Leptospira can be found in virtually all tropical and temperate areas of the world and is presumed to be the most wide spread zoonoses in the world.Humans contact leptospirosis through mucosal or percutaneous exposure to leptospires in environments contaminated by the urine of chronically infected animal sources. Despite being common, the diagnosis of leptospirosis is often not made unless a patient presents with textbook manifestations of the so called Weil’s disease, such as fever plus jaundice, renal failure and pulmonary haemorrhage. Leptospiral infection often has minimal or no clinical manifestations; of the cases in which fever develops, as many as 90% are undifferentiated febrile illnesses. Because of the variety of clinical symptoms seen in the symptomatic cases, leptospirosis at its onset is often misdiagnosed as aseptic meningitis, influenza, hepatic disease or fever (pyrexia) of unknown origin. Moreover, clinicians may fail to recognize that transmission of leptospirosis can occur in the urban setting because it is incorrectly perceived to be a rural disease. Therefore, diagnosis is based on laboratory tests rather than on clinical symptoms alone. In developing countries, laboratory facilities may be inadequate for diagnosis despite a high prevalence of the disease. Of substantial clinical importance, the syndrome of leptospiral pulmonary haemorrhage has emerged in recent years, in diverse places around the world.

Leptospirosis Diagnosis: Competancy of Various Laboratory Tests

Background: This case series analyses the beneficial effect of methylprednisolone in pulmonary leptospirosis, which usually has an aggressive course and grave outcome. Methods: 30 patients of pulmonary leptospirosis were evaluated. The initial 13 patients did not receive corticosteroids while the remaining 17 all received bolus methylprednisolone one gram intravenously for three days followed by oral prednisolone 1 mg/kg for seven days, on the basis of occasional case reports of benefit in pulmonary leptospirosis. APACHE III and lung injury scores of similar severity were considered while comparing outcomes in those who received methylprednisolone with those who did not. Results: Dyspnoea and haemoptysis were the commonest symptoms in those with pulmonary manifestations. Overall mortality was 18% (3 of 17) in patients who received methylprednisolone, as compared with 62% (8 of 13 patients) in those who did not (p 2.5), five of eight patients survived in the subgroup with corticosteroids (37% mortality) while only one of nine patients survived in the group that did not receive corticosteroids (89% mortality). Corticosteroids affected outcome only if given within the first 12 hours after the onset of pulmonary manifestations. Mortality seemed to correlate with the APACHE scores, and number of quadrants affected on chest radiographs, more than with blood gas pressures. Conclusions: Corticosteroids reduce mortality and change outcome significantly when used early in the management of pulmonary leptospirosis.

/pdf/pulmonary-leptospirosis-an-excellent-response-to-bolus-1q5837eocy.pdf

Pulmonary leptospirosis: an excellent response to bolus methylprednisolone.

The recent high-profile death of a British Olympic rower from leptospirosis has raised awareness to this uncommon but potentially fatal disease. The re-emergence of the disease abroad is well documented in the literature, but less is known about cases in the UK. The increase in participation in water sports, foreign travel and often a combination of the two, has increased the exposure of tourists subsequently returning to the UK from areas of high prevalence. Leptospirosis is a zoonotic infection. The bacteria are shed in the urine of animals to the environment from where humans are infected by incidental hosts. There is a wide spectrum of severity of symptoms, from a self-limiting febrile illness to fatal pulmonary haemorrhage, renal or liver failure. It is thought that cases remain unrecognized every year in the UK, largely due to the mild nature of symptoms and the wide differential for febrile illness and partly due to lack of awareness among clinicians. This review examines the epidemiology of leptospirosis in the UK, over the period 2006-10, the clinical features, diagnostic techniques and treatment.

/pdf/leptospirosis-and-weil-s-disease-in-the-uk-1lpnlo9guc.pdf

Leptospirosis and Weil’s disease in the UK

Leptospirosis: Increasing importance in developing countries

A pre-fattening trial was performed to evaluate the effect of replacement of fishmeal (FM) with insect meal (IM; Tenebrio molitor) on growth performance and survival rate of common catfish (Ameiurus melas). Fingerlings of A. melas (mean body weight 0.248±0.07 g) were randomly distributed over 4 indoor tanks of 2 m3 at a density of 2,000 fish/tank, and kept at a temperature of 23-25 °C in two separated recirculating aquaculture systems. Fish were divided into two groups (two tanks per group): FM and IM. Fish of the FM group were fed with a control diet (51.6% protein and 18.1% lipid), whereas those of the IM group received a diet (50.8% protein and 22.1% lipid) in which 50% of FM was substituted with IM. Chemical parameters (moisture, crude protein, total lipids, ether extract, and ash) and fatty acid profile of the two feeds is reported. The feeding trial lasted 90 days and fish were weighed at the beginning of the trial and then on monthly basis. Growth performance was good in both groups. However, fish ...

/pdf/growth-performance-of-common-catfish-ameiurus-melas-raf-169pigme7h.pdf

Growth performance of common catfish (Ameiurus melas Raf.) fingerlings fed mealworm (Tenebrio molitor) diet

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.

Laboratory diagnosis of leptospirosis

The present study was carried out to establish the gastrointestinal parasites profile in cattle at Parasitology Division of the Veterinary Research Institute, Khyber PakhtunKhwa, Peshawar. A total of 4490 fecal samples of cattle of different breeds consisting of 3731 (83.09%) females and 759 (16.91%) males were examined. These samples were processed and screened by direct smear method for the detection of parasitic ova. Ova of parasites were identified through their morphological features using the available keys. Fecal examination revealed an overall prevalence of 2901 (64.61%), while the prevalence in females and males were 2411 (83.10%) and 490 (16.90%), respectively. Out of 2901 gastrointestinal parasites encountered 2209 (76.15%) were helminthes and 395 (13.62%) were protozoan parasites.297 showed mixed infestation. The helminthes observed were Nematodes (Strongyloides papillosus, Trichuris, Haemonchus contortus, Nematodirus spathiger, Enterobius vermicularis, Dictyocaulus viviparous, Ostertagia ostertagi, Trichostrongylus colubriformis, Oesophagastomum radiatum), Trematodes (Fasciola hepatica, Fasciola gigantica, paramhistomum cervi, Dicrocoelium dendriticum, Fasciolopsis buski, Schistosoma sp) and Cestodes (Taenia, Moniezia expansa sp), while Entamoeba sp and Eimeria were the protozoa encountered. In the males, Trichostrongylus colubriformis sp. had the highest prevalence of 13.83%, while in female Trichostrongylus colubriformis spp and Ostertagia ostertagi sp had the prevalence of (16.24%) and (6.65%), respectively.

Prevalence of gastrointestinal tract parasites in cattle of Khyber Pakhtunkhwa.

Background: Neonatal seizures (NS) affect approximately 1% of neonates. Clonic, tonic, myoclonic and subtle seizures are the common types. Birth asphyxia, sepsis, metabolic derangements, intracranial bleed, kernicterus, tetanus and 5 th day fits are the common aetiologies. This study was planned to evaluate the types and causes of neonatal seizures. Methods: It was a descriptive case series conducted at Ayub Teaching Hospital, Abbottabad from 12 th December 2006 to 25 th September 2007 on neonates having seizures. Serum chemistry, blood counts, cerebrospinal fluid examination and cranial ultrasound were done in all patients. Blood culture, renal and liver function tests, computerised tomography scan, metabolic and septic screening was done in selected patients. Descriptive statistics were applied for analysis. Results: Tonic clonic seizure was the commonest type (28%) followed by multi-focal clonic, and focal tonic seizures (25% each). Birth asphyxia was found to be the main aetiology (46%). Conclusion: Tonic clonic seizure was the commonest type and birth asphyxia the main aetiology identified in the majority of neonatal seizures. Keywords : Neonatal seizures, Aetiology, Seizures, Epilepsy, Neonates

/pdf/aetiology-and-types-of-neonatal-seizures-presenting-at-ayub-3zoicb4t6g.pdf

Aetiology and types of neonatal seizures presenting at Ayub Teaching Hospital Abbottabad.

Background: Mental health disorders are becoming an increasingly common occurrence worldwide and present a major public health concern. Depression has been recognized as a major contributor in mental health disability burden. This study aims to determine the frequency of depression among individuals presenting at a rural health facility in Lahore and to identify the risk factors associated with it. Methods: A cross sectional study was conducted at Rural Health Centre Kahna nau, Lahore from January to April 2017. A sample of 384 consenting individuals presenting at the rural health facility were selected through consecutive sampling technique. Beck Depression Inventory (BDI), was used to assess the level of depression amongst the respondents. We categorized the BDI score for this study into BDI ≥20 as “depressed” and BDI <20 as “non-depressed”. Data was entered and analysed by using SPSS 16.0. Chi-square test was carried out to identify factors associated with depression, significant at a p -value of ≤0.05. Results: Out of total, 258 (69.5%) respondents were males with 197 (53%) in age category of 25–44 years. BDI scale showed 84 (23%) respondents to be suffering from depression. Age ( p =0.002), income ( p =0.003), marital status ( p =0.023), educational status (0.011), family structure ( p =0.041), history of hospitalization ( p =0.003), smoking status (0.012) and co-morbidity ( p =0.001) were significantly associated with depression. Conclusion: Our study found a substantial proportion of patients’ who were suffering from depression. Age, income, marital status, educational qualification, family structure, co-morbidity and smoking status were significantly associated with depression.  Keywords: Depression; Rural health centre; Beck Depression Inventory; Mental health

Depression and associated factors: a cross-sectional study using beck depression inventory

Child abuse is one of the most serious problems in the world. The issue of child abuse is a major concern for governments around the globe, as it has a profound effect on society. As a result of this problem, many media houses, scholars and people from all walks of life are engaged in trying to understand and examine the problem of child abuse, especially in terms of causes and measures. The present study will provide beneficial and purposeful information on child physical abuse and the feasible relationship with cultural factors. Therefore, this study aims to highlight the major problems faced by children in the form of physical abuse in Malakand district. The purpose of the present study is to fulfill the research gap in Malakand District about the consequences of physical abuse of children who have experienced numerous or all types of physical abuse. The study was based on the interviews from the volunteers about Physical punishments in Malakand.

Sher Shah

Papers

Laboratory diagnosis of leptospirosis

Prevalence of gastrointestinal tract parasites in cattle of Khyber Pakhtunkhwa.

Aetiology and types of neonatal seizures presenting at Ayub Teaching Hospital Abbottabad.

Depression and associated factors: a cross-sectional study using beck depression inventory

Socio-Cultural Factors Associated with Child Physical Abuse: Pragmatic Facts from Malakand, Pakistan