Articles

Levosimendan is a calcium sensitizer and its inotropic effect is mainly attributed to the troponin C of the myocardial fine filaments with calcium. Levosimendan also inhibits phosphodiesterase III. In contrast to inotropic effects, this does not increase calcium entry into the cell, which explains that levosimendan does not worsen myocardial diastolic dysfunction and may even improve diastolic function. Levosimendan does not increase the use of myocardial oxygen and increases coronary vasodilation and myocardial oxygen delivery. Levosimendan opens potassium channels and causes hyperpolarization in smooth muscle cell membrane, thus causing vasodilatation [1]. Levosimendan has also been reported to have antiinflammatory [2,3] and antiapoptotic effects [2].

We present a 54-year-old male with abdominal pain, Vomiting and weight loss since 5 months. Perforation was noted at recto-sigmoid junction and underwent Hartman’s procedure with end colostomy. Histology of sigmoid colon confirmed a Stercoral perforation without any evidence of dysplasia or malignancy. Patient had chemotherapy for squamous cell carcinoma (SCC) of epiglottis a year ago and was on codeine phosphate and Oromorph as and when required since his treatment for SCC for pain. Patient also had been suffering from constipation since he finished chemotherapy. Stercoral perforation always need to kept in mind in patients who present with constipation and need to take all patients who present with chronic constipation and initiate measures we encounter commonly in everyday practice. We present a brief review about Stercoral perforation and its management.

The emergence of COVID-19 worldwide in an unprecedented pandemic. COVID-19 has a significant mortality, mostly from acute lung injury. We reviewed the available literature from China and Europe in regard to the behavior of SARS-Cov2 and ability to adhere to the cell wall [1,2]. The evidence based literature describes three component for the virus to grant entry to the target cells including Cathepsin B/L (the viral cap protein needed for initial connectivity to the cell wall), the angiotensin converting enzyme 2 and a low PH environment to allow the first connectivity of the virus to the cell wall [3]. The goal of our Case study was to prevent SARS- SARS-Cov2 from entering target cells by raising the airways PH using sodium bicarbonate inhalation. The sodium Bicarbonate inhalation (4.2% concentration) has been used safely in Cystic fibrosis (CF) patients with inspissated mucoid impaction [3,4] and in chloride inhalation toxicity by opposing the effect of the low PH induced by the insulting agent [4,5]. It has not been administered for COVID -19 patients particularly prior to this study. 

Background: The treatment of chronic lymphoid leukemia currently uses news drugs which are more expensive in our countries. Its why, the results of chemotherapy remains a challenge in our sector. Aims: To evaluate the place of polychemotherapy in the treatment of chronic lymphoid leukemia in black Africa. Methods: It was a prospective, descriptive, analytic and non-comparative study, concerning the records of patients with chronic lymphoid leukemia treated and followed at the department of clinical hematology in Abidjan. Results: We included 56 patients. The average age was 62 years with extremes of 38 and 84 years. The sex ratio was 0.8 in favor of female. The clinical signs noted a tumor syndrome among which splenomegaly, classified stage III (46, 43%) and adenopathy (64, 29%). Biologically, we observed a blood lymphocytosis (50%), an anemia (39.29%) and a thrombocytopenia (62.50%). The majority of patients were classified stage A of BINET (51.79%). The COP protocol (44.64%) and the monochemotherapy with chlorambucil (39.29%) were the most used. The therapeutic response of polychemotherapy was low (12.5%) compared to 35, 71% for monochemotherapy (p = 0.0001) with overall survival significantly better in monochemotherapy. The outcome of patients used polychemotherapy were more adverse that of patients used chlorambucil alone (p = 0,003). The overall probability of survival at 12 months was 90, 9% for patients who used monochemotherapy and 63, 4% for polychemotherapy. Conclusion: Polychemotherapy in chronic lymphoid leukemia of black African has an adverse therapeutic response hence the interest of using new therapeutic possibilities.

Background: The patient in this study experienced a childhood marked by conflicts within the family, physical abuse, frequent changes of school settings, truancy, and unspecified learning disabilities. After leaving school at age 17, she was chronically depressed, had anger attacks, lacked motivation, refused psychological assistance, and had problems finding work. At age 30, this culminated in an aggravated assault of a female in an urban public space, after which she was referred to the criminal courts. She was granted probation and hospitalized for psychiatric evaluation with follow-up, outpatient psychiatric treatment. Aim: To present outcomes of longitudinal monitoring of methylphenidate effects on cognition and self-regulation during treatment of attention-deficit disorder with hyperactivity and substance use. Methods: During more than a year of treatment, psychiatric interviews and norm-referenced assessments of processing-speed and cognitive overhead monitored changes in cognition and substance use. Results: At baseline, processing-speed measures of reactive and active attention were within the average-normal range, whereas cognitive overhead/shift cost was in the atypically high range, suggestive of ADHD symptomatology. The patient engaged in daily excessive use of cannabis, amphetamines, and other illegal substances. At the end of treatment, cognitive speed was increased and cognitive overhead normalized. With reductions in ADHD symptomatology, the patient used small amounts of cannabis during weekends and showed improved self-regulation, and legal restrictions were discontinued.

Background: In this study, we aimed to investigate the role of prognostic factors on breast cancer survival in Iran. Methods: This study was carried out using data from 500 participants with breast cancer. Data were gathered from medical records of patients referring to four breast cancer research centers in Esfahan, Iran, between 1990 – 2000. Age at diagnosis (year), size of tumor, Involve lymph nodes, tumor grade, and family history and married were the prognosis factors considered in this study. A Cox model was used. Results: The median follow-up period was 29.71 months with the interquartile range of 19-61 months. During the follow-up period, 57 (10%) patients died from breast. The Cox model showed that number of lymph nodes involved, and the tumor size and grade tumor are the prognostic factors survival in breast cancer. Conclusion: This study, confirmed the importance of early diagnosis of cancer before the involvement of lymph nodes and timely treatment could lead to longer life and increased quality of life for patients.

Background: Premarital sexual practice significantly attributes for increase adolescent’s risk of unintended pregnancy, early marriage, abortion and STIs. In Ethiopia adolescents were intended to engage at early initiation to sexual intercourse without having proper protection has been one of the concerns. Study aimed to assess the prevalence of premarital sexual practice and associated factors among high school students. Method: A facilities based study design was employed. Data were collected from 291 randomly selected Negade and Finca Bamo high school students using structured questionnaire from June 1-30, 2018. Bi-variate logistic regression used to identify variables that crudely associated and variables with p - value < = 0.05 fitted to multiple logistic regression. Odds ratio with 95% confidence interval was estimated using multivariable logistic regression to identify independent predictors of premarital sex. Result: Among high school students, 31.2% reported had experienced premarital sexual practices. This shows that premarital sexual practices among high school adolescent’s students were high. Drinking alcohol [AOR = 4.06, 95%CI, (2.06 - 7.99)]. Watching pornographic video [AOR: 2.78, 95%CI, (1.45 - 5.3)] and educational status of mothers [AOR: 0.33; 95% CI (0.13, -0.84)] were significantly associated factors. Conclusion: Drinking alcohol, watching pornography and mother education were predominantly significantly associated. Therefore, an integrated effort needs to be highlighted to deter the health behavioral problems of school adolescents at the early stages. 

Background: Alcoholism is a widespread problem in Kenya and is associated with severe impacts on health and quality of life of the individual. Physical activity is an affordable and sustainable adjunct treatment option for recuperating alcoholics; however its’ rarely used in rehabilitation of alcoholics in Kenya. Objective: This qualitative study sought to elicit facilitators and barriers that influence the practice of physical activity amongst recuperating alcoholics under rehabilitation. Methods: A focus group guide was utilized to gather views and perceptions of 15 alcoholics and 5 health professionals through focus group discussions. Constant comparative approach was used to analyze verbatim transcripts obtained from in-depth interviews. This analysis entailed three stages including open, axial and selective coding. Results: Recuperating alcoholics’ recognized various forms of physical activity to promote mental and physical health during their rehabilitation. Health professionals and significant others considerably supported the recuperating alcoholics to practice physical activity however physical activity facilities and facilitation was lacking in Asumbi rehabilitation center. Conclusions: The rehabilitation centres should have physical activity experts and facilities that can offer individualized physical activity services and support needed by the recuperating alcoholics.

For something that’s literally as old as the universe, dark matter doesn’t get much attention outside scientific circles. Maybe that’s because, other than a short-lived SyFy series and a late-period Randy Newman album, this nebulous star stuff has had a tough time breaking the pop-culture barrier. But the truth is that today, dark matter has never mattered more. Our own Milky Way is embedded in a massive cloud of it, we’re looking for its interactions deep inside the earth, and there are whole galaxies without it. So what is dark matter, anyway? Why can’t scientists get enough of the stuff, even though they can’t actually find it? What deep, dark secrets does it hold? And could it ultimately shape the future of life as we know it?

Septic Iliac vein thrombophlebitis with associated psoas abscess is a rare and severe entity, which diagnosis is challenging when no risk factor is clearly present. We are presenting a case of severe septic cavitary pulmonary emboli complicated with Acute Respiratory Distress Syndrome (ARDS) that evolved rapidly to respiratory distress and multi organ failure. A 61-year-old Hispanic male, had multiple emergency department visits due to back pain, being most of them intramuscular pain medications and steroids. In the history, he had back pain that worsened accompanied by poor mobility, generalized malaise, fever and chills. Computed tomography (CT) scan showed a paravertebral psoas abscess with L5 - S1 diskitis/spondylitis inflammatory changes, which was then later evidenced by a gallium study. Further imaging studies were done, showed bilateral cavitary lung lesions, consistent with septic emboli. Subsequent blood cultures were positive for Methicillin Resistant Staphylococcus Aureus (MRSA), for which a successful combined therapeutic regimen was used. Transthoracic and transesophageal echocardiogram were not suggestive of endocarditis. Staphylococcus aureus (SA) bacteremia is one of the most common serious bacterial infections with a high risk of metastatic complications, which makes this pathogen a unique one. The combination of factors iliac vein thrombophlebitis, psoas muscle abscess, diskitis/spondylitis with ARDS makes cavitary pulmonary disease a challenging perspective. After a 6-week antimicrobial treatment, full anticoagulation, his clinical condition and image findings improved, and he was recently admitted for physical rehabilitation. Major vessels thrombophlebitis should always be considered, when primary source of septic pulmonary emboli is not clear. This case illustrates the complexity of illness and complications that may arise from a source of infection as the one in this patient. Further therapeutic strategies were tailored accordingly.