Background: The present study was conducted to study the donor profile and to assess the trends of cornea donation. Methodology: This was conducted as a hospital based cross sectional study at a tertiary care centre in Central India for a period of 5 years. Data was retrieved from 70 patients from eye bank who filled form of eye donation at Eye bank of our institution. Sociodemographic profile of donors, cause of death and time since death was recorded. Source of information regarding corneal donation and reason for not willing to donate the cornea for research purpose was recorded from the filled form. Further cornea enucleated were subjected to serology and their utilization for various purposes were recorded in questionnaire. Results: The present study retrieved data from a total of 70 donor forms with mean age of 65.84 ± 18.4 years. Cornea obtained from younger patients were mainly utilized for corneal transplantation whereas that from elderly age group > 60 years were mainly utilized for research/training purpose and the observed difference was statistically significant (p < 0.01). The corneas retrieved and utilized immediately after death were significantly used for optical or therapeutic purposes (p < 0.05). Conclusion: The present highlights the donor profile and trends of corneal donation at the tertiary care facility of Central India. It was observed that though the younger population and older population both are aware regarding corneal donation but still they are less aware on purpose for which cornea can be utilized. Quality of donor cornea is better when death to enucleation time interval was less.

Objective: During aging, skin undergoes structural, cellular and molecular changes, which not only alter skin mechanical properties but also biological and physiological functions. Structurally the epidermis becomes thinner, the dermal epidermal junction flattens and the extra-cellular matrix component of the dermis is disorganized and degraded. The dermis is composed of two compartments: The Reticular dermis is the deepest and thickest part while the upper layer, the papillary dermis, which is much thinner and is in close contact with epidermis, plays an important role in the structure and function of the skin. We have recently shown that the papillary dermis was preferentially affected by skin aging because the activity of fibroblasts in this region was especially altered as a function of age. The purpose of this study was to investigate the capacity of a flax extract as anti-aging component. Method: We investigated the capacity of a flax extract to stimulate or restore the activity of papillary fibroblasts from young and old donors in cultured monolayers and in reconstructed skin. Several biological markers of extracellular matrix homeostasis and mechanical properties were investigated. Results: The tested flax extract seemed to improve parameters known to change with age: I/ In monolayers after treatment the number of aged fibroblasts increased II/ In reconstructed skin the flax extract appears to positively regulate some biological activities; particularly in aged fibroblasts where the deposition of laminin 5, fibrillin 1, procollagen I were increased in the dermis and the secretion of specific soluble factors like MMP1, MMP3 and KGF were regulated to levels similar to those observed in young fibroblasts III/ Mechanical properties were improved particularly for elastics parameters (R5, R2 and R7). Conclusion: The flax extract is a promising anti-aging compound. The treatment of aged papillary fibroblasts resulted in a return to a younger-like profile for some of the studied parameters.

Introduction: Number of obese people is growing on a daily basis in Brazil, including morbid obese ones, but there is still a lack of studies with this subject. Due to this, the main goal of this study was to identify body profile, physiological variables behavior and oxygen consumption in grade III obese women, submitted to an ergospirometric test in arm ergometer. Method: Take part in this study, thirteen (13) female grade III obese patients between 20 and 40 years. They were submitted to an electric bioimpedance test for body composition measurement and an Ergospirometric test in arm ergometer for oxygen consumption, heart rate, and oxygen saturation, systolic and diastolic arterial pressure, resting and after exercises, analysis. Results: The patients revealed a BMI of 46.5±3.81 kg/m², 51.9±1.59% of body fat percentage. The patients reached 168.2±4.57bpm of heart rate, didn’t make any hypertensive response to the effort reaching an arterial pressure of 171.1±22.15mmHg x 87.5±4.18mmHg. Oxygen saturation was 98±0.71% and oxygen consumption peak was, also in average, 12.3±2.75ml.kg.min-1. Conclusion: It was verified that there was no oxygen saturation drop nor hypertensive response and all of the patients reached the maximum heart rate. 

Background: A structured multidisciplinary team is very important during every phase of the amputation process and a good communicative team guarantees a greater tranquility for the patient, thanks to more homogenous information, that is already discussed between the clinicians. Aim: The aim of this study was to define the efficacy and outcome value of an innovative procedure tool (TRIA-MF protocol) in the treatment of lower limb amputees before and after prosthesis use with the purpose to quantify the quality of the procedure and its economic impact on the clinical patients’ recovery. Setting: A rehabilitation institute for the treatment of neurological and orthopaedic gait disorders. Methods: 12 patients (4 women and 8 males) subjected to lower limb amputation and admitted according to the principles of inclusion criteria of the TRIA-MF protocol at the Rehabilitation Department of the Clinical Institute Città di Brescia were recruited in this study. All patients were included in an integrated and task-specific management protocol of the amputee, which allowed to follow the rehabilitation process from amputation to the final restoration, for a period of 6 months for each patient. Patients were evaluated 5 times during the study, collecting their degree of pain (VAS), their independence profile (Barthel Index) and the cirtometry of their amputation stump. Data on the duration of their admission to the rehabilitation unit, the inter-time between the amputation and acquisition of the temporary prosthesis, and between temporary prosthesis acquisition and the final prosthesis acquisition were also reported. Results: Patients of our sample, at the end of their hospitalization, highlight a significant modification of the temporal data at 1 month and 6 months from their hospital discharge. A statistical significant increase of the Barthel Index value was observed in all patients recruited in this study proceeding from time T0 to time T4; in the same way, a statistical significant decrease of the VAS scale was observed in all patients recruited proceeding from time T0 to time T4; the cirtometry of the amputation stump (expressed in cm) showed a statistical significant decrease in all patients recruited proceeding from time T0 to time T4. We haven’t observed a statistical significant correlation between the duration of the rehabilitative hospitalization and our clinical data; no statistical significant correlation was observed between the amputation stump cirtometry time-related modification and our intertime data. Conclusions: The protocol was found to be a clear and relevant tool with the definition of the operational profile for each single professional figure involved; it could also be considered as an optimal tool for coding the management and evaluation of the effectiveness of amputee treatment, with a related high reproducibility, sensitivity and specificity profile. In line with the literature, the TRIA-MF protocol has allowed us not to exceed a period of hospitalization in rehabilitation units of more than 23 days, thus showing that it is an excellent tool for optimizing the management costs of the amputee over time.

Ra-223 dichloride is a first-in-class alpha-emitting radiopharmaceutical recently introduced into clinical practice for treatment of men with Castration-Resistant Prostate Cancer (CRPC) and symptomatic bone metastases. Due to the proven benefit on Overall Survival and the favorable toxicity profile, Ra-223 therapy is gaining widespread use in both US and Europe. In this article, we describe the routinary management of patients undergoing Ra-223 treatment in our Institution. Currently, Ra-223 therapy is indicated for 6 intravenous injections (55 kBq per kg of body weight) administered every 28 days. In comparison to other radiopharmaceuticals, Ra-223 handling and administration do not need any additional training for authorized users. Due to the minimal external dose rate emission, Ra-223 dichloride can be delivered in an outpatient setting. Moreover, no particular precautions other than standard hygiene measures must be taken by patients’ family members or caregivers. Ra-223 therapy is associated to a favorable hematologic toxicity profile, while non-hematologic adverse events are generally mild and easy to manage. Given the favorable toxicity profile of this treatment, clinical trials are currently ongoing to evaluate efficacy and safety of Ra-223 treatment in combination or sequence with recently approved drugs such as abiraterone acetate, enzalutamide and sipuleucel-T. In addition, the recent interest in Ra-223 bone lesion dosimetry could open the way to a dosimetric-based therapeutic approach with Ra-223. In this new scenario, results of these promising clinical trials may help clarifying the optimal sequencing of new therapeutic possibilities for metastatic CRPC and the appropriate eligibility criteria for Ra-223 treatment in oncologic patients.

Background: The use of a custom-made orthotic plantar device is referenced as a true sensor-motor facilitation tool for the control of the postural orthostatic and orthodynamic position in patients with Parkinson’s disease. Aim: To outline the postural and kinematic effect of a pro-ergonomic multilayer foot insole versus a custom-made carbon-kevlar dynamic foot insole in a cohort of patients affected by extrapyramidal disease. Setting: A rehabilitation institute for the treatment of neurological and orthopaedic gait disorders. Methods: A sample of 8 patients (mean age of 82.6), of whom 4 affected by Parkinson’s disease (P) and 4 by Parkinsonism (PS) were recruited for the aim of this study. In line with our inclusion criteria (clinical-functional diagnosis of Parkinson’s disease or Parkinsonism, Webster scale ≤ 20, Mini-mental State Examination (MMSE) ≥ 18), the study design developed in 2 times: a. time T1 (or evaluation time), in which recruited patients affected by Parkinson’s disease or Parkinsonism were evaluated at the Hospital and Noble Resting House Paolo Richiedei through an accurate functional (Conley scale, Barthel Index scale, Tinetti scale and the Berg Balance Scale), postural evaluation (VPA) and walking examination (VGA, baropodometric evaluation, kinematic gait evaluation through WIVA system); to each group of patients of our study were therefore entrusted 4 foot-insoles, of which 2 synthetic and 2 carbon-kevlar custom-made foot-insoles called PRODYNAMIC; at the end of this step, patients started with our integrated rehabilitative treatment course. b. time T2 (or experimental time; 90 days from T1), a new clinical-instrumental evaluation of each patient was performed, repeating the clinical-functional and instrumental evaluation performed at the time T1 in a specular way; this assessment was performed in FW condition, with personal footwear and previously acquired foot-insoles used during the evaluation at the T1 time. Results: Most of our patients have been able to find benefit from the use of the plantar orthosis and integrated rehabilitation treatment so as to bring some modifications within personal postural attitude, recording an improvement but not uniform change within the sample. The results obtained by comparing the VPA at time T1 and at time T2 explain how patients affected by both clinical forms tend to establish incorrect postural attitudes due to stiffness and appearance of hypertonic plasticity, which become then structured and only partially modifiable. There was a general performance improvement in line with the VGA: within the P.B group, we observed with the use of the Prodynamic insole a partial or even complete normalization of the dynamic heel-contact phase, a better alignment of the COP in its excursion from the 1st to the 2nd rocker phase of the step, a notable facilitation to the inertial thrust in progress in the 3rd and 4th rocker phase, an improvement in the eccentric control of the patellofemoral alignment in the acceptance phase of the so-called load-response in stance and, finally, the acquisition of a more physiological propulsion structure of the trunk basin unit with an improvement of the clearance and fixation skills in the sequential phases of the step. This trend was evident but not uniform in the other groups considered. Analysis of the evolution of the degree of functionality in the daily life activities expressed by the Barthel index, passing from time T1 to the time T2, showed an improvement and consistent change in all groups considered within our study that we can find in a more or less way for the other clinical outcome data. An objective time-related and intra-group comparison of the raw static and dynamic baropodometric data acquired in our 4 study conditions showed different time-related trends for the two groups taken into consideration. A specific WIVA profile was found for each pathology group, highlighting different trends passing from time T1 to time T2 in particular of the gait cadence and gait speed. In particular, in the “Prodynamic” study condition the gait cadence shows in the Parkinson group a significant increase from time T1 to time T2, passing respectively from an average value of 41.9 ± 11.7 to 54.9 ± 1.1; patients of the Parkinsonism group showed a value of the average gait cadence at time T1 higher than the other study conditions at the same evaluation time, with an increase of this data from T1 to T2, passing from 43.1 ± 11.8 to 47.4 ± 4.4. If we consider the gait speed time-related trend, in the “Prodynamic” study condition at T1 the gait speed in Parkinson patients is similar to that recorded in the “shoe” study condition; in Parkinsonism the gait speed recorded at time T1 is higher than that recorded in the other study conditions; at time T2 there is a less evident increase in speed compared to that observed in patients with Parkinson’s. Conclusion: In today’s management of the profile of complexity of extrapyramidal pathology, the association of several health figures is of fundamental importance, with professional profiles and diversified skills, in such a way as to be able to guarantee a comprehensive management of the patient. From this point of view, the figure of the orthopedic technician will be able to play a new role within the rehabilitation team, which will be responsible for the best possible functional response (deriving from an optimal integration between orthotic and rehabilitation treatment) of patients with Parkinson’s disease.

Introduction: Laparoscopic approach is emerging as a standard of care approach for management of masses amenable to partial nephrectomy. Laparoscopic partial nephrectomy is a challenging surgery and its successful performance depends on various factors. We aim to evaluate the influence of tumor characterestics on the operative performance for laparoscopic partial nephrectomy. Methods: Patients undergoing laparoscopic partial nephrectomy in our institution were recruited for this study. The tumor profile was evaluated by a senior radiologist from cross sectional imaging (computed tomography or magnetic resonance imaging). Tumor characerestics was defined by assessing tumor size, tumor location and RENAL score. The operative performance was evaluated in terms of warm ischemia time, blood loss, operation duration and any significant operative complications. Statistical inference was drawn. Results: 37 patients who underwent laparoscopic partial nephrectomy between January 2010 and June 2012 were included in this study. The mean tumor dimension was 3.81 cms. 21 tumors involved left kidney and 16 involved right kidney. 12 were located in upper pole, 8 were located in midpole and 17 were located in lower pole. The average RENAL score was 6.56. The mean warm ischemia time, blood loss and operation duration was 26.29 minutes (min), 256.76 millilitres (ml) and 208.11 min respectively. Statistically significant correlation was appreciated between tumor location (polar location, side, anterior/ posterior location) and RENAL score and operative parameters (warm ischemia time and operation duration). Tumor size did not have any correlation with the operative parameters. Conclusion: The operative performance of laparoscopic partial nephrectomy is significantly influenced by the tumor location and RENAL score.

Background: To date, the scientific community has mainly focused on outcomes of obesity surgery such as weight loss and resolution of associated complications. Adverse post-operative events and reoperation rates have been poorly reported even if they are a marker of surgical safety and therefore of great importance in guiding patients and surgeons in the choice of the more suitable operation. Methods: This retrospective multicenter observational study is based on the data extracted from the Italian Society of Bariatric Surgery and Metabolic Disorders (S.I.C.OB.) database, which covers almost all the bariatric operations performed in Italy. We analysed the 30 days post-operative complications occurring, in the period from 2009 to 2015, after Roux-en-Y Gastric Bypass (RYGB), Sleeve Gastrectomy (SG) and Mini Gastric Bypass/One Anastomosis Gastric Bypass (MGB/OAGB) qualitatively, quantitatively and on the basis of the Clavien-Dindo classification of surgical complications. Complications following surgeries were tested using the 95% confidence interval. Statistical analysis was performed with Statistical Analysis System (SAS). Results: In the 2009-2015 time frame, a total of 31,624 operations were performed of which 6,864 RYGB, 10,833 SG and 992 MGB/OAGB. The complication rate was 4.39 %, 4.04 % and 3.83% respectively. The most frequent complications were hemoperitoneum (0.9%) and perforation, fistula and dehiscence (1%) which were higher in SG when compared with RYGB (with a statistical significance) and when compared with MGB/OAGB (without a statistical significance). When dividing the complications by the different grades of the Clavien-Dindo classification, the only significant difference encountered, from a statistical standpoint, was between MGB/OAGB and SG. MGB/OAGB was associated with a lower grade I Clavien-Dindo complication rate (1.31% versus 2.34%). Conclusion: This study supports a safe profile of obesity surgey in Italy, along with positive bariatric outcomes. The rate of 30 days post-operative complications is progressively lower after MGB/OAGB (3.83%), SG (4.04%) and RYGB (4.39%) respectively. In particular, MGB/OAGB records statistically less low-grade Clavien-Dindo complications compared to SG and RYGB. Introduction

Background: Herbal essential oil contains pharmacological benefits for intervention treatment of various diseases. Studies have demonstrated its antimicrobial, antioxidant, and anti-inflammatory effect involving in vitro cell culture and preclinical animal models. It has been also traditionally used to reduce anxiety and hypertension in human. However, scientific studies elucidating its mechanism of action and pharmacological targets, as well as its effectiveness and safety as phytotherapeutic compounds are still progressing. Recent studies showed its promising effect in depression-cardiovascular disease intervention. However, comprehensive evaluations to enlighten latest advancement and potential of herbal essential oil are still lacking. Objective: In this systematic review, the depression-cardiovascular effects of herbal essential oil on lipid profile, biochemical and physiological parameters (e.g haemodynamic) are presented. The route of delivery and mechanism of action as well as main bioactive compounds present in respective essential oil are discussed. Methods: Article searches are made using NCBI PubMed, PubMed Health, SCOPUS, Wiley Online, tandfonline, ScienceDirect and Espacenet for relevant studies and intellectual properties related to essential oil, depression and cardiovascular disease. Results: In experimentation involving in vitro, in vivo and clinical trials, herbal essential oil showed its effectiveness in reducing coronary artery disease (narrowing of the arteries), heart attack, abnormal heart rhythms, or arrhythmias, heart failure, heart valve disease, congenital heart disease, heart muscle disease (cardiomyopathy), pericardial disease, aorta disease, Marfan syndrome and vascular (blood vessel) disease. Conclusion: This review gives a valuable insight on the potential of essential oil in the intervention of depression associated with cardiovascular diseases. Studies showed that herbal essential oil could act as vasodepressor, calcium channel blocker, antihyperlipidemia, anticoagulant, antiatherogenesis and antithrombotic. It can be proposed as an interventional therapy for depression-cardiovascular disease to reduce doses and long-term side-effect of current pharmacological approach.

Acute carbon monoxide (CO) poisoning is caused by the inhalation of large quantity of CO within short time leading to morbidity and mortality. In this study, a total of eighteen (18) rabbits were divided into three (3) groups of six (6) animals each. The first group first group was poisoned with CO and labelled carbon monoxide death (CD). The second group of animals was killed prior to exposure to CO and labelled disguised death (DD), while the third was the control group (CG). The vitreous humour samples were collected from all the animals using standard methodologies. The vitreous humour total protein and albumin were estimated while its globulin content and albumin/globulin ratio were derived mathematically. Pearson correlation analyses were used to establish relationships between vitreous protein profile components and the acute graded carbon monoxide concentrations. Results indicated a significant increase (P<0.05) in vitreous total protein and globulin of the studied groups. This observation was more pronounced in the CD group of animals. Therefore the marked elevation of vitreous total protein and globulin may serve as a useful tool in the confirmation of death due to carbon monoxide poisoning.

Coroner and medical examiner offices are charged with the medicolegal investigation of deaths to determine the cause and manner of death. We describe the recent high-profile case of Otto Warmbier, who tragically died shortly after his return in a coma from North Korea and in which the coroner failed to conduct a complete autopsy, and failed to satisfy the needs of the local, national, and international communities. Medico legal death investigation offices, including both medical examiner and coroner offices, have a legal responsibility and duty to investigate deaths in the public interest for public safety and public health purposes. Although, they serve the families of the deceased as they can, their raison d’être and priority is service to the greater public good. Thus, they may conduct investigations and even autopsies over the objections of the next-of-kin. Full investigations include a complete forensic autopsy. The utilitarian public interest should, within the constraints of the office resources, drive the decision of whether to autopsy or not. Failure to autopsy can sometimes constitute a breach of faith that the public entrusts in these offices. Empirically, this seems to be a greater problem in coroner jurisdictions than in medical examiner offices. Specifically, we believe the recent case of Otto Warmbier is such a case.

Growing evidence supports the hypothesis that endothelial cell-derived microparticles (MPs) might contribute to the pathogenesis of cardiovascular (CV) disease. Endothelial cell-derived MPs play a pivotal role in the regulation of the endogenous repair system, thrombosis, coagulation, inflammation, immunity and metabolic memory phenomenon. There is evidence that the MPs are secreted actively accompanied to other regulatory molecules. All these actively synthetizing and secreting factors include proteins, adhesion and intercellular signal molecules, peptides, lipids, free DNAs, microRNAs, and even microparticles (MPs) are defined as cellular secretome. The proteomic profile of secretome is under tightly control of genetic and epigenetic mechanisms, which may altered a secretion of the proteins involved into MPs’ organization. Finally, this may contribute the modification of MP’s after their secretion and throughout transfer to the target cells. As a result, communicative ability of endothelial cell-derived MPs may sufficiently worse. Subsequently, cross talk between some components of secretome might modulate delivering cargos of MPs and their regenerative and proliferative capabilities via intercellular signaling networks. The aim of the review is to discuss the effect of various components of secretome on MP-dependent effects on endothelium.

The Positive Regulatory Domain (PRDM) protein family gene is involved in a spectrum variety of biological processes, including proliferation, differentiation and apoptosis: its member seem to be transcriptional regulators highly cell type and tissue peculiar, towards histones modifications or recruitment of specific interaction patters to modify the expression of target genes. In this study we analyzed the expression profile of different member of PRDM gene family focusing our attention on the role of PRDM2, PRDM4 and PRDM10 genes in mouse C2C12 cell line, during the differentiation of myoblasts into myotubes and speculate about the role of the protein Retinoblastoma protein-interacting zinc finger protein 1-RIZ1, coded by PRDM2 gene, as a regulator of the proliferation/differentiation switch. Results showed a reduction of PRDM2, PRDM4 and PRDM10 expression level during the commitment of the differentiation of myoblasts into myotubes. The RIZ1 silencing stimulated myoblasts differentiation, similar to the effect of serum deprivation on these cells, associated with an increase of Myogenin expression level, which is considered to be involved in the differentiation of myoblasts into multinucleated myotubes. As demonstrated by chromatin immunoprecipitation experiments, RIZ1 is associated with Myogenin promoter in proliferation condition and after 24h from differentiation induction, negatively controlling therefore Myogenin expression. Moreover RIZ1 silencing induced a reduction in PRDM4 and PRDM10 expression levels leaving us to speculate that the PRDM genes have a redundant role and they are hierarchically organized.

The probiotic effects of Bacillus coagulans and Bacillus subtilis were studied on survival, growth, concentrations of basic biochemical constituents, activities of digestive enzymes, and their colony establishments in the gut of Macrobrachium rosenbergii post-larvae (PL). Eleven groups of PL (2.03±0.05 in length and 0.18±0.01g in weight), each consists of 35 individuals maintained in 25 L of ground water and fed ad libitum with five serially diluted concentrations, 10-1, 10-3, 10-5, 10-7 and 10-9 of B. coagulans, and B. subtilis incorporated diets containing 40% protein, for 45 days. Diet without incorporation of any of these probiotics was served as control. These probiotics were found to be alive in the respective feed even on day-15 after their formulations. Significant improvement in survival, nutritional indices (weight gain, specific growth rate, food conversion ratio and protein efficiency ratio), contents of basic biochemical constituents (total protein, amino acid, carbohydrate and lipid) and activities of digestive enzymes (protease, amylase and lipase) were observed (P<0.05), particularly in 10-7 concentration of B. coagulans, and B. subtilis incorporated diets fed PL when compared with control. The biochemical confirmation tests revealed that presence of Escherichia coli, Acetonobacter sp., Salmonella sp., and Pseudomonas sp., in the gut of control PL. In the gut of PL fed with B. coagulans incorporated diet, Acetonobacter sp., Salmonella sp., and Pseudomonas sp., were found to be competitively excluded, whereas, in the gut of PL fed with B. subtilis incorporated diet, Acetonobacter sp., and Salmonella sp., only were found to be excluded competitively. Actually, colonies of Bacillus sp., and Lactobacillus sp., were found to be establishment in the gut of PL fed with B. coagulans, and B. subtilis incorporated diets. Overall, these probiotics incorporated diets produced better growth and survival due to better FCR and activities of digestive enzymes, which in turn led to better nutritional profile. Therefore they are recommended as feed additives for sustainable culture of M. rosenbergii.

In this article, we describe the case of a fifty-year-old patient with autoimmune hemolytic anemia (AIHA) with constitutional symptoms, jaundice, unquantified fever and progressive dyspnea. The patient had history of smoking and Hepatitis A and following a physical exam she was found in a regular condition, icteric but with no other further signs. Her laboratory tests revealed hemolytic anemia with a hemoglobin of 8.5 g/dL, an increase of total and indirect bilirubin, an elevated ferritin, a decreased transferrin and haptoglobin and a positive result for direct Coomb’s test. Considering this, an immune profile was ordered finding a negative result of ANAs and ENAs and a decrease of complement C3 and C4. The patient was diagnosed with AIHA and as an initial step a corticosteroid treatment was administrated however the patient showed no clinical nor chemical improvement. At her third day of hospitalization, she was unstable hemodynamically requiring transfer to Intensive Care Unit (ICU) to optimize management. After 24 hours on ICU, due to persistence of deterioration of the patient, it was decided to manage with erythropoietin (EPO). In the following days, the patient showed a rise in her hemoglobin and an overall improvement made possible the transfer to hospitalization service. The AIHA is an uncommon disease and is not the first option that comes to mind with these symptoms, currently there are not controlled studies to the treatment due to its complexity and the heterogeneity of the results. We strongly support the use of EPO in refractory cases of this pathology.

Dopamine agonists should usually be the first treatment for patients with prolactinomas of all sizes, because these drugs decrease serum prolactin concentrations and decrease the size of most lactotroph adenomas. Cabergoline is preferred first. When cabergoline develops side effects bromokriptin is switched. Cabergoline is more efficient than bromocriptine. Its side effect profile more favorable than bromocriptine. Cabergoline is an ergot dopamine agonist that is administered once or twice a week. Cabergoline can have rarely serious psychiatric adverse effects, including psychosis, impulse control disorders, dyskinesia, pulmonery fibrosis and valvular heart disease. Prolactinomas are the most common pituitary tumors, 93%-95% of the cases are microadenomas. Macroprolactinomas larger than 40 mm, known as giant prolactinomas, are exceptionally rare, accounting for 0.5% - 4% of all prolactin-hypersecreting adenomas. In our case, after the 7 x 6 cm giant macroprolactinoma operated we report the manic episode occuring during the second week of cabergoline treatment. In the treatment of patients with prolactinoma, cabergoline is a first choice drug because it has a better tolerance profile and is more effective, however, bromocriptine can be switched to when drug resistance or side effects develop to cabergoline.

Background: Hepatitis B virus infection is a major cause of liver associated morbidity and mortality with diverse spectrum of disease. It is estimated about 15% to 40% of patients with hepatitis B virus infection progress to chronic hepatitis and about 15% to 25% die from disease complications. The main aim of this study was to evaluate the serological and virological markers of patients with chronic hepatitis B virus infection to determine the natural history of chronic hepatitis B infection in the Eritrean setting. Methods: A laboratory-based cross-sectional study was conducted on 305 patients with HBsAg positive who presented to Orotta National Referral Hospital, Halibet Hospital, Sembel Hospital and National Health Laboratory in Asmara, Eritrea from January 2017 to February 2019. Enzyme-linked immunosorbent assay was performed to detect hepatitis B serological markers (anti-HBc, HBsAg, anti-HBsAb, HBeAg and anti-HBeAg). Hepatitis B DNA viral loads and liver transaminase levels were determined. Data analysis was conducted using SPSS version 25.0. Results: A total of 305 patients presented with HBsAg positive serology with a mean age of 41.3 (± 13.7) years ranging from 16 to 78 years. Males were 218 (71.5%) and females 87 (28. 5%).Anti-HBc was positive in 300 (98.4%), of which 293 (97.5%) were positive for HBsAg and 7 (2.3%) positive for anti-HBs. Among these 293 patients, 20 (6.8%) were HBeAg positive/anti-HBe positive, 242 (82.6%) HBeAg-negative/anti-HBe-positive and 31 (10.6%) were HBeAg negative/anti-HBe-positive. Detectable HBV DNA was found in 122(41.6%) of the 293 cases. Alanine transaminase was normal in 90% of HBeAg-positive and in 91.2% of HBeAg-negative patients. Hepatitis B DNA viral load was >2,000 IU/mL in 67 (22.86%) and >200,000 IU/mL level was more frequently detected in HBeAg positive (20.0%) compared to HBeAg negative (1.8%) subjects (p < 0.001). Conclusion: This study shows predominance of HBeAg-negative and low replication phase of HBV infection among patients in Eritrea. It also documented that most patients had chronic infection with normal liver transaminase levels in the absence of biochemical signs of hepatitis. This study will provide a basis for therapeutic evaluation of patients and planning national treatment guidelines in the Eritrean setting.

Introduction: HIV infection leads to metabolic disorders. The objective of this work was to study the lipid profile of HIV + patients followed at the University Teaching Hospital of Kinshasa (UTHK). Methods: This study analyzes the lipid profile of HIV + patients, aged at least 18 years, followed at the UTHK from January 1, 2008 to December 31, 2014. The medians of different types of lipids, the frequency of lipid disorders, the general clinical characteristics of patients and factors associated with dyslipidaemia were studied. Haemoglobin (Hb), White Blood Cells (WBC), Leukocyte Formula (LF), Blood Sugar, Urea, Creatinine, Transaminases, Uric Acid, CD4s+ count were analyzed. Results: The lipid balance was performed in 38.8% of patients; 38.1% of them had dyslipidaemia. Total hypercholesterolaemia (28.6%), elevated LDL-C (19%), hypertriglyceridemia (23.8%) and HDL hypocholesterolaemia (42.9%) were observed. The medians of TG (128 mg / dL), HDL-C (51 mg/dL) and LDL-C (78 mg/dL) were high. Risk factors associated with dyslipidaemia were represented by WHO stage 4, tuberculosis (TB) and hyperglycaemia. The highest levels of LDL-C and TG and the lowest HDL-C were seen when CD4s+ were below 200 elements/µL. Conclusion: The HIV/AIDS dyslipidaemia characterized in this study by HDL-C hypocholesterolaemia, hypertriglyceridemia and total and LDL hypercholesterolemia can be considered as an indicator of the progression of HIV infection.

Capsicum spp. is one of the most important economical horticulture crops due to its high consumption either by fresh vegetable or dried spice. Molecular genetic markers offer a number of applications in the genetic improvement of crop plants, which plays an important role in the areas of plant classification and breeding programs. The polygenetic characters of rare species, which are difficult to analyze by traditional methods can, be analyzed easily and classified by using molecular markers. In our study, genetic relationships of twenty-two paprika species were examined to estimate their genetic variations/similarities and to detect the polymorphism present within and among the paprika species by using RAPD-PCR markers. The results revealed that the maximum similarities among the 16 ICBD lines were 100%. The ICBD 03 had 76% similarity compared with other ICBD lines. The CC01 had comparatively low similarity with ICBD forms (30%), followed by EC01 (28%), EC02 (33%), CC02 (35%), and Kt.Pl-19 (60%). The similarity between EC01 and EC02 were 54%. Kt.Pl-19 showed different similarities compared to CC01 (41%), CC02, EC01 (38%), EC02 (29%) and ICBD 03 (40%). The different combinations were tried to optimize the RAPD-PCR profile, which helped to assessing the polymorphism/similarities within and among the Paprika germoplasms were studied.

Purpose: Children with autism spectrum disorder are at an increased risk for developing seizures, which can be triggered by classical antipsychotics. Aripiprazole is an atypical antipsychotic that has a safer drug profile. The objective is to present the experience with seizure control in autistic children who are placed on Aripiprazole. Methods: Series of consecutive autistic children with comorbid epilepsy treated with Aripiprazole were identified prospectively over a 3-year period. Monthly follow up by one pediatric neurologist was performed to document seizure control. Results: 56 autistic children with comorbid epilepsy were placed on Aripiprazole. Most children (59%) were seizure free for at least 6 months. The initial Aripiprazole dose was 5 mg in all patients. Follow up ranged between 5-8 months (mean 6.9). A total of 5 (9%) children developed seizure provocation (3/5) or worsening seizure control (2/5). There were 3 males and 2 females with ages ranging between 6-11.5 years (mean 8.5). Three of these children had a previous history of seizure worsening with other antipsychotic drugs (respiridone in 2 and haloperidol in 1). One child with seizure provocation developed status epilepticus 5 days after introducing Aripiprazole that required intensive care admission. The drug was stopped in all 5 children with no long-term effects. Conclusion: Seizure provocation or worsening seizure control is not uncommon following the introduction of Aripiprazole in autistic children with controlled epilepsy. Although the risk is low, parents should be warned and advised on what to do, particularly in the first month of therapy.