Delusional infestation with unusual pathogens: a report of three cases.

Delusional infestation (DI) is a psychiatric disorder characterized by a fixed, false belief that the patient is infested with extracorporeal agents. It is known by several names, including the more commonly used term 'delusional parasitosis'. The psychiatric disease is responsible for the cutaneous pathology. About 90% of patients with DI seek help from dermatologists, and most reject psychiatric referral. Thus, effective management requires incorporation of psychiatric principles. We report three cases of DI with inanimate materials, and examine 'Morgellons' disease. We believe that patients with unusual presentations of DI are likely to be seen more commonly in the future. These patients appear to be a subgroup of DI, and may be even more difficult to treat than other patients with DI.

Meconium peritonitis presenting as abdominal calcification: three cases with different pathology.

Intra-abdominal calcification is uncommon in newborns and has several causes of which meconium peritonitis is the most frequent. Three neonates with intra-abdominal calcification as a complication of meconium peritonitis are presented. The types of meconium peritonitis were cystic, meconium pseudocyst and meconium ascites. Two required surgical intervention. Meconium peritonitis should be considered in newborns with intra-abdominal calcification.

Urethral obstruction from Cobb's collar in association with VACTERL.

SUMMARY: Cobb's collar is a rare intraluminal congenital cause of bulbar urethral obstruction that is commonly mislabelled congenital obstructive posterior urethral membrane (COPUM) but may be distinguished from this endoscopically as it has no connecting folds to the verumontanum. In this report, Cobb's collar is described for the first time in association with the VACTERL syndrome. The abnormality was diagnosed and treated by diathermy and dilatation at the time of endoscopic evaluation, with improvement of vesicoureteric reflux on micturating cystourethrogram and renal ultrasound.

Modelling the potential impact of adherence technologies on tuberculosis in India.

BACKGROUND: For patients taking standard first-line tuberculosis treatment, missing 10% or more of their doses increases the risk of relapse six-fold. Digital technologies offer new approaches to adherence support for TB patients. We estimated the potential impact of new adherence technologies in India.METHOD: We developed a mathematical model of TB transmission dynamics in India, capturing the independent effects of missed doses and treatment default on post-treatment recurrence. We simulated the impact of interventions to address both missed doses and treatment default in the public and private healthcare sector.RESULTS: Adherence interventions, if deployed optimally in the public sector alone, would reduce cumulative TB incidence by 7.3% (95% credible intervals [CrI] 4.7-11) between 2020 and 2030, and by 16% (95% CrI 11-23) if also deployed in the private sector. This impact is roughly proportional to the effectiveness of the interventions. Reducing missed doses reduced incidence by 12% (95% CrI 7.0-18), while reducing treatment default reduced incidence by 7.9% (95% CrI 3.2-13).CONCLUSION: Minimising missed doses is at least as important as promoting treatment completion. Our results suggest that emerging technologies to improve treatment adherence could have a substantial impact on TB incidence and mortality in India.

An antimicrobial activity of cytolytic T cells mediated by granulysin.

Cytolytic T lymphocytes (CTLs) kill intracellular pathogens by a granule-dependent mechanism. Granulysin, a protein found in granules of CTLs, reduced the viability of a broad spectrum of pathogenic bacteria, fungi, and parasites in vitro. Granulysin directly killed extracellular Mycobacterium tuberculosis, altering the membrane integrity of the bacillus, and, in combination with perforin, decreased the viability of intracellular M. tuberculosis. The ability of CTLs to kill intracellular M. tuberculosis was dependent on the presence of granulysin in cytotoxic granules, defining a mechanism by which T cells directly contribute to immunity against intracellular pathogens.

Intradural dermoid masquerading as pyogenic meningitis: case report.

Intraspinal dermoids are uncommon tumours of childhood. They usually present with paraplegia, and bowel and bladder disturbances but rarely with meningeal signs. We report a 3-year-old boy with an intradural dermoid who presented with meningeal signs and masqueraded as pyogenic meningitis.

Isolated cerebellar ataxia: an early neurological complication of enteric fever.

Enteric fever is associated with a variety of clinical presentations and complications. Although central nervous system involvement is not uncommon in enteric fever, acute cerebellar ataxia as a presenting feature is rare. A 7-year-old boy with enteric fever who presented with acute cerebellar ataxia is reported.

Initial default among diagnosed sputum smear-positive pulmonary tuberculosis patients in Andhra Pradesh, India.

BACKGROUND: Under the Indian Revised National TB Control Programme (RNTCP), smear-positive pulmonary tuberculosis (PTB) patients not confirmed as starting treatment are reported as 'initial defaulters'. SETTING: Twenty districts of Andhra Pradesh State, India. OBJECTIVE: To evaluate reasons for treatment non-initiation in smear-positive PTB patients diagnosed and reported as initial defaulters by the NTP. DESIGN: A cross-sectional survey conducted of all reported initial defaulters during the period July-September 2006. RESULTS: Of 1304 reported initial defaulters, 619 (47.5%) had been placed on treatment, having been incorrectly reported due to poor documentation of patients referred for treatment in the same district or whose treatment initiation was delayed until the subsequent quarter. Of the 685 (4.5% of the total diagnosed) who were confirmed initial defaulters, 350 (51%) were untraceable, 152 (22%) had died before treatment initiation, 38 (5.5%) were treated privately, 93 (13.5%) had other reasons (e.g., refusal of treatment, chronic case, etc.) and no data were available for 52 (8%). CONCLUSIONS: Nearly 5% of smear-positive PTB patients diagnosed in the study period were confirmed as not having initiated treatment under the RNCTP. Improvements in address recording may assist efforts to retrieve these patients for treatment. Additional evaluations are needed of improved counselling of TB suspects to prevent initial default, and of reasons for death before treatment initiation.

High prevalence of drug-resistant tuberculosis, Republic of Lithuania, 2002.

BACKGROUND: Nations of the former Soviet Union have the world's highest reported levels of resistance to anti-tuberculosis drugs. We conducted the first national survey of anti-tuberculosis drug resistance in the Republic of Lithuania. METHODS: We tested Mycobacterium tuberculosis isolates from all incident culture-positive pulmonary TB patients registered in 2002. New patients were those treated for <1 month with any first-line anti-tuberculosis drug (isoniazid [INH], rifampin [RMP], ethambutol, or streptomycin); previously treated patients were those treated for > or =1 month. RESULTS: Of 1163 isolates, 475 (41%) were resistant to at least one first-line drug, and 263 (23%) were resistant to at least INH and RMP (MDR); this included 76/818 (9.3%) from new patients and 187/345 (54%) from previously treated patients. Of 52 MDR isolates randomly selected for extended testing at an international reference laboratory, 27 (51%, 95%CI 38-66) had resistance to pyrazinamide, 21 (40%, 95%CI 27-55) to kanamycin, and 9 (17%, 95%CI 8-30) to ofloxacin. CONCLUSIONS: The prevalence of MDR-TB in Lithuania is among the world's highest. Among MDR-TB isolates, aminoglycoside and fluoroquinolone resistance were common. To combat drug-resistant TB, Lithuania has implemented the WHO global TB control strategy (DOTS), and is developing an MDR-TB treatment program (DOTS-Plus).

Improved tuberculosis case detection through public-private partnership and laboratory-based surveillance, Kannur District, Kerala, India, 2001-2002.

BACKGROUND: Efforts to intensify global tuberculosis (TB) control are limited by difficulties in coordinating with private doctors. More than half of Indian TB patients may initially consult a private provider, but many are neither diagnosed accurately nor treated effectively. We established and evaluated a public-private partnership based on surveillance of TB detected in private laboratories and use of standardised directly observed treatment regimens. METHODS: In one district, the governmental TB control programme offered training in microscopy to all large private sector laboratories, and educated private physicians on the importance of microscopy for TB diagnosis. We reviewed records from participating private laboratories and all publicly diagnosed patients. RESULTS: Of 2328 pulmonary TB patients registered from July 2001 to December 2002, 404 (17%) were detected in the private sector. The annual new AFB-positive case notification rate increased by 21%, from 27.8/100,000 in 2000 to 33.5/100,000 in 2002. Surveillance at private laboratories found an additional 260 nonregistered AFB-positive patients. CONCLUSIONS: This public-private partnership substantially increased TB case detection and established a sustainable framework for private sector involvement in TB control. In the setting of a strong public sector programme, the combination of active surveillance of private laboratories along with physician sensitisation is a promising approach to improve TB case detection.

Capacity building for international tuberculosis control through operations research training.

SETTING: In resource-poor countries, few tuberculosis (TB) program staff at the national, provincial, and even district levels have the basic analytical and epidemiological skills necessary for collecting and analyzing quality data pertaining to national TB control program (NTP) improvements. This includes setting program priorities, operations planning, and implementing and evaluating program activities. OBJECTIVES: To present a model course for building capacity in basic epidemiology and operations research (OR). DESIGN: A combination of didactic lectures and applied field exercises were used to achieve the main objectives of the 6-day OR course. These were to increase the understanding of quantitative and qualitative research concepts, study design, and analytic methods, and to increase awareness of how these methods apply to the epidemiology and control of TB; and to demonstrate the potential uses of OR in answering practical questions on NTP effectiveness. As a final outcome, course participants develop OR proposals that are funded and later implemented. RESULTS: Since 1997, this OR course has been conducted nine times in five countries; 149 key NTP and laboratory staff have been trained in OR methods, and 44 OR protocols have been completed or are underway. CONCLUSION: This low-cost model course can be adapted to a wide range of public health issues.

Genital injuries in neonates following breech presentation.

Breech presentation is seen in 3-4% of babies born. Delivering a breech baby through vaginal route is difficult and carries a much higher complication rate than cesarean sections. Breech born babies carry an overall increased risk of maternal morbidity, neonatal mortality, birth asphyxia and birth injuries. Various types of birth injuries to the babies have been reported following breech delivery, but genital injuries are less commonly reported and thus, less anticipated. We report series of five babies with spectrum of genital injuries following breech delivery. These injuries led to significant short and long term morbidity in these babies. Keeping high index of suspicion, an early cesarean section can be an aide in preventing these complications. Once the baby is born, careful examination and early intervention should be done to prevent long term complications.

1,25 (OH)2 vitamin D3 modifies growth and contractile function of vascular smooth muscle of spontaneously hypertensive rats.

The effects of 1,25 (OH)2 vitamin D3 on growth of cultured vascular myocytes and on the contractile response of isolated resistance arteries to norepinephrine was examined using tissue derived from 12-week-old spontaneously hypertensive (SHR) and normotensive Wistar-Kyoto (WKY) rats. 1,25 (OH)2 vitamin D3 (214 pg/mL) stimulated the growth of superior mesenteric artery myocytes cultured from the SHR and increased the sensitivity of isolated mesenteric resistance arteries to norepinephrine. These effects were not observed in tissue of the WKY. It is concluded that 1,25 (OH)2 vitamin D3 modulates vascular growth and contractility in the SHR, but apparently not the WKY. Possible mechanisms of action are discussed.

Endoscopic correction of primary vesicoureteric reflux in children.

Sixty-nine children with 113 refluxing ureters were followed prospectively after treatment with endoscopic injection of subureteric polytetrafluoroethylene (sting). The 50 female and 19 male patients had a total of 105 procedures. Thirty-eight patients have had their vesicoureteric reflux (VUR) resolved, and 16 now have asymptomatic grade I or II reflux, giving a combined patient VUR improvement rate of 80 percent.

Variable expression of the congenital obstructive posterior urethral membrane.

OBJECTIVES: To assess the variability of membranous folds in the posterior urethra and their relationship to urethral obstruction. METHODS: Endoscopic video recordings of 19 boys with a membranous lesion in the posterior urethra were obtained over a 2.5-year period. Six had an endoscopy after a prenatal diagnosis of obstructive uropathy and 13 boys presented with either a urinary tract infection or hematuria. RESULTS: Young's type I and type III appearances were seen in all with an obstructive membrane, and those with a less obstructing membrane probably had incidental pathologic conditions. CONCLUSIONS: These observations support the thesis that the congenital attachment of the verumontanum to the anterior wall of the posterior urethra is the embryologic fore-runner to the congenital obstruction of the posterior urethra, and that there may be a variable degree of persistence of that attachment, which in some boys is not obstructive.

Extraperitoneal ureterocystoplasty with transureteroureterostomy.

Ureterocystoplasty enables the bladder to be reliably enlarged and the resultant neobladder to be lined by urothelium. Many techniques have been described for the operative management of the lower ureter, and a number of alternatives have been suggested for reconstruction of the upper renal tract and bladder. This report describes a new approach that allows renal preservation, transureteroureterostomy, and ureterocystoplasty through an extraperitoneal approach.

Autoaugmentation omentocystoplasty in a sheep model.

OBJECTIVE: To develop a sheep model of autoaugmentation omentocystoplasty and study the histologic appearance, and to compare the urodynamic results with a control group. METHODS: Ten male lambs underwent a bladder autoaugmentation reinforced with an omental patch. Three were culled early, to study urothelial survival and inflammatory changes. One was sacrificed at six months to assess late histologic changes; five sheep had a urodynamic study at that stage and two died of unknown causes without further investigation. A group of seven six-month-old male sheep, of similar weights, formed the control urodynamic group. RESULTS: The urothelial lining remained viable under the omentum, but marked inflammation and heterotopic calcification were seen within the subepithelial tissues in most of the animals. The histologic changes were reflected in the bladder dynamic data, which were no better than the control group; the average compliance value was 9.2 +/- 6.4 mL/cm H2O, compared to the control group figure of 11.8 +/- 5.2 mL/cm H2O. CONCLUSIONS: It would appear that autoaugmentation alone does not usually produce bladder augmentation in the sheep.