Malaria amongst febrile children: call for a pediatric malaria assessment tool

In 2017, malaria accounted for 435 000 deaths worldwide. Eleven percent (11%) of these deaths occurred in the Democratic Republic of Congo (DRC), where malaria continues to be a leading cause of morbidity and mortality. Children are amongst the most vulnerable to malaria, which causes 40% of childhood deaths in the country. Although many risk factors for developing malaria have been identified, there is a paucity of data available on the sociodemographic risk factors for pediatric malaria. A cross-sectional study including 131 febrile children aged 2 months to 14 years presenting to Heal Africa Hospital due to febrile illness. Guardians of participants answered a questionnaire about household and maternal characteristics, as well as child symptomatology. Malaria status was confirmed via blood smear. Results were analyzed using the chi-square test, likelihood ratios and a logistic regression. The absence of father as head of household (p=0.011) and gestational malaria (p=0.044) were significantly associated with pediatric malaria. This study provides insight into sociodemographic risk factors associated with pediatric malaria in the DRC. While further investigation is required, this study highlights the benefit of considering these factors when approaching the febrile child. A pediatric malaria assessment tool incorporating socio-demographics, symptoms and physical exam findings may guide investigations to reduce unnecessary testing and provide better patient-centred care

Formulation and evaluation of insitu mucoadhesive nasal gels of metoclopramide hydrochloride

The prolonged residence of drug formulation in the nasal cavity is of utmost importance for intranasal drug delivery. The objective of the present investigation was to develop a mucoadhesive in situ gel with reduced nasal mucocilliary clearance in order to improve the bioavailability of the antiemetic drug, Metoclopramide Hydrochloride. The in situ gelation upon contact with nasal mucosa was conferred via the use of the thermogelling Methyl cellulose whereas mucoadhesion and drug release enhancement were modulated via the use of sodium alginate and polyethylene glycol polymers respectively. The results revealed that the mucoadhesive polymer increased the gel viscosity but reduced its sol gel transition temperatures and the drug release. The inclusion of polyethylene glycol polymer counteracted the effect of mucoadhesive polymer where by it decreased the gel consistency and increased the sol gel transition as well as in vitro drug diffusion. The in vitro tests performed for mucoadhesive strength and drug diffusion showed that nasal in situ gelling formulations prepared are having good mucoadhesive strength with nearly100% drug diffusion within four hours. So this study points to the potential of mucoadhesive in situ nasal gel in terms of ease of administration, accuracy of dosing, prolonged nasal residence and improved nasal bioavailability

An International Survey of Deep Brain Stimulation Utilization in Asia and Oceania: The DBS Think Tank East.

Introduction: To evaluate the current utilization and challenges in fully implementing the use of deep brain stimulation (DBS) treatment in Asia and Oceania. Methods: We conducted a medical literature search to identify DBS research performed by investigators with a primary affiliation in Asian and Oceania countries between March 1, 2013, and March 1, 2019, followed by an international survey-based study. Additionally, we obtained added information regarding the DBS challenges and opportunities from the technology/industry perspective within China and Japan. We also described the current situation of DBS in India. Results: Most publications (390/494; 78.95%) in the English language originated from East Asia. In West Asia, Turkey, Israel, and Iran accounted for most DBS publications. We found no publications from the remaining 35 Asian countries. Lack of community referrals to tertiary centers was identified as the most common limitation for the widespread use of DBS in Asia (68.97%). In China, despite an increasing number of centers performing DBS surgeries, most of them accomplished less than 10 cases per year. In contrast, the number of DBS cases in Japan has been decreasing. Centers offering DBS surgeries as well as corresponding fellowship training in India are limited. Conclusion: Appropriate referrals, access, infrastructure, and the presence of full multidisciplinary DBS teams are common limitations of DBS in Asia. Most centers in China, Japan, and India performed less than 10 cases per year and a future study is expected to address the impact on quality in centers performing such few cases

Hypersexuality following subthalamic nucleus stimulation for Parkinson's disease

Subthalamic nucleus (STN) stimulation is an established surgical treatment for Parkinson′s disease (PD). Though the motor benefits of STN stimulation are well understood, its cognitive and behavioral effects are still not fully understood. Manic psychosis, hypersexuality, pathological gambling and mood swings are associated with advanced PD. There have been reports to suggest improvement or worsening in these symptoms following STN deep brain stimulation (DBS). We report two cases as the sole behavioral side-effects of STN stimulation despite good clinical improvement on long-term follow-up. These patients and literature review suggests the complex role of STN stimulation in motor and behavioral control

Desmoplastic non-infantile ganglioglioma: A low-grade tumor, report of two patients

Desmoplastic infantile gangliogliomas (DIGG) are low-grade (WHO Grade I) tumors of early childhood rarely occurring in older children and young adults. The mainstay of treatment is surgical. We report two older children with DIGG, both showing atypical radiology. One case was treated with radiation. The recurrence treated with only surgical excision showed excellent response to treatment

“Outcomes of unilateral Pallidotomy in focal and hemidystonia cases: a single blind cohort study”

Background: The role of Deep brain stimulation in the treatment of dystonia has been widely documented. However, there is limited literature on the outcome of lesioning surgery in unilateral dystonia. We present our long‐term experience of lesioning of Globus pallidus internus (GPi) for dystonia. Methods: Patients undergoing radiofrequency lesioning of GPi for unilateral dystonia, between 1999 to 2019 were retrospectively reviewed. All patients were evaluated using the Burke‐Fahn‐Marsden Dystonia rating scale (BFMDRS) and Dystonia Disability scale (DDS) preoperatively, at the short term follow up (<1 year) and at long‐term follow up (2‐7.5 years). Video recordings performed at these time points were independently review by a blinded movement disorders specialists. Results: Eleven patients were included for analysis. The preoperative, short‐term follow‐up and long term follow up motor BFMDRS and DDS were 15.5 (IQR 10.5, 23.75) and 10.5 (IQR 6.0,14.5); 3.0 (IQR 1.0, 6.0, p=0.02) and 3.0 (IQR 3.0, 8.0, p=0.016); and 14.25 (IQR 4.0,20.0, p=.20) and 10.5 (IQR 2.0, 15.0, p=0.71) respectively. For observers B, the BFMDRS scores at the same time points were 19 (IQR 12.5, 27.0), 7.5 (IQR 6.0,15.0 p=0.002) and 21 (IQR 7.0, 22.0, p=0.65) respectively. The improvement was statistically significant for all observations at short term follow up but not at the long term follow up. Conclusion: Pallidotomy is effective for hemidystonia or focal dystonia, in the short term. Continued benefit was seen in the longer‐term in some patients, whereas others worsened. Larger studies may be able to explain this in future. This article is protected by copyright. All rights reserved