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We report two case of infective endocarditis (IE) who were admitted and treated for other medical and surgical complications in the hospital. The first case was admitted for abdominal infection following seven month amenorrhea and the second case was admitted for bleeding esophageal varices. The risk factor in the first case was vaginal hysterectomy and mitral valve prolapse while in the second it was variceal sclerotherapy. Both patients developed infective endocarditis (IE) while being managed for their respective diseases. IE prophylaxis was not undertaken as the cardiac status at the time of admission was not available. Echocardiography played an important role in the diagnosis and management of both cases. We conclude that greater emphasis has to be placed in managing patients with cardiac condition undergoing any high risk upper gastrointestinal procedure / genitourinary procedure / abdominal surgeries. [ABSTRACT FROM AUTHOR]

Churg-Strauss syndrome is an extremely rare disease belonging to a group of primary vasculitis syndrome, which is present in approximately 1 in 1 to 3 million people. One rarefy comes across 1 or 2 cases in lifelong practice. According to Indian studies, its frequency is 1.78 in Indian population1. Only 11 patients of this disease were seen during a period of 11 years at AIIMS, New Delhi.2 This disease was first described by Churg & Strauss in 1951. The more common diseases of this group are Wegener's granulomatosis, polyarteritis nodosa, Bechets syndrome, Takayasu 's arteritis. Present case was a 40 year old male, who was referred as a suspected case of pulmonary TB / infective complications of Bronchial asthma. [ABSTRACT FROM AUTHOR]

Background & objectives: Dengue viruses are spread and maintained in an Aedes aegypti-human- Ae. aegypti cycle in urban areas of the tropics. Dengue viruses are also maintained in nature by vertical transmission by Ae. aegypti. A study was undertaken in Chennai, a known endemic city in south India, to comprehend the natural vertical transmission dynamics in Ae. aegypti and to assess its epidemiological importance. Methods: Ae. aegypti males collected in resting and landing collections were tested for dengue virus infection by antigen-capture enzyme-linked immunosorbent assay (ELISA) and further examined by insect bioassay, Toxorhynchites splendens inoculation-indirect immunofluorescence technique (Toxo-IFA) using serotype-specific monoclonal antibodies (Mabs), if found positive by ELISA. Results: Of the 509 pools of Ae. aegypti males (n=5408) screened, 15 pools, collected in April, June- July, November-December in 2003 and March, May in 2004, were found positive for dengue virus infection and the minimum infection rate (MIR) among adult males was high in June 2003 (28.0/ 1000). Three positive pools could be serotyped as dengue-2 (2 pools) and dengue-3 (1 pool). Interpretation & conclusions: Dengue virus isolations from wild caught males of Ae. aegypti indicate the occurrence of transovarial transmission. Vertical transmission was mainly observed in summer months when dengue infections in humans were low suggesting that dengue viruses adopt a novel strategy of surviving adverse climatic conditions. [ABSTRACT FROM AUTHOR]

Tuberculosis is known to be the 'Master Mimie'in disease presentations in most unusual settings. Unless a clinician is alert to its existence, such cases may be misdiagnosed. Here, such a case is presented, with rare involvement of small bones of left foot and disseminated bilateral lung lesions, in a full term pregnant female detected just after labour. As it is small, hand and foot bones are rarest of bone T.B involvements. [ABSTRACT FROM AUTHOR]

Tolosa Hunt Syndrome is a painful ophthalmoplegia & proptosis as a result of non-specific inflammation of the superorbital fissure area and cavernous sinus. Inflammation may be granulomatous or nongranulomatous & is usually unilateral. Biopsy of the lesion is required for a diagnosis but technical difficulties of usually mitigates for a trial of steroids. Treatment is Corticosteroids & a significant relief if seen in 24 to 48 hours further enhances the diagnostic possibility of Tolosa Hunt Syndrome. Some patients require aggressive therapy with Azathioprine, Methotrexate or radiation. Case Report: A 15 year old boy presented with complaints of headache, decreased vision & pain in both eyes, proptosis of right eye. Local examination showed proptosis of right eye with diminished reaction to light in right pupil. He also had partial ophthalmoplegia evident on looking up & down or to sides. Vision was poor with only finger counting at 1 metre in right eye & 6/60 in left eye. There was bilateral conjunctival infection & right lid oedema. Fundoscopy revealed dilated tortuous vessels & peripapillary oedema. CT scan of Head showed mild generalized cerebral oedema. Ultrasonogram of orbit showed thickened muscles. Since these findings were suggesting nongranulomatous changes in structures of superior orbital fissure & optic nerve, a good antibiotic cover with steroids was started. Rapid disappearance of signs & symptoms further lent credibility to a suspected diagnosis of Tolosa Hunt Syndrome. Patient's vision, proptosis & conjunctival oedema as well as papilloedema all responded in just 10 days time and he became asymptomatic. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented about a study on the role of the dengue virus serotype 3 in the prevalence of dengue fever in Madurai district, Tamil Nadu, India.

Background & objectives: The first chikungunya outbreak occurred in Kerala during 2006 affecting 14 districts, followed by another during May 2007 affecting almost whole of the State. Four of the worst affected districts viz, Pathanamthitta, Idukki, Kottayam and Thrissur were surveyed during 2007 to understand the magnitude of the problem of chikungunya fever, particularly clinical signs and symptoms. Methods: A total of 1265 persons from 310 houses were surveyed door-to-door in 20 different localities representing four affected districts. The history and examination findings from 354 clinically diagnosed chikungunya cases were recorded. The symptoms recorded were fever, headache, myalgia, arthralgia, itch/rash, oedema, eye congestion, eye pain, oral ulcers, distaste, nausea, vomiting and haemorrhage. Results: The major symptoms were fever (100%), headache (97.5%), arthralgia (99.4%) and myalgia (99.4%). A significant difference was observed in oedema, distaste, nausea and headache among different age groups and these symptoms were reported to be lower (12.2-89.8%) in younger age group than in older age group (90.4-100%). No genderwise difference was observed for any of the symptoms. In clinically diagnosed chikungunya cases higher age group (>35 years) found with higher rate of severity with symptoms of ocdema, distaste, nausea and headache when compared with lower age group (1-35 yr). Interpretation & conclusions: Chikungunya invaded Kerala State for the first time in 2006 and continues to be a major vector borne disease in the State. The clinical symptoms in affected cases highlighted high fever, sever myalgia and prolonged arthralgia, with occasional history of skin itch/rash (petechiae). [ABSTRACT FROM AUTHOR]

A letter to the editor is presented about the aetiology of dengue fever outbreak in Tirupur, Coimbatore district, Tamil Nadu, India.

In 2001, a major dengue outbreak was recorded in Chennai city, with 737 cases (90%) out of a total of 861 cases recorded from Tamil Nadu state. A KAP survey was carried out to assess the community knowledge, attitude and practice on dengue fever (DF), following the major dengue outbreak in 2001. A pre- tested, structured questionnaire was used for data collection. The multistage cluster sampling method was employed and 640 households (HHs) were surveyed. Among the total HHs surveyed, 34.5% of HHs were aware of dengue and only 3.3% of HHs knew that virus is the causative agent for DF. Majority of the HHs (86.5%) practiced water storage and only 3% of them stored water more than 5 days. No control measures were followed to avoid mosquito breeding in the water holding containers by majority of HHs (65%). Sixty percent of HHs did not know the biting behaviour of dengue vector mosquitoes. The survey results indicate that the community knowledge was very poor on dengue, its transmission, vector breeding sources, biting behavior and preventive measures. The lack of basic knowledge of the community on dengue epidemiology and vector bionomics would be also a major cause of increasing trend of dengue in this highly populated urban environment. There is an inevitable need to organize health education programmes about dengue disease to increase community knowledge and also to sensitize the community to participate in integrated vector control programme to resolve the dengue problem.

Correct and precise identification of mosquito vectors is important in many respects including development of vector control strategies. Conventional identification methods have limitations for sibling and closely related species of mosquitoes, stage and quality of the specimen used and this could be overcome by DNA-based identification methods using molecular markers such as nuclear ribosomal internal transcribed spacer (ITS) which do not demand intact or undamaged specimen. Genomic DNA is usually isolated from whole mosquito, legs, wings etc. Alternate sources for genomic DNA isolation such as eggshells, larval and pupal exuviae were explored in this study by amplifying the ITS markers. Standardization of genomic DNA extraction and ITS amplification were carried out with laboratory specimens. The same was applied to specimens collected from the field. The results show that PCR amenable genomic DNA could be isolated from fresh exuviae collected in the laboratory and not from older and/or field specimens. But exuviae of larvae and/or pupae collected in the field reared to adulthood in the laboratory yielded PCR amenable genomic DNA. The results also revealed that the ITS2 marker could very well differentiate Aedes aegypti and Aedes albopictus by producing amplicons of ~330 bp and ~520 bp, respectively. The genomic DNA from these alternate sources also supported the species-specific PCR to distinguish the Culex vishnui subgroup mosquitoes.

The adult female, adult male, pupa, and larva of Verrallina (Neomacleaya) assamensis, a new mosquito species, are described from the Dibrugarh District of Assam State, India.

Chest radiographic appearance of pulmonary tuberculosis (TB) in Human Immunodeficiency Virus (HIV) positive patients was reviewed. A study group of 50 HIV +ve cases and a control group of 100 HIV -ve cases were analysed. The chest radiographs of HIV seropositive group showed significantly higher incidence of thoracic lymphadenopathy (36% vs 8%, P<.001), pleural effusion (28% vs 10%, P<.01) and miliary pattern (12% vs 2%, P<.05) as compared to the seronegative group. Cavitation was less common in the seropositive group (8% vs 35%, P<.001) than the seronegative group. Upper zone involvement was significantly less common in the study group (38% vs 77%, P<.001) as compared to the control group.