Unusual presentation of dengue fever a child with acute myocarditis

Dengue fever [DF] is an acute febrile illness that follows a self-limiting course. However, some patients suffer from complications, including myocarditis, due to the involvement of other organs. A child presented at the Aga Khan University Hospital in Karachi, Pakistan, in June 2013 with a high-grade fever, malaise and epigastric pain radiating to the chest. Positive DF antigen and immunoglobulin M assays confirmed the diagnosis of DF. Persistent bradycardia with low blood pressure led to further cardiac investigations which showed a decreased ejection fraction and raised serum cardiac enzymes, indicating myocardial damage. With supportive care and use of inotropes, the spontaneous normalisation of cardiac enzyme levels and ejection fraction was observed. The child was discharged five days after admission. This case highlights the importance of identifying myocarditis in DF patients suffering from cardiac symptoms that are not explained by other potential aetiologies. Awareness, early suspicion and supportive care are essential to ensure favourable outcomes

Cryptosporidium and giardia in water in Alexandria: detection and evaluation of viability by flow cytometry and different stains

Cryptosporidium oocysts and Giardia cysts have become ubiquitous in surface waters worldwide. The number and extent of outbreaks of waterborne diseases indicate a significant risk for their possible transmission by drinking-water. Since many Egyptian cities depend on surface water as their main source of drinking water, knowledge of the prevalence of waterborne protozoa in water resources is important. The present study was designed to use flow cytometry to detect Cryptosporidium oocysts and Giardia cysts in water samples in Alexandria city in comparison with the standard staining techniques. Testing the viability of the encountered parasites was also carried out comparing flow cytometry and trypan blue vital stain. Thirty water samples were collected from water tanks from different districts of Alexandria city. Samples were subjected to staining techniques and flow cytometry. Stains used were modified Zeihl-Neelsen [MZN], safranin methylene blue [SMeB], modified trichrome, fluorescent stains [phenol auramine and acridine orange]. Viability was evaluated comparing trypan blue stain and flow cytometry using 4'-6-Diamidino-2-phenylindole immunostain [DAPI]. Flow cytometry proved to be much more sensitive than staining techniques with a sensitivity of 100% for both Cryptosporidium oocysts [30 samples] and Giardia cysts [11 samples]. Following flow cytometry, the fluorescent phenol auramine stain had the greatest sensitivity of 94.74% and 80% [18 and 4 samples, respectively]. The percent of live parasites present in each sample was always significantly higher by DAPI than trypan blue stain. The results of the present study clearly demonstrate that incorporation of flow cytometry can improve sensitivity of detection of Giardia cysts and Cryptosporidium oocysts in water samples. Although it is more expensive than the other staining methods, it is rapid, simple and accurate in estimating the quantity and viability of the parasites in each sample. Thus, flow cytometry can be recommended for detection of protozoa in water

Predictors of obstructive sleep apnea in snorers.

Snoring is a commong problem that poses a high risk for obstructive sleep apnea [OSA]. We studied the contribution of risk factors for OSA in snorers for full-night polysomnography [PSG]. A questionnaire was administered to subjects referred for PSG in the period from April 2002 to March 2005. There were 191 [84%] snorers identified by 227 PSG studies. They had a mean age of 48.1 +/- 9.8 years, [age range, 23-73 years] and 78.5% were males. OSA as indicated by a respiratory disturbance index [RDI] of>5 events/hour was seen in 126 [66%] subjects. In males, 72.7% had OSA, with a mean RDI of 43.0 +/- 26 events/hour, versus 41.5% [corrected] with OSA in females with a mean RDI of 27.8 +/- 26.5 events/hour [P<0.001]. The OSA group had a higher mean Epworth Sleepiness Scale [ESS] [P<0.001], a larger mean neck circumference [P<0.01], an increased mean age [P<0.050], and more witnessed apneas [P<0.001] but not choking [P=0.096]. The mean increase in body mass index was linked to OSA only in females [P<0.05] but not in the overall study [P=0.507]. Multivariate analysis showed that ESS, male gender, and a history of witnessed apneas were associated with OSA, while controlling for obesity, large neck circumference, age, and history of choking. In screening snorers for PSG, male gender, ESS and a history of witnessed apneas were the most important predictors of OSA, but other factors should be considered in referring snorers for PSG. In males, obesity did not contribute to the risk of OSA in our study population

Epidemiological trends of leprosy elimination in CLTRI rural field operation area, Tamil Nadu, India.

The analysis of computerized data of patients in our Rural Field Operation Area (Kunrathur Taluk, Kancheepuram District, Tamil Nadu) from the start of MDT in 1986 has shown a decrease of leprosy prevalence from 275/10000 in 1986 to 0.7/10000 in 2005. Leprosy has been eliminated as a public health problem after 19 years of MDT implementation. Although the control programme was started in 1962, MDT implementation began only in 1986. The new case-detection rate has declined significantly from 27.3 in 1987 to 2.4/10000 in 2005 (y = -1.6x + 2325.1, p = < 0.05). The age-specific cumulative detection rates calculated showed highest case-detection at 10-14 years for total, 10-14 years for PB, 50-54 for MB, and 10-14 for both males and females. MB percentage was more among new cases in the last three years as compared to the initial three years, and this difference was found to be statistically significant, but there was no significant difference between the first three and the last three-year periods in child, male and disability rates (grade +/-2) among new cases. Thus, the declining trend in NCDR has not reflected any change in sex and age-groups of new cases. This analysis strengthens the hypothesis of sub-clinical cases possibly transmitting the disease and MB cases accruing after long incubation period.

Serum tocopheral levels in brucellosis

The levels of various isomers of Tocopherol, a known effecter molecule influencing immune response of host to infectious agents, in sera of patients with brucellosis were measured by utilising high pressure liquid chromatographic techniques and compared with matched controls. Analysis of the results obtained revealed that in patients with brucellosis, serum levels of tocopherol were either markedly reduced or totally absent. These results suggest that the observed decrease or total lack of tocopherol in patients with brucellosis may result in an increase in the invasive disease causing ability of infecting organism, consequently promoting its survival in the host

Effect of splenectomy on some immunoglobulin levels in schistosomal hepatic fibrosis and splenomegaly in children and adults

A study of the effect of splenectomy on serum immunoglobulin levels was done on 40 patients [20 children and 20 adults] suffering from bilharzial hepatic fibrosis and splenomegaly with or without esophageal varices, using the Tripartigen immunodiffusion plates. Estimation of serum immunoglobulins were also done to 24 apparently healthy subjects [12 children and 12 adults] to serve as controls. The estimation of serum immunoglobulins concentrations [IgG, IgM, and IgA] were done before and one month after splenectomy, as well as in the splenic artery and vein blood at the time of operation. The immunoglobulins [IgG, IgM, and IgA] showed significant increase in the patients as compared with the healthy controls. One month after splenectomy, significant reduction in serum concentrations of IgM both in children and adults was noticed. The results evidently showed that the spleen has a definite significant role in derangement of immune system in patients with schistosomal hepatic fibrosis, and splenectomy significantly reduced the serum immunoglobulin level in these patients. Since the degree of liver affection is in a direct relation with the level of immunoglobulin in the blood, thus subsequent immunological reactions within the liver were reduced by splenectomy, and hence reduce the subsequent increase in the liver fibrosis

Role of splenectomy in postoperative infection

50 patients, 25 children and 25 adults underwent splenectomy and did not receive postoperative antiboitics were the material of this study. In children group, splenectomy done for Bilharzial spleen to 23 cases and the rest 2 cases for thalassemia major. All adult patient underwent splenectomy for Bilharzial spleen. Blood samples for culture were taken preoperatively and postoperatively from peripheral blood and operatively from splenic artery and splenic vein. The postoperative peripheral blood samples were taken at the zenith of fever. In children group : The preoperative peripheral, the operative splenic artery and vein blood cultures were sterile in all cases. The postoperative peripheral blood cultures were sterile in the 23 Bilharzial cases, and positive for staphylococcus aureus in 2 cases of thalassemia major, these last 2 cases were under 1 years of age. In Adults group: All blood cultures, peripheral, preoperative and postoperative, operative splenic artery and vein blood were found sterile in all cases