ABSTRACT
Visceral leishmaniasis (VL) is endemic to the southern plains of Nepal. Here, we report the first case of VL from a non-endemic Himalayan region of Nepal. The patient presented with a history of high-grade fever, splenomegaly, and anemia but had not traveled to a VL-endemic region. Visceral leishmaniasis was diagnosed following microscopic detection of the Leishmania species amastigote in a bone marrow aspirate, positive result for the rK39 test, and further validation by nested polymerase chain reaction (PCR). The patient was treated with 5 mg/kg liposomal amphotericin B and was clinically improved upon discharge. Our result suggests that VL is expanding towards non-endemic regions of Nepal, and it should therefore be considered that VL surveillance systems be strengthened, particularly for non-program districts and VL be included as a differential diagnosis in febrile illnesses.
Subject(s)
Fever/parasitology , Leishmania/isolation & purification , Leishmaniasis, Visceral/diagnosis , Leishmaniasis, Visceral/epidemiology , Amphotericin B/therapeutic use , Antigens, Protozoan/immunology , Child , Diagnosis, Differential , Fever/diagnosis , Humans , Leishmaniasis, Visceral/drug therapy , Male , Nepal/epidemiology , Polymerase Chain Reaction , Protozoan Proteins/immunology , Splenomegaly/parasitology , TravelABSTRACT
This paper studied the career experiences of emerging adults amid the pandemic and how they make sense of their career identities during this time. Twenty Indian Emerging adults (18-25 years) wrote narratives about their career stories during the pandemic. Using thematic analysis, three key themes of (1) Perceived Impact of Pandemic Crisis on Career Identity, (2) Positive Meaning-Making of Career Identity amid the Crises, and (3) Negative Meaning-Making of Career Identity amid the Crises were identified. The study concluded that despite the negative impact of Covid-19 on career experiences, most emerging adults cognitively reframed negative experiences as positive.
Une enquête narrative sur le sens de l'identité professionnelle des nouveaux adultes indiens au milieu de Covid-19. Cet article a étudié les expériences de carrière des adultes émergents pendant la pandémie et la façon dont ils donnent un sens à leur identité de carrière pendant cette période. Vingt adultes indiens émergents (18 à 25 ans) ont écrit des récits de leur carrière pendant la pandémie. À l'aide d'une analyse thématique, on a dégagé trois thèmes clés: (1) l'impact perçu de la crise pandémique sur l'identité de carrière; (2) la définition d'identité de carrière dans le contexte des crises; et (3) la définition d'identité de carrière dans le contexte des crises. L'étude a conclu que, malgré l'impact négatif de la COVID-19 sur les expériences de carrière, la plupart des adultes émergents ont recadré les expériences négatives comme étant positives.
Una investigación narrativa sobre el significado de la identidad profesional de los adultos emergentes indios en medio de Covid-19. Este trabajo estudió las experiencias profesionales de los adultos emergentes en medio de la pandemia y cómo dan sentido a sus identidades profesionales durante este tiempo. Veinte adultos emergentes indios (1825 años) escribieron relatos sobre sus historias de carrera durante la pandemia. Utilizando el análisis temático, se identificaron tres temas clave de (1) Impacto percibido de la crisis pandémica en la identidad profesional, (2) Creación de significado positivo de la identidad profesional en medio de las crisis y (3) Creación de significado negativo de la identidad profesional en medio de las crisis. El estudio concluyó que a pesar del impacto negativo de Covid-19 en las experiencias profesionales, la mayoría de los adultos emergentes reformularon cognitivamente las experiencias negativas como positivas.
ABSTRACT
Background: Cardiomyopathy is an important cause of morbidity and mortality in boys with Duchenne muscular dystrophy (DMD). Early diagnosis is a prerequisite for timely institution of cardioprotective therapies. Objective: We compared cardiac MRI (CMRI) with transthoracic echocardiography (TTE) including tissue Doppler imaging (TDI) and speckle tracking echocardiography (STE) for diagnosis of cardiomyopathy in early ambulatory boys with DMD. Methodology: This cross-sectional study was conducted between June 2018 and December 2020. Consecutive boys between 7 and 15 years of age with DMD were enrolled. Percentage ejection fraction (EF), fractional shortening, wall motion abnormalities, early diastolic mitral annulus velocity (Ea), medial mitral annulus ratio (E/Ea), and global strain were measured with STE. CMRI-derived EF, segmental hypokinesia, and late gadolinium enhancement (LGE) were studied and compared. Results: A total of 38 ambulatory boys with DMD were enrolled. The mean age was 8.8 ± 1.6 years, and none had clinical features suggestive of cardiac dysfunction. In the TTE, EF was ≤55% in 5 (15%), FS was ≤28% in 3 (9%), and one each had left ventricular wall thinning and wall hypokinesia. In TDI, none had diastolic dysfunction, and STE showed reduced global strain of < 18% in 3 (9%) boys. CMRI-derived EF was ≤55% in 20 (53%) boys and CMRI showed the presence of left ventricular wall hypokinesia in 9 (24%) and LGE in 4 (11%) boys. Conclusion: Cardiomyopathy remains clinically asymptomatic among early ambulatory boys with DMD. A significantly higher percentage of boys revealed early features of DMD-related cardiomyopathy in CMRI in comparison with echocardiography.
ABSTRACT
We present two cases of 10 and 27 years old girls with recurrence of immature teratoma after an incomplete surgical staging. In both cases, there were huge abdominopelvic masses despite decrease in tumor markers with chemotherapy. Complete surgical resection of these masses was done, and histopathology showed only mature teratoma.
ABSTRACT
The discovery of the tumor-inhibitory properties of asparaginase (ASNase) began in the early 1950s with the observation that guinea pig serum-treated lymphoma-bearing mice underwent rapid and often complete regression. About 4000 cases of acute lymphoblastic leukemia (ALL) are diagnosed very year in the US and many more through out the world. The majority of these cases are in children and young adults, making ALL the most common form of malignancy in these age groups. The treatment protocols of ALL are complex and use 6-12 drugs. Consequently, the improvement in the protocol design has improved significantly the success rate for long-term event-free survival in the past 20-30 years, which is now approximately 75% for patients afflicted with the higher risk ALL features and just above this percentage for patients with standard or good features. Despite this success, approximately 15% of patients die from ALL, making leukemic relapse the most common cause of treatment failure in pediatric oncology. ASNases have been the cornerstone of ALL therapies since the late 1970s. Native or pegylated L-asparaginase (ASNase or PEG-ASNase) are highly specific for the deamination of L-asparagine (Asn) to aspartic acid and ammonia. Depletion of Asn leads to a nutritional deprivation and inhibition of protein biosynthesis, resulting in apoptosis in T-lymphoblastic leukemias, which require Asn from external sources. The reactions of the host exposed to repeated ASNase treatments as well as the up-regulation of the mammalian enzymes to overcome the ASN-depletion toxic condition are of significant importance and may make us relearn the lessons on this important antileukemic drug.