Multicentric Hospital-Based Surveillance of Pertussis Amongst Infants Admitted in Tertiary Care Facilities in India.

OBJECTIVE: To estimate the disease and economic burden of pertussis amongst hospitalised infants in India. DESIGN: Multicentric hospital-based surveillance study. PARTICIPANTS: Hospitalised infants with clinical suspicion of pertussis based on predefined criteria. OUTCOME MEASURES: Proportion of infants with laboratory-confirmed pertussis, economic burden of pertussis amongst hospitalised infants. RESULTS: 693 clinically suspected infants were recruited of which 32 (4.62%) infants had laboratory-confirmed pertussis. Progressive cough with post-tussive emesis (50%) and pneumonia (34%) were the common clinical presentations; apnea in young infants was significantly associated with pertussis. Infants with pertussis were more likely to be younger (median age 102.5 days vs.157 days) and born preterm (42.9% vs 24.5%). Almost 30% infants with pertussis had not received vaccine for pertussis with 50% of these infants aged less than 2 months. Pertussis was associated with higher costs of hospitalisation, pharmacy and loss of working days by caregivers as compared to non-pertussis cases. CONCLUSIONS: Younger infants, those born preterm and those inadequately immunised against pertussis are at higher risk of pertussis infection. Timely childhood immunisation and introduction of maternal immunisation for pertussis can help in reducing the disease burden.

Chanarin-Dorfman syndrome: clinical report and novel mutation in ABHD5 gene.

Chanarin-Dorfman syndrome (CDS) is a multisystem, autosomal recessive genetic disorder characterized by congenital non-bullous ichthyosiform erythroderma with accumulation of lipid droplets in granulocytes and basal keratinocytes. An 18-month-old female child presented with typical dermatological features of CDS. She was born as a collodion baby. Liver biopsy showed micronodular cirrhosis along with macrovesicular hepatic steatosis. Sequencing of all exons and exon-intron boundaries of the ABHD5 gene showed that the patient was homozygous for a novel mutation g.24947delG (c.773 + 1delG) in intron 5. This is the first Indian child with mutation proven CDS.

Humeral head osteonecrosis following arthroscopic rotator cuff repair.

Humeral head chondrolysis and osteonecrosis of the glenoid have been reported; however, there is no report to date about humeral head osteonecrosis following arthroscopic shoulder procedure. We report a case of osteonecrosis of the humeral head following arthroscopic rotator cuff repair what we believe is probably secondary to disruption of its blood supply after placement of multiple metallic suture anchors. The surgical records were also reviewed in an attempt to identify the cause of the humeral head osteonecrosis.

Treatment-dependent loss of polyfunctional CD8+ T-cell responses in HIV-infected kidney transplant recipients is associated with herpesvirus reactivation.

Antiretroviral-therapy has dramatically changed the course of HIV infection and HIV-infected (HIV(+)) individuals are becoming more frequently eligible for solid-organ transplantation. However, only scarce data are available on how immunosuppressive (IS) strategies relate to transplantation outcome and immune function. We determined the impact of transplantation and immune-depleting treatment on CD4+ T-cell counts, HIV-, EBV-, and Cytomegalovirus (CMV)-viral loads and virus-specific T-cell immunity in a 1-year prospective cohort of 27 HIV(+) kidney transplant recipients. While the results show an increasing breadth and magnitude of the herpesvirus-specific cytotoxic T-cell (CTL) response over-time, they also revealed a significant depletion of polyfunctional virus-specific CTL in individuals receiving thymoglobulin as a lymphocyte-depleting treatment. The disappearance of polyfunctional CTL was accompanied by virologic EBV-reactivation events, directly linking the absence of specific polyfunctional CTL to viral reactivation. The data provide first insights into the immune-reserve in HIV+ infected transplant recipients and highlight new immunological effects of thymoglobulin treatment. Long-term studies will be needed to assess the clinical risk associated with thymoglobulin treatment, in particular with regards to EBV-associated lymphoproliferative diseases.

Anatomical considerations for percutaneous proximal humeral fracture fixation.

PURPOSE: To investigate the hypothesis that percutaneous wire fixation of proximal humeral fractures is prone to regional neurovascular injury. MATERIALS AND METHODS: 40 cadaveric shoulders had percutaneous wires inserted from anterior and lateral humeral shaft entry points into the humeral head. The shoulders were then dissected to identify the neurovascular structures in this area. RESULTS: The axillary nerve trunk and posterior circumflex humeral artery were found to be within the field of dissection. The axillary nerve was damaged on three occasions by the lateral wires, two of which were direct nerve penetrations. The anterior wires caused a single perineural injury of a terminal branch. The main neurovascular leash was 57 mm (range 35-70 mm) from the acromion tip laterally and 51 mm (range 35-85 mm) anteriorly, with a width of 6 mm (range 4-13 mm) laterally, and 12 mm (range 7-15 mm) anteriorly. CONCLUSIONS: Percutaneous wire stabilisation is an attractive fixation option but this study highlights the close proximity of the important neurovasculature. Such fixation should be performed utilising a limited open approach, with dissection to bone under direct vision, with the subsequent use of a drill-sleeve for soft-tissue protection.

Radiosurgery for patients with brain metastases: a multi-institutional analysis, stratified by the RTOG recursive partitioning analysis method.

PURPOSE: To estimate the potential improvement in survival for patients with brain metastases, stratified by the Radiation Therapy Oncology Group (RTOG) recursive partitioning analysis (RPA) class and treated with radiosurgery (RS) plus whole brain radiotherapy (WBRT). METHODS AND MATERIALS: An analysis of the RS databases of 10 institutions identified patients with brain metastates treated with RS and WBRT. Patients were stratified into 1 of 3 RPA classes. Survival was evaluated using Kaplan-Meier estimates and proportional hazard regression analysis. A comparison of survival by class was carried out with the RTOG results in similar patients receiving WBRT alone. RESULTS: Five hundred two patients were eligible (261 men and 241 women, median age 59 years, range 26-83). The overall median survival was 10.7 months. A higher Karnofsky performance status (p = 0.0001), a controlled primary (median survival = 11.6 vs. 8.8 months, p = 0.0023), absence of extracranial metastases (median survival 13.4 vs. 9.1 months, p = 0.0001), and lower RPA class (median survival 16.1 months for class I vs. 10.3 months for class II vs. 8.7 months for class III, p = 0.000007) predicted for improved survival. Gender, age, primary site, radiosurgery technique, and institution were not prognostic. The addition of RS boosted results in median survival (16.1, 10.3, and 8.7 months for classes I, II, and III, respectively) compared with the median survival (7.1, 4.2, and 2.3 months, p <0.05) observed in the RTOG RPA analysis for patients treated with WBRT alone. CONCLUSION: In the absence of randomized data, these results suggest that RS may improve survival in patients with BM. The improvement in survival does not appear to be restricted by class for well-selected patients.

Salmonella types and antibiotic susceptibility: a six months survey.

A total of 51 Salmonella strains were isolated during the six month period of May 1998 till October 1998. Of these, 41 (80.3%) were Salmonella typhi, 5 (9.8%) Salmonella pararyphi A,2 (3.9%) Salmonella worthington and 1 (1.9%) Salmonella senftenberg. The prevalent phage and biotype of Salmonella typhi was E1 (75%) and type 1 (90.2%) respectively. The commonest pattern of multiple drug resistance in Salmonella typhi was ACCoT and 92.5% of these belonged to phage E1. Out of the five Salmonella paratyphi A, one belonged to phage type 1 and the others were untypable. Similarly both the strains of Salmonella typhimurium were untypable. Thus the predominant isolate was Salmonella typhi and the commonest phage and biotype were E1 and biotype1 respectively.

Prevalence of torus palatinus and torus mandibularis in 1000 patients.

Since the presence of torus poses a problem in successful construction of dentures, a study was carried out to determine the prevalence of Torus Palatinus and Torus Mandibularis in 1000 patients, which was 9.5% and 1.4% respectively. The prevalence of Torus palatinus was more common in female than males. Majority of the tori were found in the age group of 11 to 30 yrs and were rarely seen before 10 yrs of age. The most common region was the middle of the palate as well as mandible. It is emphasized that presence of torus should be carefully evaluated and construction of denture be modified accordingly.