Intravenous whole blood transfusion results in faster recovery of vascular integrity and increased survival in experimental cerebral malaria

BACKGROUND Cerebral malaria is a lethal complication of Plasmodium falciparum infections in need of better therapies. Previous work in murine experimental cerebral malaria (ECM) indicated that the combination of artemether plus intraperitoneal whole blood improved vascular integrity and increased survival compared to artemether alone. However, the effects of blood or plasma transfusion administered via the intravenous route have not previously been evaluated in ECM. OBJECTIVES To evaluate the effects of intravenous whole blood compared to intravenous plasma on hematological parameters, vascular integrity, and survival in artemether-treated ECM. METHODS Mice with late-stage ECM received artemether alone or in combination with whole blood or plasma administered via the jugular vein. The outcome measures were hematocrit and platelets; plasma angiopoietin 1, angiopoietin 2, and haptoglobin; blood-brain barrier permeability; and survival. FINDINGS Survival increased from 54% with artemether alone to 90% with the combination of artemether and intravenous whole blood. Intravenous plasma lowered survival to 18%. Intravenous transfusion provided fast and pronounced recoveries of hematocrit, platelets, angiopoietins levels and blood brain barrier integrity. MAIN CONCLUSIONS The outcome of artemether-treated ECM was improved by intravenous whole blood but worsened by intravenous plasma. Compared to prior studies of transfusion via the intraperitoneal route, intravenous administration was more efficacious.

The Role of Nuclear Medicine in the Staging and Management of Human Immune Deficiency Virus Infection and Associated Diseases / 대한핵의학회잡지

Human immune deficiency virus (HIV) is a leading cause of death. It attacks the immune system, thereby rendering the infected host susceptible to many HIV-associated infections, malignancies and neurocognitive disorders. The altered immune system affects the way the human host responds to disease, resulting in atypical presentation of these disorders. This presents a diagnostic challenge and the clinician must use all diagnostic avenues available to diagnose and manage these conditions. The advent of highly active antiretroviral therapy (HAART) has markedly reduced the mortality associated with HIVinfection but has also brought in its wake problems associated with adverse effects or drug interaction and may even modulate some of the HIV-associated disorders to the detriment of the infected human host. Nuclear medicine techniques allow non-invasive visualisation of tissues in the body. By using this principle, pathophysiology in the body can be targeted and the treatment of diseases can be monitored. Being a functional imaging modality, it is able to detect diseases at the molecular level, and thus it has increased our understanding of the immunological changes in the infected host at different stages of the HIV infection. It also detects pathological changes much earlier than conventional imaging based on anatomical changes. This is important in the immunocompromised host as in some of the associated disorders a delay in diagnosis may have dire consequences. Nuclear medicine has played a huge role in the management of many HIV-associated disorders in the past and continues to help in the diagnosis, prognosis, staging, monitoring and assessing the response to treatment of many HIV-associated disorders. As our understanding of the molecular basis of disease increases nuclear medicine is poised to play an even greater role. In this review we highlight the functional basis of the clinicopathological correlation of HIV from a metabolic view and discuss how the use of nuclear medicine techniques, with particular emphasis of F-18 fluorodeoxyglucose, may have impact in the setting of HIV. We also provide an overview of the role of nuclear medicine techniques in the management of HIV-associated disorders.

Prevalence of Candiduria in Infants from a Tertiary Care Hospital.

Yeast related urinary tract infections are rare in healthy newborns. Study was conducted in the department of microbiology in a tertiary care hospital, New Delhi from June 2012 to June 2013. Only infants were included in the study. A total of three hundred and thirty three urine samples were received for fungal culture and microscopy. The isolation rate of Candida species amongst the 333 samples was found to be 21.62%. Amongst 333 samples received 37 (11.11%) were positive for Candida albicans while 35 (10.51%) were positive for non albicans Candida species. So, in this study among 72 isolates of Candida, Candida albicans was found in 51.39% while non-albicans Candida species was found to be in 48.61% of the Candida isloates. It is important that the specific species responsible for symptomatic infection is identified, given the differences in antimicrobial susceptibility among Candida species.

The Potential Role of Infections in Attention- Deficit Hyperactivity Disorder.

Attention deficit hyperactivity disorder ADHD is a behavioral disorder which mostly affects children in the age group of six to eleven years. The disorder affects boys more than girls. Although difficult to assess in infancy and toddlerhood, signs of ADHD may begin to appear as early as age of two or three, but the symptom picture changes as adolescence approaches. Many symptoms, particularly hyperactivity, diminish in early adulthood. However, impulsivity and inattention problems remain with upto 50% of ADHD individuals through their adult life. Recently there have been studies on correlation between ADHD and bacterial and viral infections in brain. This review focuses on possible role of various viruses and certain bacterias in development of ADHD in children.

Case of sparganosis: A diagnostic dilemma.

Sparganosis, also known as larval diphyllobothriasis, is a rare disease of humans as man is not a natural host in the life cycle of Spirometra spp. Diagnosis of the latter is difficult as it mimics other conditions that commonly cause subcutaneous or visceral fluid collection. Clinical diagnosis of this particular case was also erroneously labelled as tuberculosis but later labelled as a case of sparganosis. To the best of our knowledge, this is the first case from India where a sparganum-like parasite was isolated in drain fluid from the perinephric area.

Female genital TB and HIV co-infection.

HIV-induced immunosuppression paves the way for several infections, tuberculosis being very common in our country. Female genital tuberculosis (FGTB), presenting as menstrual irregularities, is a diagnostic challenge in an adolescent female when these may be considered normal. The present case is of a young female who presented with menstrual irregularities, diagnosed subsequently as a case of genital tuberculosis. Microbiological relapse after anti-tubercular treatment of six months caused suspicion of a co-existing immunodeficiency and investigations revealed HIV co-infection; thus emphasizing the need of HIV testing in all patients of tuberculosis for timely diagnosis and treatment support thereafter.

Ultrasonido de alta resolucion (15 MHz) en el estudio de la u¤a psoriatica / High resolution ultrasound in the study of psoriatic nail

Antecedentes. La Psoriasis es una enfermedad frecuente en la practica dermatológica. En EE.UU., 7 millones de personas (2-3por ciento) la padecen. El 5 por ciento de los pacientes con psoriasis ungueal no tienen manifestaciones cutáneas. Entre 10-20 por ciento de los pacientes con psoriasis cutanea tienen artritis psoriatica. De los pacientes con artritis psoriatica, el 53-86 por ciento presentan compromiso ungueal. Objetivo. Estudiar los cambios visibles al ultrasonido de alta resolución, en la u¤a de los pacientes psoriaticos. Material y metodo. Se utilizo equipo de ultrasonido Philips ATL 5000 equipado con SonoCT, XRES, campo de visión extendida y transductores de 15-7 MHz y 12-5 MHz. Se estudiaron 15 pacientes, 9 controles normales y 6 psoriaticos con compromiso ungueal. Mujeres n=9 y hombres n=6, promedio de edad 47,7 a¤os. Se exploraron las 2 manos en todos los pacientes (150 u¤as) y se midieron en cada paciente las distancias entre ambas placas ungueales como también entre la placa ungueal ventral y el margen óseo de la falange distal en la u¤a del dedo indice derecho. Resultados. Se describe la anatomia ultrasonografica normal de la u¤a y cuatro patrones de alteraciones visibles en el compromiso por psoriasis que incluyen: compromiso focal hipere-cogenico de la placa ventral sin compromiso de placa dorsal, perdida de definición de la placa ventral con placa dorsal indemne, ondulación de ambas placas y perdida de definición de ambas placas. Se encontró una diferencia significativa (p= 0.02) entre el promedio de distancia placa ventral ungueal y margen óseo de la falange distal para u¤as normales (1,5 mm) y para psoriasis (3,0 mms). Conclusión: El ultrasonido de alta resolución permite un estudio no invasivo de la u¤a, describiendo su anatomia y cambios morfológicos en pacientes normales y psoriaticos con compromiso ungueal. Ello puede ser útil en la monitorización de los efectos del tratamiento de psoriasis en sus distintas mani-festaciones, ya que existen cambios imperceptibles en su magnitud y ubicación para el clinico, que pueden observarse sin esperar el recambio ungueal total. Las diferencias de distancia entre las placas de la u¤a, incluyendo la distancia con el margen óseo de la falange distal, en los pacientes normales y psoriaticos, en nuestro conocimiento, no han sido previamente publicadas.

Relapse risk assessment of transplantation for patients with chronic myeloid leukaemia / 中华医学杂志(英文版)

<p><b>OBJECTIVE</b>To analyse the risk factors of relapse before bone marrow transplantation (BMT) and to present the prognostic information as good as possible.</p><p><b>METHODS</b>A total of 3142 patients, who underwent the allogeneic blood or bone marrow transplantation between 1989 and 1997 and were documented in the European Group for Blood and Marrow transplantation (EBMT), were included. Six possible risk factors including type of donor, stage of disease, age, gender, donor-recipient sex combination and the waiting time from diagnosis to transplantation of relapse were considered. The time to relapse was analysed by Kaplan-Meier curves and Cox regression with stratification on prognostic factors that did not satisfy the Proportional Hazard Assumption.</p><p><b>RESULTS</b>An amount of 447 patients relapsed out of all 3142 patients. The relapse rate was 14.2%. Type of donor and stage of disease showed a clear prognostic effect, but failed the proportional hazard assumption. Therefore, the data were stratified on the combination of type of donor and stage of disease. Within these strata an additional significant effect of age could be observed. Relative risk of age > or = 40 vs age < 40 was 1.32 (95% confidence interval 1.09 - 1.59). The prognostic model is summarized graphically.</p><p><b>CONCLUSIONS</b>The combination of type of donor, stage of disease and age of recipient at transplantation are important prognostic factors for relapse after BMT.</p>

Bacterial infections in burns patients: a three years study at RML Hospital, Delhi.

A study was undertaken at RML Hospital, Delhi to examine the bacterial infections of burn cases and determine the antibiograms of the isolates to commonly used antimicrobial agents. A total of 489 pus samples from as many patients received, over a period of three years (January 1992 to December, 1994) yielded 793 isolates. Pseudomonas sp. was the commonest (53.9%) followed by Klebsiella sp. (35.1%) Staphylococcus aureus (30.6%) Proteus sp. (23.5%). Esch. coli (14.1%) and others (4.9%). The most resistant isolate to commonly used antimicrobial was Klebsiella sp. (16.4%), followed by Esch. coli (15.4%) Pseudomonas sp. (15.2%) Proteus sp. (7.8%) and Staphylococcus aureus (4.6%). The infection of burn wounds with multiple organisms, with superadded problem of drug resistance, indicate the institution of a drug policy by the hospitals for burns patients.