Aplastic Crisis as Primary Manifestation of Systemic Lupus Erythematosus

Aplastic crisis is an unusual feature of systemic lupus erythematosus (SLE). We report the case of a 54-year-old woman presenting with both (extravascular) Coombs-positive hemolytic anemia and laboratory findings of bone marrow hyporegeneration with concomitant severe neutropenia. A bone marrow biopsy confirmed aplastic crisis. Diagnostic work-up revealed soaring titers of autoantibodies (anti-nuclear, anti-double-stranded DNA, anti-cardiolipin-IgM, and anti-beta 2-glykoprotein-IgM antibodies), indicating a connective tissue disease as the most plausible reason for bone marrow insufficiency. As the criteria for SLE were fulfilled, we initiated an immunosuppressive therapy by steroids, which led to a rapid complete hematologic and clinical remission in our patient. In this case, we could report on one of the rare cases of SLE-induced aplastic crisis showing that this condition can be entirely reversed by immunosuppressive treatment and that SLE-induced aplastic crisis yields a good prognosis. In conclusion, in a case of aplastic crisis, physicians should be aware that SLE can be a rare cause that is accessible to specific treatment

Do Quality Improvement Initiatives Improve Outcomes for Patients in Antiretroviral Programs in Low- and Middle-Income Countries? A Systematic Review.

BACKGROUND: There have been a range of quality improvement (QI) and quality assurance initiatives in low- and middle-income countries to improve antiretroviral therapy (ART) treatment outcomes for people living with HIV. To date, these initiatives have not been systematically assessed and little is known about how effective, cost-effective, or sustainable these strategies are in improving clinical outcomes. METHODS: We conducted a systematic review adhering to PRISMA guidelines (PROSPERO ID: CRD42017071848), searching PubMed, MEDLINE, Embase, Web of Science, and the Cochrane database of controlled trials for articles reporting on the effectiveness of QI and quality assurance initiatives in HIV programs in low- and middle-income countries in relation to ART uptake, retention in care, adherence, viral load suppression, mortality, and other outcomes including cost-effectiveness and long-term sustainability. RESULTS: One thousand eight hundred sixty articles were found, of which 29 were included. QI approaches were categorized as follows: (1) health system approaches using QI methods; (2) QI learning networks including collaboratives; (3) standard-based methods that use QI tools to improve performance gaps; and (4) campaigns using QI methods. The greatest improvements were seen in ART uptake [median increase of 14.0%; interquartile range (IQR) -9.0 to 29.3], adherence [median increase of 22.0% (IQR -7.0 to 25.0)], and viral load suppression [median increase 26.0% (IQR -8.0 to 26.0)]. CONCLUSIONS: QI interventions can be effective in improving clinical outcomes; however, there was significant variability, making it challenging to identify which aspects of interventions lead to clinical improvements. Standardizing reporting and assessment of QI initiatives is needed, supported by national quality policies and directorates, and robust research

Effect of Biological Rhythm on Cognitive Performance

Biological rhythm has contributed in evolution process of humankind and has created certain distinct capabilities and preferences in shaping his phycho-psychological reactions. On the basis of behavioural activities, reactions, preferences and performances during the day-night cycle, individuals are classified in chronotype as morning type (M type) and evening type (E type). Such a differentiation has been hypothesised to contributing to individual differences at the cognitive, affective and conative levels. The present study was an attempt to further study such differentiation in terms of neuro cognitive performance by using the most advanced psycho-physiological measures. The participants of both chronotypes, morning and evening were classified and later subjected to cognitive testing by using the Cambridge Neuropsychological Test Automated Battery in the morning and the evening session under repeated measure design. The study revealed that performance on neuro cognitive functions; Planning and working memory, Decision-making and response control, and Motor skills get effected differently by their biological rhythm cycle and thus under performance in these functions can be attributed to maladaptation of biological rhythm termed as biological dysrhythmia. The study also highlights the role of this behavioural maladaptation in moderating operational efficiency of soldier in combat situation

BIOLOGICS (BIOLOGICAL AGENTS): A NEW APPROACH IN THE TREATMENT OF PSORIASIS

ABSTRACTPsoriasis is a chronic inflammatory and multifactorial systemic disorder with predominant manifestation over the skin and/or joints resulting frominteractions between genetic pre-disposition and triggering environmental factors. Due to its systemic nature, patients exhibit a broad spectrum ofsymptoms that vary in severity. Although many patients, particularly those with the limited form of the disease, may be treated with topical therapy,those with extensive (moderate to severe) psoriasis eventually require phototherapy, systemic, or biologic therapy to adequately suppress the systemic,immunopathogenic process. Biological agents (biologics or biologicals) are a set of different engineered proteins. These are immunosuppressiveagents, designed to selectively interfere with the immune mechanisms that induce psoriasis. Their use is restricted to the treatment of moderateto severe psoriasis, which has failed to respond to systemic therapies (and/or phototherapy) or where such treatments are contra-indicated ornot tolerated. Biologics are becoming increasingly useful for the treatment of many skin diseases including psoriasis, particularly as alternativesfor patients who have failed to tolerate or respond to conventional systemic therapies or where non-biologic systemic agents are unsuitable due tothe presence of comorbidities. Biological therapies provide a targeted approach to treatment through interaction with specific components of theunderlying immune and inflammatory disease processes.Keywords: Immunopathogenesis, Biologicals, Psoriasis, Quality of life, Psoriasis area and severity index, Dermatology life quality index

Evaluation of CD4 count and correlation with development of opportunistic infection among HIV seropositives

Background: Opportunistic infections have been the important indicators to suspect and diagnose the HIV seropositives. CD4 count has been used an important tool to monitor the treatment and progression of disease. Methods: This study was done to study the pattern or common presentations of opportunistic infections among HIV seropositive patients and their relationship with CD4 counts. Results: Tuberculosis and candidiasis were the most common opportunistic infections in HIV infected patients followed by herpes, diarrhoea, acute respiratory infection, papular pruritic eruptions, seborrhoeic dermatitis, cryptococcal meningitis, and hepatitis B and C co-infection. Decrease in CD4 count is an important predictor to progression of the disease. Conclusions: This gives a representation of opportunistic infections in HIV seropositive patients in low prevalence state like Jharkhand

Widespread fear of dengue transmission but poor practices of dengue prevention : A study in the slums of Delhi, India

Background This study has been conducted to throw light on the knowledge and practices related to dengue fever among the poor population living in Delhi's slums. Materials A household survey was conducted in 2013 among 3,350 households. The households were stratified by a number of variables related to socio-economic status and health events such as hospitalisation. The data collection was completed through face-to-face interviews conducted with the help of 25 field investigators. Results About 8% of the households had at least one diagnosed dengue case. In comparison to the population surveyed, teenagers (15-19 years) and adults (30-34 years) were more affected whereas children under four years of age were underrepresented. Housewives are more affected by dengue (24%) compared to their share of the population surveyed (17%). Despite the fact that 77% of the respondents are worried about mosquitoes, only 43% of them monitor environment to avoid the presence of breeding sites. Conclusion One cannot exclude the possibility that though young children under the age of four years are exposed to the virus, either their cases were asymptomatic or family members infected during this period had potentially more serious symptoms leading to hospitalisation. This result could thus be explained by budget-related health choices made by this population which do not favour small children. Educational programs should target housewives to improve their impact, as they are the ones mostly responsible for water storage and cleanliness of the house and its neighbourhood. Even with a dengue experience and potentially an acute perception of the risk and its factors, a proper management of environmental conditions is lacking. This along with the fact that word-of-mouth is the main source of information quoted should be a message for municipality health workers to give door-to-door information on how to prevent breeding sites and dengue infection

Environmental Factors in the Relapse and Recurrence of Inflammatory Bowel Disease:A Review of the Literature

The causes of relapse in patients with Crohn's disease (CD) and ulcerative colitis (UC) are largely unknown. This paper reviews the epidemiological and clinical data on how medications (non-steroidal anti-inflammatory drugs, estrogens and antibiotics), lifestyle factors (smoking, psychological stress, diet and air pollution) may precipitate clinical relapses and recurrence. Potential biological mechanisms include: increasing thrombotic tendency, imbalances in prostaglandin synthesis, alterations in the composition of gut microbiota, and mucosal damage causing increased permeability

Giant Splenic Hydatid Cyst in Pediatric Age

Giant hydatid cyst in spleen is rare in the pediatric age group. We came across two cases of giant splenic hydatid cysts in pediatric age group, out of which, one case had pulmonary, liver and splenic hydatid cyst which was managed with single stage approach. As a single stage approach is a novel method with less morbidity, it should be adopted as a preferred method for the management of pulmonary and abdominal hydatidosis. Hydatid cyst is described as a slow growing cyst in literature, but the presentation of giant size hydatid cyst in our 7 and 12 year old child is difficult to explain by this concept of slow growth

High ultraviolet C resistance of marine Planctomycetes

Planctomycetes are bacteria with particular characteristics such as internal membrane systems encompassing intracellular compartments, proteinaceous cell walls, cell division by yeast-like budding and large genomes. These bacteria inhabit a wide range of habitats, including marine ecosystems, in which ultra-violet radiation has a potential harmful impact in living organisms. To evaluate the effect of ultra-violet C on the genome of several marine strains of Planctomycetes, we developed an easy and fast DNA diffusion assay in which the cell wall was degraded with papain, the wall-free cells were embedded in an agarose microgel and lysed. The presence of double strand breaks and unwinding by single strand breaks allow DNA diffusion, which is visible as a halo upon DNA staining. The number of cells presenting DNA diffusion correlated with the dose of ultra-violet C or hydrogen peroxide. From DNA damage and viability experiments, we found evidence indicating that some strains of Planctomycetes are significantly resistant to ultra-violet C radiation, showing lower sensitivity than the known resistant Arthrobacter sp. The more resistant strains were those phylogenetically closer to Rhodopirellula baltica, suggesting that these species are adapted to habitats under the influence of ultra-violet radiation. Our results provide evidence indicating that the mechanism of resistance involves DNA damage repair and/or other DNA ultra-violet C-protective mechanism.This research was supported by the European Regional Development Fund (ERDF) through the COMPETE-Operational Competitiveness Programme and national funds through FCT-Foundation for Science and Technology, under the projects Pest-C/BIA/UI4050/2011 and PEst-C/MAR/LA0015/2013. We are grateful to Catia Moreira for helping with the extraction of the pigments.info:eu-repo/semantics/publishedVersio

Conceptualizing pathways linking women's empowerment and prematurity in developing countries.

BackgroundGlobally, prematurity is the leading cause of death in children under the age of 5. Many efforts have focused on clinical approaches to improve the survival of premature babies. There is a need, however, to explore psychosocial, sociocultural, economic, and other factors as potential mechanisms to reduce the burden of prematurity. Women's empowerment may be a catalyst for moving the needle in this direction. The goal of this paper is to examine links between women's empowerment and prematurity in developing settings. We propose a conceptual model that shows pathways by which women's empowerment can affect prematurity and review and summarize the literature supporting the relationships we posit. We also suggest future directions for research on women's empowerment and prematurity.MethodsThe key words we used for empowerment in the search were "empowerment," "women's status," "autonomy," and "decision-making," and for prematurity we used "preterm," "premature," and "prematurity." We did not use date, language, and regional restrictions. The search was done in PubMed, Population Information Online (POPLINE), and Web of Science. We selected intervening factors-factors that could potentially mediate the relationship between empowerment and prematurity-based on reviews of the risk factors and interventions to address prematurity and the determinants of those factors.ResultsThere is limited evidence supporting a direct link between women's empowerment and prematurity. However, there is evidence linking several dimensions of empowerment to factors known to be associated with prematurity and outcomes for premature babies. Our review of the literature shows that women's empowerment may reduce prematurity by (1) preventing early marriage and promoting family planning, which will delay age at first pregnancy and increase interpregnancy intervals; (2) improving women's nutritional status; (3) reducing domestic violence and other stressors to improve psychological health; and (4) improving access to and receipt of recommended health services during pregnancy and delivery to help prevent prematurity and improve survival of premature babies.ConclusionsWomen's empowerment is an important distal factor that affects prematurity through several intervening factors. Improving women's empowerment will help prevent prematurity and improve survival of preterm babies. Research to empirically show the links between women's empowerment and prematurity is however needed