Central Nervous Disorders Research Articles

Delivery of therapeutics to posterior eye segment: cell-encapsulating systems.

Delivery of therapeutics to posterior eye segment: cell-encapsulating systems.

Neurovascular patterning cues and implications for central and peripheral neurological disease.

The highly branched nervous and vascular systems run along parallel trajectories throughout the human body. This stereotyped pattern of branching shared by the nervous and vascular systems stems from a common reliance on specific cues critical to both neurogenesis and angiogenesis. Continually emerging evidence supports the notion of later-evolving vascular networks co-opting neural molecular mechanisms to ensure close proximity and adequate delivery of oxygen and nutrients to nervous tissue. As our understanding of these biologic pathways and their phenotypic manifestations continues to advance, identification of where pathways go awry will provide critical insight into central and peripheral nervous system pathology.

OŚRODKOWA DROGA SŁUCHOWA A IMPLANTACJA ŚLIMAKOWA: WYKORZYSTANIE BADANIA WĘCHU DO OCENY PRZEWIDYWANEJ KOMPONENTY CENTRALNEJ W EFEKTYWNOŚCI IMPLANTU ŚLIMAKOWEGO

BackgroundCochlear implantation is a highly successful intervention that, despite remarkable improvements in hardware and software, continues to show a high degree of variability in outcomes. Performance in adult patients can potentially be affected by the integrity of spiral ganglion neurons or by the performance of the central auditory system. Prolonged deafness and dementia are conditions that affect the central auditory system and can negatively impact cochlear implant outcomes. Central auditory test batteries can evaluate the central component of hearing in patients that have significant residual hearing, but cannot be effectively used in most cochlear implant patients. A wide variety of recent studies have shown that decline in olfaction predates and often predicts a variety of central nervous system degenerative disorders. We set out to evaluate if olfaction testing could predict hearing results after cochlear implantation.Material and MethodsAdult cochlear implant candidates were recruited and olfaction measured with the University of Pennsylvania smell identification test (UPSIT). Testing variables in the analysis include patient age, UPSIT score, AzBio +10 dB score at 6 months post activation, and change in AzBio +10 dB score from preoperative to post-activation testing timesResultsLower olfaction (UPSIT) scores correlated with poorer hearing outcomes (AzBio +10 dB) at 6 months post activation. Patients with lower UPSIT scores also showed less change in AzBio +10 dB scores over a 6-month period.ConclusionsOlfactory testing may be useful in preoperative evaluation of cochlear implant patients. Identification of patients at risk for central auditory system dysfunction may be possible by evaluation of patients’ olfactory function.

Evaluation of the Anticancer Activity of Bioactive Fraction G Extracted from Pavetta crassipes in Malignant Brain Tumor Cell Lines

Objective: Natural products have served as sources of lead compounds that are commonly used in the treatment of human diseases including cancer. Pavetta crassipes has been widely demonstrated to have ethnopharmacological potential in the management of malaria, gastrointestinal conditions, central nervous system behavioral disorders, hypertension, and cancer. The goal of our study was to evaluate the biological and molecular effects of Fraction G, obtained from the plant Pavetta crassipes, on glioblastoma invasive growth and survival. Methodology: The antiproliferative effects of Fraction G, obtained from Pavetta crassipes, was evaluated using the trypan blue exclusion, (3-(4, 5-Dimethylthiazol- 2yl)-2, 5-Diphenyltetrazolium Bromide; MTT), and lactate dehydrogenase (LDH) assays. Flow cytometry and Western blotting analyses were carried out to examine the effects of Fraction G on cell cycle check-points and its effects on epidermal growth factor receptor-mediated signaling of AKT and MAPK pathways. Results: In this paper, we report that the Fraction G obtained from the plant Pavetta crassipes induced a reduction in glioma cell viability and proliferation as well as induced an increase in apoptosis as evidenced by cleaved PARP, increased caspase 3/7 activity, and cell cycle arrest in the G0/G1 check point. Furthermore, we report that Fraction G inhibited the phosphorylation of AKT and MAPK following EGF treatment. Conclusion: Taken together, our results demonstrate that Fraction G has potent inhibitory effects on pathways involved in glioblastoma proliferation and survival.

Hepatitis C and Neurological Disorders: A Patient’s Case Report

Introduction: Neurological disorders associated with hepatitis C is most often related to mixed cryoglobulinemia. The aim of this study is to show the severity of neurological disorders during hepatitis C infection. Observation: Mrs. S A, 60 years old, who had been in purpuric rash for six months, associated with physical and psychic asthenia and weight loss at 16 kg in 8 months. The evolution was marked by an alteration of the neurological state of the patient with an installation of motor deficit affecting the 04 limbs, abolition of the osteotendinous reflexes, and a hypoesthesia of the upper and lower limbs. The electromyogram (EMG) showed a sensorimotor polyradiculoneuropathy, and the etiological diagnosis was in favor of a peripheral neuropathy secondary to a cryoglobulinemia, related to hepatitis C. In addition, the patient presented after a few days of headaches, a sharp drop in visual acuity and high blood pressure, this is complicated by two episodes of convulsive seizures. A cranial CT scan is performed in an emergency without abnormalities, with no sign in relation to thrombophlebitis after injection of contrast agent. The diagnosis retained is a central neurological disease secondary to infection with the virus c associated with peripheral neurological disease. Conclusion: Neurological disorders associated with hepatitis C are rare but poor prognosis threatening the functional and vital prognosis of patients.

Management of the Pediatric Neurocritical Care Patient.

Pediatric neurocritical care is a growing subspecialty of pediatric intensive care that focuses on the management of acute neurological diseases in children. A brief history of the field of pediatric neurocritical care is provided. Neuromonitoring strategies for children are reviewed. Management of major categories of acute childhood central neurologic diseases are reviewed, including treatment of diseases associated with intracranial hypertension, seizures and status epilepticus, stroke, central nervous system infection and inflammation, and hypoxic-ischemic injury.

Management of neuropathic central pain by non-invasive brain stimulation and mirror therapy

Central neuropathic pain is common among neurological patients. Drug therapy has high pharmacoresistance and some GABAergic agents can be detrimental to the recovery process. Alternative therapies include neuromodulation techniques, such as repetitive transcranial magnetic stimulation (rTMS) and motor imagery techniques with mirror therapy. The objective of this study was to evaluate their effectiveness in clinical practice on central neuropathic pain. Thirty-two patients followed in the Physical Medicine and Rehabilitation department of Rangueil University Hospital were included. Subjects with central neurological disease (from stroke, spinal cord injury, etc.) failed drug therapy with DN4 ≥ 4. They received a first session of rTMS of 20 minutes (10 Hz frequency and intensity of 90% of the motor threshold) over the controlateral pain motor cortex then daily rTMS sessions were conducted over 5 days with motor imagery exercises and mirror therapy twice daily. Effectiveness was assessed by changes in the BPI score at 2 days, 1 month, 3 months and 6 months. At 2 days (31 patients), scores of BPI3, 5, 9 and BPI severity decreased significantly (of respectively 12.6%, P = 0.001; 10.4%, P = 0.025; 28.2%, P = 0.000 and 8.6%, P = 0.001). At 1 month (20 patients), scores of BPI 3, 5, 6, 9 and BPI severity decreased significantly (of respectively 20,8%, P = 0.011; 26.1%, P = 0.005; 26%, P = 0.045; 32.5%, P = 0.009 et 24.5%, P = 0.022). At 2 days, pain ≤ 2 years was associated with better response to treatment (responders: lower BPI severity score ≥ 2 points) (Chi2 test, P = 0.04). The positive response found at 2 days is also correlated to a positive response at 1 month (Chi2 test, P = 0.011). The preliminary results of this study show a significant decrease in pain at 48 hours and 1 month intervals. A positive response at 48 hours indicates a good predictor of response to therapeutic treatment.

Percutaneous needle tenotomy in the treatment of neuro-orthopedic complications of upper limb related to central nervous system impairment: Open study on 12 patients

The musculotendinous retractions are common complications of central neurological damage with consequences for comfort and function. Treatment of uncomfortable retractions is often surgical, mainly based on tendon gestures. The objective of this study was to evaluate the efficiency of percutaneous needle tenotomy in these indications. The indication was accepted at a medical-surgical consultation. Tenotomy was performed using an 18 Gauge needle. The patients were older than 18 years, had a history of central neurological disease, and had a musculotendinous retraction regarding a superficial tendon of upper limb. The primary endpoint was the Goal Attainment Scale (GAS). Secondary outcomes were pain, the pulp-palm distance and range of motion gain. The evaluation was conducted in pre-tenotomy, immediately post-tenotomy, 3 months and 6 months. Twelve patients (8 women) were included in our study. The mean age was 62.91 years (28–87). Neuro-orthopedic disorders were related to a stroke ( n = 4), head trauma ( n = 2), to Parkinsonian syndrome ( n = 3) at a cerebral palsy ( n = 3). The objectives identified were nursing ( n = 12), pain ( n = 11), the skin condition ( n = 5), gripping ( n = 2), posture ( n = 1) and dressing ( n = 1). The targets were achieved in all cases. The average score GAS per patient ranged from 0 to 2. GAS score was unchanged at 3 months and 6 months. Our experience confirms the locations already described for percutaneous needle tenotomy of the flexor of the fingers. We also report the effectiveness of percutaneous tenotomy in the wrist and elbow flexors without vascular and nerve injury elbow.

EP 117. 1000BRAINS study: Motor performance in the elderly – Not all parameters decline with age

It is known that motion patterns change with age ( Krampe, 2002 , Seidler, 2010 ). But is all motor performance in the elderly age-related and if not – which parameters contribute to the greater variance in elderly? The 1000BRAINS study in collaboration with the German Heinz Nixdorf Recall Study investigates structural and functional variability of the human brain during normal aging ( Caspers et al., 2014 ), enabling the analysis of various aspects of motor performance and its interaction with lifestyle and cognition in the identical large population. The aims of this study are to (1) measure objective parameters of motor performance, (2) analyze age dependency, and (3) investigate interactions with demographic and life style data. In the study 300 subjects (131 women, mean age 65.9 ± 6.1 years, range 56.4–85.4 years) were included. Within the motor test battery (MTB, see Caspers et al., 2014 ) upper limb functions were assessed by different finger tapping tasks and those of lower limb by functional measures of balance and mobility. Demographic and life style data were obtained by questionnaires. Exclusion criteria were more than one missing motor score, a history of central nervous system damage, musculoskeletal disorders or depression. Statistical analysis comprised a factor analysis on the MTB, based on z-scores, and correlation analysis (p 0.05; Bonferroni adjusted for number of factors). Factor analysis results in four main factors, extracted by Eigenvalues > 1, explaining 55.2% of the variance within the data (KMO criterion = 0.614): maximum hand speed (MHS), stability of stance (SOS), gross motor skills (GMS) and self-paced internal hand speed (IHS). Lower MHS factor values were associated with higher age, lower body height and lower educational level, more depressed mood and lower alcohol intake. Lower MHS and SOS factor values were related to lower falls-related self-efficacy. Higher education, lower age and body weight, better vibration sense, higher falls-related self-efficiency, higher physical activity and preserved ability to perform pedicure were associated with higher GMS factor loadings. IHS factor values showed no significant correlations. IHS is reflecting psychomotor speed and seems to be a stable property, varying only in the early and very late adulthood ( Turgeon and Wing, 2012 ). Higher MHS and GMS are associated with higher education, but not IHS and SOS. The relevance of education, a marker of reserve, is well known for cognition, but has only recently been addressed for motor performance (walking speed, Elbaz et al., 2013 ). Walking speed is also enclosed in GMS. The reserve hypothesis fits well to the association between education and MHS/ GMS. However, motor domains seem to interact differently with age and markers of reserve. The relation to brain structure and genetic data will be investigated in future studies.

Atorvastatin attenuates the antinociceptive tolerance of morphine via nitric oxide dependent pathway in male mice.

The development of morphine-induced antinociceptive tolerance limits its therapeutic efficacy in pain management. Atorvastatin, or competitive inhibitor of 3-hydroxy-methyl-glutaryl coenzyme A (HMG-CoA) reductase, is mainstay agent in hypercholesterolemia treatment. Beyond the cholesterol-lowering activity, exploration of neuroprotective properties of this statin indicates its potential benefit in central nervous disorders. The aim of the present study was to assess the effects of atorvastatin in development and expression of morphine-induced analgesic tolerance in male mice and probable involvement of nitric oxide. Chronic and acute treatment with atorvastatin 10 and 20mg/kg, respectively, could alleviate morphine tolerance in development and expression phases. Chronic co-administration of nitric oxide synthase (NOS) inhibitors including L-NAME (non selective NOS inhibitor; 2mg/kg), aminoguanidine (selective inducible NOS inhibitor; 50mg/kg) and 7-NI (selective neuronal NOS inhibitor; 15mg/kg) with atorvastatin blocked the protective effect of atorvastatin in tolerance reversal. Moreover, reversing the atorvastatin effect was also observed in acute simultaneous treatment of L-NAME (5mg/kg) and aminoguanidine (100mg/kg) with atorvastatin. Co-treatment of guanylyl cyclase inhibitor, ODQ (chronic dose: 10mg/kg and acute dose: 20mg/kg) was associated with prevention of atorvastatin anti-tolerance properties. Our results revealed that the atorvastatin modulating role in morphine antinociceptive tolerance is mediated at least in part via nitric oxide in animal pain models of hot plate and tail flick.

SIRT5 Deficiency Enhances Susceptibility to Kainate-Induced Seizures and Exacerbates Hippocampal Neurodegeneration not through Mitochondrial Antioxidant Enzyme SOD2.

Epilepsy is a common and serious neurological disorder characterized by occurrence of recurrent spontaneous seizures, and emerging evidences support the association of mitochondrial dysfunction with epilepsy. Sirtuin 5 (SIRT5), localized in mitochondrial matrix, has been considered as an important functional modulator of mitochondria that contributes to ageing and neurological diseases. Our data shows that SIRT5 deficiency strikingly increased mortality rate and severity of response to epileptic seizures, dramatically exacerbated hippocampal neuronal loss and degeneration in mice exposed to Kainate (KA), and triggered more severe reactive astrogliosis. We found that the expression of mitochondrial SIRT5 of injured hippocampus was relatively up-regulated, indicating its potential contribution to the comparably increased survival of these cells and its possible neuroprotective role. Unexpectedly, SIRT5 seems not to apparently alter the decline of antioxidant enzymes superoxide dismutase 2 (SOD2) and glutathione peroxidase (GPx) in hippocampus caused by KA exposure in our paradigm, which indicates the protective role of SIRT5 on seizures and cellular degeneration might through different regulatory mechanism that would be explored in the future. In the present study, we provided strong evidences for the first time to demonstrate the association between SIRT5 and epilepsy, which offers a new understanding of the roles of SIRT5 in mitochondrial functional regulation. The neuroprotection of SIRT5 in KA-induced epileptic seizure and neurodegeneration will improve our current knowledge of the nature of SIRT5 in central nervous system (CNS) and neurological diseases.

Central nervous system neuroinflammatory disorders in Asian/Pacific regions.

The discovery of aquaporin-4 (AQP4) antibodies with high specificity for neuromyelitis optica spectrum disorder (NMOSD) has induced tremendous changes in the approach and management of central nervous system (CNS) neuroinflammatory disorders. Owing to the increasing availability of the AQP4 antibody assay and evolution of diagnostic criteria for multiple sclerosis and NMOSD, recent studies have reevaluated CNS neuroinflammatory disorders. This review describes recent advances in the understanding of CNS neuroinflammatory disorders in Asian/Pacific regions. Although multiple sclerosis prevalence is lower in Asian countries than in Western countries, the overall clinical features of multiple sclerosis are comparable between these countries. Hospital-based studies have reported that the frequency of NMOSD is higher in Asian populations (22-42%) than in white populations (2-26%). Despite improvements in the AQP4 antibody assay, AQP4 antibodies are not detected in certain patients with NMOSD. Recently, myelin oligodendrocyte glycoprotein (MOG) antibodies have been identified in AQP4 antibody-negative patients with the NMOSD phenotype, and the clinical features differ slightly between MOG antibody-positive patients and AQP4 antibody-positive patients. The understanding of CNS neuroinflammatory disorders in Asian/Pacific regions continues to evolve owing to the discovery of new biological markers and recognition of broader clinical phenotypes.

Sex and Gender Differences in Central Nervous System-Related Disorders.

There are important sex differences in the brain that seem to arise from biology as well as psychosocial influences. Sex differences in several aspects of human behavior and cognition have been reported. Gonadal sex steroids or genes found on sex chromosomes influence sex differences in neuroanatomy, neurochemistry and neuronal structure, and connectivity. There has been some resistance to accept that sex differences in the human brain exist and have biological relevance; however, a few years ago, it has been recommended by the USA National Institute of Mental Health to incorporate sex as a variable in experimental and clinical neurological and psychiatric studies. We here review the clinical literature on sex differences in pain and neurological and psychiatric diseases, with the aim to further stimulate interest in sexual dimorphisms in the brain and brain diseases, possibly encouraging more research in the field of the implications of sex differences for treating these conditions.

Poor efficacy of the phosphorylated high-molecular-weight neurofilament heavy subunit serum level, a biomarker of axonal damage, as a marker of chemotherapy-induced peripheral neuropathy.

The phosphorylated form of the high-molecular-weight neurofilament heavy subunit (pNF-H) is a major structural protein in axons. The pNF-H level is elevated in the serum of certain patients with central nervous disorders, including chemotherapy-induced cognitive impairment. The present study was conducted to elucidate the potential role of pNF-H as a marker of chemotherapy-induced peripheral neuropathy (CIPN). A total of 71 patients with early breast cancer in various stages of treatment (following 1, 3 or 7 cycles of chemotherapy, or a previous history of breast cancer chemotherapy) were assessed with a self-administered PainDETECT questionnaire [pain location, pain intensity on an 11-point numeric rating scale (NRS), and various pain qualities] and a single serum pNF-H measurement. Patients were divided into two groups based on the presence or absence of bilateral symmetric pain in the distal portions of the extremities [CIPN(+) or CIPN(-)]. The χ2 and Mann-Whitney tests were used for statistical analyses. Among the participants, only 8 patients complained of CIPN. Their pain intensity was 3.5±1.9 (mean ± standard deviation) compared with 1.5±1.8 in the CIPN(-) group (P<0.01). The NRS of numbness in the CIPN(+) group was significantly higher (2.4±1.4) than that of the CIPN(-) group (1.0±1.0). Increased pNF-H levels were observed in 37.5% of the CIPN(+) patients and in 23.8% of CIPN(-) patients (P=0.40). In conclusion, CIPN is observed in the most distal portions of the peripheral nerves that are composed of dendrites but not axons. Although serum pNF-H is a biomarker of axonal damage, it is not useful as a marker of CIPN.

Alzheimer’s Disease Management: Current Therapy and Recent Drug Development

Alzheimer’s disease is an age-related central nervous disorder that has created daunting challenges for the treating physicians, the families and the society. Alzheimer’s disease, a leading neurodegenerative disorder worldwide, is a major cause of dementia in the developed and developing countries around the globe. While, there is no definitive cure for Alzheimer’s disease and no treatment is available to reverse or halt its progression. Currently Food Drug Administration approved acetylcholinesterase inhibitors and memantine, a N-methyl-D-aspartate receptor antagonist for the treatment of Alzheimer’s disease. Moreover, new therapeutic approaches, including those more closely targeted to the pathogenesis of the disease, are being developed. This potentially disease-modifying therapeutics includes both beta and gamma secretase inhibitors, cholesterol-lowering drugs, amyloid-beta immunotherapy, non-steroidal antiinflammatory drugs, hormonal modulation and the use of antioxidants. In this current review we summarize the available evidences on the newer therapeutic approaches for the treatment of Alzheimer’s disease. Review Article Abbasi and Alam; INDJ, 7(2): 1-19, 2016; Article no.INDJ.24771 2

Dysphagia in Duchenne muscular dystrophy: practical recommendations to guide management

Purpose: Duchenne muscular dystrophy (DMD) is a rapidly progressive neuromuscular disorder causing weakness of the skeletal, respiratory, cardiac and oropharyngeal muscles with up to one third of young men reporting difficulty swallowing (dysphagia). Recent studies on dysphagia in DMD clarify the pathophysiology of swallowing disorders and offer new tools for its assessment but little guidance is available for its management. This paper aims to provide a step-by-step algorithm to facilitate clinical decisions regarding dysphagia management in this patient population.Methods: This algorithm is based on 30 years of clinical experience with DMD in a specialised Centre for Neuromuscular Disorders (Inkendaal Rehabilitation Hospital, Belgium) and is supported by literature where available.Results: Dysphagia can worsen the condition of ageing patients with DMD. Apart from the difficulties of chewing and oral fragmentation of the food bolus, dysphagia is rather a consequence of an impairment in the pharyngeal phase of swallowing. By contrast with central neurologic disorders, dysphagia in DMD accompanies solid rather than liquid intake. Symptoms of dysphagia may not be clinically evident; however laryngeal food penetration, accumulation of food residue in the pharynx and/or true laryngeal food aspiration may occur. The prevalence of these issues in DMD is likely underestimated.Conclusions: There is little guidance available for clinicians to manage dysphagia and improve feeding for young men with DMD. This report aims to provide a clinical algorithm to facilitate the diagnosis of dysphagia, to identify the symptoms and to propose practical recommendations to treat dysphagia in the adult DMD population.Implications for RehabilitationLittle guidance is available for the management of dysphagia in Duchenne dystrophy.Food can penetrate the vestibule, accumulate as residue or cause aspiration.We propose recommendations and an algorithm to guide management of dysphagia.Penetration/residue accumulation: prohibit solid food and promote intake of fluids.Aspiration: if cough augmentation techniques are ineffective, consider tracheostomy.

MicroRNAs (20a, 146a, 155, and 145) expressions in a sample of Iraqi patients with multiple sclerosis

Background: Multiple sclerosis is a devastating central nervous system autoimmune disorder that is characterized by a series of inflammations, demyelinations, and neurodegenerations that affect the brain and spinal cord. The epigenetic studies specially micro Ribonucleic acid expression represent an important field of researches that probably uncover the obscurities behind the multiple sclerosis pathogenesis.Objectives: to study the expression of micro Ribonucleic acids (20a, 146a, 155, and 145) in multiple sclerosis patients by the use of real time polymerase chain reaction.Patients and Methods: A case-control study was performed using real time polymerase chain reaction technique to measure the relative expression of micro Ribonucleic acids (20a, 146a, 155, and 145) in peripheral blood leukocytes of 25 newly diagnosed untreated multiple sclerosis patients and comparing them with that of 25 clinically apparent healthy controls .Results: Studying of micro Ribonucleic acids expression in multiple sclerosis patients revealed a significant down-regulation in micro Ribonucleic acid-20a while up- regulation of micro Ribonucleic acid-155 expression in multiple sclerosis patients in comparison to controls. Micro Ribonucleic acids -146a and 145 were not associated with significant changes in its expression in multiple sclerosis patients in comparison to controls.Conclusion: multiple sclerosis is associated with significant changes in micro Ribonucleic acids expression including micro Ribonucleic acid-20a, and micro Ribonucleic acid-155 but not micro Ribonucleic acid 146a and-145 that can be measured by real time polymerase chain reaction technique.

Epidemiology of neuropathic pain

BACKGROUND AND OBJECTIVES: The prevalence of neuropathic pain varies according to specific situations, due to multiple etiologies and manifestations, and may be located anywhere in the nervous system, being classified as peripheral or central. The classification has been modified with a certain frequency by the International Association for the Study of Pain in recent years, and may, for example, be classified as possible, probable or permanent. This brief review analyzes aspects of neuropathic pain epidemiology in general Brazilian population and in different clinical situations. CONTENTS: Data on neuropathic pain prevalence in general population are not reliable due to broad heterogeneity of studies, different definitions and evaluation methods. The same difficulties are found when neuropathic pain prevalence is evaluated in Brazil. The prevalence and/or incidence in different clinical situation varies according to specific clinical situation, since it has multiple etiologies and may be located anywhere in the nervous system. Clinical situations in which neuropathic pain is more frequent are herpes-zoster, diabetes, leprosy, trigeminal and glossopharyngeal neuralgia, low back pain, and also central neurological diseases. CONCLUSION: Data on the incidence and/or prevalence of chronic pain with neuropathic characteristics are very different and although this type of pain is being broadly studied in recent years, epidemiological studies are relatively scarce and the methodology used varies a lot.

Pharmacoepidemiology: Pattern of some commonly reported diseases and drugs utilized in a tertiary health institution

Purpose: Due to a wide variation of diseases reported and drugs utilized in different regions, It became necessary to assess the pattern of diseases commonly reported and drugs utilized prior to and after visiting the University of Benin Teaching Hospital, Benin City, Edo State, Nigeria. Materials and Methods: Patients who reported with various diseases at the first point of visit were randomly selected after obtaining ethical consent from the health institution. Results: Out of 4253 patients who were assessed, the male to female ratio was 0.92:1. The age range was 56 ± 26.02 [mean ± standard deviation (SD)] years. The diseases reported were classified; the most common was trauma (open wounds: 62.69%) followed by infection (malaria: 62.51%), gastrointestinal disease (upset stomach: 65.06%), respiratory disease (cough: 69.79%), cardiovascular disease (hypertension: 68.51%), central nervous system disease (headache: 63.97%), endocrine disease (diabetes: 81.66%), musculoskeletal disorder (pain: 91.40%), and dermal disease (rash: 63.15%). The commonly utilized classes of drugs prior/post visits were analgesics (acetaminophen 44.87%/diclofenac 24.24%), antiallergic (chlorpheniramine 1.01%/loratadine 0.16%), anti-infective (ampicillin-cloxacilline 12.16%/ciprofloxacine 18.75%), antidiarrhea (oral rehydration salt 0.6%/zinc sulfate 0.25%), antifungal (clotrimazole 1.42%/fluconazole 3.12%), antihypertensive (Moduretic 10.02%/amlodipine 7.02%) antimalarial (artemether-lumefantrine 24.42%/artemether-lumefantrine 41.51%), antiulcer (mist magnesium trisilicate 1.08%/omeprazole 2.40%), anxiolytic (diazepam 0.42%/bromazepam 0.55%), and minerals/vitamins (ascorbic acid 4.00%/ferrous sulfate 1.48%). There was a significant difference in the pattern of disease among the ages (P 0.05). Conclusion: Essential drugs were being prescribed and utilized prior to and after hospital visits. It is therefore, recommended that an enhanced adequate stocking and prescribing be encouraged in accordance with the reported diseases.

Mycotoxins that Affect the Human Cardiovascular System

Mycotoxins are toxic secondary metabolites produced by fungi in the field or during storage; these fungi are mainly saprophytic molds growing on foodstuffs or animal feeds. These molds produce chemical compounds of low molecular weight that are not detected by antigens and hence are insidious poisons with no obvious symptoms. Since 1960, mycotoxins have been considered responsible for diseases and death in domestic animals and humans. Mycotoxicoses, the diseases caused by mycotoxins, have been responsible for major epidemics in humans and domestic animals since agriculture was developed. Each of these diseases is caused by specific molds that produce one or more potent toxins, usually in one specific type of commodity or feed. Among the main mycotoxigenic fungi are the genera Aspergillus spp., Penicillium spp. and Fusarium spp. The symptoms caused by mycotoxins can be acute or chronic, depending on the type of toxin and the dose. The symptoms of acute mycotoxicoses include liver and kidney damage, attacks on the central nervous system, skin disorders, hormonal effects, miscarriage, hemorrhage, vomiting, diarrhea and many others. Mycotoxins are eaten in trace quantities in the daily diet; some, such as aflatoxins, can accumulate, whereas others are quickly eliminated. Examples of chronic mycotoxicoses include Reye syndrome, Kwashiorkor, and cancers that develop in experimental animals or humans long after the mycotoxin is eaten. In the present review, we will describe some mycotoxins that cause circulatory problems, vein breakage, hemorrhage, and heart failure.