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   2005| July-September  | Volume 51 | Issue 3  
 
 
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SYMPOSIUM
Laboratory diagnosis of leptospirosis
SN Ahmad, S Shah, FM H Ahmad
July-September 2005, 51(3):195-200
PMID:16333192
Leptospirosis is a worldwide zoonosis caused by pathogenic Leptospira species, for which humans are accidental hosts. It is endemic in the tropical urban areas including our country, where seasonal epidemics are becoming increasingly common. Laboratory tests are necessary to confirm the diagnosis of clinically suspected leptospirosis due to its varied symptomatology. Moreover, leptospirosis must always be considered during the differential diagnosis of other tropical febrile illnesses .Laboratory analysis depends on the samples available and temporal stage of the illness. A confusing array of laboratory tests is described for the detection of this spirochete and antibodies. The conventional tests include direct microscopy, culture and the most widely used reference standard method -the microscopic agglutination test. In addition a variety of newer serological tests and those based on molecular techniques have been described.This review has attempted to describe the basis of these techniques and discussed the relative advantages and drawbacks of these assays with special emphasis on the selection of the most appropriate specimen and test, and the correct interpretation of the test result
  29,721 1,395 19
Unusual clinical manifestations of leptospirosis
AM Bal
July-September 2005, 51(3):179-183
PMID:16333189
Leptospirosis has protean clinical manifestations. The classical presentation of the disease is an acute biphasic febrile illness with or without jaundice. Unusual clinical manifestations may result from involvement of pulmonary, cardiovascular, neural, gastrointestinal, ocular and other systems. Immunological phenomena secondary to antigenic mimicry may also be an important component of many clinical features and may be responsible for reactive arthritis. Leptospirosis in early pregnancy may lead to fetal loss. There are a few reports of leptospirosis in HIV- infected individuals but no generalisation can be made due to paucity of data. It is important to bear in mind that leptospiral illness may be a significant component in cases of dual infections or in simultaneous infections with more than two pathogens.
  25,588 1,033 13
Leptospirosis vaccines: Past, present, and future
N Koizumi, H Watanabe
July-September 2005, 51(3):210-214
PMID:16333195
It is well known that Leptospira vaccine prevents the disease. However specificity for serovars limits the efficacy of killed whole cell vaccines. Leptospiral antigens that induce cross-protective immunity to the various serovars are sought as new vaccine candidates. In this paper, we have summarized both past and current findings about leptospiral antigens that are conserved among pathogenic leptospires and that induce protective immunity in animal models. The full-length genome sequences of two Leptospira strains have been published and reverse vaccinology has been used to identify leptospiral vaccine candidates. Although humoral immunity is thought to be dominant in protection from leptospiral infection, a role for cell-mediated immunity is now being explored.
  23,446 1,219 22
Ocular manifestations of leptospirosis
SR Rathinam
July-September 2005, 51(3):189-194
PMID:16333191
Leptospiral uveitis is a common entity in tropical countries. Ocular manifestations are noted in the second phase of illness, but these remain under-diagnosed mainly because of the prolonged symptom-free period that separates the systemic manifestations from detection of ocular manifestations.Varying ophthalmic presentations and the intrinsic nature of different types of uveitis to mimic one another also challenge the accuracy of the diagnosis. Of the individual ocular signs, the combination of acute, non-granulomatous, panuveitis, hypopyon, vasculitis, optic disc edema, membranous vitreous opacities and absence of choroiditis or retinitis have high predictive value for the clinical diagnosis of leptospiral uveitis. Geographic location of the patient, occupation, socio-economic status, risk factors related to exposure, past history of fever or jaundice also aid in diagnosis.Steroids are the mainstay of treatment for leptospiral uveitis. Depending upon the severity and anatomical location of inflammatory lesion, topical, peri-ocular and/or systemic steroids are given. The prognosis is generally good, even when the inflammation is severe.
  22,935 686 12
Human leptospirosis: Management and prognosis
Y Kobayashi
July-September 2005, 51(3):201-204
PMID:16333193
As leptospirosis is a treatable disease, early diagnosis and prompt treatment are important for better prognosis. Early diagnosis depends on the knowledge of epidemiological factors, presenting features and use of appropriate laboratory tests. Early institution of appropriate antimicrobial therapy in combination with supportive therapy reduces the mortality from this disease. Leptospires are sensitive to a variety of antimicrobial agents, including penicillin, cephems, aminoglycosides, tetracyclines and macrolides. Of these antimicrobial agents, short-term treatment with streptomycin exterminates, leptospires. When penicillin, cephems, tetracylines and macrolides are used, long-term therapy with large doses may be required from the early stage of the disease until the appearance of antibodies.
  21,629 1,253 17
GRAND ROUND CASE
A man with recurrent abdominal pain and hypotension
J Mathew, PS Menon, NS Shah, AN Supe
July-September 2005, 51(3):234-235
PMID:16333204
  17,490 213 2
SYMPOSIUM
Nephropathy in leptospirosis
S Visith, P Kearkiat
July-September 2005, 51(3):184-188
PMID:16333190
Renal involvement is common in leptospirosis. Bacterial invasion, inflammatory process, haemodynamic alterations and direct toxicity of bacterial products are thought to be responsible for the development of nephropathy. Pathologically, all renal structures are involved. Interstitial nephritis is the basic lesion, and is observed even in patients without clinical renal manifestations. Tubular necrosis is the important pathological counterpart of acute renal failure. The clinical spectrum of renal manifestations includes mild urinary sediment change, hypokalemia, tubular dysfunction, decreased response to fluid load and acute renal failure (ARF). ARF reflects the severity of leptospirosis, is catabolic and is commonly associated with cholestatic jaundice. Severe renal failure may be complicated by multiple organ involvement. Renal failure with hyperbilirubinemia represents a severe form of renal dysfunction with oligo-anuria and prolonged clinical course. Mild renal failure is usually anicteric and non-oliguric and without complication. Besides antibiotic treatment, early and frequent dialysis is life saving. ARF with major organ failure has unfavorable outcome. Plasmapheresis and continuous venovenous hemofiltration improve hemodynamics and are beneficial for the patients with acute renal failure and multiorgan involvement. Recovery of renal function is usually complete in most patients.
  15,194 1,071 20
The prevention and control of human leptospirosis
TJ John
July-September 2005, 51(3):205-209
PMID:16333194
Human leptospirosis is prevalent in several states in India, sporadically or as outbreaks, especially during rainy seasons. It affects predominantly male adults who work in agriculture, causing severe morbidity and unnecessary mortality. Yet, there is no systematic leptospirosis prevention and control programme in the country, as it is not identified as priority under the national health policy. Therefore states with leptospirosis ought to establish public health programme for its prevention and control, as part of building a comprehensive initiative for the control of all-important infectious diseases. After establishing disease surveillance and laboratory support service, the disease burden must be monitored before and during interventions for control. The District is the ideal unit of activity, with full participation of the State Government and Local Panchayati raj. The public health staff must give technical leadership and the risk factors of human leptospirosis must be identified and specific interventions targeted against them. Action must be local-area-specific and coordinated between the Departments of Health, Agriculture, Animal Husbandry, Environment and Forestry. A model leptospirosis control programme has been formulated in Kerala State and is awaiting implementation. A state level Diagnostic and Epidemiolgy centre has been established to provide technical leadership. This model must be implemented and also replicated in other states. The most important ingredient for the control of infectious diseases is the 'political will'.
  14,427 727 6
A global research agenda for leptospirosis
ER Cachay, JM Vinetz
July-September 2005, 51(3):174-178
PMID:16333188
Leptospirosis is a zoonotic spirochetal disease of global importance. This disease continues to have a major impact on people living in urban and rural areas of developing countries with inestimable morbidity and mortality. Funding for research and control efforts is currently haphazard, not organized and not effective for public health efforts, primarily because there are no concerted, ongoing international efforts to assess the impact of leptospirosis on human health. Major issues in the field need to be addressed to develop strategies of control, amelioration and treatment. These include the following: mechanisms of naturally acquired and vaccine-induced protective immunity against clinical leptospirosis; mechanisms of severe leptospirosis pathogenesis; standardized, precise and simplified taxonomy of Leptospira relevant to disease manifestations, transmission and control; effective adjunct treatments in addition to antimicrobials; and environmental assessment for risk of leptospirosis transmission and relevant mammalian reservoirs. Once effective ongoing, collaborative international efforts to assess the impact of leptospirosis on human and veterinary health are underway, appropriate mobilization of clinical and public health research funding will follow.
  14,428 647 9
ORIGINAL ARTICLE
A study of autopsy findings in 62 cases of leptospirosis in a metropolitan city in India
HP Salkade, S Divate, JR Deshpande, V Kawishwar, R Chaturvedi, BM Kandalkar, P Vaideeswar
July-September 2005, 51(3):169-173
PMID:16333187
Background: Leptospirosis is an important sporadic zoonotic disease caused by the spirochete Leptospira icterohaemorrhagiae . The disease becomes a major public health problem, particularly during the monsoon months. Materials and Methods : Analysis of autopsy findings of 62 cases of clinically suspected leptospirosis was carried out to identify the pathology and determine the cause of death. Results : Most patients were young males who presented with fever, breathlessness, haemoptysis, bleeding, oliguria and icterus. They died after a brief stay in hospital. A post-mortem diagnosis of leptospirosis was made on the basis of characteristic organ findings, aided by results of serology, Levaditi's staining and / or immunohistochemistry (IHC) on kidney sections. Massive intra-alveolar haemorrhage (48 cases), acute interstitial nephritis and / or acute tubular necrosis (45 cases) and myocarditis (24 cases) were the main autopsy findings. Haemorrhage in various organs like the heart, gastrointestinal tract, brain, pancreas and adrenals were also seen. Thirty of 54 kidney sections were positive for leptospiral antigens by IHC. There was extensive haemorrhages in the lungs in 48 (77%) cases and that was the cause of death in most of these cases. Conclusion : Bleeding into various tissues and organs is the main finding noted in this study. The post-mortem examination of patients dying of leptospirosis revealed that pulmonary haemorrhage was the cause of death in most individuals.
  10,760 423 15
IMAGES IN PATHOLOGY
Metastatic choriocarcinoma : An unusual cause of severe anaemia
M Chaturvedi, P Vaideeswar, AA Pandit
July-September 2005, 51(3):230-231
PMID:16333202
  10,035 184 -
ORIGINAL ARTICLE
Gel purified lipl32: A prospective antigen for detection of leptospirosis
P Tahiliani, M Mohan Kumar, D Chandu, A Kumar, C Nagaraj, D Nandi
July-September 2005, 51(3):164-168
PMID:16333186
Background: Leptospirosis, a zoonosis, is a re-emerging disease, affecting populations across the globe. However, the current methods of diagnosis are time- consuming, cumbersome, imprecise or expensive. Aim: To develop an assay for differential and early diagnosis of Leptospirosis. Methods and Material: IgG based ELISA for evaluation of three antigens, namely, a gel-purified recombinant protein (rLipL32), secreted proteins and whole organism sonicates of Leptospira spp. The antigens were evaluated using, rabbit polyclonal antiserum and human sera samples. Results: Studies with a rabbit polyclonal antiserum indicated the utility of these antigens in differentiating Leptospira from other common pathogenic organisms. Evaluation of these antigens with fifteen representative human serum samples indicated gel-purified rLipL32 to be a potentially useful antigen for detection of leptospirosis. The results obtained with IgG ELISA were correlated with the results of microscopic agglutination test (MAT). Conclusion: Gel-purified rLipL32 is a valuable antigen for early and accurate diagnosis of leptospirosis. Further evaluation of this assay in field conditions and larger sera samples will indicate its suitability in case of an epidemic.
  9,583 361 5
CPC
Congestive cardiac failure and anemia in a 15-year-old boy
VV Shenoy, PV Patil, VS Nagar, AK Deshpande, RT Shedge, AP Badiye, R Saigaonkar
July-September 2005, 51(3):225-227
PMID:16333200
  9,451 243 -
IMAGES IN MEDICINE
Mucolipidosis II (I - Cell Disease)
TS Kumar, JX Scott, P Raghupathy, PD Moses
July-September 2005, 51(3):232-233
PMID:16333203
  9,247 334 1
IMAGES IN RADIOLOGY
Ultrafast magnetic resonance imaging of cephalothoracopagus janiceps disymmetros
Paritosh C Khanna, SA Pungavkar, DP Patkar
July-September 2005, 51(3):228-229
PMID:16333201
  8,935 180 3
EDITORIAL
Stem cell therapy - A panacea for all ills?
L Rajgopal
July-September 2005, 51(3):161-163
PMID:16333185
  8,736 242 4
LETTER TO EDITOR
Anaphylaxis and hypersensitivity syndrome reactions in increasing severity following repeated exposure to tinidazole
SS Singbal, PV Rataboli
July-September 2005, 51(3):243-244
PMID:16333209
  8,455 175 1
CASE REPORTS
Pregnancy in a patient with hypopituitarism following surgery and radiation for a pituitary adenoma
VP Thomas, B Sathya, S George, N Thomas
July-September 2005, 51(3):223-224
PMID:16333199
This is a case of partial hypopituitarism resulting from surgery and radiation for a non- functioning pituitary macroadenoma. The patient had amenorrhea which was secondary to hypogonadotrophic hypogonadism and had been on L-thyroxine for central hypothyroidism. For pregnancy, ovulation was induced by gonadotrophins and this was followed by an intrauterine insemination. The antenatal period was uneventful and a Caesarean section was done at 33 weeks when the patient presented with preterm labour. Both infant and mother are well, eight months after delivery.
  8,400 204 1
Craniospinal dissemination of clival chondroid chordoma
SV Shinde, K Monipanda
July-September 2005, 51(3):220-222
PMID:16333198
Chondroid chordoma commonly presents as clival osseous and extradural mass. A 15-year-old boy presented with progressive visual deficit, headaches and diplopia since three years. Computed tomography (CT scan) showed a skull base tumour, but was wrongly reported at the time as chronic sphenoidal sinusitis and nasal polyps. In the past three months, he developed dysphagia, urinary retention and constipation. Terminally, he had weakness of all limbs. Fundoscopy showed optic atrophy. Temporal and spatial variation in symptoms led to a clinical diagnosis of multiple sclerosis with optic neuritis. Partial brain autopsy revealed small gelatinous tumour nodules in the subarachnoid space of middle cranial fossa encasing base of brain like arachnoiditis. Tumour deposits extended down into the spinal cord along the subarachnoid space as far as vision allowed. Histopathology and immunohistochemistry confirmed a diagnosis of chondroid chordoma. Awareness of this rare mode of dissemination will avoid misdiagnosis and delay in treatment
  7,862 212 2
Leucocytoclastic vasculitis as a presentation of adenocarcinoma rectum
A Gogia, A Kakar, S Bhalla, SP Byotra
July-September 2005, 51(3):215-217
PMID:16333196
Vasculitis has been linked to several processes, like infections, drugs and allergic, rheumatologic and neoplastic diseases. Neoplasm-associated vasculitis described in the medical literature has mostly been reported in association with haemotological neoplasms. Adenocarcinoma of rectum presenting as leucocytoclastic vasculitis is rare. We present a case of a 43-year-old male with paraneoplastic leucocytoclastic vasculitis preceding the manifestation of adenocarcinoma rectum. The vasculitis subsided on resection of the rectal malignancy and the patient did not require steroid therapy thereafter.
  7,571 202 3
STUDENTS CORNER
Curious clicks - Sigmund Freud
DN Sheth, MR Bhagwate, N Sharma
July-September 2005, 51(3):240-241
PMID:16333207
  6,106 142 -
A beginner's guide to research-part I
KS Jethwani, NM Kanodra
July-September 2005, 51(3):238-239
PMID:16333206
  5,484 279 -
CASE REPORTS
Isolated lingual leishmaniasis
F Habibzadeh, J Sajedianfard, M Yadollahie
July-September 2005, 51(3):218-219
PMID:16333197
Cutaneous leishmaniasis is endemic in Fars Province, southern Iran. However, mucosal leishmaniasis is extremely uncommon. Herein, we report a patient with isolated lingual leishmaniasis in an immunocompetent 40-year-old man. The lesion was totally excised. The patient was cured completely and is doing well after four years of follow-up, with no medical treatment
  5,459 185 7
STUDENTS CORNER
Medical undergraduate research-The game is worth the candle!
AH Goenka
July-September 2005, 51(3):236-237
PMID:16333205
  5,256 180 -
LETTER TO EDITOR
Brand confusion causes allergic dermatitis
RT Damodaran
July-September 2005, 51(3):242-242
PMID:16333208
  4,394 137 -
Alexander's disease presenting as status epilepticus in a child
R Ramachandran Nair
July-September 2005, 51(3):244-244
PMID:16333210
  4,276 159 1
A jejunoileal duplication diagnosed by Tc-99m pertechnetate abdominal scintigraphy
R Mehmet, A Mehmet, AY Fuat, B Nebil
July-September 2005, 51(3):245-246
PMID:16333211
  4,064 147 -
EXPERT«SQ»S COMMENTS
The potential use of the leptospiral major outer membrane lipoprotein LipL32 in the diagnosis of leptospirosis
Henk L Smits
July-September 2005, 51(3):168-168
  3,649 186 -
Online since 12th February '04
© 2004 - Journal of Postgraduate Medicine
Official Publication of the Staff Society of the Seth GS Medical College and KEM Hospital, Mumbai, India
Published by Wolters Kluwer - Medknow