Co-infection of Central Nervous System by M. Tuberculosis, Cryptococcus and possibly Naegleria fowleri

Co-infection due to Mycobacterium tuberculosis, Cryptococcus and Naegleria fowleri has not been reported till now in literature, to the best of our knowledge. Here we report a curious case of co-infection of the central nervous system due to these three pathogens in an apparently immune-competent, HIV negative boy. The 15 year old boy was a diagnosed case of tubercular meningitis and was on anti-tubercular and anti-epileptic treatment. However, two months later he presented again in the emergency department with sudden loss of consciousness. His CSF showed presence of capsulated budding yeast cells (suggestive of Cryptococcus) and flagellated parasites (resembling the flagellated stage of Naegleria fowleri). CSF was also positive for Cryptococcal antigens by Latex Agglutination test. The boy was HIV negative and apparently immuno-competent. He was subsequently put on amphotericin B therapy for six weeks. Repeat microscopy, done towards the end of amphotericin B course, showed clearing of CSF. However, the patient’s condition improved only slightly, owing to neurological damage caused by the pathogens as suggested by brain CT and MRI scans. Thus infection caused by the members of three different kingdoms in an apparently immunocompetent boy highlights the importance of thinking beyond the ordinary causative pathogens, and actively searching for rarer etiologies to ensure timely intervention; especially in nonresponsive cases.

Atrial myxoma: 14 years experience

Introduction: Cardiac tumors constitute only 0.2% of all tumors. Primary cardiac tumors occur infrequently with an incidence of 0.0017% to 0.19%, estimated on autopsies performed in non-selected populations. Left atrial myxomas are the most prevalent [75% to 80%] and right atrial are less common [10% to 18%]. Surgical excision yields an excellent prognosis and recurrence rate of only 3% with a very low morbidity and mortality

Objective: We aimed to review our experiences with this rare entity and highlight the various aspects of myxoma presentation, diagnosis and outcomes

Methodology: A retrospective chart review done on patients underwent excision of myxoma with histopathological confirmation since January 1991 till December 2015. Standard surgical approach adopted was single atrial, augmented with Biatrial approach where needed

Results: A total 42 cases were identified and 28 cases with complete data were included in the analysis. Mean age was 54.4 [ +/- 17.7] years, with female predominance [58% vs. 42%]. Preoperative comorbidities included hypertension [39.2%], diabetes [28.5%], IHD, dyslipidemia, and COPD [10.7%] that were comparable among gender. The mean dimension of myxoma measured on echocardiography was 4.9x3.5x2.7 cm. Sixty four percent had left sided and 35.7% had right sided myxoma. Most common symptom was dyspnea [71%], constitutional symptoms [39.3%] and stroke in [18%]. Echo being the diagnostic modality of choice. Post-operative complications occurred in 6 patients and mortality occurred in 2 [7.2%]. Mean post-operative follow up was 8.3 months and 10 years telephonic follow up completed in [32%] cases, with 2 late non-cardiac mortalities

Conclusion: Our results showed that the prevalence of cardiac myxoma is comparable with global estimates. Female gender was predominant and age and right atrial myxoma was slightly higher in our sample compare to other published literature. Myxoma can be excised successfully with a low rate of morbidity, mortality and recurrence

role of FNA cytology of the testis in management of male infertility [In Iraq]

Fine needle aspiration cytology of the testis is now well recognized in diagnosis of testicular diseases. Recently it has also gained popularity for its diagnostic and therapeutic role in male infertility. The purpose of this article is to put light on role of testicular fine needle testicular cytology in male infertility and provide brief information on method of testicular fine needle aspiration interpretation of testicular fine needle aspiration cytology for evaluation of spermatogenesis, its advantages, limitations and complications as compared to testicular biopsy, moreover to its coincidence with hormonal situation of the patient for diagnosis. This is a prospective study for sample collection during the period from January 2009-Dec 2010. The samples studied included 152 patients underwent FNA of testis for evaluation of spermatogenesis, spermiogenesis and the presence of active mature sperms in addition to hormonal assay for FSH, LH, testosterone and prolactine correlating with clinical findings The majority of cases of infertility were due to secondary maturation arrest [94 cases 61.84%] [P=0.03] followed by obstructive orchiopathy [38case 25%] and then the minority of cases were due to untreatable conditions including primary maturation arrest and total testicular atrophy FNAC is the dependent method of Azospermic patient evaluation despite of the presence of controversial ideas depending on that the FNAC size is not a suitable window to be able to represent whole testis in evaluation of azospermia

Febrile seizures: Factors affecting risk of recurrence in Pakistani children presenting the Aga Khan University Hospital

To [a] describe the effect of temperature rise on seizure recurrence in the ER [b] investigate the effect of age, gender, family and developmental history, type, duration and multiple seizures, past history and number of seizures and treatment given [either late or early] on seizure recurrence in the ER and [c] explore prognostic indicators for seizure recurrence. Data from 352 children [ages 3 - 84 months; 220 males [62.5%] 132 females [37.5%]] was taken using chart reviews for the years January 1998 - August 2000 inclusive, from the Pediatric department of the Aga Khan University Hospital. Descriptive statistics, Chi-square, and Discriminant Analysis were used. Of the 52 [16%] cases that had seizure recurrence in the ER, majority [36.5%] occurred in >38.5o < 39.5oC temperature range. The percentage declined to 15% at higher temperatures. Bivariate tests showed that age, family and developmental history, type of seizure and treatment given did not affect seizure recurrence in the ER. Past history number of seizures [p =.006], duration of seizure [p <0.001], past history of seizures [p=0.004] and multiple seizure [p=0.024] were factors significantly associated with seizure recurrence in the ER at the bivariate level of analysis. Duration of seizure was the most important prognostic indicator for FS recurrence in the ER at the multivariate level with b =0.79. Duration of seizure [>5 minutes] was the most important prognostic factor for FS recurrence. Early treatment did not affect recurrence,suggesting timely anti-pyretic vs. anti-leptic medication use

Antimicrobial activity of varthemia montana plant

Aqueous and ethanolic extracts as well as volatile oil fraction of Varthemia montana exhibited a potent antibacterial activity against Staphylococcus aureus, Staphylococcus pyogenes, Corynebacterium pyogens, Sarcina lutea, Salmonella typhimurium, E. coli, Bacillus subtilis and Klebsiela spp. in vitro. In addition, daily painting of guinea pig experimentally created wounds with 20% aqueous and ethanolic extracts of plant enhanced the healing of wound [9.6 and 8.2 days, respectively] faster than wounds of standard group treated with acriflavin and terramycine [13 days]. Both extracts and volatile oil isolated of the tested plant possessed a marked antimycotic against Candida albicans, Asperigillus niger, Asperigillus flavus, Microsporum gypseum and Microsporum canis. The antifungal activity of volatile oil is more potent than that of both extracts, especially against dermatophytes. The antimicrobial activity of Varthemia montana plant seemed to be concentration dependent