Current Understanding and Future Perspectives of Interstitial Cystitis/Bladder Pain Syndrome / 대한배뇨장애요실금학회지

Interstitial cystitis/bladder pain syndrome (IC/BPS) is a chronic disease characterized by suprapubic pain and lower urinary tract symptoms. Perhaps because of the heterogeneous nature of this disease and its multifactorial etiology, clinical trials in allinclusive populations of IC/BPS patients without phenotyping in the last decade have mainly failed to discover new therapeutic modalities of IC/BPS. Thus, phenotyping IC/BPS, aimed at identifying bladder-centric and/or bladder-beyond pathologies, including cystoscopic observation of Hunner or non-Hunner lesions of the bladder mucosa, is particularly important for the future of IC/BPS management. Based on recent discussions at international conferences, including the International Consultation on IC, Japan, it has been proposed that Hunner-lesion IC should be separated from other non-Hunner IC/BPS because of its distinct inflammatory profiles and epithelial denudation compared with non-Hunner IC/BPS. However, there are still no standard criteria for the diagnosis of Hunner lesions other than typical lesions, while conventional cystoscopic observations may miss atypical or small Hunner lesions. Furthermore, diagnosis of the bladder-centric phenotype of IC/BPS requires confirmation that identified mucosal lesions are truly a cause of bladder pain in IC/BPS patients. This review article discusses the current status of IC/BPS pathophysiology and diagnosis, as well as future directions of the proper diagnosis of bladder-centric IC/BPS, in which pathophysiological mechanisms other than those in inflammatory pathways, such as angiogenic and immunogenic abnormalities, could also be involved in both Hunner-lesion IC and non-Hunner IC/BPS. It is hoped that this new paradigm in the pathophysiological evaluation and diagnosis of IC/BPS could lead to pathology-based phenotyping and new treatments for this heterogeneous disease.

Current Understanding and Future Perspectives of Interstitial Cystitis/Bladder Pain Syndrome / 대한배뇨장애요실금학회지

Interstitial cystitis/bladder pain syndrome (IC/BPS) is a chronic disease characterized by suprapubic pain and lower urinary tract symptoms. Perhaps because of the heterogeneous nature of this disease and its multifactorial etiology, clinical trials in allinclusive populations of IC/BPS patients without phenotyping in the last decade have mainly failed to discover new therapeutic modalities of IC/BPS. Thus, phenotyping IC/BPS, aimed at identifying bladder-centric and/or bladder-beyond pathologies, including cystoscopic observation of Hunner or non-Hunner lesions of the bladder mucosa, is particularly important for the future of IC/BPS management. Based on recent discussions at international conferences, including the International Consultation on IC, Japan, it has been proposed that Hunner-lesion IC should be separated from other non-Hunner IC/BPS because of its distinct inflammatory profiles and epithelial denudation compared with non-Hunner IC/BPS. However, there are still no standard criteria for the diagnosis of Hunner lesions other than typical lesions, while conventional cystoscopic observations may miss atypical or small Hunner lesions. Furthermore, diagnosis of the bladder-centric phenotype of IC/BPS requires confirmation that identified mucosal lesions are truly a cause of bladder pain in IC/BPS patients. This review article discusses the current status of IC/BPS pathophysiology and diagnosis, as well as future directions of the proper diagnosis of bladder-centric IC/BPS, in which pathophysiological mechanisms other than those in inflammatory pathways, such as angiogenic and immunogenic abnormalities, could also be involved in both Hunner-lesion IC and non-Hunner IC/BPS. It is hoped that this new paradigm in the pathophysiological evaluation and diagnosis of IC/BPS could lead to pathology-based phenotyping and new treatments for this heterogeneous disease.

Perioperative anesthetic care of children with Congenital Cystic Adenomatous Malformation: A report of 3 cases

@#<p style="text-align: justify;">Congenital cystic adenomatoid malformation (CCAM) is a rare developmental entity. Symptomatic patients must undergo thoracic surgery for lobectomy. Perioperative anesthetic management is challenging because it involves<br />thoracotomy in a young patient that may lead to hemodynamic compromise and inadequate ventilation. We present 3 cases of pediatric patients (6 months - 2 years old) with CCAM who underwent lobectomy.</p>

Evidence of mutagenic and lethal effects of herbicides on Amazonian frogs

Os anfíbios são ótimos bioindicadores porque são sensíveis à poluição química, indicando alterações ecossistêmicas pela presença de ou pela exposição a compostos químicos. Aqui nós relatamos evidências do impacto de herbicidas, incluindo glifosato, em anfíbios em uma localidade na Amazônia central brasileira e as comparamos com dados de outros biomas no Brasil. Nós observamos malformações em três espécies de Leptodactylus e extinção local de Scinax ruber e Rhinella marina em sítios reprodutivos próximos a uma área onde herbicidas haviam sido aplicados. Os resultados observados na Amazônia são semelhantes aos observados na Mata Atlântica do Brasil, com alterações morfológicas e mortalidade em anfíbios expostos a herbicidas. Alertamos para a ameaça de expansão de culturas para a produção de biocombustíveis na Amazônia, devido ao fato de o cultivo estar associado a agroquímicos, incluindo o glifosato, representando uma ameaça à biodiversidade do bioma Amazônia. (AU)

Geometric features of vertebrobasilar arterial system in adult black Kenyans / Características geométricas del sistema arterial vertebrobasilar en kenianos negros adultos

Geometric features of vertebrobasilar system influence occurrence of posterior circulation atherosclerosis, aneurysms, stroke and neuroradiological procedures. These features show ethnic variation, but data from black Africans in Sub Saharan Africa are scarce. This study aimed to describe geometric features of vertebrobasilar system in a black Kenyan population. It was a descriptive cadaveric study at Department of Human Anatomy, University of Nairobi. One hundred and seventy three formalin-fixed adult brains of individuals (99 male; 74 female; Age range 20 - 79) who had died of non cerebrovascular causes were studied. Level and angle of confluence of vertebral artery; diameter, length and bifurcation angles of basilar artery were measured. Data were analysed by SPSS version 21 for windows. The student t - test was used to determine the sex differences at 95 % confidence interval. Data are presented in macrographs, tables and bar charts. Confluence of vertebral arteries occurred at the sulcus bulbopontinus in 79.8 %; rostral to it in 11.5 % and caudal to it in 8.7 % of cases. Mean angle of vertebral artery confluence was 46.7º and 68.9º in males and females respectively (p£0.042). Mean length of the basilar artery was 26.8 mm; 26.3 mm in males and 27.1 mm in females (p=0.465). Mean diameter was 3.52 mm; 3.32 mm in males and 3.72 mm in females (p=0.002). The mean angle of basilar artery bifurcation was 120.3º ± 15.2; 99.3º ± 32.9 in males and 140.3º ± 16.1 in females (p=0.024). It was wider than 90º in 82.9 % of males and 95.9 % females (p=0.032). In 85 (49.1 %) it was wider than 120º. The vertebrobasilar system in the Kenyan population has geometric features that constitute risk factors for atherosclerosis. These features display sex dimorphism which may explain differences in prevalence of atherosclerosis and aneurysms. Neurosurgeons and neurologists should be aware of these differences. Individuals with risk prone geometric features should be followed up for atherosclerosis.

Las características geométricas del sistema vertebrobasilar influyen en la aparición de aterosclerosis en la circulación posterior, aneurismas, apoplejía, detectados durante procedimientos neurorradiológicos. Estas características muestran variación étnica, pero los datos de los africanos negros en el África Subsahariana son escasos. Este estudio tuvo como objetivo describir las características geométricas del sistema vertebrobasilar en una población negra de Kenia. Fue un estudio descriptivo cadavérico en el Departamento de Anatomía Humana de la Universidad de Nairobi. Se estudiaron 173 cerebros adultos (99 varones, 74 mujeres, rango de edad 20-79), fijados en formalina, de individuos que habían fallecido por causas no cerebrovasculares. Se midieron el nivel y ángulo de confluencia de la arteria vertebral, diámetro, longitud y bifurcación de la arteria basilar. Los datos fueron analizados por SPSS versión 21 para Windows. La prueba t de Student se utilizó para determinar las diferencias de sexo con un intervalo de confianza del 95 %. Los datos se presentan en macrografías, tablas y gráficos de barras. La confluencia de las arterias vertebrales se produjo en el surco bulbopontino en el 79,8 %; rostral al surco en 11,5 % y caudal al surco en 8,7 % de los casos. El ángulo medio de la confluencia de la arteria vertebral fue 46,70 y 68,90 en hombres y mujeres, respectivamente (p£0,042). La longitud media de la arteria basilar fue de 26,8 mm; 26,3 mm en hombres y 27,1 mm en mujeres (p=0,465). El diámetro promedio fue de 3,52 mm; 3,32 mm en hombres y 3,72 mm en mujeres (p=0,002). El ángulo medio de la bifurcación de la arteria basilar fue de 120,30 ± 15,2; 99.30 ± 32,9 en hombres y 140,30 ± 16,1en mujeres (p=0,024). Era más amplio que 90º. En un 82,9 % de los hombres y 95,9 % de las mujeres (p=0,032) se observó un ángulo más amplio que 90°. En 85 (49,1 %) fue más amplio que 120°. El sistema vertebrobasilar en la población de Kenia tiene características geométricas que constituyen factores de riesgo para la aterosclerosis. Estas características muestran dimorfismo sexual que puede explicar las diferencias en la prevalencia de aterosclerosis y aneurismas. Los neurocirujanos y los neurólogos deben tener en cuenta estas diferencias. Las personas con características geométricas propensas al riesgo deben ser seguidas por aterosclerosis.

A Ten Year Study of Pediatric Leprosy Cases in a Tertiary Care Centre in South Kerala

Leprosy in children is a valuable marker of impact of programme. This study has been carried out to analyse the clinical and histopathological characteristics of pediatric leprosy cases attending a tertiary health care centre in South Kerala bordering Tamil Nadu. This is a retrospective, analytical study of pediatric leprosy cases seen from 01 January 2007 to 31 December 2016 in the Dermatology out-patient department of Dr. Somervell Memorial CSI Medical College, Karakonam, Trivandrum, Kerala. Seven of the 52 leprosy cases in this hospital during this study period children (age group of 6 to 14), of which 6 were females. Two cases among these were borderline lepromatous and the rest were indeterminate leprosy. Three patients had contact with lepromatous leprosy (familial). Histopathology correlated well with our clinical diagnosis. Grade 2 deformity was seen in one child, who had taken incomplete treatment earlier. While the number of cases reporting to this centre may or may not reflect true epidemiological picture at population level, data may be used to plan proper research cum intervention studies. The prevalence of childhood leprosy can be reduced if we are vigilant and improve the surveillance of contacts, as 43% of cases in this study had a contact of leprosy in the family.

The student's experience of applied equivalence-based instruction for neuroanatomy teaching / 보건의료교육평가

PURPOSE: Esoteric jargon and technical language are potential barriers to the teaching of science and medicine. Effective teaching strategies which address these barriers are desirable. Here, we created and evaluated the effectiveness of standalone learning 'equivalence-based instruction' (EBI) resources wherein the teaching of a small number of direct relationships between stimuli (e.g., anatomical regions, their function, and pathology) results in the learning of higher numbers of untaught relationships. METHODS: We used a pre and post test design to assess students' learning of the relations. Resources were evaluated by students for perceived usefulness and confidence in the topic. Three versions of the resources were designed, to explore learning parameters such as the number of stimulus classes and the number of relationships within these classes. RESULTS: We show that use of EBI resulted in demonstrable learning of material that had not been directly taught. The resources were well received by students, even when the quantity of material to be learned was high. There was a strong desire for more EBI-based teaching. The findings are discussed in the context of an ongoing debate surrounding 'rote' vs. 'deep' learning, and the need to balance this debate with considerations of cognitive load and esoteric jargon routinely encountered during the study of medicine. CONCLUSION: These standalone EBI resources were an effective, efficient and well-received method for teaching neuroanatomy to medical students. The approach may be of benefit to other subjects with abundant technical jargon, such as science and medicine.

Anti-venom Activity of Mucuna pruriens Leaves Extract Against Cobra Snake (Naja hannah) Venom.

The study was done to investigate the anti-venom activity of Mucuna pruriens leaves extract against cobra snake (Naja hannah) venom. Study Design: The mice were randomly grouped into six groups (A, B, C, D, E, and F) of five rats each. Group A served as the normal control (no induction), and the mice in the group were given normal saline (1ml/kg/body weight).Group B served as the test control (snake venom was induced but no treatment administered), Group C served as the standard control (snake venom was induced and treated with antivenin, a standard drug), Group D, E and F were all induced with the cobra snake venom and treated with ethanolic extracts of the leaves of M. pruriens for 14 days. Methodology: The induction with cobra snake venom was done with 0.075mg/kg b.w of venom and thereafter the treatment with M. pruriens extract for Group D, E and F were done with 40 mg/ kg, 60 mg/ kg and 80 mg/ kg respectively intraperitoneally in the mice. Serum blood of the animals was used to assay for total cholesterol, bilirubin, AST, ALT, GSH and catalase levels after 14days. Result: The injection of crude venom of cobra snake (Naja hannah) caused an increase in cholesterol, AST, ALT, bilirubin, catalase and glutathione in envenomated mice which significantly reduced (p<0.05) compared to all the controls after 14 days of treatment with the extract. Conclusion: The results suggests that 80 mg/ kg of the plant extract is more effective than the standard drug, therefore M. pruriens leaves has a greater anti-venom potential for curing snake bite, than antivenin.

Improved quality and quantity of written feedback is associated with a structured feedback proforma / 보건의료교육평가

Facilitating the provision of detailed, deep and useful feedback is an important design feature of any educational programme. Here we evaluate feedback provided to medical students completing short transferable skills projects. Feedback quantity and depth were evaluated before and after a simple intervention to change the structure of the feedback-provision form from a blank free-text feedback form to a structured proforma that asked a pair of short questions for each of the six domains being assessed. Each pair of questions consisted of asking the marker 'what was done well?' and 'what changes would improve the assignment?' Changing the form was associated with a significant increase in the quantity of the feedback and in the amount and quality of feedback provided to students. We also observed that, for these double-marked projects, the marker designated as 'marker 1' consistently wrote more feedback than the marker designated 'marker 2'.

The Phlebotomine sandfly fauna (Diptera: Psychodidae) of Kenya.

Visceral and cutaneous leishmaniases are endemic in some parts of Kenya, where they are transmitted by phlebobotomine sandflies of genus Phlebotomus. This review is a compilation of the currently known distribution of phlebotomine sandflies in the parts of Kenya that have been studied, from the time sandflies were first reported in the country. So far 48 species of sandflies have been identified falling in the genera Phlebotomus Rondani & Berte and Sergentomyia Franca & Parrot. Genus Phlebotomus in Kenya is represented in five subgenera, namely Phlebotomus, Larroussius, Synphlebotomus, Paraphlebotomus and Anaphlebotomus. Genus Sergentomyia has the largest number of sandflies, and is represented in four subgenera, namely Sergentomyia, Sintonius, Grassomyia and Parvidens.

Pathogenicity of Metarhizium anisopliae (Metch) Sorok and Beauveria bassiana (Bals) Vuill to adult Phlebotomus duboscqi (Neveu-Lemaire) in the laboratory.

Background & objectives: Biological control of sandflies using entomopathogenic fungi is a possible alternative to the expensive synthetic chemical control. It is potentially sustainable, less hazardous, and relatively inexpensive and merits further investigations. The objective of this study was to identify the most pathogenic fungal isolate(s) to sandflies in the laboratory. Methods: Isolates of entomopathogenic fungi Metarhizium anisopliae and Beauveria bassiana were screened for their pathogenicity against Phlebotomus duboscqi. Adult flies were contaminated using the technique described by Migiro et al (2010). Briefly, flies were exposed to 0.1 g of dry conidia evenly spread on a cotton velvet cloth covering the inner side of a cylindrical plastic tube (95 mm long × 48 mm diam). In all 25 sandflies were transferred into the cylindrical tube and allowed to walk on the velvet for one minute, after which they were transferred from the velvet into the cages in Perplex. Insects in the control treatments were exposed to fungusfree velvet cloth before being transferred into similar cages. The treatments were maintained at 25 ± 2°C, 60–70% RH and 12L: 12D photoperiod. The experiment was replicated 5 times. The most pathogenic isolates were selected for further studies. Results: A total of 19 isolates were screened against adult sandflies in the laboratory. Mortality in the controls was approximately 16.8 ± 1.7 %. All the isolates were found to be pathogenic to P. duboscqi. Mortality ranged between 76.8 and 100% on all the fungal isolates tested. The lethal time taken to 50% (LT50) and 90% (LT90) mortality ranged from 3.0–7.8 days and from 5.3–16.2 days, respectively. The virulent isolates, causing mortalities of 97.5–100%, were selected for further studies. Interpretation & conclusion: The high susceptibility of sandflies to entomopathogenic fungi suggests that fungi are potential alternatives to chemical control methods. We conclude that application of entomopathogenic fungi could result in acute mortalities of sandflies and reduction of parasite transmission and subsequently, reduction of leishmaniasis risk. This method of biological control has great potential as a new strategy for leishmaniasis control.

Laboratory and semi-field evaluation of long-lasting insecticidal nets against leishmaniasis vector, Phlebotomus (Phlebotomus) duboscqi in Kenya.

Background & objectives: Phlebotomine sandflies are vectors of leishmaniases and other diseases. Long-lasting insecticidal nets (LLINs) as possible tools for control have not been widely tested against them. The objective of this study was to determine the efficacy of Olyset® Net and PermaNet® LLINs alongside a local brand, K-O Tab® treated net (Supanet) against Phlebotomus duboscqi female sandflies. Methods: Four replicates of unwashed and 20x washed Olyset Nets and PermaNets, K-O Tabtreated and untreated Supanet and ‘no net’ treatments were evaluated against sandflies within the laboratory by tunnel tests and in semi-field conditions in the greenhouse model for their efficacy. Results: All bednets allowed entry of P. duboscqi sandflies and subsequent blood-feeding. Olyset net’s blood feeding inhibition was significantly higher than that of Supanet in the laboratory but not in semi-field condition. Of the LLINs, only Olyset net had sandflies that could not feed significantly more than those of Supanet. Additionally, no significant efficacy difference was observed between LLINs washed 20x and unwashed ones. The only significant difference noted in number of sandflies that were found dead or paralyzed within bednets in the semi-field condition was between Olyset and K-O Tab treated Supanet. In the laboratory, unwashed Olyset had a significantly higher number of sandflies killed than all other bednet treatments. Conclusion: Olyset net use in areas where sandflies are nuisance biters and/or disease vectors could be more beneficial in preventing sandfly bites than other tested bednets. It is recommended that mesh sizes of LLINs should be smaller for control of sandflies than those used for control of mosquitoes.

Comparative attractiveness of CO2-baited CDC light traps and animal baits to Phlebotomus duboscqi sandflies.

Background & objectives: In order to understand sandfly bionomics, vector species identification, and to develop methods for sandfly control, there is a need to sample sandflies in any particular habitat. This survey was aimed at determining the best method of sampling Phlebotomus (Phlebotomus) duboscqi (Diptera: Psychodidae) in the field. Methods: Different animal baits and CO2-baited CDC light traps were used to attract sandflies released in an insect-proof screen-house located in the sandfly’s natural habitat in Marigat, Baringo district of Kenya. Results: Attraction of hungry P. duboscqi female sandflies by the goat (Capra hircis) was significantly higher than that of hamster (Mesocricetus auretus), Nile grass rat (Arvicanthis niloticus), gerbil (Tatera robusta) and chicken (Gallus domestica). However, two rodent species, A. niloticus and T. robusta did not differ significantly. A linear regression analysis of weights of animal baits and number of sandflies attracted revealed an insignificant result. The fluorescent dyes used to distinguish sandflies of different day experiments seemed not to influence the sandfly numbers in relation to the studied sandfly behaviour. Interpretation & conclusion: The similar attraction pattern of P. duboscqi in semi-field environment by CO2-baited CDC light trap and the goat provides hope for solution to the problem of fast dissipating dry ice (CO2 source) in the field. Goats can, therefore, also be utilized as deflectors of vectors of cutaneous leishmaniasis from humans in zooprophylaxis in Leishmania major endemic areas where the sandfly is found.

Relationship between left ventricular diastolic function and geometric patterns in Nigerians with newly diagnosed systemic hypertension

Background: It is not known whether abnormalities of left ventricular diastolic function are influenced by the various cardiac geometric patterns in Nigerians with newly diagnosed systemic hypertension. Objective: To evaluate the relationship between the parameters of left ventricular diastolic function and the geometric patterns in this group of patients. Methods: Two-dimensional; guided M-mode echocardiography including Doppler was performed in 150 consecutive; newly diagnosed hypertensive individuals and normotensive controls aged between 35 and 74 years. Left ventricular mass index and relative wall thickness were used to classify the hypertensive individuals into four geometric patterns; and the pulsed-wave Doppler parameters obtained were used to categorise the abnormalities of diastolic function. Results: Four left ventricular geometric patterns were identified : 23 (15.3) had normal left ventricle geometry; 33 (22) had concentric remodelling; 37 (24.7) were found to have eccentric hypertrophy; and concentric hypertrophy occurred in 57 (38) of the hypertensive individuals. Left ventricular diastolic dysfunction occurred more in hypertensives with concentric left ventricular geometric pattern.Increased left ventricular mass index and relative wall thickness were found to be associated with the mitral E-wave; E/A ratio and pulmonary venous flow S-wave in the hypertensives (p 0.001). Conclusion: In newly diagnosed Nigerian hypertensives; the abnormalities in left ventricular diastolic function varied between the different left ventricular geometric patterns; being worst in those with concentric geometry

Amazon Forest maintenance as a source of environmental services

Amazonian forest produces environmental services such as maintenance of biodiversity, water cycling and carbon stocks. These services have a much greater value to human society than do the timber, beef and other products that are obtained by destroying the forest. Yet institutional mechanisms are still lacking to transform the value of the standing forest into the foundation of an economy based on maintaining rather than destroying this ecosystem. Forest management for commodities such as timber and non-timber forest products faces severe limitations and inherent contradictions unless income is supplemented based on environmenta lservices. Amazon forest is threatened by deforestation, logging, forest fires and climate change. Measures to avoid deforestation include repression through command and control, creation of protected areas, and reformulation of infrastructure decisions and development policies. An economy primarily based on the value of environmental services is essential for long-term maintenance of the forest. Much progress has been made in the decades since I first proposed such a transition, but many issues also remain unresolved. These include theoretical issues regarding accounting procedures, improved quantification of the services and of the benefits of different policy options, and effective uses of the funds generated in ways that maintain both the forest and the human population.

A floresta amazônica produz serviços ambientais, tais como a manutenção da biodiversidade, da ciclagem de água e dos estoques de carbono. Estes serviços têm um valor muito maior para a sociedade humana do que a madeira, carne bovina e outros produtos que são obtidos destruindo a floresta. Mecanismos institucionais ainda estão faltando para transformar o valor da floresta em pé no alicerce de uma economia baseada em manter, em lugar de destruir, este ecossistema. Manejo florestal para madeira e para produtos florestais não-madeireiros enfrenta limitações severas e contradições inerentes a menos que a renda seja completada com base em serviços ambientais. A floresta amazônica é ameaçada por desmatamento, exploração madeireira, incêndios florestais e mudança climática. Medidas para evitar o desmatamento incluem repressão por comando e controle, criação de áreas protegidas, e reformulação de decisões sobre infra-estrutura e sobre políticas de desenvolvimento. Uma economia que é principalmente baseada no valor dos serviços ambientais é essencial para a manutenção a longo prazo da floresta. Muito progresso foi feito nas décadas desde que eu propus uma transição deste tipo, mas vários assuntos também permanecem não resolvidos. Estes incluem assuntos teóricos relativos aos procedimentos de contabilidade, quantificação melhorada dos serviços e dos benefícios de diferentes opções de política, e usos eficazes dos fundos gerados de modo que mantêm tanto a floresta como a população humana.