Advanced keratoconus in a child with juvenile scleroderma

An 18-year-old male presented with complaints of gradually decreasing vision in both eyes for 6 years. He was a diagnosed with juvenile scleroderma at the age of 11 years by a pediatric rheumatologist. Clinical slit lamp examination showed features of ectasia, thinning, Vogt's striae, and apical scarring in both eyes. Bulbar and tarsal conjunctiva was quiet and normal. Corneal tomography revealed mean keratometry 65.8 and 65.4 diopters, thinnest pachymetry of 351 and 224 microns in the right and left eye, respectively. There was no history of itching and eye rubbing in the past. Patients of juvenile scleroderma may have associated keratoconus. The management of advanced keratoconus presents challenges related to handling and insertion of contact lenses in this condition. Keratoplasty is an option in those patients when contact lenses are not acceptable.

Rapid detection of the commonly encountered carbapenemases (New Delhi metallo-?-lactamase, OXA-48/181) directly from various clinical samples using multiplex real-time polymerase chain reaction assay

Background: Resistance due to New Delhi metallo-?-lactamase (NDM) and OXA-48/181 continues to emerge as a threat which is associated with nosocomial outbreaks and is a serious healthcare concern. Phenotypic detection being laborious and time-consuming requires rapid detection of NDM and OXA-48/181, which is achieved through real-time polymerase chain reaction (RT-PCR). Materials and Methods: In this study, RT-PCR assay was developed to simultaneously detect NDM and OXA-48/181. The assay was validated on 102 non-duplicate, phenotypically characterised clinical samples. Results: The assay showed a sensitivity and specificity of 97% and 100% for the detection of carbapenemases in comparison to conventional PCR. The in-house developed multiplex RT-PCR would help to rule-in the presence of NDM and OXA-48/181. Conclusions: Rapid detection of these carbapenemases would be assist in better patient management, in terms of accurate antimicrobial treatment, help in cohorting infected from uninfected patient to prevent spread.

Experience in managing severe malnutrition in a government tertiary treatment facility in Bangladesh.

Children with severe acute malnutrition, defined as weight-for-height <70% of the reference median or bilateral pedal oedema or mid-arm circumference <110 mm having complications, were managed in the Nutrition Unit of the Chittagong Medical College Hospital (CMCH) following the guidelines of the World Health Organization, with support from Concern Worldwide Bangladesh and ICDDR,B. In total, 171 children aged less than five years (mean +/- SD age 23.5 +/- 15.3 months) were admitted during June 2005-May 2006. Of them, 66% were aged less than two years, and 84.2% belonged to households with a monthly income of less than US$ 40. The main reason for bringing children by their families to the hospital was associated major illnesses: bronchopneumonia (33%), oedema (24%), diarrhoea (11%), pulmonary tuberculosis (9%), or other conditions, such as meningitis, septicaemia, and infections of the skin, eye, or ear. The exit criteria from the Nutrition Unit were: (a) for children admitted without oedema, an absolute weight gain of > or = 500 and > or = 700 g for children aged less than two years and 2-5 years respectively; and for children admitted with oedema, complete loss of oedema and weight-for-height >70% of the reference median, and (b) the mother or caretaker has received specific training on appropriate feeding and was motivated to follow the advice given. Of all the admitted children, 7.6% of parents insisted for discharging their children early due to other urgent commitments while 11.7% simply left with their children against medical advice. Of the 138 remaining children, 88% successfully graduated from the Nutrition Unit with a mean weight gain of 10.6 g/kg per day (non-oedematous children) and loss of -1.9 g/kg per day (oedematous children), 86% graduated in less than three weeks, and the case-fatality rate was 10.8%. The Nutrition Unit of CMCH also functions as a training centre, and 197 health functionaries (82 medical students, 103 medical interns, and 12 nurses) received hands-on training on management of severe malnutrition. The average cost of overall treatment was US$ 14.6 per child or approximately US$ 1 per child-day (excluding staff-cost). Food and medicines accounted for 42% and 58% of the total cost respectively. This study demonstrated the potential of addressing severe acute malnutrition (with complications) effectively with minimum incremental expenditure in Bangladesh. This public-private approach should be used for treating severe acute malnutrition in all healthcare facilities and the treatment protocol included in the medical and nursing curricula.

Micronutrients and anaemia.

Micronutrient deficiencies and anaemia remain as major health concerns for children in Bangladesh. Among the micronutrient interventions, supplementation with vitamin A to children aged less than five years has been the most successful, especially after distribution of vitamin A was combined with National Immunization Days. Although salt sold in Bangladesh is intended to contain iodine, much of the salt does not contain iodine, and iodine deficiency continues to be common. Anaemia similarly is common among all population groups and has shown no sign of improvement even when iron-supplementation programmes have been attempted. It appears that many other causes contribute to anaemia in addition to iron deficiency. Zinc deficiency is a key micronutrient deficiency and is covered in a separate paper because of its importance among new child-health interventions.

Prevalence of Brucella antibodies in sera of cows in Bangladesh

The study was carried out to investigate the prevalence of Brucella antibodies in sera of 120 cows in Bangladesh Agricultural University Dairy Farm and adjacent villages, Bangladesh. The epidemiological history and blood was collected from the cows. The serum samples were subjected to Rose Bengal Test (RBT)and plate agglutination test (PAT) for initial screening of Brucella antibodies and the positive sera samples were then subjected to tube agglutination test (TAT)for further confirmation. The higher rate of Brucella antibody was recorded in rural farm (5.0%)than organized farm (2.5%)and in pregnant cows (5.9%)than non-pregnant cows (4.7%). A total of 3 (4%)Brucella positive antibody cases were recorded in cows of above four years of age whereas, 1 (2.3%)positive case was found in cows of less than 4 years of age. The study revealed that number of Red Shindi was the highest and the prevalence of brucellosis in Bangladesh cow population is not negligible and it is worthwhile to consider adoption of preventive measures.

Cyclodiene insecticides-induced changes in the central depressive effect of chlorpromazine in rats.

Spontaneous motor activity (SMA), conditioned avoidance response (CAR), muscle coordination (MC) and pentobarbital sleep were tested in rats treated orally for 90 days with tolerated doses of the cyclodiene insecticides, aldrin (1 mg/kg) and endosulfan (2 mg/kg). The same tests were repeated in similarly treated animals after injecting chlorpromazine (4 mg/kg, i.p.). Both the insecticides shortened pentobarbital sleeping time indicating their microsomal enzyme inducing property. Aldrin suppressed SMA, CAR and MC, whereas endosulfan stimulated SMA, inhibited CAR and unaltered MC. However, their concurrent action with CPZ did not result in change in the central depressive effects of the latter, but its potency during the course of its action was altered. Its potency 15 min after injection was greater and 60-180 min later was lesser in these animals than that observed in control animals. This finding was interpreted to suggest that aldrin and endosulfan has quickened the biotransformation of CPZ and thereby shortened its duration of action. A temporary promotion of its potency was accounted to its active metabolites, since prior to inactivation, CPZ is known to be metabolized by the microsomal enzymes to active compounds.

A technique for quantitative measurement of clonic convulsions in rats.

A capacitance sensor which detects vibrations caused by the movements of animals can be used for measuring automatically the clonic convulsions induced by chemical convulsants. This knowledge has been utilized to devise an instrument which has satisfactorily measured the clonic convulsions induced by picrotoxin in rats.

Behavioural and biochemical changes produced by repeated oral administration of the insecticide endosulfan in immature rats.

In order to study the response of rats to repeated administration of the insecticide, endosulfan during the period of growth to maturity, food intake, body weight gain, Spontaneous Motor Activity (SMA) and Muscle Coordination (MC) were determined at regular intervals in male immature Wistar rats treated with a tolerated dose of (2 mg/kg/day) orally for 90 days. Twenty-four h after the termination of the treatment, organ weight and protein concentrations were determined. The convulsive action of picrotoxin (4 mg/kg, ip) was tested in another endosulfan-treated group. Food consumption and body weight gain decreased parallely. No changes occurred in the body tissues but for liver which was enlarged and its protein, glutamic oxaloacetic transminase and glutamic pyruvic transaminase concentrations increased. The MC was unaffected. A stimulation of SMA occurred several days (75-90) after commencing treatment and these animals responded greatly than control animals to the convulsive action of picrotoxin. These findings indicated that although endosulfan produced anorexia, there were no signs of undernourishment and motor impairment in these animals. Its toxic action were confined chiefly to the liver and central nervous system.