Extremely low HDL and residual cardiovascular risk—a case report

International Journal of Diabetes in Developing Countries - Extremely low high-density lipoprotein cholesterol (HDL-C) is defined as levels below 20 mg/dL. Association between extremely low HDL-C...     

Portal Hypertension and an Atypical Reactive Arthritis Like Presentation in a patient infected with Hepatitis C Virus Genotype 3

Background:Reactive arthritis (ReA) is defined as a peripheral arthritis lasting longer than 1 month, associated with urethritis, cervicitis, or diarrhea. The reported annual incidence of ReA is approximately 30-40 cases per 100,000 adults, occurring commonly in the age group of 16 and 35 years. It is known to be associated with gastrointestinal infections with Shigella, Salmonella, and Campylobacter species and other microorganisms, as well as with genitourinary infections (especially with Chlamydia trachomatis).Conclusions:Our case is unlike classical ReA because the patient is older, HLA B27 negative, and without florid urethritis. Admitted for fever and lower urinary tract symptoms, along with respiratory distress, the primary objective of the emergency doctors was to prevent the patient from progressing to organ failure. The diagnosis of underlying atypical/incomplete ReA could easily have been missed without adequate awareness, dermatological consultation, and a skin biopsy.     

Global Urine Metabolomics in Patients Treated with First-Line Tuberculosis Drugs and Identification of a Novel Metabolite of Ethambutol

Population level variation of drug metabolism phenotype (DMP) has great implications in treatment outcome, drug-related side effects, and resistance development. In this study, we used a gas chromatography-time of flight-mass spectrometry (GC-TOF-MS)-based untargeted urine metabolomics approach to understand the DMP of a tuberculosis (TB) patient cohort (n = 20) from Tripura, a state in the northeastern part of India. Urine samples collected at different postdose time points (2 h, 6 h, 12 h, 24 h, 36 h, and 48 h) from these newly diagnosed TB patients receiving first-line anti-TB drugs were analyzed, and we have successfully detected three of the four first-line drugs, viz., isoniazid (INH), ethambutol (ETB), and pyrazinamide (PZA). The majority of their known metabolites, acetyl-isoniazid (AcINH), isonicotinic acid (INA), isonicotinuric acid (INTA), 2,2′-(ethylenediimino)-dibutyric acid (EDBA), 5-hydroxypyrazinamide (5OH-PZA), pyrazinoic acid (POA), and 5-hydroxypyrazinoic acid (5OH-POA), were also detected. Analyzing the variation in abundances of drugs and their known metabolites and calculating the metabolic ratios in these samples, we offer comprehensive DMP information on this small patient cohort that represents Tripura, India. The majority (75%) of these patients are found to be slow acetylators of INH. The average metabolic ratios of POA/PZA and 5OH-POA/POA are 3.16 ± 3.03 and 6.09 ± 6.15, respectively. Employing correlation analysis of the metabolomics metadata and a manual prediction of drug catabolism, we have proposed 2-aminobutyric acid (AABA) as a novel metabolite of ETB. These observations indicate the usefulness of GC-MS-based metabolomics to characterize the DMP at a population level and also to identify novel drug metabolites.     

加拿大新生儿重症监护室院内感染及其变化趋势对胎龄<33周早产儿预后的影响

败血症是新生儿重症监护室(NICU)的危重病症及造成新生儿死亡的重要原因之一,根据其发病时间,可分为早发(生后2 d 内)和晚发(生后2 d 后)。其中晚发的新生儿败血症,一般考虑为院内感染(NI)。胎龄越小,出生体重越低,NI 的发生率越高。NI 的发生率在加拿大各 NICU 之间差别较大,与各中心医护人员的相关诊疗行为密切相关。在国家卫生研究院"基于循证医学的医疗质量改进项目" 的推动下,2003~2009 年间加拿大全国 NICU 总的NI 率明显下降,但不同中心各自感染率的变化趋势仍极为不同。本研究纳入了加拿大全国共24 家 NICU 在2008~2012 年间所有收入院的胎龄<33 周的早产儿共18 961 名,探讨NI 率的变化趋势以及其与早产儿预后的关系。     

Arsenic contamination in groundwater: a global perspective with emphasis on the Asian scenario

The incidence of high concentrations of arsenic in drinking-water has emerged as a major public-health problem. With newer-affected sites discovered during the last decade, a significant change has been observed in the global scenario of arsenic contamination, especially in Asian countries. This communication presents an overview of the current scenario of arsenic contamination in countries across the globe with an emphasis on Asia. Along with the present situation in severely-affected countries in Asia, such as Bangladesh, India, and China, recent instances from Pakistan, Myanmar, Afghanistan, Cambodia, etc. are presented.     

Status of groundwater arsenic contamination and human suffering in a Gram Panchayet (cluster of villages) in Murshidabad, one of the nine arsenic affected districts in West Bengal, India

A detailed study was carried out in a cluster of villages known as Sagarpara Gram Panchayet (GP), covering an area of 20 km2 and population of 24,419 to determine the status of groundwater arsenic contamination and related health effects. The arsenic analysis of all hand tubewells (n = 565) in working condition showed, 86.2% and 58.8% of them had arsenic above 10, and 50 microgl(-1), respectively. The groundwater samples from all 21 villages in Sagarpara GP contained arsenic above 50 microgl(-1). In our preliminary clinical survey across the 21 villages, 3,302 villagers were examined and 679 among them (20.6%) were registered with arsenical skin lesions. A total of 850 biological samples (hair, nail and urine) were analysed from the affected villages and, on average, 85% of them contained arsenic above the normal level. Thus, many people of Sagarpara might be sub-clinically affected. Our data was compared with the international one to estimate population in Sagarpara GP at risk from arsenical skin lesions and cancer. Proper watershed management and economical utilization of available surface water resources along with the villagers' participation is urgently required to combat the present arsenic crisis.     

Arsenic groundwater contamination in Middle Ganga Plain,Bihar, India: a future danger?

The pandemic of arsenic poisoning due to contaminated groundwater in West Bengal, India, and all of Bangladesh has been thought to be limited to the Ganges Delta (the Lower Ganga Plain), despite early survey reports of arsenic contamination in groundwater in the Union Territory of Chandigarh and its surroundings in the northwestern Upper Ganga Plain and recent findings in the Terai area of Nepal. Anecdotal reports of arsenical skin lesions in villagers led us to evaluate arsenic exposure and sequelae in the Semria Ojha Patti village in the Middle Ganga Plain, Bihar, where tube wells replaced dug wells about 20 years ago. Analyses of the arsenic content of 206 tube wells (95% of the total) showed that 56.8% exceeded arsenic concentrations of 50 micro g/L, with 19.9% > 300 micro g/L, the concentration predicting overt arsenical skin lesions. On medical examination of a self-selected sample of 550 (390 adults and 160 children), 13% of the adults and 6.3% of the children had typical skin lesions, an unusually high involvement for children, except in extreme exposures combined with malnutrition. The urine, hair, and nail concentrations of arsenic correlated significantly (r = 0.72-0.77) with drinking water arsenic concentrations up to 1,654 micro g/L. On neurologic examination, arsenic-typical neuropathy was diagnosed in 63% of the adults, a prevalence previously seen only in severe, subacute exposures. We also observed an apparent increase in fetal loss and premature delivery in the women with the highest concentrations of arsenic in their drinking water. The possibility of contaminated groundwater at other sites in the Middle and Upper Ganga Plain merits investigation.