New anti- malarial treatment to fight against drug resistance.

Malaria is a life threatening disease caused by infected Anopheles mosquito bites. Control mainly depends on early diagnosis followed by treatment with anti-malarial drugs. However,  the treatment is severely hampered because of spread of drug resistant malaria parasites. Recently drug named DDD107498 beendeveloped and about to enter human trials with all properties of potentialmalaria drug. The properties include (i) it shows effect on multiple species of malaria parasites at several lifecycle stages, (ii) single dose effectiveness, (iii) Active gametocyte clearance,(iv) good pharmacokinetics all these characters proved this drug as a new- generation anti-malarial drug.To initiate the process of development of such a compound, the scientific team searched the chemical compound library at drug discovery unit (DDU) of University of Dundee that consists of around 4700 compounds and screened against blood stage asexual forms of the deadliest malaria parasite Plasmodium falciparum 3D7 strain. The screening process filtered out a compound class based on a 2,6- disubstituted quinoline-4-carboxamide scaffold, which seems to have activity against malaria 

parasite, although it shows poor physicochemical properties.

The research team further optimized the compound to attain drug-like properties through cycles of design, synthesis and testing. The significant optimization process included (i) Replacement of Bromine with Florine to reduce molecular mass and lipophilicity, (ii) Replacement of the 3-pyridyl substituent with an ethyl-pyrrolidine group and (iii) Addition of a morpholine group via methylene spacer. The final compound generated was named as DDD107498, and was experimented both in-vitro, in-vivo and ex-vivo methods using humanized mouse model and other model organisms against P.falciparum, P. vivax and P. berghei to confirm its efficacy. The compound was further evaluated for its drug-like properties, mode of action and safety measures. A comparative study with presently available drugs was also done to confirm its better efficacy, unique mechanism of action and ability to act at multiple stages of the parasite life cycle. Read more............

Healthcare Precedence for the Future

At the turn of the last century, three major concerns involving human beings have come to the limelight which includes a drastic increase in human population with a concomitant growth in overall life expectancy, global warming and the rise of terrorism in one or its many forms. Added to this I feel one should not overlook the fact that extinction of living species (plant and animal) that is taking place as a result of human encroachment along with parasitic depletion ofnatural resources is in fact depriving the planet of its self-cleansing featurethat it inherits. The balance between the consumer (human) and the provider (earth) is further affected by a negligible replacement of such sources (example forests). The situation gets more complex if one analyses the twenty first century life style of human beings where internet and cellular phones have become part of everyday life. Such life style is essential to keep pace with the opportunities that global industrialisation provides to us. In the prism of such dynamic affairs one must expect new challenges in health care industry.

Globally, most of the developing and underdeveloped nations have failed to provide basic health care facility to its people in the last century. This led to most of the governments develop policies that encouraged investment from corporates in health care sector. Financially lucrative health care sector has already been exploited by the corporates which has given rise to health insurance. One way or the other, although the rich and powerful in this world have access to health care system, the serious problem lies how to provide adequate health care facility for the poor and downtrodden. On one side, I have seen patients seeking treatment procedures like implant supported prosthesis or aesthetic facial lifts (even though the treatment is contraindicated in them, they continue to get such treatment privileges), I must admit that I also have been a witness to a situation in a government hospital outside the gynecologyoutpatient waiting area where there were more than three hundred ladies waiting to seek consultation. Among them I also came to see that many genuine emergency cases did not get due attention. Scientifically, we don’t even know how many patients die because they do not get proper health care attention at the right time. Read more.............

An Assessment of Epidemiological Trends of Malaria in Lusaka Province of Zambia, 2009-2013

For centuries, malaria has outranked warfare as a source of human suffering. It affects more than 489 million people worldwide every year and more than 1 million people die of malaria annually, thus making it a threat to human life.Africa is the most affected continent with more than 90% of all malaria cases worldwide because of the combination of factors such as climate, mosquito vector, malaria parasite and poverty which combine to bear a negative impact on human health and retards development. Malaria disease slows economic growth by 1.3% per year translating into US $ 12 billion annual GDP loss across sub-Saharan Africa.

In Zambia, malaria is endemic with seasonal and geographical variations. It has for a long time remained the leading cause of morbidity and mortality in both the children and adults. Although malaria affects the whole population, the most vulnerable are children under the age of 5 years and pregnant women. Malaria accounts for up to 50% of all infant mortality and 20% of all maternal mortality in Zambia and presents severe social and economic burdens on communities living in endemic areas Epidemiologically, Zambia is categorized into three malaria zones namely, a low-transmission zone with parasite prevalence <1% located in south-eastern Zambia; a low stable-transmissionregion with a parasite prevalence of 10% located in north-western/south-centralZambia; and a high-transmission zone with a parasite prevalence of >20% located in northern and eastern Zambia .

The country has three distinct seasons; a rainy season which starts from November and ending in May during which malaria transmission is highest, a cool dry season from late May to August, and a hot dry season from September to November. Malaria transmission is experienced in focal locations across the country throughout the year.Plasmodium falciparum causes approximately 98% of malaria infection in Zambia while low frequency infections due to Plasmodium malariae and Plasmodium ovale also occur, and little or no transmission of Plasmodium vivax . The main malaria vectors in Zambia are Anopheles arabiensis, Anopheles gambiae s.s. and Anopheles funestus s.s . Read more...........

Presence of Anti-Protozoan activity in Pomegranate

Blastocystisspp is protozoan parasites that inhibit the intestinal tract of human beings. Many anti protozoan agents such as metronidazole are used to fight against it, Later it should be treated with nitazoxanide. The anti-microbial properties of microorganism are serious problem to treat the infectious diseases. As anti-bacterial drugs are having side effects, plant extracts are now a source for new treatment. Rats with Blastocystis spp were treated with Pomegranate peel extract to check the anti-protozoanactivity. This study observed lowered shedding of cysts, which was very close to that of nitazoxanide treatment. Therefore Pomegranate peel extract can be used as alternative for anti Blastocystis drugs.

The development of drug resistance against commonly used treatment has necessitated a search for new therapeutic agents from other sources. Recently, there has been considerable interest in the use of plant materials as an alternative method to control pathogenic microorganisms. Plant extracts have shown to be effective against resistant pathogens.Herbal medicine or phytomedicine is now attracting the world’s attention as it enhances the health of the body systems without adverse side effects, especially the immune system that protect against pathogens. Read more...........

A One-Stop Novel Drug for Malaria Treatment and Control

Malaria is a primordial disease that has been affecting human race since their origin. Albeit the parasite shows parallel divergence with hominids, it has evolved so finely and shaped its genome to a great extent to invade, dodge and damage hosts defence system. Small generation time, pressure to survive and grow under adverse environmental conditions inside host, ability to disguise and escape host immune system; help the parasite to succeed the evolutionary arms race. Hence, malaria associated morbidity and mortality is a major public healthconcern especially for underdeveloped and developing countries of the globe.Though many malaria control and eradication strategies have been followed since ages, but none of them are successful in an overall control program. In the absence of a competent vaccine for malaria prevention and at the same time emerging resistance against currently available antimalarials, the ongoing malaria control programs have been severely hampered.

Besides that, cross resistance among drugs due to their alike chemical combination is also well evidenced . As a result of which, the current malaria control program has been adversely affected by the development and spread of parasite resistant strains to the working antimalarial, ACT (Artemisinin-based Combination Therapy). Therefore, the need of the hour is to develop a drug not only that has a quick and deep action in the parasite, but also by delaying the emergence of drug resistance. Bearing these facts in mind, Baragana and co-workers5 have recently designed a multiple stage antimalarial compound, which not only can treat malaria with single dose but also help in chemo-protection and blockage of transmission with less chance of development of resistance by the parasite.To initiate the process of development of such a compound, the scientific team  searched the chemical compound library at drug discovery unit (DDU) of University of Dundee that consists of around 4700 compounds and screened against blood stage asexual forms of the deadliest malaria parasite Plasmodium falciparum 3D7 strain. Read more...........

Inhaled Micro- or Nanoparticles: Which are the Best for Intramacrophagic Antiinfectious Therapies?

Nanotechnology is a fascinating world that has provided and still provides sensational developments in many fields such as in pharmaceutics for diagnosis or drug and gene delivery to cells, tissues or organs. With regard to the latter, cell uptake of nanostructures (generally 1-100 nm) is usually much greater than that of microparticles in the range of 1-10 μm. Although the term “nano” remains ofhigh impact, not always the nanosize is preferable to a larger size. One of these cases is represented by the inhalation of drugs transported within particulate carrier in order to reach the Alveolar macrophages (AM) and eradicate surviving intracellular bacteria in pathologies such as tuberculosis, HIV, S. pneumoniae and S. aureus infections.

For an intra-macrophagic anti-infectious therapy by pulmonary administration, most antibiotics are poorly soluble in water and

their aerosolization has to be produced by using drugs in their solid state administered by means of Dry powder inhaler (DPI) devices. In this regard, it is rare that untreated drugs have features suitable for both DPI performance and targeting to AM failing to both reach alveolar epithelium and penetrate AM effectively. Therefore, particle engineering techniques have been proposed for both drug alone (micronization, polymorphic transformations, controlled crystallization, intermolecular self-assembling, spray-drying producing irregular shaped particles) and drug/excipient blending (with lactose or mannitol) or carrier-based formulations (liposomes, polymeric/lipid microparticles, cyclodextrins).

Various inhaled particulate carriers containing therapeutic agents have been used to deliver drugs to the AM leading to intracellular concentrations of the antibiotic up to 20-fold enriched compared to the administration of free drug . Particulate systems have also been engineered to facilitate uptake by macrophages or surface modified for receptor-mediated AM endocytosis.

Regarding particulate carrier-based formulations, among several other properties, particle size is crucial not only to guarantee effective dose emission by DPI, powder dispersion and deposition onto alveolar epithelium, but also effective endocytosis by AM that correlates with the efficacy of the loaded antimicrobial agents, i.e., the adequate local antibacterial concentration (>> MIC). The literature review shows several nanoparticle platforms for AM intracellular therapy. Read more..........

Screening of M. tuberculosis with the help of macrophage models

M. tuberclosis is an intracellular pathogen which survives and replicate in macrophages. To combat tuberculosis, complete knowledge of bacteria and macrophage interaction is compulsory. Growth of M. tuberclosis can be done by using microphage models; this eventually helps in screening the intracellular pathogen.  The cell source for macrophages model generally includes human peripheral blood, lungs, cell lines and bone marrow. This cell source is further utilised for screening by Chinese and Western anti-TB drugs, to study the role of SigB and SigFetc.. for figuring out the immune mechanism and pathogenesis.

The online English database PubMed, Chinese databases CNKI, SinoMed, and Wanfang were searched up to December 2010 for published articles. Two groups of terms were used for the information retrieval, one of which includes macrophage model, macrophages model, macrophage models, macrophages models, macrophage, and macrophages; the othergroup of terms comprises mycobacterium tuberculosis. For PubMed, the two groups of English terms were applied, while Chinese terms were used.Inclusion criteria were defined for this review, by which articles on cell sources, screening of anti-tuberculosis drugs, pathogenic mechanisms of tuberculosis or immunomechanism of tuberculosis of macrophage models are collected. Exclusion criteria were also developed, by which articles about other aspects of macrophage models, such as vaccination of tuberculosis, were excluded.  Read more...........

A First Clinical Case Report of West-Nile Viral Meningoencephalitis Complicated with Acute Pancreatitis in North America

WNV is a mosquito-borne virus of the flaviviridae family. It is indigenous to Africa, Asia, Europe and Australia, and has been associated with several outbreaks in Israe. WNV was virtually unknown to North America until 1999, when it made a first appearance during an epidemic of meningo-encephalitis in Queens, New York, NY . From the period between 1999 and 2004, there have then been over 7,000 reportedcases of neuro-invasive WNV induced encephalitis in the United States . The neurological manifestations of WNV infection can range from meningitis, encephalitis and cranial nerve dysfunction to acute flaccid paralysis and motor neuron disease . 

Most cases of WNV infections are asymptomatic. The incubation period is typically 2 to 14 days. There are no specific symptoms that typify WNV infections. Clinically, they may present with symptoms similar to aseptic viral meningitis, usually with fever, headache, and other non-specific symptoms. These typically carry a low associated mortality. Some patients may present with a more abrupt onset of encephalitis with altered mental status, vomiting, severe headaches, accompanied by a high grade fever. In about 15% of cases, cerebral dysfunction may progress to coma, with accompanying abnormalities such as diffuse muscle weakness, flaccid paralysis, and respiratory failure. Read more...........

Female Genital Schistosomiasis: A Neglected Tropical Disease Infecting Women of Reproductive Age in Endemic Areas

Schistosomiasis (bilharzia) is a neglected tropical disease caused by trematode parasitic worms of the genus Schistosoma . Approximately 207 million persons are infected with schistosomiasis worldwide. Female genital schistosomiasis (FGS) is characterized by the presence of schistosome eggs/worms in the upper or lower genital tract.Several studies have shown that FGS is a common manifestation in S. haematobium infection, with prevalence rate ranging from 30% to 75% in some communities. Other studies have indicated that schistosome ova deposition may be the cause of genital papillomatous tumours, leukoplakia, polyps, and ulcers similar to sexually transmitted diseases (STD). 

Pregnant or lactating women infected with schistosomiasis in endemic areas, may be complicated further by malnutrition and low immunity resulting in more pathology related to liver and kidney function. Despite the potentially enormous at-risk population, little is knownabout the schistosome-specific morbidities that are experienced by pregnant andlactating mothers and their newborns. Apparently, the patho-physiological changes that occur, have not been fully investigated in women of reproductive age residing in schistosomiasis endemic areas, in the context of treatment alogrithms for administration of praziquantel in pregnant women, especially in sub-Saharan Africa. Read more...........

Protective effects of Andrographis paniculata leaf extract on liver and renal damage and hypoglycemia during Plasmodium berghei infection

Malaria constitutes one of the biggest health problems in tropical and sub-tropical zones such as Africa, South America, Asia and Southeast Asia including Thailand. It is estimated that 250 million peoples are infected by malaria withabout 1 million deaths annually. This disease is caused by protozoa parasite in genus Plasmodium, especially P. falciparum and P. vivax which are major cause of death. For causes of death by malaria including cerebral malaria, hemolysis and severe anemia, metabolic acidosis, multiple organ failure such as liver and renal, and hypoglycemic shock have been reported. Malaria associated liver and renal damage occur between 2-5% of hospitalized patients with a mortality that can reach up to 45% . 

The pathogenesis for liver and renal damage induced by malaria is multifactorial and not well characterized, but several hypothesis suggest involvement of cytoadherence of parasitized erythrocytes, proinflammatory response, and damage due to oxidative stress. Read more..........

The Perspective of Socioeconomic Inequalities and Infectious Disease in 21st Century

At the turn of the new century, the United Nations set a series of global health goals to be achieved by 2015. Amongst the eight Millennium Development Goals (MDGs), goal six aimed to combat HIV, malaria and other diseases. Whilst progress has been made towards addressing MDG 6, improvement has been slower than anticipated and both communicable and non-communicable diseases have risen to prominence in the minds of health planners in the last few years. In recent times, attention has been focused on addressing non-communicable diseases, as statistics indicate they are the major threats to health. However, the notion that infectious diseases could be eradicated, which came to prominence in the 1960s and 70s, has proven to be false and the need to address the growing threat from infectious diseases has become clear. Since the turn of the century it has become apparent that we are losing the fight against infectious diseases, and many of the diseases we thought under control are now a threat once again. Additionally, several new forms of infectious disease have been recorded, many of which threaten human health as we have little or no resistance towards them.

The greatest advances in the health of people have come from equitable access to basic essential resources such as clean air, soil and housing, clean water and nutritious food. Environmental and economic factors, such as global warming, are creating shortages in essential resources and leading to increased human habitation in urban areas. Similarly, war and civil unrest have led to mass migration. Urban living especially for socially disadvantaged groups creates the conditions in which infectious diseases can thrive, adapt and spread quickly. Infectious diseases do not recognize borders, and increased speed of travel and the reduction in restrictions on travel have heightened the possibility of pandemics. Read more............

Gender Differences in Community-acquired Meningitis in Adults: Clinical Presentations and Prognostic Factors

Community-acquired meningitis can be caused by several treatable and untreatable infectious etiologies (e.g., bacterial, viral, and fungal infections), but most commonly the etiology is unknown. Studies show that risk factors for bacterialmeningitis include age, immunosuppression, genetic susceptibility, andanatomical defects. Mortality and morbidity for bacterial meningitis is high, with risk factors for a poor outcome including systemic compromise and a low level of consciousness. Outcome largely depends on rapid initiation of an effective empiric treatment, adjusting for age, systemic symptoms, and antimicrobial resistance .While there is some understanding of the effect of age and other risk factors on susceptibility to community-acquired meningitis, there are no studies exploring gender differences in community-acquired meningitis. The purpose of this study is to investigate gender differences in clinical presentation, laboratory and imaging results, etiologies and prognostic factors in male and female patients with community-acquired meningitis.

Case definition:This is a sub-study of another community-acquired meningitis study. Each adult patient (older than 17 years) enrolled in the study had community-acquired symptoms of meningitis (such as headache, stiff neck, fever, focal neurological deficits, or altered mental status) and a cerebrospinal fluid (CSF) white cell count of greater than 5 cells/mm3. These patients presented to an emergency department at a Houston-area hospital between 2005 and 2010. The University of Texas Health Science Center in Houston Committee for the Protection of Human Subjects and the Memorial Hermann Hospital Research Review Committee approved this study. For more.....

Risk Factors Associated with Clostridium difficile Infection in A Pediatric Hematology-Oncology Ward

Clostridium difficile is An anaerobic spore forming gram positive bacilli. It is transmitted through fecal-oral route and can cause Clostridium difficile infection (CDI) when there is alteration in normal bowel flora mostly secondary to antibiotic use. Infections with Clostridium difficile ranges from asymptomatic carrier or mild diarrhea to pseudomembranous Colitis. It is the most common cause of health-care associated diarrhea

The incidence of CDI is increasing worldwide especially after the emergence of North American pulsed-field gel electrophoresis type 1 (NAP-1) strain which wasidentified in 2002 and was the cause of multiple outbreaks of CDI. NAP-1 strain is known to produce greater quantities of Toxin A & B with higher risk of relapse resulting in more series diseases. Regarding the incidence of CDI in Saudi Arabia, There is only one small study in 2010 describing the annual prevalence which is around 1 per 1000 discharge. But there is no published data on CDI in pediatric hematology-oncology population.CDI prevalence in pediatrics population is low, but currently it is recognized as an increasingly important pathogen in children. There is increasing incidence of CDI among pediatric patients with estimated annual incidence rate of 2.6-4/1000 admission in published reports CDI accounted for 32% of diarrheal episodes among hospitalized pediatric patients.

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A Case Report of Acute Lobar Nephronia Caused by Enterobacter cloacae

Acute lobar nephronia is an uncommon type of urinary tract infection which was first described by Rosenfield in 1979 . Pathologically, it is a focal area of infected kidney without tissue liquefaction. It is thought to represent a disease state midway between tissue inflammation and abscess formation. On radiological imaging, acute lobar nephronia can be mistaken for a neoplastic condition if acute symptoms are not taken into account. Most of the published case reports or series have focused mainly on the pediatric population. Only a few cases have been reported in adults. Most cases of acute lobar nephronia are associated with Escherichia coli infection. In this present case report will describe a patient with acute lobar nephronia caused by Enterobacter cloacae.

Case report:

A 65-year-old woman first presented with a three-day history of fever (38.4°C), nausea and vomiting. She had no acute urinary symptoms or prior urological history. Her medical history included Type 2 diabetes with no known end-organcomplications and hypertension. Her regular medications included Metformin 1000 mg twice a day, Gliclazide modified release 60 mg once a day and Irbesartan 300 mg once a day.she was febrile and tachycardic (pulse of 100 beats/min). Her blood pressure was 125/75 mmHg, respiratory rate was 16 breaths/min and oxygen saturation was 96% on room air. Examination of her chest revealed normal findings. Examination of her abdomen and pelvis did not reveal any focus of tenderness. However urinalysis was positive for nitrites and leucocyte esterase.

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Review on Ebola Virus Disease: Its Outbreak and Current Status

Ebola virus disease (formerly called Ebola Hemorrhagic Fever) is a severe, often fatal, disease in humans and nonhuman primates, which is caused by the Ebola virus. Between 1976 and 2014 twenty-four epidemics of Ebola virus disease (EVD) were verified, mostly caused by Zaire Ebola virus (ZEBOV) in Equatorial Africa. Most outbreaks have been small, but the virus captured the attention of the world due to death rates that can be as high as 90% as well as the visceral manner in which it kills.

In March 2014, World Health Organization (WHO) reported a major Ebola outbreak in Guinea, Liberia and Sierra Leone, western African nations. The 2014 EVD outbreak in West Africa caused by ZEBOV is the longest,largest, deadliest, and the most complex in history. As of 11 February 2015, there were 22,859 EVD cases and a total of 9,162 deaths. Compared to the cumulative sum of past episodes in 36 years (1976-2012), 2,232 infected people and 1,503 deaths there are now over ten times the total number infection cases and over six times the total number of fatalities. The Ebola virus disease outbreak in West Africa affected impoverished post-conflict countries with weak health systems and no experience with Ebola.

Ebola is a public health nightmare because it can be contacted relatively easily (especially in a hospital setting where proper precautions are not taken) and is almost always fatal. EVD can be transmitted between humans through direct contact with bodily fluids (e.g., blood, sweat) from an infected person or contaminated objects. Whereas aerosol infection has not been reported clinically, despite it has been demonstrated in experimental infection in monkeys. Read more...........

Difficulties in Diagnosis of Malaria in Non-Endemic Areas: A Case Report of a Child in Brazil

A boy aged 11 years and eight months, coming from the state of Mato Grosso do Sul, mid-western region of Brazil, was taken to the teaching hospital of the Federal University of Mato Grosso do Sul with a history of high fever for 8 days, temperature peaking 40°C, especially in the evening and night. The febrile episodes lasted for about 2-3 hours, slightly easing with the use of antipyretics, and were followed by sweating and fatigue during defervescence. Also noticed were prostration, appetite loss and weight loss (approximately 2 kg in a week), in addition to diarrhea, vomiting and diffuse abdominal pain. Physical examination presented HR (heart rate) = 120 bpm, RR (respiratory rate) = 36 rpm, axillary temperature = 39.5°C, weight = 27 kg. The patient was pale, anicteric and showing intense prostration. 

The cardiopulmonary examination showed no noteworthy changes. He presented abdominal distension and relevant visceromegaly, with liver palpable at 6 cm below the RCM and 10 cm from the xiphoid process, very painful, and spleen at 4.5 cm below the left costal margin, painless. Both viscera occupied all mesogaster and hypochondria. The extremities showed no edema, and good peripheral perfusion was seen. The results of blood count and biochemical tests were: hemoglobin concentration =9.3 g/dL, hematocrit = 28%, leukocytes = 2900 mm3 (band neutrophils, 4%,segmented neutrophils, 61%, eosinophils, 3% lymphocytes, 29% monocytes 3%), platelet count = 150,000, sodium = 136 mmol/L, potassium = 4.4 mmol/L, urea = 49 mg/dL, creatinine = 0.8 mg/dL; AST = 54 U/L, ALT= 80U/L, TP = 5.9 g/dL, Alb = 2.5 g/dL, Globulins = 3.4 g/dL; TB = 0, 55 mg/dL, DB = 0.13 mg/dL, IB = 0.42 mg/dL. The occurrence of fever, pallor, hepatosplenomegaly, anemia and leukopenia has initially led to the diagnosis of visceral leishmaniasis (VL), since this disease is endemic in the state of Mato Grosso do Sul.

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Multi-Dimensional Approaches to Fight HIV

The human immunodeficiency virus (HIV) belongs to lentivirus group and causes HIV infection over time, leadingto acquired immunodeficiency syndrome (AIDS). AIDS is a condition in which progressive failure of the immune system in humans can be seen leading to cancers and life-threatening opportunistic infections to thrive. Journal of HIV & Retro virus is a peer reviewed open access international journal that publishes top quality scientific articles related to all the aspects of prevention and treatment techniques of HIV. In the present volume 2 issue 2 two research articles, a review article and three short communications were published. Ifeanyichukwuet al. in their research article showcased the effect of HIV infection on haematological parameters such as Immunolglbobulin levels in HIV patients.

Their studies revealed an elevation of IgG levels and ESR with a decrease in HCT and HGB values in HIV infected patients. Authors concluded that the elevated IgG is due to the retroviral infection and elevated ESR, which is an indicator of inflammatory response. Authors suggested that Immunoglobulin can be used as a marker to monitorHIV. In the research article Ongondiet al. studied about the nutritional requirements of HIV patients of different ages. Authors concluded that that malnutrition in HIV/AIDS patients will directly influence the survival chances, as the malnutrition increases the risk of opportunistic infections (OIS), and other complications.

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Pyrexia of Unknown Origin "Misleading First Impressions"

48 year old foundry worker from Kumta district, Karnataka (India) presented with 3 weeks history of fever, body ache, cough, weight loss (10 kg) and anorexia. Recently detected to have type 2 DM. No significant illness in the past. No history of any recent travel outside the district. O/E Temp 101.F, PR 112/min, RR-22/min BP 100/70 mm Hg Toxic looking. No pallor, icterus, clubbing, lymphadenopathy, skin lesions. Sparse crepitations heard over right lung base. Mild hepatomegaly present. No focal neurological deficit. With the above findings provisional diagnosis of

• Pneumonia

• Tuberculosis

• Enteric fever

• Brucellosis was made.

Materials and Methods:

Day-1:

TLC – 15,400/cu mm with neutrophilia, ESR – 140 mm/hr, RBS - 247 mg%, HIV, HbsAg, HCV status was negative. Tests for Dengue, Malaria, Typhoid, Leptospira, Brucella was negative. USG abdomen showed hepatomegaly and ECHO showed no vegetations. Blood and urine cultures were sent which were awaited, started on broad spectrum antibiotics in view of probable right lower lobe pneumonia.

Day-2:

Impression: tuberculosis/malignancy: Bronchoscopy showed only inflammatory cells, no endobronchial lesion, bronchial washings sent for gram stain, C&S, AFB.

Day-3:

He developed sudden onset of flaccid paraplegia with absent sensation below T8 level and urinary retention. Now the possibilties of acute myelitis, Spinal Abscess or Potts spine were considered.  Read more......

Visual Impairment in HIV Negative Tuberculosis Meningitis

Tuberculous meningitis (TBM) is the most common form of meningitis in the developing countries. It still carries a high morbidity and mortality despite the availability of computerised tomography (CT) scan, magnetic resonance imaging(MRI) scan and effective chemotherapy. Several recent studies involving multivariate regression analysis have suggested that stage of TBM, age, focal weakness , cranial nerve palsy and hydrocephalus are significant prognostic factors for a poor outcome at 3 months.

Visual impairment, especially blindness is a devastating outcome of TBM, occurring in 26-72%.

It can occur due to a lesion anywhere in the visual pathway because of the disease process per se, complications occurring during its course or as a result of side effects of the drugs given for its treatment. It may result from papillitis, papilloedema, primary or secondary optic atrophy, optochiasmatic arachnoiditis and occipital infarct . In addition ethambutol toxicity may also contribute to visual impairment. Sub-clinical visual impairment can be detected by visual evoked potentials. Read more.....

Joint Manifestations in HIV Infection: A Review

There is a diversity of literature on varying aspects of HIV. Central nervous system, cardio-pulmonary and abdominal complications affecting people living with HIV infection and AIDS.(PLWHA) have been extensively discussed in the literature. However, research has recently focused on how the disease affects the musculoskeletal system. It is necessary to focus among various joint manifestations in order to diagnose and properly treat various orthopedic, rheumatologic and pain symptoms amongst PLWHA. Musculoskeletal manifestations can occur at any phase of the infection but they are commonly seen in late phases. Theincidence of rheumatic manifestations in HIV infection was reported in about 4to 71.3% cases in different studies. Although musculoskeletal abnormalities in PLWHA are not as common as other systemic disorders but a wide variety of osseous, articular, muscular and soft tissue diseases may be seen. Many of these conditions are not specific for HIV infection and AIDS and can be seen in other forms of immunosuppression. However, I will be focusing only on joint disease in this review.

Epidemiology:

Studies show that musculoskeletal conditions affect 72% of HIVinfected individuals during their lifespan. In a prospective study of 74 consecutive HIV +ve patients clinical features of rheumatic manifestations were compared with 72 controls HIV –ve subjects with similar risk factors for HIV. HIV +ve group had more rheumatological manifestations than the HIV -ve group: arthralgias were found in 45%, arthritis in 10%, and Reiter’s syndrome in 8%. Thus, the study suggested that rheumatic manifestations more prevalent in HIV +ve patients.

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Emerging Antibiotic Resistance of Blood Stream Infections among Children

The emergence, growth and spread of bacteria with increasing antibiotic resistance is a significant health risk to children. Although antibiotics can be life-saving, its overuse leads to the development of resistance. Bacteria have developed varied mechanisms of resistance to all classes of antibiotics like (1) inactivation of the antimicrobial, (2) alteration of the site of antibiotic activity and (3) isolation of the target site from the antibiotic. Mechanisms of resistance to antimicrobials used to treat infectious disease have been known since before antibiotics were introduced into routine clinical usage.

Objective:

To review the emerging antibiotic resistance of blood stream infections among children.

Methodology:

We conducted a systematic search on Pub-Med and Googlescholar; reports from WHO and other organizations. We have used search terms as antibiotic resistance children.

Burden of antibiotic resistance in children:

Prescribing Support Unit (PSU) showed that out of the 40 million antibacterial prescriptions per year in primary care, around 12 million were for children. Children have high rates of minor infection but because of their increased susceptibility to serious bacterial infection are frequently prescribed for antibiotics. About 55% of children aged 0-5 years in the UK receive an average of 2.2 prescriptions for a β lactam antibiotic each year. Prescribing amoxicillin to a child more than triples the mean MIC (9.2 μg/ml vs 2.7 μg/ml, p=0.005). The correlation between community use of penicillin and penicillin resistance across 19 European countries has been reported as 0.84. Co-trimoxazole resistant pneumococci was recovered in 52% of children one week after malaria treatment with co-trimoxazole compared with 34% in controls.

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