Current knowledge of dengue pathogenesis and potential role of Carica papaya and vitamins in dengue fever

A number of biological molecules such as inflammatory enzymes and cytokines are altered during dengue virus (DENV) infection, many of which are attributed to the pathogenesis of the DENV infection. Papaya (Carica papaya) based extracts (PBE) and certain vitamins have been proven beneficial for dengue fever (DF) patients. The extract of papaya leaves were shown to improve platelet count in dengue patients. Extracts of papaya pulp based was also shown to induce in vitro IL-6 and stem cell factor in human peripheral blood mononuclear cells and stem cells of mesenchymal origin. Different vitamins such as D, E, and C have shown promise to treat dengue disease when taken in small supplementation trials. However, the exact molecular mechanisms on the beneficial roles of either PBE or vitamins are yet to be defined. Hence, the aim of this review is to link the cellular and molecular responses of DENV pathogenesis and pharmacological actions of the bio-active components of PBE or vitamins. It has also been shown that the beneficial roles of PBE and vitamins in DF are linked to thrombopoiesis, prevention of the viral entry and replication, decrease in oxidative damage assisted thrombocytopenia, and the reduction in vascular leakage. The DENV mediated fatalities are expected to expand it’s geographic boundary whilst an efficient drug and the most likely candidate vaccine against DENV are still in progress. Findings on the molecular mechanisms of food and nutrient supplement might reinforce ongoing research to treat the increasing number of DENV infected patients using natural products while waiting for the right drug and vaccine.

Management of laryngopharyngeal reflux disease

To evaluate the efficacy of medical, dietary and lifestyle modification therapy given to Laryngopharyngeal reflux [LPR] patients. Private clinic, Al-Khobar, Saudi Arabia. Prospective study. Twenty-two LPR patients were examined and treated by the author. Patients' larynges were evaluated by either video endoscopy, endoscopy only or indirect laryngoscopy. Belafsky Reflux Finding Score [RFS] and Reflux Symptom Index [RSI] were used to assess symptoms, findings and improvements. The patients were treated with 40 mg Proton Pump Inhibitor [PPI], dietary and lifestyle modification therapy for at least 3 months. Patients were followed up monthly for the first 3 months and then bimonthly for the rest of the year. Improvements were assessed using the RFS and RSI, the scale was from 0-3. Twenty two patients with suspected LPRD were included in the study, 15 males and 7 females; the mean age was 40 year. Eleven had video endoscopy, 8 endoscopy and 3 indirect laryngoscopy [rigid fibro-optic]. The main symptoms were hoarseness, throat clearing, cough and heartburn. The main findings were laryngeal redness, vocal cord [VC] edema, posterior commissure and arytenoid erythema and edema. Thirteen patients were adherent to management and follow up program, nine were excluded. All the 13 patients showed subjective and objective improvement ranging from good to excellent. One patient developed VC polyp and had to be removed surgically. The mean follow up [FU] was 6.5 months. The study showed that 40 mg PPI [Nexium tablet] per day for at least 3 months combined with diet and lifestyle modification therapy were sufficient to improve the symptoms of laryngopharyngeal reflux. RFS and RSI are excellent tools to assess improvement. Long term FU is needed to achieve a satisfactory outcome

efficacy of repositioning maneuver in the management of benign paroxysmal positional vertigo

Benign Paroxysmal Positional Vertigo [BPPV] is a very common vestibular disorder. It is characterized by short lasting positional vertigo. Different etiology may be responsible for it. The diagnosis is based on history and on the nystagmus findings. Treatment of choice is the repositioning maneuver after Epley and/or Semont. To assess the efficacy of the Repositioning Maneuver [RM] in the management of Benign Paroxysmal Positional Vertigo [BPPV]. ENT Clinics, Al Khobar, Saudi Arabia. Prospective study. Fourteen patients complaining of vertigo from May 2007 to May 2009 were included in the study. All patients were seen, examined and treated by the author. After a detailed history, audiological and vestibular tests were performed. The patients either been subjected to Epley and/or the Semont maneuver. Fourteen patients aged 30-64 years [mean 49 years], 8 males and 6 females were included in the study. All were complaining of acute short lived positional vertigo. Examination of patients showed positive Dix-Hallpike test [DHT], some canal paresis, abnormal gait test and sensorineural hearing loss. Thirteen patients were free of symptoms after the maneuvers. One showed no improvement. Patients with dizziness have to be rehabilitated. Mean follow up was 3 months. Epley and Semont maneuvers are very effective procedures to treat benign paroxysmal positional vertigo. In this study, eleven out of fourteen patients were relieved of their symptoms. The recommended time for follow up is 3 months and for reassessment one month

Epistaxis; causes and management at King Fahd hospital of the University

Objective:To study the causes of epistaxis and its management and to compare it to the current literature. Setting: A retrospective study of all cases of epistaxis seen between January 1997 - December 1999 in the ENT department of King Fahd Hospital of the University [KFHU], Al-Khobar. All patients underwent a general evaluation. Vital signs were monitored and resuscitation was carried out when needed. An intravenous line was secured, and a full blood count and coagulation profile were ordered on presentation. All patients were initially treated conservatively, by anterior and/or posterior nasal packing, or by chemical or galvanocautery. There were 204 epistaxis patients during the period under study. Their ages ranged between 2-60 years, and 64.4% were aged 20 or under. Male to female ratio was 2.7:1. The main causes of epistaxis were nose picking in 33%, external trauma 31%, rhinosinusitis in 20%, bleeding disorder in 7.3% idiopathic 6.7%, post septoplasty in 1% and in 1% due to angiofibroma. Eight per cent were hospitalized. The remaining 92% were treated as outpatients cases. Conservative treatment controlled epistaxis in all but three patients who required surgery. Five patients required blood transfusion [1.96%]. At follow-up, 8% reported mild attacks of epistaxis which stopped spontaneously and did not require treatment. Conservative treatment for epistaxis is still successful in controlling epistaxis in the majority of patients. Arterial ligation is rarely required in patients who do not respond to conservative measures. The value of coagulation screening should not be underestimated

Short stature and truncal shortening in transfusion dependent thalassemia patients: results from a thalassemia center in Malaysia.

One of the major complications in patients with transfusion dependent thalassemia is growth impairment secondary to iron overload. We studied the growth status in 66 patients with beta-thalassemia major and HbE-beta thalassemia who were transfusion dependent, aged from 2 to 24 years, and 66 controls matched for sex and age. The prevalence of short stature in transfusion-dependent thalassemics was 54.5% compared to 4.5% in control group (p<0.001). Short stature was more prevalent in those above the age of 10 years in this study group (83.3% vs 16.7%). Transfusion dependent thalassemics with short stature were found to have significantly lower mean standing height standard deviation scores (SDS), sitting height SDS and subischial leg length SDS values (p<0.001). There was also a significant difference between the mean sitting height SDS and the mean subischial leg length SDS in our thalassemics with short stature, suggesting that the short stature was due to disproportionate truncal shortening. Serum ferritin levels were significantly higher in transfusion dependent thalassemics who were short compared to those who were of normal height (p = 0.002). However, the mean pre-transfusion hemoglobin levels did not differ significantly between patients with short stature and those with normal height (p = 0.216). The prevalence of short stature also did not differ significantly between those with beta-thalassemia major and those with HbE-beta thalassemia (p = 0.32). This study highlighted the importance of providing optimal treatment in these patients, including monitoring of growth parameters and optimizing iron chelation therapy.

Quantitation of T lymphocyte subsets helps to distinguish dengue hemorrhagic fever from classic dengue fever during the acute febrile stage.

Activation of immunoregulatory T lymphocyte subsets has been observed in dengue viral infection, being more evident in dengue hemorrhagic fever (DHF) than in classical dengue fever (DF). There are, however, as yet no well-defined host markers to determine which patients with dengue viral infection will develop severe complications during the acute febrile stage of the disease. A study was performed to compare the cellular immune status in DHF, DF and non-dengue viral infections (NDF) in order to determine the value of these parameters in distinguishing DHF from classic DF and other viral infections during the acute febrile stage of the disease. This study involved 109 febrile patients admitted because of suspected DHF. Fifty patients were serologically confirmed cases of dengue infection, of which 25 had grade 1 or 2 DHF. There was a reduction in total T (CD3), CD4 and CD8 cells in DHF and demonstrated that a low level of CD3, CD4, CD8 and CD5 cells discriminated DHF from DF patients during the febrile stage of the illness. In contrast, B (CD19) cells and natural killer (NK) cells did not appear to be discriminatory in this study. Receiver operating characteristic (ROC) curve analysis showed that a combination of CD3 cell of < or = 45% and CD5 cell of < or = 55% was the best marker to identify DHF patients (sensitivity = 84% and specificity = 52% for CD3 cell of < or = 45%; sensitivity = 92% and specificity = 71% for CD5 cell of < or = 55%). CD4 cell of < or = 25% and CD8 cell < or = 30% were equally good in discriminating DHF from DF patients. On the other hand, the ROC curves indicated no clear difference between the immunoregulatory cell counts in DF from NDF Lymphopenia, atypical lymphocytosis and thrombocytopenia were significantly more evident in dengue compared to non-dengue infection but did not appear to be discriminatory among DHF and DF patients. The reduction in CD3, CD4, CD8, CD5 cells correlated with the degree of thrombocytopenia in DHF (p < 0.05) which suggests that these cells probably participate in a common pathogenetic mechanism.