Clinical features and outcomes of COVID-19 patients with concomitant herpesvirus co-infection or reactivation: A systematic review

Background

Since the first case of COVID-19 was diagnosed in Wuhan, China in late 2019, concomitant infections with Herpesviridae were documented that were presented from simple skin manifestations to severe life-threatening conditions that may lead to mortality. In this systematic review, we have included studies conducted in different parts of the world to find out the association of clinical features and outcomes of COVID-19 infection and concomitant Herpesviridae infection.

Methods

A comprehensive search was conducted in electronic databases including Medline through PubMed, Cochrane database, Scopus and Web of science (core collection). Two review authors independently screened the articles and extracted data. The Risk of bias assessment was done by using RoBANS tool.

Results

A total of 919 studies were retrieved and 19 studies were included having data of 539 patients who were infected with both COVID-19 and Herpesviridae. Herpes Simplex-1, Varicella Zoster, Cytomegalovirus, Epstein-Barr virus and Human Herpes Virus-6 were the detected viruses in the included studies. Cytomegalovirus (CMV) reactivation was the most detected concomitant infection. In case of reactivation with more than one Herpes virus mortality among patients were detected along with single viral infection in some studies. Significant association was noted in dosage and usage of steroid and Herpesviridae reactivation in COVID-19 patients. Blood markers such as D-dimer, CRP along with length of stay in the ICU and usage of invasive mechanical ventilation were found to be the significantly associated markers.

Conclusion

Findings from this study will aid clinicians to assess and treat COVID-19 cases with co-infections.

Antibody response to receptor-binding domain of SARS-CoV-2 spike protein following vaccination and natural infection with SARS-CoV-2

Background and objectives: Antibody to SARS-CoV-2 develops both after natural infection with SARS-CoV-2 and vaccination. This study was undertaken to determine the antibody response to SARS-CoV-2 among population after natural SARS-CoV-2 infection and vaccination. Material and methods: The study was carried out on adults aged 18 years and above. Study population consisted of four groups. Group-1 (control): healthy and history of no prior SARS-CoV-2 infection and vaccination, Group-2: had past SARS-CoV-2 infection and no vaccination, Group-3: received two doses of recombinant adenoviral vector vaccine ChAdOx1 (Oxford–AstraZeneca) without past SARS-CoV-2 infection, and Group-4: had past SARS-CoV-2 infection and received 2 doses of ChAdOx1 vaccination. Blood was collected 1 and 7 months after the second dose of vaccination from Group-3 and 4 individuals. Single blood sample was collected from participants of Gr-1 and 2 at the time of enrolment. Immunoglobulin G (IgG) antibodies to receptor-binding domain (RBD) of SARS-CoV-2 spike protein S1 (anti-RBDS1 IgG) was determined in serum by ELISA method. Results: Total 176 participants aged 18 years and above were enrolled. Anti-RBDS1 IgG positivity rates were 51.9%, 66.7%, 96.8% and 100% in individuals of Group-1, 2, 3 and 4 respectively. Gr-4 had significantly (p < 0.05) mean higher anti-RBDS1 IgG antibody level (120.8 ± 31.9 DU/ml) compared to other groups 1 month after 2nd dose of vaccination. No significant differences in antibody response were found among the individuals of four groups across gender and comorbidities. Seven months after the 2nd dose of vaccines, the antibody concentration declined in 85.3% (112.1 ± 30.4 DU/ml to 75.9 ± 48.7 DU/ml) and 81.5% (127.3 ± 20.4 DU/ml to 92.5 ± 43.6 DU/ml) individuals of Group-3 and Group-4 respectively. Decline of antibody was 40.6% and 34.7% in 7 months, but all remained positive except 1 in Group-3. Fever (34.4%) and headache (24.8%) were the most common adverse effects noted after vaccination. Conclusion: The study revealed that ChAdOx1 nCoV-19 vaccine induces high concentration of persisting anti-RBDS1 IgG antibody after 2nd dose and previous infection with SARS-CoV-2 acts as immune priming. Therefore, antibody screening test prior to booster dose could be a good option to maximize coverage of vaccination. IMC J Med Sci. 2023; 17(1): 009. DOI: https://doi.org/10.55010/imcjms.17.009 *Correspondence: J. Ashraful Haq, Department of Microbiology, Ibrahim Medical College, 1/A Ibrahim Sarani, Segunbagicha, Dhaka, Bangladesh. Email: jahaq54@yahoo.com

Prevalence of SARS-CoV-2 Infection Among COVID-19 Reverse Transcription-Polymerase Chain Reaction (RT-PCR) Laboratory Workers in Bangladesh

Background: Healthcare workers (HCWs) at the frontline are confronting a substantial risk of infection during the COVID-19 pandemic. This emerging virus created specific hazards to researchers and laboratory staff in a clinical setting, underlined by rapid and extensive worldwide transmission.

Objectives: This study aimed to investigate the prevalence of SARS-CoV-2 infection among COVID-19 reverse transcription-polymerase chain reaction (RT-PCR) laboratory health workers in Bangladesh.

Materials and methods: This retrospective study was conducted between October 2 to December 2, 2020. A total of 508 participants, including doctors, scientific officers, medical technologists, and cleaners working in several COVID-19 RT-PCR laboratories, were included in this study. Data were collected from each participant using a semi-structured questionnaire prepared in the format of an anonymous Google form. All statistical analyses were performed using SPSS, version 25.0 (SPSS Inc., Chicago, IL, USA).

Results: Out of the 508 participants, 295 tested positive for SARS-CoV-2 RT-PCR. Among the positive cases, 202 were men, and 93 were women, with a median age of 30 years. The most positive cases were medical technologists (53.22%) followed by doctors (28.8%). Out of the 271 symptomatic positive cases, the most typical symptoms were fever (78.5%), fatigue (70%), loss of smell and taste (65%), and cough (64%). Hypertension, obesity, and diabetes were found in 8.8%, 8.8%, and 7.1% positive cases. A + blood group was present in 37% of the positive cases, followed by the B+ blood group (27%) and O+ blood group (25%). Inadequate supply of personal protective equipment (PPE), absence of negative pressure ventilation, laboratory contamination, and no training on molecular test methods were found in 13.8%, 67.8%, 44.7%, and 40.6% of positive cases, respectively.

Conclusion: Evaluating the infection status of laboratory HCWs is crucial for drawing attention from the public, providing practical suggestions for government agencies, and increasing protective measures for laboratory HCWs.

Enabling methanol oxidation by interacting hybrid nano system of spinel Co3O4 nanoparticles decorated MXene

For the successful implementation of direct methanol fuel cells in the commercial applications, highly efficient and durable non-noble electrocatalyst based on conducting and stable non-carbonaceous support can be a potential...

Challenges in the establishment of a biosafety testing laboratory for COVID-19 in Bangladesh

At the beginning of the coronavirus disease 2019 (COVID-19) pandemic in Bangladesh, there was a scarcity of ideal biocontainment facilities to detect the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a risk group of 3 organisms. Molecular detection of SARS-CoV-2 must be performed in a BSL-2 laboratory with BSL-3-equivalent infection prevention and control practices. Establishing these facilities within a short timeframe proved to be an enormous challenge, including locating a remote space distant from the university campus to establish a laboratory, motivating the laboratory staff to work with a novel pathogen without any prior experience, allocation of funds for essential equipment and accessories, and arrangement of a safe waste management system for environmental hazard reduction. This report also highlights several limitations, such as the facility's architectural design that did not follow the biosafety guidelines, lack of continuous flow of funds, and an inadequate number of laboratory personnel. This article describes various efforts taken to overcome the challenges during the establishment of this facility that may be adopted to create similar facilities in other regions of the country. Establishing a BSL-2 laboratory with BSL-3-equivalent infection prevention and control practices will aid in the early detection of a large number of cases, thereby isolating persons with COVID-19, limiting the transmission of SARS-CoV-2, and promoting a robust public health response to contain the pandemic.

A review of epidemiology, clinical features and disease course, transmission dynamics, and neutralization efficacy of SARS-CoV-2 variants

Background

After the first detection in November 2019, SARS-CoV-2 has spread rapidly over the continents and started the pandemic of the millennium. In addition to several novels and repurposed monoclonal antibodies (mAbs) as a therapeutic option against COVID-19, scientists from across the world have developed several candidate vaccines, developed mainly targeting the Wuhan strain, with very promising results to combat this pandemic. Unfortunately like any RNA viruses, SARS CoV-2 has also gone through the accumulation of hundreds and thousands of mutations in their genome lead to the development of several variants of concerns (VOC) and variants of interests (VOI), resulting in increased transmissibility and virulence of the virus, along with their capacity to escape cross-protection. Seemingly, the main hindrance of containing this pandemic right now is the effectiveness of currently available vaccines and mAbs against newly emerging variants. Therefore, it is important to monitor variants epidemiology, transmission dynamics, clinical characteristics, as well as their immune evasion capacity to implement appropriate vaccine strategy and other containment measures.

Body

In this review, we tried to focus on variants characteristics and to what extent they can escape immunity, provided by both available vaccinated sera and convalescent sera. A stringent literature review was performed using various databases, mentioned in the methodology portion. The current geographical distribution of these variants of SARS CoV-2 has been presented using a heat map. Findings from published articles comparing these variants, in terms of genome epidemiology, transmissibility, viral load dynamics, and association with different waves have been described briefly. Due strength was given while describing variants neutralization potency against current vaccines, mAbs, and also against convalescent sera. Data from both clinical trials and in vitro/ex-vivo studies have been discussed here. Comparative findings from several articles were brought into one concise paper. After careful reviewing of all the available data, it was clear that, without hesitation, we should strengthen our vaccination strategy, because the severity of COVID 19 is reasonably lower, irrespective of variants and vaccine used.

Conclusion

We hope that many falsified myths and beliefs regarding vaccine immunity and emerging variants will be clarified in light of this available evidence, which we summarized in our paper.

Experience in establishing a high-risk biocontainment facility in response to COVID-19 pandemic under resource constrain settings

The health care systems in resource limited countries are facing major challenges in dealing with Coronavirus disease (COVID-19). In Bangladesh, a steady increase in the number of COVID-19 cases since its first report on March 8, 2020, has led to an increased demand for COVID-19 detection facilities throughout the country. The detection of severe acute respiratory syndrome (SARS-CoV-2), the causative organism of COVID-19 and a highly infectious group 3(three) organism, requires a high biocontainment laboratory with a certain standard prerequisite infrastructure. This study describes the necessary steps for establishing and running a COVID-19 laboratory under resource constraint settings. Our experience indicates that, with collaborative efforts, funding, and technical support from locally available expertise, it is feasible to set up an optimally functional biocontainment facility with an acceptable quality performance despite several short comings. BSMMU J 2021; 14 (COVID -19 Supplement): 45-50

Modelling and optimization of factors influencing adsorptive performance of agrowaste-derived Nanocellulose Iron Oxide Nanobiocomposites during remediation of Arsenic contaminated groundwater

Nanocellulose Iron Oxide Nanobiocomposites (NIONs) were synthesized from rice husk and sugarcane bagasse derived nanocelluloses for adsorptive removal of arsenic and associated contaminants present in groundwater samples. These NIONSs were superparamagnetic, hence magnetically recoverable and demonstrated promising recyclability. Synthesis of NIONs was confirmed by Transmission electron microscopy (TEM), X-Ray Diffraction (XRD), Fourier transform infrared spectroscopy (FTIR) and X-ray photoelectron spectroscopic (XPS). FTIR and XPS data together with adsorption kinetics provide insights into probable adsorption mechanism of Arsenic by NIONs. The experimental conditions for 10 different variants were modelled using response surface methodology (RSM) based on central composite design (CCD), considering the parameters; adsorbate dosage, adsorbent dosage, pH and contact time. The results identified the best performing variants and the optimal conditions for maximal absorption (~99%). These results were validated using a three-layer feed-forward Multilayer Perceptron (MLP) based Artificial Neural Network (ANN) model. Both RSM and ANN chemometric models were in close conformity for optimized conditions of highest adsorption by specific variants. The standardized conditions were used to expand the study to field-based arsenic contaminated groundwater samples and their performance to commercial adsorbents. NIONs show promising commercial potential for water remediation applications due to their high adsorptive performance, magnetic recoverability and recyclability.

Ectopic adrenocorticotropic hormone syndrome in a case of duodenal neuroendocrine tumor presenting with liver metastasis

Ectopic adrenocorticotropic hormone (ACTH) syndrome is an uncommon disorder and comprises about 15% of all patients with Cushing's syndrome (CS). Duodenal carcinoids are rare, indolent tumors usually associated with a benign progression. We hereby report a rare case of CS resulting from ectopic ACTH secretion from a duodenal neuroendocrine tumor (NET) presenting with liver metastasis. A 37-year-old female presented with abdominal discomfort and dyspepsia of 1-month duration. Ultrasound abdomen suggested a well-defined hypoechoic lesion in the left lobe of the liver, suggestive of neoplasia. On clinical examination, she had Cushingoid features and persistent hypokalemia. Midnight ACTH and cortisol levels were grossly elevated at 1027 pg/ml (n < 46 pg/ml) and 87.56 μg/dl (n < 7.5 μg/ml), respectively. Both overnight and high-dose dexamethasone suppression test confirmed nonsuppressed cortisol levels - 86.04 and 84.42 μg/dl (n < 1.8 μg/ml), respectively. Magnetic resonance imaging brain showed a structurally normal pituitary gland. Computed tomography scan of the abdomen revealed hepatic lesion with bilateral adrenal enlargement. A diagnosis of ectopic ACTH-dependent CS was made. Intraoperatively, a duodenal lesion of 0.5 cm × 0.5 cm was identified alongside an 8 cm × 6 cm exophytic lesion in segment IV of the liver. Frozen section of the duodenal lesion was positive for NET. She underwent a Whipple's surgery, cholecystectomy, and left hepatic lobectomy. Postoperatively, she showed clinical and biochemical remission. Herewith, we report the third case of duodenal carcinoid tumor presenting as ectopic ACTH syndrome and the first with liver metastasis.

Rare case of radiologically distinct but pathologically admixed vestibular schwannoma and meningioma in the cerebellopontine angle: A case report

Primary intracranial tumors generally occur as solitary tumors. The association of two primary intracranial tumors of different histogenesis in the same individual is rare, except in cases of phakomatoses or radiation-induced tumors. Meningiomas and vestibular schwannomas (VSs) are one of the commonest tumors occurring intracranially. VS account for 80% of cerebellopontine angle (CPA) tumors, with meningiomas being the second most common tumor of the CPA. The occurrence of both a schwannoma and a meningioma in the CPA is rare. We report a case with coexistent CPA meningioma and VS, which were distinct radiologically on preoperative imaging, however had admixed areas of VS and meningioma on histopathological evaluation.

Hybrid nanostructured C-dot decorated Fe3O4electrode materials for superior electrochemical energy storage performance

Here, the novel Fe₃O₄-C hybrid nanocomposite demonstrates high specific capacitance (S.C.) than the pristine Fe₃O₄nanospheres due to the presence of the highly conducting carbon quantum dots.

Haemangioma of the nasal bone

A 16 year-old female presented for her cosmetic deformity with a slowly progressing swelling of insidious onset on the upper part of the bridge of the nose slightly towards the left side for 3 year duration. Clinical & radiological examination revealed an intra-osseous tumor of nasal bone. Histopathologically the tumor was a cavernous haemangioma of nasal bone. A follow up study upto 13-year showed no recurrence. A detailed search of world literature is carried out with clinical history & history of trauma. It could that nasal bone haemangioma is separate disease entity. The patients usually seek advise for their cosmetic deformity & sometime for nasal bleeding.

Note: compact helical pulse forming line for the generation of longer duration rectangular pulse

The helical pulsed forming line (PFL) can generate longer duration rectangular pulse in a smaller length. A compact PFL using helical water line is designed and experimentally investigated. The impedance of the helical PFL is 22 [ohm sign]. The compactness is achieved in terms of reduction in length of the PFL by a factor of 5.5 using helical water PFL as compared to coaxial water PFL of same length. The helical PFL was pulsed charged to 200 kV using a high voltage pulse transformer in 4.5 μs and discharged into the matched 22 Ω resistive load through a self-breakdown pressurized spark gap switch. The rectangular voltage pulse of 100 kV, 260 ns (FWHM) is measured across the load. The effect of reduction in water temperature on the pulse width is also studied experimentally. The increase in pulse width up to 7% more is observed by reducing the temperature of the deionized water to 5 °C. It will further reduce the length of the PFL and make the system small for compact pulsed power drivers.

Compact pulse forming line using barium titanate ceramic material

Ceramic material has very high relative permittivity, so compact pulse forming line can be made using these materials. Barium titanate (BaTiO(3)) has a relative permittivity of 1200 so it is used for making compact pulse forming line (PFL). Barium titanate also has piezoelectric effects so it cracks during high voltages discharges due to stresses developed in it. Barium titanate is mixed with rubber which absorbs the piezoelectric stresses when the PFL is charged and regain its original shape after the discharge. A composite mixture of barium titanate with the neoprene rubber is prepared. The relative permittivity of the composite mixture is measured to be 85. A coaxial pulse forming line of inner diameter 120 mm, outer diameter 240 mm, and length 350 mm is made and the composite mixture of barium titanate and neoprene rubber is filled between the inner and outer cylinders. The PFL is charged up to 120 kV and discharged into 5 Ω load. The voltage pulse of 70 kV, 21 ns is measured across the load. The conventional PFL is made up of oil or plastics dielectrics with the relative permittivity of 2-10 [D. R. Linde, CRC Handbook of Chemistry and Physics, 90th ed. (CRC, 2009); Xia et al., Rev. Sci. Instrum. 79, 086113 (2008); Yang et al., Rev. Sci. Instrum. 81, 43303 (2010)], which increases the length of PFL. We have reported the compactness in length achieved due to increase in relative permittivity of composite mixture by adding barium titanate in neoprene rubber.

AUDIT OF BLOOD REQUISITION

A total of 2793 requisition forms received by the blood banks of a Service zonal hospital, between June 1995 and December 1999, were analysed. 1697 (60.71%) forms were demand for single unit blood. Blood was collected against only 1099 forms (39.34%) out of which 713 (64.88%) were single unit issue. Urgency of requirement and blood group of patients was omitted in 56% cases. 104 forms were received without mention of the indications for transfusion. History of previous transfusion and pregnancy/HDN were omitted in 25.1% and 37.38% cases respectively. At an average 14.61% of the total collection was discarded. Of the 292 units discarded, 242 units were due to non utilisation. A transfusion committee should be established in all hospitals with a licensed blood bank. It should constitute definite objectives and conduct regular audits (prospective audit, concurrent review or retrospective review), in order to achieve utmost efficiency and numerous benefits, in terms of workload, cost, errors, risks of transfusion and ultimately increased customer satisfaction. It should strive to abolish single unit and inappropriate transfusion, and advocate autologous transfusion.

Percutaneous nephrostomy by direct puncture technique: An observational study

Percutaneous nephrostomy is the procedure of establishing a temporary drainage tract of the renal pelvi-calyceal system through the skin. This study aims to find out whether low cost trocar catheter can be a suitable substitute for the relatively high cost fluoroscopy/ultrasonography guided tract dilatation and tube insertion procedure. Percutaneous nephrostomy by the trocar catheter was performed in 126 patients. Under local anesthesia, a stab wound deep enough to traverse the muscle layer was made through which the trocar - catheter drainage set was inserted under ultrasonography guidance. About 179 procedures were performed in 126 patients. Primary technical success rate was 94%, major complication rate 1.6%, minor complication rate 11% and catheter related complications like catheter blockage or dislodgement were 13%. There was no procedure related mortality in our series. The ultrasonography-guided trocar, catheter nephrostomy, is a quick, safe and low cost procedure in selected cases of upper urinary tract obstruction. The primary technical success and complication rates are comparable to any other reported procedure and its low cost is particularly suitable for developing countries like India.

Low voltage operation of plasma focus

Plasma foci of compact sizes and operating with low energies (from tens of joules to few hundred joules) have found application in recent years and have attracted plasma-physics scientists and engineers for research in this direction. We are presenting a low energy and miniature plasma focus which operates from a capacitor bank of 8.4 muF capacity, charged at 4.2-4.3 kV and delivering approximately 52 kA peak current at approximately 60 nH calculated circuit inductance. The total circuit inductance includes the plasma focus inductance. The reported plasma focus operates at the lowest voltage among all reported plasma foci so far. Moreover the cost of capacitor bank used for plasma focus is nearly 20 U.S. dollars making it very cheap. At low voltage operation of plasma focus, the initial breakdown mechanism becomes important for operation of plasma focus. The quartz glass tube is used as insulator and breakdown initiation is done on its surface. The total energy of the plasma focus is approximately 75 J. The plasma focus system is made compact and the switching of capacitor bank energy is done by manual operating switch. The focus is operated with hydrogen and deuterium filled at 1-2 mbar.

Fatty Acid Binding Domain Mediated Conjugation of Ultrafine Magnetic Nanoparticles with Albumin Protein

A novel bioconjugate of stearic acid capped maghemite nanoparticle (gamma-Fe(2)O(3)) with bovine serum albumin (BSA) was developed by taking recourse to the fatty acid binding property of the protein. From FT-IR study, it was found that conjugation took place covalently between the amine group of protein molecule and carboxyl group of stearic acid capped maghemite nanoparticle. TEM study further signified the morphology of the proposed nanobioconjuagte. The binding constant of nanoparticle with protein molecule was evaluated from the optical property studies. Also, magnetic measurement (M-H) showed retaining of magnetic property by significant values of saturation magnetization and other hysteretic parameters.

Deceased organ donor characteristics and clinical interventions associated with organ yield

While the function of each organ is used by each transplant team to assess suitability for transplantation, little is known about the donor characteristics and clinical interventions that contribute toward overall organ transplantation potential. We conduct a retrospective review of United Network for Organ Sharing (UNOS) deceased donor registry data from January 2005 to December 2006. This registry contains all deceased donors from whom organs were recovered during this time period (n = 15,601). Ordinary least-squares (OLS) regression models using variables in the registry are estimated to predict the number of organs transplanted. Outcome is the number of organs transplanted per donor. Organ yield is found to depend significantly on donor age, anoxia as cause of death, history of myocardial infarction (MI), hypertension and/or diabetes, body mass index (BMI), B or AB blood type, cocaine and/or cigarette use and hepatitis infection (p < 0.01). In addition, the clinical interventions of steroid administration, desmopressin (DDAVP) and diuretic usage, as well as oxygenation, are associated with organ yield. Both intrinsic donor characteristics and medical management practice are observed to be highly variable across organ procurement organizations (OPOs). These findings may provide important information to explore and assess the efficacy of clinical interventions, compare OPO performance and point to best practices.

Synchronous primary triple neoplasia (renal cell carcinoma and prostate cancer in combination with thyroid neoplasm). Report of an unusual case

We report a very rare case of triple primary neoplasia synchronously originating in the prostate, kidney and thyroid, in a 79-year-old male who presented with hematuria and continuous pain at the right hip. Examination revealed an enlarged nodular thyroid, while digital rectal examination showed prostatic enlargement with elevated PSA (16.7 ng/mL). Plain radiography showed an osteolytic lesion in the right ischium. Ultrasonography and CT scan of left kidney suggested renal cell carcinoma (RCC), which was subsequently confirmed on histopathology of the left radical nephrectomy specimen. Biopsies from prostate showed adenocarcinoma, along with deposits in ischial biopsy. Fine needle aspiration cytology (FNAC) of neck swellings suggested deposits from thyroid follicular carcinoma, which was subsequently confirmed by histopathology of the near-total thyroidectomy specimen. Currently, the patient is on regular follow-up since the past 24 months.

Testicular metastasis from carcinoma of prostate: report of two cases

Despite the high incidence of prostatic adenocarcinoma and its ability for wide dissemination, metastatic involvement of testis is rather uncommon. We report two cases (aged 76 and 55 years, respectively), where unilateral testicular metastasis was incidentally discovered after bilateral orchiectomy following detection of adenocarcinoma prostate in six-quadrant trucut specimen. Both patients had obstructive voiding symptoms, hard nodular prostate on direct rectal examination and raised serum prostate-specific antigen levels, without associated systemic or testicular symptoms. Extensive evaluation excluded any other possible primary, although axial skeletal metastasis was detected on radionucleotide bone scans, in the first case. These cases highlight the need for proper evaluation of testes and para-testicular structures, for accurate staging of these tumors and to exclude any possible metastasis.

Expression of CD34 as a novel marker for glioneuronal lesions associated with chronic intractable epilepsy

The spectrum of glioneuronal lesions underlying intractable epilepsies includes malformative pathologies like focal cortical dysplasia (FCD); and neoplastic lesions like gangliogliomas (GG) and dysembryoplastic neuroepithelial tumours (DNT). These may occur either singly or as dual lesions, having simultaneous presence of both elements. Currently, the relationship between the malformative and neoplastic glioneuronal lesions is poorly understood. Recently, CD34, a stem cell marker transiently expressed during early neurulation, has been identified in these tumours. This study was undertaken to (i) evaluate the role of CD34 as a diagnostic marker for glioneuronal lesions of epilepsy, namely, GG, DNT and FCD, and (ii) attempt to define the relationship among these lesions, using CD34 as a marker. Tissues resected from 47 patients with intractable epilepsy due to glioneuronal lesions (GG, FCD, DNT) were studied. These were evaluated for CD34 expression, using immunohistochemistry. Dysplastic or atypically differentiated neural precursors which could not be identified on routine haematoxylin and eosin (H&E) staining were highlighted by CD34 immunostaining. The pattern of immunostaining was diffuse in GGs, unlike FCDs, wherein cells were present singly or in small clusters. However, cases of DNT and control tissue were largely CD34-immunonegative. Based on these findings, we propose a possible common origin of GG and FCD, from a bipotent precursor that undergoes abnormal glioneuronal development, while DNTs possibly have a different origin. The CD34-immunoreactive cells represent dysplastic or undifferentiated neural precursors, which may signify a valuable marker for the diagnostic evaluation of neoplastic and/or malformative pathologies in patients with intractable epilepsy.

Compressive myelopathy due to nocardiosis from dermal lesion

Nocardiosis refers to locally invasive or disseminated infection associated with Nocardia species. Most infections enter through respiratory tract and then disseminate systemically. Rarely primary nocardial infection of the skin of the back may spread to contiguous structures including vertebrae. A 30 years male presented with indolent skin lesion in the upper dorsal region of the back for one year following an accident and subsequently developed features of spinal cord compression and parenchymal involvement of lung. The rarity of such type of spread in an immuno-competent individual has been highlighted.

Autologous transfusion--a viable alternative

INTRODUCTION

Transfusion of blood carries an inherent threat of immunological complications and an ever-increasing risk of transfusion transmitted diseases. A safer alternative to these potential dangers is autologous transfusion. This relatively simple and innocuous procedure strives to achieve the goal of 'Safe Blood', and can be practised easily in the peripheral hospitals.

MATERIAL AND METHODS

A study was conducted to evaluate this facet of transfusion medicine, in a Services Zonal Hospital, for the period January, 1998 to July, 2000.

RESULTS

A total of 45 pre-operative autologous collections were undertaken during this duration. By conducting regular interactive programmes with the healthcare workers and the patients, the rate of autologous transfusion vis-a-vis total transfusion increased from 0.34% in 1998 to 13.83% till July, 2000.

CONCLUSION

It is recommended that there should be vigorous participation at all levels in a hospital, under the auspices of an active hospital transfusion committee, to make this procedure more popular and more acceptable in today's scenario. This will not only reduce the load of allogenic transfusion, but will also help to diminish the potential hazards associated with blood transfusion.

A discrete random effects probit model with application to the demand for preventive care

I have developed a random effects probit model in which the distribution of the random intercept is approximated by a discrete density. Monte Carlo results show that only three to four points of support are required for the discrete density to closely mimic normal and chi-squared densities and provide unbiased estimates of the structural parameters and the variance of the random intercept. The empirical application shows that both observed family characteristics and unobserved family-level heterogeneity are important determinants of the demand for preventive care.

HPA-1a-mediated platelet interaction with monocytes in vitro: involvement of Fcgamma receptor (FcgammaR) classes and inhibition by humanised monoclonal anti-FcgammaRI H22

To gain insight into mechanisms of platelet destruction and its possible inhibition during fetal/neonatal alloimmune thrombocytopenia (FAIT/NAIT) the binding to monocytes (Mo) of anti-HPA-1a-sensitised platelets, the initial step in IgG-mediated destruction by effector cells, was evaluated in an in vitro assay. Neonatal Mo were compared with adult Mo as effectors in the assay. Moreover, the potential involvement of Fcgamma receptor (FcgammaR) classes during platelet destruction in the disease was tested by using FcgammaR class-specific reagents as inhibitors of the binding reaction. Neonatal Mo were 37% less active than adult Mo in their interaction with anti-HPA-1a-sensitised platelets (p < 0.05). The FcgammaRI-specific reagents human monomeric IgG and humanised anti-FcgammaRI monoclonal H22 caused virtually complete inhibition of platelet binding to Mo. When compared to an intravenous immunoglobulin preparation the inhibitory activity of H22 was 10-100 x greater than that of the latter compound. Monoclonal anti-FcgammaRII IV.3 and anti-FcgammaRIII 3G8 decreased platelet binding by 70% and 64%, respectively, but only the anti-FcgammaRII inhibition was statistically significant (p < 0.001). Finally, anti-HPA-1a-sensitised platelets bound to 131H- but not to 131R- FcgammaRIIa transfected 3T6 mouse fibroblasts (p < 0.01), in an anti-HPA-1a-concentration-dependent manner. The results suggest that FcgammaRI and FcgammaRIIa may be involved in anti-HPA-1a-mediated platelet destruction by mononuclear phagocytes during FAIT/NAIT. Moreover, the much greater potency ofmonoclonal H22 than of intravenous immunoglobulin as an inhibitor of anti-HPA-1a-mediated Mo-platelet interaction, might render it superior to the latter agent in the maternal therapy of the disorder.

Estimates of use and costs of behavioural health care: a comparison of standard and finite mixture models

Estimates of health care demand are known to depend on the empirical specification used in the analysis. In this paper, an innovative specification, the finite mixture model (FMM), is employed to estimate the utilization of and expenditures on behavioural health care. Unlike standard specifications, the FMM has the ability to distinguish between distinct classes of users of behavioural health care (e.g. the 'worried well' and the severely mentally ill). This new model is tested against standard empirical specifications using data from the National Medical Expenditure Survey. Using common risk stratifiers, estimates of utilization and costs are generated with each specification. It is found that the FMM provides a much better fit of both expenditure and utilization data than standard specifications, particularly among high intensity users that standard models have been unable to represent adequately. Furthermore, the results provide preliminary evidence that there are (at least) two distinct groups of users of behavioural health care. The empirical advantages of the FMM translate into superior estimates of mean costs and utilization that have widespread application in rate-setting exercises.

Factor VII deficiency detected in pregnancy: a case report

Factor VII deficiency is a rare hereditary coagulation disorder with an incidence estimated at 1 in 500,000 individuals. In this report, we describe the 13th case in pregnancy. The diagnosis of severe factor VII deficiency (factor VII level <5%) was established at 10 weeks' gestation after initial laboratory testing showed a markedly prolonged prothrombin time and a normal activated partial thromboplastin time. There was a history of two preterm deliveries, but there was no evidence of previous bleeding manifestations. Antenatal progress of the index pregnancy was unremarkable. Prophylactic treatment with fresh frozen plasma was started at the onset of labor and the patient had a vaginal delivery of a live girl at 36 weeks' gestation. There was no postpartum hemorrhage and mother and newborn were discharged in good condition. The patient's postpartum level of factor VII remained undetectable. Two aspects are outlined: the absence of any significant increase in factor VII clotting activity during this pregnancy and the need to give replacement therapy at labor in patients with severe factor VII deficiency to decrease the risk of postpartum hemorrhage.

Work disability and diabetes

OBJECTIVE

To determine the rates and demographic determinants of work disability, hours worked per week, work-loss days, and wages in individuals with diabetes.

RESEARCH DESIGN AND METHODS

A probit regression analysis was performed on a cross-sectional population-based survey of U.S. noninstitutionalized civilian population (National Medical Expenditures Survey--2, 1987). The sample was restricted to individuals aged > or = 25 years. A total of 1,502 individuals reported having diabetes, and 20,405 did not. Information on workforce participation and income were collected quarterly. Work disability was defined as a self-report of having been unable to work because of illness or disability for > or = 2 quarters in 1987.

RESULTS

Work disability was reported by 25.6% of individuals with diabetes, compared with 7.8% of those without diabetes. Work disability rates were higher for older people, females, and African-Americans, and lower for Hispanics and for individuals with greater non-wage income. Individuals with diabetes engaged in the workforce had more work-loss days than did nondiabetic individuals, but had similar hourly wages. Predicted mean earnings were significantly lower for individuals with diabetes at all ages, resulting in $4.7 million loss in earnings in 1987 due to work disability.

CONCLUSIONS

Work disability is significantly higher for individuals with diabetes than for those without diabetes at all ages, and results in a significant decrease in earnings. A disproportionate burden of work disability is borne by older individuals and women with diabetes. Better information on the determinants of work disability in individuals with diabetes is needed.

Search for retroviral related DNA polymorphisms using RAPD PCR in schizophrenia

Random amplification of polymorphic DNA (RAPD) is widely used to detect polymorphisms in many organisms. Individual (or strain) specific amplified bands are generated with single or pairs of primers in PCR reactions and can serve as genetic markers. We have used this method to generate a large number of reproducible bands with single primers, random and retroviral related, on 92 human DNA samples. Theoretically, RAPD PCR presents a logical approach for assessing variability among individuals. We used ten retroviral related primers (12, 20 and 22 bp) and eight random primers (10 bp) to assess individual differences in the context of testing the retroviral hypothesis for schizophrenia. Three pairs of discordant monozygotic twins, four pairs of discordant full sibs and 53 schizophrenic individuals with 25 of their unrelated matched controls were analyzed. Ten of these primers resulted in a total of approx. 850 amplified bands (65-110 bands per primer). Almost all of these bands were identical among each individual analyzed. However, the results are inconclusive with respect to the retroviral hypothesis for schizophrenia. The general lack of RAPD polymorphism in this study may argue for mechanisms other than rearrangements such as inversions, associated with the evolution of the human genome.

Provider choice and use of mental health care: implications for gatekeeper models

OBJECTIVE

To examine the ways in which the costs of nonresidential mental health care depend on (1) the type of provider who initiates the treatment episode and (2) the level of cost sharing imposed on the patient.

STUDY SETTING

The 1987 National Medical Expenditure Survey, a national probability sample of the U.S. civilian, noninstitutionalized population.

DATA COLLECTION

Data were collected during four personal interviews conducted during 1987 and 1988. Key variables include the type of provider contacted at the beginning of treatment (psychiatrist, other physician, nonmedical mental health care specialist) and the cost (total actual payments from all sources) for the treatment episode.

METHODS OF ANALYSIS

An episodic model of demand for mental health care is estimated using a two-step procedure. Multinomial probit analysis is first used to determine the factors that influence the choice of initial provider type. Right-censored Tobit analysis is used to determine the factors that affect the costs of care, including the type of provider who initiates the care episode.

PRINCIPAL FINDINGS

Results indicate that out-of-pocket price does significantly (p < .05) affect the patient's initial choice of provider type but that, after controlling for the endogeneity of provider choice, price is no longer significant in explaining overall treatment costs. After controlling for selection effects, care episodes initiated by nonspecialist physicians are found to be as expensive as those initiated by psychiatrists and significantly more expensive than episodes initiated by nonphysicians.

CONCLUSIONS

The results suggest that nonmedical mental health care specialists may be more effective than physicians in controlling costs when used as case managers in the care of persons with mental illnesses.