Dengue haemorrhagic fever: ultrasound as an aid to predict the severity of the disease

In a prospective study, the relationship between the clinical severity of dengue haemorrhagic fever (DHF) and the sonographic findings was examined. The study comprised 73 cases classified as mild (grades I–II) and 75 as severe (grades III–IV). Ultrasonography in the mild group revealed pleural effusions in 30 %, ascites in 34 %, gallbladder wall thickening in 32 %, hepatomegaly in 49 %, splenomegaly in 16 %, and pancreatic enlargement in 14 %. In the severe group, pleural effusions, ascites and gallbladder wall thickening were found in 95 %, pararenal and perirenal fluid collections in 77 %, hepatic and splenic subcapsular fluid collections in 9 %, pericardial effusion in 8 %, hepatomegaly in 56 %, splenomegaly in 16 %, and pancreatic gland enlargement in 44 %. Ultrasound may be useful for early prediction of the severity of DHF in children. Received: 15 January 1997 Accepted: 2 June 1997     

Some clinical and epidemiological observations on virologically confirmed dengue hemorrhagic fever

This study is a part of a one year prospective study on dengue hemorrhagic fever (DHF) carried out in the Department of Pediatrics, Sumber Waras Hospital in West Jakarta. Viral isolation and serologic analysis for DHF were done by Namru-2 in Jakarta. The subjects were 151 virologically confirmed DHF Patients admitted to the Department of Pediatrics during the period of September 1987-June 1988, consisting of 82 boys and 69 girls of 6 months-15 years old. The predominant age group was 5 to 9 years, representing 49.7% subjects. Dengue virus was isolated from sera during the first 8 days of illness and in 139 (42.1%) during the first 5 days of illness. Dengue virus type 1, 2, 3 and 4 were isolated from 16.6%, 13.2%, 69.5% and 0.7% subjects, respectively. The clinical manifestations revealed no striking differences between dengue 3 and others except for thrombocytopenia and shock. High fever, hemoconcentration and thrombocytopenia on admission was observed in 30.5%, 8.6% and 8.6% of subjects, respectively. Dengue shock syndrome (DSS) were observed in 23 (15.2%) with 3 (2%) fatal cases. Dengue virus serotype 3 was observed in 20 out of 23 DSS cases (86.9%) and all fatal cases were associated with dengue type 2. This study revealed that dengue 3 is the predominant virus circulating during recent epidemics and is associated with more severe clinical manifestation and with a higher incidence rate of living area.     

Current status of oral and maxillofacial radiology in West Africa

Background

Oral and maxillofacial radiology became the ninth dental specialty recognized by the American Dental Association (ADA) in 1999. This came about following the discovery of X-rays by Wilhelm Conrad Roentgen in 1895 and, 14 days later, the application of X-rays to making dental radiographs by Otto Walkhoff. The purpose of this narrative study was to review the evolution of oral and maxillofacial radiology as a dental specialty in the USA and its recognition as a program of training by the West African College of Surgeons.

Methods

This study was conceptualized as a narrative review of the literature focusing on the history and development of oral and maxillofacial radiology in the USA. It builds a synthesis that describes the recognition of oral and maxillofacial radiology as a specialty of dentistry in West Africa, UK, Japan, and Australia.

Results

The main finding was that oral and maxillofacial radiology became the ninth specialty recognized by the American Dental Association, ADA, in October 13, 1999. On March 20, 2014, the West African College of Surgeons recognized this specialty and granted accreditation for postgraduate training. In the UK, Japan, and Australia, the postgraduate education in oral and maxillofacial radiology has two patterns, namely professional training and academic training.

Conclusions

The primary goal of the postgraduate training curriculum is to train radiologists who are competent to deliver care to patients in any clinical setting, including a dental school, hospital radiology practice, or private practice.

     

Validation of a Web-Based,Time-Use Application to Assess Children’s School Meal Intakes: My E-Diary for Activities and Lifestyle (MEDAL)

My E-Diary for Activities and Lifestyle (MEDAL), a web-based application, was developed to assess the diets of children. This study examined the validity of school recess meals reported by children on MEDAL, using meal photography as the reference. Recess meals were photographed by trained researchers, and food items and portion sizes of recess meals reported on MEDAL were compared to recess meal photos. Validity was assessed by percentages of match, omission and intrusion for food items and percentages of the match, underestimation and overestimation for portion sizes. The Mann–Whitney test and the Wilcoxon matched-pairs signed-rank test examined if sex, school and day of recording influenced the validity of food item reporting. We found that participants (n = 33, aged 10–11 years) recalled 60.2% of food items consumed at recess accurately (matches); omissions (24.6%) were more common than intrusions (15.2%). Omissions tended to be side dishes, and intrusions tended to be high-calorie items. Sex, school and day of recording did not influence validity. For food portion sizes, 58.3% of items were accurately reported. Overestimations (33.3%) were more common than underestimations (8.3%). In conclusion, these children were able to report food items consumed during school recess meals using MEDAL, albeit with limitations on the degree of accuracy.     

Memory functions in prednisone-treated kidney transplant patients

The literature indicates that high daily doses of gluco-corticosteroids have a degenerating effect upon the hippocampus and thus result in reduced declarative memory capacities. In order to prevent rejection, renal transplant recipients are treated with moderate daily doses of gluco-corticosteroids and, if necessary, with high pulse-doses during a few days. The question, therefore, arises as to whether or not such standard treatments result in memory impairments. For this reason, declarative memory capacities were measured, by means of a Dutch version of Rey's 15 Words Test, in a group of 52 renal transplant recipients. Results clearly indicated severe reductions in declarative memory capacities in these patients.     

Cross-reactivity of cytomegalovirus-specific CD8+ T cells to allo-major histocompatibility complex class I molecules

BACKGROUND: In transplantation settings, cytomegalovirus (CMV) infection is a common complication. CMV infection is associated with a higher incidence of graft rejection in solid organ transplantation and graft-versus-host disease in bone marrow transplantation. The underlying mechanism of this association could be the generation of CMV-specific CD8 T cells capable of cross-reacting with alloantigens present on graft and host, respectively. METHODS: Whereas as to date, no direct ex vivo analysis can be performed of the CD8 T-cell repertoire directed at allo-major histocompatibility complex (MHC) class I molecules, virus-specific cells can be readily enumerated by use of MHC-peptide tetrameric complexes. In this study, the authors used this technique to analyze potential overlapping CD8 T-cell repertoires between self-MHC-viral peptide and allo-MHC complexes by stimulating CMV-specific CD8 T cells with alloantigens. RESULTS.: The authors found that CMV-specific CD8 T cells are activated and proliferate on stimulation with alloantigens. CONCLUSIONS: Although these cells are cytotoxic against CMV-peptide pulsed target cells, no cytotoxicity of CMV-specific cells to alloantigens could be detected, inferring that there are other mechanisms of graft damage by alloantigen-stimulated virus-specific CTL.     

Immune responsiveness in renal transplant recipients: mycophenolic acid severely depresses humoral immunity in vivo

BACKGROUND: Current immunosuppressive drug treatments for renal transplant recipients result in high one-year graft survival rates. Despite adequate suppression of the immune response directed to the allograft, the immune system remains able to cope with many infectious agents. METHODS: To define the influence of distinct immunosuppressive treatment protocols, primary and secondary cellular and humoral immune responses in groups of renal transplant recipients were studied: patient treated with prednisolone and cyclosporine A (P/CsA); with IgA CD3 monoclonal antibody as a rejection treatment superimposed on prednisolone and cyclosporine A (IgA CD3 mAb+P/CsA); and with prednisolone, cyclosporine A and mycophenolate mofetil (P/CsA/MMF). RESULTS: Primary in vitro proliferative responses to the protein antigen keyhole limpet hemocyanin (KLH) were not significantly disturbed in P/CsA treated patients, or in IgA CD3 mAb+P/CsA and P/CsA/MMF treated patients. In vitro proliferative responses to the recall antigen tetanus toxoid (TT) were similarly unaffected. Antigen-specific antibody responses to immunization with KLH and TT were not affected by treatment with P/CsA, or by IgA CD3 mAb+P/CsA, but were severely disturbed in patients treated with P/CsA/MMF. All patients displayed a profound inhibition of the delayed-type hypersensitivity skin reactivity to KLH and recall antigens. Nevertheless, in most patients with P/CsA treatment, T cell infiltrates were observed in skin biopsies from the site of KLH challenge, while expression of intercellular cell adhesion molecule-1 (ICAM-1) expression in challenged skin was significantly decreased in these patients. The balance between T helper 1 and T helper 2 cells was unaffected by immunosuppressive treatments during one year of follow-up. CONCLUSIONS: Immunosuppressive drug treatment with P/CsA inhibits delayed-type hypersensitivity skin reactions to both primary and frequently encountered antigens. Histological studies indicate an effect on ICAM-1 expression, leaving the influx of CD3pos T cells unaffected. Administration of a 10-day course of IgA CD3 mAb does not add profound immunosuppressive effects on the measured parameters. In contrast, addition of treatment with MMF profoundly decreases both primary and secondary humoral immune responsiveness in vivo. Finally, no effect of the studied immunosuppressive drugs on Th1/Th2 balance in vivo was measured.