Résumé
The discovery of the key enzymes, receptors, and transporters in cholesterol biosynthesis has enabled us to assemble fragments of knowledge concerning lipids and lipoproteins into dynamic pathways, leading to the development of a multitude of lipid-lowering drugs. After a brief recapitulation of the pathways of cholesterol metabolism and the dermatologic manifestations of lipid derangement, we shall review drugs which modify intestinal cholesterol and bile-acid reabsorption, and hepatic lipoprotein biosynthesis and catabolism. The current literature is examined to determine future therapeutic targets in lipid metabolism, as well as the role of traditional foods as lipid-lowering agents. The latest National Cholesterol Education Program guidelines for managing hypercholesterolemia are also discussed.
Résumé
valley in Himachal Pradesh (India) lies in north-western Himalayas (30°N, 70°E). This endemic focus of leishmaniasis appears peculiar where localized cutaneous leishmaniasis (LCL) co-exists with visceral leishmaniasis (VL), and Leishmania donovani is predominant pathogen for LCL whereas only a few cases have been due to Leishmania tropica. This study was carried out to collect sandflies, identify and delineate their habitat and role in transmission of human leishmaniasis in this endemic focus. Methods: During June 2003 to September 2007, 142 (M–22, F–120) sandflies were collected with aspirators from 10 endemic villages of Kinnaur and Shimla districts. Results & conclusion: Sixty-two of the identified sandflies caught belonged to the genus Phlebotomus species, including some species that are known to act as vectors of the parasites causing human leishmaniasis. The Phlebotomus (Adlerius) chinensis longiductus (Parrot), 1928 (28 sandflies), P. major (8 sandflies), P. (Larroussius) kandelakii burneyi (Lewis), 1967 (8 sandflies) were identified. The identification of the main species of vector sandfly in the region is complicated because it is still uncertain which Leishmania species cause(s) the local human leishmaniasis. Circumstantially it seems likely, however, that Phlebotomus (Adlerius) chinensis longiductus is the main vector. Other species found, such as P. major and P. (Larroussius) kandelakii burneyi, may also be responsible for some cases. A more elaborate study is recommended.
Résumé
BACKGROUND: Intralesional sodium stibogluconate (SSG) has become first line therapy for localized cutaneous leishmaniasis (LCL). AIMS: This study compares the efficacy of intralesional SSG given alone with that of intralesional SSG combined with intramuscular SSG. METHODS: Thirty-two patients aged between 5-56 years were included in the study. The first group received three injections of intralesional SSG on alternate days while the other group received three injections of intralesional SSG similar to the first group and the rest of the calculated dose as a simultaneous, intramuscular injection. Patients were followed up every four weeks to assess for cure/ the need for repeating the treatment. RESULTS: Five patients from group 1 having small nodular lesions of < six months duration were cured after 1-2 treatment cycles. However, six patients with mucosal lesions, large lesions and lesions of > six months duration needed 3-5 treatment schedules. Most plaques and mucosal lesions in seven patients in group 2 cleared with two treatment cycles. CONCLUSION: Intralesional combined with intramuscular SSG appears more effective in LCL and gave qualitatively superior healing than intralesional SSG given alone.