors and significance

A cross-sectional observational systematic study was carried out on ambulatory patients at a tertiary care hospital to determine the probable prevalence, associated factors and significance of psychiatric morbidity by using an Urdu translation of the hospital anxiety and depression [HAD] scale over a period of 6 days in a week. Results showed a prevalence of 38.4% which is slightly higher than what has been generally reported [30%]. Two variables, i.e., female sex and being a housewife were significantly related with the outcome. An attempt has been made to identify the probable reasons for this and some suggestions laid down for further work

Genetic study of primary congenital glaucoma in Sharkia

This study included 20 normal subjects as a control group and 20 cases suffering from primary congenital glaucoma. There were 4 familial cases, 4 cases with other ocular and systemic anomalies, 6 cases exposed to prenatal environmental factors and consanguinity was detected in 9 cases. Karyotyping revealed chromosomal anomalies in 3 cases of primary congenital glaucoma, this was in the form of chromatoid breaks in 2 cases and trisomy 13 in one case. All the 3 cases were exposed to prenatal environmental factors and have other ocular and systemic anomalies. Pedigrees analysis revealed that primary congenital glaucoma was inherited as multifactorial mode of inheritance

Retinitis pigmentosa clinical and genetic study

15 probands [9 males and 6 females] with retinitis pigmentosa were studied and 20 normal subjects were taken as a control group. 5 probands were typical and 10 were atypical retinitis pigmentosa. Also, 10 cases were familial, consanguinous marriage was noticed in 10 cases and 2 cases were exposed to prenatal environmental factors. Collected data from pedigrees analysis revealed that retinitis pegimentosa can follow autosomal dominant and autosomal recessive mode of inheritance. Karyotyping revealed that no chromosomal aberrations were detected in cases of retinitis pigmentosa