Evaluation of the Interventional Approaches in the Management of Cutaneous Leishmaniasis in Jazan: An Observational Study

BACKGROUND: Cutaneous leishmaniasis is a tropical infection of public health importance. Numerous treatment approaches are in practice with variable degree of success however its management has no universal consensus or practice guidelines to follow. OBJECTIVE: Analyze the management of cutaneous leishmaniasis retrospectively at a central hospital of Jazan Province, Kingdom of Saudi Arabia to identify the current treatment pattern and compare the outcomes. METHODS: This cross-sectional study was conducted based on the hospital records of patients who attended the dermatology clinic for cutaneous leishmaniasis during the year 2012 to 2015. RESULTS: Forty three patients were included in the study. There was a male preponderance (65.1%) among the patients and 60.5% of them were of pediatric age group. Monotherapy was the initial choice for 58.1% of the patients. Intralesional sodium stibogluconate (SS-IL) was the most preferred treatment for initial therapy, as monotherapy and as part of combination therapy. A complete response was achieved in 22 patients (51.2%) with initial therapy. Among the different treatment groups, SS-IL+itraconazole showed significantly higher complete response rate compared to other treatments offered as initial therapy (p<0.01). Initial SS-IL monotherapy provided complete response in 41.2% patients receiving it, while itraconazole monotherapy provided complete response in 75% and 90.9% of the patients receiving initial itraconazole+SS-IL combination therapy with achieved complete response. CONCLUSION: The findings and observations suggest that initial combination therapy with SS-IL+itraconazole significantly improved the complete response rates and thus reduced the need for additional or prolonged therapies.

Detection of Partial G6PD Deficiency using OSMMR2000-D Kit with Hb Normalization

Glucose-6-phosphate dehydrogenase (G6PD) deficiency is the most common enzyme deficiency worldwide including Malaysia. Screening of cord blood for partial G6PD deficiency is important as they are also prone to develop acute haemolysis. In this study, we determined the prevalence of partial G6PD deficient in paediatric population aged 1 month-12 years and normal term female neonates using OSMMR-D kit with haemoglobin (Hb) normalization and compare it with florescence spot test (FST). A total of 236 children, aged between between 1 month-12 years and 614 normal term female neonates were recruited for this study. Determination of normal means for G6PD activity and; cut-off points for partial and severe deficiency were determined according to WHO Working Group (1989). Determination of prevalence for partial deficiency for both groups (female patient) was done using this enzyme assay kit and findings were compared with FST. In this study, 15.7% (18/115) female children were classified as partial G6PD deficient by quantitative enzyme method (G6PD activity: 4.23-5.26U/gHb). However, FST only detected 0.9% (1/115) with minimal G6PD activity. The prevalence of partial G6PD deficiency in female neonate group was 3.42% (21/614) by enzyme assay versus 0.49% (3/614) by FST. This study concluded that our routine screening method using FST was unable to diagnose female heterozygotes. We recommend using this quantitative enzyme assay method by OSMMR-D kit since it was more sensitive in detecting G6PD deficiency in female neonates compared to FST.

Early Lineage Switch from T-Acute Lymphoblastic Leukaemia to Common B-All

Leukaemic stem cells have heterogenous differentiation potential. The immunophenotypes of blast cells are usually consistent throughout the disease course even at relapse. Rarely, blast cells may undergo a ‘lineage switch’ during the course of disease especially during relapse. We would like to highlight such a case in a 10-year old boy who presented with a two weeks history of lethargy, poor appetite, low grade fever, respiratory distress, cardiac failure, generalized oedema and hepatosplenomegaly. Full blood count showed a leucocyte count of 41.5x109/L and platelet count of 37x109/L. The peripheral blood film showed presence of numerous blast cells. Bone marrow aspiration revealed a hypercellular marrow, which consisted of mainly blast cells with high nuclear to cytoplasmic ratio and inconspicuous nucleoli. Immunophenotyping and cytochemistry results were consistent with the diagnosis of T-cell acute lymphoblastic leukaemia. The patient achieved remission after treatment with UK ALL 97 protocol, regime B chemotherapy. However, he relapsed seven months after the initial diagnosis with 26% blast cells in the bone marrow aspirate. The majority was L1 blast cells admixed with some L2 blast cells. Immunophenotyping was consistent with common precursor B acute lymphoblastic leukaemia. The treatment was changed to a more lineage specific chemotherapy. Nonetheless, the patient never achieved remission and was planned for palliative management. This case illustrated a unique and rare case of rapid lineage switch from T-cell acute lymphoblastic leukaemia to common precursor B-cell acute lymphoblastic leukaemia.

Hepatorotective effect of garlic [Allium sativum] and vitamin E on experimental liver injuries induced by ultraviolet radiation

Previous researches have demonstrated that the garlic and vitamin E were able to exert preventive properties against sunburn, delay the onset of skin tumors and reduce radiation induced tissue damage. These compounds may act as antioxidants able to scavenge free radicals and lipid peroxidation. The aim of the present study is to investigate the possible protective effect of garlic and vitamin E against ultraviolet radiation induced liver damage. A total of 60 male albino rats weighing 180-200 g were used in this study. The rats were divided into six groups. Each group contained 10 rats. Group [1] Animals were kept as control. Group [2] Animals were exposed to ultraviolet C-rays 180-280 nm for 30 successive days. Group [3] was given ethanolic extract of garlic at dose level of 0.18 ml/100 g.15 min before exposure to ultraviolet C-rays 180-280 nm for 30 successive days. Group [4] was given vitamin E at dose level of 100 mg/kg b. w 15 min before exposure to ultraviolet C-rays 180-280 nm. The fifth and sixth groups were given garlic and vitamin E respectively for 30 successive days. Histopathological effects in liver were demonstrated as necrosis, fibrosis, fatty changes, inflammatory cellular infiltration and vacuolar degeneration. Deep nuclear basophilia and karyolysis were also seen in some hepatocytes. No pathological, histochemical and ultrastructural changes could be observed in rats treated with garlic or vitamin E. Histochemical results showed marked diminution of glycogen content, DNA, protein content and increase in collagen deposition. Ultrastructural changes were observed in irradiated rats in the form of areas of cytoplasmic dissolution, partial clumping of nuclear chromatin and partial disappearance of nuclear membrane. Mitochondria had dense matrix with proliferation and vesiculation of endoplasmic reticulum. The treatment of rats with ethanolic extract of garlic or vitamin E before exposure to ultraviolet C-rays alleviated the deleterious effects of ultraviolet radiation

Genotoxicity of ranitidine-Hcl histochemical cytogenetical and teratological study

Ranitidine-HCl is widely prescribed by Egyptian physicians as an acid-supperssing medication in patients with some gastrointestinal diseases. It is frequently continued when symptoms persist. The genotoxicity of ranitidine is controversial. In the present study, its genotoxicity was assessed after drenching pregnant mice [from the 6[th]-15[th] day of gestation] saline, half therapeutic, therapeutic or double therapeutic doses of ranitidine. Teratogenicity in the offspring were detected. Chromosomal aberration were assessed in bone marrow cells of the mothers, and the embryonic cells of the 18-day embryos. The DNA frequency distribution in mother's hepatocytes and placenta were measured and statistically analyzed. Teratogenic study indicated that ranitidine causes a dose related decrease in body weight and skeletal size. The cytogenetic data indicates that ranitidine administration results in a dose dependent increase in the total aberration in both mothers and embryos. The rate of increase in polyploidy in relation to the dose is higher in mothers than embryos. The frequency distribution of DNA in hepatocytes of pregnant mice shows that the population of cells in the sub G2 representing apoptotic cells, hyper G2 representing S-hase and aneupoloid cells, and polyploid cells are increasing in dose dependent fashion. Such changes were less pronounced in the cells of the placenta. In conclusion, oral administration of ranitidine-HCl results in genotoxic features especially in adult pregnant mice

Protective effect of melatonin, methionine and zink on cadmium nephrotoxicity: histopathologically, histochemically and AgNORs quantitation

Cadmium [Cd] is a highly toxic heavy metal that is naturally present in the environment. Chronic exposure to Cd causes hepatotoxicity and nephrotoxicity. The present study aimed to study the protective effect of melatonin, methionine and zinc against histopathological, histochemical and proliferative effects of cadmium on the kidney of rats. A total of 80 female albino rats were included in this study and divided into 8 groups. They were injected intraperitonealy with cadmium chloride [CdCl2] [2 mg / kg b.w.], melatonin [10 mg / kg b.w.], methionine [42.8 mg / b.w.] or zinc [20 mg / kg b.w.] with or without CdCl2 daily for 10 days. Treatment with CdCl2 induced marked tubular cell degeneration with large areas of interstitial hemorrhage.There were marked destruction of the brush borders with decrease in glycogen and protein contents of the degenerated tubules. AgNORs count significantly increased. Injection of melatonin or methionine to CdCl2 treated rats resulted in improvement of Cd-induced histopathological and histochemical changes. AgNORs count significantly decreased. Zinc injection partially protected the kidney from Cd-induced effects. In conclusion, melatonin and methionine have a more protective effect than zink against Cd nephrotoxicity