Clinical evaluation of technetium-99m infecton for the localisation of bacterial infection

The aim of the study was to distinguish infection from inflammation in patients with suspected infection using technetium-99m Infecton. Ninety-nine patients (102 studies) referred for infection evaluation underwent imaging with 400 MBq^99mTc-Infecton at 1 and 4 h. Most patients had appropriate microbiological tests and about half (56) had radiolabelled white cell scans as well. No adverse effects were noted in any patient. The clinical efficacy of^99mTc-Infecton depended in part on whether imaging was undertaken during intibiotic therapy for infection or not. In consultation with the microbiologist, 5–14 days of appropriate and successful antibiotic therapy was considered adequate to classify some results as true-negatives. The figures for sensitivity and specificity of^99mTc-Infecton for active or unsuccessfully treated infection were 83% and 91% respectively. It is concluded that^99mTc-Infecton imaging contributed to the differential diagnosis of inflammation. It is being used as the first imaging modality when bacterial infection is suspected.     

B-cell lymphoma after angioimmunoblastic lymphadenopathy: a case with oligoclonal gene rearrangements associated with Epstein-Barr virus

We describe a patient with angioimmunoblastic lymphadenopathy with dysproteinemia (AILD), who subsequently developed large-cell immunoblastic lymphoma of B-cell immunophenotype. At the time of the initial diagnosis, histologic examination of an inguinal lymph node showed typical features of AILD, and there was no evidence of a monoclonal B-cell population by immunohistochemical analysis. In situ hybridization and Southern blot analysis for Epstein-Barr virus (EBV) were negative. At autopsy 2 years later, the patient had widespread lymph node and organ involvement by large-cell immunoblastic lymphoma of B-cell immunophenotype. Southern blot analysis performed on DNA extracted from lymph nodes, liver, and spleen showed two patterns of Ig heavy chain and kappa light chain gene rearrangements. The T-cell receptor beta chain gene was in the germline configuration. Analysis with an EBV terminal repeat region probe showed two clonal populations that paralleled the Ig gene rearrangement studies. Double-labeling immunohistochemistry and in situ hybridization confirmed the presence of EBV within the neoplastic B cells. The data support the hypothesis that EBV was not etiologically related to AILD in this case, and that EBV proliferation may occur after the onset of the disease. Further, the data suggest that some B-cell lymphomas that arise in the setting of AILD resemble EBV-associated B-cell lymphomas that arise in other immunodeficiency states.     

Restless legs syndrome among Saudi end-stage renal disease patients on hemodialysis

Objectives:

To determine the prevalence of restless legs syndrome (RLS) in Saudi patients with end-stage renal disease (ESRD) on hemodialysis.

Methods:

A cross-sectional study was carried out in 3 hemodialysis centers in Jeddah, Saudi Arabia, between June 2012 and September 2013. All patients were individually interviewed and data was collected on the following demographic features, medical history, laboratory test, the International Restless Legs Syndrome Study Group questionnaire, Epworth Sleepiness Scale (ESS), and Berlin Questionnaire.

Results:

Three hundred and fifty-five patients were recruited. The prevalence of RLS among ESRD patients was 19.4%, with most patients having moderate to severe disease. The RLS was significantly associated with obstructive sleep apnea (p<0.0001) and excessive daytime sleepiness based on the ESS (p=0.009). The RLS showed no correlation with hemodialysis adequacy, chronicity, frequency per week, and hemodialysis duration per session; however, there was a weak negative relation between adequacy of hemodialysis and RLS severity. None of the comorbidities showed any association with RLS. The odds of developing RLS increased significantly with an increasing body mass index (p=0.001). Administration of aspirin (p=0.037) and anticoagulants (p=0.035) were also associated with increased risk of RLS.

Conclusion:

Restless legs syndrome is common in ESRD patients on hemodialysis, and it is an important source of sleep disruption. In addition to body mass index, Aspirin and anticoagulants may be important risk factors.Willis-Ekbom disease or restless legs syndrome (RLS) is a sleep-related, sensorimotor, neurological disorder that primarily affects the legs.1 When severe, the disorder can also affect the arms and other parts of the body. The RLS is characterized by sore sensations in the legs and accompanied by an urge to move them, typically in the evening and night. It is worse at rest and at least temporarily relieved by activity.1,2 The prevalence of RLS in the general population ranges from 5-15%.3 It can be idiopathic in nature or secondary to conditions such as diabetes mellitus, renal failure, iron deficiency anemia, multiple sclerosis, and pregnancy. The restlessness experienced by patients with RLS can cause problems such as insomnia, excessive daytime sleepiness, poor quality of life, and depression. In its severe forms, it can develop into a chronic and devastating disorder that may require long-term treatment. The clinical management of this condition is to treat the possible causes as well as to use different drugs for symptomatic relief. However, there is no definitive cure for this condition. Patients on regular hemodialysis (HD) for the management of end-stage renal disease (ESRD) are prone to various neurological disorders, including RLS. The prevalence of RLS among HD patients is approximately 20-30%.4,5 In a Serbian study, Nikić et al6 evaluated 166 patients on HD using the International Restless Legs Syndrome Study Group (IRLSSG) criteria and found that the prevalence of RLS was 22.7%. Goffredo Filho et al7 also reported the frequency of RLS to be 14.8% among 176 Brazilian patients. With regard to our region, Salman8 reported that the prevalence of RLS was 20.3% in 123 Syrian patients on chronic HD. Finally, Al-Jahdali et al9 conducted the single local study on 227 ESRD patients on chronic hemodialysis and found that the prevalence of RLS was 50.2%. This rate was much higher than that reported previously in majority of similar studies, particularly in light of the fact that the reported percentage of RLS in the Saudi population was only 5.2%.10 In this study, our aim was to determine the prevalence of RLS among a sample of Saudi patients with ESRD maintained on regular HD, and to compare the obtained value with that previously reported. Additionally, we explored the association between the adequacy of hemodialysis and severity of RLS symptoms.     

Genetic diversity and gene structure of mitochondrial region of Anopheles minimus(Diptcra:Culicidae)-major malaria vector of North east India

Objective:To depict mitochondrial genetic variation for the first time among Anopheles minimus(An.minimus)(Diptera:Culicidae) species from two malaria endemic states of NE India.Methods:Phylogeographic analysis was carried at 9 out of 12 sites oi An.minimus confirmed malaria endemic places.Results:All sequences were Adenine-Thymine rich regions.Transitions were observed in 6 sequences where 5 mutations were synonymous substitutions and in 1 ease non synonymous mutation was observed.Three distinct clusters of haplolypes were generated.Haplotvpe diversity and low nucleotide diversity were studied.Overall negative values obtained from Tajima's D test and Fu'sF_S test indicate a recent genetic population expansion.Network analysis has explained sequence diversity that was also shown by mutations in 6 sequences.Conclusions:High genetic diversity observed within the populations of An.minimus species has several possible implications for vector control in the region.