An outbreak of schistosomiasis in travellers returning from endemic areas: the importance of rigorous tracing in peer groups exposed to risk of infection.

BACKGROUND: Each year, schools across Scotland send their students on exchange programmes to Malawi. Between 2005 and 2009, 22.8% of Scotland's new cases of schistosomiasis were from freshwater exposure in Malawi, with 41.5% diagnosed in 15-24 year olds. In January 2011, a 17-year-old male presented to our urology department with visible haematuria following freshwater exposure during a school trip to Malawi. He was subsequently diagnosed with urinary schistosomiasis. METHODS: The potential involvement of other individuals from the trip prompted further public health enquiry. The school, public health department and education authorities were notified promptly and all individuals potentially exposed to Schistosoma haematobium were invited for screening. RESULTS: All 21 participants of the exchange programme underwent serological screening. Thirteen tested positive for Schistosoma infection. Only two individuals displayed symptoms of schistosomiasis; the other 11 were asymptomatic. CONCLUSIONS: Infection rates, even following a limited exposure to S. haematobium, are high. The majority of seropositive cases may never have symptoms. Therefore, a history of foreign travel to endemic schistosomiasis areas should be sought from any young person presenting with visible heamaturia and appropriate tests instigated. Schools should adopt policies forbidding activities involving freshwater exposure in Malawi. Effective public health measures must be set in place to trace and treat any other possible cases of exposure.

Successful management of an "overlooked" ureteral stent in a transplant kidney.

The authors present a case of successful management of an encrusted ureteral stent in a transplant kidney using cystolitholapaxy and percutaneous nephrolithotomy with electromechanical lithotripsy.

Identification of the alpha2-delta-1 subunit of voltage-dependent calcium channels as a molecular target for pain mediating the analgesic actions of pregabalin.

Neuropathic pain is a debilitating condition affecting millions of people around the world and is defined as pain that follows a lesion or dysfunction of the nervous system. This type of pain is difficult to treat, but the novel compounds pregabalin (Lyrica) and gabapentin (Neurontin) have proven clinical efficacy. Unlike traditional analgesics such as nonsteroidal antiinflammatory drugs or narcotics, these agents have no frank antiinflammatory actions and no effect on physiological pain. Although extensive preclinical studies have led to a number of suggestions, until recently their mechanism of action has not been clearly defined. Here, we describe studies on the analgesic effects of pregabalin in a mutant mouse containing a single-point mutation within the gene encoding a specific auxiliary subunit protein (alpha2-delta-1) of voltage-dependent calcium channels. The mice demonstrate normal pain phenotypes and typical responses to other analgesic drugs. We show that the mutation leads to a significant reduction in the binding affinity of pregabalin in the brain and spinal cord and the loss of its analgesic efficacy. These studies show conclusively that the analgesic actions of pregabalin are mediated through the alpha2-delta-1 subunit of voltage-gated calcium channels and establish this subunit as a therapeutic target for pain control.

The monosodium iodoacetate model of osteoarthritis: a model of chronic nociceptive pain in rats?

Osteoarthritis (OA) is a widespread condition affecting the elderly population. One of the most prominent features but least studied symptoms is chronic pain associated with OA. The study objective was to determine pain endpoints in rats with monosodium iodoacetate (MIA) induced OA, and to investigate the efficacy of common nociceptive agents. Sprague-Dawley rats received an intraarticular injection of either 25 microl 80 mg/ml MIA or 25 microl 0.9% sterile saline into the right knee joint. Changes in von Frey thresholds and latencies to stroking with a cotton bud (punctate and dynamic allodynia, respectively) were measured pre- and for up to 10 weeks post-intraarticular injection. Changes in hind paw weight distribution were also determined. Both punctate allodynia and a weight bearing deficit were observed in MIA-treated rats for up to 10 weeks. Interestingly, dynamic allodynia was not detected at any time point tested. Morphine (0.3-3 mg/kg, s.c.) and tramadol (3-100 mg/kg, p.o.) dose-dependently inhibited punctate allodynia and partially reversed weight bearing deficit. In conclusion, the MIA model of OA is reproducible and mimics OA pain in humans. Analgesic drug studies indicate this model may be useful for investigating chronic nociceptive pain.

Ovariohysterectomy in the rat: a model of surgical pain for evaluation of pre-emptive analgesia?

Ovariohysterectomy in the rat led to the induction of abdominal postures and referred mechanical allodynia in the hind paws. The latter was differentiated into static and dynamic subtypes. The abdominal postures were present up to 4-5 h, whilst the two types of allodynia lasted for at least 2 days. A single administration of morphine 30 min before surgery dose-dependently (0.1-3 mg/kg, s.c.) blocked the development of abdominal postures and the two types of mechanical allodynia. The highest dose of morphine almost completely blocked these responses. The duration of action of 3 mg/kg morphine was short and similar (1.5-2 h) when administered either before or after surgery. However, multiple administrations of morphine (0.5 h before, and 0.5 and 2 h after surgery) blocked the development of abdominal postures and both allodynias for up to 2 days. In contrast, administration of three doses of morphine (3 mg/kg) in a similar dosing regime but starting 24 h after surgery, only blocked the two types of allodynia for 4 h. These data indicate the importance of blocking the induction phase of surgical pain and support the concept of pre-emptive analgesia. It is suggested that the ovariohysterectomy model should prove to be useful for studying mechanisms and designing novel therapeutic strategies for the treatment of post-operative pain.