Pattern of Hemoglobinopathy among the Young Tribes of West Bengal: A Completely Different Scenario from Rest of India

Hemoglobinopathy is a major concern among the tribal population which constitutes 8.6% of the total population, and West Bengal (WB) is the home to 5.3 million tribes. The present study was conducted on 52,880 tribal school students from all the districts of WB. Written informed consent and peripheral blood were collected for complete blood count and high‑performance liquid chromatography analysis. Beta trait was 5.3%, sickle trait was 2.35%, and hemoglobin (Hb) E (HbE) trait was 1.4% in this population. About 37.8% of beta trait belonged to the Santal tribe and 21.5% belonged to Oraon. HbS is mainly found in Alipurduar and Jalpaiguri districts at the prevalence of 3.69% and 5.96%, respectively. HbE trait is found at 6.06% in Alipurduar, of which 51% of cases are from Mech tribe only found in this district. Unlike central and Western parts of India, HbS trait in WB was significantly low among the tribes. A high prevalence of consanguinity among the tribes is considered responsible for the high rate of hemoglobinopathy.

HIV and SARS-CoV-2 co-infection: The diagnostic challenges of dual pandemics

The first critically ill patient admitted to our hospital in Cape Town, South Africa, during the COVID-19 pandemic was co-infected with HIV and SARS-CoV-2. Pneumocystis jirovecii pneumonia (PCP) and other respiratory opportunistic infections share many clinical features with severe COVID-19. Our understanding of the nuances of co-management of HIV and COVID-19 is evolving. We describe the diagnostic and therapeutic challenges presented by this case

Distal malignant biliary obstruction: a prospective randomised trial comparing plastic and uncovered self-expanding metal stents in the palliation of symptomatic jaundice

Background: The aim of this study was to determine the safety and clinical effectiveness of 10Fr plastic biliary stents compared to uncovered self-expanding metal stents (SEMS) for palliative treatment of patients with inoperable extra-hepatic malignant biliary obstruction in a public hospital in South Africa.Methods: From January 2009 to December 2013, 40 patients who were admitted to a tertiary academic centre because of distal malignant biliary obstruction were enrolled in a prospective randomized study. Patients were randomly assigned to receive an uncovered SEMS or a plastic stent deployed through the biliary stricture during endoscopic retrograde cholangiopancreatography (ERCP).Results: Patient survival time in the two groups did not differ significantly (median: SEMS ­ 114 days; plastic ­ 107 days). Stent failure was more common in the plastic stent group (7/19 vs. 1/21). The results became significant after 6 months of follow-up. There was no significant difference between the two groups in the incidence of serious adverse events.Conclusions: SEMS had a longer duration of patency than plastic stents, which recommends their use in the palliative treatment of patients with biliary obstruction due to distal malignant biliary obstruction

Muscle-based perception: theory, research and implications for rehabilitation: [review] / Percepção baseada nos músculos: teoria, pesquisa e implicações na reabilitação: [revisão]

BACKGROUND: Muscle-based perception of the spatial properties of limbs constrains the patterning, timing and magnitude of muscle forces while performing motor activities. The centrality of muscle-based perception to both ordinary and skilled actions warrants attention from the rehabilitation community, since deficits in its functioning would be related to important functional limitations. In this overview, we summarize a body of research that may be used to guide the development of effective assessment tools and rehabilitation programs that are specifically directed towards such deficits. OBJECTIVES: There were four specific aims: first, to present an information-based approach to muscle-based perception that is grounded in physical laws; second to identify central principles underlying muscle-based perception that have been revealed and supported by empirical work; third, to summarize reports that have investigated whether the principles identified can be generalized to muscle-based perception in individuals with sensory-motor impairments; and fourth to provide a preliminary discussion of the potential implications of the research presented here for issues relating to rehabilitation.

INTRODUÇÃO: A percepção muscular das propriedades espaciais dos membros restringe o padrão, período e magnitude das forças exercidas durante a execução de atividades motoras. A importância central da percepção muscular, tanto para ações rotineiras quanto para ações especializadas, merece atenção da comunidade envolvida na área de reabilitação, uma vez que alterações em suas funções podem estar relacionadas a importantes limitações funcionais. Nesta revisão, os autores apresentam um resumo da pesquisa que pode ser utilizada para guiar o desenvolvimento de ferramentas de avaliação eficazes bem como programas de reabilitação que sejam especificamente direcionados para estas disfunções. OBJETIVOS: Quatro pontos específicos foram incluídos: primeiro, a apresentação da abordagem com base em informações relativas à percepção muscular de acordo com as leis da física; segundo, a identificação dos princípios centrais determinantes da percepção muscular que vem sendo revelada e apoiada por trabalhos empíricos; terceiro, um resumo dos relatos que investigaram e se os princípios identificados poderiam ser generalizados para a percepção muscular dos indivíduos com alterações motoras e sensitivas; e quarto, uma discussão preliminar sobre as implicações potenciais da pesquisa aqui apresentada, no tocante aos assuntos relacionados à reabilitação.

Hydatid disease of the liver

Echinococcus granulosus remains a clinical problem in sheep and subsistence farming communities in South Africa. The most commonly affected organs are the liver and the lung. Most cysts remain clinically silent and are diagnosed incidentally or when complications occur. Clinical examination is unreliable in making the diagnosis. Serological testing has a broad range of sensitivity and specificity and is dependent on the purity of the antigens utilised. Ultrasound examination of the abdomen is both sensitive and cost effective. Computed tomography and endoscopic retrograde cholangiopancreatography (ERCP) are reserved for complicated cases. The differential diagnosis includes any cystic lesion of the liver. Liver hydatid cysts can be treated by medical or minimally invasive (laparoscopic and percutaneous) means or by conventional open surgery. The most effective chemotherapeutic agents against the parasite are the benzimidazole carbamates; albendazole and mebendazole. Albendazole is more efficacious; but recommended treatment regimens differ widely in terms of timing; length of treatment and dose. Medical treatment alone is not an effective and durable treatment option. PAIR (puncture; aspiration; injection; reaspiration) is the newest and most widely practised minimally invasive technique with encouraging results; but it requires considerable expertise. Open surgery remains the most accessible and widely practised method of treatment in South Africa. The options are either radical (pericystectomy and hepatic resection) or conservative (deroofing and management of the residual cavity). Various scolicidal agents are used intraoperatively (Eusol; hypertonic saline and others); although none have been tested in a formal randomised controlled trial. Laparoscopic surgery trials are small and unconvincing at present and should be limited to centres with expertise. Complicated cysts (intrabiliary rupture and secondary infection) may require ERCP to obtain biliary clearance before surgery; and referral to a specialist centre may be indicated

A Mitochondrial DNA phylogeny indicates close relationships between populations of Lutzomyia whitmani (Diptera: Psychodidae, Phlebotominae) from the rain-forest resgions of Amazônia and Northeast Brazil

Phylogenetic analysis of all 31 described mitochondrial (cytochrome b) haplotypes of Lutzomyia whitmani demostrated that new material from the State of Rondônia, in southwest Amazônia, forms a clade within a lineage found only in the rain-forest regions of Brazil. This rain-forest lineage also contains two other clades of haplotypes, one from eastern Amazônia and one from the Atlantic forest zone of northeast Brazil (including the type locality of the species in Ilhéus, State of Bahia). These findings do not favour recognizing two allopatric cryptic species of L. whitmani, one associated with the silvatic transmission of Leishmania shawi in southeast Amazônia and the other with the peridomestic transmission of Le. braziliensis in northeast Brazil. Instead, they suggest that there is (or has been in the recent past a continuum of inter-breeding populations of L. whitmani in the rain-forest regions of Brazil.

The dermal leishmaniases of Brazil, with special reference to the eco-epidemiology of the disease in Amazonia

Six species of Leishmania are at present known to cause cutaneous and/or mucocutaneous leishamniasis in Brazil, and they are all to be found in the Amazon region of this country. The eco-epidemiology of each is discussed, with the observation that the Amazonian leishmaniases are all zoonoses, with their source in silvatic mammals and phlebotomine sandfly vectors. With man's destruction of the natural forest in southern Brazil, some sandfly species have survived by adapting to a peridomestic or domiciliary habitat in rural areas. Some domestic animals, such as dogs and equines are seemingly now involved in the epidemiology of the disease. No such process has yet been reported in the Amazon region, but may well take place with the continuing devastation of its forest.

DNA probes for distinguishing Psychodopygus wellcomei from Psychodopygus complexus (Diptera: Psychodidae)

Genomic DNA fragments from males of Psychodopygus wellcomei were isolated and shown to be useful as sensitive diagnostic probles for positively separting individuals of this species from those of Ps. complexus. These two members of the Ps. squamiventris series are found sympatrically in foci of cutaneous leishmaniasis in the hill forests of southern Pará State. Of the two species, only Ps. welcomei is thought to be an important vector of Leishmania braziliensis sensu stricto, buth this is based on circumstantial evidence because of the difficulties of identifying female sandflies wothin the series. The diagnostic probes were isolated from a library of Ps. wellcomei built by ligationg short fragments of Sau 3A-resistricted, genomic DNA into the plasmid vector PUC 18. Differential screening of 1316 library clones with total genomic DNA of Ps. Wellcomei and Ps. complexus identified 5 recombinants, with cross-hybridizing inserts of repetitive DNA, that showed strong specificity for Ps. wellcomei. As little as 0.4% of the DNA extracted from an individual sandfly (=ca. 0.5 namograms) was specifically detected. The diagnostic probes were used to identify as Ps. wellcomei a wild-caught female sandfly found infected with L. braziliensis s.s., providing only the second positive association between these two species

Leishmaniose cutanea na Amazonia: isolamento de Leishmania (Viannia) lainsoni do roedor Agouti paca (Rodentia: Dasyproctidae) no estado do Para, Brasil / Cutaneous leishmaniasis in Amazonia: isolation of Leishmania (Viannia) lainsoni from the rodent Agouti paca (Rodentia: Dasyproctidae), in the state of Pará, Brazil

Fez-se registro, pela primeira vez, do isolamento de Leishmania (V.) lainsoni de um mamifero silvestre, o roedor Agouti paca (Rodentia: Dasyproctidae), no Estado do Para, Brasil. As amostras do parasita foram isoladas da pele, aparentemente integra, de 3 especimes desse roedor, capturados no municipio de Tucurui (ilha de Tocantins), em area que seria inundada pela formacao do lago da hidreletrica construida naquele municipio. Nenhum isolamento foi obtido de visceras de qualquer dos animais. A identificacao das amostras de L. (V.) lainsoni baseou-se na morfologia de amastigotas e promastigotas, no comportamento da infeccao em "hamsters", na analise bioquimica de isoenzimas e, ainda, atraves de testes com anticorpos monoclonais. A natureza inaparente da infeccao nos animais faz supor que o mamifero em questao possa representar um hospedeiro definitivo do parasita na regiao Amazonica.

A pictorial field guide for the rapid identification of sandflies (DIPTERA: PSYCHODIDAE), commonly encountered in Pará state, Brazil

A pictorial field guide to the 30 species of sandfly most commonly encountered in Pará State is presented, based on the easily recognised external characters of the length of the 5th palpal segment, thoracic infuscation, abdominal colour and head and body size. In most cases this allows identification to the species. In others, especially with females, it gives an indication of the species, which may then be confirmed with data from more detailed taxanomix studies. This type of field guide helps in teaching, rapid sorting of flies prior to dissection and in acquainting visitors with the variety of species present in a given area.A rapid technique for the taxonomic sorting of unmounted, freshly killed female sandflies is required, prior to the dissection of large numbers of a particular species. Such a method is useful in areas where numerous species occur in studies on natural flagellate infections, age determination and for ecological studies. With the above points in mind a pictorial field guide has been designed that enables the identification of unmounted, unmacerated specimens of the 30 more commonly encountered species of phleboto-mine sandflies (***) in Pará State, North Brazil. It is based on the easily recognised external characters of the length of the 5th palpal segment, thoracic infuscation, ad-dominal colour and proboscis and body size.Taxonomy of male phlebotomine sandflies is based on the structure of the genitalia and, as most of this is external, a wholly external character key is readily made. Female taxonomy, however, is based on the internal character of the cibarium, pharynx and sperma thecae. In order to produce an external character key we therefore return to an unso phisticated "phlebotometry" (see Martins et al., 1978 p. 3 for review), using relative lengths of the proboscis, palpal segments and body, along with the degree of infuscation. Ihis idea is not new; indeed many sandfly specialists presently use external characters to separate certain species (H. Fraiha, R. P. Lane, P. D. Ready, D. G. Young and R. D. Ward personal communications 1983 & 1984).A key used to separate five anthropophillic sandflies by Biagi (1966), in Mexico, was based mainly on palpal segment length and infuscation. Floch and Abonnenc (1952) stressed the use of relative lengths of palpal segments in their keys to the sandflies of French Guiana, and four members of the shannoni group have been similarly separated according to the degree of infuscation by Morales et al. (1982). The use of thoracic infuscation as a reliable character seems to be gaining favour, having been used by young & Fairchild (1974) and Ready & Fraiha (1981). Indeed Chariotis 1974) showed the usefulness of thoracic infuscation to sepenate 7 anthropophillic species, during studies onvesicular stomatitis in Panama. Identification using external characters is essential for work on viral isolations from sandflies, where bulk samples of whole sandflies are used.Perhaps the major advantage of a simple visual guide is for teaching purposes. Technical staff in this lnstitute are able to identify most of the species they encounter without having to use the standard, more unwieldly (and in many cases unavailable) internal character keys, and the guides presented below have allowed rapid species sorting prior to the dissection of sandflies in our leismaniasis study areas (Ryan et at. ,1985).

É apresentado um "levantamento ilustrado" dos 30 flebotomíneos mais comumente encontrados no Estado do Pará, Brasil, usando-se características externas, com as medidas do quinto segmento das palpos, cor do tórax e do abdomen, e medidas da cabeça e do cor po. Com isto é possível, na maioria dos casos, levar à identificação até a espécie. Exis_ tem algumas espécies, entretanto, que são mais difíceis de serem identificadas, particu larmente as fêmeas, havendo nestes casos, necessidade de um exame taxonômico mais deta lhado, para que se possa concluir a identificação. Esta orientação ilustrada é particu larmente útil a técnicos de laboratório, estudantes e entomólogos visitantes.