Human Brucellosis in Kuwait: A Prospective Study of 400 Cases

SUMMARY The clinical pattern of 400 cases of brucellosis in Kuwait ispresented. The disease was acute in 77 per cent, sub-acute in12. 5 per cent and chronic in 10. 5 per cent of cases. Raw milkwas the major source of infection. The major features on presentation,irrespective of the course of the disease, were fever, sweating,headache, rigors, arthralgia, myalgia, and low back pain. Hepato-splenomegalywas present in 41 per cent of cases and in 32 per cent neitherliver nor spleen were palpable. The haematologic findings werenot specific and hepatic dysfunction (shown by liver enzymeabnormalities) was common. Skeletal (26 per cent) and genital(8. 5 per cent) changes and neurobrucellosis (7 per cent) werethe major complications. The ELISA was the most sensitive andreliable diagnostic test especially in relation to chronic brucellosisand neurobrucellosis. ELISA allowed the determination of brucella-specificimmunoglobulins (Ig)G, IgM and IgA in the CSF, and providedprofiles of Ig, in sera, which were different in patients withchronic (elevated IgG and IgA) from those with acute (elevatedIgM alone or IgG, IgM and IgA) brucellosis. Treatment with tetracycline,doxycycline or rifampicin gave a cure rate of over 91 per centin acute and subacute brucellosis. Co-trimoxazole was associatedwith a relapse rate of 50 per cent. Two drug combinations ofstreptomycin and tetracycline, streptomycin and rifampicin orstreptomycin and doxycycline were effective, but one of fivepatients with chronic brucellosis relapsed. A combination ofstreptomycin, tetracycline and rifampicin with or without steroidswas used successfully in neurobrucellosis, septicaemic shockand subacute bacterial endocarditis.     

A case of mucocutaneous leishmaniasis in Saudi Arabia caused by Leishmania major and its response to treatment

A case is presented of mucocutaneous leishmaniasis in a male Saudi infant caused by Leishmania major. The extensive lesions of the nose and right cheek healed rapidly and completely following parenteral therapy with sodium stibogluconate (Pentostam®). This appears to be the first case of mucocutaneous leishmaniasis described in the Kingdom of Saudi Arabia. A brief comparison is drawn with the condition as described in other areas.     

Detection and prevention of chronic kidney disease in Indonesia: Initial community screening

Aim:   This survey evaluated the prevalence of chronic kidney disease (CKD if estimated glomerular filtration rate (eGFR) <60 mL/min per 1.73 m²) and its risk factors amongst subjects from urban and semi-urban areas.
Methods:   History of hypertension, diabetes mellitus, kidney disease, cardio- and cerebrovascular diseases of subjects and their families was recorded. Blood pressure was determined as the mean of three readings in the sitting position and hypertension classified according to the Joint National Committee VII. Urinalysis was assessed using Combi 10R dipstick test. Random blood glucose and serum creatinine were measured in subjects with either hypertension, proteinuria, glycosuria and/or a history of diabetes. eGFR was calculated according Cockcroft–Gault (CG) adjusted by body surface area (BSA), Modification of Diet in Renal Disease (MDRD) and Chinese MDRD equations.
Results:   Of 9412 subjects recruited, 64.1% were female. Persistent proteinuria was found in almost 3%. Systolic and diastolic hypertension was found in 10%, isolated systolic hypertension in 4.8% and isolated diastolic hypertension in 4.6%. CKD was found in 12.5% (CG), 8.6% (MDRD) or 7.5% (Chinese MDRD) of subjects with either hypertension, proteinuria and/or diabetes. Proteinuria, systolic blood pressure and a history of diabetes mellitus were independent predictors of impaired eGFR. Obesity and smoking history were found in 32.5% and 19.8%, respectively.
Conclusion:   The present study showed a high prevalence of CKD in representative urban and semi-urban areas and argues for screening and treatment of all Indonesians, particularly those at an increased risk of CKD.     

Nephrogenic adenoma of the bladder in a girl with Turner''s syndrome: An unusual association

We describe a nephrogenic adenoma of the bladder in a 14-year-old girl with Turner's syndrome. The patient also had a past history of urological surgery for vesicoureteral reflux. In this case, the multifocal lesions were successfully treated by transurethral resection.     

荟萃分析对多样本临床试验结果重现率分析(英文)

探讨应用多样本临床试验荟萃分析进行药物和治疗方案有效性和安全性研究．方法：本文采用基本分析,一种非参数方法,评价临床试验结果的重现率,用于对充血性心脏衰竭（ＣＨＦ）,ＣＨＦ伴心性死亡,ＣＨＦ伴其他原因死亡病例,对给予血管紧张素转化酶抑制剂（ＡＣＥ）治疗组和给安慰剂组各自的相对率和超常率的分析．结果：三组试验最后的结果分别为６９％,７４％,７６％,Ｐ＜０．０１,与给安慰剂组比较,ＡＣＥ治疗组减少３０／（１０００人·年）,ＣＨＦ伴心性死亡组减少４０／（１０００人·年）,Ｐ＜０．０１．结论：荟萃分析法是分析临床试验结果重现率的一种简单而有效的方法．     

Significance of Postoperative Arrhythmias in Congenital Heart Disease

The survival of patients with congenital heart disease (CHD) has increased immensely and nowadays, most children reach adulthood. The long-term outcome is hampered by the occurrence of late complications such as arrhythmias. Supraventricular and ventricular arrhythmias have an impact notably not only on morbidity but also on mortality in patients with congenital heart disease. Therefore, life-long follow-up in most of these patients is required.     

Comparison of the anticoagulant intensities of fondaparinux and enoxaparin in the organization to assess strategies in acute ischemic syndromes (OASIS)‐5 trial

Summary. Background: In the OASIS‐5 trial, fondaparinux reduced major bleeding with similar short‐term efficacy as enoxaparin but lowered death and stroke during long‐term follow‐up. The mechanism of lower bleeding and improved efficacy with fondaparinux is uncertain. Methods and Results: We compared the anti‐Xa concentration (reflecting drug levels), Xa clot time (reflecting anticoagulant effect) and endogenous thrombin potential (ETP; a global test of hemostatic function) in plasma samples collected 6, 24 and 72 h after the first dose of the study drug in 48 patients randomly assigned fondaparinux 2.5 mg day^?1 and 42 patients assigned enoxaparin 1 mg kg^?1 twice daily in the OASIS‐5 trial. Patients assigned to fondaparinux compared with enoxaparin had a significantly lower mean anti‐Xa level [0.52 IU mL^?1 (SD 0.22 IU mL^?1) vs. 1.2 IU mL^?1 (SD 0.45 IU mL^?1), P < 0.0001] and Xa clot time [64.9 s (SD 17.7 s) vs. 111.8 s (SD 29.6 s), P < 0.0001], and significantly higher ETP area under the curve (AUC) [386.7 mA (SD 51.5 mA) vs. 206.4 mA (SD 90.6 mA), P < 0.001] at 6 h, and these differences remained evident at 24 and 72 h. There was significantly less variability of the results of anti‐Xa levels, Xa clot time and ETP AUC for fondaparinux compared with enoxaparin at 6 h (P < 0.001 for each comparison). Conclusion: Fondaparinux 2.5 mg day^?1 compared with enoxaparin 1 mg kg^?1 twice daily produces less variable anticoagulant effect and lower mean anticoagulant intensity. These results most likely explain the reduced risk of bleeding seen with fondaparinux compared with enoxaparin in the OASIS‐5 trial and suggest that a lower intensity of anticoagulation than used in the past may be sufficient to prevent recurrent ischemic events and death in patients with ACS who are concurrently treated with aspirin and clopidogrel.     

Nepetalactone: A New Opioid Analgesic from Nepeta caesarea Boiss

The essential oils of Nepeta species including Nepeta phyllochlamys P. H. Davis, N. nuda L. ssp. nuda, and N. caesarea Boiss. have been screened by use of the tail-flick and tail immersion (52.5°C) methods. Of the species studied, only N. caesarea showed significant analgesic activity, besides marked sedation, which was also blocked by naloxone, indicating involvement of opioid receptors. Moreover, it was only active on mechanical, not thermal, algesic response which suggests specificity for specific opioid receptor subtypes, excluding μ-opioid receptors. Because 4aα,7α,7aα-nepetalactone is the main component of the essential oil of N. caesarea, and is present at very high levels (92–95%), it is concluded that 4aα,7α,7aα-nepetalactone is the active principle and has a specific opioid receptor subtype agonistic activity.