Status epilepticus as the only presentation of the neonatal Bartter syndrome

Bartter syndrome is a rare hereditary (autosomal recessive) salt-losing tubulopathy characterized by hypokalemia, hypochloremia, metabolic alkalosis, and normal blood pressure with hyperreninemia, The underlying renal abnormality results in excessive urinary losses of sodium, chloride, and potassium. We report a case of a four-month-old infant with neonatal Bartter syndrome, who presented only with status epilepticus. To the best of our present knowledge, there is no reported case of Bartter syndrome who presented with status epilepticus.     

Omentum autotransplantation in thromboangiitis obliterans: Report of three cases

Thomboangiitis obliterans (TAO), also known as Buerger's disease, is an important cause in India of chronic arterial occlusion of the limbs. The current modalities of therapy do not provide adequate relief to a large number of these patients. An omentum autotransplantation to the lower limbs was performed in three patients as a limb salvage procedure. The initial results with up to a year of follow-up are so far encouraging.     

Engineering colloidally stable,highly fluorescent and nontoxic Cu nanoclusters via reaction parameter optimization

Metal nanoclusters (NCs) composed of the least number of atoms (a few to tens) have become very attractive for their emerging properties owing to their ultrasmall size. Preparing copper nanoclusters (Cu NCs) in an aqueous medium with high emission properties, strong colloidal stability, and low toxicity has been a long-standing challenge. Although Cu NCs are earth-abundant and inexpensive, they have been comparatively less explored due to their various limitations, such as ease of surface oxidation, poor colloidal stability, and high toxicity. To overcome these constraints, we established a facile synthetic route by optimizing the reaction parameters, especially altering the effective concentration of the reducing agent, to influence their optical characteristics. The improvement of the photoluminescence intensity and superior colloidal stability was modeled from a theoretical standpoint. Moreover, the as-synthesized Cu NCs showed a significant reduction of toxicity in both in vitro and in vivo models. The possibility of using such Cu NCs as a diagnostic probe toward C. elegans was explored. Also, the extension of our approach toward improving the photoluminescence intensity of the Cu NCs on other ligand systems was demonstrated.

A facile synthetic strategy to engineer improved fluorescent quantum yield, colloidally stable, and low toxic Cu nanoclusters is introduced. These nanoclusters have the potential to be used as excellent bioimaging probes.     

Double Mutation in the pfmdr1 Gene Is Associated with Emergence of Chloroquine-Resistant Plasmodium falciparum Malaria in Eastern India

Malaria is a major public health problem in tropical and subtropical countries, including India. This study elucidates the cause of chloroquine treatment failure (for Plasmodium falciparum infection) before the introduction of artemisinin combination therapy. One hundred twenty-six patients were randomized to chloroquine treatment, and the therapeutic efficacy was monitored from days 1 to 28. An in vitro susceptibility test was performed with all isolates. Parasitic DNA was isolated, followed by PCR and restriction digestion of different codons of the pfcrt gene (codons 72 to 76) and the pfmdr1 gene (N86Y, Y184F, S1034C, N1042D, and D1246Y). Finally, sequencing was done to confirm the mutations. Forty-three (34.13%) early treatment failure cases and 16 (12.69%) late treatment failure cases were observed after chloroquine treatment. In vitro chloroquine resistance was found in 103 isolates (81.75%). Twenty-six (60.47%) early treatment failure cases and 6 (37.5%) late treatment failure cases were associated with the CVMNK-YYSNY allele (the underlined amino acids are those that were mutated). Moreover, the CVIEK-YYSNY allele was found in 8 early treatment failure (18.60%) and 2 late treatment failure (12.5%) cases. The presence of the wild-type pfcrt (CVMNK) and pfmdr1 (YYSNY) double mutant allele in chloroquine-nonresponsive cases was quite uncommon. In vivo chloroquine treatment failure and in vitro chloroquine resistance were strongly correlated with the CVMNK-YYSNY and CVIEK-YYSNY haplotypes (P < 0.01).     

The cost and cost-effectiveness of malaria vector control by residual insecticide house-spraying in southern Mozambique: a rural and urban analysis

OBJECTIVES: To compare two separately funded, but operationally similar, residual household-spraying (RHS) initiatives; one rural and one peri-urban in southern Mozambique. METHODS: The rural programme is a regional project involving the participation and co-ordination of organizations across three countries in southern Africa and is focussed on control in an area in Mozambique of 7552 km2. The second programme focuses on spraying a peri-urban community within a 10-km radius around MOZAL, an aluminium smelter plant of area 410 km2. An ingredients approach was used to derive unit costs for both the rural and peri-urban spraying programmes using detail retrospective cost data and effectiveness indicators. RESULTS: The economic cost per person covered per year using Carbamates for indoor residual spraying (IRS) in the rural area, excluding the costs of project management and monitoring and surveillance was $3.48 and in the peri-urban area, $2.16. The financial costs per person covered in the rural area and peri-urban area per year were $3.86 and $2.41, respectively. The economic costs per person covered were respectively increased by 39% and 31% when project management and monitoring and surveillance were included. The main driving forces behind the costs of delivering RHS are twofold: the population covered and insecticide used. Computed economic and financial costs are presented for all four insecticide families available for use in RHS. CONCLUSIONS: The results from both these initiatives, especially the rural area, should be interpreted as conservative cost estimates as they exclude the additional health gains that the newly introduced programmes have had on malaria rates in the neighbouring areas of South Africa and Swaziland. Both these initiatives show that introducing an IRS programme can deliver a reduction in malaria-related suffering providing financial support, political will, collaborative management and training and community involvement are in place.     

Renal retransplantation in patients with HLA-antibodies

The results of 92 consecutive renal retransplantations, performed during a 5-year period in recipients with HLA-antibodies, were retrospectively analysed. The actuarial 1-year graft survival (1-y GS) was 65% for all retransplantations, as compared with 63% for first grafts in sensitized recipients. For the second (n = 56), third (n = 24) and fourth-fifth (n = 12) grafts 1-y GS was 64%, 71% and 58%, respectively. Acute rejection was the major cause of graft loss (45%). Recipients with > 3 years GS of the preceding transplant had significantly better GS at retransplantation. Also, grafts with no HLA mismatches had significantly prolonged GS. One-y GS was 78% when PRA (panel reacting antibody) was less than 50%, and 60% when PRA was more than 50%. A benefit of repeated mismatches was demonstrated in the subgroup with PRA < 50%, in contrast to recipients with PRA > 50%, suggesting that, in some patients, an absence of antibody response against certain antigens might be used as a basis for future deliberate mismatching.