Common variable immunodeficiency (CVID) presenting with malabsorption due to giardiasis.

Common variable immunodeficiency is characterized with B-cell and T-cell dysfunction and hypogammaglobulinemia. Recurrent bacterial infections, such as otitis media, chronic sinusitis and recurrent pneumonia due to diminished immunoglobulin (Ig) levels and impaired antibody production are frequently observed in common variable immunodeficiency. Almost half of the patients with common variable immunodeficiency have problems related to the gastrointestinal system. A 39-year-old woman was referred to our department with the complaint of chronic diarrhea. She had experienced diarrhea without mucus or blood in the last year and had lost 30 kg. In her medical history, she had suffered from recurrent upper and lower respiratory infections like sinusitis, otitis media and pneumonia since childhood. Serum immunoglobulin levels were low. There were no parasites or ova in her stool examinations. Esophagogastroduodenoscopy detected widespread macroscopic nodular appearance on duodenum, and biopsies from the duodenum revealed giardiasis invading the tissue. She was diagnosed as common variable immunodeficiency. After metronidazole therapy and intravenous immunoglobulin infusion was started, her diarrhea attacks ceased and she regained her normal weight. Common gastrointestinal system problems in patients with common variable immunodeficiency are lactose intolerance, lymphoid hyperplasia/diffuse lymphoid infiltration, loss of villi and infection, especially with Giardia lamblia. Giardiasis may lead to severe mucosal flattening and sometimes to lymphoid hyperplasia at the lamina propria of the duodenum. Medical history should be evaluated carefully regarding recurrent respiratory infections. In such cases with chronic diarrhea, common variable immunodeficiency should be kept in mind as a possible cause.     

Pulmonary sarcoidosis: Radiographic features

Lungs are the most commonly affected organ in sarcoidosis. More than 90% of the patients have an abnormal chest roentgenogram at some stage of their illness. Radiologic abnormalities often are the first to suggest the diagnosis of sarcoidosis.     

The role of T regulatory cell-associated markers in monitoring tuberculosis treatment completion and failure

Monitoring tuberculosis (TB) treatment success is crucial for clinical decision-making. The only available tool in this regard is sputum microscopy, but it has demerits. Moreover, in case of smear negatives and extrapulmonary TB, an efficient tool is still sought for. Therefore, we evaluated T regulatory cell (Treg)-associated markers (CD25, CD39, and FoxP3) and cellular subsets in monitoring treatment success in treatment-completed groups. Expression profile of various markers and subsets were compared real time among treatment-naive pulmonary TB patients (TN-PTB), followed-up treatment-completed (TC-fu) cohort, and a not followed-up (TC-nfu) cohort. Peripheral blood mononuclear cells from various groups were incubated overnight and were stained with antibodies for specific markers and studied by flow cytometry. In both the treatment-completed groups, a decline in frequencies of CD25⁺ marker and CD4⁺CD25⁺, CD4⁺CD25⁺FoxP3, CD4⁺CD25⁺CD39⁺ Treg was observed with clearance of infection, indicating their potential in monitoring treatment success. However, in the case of treatment failure patient (Tfp), a drastic increase in frequency of CD4⁺CD25⁺FoxP3⁺ Treg subset was found, indicating its usefulness in predicting treatment failure. Although the investigation unveils markers useful in predicting treatment success or failure, the findings from this study needs to be validated in a larger cohort.     

Philic–phobic chemical dynamics of a 1st tier dendrimer dispersed o/w nanoemulsion

Olive, castor and linseed oil (oil-in-water) nanoemulsions were prepared using Tween-20, sodium dodecyl sulfate, and cetyltrimethylammonium bromide (0.12 w/w%) with 0.02 w/w% cellulose acetate propionate (CAP), 0.02 w/w% cellulose acetate butyrate (CAB), 6.2 w/w% ethyl acetate, 5.5 w/w% ethanol and 7.8 w/w% glycerol as dispersion agents. To study the dispersion effect of trimesoyl 1,3,5-tridimethyl malonate (TTDMM, 1^st tier), nanoemulsions were prepared with olive, castor and linseed oil. Their density, viscosity, surface tension and friccohesity measurements at T = (293.15, 303.15, and 315.15) K, hydrodynamic radii, surface excess concentration, surface area per molecule, and antioxidant activities were studied. Dispersion variations of TTDMM on varying surfactant and specific interactions of the hydration spheres and ester moiety of TTDMM with ethyl acetate, ethanol and glycerol linked oil–water–surfactant networks have been established. The variations in physicochemical properties suggest that the oil–TTDMM interaction abilities of the surfactant and co-surfactant moieties in the nanoemulsions cause a hydrophobic segregation. The physicochemical study of both blank and TTDMM loaded nanoemulsions have illustrated the thermodynamic stabilities in terms of hydrophobic–hydrophilic, hydrophilic–hydrophilic, van der Waals and hydrogen bonding interactions.

Stable nanoemulsions of a TTDMM dendrimer have been successfully prepared with different surfactants.     

Thrombus in Right Ventricular Outflow Tract: Unique Cause of Refractory Cyanotic Spell

Iron deficiency state in patients with cyanotic congenital heart disease can mimic as well as aggravate hyperviscosity symptoms. Correction of iron deficiency in these cases is expected to improve symptoms. We report an unexpected occurrence of refractory cyanotic spell in a child with tetralogy of Fallot due to thrombus in right ventricular outflow tract following intravenous iron sucrose therapy.