Studies on the Antibacterial Susceptibility of Uropathogens to Senna alata Extracts in Calabar, Cross River State, Nigeria

Background: Senna alata is an underutilized shrub found in many countries and is known for its traditional use in the treatment of dermatophytes and other related diseases. Therefore, this study aimed at evaluating the phytochemical and antibacterial effects of S. alata leaves extracts against bacterial isolates obtained from urinary tract infection patients in Calabar. Methodology: Matured fresh leaves of Senna alata were collected within Calabar, Cross River state, Nigeria, in May 2022 and identified by a botanist in the Department of Botany, University of Calabar. The leaves of S. alata were extracted with water, methanol and ethyl acetate using maceration and soxhlet methods. Phytochemical analysis was conducted to detect the presence of bioactive compounds using standard methods. The crude extracts of S. alata were investigated for antibacterial properties using agar well diffusion method and mechanisms of antibiosis determined using MBC/MIC ratio. Results: In both methods of extraction, methanol yielded more extracts compared to other solvents. Soxhlet methanol extract (SaMeSh) had the highest (12.21%) percentage yield while maceration ethyl acetate extract (SaEaMa) had the least (4.77%) percentage yield. The phytochemicals assayed revealed the presence of saponins, tannins, flavonoids, anthraquinones, terpenoids and steroids. However, terpenoids was not detected in methanol and ethyl acetate extracts. Senna alata extracts demonstrated broad spectrum of activity against the tested isolates at various concentrations with organic solvents exhibiting the highest antibacterial activity. However, the observed activity varied with respect to concentration of extract and types of organisms. The MIC values ranged from 31.25 to 250 mg/mL and MBC values from 62.5 to 500 mg/mL. The MIC index of the crude extracts against the test uropathogens was ?8. Conclusion: This study indicates that S. alata could be a source of novel antimicrobial agent. Further research is required to isolate, characterize and identify bioactive constituents responsible for the observed activity.

Revisiting the Concept of Non- and Minimally Invasive Interventions in Early Glottic Cancer - Part II: Single Therapy Should be Favored over the Combination of Transoral Laser Microsurgery and Radiotherapy, Regarding the Postinterventional Voice Quality

Abstract Introduction Early glottic cancer (EGC) is associated with a high cure rate. Hence, patients and physicians also focus on the impact of the proposed treatment on the speaking function of the preserved larynx. Objectives The present study assessed the impact of single-modality treatment (transoral laser microsurgery [TLM], or radiotherapy) or combination therapy for EGC on post-interventional voicing and explored factors which might explain the related perceptions. Methods A total of 108 patients filled in the voice handicap index 10 questionnaire, 1 and 2 years postinterventionally. Non-parametric tests were used for the respective statistical analyses. Results Sixty-four patients were treated with TLM, 15 with radiotherapy, and 29 with both modalities. Transoral microsurgery and radiotherapy were associated with post-interventional dysphonia, which attenuated between the first and second postinter-vention year (p = 0.000). No association between sociodemographic parameters and the attenuation of postinterventional dysphonia was identified for either treatment modality. Transoral microsurgery and radiotherapy resulted in comparable postin-terventional voicing, in the first (p = 0.940) and second (p = 0.196) postintervention years. The addition of TLM to radiotherapy resulted in worse voice quality in the second, compared with the first postintervention year (p = 0.000), demonstrating a detrimental effect on speech intelligibility in noise (p = 0.000). Conclusion Single therapy should be favored over the combination of TLM and radiotherapy for EGC in terms of retaining better postinterventional voice quality. Postinterventional dysphonia should be taken into account, during preinterventional counseling, as it may exert leverage on the quality of patients' lives. Patients and physicians should acknowledge the optimal time of voice function return, which seems to be extending up to two years posttreatment.

Is Auditory Steady-State Response Testing the Key for Diagnosing Non-Organic Hearing Disorders? Implications for Current Audiological Practice

Background and Objectives@#To describe all possible facets of non-organic hearing disorders (NOHD) and emphasize the superiority of auditory steady-state response (ASSR) over previously employed hearing assessment tools. @*Subjects and Methods@#A series of seven patients consisting of three males and four females with NOHD were assessed at Attikon University Hospital (age range: 17-59 years). Three patients had Munchausen syndrome, three intentionally feigned hearing loss, and one intentionally feigned normal hearing. The audiological evaluation consisted of tympanometry, pure-tone audiometry, and ASSR testing. @*Results@#The hearing of all patients was accurately determined using ASSR. The results were confirmed by auditory brainstem responses (ABR) and otoacoustic emissions. @*Conclusions@#NOHD is a multi-faceted condition encompassing various etiologies. ASSR testing represents an objective and reliable method of hearing assessment, which can serve as a gold standard method for distinguishing NOHD from actual hearing loss. It can reliably indicate the hearing levels at the four main frequencies (500, 1,000, 2,000, and 4,000 Hz) by obtaining a valid estimated audiogram through statistical measures. Compared to ABR testing, ASSR thresholds are closer to the actual audiometric thresholds in the presence of hearing impairment and are superior when the corresponding pure-tone audiogram is widely ranging between the adjacent frequencies or when the obtained ABR curves are not easily distinguished. A non-confrontational approach should be adopted by ENT doctors towards cases of suspected NOHD as the use of ASSR could reliably assess hearing even when medical or medico-legal implications are involved.

A comparative study on erlotinib & gefitinib therapy in non-small cell lung carcinoma patients

Background & objectives: Tyrosine kinase inhibitors (TKIs) targeting the epidermal growth factor receptor (EGFR) have been evaluated in patients with advanced non-small cell lung cancer (NSCLC). Erlotinib and gefitinib are the first-generation EGFR-TKIs for patients with NSCLC. However, there is a paucity of studies comparing the effectiveness of these two drugs. Hence, this study was aimed to compare the effectiveness and safety of erlotinib and gefitinib in NSCLC patients. Methods: This study included 71 NSCLC patients who received EGFR-TKIs between 2013 and 2016. Adverse drug reaction of both erlotinib (n=37) and gefitinib (n=34) was determined and graded according to Common Terminology Criteria for Adverse Events grading system. Effectiveness was measured using response evaluation criteria in solid tumours and progression-free survival (PFS). Pharmacoeconomic analysis was performed by cost-effective analysis. Results: When comparing safety profile, both the drugs had similar adverse events except for dermal side effects such as acneiform eruption (51.4%), rash (54.05%) and mucositis (59.5%) for erlotinib and 20.6, 26.5 and 29.4 per cent for gefitinib, respectively. The PFS of the two drugs was compared to differentiate the effectiveness of erlotinib and gefitinib. There was no significant difference between the effectiveness of the two drugs. The pharmacoeconomic analysis showed that gefitinib was more cost-effective than erlotinib. Interpretation & conclusions: This study showed that erlotinib and gefitinib had similar effectiveness but gefitinib had a better safety profile compared to erlotinib. Therefore, gefitinib could be considered a better option for NSCLC patients compared to erlotinib. However, further studies need to be done with a large sample to confirm these findings.

What motivates an ASHA? Narratives from Ramanagara district, Karnataka

Background: The National Rural Health Mission (NRHM) aimed to bridge the gap in rural health care with the introduction of the Accredited Social Health Activist (ASHA) in 2005. It is essential to identify the motivators and barriers to work performance by the ASHAs in order to facilitate better health care in the community. Objective: To identify the motivators and barriers to the work performance of ASHAs in the Solur PHC area, Ramanagara district, Karnataka. Material & Methods: A qualitative study was conducted in one PHC area of Ramanagara District, Karnataka. Four KIIs with government health functionaries and one FGD with nine ASHAs were conducted. A thematic frame-work approach was used for data analysis. Results: The main personal motivators were altruism and intrinsic satisfaction, while social support and team-work were important environmental motivators. De-motivating factors were financial problems such as insufficient pay and irregular financial incentives, as well as logistic difficulties, including transportation and safety. Conclusion: Personal, cultural, financial considerations and working conditions affect the performance of an ASHA. It is essential to address relevant issues faced by these health workers in order to improve their work satisfaction and efficiency.

Saturated Fatty Acid Intake as a Risk Factor for Cardiovascular Disease in Healthy Caucasian Adults from Western Populations.

Background: Cardiovascular disease (CVD) is the leading cause of premature death globally (WHO, 2010).For over 50 years saturated fatty acids (SFA) have been implicated as a main dietary risk factor for CVD. Therefore national guidelines recommend limiting SFA to <10% of total daily energy intake COMA, [1]. However, recent literature has begun to question this advice due to contra evidence showing SFA not to be a risk factor for CVD, Hoenselaar [2]. This study’s aim was to investigate the relationship between SFA and CVD to assess whether or not recommendations should be made to review national guidelines. Method: A systematic review and meta-analysis were conducted. Electronic research databases were searched using variations of the keywords “saturated fatty acids” and “cardiovascular disease”. Articles were only included if they had a randomised control trial (RCT) or prospective cohort (PC) study design. Additionally participants had to meet the following criteria: Caucasian, non-smokers, normal BMI, classed as healthy, no preexisting CVD related conditions, not taking cholesterol altering drugs and no inborn errors of lipid metabolism. Articles were also only included if they were conducted in western populations in an attempt to standardise environmental factors. In the PCs, only data which was adjusted for these factors was included. Articles were assessed for quality using the Jadad et al. [3] scoring/CASP tool and for confounding variables, risk of bias and homogeneity. Results: A total of 411 articles were identified. Eight articles were included after exclusion for duplication, study design, not meeting full inclusion criteria, low quality, confounding variables, high risk of bias and heterogeneity. Of these, 4 were RCTs and 4 were PCs including 193,409 participants (192,686 female, 723 male). RCT and PC data were analysed separately. For the RCTs, LDL-cholesterol concentration post high/low SFA intervention was used as a functional biomarker for CVD risk. For the PCs the number of CVD related events in the low/high SFA diet groups was used as the marker for CVD risk. In the RCT meta-analysis there was a standard mean difference (95%CI) of -0.94 (-1.17, - 0.71) (p<0.00001) favouring the low SFA diet to decrease the risk of CVD. In the PC metaanalysis a risk ratio (95%CI) of 1.00 (0.64, 1.58) (p=1.00) showed there to be no statistically significant relationship between SFA and CVD. Sensitivity analyses conducted predominantly showed no change in outcome. Discussion: RCT outcomes favoured a low SFA diet for lowering CVD risk whereas the PC outcome showed no relationship. Although these differed they indicate that SFA does not increase CVD risk in western Caucasian adults. However further research is needed before requesting recommendations for the review of national guidelines. These findings correlate with other systematic reviews/meta-analyses e.g. Skeaff and Miller, [4]. Conclusion: From the studies included SFA does not increase CVD risk in affluent Caucasian adults.

Epidural ketamine for postoperative analgesia in the elderly

We assessed the epidural use of ketamine in elderly patients undergoing major abdominal surgery. Patients older than 65 years were randomly allocated to receive preemptive epidural bupivacaine 0.125% [20 ml] combined with either epidural ketamine 40 mg [ketamine group], or epidural morphine 2 mg [morphine group]. Postoperatively, boluses of 0.125% bupivacaine [5 ml] supplemented with ketamine [2 mg/ml] or morphine [0.1 mg/ml] were given until a pain score of two was established. Analgesia at rest was assessed by a verbal rating score [0 = no pain, 1 = mild pain. 2 moderate pain, 3 = severe pain] at 1h, 2h, 6h, 12h and 24h after surgery. The patient's degree of sedation was assessed using the Ramsay sedation score and episodes of nausea and vomiting [PONV] were recorded. Patients in the morphine group were more sedated but had significantly lower pain scores and requested less rescue analgesic than patients receiving epidural ketamine [P <0.05]. In the morphine group three patients were treated for PONV while none of the patients in the ketamine group showed PONV. Epidural ketamine, when compared to epidural morphine, appears to be associated with less sedation and a smaller risk of PONV, but necessitates more frequent or continuous administration to achieve comparable analgesia

Some novel approaches for radioprotection and the beneficial effect of natural products.

Due to the increased use of ionizing radiation in various aspects of human life especially in areas pertaining to radiotherapy of cancer, food preservation, agriculture, industry and power generation, there is a need to develop an effective and non-toxic radioprotector. The currently available ones have many drawbacks including high cost, side effects and toxicity. Several novel approaches are on to locate a potent radioprotector. These include mimics of antioxidant enzymes, nitroxides, melatonin, growth factors, gene therapy, hyperthermia apart from natural products. The latter has several advantages since they are non-toxic with proven therapeutic benefits. These can be classified as natural compounds and plant extracts; polyherbal formulations; besides natural and semi-natural compounds of plant origin. A review of the above agents, their efficacy in radioprotection and possible mechanisms responsible has been carried out. As India and many Eastern countries have an enormous heritage of vast natural dietary and time tested medicinal resources it is worth exploring the possibility of developing efficient, economically viable and clinically acceptable radioprotectors for human application from these resources.

Is ultrasonography essential before surgery in eyes with advanced cataracts?

BACKGROUND: Ultrasonography is an important tool for evaluating the posterior segment in eyes with opaque media. AIM: To study the incidence of posterior segment pathology in eyes with advanced cataract and to see whether certain features could be used as predictors for an abnormal posterior segment on ultrasound. SETTING: Tertiary care hospital in South India. METHODS AND MATERIALS: In this prospective study conducted over a 6-month period, all eyes with dense cataracts precluding visualization of fundus underwent assessment with ultrasound. Presence of certain patient and ocular "risk" factors believed to be associated with a higher incidence of abnormal posterior segment on ultrasound were looked for and the odds ratio (OR) for posterior segment pathology in these eyes was calculated. RESULTS: Of the 418 eyes assessed, 36 eyes (8.6%) had evidence of posterior segment pathology on ultrasound. Retinal detachment (17 eyes; 4.1%) was the most frequent abnormality detected. Among patient features, diabetes mellitus (OR= 4.9, P= 0.003) and age below 50 years (OR= 15.4, P= 0.001) were associated with a high incidence of abnormal ultrasound scans. In ocular features, posterior synechiae (OR= 20.2, P= 0.000), iris coloboma (OR= 34.6, P= 0.000), inaccurate projection of rays (OR= 15.1, P= 0.002), elevated intraocular pressure (OR= 15.1, P= 0.004) and keratic precipitates (OR= 22.4, P= 0.004) were associated with high incidence of posterior segment pathology. Only four eyes (1.5%) without these features had abnormal posterior segment on ultrasonography. CONCLUSIONS: Certain patient and ocular features are indicative of a high risk for posterior segment pathology and such patients should be evaluated by ultrasonography prior to cataract surgery. In the absence of these risk factors, the likelihood of detecting abnormalities on preoperative ultrasonography in eyes with advanced cataracts is miniscule.

The effects of cyclophosphamide treatment on the pathogenesis of subgroup J avian leukosis virus (ALV-J) infection in broiler chickens with Marek's disease virus exposure

Studies were performed to determine the effects of Bcell suppression on the pathogenesis of Subgroup J avian leukosis virus (ALV-J) in broiler chickens. Neonatal chickens were treated with cyclophosphamide (CY) or PBS, and then infected with ALV-J (ADOL-7501) at 2 weeks of age. CY treatment induced B cell specific immunosuppression throughout the experiment confirmed by decreased bursal weight, intact lymphocyte mitogenetic activity stimulated by Con A and increased relative subpopulation of CD3-positive cells as measured by flow cytometry. Chickens in this experiment had Mareks disease virus exposure prior to three weeks of age as determined by the presence of lymphocytic infiltration and antibody. Virus neutralizing antibody against ALV-J was first observed at 6 weeks post-infection in some of the infected chickens in the PBS group. As expected, none of the chickens from the CY group and uninfected chickens developed virus-neutralizing antibody. The viremic status was measured by real time RT-PCR using SYBR green I dye. The percentage of viremic chickens was significantly higher, and more chickens had high titered viremia, in the CY treated group. No neoplastic foci consistent with ALVJ infection were observed in any of the experimental chickens. The frequency and intensity of viral antigen expression determined by immunohistochemistry was significantly higher in tissues from CY treated birds than those of PBS treated chickens at 3 weeks post-infection. This study showed that B cell specific immunosuppression with CY treatment in chickens resulted in increase in viremia and viral antigen load in tissues.

Severe acute respiratory syndrome.

Severe acute respiratory syndrome (SARS) is a form of atypical pneumonia that apparently originated in Guangdong Province of the People's Republic of China in late 2002. This first came to the world's attention in late February 2003, and has since spread worldwide. As of June 23rd 2003, the disease had been reported from 32 countries or regions globally, affecting 8459 people; 805 individuals (9.5 % of the total affected) have died of the disease. A novel coronavirus, the SARS-associated coronavirus (SARS- CoV) has been found in various specimens taken from patients with SARS. Although there has been rapid development of tests to detect SARS Co-V, these tests presently have certain limitations. Definitions of suspected, confirmed and probable cases have been formulated. Measures currently used for the management of patients with SARS include isolation, ribavirin, corticosteroid therapy and mechanical ventilation. Unfortunately, almost 10 % of affected patients succumb to their illness, underlying the need for developing more effective therapy. It remains to be seen how long it will take to bring this epidemic under control.

Effects of cyclosporin A treatment on the pathogenesis of avian leukosis virus subgroup J infection in broiler chickens with Marek's disease virus exposure

In this study, we investigated the effects of T-cell suppression on the pathogenesis of subgroup J avian leukosis virus (ALV-J). Chickens were treated with cyclosporin A (CSP) 50 mg/Kg body weight or a corresponding volume of olive oil per every three days after hatching until the end of experiment. Some of the chickens from each treatment group were infected with an isolate of ALV-J, ADOL-7501, at 2 weeks of age. The effects of viral infection were compared to uninfected birds in same treatment group. Intramuscular injection of CSP induced significant T-cell specific immunosuppression determined by decreased cutaneous basophilic hypersensitivity response and decreased lymphocyte mitogenic activity using concanavalin A. Most of the chickens examined had Marek's disease virus infection prior to 3 weeks of age. The percentage of antibody-positive birds and antibody titers were similar in infected chickens between both treatment groups. The ratio of viremic chickens was significantly higher in CSP treated group than that of the Oil treated group. Microscopically, one CSP treated chicken had a nephroblastoma at 10 weeks post infection. At 7 and 10 weeks post-infection, more chickens had myeloid cell infiltrations in multiple organs including heart, liver and occasionally lung. Expression of ALV-J viral antigen determined by immunohistochemical staining was significantly higher in CSP treated chickens than Oil treated chickens at 10 weeks post-infection. This study indicated that chemically-induced T-cell suppression may enhance pathogenicity of the AVL-J virus in broilers.

From the classical AO compression plate to the new internal fixator principle / 中华创伤骨科杂志

The importance of the biology and the care for the soft tissues and bone during internal fixation of the fracture, as the fourth AO principle, had been stressed. A conventional AO compression plate pressed against the bone surface interferes with the cortical blood flow and induces structural changes underneath the plate. Low contact dynamic contact plate(LC- DCP) could reduce the area of contact between plate and bone undercuts. Locking head screws, the Point Contact Fixator (PC Fix), and the Less Invasive Stabilisation System (LISS) had the next evolution.The so- called internal fixator can be considered as an external fixator, which has been approximated very close to the bone, however, without actually touching or compressing bone. This feature prevents any additional damage to bone vascularity. The stability of the internal fixator depends on the angular stability of the screw- plate combination. The new LISS and Locking Compression Plate( LCP) offer new options and challenges in modern operative fracture care. These implants are ideal for the MIPO (minimally invasive (percutaneous) plate osteosynthesis) and appear to have a considerably better purchase in osteoporotic bone. Nevertheless, it must be stated that these new plates and screws do not solve all problems, either as they too demand a very careful planning of every procedure, which includes a re- thinking of the classical AO principles, especially when addressing meta- and diaphyseal fractures.