Seroprevalence of Toxoplasma gondii Infection in Children With Visual and/or Hearing Disability in Comparison With Healthy Children in Iraq

@#Introduction: Infection with Toxoplasma gondii is very prevalent in Iraq. The aim of this study was to determine the seroprevalence of T. gondii infection among children with visual, hearing or both disabilities (VHDC) and among healthy children (HC) living in Diyala and Baghdad provinces in Iraq. Methods: For this study, 100 VHDC children (attending the Al-Amal Centers for Blind, Dumb and Deaf Children) and 100 age-matched healthy children were recruited. Blood was obtained from all disabled and healthy children and the sera were examined for the presence of the specific antibodies (IgG and IgM) of T. gondii. Results: Among VHDC children, the seropositivity of IgG antibodies (24.0%) was significantly higher (OR= 7.6; 95% CI= 2.5-22.8; P= 0.0003) than that in HC children (4.0%). Disabled boys (OR= 5.7; P= 0.009) and disabled girls (OR= 12.7; P= 0.0183) showed significantly higher seropositivity than healthy children. The greatest risk was in disabled children who are their mothers had one or more abortion (OR= 6.89; P= 0.0005), followed by children who have brother or sister with visual and/or hearing disabilities (OR= 5.6; P= 0.0039), children whose their mothers got infection during pregnancy (OR= 2.9; P= 0.0256), and then children whose their mothers have taken treatment (OR= 2.9; P= 0.0256). The presence of stray cats in the houses was identified as a risk factor (OR= 4.05; P= 0.0186). Conclusion: In children with visual and/or hearing disabilities, the seropositivity of IgG antibodies was significantly higher than that in healthy children.

Molecular Characterization of Some Virulence Factors of Streptococcus pneumoniae Isolated from Children with Acute Otitis Media in Hilla, Iraq.

Aims: Isolation and identification of Streptococcus pneumoniae from children with acute otitis media. Molecular detection of some virulence genes of S. pneumoniae such as pneumolysin (ply), autolysin A (LytA), Neuraminidase (NanA), Luminescence luxS, capsular polysaccharide synthesis (cpsA), pneumococcal surface antigen A (psaA), α- Enolase (Eno ) by using PCR primer. Place and Duration of Study: Hilla Teaching Hospital (ENT unit) and privacy during a period from November (2014) to March (2015), Hilla, Iraq. Methodology: A total 0f 120 Ear swabs obtained from children suffering from acute otitis media ranged from (1 months - 12 years). Only eight isolates of S. pneumoniae were isolates. Seven virulence genes were investigated in eight clinical isolates of S. pneumoniae by using PCR techniques. Results: Pneumolysin and autolysin were seen to be present in only 4 isolates which were isolated from otitis media samples, whereas Luminescence and α - Enolase gene were present in five isolates, Besides, Neuraminidase and pneumococcal capsule synthesis A were detected in all isolates. It was found that Pneumococcal Surface antigen A is present in 2 isolates.

Cytoprotection of heat - induced splenic tissue by cyanocobalamin in albino rats

To evaluate the cytoprotective role of the Cyanacobalamin on the detrimental effects of heat -induced stress on splenic tissue. An Experimental study. Department of Anatomy, Basic Medical Sciences Institute, Jinnah Postgraduate Medical Centre, Karachi from January 2010 to April 2010. Forty five Albino rats [180-200 grams] were selected and divided into group A [Control], group B [Heat - induced] and group C [Protective] Each group was further subdivided into three subgroups, based on the period of the study. The animals of the subgroups B and C received heat and the temperature was set at 42 C for six hours daily. Group C [Cl, C2 and C3] animals were protected with Cyanocobalamin [BETOLVEX] at the dosage of 0.8 mg/ kg of body weight intraperitonealy, two hours before heat induction. Then animals were sacrificed according to their time duration, spleens were removed and fixed in alcoholic formalin for 24 hours .Then tissue were processed in ascending strengths of alcohol from 70 to 100%,cleared in xylene, infiltrated and embedded in paraffin. 5 micron thick sections were stained with haemotoxylin and eosin and e. Blood samples were collected in EDTA K3 containing vacutainers for the hormonal assay of plasma ACTH level. in group B animal's heat-stress alters the immunoarchitecture of the spleen; size of all comportments of the white pulp reduces with the appearance of the tingitble body macsophages and individual apoptotic cells and free apoptotic bodies. This group also shows significant increase in plasma ACTH levels. Whereas the splenic architecture and plasma ACTH level in group C animals return to normal by the cytoprotective effects of the Cyanocobalamin. The current study demonstrates the beneficial effects of the Cyanocobalamin to alleviate the detrimental effects of the heat-stress on the immune organs

Effects of ciprofloxacin and zinc chloride in adult albino rat and pre-natal conceptus

Administration of quinolone therapy is controversial during growing age as stated by earlier authors. The flouroquinolones are currently not indicated for young children because of arthropathy and adverse effect as new born shown by studies. However the effects of ciprofloxacin and ZnCl[2] on prenatal conceptus have remained undocumented. The present study was designed to compare the effects on conceptus after maternal ingestion of ciprofloxacin and ZnCl[2] using Wastar albino rats. Ciprofloxacin and ZnCl[2] was administrated to pregnant female albino rats. Ciprofloxacin with a dose of 20 mg/Kg bodyweight and ZnCl[2] 120 microg/100 gm bodyweight two times therapeutic dose for 10 days [from day 8-18 of pregnancy]. Each animal was weighted on day 1, day 8 and day 18 of pregnancy. Abortion resulted on day 18[th] of pregnancy. Each group of pregnant animals were sacrificed on day 18 of gestation by over dose of either anaesthesia, abdomen opened, uterus and both cornua containing conceptus identified, removed, there weight recorded, crown rump length was measured and was compared with similar value of control animals. The results were statistically analysed to find out the significance. The ciprofloxacin induces a mordanting effect as obviated by increased basophilia. Our study reveals that ciprofloxacin administered in maternal, decreased maternal body weight to 38.4 +/- 0.9 gm. However simultaneous ZnCl[2] maintained the body weight to 41.4 +/- 0.7 gm, while ZnCl[2] increased the body weight to 46.5 +/- 2.25 gm. The body weight and Crown Rump length [CR Length] in conceptus decreased by 4.52 +/- 0.10 gm and 3.06 +/- 0.09 Cm respectively. That ciprofloxacin and ZnCl[2] administration maintained the body weight and CR length by 5.46 +/- 0.09 gm and 3.79 +/- 0.13 Cm respectively. That ZnCl[2] administration increased the body weight and CR length by 6.71 +/- 0.05 gm and 4.15 +/- 0.08 Cm respectively. Prenatal administration of Ciprofloxacin caused reduction in growth rate and CR length, and ZnCl[2] maintained body weight and CR length and growth of the rat conceptus.

Factors contributing to non-compliance among diabetics attending primary health centers in the Al Hasa district of Saudi Arabia

The purpose of the study was to measure the rate of non-compliance and the factors contributing to non-compliance among the diabetic patients in the Al Hasa region of Saudi Arabia. A cross-sectional survey was conducted in the Al Hasa region during the period of June 2010 to June 2011. Random sampling was carried out for the selection of 535 diabetic patients from three chronic disease centers in different parts of Al Hasa. The data were collected by means of interviewing questionnaires and file records. Any patients who had been prescribed optimum treatment and was properly advised on diet and exercise for his/her diabetes, but did not follow the medical advice, with Hb1AC of more than 7% at the time of interview, participants was 67.9% [n = 318, 95% CI 63.59 - 72.02%]. The non-compliance of males [69.34%] was higher than females [65.45%, P = .003]. The non- compliance among the urban participants was significantly higher than [71.04 vs. 60.15%, P= .023] in the rural participants. There was a statistically significant difference in the prevalence rate of non-compliance among the participants with different levels of education. Factors found to be significantly associated with non-compliance on bi-variate analysis were: female gender [OR = 1.90, CI =1.32-4.57], level of education [Illiteracy] [OR = 5.27, CI = 4.63 - 7.19], urban population [OR = 5.22, CI= 3.65 - 8.22], irregularity of the follow-up [OR = 8.41, CI = 4.90 - 11.92], non-adherence to drug prescription [OR = 4.55, CI = 3.54 - 5.56], non-adherence to exercise regimen [OR = 5.55, CI = 4.26 - 6.], insulin [OR = 1.29, CI = .71 - 1.87], and insulin with oral Metformin [OR = 1.20, CI =. 65- 1.75]. The findings indicate that there is a high rate of non-compliance among the diabetes patients in the Al Hasa region of Saudi Arabia and there is a definite need for improvement in the healthcare system, health education, and training of diabetic patients

Fibromyalgia syndrome in 104 Iraqi patients with inflammatory bowel disease

Fibromyalgia syndrome [FMS] is a common rheumatologic syndrome with multiple systemic manifestations and associated with many diseases. To assess fibromyalgia syndrome in inflammatory bowel disease. One hundred four Iraqi patients with inflammatory bowel disease were studied and compared with another [112] healthy individuals matched for age and sex as a control group. Full history was taken and complete clinical examination was done for all individuals in both groups. Fibromyalgia syndrome was diagnosed in all patients on base of the American College of Rheumatology [ACR] 1990 Criteria for the classification of FMS. Inflammatory bowel disease was detected by colonoscopy and tissue biopsy. There was a significant increase in the frequency of FMS among individuals with IBD [24%] compared to healthy control group [5.4%] [[P-value=0.0001, Odd ratio=0.18, 95% CI=0.07-0.46]. FMS occurs with increased frequency in IBD

Gynecomastia treatment should it be individualized? a prospective study

Gynecomastia is a benign enlargement of the male breast. Was to analyze a 3 year period of gynecomastia patients in Al Kindy Teaching Hospital and the surgical approach used and its outcome. A prospective study of patients consulting Al Kindy Teaching Hospital because of gynecomastia between October 2007and August 2010 was done. Data were analyzed for etiology, grade of gynecomastia, surgical technique, complications, and histological results. A total of 64 patients with 86 operations were included. Techniques included subcutaneous mastectomy alone, or subcutaneous mastectomy with wise pattern "inverted T incision". Atypical histological findings were found in 3.12% of the patients [papilloma, fibrolipoma]. Surgical revision among all patients was 7%. Body mass index higher than 25kg/m2 was found as significant risk factors for complications [p/0.043], and that higher grades of gynecomastia [grade IIb and III]had higher statistical incidence of complications p=0.01 The treatment of gynecomastia requires an individualized approach. Caution must be taken in high BMI and higher grades, which are associated with increased complication rates. Histological tissue diagnosis should be routinely performed in all true gynecomastia corrections, because histological results may reveal atypical cellular pathology

Drug utilization patterns in pregnant women: a case study at the Mount Hope Women's Hospital in Trinidad, West Indies / Patrones de utilización de medicamentos en las mujeres embarazadas: un caso de estudio en el Hospital de Mujeres Mount Hope en Trinidad, West Indies

OBJECTIVE: To explore drug (prescription, over-the-counter and herbal) utilization in pregnant women attending a public sector tertiary healthcare institution. METHODS: This was a cross-sectional case study in women attending antenatal clinics at the Mount Hope Women's Hospital. Women (506) who consecutively presented for routine care at the antenatal clinic were interviewed on the medication they took. Descriptive statistics and logistic regression for predictors of drug use were done using SPSS 16. RESULTS: There were 200 (39.5%) primigravidae, 306 (60.5%) multigravidae and 299 (59%) women were in the third trimester of pregnancy. Most women (69.8%) were between 20-35 years of age. Women took an average of 1.32, 1.22 and 0.94 prescribed drugs in each trimester, respectively. Multivitamins (59.8%) and iron/folic acid (54.2%) were the most frequently prescribed drugs. Regardless of trimester, only 20% of women took supplemental calcium. Very few women (2.4%) took herbal medications. Paracetamol was the most common over-the-counter (OTC) medication in all trimesters. Women with secondary level education were most likely to use OTC iron/folic acid (p = 0.02), paracetamol and histamine2 receptor antagonists [H2RAs] (p = 0.001). More primigravidae took non-steroidal anti-inflammatory drugs (p = 0.02) and more women in the first trimester used antiemetics (p = 0.001). Age group (p = 0.048), marital status (p = 0.001) and the trimester of pregnancy (p = 0.001) were predictors of drug utilization. CONCLUSION: Overall, women in tertiary healthcare institutions took medication as prescribed particularly multivitamins and iron/folic acid. More women with higher education took OTC paracetamol, iron/folic acid and vitamin supplements. Herbal supplements were rarely used. Research on drug utilization in primary care facilities is recommended.

OBJETIVO: Explorar el uso de los medicamentos (con prescripción, sin receta médica, herbarios) en mujeres embarazadas que asisten a una institución terciaria de atención a la salud pública dentro del sector público. MÉTODOS: Se trató de un estudio transversal de mujeres que asisten a las clínicas prenatales en el Hospital de Mujeres Mount Hope. Las mujeres (506) que consecutivamente se presentaron para cuidados de rutina en la clínica prenatal, fueron entrevistadas acerca de la medicación que tomaban. Se hicieron estadísticas descriptivas y se hizo una regresión logística para los predictores del uso del medicamento usando SPSS 16. RESULTADOS: Había 200 (39.5%) primerizas, 306 (60.5%) multíparas, y 299 (59%) embarazadas en su tercer trimestre. La mayoría de las mujeres (69.8%) tenían entre 20-35 años de edad. Las mujeres tomaban un promedio de 1.32, 1.22 y 0.94 medicamentos prescritos en cada trimestre, respectivamente. Las multivitaminas (59.8%) y el hierro/ácido fólico (54.2%) fueron los medicamentos más frecuentemente prescritos. Con independencia del trimestre, sólo 20% de las mujeres tomaron suplemento de calcio. Muy pocas mujeres (2.4%) tomaban medicaciones herbarias. El paracetamol fue el medicamento sin receta más común en todos los trimestres. Las mujeres con nivel de educación secundaria presentaban una mayor probabilidad de usar hierro/ácido fólico (p = 0.02), el paracetamol y los antagonistas de los receptores de la histamina-2- [H2RAs] (p = 0.001). Un mayor número de primerizas tomaron medicamentos anti-inflamatorios no esteroideos (p = 0.02) y más mujeres en el primer trimestre usaron anti-eméticos (p = 0.001). El grupo etario (p = 0.048), el estado matrimonial (p = 0.001) y el trimestre de embarazo (p = 0.001) fueron predictores de la utilización de medicamentos. CONCLUSIÓN: En general, las mujeres en las instituciones terciarias de atención a la salud tomaron la medicación como fue prescrita, en particular las multivitaminas y el hierro/ácido fólico. Más mujeres con mayor escolaridad tomaron medicamentos sin recetas: paracetamol, hierro/ácido fólico y suplementos de vitamina. Raramente se usaron suplementos herbarios. Se recomienda la investigación del uso de medicamentos en centros de atención primaria.

Prevalence and determinants of diabetic retinopathy in Al Hasa region of Saudi Arabia: primary health care centre based cross-sectional survey, 2007-2009

To evaluate the prevalence of diabetic retinopathy [DR] in the urban and rural areas of Al Hasa region of Saudi Arabia and to determine risk factors related to DR. This study was conducted on patient attending primary health care centers between July 2007 and June 2009. A retrospective chart review was conducted on subjects with diabetes mellitus greater than 18 years old. Ophthalmologists examined DR status through dilated pupils by using direct, indirect, and slit lamp bio-microscopy. Frequencies, percentage, and their 95% confidence intervals [CIs] were calculated. Odd's ratio was used to associate DR with possible risk factors. A P value less than 0.05 was considered statistically significant. The prevalence of DR among 473 diabetic subjects was 30% [95% CI:25.80-34.20]. The odd ratios [ORs] of DR among diabetic residing in an urban area was significantly higher than diabetics residing in rural areas [OR = 1.94 [95% CI of OR 0.82-2.89]]. DR was associated to the duration of diabetes [adjusted OR= 1.70], uncontrolled blood sugar level [adjusted OR=1.96], hyperlipidemia [adjusted OR= 2.04], and hypercholesterolemia [adjusted OR = 2.80]. DR appears to be a public health problem in the Al Hasa district of Saudi Arabia, and a planned approach is required to avoid severe visual impairment in patients with diabetes mellitus. Primary prevention and early detection could be implemented through primary health centers and non-ophthalmologists

Air filled, inflammatory, lung pseudo-cyst: etio-pathogenesis and management.

Lung cysts in children are usually of congenital origin. Necrotising pneumonias, trauma, cystic fibrosis and kerosene poisoning may be the cause of acquired cysts in the lungs during childhood. We describe a child who presented with pneumothorax and was later discovered to have a cyst in his right lung. The cyst was resected and on histology found to be of inflammatory origin with no epithelial cell lining i.e. a pseudo-cyst. The immuno-histochemical staining of the inflammatory cells from the pseudo-cyst wall showed them to be predominantly histiocytes i.e:, CD68 antigen positive. The cells showed negative staining for S-100 (marker for Langerhans cells), cytokeratins (epithelial markers) and smooth muscle actins excluding the possibility of histiocytosisX, epithelial and congenital cysts respectively. This case illustrates the occurrence of acquired pulmonary pseudocysts unrelated to known etiologic agents which should be considered in the work-up for pneumothoraces.

Histopathological pattern of endometrial curettings in cases of abnormal uterine bleeding

To determine the histopathological pattern of endometrial curetting in cases of abnormal uterine bleeding in our setup. Descriptive study. Department of Pathology Peoples Medical College Nawabshah. January 1999 to December 2008. Endometrial curettage of 1209 cases presenting with abnormal uterine bleeding ranging from age groups 20 to over 60 years were studied. The patients were subdivided in to groups according to age and pattern of bleeding. The histopathological diagnosis was made and results were tabulated. 502 [41 .5%]presented with menorrhagia, [32%] with inter menstrual bleeding, 121 [10%] patients with polymenorrhoea and 61 [5.1%] with post menopausal bleeding. The various histological diagnoses included proliferative phase, cystic hyperplasia, adenomatous hyperplasia, endometritis, polyps and endometrial carcinoma. Diagnostic curettage provides help in definite diagnosis and proper treatment and is of importance in postmenopausal bleeding. Endometrial hyperplasia is the commonest lesion in patients with dysfunctional uterine bleeding

IL-10 Implications in Psoriasis

Interleukin [IL]-10 is a pluripotent cytokine with effects on numerous cell populations, in particular circulating and resident immune cells as well as epithelial cells. With its potent immunoregulatory capacities, its main biological function seems to be the limitation and termination of inflammatory responses. Hence, its low level expression found in psoriasis may have pathophysiological relevance to this immune disease. Remarkably, the induction of IL-10 expression was found by conventional antipsoriatic therapies, supporting the hypothesis that it may be a key cytokine in psoriasis. Furthermore, the first use in clinical trials in patients with established psoriasis showed that it had moderate antipsoriatic effects and was well tolerated. Moreover, long-term application in psoriatic patients in remission showed that it decreases the incidence of relapse and prolongs the disease free interval. The IL-10 antipsoriatic activity is suggested to be due to the effects on different cell populations, including antigen presenting cells and T-cells [type 1/type 2 balance shift], but not through direct effects on keratinocytes. In conclusion, IL-10 seems to have major clinical and therapeutic implications in psoriasis. Further multicenter, placebo-controlled, double blind trials are required to be an established antipsoriatic therapy. We can come to the conclusion that IL-10 genetic polymorphism and expression is potentially a key immune marker in psoriasis

significance of alanine aminotransferase level in chronic hepatitis C infection

To determine the significance of alanine aminotransferase [ALT] level in tfirbftib hepatitis C infection in our setup. A prospective cross-sectional, observational study carried out from August 2006 to June 2008. Departments of Pathology, Nawabshah Medical College Nawabshah and research institute of LUMHS Jamshoro. A total of 344 HCV-PCR positive patients having histological evidence of chronic hepatitis with either fibrosis or inflammatory activity by biopsy were evaluated 239 men and 105 women with ages between 18-55 years of age were included in the study. All the patients went for FLISA test for the presence of HCV antibodies by ELISA kit of Biokit Spain, and then a 5.0 ml of blood was collected in a tube with separating gel, to obtain serum, which was stored at room temperature for the determination of alanine aminotransferase by Ecoline kit on Slectra automatic chemical analyzer of Merck, Germany. The ALT was estimated in 344 patients and was 4.4 times higher [mean level

54.5 U/L] than normal in 335 [97.38%] patients, while 09 [2.61%] patients showed ALT level with in normal limit. The data in the current study indicates importance of ALT in chronic hepatitis C infection, and shows that ALT is the major liver enzyme and is a marker of liver infection or hepatitis, as majority [97.38%] of patient in our study showed a high level of ALT

Bones and joints tuberculosis

Tuberculosis appears to be increasing throughout the world after years of continuous decline, despite the introduction of effective chemotherapy. This resurgence is related to the increasing ncftfider of patients immunocompronused by chemotherapeutic agents used to treat other diseases or AIDS; the appearance of multiple drug-resistant strains of tuberculosis, and aging population. Several species of mycobacteria other than Mycobacterium tuberculosis or M. bovis are known to cause infections of bones and joints. The predisposing factors are malnutrition, environmental conditions and poor living standards. Musculoskeletal tuberculosis arises from haematogenous seeding of the bacilli soon after the initial pulmonary infection. The clinical symptoms are insidious onset, pain, swelling of the joint and limited range of movements. Investigations for suspected cases include: Mantoux test, radiological imaging, fine needle aspiration biopsy, surgical biopsy, bacteriological examination, histopathological examination, and polymerase chain reaction [PCR] of a suitable specimen. The mainstay of treatment is multidrug antitubercular chemotherapy. Surgical intervention is indicated in patients with abscess formation, intractable pain, neurological deficit, spine instability, kyphosis, and unsatisfactory response to chemotherapy. The main reason for poor outcome is delayed diagnosis

Thoracotomies: indications, results and implications

Thoracotomy is a major surgical procedure requiring a thorough understanding of cardiorespiratory mechanics and maintenance of very vital organ function during the postoperative phase, which requires a high dependency environment with full monitoring capabilities. The aims of this prospective audit is to examine the indications for and outcomes of thoracotomies carried out at a secondary level hospital and to highlight the possible problems and challenges facing thoracic surgeons. Prospective study. Cardiothoracic Surgical Unit, Department of Surgery, Assir Central Hospital, Abha, Saudi Arabia. Ninety-four consecutive adult patients [Aged 12 years and over] admitted or referred to the Cardiothoracic Surgical Service and who underwent thoracotomies between October 1999 and January 2004 [53 months]. Information documented included patients' names, age, sex, type and date of operation, type of general anaesthesia, postoperative complications and post operative analgesia. There were 72 males and 22 females [M:F = 3.3:1]. The mean age was 40.8 +/- 17.1 years [Range = 13 to 80 years]. The indications were fibrothorax/encysted hydrothorax [effusion/empyema] 21 cases [22.3%]; lung bullae and cysts [with or without pneumothorax] 17 cases [18.1%]; clotted traumatic haemothorax/fibrothorax 10 cases [10.6%]. There was no mortality in these three categories. The overall mortality in our series was 5.3%. Mortality was higher in emergency thoracotomies [12.5%] and in patients needing mechanical ventilation [26.7%]. Mortality in the elective cases was 3.9%. Infection and the management of inadequate initial treatment of lung infections, traumatic haemothorax and lung cysts and bullae predominate amongst the indications for thoracotomy in our environment. Mortality is highest among those patients needing emergency thoracotomy and those needing postoperative mechanical ventilation

Factors influencing nursing students career preferences

Study of 100 nursing student who are in third and fourth classes, to determine their choices of future specialties and the factors influenced their choices. We used a modified questionnaire derived from the graduation questionnaire of the Association of American Medical College. Sixty percentage choose adult nursing as a result of presence of excillent consultant and they possess necessary skills in their clinical performance. 13% choose community health nursing as they interested to work with specific groups of population through primary health care services. 12, 5, 4 and 2% choose paediatric nursing, obstetric nursing, fundamental nursing and psychiatric nursing respectively, Avoidance of male student to obstetric and gynaecological nursing appear clearly. 4% choose learning specialties in nursing college to continue their learning in post graduate in responses to economic factors and career prestige. Understanding factors that influence the nursing student choices of specialties is an important issue in nursing education

Vibrio cholerae in the Environment

The emergence of cholera has been a significant public health problem around the world and battle to completely control this deadly disease continues. Prevalence of Vibrio cholerae [V. cholerae] microorganisms in the environment was considered as the most important factor in this regard. Soil, fresh water, sea water, aquatic plants, animals and some birds have been made target for search if they were providing reserve shelter to the causative agent during inter epidemic periods. Multiple environmental factors have been considered to have the aetiological relationship as no single source is found to host the microorganisms in an inter-epidemic period. We have attempted to review the literature from different parts of the world; encompassing experimental and isolation studies of pathogenic and non-pathogenic strains of V. cholerae in the environment. The non-pathogenic strains were also included due to converting behavior of the agents in the changing environmental scenario to pathogenic forms

Pulmonary aspergilloma simulating bronchogenic carcinoma.

When a pre-existing lung cavity is colonized by Aspergilius fumigatus, it forms a fungal ball (pulmonary aspergilloma) and the presenting symptom is usually haemoptysis that may be massive and often-times life threatening. The radiological finding is that of a ball-like structure within a lung cavitation and the typical air crescent around the ball both on plain radiography and CT scan of the chest. The present case is of a 50-year-old male who had a 25-year history of heavy smoking (40 cigarettes per day) and haemoptysis. Although the cavitating lesion, ball-like structure and the crescenteric rim of air were present on the radiographs, the possibility of bronchogenic carcinoma was held high in view. Flexible fibreoptic and transbronchial biopsies were negative for malignancy. Sputum and bronchoalveolar lavage examinations showed neither malignant cells nor fungal elements. Right thoracotomy, cavernostomy, removal of the fungal ball and obliteration of the cavity by suturing (capitonnage) were done with an uneventful postoperative period.

Multifocal spinal tuberculosis associated with paraplegia

Spine tuberculosis affecting multiple vertebrae at different levels is a rare disease. This case report describes the condition of multiple spine tuberculosis of vertebral bodies T6, T12 and L1 in a 53-year-old man. The patient presented with backache for two months followed by paraplegia due to compression of the spinal cord by tuberculous necrotic material with spinal cord compression as demonstrated on myelography. A laminectomy was done to ease the compression and combination anti-tuberculous chemotherapy was given for one year. Gradual recovery was initiated within five weeks after operation, assisted by physiotherapy. Good improvement was gained after six months and complete recovery was obtained after one year. It is recommended, therefore, that when spine tuberculosis is detected in a vertebra, x-rays of other vertebrae should be done to exclude the possibility of other spine infection

Gangrenous cutaneous mucormycosis of the anterior chest wall

Mucormycosis is a rare but serious fungal infection. We report a case of pro g ressive gangrenous cutaneous mucormycosis of the anterior chest wall