Malaria: What are the Needs for Diagnosis, Treatment and Control?

Malaria is caused by infection with obligate intracellular, singlecelled protozoa of one of the four species of plasmodium, Plasmodium falciparum , Plasmodium vivax , Plasmodium ovale and Plasmodium malaria.

Recent human cases due to Plasmodium Knowles were reported.  Of these, P. falciparum and P. vivax are the most predominant epidemiologically. Malaria is transmitted when a competent vector, the different species of female anopheles mosquitoes, take a blood meal from somebody already infected with malaria.

About 400 species of Anopheles mosquitoes have been described and approximately 30 of these species are potential vectors of malaria that affect humans.Malaria is the world’s most deadly and life-threatening parasitic disease.

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Developing and Validating Sequential Sampling Plans for Integrated Pest Management on Stored Products

The tendency to manage insects in stored products is the replacement chemical control measures by cost-effective nonchemical alternatives. Integrated Pest management (IPM) is an approach to pest control that uses cost-benefit analysis in making decisions. IPM programs include the study of factors regulating insect distribution and abundance and sampling to make inferences about insect populations.

A good IPM must balance the cost of a sampling program with higher profit of reducing pest infestation. Sampling methods as absolute sampling is very expensive and in countries where the manpower is costly is usually replaced by traps. Relative sampling costs less but is still expensive, because usually traps need to be replaced either because they are consumables or damaged.

The first step of sampling is predicting mean variance to determine the number of samples needed. The implementation of a sampling program must attach a threshold of the economic injury level, the limit from that the insect density causes the reduction of the market value of the product and the needs to make a decision of using control measures.

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Promoting Palliative Care to Cancer Patients in the Republic of Kazakhstan

The 400-Year Quest for a Good Death , [1] Harold Vanderpool traces the emergence of medical palliation to a proclamation by Sir Francis Bacon in 1605 challenging physicians to offer and continually improve palliative medical care and treatment for dying persons.

Florence Nightingale also contributed significantly to the evolution of what we call palliative care today, although the period of 1895 to 1959 – a time of great advances in medicine – unfortunately led to less appropriate care for the dying, though it contributed to discussions about the ethics of treating the dying. The following period (1960-1981) is described as a time of momentous transition.

The influence of Elisabeth Kübler-Ross and Cicely Saunders emerged, solidifying palliative care concepts in the US and UK, and thereafter worldwide. In 2015 the WHO added palliative care to its family of factsheets for the first time. To date, however, palliative care is largely absent from the global health dialogue and consequently is not practiced in most of the developing world, even though cancer is a leading cause of morbidity and mortality worldwide.

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Does Elevated Alpha-fetoprotein During Pregnancy Protect Against Breast Cancer Later in Life?

Elevated levels of maternal serum alpha-fetoprotein (sAFP) during pregnancy have long been associated with a reduced risk of breast cancer in women later in life. Since the decade of the late 1990’s and early 2000’s, investigators have reported that elevated sAFP levels during pregnancy were associated with a future reduction in breast cancer risk in both pre-and postmenopausal women.

An initial study by Richardson et al., using stored frozen maternal serum samples, reported that a reduced risk of postmenopausal breast cancer was associated with high third trimester sAFP levels in women younger than 28 years at first pregnancy. Having been stored for at least 20 years, Richardson re-assayed the frozen/thawed maternal sAFP samples from women with presently confirmed breast cancer.

A subsequent report by Danish investigators, using the country of Denmark’s national medical records as a resource, confirmed and extended the earlier studies of Richardson to include second trimester sAFP levels in premenopausal women up to age 38 years. A later study by Vatten et al. further confirmed both earlier reports of sAFP and future breast cancer risk and extended their finding to include cord serum AFP, ethnicity, and pre-eclampsia. 

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Cadaver Dissection in Anatomy: The Ethical Aspect

Ethical constraints in relation to a cadaver do not cross the mind of medical professionals as it may seem strange to devote attention to the value to be ascribed to the dead body or to ethical issues surrounding the dead body or a cadaver.

After all, it appears that there are few ethical issues surrounding dead bodies in comparison with living bodies, whereas in living people the ethical constraints are undoubtedly present. The most important book in the history of medicine is an anatomical treatise published in 1543, ‘De humani corporis fabrica’, based on dissections of the human body.

The illustrations in the seven volumes of this work by Andreas Vesalius are exquisite for their beauty, complexity and humanity.Prior to Vesalius anatomical texts were based largely on dissections of animals. Leonardo Da Vinci not being an anatomist had made beautiful pictures of the human body. His paintings were very descriptive and the entire anatomy of the human body was given a three dimensional approach with his art. In ancient ages cadavers were exhumed by unlawful means to study human anatomy.

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Reproductive and Sexual Anatomy

The vagina is a deflated tube that is 5 to 10 centimeters in length and 1.9 cm in width. It has the ability to expand and stretch when necessary. For example, during sexual intercourse, the vagina swells to approximately 10 to 20 centimeters in length and 6 cm in width.

It also forms the "birth canal" and drains blood during menstruation. The vagina normally contains various yeast and bacteria, which is necessary to maintain its health. During intercourse, the vagina produces a slippery clear discharge that acts as a lubricant with a noticeable smell. The distal part of the vagina constricts by the levator ani muscles.

 Above the pelvic floor, the vagina is much more capacious and distensible. The Bartholin glands are a pair of mucus-secreting glands, approximately 1 cm in diameter and drain through a narrow duct that is approximately 2.5 cm in length in the posterior wall of the vagina. They release secretions that moisten of the vagina and release additional moisture when a woman becomes sexually aroused.

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Management of Depression and Uses of Natural Medicine

Depression is a debilitating mental problem that could affect any one. Women are more prone to a depression than men. Unmarried, middle aged, being disabled or unemployed, and family history of depression are some of the few factors that can make a person more susceptible to a depression. Use of herbal medicine is so common in everyday life that we cannot deny that it is important. Store shelves are full of various products that are used in depression.

Given that not all brands are equal. There is a different in quality, purity and content of each product. Herbal medicines are considered a health food and are therefore not regulated by the Food and Drug Administration (FDA) as a drug. While supporting clinical data regarding herbal medicines in depression are ambiguous, primary care providers may often be asked about the safety, effectiveness and side effects of these products.

The purpose of this article is to review conventional treatment and provide information about the safety, product selection, drug interaction and the side effects of herbal medicines that have strong evidence in the treatment of depression. Herbal medicines with weak or lack of evidence are not discussed.

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Personalized NanoMedicine : Not Just a Tool but towards an Excellence

Over the decades, immense research in Biomedicine has been provided an accurate and deep understanding related to lethal diseases such as Cancer, HIV and Myocardial infarction; however, the complexity of disease and difference from individual to individual, it is difficult to diagnose at early stage and treatment. To fulfill the gap personalized medicine has been introduced, which is defined as ‘tailoring or monitoring of diagnosis and therapies to the genetic profile of an individual’.

In recent past, there is an increased interest in Nanotechnology and nanomedicine, which refers to the study of phenomena and the manipulation of matter at the atomic and molecular level. The vision of this technology is to improve productivity, health care, human potential and sociality issues such as higher limits of sustainable development. Nanoscience, evolved to the next levels and used as potential environmental monitoring agents like nanostructured gas sensors and for medical applications, particularly as drug delivery systems.

 Personalized nanomedicine is designing of novel nanomaterials with increased binding affinity, controlled navigation, sustained release of drug, good biocompatibility, and maximum therapeutic potential which are crucial for effective theranostic approaches. It may defined as  combining noninvasive imaging with targeted drug delivery seems to hold significant potential for personalizing nanomedicine-based chemotherapeutic interventions, to achieve delivery of the right drug to the right location in the right patient at the right time.

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Prolonged QT Intervals in Isolated ACTH Deficiency: Case Report and Mini Review of Literature

Isolated adrenocorticotropic hormone deficiency (IAD) is a rare disorder, characterized by secondary adrenal insufficiency with low or absent cortisol production, normal secretion of pituitary hormones except ACTH and the absence of structural pituitary defects. The clinical features include various symptoms such as vomiting, abdominal pain, myalgia, joint pain, severe hypotension, and hypovolemic shock due to glucocorticoid deficiency.

Glucocorticoid replacement is required for the symptomatic patients. Since the reports in the 1950s, ECG abnormalities such as flat or inverted T waves, prolonged QT intervals are known to occur in adrenal insufficiency. There are six reports suggesting that sudden cardiac arrest occurs in IAD due to prolonged QT intervals.

Although ECG abnormalities are modulated after hydrocortisone replacement, the mechanism by which hydrocortisone may affect ECG still remains unclear. Here we report a case of IAD whose ECG abnormalities were reversed with hydrocortisone replacement, suggesting a role played by glucocorticoids in the modulation of QT intervals. Also we show the characteristics of the six cases of IAD with QT prolonged intervals causing lethal arrhythmia.

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Do Not Resuscitate: An Argumentative Essay

The primary health care provider goal is to restore patients' health as possible by maximizing benefits and minimizing harm. Accordingly if treatment failed, the harm or burden will be more than benefits. On the other hand, if the competent patient refused treatment; that treatment is no longer justified. Unfortunately, many physicians do not know their patients’ preferences for resuscitation, and many patients have a poor understanding of their own resuscitation order.

Nurses as an essential part of the health care provider have always been beside of dying patients, their roles in providing the maximum quality of care and support for the remaining lifetime for both patients and their loved ones is traditional and expected. The nurse’s loyalty to the patient requires an expertise in the relief of physical, emotional, or spiritual suffering, which means the nurse’s roles in discussions end of life choices with patients is imminent.

Death is defined in Black’s Law Dictionary as an irreversible cessation of the vital functions, signs, circulation, and pulsation. For that if your patient stops breathing or their heart stops beating in the hospital, it is generally felt that the morally best approach is to perform Cardiopulmonary Resuscitation (CPR). However, success is not always possible, and not uncommon, this procedure is associated with a high level of morbidity but it's must be ethically justified.

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Comparison of KTP Laser Turbinate Reduction with Surgical Turbinoplasty in the Management of Inferior Turbinate Hypertrophy: A Randomised Controlled Clinical Trial

Inferior turbinate hypertrophy is one of the commonest causes of nasal obstruction. Several surgical methods are used for thereduction of inferior turbinate hypertrophy refractory to medical management. This study compared KTP laser turbinate reduction andsurgical turbinoplasty procedures.Materials and Methods This study was carried out in JIPMER, Puducherry from November 2011 to March 2013. Patients attending ENTOPD with inferior turbinate hypertrophy who were refractory to medical management were selected.

They were randomized into twogroups. Group 1 underwent KTP laser turbinate reduction Group 2 underwent Surgical turbinoplasty.Total of 60 patients were selected for the study. Onepatient lost to follow up. Hence 59 patients were considered for the study. Outof the 59 patients 29 underwent KTP laser turbinate reduction and 30 underwent Surgical turbinoplasty. Both the procedures were found tobe equally effective in terms of improvement of the symptoms associated with inferior turbinate hypertrophy.

 KTP laser turbinate reductionhad shorter operation time compared to surgical turbinoplasty and were associated with no serious intra operative or post operativecomplications.Both KTP laser turbinate reduction and surgical turbinoplasty procedures are equally effective in the treatment of inferior turbinate hypertrophy. Both the procedures are safe, minimally invasive and well tolerated by the patients.

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Plasma Concentration of Oxycodone and Pain during Hemodialysis in a Patient with Cancer

A 55-year-old man with a history of lung cancer, liver metastasis, a liver abscess, and glomerulonephritis (RPGN) associated with methicillin-resistant Staphylococcus aureus (MRSA) infection presented at our department. He underwent a right upper lobectomy, with resection of the parietal pleura, for right lung cancer. He had a recurrence of the cancer, liver metastasis, and a liver abscess postoperatively, and was treated via a left hepatic lobectomy for the metastastic liver tumor. Oxycodone (Oxycontin®; 80 mg/day) was used to treat severe pain in his right chest.

He didn’t receive drugs which influence the metabolism of oxycodone such as CYP3A4 and CYP2D6 inhibitors and inducers. Elevated serum creatinine, proteinuria, and hematuria indicated glomerulonephritis-induced renal failure. He then presented at our department for pain control during hemodialysis.He presented to us with pain in his right chest, right back, and right arm. The right chest and back pain were intermittent sharp pains, and localized in his right precordia and around his scapula.

The maximum, minimum, and average pain scores based on the 0–10 numeric rating scale (NRS) were 4/10, 2/10 and 2/10 respectively. Neither neurological disturbances, hypaesthesia, nor listlessness was identified, and the douleur neuropathique 4 questions (DN4) score was a 0/10. We therefore diagnosed these right chest and back pains as somatalgia. However, the right arm pain was continuous and intermittent, relatively sharp, and localized in the area supplied by the ulnar nerve. No shooting pain was identified.

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Paracrine Insulin-like Growth Factor Binding Protein-3 Acts as Pro-apoptotic Factor for Leydig cells in the Rat Testis

Insulin-like growth factors (IGFs) are involved in cell metabolism, growth, differentiation, and survival in most organs, including those of the reproductive axis. The activities of these factors are regulated by a family of six high affinity-binding proteins (IGFBP-1–6), which determine IGF bioavailability in circulating fluids and the cellular environment.

IGFBP-3 is the most abundant circulating IGF-binding protein and mediates IGF independent actions on cell survival and apoptosis. In the testis, IGFs and IGFBPs are localized in the same cells that express LH and FSH receptors. IGFBP-2 and -3 are the most abundant IGFBPs in this organ and large amounts of IGFBP-3 are produced by Sertoli and Leydig cells. Both FSH and (Bu)2cAMP markedly lower IGFBP-3 levels in Sertoli cells and this binding protein can either inhibit or enhance the effects on Leydig cells steroidogenesis depending on the surrounding conditions.

The involvement of IGFBP-3 in steroidogenesis, development, and tumor growth in the testis is poorly understood. Previous investigations have revealed that IGFBP-3, -4, and -2 are predominantly expressed by Leydig cells. It has been proposed that IGFBP-3 also potentiates the inhibitory effects of cytokines on steroidogenesis. Both IGFBP-3 and -4 have been reported to be down-regulated in testicular seminomas, allowing more rapid tumor growth.

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Stercoral Colitis Associated with Colon Perforation

A 68 year-old woman presented with lower abdominal pain for three days and constipation for 10 days. The patient had a history of end-stage renal disease under regular hemodialysis, and coronary artery disease with antiplatelet drug. Physical examination was unremarkable except rebounding tenderness over lower abdomen. Blood tests showed bandemia 9% in white blood cell counts and elevated C-reactive protein (>250 mg/L, reference value, <3 mg/L).

Abdominal radiography showed sign of retroperitoneal air - the presence of air outlining the psoas muscle (Figure 1, arrow) and one gas-contenting abscess at left lower quadrant abdomen. Computed tomography (CT) of the abdomen revealed a large amount of fecaloma within sigmoid colon with wall thickening and pericolic fat stranding, and extravasation of stool material at left pelvic region (Figure 2, arrow), and pneumoretroperitoneum extending from the lower abdominal abscess.

Under the impression of stercoral colitis associated sigmoid colon perforation, emergent exploratory laparotomy was performed. One 1.6*1 cm perforation of sigmoid colon with abscess formation was found. The pathologic report of colon resection specimen shows aggregates of hemosiderin-laden macrophages in colonic mucosa with focal transmural necrosis. The post-operation course was smooth, and the patient was discharge uneventfully twelve days later.

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Treatment of Urinary Incontinence in Women

About 40% of all women will develop urinary incontinence during their life, usually starting around the age of 50 years. It usually starts with the spontaneous undesired loss of urine during increased intra-abdominal pressure (coughing or sneezing) and will continue in even shorter time intervals to reach the toilet “just in time”. In its ultimate form the patient has no control anymore about her voiding function and is “always wet”.

This is a totally debilitating disorder, which massively restricts the social and private life of the affected patient. Every pharmacologic treatment attempts to reduce the urinary incontinence symptoms; however, there was no cure achieved so far.

In 1996 Petros and Ulmsten hypothesized that urinary incontinence (UI) in women is caused by the laxity of the anterior vaginal wall. In that respect the pubourethral (PUL) and the uterosacral ligaments (USL) play a major role, as they are a substantial part of the holding apparatus of the vagina. According to the “bridge allegory” they are the “tows at the pylons which keep the vagina in the correct position.

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