Knowledge and preventive practices related to Monkey pox among medical doctors in Sokoto metropolis of Sokoto State, Nigeria

Background: For effective control of Monkey pox (Mpox), clinicians need to have adequate knowledge of the disease and adopt appropriate practices to contain it. This study sought to assess the knowledge and practices of medical doctors regarding Monkey pox. Methodology: A descriptive cross-sectional design was utilized for the study and using a two stage sampling method, 210 medical doctors working in Sokoto metropolis were recruited into the study. Aset of structured, pretested and self-administered questionnaire was used to obtain relevant information from the study participants. Data obtained was analyzed using SPSS computer software version 23 with level of statistical significance set at p<0.05 Results: All the respondents were aware of Mpox with more than half (52.3%) having the internet as their commonest source of information. The majority, ((72%) of the clinicians had good knowledge and only years of working experience was significantly associated with knowledge of the disease. Preventive practices were well exhibited by all the respondents with the majority (73%) having appropriate preventive practices. Conclusion and recommendation: This study has demonstrated good knowledge towards Mpox by clinicians in Sokoto metropolis, with a greater majority exhibiting appropriate preventive practices. Sustained awareness and retraining of health care workers in general is necessary to maintain the tempo of high index of suspicion for outbreaks of Mpox and other potential epidemics and also regular use of personal protective equipment

Care-seeking pathways and diagnostic delays in extrapulmonary TB patients.

SETTING: This study was conducted at a private tertiary hospital engaged with the TB control programme in the city of Lahore, Pakistan. OBJECTIVE: To assess the healthcare-seeking pathways, different delays and factors associated with delays among the patients who presented in the outpatient department with tuberculous lymphadenitis and pleuritis, the most common manifestations of extrapulmonary TB. DESIGN: This cross-sectional study was conducted prospectively from April 2016 to August 2017. RESULTS: The median age of the 339 patients analysed was 22 years (IQR 17-30); tuberculous lymphadenitis was predominant in females (63%), while pleuritis affected more males (64%). Overall, 62% reported seeking care from healthcare providers before diagnosis, of whom 62% sought care from private facilities, 32% visited facilities >2 times and 8% visited traditional healers. Diagnostic delay was associated with tuberculous lymphadenitis, age 15-44 years, poor socio-economic status and poor TB knowledge. CONCLUSION: There was considerable delay in the management of extrapulmonary TB patients, and the health-system delay was the major contributor, leading to increased patient suffering. Efforts towards minimising health-system delay need to be prioritised for patient screening and diagnosis, with a feasible algorithm that is workable in resource-limited settings.

CONTEXTE: Cette étude a été menée dans un hôpital tertiaire privé participant au programme de lutte contre la TB dans la ville de Lahore, au Pakistan. OBJECTIF: Évaluer les parcours de recherche de soins, les différents délais et les facteurs associés aux délais parmi les patients qui se sont présentés au service des consultations externes avec une lymphadénite et une pleurite tuberculeuses, les manifestations les plus courantes de la TB extrapulmonaire. MÉTHODE: Cette étude transversale a été menée prospectivement d'avril 2016 à août 2017. RÉSULTATS: L'âge médian des 339 patients analysés était de 22 ans (IQR 17­30) ; la lymphadénite tuberculeuse prédominait chez les femmes (63%), tandis que la pleurite touchait davantage les hommes (64%). Dans l'ensemble, 62% des patients ont déclaré avoir eu recours à des prestataires de soins de santé avant le diagnostic, dont 62% dans des établissements privés, 32% ont visité des établissements >2 fois et 8% ont consulté des guérisseurs traditionnels. Le retard de diagnostic était associé à la lymphadénite tuberculeuse, à l'âge de 15 à 44 ans, à un statut socio-économique défavorable et à un manque de connaissances sur la TB. CONCLUSION: La prise en charge des patients atteints de TB extrapulmonaire accuse un retard considérable, dont le système de santé est le principal responsable, ce qui accroît les souffrances des patients. Les efforts visant à minimiser le retard du système de santé doivent être priorisés pour le dépistage et le diagnostic des patients, avec un algorithme réalisable dans des environnements aux ressources limitées.

Antiurolithiasis activities of Zea mays extract and its mechanism as antiurolithiasis remedy.

This study aimed to demonstrate the role of Zea mays or corn silk (CS) in the treatment of kidney stones after its proven effectiveness in folk medicine. Twenty-four rats were divided into four groups, the first represented the control group (negative control), and the second (positive control), was treated with 75% of ethylene glycol (EG) and 1% of ammonium chloride (AC) to induce stones in the kidneys of experimental animals. The animals of the third and fourth groups were treated with the same proportions of EG and AC, with the addition of extract of CS at a ratio of 200 and 400 mg/kg. After the 28th day, the blood samples were taken from rats. All kidneys of rats from all groups were taken to histological examination. Another ten rats were divided into two groups and took the same time as the original experiment. Group E took a normal diet and served as negative control group whereas the group F took a normal diet with 500 mg/kg of CS to investigate the mechanism of CS as antiurolithiatic treatment. Blood samples were collected on the last day of the experiment to perform the required analyses. The rats were dissected and liver and kidney samples were taken to complete the histological study. The results showed a significant decrease in the CS group in plasma MDA, serum urea, and creatinine. Moreover, the histological study, in the CS rats group appeared to be fewer CaOx crystals. On the other hand, we observed a significant increase in urinary pH, urine volume urinary Mg, and citrate in-group E when compared with the F group. In conclusion, we infer that CS works as an antiurolithiatic drug by increasing urinary pH, diuresis, and its nephroprotective vims. So, we advise its use as an antiurolithiasis treatment but in its pharmaceutical forms.

Comparative phytochemical composition, oleuropein quantification, antioxidant and cytotoxic properties of Olea europaea L. leaves.

In the present research, oleuropein (OLE) contents from two Saudi Arabian wild olive trees (Olea europaea L.) leaves (O1 and O2), were collected from two nearby geographical sites differing in altitudes, and were determined via UHPLC-MS analysis. Moreover, total bioactive contents, antioxidant, and cytotoxicity (against MCF-7 and MDA-MB-231 cells) potential were also evaluated. The sample (O2) was found to contain significantly (p < 0.05) higher OLE content (4.13 ± 1.0 mg/g DW) compared with the sample (O1) having OLE content (3.63 ± 1.1 mg/g DW). A similar trend was observed regarding total bioactive contents and antioxidant potential. However, both samples exhibited low cytotoxicity against tested cell lines. Furthermore, with hierarchical cluster analysis that compared the results of our samples (O1 and O2) to other samples reported in the literature, it was found that the variance in OLE content and biological activities from Al Baha region leaves had a resemblance to other reported superior cultivars.

COVID-19 Outbreak Forecasting Based on Vaccine Rates and Tweets Classification.

The spread of COVID-19 has affected more than 200 countries and has caused serious public health concerns. The infected cases are on the increase despite the effectiveness of the vaccines. An efficient and quick surveillance system for COVID-19 can help healthcare decision-makers to contain the virus spread. In this study, we developed a novel framework using machine learning (ML) models capable of detecting COVID-19 accurately at an early stage. To estimate the risks, many models use social networking sites (SNSs) in tracking the disease outbreak. Twitter is one of the SNSs that is widely used to create an efficient resource for disease real-time analysis and can provide an early warning for health officials. We introduced a pipeline framework of outbreak prediction that incorporates a first-step hybrid method of word embedding for tweet classification. In the second step, we considered the classified tweets with external features such as vaccine rate associated with infected cases passed to machine learning algorithms for daily predictions. Thus, we applied different machine learning models such as the SVM, RF, and LR for classification and the LSTM, Prophet, and SVR for prediction. For the hybrid word embedding techniques, we applied TF-IDF, FastText, and Glove and a combination of the three features to enhance the classification. Furthermore, to improve the forecast performance, we incorporated vaccine data as input together with tweets and confirmed cases. The models' performance is more than 80% accurate, which shows the reliability of the proposed study.

Psychological Health and Diabetes Self-Management among Patients with Type 2 Diabetes during COVID-19 in the Southwest of Saudi Arabia.

Background and objectives: The prevalence of type 2 diabetes in Saudi Arabia is high and rising steeply. However, the management of type 2 diabetic patients has largely employed a medical approach and ignored the self-care management approach. This observation has even been obscured further by the COVID-19 pandemic, which has affected the psychological health of these patients. This study aimed to understand the effects of psychological health and DSM on type 2 diabetic patients in the Jazan region during COVID-19. Materials and methods: An analytical cross-sectional study was employed in this study. Participants were type 2 diabetic patients from the diabetic center at Jazan, Saudi Arabia. The Arabic-translated version of the Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder Scale (GAD-7) were used to collect data. Data were analyzed using SPSS software. Results: Depression and anxiety were higher in females compared to males and were more reported by participants from urban compared to rural settings. Smoking and Khat chewing were inappropriate diabetic self-care management practices while exercising was appropriate. A negative correlation was observed between depression vs. health care utilization, and depression vs. diabetic self-care management. Anxiety results also showed similar findings to that of depression. Additionally, depression and anxiety were easily predicted by urban residence, and diabetic self-care management was predicted by exercise. Conclusions: Adequate self-care behavior in patients with type 2 diabetes is needed. Medical professionals should ensure improved efforts to accurately ascertain how an individual can implement the recommended lifestyle changes and facilitate self-care education.

Early TB case detection by community-based mobile X-ray screening and Xpert testing in Balochistan.

SETTING: This survey was conducted at 35 sites of 20 cities in 15 districts with low programmatic TB case notifications in the past years in Balochistan. OBJECTIVE: To assess the effectiveness of the systemic community-based screening and diagnosis for early detection of TB; and 2) to describe the characteristics and understand the strengths and weaknesses of the intervention in Balochistan, and sociodemographic factors associated with it. DESIGN: This cross-sectional descriptive study was conducted using a mobile van equipped with a digital X-ray machine with computer-aided detection for TB (CAD4TB) software for screening, followed by confirmatory high sensitivity Xpert® MTB/RIF assay testing. RESULTS: A total of 236 (3.4%) TB cases was detected out of 6,899 screened. About 1,168 (17%) presumptive TB cases were identified and 1,065 (91%) sputum samples were tested on Xpert. Among those diagnosed, 166 (70%) were Mycobacterium tuberculosis-positive and 70 (30%) were with clinical suspicion. Of the sputum samples tested, 87% (923/1065) had a probability score of >70 on CAD4TB. CONCLUSION: Community-based screening with innovative activities, comprising sensitive screening and diagnostic tools, effectively improves TB case detection, which might suffice to reduce the prevalence of TB and break the chain of infection transmission in the at-risk population.

CADRE: Cette enquête a été menée dans 35 sites de 20 villes dans 15 districts au Baloutchistan où le nombre de notifications de cas de TB était faible au cours des dernières années. OBJECTIVE: 1) Évaluer l'efficacité du dépistage et du diagnostic systémiques communautaires pour la détection précoce de la TB ; et 2) décrire les caractéristiques et comprendre les forces et les faiblesses de l'intervention au Baloutchistan, ainsi que les facteurs sociodémographiques qui y sont associés. MÉTHODE: Cette étude descriptive transversale a été menée à l'aide d'une camionnette mobile équipée d'un appareil à rayons X numérique avec logiciel de détection assistée par ordinateur pour la dépistage de la TB (CAD4TB), suivi d'un test de confirmation à haute sensibilité, l'Xpert® MTB/RIF. RÉSULTATS: Sur les 6 899 dépistés, 236 (3,4%) cas de TB a été détecté. Environ 1 168 (17%) cas présumés de TB ont été identifiés et 1 065 (91%) échantillons de crachats ont été testés avec Xpert. Parmi les cas diagnostiqués, 166 (70%) étaient positifs à Mycobacterium tuberculosis et 70 (30%) avaient une suspicion clinique. Parmi les échantillons de crachats testés, 87% (923/1 065) avaient un score de probabilité de >70 en CAD4TB. CONCLUSION: Le dépistage communautaire avec des activités innovantes, comprenant des outils de dépistage et de diagnostic sensibles, améliore efficacement la détection des cas de TB, ce qui pourrait suffire à réduire la prévalence de la TB et à rompre la chaîne de transmission de l'infection dans la population à risque.

Natural plant species inventory of hotspot areas in Arabian Peninsula: Southwest Al-Baha region, Saudi Arabia.

Plant hotspot areas are the areas that are very rich in plant species diversity. These areas have a priority for conservation. To highlight the plant diversity for nature conservation purposes a case study in Al Baha region, Saudi Arabia is presented, in which the importance of the natural vegetation and flora of one of the hotspot areas of Saudi Arabia is evaluated through the explanation of its natural plant species. A survey study has been conducted in an area of 167.6 km2, a 97 sample each with 20X20 m were laid out covering the whole ecological zones of the study site. Data of flora, vegetation cover and topography were gathered from each sample site. The study revealed about 319 plant species belonging to 228 genera and 75 families. Two species were found endemic to Saudi Arabia, 14 were endemics to Arabian Peninsula, and five were regional endemics that are only found in East Africa and Arabian Peninsula, while 39 species are rare and endangered.

A systematic review of low-cost simulators in ENT surgery.

BACKGROUND: Simulation training has become a key part of the surgical curriculum over recent years. Current trainees face significantly reduced operating time as a result of the coronavirus disease 2019 pandemic, alongside increased costs to surgical training, thus creating a need for low-cost simulation models. METHODS: A systematic review of the literature was performed using multiple databases. Each model included was assessed for the ease and expense of its construction, as well as its validity and educational value. RESULTS: A total of 18 low-cost simulation models were identified, relating to otology, head and neck surgery, laryngeal surgery, rhinology, and tonsil surgery. In only four of these models (22.2 per cent) was an attempt made to demonstrate the educational impact of the model. Validation was rarely formally assessed. CONCLUSION: More efforts are required to standardise validation methods and demonstrate the educational value of the available low-cost simulation models in otorhinolaryngology.

Pneumomediastinum following intubation in COVID-19 patients: a case series.

The number of patients requiring tracheal intubation rose dramatically in March and April 2020 with the COVID-19 outbreak. Our thoracic surgery department has seen an increased incidence of severe pneumomediastinum referred for surgical opinion in intubated patients with COVID-19 pneumonitis. Here we present a series of five patients with severe pneumomediastinum requiring decompression therapy over a 7-day period in the current COVID-19 outbreak. We hypothesise that the mechanism for this is the aggressive disease pathophysiology with an increased risk of alveolar damage and tracheobronchial injury, along with the use of larger-bore tracheal tubes and higher ventilation pressures. We present this case series in order to highlight the increased risk of this potentially life-threatening complication among the COVID-19 patient cohort and offer guidance for its management to critical care physicians.

Longitudinal Model of Periprosthetic Joint Infection in the Rat.

The majority of periprosthetic joint infections occur shortly after primary joint replacement (<3 months) and require the removal of all implant components for the treatment period (~4 months). A clinically relevant animal model of periprosthetic infection should, therefore, establish an infection with implant components in place. Here, we describe a joint replacement model in the rat with ultrahigh molecular weight polyethylene (UHMWPE) and titanium components inoculated at the time of surgery by methicillin-sensitive Staphylococcus aureus (S. aureus), which is one of the main causative microorganisms of periprosthetic joint infections. We monitored the animals for 4 weeks by measuring gait, weight-bearing symmetry, von Frey testing, and micro-CT as our primary endpoint analyses. We also assessed the infection ex vivo using colony counts on the implant surfaces and histology of the surrounding tissues. The results confirmed the presence of a local infection for 4 weeks with osteolysis, loosening of the implants, and clinical infection indicators such as redness, swelling, and increased temperature. The utility of specific gait analysis parameters, especially temporal symmetry, hindlimb duty factor imbalance, and phase dispersion was identified in this model for assessing the longitudinal progression of the infection, and these metrics correlated with weight-bearing asymmetry. We propose to use this model to study the efficacy of using different local delivery regimens of antimicrobials on addressing periprosthetic joint infections. Statement of clinical significance: We have established a preclinical joint surgery model, in which postoperative recovery can be monitored over a multi-week course by assessing gait, weight-bearing, and allodynia. This model can be used to study the efficacy of different combinations of implant materials and medication regimens. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:1101-1112, 2020.

Did diabetes mellitus affect treatment outcome in drug-resistant tuberculosis patients in Pakistan from 2010 to 2014?

Settings: All hospitals managing drug-resistant tuberculosis (DR-TB) according to national guidelines in Pakistan. Objectives: To assess the effect of diabetes mellitus (DM) and factors associated with unfavourable outcomes in DR-TB. Methods: A cross-sectional study based on a retrospective record review of patients enrolled on DR-TB treatment from 2010 to 2014 in Pakistan. DR-TB data reported to Pakistan's National TB Control Programme on a monthly basis were used for the study. Result: Among 5811 patients enrolled on second-line drugs, 8.8% had DM. Overall, 68.9% had favourable outcomes. No association was found between DM and DR-TB treatment outcomes (risk ratio 0.90, 95%CI 0.74-1.05). Unfavourable outcomes were more frequent among DR-TB patients with human immunodeficiency virus (HIV) co-infection (OR 11.58, 95%CI 2.20-60.72), extensively drug-resistant TB patients (OR 5.36, 95%CI 1.00-28.72), patients with exposure to both first-line and second-line anti-tuberculosis drugs (OR 2.45, 95%CI 1.21-4.97) and those with a previous history of treatment in the private sector (OR 1.53, 95%CI 1.16-2.02). Conclusion: Although there were limitations to correctly measuring DM and its management, DM appears not to be a risk factor for unfavourable outcomes in DR-TB patients in our study. DR-TB and HIV co-infection, second-line drug resistance and history of treatment in the private sector were nevertheless more frequently associated with adverse outcomes.

Contexte : Tous les hôpitaux prenant en charge la tuberculose pharmacorésistante (TB-DR) selon les directives nationales du Pakistan.Objectif : Evaluer l'effet du diabète (DM) et les facteurs associés à un résultat défavorable du traitement de la TB-DR.Méthode : Etude transversale basée sur une revue rétrospective de dossiers de patients enrôlés dans un traitement de TB-DR de 2010 à 2014 au Pakistan. Les registres de TB-DR envoyés au programme national de lutte contre la TB chaque mois ont été utilisés pour l'étude.Résultats : Parmi 5811 patients enrôlés dans un traitement par médicaments de deuxième ligne, 8,8% avaient un DM. Dans l'ensemble, 68,9% ont eu des résultats favorables. Il n'a pas été trouvé d'association entre le DM et le résultat du traitement de la TB-DR (ratio de risque 0,90 ; IC95% 0,74­1,05). Les facteurs associés à des résultats défavorables sont la coinfection par TB-DR et le virus de l'immunodéficience humaine (VIH) (OR 11,58 ; IC95% 2,20­60,72), la TB ultrarésistante (OR 5,36 ; IC95% 1,00­28,72), l'exposition à la fois aux médicaments de première ligne et de deuxième ligne (OR 2,45 ; IC95% 1,21­4,97) et des antécédents de traitement dans le secteur privé (OR 1,53 ; IC95% 1,16­2,02).Conclusion : Dans notre étude, avec ses limites en termes de mesures correctes du DM et de sa prise en charge, le DM ne semble pas être un facteur de risque de résultat défavorable pour les patients TB-DR. Par contre, la coinfection TB-DR et VIH, la résistance aux médicaments de deuxième ligne et les antécédents de traitement dans le secteur privé ont été associés à des résultats médiocres.

Marco de referencia: Todos los hospitales que suministran tratamiento contra la tuberculosis farmacorresistente (TB-DR) en el marco de las directrices nacionales de Pakistán.Objetivo: Evaluar el efecto de la diabetes (DM) sobre el desenlace de la TB-DR y los factores que se asocian con los desenlaces desfavorables.Método: Un estudio transversal realizado a partir del examen retrospectivo de las historias clínicas de los pacientes que iniciaron tratamiento por TB-DR del 2010 al 2014 en el Pakistán.Métodos: En el presente estudio se consultaron los registros de los casos de TB-DR que se notifican mensualmente al Programa Nacional de control de la Tuberculosis.Resultados: De los 5811 pacientes que iniciaron tratamiento con medicamentos de segunda línea, el 8,8% sufría DM. En general, el 68,9% de los casos alcanzó desenlaces favorables. No se observó ninguna asociación entre la presencia de DM y el desenlace terapéutico de la TB-DR (riesgo relativo 0,90; IC95% 0,74­1,05). Los factores que se asociaron con desenlaces desfavorables fueron la coinfección por el virus de la inmunodeficiencia humana (VIH) y la TB-DR (OR 11,58; IC95% 2,20­60,72), la TB ultrarresistente (OR 5,36; IC95% 1,00­28,72), la exposición a los dos tipos de fármacos, de primera y de segunda línea (OR 2,45; IC95% 1,21­4,97) y el antecedente de tratamiento antituberculoso en el sector privado (OR 1,53; IC95% 1,16­2,02).Conclusión: Según los resultados del presente estudio, pese a algunas limitaciones en la evaluación correcta de la DM y su tratamiento, no pareciera que la presencia de DM fuese un factor de riesgo de resultados desfavorables del tratamiento de pacientes con TB-DR. Sin embargo, la coinfección por el VIH y la TB-DR, la resistencia a fármacos de segunda línea y el antecedente de tratamiento antituberculoso en el sector privado se asociaron con desenlaces desfavorables.

Pre-treatment loss to follow-up among smear-positive TB patients in tertiary hospitals, Quetta, Pakistan.

Setting: Three public sector tertiary care hospitals in Quetta, Balochistan, Pakistan, with anecdotal evidence of gaps between the diagnosis and treatment of patients with tuberculosis (TB). Objectives: To assess the proportion of pre-treatment loss to follow-up (LTFU), defined as no documented evidence of treatment initiation or referral in TB registers, among smear-positive pulmonary TB patients diagnosed in 2015, and the associated sociodemographic factors. Design: A retrospective cohort study involving the review of laboratory and TB registers. Results: Of 1110 smear-positive TB patients diagnosed (58% female, median age 40 years, 5% from outside the province or the country), 235 (21.2%) were lost to follow-up before starting treatment. Pre-treatment LTFU was higher among males; in patients residing far away, in rural areas, outside the province or the country; and in those without a mobile phone number. Conclusion: About one fifth of the smear-positive TB patients were lost to follow-up before starting treatment. Strengthening the referral and feedback mechanisms and using information technology to improve the tracing of patients is urgently required. Further qualitative research is needed to understand the reasons for pre-treatment LTFU from the patient's perspective.

Contexte : Trois hôpitaux publics tertiaires à Quetta, Baloutchistan, Pakistan, avec des preuves empiriques d'un fossé entre le diagnostic et le traitement des patients tuberculeux (TB).Objectif : Evaluer la proportion de patients perdus de vue avant le traitement (pas de preuve documentée de mise en route du traitement ou de référence dans les registres TB) parmi les patients atteints de TB pulmonaire à frottis positif diagnostiqués en 2015, et identifier les facteurs sociodémographiques associés.Schéma : Etude rétrospective de cohorte impliquant une revue des registres de laboratoire et de TB.Résultats : Sur 1110 patients TB à frottis positif diagnostiqués (58% de femmes, d'âge médian 40 ans, 5% venant de l'extérieur de la province ou du pays), 235 (21,2%) ont été perdus de vue avant de démarrer le traitement. Cette perte de vue avant le traitement a été plus élevée parmi les hommes ; parmi les patients résidant loin, en zone rurale, hors de la province ou du pays ; et parmi ceux ne possédant pas de téléphone portable.Conclusion : Environ un cinquième des patients TB à frottis positif ont été perdus de vue avant la mise en route du traitement. Il est nécessaire de manière urgente de renforcer les mécanismes de référence et de retro-information et d'avoir une meilleure traçabilité des patients grâce aux techniques d'information. Une autre recherche qualitative est requise afin de comprendre les raisons de cette perte de vue avant le traitement selon la perspective des patients.

Marco de referencia: Tres hospitales de atención terciaria del sector público de Quetta, en la provincia de Balochistán del Pakistán, donde existen datos anecdóticos de un desfase entre el diagnóstico y el tratamiento de los pacientes con tuberculosis (TB).Objetivos: Evaluar la proporción de pérdidas durante el seguimiento antes de comenzar el tratamiento (falta de documentación de la iniciación del tratamiento o la remisión a otros centros en los registros de TB) de los pacientes con TB pulmonar y baciloscopia positiva diagnosticados en el 2015 y analizar los factores socioeconómicos determinantes.Métodos: Un estudio retrospectivo de cohortes a partir del examen de los registros de laboratorio y los registros de TB.Resultados: De los 1110 pacientes con baciloscopia positiva diagnosticados (58% de sexo femenino, mediana de la edad 40 años y 5% procedente de otra provincia o país), 235 (21,2%) se perdieron durante el seguimiento antes de iniciar el tratamiento. Estas pérdidas fueron mayores en los pacientes de sexo masculino; los pacientes que residían en zonas rurales remotas, fuera de la provincia o del país; y en las personas que no contaban con un número de teléfono celular.Conclusión: Cerca de un quinto de los pacientes con diagnóstico de TB y baciloscopia positiva se perdió durante el seguimiento antes de comenzar el tratamiento. Es urgente fortalecer el mecanismo de remisiones y de retroinformación de los resultados y mejorar la localización de los pacientes haciendo uso de la tecnología de la información. Se precisan nuevas investigaciones cualitativas que favorezcan la comprensión de las razones de esta pérdida durante el seguimiento desde la perspectiva de los pacientes.

[Intrathoracic giant peripheral nerve sheath tumor during Von Recklinghausen disease]. / Tumeur nerveuse géante du thorax au cours de la maladie de Von Recklinghausen.

We report the case of a patient aged 23, admitted for bilateral intrathoracic tumor, including a giant right. Surgery was performed by right sternothoracotomy. After 7 days, she presented an irreversible cardiac arrest. The malignant peripheral nerve sheath tumors are rare and aggressive. Their incidence is 0.001% in the general population and 0.16% in patients with neurofibromatosis type 1. These tumors are characterized by their risk of recurrence and poor prognosis. The treatment is the surgical resection. We analyze incidence, diagnosis and prognosis of these tumors.

Chronic cutaneous leishmaniasis, a great mimicker with various clinical presentations: 12 years experience from Aleppo.

BACKGROUND: Cutaneous leishmaniasis (CL) has been an endemic disease in Aleppo, Syria for many decades. During the past 12 years, there was a clear increase in the overall incidence of the disease in the region. Treatment using intralesional method of antimonial compounds became ineffective in a considerable proportion of cases and more patients developed the chronic form of the disease. OBJECTIVES: To categorize chronic cutaneous leishmaniasis (CCL) into different subtypes that mimic a wide spectrum of skin diseases, and to analyse the cause of this increase in the incidence of the disease as a whole and of the chronic type in particular. METHODS: A total number of 6200 patients with CL were seen in our centre, among which 1880 were initially diagnosed with CCL. Inclusion criteria for CCL included CL for more than 1 year. The diagnosis of CCL was made based on the clinical presentation and a positive Giemsa smear test. Biopsies were performed whenever the Giemsa smear was negative. Patients who had immunosuppression due to a medical condition or intake of immunosuppressive medications were excluded. RESULTS: Of 1880 patients, 1750 patients fit the inclusion criteria. Based on the lesion morphology, three different types of CCL were defined, among which five subtypes were observed based on clinical pattern and distribution of lesions. The two most common types of CCL were the papulonodular and plaque forms. Around 80% of all CCL cases occurred in individuals under 16 years of age and the most common location was the face (88.6% of cases). CONCLUSIONS: CCL due to Leishmania tropica can mimic many other dermatological conditions which might lead to a delay in making the correct diagnosis resulting in increased resistance to treatment. We have illustrated eight different clinical presentations of CCL and their differential diagnoses to make physicians more aware of the atypical presentations of CCL. A new treatment plan is suggested for the high-risk group of acute cutaneous leishmaniasis patients to decrease the likelihood of progressing to chronicity.

Mutations in the LPAR6 and LIPH genes underlie autosomal recessive hypotrichosis/woolly hair in 17 consanguineous families from Pakistan.

BACKGROUND: Autosomal recessive hypotrichosis/woolly hair is a rare genetic hair loss disorder characterized by sparse scalp hair/woolly hair, sparse to absent eyebrows and eyelashes, sparse axillary and body hair in affected individuals. This form of hair loss results from mutations in either LPAR6 or LIPH gene. AIM: To identify mutations in LPAR6 and LIPH genes in 17 consanguineous Pakistani families showing features of hypotrichosis/woolly hair. METHODS: Genotyping in 17 families was carried out using polymorphic microsatellite markers linked to genes causing autosomal recessive hypotrichosis/woolly hair phenotype. To screen for mutations in LPAR6 and LIPH genes, all of their exons and splice junction sites were amplified by PCR and sequenced using an automated DNA sequencer. RESULTS: Genotyping with polymorphic microsatellite markers showed linkage in eight families to LPAR6 and in nine families to LIPH gene. Sequence analysis revealed four recurrent mutations (p.Phe24HisfsX28; p.Asp63Val; p.Gly146Arg; p.Ile188Phe) in LPAR6 and two recurrent mutations (p.Trp108Arg; p.Ile220ArgfsX29) in LIPH gene. Comparison of the haplotypes generated by typing LPAR6 and LIPH genes linked microsatellite markers in different families suggested common founder natures of the two mutations (c.66_69insCATG and c.659_660delTA). CONCLUSIONS: Mutations identified in the present study extend the body of evidence implicating LPAR6 and LIPH genes in pathogenesis of human hereditary hair loss.

Digenic inheritance of an autosomal recessive hypotrichosis in two consanguineous pedigrees.

Hypotrichosis is a human hereditary hair loss disorder in which affected individuals show sparse to complete absence of hair on scalp and/or on different body parts. To date, at least eight isolated autosomal recessive and dominant forms of hypotrichosis loci have been mapped on different human chromosomes, and the corresponding genes have been identified. Detailed clinical and molecular studies were undertaken of the hereditary hypotrichosis observed in the two consanguineous families (A and B) presented here. Human genome scan, using >500 highly polymorphic microsatellite markers, identified equal evidence of linkage of the hypotrichosis phenotype on chromosomes 12q21.2-q22 and 16q21-q23.1 in both the families. The novel hypotrichosis locus on chromosome 12q21.2-q22 spans 16.3 cM (17.62 Mb), flanked by markers D12S326 and D12S101. At this locus, maximum multipoint logarithm of the odds ratio (LOD) scores of 3.68 and 3.31 were obtained in families A and B, respectively. The second hypotrichosis locus on chromosome 16q21-q23.1, identified in the two families, spans 5.58 cM (8.28 Mb) and is flanked by markers D16S3031 and D16S512. Maximum multipoint LOD scores of 3.17 and 3.31 were obtained with markers mapped at this locus in families A and B, respectively. DNA sequence analysis of six candidate genes (PLEKHG7, SLC6A15, VEZT, DUSP6, KERA and KITLG), located in the linkage interval on chromosome 12q21.2-q22, failed to detect potential sequence variants in the affected individuals of the two families. However, DNA sequence analysis of CDH3 gene, located on chromosome 16q21-q23.1, detected a single base pair homozygous insertion (c.1024_1025insG and p.342insGfsX345) in exon 9 in family A and deletion of four base pair (c.1859_1862delCTCT and p.620delSfsX629) in exon 13 in family B. We described for the first time digenic inheritance of an autosomal recessive hypotrichosis phenotype in two unlinked loci on chromosomes 12q21.2-q22 and 16q21-q23.1 in two unrelated consanguineous Pakistani families.

Mutations in the P2RY5 gene underlie autosomal recessive hypotrichosis in 13 Pakistani families.

BACKGROUND: Autosomal recessive hypotrichosis is a rare genetic irreversible hair loss characterized by sparse scalp hair, sparse to absent eyebrows and eyelashes, and sparse axillary and body hair. Affected male individuals have normal beard hair. OBJECTIVES: To search for pathogenic mutations in the human P2RY5 gene in Pakistani families with autosomal recessive hereditary hypotrichosis. METHODS: In the present report, 16 unrelated consanguineous Pakistani families having multiple affected individuals with autosomal recessive hypotrichosis were investigated. Linkage in these families was searched by genotyping microsatellite markers linked to autosomal recessive hypotrichosis loci LAH1, LAH2 and LAH3. Thirteen of the families showed linkage to the LAH3 locus on chromosome 13q14.11-q21.32. These families were then subjected to direct sequencing of the P2RY5 gene, which encodes a G protein-coupled receptor. RESULTS: Sequence analysis of the P2RY5 gene revealed two novel missense mutations (c.742A>T; p.N248Y and c.830C>T; p.L277P) in three families. Five previously described mutations including three missense (c.188A>T; p.D63V, c.436G>A; p.G146R, c.562A>T; p.I188F), one insertion (c.69insCATG; p.24insHfsX52) and one complex deletion (c.172-175delAACT; 177delG; p.N58-L59delinsCfsX88) were detected in the other 10 families. CONCLUSIONS: Mutations revealed in the present study extend the body of evidence implicating the P2RY5 gene in the pathogenesis of human hereditary hair loss.

Tea polyphenols, their biological effects and potential molecular targets.

Tea is the most popular beverage in the world, second only to water. Tea contains an infusion of the leaves from the Camellia sinensis plant rich in polyphenolic compounds known as catechins, the most abundant of which is (-)-EGCG. Although tea has been consumed for centuries, it has only recently been studied extensively as a health-promoting beverage that may act to prevent a number of chronic diseases and cancers. The results of several investigations indicate that green tea consumption may be of modest benefit in reducing the plasma concentration of cholesterol and preventing atherosclerosis. Additionally, the cancer-preventive effects of green tea are widely supported by results from epidemiological, cell culture, animal and clinical studies. In vitro cell culture studies show that tea polyphenols potently induce apoptotic cell death and cell cycle arrest in tumor cells but not in their normal cell counterparts. Green tea polyphenols were shown to affect several biological pathways, including growth factor-mediated pathway, the mitogen-activated protein (MAP) kinase-dependent pathway, and ubiquitin/proteasome degradation pathways. Various animal studies have revealed that treatment with green tea inhibits tumor incidence and multiplicity in different organ sites such as skin, lung, liver, stomach, mammary gland and colon. Recently, phase I and II clinical trials have been conducted to explore the anticancer effects of green tea in humans. A major challenge of cancer prevention is to integrate new molecular findings into clinical practice. Therefore, identification of more molecular targets and biomarkers for tea polyphenols is essential for improving the design of green tea trials and will greatly assist in a better understanding of the mechanisms underlying its anti-cancer activity.