Malaria, COVID-19 and angiotensin-converting enzyme 2: what does the available population data say?

The etiopathogenesis of COVID-19 and its differential geographic spread suggest some populations are apparently 'less affected' through many host-related factors that involve angiotensin-converting enzyme 2 (ACE2) protein, which is also the entry receptor for SARS-CoV-2. The role of ACE2 has been well studied in COVID-19 but not in the context of malaria and COVID-19. We have previously suggested how malaria might intersect with COVID-19 through ACE2 mutation and here we evaluate the currently available data that could provide a link between the two diseases. Based on the existing global and Indian data on malaria, COVID-19 and the suggested ACE2 mutation, the association could not be examined robustly, neither accepting nor refuting the suggested hypothesis. We strongly recommend targeted evaluation of this hypothesis through carefully designed robust molecular epidemiological studies.

Etiology of childhood diarrhoea among under five children and molecular analysis of antibiotic resistance in isolated enteric bacterial pathogens from a tertiary care hospital, Eastern Odisha, India

Background

Although, India has made steady progress in reducing deaths in children younger than 5 years, the proportional mortality accounted by diarrhoeal diseases still remains high. The present hospital based cross sectional study was carried out to understand the prevalence of various bacterial pathogens associated with the diarrhoea cases in under 5 years age group.

Methods

During, 1st September, 2015 to 30th November 2017, all the childhood diarrhoea cases (≤5 yrs) of SCB Medical College in Odisha, India were included in the study. Stool samples were collected and processed for the isolation of causative bacterial pathogen and the isolated bacterial pathogens were subjected to antibiotic sensitivity testing, molecular analysis of drug resistance. Clinical and demographic data were collected and analyzed.

Results

Three hundred twenty patients were enrolled in the study during the study period from whom 82 bacterial isolates were obtained indicating a proportional causality of 25.6% for bacterial diarrhoea among children in this region. Entero toxigenic E.coli (ETEC) accounted for majority of the cases and and more than 50% of the strains were found to be multi-drug resistant (resistant to more than 3 class of antibiotics). More than 50% of the strains were resistant to current choice of treatment like ciprofloxacin, ofloxacin and ceftriaxone and 2.4% being resistant to Imipenem. ESBL production was also observed in some of the strains and one isolate harboured the NDM-1 gene. Fluoroquinolone resistance was found to be linked with multiple mutations in the QRDR region followed by PMQR determinants.

Conclusion

The current study, to the best of our knowledge is first of its kind which demonstrated the etiology of bacterial diarrhoea in children less than 5 years old and identified diarrheogenic E. coli as the predominant enteropathogen in Odisha. Majority of the isolates being multi-drug resistance calls for a continuous surveillance system in the region which will be helpfulin identifying emerging resistance pattern and for developing suitable intervention stategies.

Association of Human Interleukin-35 Level in Gingival Crevicular Fluid and Serum in Periodontal Health, Disease, and after Nonsurgical Therapy: A Comparative Study

Background:

Innovating newer methods to diagnose a multifactorial disease such as periodontitis is always challenging for a clinician. Gingival crevicular fluid (GCF) which is closely associated with the periodontal tissue environment has been used a viable alternative to saliva for the diagnosis of periodontitis.

Aim:

The aim of the present study was to estimate and compare the interleukin-35 (IL-35) levels in GCF and serum among healthy, gingivitis, and chronic periodontitis (CP) individuals as well as to evaluate the effect of nonsurgical periodontal treatment (NSPT) on IL-35 level among patients with CP.

Settings and Design:

The study was conducted at the Department of Periodontics, Srirama Chandra Bhanja Dental College and Hospital, Cuttack, Odisha, India. It is a comparative study.

Materials and Methods:

A total of 60 participants were divided into healthy (Group I; n = 20), gingivitis (Group II; n = 20), and CP (Group IIIA; n = 20). GCF samples collected from each individual at baseline and 6 weeks after NSPT for Group III individuals (Group IIIB; n = 20) were quantified for IL-35 levels using enzyme-linked immunosorbent assay.

Statistical Analysis:

All analyses were performed using Shapiro–Wilk test, analysis of variance, Tukey's honestly significant difference post hoc test, and multiple regression analysis.

Results:

The mean IL-35 concentration in GCF was significantly high (P < 0.05) for Group IIIA (70.26 ± 4.0 pg/ml), as compared to Group I (54.81 ± 22.3 pg/ml) and Group IIIB (55.72 ± 10.2 pg/ml).

Conclusion:

In the present study, GCF and serum IL-35 concentration among CP individuals was highest among all the groups. Individuals receiving NSPT showed a significant reduction in IL-35 levels as compared to CP individuals.

Detection of inducible and constitutive clindamycin resistance among Staphylococcus aureus isolates in a tertiary care hospital, Eastern India

Introduction:

Clindamycin is an excellent drug for skin and soft tissue Staphylococcus aureus infections, but resistance mediated by inducible macrolide-lincosamide-streptogramin B (iMLS_B) phenotype leads to in vivo therapeutic failure even though they may be in vitro susceptible in Kirby–Bauer disk diffusion method.

Objective:

The study was aimed to detect the prevalence of iMLS_B phenotype among S. aureus isolates by double disk approximation test (D-test) in a tertiary care hospital, Eastern India.

Materials and Methods:

A total of 209 consecutive S. aureus isolates were identified by conventional methods and subjected to antimicrobial susceptibility testing by Kirby–Bauer disk diffusion method. Erythromycin-resistant isolates were tested for D-test.

Results:

From 1282 clinical specimens, 209 nonrepeated S. aureus isolates were obtained. Majority of isolates 129 (61.7%) were methicillin-resistant S. aureus (MRSA). There was statistically significant difference between outpatients 60.1% and inpatients 39.9% (P < 0.0001). From 209 S. aureus isolates, 46 (22%) were D-test positive (iMLS_B phenotype), 41 (19.6%) were D-test negative (methicillin sensitive [MS] phenotype), and 37 (17.7%) were constitutively resistant (constitutive macrolide-lincosamide-streptogramin B phenotype). The incidence of inducible, constitutive, and MS phenotype was higher in MRSA isolates compared to MS S. aureus (MSSA). The constitutive clindamycin resistance difference between MSSA and MRSA isolates were found to be statistically significant (P = 0.0086).

Conclusion:

The study revealed 22% of S. aureus isolates were inducible clindamycin resistant, which could be easily misidentified as clindamycin susceptible in Kirby–Bauer disk diffusion method. Therefore, clinical microbiology laboratory should routinely perform D-test in all clinically isolated S. aureus to guide clinicians for the appropriate use of clindamycin.

Primary actinomycosis of hand

Actinomycosis is a chronic granulomatous suppurative disease having the propensity for extension to the contagious tissue with the formation of multiple discharging sinus tracts. Primary actinomycosis of extremity is a very uncommon clinical entity and is commonly considered as a soft-tissue infection. We report here, a case of primary actinomycosis of the upper extremity in a 24-year-old male who was treated successfully with surgical excision and extended period of antimicrobial treatment.

Fungemia due to Trichosporon mucoides in a diabetes mellitus patient: a rare case report

Trichosporon species are widely distributed in nature and can occasionally belong to the human microbiota. For many years, Trichosporon beigelii, the only species of this genus, was found as the aetiological agent of superficial skin infection called white piedra. However, many cases of invasive trichosporonosis caused by different newly delineated species of Trichosporon have been published in increasing numbers in recent past years, especially in immunocompromised persons. We report a rare case of fungemia due to Trichosporon mucoides in a diabetes mellitus patient, which will add to the emerging list of trichosporonosis infections.

Prevalence of cryptococcal meningitis among people living with human immunodeficiency virus/acquired immunodeficiency syndrome in a Tertiary Care Hospital, Southern Odisha, India

Objective:

Cryptococcal meningitis (CM) caused by encapsulated opportunistic yeast Cryptococcus neoformans is an important contributor to morbidity and mortality in people living with human immunodeficiency virus/acquired immunodeficiency syndrome (PLHAs). Early diagnosis of such patients is the key to their therapeutic success. A retrospective study was conducted to evaluate the clinical features, laboratory findings, and prevalence of CM among hospitalized PLHAs in a tertiary care setting.

Materials and Methods:

A total of 112 clinically diagnosed CM patients were subjected to cerebrospinal fluid analysis and tests for human immunodeficiency virus antibodies by the standard laboratory operating procedures.

Results:

Out of 112, 16 showed a definite diagnosis of C. neoformans with the prevalence of 14.3%. Males in the age group of 21-40 years were most commonly affected than females. The clinical manifestations observed were fever and headache (100%), followed by altered sensorium (93.7%), neck stiffness (75%), and vomiting (62.5%). Overall, Cluster of differentiation 4 (CD4) T-lymphocytes count was <100 cells/μl except 1 case in which the CD4 T-lymphocytes count was 137 cells/μl. No concomitant cryptococcal and tubercular meningitis case was detected. All 16 patients responded initially to induction therapy of IV amphotericin B 1 mg/kg and fluconazole 800 mg daily for 2 weeks. Subsequently, 4 (25%) patients were lost for follow-up and 2 (12.5%) patients expired during their hospital stay.

Conclusion:

As the clinical and radiological pictures of CM are often non-pointing, routine mycological evaluation is necessary for early definite diagnosis and subsequent initiation of appropriate therapy as the majority of patients respond well to treatment if started early.

Drug resistant tuberculosis: a diagnostic challenge

Tuberculosis (TB) is responsible for 1.4 million deaths annually. Wide-spread misuse of anti-tubercular drugs over three decades has resulted in emergence of drug resistant TB including multidrug-resistant TB and extensively drug-resistant TB globally. Accurate and rapid diagnosis of drug-resistant TB is one of the paramount importance for instituting appropriate clinical management and infection control measures. The present article provides an overview of the various diagnostic options available for drug resistant TB, by searching PubMed for recent articles. Rapid phenotypic tests still requires days to weeks to obtain final results, requiring biosafety and quality control measures. For newly developed molecular methods, infrastructure, training and quality assurance should be followed. Successful control of drug resistant TB globally will depend upon strengthening TB control programs, wider access to rapid diagnosis and provision of effective treatment. Therefore, political and fund provider commitment is essential to curb the spread of drug resistant TB.

Urinary Tract Infection due to Paenibacillus alvei in a Chronic Kidney Disease: A Rare Case Report

Paenibacilli, the Gram positive, aerobic spore bearing bacilli are found normally in the environment. Though these organisms were not known to cause human disease, until recently; few species of this genus have been reported to cause infections in humans. We report here, a case of urinary tract infection in a 60-year-old chronic kidney disease patient due to this rare bacterium. The patient presented with complains of fever, dysuria, and flank pain. Routine and microscopic examination of urine revealed no abnormality except plenty of pus cells and albumin (1+). Bacterial culture showed significant bacteruria and the isolated bacteria was identified to be Paenibacillus alvei based on standard biochemical reactions.

Utilization of the prevention of parent-to-child transmission of HIV (PPTCT) services in a tertiary care hospital, Odisha, India

Aims: To assess seroprevalence of HIV among antenatal women and the extent of utilization of interventions to minimize the risk of mother-to-child transmission. Study Design: Descriptive cross-sectional study was carried out among antenatal women who attended integrated counseling and testing center (ICTC) of HIV. Sample sizes were determined from the number of pregnant women that attended ICTC. Place and Duration of Study: Data and samples were collected from a tertiary care hospital, Odisha, India during January 2009 to December 2012. Methodology: All pregnant women were counseled and tested for HIV by rapid test. All HIV-seropositive antenatal women (ANW) were linked to services and followed up for institutional delivery, single-dose nevirapine (sdNVP) prophylaxis, infant feeding options and testing of children at 18 months. Results: Out of 11,508 ANW registered and pretest counseled, 11,390 (98.97%) accepted HIV testing. Sixty women were found to be seropositive, thus showed seroprevalence rate of 0.53% (60/11,390). CD4 testing was carried out in all ANW and five (8.33%) were eligible for antiretroviral therapy (ART). Seven (11.67%) had opted for medical termination of pregnancy (MTP). All 48 ANW delivered institutionally, only 7 (14.58%) received cesarean delivery. Out of 46 live births, 5 (10.87%) ANW were on ART, 35/41 (85.37%) received sdNVP mother baby-pair prophylaxis and only 8/46 (17.39%) mother opted for replacement feeding. Twenty one children have reached 18 months till date and among them three (14.29%) were HIV-seropositive. All three were delivered vaginally, received sdNVP prophylaxis and were exclusively breast fed for 6 months. Conclusion: The HIV-seroprevalence rate among antenatal women was 0.53% and mother-to-child transmission (MTCT) rate was 14.29%. Reduction in MTCT rate needs pre or early antenatal HIV testing, prenatal antiretroviral medication, preference for cesarean delivery, 100% antiretroviral prophylaxis coverage and education on avoidance of breast-feeding. DOI: http://dx.doi.org/10.3329/bjms.v13i2.18300 Bangladesh Journal of Medical Science Vol.13(2) 2014 p.163-169

HIV counseling and testing in a tertiary care hospital in Ganjam district, Odisha, India

BACKGROUND

Human immunodeficiency virus (HIV) counseling and testing (HCT) conducted at integrated counseling and testing centers (ICTCs) is an entry point, cost-effective intervention in preventing transmission of HIV.

OBJECTIVES

To study the prevalence of HIV among ICTC attendees, sociodemographic characteristics, and risk behaviors of HIV-seropositive clients.

MATERIALS AND METHODS

It was hospital record-based cross-sectional study of 26,518 registered ICTC clients at a tertiary care hospital in Ganjam district, Odisha, India over a 4-year period from January 2009 to September 2012.

RESULTS

A total of 1732 (7.5%) out of 22,897 who were tested for HIV were seropositive. Among HIV-seropositives, 1138 (65.7%) were males, while 594 (34.3%) were females. Majority (88.3%) of seropositives were between the age group of 15-49 years. Client-initiated HIV testing (12.1%) was more seropositive compared to provider-initiated (2.9%). Among discordant couples, majority (95.5%) were male partner/husband positive and female partner/wife negative. Positives were more amongst married, less educated, low socioeconomic status, and outmigrants (P<0.0001). Risk factors included heterosexual promiscuous (89.3%), parent-to-child transmission 5.8%, unknown 3.1%, infected blood transfusion 0.8%, homosexual 0.5%, and infected needles (0.5%).

CONCLUSIONS

There is need to encourage activities that promote HCT in all health facilities. This will increase the diagnosis of new HIV cases. The data generated in ICTC provide an important clue to understand the epidemiology in a particular geographic region and local planning for care and treatment of those infected with HIV and preventive strategies for those at risk especially married, young adults, and outmigrants to reduce new infections.

A Rare case of Subcutaneous Mycosis due to Rhizoctonia solani

Rhizoctonia solani is a very common soil borne pathogen with a great diversity of host plants. A 52 year old lady presented with sole manifestation of subcutaneous swelling over the left leg for 3 months Pus was collected by aspiration revealed septate fungal hyphae. After culture on SDA at 25 C showed white cottony growth initially, progressed to buff colored to black colonies on further incubation. On LPCB mount we found septate hyphae with acute and right angled branching without any conidia and hyphal anastomosis which resembled features of Rhizoctonia solani. Patient was put on Fluconazole and responded well to the treatment. DOI: http://dx.doi.org/10.3329/bjms.v13i2.15060 Bangladesh Journal of Medical Science Vol.13(2) 2014 p.228-230

Seroprevalence of chikungunya in southern odisha

Background:

The emergence of chikungunya (CHIK) infection was observed in Odisha, India in 2006. Thereafter many cases with symptoms suggestive of CHIK were reported from different districts of Southern-Odisha. This study was aimed to know the seroprevalence, clinical presentations and seasonal trends of CHIK infection in this region.

Materials and Methods:

This study was conducted in a tertiary hospital of this region. Serum samples received in the Department of Microbiology from various districts of Southern-Odisha from April 2011 to March 2012 were included in the study. The samples were tested for CHIK and dengue Immunoglobin M (IgM) antibodies by enzyme-linked immunosorbent assay and malaria parasite by immunochromatographic test (ICT) method.

Results:

Out of the 678 serum samples tested, 174 were positive for CHIK, 15 for dengue and two samples were positive for both CHIK and dengue IgM antibodies. The most affected age group was 16-45 years. Females were more affected than males.

Conclusion:

The seroprevalence of CHIK among the suspected cases was 25.7%. Co-infection with CHIK and dengue was found to be 1.15%. The infection had spread to new areas during this outbreak.

Intestinal protozoans in adults with diarrhea

Background:

Diarrhea is one of the most common presenting complaints in human immunodeficiency virus-infected individuals.

Aims:

The study was designed to determine the magnitude of opportunistic and nonopportunistic intestinal parasitic infections among diarrheal patients and association between CD4⁺ T-cell counts and human immunodeficiency virus (HIV)-infected intestinal parasites.

Materials and Methods:

A cross-sectional study was conducted among 207 enrolled diarrheal patients attending HIV integrated counseling and testing center from January 2012 to December 2012. Stool samples were subjected to special modified Ziehl-Neelsen and chromotrope staining method for detection of opportunistic protozoans. Blood samples were also collected from all study subjects for HIV testing and CD4⁺ T-cell counts were estimated by only in HIV-infected patients.

Results:

Intestinal parasitic pathogens were detected in 46.1% HIV-infected patients and the major pathogens were opportunistic protozoans 32.2% (37/115), most common being Isospora belli 16.5% (19/115) followed by Cryptosporidium parvum 12.2% (14/115). In HIV noninfected diarrheal patients, major pathogens detected were Entamoeba histolytica/Entamoeba dispar 8.7% (8/92) and Ascaris lumbricoides 3.3% (3/92).

Conclusions:

The opportunistic intestinal protozoans especially I. belli and C. parvum were most commonly isolated in HIV-infected patients with diarrhea. Majority of the infections occurred in patients when a CD4⁺ T-cell counts were less than 200 cells/μl.

Disseminated Mycobacterium chelonae infection: Complicating a case of hidradenitis suppurativa

Mycobacteium chelonae is a rapidly growing atypical mycobacteria known to be pathogenic in humans. We report a case of Hidradenitis Suppurativa (HS) with diabetes complicated by infection of the lesions with Staphylococcus aureus and M. chelonae leading to non-healing and discharging lesions. HS is a rare, insidious and debilitating disease characterized by swollen, painful, inflamed lesions in the axillae, groin, and other parts of the body that contain apocrine glands. Discharge from HS lesions are often found to be sterile, however, polymicrobial bacterial colonization commonly occurs within sinus tracts which can lead to offensive smelling discharge, infection, cellulitis, and superinfection. The incidence of HS is very low and the association with M. chelonae makes it a rare and interesting case.

Frequency, risk factors, and antibiogram of Acinetobacter species isolated from various clinical samples in a tertiary care hospital in Odisha, India

BACKGROUND

For the past two decades, Acinetobacter spp. have emerged as an important pathogen globally in various infections.

OBJECTIVES

This study was conducted to determine the frequency, risk factors, and antibiotic resistance pattern of Acinetobacter spp. from various clinical samples.

MATERIALS AND METHODS

This retrospective, hospital record-based, cross-sectional study included a total of 8749 clinical samples collected from patients at a tertiary care hospital in Odisha, India from July 2010 to December 2012. The samples were processed and identified by standard protocol. The Acinetobacter isolates were tested for antibiotic resistance by Kirby-Bauer disk diffusion method [according to the Clinical and Laboratory Standards Institute (CLSI) guidelines].

RESULTS

From 8749 clinical samples, 4589 (52.5%) yielded significant growth and only 137 (3%, 137/4589) Acinetobacter spp. were isolated. Maximum (56.9%) isolates were obtained from pus/swab, followed by blood (13.1%) and urine (12.4%). Elderly age, being inpatients, longer duration of stay in the hospital, associated co-morbidity, and invasive procedure were found to be significant risk factors in the setup investigated (P is less than 0.05). Out of 137 isolates, 75 (54.7%) were resistant to more than three classes of antibiotics (multidrug resistant) and 8 (5.8%) were resistant to all commonly used antibiotics (pan-drug resistant). Majority of the isolates were sensitive to imipenem, meropenem, and piperacillin/tazobactam, and showed resistance rates of 19%, 22%, and 23%, respectively. All eight pan-drug resistant isolates were 100% sensitive to colistin.

CONCLUSION

This hospital-based epidemiological data will help to implement better infection control strategies and improve the knowledge of antibiotic resistance patterns in our region.

Dipylidium caninum infection in a child: a rare case report

Dipylidiasis is a zoonotic parasitic infestation caused by the dog tapeworm Dipylidium caninum. Human dipylidiasis has been rarely reported in English literature. Young children are mostly at risk of acquiring the infection due to their close association with dogs and cats. We report a rare case of Dipylidium caninum infection in a 4 year old male child. The diagnosis was based on microscopic examination of stool. Confirmation of the proglottid segments was done by histopathological examination. To the best of our knowledge this is the first human case of Dipylidium caninum reported from this part of the country.

Antimicrobial resistance in pathogens causing urinary tract infections in a rural community of Odisha, India

BACKGROUND

Antimicrobial resistance of urinary tract pathogens has increased worldwide. Empiric treatment of community-acquired urinary tract infection (CA-UTI) is determined by antimicrobial resistance patterns of uropathogens in a population of specific geographical location.

OBJECTIVES

This study was conducted to determine the prevalence of CA-UTI in rural Odisha, India, and the effect of gender and age on its prevalence as well as etiologic agents and the resistance profile of the bacterial isolates.

MATERIALS AND METHODS

Consecutive clean-catch mid-stream urine samples were collected from 1670 adult patients. The urine samples were processed and microbial isolates were identified by conventional methods. Antimicrobial susceptibility testing was performed on all bacterial isolates by Kirby Bauer's disc diffusion method.

RESULTS

The prevalence of UTI was significantly higher in females compared with males (females 45.2%, males 18.4%, OR = 2.041, 95% CI = 1.64-2.52, P ≤ 0.0001). Young females within the age group of 18-37 years and elderly males (≥68 years) showed high prevalence of UTI. Escherichia coli (68.8%) was the most prevalent isolate followed by Enterococcus spp. (9.7%). Amikacin and nitrofurantoin were the most active antimicrobial agents which showed low resistance rate of 5.8% and 9.8%, respectively.

CONCLUSION

Our study revealed E. coli as the pre-dominant bacterial pathogen. Nitrofurantoin should be used as empirical therapy for uncomplicated CA-UTIs. In the Indian setting, routine urine cultures may be advisable, since treatment failure is likely to occur with commonly used antimicrobials. Therefore, development of regional surveillance programs is necessary for implementation of national CA-UTI guidelines.

Laboratory diagnosis of chikungunya virus: do we really need it?

Chikungunya (CHIK) fever is a re-emerging Aedes mosquito-transmitted viral disease caused by CHIK virus belonging to the Togaviridae family of genus Alphavirus. The disease is almost self-limiting, occurs with characteristic triad of sudden onset fever, rash and arthritis. During the recent outbreak CHIKV was also found to cause long-term arthralgia, severe neurological disease and even fatalities. Although there are no antiviral or vaccines available for CHIKV, still there are several advantages to diagnose the infection. The present article provides an overview of various diagnostic modalities available and its significance by searching PubMed MeSH terms "Chikungunya virus" and "Diagnosis" for recent articles. The gold standard of CHIKV diagnosis is culture, yet requires facilities and skills. Highly sensitive and specific PCR assays for CHIKV have been developed, but the reagents and equipment are costly for widespread use. Serological diagnosis by detecting IgM antibody is most widely used as it is relatively cheaper and easier to perform. Disadvantages of antibody testing are cross-reactivity with other alpha viruses, cannot differentiate between recent past and acute infection, and its sensitivity varies in clinical settings. When tested for diagnosing acute CHIKV disease, sensitivities were just 4 to 22% and after 1 week rose to more than 80%. As most acutely infected patients seek medical attention within the first few days of illness, the ideal test should detect RNA or antigen. Therefore, the more realistic aim would be to develop a reliable antigen detection assay that could be used in rural areas, where CHIKV infection often occurs.

Observation of B(s)(0) → D(s)(*)+ D(s)(*)- using e+ e- collisions and a determination of the B(s)-B(s) width difference ΔΓ(s)

We have made the first observation of B(s)(0)→D(s)(*)+ D(s)(*)- decays using 23.6  fb(-1) of data recorded by the Belle experiment running on the Υ(5S) resonance. The branching fractions are measured to be B(B(s)(0)→D(s)+ D(s)-)=(1.03(-0.32-0.25)(+0.39+0.26))%, B(B(s)(0)→D(s)(*±) D(s)(∓))=(2.75(-0.71)(+0.83)±0.69)%, and B(B(s)(0)→D(s)*+ D(s)*-)=(3.08(-1.04-0.86)(+1.22+0.85))%; the sum is B[B(s)(0)→D(s)(*)+ D(s)(*)-]=(6.85(-1.30-1.80)(+1.53+1.79))%. Assuming B(s)(0)→D(s)(*)+ D(s)(*)- saturates decays to CP-even final states, the branching fraction determines the ratio ΔΓ(s)/cosφ, where ΔΓ(s) is the difference in widths between the two B(s)-B(s) mass eigenstates, and φ is a CP-violating weak phase. Taking CP violation to be negligibly small, we obtain ΔΓ(s)/Γ(s)=0.147(-0.030)(+0.036)(stat)(-0.041)(+0.042)(syst), where Γ(s) is the mean decay width.

Search for a low mass particle decaying into μ+ μ- in B0 → K*0 X and B0 → ρ0 X at Belle

We search for dimuon decays of a low mass particle in the decays B0→K*0 X and B0→ρ0 X using a data sample of 657×10(6)BB events collected with the Belle detector at the KEKB asymmetric-energy e+ e- collider. We find no evidence for such a particle in the mass range from 212  MeV/c2 to 300  MeV/c2 for lifetimes below 10(-12)  s, and set upper limits on its branching fractions. In particular, we search for a particle with a mass of 214.3  MeV/c2 reported by the HyperCP experiment, and obtain upper limits on the products B(B0→K*0 X)×B(X→μ+ μ- )<2.26(2.27)×10(-8) and B(B0→ρ0 X)×B(X→μ+ μ-)<1.73(1.73)×10(-8) at 90% C.L. for a scalar (vector) X particle.

Observation of B(s)(0) → D(s)(*-) π+ and B(s)(0) → D(s)(*-) ρ+ and measurement of the B(s)(0) → D(s)(*-) ρ+ longitudinal polarization fraction

First observations of the B(s)(0) → D(s)(*-) π+, B(s)(0) → D(s)(-) ρ+ and B(s)(0) → D(s)(*-) ρ+ decays are reported together with measurements of their branching fractions: B(B(s)(0) → D(s)(*-) π+) = [2.4(-0.4)(+0.5)(stat) ± 0.3(syst) ± 0.4(f(s))]×10(-3), B(B(s)(0) → D(s)(-) ρ+) = [8.5(-1.2)(+1.3)(stat) ± 1.1(syst) ± 1.3(f(s))]×10(-3) and B(B(s)(0) → D(s)(*-) ρ+) = [11.9(-2.0)(+2.2)(stat) ± 1.7(syst) ± 1.8(f(s))]×10(-3) (f(s) = N(B(s)(*) B(s)(*))/N(bb)). From helicity-angle distributions, we measured the longitudinal polarization fraction in B(s)(0) → D(s)(*-) ρ+ decays to be f(L)(B(s)(0) → D(s)(*-) ρ+) = 1.05(-0.10)(+0.08)(stat)(-0.04)(+0.03)(syst). These results are based on a 23.6  fb(-1) data sample collected at the Υ(5S) resonance with the Belle detector at the KEKB e+ e- collider.

Measurement of |V{ub}| from inclusive charmless semileptonic B decays

We present the partial branching fraction for inclusive charmless semileptonic B decays and the corresponding value of the Cabibbo-Kobayashi-Maskawa matrix element |V{ub}|, using a multivariate analysis method to access approximately 90% of the B-->X{u}lnu phase space. This approach dramatically reduces the theoretical uncertainties from the b-quark mass and nonperturbative QCD compared to all previous inclusive measurements. The results are based on a sample of 657x10{6} BB[over ] pairs collected with the Belle detector. We find that DeltaB(B-->X{u}lnu;p(l){*B}>1.0 GeV/c)=1.963x(1+/-0.088{stat}+/-0.081{syst})x10{-3}. Corresponding values of |V{ub}| are extracted using several theoretical calculations.

Measurement of the Decay B_(s);(0)-->D_(s);(-)pi;(+) and Evidence for B_(s);(0)-->D_(s);(-/+)K;(+/-) in e;(+)e;(-) Annihilation at sqrt[s] approximately 10.87 GeV

We have studied B_(s);(0)-->D_(s);(-)pi;(+) and B_(s);(0)-->D_(s);(-/+)K;(+/-) decays using 23.6 fb;(-1) of data collected at the Upsilon(5S) resonance with the Belle detector at the KEKB e;(+)e;(-) collider. This highly pure B_(s);(0)-->D_(s);(-)pi;(+) sample is used to measure the branching fraction, B(B_(s);(0)-->D_(s);(-)pi;(+))=[3.67_(-0.33);(+0.35)(stat)-0.42+0.43(syst)+/-0.49(f_(s))]x10;(-3) (f_(s)=N_(B_(s);((*))B[over ]_(s);((*)))/N_(bb[over ])) and the fractions of B_(s);(0) event types at the Upsilon(5S) energy, in particular N_(B_(s);(*)B[over ]_(s);(*))/N_(B_(s);((*))B[over ]_(s);((*)))=(90.1_(-4.0);(+3.8)+/-0.2)%. We also determine the masses M(B_(s);(0))=(5364.4+/-1.3+/-0.7) MeV/c;(2) and M(B_(s);(*))=(5416.4+/-0.4+/-0.5) MeV/c;(2). In addition, we observe B_(s);(0)-->D_(s);(-/+)K;(+/-) decays with a significance of 3.5sigma and measure B(B_(s);(0)-->D_(s);(-/+)K;(+/-))=[2.4_(-1.0);(+1.2)(stat)+/-0.3(syst)+/-0.3(f_(s))]x10;(-4).

Evidence for neutral B meson decays to omegaK*0

We present the results of a study of the charmless vector-vector decay B0-->omegaK*0 with 657 x 10(6) BB pairs collected with the Belle detector at the KEKB e+e- collider. We measure the branching fraction to be B(B0-->omegaK*0) = [1.8+/-0.7(stat)+/-0.3(syst)]x 10(-6) with 3.0sigma significance. We also perform a helicity analysis of the omega and K*0 vector mesons, and obtain the longitudinal polarization fraction fL(B0-->omegaK*0) = 0.56+/-0.29(stat) -0.08(+0.18)(syst). Finally, we measure a large nonresonant branching fraction B[B0-->omegaK+pi(-);M Kpi in(0.755,1.250) GeV/c2] = [5.1+/-0.7(stat)+/-0.7(syst)]x 10(-6) with a significance of 9.5sigma.

Observation of a near-threshold enhancement in the e+e- -->Lambda+_(c)Lambda-_(c) cross section using initial-state radiation

We report a measurement of the exclusive e+ e- -->Lambda+_(c)Lambda-_(c) cross section as a function of center-of-mass energy near the Lambda+_(c)Lambda-_(c) threshold. A clear peak with a significance of 8.2sigma is observed in the Lambda+_(c)Lambda-_(c) invariant mass distribution just above threshold. With an assumption of a resonance origin for the observed peak, a mass and width of M=[4634 (+8)_(-7)(stat)(+5)_(-8)(syst)] MeV/c(2) and Gamma_(tot)=[92 (+40)_(-24)(stat)(+10)_(-21)(syst)] MeV are determined. The analysis is based on a study of events with initial-state-radiation photons in a data sample collected with the Belle detector at the Upsilon(4S) resonance and nearby continuum with an integrated luminosity of 695 fb(-1) at the KEKB asymmetric-energy e+ e- collider.

Measurement of branching fractions, isospin, and CP-violating asymmetries for exclusive b-->dgamma modes

We report new measurements of the decays B+-->rho+gamma, B0-->rho0gamma, and B0-->omegagamma using a data sample of 657x10(6) B meson pairs accumulated with the Belle detector at the KEKB e+e- collider. We measure branching fractions B(B+-->rho+gamma)=(8.7_-2.7-1.1;+2.9+0.9)x10(-7), B(B0-->rho0gamma)=(7.8_-1.6-1.0;+1.7+0.9)x10(-7), and B(B0-->omegagamma)=(4.0_-1.7;+1.9+/-1.3)x10(-7). We also report the isospin asymmetry Delta(rhogamma)=-0.48_-0.19-0.09;+0.21+0.08 and the first measurement of the direct CP-violating asymmetry ACP(B+-->rho+gamma)=-0.11+/-0.32+/-0.09, where the first and second errors are statistical and systematic, respectively.

Search for B+-->D*+pi0 decay

We report on a search for the doubly Cabibbo suppressed decay B+-->D*+pi0, based on a data sample of 657x10(6) BB pairs collected at the Upsilon(4S) resonance with the Belle detector at the KEKB asymmetric-energy e+e- collider. We find no significant signal and set an upper limit of B(B+-->D*+pi0)<3.6x10(-6) at the 90% confidence level. This limit can be used to constrain the ratio between suppressed and favored B-->D*pi decay amplitudes, r<0.051, at the 90% confidence level.

Observation of B{0}-->ppK*0 with a large K*0 polarization

Using a 492 fb{-1} data sample collected near the Upsilon(4S) resonance with the Belle detector at the KEKB asymmetric-energy e{+}e{-} collider, we observe the decay B{0}-->ppK*0 with a branching fraction of (1.18{-0.25}{+0.29}(stat)+/-0.11(syst))x10{-6}. We study the decay dynamics of B{0}-->ppK*0 and compare with B{+}-->ppK*+. The K*0 meson is found to be almost 100% polarized (with a fraction of (101+/-13+/-3)% in the helicity zero state), while the K*+ meson has a (32+/-17+/-9)% fraction in the helicity zero state. The direct CP asymmetries for B{0}-->ppK*0 and B{+}-->ppK*+ are measured to be -0.08+/-0.20+/-0.02 and -0.01+/-0.19+/-0.02, respectively. In addition, we report improved measurements of the branching fractions B(B{+}-->ppK*+)=(3.38{-0.60}{+0.73}+/-0.39)x10{-6} and B(B{0}-->ppK{0})=(2.51{-0.29}{+0.35}+/-0.21)x10{-6}, which supersede our previous measurements.

Measurement of B(Ds{+}-->mu+nu(mu))

We present a measurement of the branching fraction B(D{s}{+}-->mu{+}nu{mu}) using a 548 fb{-1} data sample collected by the Belle experiment at the KEKB e{+}e{-} collider. The D{s} momentum is determined by reconstruction of the system recoiling against DKgammaX in events of the type e{+}e{-}-->D{s}{*}DKX, D{s}{*}-->D{s}gamma, where X represents additional pions or photons from fragmentation. This full-reconstruction method provides high resolution in the neutrino momentum and thus good background separation, equivalent to that achieved by experiments at the tau-charm factories. We obtain the branching fraction B(D{s}{+}-->mu{+}nu{mu})=[6.44+/-0.76(stat)+/-0.57(syst)]x10{-3}, implying a D{s} decay constant of f{D{s}}=[275+/-16(stat)+/-12(syst)] MeV.

The year of magical thinking: Joan Didion and the dialectic of grief

Joan Didion is a prominent American writer. In late 2003, while her only child lay critically ill, her husband, John, died suddenly. Theirs was a marriage of great intimacy and love. Grief enveloped her. Eventually she began to write an account of the first 12 months of her bereavement and the vigil for her child: The year of magical thinking. Raw, insightful and challenging, it is a rich, generous and graceful document. Didion draws on the literature of grief, personal and professional. Here, those readings are examined and reflections are made on the singular, unique grief of the author in the context of current theories on bereavement.

Production of new charmoniumlike states in e+e- -->J/psiD*D[over](*) at sqrt[s] approximately 10.6 GeV

We report a study of the processes e+e- -->J/psiD*D[over](*). In J/psiD*D[over]* we observe a significant enhancement in the D*D[over]* invariant mass spectrum, which we interpret as a new charmoniumlike state and denote X(4160). The X(4160) parameters are M=(4156(-20)+25+/-15) MeV/c2 and Gamma=(139(-61)+111+/-21) MeV. We also report a new measurement of the X(3940) mass and width: M=(3942(-6)+7+/-6) MeV/c2 and Gamma=(37(-15)+26+/-8) MeV. The analysis is based on a 693 fb(-1) data sample recorded near the Upsilon(4S) resonance by the Belle detector at the KEKB asymmetric-energy collider.

Intraocular Pressure Changes Associated with Intubation with the Intubating Laryngeal Mask Airway Compared with Conventional Laryngoscopy

This open, prospective, randomised study was designed to evaluate the changes in intraocular pressure and haemodynamics after tracheal intubation using either the intubating laryngeal mask airway (ILMA) or direct laryngoscopy. Sixty adult patients, ASA physical status 1 or 2 with normal intraocular pressure were randomly allocated to one of the two techniques. Anaesthesia was induced with propofol followed by rocuronium. Tracheal intubation was performed using either the ILMA or Macintosh laryngoscope. Intraocular pressure, heart rate and blood pressure were measured immediately before and after tracheal intubation and then minutely for five minutes. In the laryngoscopy group there was a significant increase in intraocular pressure (from 7.2 ± 1.4 to 16.8 ± 5.3 mmHg, P <0.01), which did not return to pre-intubation levels within five minutes, and also in mean arterial pressure after tracheal intubation, which returned to baseline levels after five minutes. In the ILMA group there were no significant changes in intraocular pressure (from 7.6±1.8 to 10.4±2.8 mmHg, P >0.05) or mean arterial pressure after tracheal intubation. Time to successful intubation was longer with the ILMA, 56.8 ± 7.8 seconds, compared with the laryngoscopy group, 33±3.6 seconds (P <0.01). Mucosal trauma was more frequent with the ILMA (eight of 30) compared with the laryngoscopy group (three of 30) (P <0.01). The postoperative complications were comparable. In terms of minimising increases in intraocular pressure and blood pressure, we conclude that the ILMA has an advantage over direct laryngoscopy for tracheal intubation.

Observation of a resonancelike structure in the pi +- psi' mass distribution in exclusive B-->Kpi +- psi' decays

A distinct peak is observed in the pi +/- psi' invariant mass distribution near 4.43 GeV in B-->K pi +/- psi' decays. A fit using a Breit-Wigner resonance shape yields a peak mass and width of M=4433+/-4(stat)+/-2(syst) MeV and Gamma=45-13+18(stat)-13+30(syst) MeV. The product branching fraction is determined to be B(B 0-->K -/+Z+/-(4430)) x B(Z+/-(4430)-->pi+/-psi')=(4.1+/-1.0(stat)+/-1.4(syst)) x 10(-5), where Z+/-(4430) is used to denote the observed structure. The statistical significance of the observed peak is 6.5 sigma. These results are obtained from a 605 fb(-1) data sample that contains 657 x 10(6) BB pairs collected near the Upsilon(4S) resonance with the Belle detector at the KEKB asymmetric energy e+ e- collider.

Observation of B_(s)(0)-->phigamma and search for B_(s)(0)-->gammagamma decays at Belle

We search for the radiative penguin decays B_{s}{0}-->varphigamma and B_{s}{0}-->gammagamma in a 23.6 fb{-1} data sample collected at the Upsilon(5S) resonance with the Belle detector at the KEKB e{+}e{-} asymmetric-energy collider. We observe for the first time a radiative penguin decay of the B_{s}{0} meson in the B_{s}{0}-->varphigamma mode and we measure B(B_{s}{0}-->varphigamma)=(57_{-15}{+18}(stat)-11+12(syst))x10{-6}. No significant B_{s}{0}-->gammagamma signal is observed and we set a 90% confidence level upper limit of B(B_{s}{0}-->gammagamma)<8.7x10{-6}.

Measurement of time-dependent CP-violating parameters in B(0)-->K_(S)(0)K_(S)(0) decays

We report a measurement of the CP-violating parameters in B;{0}-->K_{S}{0}K_{S}{0} decays based on a data sample of 657x10{6} BB[over ] pairs collected at the Upsilon(4S) resonance with the Belle detector at the KEKB asymmetric-energy e;{+}e{-} collider. In this Letter, one neutral B meson is fully reconstructed in the B;{0}-->K_{S}{0}K_{S}{0} decay mode, and the flavor of the accompanying B meson is identified by its decay products. The CP-violating parameters are measured from the asymmetry in the distributions of the proper-time interval between the two B decays: S_K_{S}{0}K_{S}{0}}=-0.38_{-0.77}{+0.69}(stat)+/-0.09(syst) and A_{K_{S}{0}K_{S}{0}}=-0.38+/-0.38(stat)+/-0.05(syst).

Observation of anomalous upsilon(1S)pi+pi(-) and upsilon(2S)pi+pi(-) production near the upsilon(5S) resonance

We report the first observation of e;{+}e;{-}-->Upsilon(1S)pi;{+}pi;{-}, Upsilon(2S)pi;{+}pi;{-}, and first evidence for e;{+}e;{-}-->Upsilon(3S)pi;{+}pi;{-}, Upsilon(1S)K+K-, near the peak of the Upsilon(5S) resonance at sqrt[s] approximately 10.87 GeV. The results are based on a data sample of 21.7 fb;{-1} collected with the Belle detector at the KEKB e;{+}e;{-} collider. Attributing the signals to the Upsilon(5S) resonance, the partial widths Gamma(Upsilon(5S)-->Upsilon(1S)pi;{+}pi;{-})=0.59+/-0.04(stat)+/-0.09(syst) MeV and Gamma(Upsilon(5S)-->Upsilon(2S)pi;{+}pi;{-})=0.85+/-0.07(stat)+/-0.16(syst) MeV are obtained from the observed cross sections. These values exceed by more than 2 orders of magnitude the previously measured partial widths for dipion transitions between lower Upsilon resonances.

Observation of a new DsJ meson in B+-->D0D0K+ decays

We report the observation of a new DsJ meson produced in B+-->D0DsJ-->D0D0K+. This state has a mass of M=2708+/-9(-10)(+11) MeV/c2, a width Gamma=108+/-23(-31)(+36) MeV/c2 and a 1- spin-parity. The statistical significance of this observation is 8.4 sigma. The results are based on an analysis of 449 x 10(6) BB events collected at the Upsilon(4S) resonance with the Belle detector at the KEKB asymmetric-energy e+e- collider.

Observation of the psi(4415)-->DD2*(2460) decay using initial-state radiation

We report measurements of the exclusive cross section for e(+)e(-)-->D(0)D(-)pi(+) over the center-of-mass energy range 4.0 GeV to 5.0 GeV with initial-state radiation and the first observation of the decay psi(4415)-->D(0)D(-)pi(+). From a study of the resonant substructure in psi(4415) decay we conclude that the psi(4415)-->D(0)D(-)pi(+) decay is dominated by psi(4415)-->DD(2)(*)(2460). We obtain B(psi(4415)-->D(0)D(-)pi(nonresonant)(+))/B(psi(4415)-->DD(2)(*)(2460)-->D(0)D(-)pi(+))<0.22 at 90% C.L. The analysis is based on a data sample collected with the Belle detector with an integrated luminosity of 673 fb(-1).

Time-dependent CP-violating asymmetry in B0-->rho0gamma decays

We report the first measurement of CP-violation parameters in B0-->rho0gamma decays based on a data sample of 657x10(6)BB pairs collected with the Belle detector at the KEKB asymmetric-energy e+e- collider. We obtain the time-dependent and direct CP-violating parameters, Srho0gamma=-0.83+/-0.65(stat)+/-0.18(syst) and Arho0gamma=-0.44+/-0.49(stat)+/-0.14(syst), respectively.

Search for B --> h(*)nunu[over ] decays at Belle

We present a search for the rare decays B --> h(*)nunu[over ], where h(*) stands for a light meson. A data sample of 535 x 10{6} BB[over ] pairs collected with the Belle detector at the KEKB e{+}e{-} collider is used. Signal candidates are required to have an accompanying B meson fully reconstructed in a hadronic mode and signal side particles consistent with a single h(*) meson. No significant signal is observed and we set upper limits on the branching fractions at 90% confidence level. The limits on B{0} --> K{*0}nunu[over ] and B{+} --> K{+}nunu[over ] decays are more stringent than the previous constraints, while the first searches for B{0} --> K{0}nunu[over ], pi{0}nunu[over ], rho{0}nunu[over ], varphinunu[over ] and B{+} --> K{*+}nunu[over ], rho{+}nunu[over ] are reported.

Search for the CP-violating decays Upsilon(4S)-->B0B0-->J/psiKS0+J/psi(etac)KS0

We report the first search for CP-violating decays of the Upsilon(4S) using a data sample that contains 535 x 10(6) Upsilon(4S) mesons with the Belle detector at the KEKB asymmetric-energy e(+)e(-) collider. A partial reconstruction technique is employed to enhance the signal sensitivity. No significant signals were observed. We obtain an upper limit of 4 x 10(-7) at the 90% confidence level for the branching fractions of the CP violating modes, Upsilon(4S)-->B(0)B(0)-->J/psiK(S)(0)+J/psi(eta(c))K(S)(0). Extrapolating the result, we find that an observation with 5sigma significance is expected with a 30 ab(-1) data sample, which is within the reach of a future super B factory.

Observation of B(0)-->D(*-)tau(+)nu(tau) decay at Belle

We report an observation of the decay B{0}-->D{*-}tau{+}nu{tau} in a data sample containing 535x10{6} BB pairs collected with the Belle detector at the KEKB asymmetric-energy e{+}e{-} collider. We find a signal with a significance of 5.2sigma and measure the branching fraction B(B{0}-->D{*-}tau{+}nu{tau})=(2.02{-0.37}{+0.40}(stat)+/-0.37(syst))%. This is the first observation of an exclusive B decay with a b-->ctaunu{tau} transition.