Plasmodium knowlesi - an emerging pathogen

Ten years have passed since the publication of a large focus of Plasmodium knowlesi infections in the human population. The discovery was made during a molecular investigation of atypical P. malariae cases in the Kapit Health Division, Sarawak, Malaysian Borneo. Patients were more symptomatic with higher parasite counts than expected in P. malariae infections. The investigation found only P. knowlesi DNA present in patient blood samples. Morphological similarity had allowed P. knowlesi to masquerade as P. malariae during routine diagnostic microscopy for malaria. P. knowlesi, a malaria parasite of macaque monkeys, had entered the human population. The subsequent development of P. knowlesi species-specific PCR assays soon demonstrated that the entry was not confined to the Kapit Division but extended across island and mainland Southeast Asia. Relevant clinical descriptions and guidelines for the treatment and management of patents with P. knowlesi malaria were not available. Nor was it clear whether P. knowlesi had undergone a host switch event into the human population or if infections were zoonotic. The outputs of studies on P. knowlesi malaria during the past 10 years will be summarized, highlighting major findings within the context of pathophysiology, virulence, host switch events, treatment, control and importantly malaria elimination.

A Psoriatic Arthritis Patient with Multiple Rare Complications – case report and review of literature

A 28 year old male patient of psoriasis was admitted in a tertiary care hospital of Bangladesh with typical skin lesions for 18 years, nail changes for 16 years, arthritis for 12 years and eye changes for 3 years. In addition he had other rare extra articular complications like severe aortic stenosis, moderate aortic regurgitation and mild mitral regurgitation. He had a positive family history of psoriasis. HLAB27 is positive and X-ray of hands and feet showed classical findings of psoriatic arthritis. We presented the case to show the early age of onset, severity of the disease with rapid progression and multiple extra articular complications. DOI: http://dx.doi.org/10.3329/pulse.v5i2.20266 Pulse Vol.5 July 2011 p.48-53

Repetitive transcranial magnetic stimulation in neuropathic pain secondary to malignancy: a randomized clinical trial

BACKGROUND

Significant analgesic effects of repetitive transcranial magnetic stimulation (rTMS) have been found in several studies of patients with chronic pain of various origins, but never for malignancy. The objective of this study was to assess the efficacy of 10 sessions of rTMS over the primary motor cortex (M1) in patients suffering from malignant neuropathic pain.

METHODS

Thirty-four patients were randomly allocated into one of two groups to receive real (20 Hz, 10 s, 10 trains with 80% intensity) or sham rTMS daily for 10 consecutive days. Patients were evaluated using a verbal descriptor scale (VDS), a visual analogue scale (VAS), Leeds assessment of neuropathic symptoms and signs (LANSS) and Hamilton rating scale for depression (HAM-D) at baseline, after the first, fifth and 10th treatment sessions, and then 15 days and 1 month after treatment.

RESULTS

There were no significant differences between real and sham groups in the duration of illness or pain rating scores at the baseline. A significant 'Time × Group' interaction was recorded indicating that real and sham rTMS had different effects on the VDS, VAS, LANSS and HAM-D scales. Post-hoc testing showed that the group of patients treated with real rTMS had greater improvement in all scales that persisted up to 15 days, but were not present 1 month later. Significant positive correlations between the percentage of pain reduction and HAM-D after the 10th session and 15 days later were recorded.

CONCLUSION

The results demonstrate that 10 rTMS sessions over the M1 can induce short-term pain relief in malignant neuropathic pain.

Low-temperature solution-processed flexible solar cells based on (In,Ga)N nanocubes

Indium gallium nitride nanocubes were syntheized via a low-temperature chemical route. Energy-dispersive X-ray spectroscopy and X-ray diffraction analyses confirmed the successful fabrication of (In,Ga)N with various indium mole fractions. The bandgap of the material was tunded as a function of the indium content. The fabricated nanocubes showed a deep level photoluminescence emission at 734 nm as well as in the visible region at 435-520 nm. The Hall effect measurements showed the hole concentration to constantly increase from 6.2 × 10(16) to 2.3 × 10(18) cm(-3), while the hole mobility to decrease from 0.92 to 0.1 cm(2) /(V s) as the doping ratio increases from 0.005 to 0.025 cm(-3). The solar cell device made of nanocubes film containing 0.4 indium on flexible substrates showed a short-circuit current density of 12.47 mA/cm(2) and an open-circuit voltage (Voc) of 0.48 V with 54% fill factor. The relationship between Voc and indium content in the fabricated films was also investigated.

Effectiveness of levofloxacin in enteric fever

This intervention study was conducted to determine the efficacy of Levofloxacin in the treatment of uncomplicated enteric fever. Among 100 patients, who were purposively selected for the study had presented sign and symptoms of enteric fever with blood culture positive salmonella in laboratory findings during the admission in the department of Medicine, Uttara Adhunik Medical College & Hospital, Dhaka. Patients who fulfilled the diagnostic criteria were enrolled in the study and divided into two groups. One group was treated with oral levofloxacin 750mg once daily (OD) and another was injected with Levofloxacin 500mg once daily for 7 days. All the patients were examined twice daily to observe the clinical cure or failure of levofloxacin. Study was conducted from January 2008 to December 2008. Statistical analysis was performed by using statistical software SPSS version 12. Among the 100 patients in the study, majority of them 46(92%) were aged between 15 to 25 years, the next group was between 25 to 35 years 26(52%) and only three patients were aged above 65 years. Significant number of the patients were male (67), and the rest of them were female. The patients were clinically examined specially for anaemia, jaundice, caecal gurgling, hepatosplenomegaly in both the groups and the relevant investigations were performed. It was found that 46 patients in group A, who took oral levofloxacin, were cured after seven days, whereas 48 patients in group B were fully cured by taking injectable levofloxacin by seven days. In this study, levofloxacin was found to be the most effective drug in both oral and injectable form in one-week treatment of uncomplicated typhoid.

Preparation and characterization of nanometric Mn ferrite via different methods

The structure and magnetic properties of MnFe(2)O(4) ferrites have been investigated using five different preparation methods, including the ceramic technique, flash combustion, co-precipitation, sol-gel and citrate methods. The characteristics of one sample prepared by different methods have been studied to select the better method, i.e. the one that is the simplest and does not require an elaborate instrumental set-up. The results indicated that the citrate method gives the lowest value for the lattice parameter and particle size (14.1 nm), while the highest values are obtained with the ceramic method. The smallest nanosizes were obtained in the citrate and flash methods (14.1 and 40.7 nm, respectively).

Effect of daily repetitive transcranial magnetic stimulation for treatment of tinnitus: comparison of different stimulus frequencies

We compared the effect of different frequencies of repetitive transcranial magnetic stimulation (rTMS) (1 Hz, 10 Hz, 25 Hz and sham (occipital, 1 Hz)), given daily over the left temporoparietal cortex for 2 weeks, on 66 patients with chronic tinnitus randomly divided into four treatment groups. Patients were assessed using the Tinnitus Handicap Inventory, self-ratings of symptoms and audiometric measures of residual inhibition before, immediately after 2 weeks' treatment and monthly thereafter for 4 consecutive months.

RESULTS

There were no significant differences in basal measures between the four groups of patients. A two-factor ANOVA revealed a significant "rTMS" x "time" interaction for all measures. This was because real rTMS produced greater improvement than sham. However, there was no significant difference between the responses to different frequencies of rTMS. The response to rTMS depended on the duration of tinnitus: patients who had tinnitus for the longest period of time were the least likely to respond to treatment.

CONCLUSION

Daily sessions of rTMS over the temporoparietal cortex may be a useful potential treatment for tinnitus.

Platelet aggregation and physiological anticoagulants in sickle-cell disease

During the period January 2002-December 2004, we assessed 30 sickle-cell anaemia patients admitted to hospital in Al Khobar with vaso-occlusive crisis for levels of antithrombin (AT) III, protein C (PC) and protein S (PS). We also did platelet aggregation studies. Steady state levels were assessed during follow-up and compared with 36 adult controls. Levels of PC, PS and AT III in the control group were significantly higher than in those in vaso-occlusive crisis and those in steady state (P < 0.001). There was a statistically significant difference between controls and patients for all platelet aggregation factors except adrenaline. There was no significant difference between the levels of PC, PS, AT III and platelet aggregation variables in patients in the steady state and in vaso-occlusive crisis.

Longlasting antalgic effects of daily sessions of repetitive transcranial magnetic stimulation in central and peripheral neuropathic pain

BACKGROUND AND OBJECTIVE

A single session of repetitive transcranial magnetic stimulation (rTMS) over motor cortex had been reported to produce short term relief of some types of chronic pain. The present study investigated whether five consecutive days of rTMS would lead to longer lasting pain relief in unilateral chronic intractable neuropathic pain.

PATIENTS AND METHODS

Forty eight patients with therapy resistant chronic unilateral pain syndromes (24 each with trigeminal neuralgia (TGN) and post-stroke pain syndrome (PSP)) participated. Fourteen from each group received 10 minutes real rTMS over the hand area of motor cortex (20 Hz, 10x10 s trains, intensity 80% of motor threshold) every day for five consecutive days. The remaining patients received sham stimulation. Pain was assessed using a visual analogue scale (VAS) and the Leeds assessment of neuropathic symptoms and signs (LANSS) scale, before, after the first, fourth, and fifth sessions, and two weeks after the last session.

RESULTS

No significant differences were found in basal pain ratings between patients receiving real- and sham-rTMS. However, a two factor ANOVA revealed a significant "+/- TMS" x "time" interaction indicating that real and sham rTMS had different effects on the VAS and LANSS scales. Post hoc testing showed that in both groups of patients, real-rTMS led to a greater improvement in scales than sham-rTMS, evident even two weeks after the end of the treatment. No patient experienced adverse effects.

CONCLUSION

These results confirm that five daily sessions of rTMS over motor cortex can produce longlasting pain relief in patients with TGN or PSP.

Placental pathology in relation to the White's classification of diabetes mellitus

The objective of this study was to investigate various macroscopic and microscopic features of the placenta in pregnancies complicated by diabetes according to White's classification. A total of 148 placentas were studied. Sixty-five were from control patients and 83 from diabetic mothers. The diabetic mothers were further divided into three groups according to White's classification. There were 40 cases in White's group A and 36 cases in White's group B. There were 7 cases in White's groups C and D combined. Advanced maternal age and grandmultiparity were significantly higher in White A, White B and White C&D compared to the normal group. Mean weight of the mother was higher in White group A and group B compared to the control group and group C&D. The placental weight and neonatal weight were increased provided the diabetes was not complicated by vascular disease. With accompanying vascular disease the placental weight and neonatal weight were reduced compared to the controls. As a result of increased perinatal jeopardy the rate of operative delivery was higher in diabetic mothers. No major difference was observed in microscopic changes of placentas in different groups according to White's classification and the normal group.

Frequency of ABO blood groups in the Eastern region of Saudi Arabia

OBJECTIVE

To document the frequency of the ABO and Rhesus blood groups in Saudi male donors, and to compare our results with the results of other studies in the Kingdom and elsewhere.

METHODS

This study included a total of 57396 male potential blood donors; 19496 blood donors between the years 1985-1989 (referred to as first period of study) and 37700 blood donors between the years 1995-1999 (2nd period). The blood donors were Saudis, coming to donate blood for various reasons to the Blood Bank Department of King Fahd Hospital of the University, Al-Khobar, Kingdom of Saudi Arabia. ABO and Rhesus blood groups from 200 Saudi females were also determined. The frequency of ABO blood groups and Rhesus status were calculated separately.

RESULTS

Our results revealed the most common blood group was O, (52%) during the first period of study and likewise the most common blood group (51%) during the 2nd period. The lowest blood group frequency was AB (4%) and (4%) during the first and 2nd period. Rhesus positive blood donors comprised 93% and Rhesus-negative donors were 7% during the first period, while they amounted to 91.5% and 8% during the 2nd period. Overall frequency of ABO and Rhesus blood groups during the 2 periods were the following: O-positive 48% and 46%; A-positive 24% and 24.5%; B-positive, 17% and 17%; AB positive 4% and 4%; O negative 4% and 5%; A negative 2% and 2%; B-negative 1% and 2%; and AB negative, 0.23% and 0.32%. Comparison of our results with the other studies from the Kingdom and other nationalities is also presented.

CONCLUSION

Our results show that the most frequent blood group in Saudis is O-positive. Blood group A is observed at a lower frequency relative to values from Western populations, whereas a significant increase in blood group B combined with a slight increase in blood group AB was recorded. Knowledge of the frequencies of the different blood groups in Saudi Arabia is very important for Blood Banks and transfusion service policies. Knowledge of blood group phenotype distribution is also important for clinical studies (for example disease association), as well as for population studies.

Ulcerative colitis in Saudi Arabia: a retrospective analysis of 33 cases treated in a regional referral hospital in Gizan

BACKGROUND

Until recently ulcerative colitis (UC) was considered rare among Arabs. Information on its occurrence among Saudi is scant and limited to a few reports from urban populations.

AIM OF STUDY

to assess the frequency and clinico-pathologic pattern of this disease in a rural population in Gizan region, Saudi Arabia.

METHODS

thirty three patients found to have UC over a 4-year period in King Fahad Central Hospital were analyzed retrospectively.

RESULTS

there were 24 males and nine females patients with UC (ages ranged from 17-70 years, mean age 43.5 years). The commonest presenting symptoms were abdominal pain and diarrhea in 30 and 26 patients respectively. Extra-intestinal manifestations were rare, occurred in only two patients. Total or pancolitis was found in ten (30%) patients and it was severe in nine of them. The disease extended to the splenic flexure in eight (24.2%) of the patients. A total colectomy was required in one patient with severe pan-colitis and a focus of malignancy was present in the resected specimen. No patient died during the follow-up period that ranged from one to six years.

CONCLUSION

the study confirmed the occurrence of UC among the rural population studied. The male preponderance, the older age at presentation and relatively milder diseases appeared to be differentiating features from the pattern among western populations.

Familial thrombocytosis as a recessive, possibly X-linked trait in an Arab family

Familial thrombocytosis (FT) has previously been described as an autosomal-dominant disorder with manifestations similar to those of sporadic essential thrombocythaemia. We studied an Arab family consisting of four brothers, aged 4-8 years, who had either sustained markedly elevated (> 1000 x 109/l) or moderately elevated (> 500 x 109/l) platelet counts, two healthy sisters and their parents who had normal platelet counts. The four brothers with FT had normal plasma thrombopoietin levels and are currently not presenting with any thrombotic or haemorrhagic complications. Mutation analysis at the thrombopoietin gene (THPO) of the affected family members failed to detect the intron 3 G-->C splice mutation that had been described as causing FT. In addition, segregation analysis using a polymorphic CA marker revealed completely discordant THPO alleles among the affected brothers. We postulate the existence of a new locus for FT whereby the disease is transmitted as a recessive, possibly X-linked trait.

The status of rubella immunity among pregnant women in Kuwait: screening in childbearing age should be reintroduced

The objective of this study was to investigate the immunity against rubella in the obstetric population in Kuwait by testing 600 pregnant women at a prenatal clinic, using the haemagglutination inhibition technique. In addition, a comparison was made between this study and one done in 1978 at the same clinic; its relation to the vaccination programme is also discussed. 7.7% of the population under study were non-immune. Statistically significant effect was demonstrated for maternal age but not for parity and nationality. Though it has been almost 20 years since an intense rubella vaccination programme was implemented, the percentage of non-immune pregnant women has not decreased. In Kuwait, termination of pregnancy for congenital rubella syndrome is prohibited. As a result, it is recommended that women be screened and vaccinated at the time of marriage.

Middle cerebral artery to umbilical artery resistance index ratio in the prediction of neonatal outcome

OBJECTIVE

The objectives of this study were to evaluate the usefulness of the middle cerebral artery to umbilical artery resistance index ratio (C/U ratio) as a predictor of adverse perinatal outcome, and to show that the absence of fetal umbilical artery end-diastolic velocity (AEDV) in SGA fetuses is associated with high morbidity and mortality.

METHOD

In this prospective study, color Doppler flow imaging was used for the estimation of the C/U ratio in fetuses that were small for their gestational age, in 70 singleton pregnancies between 29 and 42 weeks of gestation. The subjects were categorized into two groups, with Group A consisting of 35 small for gestational age (SGA) fetuses with a normal C/U ratio (1.05 or higher), and Group B comprising 35 SGA fetuses with an abnormal C/U ratio (below 1.05).

RESULT

The mean C/U ratio values for birth weight and gestational age were higher in group A than in group B. Fetuses born to mothers in group B stayed longer in the neonatal special care unit (NSCU), whereas the period from ultrasound examination to delivery was higher in the cases in group A. A higher percentage of mothers with an abnormal C/U ratio underwent cesarean section. Fetuses with an absent end-diastolic velocity of the umbilical artery had a higher morbidity. Three stillbirths occurred in fetuses with an absent end-diastolic velocity of the umbilical artery.

CONCLUSION

Our results suggest that the C/U ratio is a good predictor of neonatal outcome, and could be used to identify fetuses at risk of morbidity and mortality. Fetal umbilical artery AEDV with intrauterine growth restriction is associated with high perinatal morbidity and mortality.

Nutritive value of traditional sweets consumed in the Arab Gulf countries

Proximate, mineral, fatty acid and cholesterol composition of eight traditional sweets commonly consumed in the Arab Gulf countries were determined. Four sweets were obtained from Bahrain, whereas the other sweets were obtained from Oman. Protein level ranged from 0.2 to 9.0%, while the fat content ranged from 7.9 to 18.0%. In general, the sweets were found to be high in energy content but poor in most minerals. Iron and zinc contents were low (less than 2 and less than 1 mg/100 g for iron and zinc, respectively). Cholesterol was high in four sweets (range from 10.6 to 20.4 mg/100 g), mainly because of the use of animal fat in preparation of these sweets. The fatty acids profiles showed that palmitic and oleic acids were predominant. One sweet (eggbaith) was found to be very high in linoleic (42%) and low in palmitic (9.6%) acids. The study showed that some traditional sweets are nutritious, while others should be consumed with moderation.

Cytogenetics of the Anopheles gambiae complex in Sudan, with special reference to An. arabiensis: relationships with East and West African populations

The species composition of malaria vector mosquitoes belonging to the Anopheles gambiae complex (Diptera: Culicidae) from >40 localities in Sudan, representing most ecological situations, was determined by analysis of ovarian polytene chromosomes. Of 2162 females, 93% were identified as An. arabiensis Patton and 7% were An. gambiae Giles sensu stricto. No hybrids were found between the two species. Anopheles arabiensis occurred in all but two sites, whereas An. gambiae s.s. was effectively limited to the southernmost, more humid localities. For chromosomal paracentric inversions, the degree of polymorphism was low in An. gambiae s.s. (inversions 2La, 2Rb and 2Rd), higher in An. arabiensis (inversions Xe, 2Ra, b, bc, d1, s; 3Ra, d). Anopheles gambiae samples from Sudan were all apparently panmictic, i.e. they did not show restricted gene flow such as observed among West African populations (interpreted as incipient speciation). Chromosomal inversion patterns of An. gambiae in southern Sudan showed characteristics of intergrading Savanna/Forest populations similar to those observed in comparable eco-climatic situations of West Africa. Anopheles arabiensis was polymorphic for inversion systems recorded in West Africa (2Ra, 2Rb, 2Rdl, 3Ra) and for a novel 2Rs polymorphism, overlapping with inversion systems 2Rb and 2Rd1. Samples carrying the 2Rs inversion were mostly from Khashm-el-Girba area in central-eastern Sudan. In the great majority of the samples all polymorphic inversions were found to be in Hardy-Weinberg equilibrium. Sudan populations of An. arabiensis should therefore be considered as generally panmictic. Anopheles arabiensis shows more inversion polymorphism in west than in east African populations. Sudan populations have more evident similarities with those from westwards than those from eastwards of the Great Rift Valley. The possible influence of the Rift on evolution of An. arabiensis is discussed.

Potentiometric sensors for the selective determination of sulbutiamine

Five novel polyvinyl chloride (PVC) matrix membrane sensors for the selective determination of sulbutiamine (SBA) cation are described. These sensors are based on molybdate, tetraphenylborate, reineckate, phosphotun gestate and phosphomolybdate, as possible ion-pairing agents. These sensors display rapid near-Nernstian stable response over a relatively wide concentration range 1x10(-2)-1x10(-6) M of sulbutiamine, with calibration slopes 28 32.6 mV decade(-1) over a reasonable pH range 2-6. The proposed sensors proved to have a good selectivity for SBA over some inorganic and organic cations. The five potentiometric sensors were applied successfully in the determination of SBA in a pharmaceutical preparation (arcalion-200) using both direct potentiometry and potentiometric titration. Direct potentiometric determination of microgram quantities of SBA gave average recoveries of 99.4 and 99.3 with mean standard deviation of 0.7 and 0.3 for pure SBA and arcalion-200 formulation respectively. Potentiometric titration of milligram quantities of SBA gave average recoveries of 99.3 and 98.7% with mean standard deviation of 0.7 and 1.2 for pure SBA and arcalion-200 formulation, respectively.

The prevalence of antibody to human parvovirus B19 in pregnant women in Kuwait

Infection with parvovirus B19 during pregnancy is known to be associated with various fetal damage, such as aplastic anemia and hydrops fetalis. Our objective was to study the seroprevalence of parvovirus B19 in the obstetric population in Kuwait and to compare this with that in the adult population in other regions. Blood samples from 1047 pregnant women were used in this prospective study. Information regarding patient's age, parity, nationality and symptoms was obtained at the time of collection of the sample. Blood was tested for IgG and IgM antibodies specific for parvovirus B19 using the ELISA technique. The overall prevalence for IgG and IgM was 53.3 and 2.2%, respectively. IgG seropositivity was higher in non-Kuwaiti women, while IgM antibodies was more frequent in Kuwaiti women. A total of 17.4% of the acutely infected patients were symptomatic. Prevalence of parvovirus B19 infection in Kuwait is comparable with that in the other countries.

Hereditary hemorrhagic telangiectasia: A Case Report

Full text is available as a scanned copy of the original print version.