Showing papers in "International Blood Research & Reviews in 2021"

Adult Lymphomas in a Tertiary Hospital in South – South Nigeria: A Review of Clinicopathologic Features and Treatment Outcome

Abstract: Background: There has been an increase in the prevalence of Lymphomas in our environment lately. Thorough literature search reveals a limited number of reports on the prevalence of Lymphoma and no information on the clinicopathologic pattern and outcome of treatment of this disease in our centre. Data on the burden of Lymphoma across different regions are important, as Original Research Article Akpan et al.; IBRR, 12(1): 28-40, 2021; Article no.IBRR.65104 29 there may be variation in incidence in different locations even within the same country. This will keep healthcare providers informed about the current trend of Lymphomas in the region and facilitate prompt and appropriate diagnosis and treatment as well as assist Government agencies in better healthcare planning. Aim: To determine the burden, clinicopathologic characteristics and treatment outcome of Lymphoma among a cohort of adult patients accessing care in a Referral Hospital in Southern Nigeria Methods: This was a longitudinal prospective study of all lymphoma cases managed in the Department of Haematology, University of Uyo Teaching Hospital, Uyo, between January 1, 2014 and December 31, 2018 Results: There were 59 cases. Forty 40 (67.8%) were males and 19(32.2%)were females giving a male to female ratio of 4.4:1. Hodgkin Lymphoma(HL) accounted for 11(18.6%) of the cases while Non-Hodgkin Lymphoma(NHL) accounted for 48( 81.4%)of the cases , with the mean ages for HL and NHL patients being 32.09 +9.22 years and 40.88 + 12.21 years, respectively. The distribution of the different histologic subtypes of the malignancy were as follows: HL; Nodular Lymphocyte Predominant(7cases;63.6%), Nodular Sclerosis(2 cases;18.2%) and Lymphocyte Depleted(2 cases;18.2%). NHL; Small Lymphocytic Lymphoma(23cases;47.9%),Diffuse Large Cell Lymphoma(15 cases;31.3%),unspecified (4 cases;8.3%), Follicular Lymphoma(2 cases;4.2%),Lymphoblastic Lymphoma(2 cases;4.2%), Mantle Cell Lymphoma(1 case;2.1%) and Adult T-Cell Lymphoma(1 case;2.1%). Fourteen 14 (29.2%) out of all the NHL patients had immunohistochemistry and only nine 9 of them were CD20 positive. Relapse rate among the cohort was 11.9% (7/59), while 15.3% (9/59) were still in remission. The cure rate was 5.1%, loss to follow up was 22.0% and 37.3% of patients died in the course of therapy either from advanced disease, non -compliance to treatment or late presentation. All the HL patients received ABVD (Adriamycin, Bleomycin, Vinblastine and Dacarbazine) regimen alone. Majority of the NHL patients (91.7%, 44/48) received CHOP (Cyclophosphamide, Doxorubicin, Oncovin and Prednisolone) regimen alone, while 8.3% (4/48) received Rituximab with CHOP (R-CHOP). Conclusion: The clinicopathological profile, age and sex distribution of lymphoma in our study were comparable to those reported by other authors with nodular lymphocyte predominant being the most common HL histologic subtype and small lymphocytic lymphoma the predominant NHL histologic subtype in our environment. The general outcome was very poor with a high default rate and unsettling mortality figures.

Serum Antioxidant Enzymes, Haematological Values and Uric Acid Concentrations in Prostatic Disease Patients: An Investigative Study

Abstract: Aim: In this study, the haematology, serum antioxidant enzymes, and uric acid concentrations in prostatic disease patients attending the Nephrology Department of Abia State University Teaching Hospital, Aba were evaluated. Methodology: A total of one hundred and ten (110) adult males (aged 40-80 years) comprising of sixty (60) prostatic disease patients and 50 normal subjects were recruited. The prostatic disease patients comprised of 30 prostatitis, 20 Benign Prostatic Hyperplasia (BPH), and 10 prostate cancer patients. Haematological parameters, antioxidant enzyme levels, and uric acid concentration were Original Research Article Agnes et al.; IBRR, 12(2): 31-38, 2021; Article no.IBRR.61400 32 determined on blood samples collected from the subjects between January 2017 and December 2019. Results: Results obtained following analysis indicated a significant fall in red blood cell count, haematocrit levels and haemoglobin concentrations in all the prostatic disease patients when compared with control subjects (p<0.05) but no significant difference was observed between the values of these parameters in the three categories of patients studied (p>0.05). Leukocyte and lymphocyte counts in the patients also did not significantly differ from those of the control subjects (p>0.05) but platelets counts were significantly lower (p<0.05). Significant elevations were observed in monocytes and granulocytes counts of prostatitis and prostate cancer patients (p<0.05). Serum antioxidant enzymes activities including superoxide dismutase (SOD) and glutathione peroxidase (GPx) were lower in the prostatic disease patients than in the control (p<0.05) with SOD and GPx levels being lowest in prostatitis and prostate cancer patients respectively while serum uric acid concentration was only higher than control in the prostatitis patients (p<0.05). Conclusion: We, therefore, conclude that complications and deaths due to prostatic diseases may be due to the systemic effects of anaemia and fall in the body’s antioxidant defense line accompanying the conditions.

Anemia: Considerations for the Dental Practitioner

Abstract: Anemia is a condition of decreased red blood cell number or hemoglobin concentration, or of disturbance in their function, ultimately leading to decreased oxygen transport to tissues. Many factors and diseases may lead to anemia, with wide manifestations systemically as well as orally. Therefore, a sound understanding of this condition is essential for the dental practitioner, with emphasis on alerting signs, dental management and proper communication with patient’s physician.

Prevalence and Factors Associated to Persistent Anemia among Pregnant Women in the Buea Health District, Cameroon

Abstract: Introduction: Anemia in pregnancy represents a life-threatening but preventable reason for maternal and childhood morbidity and mortality. Although intervention measures are practiced in most affected countries like Cameroon, the impact of anemia on pregnant women is still apparent in most local communities. The relative contribution of sociodemographic related to anemia throughout gestation varies greatly and warrants investigation in urban and rural communities in developing countries, where the condition is most apparent. Methods: A cross-sectional study design was carried out from February to July 2019 at six sites, Original Research Article Ako et al.; IBRR, 12(1): 20-27, 2021; Article no.IBRR.60708 21 Regional Hospital Buea, Bokwango Integrated Health Center (IHC), Buea Road IHC, Buea town IHC, Molyko IHC, and Great Soppo IHC. A total of 408 pregnant women were enrolled in the study. The sociodemographic characteristics identified through questionnaires filled by the participants included age, marital status, educational status, occupation, gravida status, alcohol intake, iron folate intake, knowledge on anemia and crave for non-food substance. The clinical factors of participants gathered included previous records of diarrhea within the last 6 months, diagnosis for worm infection for the last 6 months, diagnosis for Malaria for the last 6 months. A blood sample was collected and analyzed with a haemoglobinometer ( HemoCue 201+ system, Sweden). SPSS version 22 statistical package software was used to perform the data analysis. Factors related to anemia among participants unadjusted and adjusted odds ratios with their 95%CI were calculated using logistic regression models. Results: The prevalence of anemia was 50 %. Among the anemic study participants 0.74 %, 11.76 %, and 37.50 % recorded severe, moderate, and mild levels of anemia respectively. The majority of the anemic participants 195 (95.6%) and 126 (61.8) had recently been diagnosed for Malaria and worm infections respectively. Craving for non-food substances (Calabar clay) and poor adherence to iron folate intake had a prevalence of 120 (58.8%) and 117 (57.4%) respectively. Multinomial logistic regression analysis showed that, irregular adherence to iron folate intake and reduce intake of iron folate frequency 2-3 times/week was statistically significantly associated with anemia (p=0.0001 and p= 0.0001 respectively). We equally observed a statistically significant association of alcohol drink consumption and craving for non-food substances (Calabar clay) with anemia (p=0.004 and p=0.0001 respectively). Cases of worm infection for the last 6 months were statistically significantly related to anemia (p = 0.004). Conclusion: Anemia is high among pregnant women in the Buea health district. Factors associated with persistent anemia despite intervention measures in the community hospitals include malaria; no intake or reduced intake of iron folate; alcohol drinks consumption; craving for non-food substances (Calabar clay) and previously diagnosed worm infection within the last 6 months.

Survival in Patients with Acute Lymphoblastic Leukemia and COVID-19 in Mexico

Abstract: Aims: To determine the survival of patients with acute lymphoblastic leukemia and COVID-19. Study Design: Prospective, analytical and relational. Place and Duration of Study: Hematology department, Hospital of Specialties, High Specialty Medical Unit, National Medical Center \"Gral. Manuel Avila Camacho\", Puebla, Mexico, during the period June 2020-April 2021 Methodology: Patients aged 15 to 64 years, both sexes, with acute lymphoblastic leukemia and a confirmed diagnosis of COVID-19 by PCR. The variables included were; sex, age (groups: 15-20; 21-29; 30-39; 40-49; 50-59; and 60-64), comorbidities, general treatment and hematological treatment response. Survival was determined for the diagnosis of COVID-19 for 11 months, using Original Research Article Martinez et al.; IBRR, 12(3): 32-39, 2021; Article no.IBRR.68658 33 the Kaplan Meier estimator and the Log-Rak test; Cox regression model (univariate and multivariate); as well as Chi square and V-Cramer with a 95% confidence interval and using the statistical program SPSS Ver. 25. Results: The study consisted of 20 patients, of which 33.3% were women, with an average age of 37.75 ± 11.63 years; The men registered an age of 28.50 ± 18.05 years. Overall survival was 50%, with a lower limit of 101.3 and an upper limit of 242.5 days, with a mean of 171.9 days; and median at 17 days. No significant differences were found in survival regarding sex, comorbidities, general treatment and hematological response. However, mortality in patients with comorbidities was higher (p = 0.051). Conclusion: Survival in patients with acute lymphoblastic leukemia and COVID-19 is low, due to complications that increase mortality, mainly owing to hematological suppression, and even more so with the presence of comorbidities.

Convalescent Plasma for COVID-19- is it Time to Say Goodbye? A Single-Center, Retrospective, Observational Study from Northern India

Abstract: Background: COVID-19 pandemic continues threatening the world with no effective treatment to tackle the menace. Till date, there is conflicting evidence on efficacy of CP in reducing COVID-19 related mortality. The objective of this study was to see disease progression and 7, 14 and 28-day mortality after CP therapy and analyze CP efficacy with/without Remdesivir. Materials and Methods: A retrospective single-centre observational study done from August 20, 2020, to 20 November 2020. Records of 294 COVID-19 patients with moderate to severe disease given CP therapy were analysed based on disease progression and length of hospital stay, further subcategorized on age, clinical profile, risk factors, ward/ICU, ventilatory support and co-administration of Remdesivir. Results: Lowest 7-day mortality rate was seen within age group 20-40 years (0%) and was highest in ≥61 years (24.3%). 87 patients on ventilatory support showed higher 28day mortality (48.28%) compared to non-ventilated (10.14%), (P<0.00001). Lesser 7-day mortality was seen in early CP therapy ≤3 days of admission (P=0.01). Patients requiring ICU admission showed higher 14 and 28-day mortality compared to ward P=0.001%). Median (IQR) length of hospital stay from CP transfusion was shorter, 4 (3 to 9) days in group 2 (CP only) compared to 7 (4 to 12) days in group1 (CP+Remdesivir ). Conclusion: CP therapy in ≤3 days of hospital admission in COVID-19 patients with moderate to severe infection not on ventilatory support showed reduction in mortality and length of hospital stay. Length of hospital stay was shorter in the CP-only group as compared to the CP+ Remdesivir group.

Haematological Study on the Effects of Goko Cleanser (Herbal Mixture) on Adult Female Wistar Rats

Abstract: Introduction: Goko cleanser is one of the popular herbal mixtures used by the Nigerian populace. This study was carried out to evaluate the effects of this herbal mixture on some haematological parameters of adult female Wistar rats. Methodology: A total of twenty five Wistar rats weighing about 160 – 280g were divided into five groups according to their corresponding weights. The groups were designated as groups 1 – 5. Group 1 served as the control group, while groups 2, 3, 4, and 5 received 1000mg/Kg, 1500mg/Kg, 2000mg/Kg and 4000mg/Kg respectively. Results: The TWBC, PCV, PLATELET count, and RBC and Hb showed a statistically significant (p<0.05) increase for the test groups 2 – 5 when compared to the control group. The body weight Original Research Article Onyejike et al.; IBRR, 12(1): 8-19, 2021; Article no.IBRR.64122 9 had a statistically significant (p<0.05) decrease in groups 2, 4, and 5; while group 3 had a statistically insignificant (p>0.05) decrease. Conclusion and Recommendation: This study revealed that Goko Cleanser contains some haemopoietic benefits, but inhibit appetite centres. Hence, this study recommends that further study be carried out on the effects of this herbal mixture on the brain so as to reveal the extent of its effect on the appetite centres.

Evaluation of Changes in Haematological Parameters of Sickle Cell Anaemia Subjects in Rivers and Bayelsa States

Abstract: Aim: The aim of this study was to evaluate changes in some haematological parameters in sickle cell anaemia subjects in Rivers State. Study Design: This study is a cross-sectional observational study. Place and Duration of Study: University of Port Harcourt Teaching Hospital, Rivers State, and the Federal Medical Centre, Yenagoa, Bayelsa State, between the months of February and August, 2020. Methodology: A total of four hundred and fifty (450) subjects with age range of 1-50 years were randomly selected. There are about 200 registered patients (adults and children alike) at the sickle cell clinics of the University of Port Harcourt Teaching Hospital, and the Federal Medical Centre, Yenagoa, with an average of 4 new patients per month. The sample size was obtained using a prevalence of sickle cell anaemia of 2% and the sample size was calculated using Cochran sample size formula. Five milliliters (5ml) of venous blood sample was withdrawn from the peripheral vein in the upper limb of subjects using a standard venipuncture technique. The sample was rocked gently to mix and kept at room temperature and the haematological parameters were analyzed within 4 hours of samples collection. The haematological parameters: total white blood cell count (WBC), red blood cell count (RBC), Haemoglobin concentration (Hb), Haematocrit, mean cell volume (MCV), mean cell haemoglobin (MCH), mean cell haemoglobin concentration (MCHC), red cell distribution width (RDW-CV), Platelet count (PLT), MPV, Neutrophils, Lymphocyte, Monocyte, Eosinophils, and Basophils) were analyzed using Mindray BC-6800 auto Haematology analyzer system. Data management and statistical analyses were conducted using Statistical Analyses System SAS 9.4 (SAS Institute, Cary, North Carolina, USA) and p values less than .05 were considered statistically significant. Results: The results showed the mean comparison of haematological parameters in sickle cell anaemia and control subjects. The mean comparison of Haemoglobin F was significantly reduced statistically (p<.05) in vaso-occlusive crises (VOC) condition than steady state compared with the control group. There was increase trend of haematological parameters showing statistically significant difference across the subject conditions compared with the control. There were exceptions in few cases especially in lymphocytes which was not significant (p>.05) in the steady state and vaso-occlusive crisis compared with the control. Similarly, Neutrophils was not significant (p>.05) in the steady state and vaso-occlusive crisis compared with the control. Furthermore, Basophils was more significant (p<.05) in the steady state than in the vaso-occlusive crisis and control groups. Similarly, absolute eosinophil was less significant statistically (p<.05) in the steady state and vaso-occlusive crisis than in the control group. Conclusion: This study has shown that there are changes in haemtological parameters between SCA subjects and control subjects and the VOC and steady state sickle cell anaemia (SCA) subjects.

Which Strategy to Manage Severe Vaso-occlusive Crisis in Patients with Sickle Cell Disease in Countries with Limited Healthcare Capacities?

Abstract: We evaluated the treatment of morphine by intravenous patient controlled analgesia versus intermittent subcutaneous routes on patients with sickle cell disease developing severe vasoocclusivecrisis. Objectives: The primary objective was to compare intravenous patient controlled analgesia (PCA) versus intermittent subcutaneous injection of morphine (SC) on sickle cell patients developing severe vaso-occlusive crisis during the first 24 hours of admission. The secondary objective was to assess the side effects of morphine in both regimens. Methods: A randomized controlled trial of 77 patients in the PCA and 81 in the SC group was conducted at the Sickle Cell Center of Brazzaville in the Republic of Congo. Participants aged from 15 to 45 years old with severe vaso-occlusive crisis were included in the study. Results: Both regimens provided pain relief. However, a significant pain reduction was observed 30 minutes after the administration of morphine in the PCA group (P= 0.001). The mean scores in the Original Research Article Ngolet et al.; IBRR, 12(2): 7-13, 2021; Article no.IBRR.65227 8 PCA and SC regimens were respectively: 1.16±1.40 and 4.30±2.32. The total median dose of morphine administered in the PCA regimen was markedly lower: 24,6±4,16 mg versus 36.6±3.1 mg in the SC group (P=0.01). Morphine administered by PCA provided pain relief during 24 hours while intermittent severe pain was experienced in the SC group (P=0.014). Sedation score S2, S3 was significantly observed in the SC group (P< 0.05).

Chronic Lymphocytic Leukemia in an Adolescent Girl: A Case Report and Clinico-Pathologic Review

Abstract: Chronic lymphocytic leukemia (CLL) in pediatric age is rare in the literature. It is a common disease of older adults, characterized by clonal proliferation and progressive accumulation of monoclonal B-cell lymphocytes. The diagnosis is established by immunophenotyping and prognosis is defined by staging system (Rai and Binet), as well as by several biological and genetic markers. We report a case of CLL diagnosed in an adolescent girl presented at 16 years of age. The case is being reported to improve awareness regarding this rare entity in children. Case Presentation: A 16 year old female presented with fever, weight loss and cervical lymphadenopathy. After baseline workup, lymph node biopsy, bone marrow biopsy along with immunohistochemistry and flowcytometry on peripheral blood was performed to establish the diagnosis. The clinico-pathologic features including extensive immunophenotyping were consistent with CLL. Discussion: Management guidelines for older adults are very well established but no standardized protocol exists for pediatric age group. We offered her Fludarabine and Cyclophosphamide as first line regimen and she responded well and achieved remission after four cycles. Unfortunately disease relapsed within two years. At this time, determination of optimum therapeutic protocol was a unique challenge as hematopoietic stem cell transplant (HSCT) was not available at our institute. Conclusion: CLL is an extremely rare malignancy in childhood and adolescence. Therefore age specific treatment protocols are not established. Reporting this case will help in eliciting the high index of suspicion among pathologists and oncologists for this exceptionally unusual and life threatening disease so that delays can be avoided.

An Asymptomatic Tropical Infection in a Pregnancy Complicated by a Hematological Neoplasm-accidental Passenger or Effect of Immunosuppression?

Abstract: Lymphatic filariasis is a vector borne infection classified under the WHO category of Neglected Tropical Disease (NTD). It is a major public health concern globally. This study describes this vector-borne infection in a young pregnant lady, a known case of chronic myeloid leukemia (CML) on chemotherapy. Such an association is hitherto unreported.

HBV and HEV Co-infections among Animal Handlers and Non-Animal Handlers in Osun State, Nigeria

Abstract: Aim: Co-infection of hepatitis A, B, C, D, and E viruses may lead to severe morbidity and mortality. This study was conducted to determine prevalence of co-infection of HBV and HEV among animal and non-animal handlers in Osun State, Nigeria. Study Design: Cross-sectional study. Place and Duration of Study: Ladoke Akintola University of Technology (LAUTECH), Nigeria, between June 2015 and July 2019. Methods: A total of 180 blood samples were obtained and screened for Hepatitis B and E virus from cohorts of 90 animal handlers and 90 non-animal handlers. Questionnaires on HBV and HEV were administered to obtain a demographic characteristic of the participants. HBsAg and anti-HEV antibodies were screened using HBsAg and HEV ELISA kits. Results: Results showed the overall prevalence of HBV and HEV Co-infection to be 12.2 %. There was variation in the HBV/HEV co-infections rates among the studied population, with a co-infection Original Research Article Gidado et al.; IBRR, 12(1): 1-7, 2021; Article no.IBRR.60756 2 rates of 15.9%, 14.3% and 7.8% for butchers, pig handlers and non-animal handlers, respectively. Sources of drinking water was the predisposition factor for HBV/HEV coinfections (P=0.02). The results revealed that subjects who used tap and river as a drinking water source had the highest prevalence followed by well and sachet and then all water source. Although results portray no statistically significant association with, frequent washing of hands after, rearing of animal, type of toilet, eating of pork, consumption of grilled meat and cow skin (P> 0.05). Conclusion: This study reported a high prevalence of HBV/HEV coinfections among animal and non-animal handlers in Osun State, Nigeria. There is, therefore, the need to increase health promotion efforts such as immunization, health education, campaign, provision of adequate blood screening equipment and proper hygiene is recommended for further reduction in HBV/HEV transmission. Since the consumption of contaminated water is the main transmission route of HEV, improving the level of public health sanitation in the area should be considered a priority by policymakers.

Assessment of Gene Frequencies of Human Platelet Alloantigens in Rivers-State, Nigeria Based on ABO/Rhesus Blood Groups Distribution

Abstract: Aim: The aim of this study was to assess the Gene Frequencies of Human Platelet Alloantigens in Rivers-State, Nigeria based on ABO/Rhesus blood groups distribution Study Design: A randomized controlled trial. Place and Duration of Study: Rivers State University Medical Centre, Port Harcourt, Safety Molecular Pathology Laboratory, Enugu State, Justcare clinical laboratory Port Harcourt Rivers State and University of Port Harcourt Teaching Hospital, between October 2019 and March 2020. Methodology: The subjects consisted of apparently healthy individuals who were of Rivers State origin totaling 104 persons aged 17 to 42 years. They were under-graduate and post graduate students of Rivers State University of Port Harcourt. Five major ethnic groups were considered which included Ikwerre, Ogoni, Ijaw, Etche and Ogba. Their demographic information was collected using a sample register and a questionnaire. Samples were collected from the antecubital vein. 10ml of blood was collected, 5ml was transferred into EDTA sample bottle (Ethylene diamine tetracetic acid) while 2ml was dispensed into plain bottle and labeled accordingly. Serological testing Original Research Article Wenah-Emmanuel et al.; IBRR, 12(3): 23-31, 2021; Article no.IBRR.68552 24 including HIV (RVS) screening, HBsag, HCV and VDRL were all as part of the inclusion criteria immediately after samples were collected. The remaining sample was analyzed using genotyping of Human Platelet Antigens by High Resolution Melting Curve Analysis Polymerase Chain Reaction (HRM-PCR), while tile method also known as forward/cell grouping method which is based on haem-agglutination reaction was used for ABO/Rh blood grouping. The melt curve analysis was done using the MicPCR software while the frequency analysis was done using Number Cruncher Statistical Software (NCSS) Version 13. GraphPad Prism Version 8.0.2 was used to determine the statistical significance between the various HPA genotypes and the ethnic groups and p-values of < 0.05 were considered to be statistically significant. Results were presented in percentages, mean+/standard deviation and in tables Results: The results showed that the A blood group had highest frequencies of 19.2% and 17.7% for HPA-5 b/b and HPA-4 a/a, while the least was 0.8% each for HPA-3 a/a, HPA-4 b/b and HPA-5. For blood group B, the highest were 20.0% (HPA-5 b/b) and 16.7% (HPA-3 b/b), and the least were 5.0% each for HPA-1 b/b and HPA-4 a/b, while blood group B had highest frequencies for HPA-1 a/a, HPA-2 b/b, HPA-3 b/b, HPA-4 a/b and HPA-5 b/b (20.0% each). The blood group O + HPA gene patterns had their highest values at 19.7% (HPA-5 b/b), 16.5% (HPA-4 a/a) and 13.7% (HPA-3 b/b) and the least was 7.9% (HPA-1 a/b), while for the blood group O , the highest was observed for HPA-3 b/b and HPA-5 b/b (20.0% each) and the least for HPA-1 a/a and a/b, HPA-2 a/b and b/b, and HPA-4 a/b and b/b (10.0% each). Conclusion: Based on the results, we conclude that A blood group had highest HPA frequencies. Whilst, the highest for blood group B were (HPA-5 b/b) and (HPA-3 b/b), and blood group B had highest frequencies for HPA-1 a/a, HPA-2 b/b, HPA-3 b/b, HPA-4 a/b and HPA-5 b/b. The blood group O HPA gene patterns had their highest values (HPA-5 b/b), (HPA-4 a/a) and (HPA-3 b/b) and the least was (HPA-1 a/b), while for the blood group O , the highest was observed for HPA-3 b/b and HPA-5 b/b and the least for HPA-1 a/a and a/b, HPA-2 a/b and b/b, and HPA-4 a/b and b/b.

Interaction between Phagocytic Cells with Antiphagocytic Properties of Cryptococcus neoformans: When Love and Hate Collide

Abstract: Global systemic fungal infection, including meningeal cryptococcosis caused by the encapsulated yeast Cryptococcus spp, continue to rise in number, especially among HIV infected individuals. Infection occur through inhalation of spore which is abundant in the environment. Initially this fungus stay in the lungs for a certain time without causing any symptoms and when the host’s cellular immune status is depleted, it can uses monocyte as a vehicle to take them to the brain, using a mechanism called Trojan Horse mechanism. Normal alveolar macrophage as the first line of innate immune system in the lungs are supposed to phagocytose, internalized and then destroy it inside an organelle named phagolysosome. But Cryptococcus spp seemed to have a built in antiphagocytic mechanism to avoid destruction and even can multiply therein. The interaction between this clever yeast and the host’s phagocytic cells determine the course of the disease. Keywords: Macrophage; monocyte; yeast; polysaccharide capsule; virulence.

Medical Students and the Level of Their Knowledge on Normal Flora: Results from an Electronic Questionnaire Conducted in a Private Medical School

Abstract: Introduction: So far, study on medical student’s knowledge regarding human normal flora is not available in the internet. Normal flora is initially beneficial for their host, but what was once part of the normal flora can later become dangerous to their host, e.g become the agent of endogenous disease. The knowledge regarding normal flora is important for medical students, because it related with many aspects of their recent and future education and trainings, especially in the clinical phase. The aim of this simple cross sectional, questionnaire based study is to measure the level of knowledge regarding normal flora. Study Design: Cross sectional, electronic questionnaire-based survey Place and Duration of Study: Faculty of Medicine, Universitas Kristen Indonesia, Jakarta, Indonesia and conducted for 1 month (March 2021).