SPONTANEOUS TRANSVAGINAL INTESTINAL EVISCERATION IN AN ELDERLY WOMAN.

Introduction: Transvaginal intestinal evisceration is a rare surgical emergency that is associated with morbidity and mortality. Only a few cases of transvaginal evisceration have so far been described. The predisposing risk factors associated with this clinical condition are multifactorial. Case presentation: We report a case of an 85-year-old female that presented with spontaneous small bowel evisceration through the vagina. The loops of the small bowel appeared edematous and thickened but there was demonstrable visible peristalsis. She had no previous laparotomy or vaginal surgery. An emergency laparotomy was performed, and the small bowel was reduced into the abdomen through the vaginal defect. Afterward, a total abdominal hysterectomy was performed with the closure of the vaginal vault. The postoperative period was uneventful. Conclusion: The spontaneous evisceration of bowel loops can be successfully managed when patients with such cases present early and promptly managed. Prompt diagnosis and surgical management are crucial to prevent complications. If the eviscerated viscera are non-viable, resection and restoration of bowel continuity are imperative. Management should be individualized and multidisciplinary.

OBSTRUCTED CONGENITAL HERNIA OF UMBILICAL CORD IN A NIGERIAN NEWBORN AND ITS DIAGNOSTIC CONUNDRUM.

Background: Congenital Hernia of umbilical cord (CHUC) is a rare presentation. The failure of return of intestinal loops following physiological herniation has been postulated as the embryological basis of this condition. This is usually mistakenly termed as omphalocele minor. We aim to highlight this rare finding, the clinical features, diagnostic dilemma, and management of CHUC. Case Presentation: He is a 4-day old male with obstructed CHUC. He had an oedematous umbilical stump, with circumferential normal abdominal wall skin folds in the form of a collar wrapping round the proximal aspect of the protrusion. The umbilical defect measured about 4 cm in diameter. Subsequently, surgical reduction and repair of defect was done, with resolution of symptoms. Conclusion: CHUC though a rare entity and easily missed, accurate diagnosis and management offer good prognosis. Also, recognition will prevent iatrogenic bowel injury from careless clamping of the cord with associated morbidity and mortality. It also helps to prevent mis categorization and prevent unwarranted anxiety with misdiagnosis.

Enhancing the antimalarial activity of artesunate.

The global challenge to the treatment of malaria is mainly the occurrence of resistance of malaria parasites to conventionally used antimalarials. Artesunate, a semisynthetic artemisinin compound, and other artemisinin derivatives are currently used in combination with selected active antimalarial drugs in order to prevent or delay the emergence of resistance to artemisinin derivatives. Several methods, such as preparation of hybrid compounds, combination therapy, chemical modification and the use of synthetic materials to enhance solubility and delivery of artesunate, have been employed over the years to improve the antimalarial activity of artesunate. Each of these methods has advantages it bestows on the efficacy of artesunate. This review discussed the various methods employed in enhancing the antimalarial activity of artesunate and delaying the emergence of resistance of parasite to it.

OPHTHALMIC ARTERY AND CENTRAL RETINAL ARTERY DOPPLER PATTERNS IN PRIMARY OPEN ANGLE GLAUCOMA PATIENTS AT THE LAGOS UNIVERSITY TEACHING HOSPITAL, NIGERIA.

BACKGROUND: Circulatory abnormalities of retrobulbar vessels are increasingly being linked to the aetiopathogenesis of primary open angle glaucoma. These abnormalities can be assessed with a colour Doppler Imaging of retrobulbar vessels. AIMS AND OBJECTIVES: To compare the Doppler ultrasound patterns of central retinal artery and ophthalmic artery in new patients with primary open angle glaucoma (POAG) diagnosis with those of non-glaucomatous group. DESIGN OF THE STUDY: A hospital-based, comparative, cross-sectional study. SETTING: Department of Ophthalmology (Guinness Eye Centre) and Department of Radiology, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria. MATERIALS AND METHODS: End diastolic velocity (EDV), Peak systolic velocity (PSV) and resistivity index (RI) were measured in the central retinal artery (CRA) and ophthalmic artery (OA) of both eyes of newly diagnosed POAG patients. The CDI values of newly diagnosed POAG patients were compared with age-gender matched non-glaucomatous group. The Doppler values of the better and worse eye of patients with asymmetrical POAG were also compared. RESULTS: One hundred subjects (200 eyes) comprising of 50 POAG patients and 50 non-glaucomatous healthy subjects were recruited for this study. The male to female ratio was 1:1.1(24 males and 26 females) for POAG patients and 1:1 (25 males and 25 females) for non-glaucomatous subjects. The CRA and OA in both eyes of POAG patients had a significantly lower mean EDV and PSV compared with those of non-glaucomatous group (p< 0.001). The CRA and OA in both eyes of POAG patients had a significantly higher mean RI compared with those of non-glaucomatous group (p< 0.001). A significant positive Pearson correlation was seen between the IOP and the RI in the CRA and OA in both eyes. Also, statistically significant negative Pearson correlations were seen between the IOP and the PSV and EDV in the OA and CRA in both eyes. CONCLUSION: This study demonstrated a significant reduction in EDV and PSV as well as an increase in RI of the CRA and OA in both eyes among POAG patients compared to the non-glaucomatous group.

Applications of calixarenes in cancer chemotherapy: facts and perspectives.

Research on the therapeutic applications of calixarene derivatives is an emerging area of interest. The anticancer activity of various functionalized calixarenes has been reported by several research groups. Due to their superior geometric shape, calixarenes can accommodate drug molecules by forming inclusion complexes. Controlled release of anticancer drugs by calixarenes might help in targeted chemotherapy. This review summarizes the anticancer potential of the calixarenes and their drug loading properties. The potential use of calixarenes in chemoradiotherapy is also highlighted in brief.