Typhoid fever presenting as acute psychosis in a young adult: case report and literature review of typhoid psychosis.

The rarity of acute psychosis in typhoid fever can result in delayed and misdiagnosis of the condition. We report a case of a 20-year-old man who presented with fever and acute psychotic symptoms. This was associated with headache, dizziness, and body weakness. There were no other significant symptoms. Neurological examination revealed reduced muscle tone of bilateral lower limbs but otherwise unremarkable. The computed tomography (CT) scan of his brain showed no abnormality. Blood specimens for microbiological culture grew Salmonella Typhi. This isolate was susceptible to chloramphenicol, ampicillin, ceftriaxone, ciprofloxacin, and trimethoprim-sulfamethoxazole. He was treated with intravenous ceftriaxone for one week and responded well. He was discharged with oral ciprofloxacin for another week. The repeated blood and stool for bacterial culture yielded no growth of Salmonella Typhi.

First case of pulmonary hydatid cyst in a pregnant Syrian refugee woman in Malaysia.

Pulmonary hydatid cyst (PHC) in pregnancy is a very rare pathology. We report here a case of ruptured PHC during pregnancy in a 26-year old Syrian (refugee) woman who presented with complaints of productive cough with metallic taste and dyspnoea. PHC was suspected due to her clinical and radiological findings. Interestingly, the sputum examination confirmed the diagnosis as numerous protoscoleces were present. Serology for Echinococcus infection revealed positive at high titre. Early diagnosis and prompt treatment by providing care improves the patient outcome. Parasitological examination of the respiratory specimen in suspected ruptured PHC is desirable as a valuable detection tool.

Typhoid fever presenting as acute psychosis in a young adult: case report and literature review of typhoid psychosis

@#The rarity of acute psychosis in typhoid fever can result in delayed and misdiagnosis of the condition. We report a case of a 20-year-old man who presented with fever and acute psychotic symptoms. This was associated with headache, dizziness, and body weakness. There were no other significant symptoms. Neurological examination revealed reduced muscle tone of bilateral lower limbs but otherwise unremarkable. The computed tomography (CT) scan of his brain showed no abnormality. Blood specimens for microbiological culture grew Salmonella Typhi. This isolate was susceptible to chloramphenicol, ampicillin, ceftriaxone, ciprofloxacin, and trimethoprim-sulfamethoxazole. He was treated with intravenous ceftriaxone for one week and responded well. He was discharged with oral ciprofloxacin for another week. The repeated blood and stool for bacterial culture yielded no growth of Salmonella Typhi.

Biochemical changes in cultivars of sweet oranges infected with citrus tristeza virus / Mudanças bioquímicas em vários cultivares de laranjas doces infectadas com o vírus citrus tristeza

Abstract Citrus fruit production occupies a place of considerable importance in the economy of the world including Pakistan. Tristeza disease caused by Citrus Tristeza Virus (CTV) exists in various forms that may or may not cause symptoms in the plants. The bioactive compounds and antioxidants are naturally present in plants and provide a defense mechanism that is generally accelerated in response to a stress. The objective of the present study was to target and analyze the citrus plants that were CTV positive to observe the changes in the enzymatic and non-enzymatic antioxidants of citrus (Sweet Oranges only). It was observed that in response to CTV infection, both the non-enzymatic antioxidants (total flavonoid, ascorbic acid, phenolic acid) and enzymatic antioxidants (catalase, superoxide dismutase and peroxidase) activities showed an increasing trend overall. The profiling of antioxidants in response to a viral infection may help in the discovery of new biomarkers that can be used as a monitoring tool in disease management.

Resumo As frutas cítricas ocupam um lugar de considerável importância na economia do Paquistão, assim como o resto do mundo. A doença da tristeza causada pelo Vírus da Tristeza dos Citros (CTV) existe em várias formas que podem ou não apresentar sintomas nas plantas. Os compostos bioativos e antioxidantes estão naturalmente presentes nas plantas e fornecem um mecanismo de defesa que é geralmente acelerado em resposta a um estresse. O objetivo do presente estudo foi analisar as alterações causadas pelo CTV nos antioxidantes enzimáticos e não enzimáticos de laranjas doces. Foi observado que, em resposta ao ataque de CTV, os antioxidantes não enzimáticos como flavonoides totais, ácido ascórbico, ácido fenólico e antioxidantes enzimáticos, como as atividades de catalase, superóxido dismutase e peroxidase, geralmente mostram uma tendência crescente. O perfil de antioxidantes em resposta a um ataque viral pode ajudar na descoberta de novos biomarcadores que podem ser usados ​​como uma ferramenta de monitoramento no gerenciamento de doenças.

Biochemical changes in cultivars of sweet oranges infected with citrus tristeza virus.

Citrus fruit production occupies a place of considerable importance in the economy of the world including Pakistan. Tristeza disease caused by Citrus Tristeza Virus (CTV) exists in various forms that may or may not cause symptoms in the plants. The bioactive compounds and antioxidants are naturally present in plants and provide a defense mechanism that is generally accelerated in response to a stress. The objective of the present study was to target and analyze the citrus plants that were CTV positive to observe the changes in the enzymatic and non-enzymatic antioxidants of citrus (Sweet Oranges only). It was observed that in response to CTV infection, both the non-enzymatic antioxidants (total flavonoid, ascorbic acid, phenolic acid) and enzymatic antioxidants (catalase, superoxide dismutase and peroxidase) activities showed an increasing trend overall. The profiling of antioxidants in response to a viral infection may help in the discovery of new biomarkers that can be used as a monitoring tool in disease management.

Study on some factors affecting survivability of airborne fungi.

The aim of the present study was to investigate the effect of some air pollutants and meteorological parameters on the survivability of airborne fungi. Fungi were collected by using a slit impactor sampler calibrated to draw 20 L/min, for 3 min. Nitrogen dioxide (NO(2)), sulfur dioxide (SO(2)), particulate matter (PM), relative humidity (RH %), temperature (T °C) and wind speed (WS) were also measured. Air samples were taken during the period from March 2006 to February 2007. Fungal concentrations ranged between 45 and 451 CFU/m(3) with an annual mean concentration of 216 CFU/m(3). The lowest fungal concentration was found in the summer, however the highest one was found in the autumn. NO(2,) SO(2) and PM averaged 83.66 µg/m(3), 67.01 µg/m(3), and 237.69 µg/m(3), respectively. T °C was positively and negatively correlated with Aspergillus (P = 0.000) and Penicillium (P = 0.007), respectively. RH% was positively correlated with total fungi (P = 0.001), Aspergillus (P = 0.002) and Cladosporium (P = 0.047). Multiple regression analysis showed that T °C and RH% were the most predicted variants. Non-significant correlations were found between fungal concentrations and air pollutants. Meteorological parameters were the critical factors affecting fungal survivability.

Diurnal distribution of airborne bacteria and fungi in the atmosphere of Helwan area, Egypt.

Airborne bacterial and fungal composition in an industrial town of Helwan, Egypt, was studied using a slit impactor sampler during the period from March 2006 to February 2007. Airborne bacterial concentrations were usually higher than fungi. Bacteria and fungi had similar diurnal variation patterns. Airborne microorganisms reached their concentration peaks in the evening and gradually decreased during the night time. The hourly concentration peaks of the bacteria and fungi appeared at 20:00h. A significant difference (P < or =0.05) was found between the hourly mean concentrations of airborne fungi in winter compared to other seasons. Fungi concentrations were significantly higher (P< or =0.05) on working weekdays than weekends. Aspergillus, Penicillium, Alternaria and Cladosporium were the most predominant airborne fungal genera. Aspergillus showed double peak patterns whereas Penicillium, Alternaria and Cladosporium showed one peak pattern. The diurnal variations of the bacteria and fungi could be divided into four periods: 1) the morning maximum concentration (6:00h-10:00h), 2) midday to afternoon pattern (10:00h-16:00h), 3) the evening concentration peak (18:00h-20:00h) and 4) the gradual decrease of night time concentration (22:00h-24:00h). Geographical location, human activity, growth cycle of organisms and meteorological factors were the main criteria controlling the temporal variations of the air microorganisms in the Wadi Hof area.

Significance of intracytoplasmic crystalline inclusions in plasma cells - a review with case discussion.

Dense lymphoplasmacytic infiltrate in tissues pose diagnostic challenge to pathologists. Presence of intracytoplasmic crystalline inclusions in plasma cells has been strongly linked with B- cell lymphoproliferative disorders, although isolated reactive cases are also reported. We reviewed the literature and present clinical, morphological and immunohistochemical findings in a polyp of the cervix. The polyp showed extensive plasma cell infiltrate with needle shaped and elongated intracytoplasmic inclusions in many of them. These cells were positive for CD 79alpha, CD 138, kappa and lambda light chain ( equal proportions) and IgG. They were negative for cytokeratin, desmin, CD 20, CD 68, and IgA. Immunoprofile, laboratory data and clinical follow up were consistent with reactive nature of the lesion. This case highlights the fact that the presence of intracytoplasmic crystalline inclusions should not be considered pathognomonic of B-cell lymphoproliferative disorder.

Indoor air quality during renovation actions: a case study.

A temporary renovation activity releases considerably high concentrations of particulate matter, viable and non-viable, into air. These pollutants are a potential contributor to unacceptable indoor air quality (IAQ). Particulate matter and its constituents lead, sulfate, nitrate, chloride, ammonium and fungi as well as fungal spores in air were evaluated in a building during renovation action. Suspended dust was recorded at a mean value of 6.1 mg m(-3) which exceeded the Egyptian limit values for indoor air (0.15 mg m(-3)) and occupational environments (5 mg m(-3)). The highest particle frequency (23%) of aerodynamic diameter (dae) was 1.7 microm. Particulate sulfate (SO(4)(2-)), nitrate (NO(3)(-)), chloride (Cl(-)), ammonium (NH(4)(+)) and lead components of suspended dust averaged 2960, 28, 1350, 100 and 13.3 microg m(-3), respectively. Viable fungi associated with suspended dust and that in air averaged 1.11 x 10(6) colony forming unit per gram (cfu g(-1)) and 92 colony forming unit per plate per hour (cfu p(-1) h(-1)), respectively. Cladosporium(33%), Aspergillus(25.6%), Alternaria(11.2%) and Penicillium(6.6%) were the most frequent fungal genera in air, whereas Aspergillus(56.8%), Penicillium(10.3%) and Eurotium(10.3%) were the most common fungal genera associated with suspended dust. The detection of Aureobasidium, Epicoccum, Exophiala, Paecilomyces, Scopulariopsis, Ulocladium and Trichoderma is an indication of moisture-damaged building materials. Alternaria, Aureobasidium, Cladosporium, Scopulariopsis and Nigrospora have dae > 5 microm whereas Aspergillus, Penicillium and Verticillium have dae < 5 microm which are suited to penetrate deeply into lungs. Particulate matter from the working area infiltrates the occupied zones if precautionary measures are inadequate. This may cause deterioration of IAQ, discomfort and acute health problems. Renovation should be carefully designed and managed, in order to minimize degradation of the indoor and outdoor air quality.

Antimalarial drug resistance in the Eastern Mediterranean Region.

Studies done between 1997 and 2003 are reviewed to give an overall picture of antimalarial drug resistance in the Eastern Mediterranean Region of the World Health Organization (WHO). The situation in 8 countries where resistance has been reported is detailed. It has been difficult to abandon chloroquine as first-line treatment even though resistance to it is widespread. Resistance to sulfadoxine-pyrimethamine has also been detected. The spread of resistance could be slowed down by the adoption of effective national policies and control programmes. Coordination between counties and with other WHO regions, as opposed to working in isolation, could further reduce the spread of resistance.

Antimalarial drug resistance in the Eastern Mediterranean Region

Studies done between 1997 and 2003 are reviewed to give an overall picture of antimalarial drug resistance in the Eastern Mediterranean Region of the World Health Organization [WHO]. The situation in 8 countries where resistance has been reported is detailed. It has been difficult to abandon chloroquine as first-line treatment even though resistance to it is widespread. Resistance to sulfadoxine-pyrimethamine has also been detected. The spread of resistance could be slowed down by the adoption of effective national policies and control programmes. Coordination between counties and with other WHO regions, as opposed to working in isolation, could further reduce the spread of resistance

Suspended particulates and bioaerosols emitted from an agricultural non-point source.

Suspended particulate and bioaerosol levels were measured at three sites downwind of an agricultural non-point source during the wheat harvesting season. Suspended particulates were detected at mean values ranging from 10000 to 2420 micrograms m-3 at distances of from 20 to 60 m downwind of the source, respectively. Airborne viable bacterial counts were recorded at mean values ranging between 10(4) and 10(6) colony forming units (cfu) m-3, whereas, Gram negative (Gram -ve) bacteria varied between 10(3) and 10(5) cfu m-3. Fungi levels were detected at mean values varying between 10(5) and 10(6) cfu m-3. However, streptomycetes were found at lower counts than those recorded for viable bacteria and fungi. Total viable bacteria, Gram -ve bacteria, fungi and streptomycetes associated hay fragments were determined at mean values of 1.5 x 10(6), 1.6 x 10(3), 2.2 x 10(4) and 6 x 10(3) cfu g-1 of hay, respectively. Cladosporium, white and red yeasts as well as Alternaria were the predominant airborne fungi, whereas, Alternaria was the dominant species associated with hay fragments. Pseudomonas, Acinetobacter and Enterobacteriaceae were the dominant Gram -ve bacteria. The most common fungal genera, such as Cladosporium and Fusarium (minor short axis), as well as Streptomyces species have an aerodynamic diameter (dae) of less than 5 microns, which can penetrate and deposit in the alveoli. Farmers and nearby residents are exposed to high levels of organic dust and bioaerosols during the wheat harvesting season. This may cause health problems in exposed persons based on toxic or allergic reactions.

Sentinel posts for monitoring therapeutice efficacy of antimalarial drugs against Plasmodium falciparum infections in the Sudan.

A protocol for assessment of the therapeutic efficacy of chloroquine against Plasmodium falciparum malaria was evaluated in Sudan. An in vivo test was implemented in five sentinel posts in areas of unstable malaria during the transmission season. A standard dose of oral chloroquine was administered to a random sample of patients with uncomplicated falciparum malaria attending primary health care units and they were followed-up for clinical and parasitological response for 14 days. Designations of "early treatment failure", "late treatment failure" and "adequate response" were based on clinical and parasitological criteria. Data analysis for prevalence of resistance was done for each individual sentinel post, using two-stage Lot QualityAssurance Sampling. At 95% confidence level and 80% power, the prevalence of chloroquine resistance was found to be 25% in all five posts. It is concluded that the protocol was simple and easily applicable at the peripheral level and could be the basis for sentinel post's for continuous monitoring of malaria drug resistance in the whole country.

Household expenditure on malaria case management in Wad-Medani, Sudan.

This study was done in Wad-Medani town in the central Sudan. A household survey and a hospital survey were conducted using structured questionnaires to assess household expenditure on malaria case management. A total of 360 cases of malaria were reported in the household survey. They were assessed by a questionnaire focused on household income daily expenditure and resources), with special attention to treatment and cost incurred. Also, a random sample of malaria cases hospitalized in the medical, obstetrical and paediatric wards in Wad-Medani hospitals were interviewed, comprising 75 adult patients and 75 children. Cases in the house survey were treated in health centers, private clinics, health insurance facilities or by self-medication. The mean expenditure on diagnosis and treatment of an episode of malaria was US dollars 5.12 for home-treated cases and US dollars 17.2 for a hospitalized case, representing a significant economic burden to family income. This cost varied according to type of treatment, type of health care provider and in hospitalized versus home-treated cases.

Malaria case management at the community level in Gezira, Sudan.

This study was done to investigate malaria case management at the community level in Gezira, Sudan, which is an area of unstable malaria predominantly due to Plasmodium falciparum. Questionnaire surveys were conducted at four consecutive weekly intervals in October 1995. A sample of 400 households (3062 persons) including 200 rural and 200 urban households was studied. Use of antimalarials was assessed in terms of diagnosis, types of antimalarial used, self-medication and compliance. During the four weeks of observation, 25.1% of the rural population and 35.6% of the urban population received at least one course of antimalarial drugs. Diagnosis was confirmed microscopically in 81.7% of treated persons in the urban community and in only 34.3% those treated in the rural community. Chloroquine is the most frequently used antimalarial in both communities with notable overuse of injections in rural patients and in patients treated by paramedical health workers. Self-medication was commoner in rural than in the urban population (41.2% versus 23.9%). Compliance with the standard therapeutic doses was poorest with quinine and best with sulfadoxine/pyrimethamine. It is suggested that interventions to improve the use of antimalarials should include health education, training of health workers and dissemination of national treatment policies.

Organic dust and gaseous contaminants at wood working shops.

Airborne dust bioaerosols, ammonia and formaldehyde levels were determined inside two different (ventilated and unventilated) wood working shops. Airborne dust was found at mean values of 4.3 and 3.01 mg m(-3). These levels were higher than that recommended by Egyptian environmental law [1 mg m(-3) indoor maximum allowable concentration (MAC) for hard wood]. The highest frequency of aerodynamic size distribution of airborne wood dust was detected at a diametre of 4.9 microm which was recorded during a machining operation. Total viable bacteria were recorded at a mean value of 10(4) colony-forming units (cfu) m(-3), whereas Gram-negative bacteria were found at very low counts (10(1) cfu m(-3)). Fungi levels were recorded at mean values of 10(3) and 10(2) cfu m(-3) in ventilated and unventilated shops, respectively. Penicillium, Aspergillus, Cladosporium and yeast species were dominant isolates. Moreover, actinomycetes were found at a mean value of 10(3) cfu m(-3) at both workshops. Ammonia was detected in relatively low concentrations (mean values of 457 and 623 microg m(-3)), whereas formaldehyde was found in relatively moderate concentrations (mean values of 0.42 and 0.64 ppm).

Evaluation of airborne lead in the welding working environment.

Manual and automatic welding machines (which use leaded alloys) are considered to be important sources of the emission of lead fumes into the general air of the working environment. Three workplaces at a television factory were selected for the present study, to determine the control class of the working unit. The concentrations of conventional measurements ("A" sampling points) were lower than the administrative control level (statutory standard of lead, 150 microg m(-3)), whereas the maximum concentration of 264.1 microg m(-3) ("B" sampling point) was higher at one working unit than the administrative control level. However, the control classes varied between class III (bad) and class I (good).

Indoor and outdoor formaldehyde concentrations in homes in residential areas in Greater Cairo.

Indoor and outdoor measurements of formaldehyde were conducted at seven flats located in residential areas in Greater Cairo, during spring and summer seasons 1999. The mean daytime formaldehyde concentrations in kitchens, bedrooms and living rooms were 89, 100 and 100 ppb, respectively, in the seven flats. Significant positive correlations were found between the concentrations of formaldehyde found in these three rooms. On the other hand, no significant differences were found between the mean formaldehyde concentrations in these three rooms. The maximum mean concentration of formaldehyde (147 ppb) was recorded in a new flat, while the minimum concentration (43 ppb) was observed in an old flat. The maximum hourly and daytime concentrations were 350 and 225 ppb, respectively. Air temperature, relative humidity and the age of the flat are factors affecting the emission and concentration of formaldehyde. The maximum indoor and outdoor formaldehyde concentrations were recorded during the summer season. During the spring, 38% of the samples indicated that the concentration of formaldehyde in the seven flats exceeded 0.1 ppm, the American Society of Heating, Refrigerating, and Air Conditioning Engineers' (ASHRAE) standard; in the summer, this figure increased to 53%.

Student assessment in community settings: a comprehensive approach.

Student assessment in community settings presents problems for medical teachers, e.g., difficulties in assessing the contribution of individual members to group work, and lack of test standardization due to varying field conditions. The Faculty of Medicine, University of Gezira, Sudan is a community-oriented, community-based medical school which has adopted a comprehensive approach to student assessment in community settings using various methods, including peer assessment, a supervisory checklist, community feedback, reports from students, short essay questions (SEQs) and multiple choice questions (MCQs). Each method focuses on a specific aspect of the objectives of the community-based programme and is weighted in the final grade according to the extent to which objectives were covered. This assessment programme contrasts with the conventional teacher-centred approach, and is continuously monitored and improved using a variety of sources of information. A total of 105 students participated in a study designed to measure the reliability and validity of this approach. The reliability of the methods was tested by computing the alpha coefficient and was found to range between 0.77 and 0.92. This was considered acceptable. The validity of the instruments was examined using confirmatory factor analysis, and their content validity was reviewed. The results show that the comprehensive approach used is fairly valid. It is suggested that the University's approach is successful in solving some of the problems of student assessment in community settings.