In Vivo-Expressed Proteins of Virulent Leptospira interrogans Serovar Autumnalis N2 Elicit Strong IgM Responses of Value in Conclusive Diagnosis

Leptospirosis is a serious zoonosis that is underdiagnosed because of limited access to laboratory facilities in Southeast Asia, Central and South America, and Oceania. Timely diagnosis of locally distributed serovars of high virulence is crucial for successful care and outbreak management. Using pooled patient sera, an expression gene library of a virulent Leptospira interrogans serovar Autumnalis strain N2 isolated in South India was screened. The identified genes were characterized, and the purified recombinant proteins were used as antigens in IgM enzyme-linked immunosorbent assay (ELISA) either singly or in combination. Sera (n = 118) from cases of acute leptospirosis along with sera (n = 58) from healthy subjects were tested for reactivity with the identified proteins in an ELISA designed to detect specific IgM responses. We have identified nine immunoreactive proteins, ArgC, RecA, GlpF, FliD, TrmD, RplS, RnhB, Lp28.6, and Lrr44.9, which were found to be highly conserved among pathogenic leptospires. Apparently, the proteins ArgC, RecA, GlpF, FliD, TrmD, and Lrr44.9 are expressed during natural infection of the host and undetectable in in vitro cultures. Among all the recombinant proteins used as antigens in IgM ELISA, ArgC had the highest sensitivity and specificity, 89.8% and 95.5%, respectively, for the conclusive diagnosis of leptospirosis. The use of ArgC and RecA in combination for IgM ELISA increased the sensitivity and specificity to 95.7% and 94.9%, respectively. ArgC and RecA thus elicited specific IgM responses and were therefore effective in laboratory confirmation of Leptospira infection.     

Hand impairment and activity limitations in four chronic diseases

Study designRetrospective cohort.IntroductionHand involvement in osteoarthritis (OA) and rheumatoid arthritis (RA) are well known to occupational and physical therapists; however, it is not known whether the impairments and activity limitations with diabetes (DMII) and systemic sclerosis (SSc) are as severe as those observed with OA and RA.PurposeTo compare the hand impairments and activity limitations in the 4 diseases.MethodsA convenience sample of 156 participants received evaluations of hand impairments: strength, joint motion, and dexterity and completed a hand activity limitations questionnaire.ResultsThe SSc and RA participants had weaker pinch, decreased joint motion and more activity limitations than the DMII and OA groups. There were no significant differences between the groups for right hand grip strength and pegboard dexterity, and applied dexterity.ConclusionsOA and DMII groups had significantly less impairments and activity limitations than the SSc and RA groups.Level of evidence2C.     

Regional anesthesia in a very low-birth-weight neonate for a neurosurgical procedure

BACKGROUND AND OBJECTIVES: Peripheral nerve blocks can be successfully utilized in infants for neurosurgical procedures. Our objective was utilizing a series of peripheral nerve blocks for a neurosurgical procedure in a very low-birth-weight neonate. CASE REPORT: We report the use of supraorbital, great auricular, and greater occipital nerve block in a very low-birth-weight neonate (700 g) who was scheduled for a neurosurgical procedure. DISCUSSION: We were able to successfully utilize peripheral nerve blocks and were able to blunt physiologic responses to surgical stress without compromising hemodynamic stability using high-dose opioids.     

A comparison of three doses of a commercially prepared oral midazolam syrup in children.

Midazolam is widely used as a preanesthetic medication for children. Prior studies have used extemporaneous formulations to disguise the bitter taste of IV midazolam and to improve patient acceptance, but with unknown bioavailability. In this prospective, randomized, double-blinded study we examined the efficacy, safety, and taste acceptability of three doses (0.25, 0.5, and 1.0 mg/kg, up to a maximum of 20 mg) of commercially prepared Versed((R)) syrup (midazolam HCl) in children stratified by age (6 mo to <2 yr, 2 to <6 yr, and 6 to <16 yr). All children were ASA class I-III scheduled for elective surgery. Subjects were continuously observed and monitored with pulse oximetry. Ninety-five percent of patients accepted the syrup, and 97% demonstrated satisfactory sedation before induction. There was an apparent relationship between dose and onset of sedation and anxiolysis (P < 0.01). Eight-eight percent had satisfactory anxiety ratings at the time of attempted separation from parents, and 86% had satisfactory anxiety ratings at face mask application. The youngest age group recovered earlier than the two older age groups (P < 0.001). There was no relationship between midazolam dose and duration of postanesthesia care unit stay. Before induction, there were no episodes of desaturation, but there were two episodes of nausea and three episodes of emesis. At the time of induction, during anesthesia, and in the postanesthesia care unit, there were several adverse respiratory events. Oral midazolam syrup is effective for producing sedation and anxiolysis at a dose of 0.25 mg/kg, with minimal effects on respiration and oxygen saturation even when administered at doses as large as 1.0 mg/kg (maximum, 20 mg) as the sole sedating medication to healthy children in a supervised clinical setting. IMPLICATIONS: Commercially prepared oral midazolam syrup is effective in producing sedation and anxiolysis in doses as small as 0.25 mg/kg; there is a slightly faster onset with increasing the dose to 1.0 mg/kg. At all doses, 97% of patients demonstrated satisfactory sedation, whereas 86% demonstrated satisfactory anxiolysis when the face mask was applied.     

Fatal intratumoral hemorrhage in posterior fossa tumors following ventriculoperitoneal shunt

We report on two patients with rare major intratumoral hemorrhage following ventriculoperitoneal shunt in posterior fossa tumors. A 28-year-old woman with a midline posterior fossa lesion, whose imaging features suggested a fourth ventricular ependymoma with obstructive hydrocephalus, was subjected to a right ventriculoperitoneal shunt. Her consciousness deteriorated, and she experienced massive intratumoral hemorrhage and later died. An eight-year-old girl presented with raised intracranial pressure and ataxia caused by vermian astrocytoma with obstructive hydrocephalus. She also developed a massive tumor bleed following a ventriculoperitoneal shunt and was subjected to emergency decompression of the tumor with the bleeding. She remained vegetative at discharge and died 18 months later. Intratumoral hemorrhage is a rare but important cause of morbidity and mortality in patients with posterior fossa tumors who undergo ventriculoperitoneal shunt.     

Prospects of zona pellucida glycoproteins as immunogens for contraceptive vaccine

The zona pellucida (ZP) surrounding a mammalian oocyte mediatesthe initial recognition and binding of spermatozoon to oocytein a relatively species-specific manner and plays an importantrole in the subsequent activation events during the fertilizationprocess. The ZP comprises three biochemically and immunologicallydistinct glycoproteins termed ZP1, ZP2 and ZP3. The criticalrole of ZP glycoproteins in reproduction together with theirtissue-specific nature have led to their being considered aspotential candidate antigens for immunocontraception. Immunizationof females with ZP glycoproteins leads to a block of fertilityin several animal models. However, it is invariably associatedwith either a transient or an irreversible alteration in thecyclicity, hormonal profile and follicular development in theovary. To overcome these problems, attempts are being made todelineate relevant `B' cell epitopes on ZP proteins so as todesign immunocontraceptive vaccines based on synthetic peptidesdevoid of oophoritogenic `T' cell epitopes. Monoclonal antibodiescapable of inhibiting the gamete interaction are being employedto delineate such regions. Additionally, DNA-recombinant technologyhas made it feasible to obtain, in reasonably large quantities,the ZP glycoproteins from human and non-human primates. Availabilityof sequence information of these zona proteins and the availabilityof recombinant antigens (devoid of other ovarian-associatedproteins) will further help in understanding more preciselytheir functions during fertilization and make it feasible toundertake immunization studies to determine their prospectsas immunogens for fertility regulation.