Background : Burkholderia cepacia has been described as a cause of opportunist infections in patients with immune deficiency because of the high transmission rates. Actually the B. cepacia is subdivided in nine different genomic species that show morphological similarity, called genomovars. High mortality rates have been associated with infections caused by genomovars in susceptible patients; antibiotics are not efficient because of the high resistance level and genomic mutability. Little is known about the epidemiological traits of this bacterium; therefore, their isolation remains a relevant technical problem.Aims : The objective of this review is to describe Burkholderia cepacia as a bacterial complex with high pathogenicity and variability of habitats. Materials and Methods : A systematic search was realized using the international bibliographic databanks SCIELO, HIGHWIRE, PUBMED, SCIRUS and LILACS to provide a useful and practical review for the health workers that do not know this microorganism. Conclusions : Today, B. cepacia complex is a very important problem for the acquired immunodeficiency syndrome and cystic fibrosis patients. The immunodeficiency caused by these diseases is a positive factor for this microorganism to infect and kill these patients. Therefore, this opportunistic pathogen should be pointed out as a risk to these patients, and hospitals all over the world must be prepared to detect and combat this bacterium.

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Context : The introduction of highly effective generic antiretroviral drugs at reduced cost has transformed the face of HIV/AIDS epidemic in developing countries like India. However, there is an urgent emphasis on developing and implementing guidelines for antiretroviral treatment monitoring by laboratory methods utilizing the available technologies in resource-limited settings. Aim : We studied the efficacy of antiretroviral treatment, adherence to therapy and motivation of patients for regular treatment monitoring by CD4 counts. Settings and Design :A longitudinal cohort study on an established cohort of 166 HIV-1-infected Indian individuals. Materials and Methods: Study subjects were followed up for the period from January 2002 to November 2006. Their clinical status and treatment regimen were recorded, and CD4 counts were performed at each visit. Statistical Analysis : Repeated-measures ANOVA was used to compute changes in median CD4 counts at each visit in the different treatment groups. Results : We observed a growing awareness and motivation for regular HIV disease monitoring among patients, accompanied by a trend of increasing median CD4 counts at all subsequent follow-up visits after initiation of antiretroviral treatment. Conclusions :The study gives an insight into the institutional efforts for the establishment of cohorts for longitudinal studies, which will help in designing effective treatment guidelines, thus providing impetus to the free public sector antiretroviral therapy program in India. Such formative research aims to fill the lacunae in the limited available data for the formulation of treatment-monitoring guidelines in resource-poor settings of developing countries like India.

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Background :A supportive home environment is one of the factors that can favorably determine the outcome of specific learning disability (SpLD) in a school-going child. However, there is no reliable information available on parental knowledge about SpLD. Aims :To investigate parental knowledge of SpLD and to evaluate the impact of an educational intervention on it. Settings and Design : Prospective questionnaire-based study conducted in our clinic. Materials and Methods : From April to November 2002, 50 parents who were conversant in English and willing to follow up were interviewed. After the interview, each parent was administered a structured educational program and re-interviewed after 3 months. Statistical analysis : The pre- and post-intervention responses were compared using Chi-square test. Results : After the intervention, there was significant improvement in parental knowledge of (i) the meaning of the term 'SpLD' (32/50 vs. 50/50, P < 0.0001), (ii) the fact that remedial education given by a special educator is the recommended therapy for SpLD (33/50 vs. 45/50, P = 0.004), (iii) the meaning of the term 'remedial education' (24/50 vs. 46/50, P < 0.0001), (iv) the frequency and duration of remedial education necessary to achieve academic competence (7/50 vs. 31/50, P < 0.0001), (v) the meaning and purpose of provisions (28/50 vs. 49/50, P < 0.0001) and (vi) the fact that SpLD is a lifelong disorder (11/50 vs. 22/50, P = 0.019). However, parental knowledge about the cause of SpLD did not improve (8/50 vs. 14/50, P = 0.147). Conclusion :Parental knowledge of their child's SpLD is inadequate and this can be significantly improved by a single-session educational program.

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Adult-onset Still's disease (AOSD) is a rheumatic disorder of unknown etiology characterized by a triad of fever, polyarthritis and evanescent rash. We present a case report of a 28-year-old female who presented with complaints of fever, joint pains, rash, weakness for the past 4 years and diarrhea for the past 2 years. On investigation the patient was diagnosed to be a case of AOSD. Duodenal biopsy report was suggestive of celiac disease with a positive IgA tissue transglutaminase and anti-endomysial antibody. The patient was started on weekly methotrexate and gluten-free diet, and her symptoms gradually improved. The patient remains in our follow-up and is doing well.

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Background : Communicable disease surveillance is to have baseline data which will be helpful for planning and also for identifying epidemics under non-evident conditions. Objective : To delineate the pattern of occurrence of communicable diseases so as to enable early identification, followed by appropriate and timely response to outbreaks. Materials and Methods :Reports of listed communicable diseases from various departments and centers of Government Medical College, Chandigarh, involved in clinical care and laboratory diagnosis, were collected by the Department of Community Medicine on a weekly basis. Analysis of surveillance data was done for a period of 1 year - including reports from March 2005 to February 2006. Statistical Analysis : Percentage, normal test of proportions, time series analysis. Results : Out of 19,378 cases of various communicable diseases, 11,575, i.e., more than half, were dealt with by health centers. Thus maximum cases of acute respiratory infections (ARIs) [8,278 (71.87%)] and acute diarrheal diseases (ADDs) [3,148 (54.4%)] were dealt with by health centers. Of 19,378 cases, 11,518 (59.44%) were of ARIs, 5,786 (29.86%) of ADDs and 550 (2.84%) of pulmonary tuberculosis. There was no significant difference in the incidence of either disease between two sexes. Most, i.e., 4,413 (38.31%), cases of ARIs and 512 (86.49%) cases of pneumonia were reported in winter; ADDs - 2,607 (45.05%) in summer; and typhoid - 94 (41.04%) in the monsoon season. Conclusion : Maximum workload of common communicable diseases was borne by health centers. The most common morbidity was ARIs, followed by ADDs and pulmonary tuberculosis. No significant gender predilection was seen. Overall reporting of communicable diseases observed in three different seasons was found to show a gradual increase from winter to summer through monsoon. Some specific seasonal trends were demonstrated by various morbidities.

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Background: Reactive oxygen species are indicated to play a prime role in the pathophysiology of brain damage following a severe head injury (SHI). Aim: The current study was designed to understand the time-relative changes and relationship between erythrocyte antioxidant enzyme activities and Glasgow Coma Scale (GCS) scores of SHI patients in the 21-day posttraumatic study period. Settings and Design: The study included 24 SHI patients and 25 age- and sex-matched normal controls (NC). Activities of superoxide dismutase (SOD), glutathione reductase (GR) and glutathione peroxidase (GSH-Px) were assayed in these patients and controls. The GCS scores of these patients were also recorded for the comparative study. Materials and Methods: Venous blood samples were collected on day 7 (D7) and D21 from SHI patients and NC for the assay of SOD, GR and GSH-Px activities. These changes were correlated with age and changes in GCS scores of patients. Statistical Analysis: A one-way analysis of variance (ANOVA) was used to compare mean values of each parameter between group 1 (NC), group 2 (D7 changes in SHI patients) and group 3 (D21 changes in SHI patients). ANOVA was followed by Bonferroni post hoc tests. The Pearson correlation was applied to correlate between the antioxidant parameters and age and GCS scores of these patients. Results: A significant increase in erythrocyte SOD and GSH-Px activities was observed in group 3 as compared to groups 1 and 2. The increase in GSH-Px activity was significant in group 2 as compared to group 1. Although not significant, there was an increase in mean GR activity in groups 2 and 3 as compared to group 1. Conclusion: These findings indicate that SHI patients have shown significantly enhanced erythrocyte SOD and GSH-Px activities during the 21-day posttraumatic study period.

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