Differentiating dengue virus infection from scrub typhus in Thai adults with fever

Dengue fever and scrub typhus are common infections in Asia that often present as acute febrile illness of unclear etiology. We prospectively evaluated febrile adults presenting to the outpatient department of a hospital in northern Thailand to attempt to identify distinguishing characteristics between the two infections. Fifty-four patients were infected with scrub typhus and 35 were infected with dengue virus. Dengue virus infection was associated with hemorrhagic manifestations, particularly bleeding from the gums, which was reported by 27% of the dengue patients, but by none of the scrub typhus patients (P < 0.001, by Fisher's exact test). A low platelet count (< 140,000/mm3) and low white blood cell count (< 5,000/mm3) were strongly associated with dengue infections: odds ratio = 26.3 (95% confidence interval [CI] = 7.4-93.2) for platelet count and 8.2 (95% CI = 2.6-25.5) for leukocyte count. Prospective evaluations of the usefulness of these simple criteria to differentiate scrub typhus from dengue infection are needed in other areas, particularly where rapid confirmatory diagnostic tests are not available.     

Apparent relapse of imported Plasmodium ovale malaria in a pregnant woman

A 27 week pregnant woman who had lived in Bangkok, Thailand, for 18 months presented to her obstetrician with a 1-week history of intermittent fever and malaise. Medical history was significant for multiple episodes of malaria during her 10 years of employment in sub-Saharan Africa before her relocation to Thailand. The initial malaria smear was negative. She returned a week later with no resolution of her symptoms, at which time she was found to have Plasmodium ovale by microscopy and polymerase chain reaction. She had an excellent response to chloroquine, which she continued weekly until 36 weeks of gestation. She delivered a healthy term infant and received radical cure with primaquine after cessation of breastfeeding. This case shows challenging issues in detection and management of imported P. ovale malaria.     

Upper cervical myelopathy due to arachnoiditis and spinal cord tethering from adjacent C-2 osteomyelitis. Case report and review of the literature

Myelopathy caused by a spinal cord infection is typically related to an adjacent compressive lesion such as an epidural abscess. The authors report a case of progressive high cervical myelopathy from spinal cord tethering caused by arachnoiditis related to an adjacent C-2 osteomyelitis. This 70-year-old woman initially presented with a methicillin-sensitive Staphylococcus aureus osteomyelitis involving the C-2 odontoid process. She was treated with appropriate antibiotic therapy but, over the course of 4 weeks, she developed progressive quadriparesis. A magnetic resonance image revealed near-complete resolution of the C-2 osteomyelitis, but new ventral tethering of the cord was observed at the level of the odontoid tip. She subsequently underwent open surgical decompression and cord detethering. Postoperatively she experienced improvement in her symptoms and deficits, which continued to improve 1 year after her surgery. To the authors' knowledge, this is the first reported case of progressive upper cervical myelopathy due to arachnoiditis and cord tethering from an adjacent methicillin-sensitive S. aureus C-2 osteomyelitis.     

Management of acute urinary retention: a worldwide survey of 6074 men with benign prostatic hyperplasia

Study Type – Therapy (symptom prevalence) Level of Evidence 2a What's known on the subject? and What does the study add? Largest survey ever conducted evaluating the management of AUR in real life practice in a wide range of health care systems. It shows that urethral catheterization followed by a TWOC has become a standard worldwide and that α₁‐blockade prior to TWOC doubles the chances of success. It also evidences important differences (hospitalization rate, duration of catheterization ...) between countries/regions reflecting lack of guidelines. This large survey also clearly identifies predictors of TWOC failure.

OBJECTIVES

• ? To evaluate the management of acute urinary retention (AUR) associated with benign prostatic hyperplasia (BPH) in real‐life practice.
• ? To identify predictors of successful trial without catheter (TWOC).

MATERIALS AND METHODS

• ? In all, 6074 men catheterized for painful AUR were enrolled in a prospective, cross‐sectional survey conducted in public and private urology practices in France, Asia, Latin America, Algeria and the Middle East.
• ? Patient clinical characteristics, type of AUR and its management (type of catheterization, hospitalization, TWOC, use of α₁‐blockers, immediate or elective surgery) and adverse events observed during the catheterization period were recorded.
• ? Predictors of TWOC success were also analysed by multivariate regression analysis with stepwise procedure.

RESULTS

• ? Of the 6074 men, 4289 (71%) had a spontaneous AUR and 1785 (29%) had a precipitated AUR, mainly as the result of loco‐regional/general anaesthesia (28.5%) and excessive alcohol intake (18.2%).
• ? Presence of BPH was revealed by AUR in 44% of men. Hospitalization for AUR varied between countries, ranging from 1.7% in Algeria to 100% in France. A urethral catheter was inserted in most cases (89.8%) usually followed by a TWOC (78.0%) after a median of 5 days. Overall TWOC success rate was 61%.
• ? Most men (86%) received an α₁‐blocker (mainly alfuzosin) before catheter removal with consistently higher TWOC success rates, regardless of age and type of AUR. Multivariate regression analysis confirmed that α₁‐blocker before TWOC doubled the chances of success (odds ratio 1.92, 95% CI 1.52–2.42, P < 0.001).
• ? Age ≥70 years, prostate size ≥50 g, severe lower urinary tract symptoms, drained volume at catheterization ≥1000 mL and spontaneous AUR favoured TWOC failure. Catheterization >3 days did not influence TWOC success but was associated with increased morbidity and prolonged hospitalization for adverse events.
• ? In the case of TWOC failure, 49% of men were recatheterized and had BPH surgery and 43.5% tried another TWOC with a success rate of 29.5%. Elective surgery was preferred to immediate surgery.

CONCLUSIONS

• ? TWOC has become a standard practice worldwide for men with BPH and AUR.
• ? In most cases, an α₁‐blocker is prescribed before TWOC and significantly increases the chance of success.
• ? Prolonged catheterization is associated with an increased morbidity.

     

Development of a mathematical model to describe the transport of monocyte chemoattractant protein-1 through a three-dimensional collagen matrix

IntroductionMonocyte chemoattractant protein-1 is a bioactive molecule that is expressed in significant amounts in all stages of atherosclerosis. The role of monocyte chemoattractant protein-1 in this disease is to recruit monocytes across the endothelium and into the arterial tissue. Eventually, the monocytes differentiate into cholesterol-engorged macrophages called “foam cells” that result in atherosclerotic plaque formation. The mechanism that monocyte chemoattractant protein-1 uses to mediate monocyte transendothelial migration is believed to be via its concentration gradient. However, the formation of the monocyte chemoattractant protein-1 concentration gradient in the extracellular matrix is still poorly understood.MethodsA three-dimensional in vitro vascular tissue model has been developed to study the cellular mechanisms involved in the early stages of atherosclerosis. In the present study, a mathematical model is used to determine the gradient of monocyte chemoattractant protein-1 in the collagen matrix of the three-dimensional in vitro vascular tissue model. Experiments were performed to investigate the stability of monocyte chemoattractant protein-1 and the interaction between monocyte chemoattractant protein-1 and the collagen matrix.Results and conclusionsMonocyte chemoattractant protein-1 is stable for at least 24 h under experimental conditions and monocyte chemoattractant protein-1 interacts with the collagen matrix. The diffusion coefficient for the transport of monocyte chemoattractant protein-1 in the collagen matrix and the rate constant for the binding of monocyte chemoattractant protein-1 to collagen were determined to be 0.108 mm² h^?1 and 0.858 h^?1, respectively. Numerical results from the model indicate that the concentration gradients of both soluble and matrix-bound (or static) monocyte chemoattractant protein-1 are formed inside the collagen matrix.     

Substrate specificity of avian influenza H5N1 neuraminidase

AIM: To characterise neuraminidase(NA) substrate specificity of avian influenza H5N1 strains from humans and birds comparing to seasonal influenza virus.METHODS: Avian influenza H5N1 strains from humans and birds were recruited for characterising their NA substrate specificity by using a modified commercial fluorescence Amplex Red assay. This method can identify the preference of α2,6-linked sialic acid or α2,3-linked sialic acid. Moreover, to avoid the bias of input virus, reverse genetic virus using NA gene from human isolated H5N1 were generated and used to compare with the seasonal influenza virus. Lastly, the substrate specificity profile was further confirmed by high-performance liquid chromatography(HPLC) analysis of the enzymatic product. RESULTS: The H5N1 NA showed higher activity on α2,3-linked sialic acid than α2,6-linked(P 0.0001). To compare the NA activity between the H5N1 and seasonal influenza viruses, reverse genetic viruses carrying the NA of H5N1 viruses and NA from a seasonal H3N2 virus was generated. In these reverse genetic viruses, the NA activity of the H5N1 showed markedly higher activity against α2,3-linked sialic acid than that of the H3N2 virus, whereas the activities on α2,6-linkage were comparable. Interestingly, NA from an H5N1 human isolate that was previously shown to have heamagglutinin(HA) with dual specificity showed reduced activity on α2,3-linkage. To confirm the substrate specificity profile, HPLC analytic of enzymatic product was performed. Similar to Amplex red assay, H5N1 virus showed abundant preference on α2,3-linked sialic acid.CONCLUSION: H5N1 virus maintains the avian specific NA and NA changes may be needed to accompany changes in HA receptor preference for the viral adaptation to humans.     

Gender differences in epidemiological factors associated with treatment completion status of leprosy patients in the most hyperendemic district of Nepal

The introduction of multidrug therapy (MDT), recommended by WHO, has been a major advance in the treatment of leprosy because of its relatively short treatment course and low rate of relapse. Although leprosy treatment is provided to both sexes equally, in most parts of the world significant differences have been found in treatment status. The main objective of the study was to investigate gender differences in epidemiological factors associated with treatment status of leprosy patients. An analytic cross-sectional study was carried out in the most hyperendemic Dhanusa District, Nepal. Stratified random sampling was applied for selection of the patients. Statistical analysis of the differences in treatment status, between males and females, and among other epidemiological factors of interest was carried out using multiple logistic regression. Chi-square/Fisher's exact test were also used to assess significant differences in values between males and females. There were 580 leprosy patients (385 male and 195 female) aged >15 years registered for MDT between April 1, 2001 to March 31, 2002 in the 16 main health centers of the district. Of the 580 patients, a total of 273 (183 male and 90 female) were included in the study, to collect data on clinical type of leprosy, patterns of physical deformity/disability, site of skin lesions, and socio-demographic information. There were 183 male (68.3% on MB-MDT) and 90 female (61.1% MB-MDT) leprosy patients. We found that 79.2% of male patients completed treatment, while 34.4% female patients did not complete within the given time frame. Significant gender differences among leprosy patients were found in the distribution of disability grades and treatment completion status. However, there was no significant gender difference in the distribution of leprosy types and skin lesion sites. The study also found significant associations between treatment completion status and gender (adjusted OR 2.05, 95% CI: 1.07-3.94), educational status (adjusted OR 2.37, 95% CI: 1.12-4.99), disability grade I (adjusted OR 3.14, 95% CI: 1.23-8.04), and disability grade 0 (adjusted OR 2.92, 95% CI: 1.14-7.47) after adjustment for all other leprosy/demographic factors.     

Coupling morphogenesis to mitotic entry

In eukaryotes, cyclin B-bound cyclin-dependent protein kinase 1 promotes mitotic entry but is held in check, in part, by Wee1 protein kinase. Timely mitotic entry in budding yeast requires inactivation of Swe1 (Wee1 ortholog). Perturbations of the septin collar at the bud neck lead to Swe1 stabilization, delaying the G(2)/M transition. Swe1 is recruited to the neck and hyperphosphorylated before ubiquitin-mediated degradation. Hsl1 kinase (Nim1 ortholog), a negative regulator of Wee1, is required for efficient Swe1 localization at the neck but seems not to phosphorylate Swe1. Here, we show that two other kinases targeted sequentially to the neck, Cla4/PAK and Cdc5/Polo, are responsible for stepwise phosphorylation and down-regulation of Swe1. This mechanism links assembly of a cellular structure to passage into mitosis.     

Irrigation of the distal vas deferens during vasectomy: does it accelerate the post-vasectomy sperm-free rate?

A prospective, non-randomized, partially blinded, controlled trial was conducted to evaluate the efficacy of irrigation with normal saline solution (NSS) during no-scalpel vasectomy (NSV) compared with NSV alone in 62 men. In the NSS irrigation group, an Angiocath 24-gauge needle was inserted into the distal vas lumen, and 20 mL NSS solution was used to irrigate the vas manually on both sides. Post-operative follow-up included urine samples collected immediately and semen samples for sperm count at 2, 6 and 12 weeks post-vasectomy. The difference in the number of spermatozoa appearing in the post-vasectomy urine samples and the mean urine sperm count in both groups were significantly different ( p < 0.0001 and p < 0.01, respectively). The numbers of post-operative ejaculations, the mean sperm concentration, and the number of patients who achieved sterility (defined as no motile spermatozoa in the ejaculate) in both groups at 2, 6 and 12 weeks were similar ( p > 0.05). It is concluded that although irrigation of the distal vas with NSS was successful in removing a large number of spermatozoa from the tract, this procedure did not significantly accelerate the rate of achieving absence of motile spermatozoa in the ejaculate.