Treatment Options of Lemmel\u27s Syndrome: a Case of Benign Obstructive Jaundice in the Elderly

Lemmel\u27s syndrome, also known as duodenal diverticulum obstructive jaundice, is a rare cause of benign obstructive jaundice that should be included in the differential diagnosis of biliary obstruction when PAD is present, in the absence of cholelithiasis or other detectable obstacle. Diagnosing Lemmel\u27s syndrome could be challenging, but being aware of this condition is important to avoid mismanagement and it begins with identification of PAD, while interpreting any bile duct imaging. It can be misinterpreted as periampullary tumors, biliary stones, or pancreatic pseudocyst. Symptomatic patients can be successfully managed endoscopically in many cases but surgical management would be necessary in selected cases.We present a patient with benign obstructive jaundice caused by Lemmel\u27s syndrome who was successfully treated with endoscopic sphicterectomy. A 67 years old female presented to the emergency department with chief complaint of jaundice. The patient was assesed to have obstructive jaundice cause by a duodenal mass, elevation of transaminase enzime supected caused by drug induced liver injury, hypertension (controlled), and anterior extensive coronary ischemia. Endoscopic retrograde cholangiopancreatografi (ERCP) showing mutiple giant diverticle in second part of duodenum, stenosis of the distal CBD with compression of diverticular extra luminal as a differential diagnosis. Endoscopic ultrasound (EUS) was performed to exlude a periampullary tumor, resulting distal CBD stenosis due to compression of multiple periampullary diverticula (PAD). We performed an endoscopic sphinterectomy (EST) and the stent was removed. A further evaluation of the tuberculous lymphadenitis was planned as outpatient setting. One month follow-up, no recurence of jaundice was observed

Bioprospecting of Bacterial Symbiont of Tunicate Didemnum Molle From Sambangan, Karimunjawa Islands

Coral reef is a productive ecosystem with high biodiversity in the sea and being targeted to find a useful bioactive compound. However, the serious problem in development of bioactive compounds from marine invertebrate is the supply problem, because to get a small amounts of active compounds a massive numbers of sea organisms are needed. Tunicate is an animal in coral reef ecosystem that produces many bioactive compounds with pharmacological activities, such as, antibacterial, antitumor, and anticancer compounds. It has been reported that bacterial symbionts of coral reef invertebrates may synthesize the same compounds as the host. The purposes of this research are to isolate and to identify microbes which have antibacterial activity against MDR bacteria based PCR 16S rRNA and to detect the existence of PKS and NRPS biosynthetic gene fragments from tunicate bacteria of Didemnum molle. Out of 15 bacterial isolates, one isolate showed antibacterial potential against Escherichia coli and Staphylococcus sp. Molecular identification result showed that TS2A5 bacterium has a homology of 99 % with Virgibacillus sp. strain GSP17 16S ribosomal RNA gene. This isolate was also capable of amplifying NRPS gene fragment

Esophageal Varices Bleeding in Portal Hypertension Due to Portal Vein and Splenic Vein Obstruction

Based on its relation to the liver sinusoid, increased pressure of portal vein can occur at three levels: presinusoid, sinusoid ,and postsinusoid. Obstruction of the presinusoid veins can be caused by extra- hepatic condition such as venous thrombosis. We reported a case of portal hypertension with esophageal varices bleeding was a result of obstruction due to thrombosis of the splenic vein and portal vein under hypercoagulant conditions due to thrombocytosis. The management of esophageal varices was sclerotherapy while for overcome the thrombosis the patient was given hydroxy urea

Genetic continuity across a deeply divergent linguistic contact zone in North Maluku, Indonesia

<p>Abstract</p> <p>Background</p> <p>The islands of North Maluku, Indonesia occupy a central position in the major prehistoric dispersal streams that shaped the peoples of Island Southeast Asia and the Pacific. Within this region a linguistic contact zone exists where speakers of Papuan and Austronesian languages reside in close proximity. Here we use population genetic data to assess the extent to which North Maluku populations experienced admixture of Asian genetic material, and whether linguistic boundaries reflect genetic differentiation today.</p> <p>Results</p> <p>Autosomal and X-linked markers reveal overall Asian admixture of 67% in North Maluku, demonstrating a substantial contribution of genetic material into the region from Asia. We observe no evidence of population structure associated with ethnicity or language affiliation.</p> <p>Conclusions</p> <p>Our data support a model of widespread Asian admixture in North Maluku, likely mediated by the expansion of Austronesian-speaking peoples into the region during the mid Holocene. In North Maluku there is no genetic differentiation in terms of Austronesian- versus Papuan-speakers, suggesting extensive gene flow across linguistic boundaries. In a regional context, our results illuminate a major genetic divide at the Molucca Sea, between the islands of Sulawesi and North Maluku. West of this divide, populations exhibit predominantly Asian ancestry, with very little contribution of Papuan genetic material. East of the Molucca Sea, populations show diminished rates of Asian admixture and substantial persistence of Papuan genetic diversity.</p

A Polynesian Motif on the Y Chromosome: Population Structure in Remote Oceania

This is the publisher's version, also available electronically from http://digitalcommons.wayne.edu/humbiol/vol79/iss5/5/.The Polynesian motif, a mitochondrial DNA marker of ancestral Polynesian communities, has filled a critical role in reconstructions of remote Oceanic history. Although the motif provides an effective narrative for Polynesian females, no equivalent male history is available from paternal lineages. Here, we describe a Y-chromosome binary polymorphism with absolute Polynesian affinity. We illustrate its unique spatial and temporal connections to early Polynesian communities, and through an analysis of associated short tandem repeat variation, we describe the first clear genealogic structure within Polynesia. Unlike the eastern and western regions advocated by archeology, we identify a tripartite structure comprising interaction spheres in the west (Tonga and Samoa), center (Tahiti), and east (Rapanui/Easter Island). Such patterning, a product of early regional contact and subsequent isolation, signals the conflicting roles of mobility and seclusion in Polynesian prehistory

Mitogenomes reveal two major influxes of Papuan ancestry across Wallacea following the last glacial maximum and Austronesian contact

The tropical archipelago of Wallacea contains thousands of individual islands interspersed between mainland Asia and Near Oceania, and marks the location of a series of ancient oceanic voyages leading to the peopling of Sahul—i.e., the former continent that joined Australia and New Guinea at a time of lowered sea level—by 50,000 years ago. Despite the apparent deep antiquity of human presence in Wallacea, prior population history research in this region has been hampered by patchy archaeological and genetic records and is largely concentrated upon more recent history that follows the arrival of Austronesian seafarers ~3000–4000 years ago (3–4 ka). To shed light on the deeper history of Wallacea and its connections with New Guinea and Australia, we performed phylogeographic analyses on 656 whole mitogenomes from these three regions, including 186 new samples from eight Wallacean islands and three West Papuan populations. Our results point to a surprisingly dynamic population history in Wallacea, marked by two periods of extensive demographic change concentrated around the Last Glacial Maximum ~15 ka and post-Austronesian contact ~3 ka. These changes appear to have greatly diminished genetic signals informative about the original peopling of Sahul, and have important implications for our current understanding of the population history of the region.1. Introduction 2. Materials and Methods 2.1. Sample Collection and Ethics 2.2. Mitochondrial Sequence Generation 2.3. Combined Wallacea–Sahul Dataset 2.4. Phylogenetic Parameter Estimation 2.5. Using Ancestral Node Dates from Geographically Exclusive Clades to Infer Demographic History 2.6. Migration Model Inference and Testing 2.7. Simulating and Estimating the Timing of Migration Events 3. Results 3.1. Summary of New Mitochondrial Haplogroups from Wallacea and West Papua 3.2. Phylogeographic Analyses 4. Discussion 4.1. Post-LGM Population Expansions and Movements 4.2. Redistribution of Papuan mtDNA Lineages Following Austronesian Contact 4.3. Comparison with Wallacean Archaeological and Linguistic Records 5. Conclusion

Randomized, Open-Label Trial of Primaquine against Vivax Malaria Relapse in Indonesia

Radical cure of Plasmodium vivax infection applies blood schizontocidal therapy against the acute attack and hypnozoitocidal therapy against later relapse. Chloroquine and primaquine have been used for 60 years in this manner. Resistance to chloroquine by the parasite now requires partnering other blood schizontocides with primaquine. However, the safety and efficacy of primaquine against relapse when combined with other drugs have not been demonstrated. This randomized, open-label, and relapse-controlled trial estimated the efficacy of primaquine against relapse when administered with quinine or dihydroartemisinin-piperaquine for treatment of the acute infection. Among 650 soldiers who had returned to their malaria-free base in Java, Indonesia, after 12 months in malarious Papua, Indonesia, 143 with acute P. vivax malaria were eligible for study. One hundred sixteen enrolled subjects were randomized to these treatments: artesunate (200-mg dose followed by 100 mg/day for 6 days), quinine (1.8 g/day for 7 days) plus concurrent primaquine (30 mg/day for 14 days), or dihydroartemisinin (120 mg) plus piperaquine (960 mg) daily for 3 days followed 25 days later by primaquine (30 mg/day for 14 days). Follow-up was for 12 months. One hundred thirteen subjects were analyzable. Relapse occurred in 32 of 41 (78%) subjects administered artesunate alone (2.71 attacks/person-year), 7 of 36 (19%) administered quinine plus primaquine (0.23 attack/person-year), and 2 of 36 (6%) administered dihydroartemisinin-piperaquine plus primaquine (0.06 attack/personyear). The efficacy of primaquine against relapse was 92% (95% confidence interval [CI]=81% to 96%) for quinine plus primaquine and 98% (95% Cl=91% to 99%) for dihydroartemisinin-piperaquine plus primaquine. Antirelapse therapy with primaquine begun a month after treatment of the acute attack with dihydroartemisinin-piperaquine proved safe and highly efficacious against relapse by P. vivax acquired in Papua, Indonesia