Liver injury caused by a herbal and dietary supplement: a case report

We present a case of a previously healthy male admitted with acute hepatitis while using a body building supplement. An exhaustive laboratory workup for causes of hepatitis was unrevealing. He responded well to withdrawal of the supplement and a course of corticosteroids

Stratification of persons with diabetes into risk categories for foot ulceration

Background: Patients with diabetes mellitus are at a higher risk of lower extremity complications as compared to their non-diabetic counterparts.Objective: To study risk factors for diabetic foot ulcer disease and stratify patients with diabetes into risk categories for foot ulceration.Design: Cross-sectional descriptive study over five months period.Setting: Diabetic outpatient clinic, at the Kenyatta National Hospital.Subjects: Two hundred and eighteen ambulatory subjects with diabetes mellitus without active foot lesions.Results: The prevalence of previous foot ulceration was 16% while that of previous amputation was 8%. Neuropathy was present in 42% of the study subjects and was significantly associated with age, male gender, duration of diabetes, random blood sugar, systolic blood pressure and the presence of foot deformity. Peripheral arterial disease was present in 12% and showed significant association with male gender. Foot deformities were observed in 46% of study subjects and were significantly associated with age, male gender, and presence of neuropathy. Subsequently 57% were categorised into IWGDF group 0 - no neuropathy, 10% were placed in group 1- neuropathy alone, 16% were put in group 2 - neuropathy plus either peripheral arterial disease or foot deformity and 17% were placed in risk group 3 - previous foot ulceration/amputation.Conclusion: More than one third (33%) of diabetic patients were found to be at high risk for future foot ulceration (lWGDF groups 2 and 3). Published evidence exists that shows improved outcomes with interventions targeting individual patients with diabetes at high-risk of foot ulceration. Long term prospective studies to determine outcomes for the different risk categories should be carried out locally

A breathprint of influenza a virus infection in the ferret model

Influenza viruses (IV) pose a major public health concern, since they are highly contagious and still have a high global annual mortality. Current diagnostic methods are slow or have high error rates; therefore, a rapid detection tool is highly desirable to inform clinical management. Exhaled breath is a useful diagnostic in a number of diseases. In this work, we examined the exhaled breath of six ferrets collected pre- and post-IV infection. Exhaled breath analysis was carried out using a comprehensive two-dimensional gas chromatography (GC×GC) hyphenated with a time-of-flight mass spectrometer (ToF MS). Random Forest, a non-parametric machine learning algorithm, was used to select the most relevant diagnostic volatile organic compound (VOC) features and build the model using a cross-validation approach, obtaining an accuracy of 0.973 (out of 1.000). Using this approach, we defined 31 VOC features, which together produce a profile capable of discriminating between uninfected and IV-infected ferrets. Further characterization revealed an abundance of hydrocarbons, which is consistent with increased oxidative stress known to occur during viral infection. Our study is the first of its kind to define a unique exhaled breath signature for influenza infection in ferrets and will be useful for development of a rapid precision diagnostic technique

Pre-existing heterosubtypic immunity provides a barrier to airborne transmission of influenza viruses.

Human-to-human transmission of influenza viruses is a serious public health threat, yet the precise role of immunity from previous infections on the susceptibility to airborne infection is still unknown. Using the ferret model, we examined the roles of exposure duration and heterosubtypic immunity on influenza transmission. We demonstrate that a 48 hour exposure is sufficient for efficient transmission of H1N1 and H3N2 viruses. To test pre-existing immunity, a gap of 8-12 weeks between primary and secondary infections was imposed to reduce innate responses and ensure robust infection of donor animals with heterosubtypic viruses. We found that pre-existing H3N2 immunity did not significantly block transmission of the 2009 H1N1pandemic (H1N1pdm09) virus to immune animals. Surprisingly, airborne transmission of seasonal H3N2 influenza strains was abrogated in recipient animals with H1N1pdm09 pre-existing immunity. This protection from natural infection with H3N2 virus was independent of neutralizing antibodies. Pre-existing immunity with influenza B virus did not block H3N2 virus transmission, indicating that the protection was likely driven by the adaptive immune response. We demonstrate that pre-existing immunity can impact susceptibility to heterologous influenza virus strains, and implicate a novel correlate of protection that can limit the spread of respiratory pathogens through the air