Molecular detection of Leishmania species in human and animals from cutaneous leishmaniasis endemic areas of Waziristan, Khyber Pakhtunkhwa, Pakistan

Objectives:To detect Leishmania species in human patients, animal reservoirs and Phlebotomus sandflies in Waziristan, Pakistan.Methods:Tissue smears and aspirates from 448 cutaneous leishmaniasis (CL) suspected patients were analyzed. To sort out role of the reservoir hosts, skin scrapings, spleen and liver samples from 104 rodents were collected. Furthermore, buffy coat samples were obtained from 60 domestic animals. Sandflies were also trapped. All human, animals and sandfly samples were tested by microscopy, kinetoplastic PCR and internal transcribed spacer 1 (ITS1) PCR followed by restriction fragment length polymorphism for detection of Leishmania species.Results:An overall prevalence of 3.83% and 5.21% through microscopy and ITS1 PCR respectively was found. However, the statistically non-significant correlation was found between area, gender, and number of lesions. The presence of rodents, sandflies, domestic animals and internally displaced people increased the risk of CL. Using ITS1-PCR-RFLP, Leishmania tropica (L. tropica) was confirmed in 106 samples while 25 of the isolates were diagnosed as Leishmania major (L. major). Similarly, 3/104 rodents were positive for L. major and 14 pools of DNA samples containing Phlebotomus sergenti sandflies were positive for L. tropica. None of samples from domestic animals were positive for leishmaniasis.Conclusions:In the present study, L. tropica and L. major are found to be the main causative agents of CL in study area. Movement of internally displaced people from CL endemic areas presents a risk for nearby CL free areas. To the best of our knowledge, we report for the first time L. major infection in rodents (Rattus rattus) and L. tropica in Phlebotomus sergenti sandflies trapped in Waziristan, Pakistan.

Complications in craniocerebral aspergillosis of sino-nasal origin in immunocompetent patients

Four immunocompetent patients of craniocerebral aspergillosis of sino-nasal origin who developed complications have been described. They developed intracerebral haemorrhages, multifocal infarctions and intraventricular dissemination of aspergillus infection and 2 patients developed acute hydrocephalus. All 4 patients have been managed by standard therapeutic regimens including both surgical resection followed by antifungal therapy while CSF shunting was done as required. Only one patient survived till the last clinical follow-up. Magnetic resonance angiography along with routine magnetic resonance imaging at the time of initial work-up may be helpful to pick up mycotic aneurysms and vascular occlusions

Implementation of task-based and problem-based pharmacotherapy course for pre-clinical medical students

Pharmacology, like other basic science disciplines, is still taught didactically in many medical schools. Increasing number of drugs, changes on general principles of mechanisms of drug action and more information on properties of drugs require innovative approaches to undergraduate education. Research in medical and pharmaceutical education is increasingly utilizing a variety of innovative teaching methods to ultimately improve retention of knowledge. This paper describes implementation of new task-based and problem-based pharmacotherapy course for 3rd year pre-clinical medical students at Faculty of Medicine and Health Sciences, Omdurman Islamic University

Gorlin syndrome: single case report and review

We report a 25 year old Sudanese male patient, Hawaeer tribe. He presented with multiple naevoid basal cell carcinomas in the face [14 in number], and multiple mandibular odontogenic keratocytes. This is considered as the first case record from Sudan, as Gorlin syndrome is known to be a rare presentation in Africans

audit of head trauma care and mortality

To analyze the factors contributing to deaths from head trauma by using standardized assessment parameters and to provide a peer-review of head injury deaths with focus on identifying deficiencies and analyzing contributory factors. Design: Descriptive study. Place and Duration of Study: The study was carried out at the Emergency, Aga Khan University Hospital during January 1998 to December 1999. Subjects and Method: One hundred and three patients above the age of 15 years presenting alive to the Aga Khan University Hospital [AKUH] emergency with head injury were included in this study. Identified deaths data was reviewed by the Hospital Trauma Peer Review Committee and consensus arrived at for categorization of deaths. The potential deficiencies in care were identified and final recommendations made. The data was computed on CDC Trauma Registry [V 3.0] and SPSS [V 8.0]. Mean age was 31.9 years [n=103] with predominant male population [4:1]. Severe head injury [GCS<8] accounted for 21.3% [n=22] of all cases with a total number of deaths being 12.6% [n=13]. Deaths were categorized preventable in 3 cases with non-preventable and potentially preventable in 4 and 6 cases respectively. Road traffic accidents were the predominant mechanism [n=8] in all deaths [n=13]. The time interval in relation to mortality was biphasic, most deaths occuring either within 24 hours or between 3-7 days of injury. Inappropriate pre-hospital treatment, pre-hospital delays and inappropriate mode of transportation without inter-hospital communication were the process-related defects in pre-hospital care with major determinant of deaths outside AKUH [n=5]. Prolonged emergency stay, delayed intensive care availability were the process-related deficiencies whereas inappropriate initial resuscitation, inappropriate initial head injury management were provider-related deficiencies in in-hospital care. Transfer of inappropriately managed patients, lapses in inter-hospital communications, delayed transfers were identified as the major pre-hospital factors whereas lack of ICU beds, portable ventilators in emergency room, delays in CT scan facilities were the deficiencies in the hospital services. Opportunities for improvement in head trauma care are needed to focus on initial resuscitation and appropriate surgical management

Seasonal variation in bacterial pathogens isolated from stool samples in Karachi, Pakistan

To determine the seasonal variation of the commonly isolated bacterial pathogens in stool samples. A retrospective descriptive study was undertaken of all the stool samples submitted from within Karachi to the Aga Khan University Hospital Laboratory over a period of five years [January 1997- December 2001] in order to determine the commonly isolated bacterial pathogens and to predict their seasonal variation. A total of 16379 stool samples were included in this review. Bacterial isolates were found in 6670 stool samples [culture detection rate=40.7%]. The mean age at the time of culture of each sub-group was <1 year group [6.58 +/- 3.1 months], 1-5 years [2.13 +/- 0.94 years], 5-14 years [8.3 +/- 2.6 yrs] and adults [43.2 +/- 18.5 years]. Male: Female ratio was 1.2:1. Vibrio cholera 01 Ogawa [32.8%], Campylobacter jejuni [17.3%], Enteropathogenic Escherichia coli [9.9%], Salmonella paratyphi b [6.6%] and Shigella flexneri [6.2%] were the most common organisms isolated. These organisms show a distinct seasonal variation with summer predilection. In contrast to the previous studies from South Asia, which have identified E. coli, followed by Vibrio cholerae as the most common enteric isolates, we found Vibrio cholera 01 Ogawa followed by Campylobacter jejuni as the most common enteric pathogens isolated in an urban setting. It is important to consider seasonal variation when empirically treating diarrheal diseases in our region

Effect of immobilization on nerve conduction

Electrophysiological examination of the nerves in the immobilized [after linear, simple and closed fractures] disclosed an ample information regarding functional status of the nerves. Thirty nine patients [9 females and 30 males], having one upper limb immobilized by plaster of Paris were subjected in the study for measurement of motor and sensory conduction velocities of median and ulnar nerves. The conduction velocities were in both nerves. The distal motor latency of median and ulnar nerves was prolonged in immobilized limbs. These Findings showed clearly that immobilizatiaon produced neuropathic changes of variable degrees which need to be watched so that more serious disorders could be avoided