Human pulmonary dirofilariasis presenting as a solitary pulmonary nodule: A case report and a brief review of literature

Human pulmonary dirofilariasis (HPD) is an uncommon disease in the United States. Dirofilaria is commonly known as “heartworm” based on the false belief that the worm resides in the heart which was based on findings from early necropsy reports. The first case was reported as an incidental autopsy finding in 1941. Since then only 87 more cases have been reported so far. We present an interesting case of this rare zoonotic disease affecting an elderly gentleman who presented with a rapidly growing lung nodule. We present a brief review of literature concerning the diagnosis and management of this disease.

Occult HBV infection among anti-HBc positive HIV-infected patients in apex referral centre, Eastern India

BACKGROUND

The prevalence of occult HBV, defined by the presence of HBV DNA in individuals with antibodies to HBV core antigen and with absence of HBV surface antigen, but its clinical significance and virological features in HIV-infected patients is still unclear.

AIM

To investigate the prevalence, clinical significance and molecular characterization of occult hepatitis B virus infection in ART-Naive HIV-positive individuals.

MATERIAL AND METHODS

Among the 1077 HIV-infected patients with different risk factors for HIV infection, 297 were HBsAg-ve ART-naive, of them 112 was randomly selected for the study. HBV DNA was tested by in-house PCR and quantified by qPCR. Molecular characterization was performed by sequencing the envelope and overlapping polymerase genes.

RESULTS

We found the prevalence of occult HBV to be 10.7% among a randomly selected group of HBsAg-ve/antiHBc+ve HIV-infected patients. Overall 33.9% (38 of 112) of the patients were antiHBc positive indicating exposure to HBV infection. HBV DNA was detected in 12/38 (31.5%) antiHBc positive samples and 50% of them had CD4 T cell count < 200 cells/mm(3). HCV coinfection was low (2.7%). No surrogate marker for OBI could be identified. Presence of antiHBs antibodies did not rule out OBI. Liver biopsy in six cases showed varying stages of chronic hepatitis. Several mutations were detected but not the common immune escape mutant G145R.

CONCLUSION

In conclusion the prevalence of OBI was significantly high among HIV coinfected patients, which highlights the importance of HBV DNA testing in these patients and indicates need for further prospective studies in larger cohorts to assess its clinical significance.

Associations between pollen counts, pollutants, and asthma-related hospital admissions in a high-density Indian metropolis

BACKGROUND

The seasonal pattern of asthma-related hospitalization has often been correlated with ambient allergen/pollutant levels.

OBJECTIVE

To examine the relationship between asthma-related hospital admissions (ARHA) and outdoor pollen, spore, and pollutant levels for adult patients in a densely populated Indian megacity Kolkata.

METHODS

ARHA data were obtained from two major teaching hospitals of the city. Pollen and spores causing allergic sensitization were identified by skin prick tests (SPTs) among respiratory allergic subjects (N = 1353). Outdoor concentrations of aeroallergens were determined using a Burkard sampler for five consecutive years (2004-2009). Levels of NO(2), SO(2), suspended particulate matters (SPMs), and respirable particulate matters (RPMs) were made available by West Bengal Pollution Control Board (WBPCB, Government of West Bengal). Poisson multivariate Poisson regression (with adjustments for overdispersion) was used to model the data. Results. We found that ARHA in Kolkata increased with predictable regularity in March and September, while remaining low in January and July. SPT showed highly positive skin reactions with grass/weed and palm pollens in respiratory allergic patients, while Aspergilli spores also evoked good sensitivity. In our regression model, the airborne pollen types, Cheno-Amaranthaceae and Cyperaceae, and the inorganic pollutant, SO(2) and RPM, were significantly associated with ARHA (p < .05).

CONCLUSION

ARHA in the megacity of Kolkata shows two seasonal peaks that can be correlated with outdoor grass/weed pollen and RPM concentrations. In contrast, the city's ambient fungal spore counts were not found to be significantly associated.

Evaluation of Cerebrospinal fluid adenosine deaminase activity as a complimentary tool in the early diagnosis of tuberculous meningitis in children

The diagnosis of tuberculous meningitis cannot be made or excluded on the basis of clinical findings. Definite laboratory diagnosis is cumbersome and time consuming. Delay in diagnosis and institution of proper treatment is directly related to poor outcome and sequalae. Adenosine deaminase activity (ADA) was estimated in cerebrospinal fluid (CSF) in addition to routine CSF analysis of 32 patients of tuberculous meningitis (TBM) and 7 patients of partially treated pyomeningitis (PTM), 10 patients aseptic meningitis (AM) and 13 patients pyogenic meningitis (PM). Mean ADA levels in CSF of TBM patients were higher (15.42 U/L) as compared to 7.21 U/L, 6.41 U/L and 7.50 U/L in PTM, AM and PM respectively. This difference of ADA values in CSF between TBM and other types of meningitis was statistically significant (p<0.01). ADA values were also compared with other biochemical and cytological parameters of CSF & a positive correlation was found with CSF protein level. Sensitivity and specificity of ADA levels in CSF of children to diagnose tuberculous meningitis was 75% and 90% respectively at 10 U/L cut off of ADA levels in CSF. Journal of College of Medical Sciences-Nepal,2012,Vol-8,No-2, 17-23 DOI: http://dx.doi.org/10.3126/jcmsn.v8i2.6833

A case of leptospirosis in a child with unusual clinical manifestation

Leptospirosis is a re-emerging zoonotic disease with a worldwide distribution. In the mild form it may present as flu like illness. Severe form characterized by jaundice, renal dysfunction and hemorrhagic diathesis is referred to as Weil’s syndrome. Very few cases have been reported in India, and pediatric cases are extremely rare. We report a case of leptospirosis in a 12 year old girl who presented with irregular fever, malaise and spontaneous bleeding from nose. She also had headache, vomiting, subconjunctival hemorrhage, photophobia, pain abdomen, cervical lymphadenopathy, myalgia, and arthralgia. She developed severe coagulopathy, bilateral pleural effusion, ascitis, acalculous cholecystitis ultimately leading to ARDS and later multi-organ failure. ELISA for IgM leptospira was sent which came to be positive. She was given several units of packed cell, platelet concentrate, and plasma transfusion, and later mechanical ventilation and inotropic support. The patient was put on intravenous penicillin G.. which was continued for 10 days. Three weeks following admission, she had made a complete recovery and was discharged. Journal of College of Medical Sciences-Nepal,2012,Vol-8,No-2, 37-41 DOI: http://dx.doi.org/10.3126/jcmsn.v8i2.6836

Human umbilical cord Wharton's jelly stem cells and its conditioned medium support hematopoietic stem cell expansion ex vivo

Bone marrow mesenchymal stromal cells (BMMSCs) have been used as feeder support for the ex vivo expansion of hematopoietic stem cells (HSCs) but have the limitations of painful harvest, morbidity, and risk of infection to the patient. This prompted us to explore the use of human umbilical cord Wharton's jelly MSCs (hWJSCs) and its conditioned medium (hWJSC-CM) for ex vivo expansion of HSCs in allogeneic and autologous settings because hWJSCs can be harvested in abundance painlessly, are proliferative, hypoimmunogenic, and secrete a variety of unique proteins. In the presence of hWJSCs and hWJSC-CM, HSCs put out pseudopodia-like outgrowths and became highly motile. Time lapse imaging showed that the outgrowths helped them to migrate towards and attach to the upper surfaces of hWJSCs and undergo proliferation. After 9 days of culture in the presence of hWJSCs and hWJSC-CM, MTT, and Trypan blue assays showed significant increases in HSC numbers, and FACS analysis generated significantly greater numbers of CD34(+) cells compared to controls. hWJSC-CM produced the highest number of colonies (CFU assay) and all six classifications of colony morphology typical of hematopoiesis were observed. Proteomic analysis of hWJSC-CM showed significantly greater levels of interleukins (IL-1a, IL-6, IL-7, and IL-8), SCF, HGF, and ICAM-1 compared to controls suggesting that they may be involved in the HSC multiplication. We propose that cord blood banks freeze autologous hWJSCs and umbilical cord blood (UCB) from the same umbilical cord at the same time for the patient for future ex vivo HSC expansion and cell-based therapies.

Magnetic nonuniformity and thermal hysteresis of magnetism in a manganite thin film

We measured the chemical and magnetic depth profiles of a single crystalline (La(1-x)Pr(x))(1-y)Ca(y)MnO(3-δ) (x=0.52±0.05, y=0.23±0.04, δ=0.14±0.10) film grown on a NdGaO(3) substrate using x-ray reflectometry, electron microscopy, electron energy-loss spectroscopy, and polarized neutron reflectometry. Our data indicate that the film exhibits coexistence of different magnetic phases as a function of depth. The magnetic depth profile is correlated with a variation of chemical composition with depth. The thermal hysteresis of ferromagnetic order in the film suggests a first-order ferromagnetic transition at low temperatures.