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Objective: Unusual clinical course Background: Mechanical and functional intestinal obstruction are serious postoperative complications. Acute colonic pseudo-obstruction (Ogilvie's syndrome) is an acute functional obstruction of the large intestine with various causes, including electrolyte disturbances, certain drugs, trauma, hypothyroidism, and, less often, certain procedures, such as abdominal, pelvic, orthopedic, cardiac, and, rarely, thoracic surgeries. It presents with abdominal distension without evidence of mechanical obstruction. This report is of a 66-year-old man with postoperative Ogilvie's syndrome 1 day after diaphragmatic plication surgery. Case Report: We present a case of a 66-year-old man with no pre-existing chronic diseases who underwent diaphragmatic plication surgery performed to treat symptomatic diaphragmatic eventration, which was associated with chronic colonic dilation. One day after the procedure, the patient experienced hemodynamic instability, abdominal tenderness and distention, leukocytosis, and elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). An abdominal CT scan revealed massive colonic dilation with interposition of the splenic flexure into the diaphragm. Consequently, the patient underwent emergency exploratory laparoscopy, which was later converted to upper laparotomy, during which colonic decompression was performed without identifying any evidence of incarceration. Subsequently, colonic decompression was repeated via sigmoidoscopy, and no mechanical obstruction was found. Lastly, medical treatment was effective in improving the patient's condition. Conclusions: In this complicated case, identifying the definite diagnosis was challenging due to the unusual presentation. This rare case might contribute to recognizing a new risk factor for postoperative colonic obstruction, which is preoperative colonic dilation. Also, this case has highlighted the importance of promptly diagnosing postoperative Ogilvie's syndrome to prevent large-bowel perforation. [ABSTRACT FROM AUTHOR]

Background: Invasive candidiasis is not uncommon in critically ill patients but has variable epidemiology and outcomes between intensive care units (ICUs). This study evaluated the epidemiology, characteristics, management, and outcomes of patients with invasive candidiasis at 6 ICUs of 2 tertiary care centers. Methods: This was a prospective observational study of all adults admitted to 6 ICUs in 2 different hospitals between August 2012 and May 2016 and diagnosed to have invasive candidiasis by 2 intensivists according to predefined criteria. The epidemiology of isolated Candida and the characteristics, management, and outcomes of affected patients were studied. Multivariable logistic regression analyses were performed to identify the predictors of non-albicans versus albicans infection and hospital mortality. Results: Invasive candidiasis was diagnosed in 162 (age 58.4 ± 18.9 years, 52.2% males, 82.1% medical admissions, and admission Acute Physiology and Chronic Health Evaluation II score 24.1 ± 8.4) patients at a rate of 2.6 cases per 100 ICU admissions. On the diagnosis day, the Candida score was 2.4 ± 0.9 in invasive candidiasis compared with 1.6 ± 0.9 in Candida colonization (P <.01). The most frequent species were albicans (38.3%), tropicalis (16.7%), glabrata (16%), and parapsilosis (13.6%). In patients with candidemia, antifungal therapy was started on average 1 hour before knowing the culture result (59.6% of therapy initiated after). Resistance to fluconazole, caspofungin, and amphotericin B occurred in 27.9%, 2.9%, and 3.1%, respectively. The hospital mortality was 58.6% with no difference between albicans and non-albicans infections (61.3% and 54.9%, respectively; P =.44). The independent predictors of mortality were renal replacement therapy after invasive candidiasis diagnosis (odds ratio: 5.42; 95% confidence interval: 2.16-13.56) and invasive candidiasis leading/contributing to ICU admission versus occurring during critical illness (odds ratio: 2.87; 95% confidence interval: 1.22-6.74). Conclusions: In critically ill patients with invasive candidiasis, non-albicans was responsible for most cases, and mortality was high (58.6%). Antifungal therapy was initiated after culture results in 60% suggesting low preclinical suspicion. Study registration: NCT01490684; registered in ClinicalTrials.gov on February 11, 2012. [ABSTRACT FROM AUTHOR]

Objectives: Our study aimed to report the epidemiology, clinical presentations, diagnostic and therapeutic approaches, and outcomes of Crohn's disease (CD) in pediatric patients in Bahrain. Methods: We conducted a retrospective review of the medical records of patients with CD diagnosed in the pediatric department, Salmaniya Medical Complex, Bahrain, between 1984 and 2017. We used the data to calculate the annual incidence and cumulative prevalence. Data about gender, nationality, clinical presentation, age at presentation and diagnosis, duration of illness, consanguinity, family history, contact with smokers, and comorbidities were gathered. Results of hematological, biochemical, and serological tests were also collected. All radiological, endoscopic, and histopathological findings were reviewed. Data about medical therapy, relapse episodes, hospital admissions, complications, and outcomes were collected. Results: Of 108 pediatric patients diagnosed with inflammatory bowel disease (IBD), 51 (47.2%) patients had CD. The annual incidence was 1 in 100 000 per year (range = 0-5 patients/year) with significant rise on comparing the three decades (p = 0.0001). Prevalence was 9.32 patients per 100 000 pediatric populations. Thirty-four patients (66.7%) were males, and the median age was 18.5 years (range = 6.4-35.0). Common clinical presentations were recurrent abdominal pain and weight loss. Family history of IBD was found in 10 patients. One patient had positive antineutrophil cytoplasmic antibody. The terminal ileum was involved in 68.1%, colon in 63.8%, and perianal area in 17.0% patients. Biological therapy was used in five patients. Surgical intervention was required in six patients. The mean follow-up period was 9.2±5.6 years. Conclusions: The clinical characteristics of our population are comparable to that reported in neighboring countries and worldwide. [ABSTRACT FROM AUTHOR]

Behçet's disease (BD) is an autoinflammatory, chronic relapsing/remitting disease of unknown aetiology with both innate and acquired immune cells implicated in disease pathogenesis. Peripheral blood natural killer (NK) cells and their CD56Dim/CD56Bright subsets were surface phenotyped using CD27 and CD16 surface markers in 60 BD patients compared to 60 healthy controls (HCs). Functional potential was assessed by production of interferon (IFN)-γ, granzyme B, perforin and the expression of degranulation marker CD107a. The effects of disease activity (BDActive versus BDQuiet) and BD medication on NK cells were also investigated. Peripheral blood NK cells ( P < 0·0001) and their constituent CD56Dim ( P < 0·0001) and CD56Bright ( P = 0·0015) subsets were depleted significantly in BD patients compared to HCs, and especially in those with active disease (BDActive) ( P < 0·0001). BD patients taking azathioprine also had significantly depleted NK cells compared to HCs ( P < 0·0001). A stepwise multivariate linear regression model confirmed BD activity and azathioprine therapy as significant independent predictor variables of peripheral blood NK percentage ( P < 0·001). In general, CD56Dim cells produced more perforin ( P < 0·0001) and granzyme B ( P < 0·01) expressed higher CD16 levels ( P < 0·0001) compared to CD56Bright cells, confirming their increased cytotoxic potential with overall higher NK cell CD107a expression in BD compared to HCs ( P < 0·01). Interestingly, IFN-γ production and CD27 expression were not significantly different between CD56Dim/CD56Bright subsets. In conclusion, both BD activity and azathioprine therapy have significant independent depletive effects on the peripheral blood NK cell compartment. [ABSTRACT FROM AUTHOR]

Case: Isolated avulsion of the teres minor tendon is exceedingly uncommon and, to our knowledge, the presentation and arthroscopic repair of this type of injury have not been described. Known musculotendinous avulsions about the shoulder frequently involve the supraspinatus, long head of the biceps, and pectoralis major. Conclusion: We present the case of a patient with an isolated teres minor avulsion and an otherwise intact rotator cuff. The patient underwent successful arthroscopic repair and rehabilitation, allowing for a return to the pre-injury level of function. [ABSTRACT FROM AUTHOR]

The aim is to test the efficacy of a single oral dose of fosfomycin trometamol in preventing urinary tract infection as compared to ciprofloxacin in patients undergoing invasive urodynamics studies. Patients were randomized into 2 groups: A and B. Group A: a random group of patients undergoing urodynamics studies received a single pre-procedure dose of fosfomycin trometamol 3 gms orally 3 hours before the study. Group B: a random group of patients received a single pre-procedure dose of 500 mg ciprofloxacin 3 hours before the study. A total of 65 patients enrolled in the study (45 females and 20 males); the age range from 10 to 75 years with a mean of 50.32 ± 13.5. There were 39 patients in group A and 26 patients in group B. The post-procedure urine analysis showed increased presence of WBCs in Group A (fosfomycin trometamol) compared to group B (ciprofloxacin). Post-procedure, the negative urine cultures were reduced from 59% to 20.5% for group A and comparably from 57.7% to 23.1% in group B. A single dose of both fosfomycin trometamol and ciprofloxacin were equally in-effective in the prophylaxis against urinary tract infection in patients undergoing urodynamics studies. [ABSTRACT FROM AUTHOR]

Background. Access to antiretroviral therapy and human immunodeficiency virus (HIV) care is increasing in resource-limited settings. We evaluated clinical, behavioral, and demographic risk factors associated with virologic suppression in a public, urban clinic in Kampala, Uganda. Methods. We conducted a cross-sectional, observational study of 137 HIV-infected patients who were receiving antiretroviral therapy at the infectious diseases clinic at Mulago Hospital (Kampala). We measured the prevalence of viral suppression, evaluated risk factors associated with virologic failure, and documented phenotypic resistance patterns and genotypic mutations. Results. A total of 91 (66%) of 137 participants had an undetectable viral load (<400 copies/mL) after a median duration of 38 weeks (interquartile range, 24-62 weeks) of antiretroviral therapy. Median CD4 cell count was 163 cells/mm³ (interquartile range, 95-260 cells/mm³). The majority of the patients (91%) were treated with nonnucleoside reverse-transcriptase inhibitor-based 3-drug regimens. In multivariate analysis, treatment with the first antiretroviral regimen was associated with viral suppression (odds ratio, 2.6; 95% confidence interval, 1.1- 6.1). In contrast, a history of unplanned treatment interruption was associated with virologic treatment failure (odds ratio, 0.2; 95% confidence interval, 0.1-0.6). Of 124 participants treated with nonnucleoside reverse-transcriptase inhibitors, 27 (22%) were documented to have experienced virologic treatment failure. The most common mutation detected was K103N (found in 14 of 27 patients with virologic treatment failure). Conclusions. Although many HIV-infected people treated in Kampala, Uganda, have advanced HIV disease, the majority of patients who received antiretroviral therapy experienced viral suppression and clinical benefit. Because of the frequent use of nonnucleoside reverse-transcriptase inhibitor-based therapy, the majority of resistance was against this drug class. In resource-limited settings, initiation of therapy with a potent, durable regimen, accompanied by stable drug supplies, will optimize the likelihood of viral suppression. [ABSTRACT FROM AUTHOR]

Abstract: Objective: : To assess the impact of the Women''s Health Initiative (WHI) study on gynecologists’ attitudes regarding hormone therapy (HT). Methods: : Questionnaires were mailed to a random sample of Lebanese gynecologists (n =178). The questionnaires solicited practice patterns of HT for postmenopausal women and information provided while counseling before and after the WHI study. Descriptive statistical methods were used to evaluate the responses. Results: : Questionnaires were returned by 140 physicians (78.7%), 93.6% of whom were aware of the WHI study. More than 90% of respondents routinely offered HT prior to the study. Of the 85.6% who used a combination of oral estrogen and progesterone (E/P), 40.0% used conjugated equine estrogen (CEE) and medroxyprogesterone acetate (MPA). Around 67% of gynecologists reported a change in their therapeutic approach after the study. The main changes were: not offering CEE+MPA (27.3%), prescribing CEE+MPA to a select group of patients (37.5%), using other forms of HT (56.8%), or abandoning any form of HT (6.8%). Other practice modifications included a shift to the use of tibolone (18.2%) or alternative therapies (29.5%). Whereas 76.2% of physicians counseled their patients about a decreased risk of cardiovascular events with HT prior to WHI study, only 34.1% continued to do so after the study (p &#60;0.001). The percentage of gynecologists that inform their patients of an increased risk of breast cancer on HT rose from 45.2 to 73.2% (p =0.018). Almost 51% of gynecologists allow their patients to participate in decision making regarding the type of HT, 42.4% would choose for their patients after counseling, while 6.8% of physicians do not counsel their patients in order not to confuse them. Conclusion: : In a representative sample of Lebanese gynecologists, there was a significant change in physicians’ attitudes towards HT following the publication of the WHI study. [Copyright &y& Elsevier]

Case: A 9-year-old boy sustained intrasubstance tears of the rotator cuff and periscapular muscles due to a fall, resulting in scapular winging and severely decreased shoulder range of motion. Treatment consisted of a modified thoracolumbosacral orthosis (TLSO) with a shoulder immobilizer attachment (to reduce the scapula to the thoracic wall and hold the arm in 10° of abduction). The brace was worn for 8 weeks. The patient recovered full, pain-free shoulder function and range of motion, and returned to high-level athletics. Conclusion: Pediatric massive intrasubstance rotator cuff and periscapular muscle tears can be treated nonoperatively with use of a modified TLSO. [ABSTRACT FROM AUTHOR]

Background: Renal cell carcinoma (RCC) is a seventh ranked malignancy with poor prognosis. RCC is lethal at metastatic stage as it does not respond to conventional systemic treatments, and there is an urgent need to find out promising novel biomarkers for effective treatment. The goal of this study was to evaluate the biomarkers that can be potential therapeutic target and predict effective inhibitors to treat the metastatic stage of RCC. Methods: We conducted transcriptomic profiling to identify differentially expressed genes associated with RCC. Molecular pathway analysis was done to identify the canonical pathways and their role in RCC. Tissue microarrays (TMA) based immunohistochemical stains were used to validate the protein expression of cyclinD1 (CCND1) and were scored semi-quantitatively from 0 to 3+ on the basis of absence or presence of staining intensity in the tumor cell. Statistical analysis determined the association of CCND1 expression with RCC. Molecular docking analyses were performed to check the potential of two natural inhibitors, rutin and curcumin to bind CCND1. Results: We detected 1490 significantly expressed genes (1034, upregulated and 456, downregulated) in RCC using cutoff fold change 2 and p value < 0.05. Hes-related family bHLH transcription factor with YRPW motif 1 (HEY1), neuropilin 2 (NRP2), lymphoid enhancer-binding factor 1 (LEF1), and histone cluster 1 H3h (HIST1H3H) were most upregulated while aldolase B, fructose-bisphosphate (ALDOB), solute carrier family 12 (SLC12A1), calbindin 1 (CALB1) were the most down regulated genes in our dataset. Functional analysis revealed Wnt/β-catenin signaling as the significantly activated canonical pathway (z score = 2.53) involving cyclin D1 (CCND1). CCND1 was overexpressed in transcriptomic studies (FC = 2.26, p value = 0.0047) and TMA results also showed the positive expression of CCND1 in 53 % (73/139) of RCC cases. The ligands - rutin and curcumin bounded with CCND1 with good affinity. Conclusion: CCND1 was one of the important upregulated gene identified in microarray and validated by TMA. Docking study showed that CCND1 may act as a potential therapeutic target and its inhibition could focus on the migratory, invasive, and metastatic potential of RCC. Further in vivo and in vitro molecular studies are needed to investigate the therapeutic target potential of CCND1 for RCC treatment. [ABSTRACT FROM AUTHOR]

This experiment was conducted to determine the effect of papaya leaf (Carica papaya) and kalo jeera (Nigella sativa) seeds powdered supplementation in drinking water as a growth promoter in broiler chickens. A total of 20 Cobb-500 broiler chicks (day-old) were purchased from local hatchery (Nourish Poultry and Hatchery Ltd.) and after seven days of acclimatization chicks were randomly divided into two groups, A (n=10) and B (n=10). The group A was kept as a control and not treated. The group B was supplemented with papaya leaf and kalo jeera powder with feed and water. Weekly observations were recorded for live body weight gain up to 5th weeks and hematological tests were performed at 35th day's age of broiler to search for hematological changes between control (A) and treatment (B) groups. The initial body weight of groups A and B on 1st were 41.00±0.56 gm and 41.50±0.35 gm, respectively and after 35th day of experiment final body weight were 1470±57.35 gm and 1720±58.56 gm, respectively and economics of production were analyzed and found that net profit per broiler was Tk. 8.91 and Tk. 20.69, respectively. The treatment group B was recorded statistically significant (at 1% level) increased (17.00%) for live body weight than that of control group A. The hematological parameters total erythrocyte count (TEC), erythrocyte sedimentation rate (ESR) and hemoglobin (Hb) estimation value of treatment group shows significant difference, while hemoglobin estimation does not show significant difference from control group. The results suggest that better growth performance could be achieved in broilers supplemented with papaya leaf and kalo jeera seeds. [ABSTRACT FROM AUTHOR]

Keloids are common and cause functional and psychological morbidity. A wide variety of treatments, all in current usage, indicate that no treatment has been shown to be markedly superior to the others. This study was done using pulsed dye laser followed by more traditional intralesional steroid injection in the treatment of keloid. The aim of this study was to determine the effectiveness of the PDL in combination with intralesional triamcinolone acetonide (TCA) in the treatment of keloid and to elucidate possible side effects and complications. A prospective clinical trial was done in the Department of Dermatology & Venereology, Combined Military Hospital, Dhaka Cantonment, Dhaka, from December 2013 to February 2014. Adult patients of both sexes (Fitzpatric skin type IV & V) aged between 15 and 50 years with varying degree of keloids were randomly selected for the study. In this single-blinded clinical trial, 50 patients were randomly assigned and was irradiated by 595-nm flashlamp-pumped pulsed-dye laser (PDL, 5-7.5 J/cm²) at the 1st, 4th, and 8th weeks and Intralesional steroid was given following PDL. Lesions were assessed for vascularity, pliability, pigmentation and height. The study showed an excellent improvement in nearly all measures, Good to excellent improvements (>76% improvement) were reported by 93% patient. Vancouver scar scale (0-14) decreased from 12.17 to a post treatment value of 3.41which is an excellent achievement. Results were reported by the blinded observer as follows: in vascularity (from 2.7 to 0.61), in pliability (from 3.9 to 1.1), in hyperpigmentation (from 2.4 to 0.92), in height (from 2.87 to 0.78). [ABSTRACT FROM AUTHOR]

This article presents a study on the use of sulfadoxine-pyrimethamine, chlorproguanil-dapsone or chloroquine for the treatment of plasmodium vivax malaria in Afghanistan and Pakistan. The purpose of the study was to test the efficacy and safety of 2 antifolate drugs against P vivax malaria and compare each with choloroquine. The study found that although chloroquine remains the drug of choice, antifolates are effective against P vivax malaria in South Asia and the drugs may be appropriate for unified treatment where species-specific diagnosis is unavailable.

Abstract: Background: Suction blister grafting (SBG) is a technique where the pigmented epidermis is harvested from the donor site by induction of a blister using different suction methods as syringes, Chinese cups, suction device, etc. However, pain, time consumption, incomplete blister formation, and failure of blister development are the main limitations. Objective: To compare between cups and syringes of similar diameter in inducing suction blisters. Patients and methods: In 30 patients with stable nonsegmental vitiligo, 2‐cm‐diameter (20 ml) syringe was applied on the anterolateral aspect of one thigh and a 2‐cm‐diameter cup on the corresponding site of the other thigh where right and left sides were chosen randomly. Patients were observed untill complete blister development or for a maximum of 3 hours. Suction blister induction time (SBIT) and the blister diameter were recorded for each patient. Pain during the process of induction was evaluated. Results: Incomplete blister development was noted in 9 out of 30 (30%) with 2 cm syringes and 6 out of 30 (20%) with the similar diameter cups with no significant difference (P = 0.49). No significant difference was found between SBIT induced by the 2 cm syringes and the similar size cups (101.17 ± 68.14 minutes, 98 ± 56.84 minutes, respectively) (P = 0.85). Meanwhile, blister diameter induced by either syringe or cup was not significantly different (P = 0.37). Anesthesia was for short duration with xylocaine, and pain was intolerable in both sides in the first seven patients. A combination of xylocaine and bupivacaine was used with prolonged loss of pain in 17 of the remaining 23 patients and tolerable pain in six patients similarly in both sides. Conclusion: According to present results, the differences in SIBT, diameter of blisters, and number of complete blister formation induced by either syringes or cups of similar size were not significant. Therefore, whatever the available and feasible technique for the surgeon will be the ideal choice. A combination of xylocaine and bupivacaine is recommended to overcome the accompanying pain of the procedure. [ABSTRACT FROM AUTHOR]

• Degradation of carbamazepine was investigated in UV-assisted AOPs. • Carbamazepine was recalcitrant to sole UV but susceptible to UV/H 2 O 2 /Fe2+ oxidation. • Second order rate constant of carbamazepine with OH was (8.83 ± 0.27) × 109 M−1 s−1. • The UV/H 2 O 2 /Fe2+ treatment was efficient in toxicity reduction of CBZ. • Degradation mechanism was proposed from identified degradation products. Carbamazepine (CBZ), a widely used antiepileptic drug, was removed by UV–254 nm based advanced oxidation processes. CBZ was found to be stable under sole UV, however, removal of CBZ was promoted using Fe3+ and Fe2+ with UV. Further, removal efficiency of CBZ was significantly enhanced by coupling H 2 O 2 with UV and Fe3+/Fe2+. At 3600 mJ cm−2, 7.5, 60.2, 74.3 and 90.6% CBZ degradation was achieved in UV, UV/H 2 O 2 , UV/H 2 O 2 /Fe3+ and UV/H 2 O 2 /Fe2+, using CBZ, H 2 O 2 , Fe2+ and Fe3+ at 21.16, 1060.00, 17.91 and 17.91 μM, respectively. Higher CBZ degradation in the presence of H 2 O 2 was attributed to HO whose second-order rate constant with CBZ was calculated to be (8.83 ± 0.27) × 109 M−1 s−1. Removal of CBZ by UV/H 2 O 2 /Fe2+ system was optimum at pH 3.0, as 80.8, 90.6 and 70.4% CBZ degradation was observed at pH 2.0, 3.0 and 6.5, respectively. The removal of CBZ by UV/H 2 O 2 /Fe2+ was retarded in the presence of Cl− and humic acid as revealed from 84.5 and 56.7% CBZ degradation in the presence of Cl− and humic acid, respectively, compared to 90.6% in their absence at 3600 mJ cm−2. The CBZ degradation products were found to be less toxic than the parent compound, suggesting important role of UV-assisted AOPs in efficient removal and toxicity reduction of CBZ and their degradation products. [ABSTRACT FROM AUTHOR]

Tick infestation is commonly found in every commercial cattle farm and domestically reared cattle. Farm generally used acaricides to treat tick infestation; however finding new, cheap and alternative source of acaricides is a prime concern. Here, we investigated the in-vitro efficacy of verenda (Ricinus communis) leaves extracts to treat tick infestation. We prepared aqueous, methanolic and ethanolic extract of verenda leaves to apply on ticks. A total of 90 ticks (both hard ticks and soft ticks) was collected from cattle in local area of Mymensingh region and divided into 3 treatment groups: A (aqueous), B (ethanol), C (methanol) and D (control). All groups were sub-divided into 3 sub-groups on the basis of concentration of 1%, 2% and 3% treatments. Ticks were treated with different concentration of extract and observation of tick was performed 12, 24 and 36 hours interval. The whole experiment was repeated thrice. Our data suggests 3% methanolic extract confer highest efficacy against ticks and verenda leaves extract could be used alternatively as acaricides. [ABSTRACT FROM AUTHOR]

Background: Clinical trials in severe falciparum malaria require a large sample size to detect clinically meaningful differences in mortality. This means few interventions can be evaluated at any time. Using a validated surrogate endpoint for mortality would provide a useful alternative allowing a smaller sample size. Here we evaluate changes in coma score and plasma lactate as surrogate endpoints for mortality in severe falciparum malaria. Methods: Three datasets of clinical studies in severe malaria were re-evaluated: studies from Chittagong, Bangladesh (adults), the African ‘AQUAMAT’ trial comparing artesunate and quinine (children), and the Vietnamese ‘AQ’ study (adults) comparing artemether with quinine. The absolute change, relative change, slope of the normalization over time, and time to normalization were derived from sequential measurements of plasma lactate and coma score, and validated for their use as surrogate endpoint, including the proportion of treatment effect on mortality explained (PTE) by these surrogate measures. Results: Improvements in lactate concentration or coma scores over the first 24 hours of admission, were strongly prognostic for survival in all datasets. In hyperlactataemic patients in the AQ study (n = 173), lower mortality with artemether compared to quinine closely correlated with faster reduction in plasma lactate concentration, with a high PTE of the relative change in plasma lactate at 8 and 12 hours of 0.81 and 0.75, respectively. In paediatric patients enrolled in the ‘AQUAMAT’ study with cerebral malaria (n = 785), mortality was lower with artesunate compared to quinine, but this was not associated with faster coma recovery. Conclusions: The relative changes in plasma lactate concentration assessed at 8 or 12 hours after admission are valid surrogate endpoints for severe malaria studies on antimalarial drugs or adjuvant treatments aiming at improving the microcirculation. Measures of coma recovery are not valid surrogate endpoints for mortality. [ABSTRACT FROM AUTHOR]

The middle aortic syndrome (MAS) is rare (about 0.5-2% of all the cases of aortic coarctation) vascular disorder characterized by severe narrowing in the descending thoracic aorta, abdominal aorta, or both. It can be congenital or acquired due to several conditions. MAS may present clinically as uncontrolled hypertension, abdominal angina or lower limb claudication. Surgical treatment is effective in controlling symptom and improves life expectancy. [ABSTRACT FROM AUTHOR]