Dennis R. A. Mans

Assessment of Eight Popularly Used Plant-Derived Preparations for Their Spasmolytic Potential Using the Isolated Guinea Pig Ileum

Aqueous extracts from eight plant species that are popularly used as spasmolytics have been evaluated for these pre-sumed activities. The species included Kalanchoë pinnata (Lam.) Pers. (Crassulaceae), Cymbopogon citratus Stapf. (Gramineae), Gossypium barbadense L. (Malvaceae), Caesalpinia pulcherrima (L.) Schwartz (Caesalpiniaceae), Tagetes erecta L. (Compositae), Bixa orellana L. (Bixaceae), Cassia alata L. (Caesalpiniaceae), and Phyllanthus amarus Schum. & Thonn. (Euphorbiaceae). Potential spasmolytic activity of the extracts was judged by their ability to reduce forces of smooth muscle contraction of a 2-cm-long piece of guinea pig ileum induced by EC50 acetylcholine (27 ± 5 µg/l) or EC50 histamine (102 ± 13 µg/l). The dried extracts were used at concentrations of 0.01, 0.1, 1, and 10 mg/ml. Incubations were carried out in Tyrode buffer kept at a temperature of 37°C and mixed with 5% CO2 in air and were monitored for 30 s with 60-s intervals. Results (means ± SD; n ≥ 3) were expressed relatively to forces of contraction due to EC50 acetylcholine or EC50 histamine alone. The extract from K. pinnata reduced the force of contraction due to histamine but not that due to acetylcholine progressively (40% to 95%) with concentrations increasing from 0.01 to 10 mg/ml. At 10 mg/ml, the C. pulcherrima and B. orellana extracts also counteracted only the histamine-induced force of contraction (by about 25% and 50%, respectively). The C. citratus extract decreased the acetylcholine-induced force of contraction by 20% to 60% at 0.1 to 10 mg/ml and that induced by histamine by 60% to 90% at 0.01 to 10 mg/ml. On the other hand, the G. barbadense extract potentiated rather than reduced forces of contraction due to both acetylcholine and histamine (1.2- to 2-fold at 0.01 to 10 mg/ml). The T. erecta extract had such an effect only on the acetylcholine-induced force of contraction (about 2-fold at 10 mg/ml). The use of the former but not the latter sample alone led to an increase in smooth muscle tone that was not reversed by atropine or chlorpheniramine. The C. alata and P. amarus extracts did not significantly modify forces of contraction due to either acetylcholine or histamine. Our results suggest that preparations from K. pinnata, C. citratus, C. pulcherrima, and B. orellana, but not from G. barbadense, T. erecta, C. alata, and P. amarus, may be useful against smooth muscle spasm. These actions were probably mediated by distinct mechanisms.

First Case of Cutaneous Leishmaniasis Caused by Leishmania (Viannia) braziliensis in Suriname

The main causative agent of cutaneous leishmaniasis (CL) in Suriname is Leishmania (Viannia) guyanensis. This case report presents a patient infected with Leishmania (Viannia) braziliensis, a species never reported before in Suriname. This finding has clinical implications, because L. braziliensis has a distinct clinical phenotype characterized by mucocutaneous leishmaniasis, a more extensive and destructive form of CL that requires different treatment. Clinicians should be aware that chronic cutaneous ulcers in patients from the Guyana region could be caused by L. braziliensis.

Studies on the sand fly fauna (Diptera: Psychodidae) in high-transmission areas of cutaneous leishmaniasis in the Republic of Suriname

BackgroundSand flies (Diptera: Psychodidae) are the vectors of Leishmania parasites, the causative agents of leishmaniasis. Cutaneous leishmaniasis is an increasing public health problem in the Republic of Suriname and is mainly caused by Leishmania (Vianna) guyanensis, but L. (V.) braziliensis, L. (L.) amazonensis, and L. (V.) naiffi also infect humans. Transmission occurs predominantly in the forested hinterland of the country. Information regarding the potential vectors of leishmaniasis in Suriname is limited. This study aims to broaden the knowledge about vectors involved in the transmission of cutaneous leishmaniasis in Suriname. For this purpose, sand flies were characterized in various foci of cutaneous leishmaniasis in the country, the districts of Para, Brokopondo, and Sipaliwini.MethodsSand flies were collected in areas around mining plots and villages using CDC light traps in the period between February 2011 and March 2013. They were categorized by examination of the spermathecea (females) and the external genitalia (males).ResultsA total of 2,743 sand fly specimens belonging to 34 different species were captured, including four species (Lutzomyia aragaoi, Lu. ayrozai, Lu. damascenoi, and Lu. sordellii) that had never before been described for Suriname. Five percent of the catch comprised Lu. squamiventris sensu lato, one female of which was positive with L. (V.) braziliensis and was captured in a gold mining area in Brokopondo. Other sand fly species found positive for Leishmania parasites were Lu. trichopyga, Lu. ininii, and Lu. umbratilis, comprising 32, 8, and 4%, respectively, of the catch. These were captured at gold mining areas in Brokopondo and Sipaliwini, but the Leishmania parasites they had ingested could not be identified due to insufficient amounts of DNA.ConclusionsThe sand fly fauna in Suriname is highly diverse and comprises Lutzomyia species capable of transmitting Leishmania parasites. Four new Lutzomyia species have been found, and four species - Lu. squamiventris (s.l.), Lu. trichopyga, Lu. ininii, and Lu. umbratilis - have been found to harbor Leishmania parasites. The latter were among the most abundant species captured. These observations may contribute to the understanding of leishmaniasis transmission and the development of control programs in Suriname.

Diabetes and diabetic retinopathy in people aged 50 years and older in the Republic of Suriname

Background/Aims Population-based surveys on diabetes and diabetic retinopathy (DR) are necessary to increase awareness and develop screening and therapeutic programmes. The aim was to estimate the prevalence of DR in older adults of different ethnic backgrounds in Suriname. Methods Fifty clusters of 60 people aged ≥50 years were randomly selected with a probability proportional to the size of the population unit. Eligible people were randomly selected through compact segment sampling and examined using the Rapid Assessment of Avoidable Blindness plus Diabetic Retinopathy (RAAB + DR) protocol. Participants were classified as having diabetes if they: were previously diagnosed with diabetes; were receiving treatment for glucose control; had a random blood glucose level >200 mg/dL. These participants were dilated for funduscopy, assessed for DR following the Scottish DR grading protocol and evaluated for ethnicity and DR ophthalmic screening frequencies. Results A total of 2806 individuals was examined (response 93.6%). The prevalence of diabetes was 24.6%. In these patients any type of DR and/or maculopathy occurred in 21.6% and sight-threatening DR in 8.0%. Of the known diabetics, 34.2% never had an eye examination for DR and in 13.0% the last examination was >24 months ago. The prevalence of diabetes was significantly higher in Hindustani people compared with other major ethnic groups. Conclusions The prevalence of diabetes and diabetics without regular DR control in people aged ≥50 years in Suriname was higher than expected. The uptake for special services for DR has to be expanded to decrease patient delay and DR-induced blindness.

Monitoring the response of patients with cutaneous leishmaniasis to treatment with pentamidine isethionate by quantitative real-time PCR, and identification of Leishmania parasites not responding to therapy.

Leishmania (Viannia) guyanensis is believed to be the principal cause of cutaneous leishmaniasis (CL) in Suriname. This disease is treated with pentamidine isethionate (PI), but treatment failure has increasingly been reported.

Phacoemulsification under topical anaesthesia in remote areas: experiences in the Amazon

Despite many global initiatives to eliminate avoidable blindness, the number of cataract-blind people is still unacceptably high in many parts of the world, particularly in remote rural areas of developing countries. One of the established ways to increase the uptake of cataract services is by extending ophthalmic care facilities to rural areas through mobile eye units, thereby providing cataract surgical services close to large numbers of affected individuals. Unfortunately, however, results of camp surgery are often poor. As a result, the quality and safety of surgery in eye camps is questioned, and a growing body of evidence suggests that cataract surgery can be only performed in adequately equipped facilities. In this paper, we report that high-quality cataract surgery in the field is possible, even under the most primitive circumstances. We show that skilled surgeons, modern equipment and good organization make it feasible to perform high-quality phacoemulsification under topical anaesthesia in remote rural areas of the Amazon rainforest. A retrospective descriptive study was conducted by including consecutive patients with cataract who had undergone phacoemulsification and intraocular lens (IOL) implantation under topical anaesthesia in the interior of Suriname (Laduani, Kwamalasamutu, Fig. 1) between November 2011 and December 2012. The data retrieved from the clinical notes included gender, age at surgery, surgical details and postoperative complications, as well as preoperative and postoperative visual acuity. The postoperative uncorrected visual acuity was taken at the final visit at least 1 week after surgery. Snellen acuity (E chart) was categorized using the World Health Organization (WHO) guidelines. When visual outcome was poor (<6/60) the cause was recorded. The classification of intraoperative and immediate postoperative complications followed the Oxford Cataract Treatment Evaluation Team classification of cataract surgery-related complications. Equipment for the mobile eye unit was transported by air to the area. The operation theatre was created in a room of a local home or medical post, where the mobile phacoemulsification system was installed. Two portable surgical microscopes (Carl Zeiss, West Germany), two phacoemulsification machines (Laureate, Legacy [Alcon], Fort Worth, Texas, USA), Melag steam autoclaves (Berlin, Germany), an ultrasound cleaner and power generators were available. Patients arrived by foot, by boat or were carried in a wheelbarrow for eye examination and treatment. Thorough preoperative eye examination was accomplished, and biometric IOL measurements were carried out by a trained ophthalmic assistant using the Alcon Bioscan (OcuScan RxP). After disinfecting the conjunctiva and eyelids with povidone-iodine (50 mg/mL), phacoemulsification under topical anaesthesia (lidocaine 40 mg/mL) was performed, and a hydrophobic foldable acrylic IOL (SN60WF; Alcon) was implanted in the capsular bag. Most patients went home immediately after surgery. Those who came from far spent the night in hammocks near the clinic waiting for their first postoperative examination. Routine postoperative care included three times-daily application of a topical dexamethason–tobramycine (Tobradex, Alcon Laboratories, Forth Worth, Texas, USA) combination (1/3 mg/mL) for 3 weeks, and the administration of acetazolamide (Diamox, Apotex, Toronto, Canada) tablets (250 mg) to patients who had a high palpatory intraocular pressure 1 day postoperatively or those with significant corneal oedema. All patients were reviewed within 24 h, and subsequent visits were determined according to clinical need. A total of 92 patients had undergone surgery for cataract. Four patients were selected for surgery under retrobulbar anaesthesia, two of whom underwent planned extracapsular cataract extraction. In total, 88 eyes of 88 patients had been included; 27 (31%) patients were male. The median age of the patients was 73 years (range 52–88 years). Two intraoperative complications occurred in two eyes (2.3%). Both cases involved posterior capsule rupture of Oxford Cataract Treatment Evaluation Team grade III. One case required anterior vitrectomy with IOL implantation in the sulcus. The other case involved a dropped nucleus and was transported by air to the Academic Hospital Paramaribo for pars plana vitrectomy. No cases of postoperative endophthalmitis were reported. Eighty-seven (99%) of the 88 operated eyes were examined at the final visit. Before surgery, 61% of the operated eyes were either blind (less than WHO category 3/60; Table 1) or severely visually impaired (less than WHO category 6/60; Table 1). Only 9% had satisfactory vision (WHO category 6/18 or better; Table 1). At the final postoperative visit, poor visual outcome (less than WHO category 6/60) was noted in 9% of the eyes (Table 2), and good vision (WHO category 6/18 or better) was found in 70% of the eyes, which had undergone phacoemulsification with IOL implantation (Table 2). Seven of the eight eyes with visual acuity <WHO category 6/60 at follow up had a pre-existing ocular pathology, including end-stage glaucoma, branch retinal vein occlusion, idiopathic optic atrophy or extending pterygium. The poor outcome of one eye was caused by corneal endothelial decompensation due to a long phacoemulsification time. When considering that 67 of the 87 patients had better vision after surgery following WHO classification, it can be concluded that our intervention had improved vision in more than 77% of this patient population. In conclusion, this report confirms the possibility of high-quality cataract surgery in remote areas in

Beneficial effect of medicinal plants on the contractility of post-hypoxic isolated guinea pig atria – Potential implications for the treatment of ischemic–reperfusion injury

Abstract Context Ischemic–reperfusion injury is accompanied by a decreased contractility of the myocardium. Positive-inotropic agents have proven useful for treating this condition but may exert serious side-effects. Objective In this study, aqueous preparations from Abelmoschus esculentus L. Moench (Malvaceae), Annona muricata L. (Annonaceae), Bixa orellana L. (Bixaceae), Cecropia peltata L. (Moraceae), Erythrina fusca Lour. (Fabaceae), Psidium guajava L. (Myrtaceae) and Terminalia catappa L. (Combretaceae) were evaluated for their ability to improve the decreased contractility of isolated guinea pig atria after hypoxic stress. Materials and methods Guinea pig atria isolated in Ringer-Locke buffer gassed with 100% O2 at 30 °C were exposed for 5 min to hypoxia, then allowed to recover in oxygenated buffer alone or containing a single plant extract (0.001–1 mg/mL). The contractility (g/s) and beating frequency (beats/min), as well as troponin C contents of the bathing solution (ng/mL), were determined and expressed as means ± SDs. Results The extracts of A. muricata, B. orellana, C. peltata and T. catappa caused an increase in the contractility compared to untreated atria of 340 ± 102%, 151 ± 13%, 141 ± 14% and 238 ± 44%, respectively. However, the latter two preparations increased the troponin C contents of the bathing solution to 36 ± 11 and 69 ± 33, compared to the value of 11 ± 3 ng/mL found with untreated atria. Conclusions Preparations from A. muricata and B. orellana may possess positive-inotropic properties which may improve the contractility of the post-hypoxic myocardium. Studies to assess their usefulness in ischemic–reperfusion injury are warranted.

Causes of blindness and visual impairment in the interior Maroon population in the Republic of Suriname

doi: 10.1111/aos.12224 Editor, T he Republic of Suriname is an example of a developing country where avoidable and treatable blindness remains an important public health problem. In Suriname, specialized ophthalmic care is mainly concentrated in the urban areas, particularly in the Suriname Eye Center (SEC) of the Academic Hospital Paramaribo (AZP). Unfortunately, the hinterland population is not always able to reach the SEC, and little is known about the ophthalmic situation in these remote communities. These populations comprise almost exclusively Maroon and Indigenous (Amerindian) tribes. The Maroons originate from the Gold Coast and the Slave Coast of West Africa, a region that now encompasses Ghana, Togo and Nigeria. Because of their isolated way of life, the burden of blindness and visual impairment among Maroons is expected to be relatively high. When considering their African origin and tropical living environment, cataract and glaucoma are likely to be identified as important underlying causes (Mason et al. 1989; Leske et al. 1994; Hyman et al. 2001). So far, no standardized surveys about the scale and causes of blindness and visual impairment in this area have been conducted. However, the information emerging from such studies is crucial for the development of preventive and therapeutic eye care programmes. Therefore, the SEC initiated a population-based survey to assess the causes of blindness and visual impairment in this rural population of African descent. The survey was conducted in the Maroon villages along the Upper Suriname River between December 2011 and June 2012. Individuals at risk or suspected to be blind or visually impaired were actively recruited for eye examination. Systematic ophthalmic examination was performed by trained eye nurses and two ophthalmologists using the Eye Examination Record version III developed by the World Health Organization (WHO) for the Prevention of Blindness Program (1988). Following the WHO criteria, bilateral blindness was defined as presenting VA <3 ⁄ 60 in the better eye with available correction, severe visual impairment (SVI) as presenting VA <6 ⁄ 60 to ‡ 3 ⁄ 60, and visual impairment (VI) as VA <6 ⁄ 18 to ‡ 6 ⁄ 60.

Is the dog a possible reservoir for cutaneous leishmaniasis in suriname

Cutaneous leishmaniasis (CL) is an emerging disease in Suriname, with at least 200 cases per year. Little is known about the biology of CL in the country. The most important parasite species is Leishmania Viannia guyanensis, but possible vectors and reservoirs are hardly incriminated. In the present study, it was investigated whether the dog could possibly be a zoonotic reservoir for the disease in Suriname. Forty-seven dogs were examined for overt clinical signs of leishmaniasis, and blood samples were collected on filter paper for serology (direct agglutination test) and molecular biology (by polymerase chain reaction). Three dogs had clinical signs that could be compatible with canine cutaneous leishmaniosis: dermatitis (two) or nasal lesion (one). Two dogs were seropositive with DAT (titre > 1 : 1600), and three animals had a borderline titre (1 : 800). All other animals (n = 42) were DAT negative. PCR analysis found Leishmania DNA equivalent to 1 parasite per mL in only one dog at a first round of analysis, but this animal was negative after retesting. The clinical, serological, and molecular data show some preliminary lines of evidence that canine leishmaniosis is present in Suriname, but further studies are needed to incriminate the reservoir, including a possible sylvatic cycle.

Epidemiological, biological and clinical aspects of leishmaniasis with special emphasis on Busi Yasi in Suriname

The parasitic disease leishmaniasis is caused by protozoa of the genus Leishmania which are transmitted by sand fly vectors of the genus Phlebotomus in the Old World and Lutzomyia in the New World. Transmission can either be anthroponotic (human to human) or zoonotic through mammalian reservoirs such as dogs and rodents. Leishmaniasis has three principal clinical manifestations, namely cutaneous leishmaniasis (CL), mucocutaneous leishmaniasis (MCL), and visceral leishmaniasis (VL). The cutaneous form characteristically causes skin ulcers, the mucocutaneous form manifests as lesions of skin, mouth, and nose, and the (potentially lethal) visceral form affects the internal organs such as spleen and liver and also invades the bone marrow. Leishmaniasis is endemic in about ninety-eight countries and the diverse types of the disease occur in different regions of the world. CL is most common in Afghanistan, Algeria, Pakistan, Iran, Brazil, and Colombia; MCL is mainly restricted to countries of the Amazon Basin; and VL is most frequently seen in the Indian sub-continent, the Horn of Africa (Sudan and Ethiopia), and Brazil. The current global prevalence is estimated at about 12 million, and each year, the disease in one of its forms makes about 2 million new victims and claims up to 50,000 fatalities. This paper presents epidemiological, biological, and clinical aspects of leishmaniasis throughout the world; then focuses on the disease in the Republic of Suriname (South America); addresses in more detail the species of Leishmania parasites in that country; and concludes with potential future directions to improve our understanding of leishmaniasis in Suriname.