Extensive Worm Infestation - A Case Report

Aspergillus infection in an immunocompetent human host is a rare entity. In most cases it presents as an opportunistic pathogen in immunocompromised patients. The portal of entry is usually the respiratory tract or direct inoculation of the organism to the site. Aspergillusosteomyelitis is a debilitating and severe form of Invasive Aspergillosis.
This paper presents a case of osteomyelitis of the hip without a recent obvious source of entry and reviews the literature of osteomyelitis and bone infections caused by Aspergillus.
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Osteomyelitis of the Hip secondary to Aspergillus fumigatus - A Case Report and Comprehensive Review of the Literature

Aspergillus infection in an immunocompetent human host is a rare entity. In most cases it presents as an opportunistic pathogen in immunocompromised patients. The portal of entry is usually the respiratory tract or direct inoculation of the organism to the site. Aspergillusosteomyelitis is a debilitating and severe form of Invasive Aspergillosis.
This paper presents a case of osteomyelitis of the hip without a recent obvious source of entry and reviews the literature of osteomyelitis and bone infections caused by Aspergillus.
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Sarcoidosis - A Case of “Resistant Tuberculosis”

Context: Sarcoidosis is a multisystem granulomatous disease of unknown aetiology. It is an under diagnosed disease in India. The close resemblance to tuberculosis and the lack of awareness contribute to the under reporting of cases.
Case report: We present a 17 year-old male who was refractory to antituberculous treatment and ultimately turned out to have sarcoidosis.
Conclusion: This case report highlights the importance of considering sarcoidosis as a differential diagnosis, in a country like India, where tuberculosis is endemic. The clinical course of this case was different from that reported in Western Literature.

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Procalcitonin versus C-Reactive Protein in Neonatal Sepsis

Objectives: To compare between C-reactive protein (CRP) and Procalcitonin (PCT) regarding diagnosis and outcome of neonatal sepsis.
Design: Prospective observational study.
Setting: Neonatal Intensive Care Unit (NICU).
Participants: Seventy newborn Infants admitted to NICU for sepsis management.
Results: Of the total 70 Neonates admitted in NICU, 31.4%, 42.9% and 25.7% were categorized as proven sepsis, suspected sepsis and clinical sepsis respectively. Procalcitonin was positive in 100% compared to the CRP positivity in 63.6% of the proven sepsis cases. Mortality rate is significantly increased in proven sepsis compared to clinical sepsis.
Intervention: Sepsis workup laboratory tests.
Main Outcome Measures: Specific diagnostic and prognostic impact of the tests.
Conclusion: Comparing with CRP, PCT is not only a good diagnostic measure of neonatal sepsis but also effective predictor of sepsis outcome.
Keywords:Procalcitonin; CRP; Neonatal; Sepsis; UTI

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Case Series of Pneumococcal Meningitis in the Post 13-valent Pneumococcal Conjugate Vaccine Era

Streptococcus pneumoniae is a leading cause of meningitis. Although rates of bacterial meningitis have decreased after pneumococcal conjugate vaccine introduction, pneumococcal meningitis has not been eliminated. In this case series, we describe the presentation, serotypes, and outcomes of 11 children with pneumococcal meningitis at a tertiary children's hospital after the 13-valent pneumococcal conjugate vaccine (PCV13) was introduced, from 2011-2013. The median age of children with meningitis was 7 years. The majority of the isolates (82%) were susceptible to penicillin. Most isolates (73%) were serotyped and there was no evidence of disease caused by serotypes contained in PCV7. Only two patients had disease caused by serotypes contained in PCV13 and neither of these patients was eligible to receive PCV13. Significant findings from our study include: lack of documented fever in a portion of patients admitted with meningitis, older age of children with pneumococcal meningitis, and no evidence of PCV7 serotypes causing invasive disease.


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Therapeutic Hypothermia Still Effective in Prevention of Anoxic Encephalopathy following Extended Period of Pulselessness during Cardiac Arrest

There are approximately 300,000 out-of-hospital cardiac arrests per year with less than 10% of those surviving. More than half of survivors suffer permanent neurologic deficits. Therapeutic hypothermia has proven effective at thwarting neurologic damage occurring in the 16-hour window following return of spontaneous circulation (ROSC). Despite recommendations by the American Heart Association (AHA), many cardiologists have been slow to implement therapeutic hypothermia. While many trials have discussed the relevance of initial rhythm and delay of cooling, there has been limited discussion of the efficacy of therapeutic hypothermia in the presence of extended pulselessness.
A 40-year-old male with past medical history of an ST-segment elevation myocardial infarction 8 years prior, presented with an out-ofhospital cardiac arrest. Cardiopulmonary resuscitation was immediately initiated. The patient remained in ventricular fibrillation for 50 minutes with only one episode of a momentary pulse prior to persistent ROSC.


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Acculturation and Subclinical Atherosclerosis among U.S. South Asians:Findings from the MASALA study

Objective: Longer duration of residence among immigrants to the United States, a proxy measure of acculturation, has been associated with higher subclinical atherosclerosis. South Asian immigrants are the second fastest growing immigrant group in the U.S. but little is known about the effects of acculturation with atherosclerosis in this high cardiovascular risk population.
Methods: We conducted a cross-sectional analysis using data from a community-based cohort called the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study. Participants (n=900) were between ages of 40-84 years and had no existing cardiovascular disease. We developed a multi-dimensional measure of acculturation in South Asians, called traditional cultural beliefs, and measured other proxy measures of acculturation to determine whether they were associated with higher levels of subclinical atherosclerosis after controlling for socioeconomic, behavior/lifestyle, and cardiovascular risk factors.
Results: Mean duration of residence in the U.S. was 27±11 years and tertiles of strength of traditional cultural beliefs were examined. Longer duration of U.S. residence was associated with higher levels of coronary artery calcium even after adjustment for covariates and lifestyle mediators. The novel measure of strength of traditional cultural beliefs was associated with lower common carotid intima media thickness among those with moderate traditional beliefs only.
Conclusions: These findings support the need for better conceptualization and measurement of how migration influences cultural beliefs and practices, and their subsequent influence on health behaviors and cardiovascular disease risk.


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The Echocardiographic Tei-index Compared to Transpulmonary Thermodilution Measurement With Different Hemodynamic Biomodels

Objective: To compare Doppler flow Tei-indexes with standard intermittent transpulmonary thermodilution measurement with different hemodynamic loading conditions.
Type of study: Experimental comparative study.
Materials and methods: Total 48 piglets (6 weeks old, average weight 23kg) under general anesthesia, were divided into groups under cardiac loading conditions (at rest, with increased left ventricular afterload, with increased right ventricular preload). At 60 and 120 minutes the animals were examined by echocardiography and simultaneously transpulmonary thermodilution was used to measure cardiac output. Tei-indexes data were compared with invasively monitored haemodynamic data.
Results: A total of 1632 parallel data were obtained. Correlation was found between values of right Tei-index and changes in right ventricular preload (p<0.05) and afterload (p<0.01). Correlation was also found between left Tei-index values and changes of left ventricular preload (p<0.001), afterload (p<0.001), stroke volume (p<0.01), and cardiac output (p<0.01).
Conclusions: Tei-index as global myocardial performance selectively for the right and left ventricle can be recommended for monitoring of circulation and cardiac performance..


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Could Non-Linear Heart Rate Variability Analysis of Short RR Intervals Series Give Clinically Valuable Information in Heart Disease?

New analytic methods based on nonlinear system theory have been developed to characterize the nonlinear features in HR dynamics. It is known from long time series (24h ECG recordings) that patients with chronic heart failure or stable coronary heart disease have altered fractal organization in heartbeat dynamics. During such long-time series, many confounding could limit the assessment of autonomic functions. The aim of this study was to test the hypothesis that non-linear indices obtained from short RR intervals series (256 points) can reveal abnormalities in HR behavior in cardiac disease. In 18 healthy subjects, 42 coronary artery disease and 32 chronic heart failure patients, heart rate variability was characterized during supine rest and active standing by spectral analysis, the short- and long-term fluctuations in the R-R interval, approximate and sample entropy and correlation dimension.


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Changes in Heart Function in Patients with Heart Failure after the Completion of Land-Based and Partial Water-Based Exercise Programmes

Background: Opinion is divided as to the changes in ventricular function brought about by exercise, with few studies on water-based exercise programmes for heart-failure patients. This study investigates whether following a partial water-based exercise programme could lead to an earlier improvement in ventricular function in heart-failure patients compared with a land-based exercise programme.
Methods: The randomized clinical trial involved 24 heart-failure patients (ejection fraction <40%, functional class II or III), who participated in two exercise programmes (land-based or partial water-based) lasting three weeks.
Results: We observed an increase in ejection fraction (2.19±0.77 %; p=0.009), posterior wall thickness (0.79±0.23 mm; p=0.002) and mitral A wave duration (7.38±2.56 ms; p=0.009) and a decrease in the difference in duration between the pulmonary A wave period and the mitral A wave one (-5.33±2.50 ms; p=0.043) in both groups after the exercise programme had been completed. We also saw a significant increase in plasma nitrate concentration levels. Only the ratio of peak E wave (early or rapid-filling) velocity to early diastolic flow propagation velocity, the diameter of the inferior vena cava and the thickness of the posterior wall give different results depending on the exercise programme followed.
Conclusions: Changes in ventricular function show early improvement in systolic and diastolic function independently of the type of exercise, but it seems to be that, depending on the design of the programme, different adaptive mechanisms are set in motion.


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m6a RNA Methylation: The Implications for Health and Disease

The recent resurgence of interest in m6a has been spurred by some intriguing findings detailing the effects and dynamics of this epigenetic modification. The m6a modification is a highly reactive and fluid modification which can respond rapidly to a broad variety of stimuli, and translate these signals into cellular activity. The little information that has been established on its functional capacity has opened up many new avenues of research and has tremendous implications for several fields of study. Here we outline the breakthroughs which have led to the resurgence of interest in this modification and discuss the effects and potential they represent in terms of control in the immune system, viral replication and infection, as well as the occurrence and progression of cancer.


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Esophageal carcinoma is the eighth most common cancer, and the sixth most common cause of cancer-related deaths worldwide [1]. Esophageal carcinomas in developing nations account for more than 80% of the total cases and deaths [1]. Esophageal cancer can arise as esophageal squamous cell carcinoma (ESCC) or esophageal adenocarcinoma (EAC), which have distinct etiological and pathological characteristics. ESCC is the most common histological type of esophageal cancer in the Eastern world, and its incidence remains stable [2,3]. In contrast, the epidemiology of esophageal cancer in developed nations has dramatically changed over the past 40 years. Forty years ago, ESCC accounted for more than 90% of esophageal cancer cases in the United States. However, adenocarcinoma has now become the leading type of esophageal cancer in the United States, representing 80% of cases [4].


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Duodenal Contents Reflux can Induce Esophageal Squamous Cell Carcinoma as Well as Adenocarcinoma

Esophageal carcinoma is the eighth most common cancer, and the sixth most common cause of cancer-related deaths worldwide [1]. Esophageal carcinomas in developing nations account for more than 80% of the total cases and deaths [1]. Esophageal cancer can arise as esophageal squamous cell carcinoma (ESCC) or esophageal adenocarcinoma (EAC), which have distinct etiological and pathological characteristics. ESCC is the most common histological type of esophageal cancer in the Eastern world, and its incidence remains stable [2,3]. In contrast, the epidemiology of esophageal cancer in developed nations has dramatically changed over the past 40 years. Forty years ago, ESCC accounted for more than 90% of esophageal cancer cases in the United States. However, adenocarcinoma has now become the leading type of esophageal cancer in the United States, representing 80% of cases [4].


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Targeted Approach for Prostate Cancer Treatment: Synthesis and Characterization of Docetaxel-Loaded Perfluorocarbon Nanodroplets

The purpose of this study is to synthesize and characterize nanodroplets, loaded with docetaxel for treatment of prostate cancer under MR-guided focused ultrasound. Water insoluble docetaxel encapsulated in nanodroplets is expected to be delivered into tumors with greater efficiency while minimizing drug related systemic toxicities when used in combination with focused ultrasound. The sequence of our studies toward development and characterization of docetaxel-loaded nanodroplets is as follows. First, we developed methods for synthesis of ultrasound-responsive, docetaxel-loaded nanodroplets (Doc-nd) by a solid dispersion technique. 


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Concerns about Soy Cultivation: What is Known and What is not Known

There is a discrepancy in how phytoestrogens and soy products are viewed in science and medicine. Among edible plants, phytoestrogens are most abundant in soy, and are structurally and functionally analogous to estrogens, with their biological action mediated by estrogen receptors. Soy products are widely used in infant food and other foodstuffs; and, at the same time, phytoestrogens have been applied for compensation of hormone deficiency in menopause. Furthermore, soy is applied as livestock fodder, and residual phytoestrogens and their active metabolites can remain in meats. There are only few reports on modified gender-related behavior or feminization in humans as a result of soy consumption. In animals, the intake of phytoestrogens was reported to impact fertility, sexual development and behavior. 

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β(1-3)(1-6)-D-Glucan with Strong Effects on Immune Status in Chicken: Potential Importance for Efficiency of Commercial Farming

In face of the challenge of the emergent new diseases and the current efforts of the governments to ban growth-promoting antibiotics and to improve conditions and overall health of the farmed animals, new opportunities are created for natural, highly effective, cost affordable immunomodulators. Supplementation of animal feed with β-glucans has repeatedly been shown to modulate the immune system. In this study we focused on evaluation of the effects of new insoluble, fungi-derived β-glucan as dietary supplement in chicken. We found that his β-glucan has the potential to stimulate growth, phagocytic activity, and IL-2 production. In addition, it significantly lowered the levels of TNF-α and cortisol levels elevated by a lipopolysaccharide challenge.
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Missing Breakfast, Sleep and Exercise: Are You Skipping Out Years of Life

Objective: People who regularly have breakfast are a third less likely at risk, of being obese than those who are breakfast skippers. The study aims to find the relationship between breakfast and sleeping habits with adiposity among medical students.
Design: Single center cross sectional study at a medical college of Karachi. The study was conducted from July 2011 till November 2011. We collected sample from students of each year of medical school. Convenient sampling was implied for the collection of data.
Setting: Karachi, Pakistan.
Results: Mean age of participants was 20.85 ± 0.9 years, while mean BMI of participants was 24.7 ± 6.31 kg/m2. Average physical activity was 208 min/week ± 92 min/week, while average sleep duration was 7.1 hours ± 3.9 hours. We observed that females (63.4%, 71/112) tend to skip breakfast around twice more than males (27.9%, 34/122). People who took breakfast were found to be more physically active then those who skipped breakfast. Participants who had regular breakfast were found to have a lower BMI than those who did not.
Conclusion: Since it was found that a regular consumption of breakfast not only lowers BMI but also makes a person more physically fit. Therefore it is recommended to start the day with a healthy breakfast having all the essential nutrients.
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Intent vs. Implementation—Food Allocation to Adult Males in WIC Households

The intent of the Special Supplemental Food and Nutrition Program for Women, Infants and Children (WIC) program is found in its name—to increase the health status of a targeted group through supplemental food. Households often contain multiple members who are categorically ineligible, including older ineligible children and adult males. This paper focuses on potential spillover of benefits to adult males. Comparing multiple outcomes across treated and untreated households, the author finds evidence that consumption of certain WIC foods is higher among men in WIC households compared to the most appropriate comparison group: income eligible non-WIC participants. The author also finds evidence that this difference is attributable to food-sharing and not an income effect as there is no increase in the consumption of other, non-WIC foods. The increased consumption of cereal, milk and juice is only remarkable among married men in WIC households and not among single fathers. 
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A Comparison of Blood Amino Acid Concentrations Following Ingestion of Rice and Whey Protein Isolate A Double-Blind Crossover Study

Background: This study investigated comparative concentrations of individual amino acids, total amino acids (TAA), non-essential amino acids (NEA) and essential amino acids (EAA) in the blood after the administration of Rice Protein Isolate (RPI) compared to Whey Protein Isolate (WPI).
Methods: After a 12 hour overnight fast, 10 trained male subjects were randomly assigned to receive either 48 grams of RPI or WPI in a double-blind, crossover design, separated by a washout period of 7 days. Blood draws were taken immediately prior to and at 1, 2, 3, and 4 hours following consumption of WPI or RPI. Pharmacokinetic parameters of plasma concentrations of amino acids were analyzed by a repeated measure ANOVA. AUC0-t, and Cmax were analyzed by t-tests.
Results: WPI and RPI showed a significant difference between Tmax for essential amino acids (EAA: RPI 87 ± 7 min, WPI 67 ± 4 min, p=0.03), non-essential amino acids (NEA: RPI 97 ± 4 min, WPI 71 ± 5 min, p<0.001), and total amino acids (TA: RPI 93 ± 4 min, WPI 69 ± 3 min, p<0.001), however no significant differences were detected for AUC (EAA: RPI 649.5 ± 140.9 nmol/ml, WPI 754.2 ± 170.0 nmol/ml, p=0.64; NEA: RPI 592.7 ± 118.2 nmol/ml, WPI 592.7 ± 121.2 nmol/ml, p=0.98; TAA: RPI 615.9 ± 88.6 nmol/ml, WPI 661.1 ± 98.7 nmol/ml, p=0.74), and neither for Cmax (EAA: RPI 176.1 ± 37.5 nmol/ml, WPI 229.5 ± 51.2 nmol/ml, p=0.41; NEA: RPI 160.0 ± 31.1 nmol/ml, WPI 178.4 ± 34.0 nmol/ml, p=0.69; TA: RPI 166.6 ± 23.4 nmol/ml, WPI 199.3 ± 28.8 nmol/ml, p=0.38). On an individual amino acid basis, WPI was faster or equal for all amino acids with the excpetion of leucine, which reached Cmax faster in the RPI group.
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Nutritional Aspects in Heart Failure

Heart failure (HF) is a complex clinical syndrome, of a progressive character, that has a limited prognostic factor and manifested by various extracardiac aspects. It represents a serious and growing public health problem worldwide, both for its high prevalence and the severity of its clinical manifestations, being the final common pathway of most diseases. Undernutrition is often associated with HF, especially in the later stages of the disease, and may chronically reach cardiac cachexia, a severe manifestation related to poor clinical prognosis. Nutritional care is accepted as an integral and indispensable part of the treatment of HF and seeks to improve the nutritional status of the patient, aiming to replenish energy reserves, increasing skeletal muscle tissue and improving exercise capacity. Micronutrient deficiency is common in patients with HF and its origin seems to be multifactorial, among which prolonged use of diuretics, low dietary intake and increased nutrient losses are related. In this review the nutritional aspects will be addressed for HF, with emphasis on the implications and nutritional recommendations.
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Impact of Training Programme on Knowledge and Perception of Primary Health Care (PHC) Workers on Nutrition Component of Safe Motherhood Initiative in South-West Nigeria

One of the core components of Safe Motherhood Initiatives (SMI) is nutrition, yet only few studies have considered this adequately. The goal of this intervention study was to evaluate the effect of training programme on knowledge and perception of PHC health workers on nutrition components of SMIs. The study was quasi-experimental involving two groups of 30 PHC health workers each purposively selected from Egbeda Local Government Area (LGA) (experimental group-EG) and Ido LGA (control group-CG). The two groups completed validated questionnaire at baseline. Knowledge and perception of nutrition components of SMIs were assessed using 42-point and 28-point scales respectively.
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The Effects of A Combined Exercise, Healthy Diet, and Dental Hygiene Program on Body Composition, Physical Condition, Eating Habits, and Dental Care for Shelter Home Residents with Intellectual Disabilities

Background: Physical inactivity, poor diet habit, and poor dental hygiene are big concerns among people with intellectual disabilities that cause a rise in obesity rates with increases in the risk of chronic diseases as well as emotional problems. A healthy diet and regular physical activity can prevent chronic diseases. Proper oral hygiene may improve a person's health and quality of life. Yet, the effects of physical activity, healthy diet and oral care programs on people with intellectual disabilities who live in shelter home sare lack. The present study investigated the influence of a program integrating physical activity, a healthy diet, and dental hygiene on the physical functions, body composition, exercise and dietary habits, and oral care of a group of adults with intellectual disabilities living in a shelter home.
Methods: Residents living in a shelter home (27 males and 24 females) participated in a 10-month integrated program consisted of a series of physical activity, healthy diets, and dental hygiene regime delivered by nurse and physiotherapist. Body composition, physical functions, changes in exercise and eating habits and dental hygiene were measured before and after the program.
Results: After the program the participants showed a trend of improvement on physical functions on the Timed Up and Go test, Sit to Stand, single leg standing and Berg Balance Scale. Moreover, they tended to exercise for a longer duration and performed more than one type of exercise. The skills on brushing teeth were significantly improved and more participants acquired correct dental knowledge. However, no significant improvements on the body composition and eating habit.
Conclusion: The present program integrating physical exercise, a healthy diet, and dental hygiene led some clinical improvement in physical function and exercise habit after the program for people with intellectual disabilities living in a shelter home. Moreover, improvements were seen in their skill in brushing their teeth and in their dental knowledge. No significant change was seen in their body composition and eating habits.
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Dietary Intake of Children Participating in the USDA Summer Food Service Program

The USDA summer food service program (SFSP) provides free lunches during the summer. This study examined the foods selected and consumed by participating children. Three hundred and two children were observed in 14 schools during a 4-week period in June, 2011; 50% were male; 75% were in elementary school. Dietary intake was observed and recorded; selected and consumed foods were entered into nutrient analysis software to obtain selected and consumed nutrients. Meals offered to students met the National School Lunch Program (NSLP) meal patterns. However, students selected meals that were low in Vitamin C, and did not include the two servings of fruit and/or vegetable allowed in the meal pattern. Elementary students consumed a mean of 63% of energy selected and 0.57 serving of fruit+ vegetables (0.29 cup); intermediate students consumed 73% of energy selected and mean a 0.39 serving of fruit+ vegetables (0.20 cup). Food waste was high (>30%) for fruit, vegetables and s. The SFSP as offered to children met the USDA lunch standards but interventions are needed to improve student food selection and consumption.

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Developing and Testing Nutrition Messages for Asian Indian Mothers

Objective: To develop and test nutrition messages for Asian Indian mothers addressing eight feeding behaviors likely to influence children's dietary intake and weight.
Methods: Based on the previous research, nine nutrition education messages were adapted from those developed by the United States Department of Agriculture and 29 new messages were developed. Cognitive response testing was conducted with ten immigrant Asian Indian mothers of children ages 5-10 years to evaluate core and supporting messages. Comprehensibility, agreement with, and feasibility of acting on nutrition messages was assessed during the cognitive interviews. Content analysis of the data was conducted by generating common themes, organizing the themes in display matrix, and quantifying the responses.
Results: The resulting 38 core and supporting messages for eight feeding behaviors were categorized into three groups: 1) Mealtime environment (family meals, TV viewing while eating, and parental modeling of health eating), 2) Availability and accessibility of healthy food at home, and 3) Controlling child feeding behaviors (restricting consumption of certain food, offering food rewards for finishing meal, and pressuring to eat). Mothers were receptive to 31 messages, with minor revisions made to five messages to improve clarity and increase acceptability. Two messages that received strong negative responses were deemed inappropriate for this population.
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