PAIgG and PAIgM levels in secondary dengue virus infections lead to thrombocytopenia in patients from KP, Pakistan

Objective: To understand the impact of platelet associated immunoglobulin G (PAIgG)/platelet associated immunoglobulin M (PAIgM) on severity of dengue virus infection leading to thrombocytopenia. Methods: In this study we examined a total of 52 patients who were having secondary infection of dengue in acute phase by using competitive ELISA. Results: A decrease in the platelet count was observed at the acute phase of infection while all along the recovery stage the count of platelet was significantly increased. A significant decrease was observed in PAIgG and PAIgM in these subjects. Inverse correlation was found between platelets count and PAIgG/PAIgM among the subjects studied. In the platelets elution from ten subjects, anti-dengue virus immunoglobulin G and immunoglobulin M were observed. PAIgG and PAIgM with inclined levels were higher in dengue hemorrhagic fever than the classical dengue fever. In the development of dengue hemorrhagic fever PAIgM inclined level was independently associated with high specificity, showing a possible indication of dengue hemorrhagic fever. Conclusions: This study suggests that in secondary dengue virus infection, the PAIgG and PAIgM levels, and the activity of anti-dengue virus play key roles, both in the development and severity of the disease.

Detection of Mycobacterium tuberculosis and Mycobacterium bovis from human sputum samples through multiplex PCR

Tuberculosis [TB] has a long history and being present even before the start of recording history. It has left detrimental effects on all aspect of the life and geared the developments in the science of health. TB is caused by Mycobacterium tuberculosis complex [MTBC] including five species M. tuberculosis, M. bovis, M. africanum, M. canetti, and M. microti. M. tuberculosis and M. bovis infect both animals and humans. Therefore, differentiation of these two closely related species is very important for epidemiological and management purpose. We undertook the present study to characterize mycobacteria isolated from sputum of known TB patients by conventional methods and further, by multiplex PCR [mPCR] to detect the prevalence of Zoonotic TB [TB caused by M. bovis]. Sputum samples from TB patient were collected from two tertiary care hospitals in Peshawar i.e. Lady Reading Hospital and Hayatabad Medical Complex. All the samples were subjected to Ziehl Neelsen [ZN] stain, culture on Lowenstein Jensen [LJ] and Stone Brink medium, Nitrate reduction test and multiplex PCR. A total of hundred mycobacterial strains were isolated from these samples on the basis of ZN staining, cultural and biochemical methods. Later on, these isolates were subjected to multiplex PCR by using pncATB-1.2 and pncAMT-2 primers specific to M. tuberculosis and JB21, JB22 primers specific to M. bovis. By means of conventional method, these hundred cultures isolates were differentiated into M. tuberculosis [ninety six] and M. bovis [four]. Furthermore, by mPCR, it was determined that out of hundred isolates, ninety-eight were identified as M. tuberculosis and two isolates as M. bovis. This molecular method enables to differentiate M. bovis from M. tuberculosis in human sputum

Stroke; a hospital based study on stratification of risk factors of stroke, its clinical features and response to treatment in Mirpur Azad Kashmir

The objective of the present study was to determine the risk factors of stroke, its clinical features and response to treatment in Mirpur Azad Kashmir. Prospective observational study. This study was conducted at Medical Wards of DHQ Teaching Hospital Mirpur Azad Kashmir from March 2012 to January 2013. Two hundreds patients with established diagnosis of stroke were selected. A questionnaire was prepared in accordance with the objectives of the study. Questionnaire contained detail history, general physical examination, and neurological examination. Association of risk factors with stroke was also studied. Different clinical features were also noted and response to the given treatment was checked by morbidity and mortality ratio. The data thus obtained was subjected to statistical analysis. One hundred and thirty two[66%] had hypertension, fifty five[27.5%] were smoker, fifty three[26.5%] had diabetes, twenty five[12.5%] had ischemic heart disease. In clinical features one hundred and two [51%] had headache, ninety nine [49.5%] had hemiplegia, ninety four patients [47%] had loss of consciousness. On CT scan finding one hundred and forty four patients [72%] had infarction while fifty six [28%] had hemorrhagic stroke. After recommended treatment patients discharged were one hundred and eighty two [91%] while eighteen[9%] died within a month. Hypertension, smoking, diabetes are major modifiable risk factors, headache, hemiplegia, loss of consciousness are major clinical features, chances of ischemic stroke are much more as compared to hemorrhagic. Response to treatment is good

Weight loss in HCV patients can be used as a surrogate marker for evaluation of interferon [IFN-alpha] treatment efficacy - a prospective pilot study

The aim of the study was to investigate whether weight loss followed the same pattern in HCV patients ['responders' and 'non-responders] after interferon [IFN-alpha] treatment. A total of 20 male HCV positive patients [mean age 33.1 +/- 9.9] in Peshawar, Pakistan participated in this study. They were initially tested as HCV positive, and were given IFN/Ribavarin treatment for 6 months. Changes in body weight [BW], lean body mass [LBM] and body fat [BF] were monitored on monthly basis. End to treatment response [ETR] was established by a final undetectable HCV RNA in serum at the end of therapy and the patients were categorized as either 'responders' or 'non-responders'. The results show a total of 12 out of 20 patients as 'responders' [60%]. All patients lost weight and the mean weight loss in 'responders' and 'non-responders' was 6.2 [ +/- 1.5] and 5.8 [ +/- 1.4] Kg, respectively. There was a significant difference in the mean change in BW, LBM, and BF between 'responders' and 'non-responders' during the last 3 month period only. This suggests that difference in drug response in HCV starts from month 4 and onwards [i.e. during the last 3 months]. In conclusion, weight trends during treatment should be monitored as weight loss may be used as a surrogate marker for ERT to the current standard of care.

effects and underlying mechanism of interferon therapy on body weight and body composition

Body weight changes in HCV patients on interferon therapy are well documented. However, the underlying mechanism involved in these changes is poorly understood and rarely reported. The main objectives of this review are to 1] discuss changes in body weight and other compartments of body composition, particularly, body fat, and 2] to discuss the underlying mechanism for these changes. The literature review suggests weight loss [12-29%] as a function of interferon therapy is common, affecting up to 90% of HCV patients. Whilst, loss in weight means proportionate loss in other body compartments [lean body mass and body fat, in particular] data on changes in segmented body composition are fragmentary. The possible mechanisms underlying weight loss or changes in other body composition have been reported and these include suppressed appetite due to induction of TNF by IFN, a decrease in serum leptin level, and importantly mitochondrial damage induced by the therapy. It is, therefore, suggested that close monitoring of chronic HCV patients receiving PEG-IFN and/or ribavirin for side effects of these drugs, particularly those related to weight loss, is vitally important from clinical point of view