HIV/AIDS is one of twenty first century’s challenges to human being with protean manifestation affecting nearly all organs of our body. It is causing high morbidity and mortality especially in sub-Saharan Africa with numerous ocular complications and blindness. The purpose of this study was to determine the patterns of ocular manifestations of HIV/AIDS and their correlation with CD4+Tcells count.t-test and logistic regression were also done.A cross-sectional study was done on 348 HIV-positive patients presented to Anti-Retroviral Therapy clinics. Data were collected using face-to-face interview, clinical examination and laboratory investigation, and analyzed using SPSS version 13 software. Statistical association test was done and p<0.05 was considered significant. Other statistical tests like student Of 348 patients, 175 were on antiretroviral therapy and 173 were not on therapy. The mean duration of therapy was 27 months. The overall prevalence of ocular manifestations was 25.3%. The commonest ocular manifestation was keratoconjunctivitis sicca (11.3%) followed by blepharitis (3.2%), molluscum contagiosum (2.6%), conjunctival squamous cell carcinoma (2.3%), conjunctival microvasculopathy (2.3%), cranial nerve palsies (2%), herpes zoster ophthalmicus (HZO) (1.2%), and HIV retinopathy (0.6%). HIV retinopathy and conjunctival microvasculopathy were common in patient with CD4+ count of <200 cells/μl while HZO and molluscum contagiosum were common in patients with CD4+ count of 200–499 cells/μl. Prevalence of ocular manifestation was higher among patients on HAART (32.6%) than those patients not on HAART (17.9%) (p<0.05). There was statistically significant association between ocular manifestation and sex, CD4+Tcells count, and age (p<0.05). CD4+ count, <200 cells/μl and age >35 years were independent risk factors for ocular manifestations.The study showed that the prevalence of ocular manifestation of HIV/AIDS is lower than previous studies and could be due to antiretroviral therapy. Lower CD4 count is a risk as well as predictor for ocular manifestations. In the cells/mm3. The inccells/mm3. Retinalcells/mm3. In the cells/mm3,13.Only few studies were done in Ethiopia and the majority of these studies were in the pre-HAART era (before 2002) and the study population was symptomatic patients with advanced stage of the disease and hence doesn’t reflect the true picture of HIV-related ocular manifestation among HIV-positive in the presence of anti-retroviral therapy. The purpose of this study is, therefore, to describe the prevalence and pattern of ocular manifestation among HIV/AIDS patients and determine correlation with the CD4+T cell count.A cross-sectional study was conducted at two Anti-Retroviral Therapy (ART) clinics  from October to November 2009. From a total of 5692 adult HIV/AIDS patients, a sample of 369 was taken using 95% CI using simple random sampling technique. Only adults were included in the study because of consent issues. Proportionate numbers of patients were selected from the two ART centers and 185 patients were taken from those on Highly Active Anti-Retroviral Therapy (HAART) and 184 patients from those not on HAART. Patients with additional medical problems like Diabetes mellitus, hypertension and ocular trauma, which can have overlapping manifestation with HIV/AIDS, were excluded from the study.Data were collected using interview, clinical examination and laboratory investigation. Questionnaire and recording format were used for the interview and recording clinical examination findings. Before the actual data were collected, a pretest was done on 37 (10%) study subjects. The interview was conducted by trained ophthalmic nurses. Eye examinations included; best corrected visual acuity test, intraocular pressure measurement, adnexal examination, pupil, motility, alignment, anterior segment, dilated fundus examination, and cranial nerve function tests. All ophthalmic examinations were done by investigators. The following tools were used for ophthalmic examinations; Snellen visual acuity charts, Schiotz tonometer, indirect ophthalmoscope, slit lamp biomicroscope, 20D Volk lens, 90D Volk lens, and Goldmann three-mirror lens. To prevent cross contamination, the instruments were irrigated with tap water and then disinfected by soaking in absolute alcohol for 10 minutes and rinsed with tap water and allowed to dry for 10 minutes after each procedure. For dilated fundus examination 1% tropicamide with or without phenylephrine was used and to anaesthetize the surface of the eye during intraocular pressure measurement and gonioscopy, 1% tetracaine eye drop was used. For some patients, based on their clinical finding, toxoplasmosis and syphilis serology tests were done. Histopathologic technique was used to confirm cases of tumor. For all patients who did not have CD4+ T cell count within three months before data collection, CD4 count was done during the study and 238 had new CD4+ T cells count.X2-test was used to see association and p<0.05 was considered significant. Other statistical tests like student t-test and logistic regression were also used to see associations and differences between variables.Data were analyzed using SPSS version 13 software. The study was conducted following Helsinki declaration and after it was approved by the Ethical Committee of Jimma University. Informed consent was taken and only those who consented were studied.Out of 369 sampled study subjects, 348 patients were studied with the response rate of 94%. The mean age of the study subjects was 31.9 years (SD± 8.96) and 62% (216) of patients were in the age group of 20–34 years. The majority of the patients (74.1%) seen were female. One hundred seventy five patients were on HAART and the rest (173) were not on HAART. The mean duration of HAART was 27 months .Of the 348 patients, 88 (25.3%) had ocular manifestation. The prevalence of ocular manifestation in males (33.3%) was higher than the prevalence in females (23.3%) and this difference was statistically significant (p<0.05) Table . Ocular The mean CD4+ T cells count for those patients on HAART and those who were not on HAART were 366.85 cells/ml (SD±236.58) and 367.59 (SD±218.25) respectively. This mean difference was not statistically significant . Prevalence of ocular manifestation was higher among patients on HAART (32.6%) than among patients not on HAART (17.9%) (p<0.05). But there was no statistically significant difference existed for patients with lower CD4+ cells count whether they were on HAART or not (p=0.099).Patients with ocular manifestation had less CD4+ T cells count compared to patients without ocular manifestation with mean CD4+ T cell count of 308.74 cells/μl, and 386.56 cells/μl respectively and this was a statistically significant difference . Patients with CD4+T cell count of <200 cells/μl comprised 36.5% of patients with ocular manifestation and only 18.7% of patients without ocular manifestation were in this CD4+T cell count category . But when controlled for age and CD4+ T cell count, this was not statistically significant (OR (CI) =1.37(0.77-2.41), P>0.05). Patients of age >35 years old were 1.86 more likely to have ocular manifestation compared to patients of age ≤ 35 years old and it was statistically significant ). The odds of having ocular manifestation was 2.52 for patients with CD4+ T cells count less than 200 cells/μl compared to patients with a CD4+ T cell count of ≥200 cells/μl and it was statistically significant . Patients on ART were 1.86 times more likely to have ocular manifestation compared to those who were not on ART and it was statistically significant   patients. The commonest adnexal manifestation was blepharitis which was seen in 3.2% patients. Molluscum contagiosum, conjunctival squamous cell carcinoma and conjunctival microvasculopathy were seen in 2.6%, 2.3%, and 2.3% respectively (Table Forty three (12.3%) patients had anterior segment manifestations; the commonest manifestation being Keratoconjunctivitis sicca which was seen in 11.5% of all patients. Only 2 (0.6%), and 1(0.3%) patients had infectious keratitis and uveitis respectively  patients had either posterior segment or neuro-ophthalmic manifestations. Facial nerve palsy was seen in 6 (1.8%) patients and it was common in patients with a CD4+ T cell count of ≥200 cells/μl (Table The majority of patients 97.23%) had visual acuity of >6/18 in either or both eyes. No patient was found to be bilaterally blind but 9 patients (2.6%) had monocular blindness  was lower than the mean CD4+ T cell count of patients without ocular manifestation (386.56 cells/μl). It was also found that ocular manifestation was common in patients with a CD4+ T cell count of <200 cells/μl. These findings are similar to other studies conducted in India . There wIn this study it was found that age >35 years, and CD4+ T cell count of <200 cells/μl were independent risk factors for patients to develop ocular manifestations. CD4+ T cell count <200 cells/μl being a risk factor is a well-established fact ,18 and tThe commonest ocular manifestations in this study were adnexal (12.8%) of which blepharitis was the commonest (3.2%) followed by molluscum contagiosum (2.6%), conjunctival Squamous cell carcinoma (2.3%) and conjunctival microvasculopathy (2.3%). This finding is different from the study conducted in Gondar University hospital  where thThe commonest anterior segment manifestation was Keratoconjunctivitis sicca (11.5%). The prevalence is similar to another study (10%-20%) .Neuro-ophthalmic manifestations were seen in 2.6% of all patients which is lower than the finding of the Gondar study (9.6%) . HIV retThe overall prevalence of ocular manifestation of HIV/AIDS was lower than what is reported in previous studies but it is still reasonably high. The prevalence was higher among male patients, patients with lower CD4+ T cell count and older patients. The commonest ocular manifestations were anterior segment and adnexal manifestations. Posterior segment manifestations were rare and there was no case of CMV retinitis. Age >35 years, and CD4+ T cell count of <200 cells/μl were found to be independent risk factors for developing ocular manifestations.Though ocular manifestations of HIV/AIDS are low, HIV/AIDS patients especially those with lower CD4+ T cell count and older patients should have eye checkup and follow up by an ophthalmologist; and there should be concerted care with a multidisciplinary approach. Further prospective study should be carried out to investigate why some ocular findings are rare in our setting so that the real clinical picture and possible reasons will be known. The association between age and ocular manifestation warrants further investigation.ART: Antiretroviral therapy; AIDS: Acquired immunodeficiency syndrome; CD: Cluster of differentiation; CMV: Cytomegalovirus; HAART: Highly active antiretroviral therapy; HIV: Human immunodeficiency virus; HZO: Herpes zoster ophthalmicus.None of the authors have any proprietary interests or conflicts of interest related to this manuscript.SB conceived, designed, acquired, analyzed and interpreted the data; drafted the manuscript and approved for publication. YG participated in the conception, design and interpretation of data; revised the manuscript critically and approved for publication. FT participated in the design and interpretation of data; revised the manuscript. All authors read and approved the final manuscript.The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2415/13/20/prepub


The aim of this article is to make an evaluation on the clinical features of patients with Kawasaki disease who require a cardiac surgical procedure including coronary artery bypass grafting, coronary arterial aneurysmorrhaphy or heart transplantation.English literature of Kawasaki disease for cardiac surgery (1990–2011) was retrieved in the Pubmed database. The clinical features of the patient setting from the representative articles were collected and analyzed.Patients with Kawasaki disease were very young, with some requiring a cardiac surgical procedure at a very early age. The interval between the onset and the surgical operation was 9.5±9.4 years. The prevalence of myocardial infarction and re-infarction was high. Giant aneurysm, critical stenosis with calcification and thrombus formation of the coronary arteries often warrant coronary artery bypass, heart transplantation or coronary arterial aneurysm plication. The left internal mammary artery to the left anterior descending coronary artery was the most commonly used graft in coronary artery bypass. Graft patency rate was 82.4% at 21.4±32.3 (range 0.1–252) month follow-up. The early and late mortalities of this patient setting were 0.6 and 3.0%, respectively.Patients with Kawasaki disease may develop coronary artery lesions prone to aneurysmal formation with calcification and thrombus and may require coronary artery bypass at a very early age. With the left internal mammary artery as the first choice of bypass graft, the long-term patency and patient survival was satisfactory. Kawasaki disease, also known as mucocutaneous lymph node syndrome, is an autoimmune disease affecting the blood vessels of the whole body, characterized by the typical changes in the mucous membranes and the enlarged lymph nodes. Poor response to antibiotics is a feature of the disease . It occuOne of the predominant sequelae of Kawasaki disease is coronary artery disease. Among children with Kawasaki disease, 15–25% may develop coronary aneurysms . Accordit-test was used to compare the quantitative data when necessary and p<0.05 was considered to be of statistical significance.English literature of Kawasaki disease patients who required a cardiac surgical procedure including coronary artery bypass grafting (CABG), coronary arterial aneurysmorrhaphy or heart transplantation (1990–2011) was retrieved in the Pubmed database. The clinical features of the patient setting from the representative articles were collected and analyzed. Data were expressed as mean ±s tandard deviation. Unpaired A total of 71 representative articles  –78 were n=64), and at the time of operation it was 13.3±11.1  years (n=135) with an interval between the onset and the surgical operation of 9.5±9.4 years  (n=72).Of the patients whose gender was given, 88 were males and 28 were females with a male-to-female ratio of 3.1:1. Age at the onset of Kawasaki disease was 4.0±3.6  years  , ischemic changes in one (9.1%), subendocardial ischemia in two (18.2%), and normal in three (27.3%) patients, respectively. Echocardiography was a diagnostic tool in 33 patients: coronary artery aneurysm in 17 (51.5%), regional wall abnormality  in four (12.1%), coronary artery dilation in two (6.1%), coronary artery calcification in two (6.1%), left ventricular aneurysm in one (3.0%), intra-coronary aneurysm thrombus in two (6.1%), left ventricular dysfunction+global hypokinesis+left ventricular aneurysm+coronary artery aneurysm in one (3.0%), and normal in three (9.1%) patients, respectively. Perfusion scintigraphy was used in at least three patients for the assessment of the left ventricular function of the patients , 48, 55.p=0.4600). The three LM aneurysms were 6.8, 13 and 20 mm, and the three aneurysms of the circumflex coronary artery were 6, 6 and 17 mm in diameter, respectively. In 58 (9.1%) patients, concurrent aneurysm and stenosis lesions developed in 86 coronary arteries including 46 (53.5%) LADs, 28 (32.6%) RCAs, 8 (9.3%) LMs, and 4 (4.7%) circumflex coronary arteries. Other findings included coronary artery ectasia in five (16.7%) (The left anterior descending coronary artery (LAD), right coronary artery (RCA) and left main coronary artery (LM) were the most commonly involved coronary arteries in patients presenting with Kawasaki disease . Stenosi (16.7%) , 55, 56, (16.7%) , and lefp=0.8006), or between that of the arterial grafts and of the saphenous vein grafts (SVGs) , even though the duration of the IMA tended to be longer than that of the other arterial grafts and that of the arterial was longer than that of the SVGs.Four (0.6%) patients underwent heart transplantation, one (0.2%) patient had repair to an LM rupture , and 632There were four early deaths and 19 late deaths at 3 months–16 years after the operation with an early and a late mortality of 0.6 and 3.0%, respectively.The coronary artery stenotic lesions in Kawasaki disease commonly involve severe calcification, whereas adult coronary artery lesions prevail with atherosclerosis . Severe Coronary arteries may be occluded suddenly in Kawasaki disease with thrombus formation in the aneurysm . ThrombuAn inflammatory infiltrate in the lymphocytes, macrophages and immunoglobulin A plasma cells in the coronary arteries constitute the pathogenesis of the coronary pathologies . HistoloIntravenous gamma globulin and appropriate doses of aspirin such as 3 mg/kg/day are ways of treatment at the acute stage . TreatmeThe IMA graft in pediatric patients with Kawasaki disease can increase in length and diameter because the IMA is a living graft and, therefore, has a self-regulating function . BecauseHsu et al.  adopted In general, patients with Kawasaki disease were very young, some requiring a cardiac surgical procedure at a very early age. The interval between the onset and the surgical operation was 9.5±9.4 years. The prevalence of myocardial infarction and re-infarction was high. LAD, RCA and LM were the most commonly involved coronary arteries with 89.5% of the lesions located in the proximal coronary artery. Giant aneurysm, critical stenosis with calcification and thrombus formation of the coronary arteries often led to a CABG, heart transplantation or coronary arterial aneurysm plication. Left IMA to LAD was the most commonly used bypass graft of CABG. Graft patency rate was 82.4% at 21.4±32.3 (range 0.1–252) month follow-up. The early and late mortalities of this patient setting were 0.6 and 3.0%, respectively.In conclusion, patients with Kawasaki disease may develop coronary artery lesions and warrant CABG at a very early age. With left IMA to LAD anastomosis as the first choice of bypass graft, the long-term patency and patient survival were satisfactory.


This study aimed to determine the epidemiological impact of rice cultivation in inland valleys on malaria in the forest region of western Côte d’Ivoire. The importance of malaria was compared in terms of prevalence and parasite density of infections and also in terms of clinical malaria incidence between three agro-ecosystems: (i) uncultivated inland valleys, (R0), (ii) inland valleys with one annual rice cultivation in the rainy season, (R1) and (iii) developed inland valleys with two annual rice cultivation cycles, (R2).Between May 1998 and March 1999, seven villages of each agro-ecosystem  were randomly selected among villages pooled by farming system. In these 21 villages, a total of 1,900 people of all age groups were randomly selected and clinically monitored during one year. Clinical and parasitological information was obtained by active case detection of malaria episodes carried out during eight periods of five consecutive days scheduled at six weekly intervals and by cross-sectional surveys.Plasmodium falciparum was the principal parasite observed in the three agro-ecosystems. A level of holoendemicity of malaria was observed in the three agro-ecosystems with more than 75% of children less than 12 months old infected. Geometric mean parasite density in asymptomatic persons varied between 180 and 206 P. falciparum asexual forms per μL of blood and was associated with season and with age, but not with farming system. The mean annual malaria incidence rate reached 0.7 (95% IC 0.5-0.9) malaria episodes per person in R0, 0.7 (95% IC 0.6-0.9) in R1 and 0.6 (95% IC 0.5-0.7) in R2. The burden of malaria was the highest among children under two years of age, with at least four attacks by person-year. Then malaria incidence decreased by half in the two to four-year age group. From the age of five years, the incidence was lower than one attack by person-year. Malaria incidence varied with season with more cases in the rainy season than in the dry season but not with farming system.In the forest area of western Côte d’Ivoire, inland valley rice cultivation was not significantly associated with malaria burden. Anopheles gambiae s.l. populations. Furthermore, the epidemiological impact of rice cultivation varies according to the local malaria situation [Africa has the highest population growth rate of any continent . This exituation . A revieituation ,5. Conveituation -9. Most ituation .Thus, an interdisciplinary study of relationships between rice cultivation systems and malaria was conducted between 1997 and 1999 at regional level in three West African important settings: Sahel, savannah and forest. The Sahel study carried out in Mali showed that rice cultivation altered the transmission pattern from seasonal to perennial and reduced the incidence of malaria fevers in children aged less than 14 years . In savaThe present study was carried out thirteen years ago in the forest region of western Côte d’Ivoire. Its objective was to compare malaria burden in three inland valley rice production systems in terms of prevalence and parasite density of infection, and also in terms of clinical malaria incidence. Furthermore the results of the present study may be put in perspective with the situation in Côte d’Ivoire after implementation of malaria control strategies.A longitudinal study was carried out in the forest zone in the west of Côte d’Ivoire Figure . The metThe same methodology of sampling as the one used in the savannah area was applied here . The popActive case detection (ACD) for malaria episodes was done during eight periods of five consecutive days at six-weekly intervals in the year. During these periods the monitoring was made as described previously . BrieflyPlasmodium species were identified and asexual forms of each species counted on 200 leucocytes. The parasite density was calculated by assuming an average of 8,000 leucocytes/μL of blood. A randomly selected 10% sample of the thick smears was double-read for quality control. The readings of the six technicians were compared using a set of blood smears.Thick blood smears were stained with Giemsa in the field and examined using a microscope  at Institut Pierre Richet (IPR) in Bouaké by six experienced technicians under the supervision of a parasitologist. Plasmodium falciparum, Plasmodium malariae and Plasmodium ovale asexual blood forms, (2) density of P. falciparum asexual blood forms in parasite-positive thick smears, and (3) prevalence of P. falciparum gametocytes. A generalized estimating equation (GEE) approach was used for statistical analysis of repeated measures [Demographic, clinical, parasitological and attendance data were double-entered independently in an Access database (ver.7 1995). Data were analysed using Stata V11 software. Only one blood sample per person per monitoring period was considered for the analysis. When a pathological condition was detected, it was the blood sample taken during the clinical episode that was considered for the analysis. When several blood samples from an asymptomatic period were available, one of them was randomly selected for the analysis. Parasitological data were analysed separately in terms of (1) prevalence of measures . The GEEP. falciparum gametocyte presence were analyzed as a binomial response in logistic regression model. The parasite density was log transformed and analysed with a link function for a linear regression model. These two dependent variables were analysed according to demographic , seasonal and agro-ecosystem variables.The prevalence of asymptomatic malaria infection and the prevalence of versus asymptomatic state) as dependent variable, and parasite density, age and season as independent variables. In this type of model, a random intercept variable is allowed to vary with subjects and this random subject-specific intercept allows taking into account the interdependency of observations made on the same person. For each clinical episode, the probability that it was caused by malaria was estimated by the Attributable Fraction (AF) calculated from the odds ratios associated with the estimated parasite density in each logistic model [The association between the parasite density and the occurrence of clinical episodes was tested using a random effect logistic regression model for each agro-ecosystem, taking clinical status  years in R0 and 22 (21–23) years in R1 and R2. The female/male ratio was 1.20 in R0, 1.02 in R1 and 1.03 in R2  in R0, 44.9% (95% CI: 41.7-48.2) in R1 and 47.1% (95% CI: 45.6-48.7) in R2 ) asexual forms per μL of blood and significantly decreased with age.The geometric mean parasite density in positive asymptomatic persons varied in the three agro-ecosystems between 180 and 206 em Table . ParasitP. falciparum gametocytes was higher in the rainy season than in the dry season .The mean annual gametocyte rates were similar between the 3 farming systems, 2.1% (95% CI: 1.8-2.4) in R0, 2.5% (95% CI: 2.2-2.7) in R1 and 2.2% (95% CI: 1.9-2.5) in R2, respectively. The highest rates were observed in the 0–4 old children (P < 0.0001). Prevalence of Plasmodium-positive thick blood films of asymptomatic subjects was 0.994, 0.042 and 0.007 for respectively P. falciparum, P. malariae and P. ovale. According to multivariate GEE linear regression model, the prevalence of P. malariae infections was similar in R0 (2.3%) and R1 (2.0%) (OR: 0.76 (95% CI: 0.52-1.11); P = 0,151), but slightly lower in R2 (1.7%) than in R0 (OR: 0.67 (95% CI: 0.48-0.93); P = 0.019). Children 0–4 years old were the most frequently infected (P < 0.0001). According to season prevalence of P. malariae species was higher in dry season (2.5%) than in wet season (1.7%) (OR: 0.66 (95% CI: 0.49-0.87); P = 0.006). The P. ovale asymptomatic infection rates were similar in the three agro-ecosystems (P = 0.564) and seasons (P = 0.654). Children 0–4 years old were the most frequently infected (P < 0.0001).The plasmodial formula on the 13,746 P. falciparum alone, three with P. malariae alone and 58 individuals with mixed infection . The P. malariae infections showed densities of 100 and 40 parasites/μL. Among 47 out of the 58 mixed infections P. falciparum was more frequent than the other plasmodial species. Whatever the age group sick patients had higher geometric mean parasite densities than healthy people . To quantify malaria morbidity, the method of estimation of the fever fraction attributable to malaria was used . In the P. falciparum because the transmission is intense throughout the year, with a peak during the rainy season [In the three farming systems, clinical malaria decreased strongly and quickly with age. Infants were more affected than children and from the age of five years, people experienced less than one episode a year. All the parasitological and clinical findings indicate that the naturally acquired immunity to falciparum malaria starts at a very early age and the majority of infected adults and older children rarely experience overt disease . Indeed y season . The parIn the forest area the inland valley rice cultivation did not influence the rates of malaria infection and disease although it appeared as a risk for malaria transmission. An economic study carried out on 750 households (21 villages) in the three agro-ecosystems also showed that malaria had no effect on coffee and cocoa productions and that lowland irrigated rice cultivation was not a risk factor for malaria infection .People living in the R0 agro ecosystem where no inland valley was cultivated spent probably more time in the camp for working in the coffee and cocoa plantations than in the other agro systems. This situation could explain the high rate of absence of inhabitants during the surveys of the medical team (18% in R1 and R2 and 30% in R0). Despite this potential behavioural difference and the differences in ethnic group of the populations, there was no significant difference in malaria burden between the three agro-ecosystems.et al.[Two other studies carried out within the framework of the Health Research Consortium hosted by the West African Rice Development Association (WARDA) (currently known as the Africa Rice Center), following a North–south transect in West Africa showed quite different results. In Côte d’Ivoire in the savannah zone where the same methodology as in the forest zone was used, malaria was hyper-endemic. The mean annual incidence rate reached 0.9 (95% IC: 0.8-1.0) clinical malaria episodes per person in R0, 0.6 (95% CI: 0.5-0.7) in R1 and 0.8 (95% CI: 0.7-1.0) in R2 . The devet al.,32 showeThe study carried out in Mali in the semi-arid sub-Saharan environment showed that irrigated rice cultivation altered the malaria transmission pattern from seasonal to perennial and reduced annual morbidity incidence more than two-fold, compared to cultivation without irrigation .This study, together with the other studies conducted in the framework of the Health Research Consortium in the forest, the savannah and the Sahel were performed on a large scale with a similar methodology in the context of farming systems rather than in single villages. The findings in these ecologically different zones  clearly confirm the conclusion that Carnevale and colleagues  and IjumThe study also provides an important basic data set before Côte d’Ivoire implemented the Roll Back Malaria strategies. It should permit to put the results of the current malaria control programme in Côte d’Ivoire into perspective.The authors declare that they have no competing interests.


Chikungunya fever is reported in India after 32 years. Immunoglobulin M antibodies and virus isolation confirmed the cause. Phylogenic analysis based on partial sequences of NS4 and E1 genes showed that all earlier isolates (1963–1973) were Asian genotype, whereas the current and Yawat (2000) isolates were African genotype. In India, the first CHIKV outbreak was recorded in 1963 in Calcutta and was followed by epidemics in Chennai, Pondicherry, and Vellore in 1964; Visakhapatnam, Rajmundry, and Kakinada in1965; Nagpur in1965; and Barsi in 1973  was used to detect the virus in cell culture and in crushed heads of adult mosquitoes (Alphavirus genus–specific primers that produced a 472-bp fragment (NS4 gene) were F1 5´ GAY GCI TAY YTI GAY ATG GTI GAI GG 3´ and R1 5´ KYT CYT CIG TRT GYT TIG TIC CIGG 3´ (Pfx enzyme (Invitrogen) was used. Cycling conditions were 1 cycle at 94°C for 5 min; then 35 cycles each of 94°C (1 min), 50°C (1 min), and 68°C (1.5 min); followed by final extension of 7 min at 68°C. The PCR products were purified by using QIAquick PCR Purification Kit (Qiagen) and sequenced by using BigDye Terminator Cycle Sequencing Ready Reaction Kit  and an automatic sequencer .We studied CHIKV isolates obtained during current investigations and viruses isolated during earlier epidemics in India (1963–2000) . RNA wasUsing ClustalX, version 1.83, multiple alignments of nucleotide sequences were performed. The phylogenic status of the CHIKV isolates was assessed with the software MEGA 3.1 . Cases were reported from 11 of 23 districts in Andhra Pradesh, 15 of 27 in Karnataka, and 16 of 35 in Maharashtra . ResultsState governments of Andhra Pradesh, Karnataka, and Maharashtra have declared outbreaks of CHIKV. By mid-April, the declared numbers of fever cases associated with this outbreak were >25,000 in Andhra Pradesh, >65,000 in Maharashtra, and >36,000 in Karnataka. In absence of active surveillance for this disease, these numbers may be underestimates.Ae. aegypti. Ae. albopictus was either absent or present in negligible numbers. The population of Ae. aegypti was reasonably high in most of the localities; adult household indexes and Breteau indexes, respectively, were 10–60 and 13–75 in Andhra Pradesh, 20–70 and 40–200 in Karnataka, and 10–30 and 30–50 in Maharashtra. High density of Ae. aegypti populations in affected areas and 23 isolations or detections of CHIKV from adult mosquitoes indicate that this species is the main vector in India. Earlier outbreaks in India were mainly restricted to large cities; in contrast, the current outbreak is predominantly rural.The predominant mosquito species in the affected areas was Anti-CHIKV IgM was detected in 33.5% to 41.9% of patients tested. The finding of antibodies to dengue virus in 0.9% to 9.9% of patients and to CHIKV and dengue virus in 0.4% to 4.3% of patients indicates that these viruses cocirculate in the area. Nine patients whose acute-phase serum sample was negative had anti-CHIKV IgM in the early convalescent-phase sample, collected during the second week of illness.NS4-based phylogenic analysis identified the Yawat isolate (2000) from Maharashtra as central/East African genotype, not Asian genotype as reported earlier A and E1 This report confirms CHIKV as the causative agent for large outbreaks of fever with arthralgia and arthritis in 3 Indian states. Thus, chikungunya fever has emerged in outbreak form after 32 years.The current epidemic is caused by central/East African genotype of CHIKV. That the Yawat isolate is grouped with central/East African genotype suggests that this genotype had been introduced >5 years before the current outbreaks. In this context, determining the genotype of currently circulating strains in Southeast Asia and understanding the modes of transportation of this strain in India and the conditions favoring such large outbreaks would be worthwhile.


With combined antiretroviral therapy (cART) life expectancy of HIV-infected persons is close to the one of non-infected persons. Identifying neurocognitive deficits in ageing HIV-infected individuals is important. This study aimed to evaluate the acceptability of screening neurocognitive deficits in HIV-infected patients. Thirty patients  from the HIV clinic were examined with a new screening test and an in-depth neuropsychological examination. The screening tests consisted of questions and examinations on cognition in everyday situations, mood and selected cognitive functions . Also, patients received a questionnaire to evaluate test acceptance. The mean age of the patients was 52.5 (30–74) years, mean education 12.5 (8–18) years. Seven patients had HIV-stage CDC A, 12 B and 11 CDC stage C. The mean CD4 count was 657 cells/µl, the mean HIV viral load<20 cop./µl. All patients were treated with cART (7 with efavirenz). The screening test was done assisted by a nurse and lasted 26 minutes (mean). The screening indicated pathological signs of neurocognitive function in 11 (42%) patients. The in-depth neuropsychological assessment revealed pathological conditions in 25 (83%) of patients; i.e. 16 (53%) patients had ANI (asymptomatic neurocognitive impairment), 8 (27%) had MND (mild neurocognitive disorder) and 1 (3%) had HAD (HIV-associated dementia). Most patients (43.3%) judged the test as not too difficult and 56.6% as partly difficult. 96.6% of patients viewed the instructions of nurses as clear, 3.3% as unclear. 93.3% felt the test has not affected privacy and 83.3% estimated the screening as valuable and not worriesome. 83.4% of all patients were interested in their results and for none of the patients the test was too long. The test acceptability by the study nurses was also good. Only in 3.4% of tested persons they judged the test as too difficult for the patient. In 86.7% of tests they estimated the screening as valuable and in again 86.7% as not worrisome. For none of the nurses the test duration was too long. Only 16.6% of the patients had a completely normal neurocognitive testing. A short screening test lasting less than half an hour to search neurocognitive disorders assisted by a nurse is widely accepted by patients and nurses.


To the Editor: Prevalence of chronic hepatitis C virus (HCV) among blood donors has been assessed in a few West African countries; most recent estimates range from 1.1% to 6.7%  . Confirmation was performed by a recombinant-immunoblot assay . HCV RNA was detected by a qualitative reverse transcription–polymerase chain reaction . Genotype was determined by the INNO-LiPA HCV II assay (Innogenetics). Presence of hepatitis B surface antigen (HbsAg) and alanine-aminotransferase (ALAT) level are routinely assessed, as well as HIV and human T-lymphotropic virus type l infection.–4). EIA HCV antibodies were found in 18 donors (1.6%). Immunoblot assay was positive for nine, yielding an overall prevalence of 0.8% . Eight of the nine were repeat donors, but the difference in prevalence compared with first-time donors did not reach statistical significance (1.1% vs. 0.3%). HCV-infected donors tended to be older than uninfected donors , and the trend with age was significant . ALAT levels of infected study participants were in the normal range (17–55 IU). One participant had an ALAT level above normal. Genotype 2ac has been identified on line immunoassay–positive samples (three samples not tested). HBsAg was detected in 13% of the new donors. No co-infection with HCV and hepatitis B virus was found.The age of the 1,081 donors ranged from 18 years to 61 years (mean 35.6 years), and 81% were men. First-time donors accounted for 31% and were younger than repeat donors  and lower than in other West African countries such as Ghana or Guinea, where prevalence ranges from 2.8% to 6.7% . This estimate is low since it includes only the marginal cost of the reagent kits. This screening cost could be reduced by discarding blood units that test positive after only one enzyme-linked immunosorbent assay , at the price of nearly 3% of blood units wrongly discarded. France has demonstrated that this strategy has the best cost-effectiveness ratio, as long as the prevalence remains below 8% (


High prevalence of Hepatitis C virus (HCV) has been reported among the dialysis patients throughout the world. No serious efforts were taken to investigate HCV in patients undergoing hemodialysis (HD) treatment who are at great increased risk to HCV. HCV genotypes are important in the study of epidemiology, pathogenesis and reaction to antiviral therapy. This study was performed to investigate the prevalence of active HCV infection, HCV genotypes and to assess risk factors associated with HCV genotype infection in HD patients of Khyber Pakhtunkhwa as well as comparing this prevalence data with past studies in Pakistan.Polymerase chain reaction was performed for HCV RNA detection and genotyping in 384 HD patients. The data obtained was compared with available past studies from Pakistan.Anti HCV antibodies were observed in 112 (29.2%), of whom 90 (80.4%) were HCV RNA positive. In rest of the anti HCV negative patients, HCV RNA was detected in 16 (5.9%) patients. The dominant HCV genotypes in HCV infected HD patients were found to be 3a (n = 36), 3b (n = 20), 1a (n = 16), 2a (n = 10), 2b (n = 2), 1b (n = 4), 4a (n = 2), untypeable (n = 10) and mixed (n = 12) genotype.This study suggesting that i) the prevalence of HCV does not differentiate between past and present infection and continued to be elevated ii) HD patients may be a risk for HCV due to the involvement of multiple routes of infections especially poor blood screening of transfused blood and low standard of dialysis procedures in Pakistan and iii) need to apply infection control practice. Hepatitis C virus (HCV) infection is a major public health problem, with an estimated global prevalence of 3% occurring in about 180 million carriers and approximately 4 million people have been newly infected annually  and geneIn Pakistan currently, approximately 10 million people are suffering from this tremendous disease which cover 6% of the overall population. A high prevalence of HCV Ab (38% weighted average) was described in the studies of patients undergoing chronic dialysis in Pakistan . The sprThe striking genetic heterogeneity of the RNA genome of HCV is well recognized ,10. On t384 HD patients were randomly selected collected from three hospitals of Peshawar, Khyber Pakhtunkhwa: Khyber Teaching Hospital, National Diagnostic Dialysis Center and Dialysis Ward Hayatabad Medical Complex. All patients were briefed about the study and proper willing consent was signed.All patients were interviewed for demographic data and risk factors to HCV infections including history of number of blood transfusion, intravenous drug use (IDU), surgical interventions, and dental treatment, multiple sexual partners, barber shop, piercing instruments and exposure to known HCV-positive persons, number of years on dialysis and change of the center. Blood (5CC in sterile syringes) were collected from HD patients; sera were separated in two aliquots and frozen at -70°C for HCV RNA detection and genotyping.All the subjects were screened for anti HCV antibodies third generation test according to the manufacture instructions (Accurate Diagnostics USA).RNA was isolated from 100 μL serum, using RNAzole RNA purification kit (Trizole Inc. USA) as per manufacturer protocols. HCV RNA was Reverse transcribed with 200 U of Maloney murine leukemia virus reverse transcriptase (Fermentas USA) and amplified with nested primers specific for 5' untranslated region of HCV genome. Amplified product was subjected in 2% agarose gel for electrophoresis.HCV RNA positive samples were genotyped with primers specific for core region of different HCV types by type specific PCR as mentioned elsewhere .For contamination control RNA extraction, cDNA amplification and electrophoresis were carried in separate areas. Both negative and positive controls were run parallel to the patient samples in each batch.2 test were used to accesses the association between HCV positivity and variables. Statistical significance was evaluated at 0.05 levels.χThis study involved 384 patients treated with HD and was screened for anti HCV and tested for HCV RNA and HCV genotypes during January 2010-April 2010. The mean age of the patients was 40.9 ± 5.54 years (age rang15-75 years). 244 were male (mean age 40.4 ± 8.4) and 140 were female (age range 41.7 ± 10.07), 340 patients were married (mean age 42.7 ± 8.03) and 48 were unmarried (mean age 28 ± 4). The mean duration of HD was 6.7 years (range 1-12 years). Change of dialysis centre was noted in twelve patients. Of the total, 112 (29.2%) patients were anti HCV positive; 48 were females (42.85%) and 64 were males (57.14%). HCV RNA was detected in 90 (80.4%) anti HCV positive patients and in 16 (5.9%) anti HCV negative patients. None positive patients had exposure to known HCV-positive persons.In current study the genotype distribution was as 3a (42.85%), 3b 23.21%). 2a (14.28%), 1a (16.07%), untypable (8.92%), 1b (3.57%) and 4 (1.78%)  were found significant while gender  and marital status  of the patients were not statistically significant.Table Table Regarding the duration on HD, 42% patients were being dialyzed during 1997-2009 and 58% from 2004-2009 with most prevalent genotypes 3a, 3b and 2a, and untypable and mixed genotypes, respectively.The HCV infection continues to be a major disease burden on the world. For example, the prevalence of HCV antibodies among dialysis patients has been reported to range from: 8 to 36% in North America, 39% in South America, 1 to 54% in Europe, 17 to 51% in Asia1.2 to 10% in New Zealand and Australia . The firThe incidence and prevalence of HCV among dialysis patients varies markedly from country to country -20 and aA panel of 30 top gastroenterologists of the country met in 2004 at a conference and reported that 75%-90% of HCV Pakistani patients were harboring genotype 3a, followed by genotype 1 ,28.The prevalence was higher among the males. High prevalence in male as compared to female could be due to their exposure to various HCV risk factors  particulBlood transfusion(s) constitute a part of treatment in many HD patients and thus exposed greatly to HCV ,14,29. TNeedle sharing and household contacts were not significant risk factors in this study, similar to other literature ,15. TherThis study showed a statistically significant difference in the prevalence of HCV infection between patients who were on dialysis for more than five years, and patients who were on dialysis for less than five years. Various other studies ,18,29-31It is concluded from pervious and current study that HCV prevalence in HD patients continued to be elevated in Pakistan. HCV genotype 3 accounts for approximately one-thirds of HCV-infected HD patients and the distribution of HCV genotypes in HD patients is similar to that in other population of Pakistan. High prevalence of HCV in HD patients demonstrated that environment of dialysis treatment itself function as a vehicle in dissemination of HCV among HD patients as well as they are exposed to the same community risk factors as general population.The authors declare that they have no competing interests.SK, SA and IA were involved in the designing the study. NU helped in collection of samples/data. SA and SNK did experimental work. SS and JK revised critically the manuscript. All the authors read and approved the final manuscript.


Seizure is an emergency in pediatrics. It really matters to the parents of the involved child to have information about the causes, management and prognosis. First unprovoked seizures (FUS) are seizures that occur in patients without fever, trauma or infection. Due to the rapid improvement in diagnostic techniques in the last few decades, the etiology will be revealed and this term will no longer exist. This Study was designed to evaluate brain imaging findings in FUS patients.Ninety-six children with FUS, who were admitted in three major children’s hospitals in Tehran, underwent brain imaging and were enrolled into the study. The decision about the type of imaging (CT or MRI) was based on the patient’s medical and financial conditions. An expert radiologist in the field of pediatric neuroimaging interpreted the images.Altogether, 27.1% had abnormal findings of which 29.2% were in the brain MRI group and 14.3% were in the brain CT scan group. Abnormal results were gliosis (10.4%), hemorrhage (4.2%), dysgenesis (2.1%), dysmyelination (7.3%), encephalomalacy (1%), atrophy (5.2%) and infarction (2.1%). In some patients, the lesions were in 2 or 3 sites and some had more than one type of lesion.There was no association between the duration, age and type of seizure and imaging abnormlities. However, we found an association between the location of the lesion and the type of seizure.We recommend brain imaging in all patients with FUS and apart from some exceptions, brain MRI is superior to CT. Seizure is a common neurologic problem that occurs in 3-5% of children .First unprovoked seizure (FUS) is a type of seizure with no obvious precipitating cause , but impImaging studies are one of the modalities that are very important in the management of this abnormality revealing abnormal findings more common than before. Abnormal imaging findings which are mentioned as 10% ,4, 21%  and 31% In a study conducted by Mark King  in 1998 Researchers , 10, 11 So we decided to carry out a survey as a systematic evaluation to find the abnormal imaging findings in Iranian cases.We evaluated 96 cases admitted to Shahid Beheshti and Tehran university-affiliated hospitals with first unprovoked seizure (FUS). All cases were sent for imaging, All the imagings were performed by 1.5 Tesla MRI or 16-slice CT scan Siemens. Sedation was given if needed to reduce motion artifacts . All ourThe entire imagings were evaluated by an experienced pediatric radiologist and reassessed in cases of doubt in a neuroradiological meeting with child neurologists. All of the clinical and paraclinical data were included in a figure for further evaluation. Imaging findings such as mass, encephalomalacia, porencephaly, gliotic and demyelinating lesions, the location of the lesion with demographic data such asgender, age, duration of the seizure, type of seizure, past medical history and labor history were included.The main including criteria were: 1-first seizure. 2- no fever. 3- no recognized drug usage. 4-no evidence of CNS infection. 5- no background or evidence of previous seizure. 6- no neurological sign. 7- age older than 1 month.This study was a cross sectional descriptive-analytic study. The data were analyzed by SPSS version 16 using t-test, Fisher’s test, Kolmogorov-Smirnov, Mann- Whitney and Chi square tests. A p value lower than 0.05 was considered as statistically significant.Ninety-six cases [of which 53 (55.2%) were male] were included in the study. The patients’ mean age was 68/7±48/2  months. According to the type of seizure,s ix groups; namely, generalized tonicclonic 60/96 (62.5%), generalized tonic 14/96 (14.6%), atonic seizure 12/96 (12.5%), absence 3/96 (3.1%), focal complex 6/96 (6.3%) and simple focal 1/96 (1%) were categorized . Sixty-eight of 96 cases (70.8%) had no family history of seizure. The mean duration of the seizures was 4.6 minutes  and none of the cases had a prenatal or perinatal history of hemorrhage or asphyxia.Eighty-two cases (85.4%) underwent MRI and 14 cases (14.6%) underwent CT scan. Twenty-six of the patients (27.1%) had an abnormal imaging. 24 cases with MRI (29.27%) had abnormality and 2 of 14 cases with CT scan (14.3%) had abnormal findings .The mostThe location of brain involvement was a white matter lesion in 10 cases (10.4%), corpus callosum in three (3.1%), thalamus in one (1%)  and basaWe had no lesion in the ventricular system, midbrain, pons or occipital region . Although seven (7.3%) cases had more than one location and more than one kind of lesion. We had electroencephalographic abnormality in 29 (30.2%) cases. Evaluation for any correlation between the findings was carried out. MRI revealed more lesions than CT scan; however, no significant difference is noticed (p=0.286). There was also no difference between the type of seizure and imaging modality for the detection of abnormality; though generalized tonic-clonic (GTC) was the most common seizure pattern detected (p=0.611).Otherwise more common findings are descriptive in this study without significant correlation.In retrospective studies by Khodapanahandeh  in Iran Beverly  found EEAndrew Kalnin  found abFollow up and data reveal 50% of the patients with FUS showed only one time seizure and had no experience of recurrence seizure unrelated to underlying brain anomaly. But findings abnormal brain is helpful for better management of these patients. In Khodapanahandeh’s study , the patShinnar  in a 10-According to Kings , 12.7% cIn 2010, Bano  revealedIn a study by Kalnin  in 2008 The most common lesions were ventriculomegaly (51%), gliosis (23%), dysplasia or heterotopias in 12%, brain atrophy in 12%, white matter disease in 9% and encephalomalacia in 6% which was different from what we found.Jasone  in 181 cSuggestions1) Imaging as a main diagnostic tool must be performed for every case with FUS.2) MRI with the accuracy of depicting white matter abnormalities and myelinating disorders has advantage over CT scan, especially in children older than 6 months of age. On the other hand, white matter abnormality is the leading cause of abnormality in our study.


Previous randomized controlled trials demonstrated a protective effect of renin angiotensin system blocking agents for the development of type-2 diabetes in patients with pre-diabetes. However, there are no real-world data available to illustrate the relevance for clinical practice.Open, prospective, parallel group study comparing patients with an ACE inhibitor versus a diuretic based treatment. The principal aim was to document the first manifestation of type-2 diabetes in either group.A total of 2,011 patients were enrolled . 1,507 patients were available for the per-protocol analysis . New-onset diabetes was less frequent in the ramipril than in the diuretic group over 4 years. Differences were statistically different at a median duration of 3 years . Both treatments were equally effective in reducing BP (14.7 ± 18.0/8.5 ± 8.2 mmHg and 12.7 ± 18.1/7.0 ± 8.3 mmHg) at the 4 year follow-up . In 38.6% and 39.7% of patients BP was below 130/80 mmHg (median time-to-target 3 months). There was a significant reduction of cardiovascular morbidity and mortality in favour of ramipril (p = 0.033). No significant differences were found for a change in HbA1c as well as for fasting blood glucose levels during follow-up. The rate of adverse events was higher in diuretic treated patients .Ramipril treatment is preferable over diuretic based treatment regimens for the treatment of hypertension in pre-diabetic patients, because new-onset diabetes is delayed. About 20% of patients with hypertension will develop type 2 diabetes in a three year period  and hypeIt was therefore important to recognize that diabetes development may be prevented by preferring blockers of the renin angiotensin system (RAS) as opposed to older treatment options such as betablockers and diuretics which promoted its development . CalciumBecause there is no large scale study on the effectiveness of blocking the RAS for the prevention of diabetes in "real world" clinical practice -20 we deADaPT is an open, prospective, non-randomised parallel group observation at 150 office based general physicians and internists. A detailed description of the design of the ADaPT investigation has been published previously . The stuInclusion criteria for ADaPT were based on the PreDisc Score : Age ≥ 4The primary evaluation criterion of ADaPT was the first manifestation of type 2 diabetes (fasting glucose level ≥ 126 mg/dl/≥ 7.0 mmol/l). Blood glucose related further criteria were the deterioration of pre-diabetes indicated by an increase of HbA1c of at least 10% over baseline, an increase of fasting glucose levels and a change of HbA1c. All laboratory values were analyzed in a central core laboratory. Blood pressure related criteria were achievement of a target BP < 130/80 mm Hg and the time needed to reach target. Major cardiovascular events and mortality as well as the type and frequency of adverse or serious adverse events (AE/SAE) were also recorded.Data were obtained on a paper case report form and entered into a Microsoft Access 2003 database. Analyses were conducted with SPSS 17.0. Patients treated with ramipril (or ramipril-based combination therapies) and patients who received various a diuretic based treatment strategy (with the exception of ACEi or ARBs) were compared using descriptive statistics for continuous target data per treatment group and per total including the following: number of patients, means ± standard deviation, or median. The absolute and relative frequencies in percentages were determined. For a comparison of the treatment groups with respect to the incidence of specific events (e.g. patients with first manifestation of diabetes mellitus type 2 or proportion of patients with deterioration of pre-diabetes), the chi-square or the log-rank tests was used.Between August 2004 and March 2006 a total of 2,108 patients were enrolled. Ninety-seven had to be excluded because of violations against the study protocol resulting in 2,011 patients available for the intention to treat analysis - 1,350 patients were allocated to a ramipril based and 661 patients to a diuretic based therapy. The per-protocol analysis  excluded all ramipril patients, who had received any diuretic or a beta-blocking agent and all patients of the diuretic group with concomitant ACEi or ARBs. In the ramipril group 15.3% received calcium channel blocker and no patient in the diuretic group received a betablocker. Of these 1,394 patients were available for the 1 year follow-up, 1,286 for the 2 year, 1,040 patients for the 3 year and 483 for the 4 year follow-up.Patients enrolled  had a mean age of 69.1 ± 10.3 years, and 51.6% were female. The mean BMI was 29.9 ± 4.9 kg/m2, which meant that 41.7% were obese. With the exception of a larger proportion of female patients in the diuretic group  all other characteristics, risk factors, laboratory values and co-medication were comparable in the two study groups (Table Office blood pressure at baseline was 147.4 ± 15.9/87.3 ± 9.3 mmHg in the ramipril group and 144.6 ± 15.3/86.5 ± 9.4 mmHg in the diuretic group (p < 0.001/p = n.s.). Daytime ambulatory blood pressure was 138.2 ± 15.1/81.4 ± 10.0 with ramipril and 135.0 ± 15.0/80.4 ± 10.8 with diuretics . HbA1c was 5.6 ± 0.6% and 5.7 ± 0.7% respectively (p = n.s.). While none of the patients had diabetes at enrolment, 37.0% of ramipril treated and 40.4% of diuretic treated patients had a family history of diabetes (p = n.s.).Patient characteristics of the per-protocol (PP) population were essentially identical to the ITT population Tables , 2, 3. TThe primary evaluation criterion was the first manifestation of type 2 diabetes defined as a fasting glucose level ≥ 126 mg/dl/≥ 7.0 mmol/l. The prevalence of type-2 diabetes was 0% at baseline (per exclusion criteria). Incidence rates were consistently higher in the diuretic than in the ramipril group through years 1 to 4. Strikingly however, incidence rates were 16.9 and 18.2% in the first year and between 2.5 and 7.6% in subsequent years 2 to 4. The prevalence rose continuously during follow-up .Laboratory assessments were performed every year. No data were available on the initiation of antidiabetic medication during follow-up.Fasting glucose levels at baseline were about equal in both groups . Values remained rather stable over the 4 year observational period; both within group comparisons showed a trend towards slightly lower values after year 4 in the ramipril group but were not significant  and remained virtually similar between groups throughout the 4 year observation. There was however a gradual deterioration in 0.1% steps per year, resulting in an HbA1c of 6.0 ± 0.7% in both groups at 4 years . After 4 years follow up albuminuria was slightly reduced in the ramipril group , while it was increased in the diuretic group .The difference in total mortality (2.0% with ramipril vs. 2.9% with diuretics) as well as differences in major cardiovascular events (3.7% with ramipril vs. 5.0% with diuretics) including first manifestation of symptomatic coronary heart disease, peripheral arterial occlusive disease and cerebrovascular events was similar in both treatment groups (p = n.s.), while showing a trend for lower rates in the ramipril group. In a post hoc Kaplan-Meier analysis grouping both mortality and cardiovascular events, the difference between the ramipril and the diuretic treated group became significant in favour of ramipril (p = 0.033) Figure .Serious adverse events  were more frequent in the diuretic based treatment group . The most frequent classification as per MedDRA system organ class  as compared to subsequent years . This is in contrast with results of NAVIGATOR where incidence rates were about 9% each year and was not different across years 1 to 5 .3% as co,25 and 2The possibility for physicians in this real world trial to add a calcium channel blockers to the ramipril group and a betablocker to the diuretic group may be perceived to confound the principal comparison of this investigation and limit its interpretation. This is because betablockers have been demonstrated to adversely affect glucose control and calcium channel blockers, which were neutral with respect to the development of diabetes in a large network meta-analysis published by Elliott  and suppBased on these considerations we are convinced that the effects of ramipril over a diuretic based antihypertensive treatment can also be observed in clinical practice. As pointed out by Al-Mallah the number of patients to prevent one case of new onset diabetes (50-100) is too small to justify their use for simple prevention . HoweverAny cardiovascular events were reduced with ramipril vs. diuretic based treatment in our study (p = 0.033). However, these results have to be considered with caution since they were determined from cases announced to the trialists as adverse or serious adverse events and serious underreporting of adverse events has been documented for observational studies . FurtherGiven that 50 to 100 patients have to be treated with RAS blocking agents to prevent one case of new onset diabetes  might caTherefore patients were selected for ADaPT based on the PreDisc-Score, that closely correlates to the outcome of an OGTT . The PreThe utility of the PreDisc-Score in the present has to be considered on the background of a number of variables. 1) Non-interventional studies such as ADaPT are prone to unknown bias because they are non-randomized and non-blinded. A possible result is a blurred estimate of the true effect which might underestimate differences between treatment groups. To cope with this the PreDisc-Score appears appropriate to select a patient population at high risk. 2) Despite the selection of high risk patients incidence rates within 4 years are not different from trials such as NAVIGATOR/DREAM , which mLimitations of our study are mainly the observational, not randomized character, which doesn't prevent bias through unknown impacting parameter. Yet the study goal was to confirm in a large cohort reflecting daily medical practice the findings of large existing randomized clinical trials. The only noteworthy differences in the baseline characteristics of both treatment groups seem to be a slightly higher proportion of male patients (51.4 vs. 42.6%) and higher percentage of calcium channel blocker use in the ramipril group (18.6 vs. 15.3%). We do not know if this affected the outcome in any relevant perspective, but such minor differences can never completely be ruled out in observational registries. As mentioned before a noteworthy limitation for interpretation of the presented outcome data is the fact, that the cardiovascular event and mortality analysis was only based on the AE/SAE reporting.The present study documents a high incidence rate for type-2 diabetes during the course of a four year observational period. Our key finding is in line with the large prospective randomized studies such as ASCOT-BPLA, VALUE, DREAM and NAVIGATOR and meta-analyses, which reported a significantly reduced incidence of new-onset diabetes with RAS based pharmacotherapy compared to diuretics, beta-blockers or placebo in pre-diabetic, hypertensive or cardiovascular risk patients. Patients at risk for the development of diabetes, who are identified with the PreDisc-Score should preferably be treated first line with ramipril rather than a diuretic or beta blocking agent for arterial hypertension.All authors made substantial contributions to conception and design, or acquisition of data, or analysis and interpretation of data. CZ and PB have drafted the manuscript. The other authors revised the manuscript for important intellectual content and all authors granted final approval of the manuscript to be published.WZ, JS, SL, SM, CH, JH, CZ and PB received consultancy fees, attended advisory boards and have held lectures for a number of pharmaceutical companies including Sanofi-Aventis. WDP declares to be and CZ to have been an employee of Sanofi-Aventis Germany. CDS has no conflict of interest to declare.


To the Editor: Rift Valley fever (RVF) is caused by a Phlebovirus (family Bunyaviridae) transmitted by a wide range of mosquitoes , a large number of live ruminants enter Grande Comore from Anjouan and Mohéli, the other 2 islands of the Republic, from Madagascar and Tanzania without quarantine or any other preliminary veterinary control.,We report results from a serosurvey of the ruminant populations on the 3 islands of the Republic of Comoros during the 2009 dry season (April–August). A total of 488 blood samples were collected from randomly selected sheep, goats, and horned cattle and sent to laboratory facilities in Mayotte to be tested by an RVFV immunoglobulin (Ig) G competitive ELISA . Significant differences in RVFV seroprevalence were found between islands (p<0.005), especially between Anjouan  and Moheli ; p = 0.011). Of the 50 samples tested in seroneutralization, 31/31 (100%) of RVFV IgG ELISA-positive serum samples were confirmed as positive for RVFV . The 3 species were positive for IgG, with prevalence of 30.6% (95% CI 24.2%–37.1%) for cattle, 33.5% (95% CI 27.6%–39.3%) for goats, and 39.0% (95% CI 24.1%–54.0%) for sheep. Using a χfor RVFV .The serologic evidence of RVFV circulation in the ruminant population of the Republic of Comoros is in accordance with the epidemiologic situation described in other countries in the area. Actually, the serosurvey was implemented after the RVF outbreaks reported in several countries in eastern Africa in 2007 during El Niño rains  and the contagious ecthyma (1999) were probably introduced into the country by live ruminants imported from Madagascar (


We examined factors associated with late presentation of HIV using the new European consensus definition . The frequency of late presentation was highest in those aged 50 years or older and remained unchanged over time (64.3% in 1996-1998 and 65.4% in 2008-2010). In contrast, among those aged less than 50 years, the proportion with late presentation decreased over time (57.1% in 1996-1998 and 38.5% in 2008-2010). Other factors associated with late presentation were African ethnicity and being a male heterosexual.Of the 1536 included in the analysis, 86% were male and 10% were aged 50 years and older. Half the cohort (49%) had a CD4 cell count below 350 cells/mmThe mortality rate was 15.47/1000 person-years (pyrs) (95%-CI: 13.00-18.41). When compared with younger adults, older individuals had a higher mortality, after adjusting for confounders (rate ratio (RR) = 2.87; 95%-CI: 1.88-4.40).Older adults were more likely to present late and had a higher mortality. Initiatives to expand HIV testing in clinical and community setting should not neglect individuals aged over 50. Thcells/mm3,20. Howells/mm3[3 and the D4 count . Two recD4 count  while thD4 count .3), and mortality in a large UK cohort comprising predominantly of men who have sex with men (MSM) over a 14-year period.In this study, we examined factors associated with late presentation  patients with no documented baseline CD4 cell count for reasons stated in Figure For the analysis on mortality, 64 (3.5%) patients only attended once and did not contribute to follow-up time, while the dates of HIV diagnosis were missing for 9 patients leaving 1965 (96.4%) patients eligible for this analysis  estimated using logistic regression. The likelihood ratio test statistic was used to estimate the We also examined for the median time to initiation of HAART for the two age groups stratified by CD4 cell count at presentation using the Kaplan-Meier approach. For this analysis, patients were censored at the time started HAART for those on treatment and time last seen for those who remained untreated at the end of follow-up.To estimate mortality rates, participants were censored at the earliest of: death, date last seen, or end of follow-up (31 May 2010). Poisson regression modelling was used to estimate survival probability. Patients who attended at least once following the enrollment visit contributed person-years (pyr) for the analyses. Age was the primary exposure when fitting the multivariable Poisson regression model. This was adjusted for a priori confounders such as ethnicity and HIV risk group irrespective of whether they acted as confounders in this study or not. All analyses were carried out using STATA 11.0 .Of the 2038 patients enrolled with HIV infection between January 1996 and May 2010, 1536 (75.4%) patients had documented CD4 cell counts within 3 months of diagnosis and formed the basis of the analysis on late presentation. Of the 1536 patients, 1316 (86%) were male and 151 (9.8%) were aged 50 years and older when diagnosed with HIV infection. The median age at HIV diagnosis was 33.1 years (IQR 27.8-38.7) and 54.8 years (IQR 52.0-60.0) respectively, for those aged <50 and ≥50 years at diagnosis and 34.2 years (IQR 28.2-41.5) for the whole cohort.p = 0.74 and 0.41 respectively). Patients with missing information on CD4 count were significantly more often heterosexual and of African ethnicity (p = 0.007 and 0.008 respectively).The majority of the cohort were Caucasian (79.5%) and MSM (73.8%). Of the 239 participants of African-Caribbean ethnicity, 90% acquired their HIV through heterosexual intercourse while 87% of Caucasians acquired their HIV through homosexual intercourse. There was no difference in the age and sex distributions of patients with missing CD4 count at presentation (3 at HIV diagnosis and 23% (359/1536) presented with a CD4 count less than 200 cells/mm3. The median CD4 cell count for late and early presenters was 211 cells/mm3 (IQR 83-289) and 527 cells/mm3 (IQR 423-659) with median ages of 35.9 years (IQR 29.7- 43.6) and 32.9 years (IQR 27.5- 39.0) respectively.Approximately half (49%) the cohort presented late with a CD4 count less than 350 cells/mmOn univariable analyses, late presentation was associated with older age, being of non-Caucasian origin and being either a female or male heterosexual Table . On multp-trend = 0.0001). In contrast, among those over the age of 50 years, the proportion of patients presenting late was constant over time .The proportion presenting late decreased from 57.1% among those younger than 50 years in 1996-1998 to 38.5% in the 2008-2010 . The corresponding proportions among heterosexuals were 66.3%, 66.5% and 65.0% respectively (p-trend = 0.78).There was also evidence of a difference in trends of presenting late with sexual orientation. Among MSM, 51.3% presented late in 1996-2001 period, compared with 42.4% in 2002-2005 and 39.1% in the 2006-2010 (p (log-rank test) = 0.001 whilst amongst those presenting early it is 1041 days (IQR 467-1491) and 1236 day respectively (IQR 607-2290); p (log-rank test) = 0.0001  and 98.0 days respectively (IQR 39.0 -476.0); 3 respectively while 47 deaths occurred in individuals with unknown CD4 cell counts before death.Overall 127 deaths occurred in 1965 patients between Jan 1996 and May 2010; 26 and 54 deaths were in individuals presenting with CD4 cell count greater and less than 350 cells/mmpneumocystis jirovecii pneumonia (PCP) as well as AIDS-related malignancies in both age groups. 34/127(26.8%) of deaths were non-AIDS related death, predominantly due to malignancies. The causes for the remaining deaths were unspecified.64/127 (50.4%) of deaths were AIDS related death, and were predominantly due to AIDS- related bacterial pneumonia and Overall mortality rate in the cohort after 8210.30 person years (pyrs) of follow up was 15.47 per 1000 pyrs (95% CI: 13.00-18.41).3, 23/54(42.6%) in those with CD4 count less than 350 cells/mm3 and 29/47 (61.7%) in those with unknown CD4 count.53/127 (41.7%) of deaths occurred within the first year of follow up in cohort; 1/26(3.9%) in those presenting with CD4 count greater than 350 cells/mm3. 4/12(33.3%) and 8/12(66.7%) were in individuals with CD4 count less than 350 cells/mm3 and unknown CD4 count respectively.12/30 (40%) of deaths among individuals 50 years or older occurred in the first 12 months of presentation. None of these 12 deaths occurred in individuals with CD4 count greater than 350 cells/mm3. 19/41(46.3%) and 21/41(51.2%) of these deaths were in individuals with CD4 count less than 350 cells/mm3 and Unknown CD4 count respectively.41/97(42.3%) of deaths among individuals less than 50 years occurred in the first 12 months of presentation. Only 1 of these early deaths occurred in an individual with CD4 cell count greater than 350 cells/mmTable 3 was associated with a doubling of mortality while ART was associated with 37% reduction in mortality.On Univariable analysis, individuals who were 50 years or older at HIV presentation had a higher mortality compared to younger adults-HR 2.70 (95% CI: 1.80-4.08). Being diagnosed with a CD4 count <350 cells/mm3. Prior to this ART was initiated at CD4 <200 cells/mm3. We observed that there was no difference in the adjusted decrease in mortality in the 3-year period preceding the change in guidelines and the 2-year period following this, both periods showing an 80% decrease in mortality (full results not shown).On multivariable analysis, older age, earlier calendar period, and lower or unknown CD4 count were significantly associated with increased mortality. ART was also associated with a more marked reduction in mortality after adjustments. The reduction in mortality on ART was similar for the group who had been on it for less than 12 months with that of individuals who had been on it for longer, hence only the combined results for being on ART was shown. The decrease in mortality in the later calendar periods was further explored because of the change in UK guidelines in 2008 recommending the initiation of treatment when CD4 <350 cells/mmp-interaction = 0.67).No statistical interaction was detected between age at presentation and late presentation on mortality , with a likely associated increase in mortality.The association of late presentation with increased mortality has also been described in other studies both in the UK ,36,37 an3. Some deaths were coded as unspecified especially in those who died outside healthcare facilities as further information was lacking. This could have resulted in misclassification of some causes of deaths. Finally, the majority of the patients in this cohort were Caucasian MSM, hence the findings cannot be generalised to a cohort that is diverse in both ethnicity and sexual orientation; however this does not undermine the study validity.The strengths of this study lie in the utilization of the new European consensus definition for late presentation as this would facilitate regional comparisons within Europe and allow investigation of temporal trends after interventions , and theAs a result of the high mortality associated with late diagnosis, strategies must be put in place to encourage HIV testing. The CDC recommend routine testing in all healthcare settings for patients aged 13–64 years, unless the local HIV prevalence is known to be less than 0.1% .In addition to recommending routine testing in genitourinary medicine and antenatal clinics, 2008 UK guidelines for HIV testing also advocate that tests should be offered to all adults registering in general practice and to all general medical admissions patients in areas where diagnosed HIV prevalence is greater than 2 per 1,000 among 15 to 59 year olds . The UK HIV testing should take an ‘opt-out’ approach. Higher rates of HIV testing are achieved with such ‘opt-out’ approaches than opt-in approaches ,46. IdenThis paper showed that HIV late presentation is very common and does not appear to be improving in older adults. This impacts individual health as documented by increased mortality in this study. The consequent increase in hospitalizations also results in increased health care costs. Most HIV transmissions are from individuals unaware of their status.Prompt HIV diagnosis could be achieved through a policy that enables HIV test to be offered routinely alongside other investigations.All authors declare there are no competing interests that are relevant to this article.CI conceived the study and participated in the design, analysis and draft of the manuscript. DC made substantial contributions to the study design and draft of the manuscript. YG contributed to the design and draft of the manuscript. HW contributed to the statistical analysis and draft of the manuscript. MF participated in the design, analysis, coordination and draft of the manuscript. All authors read and approved the final manuscript.The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2458/13/397/prepub


Transcatheter aortic valve implantation (TAVI) is evolving rapidly as a therapeutic option in patients deemedto be at high risk for surgical aortic valve replacement. Early outcome and survival of controlled feasibility trials and single-center experience with TAVI have been previously reported. Valve performance and hemodynamics seem to improvesignificantly after TAVI. Long-term outcome up to 3 years have been demonstrated in recent studies. Admittedly, the resultsare encouraging with a survival rate at 2 and 3 years ranging from 62 to 74% and from 56 to 61% respectively. Theimprovement in hemodynamical and clinical status sustained beyond the 3 years follows up. However, paravalvular leakageafter TAVI remains an important issue in this rapidely evolving field. Aortic stenosis (AS) is the most common valvular disease in the world. The surgical therapy is currently the gold standard for the treatment of the calcified stenotic valve . With meTranscatheter aortic valve implantation is a novel and rapidly evolving technique. It was first introduced in 2002 and is currently available as an alternative to conventional AVR for patients with severe symptomatic AS who are deemed to be at high risk for open heart surgery. Several studies showed the feasibility and safety of TAVI in those patients with high STS and EuroSCORES  , 5. PatiThis review summarizes the most recent data published concerning the long-term results of patients undergoing TAVI including mortality, durability and hemodynamic performance up to 3 years. The most recent TAVI studies showed improved 30-day and 1-year survival with growing experience. The first transfemoral and transapical TAVI experiences demonstrated a higher 30-day mortality ranging from 12 to 15% and in some series up to 20% , 14. Mos1. There are very few data demonstrating the long-term survival in patients following TAVI. Most centres began with a TAVI program in 2009. Walther et al. presented recently the results of TAVI at 3-year follow up. A total of 299 patients underwent transapical aortic valve implantation from February 2006 until January 2010 using the Edwards SAPIEN transcatheter prosthesis. In their study, the 30-day survival was 91%, 73% at 1 year, 68% at 2 years, and 58% at 3 years [et al. presented the long-term results of transfemoral and transapical Edwards Sapien implantation in one single-center in 70 patients during a mean follow up of 3.7 years. Similar to the previous study, the 1-year, 2-year and 3-year survival rates were 81%, 74% and 61%, respectively [et al. presented the long-term outcomes of a large Italian registry undergoing TAVI with the Medtronic CoreValve device. The survival rate at 1-year, 2-year and 3-year were 76.4%, 69.7% and 56.2% respectively [The published data for long-term survival are shown in Table  3 years . Gurvitcectively . Congrueet al. presented recently the 2-year results in 227 patients following transfemoral and transapical TAVI. The Medtronic CoreValve prosthesis was implanted in 174 patients and the Sapien Edwards prosthesis in 53 patients. The early and long-term mortality rates were not different from previous reports. The survival rates at 30-day, 1-year and 2-year were 88.5%, 74.5% and 64.4% respectively [Bleiziffer ectively . AccordiA recent multicenter single-arm study with symptomatic patients with severe aortic stenosis undergoing TAVI demonstrates a 30-day all-cause mortality of 15.2% and a 2-year survival of 61.9% . The stuThe device performance and durability is still subject of investigation. The published TAVI studies presented excellent postoperative device function, however, long-term results of device durability are still lacking. Concerns about tissue deterioration, endocarditis and tissue injury through crimping and after balloon dilatation, frame fracture and valve migration have been largely discussed and may potentially impact long-term valve function. 2 and range from 4 to 15%. Usually, the initial AR after TAVI stays unchanged and no progression to severe AR is described over time [et al. [The excellent device performance for transcatheter aortic valves is inasmuch tempered by the increased risk of paravalvular leakage, caused by the native valve cusp calcifications which remain in situ. The incidence of moderate paravalvular regurgitation is ranging from 4% to 40% , 25. In ver time , 28. The [et al.  describe [et al. .3). Leaflet deterioration after TAVI has been published in only one single case report. Ong et al. demonstrated a remarkable degeneration of a CoreValve prosthesis five years after implantation [All previous studies documented no evidence of structural valve detoriation or significant changes of the hemydynamic status of the prostheses -22  [et al. observed in only 1.4% of all patients a valve endocarditis. However, late follow-up data in these patients remain relatively sparse [In all studies, the incidence of endocarditis was very low. Walther s (0.4%) . The SOUs (0.4%)  reportedy sparse . 1). All studies presented the effective orifice area (EOA) and transvalvular aortic mean gradients. In the study of Gurvitch et al., echocardiographic follow-up data were available in 37 patients. The mean aortic gradient decreased significantly from 45 mmHg to 10 mmHg after TAVI (p<0.01) with a subsequent increase to 12 mmHg after 3 years. The calculated aortic valve area increased significant from 0.6 ± 0.2 cm2 at baseline to 1.7 ± 0.4 cm2 after TAVI with a subsequent attrition at 12 months to 1.5 ± 0.3 cm2 and to 1.4 ± 0.3 cm2 after 3 years [et al. showed a significant decrease in the aortic mean gradient from 52 mmHg to 10.3 mmHg after 1 year and a gradient of 10.3 mmHg after 3 years follow up [2 at baseline to 1.7 cm2 after TAVI and remained unchanged after 3 years (1.7 cm2). The study of Bleiziffer et al. confirmed all previous findings. The mean aortic gradient decreased significantly from 48 mmHg at baseline to 12 mmHg at discharge with no changes over 2 years follow up. The calculated aortic valve area increased from 0.67 cm2 at baseline to 1.55 cm2 at discharge and remained unchanged 2 years after TAVI [The hemodynamics and valve efficacy were assessed by echocardiographic controls up to 3 years follow up . Moreover, 50% of all strokes occurred during the first 24h after the implantation with a peaking high hazard phase in the first postoperative week [et al. described possible risk factors for early and late neurogical events occurring in the PARTNER Trial. The risk of late stroke is influenced by patient’s comorbidities [The major neurological adverse outcomes are illustrated in Table ive week , 32. Thebidities . Those fAmong all studies, the stroke rate at 2-3 years was different and ranged from 3.9% to 13.5%. Different definitions of neurological events could explain the divergence in the percentage reported in all studies. Such differences in endpoint definitions should be eliminated in the future by using the standardized VARC criteria . TAVI exhibits excellent hemodynamic and clinical improvement in patients presented with high surgical risk for SAVR. The improvement sustained up to 3 years follow up with a survival rate of approximately 60%. Valve deterioration and tissue endocarditis are very rare even at 3 years follow up. However, the aortic insufficiency after TAVI remains an important issue in this rapidly evolving field.


Sodium Dodecyl Sulfate (SDS) is one of the most widely used anionic detergents. The present study deals with isolation and identification of SDS-degrading bacteria from a detergent contaminated pond situated in Varanasi city, India.Employing enrichment technique in minimal medium (PBM), SDS-degrading bacteria were isolated from pond water sample. Rate of degradation of SDS was studied in liquid PBM and also degradation of different concentrations of SDS was also studied to find out maximum concentration of SDS degraded by the potent isolates. Alkyl sulfatase activity (key enzyme in SDS degradation) was estimated in crude cell extracts and multiplicity of alkyl sulfatase was studied by Native PAGE Zymography. The potent isolate was identified by 16S rRNA sequence analysis.Pseudomonas putida strain SP3.Using enrichment technique in minimal medium containing SDS as a sole carbon source, initially three SDS degrading isolates were recovered. However, only one isolate, SP3, was found to be an efficient degrader of SDS. It was observed that this strain could completely metabolize 0.1% SDS in 16 h, 0.2% SDS in 20 h and 0.3% SDS in 24 h of incubation. Specific activity of alkyl sulfatase was 0.087±0.004 µmol SDS/mg protein/min and Native PAGE Zymography showed presence of alkyl sulfatase of Rf value of 0.21. This isolate was identified as P. putida, which shows high rate of SDS degradation and can degrade up to 0.3% SDS. It appears that this isolate can be exploited for bioremediation of this detergent from water systems.This is the report of isolation of SDS-degrading strain of  In India, ponds are often used for washing of clothes by washer men and for bathing purposes by local people . In somePseudomonas are capable of degrading SDS and utilizing it as a carbon source , which is subsequently oxidized to 1-dodecanoic acid. Finally, 1-dodecanoic acid enters into - oxidation pathway and is utilized as carbon source (Sodium Dodecyl Sulfate (SDS) is an anionic detergent widely used in the manufacturing of a number of household and industrially useful products . Like ann source , 18 thouhe world –15. The he world , 19. TheIntensive survey revealed that there are a number of ponds in Varanasi city which are frequently used for washing and bathing purposes. As SDS is one of the widely used detergents, we became interested in screening for the presence of SDS degrading bacteria from pond water. In the present study, we have made an attempt to isolate and identify SDS degrading bacteria from a man made pond situated at Sunderpur in Varanasi city India.2HPO4 0.1%, KH2PO4 0.1%, NH4Cl 0.1%, MgSO4.7H2O 0.02%, NaCl 0.05%, CaCl2 0.002%, trace elements  pH 7.5) supplemented with SDS (0.1%) in a 250 ml culture flask and incubated at 37°C and 150 rpm in a shaker . After 3-4 days of growth, the culture (1 ml) was transferred to fresh 100 ml PBM supplemented with SDS (0.1%). Sub- culturing was repeated for at least 3-4 times which resulted in the enrichment of putative SDS-degrading bacteria. For isolation of SDS-degrading bacteria, 0.1 ml of enrichment culture was serially diluted in PBM and was spread on PBM agar plates containing SDS (0.1%). The plates were incubated at 37°C in a BOD incubator for 2–3 days until minute colonies appeared and based on colony morphology, different SDS-degrading bacteria were isolated.Enrichment and isolation of SDS-degrading bacteria. For the isolation and enrichment of SDS- degrading bacteria, 1 ml of pond water was inoculated in 100 ml sterilized PBM  medium .The cultures were centrifuged at 8,000 rpm for 5 min at room temperature, washed with PBM and then OD600 nm of each isolate was adjusted to approximately 10.0 with PBM, 0.250 ml of the culture was used to inoculate 100 ml of PBM containing varying concentration of SDS (0.1 to 0.5%). The cultures were incubated at 37°C with shaking at 120 rpm. At regular intervals, samples were removed and assayed for culture OD at 600nm and residual SDS by stains all (Preparation of crude cell extracts. Strain SP3 was grown in PBM containing SDS (0.1%) as a sole carbon source. Cells were harvested in mid logarithmic phase by centrifugation at 10,000 rpm for 20 min at 4°C in a Sorvall RC-5B superspeed refrigerated centrifuge . Cell pellets were washed twice and resuspended in 10 mM Tris-HCl (pH 7.5). The cells were ruptured by sonication for a total duration of 3 min, consisting of intermittent sonication for 30 s on and 30 s off, operated at level 5 and a 25% duty cycle in a Branson Sonifier 450 . To minimize heat inactivation of enzymes, samples were sonicated in eppendorf tubes kept on ice. Cell debris was removed by centrifugation at 12,000 rpm for 10 min at 4°C. The cell extracts were stored at -20°C prior to assay for alkyl sulfatase activity  complete degradation of SDS was observed in 16h of incubation with concomitant increase in the culture OD indicating utilization of this detergent as a carbon source . It was observed that this strain could completely metabolize 0.1% SDS in 16 h, 0.2% SDS in 20 h and 0.3% SDS in 24 h with increase in culture , NBAII PF-4K (Accession No. HM439958.1),AKMP7 (Accession No. GU396282.1), 31920-1 (Accession No. FJ932760.1) respectively. So, this isolate was identified as P. putida strain SP3 and the sequence was submitted to NCBI database (Accession No. HQ005307.1) (05307.1) .Pseudomonas betelli and Acinetobacter johnsoni capable of metabolizing SDS. It was observed that Acinetobacter johnsoni was able to degrade 93.6% of 0.05% SDS within 5 days of incubation; whereas, Pseudomonas betelli did so to the extent of 84.6% in the same time period. The highest peak of SDS degradation occurred during the logarithmic phase of bacterial growth. Shukor et al. , three SDS-degrading bacterial isolates were recovered from the pond water. These isolates were selected on the basis certain morphological features such as color, pigment production, colony morphology etc. The rate of degradation of SDS by these isolates was studied by monitoring disappearance of SDS with time and also by measuring the growth of the isolate. It was observed that these isolates showed varying rates of SDS biodegradation. Only one isolate, namely SP3, showed appreciable level of biodegradation. This strain took 16h to completely degrade 0.1% SDS in PBM. Degradation of higher amounts of SDS was also studied. This strain was able to degrade up to 0.3% SDS in PBM. At higher concentrations of SDS, i.e. 0.4, and 0.5% SDS the degradation was incomplete. There are a number of reports of isolation of SDS-degrading bacteria from different parts of the world , 13, 23.r et al.  have isoPseudomonas ATCC19151 and P. aeruginosa PA01 that these isolates harbor single alkyl sulfatases SdsA (P. putida strain S-313 harbors an alkyl sulfatase AtsK which belongs to α-ketoglutarate dependent dioxygenase superfamily of enzymes (P. putida KT2440 genome revealed that in addition to AtsK, this strain also harbors another alkyl sulfatase which shows low level homology to alkyl sulfatase SdsA1 belonging to P. aeruginosa PA01.Alkyl sulfatase activity in this isolate was also studied during exponential phase of growth with SDS as a carbon source. This isolate showed an alkyl sulfatase specific activity of 0.087 ± 0.004 µmol SDS/mg protein/min. Native PAGE zymography indicated the presence of an alkyl sulfatase of Rf value of 0.21, which was present in this isolate irrespective of growth stage. Literature survey suggests that there is much ambiguity regarding presence of alkyl sulfatase. Earlier reports suggested that bacteria capable of metabolizing SDS and related alkyl sulfate esters harbor multiple alkyl sulfatases, which are expressed during different growth stages , 25. On ses SdsA  and SdsAses SdsA  respecti enzymes . A survePseudomonas putida strain 3.5.8, NBAII PF-4K, AKMP7, 31920-1 respectively. So, this isolate was identified as P. putida strain SP3. Until now there are several reports of isolation of SDS-degrading bacteria belonging to family Pseudomonas (P. putida from this region.16S rRNA gene sequencing is one of the widely used methods of bacterial identification. This isolate was identified based on 16S rDNA sequencing. The sequence of SP3 showed 99% similarity to udomonas , 26, 27.P. putida KT2440 revealed the presence to two alkyl sulfatase genes. We feel that it would be interesting to confirm the identity of this alkyl sulfatase. We hope that this would provide new insights into degradation of SDS and related alkyl sulfate esters.In conclusion, it appears that this strain is better adapted for rapid removal of SDS as compared to other strains isolated by different laboratories. So, this strain can be efficiently utilized for removal of detergents from detergent contaminated water systems. Additionally, a single alkyl sulfatase was observed during growth of this strain in presence of SDS. However, a search of genome sequence of