Dalbergiella welwitschia (Baker) Baker f. alkaloid-rich extracts attenuate liver damage in streptozotocin-induced diabetic rats.

This experiment was conducted to evaluate the Dalbergiella welwitschia alkaloid-rich extracts on liver damage in streptozotocin-induced diabetic rats. Hence, to induce diabetes, 45 mg/kg body weight of streptozotocin was intraperitoneally injected into the Wistar rats. Subsequently, 5 % (w/v) of glucose water was given to the induced animals for 24 h. Thus, the animals (48) were grouped into five groups (n = 8), containing normal control (NC), diabetic control (DC), diabetic rats placed on low (50 mg/kg body weight) and high (100 mg/kg body weight) doses of D. welwitschi alkaloid-rich leaf extracts (i.e. DWL and DWH respectively), and diabetic rats administered 200 mg/kg body weight of metformin (MET). The animals were sacrificed on the 21st day of the experiment, blood and liver were harvested, and different liver damage biomarkers were evaluated. The results obtained demonstrated that diabetic rats administered DWL, DWH and MET significantly (p < 0.05) increased hepatic AST, ALT, albumin, SOD, CAT, GSH, and GPX levels when compared to DC with no significant (p > 0.05) different when compared with NC. Also, diabetic rats administered DWL, DWH and MET revealed a significant (p < 0.05) decrease in GGT and MDA levels, as well as, fragmented DNA and protein carbonyl levels when compared to DC with no significant (p > 0.05) different when compared with NC. In addition, histological examination revealed that diabetic rats placed on DWL, DWH and MET normalized the hepatocytes. Consequently, it can be inferred that alkaloid-rich extracts from D. welwitschi leaf could be helpful in improving liver damage associated with diabetes mellitus rats.

Association between Alanine Aminotransferase, Hypertension and Obesity in Nigerians.

BACKGROUND: Cardiovascular diseases (CVDs) are the leading causes of morbidity and mortality worldwide. Alanine aminotransferase (ALT) is associated with hypertension and obesity. OBJECTIVES: To determine the association between ALT within the reference range with hypertension and obesity. METHODS: This study utilized the data of a cross-sectional health survey involving 558 adult participants. Anthropometry, blood pressure, and plasma glucose were determined with standard protocols. Quartiles of log-transformed ALT were generated and the association with obesity/hypertension was determined with ANOVA and regression analysis. RESULTS: There were 205 (36.7%) men. The mean fasting plasma glucose (FPG) of all participants was 4.7 (1.6) mmol/L. In men, there was a positive correlation between ALT and body mass index (BMI) (r=0.148; p=0.038), waist circumference (WC) (r=0.166; p=0.020), and waist-to-height-ratio (WHtR) (r=0.163; p=0.021). No correlation was observed between ALT and anthropometric indices in women, or with blood pressure indices in both genders. In men, only WHtR (p for trend, 0.045) was significantly associated with ALT quartiles, whereas in women, only WC (p for trend, 0.028) was significantly associated with ALT quartiles. In men, compared to 1st quartile, the OR for general obesity of the 4th quartile of Log ALT was 2.662 (95% CI 1.219 - 5.816; p=0.014). In women, the OR for hypertension of the 3rd quartile of Log ALT versus the 1st quartile was 1.955 (95% CI 0.694 - 2.416; p=0.041). Log ALT did not predict hypertension and obesity in men and women, respectively. CONCLUSIONS: The risks of obesity and hypertension increase as the ALT level increases within the normal ALT range. People with normal levels of ALT in the upper limits need to be evaluated for metabolic disorders.

CONTEXTE: Les maladies cardiovasculaires (MCV) sont des causes principales de morbidité et de mortalité dans le monde. L'alanine aminotransférase (ALT) est associée à l'hypertension et à l'obésité. OBJECTIFS: Déterminer l'association entre l'ALT dans la plage de référence avec l'hypertension et l'obésité. MÉTHODES: Cette étude utilise les données d'une enquête transversale sur la santé impliquant 558 participants adultes. L'anthropométrie, la pression artérielle et la glycémie plasmatique ont été déterminées selon des protocoles standard. Les quartiles de l'ALT transformée en logarithme ont été générés et son association avec l'obésité/l'hypertension a été déterminée avec une analyse de variance (ANOVA) et une analyse de régression. RÉSULTATS: Il y avait 205 hommes (36,7%). La glycémie plasmatique à jeun moyenne (FPG) de tous les participants était de 4,7 (1,6) mmol/L. Chez les hommes, il y avait une corrélation positive entre l'ALT et l'indice de masse corporelle (IMC) (r=0,148, p<0,038), la circonférence de taille (CT) (r=0,166, p<0,020) et le rapport tour de taille/taille (WHtR) (r=0,163, p<0,021). Aucune corrélation n'a été observée entre l'ALT et les indices anthropométriques chez les femmes, ni entre les indices de pression artérielle dans les deux sexes. Chez les hommes, seul le WHtR (p pour la tendance, 0,045) était significativement associé aux quartiles de l'ALT, tandis que chez les femmes, seule la CT (p pour la tendance, 0,028) était significativement associée aux quartiles de l'ALT. Chez les hommes, par rapport au 1er quartile, le rapport de cotes (RC) pour l'obésité générale du 4ème quartile de Log ALT était (2,662, IC à 95%, 1,219-5,816; p=0,014). Chez les femmes, le RC pour l'hypertension du 3ème quartile de Log ALT versus le 1er quartile était (1,955, IC à 95%, 0,694-2,416; p=0,041). Le Log ALT n'a pas prédit l'hypertension et l'obésité chez les hommes et les femmes respectivement. CONCLUSIONS: Le risque d'obésité et d'hypertension augmente à mesure que le niveau d'ALT augmente dans la plage normale d'ALT. Les personnes présentant un niveau normal d'ALT aux limites supérieures doivent être évaluées pour des troubles métaboliques. MOTS-CLÉS: Maladies cardiovasculaires, Obésité, Hypertension, Alanine aminotransferase.

Knowledge and Prevalence of Heart Disease Risk Factors Among Staff of a Tertiary Institution in Nigeria.

BACKGROUND: Cardiovascular disease is the most common cause of mortality worldwide. Hence, awareness of cardiovascular risk factors is an essential step towards effective reduction of the disease burden. This study determined the knowledge and prevalence of cardiovascular risk factors among Staff of Ekiti State University. Ado-Ekiti, Nigeria. METHODS: A cross-sectional study which comprised of 223 members of staff. RESULTS: There were 103 males (46.2%). Low knowledge of heart disease risk factors was found in 68.6% of the respondents. The prevalence of hypertension, diabetes mellitus, overweight, obesity, physical inactivity was 35.4%, 12.1%, 31.8%, 23.3%, and 83% respectively. Family history of hypertension was a predictor of a high level of knowledge. CONCLUSION: A low level of knowledge and increasing prevalence of cardiovascular risk factors existed among staff of Ekiti State University, Nigeria. Hence, there should be a step-up of awareness campaigns and promotion of healthy lifestyle among this category of people.

Serum Uric Acid Predicts Antihypertensive Medication Adherence in Nigeria: A Hospital Based Study.

BACKGROUND: Hypertension is a major risk factor for cardiovascular morbidity and mortality. Optimum adherence to medication is still a perplexing matter for hypertensive patients in Nigeria and serum markers use as predictor for medication adherence has not been conclusive. AIM: To define the level of antihypertensive medication adherence, its possible correlation with serum uric acid (SUA) levels and other predictors of antihypertensive medication adherence among Nigerian patients. METHODS: Patients were recruited from the University Teaching Hospital Cardiology Clinic. Blood was drawn for SUA levels. Validated 8-item MMAS-8 was administered to hypertensives to measure adherence, and correlations analysed between SUA levels and the MMAS-8 score, with SPSS-23. SUA is defined as elevated in men with concentrations of =430µmols/l, normal range 200-430µmols/l, and =360µmol/l in women, normal range140-360µmol/l. Linear regression analysis of the predictors of antihypertensive medication adherence was done. A statistical p value of <0.05 was considered significant. RESULTS: The total number and mean age of the cases were 271 and 60.8±12.3years respectively. MMAS-8 revealed that about half of the hypertensives (131 cases, 48.3%) had low adherence (MMAS-8 score 4), 81 cases (29.5%) had medium adherence (MMAS-8 score 2) while 59 cases (22.1%) showed high adherence (MMAS-8 score 0). Bivariate Correlation between SUA levels in hypertensives and antihypertensive medication adherence was of moderate degree and significant (r=0.396, p<0.001) suggesting that SUA levels increased with increasing non-adherence to antihypertensive medications. This correlation remained significant after adjusting for singular confounding variables like age (r=0.371 fair relationship, p=<0.001), DM (r=0.382 fair relationship, p<0.001); blood pressure (BP) duration and class r=0.356, 0.306, fair relationship p<0.001 respectively). The correlation between SUA levels and adherence to antihypertensive medications was weakened (r=0.209, p<0.001) after adjusting for combined confounding variables. Linear regression revealed that SUA levels is a predictor of antihypertensive medication adherence. CONCLUSION: Antihypertensive medication adherence was unsatisfactory, elevated SUA levels correlated with low antihypertensive adherence, and this correlation was influenced by several singular and combined confounding variables in our patient population. Hence SUA levels can be a predictor and a marker of antihypertensive medication adherence.

A Multicentre Study of Awareness and Practice of Vaccination Against Infectious Diseases Among Haemo-Dialysis Subjects in Nigeria.

BACKGROUND: Numerous studies indicate that immunization against vaccine-preventable infectious diseases lowers mortality among Chronic Kidney Disease/dialysis patients and improve their quality of life. However, their knowledge and practice of this appears to be poor in Nigeria and parts of Africa. OBJECTIVES: We set out to determine subjects' awareness of vaccination against preventable infectious diseases and its impact on their participation in vaccination programs. METHODS: A prospective, cross-sectional study. Data was collated using questionnaires, laboratory results and dialysis entries and analyzed using IBM SPSS Statistics19. RESULTS: One hundred and twenty-four participants (mean age, 48.26±14.45 years) undergoing maintenance haemodialysis were studied. Sixty-two subjects (50.4%), 15.3% and 16.9% had heard of Hepatitis B Virus, S. pneumoniae and H. influenza virus respectively. Thirty-four (54.6%) of the participants first heard of these infections from sources other than healthcare personnel. Of the three common infections, study participants only received formal counselling on Hepatitis B Virus (HBV) infection. Majority had never heard of S. pneumoniae or H. influenzae. Seven (5.7%) had completed their HBV immunisation schedule only. Better educated participants were more aware of necessary vaccination against Hepatitis B Virus (p=0.000) S. pneumoniae (p=0.005) and H. influenza virus (p = 0.003). A significantly higher proportion of participants who received health-personnel driven formal education commenced vaccination against Hepatitis B virus (p=0.000). CONCLUSION: Awareness and practice of vaccination against infectious diseases by haemodialysis patients was found to be poor. Defective system and practice of information dissemination by healthcare workers was remarkably contributory.

The awareness of primary caregivers in South Africa of the human rights of their children with intellectual disabilities.

BACKGROUND: Besides the right to freedom, human rights can be seen as a basic requirement also for the maintenance of human dignity and the opportunity to thrive - particularly in the case of children with disabilities. It is imperative to explore primary caregivers' awareness of the human rights of their children with intellectual disabilities in view of the role they may play in either facilitating or restricting these rights. This paper explores the awareness of 219 primary caregivers of the human rights of their children with intellectual disabilities. METHOD: A descriptive survey design was used with a custom-designed questionnaire that employed a deductive content analysis based on the articles of the United Nations Convention on the Rights of a Child. Comparisons were drawn between the awareness of primary caregivers from urban and those from rural areas. RESULTS: The majority (85.5%) of participants agreed that their child with intellectual disability had rights. Three broad kinds of right were mentioned (in descending order): provision rights, protection rights and participation rights. Participants from both urban and rural areas mentioned education (a provision right) most frequently. However, participants from urban areas were more aware of the different rights that existed than were their counterparts from rural areas. CONCLUSION: Primary caregivers in both rural and urban areas are aware of the rights of their children with disabilities, although there are significant differences between them.

South African families raising children with autism spectrum disorders: relationship between family routines, cognitive appraisal and family quality of life.

BACKGROUND: The purpose of this study was to investigate the relationship between family routines, cognitive appraisal of the impact of autism spectrum disorders (ASD) on the family and family quality of life (FQOL) in families raising children with ASD in South Africa. METHODS: A sample of 180 families of young children with ASD who were receiving disability-related services in the Gauteng province of South Africa completed a self-administered survey. Structural equation modelling was used to examine the direct relationship between the regularity of family routines and FQOL, and the mediating effect of cognitive appraisal on this relationship. RESULTS: The results suggested a direct, positive relationship between the regularity of family routines and families' satisfaction with their FQOL. Furthermore, cognitive appraisal of the impact of ASD on the family mediated this relationship in a partial manner. CONCLUSION: A higher frequency of regular family routines was strongly associated with a higher satisfaction level of FQOL. Also, cognitive appraisal of the impact of ASD acted as a mechanism through which the regularity of family routines influenced FQOL. We discuss the research and clinical implications of these findings.

The Effect of a Non-Powered, Self-Initiated Mobility Program on the Engagement of Young Children with Severe Mobility Limitations in the South African Context.

AIM: To determine the effect of a non-powered, self-initiated mobility program on the engagement of young children with severe mobility limitations, in the South African context. METHODS: A multiple-probe-across-participant design was used. Four children (aged 2-6 years) with severe mobility limitations underwent an intervention that targeted non-powered, self-initiated mobility. The intervention comprised eight sessions over a 2-week period. Engagement was measured during each baseline, intervention and postintervention session using the Individual Child Engagement Record-Revised (ICER-R). The data were presented graphically and analyzed using statistical procedures appropriate for single-subject designs. RESULTS: Participants demonstrated an improvement in engagement during the time in which non-powered, self-initiated mobility program was introduced. A reciprocal deterioration in nonengagement was also demonstrated. The results of the study are discussed in terms of various intrinsic and extrinsic factors. CONCLUSIONS: The use of a non-powered, self-initiated mobility program may be effective in improving engagement in some young children with severe mobility limitations.

Codeine misuse and dependence in South Africa--learning from substance abuse treatment admissions.

BACKGROUND: Misuse of prescription and over-the-counter codeine-containing products is a global public health issue. OBJECTIVES: To investigate the extent of treatment demand related to the misuse of codeine or codeine dependence in South Africa (SA) and the profile of patients seeking treatment, so as to understand the nature and extent of the problem. METHOD: Data were collected from centres participating in the South African Community Epidemiology Network on Drug Use in 2014. A total of 17 260 admissions were recorded. RESULTS: There were 435 recorded treatment admissions for codeine misuse or dependence as a primary or secondary substance of abuse (2.5% of all admissions). Of treatment admissions, 137 (0.8%) involved codeine as the primary substance of abuse; 74.9% of patients were males, with an even spread across population groups. Ages ranged from 11 to 70 years, with the highest proportion aged 20 - 29 years; >40% were referred by self, family and/or friends, and 26.7% by health professionals; and 36.8% had received treatment previously. The majority reported misuse of tablets/capsules, with 17.6% reporting misuse of syrups. Oral use comprised 96.6% and daily use 63.1%. CONCLUSIONS: Data from treatment admissions related to codeine misuse and dependence are informative, but provide an incomplete picture of the nature and extent of codeine-related problems in SA. Other data sources must be considered before further regulatory/policy changes regarding codeine are implemented.

Decline in adolescent treatment admissions for methamphetamine use in Cape Town.

BACKGROUND AND OBJECTIVES: The purpose of this report is to describe the changing trends in adolescent treatment admissions for methamphetamine in Cape Town, and to discuss possible implications. METHOD: Data were collected on admissions for drug abuse treatment through a regular monitoring system involving drug treatment centres and programmes in Cape Town, every 6 months as part of the South African Community Epidemiology Network on Drug Use (SACENDU). A one-page form was completed by treatment centre personnel for each patient to collect demographic and substance abuse data. RESULTS: The results indicate that between 2004 and 2006, a significant increase in the proportion of adolescent treatment admissions for methamphetamine abuse occurred, while a significant decrease occurred between 2006 and 2011. CONCLUSIONS: The initial increase in adolescent treatment admissions for methamphetamine abuse from 2004 to 2006, and subsequent decrease between 2006 and 2011, may suggest a change in methamphetamine abuse patterns among adolescents in Cape Town.

Monitoring the prevalence of methamphetamine-related presentations at psychiatric hospitals in Cape Town, South Africa.

OBJECTIVE: This study aimed to determine a demographic profile of methamphetamine (MA)-related admissions to major psychiatric services in Cape Town, obtain a substance use profile from admitted patients, a profile of common MA-related symptoms encountered during the assessment of the patients presenting with MA-related problems, and a brief profile of the psychiatric diagnoses made. METHOD: Staff in six psychiatric hospitals or wards in Cape Town collected data on methamphetamine related admissions between July and December 2008 using a one-page record review form. The data collection form consisted of the patient's demographic details, presenting symptoms, previous admission details, current MA and other substance use information, and DSM-IV diagnosis. RESULTS: A total of 235 forms were completed. Most patients were male (69%) and the mean age was 25 years. The most common presenting symptoms were aggressive behaviour (74%), followed by delusions (59%) and hallucinations (57%). Males were two times more likely to present with aggression as compared to females, while females were significantly more likely to present with depressed mood or euphoric/elevated mood. The majority of patients had substance-induced psychotic disorder (41%), followed by schizophrenia (31%). Twelve percent (12%) had bipolar mood disorder. CONCLUSION: MA-related psychiatric admissions pose serious challenges to all health services dealing with these patients. Further training and treatment protocol development and distribution is indicated.

Descriptive analysis of blood pressure control among treated hypertensive patients in a tertiary hospital in Nigeria.

BACKGROUND: Blood pressure (BP) is poorly controlled in sub-Saharan Africa and this is due to poor utilization of antihypertensive drugs among other factors. Evaluation BP control will provide basis for recommendation for appropriate therapeutic measures for achieving target BP. AIM: To determine the pattern of BP control as a measure of impact of antihypertensive usage among treated hypertensive patients in University of Ilorin Teaching Hospital in Nigeria. METHODOLOGY: This is a descriptive-analytical study of 605 treated adult hypertensive patients who have been attending our specialist clinics for at least one year. Definition of blood pressure control was according to the World Health Organization criteria. RESULTS: The results showed that the mean age was 58.48 +/- 11.65 with 211 (34.9%) males (M:F =1:1.87). Median duration of follow up was 4(1-27) years. 152 (25%) were diabetic, 381 (63%) were taking antiplatelet aspirin and 213 (35.2%) had cardiovascular events. There was a significant difference between the first visit BP (initial BP) and last BP observed during the study (SBP[initial])=154 +/- 28mmHg, SBP(last)=133 +/- 21 mmHg (p<0.01); DBP[initial]=95 +/- 17mmHg, DBP[last]=80 +/- 12mmHg (p<0.001)).The pattern of BP control was: SBP+DBP controlled 322(53.3%); SBP+DBP uncontrolled 149 (24.6%); SBP controlled/DBP uncontrolled 39 (6.4%); DBP controlled/SBP uncontrolled 95 (15.7%).The control rate among the diabetic subgroup was 23.7%. CONCLUSION: BP control rate among treated hypertensive patients in our institution is significantly higher than reports from similar patient populations in similar healthcare centres in Nigeria and sub-Saharan Africa which reflects an improved and appropriate usage of antihypertensive drugs recently observed in our institution. The rate of control among diabetics is still very poor.

The role of echocardiography in the management of stroke.

BACKGROUND: Echocardiography is increasingly being used as a screening test to identify sources of cardiogenic embolism in patients with ischemic stroke or transient ischaemic attack (TIA). However, no consensus exists presently on the utilization of this imaging facility in individuals with stroke. OBJECTIVE: To evaluate the yield of transthoracic echocardiography in patients with ischaemic stroke with a view to providing guidance in its use in clinical management of stroke. METHODS: One hundred and twenty-six consecutive stroke patients with 90 controls were recruited prospectively. Patients were examined echocardiographically for evidence of intramural thrombus, congenital defects, valvular heart disease, wall motion abnormalities and intra-cardiac masses using two-dimensional, m-Mode and Doppler facilities. RESULTS: Potential cardiac source of emboli (CSE) was identified in 23.0% of the stroke patients. Those who had CSE identified aged 53.0(20.8) years were younger (p=0.0001) than those who did not have CSE, 57.2 (13.5) years. Five (4.0%) patients had rheumatic valvular heart disease with demonstrable clots in the left atrium. On the other hand, four(3.2%) patients had RHD without thrombi seen. Two patients had biventricular thrombi. One of these patients had giant clots within the ventricles and multiple freely mobile thrombi in right ventricle without obvious cardiac structural defect. CONCLUSION: Young stroke or transient ischaemic attacks patients who have clinical signs suggesting the heart as the potential CSE should have low threshold for echocardiography. However, there is a need for rationalisation of request for echocardiography where such clinical signs are absent.

The Role of Echocardiography in the Management of Stroke

BACKGROUND: Echocardiography is increasingly being used as a screening test to identify sources of cardiogenic embolism in patients with ischemic stroke or transient ischaemic attack (TIA). However; no consensus exists presently on the utilization of this imaging facility in individuals with stroke. OBJECTIVE: To evaluate the yield of transthoracic echocardiography in patients with ischaemic stroke with a view to providing guidance in its use in clinical management of stroke. METHODS: One hundred and twenty-six consecutive stroke patients with 90 controls were recruited prospectively. Patients were examined echocardiographically for evidence of intramural thrombus; congenital defects; valvular heart disease; wall motion abnormalities and intra-cardiac masses using twodimensional; m-Mode and Doppler facilities. RESULTS: Potential cardiac source of emboli (CSE) was identified in 23.0of the stroke patients. Those who had CSE identified aged 53.0(20.8) years were younger (p=0.0001) than those who did not have CSE; 57.2 (13.5) years. Five (4.0) patients had rheumatic valvular heart disease with demonstrable clots in the left atrium. On the other hand; four(3.2) patients had RHD without thrombi seen. Two patients had biventricular thrombi. One of these patients had giant clots within the ventricles and multiple freely mobile thrombi in right ventricle without obvious cardiac structural defect. CONCLUSION: Young stroke or transient ischaemic attacks patients who have clinical signs suggesting the heart as the potential CSE should have low threshold for echocardiography. However; there is a need for rationalisation of request for echocardiography where such clinical signs are absent

Anabolic effect of Hibiscus rosasinensis Linn. leaf extracts in immature albino male rats.

UNLABELLED: Many plants remedies have been employed in solving man's health needs especially the nutritive value which enhances health living. Aphrodisiac plants are plants with anabolic properties i.e. they help in protein synthesis and enhances sexual abilities in males. They are also known as androgenic plants because their properties are similar to that of androgen a male hormone. Cold aqueous extract of Hibiscus rosasinensis leaves is reported by local traditional practioners in Western Nigeria to be aphrodisiac. OBJECTIVE: To investigate the anabolic properties of Hibiscus rosasinensis. MATERIALS AND METHOD: Three groups (8/group) of immature male rats of known weights were administered equal doses of aqueous (cold and hot) and alcoholic extracts of Hibiscus rosasinensis leaves for 8 weeks. The gain in body and isolated sexual organs (testis, epididymis, seminal vesicle and prostate) weights were determined after treatment and compared to the value obtained from a fourth untreated group which served as the control. Section through the testes of both the treated and untreated rats were also examined microscopically and displayed as a photomicrograph for comparism. All data were statistically analysed and displaced in graphic form. RESULTS: Over the 8 weeks of treatment, the control, the cold aqueous extract dosed, hot aqueous extract dosed and alcoholic extract dosed rats gained 8%, 15%, 18% and 22% in body weights respectively. The increase in the weight of testis, epididymis, seminal vesicle and prostate of the alcoholic extract dosed rats was 19%, 30%, 31% and 40% respectively. CONCLUSION: The anabolic effect of the leaf extracts of H. rosasinensis is hereby established. More work needs to be done on these leaf extracts to know their effect on the gonadotrophin hormones which regulate the activity of the androgens in relation to spermatogenesis.

A discussion of individual variability, in activity-based interventions, using the niche concept.

BACKGROUND: Activity-based intervention has been defined as a child-directed, transactional approach that uses logically occurring antecedents and consequences to develop functional and generative skills by embedding intervention of children's individual goals and objectives in routine, planned or child-initiated activities. In this approach, clear goals and objectives that are functional and embedded in a play activities or routines are developed. The teacher mediates the child's environment to facilitate learning with the child directing the teacher on the pace, duration spent on the objective. Learning and development in this framework occur through both a carefully planned environment and adult facilitation. Progress made by a child using this approach focuses on observational data that describe if the child is able to respond in functional and generative ways. While activity-based interventions are usually provided for a group of children, progress is measured by describing individual children's responses. Individual variations in the children's progress, despite exposure to the same interventions are an area that is seldom discussed. This article aims to explore the niche concept and its application to explaining this variation between individuals. METHODS: Four children participated in this single-subject, multiple-probe study across four participants. A 3-week long activity-based aided language stimulation programme was developed. The effect of the programme was determined by describing the individual participants understanding of the 24 targeted vocabulary items. RESULTS: The results of the activity-based language programme are presented and the variability among the participants is discussed using the niche concept. The role of the niche concept in individual development is described and the implications thereof are discussed. CONCLUSIONS: Finally, activity-based intervention research is placed in a systems perspective and possible outcome measures of this intervention are discussed from a multidimensional ecological perspective.

[Thrombolytic treatment of obstructions of mechanical valve prostheses. Apropos of 4 cases and analysis of the literature]. / Traitement thrombolytique des obstructions des prothèses valvulaires mécaniques. A propos de quatre cas et analyse de la littérature.

The obstruction of the mechanical valve prothesis (OMVP) is a serious complication. The treatment of this complication was classically surgical. Recently, the thrombolytic treatment was introduced as an alternative approach for patients with high perioperative risk and for those in whom the mechanism of the obstruction is a recently formed thrombus. The authors report four cases of OMVP treated by a thrombolytic agent (Streptokinase, SK, Streptase). Immediate success was obtained in all theses four cases. One late recurrence with fatal issue was noted. All four prostheses were Saint Jude medical (SJM), three in mitral and one in aortic position respectively. The details of the clinical presentation (acute or progressive dyspnea) as well as the contribution of the echocardiography to the diagnosis were presented. The evolution of this therapeutic approach and the international recommendations were reviewed.

Gastric involvement in Waldenstrom macroglobulinemia: CT findings.

Waldenstrom macroglobulinemia is a plasma cell dyscrasia that rarely presents with gastrointestinal involvement. We report a case of gastric involvement of Waldenstrom macroglobulinemia detected by CT.

Biological risk factors for sudden death in patients with coronary artery disease and without heart failure.

In a study of biological risk factors for sudden death in patients with coronary artery disease, 320 patients were, prospectively, recruited and followed-up over two years. None of the patients had heart failure or recent myocardial infarction. The following variables were recorded: previous acute myocardial infarction, hypertension, smoking habits, ventricular arrhythmia; the angiographic variables included: left ventricular ejection fraction, Jenkins' and mean atherosclerotic scores; lipid profile: cholesterol, triglycerides, high density lipoprotein cholesterol, low density lipoprotein cholesterol, apolipoproteins Al and B; hemostatic profile: fibrinogen, fibrinopeptide A, antithrombin III, factor VIII antigen, factor VIII coagulant, protein C, plasminogen, alpha 2-antiplasmin, euglobulin clot lysis time and tissue plasminogen activator before and after venous occlusion, tissue plasminogen activator inhibitor, platelet factor 4, beta-thromboglobulin. During the follow-up period, 12 of the patients died suddenly. In these patients, ejection fraction was lower: 49 +/- 16% versus 61 +/- 14% for the other patients (P less than 0.02), fibrinogen higher: 3.9 +/- 0.8 g/l versus 3.5 +/- 0.8 for the living patients (P less than 0.05) and protein C lower: 89 +/- 39% versus 111 +/- 39% (P = 0.06) for the other patients. In multivariate analysis: lower ejection fraction (P less than 0.008), older age (P less than 0.03) and lower protein C (P less than 0.01) were correlated with sudden death. Among the patients with coronary artery disease, the raised fibrinogen and the decreased protein C appeared to be risk factors for sudden cardiac death. These alterations reflected a prothrombotic state which might increase the ischemic risk, due to an acute thrombosis, leading to the fatal ventricular arrhythmia. Determination of these hemostatic variables might be a useful adjunct for assessment of the vital prognosis of patients with coronary artery disease, especially the risk of sudden death in addition to other known clinical, electrocardiographic, hemodynamic risk factors. This would also guide both the instigation of complementary investigations and appropriate therapy in such high risk group of patients.