The role of inflammation, oxidative stress and the apolipoprotein E genotype in HIV-associated cognitive impairment: a clinical, biochemical and neuro-imaging study

Includes abstract.Includes bibliographical references (leaves 113-135).Twenty percent of HIV-infected patients develop HIV-associated neurocognitive disorders (HAND), a spectrum of neurological diseases which includes HIV-associated dementia (HAD), a debilitating sUb-cortical dementia. HIV-related cognitive impairment is a primary neurological complication of HIV infection, as opposed to neurological diseases secondary to opportunistic infections in the immune compromised host. Our study investigated the role of systemic markers of inflammation and oxidative stress, inflammatory changes in the brain on magnetic resonance spectroscopy (MRS) and the role of the APOE E4 allele in HIV-associated dementia (HAD) in a South African population. We hypothesized that cognitive impairment and brain inflammation would correlate with systemic markers of inflammation and oxidative stress; with an inverse relation to anti-oxidant capacity

Role of Bronchoscopy in Diagnosis of Pulmonary Infections in Non-HIV Immunocompromised Host

INTRODUCTION: Immunocompromised patients are prone to develop pulmonary infections and appearance of lung infiltrate is not uncommon. Most causes are infectious but upto 30% may have non-infectious causes. Hence identifying the right cause and initiating specific therapy leads to avoidance of use of large number of empirical antimicrobials. Bronchoscopy and bronchoalveolar lavage is considered as fast and reliable procedure and has been extensively used. AIM OF THE STUDY: To evaluate the diagnostic efficacy and safety of bronchoscopy in non-HIV immunocompromised with pulmonary infiltrates. MATERIALS AND METHODS: We included 65 consecutive NON-HIV immunocompromised patients with new pulmonary infiltrates from DEC 2015 to JUNE 2016 who were sputum AFB smear negative. All patients were subjected to flexible bronchoscopy and BAL after CBC, BT, CT Chest Xray and CT Scan was done. The main indication of bronchoscopy was failure to respond to empirical antimicrobial therapy. BAL samples were sent Bacterial & Fungal Culture, KOH, grams & AFB stain, GeneXpert for MTB, cytology and special stains like Pneumocystis carini. RESULTS: The patients included in our study were cancer patients receiving chemotherapy, Post Renal Transplant on immunosuppresives, Chronic Kidney Disease On maintenance Haemodialysis, Haematological malignancies, Rheumatological disorders on treatment with immunosuppresants and Biological agents. An etiological diagnosis was obtained in 52 (80%) out of 65. Infectious causes were identified in 41 cases (63%) and non-infectious causes in 10 cases (17%). Bronchoscopy led to change of treatment in 37 cases (56%). Only minor complications like transient hypoxemia, minor bleeding were observed apart from one case of pneumothorax. CONCLUSION: FOB and BAL are useful and safe in immunocompromised patients led to 56% change in treatment plan in our study which was statistically significant

Mucormycosis in a healthy elderly patient presenting as oro-antral fistula: report of a rare incidence

Mucormycosis is a rare opportunistic fungal infection that commonly affects patients who are immuno-compromised. It invariably presents as an acute spreading infection, with very poor prognosis if not treated promptly. We report a case of mucormycosis in immuno-competent elderly patient, presenting as oro-antral communication. Patient’s history, clinical and laboratory evaluation revealed no systemic predisposing factors. The disease was non-fulminant, localized and showed remission after local measures, without parentral anti-fungal therap

Acute osteomyelitis of the acetabulum induced by Staphylococcus capitis in a young athlete

Acute hematogenous osteomyelitis (AHOM) of the acetabulum is a rare condition in children and usually caused by Staphylococcus aureus. We present an 11-year-old soccer athlete who suffered from acute osteomyelitis involving the acetabulum caused by S. capitis, a normal flora of the human skin but never reported in this condition. The disease was associated with repetitive skin injuries of the knee and potential osseous microtrauma of the hip joint by frequent rigorous exercise. This unusual case suggests that osseous microtrauma of the acetabulum, in addition to repetitive skin injuries, allowed normal skin flora to colonize to the ipsilateral acetabulum, which served as a favorable niche and subsequently led to AHOM

Time trend and clinical pattern of extrapulmonary tuberculosis in Serbia, 1993-2007

Background/Aim. Increased incidence of extrapulmonary tuberculosis (XPTB) is reported worldwide. Serbia is a country in socio-economic transition period with lowmiddle HIV prevalence and intermediate-to-low tuberculosis (TB) incidence rate, 100% directly observed treatment (DOT) coverage, and mandatory BCG vaccination at birth. The aim of the study was to examine the incidence trend and clinical features of XPTB in Serbia during a 15-year period. Methods. This retrospective observational study included XPTB cases diagnosed in the period between 1st January 1993 and 31st Decembre 2007, according to the reports of the National Referral Institute of Lung Diseases and Tuberculosis in Belgrade and Central Tuberculosis Register. Population estimates with extrapolations were based on 1991 and 2002 census data. Results. While the overall TB incidence rate showed a slight, not significant decreasing trend (p = 0.535), a significant increase was found for XPTB (y = 1.7996 + 0.089x; R2 = 0.4141; p = 0.01). A total of 2,858 XPTB cases (newly diagnosed and 10% relapses) gave an average age specific incidence rate of 2.51/100,000 population (95% confidence interval, SD = 0.6182) with 8.9% annual increase. The male-to-female ratio was 0.54. Lymph nodes were most frequently affected site (48.5%) followed by genitourinary (20.5%), pleural (12%), and osseo-arthicular (10.3%) TB. Treatment outcome was successful in 88.29% of patients (cured and completed), 3.64% died, 5.18% interrupted, 0.57% displaced, and 2.3% unknown. Conclusion. Increasing trend of XPTB incidence rate may be a result of increased morbidity due to still present risk factors, possible higher detection rate in Serbia and better notification. A high coverage of newborns with BCG vaccination at birth might contribute to a decreased number and rare XPTB cases in children

Study of Association between Cytomegalovirus Infection and Multiple Sclerosis

الخلفية: يعد مرض التصلب العصبي المتعدد مرض مزمن من امراض الجهاز المناعي التي تصيب الجهاز العصبي المركزي حيث ان البحوث  والدراسات السابقة تشير الى ادلة على ان الفايروس المضخم للخلايا قد يكون له دور ضار او مفيد في مرض التصلب العصبي المتعدد من الناحية الباثولوجية المناعية وقد تم اجراء هذه الدراسة لتقييم مدى انتشار الفيروس المضخم للخلايا في مصل مرضى متعددة التصلب ومدى تاثيره على المرضى التصلب العصبي المتعدد . الاساليب: لقد تم اجراء الدراسة في مستشفى رزكاري التعليميفي أربيل/ العراق. حيث تم اخذ مجموعة من المرضى والتى تتألف من 50 مرضى التصلب العصبي المتعدد. و تم اخذ 30 شخصا صحيحا كعينة سيطرة مع اخذ بالاعتبار التقارب في الاعمار بين الفئتين و نوع  بين الجنسين و قد تم دراسة نسبة انتشار الفايروس  Cytmegalovirus Anti-IgGفي كلا الفئتين. النتائج: من بين 50 من مرضى التصلب العصبي المتعدد في هذه الدراسة، كان 17 (34 ٪ ) مريضا  يعانون من الانتكاس التصلب المتعدد التصلب و 33 مريضا (66 ٪) كان لها دورة نمط التقدم التدريجي من الدرجة ثانية . وكانت العامة الظاهرة على المرضى هي ضعف أطرافهم، شفع، التعمية البصرية، نقص الحسي والترنح. كشفت النتائج زيادة كبيرة جدا من عيار مضاد IgG لفايروس المضخم للخلايا لدى مرضى التصلب العصبي المتعدد مقارنة مع مجموعة السيطرة. مع ارتفاع عيار الفايروس في المرضى الذين يعانون من أكثر من 4 الانتكاسات او الاعراض المرضية في الجهاز العصبي التي تعكس مدى النشاط المرضي لديهم. الاستنتاج: من خلال هذا البحث لقد كانت نسبة انتشار الفايروس المضخم للخلايا أعلى في المرضى الذين يعانون من التصلب العصبي المتعدد مقارنة بعينة السيطرة اي الاشخاص الصحيين وقد يكون لها دور ايجابي في ازدياد نسبة المرض في المرضى التصلب العصبي المتعدد ولكن هناك حاجة لدراسات اخرى ابعد من ذلك لإثبات هذه النتيجة.Background: Multiple Sclerosis is chronic autoimmune inflammatory demylinative disease of the central nervous system that affects usually young ages. Cytomegalovirus still controversy and have either protective role in induction of multiple sclerosis disease via molecular mimicry. The current study was designed to assess the sero-prevalence of anti-Cytomegalovirus IgG in multiple sclerosis patients; its impacts if any association of Cytomegalovirus with either disease initiation and or disease activity. Materials and methods: The study was conducted in Rizgary teaching hospital Erbil /Iraq. Patients group enrolled comprised of 50 multiple sclerosis patients. The controls group comprised of 30 healthy persons with age and gender match. Anti-Cytomegalovirus IgG titer using enzyme- linked immunosorbent assay test was assessed in Multiple Sclerosis patients. Results: A total of 50 multiple sclerosis patients is enrolled in this study, 17 Patients (34 %) had Relapsing Remitting multiple sclerosis and 33 patients (66%) had secondary progressive pattern course. Common presenting symptoms were limb weakness, diplopia, visual obscuration, sensory impairment and ataxia. Results revealed a highly significant increase of anti-CMV IgG titer in MS patients compared with controls group; with higher titer in patients with more than 4-relapses that reflects disease activity. Conclusions: Seropositivity of Cytomegalovirus was higher in Multiple Sclerosis patients than controls; therefore, it may have a possible role in Multiple Sclerosis pathogenesis but further studies are needed to prove this result