The resurgence of Measles in 2019

Measles, a highly contagious infection caused by a single stranded RNA Paromyovirus is transmitted through aerosol droplets and contact with nasopharyngeal secretions of the infected patient.' The incubation period lasts between 10 and 14 days. The Prodromal phase presents with high grade fever, cough, coryza and conjunctivitis. Punctate blue-white spots on the buccal mucosa called Koplik spots are pathognomic of measles. The typical maculopapular rash appears 3-5 days after the onset of fever. It starts from the neck and spreads down to the lower limbs; it decreases in the same pattern lasting for 5-6 days. The patients are considered contagious 4 days prior to 4 days after the appearance of rash.

The Effect of Media and Light on In Vitro Sporulation of Alternaria Solani.

Early blight of tomato incited by Alternaria solani is an economically significant disease especially in commercial tomato cultivation under greenhouse and field conditions. Since, A. solani is a shy sporulator, the present investigation was taken to assess the optimum in vitro conditons for growth and sporulation of early blight pathogen. Ten A. solani isolates obtained from diseased leaf samples collected different crop growing areas of India were used in the present study. The effect of different incubation periods, fluorescent light, cold-water treatment and media were evaluated. Our results revealed maximum sporulation of A. solani on tomato fruit extract agar medium (TFEA) under continuous light for 7 days at 250C, followed by cold-water treatment and further incubated in darkness at 200C for 48 h. The sporulation of test pathogen was however sparse on V-8 juice agar. Further, the A. solani isolates on V-8 juice agar did not respond to the treatments imposed. Among the isolates, JAS (Jhajjar) isolate, that is more versatile in its ability to produce spores recorded irregular margin with abundant aerial mycelium.

Periapical tissue reaction to calcium phosphate root canal sealer in porcine model.

Background: Calcium phosphate cements (CPC) are a group of biomaterials possessing wide scope of use in various branches of medical science. These materials have been proposed to be highly biocompatible and osteoconductive. This study is based on a newly developed CPC formulation (Chitra-CPC) and is aimed at the evaluation of its biocompatibility through an Endodontic Usage Test in a porcine study model. Objective: To evaluate the periapical tissue reaction to Chitra-CPC when used as a root canal sealer/filler material in comparison with a resin sealer, AH Plus (Dentsply). Materials and Methods: The procedure was done on porcine animal model following the ISO 7405 criteria. The material was implanted intentionally into the periapical area of 36 teeth through a root canal procedure carried out in six animals which were divided equally among 1-month and 3-month time periods. Results were based on the histological evaluation of the autopsied specimens after the prescribed time periods. Results: Mild to moderate periapical tissue reaction was found in Chitra-CPC samples belonging to the 1-month time period, whereas majority of the 3-month CPC samples showed an absence of inflammation. Samples of AH Plus in 1-month period showed severe to moderate inflammation, whereas 3-month AH Plus samples had a mild to moderate inflammation. Conclusions: Chitra-CPC is a biocompatible material.

Renal thrombotic microangiopathy and cerebral venous thrombosis in a young man.

We report a patient of primary catastrophic antiphospholipid syndrome who presented with rapidly progressive renal failure and seizures. He was detected to have thrombotic microangiopathy on kidney biopsy and deep cerebral venous thrombosis. The patient was successfully managed with anticoagulants, steroids, plasmapheresis and cyclophosphamide.

Reversible segmental portal hypertension--an unusual presentation of abdominal tuberculosis in a renal transplant recipient.

Infections are the commonest cause of morbidity and mortality in renal transplant recipients. In India, tuberculosis is a one such common infection in these patients and presents with protean manifestations. We report here a case of pyrexia of unknown origin (PUO) and segmental portal hypertension in a renal transplant recipient. Search for the cause of portal hypertension revealed abdominal tubercular lymphadenitis. Treatment with anti-tubercular therapy caused regression of segmental portal hypertension.

Spectrum of renal lesions in HIV patients.

BACKGROUND: A variety of renal lesions have been reported in HIV positive patients from western world however there is paucity of Indian data. METHODS: Over a four year period, all hospitalised HIV positive patients were screened for renal involvement. Screening was done with urinalysis. Those with abnormality in urine examination underwent further assessment with clinical, biochemical, immunological profile and renal biopsy. Renal histology was studied by light and electron microscopy. RESULTS: Twenty-five (17.6%) of the 142 patients screened, had proteinuria/abnormal urinary sediment however none of the patient had proteinuria in nephrotic range. Fourteen of these 25 patients were asymptomatic while others had AIDS. Renal biopsy was studied by light microscopy in all and by electron microscopy in 11 cases. On histology mesangioproliferative GN was encountered in eight, focal segmental glomerulosclerosis in four and collapsing GN in one patient. In two cases cryptococcal infiltration and in one lymphomatous deposits were seen in glomerulus and interstitium. In one patient interstitium showed granulomas and in other three mononuclear cell infiltration. Histology was normal in 8 (32%) patients. On EM visceral cell hyperplasia and vacuolisation was seen in all, two had collapse of glomerular basement membrane and in three cases tubuloreticular structures were seen. There was no co-relation of renal histology with duration or severity of the disease (p > 0.05). No deterioration of renal function was seen over a short follow up period of 4.2 months (1-20 months). CONCLUSION: This study highlights that HIV patients exhibiting abnormal urinary sediment usually have underlying renal lesion and at times unexpected opportunistic infections may be present.

Hypochromic anaemia in chronic renal failure--role of aluminium.

BACKGROUND: Anaemia is a cardinal feature of chronic renal failure and classically it is normochromic normocytic. Hypochromic anaemia in these patients is often attributed to iron deficiency. AIM: This study was aimed to find the contribution of aluminium in causation of anaemia in CRF patients. METHODS: Dialysis dependent patients of chronic renal failure with adequate dietary intake (> 1500 Cals/day) and no apparent source of blood loss were evaluated for type of anaemia. (During period of this study centre didn't have reverse osmosis plant for water treatment). Evaluation included upper GI endoscopy, complete hemogram, serum proteins, serum iron, total iron binding capacity, and bone marrow iron status. For aluminium evaluation serum aluminium levels were done. RESULTS: Sixty-four patients were evaluated for type of anaemia. Mean age of patients was 41.19 years (15-76 years) with male:female ratio 2.3:1. Classical normochromic picture was seen in 28.5% while rest had hypochromic picture. On bone marrow aspiration study two patients had zero iron stores while all others had normal/excessive iron stores. In 10 patients with hypochromic picture, mean serum aluminium levels were 170 micrograms/L (30-310 micrograms/L). CONCLUSIONS: This study highlights the high prevalence of hypochromic anaemia in patients with adequate dietary intake and aluminium overload in Indian CRF patients.

Efficacy of enalapril in the treatment of steroid resistant idiopathic nephrotic syndrome.

Fifteen patients of idiopathic nephrotic syndrome who failed to respond to 8 weeks of corticosteroid therapy formed the material for this study. There were 10 males and 5 females, age ranging from 4 to 56 years. Three patients had hypertension. Histological lesions were focal and segmental glomerulosclerosis (FSGS) in 8; membranous glomerulonephritis in 3; mesangial proliferative glomerulonephritis in 2 and membranoproliferative glomerulonephritis in 2 patients. Proteinuria ranged from 3.64 to 8.66 g/1.73 m2/day. Serum albumin ranged between 2.2 to 3.3 g/dl. Serum creatinine was elevated > 1.5 mg/dl in 3 cases. After discontinuing steroids, enalapril was started in a dose of 2.5 mg/day and increased by 2.5 mg/day every 3-4 days till the maximum tolerated dose but not exceeding 20 mg/day. Proteinuria, serum albumin and serum creatinine estimations were done every 4 weeks for six months and every three months thereafter. Patients were followed up for 6 to 30 months. Proteinuria decreased to < 1.5 g/1.73 m2/day in 12 patients (80%) and to < 0.5 g/1.73 m2/day in 10 patients (66.7%) by 8 weeks. There was no significant decrease in proteinuria in 3 (20%) patients; two of these were cases of FSGS and one of membranoproliferative glomerulonephritis. Oedema, hypoalbuminaemia and hypercholesterolaemia returned to normal in all patients who had a decrease in the proteinuria. There was no correlation between the histological lesion and response to enalapril. There was no rise in the serum creatinine level above the baseline in any of the patients. Except for cough in one patient, no other significant side effects were observed. We conclude that enalapril is effective in reducing proteinuria and thereby the morbidity in steroid resistant nephrotic syndrome irrespective of the underlying pathology.

Invasive pulmonary aspergillosis and nocardiosis in an immunocompromised host.

A case of invasive pulmonary aspergillosis and nocardiosis following high dose prolonged steroid therapy given for suspected rapidly progressive glomerulonephritis is reported. A favourable response was achieved with a combination of amphotericin B and cotrimoxazole. A high index of suspicion and aggressive investigations are necessary for confirmation of diagnosis and early institution of appropriate therapy.

Cervical status as a predictor of preterm labour.

A study was conducted on 140 pregnant women at and after 28 weeks of pregnancy for finding out the relationship of cervical length and position with onset of preterm labour. Incidence of preterm labour was significantly higher (p < 0.001) in women with central position of cervix (54.67%) than that with posterior position of cervix (10.77%). Onset of preterm delivery was closely related to cervical length of 2.5 cm or less irrespective of central (82.75%) or posterior (20%) position of cervix (p < 0.001).