Amoxillin- and pefloxacin-induced cholesterogenesis and phospholipidosis in rat tissues

BACKGROUND

To investigate whether amoxillin and pefloxacin perturb lipid metabolism.

METHODS

Rats were treated with therapeutic doses of each antibiotic for 5 and 10 days respectively. Twenty four hours after the last antibiotic treatment and 5 days after antibiotic withdrawal, blood and other tissues (liver, kidney, brain, heart and spleen) were removed from the animals after an overnight fast and analysed for their lipid contents.

RESULTS

Both antibiotics produced various degrees of compartment-specific dyslipidemia in the animals. While plasma and erythrocyte dyslipidemia was characterised by up-regulation of the concentrations of the major lipids (cholesterol, triglycerides, phospholipids and free fatty acids), hepatic and renal dyslipidemia was characterised by cholesterogenesis and phospholipidosis. Splenic dyslipidemia was characterised by cholesterogenesis and decreased phospholipid levels. Cardiac and brain cholesterol contents were not affected by the antibiotics. A transient phospholipidosis was observed in the brain whereas cardiac phospholipids decreased significantly. Lipoprotein abnormalities were reflected as down-regulation of HDL cholesterol. Furthermore, the two antibiotics increased the activity of hepatic HMG-CoA reductase. Although erythrocyte phospholipidosis was resolved 5 days after withdrawing the antibiotics, dyslipidemia observed in other compartments was still not reversible.

CONCLUSION

Our findings suggest that induction of cholesterogenesis and phospholipidosis might represent additional adverse effects of amoxillin and pefloxacin.

Tissue dyslipidemia in Salmonella-infected rats treated with amoxillin and pefloxacin

BACKGROUND

This study investigated the effects of salmonella infection and its chemotherapy on lipid metabolism in tissues of rats infected orally with Salmonella typhimurium and treated intraperitoneally with pefloxacin and amoxillin.

METHODS

Animals were infected with Salmonella enterica serovar Typhimurium strain TA 98. After salmonellosis was confirmed, they were divided into 7 groups of 5 animals each. While one group served as infected control group, three groups were treated with amoxillin (7.14 mg/kg body weight, 8 hourly) and the remaining three groups with pefloxacin (5.71 mg/kg body weight, 12 hourly) for 5 and 10 days respectively. Uninfected control animals received 0.1 ml of vehicle. Rats were sacrificed 24h after 5 and 10 days of antibiotic treatment and 5 days after discontinuation of antibiotic treatment. Their corresponding controls were also sacrificed at the same time point. Blood and tissue lipids were then evaluated.

RESULTS

Salmonella infection resulted in dyslipidemia characterised by increased concentrations of free fatty acids (FFA) in plasma and erythrocyte, as well as enhanced cholesterogenesis, hypertriglyceridemia and phospholipidosis in plasma, low density lipoprotein-very low density lipoprotein (LDL-VLDL), erythrocytes, erythrocyte ghost and the organs. The antibiotics reversed the dyslipidemia but not totally. A significant correlation was observed between fecal bacterial load and plasma cholesterol (r=0.456, p<0.01), plasma triacyglycerols (r=0.485, p<0.01), plasma phospholipid (r=0.414, p<0.05), plasma free fatty acids (r=0.485, p<0.01), liver phospholipid (r=0.459, p<0.01) and brain phospholipid (r=0.343, p<0.05).

CONCLUSION

The findings of this study suggest that salmonella infection in rats and its therapy with pefloxacin and amoxillin perturb lipid metabolism and this perturbation is characterised by cholesterogenesis.

Melkerssons-Rosenthal syndrome: a case report and review of the literature

Melkerssons-Rosenthal syndrome is a clinical entity identified by the presence of the triad of recurrent facial paralysis, recurrent often permanent (labial) oedema, and to a lesser extent the placation of the tongue. The striking event is that of recurrent lower motor facial paresis. This should arouse the search for the other components of the triad which is not always complete. The major worry of the patients is however the facial paresis/oedema and the attendant inability to close the eyes which might sometimes get infected. Hallmark of management remains physical therapy and corticosteroid and/or antiviral agents. A high index of suspicion is required to make the diagnosis of Melkerssons-Rosenthal syndrome.

Benefit of modified plasmapheresis in the management of myasthenia gravis: a case report

BACKGROUND

Myasthenia gravis is an autoimmune disease condition caused by the generation of antibodies against the acetylcholine receptor sites at the neuromuscular junction. The treatment modalities include anticholinesterase drugs, corticosteroids, immunotherapy, thymectomy and plasmapheresis. However, because of the poor financial state of our patients and the dearth of appropriate equipment in our centres modifications are made to standard treatment modalities including plasmapharesis.

METHOD

We report a case of myasthenia gravis who was on various occasions on neostigmine, pyridostigmine and prednisolone. After about 18 months of treatment, he developed myasthenic crises on two occasions. He was admitted in the ICU for respiratory support where he also had modified plasmapheresis.

RESULTS

The patient had remarkable improvement following the modified plasmapheresis with reversal of symptoms of the myasthenic crises.

CONCLUSION

In the absence of facilities for standard plasmapheresis in this environment, the use of modified plasmapheresis is hereby recommended.

Gastrointestinal complications in stroke survivors

The objective of this study was to highlight the gastrointestinal problems that occur in stroke survivors, which may also reduce their quality of life. Stroke patients admitted over an 18-month period were evaluated for common gastrointestinal symptoms as well as type and site of stroke. Symptoms evaluated included vomiting, dysphagia, constipation, masticatory difficulties and sialorrhea among others. Similar symptoms were sought for among controls. There were 54 experimental and 46 control subjects consisting of 25 (46.3%) men and 29 (53.7%) women and 32 (69.6%) men and 14 (30.4%) women respectively. The dominant gastrointestinal symptom was constipation 14 (25.9%), followed by masticatory difficulty 11 (20.4%). Other significant gastrointestinal (GI) symptoms and signs were incomplete bowel evacuation, fecal incontinence, sialorrhea, and dysphagia. There was no significant difference in GI symptoms in either sex, site or type of stroke, except that constipation and incomplete evacuation were commoner in ischaemic stroke. It is advocated that feeding and bowel care should be instituted among stroke patients.

The determinants of seizure severity in Nigerian epileptics

BACKGROUND

Epilepsy is a chronic disease and the control of seizures is central to its management. While seizure frequency has been the traditional index of epilepsy control. severity of seizures is probably as important as seizure frequency in this regard. Seizure severity scales have therefore been developed to assess the impact of antiepileptic drugs on seizure control. The eight items of the national hospital seizure severity scale were applied in this study to Nigerian subjects with epilepsy to determine which aspects of seizure severity were considered relevant from the patients' perspective.

MATERIALS AND METHODS

Twenty-eight confirmed subjects with epilepsy at the University College Hospital, Ibadan, were studied. The National Hospital seizure severity scale questionnaire was administered to all subjects. This assesses generalisation of seizures, falls, injuries, urinary incontinence, warning interval before loss of consciousness, automatisms and time of recovery on a graded scale.

RESULTS

The most frequent indices of seizure severity in Nigerian epileptics is the generalisation of seizures in 85.7% of subjects, incontinence of urine in 78.6%, absence of protective warning time in 75% and occurrence of serious injuries in 71.5%. Occurrence of falls and disruptive automatisms were less frequent. Seizure severity scores were worse in subjects with longer duration of epilepsy and in those on monotherapy.

CONCLUSIONS

The indices of seizure severity that occurred most frequently in Nigerian subjects with epilepsy were generalisation of seizures, incontinence of urine, absence of protective warning time and serious injuries. These may need to be addressed in the management of epilepsy patients. Subjects on monotherapy in this study had worse seizure severity scores and this may indicate the need to consider early rational polytherapy in order to improve seizure control.

A questionnaire survey of senior house officers/registrars response to their training at University College Hospital, Ibadan

This study evaluated the responses of randomly selected 54 senior house officers (SHO)/registrars to questions on their training at the University College Hospital, Ibadan, Nigeria. Previous studies have identified excess workload, poor supervision and inadequate hours of formal educations as areas deserving increased attention. The aim of this study is to assess the residents perception of their training and to offer recommendations where necessary. Many residents felt they are often called to attend to problems beyond their experiences and competence. As many as 66.7% as at 3 months and above into training, have not had the opportunity to discuss their training progress with their supervising consultants. The study therefore calls for more hours of formal teaching and consultants' regular evaluation of residents training. A regular conduct of auditing of training programmes is recommended.

Autoimmune diseases in a Nigerian woman--a case report

Autoimmune diseases (AD) are conditions in which there is the development of antibodies against self cells/ organs. AD could either be organ-specific or non-organ specific (systemic) in clinical presentation. Commonly reported ADs includes: Myasthenia gravis, Hashimoto thyroiditis, Guillian-Barre syndrome, vitiligo, type 1 diabetes mellitus, Graves diseases, Goodpastures syndrome, pemphigus, rheumatoid arthritis, systemic lupus erythematosis, Addisons disease, multiple sclerosis, pernicious anaemia, autoimmune haemolytic anaemia, chronic active hepatitis, idiopathic thrombocytopenic purpura. There is paucity of locally documented information on the occurrence of AD in same patient in our environment. We therefore report the case of a 66 year old woman who presented at the University College Hospital (UCH), Ibadan, with a spectrum of the AD, Vitiligo, rheumatoid arthritis, myasthenia gravis, impaired glucose tolerance.

The quality of life of chronic epileptic patients in Ibadan, Nigeria

Epilepsy is a disease that significantly impairs the quality of life of the sufferers. Measures of quality of life have been developed to assess the overall impact of management on the patients. While studies on quality of life have been previously carried out in Nigerians, a standardised and validated inventory has not been used for this purpose because these are just being developed. Thirty-two epileptics (24 males and 8 females) attending the Neurology clinic of the University College Hospital, Ibadan, were studied. Each subject had complete physical examination and elecroencephalography. A short screening quality of life questionnaire (QOLIE 10) was administered to the subjects during routine clinic visits. The commonest aspect of quality of life affected in the subjects was feeling of energy, which was impaired in 15 (46.8%) subjects. This was followed by memory problems in 11 (34.4%). Fear of experiencing the next seizure was reported by eight (25.8%) of subjects. Only five (16.7%) and three (10.3%) of the subjects respectively reported work and social limitations like attending social occasions. No subject reported difficulty with driving or operating machinery, or mental disturbances. Energy and memory deficits are the major problems affecting the quality of life of epileptics in this study. Most subjects did not consider physical and social limitations important.

A 3-year review of neurologic admissions in University College Hospital Ibadan, Nigeria

A 3 year review of neurologic admissions into the adult medical wards at the UCH, Ibadan, Nigeria between January 1998 and December 2000 is presented. The study design involved the scrutiny of the records of all the neurological admissions, male and female to the medical ward. The identified cases were then classified and only cases confirmed as neurological were further analysed. Stroke, predominantly non-hemorrhagic accounted for 50.4% of cases for the period of study. Stroke is therefore the most common cause of adult neurologic admissions on medical wards of UCH. Central nervous system infections, comprising mainly of tetanus and meningitis accounted for 14.2% (111) and 12.4% (97) of case respectively. The myelopathies were the cause of neurologic admissions in 8.1% (63) of cases followed by seizure disorders. Headache was the reason for admission in 0.9% (7) of cases. Parkinsons disease, hypertensive encephalopathy, Guillian Barne syndrome, seasonal ataxic neuropathy, cavernous sinus thrombophlebitis, normal pressure hydrocephalus were rarely the cause of admission. Similarly, dystonia, and cerebral malaria recorded 0.13% (1) of cases each. A case is made for the establishment of regional stroke units in Nigeria.

Hepatocellular carcinoma presenting as a septicaemia-like illness in an African adolescent

Although primary hepatocellular carcinoma (PHC) is quite common in adults in Africa, it is very rare in those under 25. The clinical diagnosis is usually straightforward by the time patients present and it is unusual to encounter differential diagnostic problems. We report an unusual clinical manifestation of PHC at the very young age of 15 years. The case presented clinically as a septicaemia-like illness that was initially thought to be typhoid. The patient died within 72h of presentation and the true diagnosis was only made at post-mortem. This case simultaneously highlights several problems commonly encountered in medicine in the developing world: late presentation, self-medication, and investigative and diagnostic difficulties related to inadequate facilities.

Severe large and small bowel fibrosis clinically mimicking gross splenomegaly

The case of an 18-year-old female, with mild left hypochondrial pain and an abdominal mass mimicking gross splenomegaly, with severe small and large bowel fibrosis and adhesions and numerous mononuclear cellular infiltrate on histology, is presented. A clear picture of intestinal obstruction only unfolded terminally. She died within 48 hours of presentation. Our patient illustrates the fact that severe intestinal adhesions may present with very mild symptoms and signs and therefore a high index of suspicion is necessary, to reduce the attendant high mortality in intestinal obstruction in our environment.