Pentalogy of Cantrell; complete expression in a nine-month-old-boy

Pentalogy of Cantrell is a rare congenital malformation whose exact cause is not completely understood; it is characterized by defects in the anterior abdominal and thoracic walls consisting of omphalocoele, diaphragmatic defect, ectopia cordis, intracardiac defects and sternal clefts. The complex has variable clinical expression with complete and incomplete expressions reported. We, therefore, report a case of complete manifestation of the pentad in a 9-month-old boy.     

Prevalence,Distribution and Antibiotic Resistance of Emergent Arcobacter spp. from Clinically Healthy Cattle and Goats

Prevalence, distribution and antibiotic resistance of Arcobacter spp. were investigated in cattle, goats, floor and treated water samples in this study. The prevalence of Arcobacter in adult and young was recorded as 8/110 (7.27%) and 4/83 (4.81%), respectively, which showed insignificant difference (P = 0.3503) in detection rates between adult and young cattle. A total of 33.33% of the floor samples and 11.11% of the treated water samples analysed were determined as positive for Arcobacter. Among the species isolated, over all, A. butzleri (45%) was the most frequently detected species, followed by A. skirrowii (5%). A. butzleri was isolated from adult cattle, floor and water samples at the rates of 75.0%, 33.4% and 50%, respectively. Co‐colonization of species was not uncommon, and 50% of the samples were carrying more than one Arcobacter species. Only 12.5% sample from cattle (adult) was detected positive for only A. skirrowii. All samples from young animals, floor and water contained mixed isolates. None of the samples from goat farm was found to be carrying Arcobacter species. On profiling of antimicrobial resistance patterns, it was found that only one A. butzleri isolate (3.7%) was sensitive to all nine antibiotics tested. A. butzleri was found highly resistant to ampicillin (55.6%), followed by cefotaxime (33.4%) and ciprofloxacin (33.4%). Overall, 20% of the isolates showed multidrug resistance (resistant ≥4 antibiotics). Gentamicin and enrofloxacin can be used as drugs of choice for the treatment for Arcobacter infections.     

Impact of a Federal Healthy Start Program on Feto-infant Morbidity Associated with Absent Fathers: A Quasi-experimental Study

The absence of fathers during pregnancy increases the risk of feto-infant morbidities, including low birth weight (LBW), preterm birth (PTB), and small-for-gestational age. Previous research has shown that the Central Hillsborough Healthy Start project (CHHS)—a federally funded initiative in Tampa, Florida—has improved birth outcomes. This study explores the effectiveness of the CHHS project in ameliorating the adverse effects of fathers’ absence during pregnancy. This retrospective cohort study used CHHS records linked to vital statistics and hospital discharge data (1998–2007). The study population consisted of women who had a singleton birth with an absent father during pregnancy. Women were categorized based on residence in the CHHS service area. Propensity score matching was used to match cases (CHHS) to controls (rest of Florida). Conditional logistic regression was employed to generate odds ratios (OR) and 95 % confidence intervals (CI) for matched observations. Women residing in the CHHS service area were more likely to be high school graduates, black, younger (<35 years), and to have adequate prenatal care compared to controls (p < 0.01). These differences disappeared after propensity score matching. Mothers with absent fathers in the CHHS service area had a reduced likelihood of LBW (OR 0.76, 95 % CI 0.65–0.89), PTB (OR 0.72, 95 % CI 0.62–0.84), very low birth weight (OR 0.50, 95 % CI 0.35–0.72) and very preterm birth (OR 0.48, 95 % CI 0.34–0.69) compared to their counterparts in the rest of the state. This study demonstrates that a Federal Healthy Start project contributed to a significant reduction in adverse fetal birth outcomes in families with absent fathers.     

Characteristics associated with reported sputum culture conversion in the era of re-emergent Mycobacterium tuberculosis in the State of North Carolina, 1993-1998.

OBJECTIVE: To determine predictors of sputum culture conversion among patients undergoing treatment for pulmonary tuberculosis. DESIGN: Cohort study based on data collected through the expanded tuberculosis control program in the State of North Carolina, USA. Survival analysis using Kaplan-Meier product-limit estimator and Cox proportional hazards models was employed to compute estimates for time to sputum conversion and rate ratios, respectively. RESULTS: Sputum conversion was reported in 1144 of 1735 cases (66%). Documented conversion rose significantly from 52.9% at baseline to a peak of 95.1% by the end of the study, representing a 5.1% annual increase in the proportion of patients with reported conversion (P = 0.007). Patients co-infected with the human immunodeficiency virus (HIV) had a 46% lower rate of sputum conversion than non-HIV-infected TB patients (adjusted hazard ratio [HR] 0.54, 95%CI 0.44-0.67). Other significant predictors of reported conversion rates included directly observed therapy (DOT) (P = 0.02), the number of drugs used in the therapy regimen (P = 0.001), and non-injectable drug use (P = 0.012). CONCLUSION: The rate of reported sputum culture conversion in TB patients was low, consistent with an earlier population-based report. The symbiotic relationship between HIV and mycobacterial infection might be a factor that compromised response to therapy in coinfected individuals.     

Sickle cell disease and pulmonary hypertension in Africa: a global perspective and review of epidemiology, pathophysiology, and management

Secondary pulmonary hypertension (PAH) has been shown to have a prevalence of 30% in patients with sickle cell disease (SCD) with mortality rates of 40% at 40 months after diagnosis in the United States. The burden of SCD is highest in sub-Saharan Africa, especially in Nigeria (West Africa), where approximately 6 million people are afflicted. The true global incidence, prevalence, and burden of SCD and its associated end organ complications however remain unknown. Chronic hemolysis represents a prominent mechanistic pathway in the pathogenesis of SCD-associated pulmonary hypertension via a nitric oxide (NO) scavenging and abrogation of NO salutatory effects on vascular function, including smooth muscle relaxation, downregulation of endothelial adhesion molecules and inhibition of platelet activation. Many known infectious risk factors for PAH are also hyperendemic in Africa, including Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS), chronic hepatitis B and C, and possibly malaria. Interactions between these infectious complications and SCD-related hemolysis could yield an even higher prevalence of pulmonary hypertension and compound the existing global health systems challenges in managing SCD. Indeed, our preliminary analysis of African immigrants currently in the United States suggests that pulmonary hypertension represents a significant complication of SCD in the African subcontinent. There is clearly a need to include Africa and other parts of the world with high SCD prevalence in future comprehensive studies on the epidemiology and treatment of end organ complications of an aging SCD population world-wide.