Usha Sharma

Knowledge of HIV/AIDS transmission and screening in United States blood donors.

BACKGROUND : Increased knowledge of HIV transmission and behavioral and test screening may encourage high‐risk blood donors to self‐defer.

Incidence rates of viral infections among repeat donors: are frequent donors safer?

BACKGROUND: Incidence rates (IRs) for viral infections may vary with the frequency of donation among repeat, community, whole‐blood (WB) donors, with IRs thought to be lower among donors with higher frequency of donation.

Diagnostic criteria for Tuberculous Meningitis

Objective : Tuberculous Meningitis is associated with a high morbidity and mortality if there is a delay in diagnosis. The diagnosis is based on clinical evaluation since the bacteriological diagnosis takes time and has a low yield. This study attempts to validate these criteria in children with TBM.Methods : Forty-two children clinically suspected to have TBM were enrolled in the study. History, examination, CT scan and CSF findings were utilized to categorize patients into “definite”, “highly probable”, “probable” and “possible” TBM based on the criteria laid down by Ahuja et al. The validity of these criteria was tested against bacterial isolation and response to treatment.Results : Thirty one children, with complete data, were included for analysis. Using “improvement on therapy” as a criterion for definite TBM, we analyzed the sensitivity and specificity of the Ahuja criteria in diagnosing TBM. Using the criteria of “highly probable” TBM, the sensitivity was 65% with a specificity of 75%. When the criteria of “probable” TBM were used, the sensitivity increased to 96% while the specificity dropped to 38%. In an attempt to make these criteria more appropriate for children, we modified the criteria by including mantoux reaction, and family history of exposure in the criteria. The modified criteria gave a sensitivity of 83% and a specificity of 63%.Discussion : A sensitivity of 65% (highly probable group) implies that 35% of TBM patients will be missed, while the probable criteria gave a 63% false positive rate suggesting that the trade-off for a higher sensitivity makes the criteria very unreliable. Our modification of the criteria gave us a reasonable sensitivity of 83% with a higher specificity of 63%. The false positive rate was also reduced to 38%. Thus the modified Ahuja criteria worked better for children with TBM.Conclusion : The modified Ahuja criteria are better applicable for use in pediatric patients with TBM. Since the number of patients was small in this study, the study needs to be validated with a larger sample size

Chemokine-Independent In Vitro Resistance to Human Immunodeficiency Virus (HIV-1) Correlating with Low Viremia in Long-Term and Recently Infected HIV-1-Positive Persons

Chemokines have been implicated as protective factors against human immunodeficiency virus (HIV) infection, competing for binding to receptors that also function as coreceptors for HIV. In this study of HIV-positive donors, peripheral blood mononuclear cell (PBMC) culture resistance to endogenous and exogenous HIV correlated with low plasma viremia and high in vitro RANTES production. However, resistant cells were not rendered susceptible by neutralization of C-C chemokines, and addition of C-C chemokines did not consistently suppress endogenous virus or exogenous HIV-1MN. In contrast, CD8 T cell depletion markedly decreased the frequency of resistant cultures without reducing C-C chemokine production. Among newly infected persons, half exhibited phenotype switching from preinfection susceptibility to postinfection resistance, suggesting that genetically predetermined constitutive cytokine production or allelic receptor expression are not generally responsible for in vitro resistance and nonprogression.

Measles encephalitis: A clinical study of 25 cases

SummaryA detailed clinical study of 25 cases of post-measles encephalitis has been presented. Male preponderance was evident, male: female ratio being 3:2. The Maximum number of patients (84%) were below 5 years of age. The symptoms of encephalitis were noticeable in 88% of cases between the 3rd to 15th day of appearance of the rash. The mortality rate was 8% only but if 5 patients who left against medical advice and were in a moribund condition, are included, it increases to 28% which is quite significant. Residual sequelae developed in 8% of cases who were followed up for a few months.

Cerebral (encephalopathy) associated with ascariasis

Summary25 cases having nervous system manifestations complicating ascariasis were encountered during a short period of 6 months. Almost all of them presented with symptoms of irritability, restlessness, grinding of teeth and most of them had cephalgia, convulsions and a stuporous state simulating encephalitis or meningitis justifying the term “Ascaris encephalopathy” of toxic/allergic type. The hypotheses of its pathogenesis have been discussed. The presenting symptoms and signs, relevant laboratory investigations, and treatment have been discussed.

Breast-Feeding and Human Immunodeficiency Virus

Breast-feeding provides nutritional, immunological, and psychological benefits. It protects children from mortality and morbidity associated with diarrheal diseases, pneumonia and other infections. Breast feeding has also been shown to prolong the interval between births and thereby improve child survival and maternal health. However, studies suggest that in certain populations, breast feeding may account for nearly 14% of perinatal human immunodeficiency virus type 1 (HIV-1) transmission. It is therefore important that the risk of HIV-1 infection through breast feeding be weighed against the morbidity and mortality associated with bottle feeding. This paper discusses the literature dealing with breast feeding in women with HIV-1 infection. Specifically, the review addresses the issues surrounding infant mortality in areas of different HIV-1 prevalence where breast-feeding or bottle-feeding may be employed. Analysis suggests that the benefits of breast-feeding or bottle-feeding may be employed. Analysis suggests that the benefits of breastfeeding can substantially outweigh the putative risk of HIV-1 transmission unless the prevalence of HIV-1 infection is high or the difference in mortality between breast-fed and bottle-fed infants is very low.

Evaluation of B.C.G. test in the malnourished

Randomly selected 1,240 children suffering from various types of tuberculosis, and 700 children with other illness were simultaneously tested with P.P.D. & B.C.G. vaccine. Mantoux test was positive in 70.1% cases having tuberculosis with normal nutrition, while B.C.G. was positive in 100%.In various grades of malnutrition B.C.G. vs Mantoux test positivity was as follows: under nutrition 99.1% vs 44.0%, marasmus 95.4% vs 3.5%, marasmic kwashiorkor 80% vs 40%. In nontubercular children in various grades of malnutrition, B.C.G. test was positive with a greater frequency than Mantoux test. Hence B.C.G. was a better diagnostic test in all the three grades of malnutrition, making it more useful and reliable than the tuberculin test.

A clinical profile of diarrhoea in infancy and childhood a study of 200 cases

Summary200 cases of acute diarrhoea below 12 years of age were studied. Its incidence among hospitalized children was 26.5%. A majority of the cases was seen during summer months. Artificially fed infants were affected more often as compared to breast fed ones. 63% of cases had various grades of malnutrition. Dehydration of various degrees was seen in 93.5% of cases. Stool was positive for parasitic infestation in 17% of cases. Bacterial flora was increased in 68% of cases.

Leiomyoblastoma of small intestine

Gastrointestinal tumours are rare in children and leiomyoblastoma of small intestine is still rarer. We report a case of leiomyoblastoma of small intestine in a child who presented with acute intestinal obstruction.