Unilateral Presentation of Pulmonary Alveolar Proteinosis

Pulmonary alveolar proteinosis (PAP) is a rare disorder, in which lipoproteinaceous material accumulates within the alveoli. We report a case of a 27-year-old male patient with acute worsening of breathlessness over the last 7�months and cough with desaturation up to 79% on room air. Contrast-enhanced computerized tomography of the thorax revealed unilateral diffuse crazy-paving pattern likely PAP. Transbronchial lung biopsy confirmed the diagnosis of PAP. The present case highlights the unusual presentation of PAP with unilateral involvement. To the best of our knowledge, this is the first reported case of unilateral PAP from India with a biopsy diagnosis and resolution with whole lung lavage.

Molecular characterization of Chikungunya virus during an outbreak in South India.

Introduction: Re-emergence of Chikungunya is a major public health problem in the southern states of India. Objectives: This study was undertaken to investigate an outbreak of Chikungunya, in June-August 2008 using PCR and determine the prevalent genotypes of Chikungunya virus (CHIKV) associated with the outbreak. Materials and Methods: Samples of blood were collected (in heparinized vacutainer tubes) from suspected patients of CHIKV infection from both Government Taluk Hospital in Kerala and a tertiary care hospital in Chennai, Tamil Nadu. A one-step RT-PCR was carried out on a block thermo-cycler targeting the E2 gene that codes for the viral envelope protein. The amplicons were verified for 305 bp size by standard agarose gel electrophoresis. The PCR products were purified, sequenced, and compared with other CHIKV strains reported from different geographical regions. A phylogenetic tree was constructed using MEGA 4. Results: Altogether 118 samples were collected from patients who presented with sudden onset of fever and/or joint pain, myalgia, and headache. CHIKV infection was confirmed by RT-PCR in 14 patients and all these cases were from Kerala. The positivity correlated with the early stage of the disease as all these patients had fever of less than seven days duration. The study isolates have been allotted the GenBank accession nos. GQ272368-GQ272381. Phylogenetic analysis of recent CHIKV isolates by partial sequencing of E2 region shows that isolates are closely related to strains from neighboring states and the African type. Conclusion: RT-PCR is a useful technique for the early detection of CHIKV infection during outbreaks. Molecular characterization of the strains indicates that majority of the strains have originated from the Central/East African strains of CHIKV.

UDP-galactose 4-epimerase from Escherichia coli: equilibrium unfolding studies.

UDP-galactose 4-epimerase from Escherichia coli is a homodimer of 39 kDa subunit with non-covalently bound NAD acting as cofactor. The enzyme can be reversibly reactivated after denaturation and dissociation using 8 M urea at pH 7.0. There is a strong affinity between the cofactor and the refolded molecule as no extraneous NAD is required for its reactivation. Results from equilibrium denaturation using parameters like catalytic activity, circular-dichroism, fluorescence emission (both intrinsic and with extraneous fluorophore 1-aniline 8-naphthalene sulphonic acid), 'reductive inhibition' (associated with orientation of NAD on the native enzyme surface), elution profile from size-exclusion HPLC and light scattering have been compiled here. These show that inactivation, integrity of secondary, tertiary and quaternary structures have different transition mid-points suggestive of non-cooperative transition. The unfolding process may be broadly resolved into three parts: an active dimeric holoenzyme with 50% of its original secondary structure at 2.5 M urea; an active monomeric holoenzyme at 3 M urea with only 40% of secondary structure and finally further denaturation by 6 M urea leads to an inactive equilibrium unfolded state with only 20% of residual secondary structure. Thermodynamical parameters associated with some transitions have been quantitated. The results have been discussed with the X-ray crystallographic structure of the enzyme.

A study of ocular morbidity among elderly population in a rural area of central India.

A cross-sectional study was conducted in five randomly selected villages in Wardha district of Maharashtra state to study the magnitude and factors related to the prevalence of ocular diseases among the elderly population. A total of 903 persons above 50 years were screened. The prevalence of low vision was 32% while that of blindness was 12.2%. Ocular morbidity rate was 1.21 lesions per elderly person and it increased significantly with increasing age (p < 0.001). Ocular diseases were found to be more prevalent among males, low socio-economic status group and landless labourers (p < 0.001). There was a high prevalence of refractive errors (40.8%), cataract (40.4%), aphakia (11.1%) followed by pterygium (5.2%), glaucoma (3.1%) and corneal opacities (3%). Prevalence of diseases of the lens and iris increased significantly with increasing age (p < 0.001). There is a need to evolve strategies for reducing the burden of ocular diseases and improve geriatric eye health under the existing infrastructure of health care delivery in our country.

Magnitude of acute respiratory infections in under five children.

A community based study was carried out in a rural area of Wardha district in Maharastra to measure the incidence of acute respiratory infections among children below 5 years age. 384 under five children were followed up fortnightly for one calendar year to estimate the incidence of acute respiratory infections (ARI). There were 1298 episodes of ARI averaging 3.67 episodes/child/year. The incidence of lower respiratory infections was 0.07 episodes/child/year. The incidence of ARI was found to be closely associated with nutritional status of the child, socio-economic status of the family, maternal literacy status and family size. Environmental factors like type of house, ventilation and fuel used for cooking were found to influence the incidence of ARI.

Clinical and electroneurophysiological assessment of leprosy patients on dapsone monotherapy--a two year follow-up study.

Fifty-three persons with tuberculoid type of leprosy having a thickened nerve on one side and a clinically normal nerve on the contralateral side were studied before, during and after two years of therapy for electrophysiological abnormalities in apparently normal and in obviously thickened nerves. Twenty-seven patients had received treatment with dapsone 100 mg orally and 26 cases had received rifampicin therapy. It was found that there was no extension of anesthesia or diminution of motor power over a period of two years. There was no significant difference between the initial and final recordings of motor and sensory nerve conductions if aggregate figures were taken. However, taking individual cases, deterioration in nerve conduction (increased latency and decreased velocity) was found in two patients, of whom one had received dapsone and the other had received rifampicin.

Epidemiological aspects of visual impairment above 50 years in a rural area.

A cross-sectional survey was conducted in 5 villages in central India to find out the extent, causes and epidemiological factors for visual impairment among 903 individuals aged above 50 years; 44.3% of them were visually impaired (29.4% with low vision and 14.9% blind). Age-specific visual impairment increased at a rate of 13.2% with each decade of advancing age. Landless labourers suffered more from visual impairment than other occupational groups (p < 0.05). Socioeconomic and literacy status of the population did not significantly influence the prevalence of visual impairment. Major causes of visual impairment were cataract (48.5%), refractive errors (24.5%), age-related macular degeneration (10%), glaucoma (6.8%), and others (10.2%). In view of the high prevalence of visual impairment among the elderly individuals, it is necessary to intensify our efforts in motivating them for early detection and treatment.

Vitamin A intake and vitamin A deficiency in rural children.

The prevalence of vitamin A deficiency was estimated in 366 rural children in the age group of 1 to 15 years. In a systematically selected subsample of 90 children, the dietary intake of vitamin A was assessed. The prevalence of vitamin A deficiency signs ranged from 24.1 to 34.8%. The adequacy of dietary intake of vitamin A ranged from 8 to 12% when compared with the recommended dietary allowance. The dietary intake of children with and without vitamin A deficiency was not different (p greater than 0.05). The main source of beta carotene in the diet was cereals accounting for 47.9% of the total beta carotene intake.

Primary school teacher as a primary health care worker.

School children (1608) were examined for three items (nails, scalp hairs and teeth) relating to personal hygiene and relevant infective conditions from two sets of villages i.e. one set where primary school teacher was working as primary health care worker (Group I) and the other set where Community Health Volunteer (CHV) was delivering primary health care (Group II). The objective was to evaluate the efficiency of school teachers' role vis-a-vis CHVs' in imparting health education to school children. Out of 1608 school children, 801 belonged to Group I villages and the remaining 807 to Group II villages. From the results, it was evident that children of Group I villages were better with respect to all the items related to personal hygiene and infective conditions excepting scalp infections, where difference was not statistically significant, indicating teachers' superiority over the CHVs' in imparting health education to school children.