review article on herpes simplex encephalitis

Herpes Simplex encephalitis [HSE] is a life threatening outcome of Herpes simplex virus [HSV] infection of the central nervous system [CNS]. HSV accounts for 2-5 percent of all cases of encephalitis. One third of cases occur in those younger than 20 years old and one half in those older than 50 years old. Clinical diagnosis is recommended in the encephalopathic, febrile patients with focal neurological signs. However, the clinical findings are not pathogonomic because numerous other diseases of CNS can mimic HSE. Diagnosis should be confirmed based on medical history, analysis of cerebrospinal fluid [CSF] for protein and glucose contents, the cellular analysis and identifying the pathogens by serology and Polymerase Chain Reaction [PCR] amplification .The diagnostic gold standard is the detection of HSV DNA in the cerebrospinal fluid by PCR. But negative results need to be interpreted regarding the patients clinical signs and symptoms and the time of CSF sampling. Spike and slow wave patterns is observed in Electroencephalogram [EEG]. Neuroimaging, especially Magnetic Resonance Imaging [MRI] is essential for evaluating the patients, which shows temporal lobe edema or hemorrhage. All patients with HSE should be treated by intravenous Acyclovir [10mg/kg q8hr for 14-21 days]. After completing therapy, PCR of the CSF can confirm the elimination of replicating virus, assisting further management of the patient

[Chondro-protective effects of pomegranate on experimental osteoarthritis]

To study the effectiveness of pomegranate juice [PJ] on osteoarthritis [OA], we used mono-iodoacetate [MIA], an inhibitor of glycolysis, in tibiofemoral joint of mice that promotes loss of articular cartilage similar to that noted OA. Pomegranate juice [PJ] is increasing in popularity because of its high antioxidant content, already known to help prevent heart disease. However, no histopathological studies have undertaken in vivo to investigate whether PJ protect articular cartilage. We described the histopathology in the subchondral bone and cartilage of mice knee joint treated with a single intra-articular injection of MIA [0.1 mg] and sacrificed at 1, 14 and 28 days post injection. Then, the beneficial effect of oral PJ was studied in different groups; group 1: administration of PJ [4ml/kg], group 2: administration of PJ [10ml/kg] and group 3: administration of PJ [20ml/kg]. Histopathological changes in knee joints were studied after two weeks. Histologically, the early OA was characterized by areas of chondrocytes degeneration/ necrosis sometimes involving the entire thickness of the articular cartilage in the tibial plateaus and femoral condyles. Changes to the subchondral bone and proteoglycane contents, were observed and also, there was focal fragmentation and collapse of bony trabeculae with fibrosis and necrosis. Synovial cell proliferation was noted. Interestingly, administration of PJ in different group of mice prevented the negative effects of iodoacetate, in a dose dependent manner. Chondrocyte damages were significantly prevented and proteoglycane were less affected, especially in group receiving high amount of PJ and no cell proliferation and inflammatory cell were detected in synovium. Fast and progressive damage to articular cartilage is induced by single intra-articular injection of MIA, which mimic exactly human OA. In this study, the effectiveness of PJ in improvement of histopathological damages is emphasized and its chondroprotective effects in vivo are highlighted

[Atypical Kawasaki: the often missed diagnosis]

Kawasaki disease is an acute febrile vasculitis of childhood first described by Dr. Tomisaku Kawasaki in Japan in 1967. The disorder occurs worldwide, with Asians at highest risk. Approximately 20% of untreated patients develop coronary artery abnormalities including aneurysms, with the potential for the development of coronary artery thrombosis or stenosis, myocardial infarction, aneurysm rupture, and sudden death. Kawasaki disease has replaced acute rheumatic fever as the leading cause of acquired heart disease in children. The disease is characterized by fever, bilateral nonexudative conjunctivitis, erythema of the lips and oral mucosa, changes in the extremities, rash, and cervical lymphadenopathy. The classic diagnosis of Kawasaki disease has been based on the presence of /= 4 of the 5 principle clinical features. During the past few years there have been several reports of patients with coronary aneurysms corresponding to changes in Kawasaki disease who did not exhibit the other required symptoms. The diagnosis of Atypical Kawasaki, in addition to coronary aneurysms, requires the presence of three to four of the major symptoms. Atypical Kawasaki is more common in infants than in older children, making accurate diagnosis and timely treatment especially important in these young patients who are at substantial risk of developing coronary abnormalities. Therefore, Kawasaki disease should be considered in an infant with prolonged, high fever in spite of atypical or incomplete presentation and echocardiography may help us to begin earlier treatment in these high risk patients