The development and evaluation of a community-based clinical diagnosis tool and treatment regimen for postpartum sepsis in Bangladesh and Pakistan

BACKGROUND

Postpartum sepsis accounts for most maternal deaths between three and seven days postpartum, when most mothers, even those who deliver in facilities, are at home. Case fatality rates for untreated women are very high. Newborns of ill women have substantially higher infection risk.

METHODS/DESIGN

The objectives of this study are to: (1) create, field-test and validate a tool for community health workers to improve diagnostic accuracy of suspected puerperal sepsis; (2) measure incidence and identify associated risk factors and; (3) describe etiologic agents responsible and antibacterial susceptibility patterns. This prospective cohort study builds on the Aetiology of Neonatal Infection in South Asia study in three sites: Sylhet, Bangladesh and Karachi and Matiari, Pakistan. Formative research determined local knowledge of symptoms and signs of postpartum sepsis, and a systematic literature review was conducted to design a diagnostic tool for community health workers to use during ten postpartum home visits. Suspected postpartum sepsis cases were referred to study physicians for independent assessment, which permitted validation of the tool. Clinical specimens, including urine, blood, and endometrial material, were collected for etiologic assessment and antibiotic sensitivity. All women with puerperal sepsis were given appropriate antibiotics.

DISCUSSION

This is the first large population-based study to expand community-based surveillance for diagnoses, referral and treatment of newborn sepsis to include maternal postpartum sepsis. Study activities will lead to development and validation of a diagnostic tool for use by community health workers in resource-poor countries. Understanding the epidemiology and microbiology of postpartum sepsis will inform prevention and treatment strategies and improve understanding of linkages between maternal and neonatal infections.

Abstract P2-09-04: Implementation of next generation cancer gene panel testing in a large HMO

Background: Next generation cancer gene panel testing is fairly new in clinical practice. Little is known about the diagnostic yield of multigene cancer panel testing in community based hospitals.

Objective: To describe characteristics of a diverse cohort who underwent high/moderate risk multigene panel testing for either a personal or a family history of cancer in a large health plan, and report the proportion of pathogenic/likely pathogenic variants (PV/LPV) and variants of unknown clinical significance (VUS) by race/ethnicity.

Methods: Subjects included all 586 female patients who were referred for genetic counseling and underwent multigene panel testing between July 2014 and January 2015. Based on a literature review, the custom-designed high/moderate risk gene panel included 20 cancer susceptibility genes (described below). All tests were performed by the same commercial laboratory (GeneDx).

Results: Of the 586 women, 78 (13.3%) tested positive PV/LPV316 (53.9%) tested negative; and 192 (32.8%) carried one or more VUS. Age at testing ranged from 22-81 years (median 50 years). More women with PV/LPV results tended to be obese than those who tested negative (39.7% vs. 31.2%), and had greater comorbidity (Charlson Index of >3, 35.9% vs. 33.2%).

Of 586 women, 305 (52.0%) had a cancer diagnosis, mainly first primary breast cancer (n=290, 95.1%), while some also had a second primary breast cancer (n=67, 11.4%). Of the 305 women with cancer, 131 (42.9%) were diagnosed prior to the multigene testing implementation (1987-2013), while 174 (57.1%) were diagnosed after implementation.

The cohort was diverse in terms of race/ethnicity: Western/Northern European (31.2%), Latina/Caribbean (30.0%), Asian (14.8%), African-American (7.2%), Ashkenazi Jewish (6.3%), Native American (5.9%), and other (14.9%) (percent exceeds 100% due to mixed race/ethnicity). Of the 192 women who carried a VUS, 60.4% were Western/Northern European, and 46.4% were Latina/Caribbean. Pathogenic or likely pathogenic mutations were higher in Latina /Caribbean women (37.2%), followed by Western/Northern European (26.7%), and African (10.3%). We identified a total of 84 pathogenic mutations among the 78 women with PV/LPV in the following genes: BRCA1 (n=22), BRCA2 (n=17), MUTYH (n=16; all heterozygous), CHEK2 (n=9), ATM (n=4), PALB2 (n=4), PMS2 (n=3), MLH1 (n=2), VHL (n=2), and one mutation in each of the following genes: APC, CDH1, PTEN, TP53, and STK11. VUS were detected in 192 patients (32.7%) of the 586 tested. VUS in ATM (n=57), APC (n=32) and CHEK2 (n=25) comprised 59.4% of all VUS detected.

Discussion: The large percent of VUS was surprising, given that our panel included only high/moderate risk cancer genes. The over-representation of BRCA1/2 among all mutations (45.1%) likely reflected a greater proportion of patients referred for genetic counseling with a personal and/or family breast cancer history. Given that 35% of our positive results were dominant-acting pathogenic or suspected pathogenic mutations, our results suggest that multigene cancer panel testing is an appropriate method for detecting germline mutations in a high-risk cohort in a managed care setting.

Citation Format: Haque R, Alvarado M, Ahmed SA, Chung J, Tiller GE. Implementation of next generation cancer gene panel testing in a large HMO. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P2-09-04.

Autochthonous Hookworm-Related Cutaneous Larva Migrans Disease in Northeastern Italy: A Case Report

Here we report the case of a 42-yr-old patient who presented himself to us with a serpiginous erythematous lesion from the wrist of the right forearm up the arm to the right shoulder A similar lesion of a smaller size was also present in the left forearm. On the basis of clinical manifestations and progression of the lesion, combined with previous treatments and different diagnostic investigations, hookworm-related cutaneous larva migrans (HrCLM) disease was hypothesized. Albendazole was employed as treatment and the resolution of the symptoms confirmed the diagnosis. The relevance of the reported case relies on 3 main aspects: the acquisition of the disease in Italy, the initial treatment with topical corticosteroids that sped up the progression of the cutaneous trail, and the uncommon location of the lesions. Furthermore, the anamnestic data and the laboratory/clinical investigations strongly suggested an occupational exposure to the etiological agent. As illustrated here, HrCLM might represent a challenge for Western physicians in terms of diagnosis, treatment, and ways of acquisition. Describing the clinical presentation and the treatment of cases of cutaneous larva migrans might contribute to early and correct diagnosis, to an increase of our knowledge on this disease, and to an update on its epidemiology.

Carcinoid tumours in a tertiary hospital in northern Nigeria: morphological pattern and review of the literature

BACKGROUND

Carcinoid tumours are uncommon neuroendocrine neoplasms that may be found anywhere in the body but are most commonly seen in the gastro-intestinal and respiratory tracts and usually follow an indolent course. However, some tumours particularly the larger ones may metastasize to liver or regional lymph nodes. This study described the histological types of carcinoid tumors seen in a tertiary institution in Northern Nigeria.

METHODS

This is a retrospective study in which surgical biopsy specimens seen over a 10-year period were reviewed with respect to age, sex, site and histological type.

RESULTS

Five cases consisting of 1 endoscopic, 1 wedge, 3 hemicolectomy specimens were studied. There was a slight female preponderance with a female to male ratio of 1.5:1. The peak age of occurrence was the 6th decade of life (mean age was 36.4 years). Two cases were located in the large colon and a case each in the stomach, lymph node, and tongue. Three cases show trabecular pattern, while 2 cases were mixed pattern, in all the cases there are neither mitosis nor necrosis. These features are in keeping with typical carcinoids. Two out of the five cases were metastases to the lymph node and the tongue.

CONCLUSION

Carcinoid tumours are rare, slow-growing NETs that display a relatively indolent disease course. Carcinoid tumours are uncommon in our environment and the cases seen are of good prognostic type.

Synthesis, characterization and structure effects on selectivity properties of silica gel covalently bonded diethylenetriamine mono- and bis-salicyaldehyde and naphthaldehyde Schiff(,)s bases towards some heavy metal ions

Four silica gel-immobilized new metal chelate Schiff(,)s bases were synthesized (I-IV). Silica gel chemically bonded diethylenetriamine mono-naphthaldehyde and mono-salicyaldehyde Schiff's bases (phases I and III) were produced via the interaction of silica gel-modified diethylenetriamine with naphthaldehyde and salicylaldehyde, respectively. However, phases II and IV arose through the interaction of bis-naphthaldehyde and bis-salicylaldehyde Schiff(,)s bases of diethylenetriamine with 3-chloropropyltrimethoxysilane modified silica gel. The characterization of such new phases, their capabilities towards selective extraction or separation of Fe(III), Ni(II), Cu(II), Zn(II), Cd(II) and Pb(II) ions were studied and evaluated by both batch and column techniques as a function of pH and time of contact. Phases III and I showed high performance towards Cu(II) extraction, where their Cu(II) sorption determined to be 0.957 and 0.940 mmol g(-1), respectively. However, for phases IV and II, the great affinity was devoted to Fe(III) extraction followed by Cu(II) ions. The reactivity of metal ion sorption was discussed in the light of effects of bulkiness as well as orientation of immobilized chelate on sorbent reactivity. Donor sites of phases III and I (diethylenetriamine and azomethene nitrogens along with phenolic hydroxyl group oxygen) are fully active, whereas phases IV and II are partially active with only participation of oxygen and azomethene nitrogen. The order of increasing thermal stability (IV<II<I<III) and fastness of metal uptake equilibration process coincides satisfactorily with decreasing bulkiness of the chelate. Results of separation under dynamic conditions of binary mixtures containing Cu(II) with Ni(II), Zn(II), Cd(II) and Pb(II) using phase III are in accordance with its selectivity towards Cu(II) retention relative to the other coexisting ions.

Abstract P3-08-06: Triple Negative Breast Cancer and BRCA Status: Implications for Genetic Counseling

BACKGROUND: Controversy exists whether women newly diagnosed with triple negative breast cancer (TNBC) should be referred to genetic counseling as they may be more likely to be BRCA carriers. However, prior studies included small numbers of carriers and their results have had limited influence on practice guidelines. The objective of this study was to determine the association of breast cancer molecular subtype and BRCA status in a large group of medically insured women.

METHODS: We examined a cohort of 2,105 women with breast cancer history tested for BRCA mutations in a large California health plan from 1997–2011. BRCA test results were recorded in the health plan's clinical genetics registry. Of the 2,105 breast cancer patients, 249 were BRCA mutation carriers (143 BRCA1 carriers, and 106 BRCA2 carriers). We conducted data linkages of all patients with the health plan's NCI-SEER affiliated tumor registry and identified ER, PR, and HER2. HER2 status was also captured from pathology reports using natural language processing. ER, PR, and HER2 status were assessed by immunohistochemical or FISH techniques. Patients were classified into four main biologic subtypes: triple negative (ER−/PR−/HER2−); luminal A (ER+ and/or PR+/HER2−); luminal B (ER+ and/or PR+/HER2+); and HER2-enriched (HER2+/ER−). We examined the association between molecular subtypes (collapsed into TNBC vs. non TNBC categories) and BRCA1/2 mutation status using contingency table analyses. P-values (two-sided) were estimated using chi-square analysis. Multivariable logistic regression was used to estimated adjusted odds ratios (OR) and 95% confidence intervals.

RESULTS: TNBC subtype was strongly associated with BRCA status (P &lt; 0.0001). Women with TNBC tumors were five-fold more likely to be BRCA carriers than women who had non-TNBC breast tumors (OR = 5.6, 95% CI: 4.1–7.5). Specifically, the association of TNBC with BRCA1 was more robust (OR = 12.2, 95% CI: 8.3–17.9). Adjusting for age and stage of breast cancer diagnosis and race/ethnicity did not materially modify the association between TNBC and BRCA1 status. TNBC was not associated with BRCA2 status (OR = 1.6, 95% CI: 0.9–2.7).

Spectral shifting by dyes to enhance algae growth

The photosynthetic growth action spectrum of a green alga at three bands of visible light (blue, orange, and red) at fixed quanta input and under light-limiting conditions was measured in a batch cultivation system. Quantum efficiencies (biomass dry weight increment per quanta absorbed) were better in the yellow-red region than in the blue region. Results served as a basis for the design and optimization of a dye system that would shift the energy of solar radiation to the required wavelength range by absorbing ultraviolet to blue radiation and emitting in the yellow-red, thus enhancing algae growth. Direct incorporation of dyes into the growth medium, although theoretically expected to enhance growth, in fact resulted in dye decomposition, toxicity to algae and consequently in growth inhibition. Indirect application of dyes in a double tubular reactor (algae inside and dye solution outside) demonstrated growth enhancement for certain dyes with high quantum yields and stability, which had suitable absorption/emission spectra for artificial light sources used. The maximum indirect growth enhancement was obtained using rhodamine 6G at a concentration of 3x10(-5)M with tungsten filament lamp sources.

Physiological responses to temperature and haeme synthesis modifiers in earthworm Lumbricus terrestris (Annelida: Oligochaeta)

Earthworms (Lumbricus terrestris) acclimated at 2° and 6°C above their average habitat temperature (10°C) had respectively 15 and 40% higher rate of respiration than those at habitat temperature. At 14°C, the rate of respiration and blood hemoglobin (Hb) concentration both increased by ∼60 and 50%, respectively, of the values at habitat temperature. At higher temperatures the rate of respiration and Hb synthesis started decreasing. At 20-23°C, the respiration and Hb concentration decreased respectively by about 85% and 35% of that at 14°C. Decrease in blood Hb concentration at higher temperatures appeared to be due to the lowering of the activity of blood enzyme δ-aminolaevulinic acid dehydratase (ALAD). Exposure of 20-23°C-acclimated pale worms to ALAD inhibitor (lead), lowered the already compromised rate of respiration and blood Hb concentration; while exposure to hexachlorobenzene (HCB, inducer of haeme synthesis) and ferric chloride (enhancer of haeme synthesis) did not overcome the inhibitory effect of high temperature on Hb synthesis. At 20-23°C the affinity of Hb for oxygen also decreased as indicated by the lowering of oxy-Hb (HbO) concentration in blood. The lowering of concentration of blood Hb and its affinity for oxygen may lower the amount of oxygen delivered to cells, which may limit the level of aerobic metabolism (glycolysis, oxidative phosphorylation), as indicated by an increase in blood glucose concentration and a decrease in in vitro activities of mitochondrial electron transport system components (ETS) namely NADH-cytochrome c reductase, succinate dehydrogenase, cytochrome c oxidase, and ATPases. Although the oxygen concentration in air, at sea level, does not decrease significantly from 6° to 20-23°C (lack of hypoxia), lowering of both Hb and HbO concentrations by high temperature may cause significant hypoxemia. The latter may lead to inhibition of the activity of muscle mitochondrial respiratory enzymes (ETS). The resulting inhibition of ATP synthesis and hydrolysis may cause deficit of energy needed for peristalsis/fictive locomotion of body and heart muscles (as indicated by a decrease in heart rate) to facilitate diffusion and transport of gases. The upper critical temperature (20-23°C) also slows down the heart rate and causes hyperosmotic stress (hypovolemia). Thus, a rise in soil temperature above 18°C, which inhibits Hb synthesis, Hb oxygenation, and mitochondrial ETS activity, and slows down the heart rate and causes hyperosmotic stress, can make this and higher temperatures lethal to populations of these earthworms, especially in the presence of metabolic inhibitors and respiratory poisons.

Abdominal tuberculosis in surgical practice in northern Nigeria

BACKGROUND

Abdominal tuberculosis is a common complication of pulmonary tuberculosis. With the rising incidence of HIV, tuberculosis has become a major public health problem particularly in developing countries.

METHODS

This is a retrospective study involving patients whose surgical specimens were processed at the central histopathology laboratory of the Ahmadu Bello University Teaching Hospital (ABUTH) Zaria--Nigeria, between January 1975 to December 2006.

RESULTS

There were 68 males and 49 females, aged 12-70 years (mean 28.6 yrs 11 yrs). While paroxysmal dry cough was present in about 20 patients, abdominal pain and distension were very common. Concomitant pulmonary tuberculosis was confirmed in 15 patients (14%). The findings at Surgery in 66 patients are presented in fig. 2. Multiple deposits on the peritoneum and omentum were the commonest findings (48.7% and 26.2%) respectively

CONCLUSION

Abdominal tuberculosis is not uncommon and there is need to establish an early less invasive diagnostic protocol.

Zidovudine induced pure red cell aplasia: a case report

BACKGROUND

Zidovudine, a Nucleoside Reverse Transcriptase Inhibitor (NRTI) is one of the earliest antiretroviral agents used as a combination in the Highly Active Antiretroviral Therapy (HAART) for the treatment of HIV infection. Its use is however not without adverse effect particularly bone marrow aplasia leading to varying degrees of cytopenias predominantly anaemia. This calls for adequate evaluation and monitoring of patients on this drug. Its major side effect of anaemia limits its use in some patients. We report a case of Zidovudine induced anaemia and bone marrow aplasia in a patient infected with HIV.

METHOD

The Hospital case note of a 27 year old widow with HIV infection and anaemia, who has been on HAART (Zidovudine, Lamivudine and Nevirapine) for one year, was reviewed.

RESULT

She presented with severe anaemia (PCV of 0.05), White cell and platelet counts were within normal limits and reticulocyte count of 0.001%. Bone marrow aspiration and biopsy were diagnostic of pure red cell aplasia on a background hypocellular marrow. She was transfused with four (4) units of packed cells and Zidovudine was replaced with Stavudine. She made remarkable improvement and remains transfusion independent afterwards.

CONCLUSION

Zidovudine is well a known cause of anaemia and thus should be used with caution in the initiation of antiretroviral therapy.

Response rate of Malaysian blood donors with reactive screening test to transfusion medicine unit calls

Blood donors with reactive screening test results are requested to come in for counseling by letter and telephone call. It has been noticed many donors responded to neither the letters nor the telephone calls. We evaluated 589 cases with reactive screening test results (208 positive for hepatitis C, 209 for hepatitis B, 85 for VDRL and 87 for HIV). In the hepatitis C positive group 61 donors (29.3%) did not respond and 4.7% missed their follow-up appointment. Similarly low response rates were noted with the HBV (58.9%) and VDRL (67.1%) positive groups. Among HIV positive donors 46.0% failed to respond to multiple calls. We conclude that blood donors in Malaysia have a poor response to calls from the blood transfusion unit. A review of the effectiveness of the current deferral system and an increased public knowledge of transmissible infectious diseases may encourage blood donors to have a better response rate.

Sputum neurokinin A in Egyptian asthmatic children and adolescents: relation to exacerbation severity

BACKGROUND

Neurogenic inflammation may participate in the development and progression of bronchial asthma. The molecular mechanisms underlying neurogenic inflammation are orchestrated by a large number of neuropeptides including tachykinins such as neurokinin A (NKA) and substance P. Tachykinins are secreted from sensory airway nerves and inflammatory cells after allergens exposure. In clinical practice, assessment of airway inflammation is difficult. Therefore, detection of biological markers of airway inflammation in sputum might offer help for proper monitoring of asthma severity.

AIM OF THE STUDY

We aimed to measure sputum NKA in relation to acute asthma exacerbations of varying severity.

METHODS

Sputum NKA was measured by enzyme-linked immunosorbent assay in 24 children and adolescents during and after acute asthma exacerbation and 24 healthy matched controls.

RESULTS

Sputum NKA was significantly higher in asthmatic patients during acute exacerbation than controls [217.5 (284) vs 10 (7) ng/ml, P < 0.001]. When patients with acute asthma exacerbation were followed-up till remission, sputum NKA levels decreased significantly, but they remained significantly higher than controls. Sputum NKA levels were significantly higher in severe than moderate and in moderate than mild exacerbations, and was negatively correlated to peak expiratory flow rate (r = -0.9, P < 0.001). Sputum NKA had significant positive correlations to eosinophil counts in blood and sputum (r = 0.6, P < 0.001 and r = 0.7, P < 0.001 respectively).

CONCLUSIONS

Sputum NKA is up-regulated during acute asthma exacerbation and it positively correlates to its severity. Thus, NKA may aid in objective classification of the exacerbation severity. In addition, NKA may be a target for new asthma therapy.

Blood pre-donation deferrals--a teaching hospital experience

Blood donor selection contributes to the safety of both the donor and the recipient. The objective of this study was to identify the number and causes of blood pre-donation deferrals at the Hospital Universiti Sains Malaysia (HUSM). A retrospective study was carried out to retrieve data regarding deferred blood donors at the HUSM in the year 2006. A total of 4,138 blood donors donated blood at the Transfusion Medicine Unit, of whom 231 were deferred or rejected as donors. The percentage of deferred donors was 5.6%. The main reason for deferral was a low hemoglobin (40.7%), with females constituting the majority of those deferred. This was followed by high blood pressure (29.4%) and male donors were predominant in this group. Medical illness caused 15.6% of donor deferrals. The majority of deferred donors were regular donors (64.1%). We recommend setting new hemoglobin criteria for donor deferral according to the reference range obtained for the particular population. Most of the other deferrals were preventable by proper health care education and awareness.

Trends in hepatitis B virus infection among blood donors in Kelantan, Malaysia: a retrospective study

The objective of this study was to determine the prevalence and trends in hepatitis B infection among blood donors attending the Transfusion Medicine Unit at the Hospital Universiti Sains Malaysia, Kelantan, Malaysia. A retrospective study was carried out by reviewing the results of HBsAg among blood donors for the years 2000 to 2004. During this period, 44,658 blood donors were studied. We noted that there was a significant difference in the prevalence of hepatitis B infection between regular and first time donors. There was also a decreasing trend noticed in both study groups. The mean prevalence was significantly different between first time (1.83%) and regular donors (0.45%) (p < 0.005). There is a need to improve public awareness programs to lower the incidence of hepatitis B infection in the general population and consequently first time blood donors. Future studies are also required to determine the trends and outcomes of these programs.

Effect of temperature on heavy metal toxicity to earthworm Lumbricus terrestris (Annelida: Oligochaeta)

Earthworms (Lumbricus terrestris) acclimated at 2 degrees C above their habitat temperature (10-12 degrees C) showed about 5% increase in basal rate of oxygen consumption, which increased to about 38% in 14-16 degrees C- and 40% in 16-18 degrees C-, but decreased by 84% in 20-22 degrees C-acclimated worms. Temperature also increased the blood hemoglobin (Hb) concentration, which decreased slightly in 20-22 degrees C-acclimated worms. The worms acclimated at 20-22 degrees C showed their blood to be hypovolemic than that of 10-12 degrees C worms indicating dehydration. Pre-exposure of 10-14 degrees C-acclimated worms to sublethal concentrations of zinc, copper, and lead did not significantly affect the rate of respiration. However, at higher temperatures all these metals inhibited oxygen consumption; zinc, lead, and cadmium by approximately 11% and copper by approximately 18% of that at 14-16 degrees C. At 20-22 degrees C, the respiration was further inhibited, 36% by copper, 18% by cadmium, and approximately 10% by lead and zinc. Copper, lead, and zinc decreased the temperature-enhanced increase in blood Hb concentration at all temperatures. In 20-22 degrees C-acclimated worms heavy metal exposure slightly lowered the oxygen affinity of Hb as well as caused shifts in carbon monoxide difference spectra. The acute toxicity of these metals was not affected by a 2 degrees C rise in acclimation temperature but increased by 17% (lead), 33% (copper), and 5% (zinc) in 14-16 degrees C- and by 40% (lead), 149% (copper), and 132% (zinc) in 20-22 degrees C-acclimated worms. The increase in toxicity of metals caused by high temperatures may be due to limiting the scope of aerobic metabolism (oxygen extraction, transport, and utilization) via quantitative and qualitative effects on Hb. This terrestrial species appears to be tolerant of slight increases in habitat temperature, such as that expected with current global climate change.

Identification of hemoglobin AC heterozygote status in a Malay family: a decision between hemoglobin electrophoresis and high performance liquid chromotography

Thalassemia is a common public health problem among Malays. Hemoglobin C (Hb C) is a hemoglobin beta variant resulting from a single base mutation at the 6th position of the beta-globin gene leading to the substitution of glycine for glutamic acid. Hb C is commonly detected in West Africans and in African American but has not been reported in Malaysia. It can be falsely diagnosed as HbE trait in the Malaysian Thalassemia Screening Program which utilizes cellulose acetate hemoglobin electrophoresis. This is the first reported case of Hb AC heterozygote status in a Malay family, with unusual splenomegaly in one of the family members.

Effect of temperature on heavy metal toxicity to juvenile crayfish, Orconectes immunis (Hagen)

The acute toxicity of four selected heavy metals to juvenile crayfish Orconectes immunis (Hagen) (1-2 g wet body wt. each) at room temperature increased in the following order: cadmium (x3) < copper (x10) < zinc (x2) < lead. The toxicity of these metals to crayfish acclimated at 17, 20, 23/24, and 27 degrees C increased with temperature (by 7-20% between 20 and 24 degrees C and 14-26% between 20 and 27 degrees C) as judged by the lowering of LT(50) (time to kill 50% of test animals at a fixed concentration) values. A 4 degrees C rise in temperature (from 20 to 24 degrees C), which increased the toxicity of copper by about 7%, increased the rate of oxygen consumption by about 34%. Heavy metals inhibited the rate of oxygen consumption at all temperatures. In 20 degrees C-acclimated crayfish, copper caused about 17% inhibition of oxygen consumption compared to about 7-12% by other metals including the most toxic cadmium. A 3-4 degrees C rise in temperature tripled the inhibitory effect of copper (20%), cadmium and zinc (26 and 18%, respectively), but not of lead, on oxygen consumption. A 7 degrees C-rise in temperature (from 20 to 27 degrees C) increased the inhibitory effect of heavy metals, including lead, on oxygen consumption by up to 54% in the case of copper. The data indicate that rising global temperatures (currently 0.60 degrees C) associated with climate change can have the potential to increase the sensitivity of aquatic animals to heavy metals in their environment.

Thalassemia among blood donors at the Hospital Universiti Sains Malaysia

The aim of this study was to screen and identify the types of thalassemia among blood donors at the Hospital Universiti Sains Malaysia (HUSM). Thalassemia screening was performed by hemoglobin electrophoresis. A total number of 80 blood samples were obtained from donors at the Transfusion Medicine Unit, HUSM. The ethnic origins of the donors were Malays (n=73, 91.3%) and non-Malays (n=7, 8.75%). Males comprised 88.1% of the donors. Thalassemia was detected in 16.25% (n=13) of the blood donors. Of those with thalassemia, 46.2% (6/13) were anemic. Microcytosis and hypochromia were detected in 84.6% (n=l1) and 84.6% (n=l1) of these donors, respectively. The types of thalassemias detected were Hb E, 11.25% (n=9/80) and beta thalassemia trait, 5% (n=4/80). Among the thalassemias detected, the Hb E hemoglobinopathy was comprised of Hb E/ alpha-thalassemia (38.5%: n=5), Hb E /beta-thalassemia (23.1%: n=3), Hb E trait (7.6%: n=1) and beta-thalassemia (30.8%: n=4). In conclusion, screening for thalassemia trait should be included as part of a standard blood testing before blood donation. Further studies are required to look at the effects of donated thalassemic blood.

Temporal lobe involvement in Japanese encephalitis: problems in differential diagnosis

BACKGROUND AND PURPOSE

On MR imaging and CT, Japanese encephalitis (JE) shows lesions in the thalami, substantia nigra, basal ganglia, cerebral cortex, cerebellum, brain stem, and white matter, whereas temporal lobe involvement is characteristically seen in Herpes simplex encephalitis (HSE). Temporal lobe involvement in JE may cause problems in differentiating it from HSE. We undertook this study to show the temporal lobe involvement pattern in JE and highlight differentiating features from temporal lobe involvement in HSE.

METHODS

Sixty-two patients with JE underwent CT or MR imaging or both. MR imaging was done in 53 and CT in 53. The diagnosis of JE was confirmed by cerebrospinal fluid (CSF) IgM enzyme-linked immunosorbent assay.

RESULTS

Eleven (17.7%) patients showed temporal lobe involvement with abnormal MR imaging in all. All the patients showed hippocampal involvement. Two patients showed extension of lesions into the amygdala and uncus with insular involvement in 1. The rest of the temporal lobe was spared. All patients had thalamic and substantia nigra involvement with basal ganglia involvement in 7. Six of 9 CT scans were abnormal and the temporal lesions were seen in 2.

CONCLUSIONS

The temporal lobe involvement pattern is fairly characteristic and mostly involves the hippocampus, usually sparing the rest of the temporal lobe. This and the concurrent involvement of the thalami, substantia nigra (SN), and basal ganglia allow differentiation from HSE. However, if the temporal lobe involvement is more severe, laboratory tests may be the only way to differentiate it from HSE, and it may be prudent to start antiviral therapy in the interim period.

The prevalence of human cytomegalovirus seropositivity among blood donors at the Unit of Blood Transfusion Medicine, Hospital Universiti Sains Malaysia

Human cytomegalovirus (HCMV) is a species-specific DNA virus of the Herpetoviridae family. After a primary infection, HCMV persists in a latent form most probably in bone marrow progenitor cells or in peripheral blood monocytes. The virus can reactivate to result in shedding of the virus leading to virus dissemination and new infections. Immunocompromized patients are the ones most vulnerable to serious diseases occasionally acquired in blood transfusions. In a human population, HCMV seropositivity increases steadily with age to become approximately 100% in adults. This study was performed to detect seropositivity among regular blood donors in The Hospital of the Universiti Sains Malaysia, in the state of Kelantan. Using an enzyme immunoassay, it was found that 97.6% of blood donors were HCMV-positive. HCMV is highly prevalent and may be endemic in Kelantan. Hence, long-term strategies are required for the reduction of disease dissemination, and to prevent the exposure of immunocompromized patients to the virus.

Adolescent abuse in a community sample in Beni Suef, Egypt: prevalence and risk factors

Adolescent abuse was studied in 555 school students (mean age 15.6 +/- 1.5 years) selected by multistage random sampling in Beni Suef in 1998. Each student received a general physical examination and a pre-coded questionnaire to identify determinants of abuse. Prevalence of abuse was 36.6%. Emotional, physical, sexual and combined abuse prevalence was 12.3%, 7.6%, 7.0% and 9.7% respectively. Significant predictors of sexual abuse were hyperactive child, disabled child, disinterested mother, low birth order child or wasted child. For physical abuse, significant predictors were maternal disinterest, maternal education and injuries. Significant predictors of emotional abuse were overcrowding, disease and mistreatment by a teacher. Violent behaviour was reported for more than 20% of the emotionally and the sexually abused.

Expression, purification, and efficacy of the type A botulinum neurotoxin catalytic domain fused to two translocation domain variants

Clostridial neurotoxins are potent inhibitors of synaptic function, with the zinc-dependent proteolytic light chain (LC) portion of the toxin cleaving one of three neural SNARE proteins. In nature, the LC is expressed as a part of a much larger toxin and hemagglutinin complex, protecting it from environmental degradation and preserving its catalytic activity. We developed forms of the LC of type A botulinum neurotoxin (BoNT-A) with parts of the larger toxin gene, for use as reagents in high-throughput assays to screen for potential LC antagonists, to further elucidate the toxin's mechanism of action, and to study immunological responses to the toxin. Three BoNT-A constructs were engineered and expressed: the LC, LC with translocation region (LC+H(n)), and the LC with the belt portion of the translocation region (LC+Belt). Purification was optimized to a two-step process, with relatively high yields of all three constructs obtained. Activity assays showed all three constructs to be active, with the LC being the most active. Immunogenic protection against native BoNT-A toxin challenge was observed for all three constructs, with the best protection observed with the LC+H(n) and LC+Belt proteins.