Bilateral miliary shadowing on chest x-ray

A patient presented with recent onset of increasing shortness of breath, weight loss and low-grade fever. His chest X-ray revealed bilateral miliary shadowing. He was investigated with CT-scanning of thorax. Later, a biopsy from supra-clavicular node and its immunocytochemistry studies confirmed metastasis from primary lung cancer. Primary lung cancer with miliary pulmonary metastases is a rare happening and is mostly associated with lung adenocarcinoma.

Type I retinopathy of prematurity in infants with birth weight less than 1251 g: incidence and risk factors for its development in a nursery in Kuwait

To report the rate of acute retinopathy of prematurity [ROP] and Type I ROP among infants with birth weight [BW] <1251 g and identify the risk factors for the development of Type I ROP. A retrospective review of ROP records of infants with BW <1251 g was performed to identify infants with acute ROP and Type I ROP. Infants with Type I ROP were compared with those without Type I ROP to assess the risk factors for the development of Type I ROP. P < 0.05 was statistically significant. Multivariate analysis was performed and odds ratio [OR] and 95% confidence intervals [CI] were calculated. Among the 207 infants with BW <1251 g, acute ROP occurred in 154 infants [74.4%] and Type I ROP in 95 eyes of 50 infants [24.4%]. The numbers of infants with BW <750 g and BW <1000 g were 19.3% and 58.4%, respectively, and the incidences of Type I ROP were 50% and 36.4%, respectively, among them. Forty-four [46.3%] eyes were treated at stage 2+ ROP in zone I or II. All the eyes treated for Type I ROP showed complete regression. Gestational age at birth [OR 0.657, 95% CI: 0.521-0.827; P< 0.000l] and number of ventilated days [OR 1.017, 95% CI: 1.005-1.029; P= 0.006] were identified as independent risk factors for the development of Type I ROP. The rate of Type I ROP in this study is higher than that in previous studies due to the higher number of infants with BW <1000 g in our cohort and the treatment of more eyes with stage 2+ ROP. However, all the treated eyes had a favorable outcome. Gestational age at birth and number of ventilated days were independent risk factors for the development of Type I ROP

Pneumococcal disease and vaccination in the Americas: an agenda for accelerated vaccine introduction

Este trabajo resume las presentaciones y los debates que hubo en una reunión sobre la vigilancia de las enfermedades neumocócicas en las Américas, celebrada en la ciudad de México, México, el 2 de noviembre de 2004. La reunión la habían organizado la Organización Panamericana de la Salud (OPS) y el Plan para el Desarrollo Acelerado y la Introducción de Vacunas Antineumocócicas (PneumoADIP, por Pneumococcal Vaccines and Accelerated Development and Introduction Plan) de la Alianza Mundial para Vacunas e Inmunización (GAVI, por Global Alliance for Vaccines and Immunization). Las personas que participaron en la reunión revisaron el estado de la vigilancia de las enfermedades neumocócicas en la Región de las Américas, así como cálculos de la carga de enfermedades neumocócicas, la distribución de serotipos de Streptococcus pneumoniae que provocan enfermedad invasora, el estado de la introducción de vacunas antineumocócicas, análisis económicos sanitarios, y aspectos económicos de la introducción de la vacuna. Los participantes de la reunión también se dedicaron a identificar los próximos pasos necesarios para generar la información esencial que hace falta para facilitar la toma de decisiones en torno a la introducción de una vacuna antineumocócica. La vigilancia coordinada de las enfermedades neumocócicas en la Región de las Américas se remonta a 1993, cuando la OPS estableció el proyecto conocido por Sistema Regional de Vacunas (SRV), dedicado a la vigilancia de la meningitis y la neumonía por bacterias, incluido el neumococo. Los datos obtenidos mediante las actividades de vigilancia del SRV indican que la distribución de los principales serotipos en las Américas ha sido estable a lo largo del tiempo (pero que la resistencia a los antibióticos va en aumento), siendo el serotipo 14 el que más se aísla en la mayoría de los países que participan en el SRV. Según se deduce de los datos sobre serotipos procedentes de seis de los países abarcados por el SRV (Argentina, Brasil, Chile, Colombia, México y Uruguay), la vacuna septavalente cubriría a alrededor de 65% de los serotipos, la nonavalente cubriría a más de 77% y la undecavalente cubriría a más de 83%.

PneumoADIP: an example of translational research to accelerate pneumococcal vaccination in developing countries.

Historically, the introduction of new vaccines in developing countries has been delayed due to lack of a coordinated effort to address both demand and supply issues. The introduction of vaccines in developing countries has been plagued by a vicious cycle of uncertain demand leading to limited supply, which keeps prices relatively high and, in turn, further increases the uncertainty of demand. The Pneumococcal Vaccines Accelerated Development and Introduction Plan (PneumoADIP) is an innovative approach designed to overcome this vicious cycle and to help assure an affordable, sustainable supply of new pneumococcal vaccines for developing countries. Translational research will play an important role in achieving the goals of PneumoADIP by establishing the burden of pneumococcal disease and the value of pneumococcal vaccines at global and country levels. If successful, PneumoADIP will reduce the uncertainty of demand, allow appropriate planning of supply, and achieve adequate and affordable availability of product for the introduction of pneumococcal vaccines. This model may provide a useful example and valuable lessons for how a successful public-private partnership can improve global health.

An outbreak of echovirus meningitis in children.

An outbreak of aseptic meningitis in children as evidenced by increase in the number of admissions in a tertiary care hospital is described. Clinical data and stool samples were collected from 25 hospitalized infants and young children. The stool samples were subjected to virological investigations. Fever and vomiting were the commonest symptoms. Cerebrospinal fluid (CSF) showed lymphocytic pleocytosis in majority of cases. Of the 25 stool samples, 14 showed an enterovirus specific cytopathogenic effect (CPE) in rhabdomyosarcoma (RD) cell line. All the 14 samples were positive for enterovirus RNA by reverse transcription-polymerase chain reaction (RT-PCR). Partial sequencing of the Virion protein 1 (VPI) region of the enterovirus genome carried out on the first 7 isolates revealed 5 isolates to be echovirus serotype 4 and one each to be echovirus serotypes 3 and 30. All children showed a rapid recovery and were discharged within 3 days of admission.

Neonatal mortality - a hospital based study in Kuwait

The aim of this study is to evaluate the incidence of neonatal mortality rate [NMR] and causes leading to neonatal deaths in this center. It is the first reported detailed study of neonatal vital statistics in Kuwait. Both prospective and retrospective procedures for data collection were used to assess the neonatal mortality for 5545 live births in Adan Hospital during the period from first of January 1999 till end of December 1999. The results showed that of a total 5545 live births enrolled in this study, the overall neonatal mortality was 6.49 per 1000 live births. The main causes of neonatal deaths were congenital anomalies, preterm birth related problems and hypoxic ischemic encephalopathy. These causes accounted for around 94% of all neonatal deaths. Around 55.6% of the deaths were considered preventable

Conclusion: identification of suboptimal care and the avoidable factors based on agreed set of standards seems to be valuable in improving the quality of medical care and reducing the neonatal mortality

Safety and immunogenicity of Haemophilus influenzae type B vaccine given in combination with DTwP at 6, 10 and 14 weeks of age.

OBJECTIVE: To assess the immunogenicity and reactogenicity of a tetanus conjugate Haemophilus influenzae type b vaccine (Act-Hib) when extemporaneously mixed and administered as a DTwP-Hib combination using an Indian DTwP vaccine (BE DTwP) in comparison with a licensed DTwP-Hib combination vaccine. METHODS: 378 healthy infants were enrolled and randomly allocated to receive either three doses, at 6, 10 and 14 weeks of age, of Act-Hib in combination with BE DTwP (Group A, n = 160), TetrAct-Hib (Group B, n = 160), or BE DTwP and Act-Hib as separate injections (Group C, n = 58). Sera collected before the first dose and one month after the third dose were tested for antibodies to vaccine antigens. Safety was determined using parental diary cards. RESULTS: Anti-Hib antibody concentrations indicative of short-term protection (> 0.15 g/ml) were elicited in all but one subject in Group A (99.3%), and all subjects in Groups B and C. The concentration of 1 g/ml, considered to provide long-term protection, was achieved in 96.7%, 100% and 98.2% of the infants in Groups A, B and C, respectively. All children displayed satisfactory responses to the three DTwP component antigens, TetrAct-Hib eliciting higher titers against diphtheria and tetanus than BE DTwP. No vaccine-associated serious adverse events occurred. The BE DTwP vaccine was associated with more reports of fever than TetrAct-Hib, but most symptoms were regarded as mild and all resolved without sequelae. CONCLUSIONS: Combining Act-Hib and a local DTwP vaccine did not affect the anti-Hib response. In countries where DTwP vaccine available for use in the EPI program is manufactured by a local or other developing country manufacturer, mixing it with lyophilised Act-Hib is a reasonable option though the immunogenicity may have to be documented before routine use. However, use of TetrAct-Hib combination vaccine would be preferable in view of its lower reactogenicity and superior immunogenicity with respect to diphtheria and tetanus.

A pilot study on the seroprevalence of parvovirus B19 infection.

BACKGROUND & OBJECTIVES: Human parvovirus B 19 (PVB 19) causes aplastic crisis in children with congenital haemolytic anaemia, erythema infectiosum, abortion and stillbirth. Since data on PVB 19 prevalence is lacking in India, a pilot study was undertaken to estimate the prevalence of IgG antibody in children and adults. METHODS: The samples were obtained from children attending our hospital and from volunteer blood donors, majority of whom were from south India. They included 45 children aged 1-5 yr, 39 aged 6-10 yr, 42 aged 11-15 yr and 100 healthy blood donors > 15 yr of age. Sera were tested for the presence of antibody to PVB 19 using a commercial enzyme immuno assay (EIA). RESULTS: Of 226 samples tested, 113 (50%) were positive for PVB 19 IgG. The prevalence of antibody increased from 8.9 per cent at 1-5 yr to 70 per cent in those > 15 yr: the median age of infection was between 6 and 15 yr. Sex and domiciliary status did not have significant effect on the prevalence of antibody. The IgG antibody index increased significantly with age, suggesting repeated exposure to the virus. INTERPRETATION & CONCLUSION: This seroprevalence study indicates that large numbers of individuals show exposure to PVB 19 virus. The exposure as indicated by IgG positivity is seen to increase with age. The IgG negative individuals may be considered to be at risk of developing infections due to PVB 19.