Clinical Features and Laboratory Findings of Visceral Leishmaniasis in Children Referred To Children Medical Center Hospital,Tehran, Iran during 2004-2011

Background

Visceral leishmaniasis (VL) is one of the most important parasitic diseases endemic in northwestern and southern areas of Iran. The aim of the present study was to review the records of children hospitalized with VL in order to characterize the clinical features of children as well as laboratory finding in Children Medical Center Hospital, Tehran, Iran.

Methods

The medical records of all children with a final diagnosis of VL were reviewed from 2004 to 2011. Demographic, clinical information, laboratory finding and treatment were considered.

Results

A total number of 34 children with confirmed VL through 2004-2011 were included in the study. The most prevalent sign and symptoms were fever (97.1%), pallor and weakness (97.1%), appetite loss (61.8%), splenomegaly (97.1%) and hepatomegaly (88.2%). The most frequent laboratory abnormalities were hematological including anemia (97.1%), thrombocytopenia (91.2%) and leukopenia (67.6%). Direct agglutination test (DAT) was performed in 23 cases and all of them showed anti-Leishmania antibodies with titers of ≥ 1: 3200. In addition, 90% of patients had positive rK39 results. Identification of Leishmania in the aspirates of the bone marrow was found in 83.3% of patients.

Conclusion

Regional surveillance system in order to monitoring of leishmaniasis trends as well as detection of new emerging foci is recommended.     

An in vitro study of the quality of root fillings in teeth obturated by lateral condensation of gutta-percha or Thermafil obturators

The aim of this in vitro study was to assess the quality of root canal obturation and degree of linear apical dye penetration in teeth root filled with either laterally condensed gutta-percha or Thermafil obturators, A total of 150 teeth with single roots were included in the study. All canals were prepared using a standard step-back technique with anticurvature filing. Radiographs taken of the teeth to show the maximum degree of canal curvature were then exposed and the angle, radius and position of curvature determined. This information about the canals, together with their working length and diameter at end-point, was used to divide the teeth into two experimental and two control groups. A total of eight teeth were excluded because of technical difficulties, 65 were filled with Thermafil obturators, 63 were filled with laterally condensed gutta-percha whilst 14 teeth remained unfilled and acted as controls. Following obturation, the teeth were radiographed in two planes and the technical quality of fill assessed on a four-point scale. All access cavities were then sealed and the teeth immersed in dye for 48 h before being split longitudinally. Linear dye penetration via the apical foramen was then assessed. Canal obturation with Thermafil obturators (0.7 min) was significantly quicker (P > 0.001) than lateral condensation (6.4 min). Apical extrusion of sealer and gutta-percha occurred significantly more often with Thermafil obturators but there was little difference in the technical quality of the fillings and no significant difference in dye penetration. Under the conditions of this study, Thermafil obturators proved a satisfactory alternative to lateral condensation of gutta-percha.     

Return to Work following Limb Injuries

Motivation for work, level of physical disability, period ofincapacity, completion of an employment rehabilitation courseand unemployment in the general population are the major determinantsof an early return to stable employment in the disabled. Ina study of 350 men and 29 women with limb injuries who weredischarged from three rehabilitation centres, those with onlysoft tissue injuries were less disabled, incapacitated for shorterperiods and completed employment rehabilitation courses comparedwith those with fractures, dislocations or amputations. Therewas, however, no association between the type of injury andmotivation for work. Return to work after rehabilitation wasunrelated to the type or site of injury. In this group of patients,motivation for work appeared to have a greater influence onthe outcome of rehabilitation than other known predictors Requests for reprints should be addressed to:Dr K. Sheikh, Department of Epidemiology, School of Public Health, University of Michigan, 109, Observatory Street, Ann Arbor, Michigan 48109, USA.     

A Case Report of Lethal Multiple Pterygium Syndrome

We report a patient with a lethal multiple pterygium syndrome. The patient was the first child born to a 28-year old mother. The family history was unremarkable; no consanguinity was reported. The patient was the product of a 37-week gestation by cesarian section, and admitted to our intensive care unit after resuscitation. He weighed 2,158 g, and measured 33cm (CHL). The patient had hydrops, cystic hygroma on the back of the neck, hypertelorism, a flat upturned nose, a highly arched cleft palate, micrognathia, low set ears and multiple pterygia. In addition, the finger showed slender and hypoplastic ridges and creases. The feet showed rocker-bottom deformities. Furthermore, the genitalia was normally formed male with bilateral cryptorchism. The spine showed scoliosis and lordosis with vertebral bony fusions, separations and reduced intervertebral spaces. The ribs were 11 pairs and gracile. The lung was hypoplastic, and the heart was small but normal in structure. Chromosomal examination revealed a normal male karyotype (46, XY). The infant died within two hours after birth.
Gillin and Pryse-Davis (1976) described three female siblings with this early lethal disorder. This disorder was separated from other conditions associated with pterygia by Hall et al. (1982). At least 30 cases have been reported. However, this type of case seems to have not been reported in Japan. This disorder is considered autosomal-recessive, but in other report, X-linked recessive inheritance is proposed. Therefore, further studies are necessary in order to make a more precise etiology of this disorder.     

UNEMPLOYMENT AND THE DISABLED

An analysis of Employment Services Division statistics showsa close relationship between the levels of unemployment in thedisabled rehabilitated at the Employment Rehabilitation Centres(ERCs) and the rates of unemployment in the general populationin the whole of Great Britain (r = 0.90) or in the local areasof the Centres (r = 0.66). There is also a significant associationbetween the levels of unemployment in 749 rehabilitees passingthrough one ERC and the rates of unemployment in their homeareas. The results have practical implications for both the employmentand medical rehabilitation services.     

LH PULSE FREQUENCY IN RELATION TO POSITIVE OESTROGEN-GONADOTROPHIN FEEDBACK IN AMENORRHOEA

The relationship between the pattern of pulsatile LH release and the response to oestrogen provocation was studied in twenty amenorrhoeic or oligomenorrhoeic subjects. In 12 subjects with positive oestrogen-gonadotrophin feedback a definite pulsatile pattern of LH release was demonstrated with a pulse frequency of 60--80 min and an increase from nadir to peak ranging between 30 and 58%. The mean basal LH concentration was significantly higher in this group (P less than 0.001). Of eight subjects who had absence of positive feedback, five showed infrequent pulses, 1--2 during the four-hour period. These were of low amplitude and with a percentage increase of 45--70 from nadir to peak. The remaining three did not have a pulsatile pattern of LH release. Positive feedback, as demonstrated by an oestrogen provocation test was thus found only in patient having 3 or more LH pulses in the 4 h study period; an LH pulse frequency similar to that in the early follicular phase in regularly menstruating women.     

Functional variation in the arginine vasopressin 2 receptor as a modifier of human plasma von Willebrand factor levels

Summary. Objectives: Stimulation of arginine vasopressin 2 receptor (V2R) with arginine vasopressin (AVP) results in a rise in von Willebrand factor (VWF) and factor VIII plasma levels. We hypothesized that gain‐of‐function variations in the V2R gene (AVPR2) would lead to higher plasma levels of VWF and FVIII. Methods and Results: We genotyped the control populations of two population‐based studies for four AVPR2 variations: a‐245c, G12E, L309L, and S331S. Rare alleles of a‐245c, G12E, and S331S, which were in linkage disequilibrium, were associated with higher VWF propeptide, VWF and FVIII levels. The functionality of the G12E variant was studied in stably transfected MDCKII cells, expressing constructs of either 12G‐V2R or 12E‐V2R. Both V2R variants were fully glycosylated and expressed on the basolateral membrane. The binding affinity of V2R for AVP was increased three‐fold in 12E‐V2R–green fluorescent protein (GFP) cells, which is in accordance with increased levels of VWF propeptide associated with the 12E variant. The dissociation constant (K_D) was 4.5 nm [95% confidence interval (CI) 3.6–5.4] for 12E‐V2R–GFP and 16.5 nm (95% CI 10.1–22.9) for 12G‐V2R–GFP. AVP‐induced cAMP generation was enhanced in 12E‐V2R–GFP cells. Conclusions: The 12E‐V2R variant has increased binding affinity for AVP, resulting in increased signal transduction, and is associated with increased levels of VWF propeptide, VWF, and FVIII.