Role of informal care providers in home based long term care in diabetes mellitus at Kaiwara Primary Health Center area,Karnataka, India

ObjectiveTo find the prevalence of diabetics, identify informal care providers for them in Kaiwara Primary Health Center (PHC) area, assess the level of knowledge and skills of an informal care provider in home based long term care and improve the level of knowledge and skill of the informal care provider through a structured training capsule.MethodsA cross sectional and an interventional study was conducted on diabetics and their informal care providers in Kaiwara PHC area. Data were collected using pre-tested, structured questionnaire by an interview method. A structured training capsule was developed and implemented. Evaluation of the knowledge and skills was assessed at the beginning and at the end of the training. Student's paired/unpaired ‘t’ tests and correlation analysis were done.ResultsImprovement scores were calculated by subtracting the pre-evaluation scores from the post-evaluation scores. The mean improvement scores was (2.66±0.32) and was statistically significant (P <0.001). No significant difference in mean values was found in the knowledge and skills scores in relation to the socio-demographic variables in the study.ConclusionsKnowledge and skills component of the informal care provider in home based care of diabetes could be perceived as a “felt need”.     

Borrelia isolates in Northern Colorado identified as Borrelia bissettii

Previous work described Borrelia burgdorferi sensu lato group DN127 as a new genospecies, Borrelia bissettii, and prompted the present study to identify the Borrelia spp. that exist in northern Colorado. To determine the genospecies present, we analyzed two specific intergenic spacer regions located between the 5S and 23S and the 16S and 23S ribosomal genes. Phylogenetic analysis of the derived sequences clearly demonstrated that these isolates, originating from rodents captured in the foothills of northern Colorado, diverged from B. burgdorferi sensu stricto by 5 to 5.5% and were members of the new genospecies B. bissettii.     

Borrelia burgdorferi-pulsed dendritic cells induce a protective immune response against tick-transmitted spirochetes.

Borrelia burgdorferi-pulsed dendritic cells and epidermal cells were able to initiate the production of anti-outer surface protein A (OspA) antibody in vitro with normal T and B cells from either BALB/c or C3H/HeJ mice. Inhibition of anti-B. burgdorferi antibody production was observed after 3 days, but not after 2 days, of exposure of the antigen-presenting cells to tumor necrosis factor alpha +/- granulocyte-macrophage colony-stimulating factor. Furthermore, splenic dendritic cells pulsed in vitro with live B. burgdorferi spirochetes and then adoptively transferred into naive syngeneic mice mediated a protective immune response against tick-transmitted spirochetes. This protection appeared not to be due to killing of spirochetes in the feeding ticks, since ticks fed to repletion on B. burgdorferi-pulsed dendritic cell-sensitized mice still harbored live spirochetes. Western blot analysis of the sera collected from dendritic cell-sensitized mice demonstrated that the mice responded to a limited set of B. burgdorferi antigens, including OspA, -B, and -C compared to control groups that either had received unpulsed dendritic cells or were not treated. Finally, mice in the early stage of B. burgdorferi infection were able to develop anti-OspA antibody following injection with B. burgdorferi-pulsed dendritic cells. Our results demonstrate for the first time that adoptive transfer of B. burgdorferi-pulsed dendritic cells induces a protective immune response against tick-transmitted B. burgdorferi and stimulates the production of antibodies specific for a limited set of B. burgdorferi antigens in vivo.     

Disseminated Histoplasmosis in a 13-year-old girl: a case report

Background

Disseminated histoplasmosis is a rare fungal infection and most documented cases are in immune-compromised individuals such as those with acquired immuno-deficiency syndrome.

Objective

To describe a case of disseminated histoplasmosis in an adolescent girl.

Method

We report a case of disseminated histoplasmosis in a 13-year-old adolescent girl. She was admitted for 16 days because of neck masses of 3 years duration, generalized body swelling of 3 months and reduction in urinary output of 2 months. She tested negative for human immunodeficiency virus antibodies.

Result

An autopsy was performed because a definitive diagnosis could not be made while the patient was still alive. The autopsy revealed central caseating areas in the lymph nodes and membranoproliferative glomerulonephritis. The periodic acid-Schiff staining technique for tissues showed viable yeast cells suggestive of histoplasmosis. Zeihl-Neelsen''s staining for mycobacteria tuberculosis was negative.

Conclusion

Undiagnosed case of disseminated histoplasmosis while the patient was alive is being reported in a 13-year-old girl. Disseminated histoplasmosis should be considered as a differential diagnosis of childhood chronic infections and malignancies as in Nigeria.     

SIMULTANEOUS EXPOSURE TO LEAD,ARSENIC AND MERCURY FROM INDIAN ETHNIC REMEDIES

SUMMARY We report the case of an Asian woman who was exposed to toxic levels of lead, arsenic and mercury through the use of Indian ethnic remedies, and who suffered symptomatic lead poisoning. We know of no other case of exposure to such a combination of heavy metals from this source. We believe that control of the dispensing of these compounds is essential.     

Small renal neoplasms: diagnostic imaging, pathologic features, and clinical course

We retrospectively studied nine patients with solitary renal neoplasms that were first visible when smaller than 3 cm in diameter to determine their imaging and pathologic characteristics and clinical course. These neoplasms represented 14% of the total renal neoplasms discovered over a 6-year period, and only one-third were initially identified by screening urography. While seven of the patients had hematuria, most had associated urologic conditions (calculi, prostatism). Two patients had widespread metastases 2 and 4 years after the carcinomas first appeared. The remaining seven patients are alive and well 8 months to 6 years after undergoing nephrectomy, despite the significant delayed diagnosis in three patients. Only one lesion was pathologically benign (an oncocytoma). Two of the renal cell carcinomas were found within the walls of partially calcified renal cysts. Two (22%) of nine neoplasms exhibited aggressive biologic behavior, which suggests that these lesions may have greater metastatic potential than previously thought. We suggest that computed tomography be performed after screening urography and cystoscopy when unexplained hematuria is present.     

THE NASAL DELIVERY OF SYSTEMIC DRUGS

Systemic drugs are increasingly being administered intranasally. We highlight the potential problems and the effect of nasal pathology on absorption and bioavailability. There is insufficient information to evaluate the effect of these factors on therapeutic effectiveness. However, there is evidence that nasal pathology can influence mucociliary clearance and absorption, so the prescriber should recognise and consider the effect of any intranasal pathology. We suggest that, until the effects of these factors are quantified, patients who are about to embark on long-term intranasal medication should have a rhinological assessment, particularly if they have any nasal symptoms. By doing this, factors that may cause reduced bioavailability can be identified. It would also prevent pre-existing mucosal changes being wrongly attributed to nasal drugs.