Metabolites alterations associated with obesity: A scoping review

INTRODUCTION

Obesity can be considered a major public health concern throughout the world. Various studies have been conducted to combat the rising number of cases of this health problem. Therefore, identifying the roots of the disease is critical in developing the desperately needed treatment approaches. However, in order to fully understand the origin of this disease, figuring out the metabolites present, and the alterations that occurred in a particular metabolism are crucial, and the information regarding the metabolites involved is limited. The aim of this study is to analyse the literature relevant to the metabolites involved in obesity conditions through a scoping review.

MATERIALS AND METHODS

This review utilises three databases (SCOPUS, Science Direct, and PubMed). The search phrases used are (Metabolomic* OR Metabolite*) for metabolomic study, (3T3-L1 OR Adipocyte OR "Adipose Tissue") for experimental design, and (Obesity) for obesity condition. Each of the search keywords was separated by an "AND" term in the databases. Other terms related to obesity, such as insulin resistance, heart disease, type 2 diabetes, muscular disorders, respiratory problems, and psychological problems were omitted because they did not contribute to the total number of studies discovered.

RESULTS

A total of 27 research publications were included in this scoping review. Most of the study focuses on metabolomics in obesity. Metabolites detected were found in various metabolic pathways including amino acids, carbohydrates, lipids as well as other metabolisms. Most of these metabolites discovered in obese conditions showed an alteration when compared to the level of the metabolite in normal conditions.

CONCLUSION

Unfortunately, these studies had some limitations in which the metabolites detected varied between the articles and the information concerning the relationship between the technique or instrument utilised and the metabolites detected in the samples were not well described. Therefore, using the findings obtained in this study, it can help to determine the direction of the study in the future.

Larvicidal potential of plant-based extracts against dengue vector: A short review

INTRODUCTION

Dengue fever, a vector borne disease transmitted primarily by Aedes albopictus and Aedes aegypti mosquitoes, has triggered a significant global resurgence. While many vector control programs depend on the use of chemical insecticides to curb outbreaks, its heavy reliance raises environmental concerns and the risk of insecticide resistance. Alternatively, botanically derived insecticidal agents with larvicidal properties offer an ecofriendlier option. This review aims to analyze scientific reports that described the effectiveness of plant-derived extracts for vector control.

MATERIALS AND METHODS

A literature search was performed to analyze studies that focused on plant-based extracts used for larvicidal purposes using databases such as Science Direct. Springer, PubMed, and Scopus. The inclusion criteria for publications were larvicidal effects, published in English from the year 2017 and availability of full-text articles. The available literature was further characterized by the value of larvicidal activities of LC50 and LC90 (< 50 ppm), of 22 different parts of plant species from 7 plant families namely Apiaceae, Asteraceae, Lauraceae, Magnoliaceae, Myrtaceae, Piperaceae and Rubiaceae.

RESULTS

When comparing the values of LC50, 12 plants species (Artemisia vulgaris, Crassocephalum crepidioides, Echinops grijsii, Melaleuca leucadendra, Neolitsea ellipsoidea, Pavetta tomentosa, Piper betle, Piper caninum, Piper Montium, Piper muntabile, Piper ovatum, Tarenna asiatica) showed promising larvicidal efficacies with LC50 < 10 ppm.

CONCLUSION

This review emphasizes the effective alternatives of plant extracts for the potential production of larvicides. Piper betle extract and chloroform extract of Tarenna asiatica reported the most significant larvicidal activity (LC50 < 1 ppm) against mosquito vectors. Further reviews focusing on the mode of actions of its phytochemically constituents are essential for the future development of potentially significant plant-based larvicides.

Phytochemical quantification and HPLC analysis of Parkia speciosa pod extract

INTRODUCTION

Parkia speciosa Hassk., commonly known as bitter bean or twisted cluster bean, is a tropical leguminous plant species native to Southeast Asia. The plant's edible pods have been traditionally used in various cuisines, particularly in Malaysian, Thai, and Indonesian cooking. Apart from being used as a food ingredient, the pods of P. speciosa also have a range of potential applications in other fields, including medicine, agriculture, and industry. The pods are said to have several phytochemicals that hold great therapeutic values such as reducing inflammation, improving digestion, and lowering blood sugar levels. However, there is limited information on the specific phytochemical contents of the pods in the literature. Thus, the aim of this study is to quantify the total phenolic and flavonoid compounds and to determine the concentrations of four selected phytochemical compounds in the P. speciosa pod extract (PSPE).

MATERIALS AND METHODS

Quantification of the total phenolic (TPC) and flavonoid contents (TFC) in PSPE were done via colourimetric methods; and the determination of the concentrations of four specific phytochemicals (gallic acid, caffeic acid, rutin, and quercetin) were done via High- Performance Liquid Chromatography (HPLC).

RESULTS

Colourimetric determination of PSPE showed TPC and TFC values of 84.53±9.40 mg GAE/g and 11.96±4.51 mg QE/g, respectively. Additional analysis of the phytochemicals using HPLC revealed that there were 6.45±3.36 g/kg, 5.91±1.07 g/kg, 0.39±0.84 g/kg, and 0.19±0.47 g/kg of caffeic acid, gallic acid, rutin, and quercetin, respectively.

CONCLUSION

The findings show that PSPE contains substantial amounts of caffeic acid, gallic acid, rutin, and quercetin, which may indicate its potential as antibacterial, anti-inflammatory, anti-lipid, and antiviral medicines.

Safety of dual antiplatelet therapy using aspirin and low-dose Prasugrel with platelet reactivity testing in flow diverter treatment of intracranial aneurysms

BACKGROUND

Dual antiplatelet therapy (DAPT) is standard care for intracranial stenting to prevent thrombotic complications. Clopidogrel resistance has resulted in patients receiving newer P2Y12 inhibitors like Prasugrel, which may reduce thrombotic complications but could increase haemorrhagic complications. This study, utilising platelet reactivity testing, compared thrombotic and haemorrhagic complications associated with Clopidogrel or 20 mg Prasugrel loading in patients treated with flow diverters (FD) for intracranial aneurysms.

METHODS

We retrospectively analysed prospectively collected data from 225 consecutive FD procedures. All patients received aspirin. 147 cases received Clopidogrel and 82 received Prasugrel. All patients had VerifyNow testing before the procedure.

RESULTS

P2Y12 non-responders were significantly more likely to have thrombotic complications than responders and hyper-responders (7% vs. 2%, p = 0.01). Low-dose Prasugrel resulted in a significantly lower rate of non-responders when compared with Clopidogrel (7% vs. 25%, p < 0.01). We found no statistically significant difference in rates of haemorrhage between the Clopidogrel and Prasugrel groups (2.4% vs. 3.9%, p = 0.47). There were 12 complications (≤7 days) in the Clopidogrel group versus 6 in the Prasugrel group (9% vs. 7.8%, respectively, p = 0.91) and a non-significant reduction in thrombotic complications in the Prasugrel group (5.2% vs. 3.9%, p = 0.88). No significant difference was shown in long-term complications between the groups (p = 0.33).

CONCLUSION

These results support the use of platelet reactivity testing and the safety of low-dose Prasugrel for FD treatment of intracranial aneurysms.

O049 FRAX score assessment of long term follow up thyroid cancer patients

Introduction

Thyroid stimulating hormone (TSH) suppression with Levothyroxine (LT4) following thyroid cancer surgery is recommended in some patients under long term follow up. However, LT4 may cause reduced bone mineral density. We aimed to assess patients in our long-term thyroid cancer follow up clinic for risk to bone health.

Methods

We conducted a review of all patients in the thyroid cancer follow-up clinic and calculation of FRAX score for those that are &gt;40 years old who are followed up in the Endocrine Surgical Service of NUH. Subsequently patients were categorised into risk groups according to the Osteoporosis Group Guideline (2017) and managed accordingly.

Results

78 patients were identified and had ongoing follow up. 23 patients were excluded as they were &lt;40 years old. 10 patients did not want to participate in the study. 45 patients were assessed with the FRAX score. There were 31 female and 14 male patients, mean age 60.8 (±12.3) years. The mean follow up was 75.0 (±78.9) months. 11% (five patients) were found to require treatment for Osteoporosis without a bone mineral density (BMD) scan, 38% (17 patients) were recommended to assess their BMD, 4% had borderline risk to measure BMD, and 47% required lifestyle and dietary modification.

Conclusion

Thyroid cancer patients aged 40 and above represent a cohort in whom osteoporosis is a substantial risk and warrant assessment with a FRAX score.

Take-home message

Thyroid cancer patients aged 40 and above represent a cohort in whom osteoporosis is a substantial risk and warrant assessment with a FRAX score.

POS1292 ULTRASONOGRAPHIC GUIDED INTRA ARTICULAR STEROID AND HYALURONIC ACID IN ADHESIVE CAPSULITIS WITH AND WITHOUT SUPRASCAPULAR NERVE BLOCK

Background

Adhesive capsulitis (AC), often known as frozen shoulder, is a common musculoskeletal condition characterised by shoulder pain and reduced active and passive mobility. Intra-articular injections is an effective treatment option and provide faster pain relief in patients with AC

Objectives

Compare the effictiveness of intra articular injection (IAI) of steroid and HA with or without Suprascapular nerve block (SSNB) in the management of AC.

Methods

Randomized control trial involved 80 patients (62 women and 18 men) clinically diagnosed as having adhesive capsulitis divided into 2 main groups; intra articular injection with SSNB (40 cases) and without SSNB (40 cases), each group divided into 2 subgroups; Twenty patients were treated with ultrasound guided intra articular injection of steroid (4ml of 2% lidocaine and 2 ml of 40 mg/ml triamcinolone) and another twenty patients were treated with ultrasound guided intra articular injection of hyaluronic acid (4 ml of 2% lidocaine and 2 ml hyaluronic acid).

Results

Intra articular shoulder injection with SSNB has higher significant visual analogue scale (VAS) score at baseline and lower significant VAS score at 1st and 3rd week (p < 0.001). However, there was no significance between both groups regarding disability score at 3rd weak (p=0.316). In contrast, there was a high significance between them considering disability score at baseline, 1st, 6th weak (p<0.001 and 0.008, respectively).

Conclusion

In patients with adhesive capsulitis, both a combination an IAI alone or with SSNB dramatically improved pain and functional results. The use of an SSNB in conjunction with an IAI especially with steroid enhanced therapeutic effectiveness.

References

[1]D’Orsi GM, Via AG, Frizziero A, Oliva F. Treatment of adhesive capsulitis: a review. MLTJ. 2012; 2(2):70-78.

[2]Kingston K, Curry EJ, Galvin JW, Li X. Shoulder adhesive capsulitis: epidemiology and predictors of surgery. J Shoulder Elbow Surg. 2018 Aug;27(8):1437-1443.

[3]Zreik NH, Malik RA and Charalambous CP. Adhesive capsulitis of the shoulder and diabetes:a meta-analysis of prevalence. MLTJ. 2016;6 (1):26-34.

[4]Rangan A, Hanchard N, McDaid C. What is the most effective treatment for frozen shoulder? BMJ 2016;354:i4162.

Disclosure of Interests

None declared

Balloon-Assistance for the Transcirculation Access of a Remodeling Balloon for Coiling of Wide-Necked Aneurysms: Report of Two Cases

Balloons are valuable tools in the armamentarium of a neurointerventionist. In this report, we describe 2 cases in which a balloon aided in the navigation of a second remodeling balloon through difficult vascular anatomy. The first case was a patient with a ruptured proximal posterior inferior cerebellar artery aneurysm and the second case was a patient with a ruptured anterior communicating artery aneurysm. In both cases, the coiling microcatheter and the remodeling balloon catheters were advanced through different vessels. The remodeling balloon reached the target location using a transcirculation approach, and the navigation of the remodeling balloon was aided by utilizing a second balloon. Challenging vascular anatomy is often encountered when performing neuroendovascular procedures. The strategy of using balloon assistance for the transcirculation access of a remodeling balloon can be used successfully in difficult situations to manage complex aneurysms.

809 Evaluation of the Two Week Wait Colorectal Cancer Pathway in a District General Hospital

Introduction

Updated guidelines published by the National Institute for Health and Care Excellence in 2015 widened the referral criteria for the two week wait (2WW) pathway for suspected lower gastrointestinal cancer, in an attempt to increase early diagnosis. The aim of this study was to evaluate the compliance of referrals received via the (2WW) pathway for suspected lower gastrointestinal cancer.

Method

We conducted a retrospective study which utilised a local cancer registry to identify all patients who had been referred to United Lincolnshire Hospitals Trust over a two-month period. Electronic patient records were checked to establish whether patients fulfilled the 2015 referral criteria.

Results

Out of 615 patients referred, 51 (8%) had colorectal cancer. 92 (15%) referrals did not meet the criteria for the 2WW pathway. Whether or not the referral was ‘appropriate’ had no significant effect on the diagnoses of bowel cancer (X2 = .003, p&gt;.05).

Conclusions

16% of all referrals did not meet criteria. This may appear as an inefficient use of resources, however there was no difference in rates of cancer between appropriate and inappropriate referrals. The referral criteria are likely to evolve over the course of time, and perhaps clinicians’ judgement should be taken into account.

COVID-19 in forensic psychiatry settings: The unique vulnerability of patients in secure services

Introduction

Secure forensic mental health services treat patient with high rates of treatment resistant psychoses, typically schizophrenia. These groups have high rates of obesity and medical co-morbidities. Population based studies have identified high risk groups in the event of SARS-CoV-2 infection, including those with long term medical conditions.

Objectives

The aim of this study was to compare the vulnerability to serious adverse outcome in the event of COVID-19 infection in a forensic psychiatric patient population.

Methods

All patients of a complete National Forensic Mental Health Service (n=141) were rated for risk of adverse outcome in the event of SARS-CoV-2 infection, using two structured tools, the COVID-AGE tool and the COVID-Risk tool.

Results

Eighty-two patients (58.2%) met criteria for obesity, 32 had type II diabetes and 28 were hypertensive. Mean chronological age was 45.5 years (SD 11.4, median 44.1), while mean COVID-AGE was 59.1 years (SD 19.4, median 58.0), mean difference 13.6 years (SD 15.6) paired t=10.9, df=140, p=0.000. Three patients (2.1%) were chronologically over 70 years compared to 40 (28.4%) with a COVID-AGE over 70 (X2=6.99, df=1, p=0.008, Fishers exact test p=0.027).

Conclusions

These risk assessments may identify the extent of increased risk among a uniquely medically vulnerable patient group. Patients in secure forensic psychiatric services represent a high-risk group for adverse outcomes in the event of SARS-COV-2 infection. Population based cocooning and self-isolating guidance based on chronological age may not be sufficient. There is an urgent need for better physical health research and treatment in this group.

Adverse effects of energy drink on rat pancreas and the therapeutic role of each of bone marrow mesenchymal stem cells and Nigella Sativa oil

BACKGROUND

Energy drinks have been observed to threaten public health leading to many medical problems. Bone marrow-derived mesenchymal stem cells (BMSCs) have broad prospects in tissue regeneration. Nigella Sativa (NS) possess great therapeutic properties for the treatment of a wide range of diseases.

MATERIALS AND METHODS

Forty adult male albino rats were divided into: control group and treated group. The treated group was further subdivided into: energy drink subgroup 2a, BMSCs-injected subgroup 2b, NS-injected subgroup 2c. Histological, immunohistochemical and biochemical assessment was performed.

RESULTS

Administration of energy drink revealed that it adversely affected the pancreatic cytoarchitecture. BMSCs and NS have been similarly observed to significantly ameliorate the histological, biochemical and immunohistochemical changes induced by energy drink.

CONCLUSIONS

The extent of pancreatic regeneration, exerted by each of BMSCs and NS oil, is nearly similar but the effect of BMSCs is more superior; however, NS could be privileged to BMSCs as a line of treatment being easily accessible and of lower cost.

Role of Blood Oxygen Level-dependent MRI in Differentiation of Acute Renal Allograft Dysfunction

Early graft dysfunction after renal transplantation manifests as acute rejection (AR) or acute tubular necrosis (ATN). Blood oxygen level-dependent (BOLD) magnetic resonance (MR) imaging is a noninvasive method of assessing tissue oxygenation, which may be useful for predicting acute allograft dysfunction. This was a prospective study involving 40 patients scheduled for renal transplantation from August 2012 to August 2014. In addition, 15 healthy donors were also enrolled in this study. All recipients underwent BOLD MR imaging (MRI) and R2* mapping 10–20 days after transplant, and additionally within 48 h of biopsy if there was any evidence of graft dysfunction. The healthy donors underwent BOLD MRI 1–2 days before surgery. The biopsies were grouped into AR, ATN, and no evidence of AR or ATN. The mean medullary R2*, cortical R2*, corticomedullary gradient, and medullary: cortical R2* ratio were compared between groups using one-way analysis of variance. Spearman's correlation and multinomial linear regression were applied to determine the influence factors of R2* value. Overall, nine patients had graft dysfunction. Six were reported as AR, two as ATN, and one as no evidence of ATN or rejection. The mean medullary and cortical R2* were significantly higher in ATN group compared with AR and normal group, whereas the mean medullary and cortical R2* of AR group were significantly lower than normal group. The corticomedullary gradient of AR group was significantly lower compared with ATN and normal group. Medullary R2*:cortical R2* ratio was significantly lower in AR group compared with normal group. No significant difference was noted between the 15 donors and patients with normal graft function. R2* values on BOLD MRI are significantly decreased in AR allografts and increased in an early stage of ATN allografts, suggesting that BOLD MRI can become a valuable tool for discriminating between AR and ATN.

Outcome of indeterminate liver lesions on computed tomography in patients with colorectal cancer

Introduction The aim of this study was to determinate the outcome of indeterminate liver lesions on computed tomography (CT) in patients with a background history of colorectal cancer (CRC) and to identify clinicopathological variables associated with malignancy in these lesions. A secondary aim was to devise a management algorithm for such patients. Methods Patients referred to our institution with indeterminate liver lesions on CT with a background history of CRC between January 2012 and December 2014 were included in the study. Clinicopathological factors, surveillance period and histological findings were analysed. Results Fifty-six patients with indeterminate liver lesions were identified. Fifty-three (94.6%) of these required further imaging (magnetic resonance imaging [MRI; n=50] and positron emission tomography combined with CT [n=3]). For the patients who had MRI, the underlying diagnosis was benign in 19 and colorectal liver metastasis (CRLM) in 8 while 23 patients and an indeterminate lesion. In cases that remained indeterminate following MRI, liver resection was performed in 2 patients for a high suspicion of CRLM while the 21 remaining patients underwent interval surveillance (median: 9 months, range: 3-52 months). Of these 21 patients, 14 had benign lesions while CRLM was noted in 6 patients and an incidental hepatocellular carcinoma in a single patient. Age ≥65 years was the only statistically significant clinicopathological factor in predicting an underlying malignancy in patients with indeterminate liver lesions on CT. Conclusions Over a third of the patients diagnosed with indeterminate liver lesions on CT subsequently showed evidence of CRLM. These indeterminate lesions are more likely to be malignant in patients aged ≥65 years.

The front-line general surgery consultant as a new model of emergency care

Introduction Emergency general surgery services in England are undergoing rapid structural change with the aim of improving care. In our centre, the key issues identified were high numbers of admissions, inappropriate referrals, prolonged waiting times, delayed senior input and poor patient satisfaction. A new model was launched in January 2015 to address these issues: the surgical triage unit (STU). This study assesses the success of the new service. Methods All emergency general surgical admissions during a five-month period before introduction of the STU were compared with those of a comparable five-month period after its introduction. Process, clinical and patient experience outcomes were assessed to identify improvement. Results Attendance fell from 3,304 patients in the 2014 cohort to 2,830 in the 2015 cohort. During the 2015 study period, 279 more patients were discharged on the same day. Resource requirement fell by 2,635 bed days (23%). The number of true surgical emergencies remained consistent. Rates for reattendance (7.8% for 2014 vs 8.1% for 2015) and readmission (5.7% for 2014 vs 5.7% for 2015) showed no significant difference. Patient experience data demonstrated a significant improvement in both net promoter score (64.1 vs 82.2) and number of complaints (34 vs 5). Clinical outcomes for low risk procedures remained similar. Emergency laparotomy in-hospital mortality fell (11.4% vs 10.3%) despite preoperative risk stratification suggesting a risk burden that was significantly higher than the national average. Conclusions This novel model of emergency general surgery provision has improved clinical efficiency, patient satisfaction and outcomes. We encourage other units to consider similar programmes of service improvement.

Serial MR Imaging in Suprasellar Xanthogranuloma: Growth Pattern and New Lesions

Xanthogranuloma is a rare lesion of the sellar-suprasellar region. We describe a case of suprasellar xanthogranuloma in whom serial MRI revealed features that have not been previously described--development of dural tail, vascular encasement and intra-axial lesions in posterior fossa.

Acute tubular necrosis associated with non-hemorrhagic Dengue fever: a case report

Dengue fever (DF) is an arthropod-born viral infection affecting humans. Dengue viruses are transmitted through the bites of the mosquito Aedes aegypti. Acute renal failure (ARF) is reported in patients who are affected mainly with Dengue hemorrhagic fever (DHF), which is a severe presentation of the disease. We report the case of a 24-year-old Omani female with no past history of particular medical problems. She was referred to our hospital for the further management of acute renal failure. She had clinical features of DF without DHF. The kidney biopsy showed features of acute tubular necrosis (ATN). She had a complete recovery after 25 days and required three sessions of hemodialysis. We conclude that DF even without DHF may lead to ATN and ARF. Clinicians should be aware of this etiology. Treatment is supportive and may require dialysis. The prognosis could be favorable.

Biodegradation of organophosphate pesticide chloropyrifos by Egyptian bacterial isolates

Sixteen microbial isolates capable of growing on Dursban as a secondary substrate were isolated from three soil and sewage water samples collected from different localities polluted with pesticides. Six developed isolates only were capable of biodegrading Dursban and utilizing it as only sole source of carbon, energy and phosphorus. The six bacterial isolates were managed to grow on enrichment medium containing Dursban up to 40 ml/liter, for seven days at 25 degrees C. Each isolate exhibited growth and degradation of Dursban concentrations that best bacteria were identified as Pseudomonas stutzeri S7B4 and Flavobacterium balustinum S8B6. These two bacterial isolates were subjected to some environmental and nutritional parameters that affect the biodegradation process of Dursban. The optimum conditions includes :incubation period, 7 days; Dursban concentrations, 10 ml/l; inoculum size, 4 ml/l; incubation temperature, 35 degrees C; optimum pH value, 7; carbon source, fructose and ribose, respectively; nitrogen source, urea and peptone, respectively; amino acid, histidine; and vitamin, yeast extract, under shaking condition (200 rpm). Only the most potent microbial isolate Pseudomonas stutzeri was grown on their own mineral salts medium which contained 40 mlM/l in case of Dursban in the absence and presence of fructose as the best carbon source for two time intervals i.e. 7 and 15 days. Absence of phosphorus and the presence of many oxidized compounds revealed that the ability of P. stutzeri to biodegrade and detoxify Dursban using it as the sole phosphorus, carbon and energy sources. GC-MS analysis of all three treatments of Dursban-bioremediation process showed no detection of any phosphorus compounds especially Dursban in the three treatments, indicated that both bacterial strains i.e. P. stutzeri S7-B4 and F. balustinum S8B6 were able to utilize Dursban pesticide as carbon and phosphorus sources. Thus, it is possible to use both bacterial strains in the bioremediation of pesticides especially Dursban-contaminated sites.

Efficacy, Tolerability, and Safety of Lanthanum Carbonate in Hyperphosphatemia: A 6-Month, Randomized, Comparative Trial versus Calcium Carbonate

BACKGROUND/AIMS

Hyperphosphatemia is an important clinical consequence of renal failure, and its multiple adverse systemic effects are associated with significantly increased risks of morbidity and mortality in dialysis patients. Existing oral phosphate binders have not permitted control of serum phosphate within currently accepted guidelines. This study compares lanthanum carbonate with calcium carbonate for control of serum phosphate in hemodialysis patients.

METHODS

In this European multicentre study, 800 patients were randomised to receive either lanthanum or calcium carbonate and the dose titrated over 5 weeks to achieve control of serum phosphate. Serum levels of phosphate, calcium and parathryoid hormone were followed over the following 20 weeks.

RESULTS

Around 65% of patients in each group achieved phosphate control, but in the calcium carbonate group this was at the expense of significant hypercalcemia (20.2% of patients vs. 0.4%). Consequently, calcium x phosphate product tended to be better controlled in the lanthanum group.

CONCLUSION

This 6-month study demonstrates that serum phosphate control with lanthanum carbonate (750-3,000 mg/day) is similar to that seen with calcium carbonate (1,500-9,000 mg/day), but with a significantly reduced incidence of hypercalcemia. Lanthanum carbonate is well tolerated and may be more effective in reducing calcium x phosphate product than calcium carbonate.

Prevalence, knowledge, attitude, and practice of epilepsy in Kerala, South India

PURPOSE

To ascertain the prevalence and pattern of epilepsy and to characterize and quantify knowledge, attitude, and practice (KAP) toward epilepsy among the people of the state of Kerala, which is distinguished from the rest of India by a high level of literacy and health awareness of its population.

METHODS

We conducted a door-to-door survey covering the entire population of 238,102 people residing in 43,681 households in a semiurban area of central Kerala. The screening questionnaire administered by medical social workers had a sensitivity of 100% for identifying persons with epilepsy. Neurologists examined all the individuals suspected of having epilepsy. We evaluated KAP toward epilepsy among 1,118 subjects (439 males and 679 females; mean age, 33.3 years; age range, 15-85 years) from households without epilepsy in the study area.

RESULTS

Through a three-phased survey, we ascertained 1,175 cases (616 males and 559 females) with active epilepsy, providing a crude point prevalence ratio of 4.9 cases per 1,000 people and an age-adjusted prevalence ratio of 4.7 cases per 1,000 population. The highest age-specific prevalence rate of 6.5 per 1,000 occurred in the 10- to 19-year-old age group. Sex-specific prevalence rates did not significantly differ. The proportion of generalized and localization-related epilepsies was 58.8% and 30.6%, respectively. Ninety-nine percent of the KAP respondents had read or heard about epilepsy. Thirty-one percent and 27% thought epilepsy was a hereditary disorder and a form of insanity, respectively. About 40% of the respondents felt that individuals with epilepsy could not be properly educated or employed. Eleven percent would object to their children having contact with epileptic children.

CONCLUSIONS

The prevalence and pattern of epilepsy in central Kerala, South India, do not differ from that of developed countries. Although the awareness of epilepsy among the people of Kerala was comparable to that of developed countries, the attitudes were much more negative. The need for educating the people of Kerala on epilepsy and for incorporating an adequate knowledge of epilepsy in the school curricula cannot be overemphasized.

The first liver transplant in Saudi Arabia and the Arab world

The first liver transplant in Saudi Arabia and in the Arab world was performed on the 30th of July, 1990, in the Armed Forces Hospital in Riyadh, on a 23-year-old male with end-stage liver disease due to sclerosing cholangitis. There were no major post-operative or post-transplantation complications. Now, sixteen months post-transplantation, the patient is doing well on immunosuppressive therapy with an almost normal liver function, and is already back at work and carrying out normal activities. This report shows that liver transplantation can be performed successfully in this part of the world.

Phosphoamino acid phosphatases in normal and cancerous tissues of the human uterus, cervix and ovary

The activities of phosphoamino acid phosphatases were measured in human myometrium and fibroma and normal and cancerous tissues of the cervix and ovary. Phosphoserine and phosphothreonine phosphatases were detected only in myometrium and fibroma and the values were relatively low. Phosphotyrosine phosphatase activities in myometrium and fibroma fell within a similar range; this was also the case for ovary and ovarian carcinoma, whereas values for cervical tumours were significantly higher than for normal cervix. Activities of phosphotyrosine phosphatase in serum from patients with cervical or other tumours were, in most cases, within the range of values obtained for normal serum.

Alkaline phosphatase and phosphoamino acid phosphatases in normal and cancerous tissues of the human larynx

The activities of alkaline phosphatase and phosphoamino acid phosphatases were measured in normal and cancerous regions of the human larynx. For each larynx, alkaline phosphatase and phosphotyrosine phosphatase activities were higher in the tumor than in the corresponding normal tissue. Phosphothreonine and phosphoserine phosphatase activities were relatively low and there were no consistent trends. The increased alkaline phosphatase activity in the tumors supports histological observations that ossification of cartilage seems to occur at the site of invasion; the phosphatase acting on phosphotyrosine could serve as a regulator of cell differentiation during tumorigenesis.

Phosphoamino acid phosphatases in human normal and leukaemic lymphocytes

The activities of phosphoamino acid phosphatases were measured in lymphocytes from normal adults. For cells from white individuals the mean value (+/- SD) for phosphotyrosine phosphatase activity was 342 +/- 120 mU/mg protein; mean values for phosphothreonine and phosphoserine phosphatase activities were 35.6 +/- 17.1 and 21.6 +/- 10.2 mU/mg protein, respectively. The corresponding activities were similar to these for both the Indian and Bantu population groups. The activity of phosphotyrosine phosphatase was significantly lower in lymphocytes from white children with acute lymphocytic leukaemia than in cells from normal children or adults. For phosphothreonine and phosphoserine phosphatases, there was no significant difference between activities obtained in lymphocytes from normal and leukaemic children.