Comparison of conventional, immunological and molecular techniques for the diagnosis of symptomatic congenital human cytomegalovirus infection in neonates and infants.

Purpose: Human cytomegalovirus (HCMV) is the commonest pathogen causing congenital infection globally. The diagnosis of congenital infection is based either on viral isolation (in cell culture) or demonstration of HCMV DNA from the urine. Saliva is also being used as an alternative sample to urine for the same. The objective of this study was to compare the following assays-polymerase chain reaction (PCR) from urine, saliva and blood, serology (anti-HCMV IgM) and antigen detection (HCMV pp65 antigenaemia) for the diagnosis of congenital HCMV infection. Materials and Methods: Urine and blood samples were collected from 31 infants (median age: 13 weeks) with suspected HCMV infection. For 18 infants, additional saliva samples were collected and all the above assays were compared. Results: PCR for HCMV DNA from urine and anti-HCMV IgM were performed for all 31 infants. Of these, 22 (70.9%) were positive for both assays. In 18 (of the 22) infants positive by both assays, PCR for HCMV DNA from saliva was positive in all 18 (100%), PCR from blood in 7/18 (38.8%) and HCMV pp65 antigenaemia only in 1/18 (5.5%) of the infants. Conclusion: Detection of HCMV DNA in urine combined with anti-HCMV IgM are suitable assays to diagnose HCMV infection in infants. Both PCR from the blood and HCMV pp65 antigenaemia lack sensitivity in infants. Salivary PCR combines convenience with high sensitivity and can substitute PCR from urine, especially in the outpatient and fi eld settings. To the best of our knowledge, this is the fi rst study from India to evaluate salivary PCR for the diagnosis of congenital HCMV infection.

Can Neonatal Pneumoperitoneum be Managed by Conservative Management Alone.

Common causes of pneumoperitoneum in neonates includes necrotising enterocolitis (NEC), specific infections, gastro intestinal obstruction, iatrogenic causes, idiopathic focal intestinal perforation, perforation secondary to intra thoracic pathology, mechanical ventilation etc. Primary peritoneal drainage and exploratory laparotomy remain the definitive management of pneumoperitoneum in neonates. Here we report a case of suspected spontaneous idiopathic intestinal perforation managed conservatively with monitoring of vital signs. The neonate had an uneventful recovery. This case highlights the need to identify infants with benign or non surgical causes of pneumoperitoneum thus avoiding unnecessary laparotomies and referrals in these vulnerable neonates.

Fahr's Disease: An Uncommon Cause of Intracranial Calcification in Children.

Idiopathic bilateral striopallidodentate calcification or Fahr’s disease is a degenerative disease normally found in the 5-6th decade of life. Here we report one of the youngest cases of sporadic Fahr’s disease presenting at five years of age with minimal clinical features but extensive intracranial calcification, a rarity.

Adjuvant therapy in cerebral malaria.

Cerebral malaria is the most common cause of non-traumatic encephalopathy in the world. The mainstay of therapy is either quinine or artemisinin, both of which are effective antimalarials. The clinical picture of cerebral malaria may persist or even become worse in spite of the clearance of parasites from blood. The death rate is unacceptably high even with effective antimalarials in tertiary care hospitals. The mortality increases in presence of multi organ failure (renal failure, jaundice, respiratory distress, severe anaemia, lactic acidosis, etc.). The pathogenesis of cerebral malaria is multifactorial and includes clogging, sequestration, rosette formation, release of cytokines, cerebral oedema, increased intracranial hypertension, etc. Attempts are made to use adjuvant therapy which will act through alternate mechanisms and address one or more of the pathogenetic processes. In this review, we have discussed the role of corticosteroids, pentoxifylline, desferrioxamine, mannitol and newer agents in the treatment of cerebral malaria. Though the literature on adjuvant therapy in cerebral malaria is large enough, there are a number of shortcomings in the clinical trials, many being open and non randomized or of very small sample size. Further research is of utmost importance through large multicentric, double-blind controlled trials to show the efficacy of any of these drugs.

Unilateral renal agenesis associated with urinary outflow tract obstruction in a diabetic pregnancy.

We report a case of diabetic pregnancy where the foetus had enlarged cystic left kidney with agenesis of right kidney. The urinary bladder was dilated and urethra revealed posterior urethral valve an postmortem.

Seroprevalence of anti HCV antibody in and around Cuttack, Orissa.

One hundred ninety (190) serum samples and 52 control samples consisting of high risk individuals were screened for anti HCV antibody by 3rd generation ELISA test. The prevalence rate was found to be 1.57% in total but it was 2.12% in healthy voluntary blood donors. All were males between the age group of 21 to 40 years. All the control samples were found to be seronegative for anti HCV ab.

Comparative evaluation of immunochemical methods for estimation of albumin in microalbuminuria.

Three immuno assays namely radioimmunoassay (RIA), radial immunodiffusion (RID) and rocket immunoelectrophoresis (RIE) were compared for their performance and utility. The accuracy limits of the methods were compared and also between methods using RIA as the reference. Urine samples, from known diabetic patients with albumin concentration ranging from 2.5 mg/l to 120 mg/l were analysed by the three methods. The mean differences were only 0.91 mg/dl and 0.5 mg/dl respectively for RID vs RIA and rocket vs RIA which is not statistically significant. Excellent correlation was seen between RIA and RIE (r = 0.98) and also between RIA and RID (r = 0.97). Compared to RID, RIE required less time and was more precise. RIA is suited for assaying large sample loads yet not suited for laboratories receiving samples occasionally. For a small pathological laboratory with limited facility rocket electrophoresis may be the most suitable method taking into consideration accuracy, time and cost.

Beta hemolytic streptococcal carriers among school children in western Orissa.

Detection of carriers of Beta hemolytic streptococci and serogrouping of the strains isolated from throat of School Children helps in the epidemiological serosurveillance of the disease. With this in view the carriers among otherwise healthy school children in and around Buria, a small town in western Orissa, have been detected and the Streptococci isolated are grouped and typed.

Serum zinc in corneal ulcer--a preliminary report.

In recent times zinc is emerging as a nutrient of clinical importance and had been found to be low in serum in various disease conditions. In the current study 11 control cases and 22 corneal ulcer cases were taken. Their serum zinc level was measured by atomic absorption spectrophotometer. Serum zinc level in recalcitrant corneal ulcer cases was found to be below normal.

Association of hepatitis B virus with chronic liver diseases and hepatocellular carcinoma.

The idea of hepatitis-cirrhosis-hepatocellular carcinoma sequence in liver was proposed by the workers in tropical Africa, the homeland of hepatocellular carcinoma. The discovery of Australia antigen by Blumberg et al provided the missing link and it was observed by several workers as well as the present group that Hepatitis B surface antigen (HBSAg) and that to Hepatitis B Virus (HBV) is someway related with the incidence of chronic liver disease and hepatocellular carcinoma (HCC).