In a double-blind trial on 37 asymptomatic microfilaraemic subjects (minimum 400 microfilariae [mf] per mL) with Wuchereria bancrofti infection, the safety, tolerability and macrofilaricidal efficacy of 12 fortnightly doses of ivermectin, 400 micrograms/kg (ivermectin group), was compared with 12 fortnightly doses of diethylcarbamazine (DEC), 10 mg/kg (DEC group), over a period of 129 weeks after treatment. A control group (LDIC group) was treated with low dose ivermectin to clear microfilaraemia, for ethical reasons. Both ivermectin and DEC in high multiple doses were well tolerated and clinically safe. Macrofilaricidal efficacy was assessed by prolonged clearance of microfilaraemia, appearance of local lesions, and reduction of circulating W. bancrofti adult antigen detected by an antigen capture enzyme-linked immunoassay based on the monoclonal antibody AD12. Mf counts fell more rapidly after ivermectin than after DEC, but low residual mf levels were equivalent in these groups after week 4. Conversely, filarial antigen levels fell more rapidly after DEC than after ivermectin, but low residual antigen levels in these groups were statistically equivalent at all times beyond 12 weeks. Mild, self-limited systemic reactions to therapy were observed in all 3 treatment groups. Local reactions, such as development of scrotal nodules, were observed in several subjects in the DEC and ivermectin groups. These results suggested that high dose ivermectin and DEC both had significant macrofilaricidal activity against W. bancrofti, but neither of these intensive therapeutic regimens consistently produced complete cures. Thus, new drugs or dosing schedules are needed to achieve the goal of killing all filarial parasites in the majority of patients.

BackgroundInfectious mononucleosis is one of the main manifestations of Epstein – Barr virus, which is characterized by fever, tonsillar-pharyngitis, lymphadenopathy and atypical lymphocytes. Although 60% of patients with IMN develop cold type antibodies, clinically significant hemolytic anemia with a high ferritin level is very rare and validity of serum ferritin as an important biomarker has not been used frequently.Case presentation18-year-old girl presented with fever, malaise and sore throat with asymptomatic anemia, generalized lymphadenopathy, splenomegaly and mild hepatitis. Investigations revealed that she had cold type autoimmune hemolysis, significantly elevated serum ferritin, elevated serum lactate dehydrogenase level with serological evidence of recent Epstein Barr infection. She was managed conservatively and her hemoglobin and serum ferritin levels normalized without any intervention following two weeks of the acute infection.ConclusionCold type autoimmune hemolytic anemia is a rare manifestation of infectious mononucleosis and serum ferritin is used very rarely as an important biomarker. Management of cold type anemia is mainly supportive and elevated serum ferritin indicates severe viral disease.

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Introduction: Moringa (Moringa oleifera) is a plant found in many regions. Its extracts, especially of leaves are a rich source of fibre, proteins and micronutrients including iron, thus potentially used for haematological applications including iron deficiency anaemia affecting approximately one-third of the global population. Objectives:To systematically review the effect of M. oleifera on haematological parameters Methods: Preferred Reporting Items for Systematic Reviews (PRISMA) guidelines were followed. PubMed, Cochrane library, Agricola, CINAHL and EMBASE databases were searched. Selection of articles were done in with three screening questions by two independent reviewers intervened by a third, resolving conflicts. Human studies on Moringa with relevant outcomes were included. Risk of bias assessment was done with Grading of Recommendations Assessment Development and Evaluation (GRADE) Criteria. Heterogeneity was assessed and results were narratively synthesized without meta-analysis. Registration from International Prospective Register of Systematic Reviews (ID: CRD42020181432) was obtained.Results: Following de-duplication, there were 215 articles. Eight studies on M. oleifera leaf extracts, covering nine outcomes were included (four studies on children below 2 years and two each on pregnant women and reproductive & postmenopausal women). Among children under 2 years, mean improvement in haemoglobin level ranged between 0.31-2.6 g/dl, with a reduction of the prevalence of anaemia by 53% (95% CI=35.1, 72.0; p<0.001). Haemoglobin level among anaemic women in reproductive ages showed an improvement with a mean difference (MD) of 0.794 (SD=0.81) (p<0.05) in the interventional group and of 0.644 (SD=0.83) in the control group. Postmenopausal women showed a significant improvement of 17.5% in haemoglobin compared to baseline (p≤0.01). Two studies showed improvements in ferritin levels with an MD of 29.378 ng/mL (SD=42.48; p=0.012) among anaemic women and 31.9 (SD=23.8) among children under 2 years. One study showed an improvement in the MD of erythrocyte count (0.482; SD=2.26), hematocrit (0.947; SD=4.56), MCV (0.635; SD=11.22), MCH (1.312; SD=4.94), MCHC (2.459; SD=2.86) and RDW (1.4; SD=2.07) compared to the control group. Among the pregnant women, improvements in both MCH and MCV were statistically significant in the intervention group (p<0.05). Conclusions & Recommendations:Moringa leaf extracts as a natural supplement is seemingly useful for improving haematological parameters, especially the haemoglobin level among children and female adults.

Background Parathyroid carcinoma is an uncommon cause of PTH-dependent hypercalcemia. Only a handful of cases have been reported of parathyroid carcinoma during pregnancy. Case presentation Twenty-four – Year – old female presented with proximal myopathy was found to have hypercalcemia. Her serum corrected total calcium was – 15 mg/dl (8.5 – 10.3), serum phosphate – 2.3 mg/dl (2.5 – 4.5), intact PTH – 118 pg/ml (20 – 80), Vitamin D – 15 ng/ml and Urine Ca/Cr ratio – 2.1 (0.1 – 0.2). Her CECT–neck revealed a well-defined mass lesion posterior to the right lobe of the thyroid – 2.6 cm × 2.5 cm × 2.9 cm in size. She was started on vitamin D supplementation, and she underwent right lower focal parathyroidectomy. Her PTH levels normalized following surgery. Her histology revealed an atypical parathyroid adenoma. She was treated with calcium and vitamin D. Her follow up was uneventful. One year following initial surgery the patient became pregnant and at 16 weeks of POA, the patient presented with a rapidly enhancing neck mass for one week duration. Her biochemical investigations were suggestive of a recurrence of primary hyperparathyroidism. Her ultrasound scan of the neck revealed a well-defined discreate hypoechoic nodule, superior to the thyroid isthmus which was confirmed by a non-contrast MRI scan of the neck. She underwent an uncomplicated second trimester parathyroid tumour excision with normalization of post op PTH. Her histology revealed a parathyroid carcinoma with vascular and capsular invasion. Her genetic studies revealed a novel frameshift mutation of the CDC73 gene. She was treated with calcium and vitamin D supplementation and closely followed up with ionized calcium and PTH levels which were normal throughout the pregnancy. She had an uncomplicated caesarean section at a POA of 37 weeks. Currently she is twelve weeks post-partum, in remission of disease. Conclusion This case shows the importance of stringent follow up of atypical parathyroid adenoma patients, the benefit of second trimester surgery in management of hypercalcemia due to parathyroid carcinoma during pregnancy and the importance of identifying the novel CDC73 gene mutation.