HIV/AIDS selective infectivity–report of two peculiar cases

We report two peculiar cases that were observed in two communities of Anambra State, South East Nigeria. The first case was a woman of 44 with a history of blood transfusion from a donor of questionable HIV status. A pint of blood was transfused in a private Hospital on the 15 th January, 2000. She has had no form of antiviral therapy until 22nd April, 2008 when she came to the hospital for routine medical check up. Her HIV result came out confirmed positive while that of her husband came out negative. She has had active sexual life with her husband in the previous eight years as they have had some difficulties in getting their desired extra two children having earlier gotten a boy and a girl. The second case involves a family of six. A couple with four children of ages about 6 months, 2 years, 3 years and 5 years. The youngest, a female presented with fever and multiple lymphadenopathy. She tested HIV positive and so was her mother and her second sibling. But her father and two other siblings remained negative at post three and six months intervals from their very first test date with us. These reported cases appear to go contrary to earlier formed opinion on HIV transmission. We support the opinion on a naturally, occurring substance, APOBEC3G which possibly confers permanent immunity against the HIV virus. We recommend clinical trials of the characterized APOBEC3G as a vaccine for non HIV infected persons of all ages and to people living with as a therapeutic drug.     

LOCALIZED LEPROMATOUS LEPROSY AND ITS RESPONSE TO CHEMO-IMMUNOTHERAPY

Background. This is an unusual presentation of lepromatous leprosy (ll ) in a young boy, 12 years of age. The study forms part of a large scale immunotherapeutic trial with Mycobacterium w (M.w) antileprosy vaccine. The trial is being conducted in two major hospitals in New Delhi, India. Materials and Methods. This patient presented with three lesions: one on each forearm and the third on the left leg. He was classified initially as borderline tuberculoid leprosy. Slit-skin smears and histopathology from the lesions proved the diagnosis to be lepromatous leprosy with a bacterial index (bi ) 6+. The initial lepromin test was negative. The patient was treated with chemo-immunotherapy (standard multidrug therapy and immunotherapy with Mycobacterium w vaccine). Results. Investigations after 1 year (15 months) of multidrug therapy and three doses of vaccine, showed a remarkable fall in the bi from 6 to 0 in the lesions, a lepromin positivity of 5 mm, and a histological upgrading from lepromatous leprosy to borderline tuberculoid. Immunologic studies at 15 months revealed a good LTT response and high levels of cytokines, specifically IL-2 and IFN-γ. Conclusions. This report presents an LL patient with disease limited to a few sites. It stresses the importance of slit-smear and biopsy in all patients of leprosy, and it highlights the upgrading observed on administration of chemo-immunotherapy.     

Serum inhibin B may be a reliable marker of the presence of testicular spermatozoa in patients with nonobstructive azoospermia

Objective: To establish the predictive value of serum inhibin B levels as an indicator of the presence of testicular spermatozoa in nonobstructive azoospermia, compared with the traditional serum FSH marker.

Design: Prospective study.

Setting: Private high-complexity reproductive center with university affiliation.

Patient(s): Seventy-eight patients with nonobstructive azoospermia, 15 patients with obstructive azoospermia, and 10 fertile volunteers.

Intervention(s): Blood samples, testicular sperm extraction, percutaneous epididymal sperm aspiration, and semen collection.

Main Outcome Measure(s): Serum levels of inhibin B and FSH and presence of spermatozoa on TESE, PESA, or regular semen analysis.

Result(s): Patients with nonobstructive azoospermia has significantly higher levels of serum FSH and significantly lower levels of inhibin B. Mean inhibin B serum levels were significantly higher in patients with nonobstructive azoospermia who had spermatozoa on TESE than in those in whom no spermatozoa were found (89.31 ± 73.24 pg/mL vs. 19.23 ± 22.34 pg/mL), but mean FSH serum levels did not have similar predictive power (21.37 ± 12.92 IU/mL vs. 19.27 ± 10.28 IU/mL). The cut-off level of inhibin B separating both groups, as determined by the receiver-operating characteristic curves, was >53 pg/mL.

Conclusion(s): Serum inhibin B level seems to be more accurate than serum FSH level in prediction of the presence of testicular spermatozoa in patients with nonobstructive azoospermia.     

外源性一氧化氮对创伤愈合过程中一氧化氮合酶表达及瘢痕形成的影响

目的:应用组织化学、免疫组织化学及计算机辅助图像分析方法,观察外源性一氧化氮在创伤愈合过程不同时间,对一氧化氮合酶表达和胶原形成的影响,探讨其在促进创伤愈合和抑制病理性瘢痕形成中的机制。方法:实验于2004-09/2006-03在河北省人民医院整形烧伤外科及河北省人民医院临床医学研究中心完成。以硝普钠为一氧化氮供体,将60只大鼠随机分为对照组及硝普钠0.5,1,2,4mmol/L组,每组12只,通过建立大鼠创伤模型,并分别在创面局部应用50g/L葡萄糖溶液、0.5,1,2,4mmol/L硝普钠,观察及测量创伤后3,7,10,14d的肉芽组织生长情况、一氧化氮合酶的表达情况和肉芽组织中羟脯氨酸含量。结果:60只大鼠全部进入结果分析。①形态学观察:对照组于创伤后14d可完全愈合;硝普钠0.5mmoL/L组及1mmoL/L组肉芽组织生长良好,且愈合时间较对照组提前三四天;硝普钠2mmoL/L组及4mmoL/L组愈合情况不良,完全愈合时间延迟,皮肤张力较低,炎症反应明显。②一氧化氮合酶蛋白表达:大鼠皮肤创伤后角质形成细胞、汗腺、毛囊和骨骼肌细胞以及创伤后肉芽组织的炎症细胞、成纤维细胞、血管内皮细胞均不同程度的表达一氧化氮合酶蛋白。对照组在第3天和第14天分别呈现一氧化氮合酶阳性颗粒表达高峰,而硝普钠各组仅在第7～10天出现表达一氧化氮合酶阳性高峰,呈先增加后减少的趋势。③羟脯氨酸含量:对照组从创伤后第3,7,10,14天羟脯氨酸含量进行性增加[依次为(1.637±0.127),(2.250±0.169),(2.420±0.201),(2.908±0.241)mg/g];硝普钠0.5mmol/L组在创伤后第3,7天羟脯氨酸含量低于对照组[(1.435±0.147),(1.766±0.211)mg/g,P<0.05或P<0.01],而在第10天和第14天羟脯氨酸含量均高于对照组[(3.128±0.240),(3.437±0.239)mg/g,P<0.01];硝普钠1mmol/L组和2mmol/L组在第10天和第14天的羟脯氨酸含量明显高于对照组[(1mmol/L组:(3.244±0.245)(3.582±0.282)mg/g,P<0.01;硝普钠2mmol/L组:(3.666±0.263),(4.301±0.268)mg/g,P<0.01);硝普钠4mmol/L组仅在创伤后第3天表现比对照组多[(1.912±0.139)mg/g,P<0.01),其余均与对照组水平相近。结论:局部应用外源性一氧化氮具有显著的促修复作用,主要体现在伤后第7～10天,小剂量的一氧化氮促进创面愈合的作用远远大于大剂量一氧化氮。     

Pregnancies established through intracytoplasmic sperm injection （ICSI） using spermatozoa with dysplasia of fibrous sheath

Aim: Dysplasia of the fibrous sheath (DFS) is an anomaly found in asthenozoospermic patients with extremely low or absent motility. In order to determine the efficacy of ICSI in these patients, a retrospective analysis of ICSI results in DFS patients has been done. Methods: Ten ICSI attempts were performed in 6 patients with diagnosis of Dysplasia of the Fibrous Sheath studied by transmission and scanning electron microscopy. Results: In the cases studied, sperm concentration was (29.62 _ 18.05) x 106/mL, total motility was 1.14 _ 1.31%. Progressive motility was 0% except for one case with 0.1%. One hundred and three preovulatory oocytes were obtained and 94 metaphase 11 oocytes were injected. Sixty-nine of them showed two pronuclei (fertilization rate: 73.4% ). Forty-nine embryos were obtained and 34 were transferred (mean: 3.4 embryos per transfer). Five pregnancies were diagnosed by β-hCG plasma level determinations that resulted to be one preclinical abortion, one clinical abortion and three deliveries. Another pregnancy (ongoing) was achieved from a cryopreserved embryo transfer. Conclusion: These results showed that ICSI provides a suitable solution for patients suffering from irreversible sperm defects such as DFS. Nevertheless, it is mandatory to inform couples of possible transmission risks to offspring, which are unknown at present. Only when the etiology of this problem is disclosed, it will be possible to assess the real genetic risk.     

Cellulitis caused by Aeromonas hydrophila

We report the case of a cirrhotic patient with leukocytoclastic vasculitis who developed a rapid and progressive cellulitis with hemorrhagic bulla and sepsis due to Aeromonas hydrophila, the portal of entry was the surgical leech of a cutaneous biopsy.     

The contralateral effects of large tumors on brain stem auditory evoked potentials

Brain stem auditory evoked potential (BAEP) testing has been demonstrated to be a useful diagnostic tool in the presence of severe or complete sensorineural hearing loss. From a series of 38 patients with tumors in the vicinity of the VIIIth nerve, 13 patients with tumors larger than 2 cm had abnormal BAEP results contralateral to the involved side. The abnormalities observed on the noninvolved side included prolonged peak latencies, reduced amplitudes, poor wave shape and poor response stability. The significance of these findings is twofold: 1. Large tumors may disrupt BAEP test results on the side contralateral to the lesions, 2. Important information may be obtained on patients having complete sensorineural hearing loss on the involved side.