Lympho-proliferative responses to various Fasciola hepatica worm's antigens: an in vitro study

Fascioliasis is an important zoonotic disease with approximately 2-4 million people infected worldwide and a further 180 million at risk of infection. F. hepatica can survive within the bile ducts for many years through its ability to suppress the host immunity with Fasciola cathepsin L1 cysteine protease and Glutathione S transferase playing an important role. The aim of the present study is to investigate the in vitro lympho-proliferative responses of hepatic hilar lymphocytes [HLN] of infected sheep in response to different F. hepatica antigens. The suppressive effects of Fasciola excretory/secretory [ES] and tegument [TEG] and their fractions were also investigated. Our results showed that both ES and TEG had significant suppressive effects on lymphoproliferation, up to 74% and 92%, respectively. When these antigens were fractionated, fraction 3 [MW of >10000-30000] of both ES [64%] and TEG [59%] in addition to fraction 4 [MW of

Bedside manners: do we care?

Teaching bedside manner might prove to be one of the most challenging tasks in medical education as it is not easy to structure or formalise such training. Besides, the rigorous training process for acquiring clinical and technical skills often overshadows the humanistic aspect of medical care. The aim of this study was to assess the perception of final year medical students as well as the faculty regarding the teaching and practice of bedside manner including a brief evaluation of students' bedside manner. A cross-sectional study was conducted involving final year medical students from five medical colleges [n=193] and faculty from a single institution [n=29]. Sample was selected using systematic random or convenient sampling techniques. Data was collected using self administered, anonymous, structured questionnaire. Data were analysed using SPSS-17. While evaluating students' bedside manner, 85% of the students reported they always take consent while interacting with a patient whereas, only 17% of the faculty members agreed with this. Only 3% of the faculty members reported that students take care of privacy of patients and none of them thought that students reassure a patient during an encounter whereas the percentages among students were 76% and 48%, respectively. Though students thought they need to improve, majority [56%] of them was confident of their bedside manner. On the other hand, 83% of the faculty members rated students' bedside manner from fair to poor. A large proportion [69%] of the faculty members were not satisfied with the quality of teaching regarding bedside manner, reporting lack of focus on this particular aspect of medical care as the most important cause. Majority of the students [87%] believed doctors have a better bedside manner in private as compared to public hospitals. Students have an inflated evaluation of their bedside manner but majority felt a need to improve. A sharp contrast exists between students' and faculty's opinion regarding the practice of bedside manner by students. An outright lack of focus on bedside manner was reported as the most important cause for inadequate emphasis on teaching this particular aspect of medical care

[Effects of bupivacain infiltration on insulin, glucose, prolactin and cortisol responses to operative stress after unilateral inguinal hernoiraphy among 3-7 year-old children]

Operative stress and post-operative pain are important issues in medicine. After any types of surgery, the stress hormones release responding to pain. In this study we applied Bupivacain infiltration in surgical wounds of inguinal hernia amongst children aged 3-7 years and evaluated its effects on some stress hormones and plasma levels of glucose. In this prospective study, 116 children aged 3-7 years [24 females, 92 males] undergone unilateral repair of inguinal hernia under general anesthesia at Mofid children hospital during 2005-2007, were devided into 2 groups. Perincisional wound infiltration of 1-2 mg/kg of Bupivacain was performed in experimental group. In both groups, 10-15 mg/kg of Acetaminophen suppository were recommended at the recovery room. 4 ml of blood samples were obtained at three distinct stages [preincisional stage, at the end of operation and 4 hours after operation] to measure the insulin, prolactin cortisol and glucose plasma levels of subjects. Post operative pain was measured objectively by Hannalla scale. In both groups plasma prolactin levels increased at the end of operation along with insulin, cortisol and glucose. However, these differences became statistically significant just for insulin. There were no significant differences between other variables. In addition, although the plasma concentration of above mentioned variables became lesser in the 4[th] hour of postoperative period in experimental group, there were no statistically significant difference compared to those of control group. Wound infiltration of Bupivacain decreases the stress hormones and pain during the post-operative period. We recommend this type of infiltration applying long-acting anesthetic agents with fewer numbers of side-effects

Influence of therapy on early development of osteoporosis in male smoker subjects with hypoandrogenism influenced by life style and schistosomal hepatic fibrosis

The study aims to evaluate the multifact outcome of hypoandrogenemia colinked with the impact of oxidative stress induced by glucose intolerance, Schistosomal hepatic fibrosis [SHF] and cumulative smoking influence on bone remodeling and early development of osteoporotic manifestations. The effect on vascular endothelium immune mediated mechanisms and antioxidant capacity were monitored in cases of 30 middle aged selected male cases involving 20 subjects with hypoandrogenemia who were either smokers and subjected to sedentary life style, glucose intolerance and SHF [GI] or without [GII] as well as cases of GI after following 6 months therapy [GIII] compared to controls [GIV]. Monitoring of clinical picture and biochemical assessments of osteoporotic indices [osteocalcin, bone alkaline phosphatase, parathyroid hormone, urinary cyclic AMP], hypoandrogenism [dehydroepiandrosterane sulphate "DHEAS" and testosterone] glycemic determinant [insulin] immunoinflammatory response [interleukein-6 "IL-6", tumor necrosis factor a "TNF-alpha", E-selectin, ceruloplasmin] smoking index [serum cotinine], tolal antioxidant capacity [AOC] and lipid peroxidation product [malonedialdehyde] were done before and after 6 months therapeutic program involving supplement of DHEAS, chromium picolinate, and megavit zinc alongside smoking cessation and physical exercise daily for at least 30 minutes. It was evident that the adjustment of hormonal status and antioxidant potential should be dealt with smoking cessation to maintain physical fitness and to retard the early onset of osteoporosis. the recognition of the profound impact of life style choices on bone health, risk factors of which the most frequent include smoking, hypoandrogenemia and glucose intolerance besides metabolic and immunoinflammatory derangement posed by SHF all of which induce oxidative stress and potentiate the early development of osteoporosis in middle aged male smokers. Cessation of smoking and adopting active life style with at least half hour daily sportive exercise besides supplements with DHEAS, chromium, zinc and multivitamin-mineral supplement for six months had retarded and readjusted osteoprotic manifestations in studied group

Arsenic contamination in groundwater: a global perspective with emphasis on the Asian scenario.

The incidence of high concentrations of arsenic in drinking-water has emerged as a major public-health problem. With newer-affected sites discovered during the last decade, a significant change has been observed in the global scenario of arsenic contamination, especially in Asian countries. This communication presents an overview of the current scenario of arsenic contamination in countries across the globe with an emphasis on Asia. Along with the present situation in severely-affected countries in Asia, such as Bangladesh, India, and China, recent instances from Pakistan, Myanmar, Afghanistan, Cambodia, etc. are presented.

An eight-year study report on arsenic contamination in groundwater and health effects in Eruani village, Bangladesh and an approach for its mitigation.

Based on several surveys during 1997-2005 and visits of a medical team to Eruani village, Laksham upazila, Comilla district, Bangladesh, the arsenic contamination situation and consequent clinical manifestations of arsenicosis among the villagers, including dermatology, neuropathy, and obstetric outcome, are reported here. Analysis of biological samples from patients and non-patients showed high body burden of arsenic. Even after eight years of known exposure, village children were still drinking arsenic-contaminated water, and many of them had arsenical skin lesions. There were social problems due to the symptoms of arsenicosis. The last survey established that there is a lack of proper awareness among villagers about different aspects of arsenic toxicity. The viability of different options of safe water, such as dugwells, deep tubewells, rainwater harvesting, and surface water with watershed management in the village, was studied. Finally, based on 19 years of field experience, it was felt that, for any successful mitigation programme, emphasis should be given to creating awareness among villagers about the arsenic problem, role of arsenic-free water, better nutrition from local fruits and vegetables, and, above all, active participation of women along with others in the struggle against the arsenic menace.

Tetanus in children- An exclusive study

To document the causes, mode of presentation and establish the morbidity and mortality of tetanus in childhood age group. Descriptive study. Department of Paediatric Surgery, Nishtar Medical College and Hospital, Multan. It was carried out for three years from January 2002 to December 2004. All paediatric patients presenting with tetanus during these three years were inducted in the study. However neonatal cases were excluded from study. All but two cases were admitted through emergency. The remaining two arise in the ward, one being treated for burns and other for long bone fracture in orthopaedic ward. Complete history and clinical findings were noted in a predesigned proforma and a treatment protocol was started. There is four bedded tetanus bay with basic treatment facilities in our ward. However our tetanus bay lacks ventilators and cardiopulmonary monitors. Complications arising 4 during the treatment were noted. A total of 96 patients were included in the study. There were 66 male and 30 female children. The youngest child was of 15 months of age and elder one of 12 years of age. Almost 2/3[rd] [65.62%] of 5 patients belonged to rural background. Wounds supposedly responsible for tetanus were present in 60 patients. Chronic SOM in 10 patients and idiopathic in 26 patients. Abdominal rigidity was present in 90.62% and lock jaw in 85% cases. Lock fit time was <2 days in 25[26.4%] cases. Seven patients required tarcheostomy. Respiratory and anemic complications were amongst the common. Overall mortality was 21.95%. Children make almost1/3[rd] of the total cases of tetanus. The disease pattern remains the same. However survival is better than adults and neonatal tetanus

[Multiple endocrine Neoplasia type 2B [MEN2B] [A case report]]

Multiple endocrine neoplasia syndrome [Type 2B] is a condition associated with systemic malignancies and posses orofacial manifestations. The oral mamifestations help clinician to diagnose disease in early ages. In this article a case is reported with MEN2B syndrome which was diagnosed on the basis of orofacial findings. An eight years old boy was refered for routine dental cares to Mashhad Dental School. In clinical examinations, multiple papules [which defined as neuroma by histopathologic examination] was found on the lip comissures, tip of the tounge and margin of lower eyelids. He had long, narrow face, high arched palate and eversion of eyelids. On the basis of oral and ocular findings, the diagnosis of MEN2B syndrome was made and the patient was refered to a pediatric endocrinologist. Thyroid scan showed cold nodules in thyroid gland which was confirmed by histopathologic examination as medullary carcinoma after total thyroidectomy. Epinephrine and neurepinephrine metabolites were high in urine analysiy setting him in suspicion to develop pheochromocytoma in future. Now the patient is under specialist control. Early diagnosis of MEN2B syndrome is necessary for successful treatment. The dentist may be the first one who diagnoses this syndrome by it's orofacial signs. So Dentists should be aware of oral findings of this disease

Comparison of retrobulbar anesthesia and intracameral anesthesia using preservative free bupivacine hydrochloride 0.5 % in phacoemulsification with posterior chamber intraocular lens implantation

To compare the retrobulbar anesthesia and intracameral anesthesia using preservative-free bupivacaine hydrochloride 0.5% in terms of effectiveness, complications and comfort to the patient during phacoemulsification with posterior chamber intraocular lens implantation. This was a hospital based comparative study of two methods of anesthesia, conducted at LRBT Free Eye and Cancer Hospital, Lahore from January to July 2000. Study included 200 patients with uncomplicated age-related cataract, equally divided in two groups on simple random basis. Group A [100 patients] received the retrobulbar anesthesia and Group B [100 patients] received the intracameral anesthesia with bupivacaine hydrochloride 0.5% for phacoemulsification with posterior chamber intraocular lens implantation. Outcome measures like pain, visual acuity, intraocular pressure and anterior chamber reaction were compared. On day 1, 79% of the patients in group A and 82% patients in group B had unaided visual acuity ranging between 6/6-6/18. On day 7, this was 88% in group A and 89% group B. On day 1, 99% in group A and 98% in group B had <1+ cells in the anterior chamber while on day 7 this increased up to 100%. On day 1, 97% in group A and 98% group B had intraocular pressure less than 20 mmHg. On day 7, it increased up to 100% in both groups. 97% patients in group A and 96% patients in group B had painless surgery. Results were analysed using computer software SPSS version 10.0. Results showed no significant statistical difference between two groups in terms of pain, visual acuity, intraocular pressure, anterior chamber reaction and patient comfort. In the hands of expert surgeons and in selected patients, intracameral anesthesia with preservative-free bupivacaine hydrochloride 0.5% is a safe and effective technique of ocular anesthesia for phacoemulsification with posterior chamber intraocular lens implantation