Tuberculosis in HIV-infected South African children with complicated severe acute malnutrition.

Academic tertiary referral hospital in Durban, South Africa. To describe the incidence and diagnostic challenges of tuberculosis (TB) in human immunodeficiency virus (HIV) infected children with severe acute malnutrition (SAM). Post-hoc analysis of a randomised controlled trial that enrolled antiretroviral therapy naïve, HIV-infected children with SAM. Trial records and hospital laboratory results were explored for clinical diagnoses and bacteriologically confirmed cases of TB. Negative binomial regression was used to explore associations with confirmed cases of TB, excluding cases where the clinical diagnosis was not supported by microbiological confirmation. Of 82 children enrolled in the study, 21 (25.6%) were diagnosed with TB, with bacteriological confirmation in 8 cases. Sputum sampling (as opposed to gastric washings) was associated with an increased risk of subsequent diagnosis of TB (adjusted relative risk [aRR] 1.134, 95%CI 1.02-1.26). Culture-proven bacterial infection during admission was associated with a reduced risk of TB (aRR 0.856, 95%CI 0.748-0.979), which may reflect false-negative microbiological tests secondary to empiric broad-spectrum antibiotics. TB is common in HIV-infected children with SAM. While microbiological confirmation of the diagnosis is feasible, empiric treatment remains common, possibly influenced by suboptimal testing and false-negative TB diagnostics. Rigorous microbiological TB investigation should be integrated into the programmatic management of HIV and SAM

Polycystic ovary syndrome

The document attached has been archived with permission from the editor of the Medical Journal of Australia. An external link to the publisher’s copy is included.Polycystic ovary syndrome (PCOS) affects 5-20% of women of reproductive age worldwide. The condition is characterized by hyperandrogenism, ovulatory dysfunction and polycystic ovarian morphology (PCOM) - with excessive androgen production by the ovaries being a key feature of PCOS. Metabolic dysfunction characterized by insulin resistance and compensatory hyperinsulinaemia is evident in the vast majority of affected individuals. PCOS increases the risk for type 2 diabetes mellitus, gestational diabetes and other pregnancy-related complications, venous thromboembolism, cerebrovascular and cardiovascular events and endometrial cancer. PCOS is a diagnosis of exclusion, based primarily on the presence of hyperandrogenism, ovulatory dysfunction and PCOM. Treatment should be tailored to the complaints and needs of the patient and involves targeting metabolic abnormalities through lifestyle changes, medication and potentially surgery for the prevention and management of excess weight, androgen suppression and/or blockade, endometrial protection, reproductive therapy and the detection and treatment of psychological features. This Primer summarizes the current state of knowledge regarding the epidemiology, mechanisms and pathophysiology, diagnosis, screening and prevention, management and future investigational directions of the disorder.Robert J Norman, Ruijin Wu and Marcin T Stankiewic

Formation of chlorins and meso-substituted porphyrins through intramolecular nitrogen-carbon migration of N-substituted porphyrins

A series of N-substituted porphyrins were synthesized either by direct alkylation of the symmetrical porphyrins or from the unsymmetrical porphyrins obtained via MacDonald\u27s procedure using the appropriate N-substituted dipyrromethanes. Depending upon the nature of the peripheral substitutions in the porphyrin system, the nickeI(II)-promoted rearrangement of these compounds gave either meso-substituted or unsubstituted Ni(II)porphyrins or chlorins. The chlorins and meso-substituted porphyrins were formed via the intramolecular migration of the N-substituent to carbon. This approach provides easy access for the synthesis of chlorins and the meso-substituted porphyrins, which are otherwise difficult to synthesize. Copyright © 2008 Society of Porphyrins & Phthalocyanines

Ferulic acid ester from <i style="mso-bidi-font-style:normal">Colebrookea oppositifolia</i>

1502-1503Chemical investigation of the petroleum ether extract of the leaves of <i style="mso-bidi-font-style: normal">Colebrookea oppositifolia Smith syn. <i style="mso-bidi-font-style: normal">C. ternifolia Roxb. (Lamiaceae) afford five compounds namely n-triacontane, cetyl alcohol, 32-hydroxydotriacontyl ferulate, b-sitosterol and 5,6,7,4′-tetramethoxyflavone. Isolation of 32-hydroxydotriacontyl ferulate is being reported for the first time from this plant. Structures of these compounds have been elucidated on the basis of spectral (IR, NMR, MS) data. </span