Quantification of neurometabolites in subacute sclerosing panencephalitis by 1H-MRS

The authors studied 20 patients with subacute sclerosing panencephalitis (SSPE) to investigate the correlations between MRI, magnetic resonance spectroscopy (MRS), and clinical status. MRI findings did not correlate with clinical status. By contrast, all patients had reductions in N-acetyl aspartate (NAA) and increase in myoinositol (mI) (p < 0.01), and NAA and mI concentrations correlated with clinical severity (p < 0.05). During follow-up, NAA continued to decline. (1)H-MRS may be a useful measure of disease severity and progression in SSPE.     

Anogenital warts in Northern Nigeria: A ten-year Review

Background:

Anogenital warts are a common cause of morbidity affecting mainly the productive age group of the economy. Paucity of data in Nigeria necessitated this study.

Materials and Methods:

The pathology records of anogenital warts diagnosed in the Department of Pathology, Ahmadu Bello University Zaria between 1^st January 2000 and 31^st December 2009 were reviewed.

Results:

A total of 68 warts were diagnosed within the study period with anogenital warts constituting 39.7%. Majority of cases (62%) were in the 20-39 years age group (range: 5–50 years) and vulva was the most common site affected.

Conclusion:

Genital warts are common in our environment, biopsy of suspicious lesions is recommended for diagnostic yield.     

Extracorporeal membrane oxygenation for refractory, life-threatening, and herpes simplex virus 1-induced acute respiratory distress syndrome. Our experience and literature review

We report our first experience of treating an immunocompetent adult patient with acute respiratory distress syndrome (ARDS) due to type 1 herpes simplex (HSV1) pneumonitis, using extracorporeal membrane oxygenation (ECMO). Similar cases reported in literature are reviewed as well. The therapeutic options for this particular complication are discussed. Pneumonia caused by HSV1 is a rare finding in immunocompetent individuals; it occurs more often in immunosuppressed and ventilated patients. It is a severe illness; therefore, early diagnosis and initiation of treatment are imperative. Diagnosis is based on cytologic and histologic findings, viral cultures, or serologic methods. This condition can be reversible; however, often, it can progress into refractory ARDS with limited therapeutic options available. We demonstrate the causative role of HSV1 in refractory ARDS of a previously healthy 18-year-old man who presented to the intensive care unit with acute respiratory distress after a week of flulike syndrome. Due to severe hypoxemia and hypercarbia, the patient required mechanical ventilation and later emergent blood oxygenation with extracorporeal support. For the first time in this condition, we used venovenous ECMO management, to rest the lung, sustain blood oxygenation and end-organ oxygen delivery, and promote potential lung recovery. During ECMO and after our etiologic diagnosis, specific therapy was introduced. After viral negativization, corticosteroid therapy (Meduri protocol) was initiated. Extracorporeal membrane oxygenation allowed us to initiate therapy while maintaining end-organ oxygenation and support the patient until lung recovery. After 18 days of ECMO, our patient recovered completely. Near-normal lung structures and functions were documented on a chest x-ray/computed tomography, thoracic ultrasonography, and pulmonary functional tests at hospital discharge and at a 1-year follow-up. Data suggest that severe pulmonary involvement in HVS1 infection associated with septicemia/shock is a rare but often fatal in immunocompetent adult as well. We suggest that ECMO might be the selected treatment for severe refractory ARDS in this clinical scenario. It seems to be an effective and useful ultimate therapeutic strategy for preventing death and furthermore permitting near-full pulmonary function recovery.     

Primary drug resistance to anti-tuberculosis drugs in major towns of Amhara region, Ethiopia

Drug resistance is a major obstacle to effective TB control program performance. In this study, we assessed the prevalence of primary drug resistance in Mycobacterium tuberculosis (Mtb) isolates in Amhara Region, Ethiopia. A total of 112 Mtb isolates from cases with newly diagnosed pulmonary TB were subjected to drug susceptibility testing (DST) in a cross-sectional study. Isolates were tested for sensitivity to isoniazid, rifampicin, ethambutol, and streptomycin using the MGIT 960 protocol. A total of 93 Mtb isolates yielded valid DST results and 28 (30.1%) were resistant to one or more of first line anti-TB drugs. One isolate (1.0%) was multi-drug resistant (MDR), five (5.4%) were classified as poly-resistant and 22 showed single drug resistance to either streptomycin (n = 19) or isoniazid (n = 3). Isolates from HIV-positive patients were more likely to be resistant to at least one of the four anti-TB drugs compared with HIV-negative individuals (odds ratio 2.76, 95% confidence interval 1.06-7.22; p = 0.03). The study showed a high prevalence of primary drug resistance. Even though the prevalence of MDR was low, conditions that can contribute to the development of MDR are increasing. Therefore, regular monitoring of drug resistance and enhanced implementation of TB/HIV collaborative activities in the study region are imperative.     

Long-Term Strength Development of Fly Ash-Based One-Part Alkali-Activated Binders

This research aims to study the effect of the dosage of anhydrous sodium metasilicate activator on the long-term properties of fly ash-based one-part alkali-activated binders (OPAAB) cured at ambient conditions. Powdered sodium metasilicate activator was utilized in the range of 8–16% by weight of the fly ash in producing the OPAAB. The properties examined are hardened density, compressive strength, flexural strength, water absorption, efflorescence formation, and microstructural analysis. The experimental result revealed that the binders exhibited excellent long-term strength properties. The compressive strength of the OPAAP is well correlated with its hardened density. The pastes were found to exhibit good soundness characteristics over the long-term. The absorption of water decreases with an increase in the activator dosage from 8–12%, and beyond that, the water absorption relatively remains the same. Field emission scanning electron microscope (FESEM) micrograph revealed uniformly formed solid matrices with the micro-crack present were observed in the samples. The larger pore size promotes the crystallization of the resulting hydrate substances (N, C)-A-S-H gel. The initial dissolution of the OPAAP occurred within the first 30 min. At longer age of curing, mixtures with a higher dosage of powdered activator tend to absorb less water. Strength properties beyond 28 days are considered as the long-term strength.