Prevalence and clinical presentation of Cryptococcal meningitis among HIV seropositive patients

A total of 573 HIV seropositive and clinically suspected cases of Cryptococcal meningitis were included in the study, from January 2006 to January 2007. CSF samples were processed by negative staining with 10% Nigrosin, cultured on Sabouraud's dextrose agar, biochemical tests, such as urease test and brownish growth in Niger seed agar. The prevalence of Cryptococcal meningitis was found to be 2.79%. The most common signs and symptoms were: fever (100%), headache (100%), altered sensorium (100%), and neck stiffness (90%). All the patients responded to intravenous Amphotericin B treatment.

Patients' attitude towards the use of a chaperone in breast examination

INTRODUCTION

The aim of this study was to assess the attitude and the preferences of patients towards the use of a chaperone during breast examination.

PATIENTS AND METHODS

A two-part questionnaire was circulated among 204 consecutive new patients, attending both symptomatic breast and screened assessment clinics.

RESULTS

A total of 200 questionnaires were fully completed and returned. Although 104 (52%) patients felt that they did not need a chaperone during breast examination, 65 (33%) preferred to have one. Amongst these 65 patients, the majority (52%) wanted a chaperone in the presence of both a male and female doctor whereas 19 (29%) wanted a chaperone in the presence of a male doctor. When patients were asked which person would be the best chaperone for them, 63 patients (32%) preferred their spouse to act as a chaperone, whereas 57 (29%) preferred a clinic nurse. However, the majority of teenagers and young adults (10-30 years) preferred their parents to act as a chaperone. On asking the reason for preferring a chaperone during breast examination, 69% felt a chaperone helped them to feel more at ease, 28% felt they get more support, 23% get less embarrassed and 10% felt safer. The majority (54%) preferred the nurse to offer a chaperone instead of the doctor (22%). Patients generally said they were comfortable in asking for a chaperone (68%). Overall, 68% of patients considered the offer of a chaperone as a sign of respect and the majority felt the attitude (32%) and gender (20%) of the clinician are the two most important factors influencing the chaperone use. Most patients were of the opinion that the presence of a chaperone does not have a negative effect on the doctor-patient relationship (75%), patient confidentiality (74%) and do not cause embarrassment (68%). Following their assessment in clinic, the patients' views on the use of a chaperone were not significantly changed.

CONCLUSIONS

There is a wide variety of opinion among patients about the desirability of a chaperone during breast examination. However, the majority consider the offer of a chaperone as a sign of respect and many patients commented that the presence of a chaperone is important for medicolegal protection of both patient and clinician. In recent years, there has been an increasing call from medicolegal societies and medical insurance companies for greater use of chaperones during intimate examinations. We feel that recommendations regarding the use of a chaperone should now be incorporated into the British Association of Surgical Oncology guidelines.

Lack of conformity between Indian classroom furniture and student dimensions: proposed future seat/table dimensions

Children spend one-quarter of a day in school. Of this, 60-80% of time is spent in the classroom. Classroom features, such as workspace and personal space play an important role in children's growth and performance as this age marks the period of anatomical, physiological and psychological developments. Since the classroom is an influential part of a student's life the present study focused on classroom furniture in relation to students' workspace and personal space requirements and standards and was conducted in five schools at Mumbai, India. Dimensions of 104 items of furniture (chairs and desks) were measured as were 42 anthropometric dimensions of 225 students from grade six to grade nine (age: 10-14 years). Questionnaire responses of 292 students regarding the perceived adequacy of their classroom furniture were collected. Results indicated that the seat and desk heights (450 mm, 757 mm respectively) were higher than the comparable students' anthropometric dimensions and that of the recommendations of Bureau of Indian Standards (BIS) (340 + 3 mm, 380 + 3 mm seat-heights, 580 + 3 mm 640 + 3 mm desk-heights) as well as Time-Saver Standards (TSS) (381.0 mm seat-height and 660.4 mm desk-height). The depth of the seats and the desks (299 mm, 319 mm, respectively) were less than comparable students' anthropometric dimensions and the recommendations of BIS (IS 4837: 1990). Students reported discomfort in shoulder, wrist, knee and ankle regions. Based on the students' anthropometric data, proposed future designs with fixed table-heights and adjustable seat-heights along with footrests were identified.

Ras pathway activation in malignant mesothelioma

INTRODUCTION

Mutations in Ras family genes are rare in malignant mesothelioma. The role of activation of the Ras signaling pathway in the pathogenesis of mesothelioma is not clear.

METHODS

We studied the activation status of the Ras pathway and the status of other Ras-associated kinases in a panel of human mesothelioma cell lines. In addition, we tested the effect of inhibition of several kinase pathways on mesothelioma cell proliferation. The potential role of kinase signaling on the regulation of cap-dependent translation was also studied.

RESULTS

In general, Ras-guanosine triphosphate (GTP) was higher in mesothelioma cell lines when compared with a nontransformed mesothelial cell line (LP9). Furthermore, known Ras effectors such as extracellular-regulated kinase 1/2, p38 mitogen-activated protein kinase, and c-Jun N-terminal kinase were found to be active in most of the mesothelioma cell lines tested. Exposure to specific inhibitors of extracellular-regulated kinase 1/2 (U0126) and c-Jun N-terminal kinase (SP600125) significantly decreased the proliferation of H2596 and H2373 cells compared with mock-treated cells. SP600125-mediated c-Jun N-terminal kinase inhibition, but not extracellular-regulated kinase 1/2 inhibition, resulted in a decrease in phosphorylation of 4E-BP1, consequently decreasing cap-dependent activation.

CONCLUSIONS

These experiments provide a rationale for targeting Ras and associated signaling pathways in mesothelioma and also suggest cap-dependent translation as one mechanism by which Ras induces proliferation in this disease.

Traumatic pulmonary pseudocysts

We describe a case of a 19-year-old man who developed traumatic pulmonary pseudocysts after a rollover road traffic crash. These were associated with significant pulmonary haemorrhage requiring a period of mechanical ventilation, but resolved without specific intervention. Review of the literature confirms that this rare complication of blunt chest trauma occurs usually in young adults and, although normally benign, can be associated with life-threatening haemoptysis and secondary infection.

Lipid abnormalities in hypertensive urban population of dibrugarh district of upper assam

AIMS

This study aimed to ascertain the prevalence of hypertension among an urban population of Dibrugarh district in Upper Assam and to study the profile of lipid abnormalities in the hypertensives.

METHODOLOGY

The study was conducted for a period of one year - from 1 April 2003 to 31 March 2004, and covered 1005 persons selected from a population of approximately 200,000 urban dwellers of Dibrugarh town in Upper Assam. Hypertension was defined on the basis of the Joint National Committee VII criteria and dyslipidemia on the basis of the Adult Treatment Panel III guidelines. The fasting lipid profile was determined for hypertensives as well as controls who did not have hypertension.

RESULTS

The prevalence of hypertension in the selected population was found to be 27.9%, of which 54% of those with hypertension also had dyslipidemia. The maximum incidence of hypertension as well as dyslipidemia was observed in the age group of 50-59 years. Of the hypertensives, 34.4% had an elevated level of total cholesterol (>/= 200 mg%), 25.2% had elevated triglycerides (>/= 200 mg%), 33.1% had elevated low-density lipoprotein-cholesterol (>/= 130 mg%), and 22.5% had a low high-density lipoprotein cholesterol level (< 40 mg%).

CONCLUSION

The prevalence of hypertension in this population was higher than the national average of 23%. Dyslipidemia was present in 54% of the hypertensives. Most hypertensives were smokers or alcoholics, and had a higher body mass index than the normotensives and a positive family history. These findings suggest the possibility that this population would be relatively more vulnerable to coronary and cerebrovascular diseases.

A clinico-serological study of neurocysticercosis in patients with ring enhancing lesions in CT scan of brain

AIMS OF THE STUDY

To study the clinical profile of neurocysticercosis and the utility of serological test using enzyme linked immunosorbent assay (ELISA) in patients with ring enhancing lesions in CT scan of brain.

METHODS

A total of 51 patients presenting between April 2003 to March 2004 to the Assam Medical College and Hospital, Dibrugarh, with ring enhancing lesions in CT scan of brain suggestive of neurocysticercosis were included in the study. Serum samples for ELISA test were taken from all patients and controlled sera were taken from 20 patients admitted in the ward, who did not have clinical evidence of cysticercosis and whose CT scan of brain were either normal or revealed lesion other than cerebral cysticercosis.

RESULTS

The maximum incidence of neurocysticercosis was found in the age group between 21 and 30 years (43.41%). Seizures were the commonest clinical presentation (100%). Eleven patients (21.56%) had ring enhancing lesions with central scolex. Fourty patients (78.44%) showed only ring enhancing lesions. ELISA test for definitive neurocysticercosis showed a sensitivity of 82.60% and specificity of 100%, while patients with CT scan features of neurocysticercosis had a sensitivity of 78.43% with ELISA.

CONCLUSION

ELISA for cysticercosis showed a sensitivity of 82.60% and specificity of 100%. The study also shows that therapeutic effectiveness with albendazole is quite satisfactory. As the study population is small in number which was conducted in a span of one year, an evaluation with a larger number of patients will definitely throw more light on the subject.

AT4 receptor activation increases intracellular calcium influx and induces a non-N-methyl-D-aspartate dependent form of long-term potentiation

The angiotensin 4 receptor (AT4) subtype is heavily distributed in the dentate gyrus and CA1-CA3 subfields of the hippocampus. Neuronal pathways connecting these subfields are believed to be activated during learning and memory processing. ur laboratory previously demonstrated that application of the AT4 agonist, Norleucine1-angiotensin IV, enhanced baseline synaptic transmission and long-term potentiation, whereas perfusion with the AT4 antagonist, Norleucine1-Leu3-psi(CH2-NH2)3-4-angiotensin IV disrupted long-term potentiation stabilization in area CA1. The objective of the present study was to identify the mechanism(s) responsible for Norleucine1-angiotensin IV-induced increase in hippocampal long-term potentiation. Hippocampal slices perfused with Norleucine1-angiotensin IV for 20 min revealed a notable increase in baseline responses in a non-reversible manner and were blocked by the alpha-amino-3-hydroxy-5-methyl-4-isoxazole propionate receptor antagonist, 6-cyano-7-nitroquinoxaline-2,3-dione disodium salt. Infusions of Norleucine1-angiotensin IV prior to, but not after theta burst stimulation, significantly enhanced long-term potentiation compared with control slices. Further, N-methyl-D-aspartate receptor-independent long-term potentiation could be induced by tetanization during the perfusion of Norleucine1-angiotensin IV in the presence of the N-methyl-D-aspartate antagonist, D,L-2-amino-5-phosphonovaleric acid. Blockade of select voltage dependent calcium channels significantly reduced Norleucine1-angiotensin IV-induced increase in baseline responses and subsequent long-term potentiation suggesting that AT4 receptor activation increases intracellular calcium levels via altering voltage dependent calcium channels and triggers an N-methyl-D-aspartate-independent form of long-term potentiation. In support of this notion the application of Nle1-angiotensin IV to cultured rat hippocampal neurons resulted in increased intracellular calcium derived exclusively from extracellular sources. Consistent with these observations Nle1-angiotensin IV was capable of augmenting the uptake of 45Ca2+ into rat hippocampal slices. Taken together, these data indicate that increased calcium influx through postsynaptic calcium channels contribute to Norleucine1-angiotensin IV-induced enhancement of long-term potentiation.

Diagnostic role of stool culture & toxin detection in antibiotic associated diarrhoea due to Clostridium difficile in children

BACKGROUND & OBJECTIVE

Mere diagnosis of Clostridium difficile by culture does not help in the diagnosis of antibiotic associated diarrhoeae (AAD) due to C. difficile. Detection of toxins A and B form the mainstay in the diagnosis of AAD due to C. difficile. This study was undertaken to find out the role of stool culture and toxin detection in the diagnosis of AAD due to C. difficile. As there are very few documented reports from India about AAD due to C. difficile in children in the age group of 5-12 yr, this age group was selected.

METHODS

Faecal samples were collected from 250 hospitalized children in the age group of 5-12 yr who developed diarrhoea on receiving antibiotics for different medical problems for more than five days duration. Also faecal samples of 250 age and sex matched controls were collected. Culture for C. difficile was done on cycloserine cefoxitin fructose egg yolk agar (CCFA) and colonies were identified by standard laboratory techniques. ELISA for toxins A and B detection and tissue culture on HeLa cells for toxin B detection were also done.

RESULTS

Overall positivity was 18 per cent in this study group compared to the controls (P<0.001). Maximum positive cases were in 5-8 yr age group (84.4%). Severe diarrhoea, liquid stool with mucus and blood, faecal leucocytes >5/high power field, altered flora and presence of Gram-positive bacilli with oval subterminal spores on Gram stain were sensitive predictors for diagnosis of AAD due to C. difficile. Amongst positive cases, 68.9 per cent responded to discontinuation of antibiotics and 31.1 per cent to metronidazole therapy.

INTERPRETATION & CONCLUSION

C. difficile was an important pathogen responsible for antibiotic associated diarrhoea (AAD) in children of 5-12 yr age group. Conservative use of antibiotics would be beneficial to decrease the incidence of AAD.

Interleukin-1beta stimulates growth hormone-releasing hormone receptor mRNA expression in the rat hypothalamus in vitro and in vivo

Changes in growth hormone-releasing hormone (GHRH), GHRH-receptor (R), somatostatin and interleukin (IL)-1beta mRNA levels were determined in fetal rat hypothalamic cultures after administration of IL-1beta (1, 10, 100 ng/ml, 2 h incubation), and in adult rat hypothalamus 5 h after intracerebroventricular injection of IL-1beta (2.5 and 25 ng). IL-1beta stimulated GHRH-R mRNA expression both in vitro (10 and 100 ng/ml) and in vivo (2.5 and 25 ng). Somatostatin mRNA was significantly stimulated and GHRH mRNA slightly reduced in vitro, while these mRNA species were not altered in vivo in response to IL-1beta. IL-1beta stimulated its own expression both in vitro (10 and 100 ng/ml) and in vivo (25 ng). IL-1beta-induced mRNA responses occurred 2 h after treatment in vitro (incubation times, 30 min to 6 h). IL-1beta also elicited slight GHRH releases in vitro. Up-regulation of hypothalamic GHRH-R by IL-1beta may explain previous findings suggesting that IL-1beta stimulates GHRH activity.

An observational study to detect leptospirosis in Mumbai, India, 2000

BACKGROUND

Leptospirosis is relatively uncommon in children. Following torrential rains and flooding an outbreak of leptospirosis was suspected in Mumbai.

AIMS

To investigate the possibility of an outbreak of leptospirosis and describe the clinical illness.

METHODS

From 24 July to 14 September 2000, children with a history of abrupt onset of high fever (>39 degrees C), who presented to our hospital, were admitted and tested serologically for anti-Leptospira antibodies by a quantitative enzyme linked immunosorbent assay (ELISA) test. An IgM titre of more than 20U/ml confirmed the diagnosis of leptospirosis. Clinical features in the confirmed leptospirosis and leptospirosis negative groups were analysed.

RESULTS

Of 53 children screened, 18 (34%) had leptospirosis. In all 18, the disease was anicteric and responded well to intravenous penicillin. Four clinical features present at the time of admission were significantly associated with leptospirosis: a history of contact with flood water (18/18 v 16/35), conjunctival suffusion (5/18 v 1/35), abdominal pain (9/18 v 5/35), and skin rash (5/18 v 1/35). As the number of these four features concomitantly present increased, the chances of the child having leptospirosis also increased significantly. A history of contact with flood water had a sensitivity of 100%, and the presence of conjunctival suffusion, abdominal pain, and skin rash had a specificity of 97%, 86%, and 97%, respectively, for identifying children with leptospirosis.

CONCLUSION

Leptospirosis should be suspected in febrile children with contact with flood water.