RESPIRATORY INFECTIONS RESEARCH IN AFGHANISTAN: BIBLIOMETRIC ANALYSIS WITH THE DATABASE PUBMED.

BACKGROUND: Infectious diseases research in a low-income country like Afghanistan is important. METHODS: In this study an internet-based database Pubmed was used for bibliometric analysis of infectious diseases research activity. Research publications entries in PubMed were analysed according to number of publications, topic, publication type, and country of investigators. RESULTS: Between 2002-2011, 226 (77.7%) publications with the following research topics were identified: respiratory infections 3 (1.3%); parasites 8 (3.5%); diarrhoea 10 (4.4%); tuberculosis 10 (4.4%); human immunodeficiency virus (HIV) 11 (4.9%); multi-drug resistant bacteria (MDR) 18 (8.0%); polio 31 (13.7%); leishmania 31 (13.7%); malaria 46 (20.4%). From 2002-2011, 11 (4.9%) publications were basic science laboratory-based research studies. Between 2002-2011, 8 (3.5%) publications from Afghan institutions were identified. CONCLUSION: In conclusion, the internet-based database Pubmed can be consulted to collect data for guidance of infectious diseases research activity of low-income countries. The presented data suggest that infectious diseases research in Afghanistan is limited for respiratory infections research, has few studies conducted by Afghan institutions, and limited laboratory-based research contributions.

A novel mechanism of rapid nuclear neutrophil extracellular trap formation in response to Staphylococcus aureus.

Neutrophil extracellular traps (NETs) are webs of DNA covered with antimicrobial molecules that constitute a newly described killing mechanism in innate immune defense. Previous publications reported that NETs take up to 3-4 h to form via an oxidant-dependent event that requires lytic death of neutrophils. In this study, we describe neutrophils responding uniquely to Staphylococcus aureus via a novel process of NET formation that did not require neutrophil lysis or even breach of the plasma membrane. The multilobular nucleus rapidly became rounded and condensed. During this process, we observed the separation of the inner and outer nuclear membranes and budding of vesicles, and the separated membranes and vesicles were filled with nuclear DNA. The vesicles were extruded intact into the extracellular space where they ruptured, and the chromatin was released. This entire process occurred via a unique, very rapid (5-60 min), oxidant-independent mechanism. Mitochondrial DNA constituted very little if any of these NETs. They did have a limited amount of proteolytic activity and were able to kill S. aureus. With time, the nuclear envelope ruptured, and DNA filled the cytoplasm presumably for later lytic NET production, but this was distinct from the vesicular release mechanism. Panton-Valentine leukocidin, autolysin, and a lipase were identified in supernatants with NET-inducing activity, but Panton-Valentine leukocidin was the dominant NET inducer. We describe a new mechanism of NET release that is very rapid and contributes to trapping and killing of S. aureus.

Infectious diseases of Afghan immigrants in the United States: review of published reports.

Infectious diseases of immigrants may differ from patients born and resident in the same country, especially if immigrants from Africa or Asia live in Europe or North America. Because the available information is limited published reports of infections of Afghan immigrants in the United States and other countries were analysed. Four reports from the US and 15 reports from other countries were identified [7, (46.7%) Pakistan, 5 (33.3%) Iran, 1 (6.7%) United Kingdom, 1 (6.7%) Germany, 1 (6.7%) Israel)]. Reports from the US were case reports or case series of infections with gastro-intestinal parasites and Mycobacterium tuberculosis (1, 25%), Echinococcus species (2, 50%), and Plasmodium vivax (1, 25%). Reports from other countries were case reports, case series, or surveys and investigated infections with Echinococcus species (2, 13%), Hepatitis B virus (HBV) (1, 6.7%), M. tuberculosis (6, 40%), P. falciparum (1, 6.7%), Leishmania tropica (3, 20%), Fasciola hepatica (1, 6.7%), and M. leprae (1, 6.7%). The reports suggest that Echinococcus species and L. tropica infections can be encountered in Afghan immigrants in the US, and the frequency of a positive PPD (purified protein derivative) response or HBsAg test was increased. An infectious diseases database specific for the country of residence readily available to clinicians treating Afghan patients outside of Afghanistan may be useful.

Infectious diseases of Khmer immigrants in the United States: review of published reports.

Infectious diseases are influenced by where patients have lived or travelled in the past, e.g., infection with Schistosoma mekongi can be acquired during freshwater contact in Cambodia, but not in the United States. Here the infectious diseases of Khmer immigrants in the United States were studied by reviewing published reports. Thirteen case series and 9 case reports of 5,222 patients were identified. Most reports were of infections with gastrointestinal parasites (8, 36%), Plasmnodium species (3, 14%), Mycobacterium tuberculosis (3, 14%), and Mycobacterium leprae (2, 9%). Other reports included infections with Burkholderia pseudomallei, Trichinella spiralis, and Schistosoma japonicum. In conclusion, Khmer patients in the US can be infected with different gastrointestinal. parasites, different extrapulmonary forms of tuberculosis have been reported, and 2 reports of M. leprae were identified. A country-specific database for origin and current residence for Khmer and other immigrant groups providing access to specialised information may be useful for clinicians taking care of immigrants.

Mycetoma fungal infection: multiple organisms as colonizers or pathogens?

We describe a patient with mycetoma or Madura foot, in which histopathological stains of the bone and surface cultures suggested three different organisms including Nocardia species as the cause. Criteria for the diagnosis of the organisms, differentiation between colonizer and pathogen, and significance of mixed infections are discussed.

Unilateral paralysis of the diaphragm during pregnancy: case report and literature review.

Unilateral diaphragmatic paralysis is usually asymptomatic and diagnosed incidentally and often does not need any additional diagnostic workup, but in the setting of pregnancy it may require additional investigations. We describe a patient in her last trimester of pregnancy (36th week) who presented to the hospital with symptoms suggestive of upper respiratory tract infection and with a chest radiograph showing left diaphragmatic eventration, for which she underwent thoracotomy and cesarean section. In the report, we review the normal respiratory changes associated with pregnancy and discuss the management of patients with diaphragmatic paralysis and pregnancy.

Overuse of prothrombin and partial thromboplastin coagulation tests in medical inpatients.

INTRODUCTION: In the monitoring of anticoagulant therapy, prothrombin time (PT) is used to measure the effect of warfarin, whereas the partial thromboplastin time (PTT) measures the therapeutic effect of unfractionated heparin. Low molecular weight heparin (LMWH) does not require routine monitoring. OBJECTIVE: We collected data on the frequency of simultaneous PT and PTT requests, where only one or neither is indicated, and estimated the potential cost savings if ordering was appropriate. METHODS: The study was performed at Nassau University Medical Center, a major teaching institution in East Meadow, New York. Inpatient charts were reviewed consecutively until 50 patients prescribed warfarin alone, intravenous heparin alone, or LMWH alone were selected. We then determined which coagulation tests were performed each day for these patients by review of their computerized laboratory results. The costs of laboratory tests were obtained from the hospital laboratory and were used to calculate potential savings. RESULTS: PT and PTT coagulation tests were requested together in all 50 patients. Seventeen patients on LMWH alone had 30 sets of PT/PTT performed (60 tests). Seventeen patients on intravenous heparin had 87 PTs performed. Twelve patients on warfarin had 60 PTTs performed. In total, 232 unneeded PT or PTTs were ordered in these 50 patients, or 4.6 per patient during hospitalization. CONCLUSION: The review of the records of 50 medical inpatients found that PT and PTT were invariably requested together, despite a lack of indication. The 50 patients incurred a total of $2434 in unneeded costs. If representative of common clinical practice, significant cost savings may be possible. Education, computerization, and information on costs of individual tests may reduce unneeded investigations.

Case report: Dexatrim (Phenylpropanolamine) as a cause of myocardial infarction.

Phenylpropanolamine (PPA) is a sympathetic amine used in over-the-counter cold remedies and weight-control preparations worldwide. Its use has been associated with hypertensive episodes and hemorrhagic strokes in younger women. Several reports have linked the abuse of PPA with myocardial injury, especially when overdose is involved. We report here the first case of Dexatrim (PPA)-induced myocardial injury in a young woman who was using it at recommended doses for weight control. In addition, we review the 7 other cases of PPA related myocardial injury that have been reported so far. Physicians and patients should be alert to the potential cardiac risk associated with the use of PPA, even at doses generally considered to be safe.

Helminthic infections mimicking malignancy: a review of published case reports.

BACKGROUND: Infectious diseases, including infections with helminths, can initially present similarly to malignancies. The goal of the article is to review reports of helminthic infections that are initially diagnosed as malignancy. METHODOLOGY: The database PubMed was searched for English language references published as of July 2009. RESULTS: The following published case reports and case series, mainly from Asia and Africa, were identified: Nematodes: 8 publications (1 patient with Angiostrongylus cantonensis, 2 Stronglyloides stercoralis, 1 Toxocara species, 1 Dioctophyma renale, 1 Ascaris species, 1 Gnathostoma spinigerum, 1 Dirofilaria repens); Trematodes: 7 publications (46 patients with Schistosoma species, 2 Fasciola hepatica, 1 Paragonimus westermani); Cestodes: 6 publications (10 patients with Echinococcus species, 1 Sparganum mansoni). CONCLUSION: To avoid unnecessary investigations and treatment, physicians should be aware when diagnosing patients from Asia or Africa that a large number of helminthic infections can present similar to malignancies.

Case histories of infectious disease management in developing countries: Phnom Penh and Kabul.

Healthcare in developing countries is affected by severe poverty, political instability and diseases that may be of lesser importance in industrialized countries. The aim of this paper was to present two cases and histories of physicians working in hospitals in developing countries and to discuss the opportunities for clinical investigation and collaboration. Cases of patients in Phnom Penh, Cambodia, with histoplasmosis, cryptococcal meningitis, crusted scabies, cerebral lesions and human immunodeficiency virus and of patients in Kabul, Afghanistan, with liver cirrhosis, nephrotic syndrome and facial ulcer are discussed. Greater developmental support is required from industrialized nations, and mutually beneficial cooperation is possible since similar clinical problems exist on both sides (e.g. opportunistic cardiovascular infections). Examples for possible support of hospital medicine include physician interchange visits with defined objectives (e.g. infection control or echocardiography training) and collaboration with clinical investigations and projects developed locally (e.g. epidemiology of cardiovascular diseases or nosocomial bloodborne infections).

Prevalence and predictors of positive tuberculin skin test results in a research laboratory.

Latent tuberculosis was studied in a research laboratory. A prevalence of positive tuberculin skin test results (>or= 15 mm) of 20% was found and the main predictors were place of birth in a foreign country with high prevalence of tuberculosis and a history of contact with patients with untreated active tuberculosis.

Phagocytosis of Salmonella montevideo by human neutrophils: immune adherence increases phagocytosis, whereas the bacterial surface determines the route of intracellular processing.

Complement-opsonized particles become immune adherent to complement receptor 1 (CR1 or CD35) on human erythrocytes, allowing particles to be ingested by phagocytes in the liver and the spleen. We investigated the role that immune adherence plays in the uptake and killing of Salmonella montevideo by human neutrophils. Exposure to serum induced loss of flagella and facilitated immune adherence, which was followed by more-efficient phagocytosis and killing, compared with that after exposure to serum-opsonized, free bacteria. One correlate of bacterial killing is the fusion of phagosomes with lysosomes, which can be monitored by Lyso-Tracker or lysosomal-associated membrane protein 2 colocalization with the intracellular bacteria. At 5 min, phagolysosmal fusion was significantly faster for immune-adherent bacteria than for non-immune-adherent bacteria, but, by 35 min, the difference between the 2 groups was minimal. Immune adherence also facilitated the ingestion of antibody complement-opsonized fluorescent microspheres, but, unlike bacteria, most internalized microspheres failed to fuse with lysosomes. However, addition of lipopolysaccharide, a Toll-like receptor ligand, to microspheres directed their intracellular trafficking, resulting in rapid lysosomal fusion. Thus, immune adherence facilitates phagocytosis, but the route of intracellular processing depends on the molecular nature of the target and is independent of host complement and antibody.

Case histories of infectious disease management in developing countries: Phnom Penh and Kabul / As doenças infecciosas nos países em desenvolvimento: Phnom Penh e Cabul

Healthcare in developing countries is affected by severe poverty, political instability and diseases that may be of lesser importance in industrialized countries. The aim of this paper was to present two cases and histories of physicians working in hospitals in developing countries and to discuss the opportunities for clinical investigation and collaboration. Cases of patients in Phnom Penh, Cambodia, with histoplasmosis, cryptococcal meningitis, crusted scabies, cerebral lesions and human immunodeficiency virus and of patients in Kabul, Afghanistan, with liver cirrhosis, nephrotic syndrome and facial ulcer are discussed. Greater developmental support is required from industrialized nations, and mutually beneficial cooperation is possible since similar clinical problems exist on both sides (e.g. opportunistic cardiovascular infections). Examples for possible support of hospital medicine include physician interchange visits with defined objectives (e.g. infection control or echocardiography training) and collaboration with clinical investigations and projects developed locally (e.g. epidemiology of cardiovascular diseases or nosocomial bloodborne infections).

A assistência à saúde em países em desenvolvimento é afetada pela pobreza extrema, instabilidade política e doenças que podem ter menor importância em países industrializados. O objetivo deste trabalho foi apresentar dois casos e histórias de médicos que trabalham em hospitais de países em desenvolvimento e discutir as oportunidades de investigação clínica e cooperação. São discutidos casos de pacientes em Phnom Penh, no Camboja, com histoplasmose, meningite criptocócica, sarna, lesões cerebrais e vírus da imunodeficiência humana, e de pacientes em Kabul, no Afeganistão, com cirrose hepática, síndrome nefrótica e úlcera facial. Maior apoio ao desenvolvimento por parte dos países desenvolvidos é essencial, e uma cooperação mutuamente benéfica é possível, visto que problemas clínicos similares existem em ambos os lados (p. ex. infecções cardiovasculares oportunistas). Exemplos para possível apoio à medicina hospitalar incluem intercâmbio de médicos para visitas com objetivos definidos (p. ex. controle de infecção ou treinamento em ecocardiografia) e colaboração com investigações clínicas e projetos desenvolvidos localmente (p. ex. epidemiologia de doenças cardiovasculares ou infecções hospitalares causadas por via sanguínea).

Prevalence and predictors of positive tuberculin skin test results in a research laboratory / Prevalência e fatores preditores do teste cutâneo de tuberculina em um laboratório de pesquisa

Latent tuberculosis was studied in a research laboratory. A prevalence of positive tuberculin skin test results (> 15mm) of 20 percent was found and the main predictors were place of birth in a foreign country with high prevalence of tuberculosis and a history of contact with patients with untreated active tuberculosis.

A tuberculose latente foi estudada em um laboratório de investigação. Foi encontrada uma prevalência de 20 por cento de resultados positivos para o teste cutâneo de tuberculina (> 15mm) e os principais fatores preditores foram ser natural de um país estrangeiro com alta prevalência de tuberculose e ter uma história de contato com doentes com tuberculose ativa não tratada.

Mycetoma fungal infection: multiple organisms as colonizers or pathogens?

We describe a patient with mycetoma or Madura foot, in which histopathological stains of the bone and surface cultures suggested three different organisms including Nocardia species as the cause. Criteria for the diagnosis of the organisms, differentiation between colonizer and pathogen, and significance of mixed infections are discussed.

Descrevemos um paciente com micetoma ou maduromicose de pé, no que colorações histopatológicos de osso e de culturas superficiais sugeriram três organismos diferentes, incluindo espécies de Nocardia como causador. Os critérios de diagnóstico dos organismos, a diferenciação entre colonizador e patógeno, e a significância das infecções mistas são discutidos.