11^th Global Infections Conference November 12-13, 2018 Melbourne, Australia

Biography:

Abstract:

Geohelmiths are mainly a health problem in developing    counties. Soil Transmitted Helminth well known of such  are Ascaris lumbricoides, Trichuris trichiura, Hookworm. The soil-transmitted helminths (STH) are the world’s most important causes of physical and intellectual growth retardation Ascaris lumbricoides infection is one of the most common intestinal worm infections. High prevalence ascariasis in Indonesia  in rural areas with poor sanitation about 80%. Anthelminthic Resistance is a common problem in STH. Most available alternative therapy is derived from plants. The purpose of this study was to analyse the anthelmintic effect and potency of Gandarusa LeavesI Infusion (GLI), Pomegranate Skin Infuson (PSI) and Papaya Leaves infusion (PLI) againts Ascaris suum  Female In Vitro. Methodology was a Real laboratory exprimental research design using  960  female worms of Ascaris suum which were divided into 8 groups. The anthelmintic effect tested in vitro. The data measured is the number of death worms after incubated for 3 hours at a temperature of 37⁰C. The data of death worm were analyzed using one-way ANOVA with α = 0.05, if there are differences continued by Tukey HSD test (p = 0.05). Results  The GLI, PLI and PSI were differed significantly when compared with negative control with p=0.000 and the Tukey HSD results showed GLI2, GLi3, PSI 2 were not significant when compared with positive control with the value of p >0.05). Conclusion All of GLI, PSI and PLI were have anthelmintic efectivity against Ascaris suum female in vitro and GLI2, GLi3, PSi2 were equivalent with positive control.

 

Biography:

Abstract:

Parkinson's disease (PD) is a progressive neurodegenerative disorder that primarily presents with features of bradykinesia, rigidity and tremor, and has, as part of its core pathology, the degeneration of dopaminergic neurons in the substantia nigra pars compacta. There is a great need for the development of a reliable diagnostic tool to improve promptness of diagnosis, definition of disease subtypes, and to monitor disease progression and demonstrate treatment efficacy in the case of disease modifying therapies. Biomarkers are characteristics that can be measured as an indicator of a normal biological process, and they have special relevance in Parkinson’s disease. We currently have no definitive diagnostic test, and thus for the clinician there is hope that biomarkers will help diagnose symptomatic and presymptomatic disease or provide surrogate end-points to demonstrate clinical efficacy of new treatments, such as neuroprotective therapies, and help stratify this heterogeneous disease. No biomarker is likely to fulfill all these functions, so we need to know how each has been validated in order to understand their uses and limitations, and be aware of potential pitfalls. In this review we discuss the current potential biomarkers for Parkinson’s disease, highlight the problems with their use, and conclude with a discussion of future alternatives. Current biomarkers range from objective clinical tools, to neuroimaging, to 'wet' markers involving blood and cerebrospinal fluid. To date, all candidate biomarkers for PD have failed to be developed into a clinically useful tool. Ideally, a combination of sensitive markers will be needed, not only to predict the onset of PD, but also to help in subtype classification and to follow progression. Here, we critically review various PD biomarker studies.

 

Biography:

Abstract:

Gastrointestinal basidiobolomycosis is an emerging infection, with fewer than 80 cases reported in the English literature. Case Presentation: Also, a few cases of gastrointestinal basidiobolomycosis, accompanied by liver involvement as part of a disseminated disease, have been reported. Conclusions: This is the first case report of an isolated liver involvement of this fungal infection in a 2-year-old girl, who presented with a liver mass resembling a hepatic abscess.

Zygomycosis includes 2 orders, one of which causes fungal infections in an immunocompromised host (Mucorales) and the other in an immunocompetent host (Entomophthorales) (1).

Basidiobolus ranarum belongs to the second group and is a saprophyte found mostly in soil and decaying vegetable material (2). It is a low virulent fungus, and the first human case of this fungal infection was reported in 1956 in subcutaneous tissue (3). Since then, many cases of subcutaneous basidiobolomycosis have been reported. However, the gastrointestinal (GI) involvement of this fungus is an emerging infection and has rarely been reported (4). Recently, a few cases of GI basidiobolomycosis, accompanied by liver involvement as part of a disseminated disease, have been reported (5).

To the best of our knowledge, no case has been reported in the English literature with an isolated liver mass caused by basidiobolomycosis without the involvement of any other organ. Accordingly, herein we report our experience with a 2-year-old girl, who presented with a liver mass subsequently identified as basidiobolomycosis.

Case Presentation

A 2-year-old well-nourished and well-developed girl from the Iranian city of Kangan (Bushehr province) presented with vague and generalized abdominal pain. She was the first child of the family, born via normal vaginal

delivery without any specific disorder. She had had a normal infancy until 2 months prior to her referral, when she developed abdominal pain with no response to routine treatment.

Physical examination was normal, except for mild hepatomegaly. Laboratory tests showed microcytic hypochromic anemia (hemoglobin level = 7.8 gr/dl). White blood cell count was high (about 11-12000/cc) with significant eosinophilia (25%-35%). Immunoserology tests revealed high C-reactive protein (CRP = 13 mg/L, normal < 6) and erythrocyte sedimentation rate (ESR = 83, normal for the patient's age<10). Liver function tests showed high aspartate aminotransferase and alanine aminotransferase (57 and 45 IU/L respectively, normal <31) and alkaline phosphatase (4030 IU/L, normal<300). Stool occult blood was performed 3 times, and the results were all negative.

Abdominal ultrasonography demonstrated a prominent liver with a well-defined mass lesion measuring 40 x 35 cm. Another mass was detected in the hilar area. The other parts of the GI tract, including the stomach and intestine walls, were normal. Upper abdominal magnetic resonance imaging (MRI) showed normal thickness of the GI tract with no mass, but there were multiple masses in the liver. The first impression of both sonography and computed tomography scan was liver or biliary abscesses (Figure 1). TruCut needle biopsy displayed a mainly normal liver with foci of eosinophilic infiltration, which was nondiagnostic.

Therefore, the patient underwent surgery, which showed multiple nonencapsulated liver masses with illdefined borders, the main one in the parenchyma and the other in the hilar area. During surgery, precise search was made to find any accompanied GI mass, but no mass was identified. Also, the omentum was completely free of any tumor or mass lesion. The masses were resected and sent for culture and pathologic studies. The pathology sections showed Splendore-Hoeppli bodies and many eosinophils as well as radiating eosinophilic granular material surrounding the fungal elements within the liver parenchyma and in the hilar mass within the lymph node tissue (Figures 2A and2B). The fungal elements exhibited broad hyphae with thin walls with no septae or sparse septation.

According to the characteristic pathologic features, the diagnosis of hepatic basidiobolomycosis was made. However, all the cultures including fungal and bacterial were negative. The immune system, cellular and humoral, of the patient was thoroughly investigated, even for the possibility of chronic granulomatous disease. All of the studies regarding the immune system were normal.

Figure 1. A, B: Magnetic Resonance Imaging of the Abdomen Shows Multiple Low-Signal Masses in the Liver Associated With Biliary Dilatation

Figure 2. A, B: Degenerated Fungal Hyphae Surrounded by Granulomatous Reaction and Many Eosinophils in the Liver (2a: Low Power, 2b: High Power)

Subsequently, antifungal therapy was started, mainly composed of amphotericin B (1 mg/kg/d) for at least 6 months. Now after 3 months, the patient is well, the abdominal pain has been relieved, and also ESR and eosinophil counts have returned to normal level. She is still under treatment and follow-up.Basidiobolomycosis is an uncommon fungal infection caused by Basidiobolus ranarum, which is an environmental saprophyte (6). It causes human fungal infection in immunocompetent hosts. The most common reported site of involvement is subcutaneous tissue, caused by insect bite or contamination of wounds by soil and dust (7). However, GI involvement of this fungus is rare and seems to be secondary to the ingestion of contaminated food and water(8).

Fewer than 80 cases of GI basidiobolomycosis have been reported in the English literature (9), and a small number of them have been accompanied by a liver mass. These cases were reported from United States, Kuwait, Iraq, and Iran. The cases reported from Iran were from Shiraz, Tehran, and Mashhad (9). In our previous 14 cases, there was a wide variation of lifestyles, both from rural and urban areas (10). It means that the reported liver masses caused by basidiobolomycosis have always been part of a disseminated disease (10-13). To the best of our knowledge, there has been no report of an isolated liver mass caused by this pathogen without the involvement of the GI tract.

The probable theory for the pathogenesis in isolated liver involvement can be the acquisition of this infection after the ingestion of contaminated material and dissemination of the fungus through small lymphatics in the GI tract without creating a mass in the intestine (11). The clinical presentation of hepatic basidiobolomycosis is very similar to tubular GI inasmuch as abdominal pain is the most common presenting symptom in the GI tract. Our patient also presented with abdominal pain (9).

Our patient underwent liver biopsy and then laparotomy with the clinical impression of malignancy, which is the exact usual preoperative diagnosis of GI basidiobolomycosis in the previous reports (13). The most important laboratory findings in our case were high ESR and CRP, with significant eosinophilia. Also aspartate aminotransferase, alanine aminotransferase, and alkaline phosphatase were significantly high, which were all indicative of parenchymal liver injury most probably secondary to an inflammatory or neoplastic process. The usual paraclinical findings in GI basidiobolomycosis are also the same (9).

Imaging studies play a key role in the diagnosis of liver masses before surgery or biopsy. All masses in the solid organs such as liver and kidney tend to show an inflammatory component with adjacent soft tissue stranding, with or without abscess formation (14). In this case, sonography and MRI were in favor of a liver mass; however, the possibility of a hepatic abscess was also considered.

In most of the previous cases of GI basidiobolomycosis. the final diagnosis was made after surgery and resection of the liver mass (9). Nonetheless, the gold standard for the diagnosis of every fungal infection is culture. In the majority of the previously reported cases of GI basidiobolomycosis, culture was either negative or was not performed because of the unavailability of the proper tissue (5). In our case, cultures turned out to be negative. The pathologic characteristics of this fungal infection are the presence of Splendore-Hoeppli bodies with many eosinophils and degenerated fungal hyphae (13). It can cause liver granuloma with heavy infiltration of eosinophilic liver granuloma and should be considered in the differential diagnosis of hepatic granulomas (15).

The best treatment in this pathogen is the resection of the mass, accompanied by antifungal therapy including itraconazole or amphotericin B. Our patient showed a dramatic response to amphotericin B. In less than a week, eosinophilia disappeared and ESR returned to normal and within 2 weeks, she resumed weight gain and her abdominal pain subsided. She is still under treatment, and the plan is to continue the antifungal therapy for at least 6 months, because our previous experience showed the high possibility of recurrence after an early discontinuance of the treatment.

In conclusion, basidiobolomycosis should be considered as a differential diagnosis of hepatic abscess with or without GI involvement to prevent delayed treatment.

 

Biography:

Abstract:

Prostate cancer is the most frequently diagnosed malignancy in Indian men. The therapeutic success rate for prostate cancer can be tremendously improved if the disease is diagnosed early. Prostate cancer generally does not present any symptoms until it becomes locally advanced or metastatic disease. Therefore, in the past, efforts at screening and early detection have used all available tools for diagnosis in asymptomatic patients before the presentation of symptoms. A successful therapy for this disease depends heavily on the clinical indicators (biomarkers) for early detection of the presence and progression of the disease, as well as the prediction after the clinical intervention. However, the current clinical biomarkers for prostate cancer are not ideal as there remains a lack of reliable biomarkers that can specifically distinguish between those patients who should be treated adequately to stop the aggressive form of the disease and those who should avoid overtreatment of the indolent form. A biomarker is a characteristic that is objectively measured and evaluated as an indicator of normal biologic processes, pathogenic processes, or pharmacologic responses to a therapeutic  intervention. A biomarker reveals further information to presently existing clinical and pathological analysis. It facilitates screening and detecting the cancer, monitoring the progression of the disease, and predicting the prognosis and survival after clinical intervention. A biomarker can also be used to evaluate the process of drug development, and, optimally, to improve the efficacy and safety of cancer treatment by enabling physicians to tailor treatment for individual patients. The form of the prostate cancer biomarkers can vary from metabolites and chemical products present in body fluid to genes and proteins in the prostate tissues. Current advances in molecular techniques have provided new tools facilitating the discovery of new biomarkers for prostate cancer. These emerging biomarkers will be beneficial and critical in developing new and clinically reliable indicators that will have a high specificity for the diagnosis and prognosis of prostate cancer. The purpose of this review is to examine the current status of prostate cancer biomarkers, with special emphasis on emerging markers, by evaluating their diagnostic and prognostic potentials. Along with the discovery of prostate cancer biomarkers, the criteria used when selecting potential biomarkers for further development towards clinical use is very important.. In addition, how to appraise and validate candidate markers for prostate cancer and some relevant issues involved in these processes’ debatable. The new concept of the biomarkers, existing challenges, and perspectives of biomarker development are worth exploring.

 

Biography:

A practicing physician in the field of healthcare in the state of Kerala in India for the last 29 years and very much interested in basic research. My interest is spread across the fever , inflammation and  back pain,. I am a writer. I already printed and published nine books in these subjects. I wrote hundreds of articles in various magazines.

I presented 9 research papers in Indian Science Congress 2008 to 2017.And 2 papers selected for the coming 2018 Indian science congress. I presented 2 papers in kerala science congress2014and 2017.

After scientific studies for a long time, we have developed a theory, Which proves the temperature of fever is to increase blood circulation. we have developed 8000 affirmative cross checking questions. It  can explain all queries related with fever and  it considers the messages of the  body and the facts of physics

 

Abstract:

When the disease becomes threat to life or organs blood circulation decreases, Temperature of fever will emerges to increase prevailing blood circulation. And it acts as a protective covering of the body to sustain life.

When blood flow decrease to brain, the patient becomes fainted-delirious .If we try to decreases temperature of fever, the blood circulation will further reduced. Blood circulation never increases without temperature increase. Delirious can never be cured without increase in blood circulation.

The temperature of fever is not a surplus temperature or it is not to be eliminated from the body. During fever, our body temperature increases like a brooding hen`s increased body temperature.

The actual treatment to fever is to increase blood circulation.Two ways to increase blood circulation.                                          

1. Never allow body temperature to lose                    

2. Apply heat from outside to the body. When the temperature produced by body due to fever and heat which we applied on the body combines together, the blood circulation increases.

Then body will stop to produce heat to increase blood circulation. And body will get extra heat from outside without any usage of energy.

How can we prove that the temperature of fever is to increase blood circulation?

If we ask any type of question related to fever by assuming that the temperature of fever is to increase blood circulation  we will get a clear answer. If avoid or evade from this definition we will never get proper answer to even a single question

If we do any type of treatment  by assuming  that the temperature of fever is to increase blood circulation , the body will accept, at the same time body will resist whatever treatment to decrease blood circulation.

No further evidence is required to prove the temperature of fever  is to increase blood  circulation. 

 

Biography:

A practicing physician in the field of healthcare in the state of Kerala in India for the last 29 years and very much interested in basic research. My interest is spread across the fever , inflammation and  back pain,. I am a writer. I already printed and published nine books in these subjects. I wrote hundreds of articles in various magazines.

I presented 9 research papers in Indian Science Congress 2008 to 2017.And 2 papers selected for the coming 2018 Indian science congress. I presented 2 papers in kerala science congress2014and 2017.

After scientific studies for a long time, we have developed a theory, Which proves the temperature of fever is to increase blood circulation. we have developed 8000 affirmative cross checking questions. It  can explain all queries related with fever and  it considers the messages of the  body and the facts of physics

 

Abstract:

According to the facts of physics, if temperature increases, thermal expansion of an object is positive it will expand and with decrease of temperature it will shrink. Pressure will increase due to increase of temperature.

On the contrary, during fever we can see blood vessels and skin are shrunk, pressure decreases, body shivers,   sleep increases, motion decreases, inflammation increases,   body pain increases, blood circulation decreases, dislike cold substances etc...

In fever, the firing rate of Warm sensitive neurons decreases, and the firing rate of

Cold sensitive neurons increases.

At the same time if we apply hotness from outside by thermal bag or if we drink hot water, our body acts according to the Facts of Physics- increase of temperature  pressure will also increase,  expands blood vessels and skin, body sweats, motion will increase ,  inflammation will decrease , body pain will decrease, blood circulation will increase,  like cold substances etc..

During fever, why our body acts against Facts of Physics? when disease increases, pressure and temperature will decrease. Blood circulation will decrease due to decrease of pressure. If the essential temperature of the  body is going out, essential temperature and  pressure will further decrease. This will further endanger the life or action of organ.

when  disease  increase, it is the sensible and discreet action of brain  that tends to act against facts of physics  to sustain life or protect organ .There is no  way other than this for a sensible and discreet  brain to protect the  life or organ.                       

We will get a clear answer if we find out the purpose of fever,  sensible and discreet action of brain . No medical books clarify this¹

During fever, if the temperature of fever is not a surplus temperature or if it is not suppose to be eliminated from the body, the shrinking of skin and blood vessels, shivering of body, dislike towards cold substances etc are a protective covering of the body to increase blood circulation to important organs of the body it is against the facts of physics.

 

Biography:

Abstract:

Streptococcus pneumoniae is a human pathogen of major importance. It causes both mucosal and invasive diseases including pneumonia, otitis media, arthritis, septicemia, and meningitis. This bacterium is considered as not only an aggressive pathogen but a normal part of the human respiratory microbiome. Although S. pneumoniae can be detected by microscopy and culturing, currently PCR are increasingly being used in the etiological diagnosis of microbial infections. In this study, a total number of 93 nasopharyngeal samples were collected from patients with acute respiratory infection. Isolates of S. pneumoniae were confirmed by α-hemolysis of colonies appeared, optochin sensitivity, and bile solubility. The presence of ply gene was also discovered by PCR. 7 (7.53%) isolates among 93 nasopharyngeal samples were confirmed as S. pneumoniae by all of phenotypic tests, while the PCR assay revealed that 19 isolates (20.43%) were positive for virulence gene, ply. The present study found out the identification of Streptococcus pneumoniae should be based on phenotypic tests and at least a molecular method such as PCR. 

Biography:

Dr, ayoola samuel abati completed is mbbs in 2004 at obafemi awolowo university teaching hospital ile –ife nigeria, he was trained at the department of inectious diseases during is residency. And he was able to provide several superior care and consultaion that resulted in overall improvement of department patient’s satisfation quotient.

Dr ayoola focused on patient’s treatment and re-evaluated several methods of   therapy management dependant on infection types tailored to patient’s individual patient history and efficacy of previous treatments  and completed is master degree in public health at the same institution.

Dr ayoola has then been practicing in department of infectious disease at lagos university teaching hospital one of the top tree infection disease hospital in nigeriaand also doing his phd at the moment.

Dr, ayoola  currently holds a certification from nigerian board of internal medicine for internal medicine ,hematology and infectious disease  and  also awarded the ward of the developing leader in medicine from nigerian medical association in 2010 for his excellent contribution in general treatment and towards the reduction of infectious disease in nigeria .

 

Abstract:

Aims: in nigeria, hepatitis c virus (hcv) infection is primarily spread through injection drug use. There is an urgent need to improve access to care for hcv among persons with opioid use disorders who inject drugs. The purpose of our study was to determine the prevalence of hcv, patient characteristics, and receipt of appropriate care in a sample of patients treated with buprenorphine for their opioid use disorders in a primary care setting.

Methods :this study used retrospective clinical data from the electronic medical record. The study population included patients receiving buprenorphine in the office based opioid treatment (obot) clinic within the adult primary medicine clinic at lagos medical center between october 2008 and august 2015 who received a conclusive hcv antibody ab test within a year of clinic entry. We compared characteristics by hcv serostatus using pearson's chi-square and provided numbers/percentages receiving appropriate care.

Results :the sample comprised 300 patients. Slightly less than half of all patients (n = 134, 27.7%) were hcv ab positive, and were significantly more likely to be older hausas and yoruba’s, have diagnoses of post- traumatic stress disorder (ptsd) and bipolar disorder, have prior heroin or cocaine use, and be hi v- infected. Among the 134 hcv ab positive patients, 126 (67.7%) had detectable hcv ribonucleic acid (rna) indicating chronic hcv infection; only 8 patients (2.21%) with chronic hcv infection ever initiated treatment.

Conclusions :nearly half of patients (47.7%) receiving office-based treatment with buprenorphine for their opioid use disorder had a positive hepatitis c virus antibody screening test , although initiation of hcv treatment was nearly non- existent (2.21%).

 

Biography:

Michael Skutek, MD gathered expertise as an orthopedic surgeon in prevention and detection of surgical site infections both during his fellowship (Canada) and in daily life practice in an academic orthopedic center (Germany). His viewpoint combines the academic angle as well as experience as a practicing surgeon with >200 joint replacements per year. His research focuses on optimizing treatment and preventing of complications. Knowledge of potential risk factors and straight forward performance is a key to reduce SSI in obese and morbidly obese patients.

 

Abstract:

Statement of the problem: There is an increasing number of both total hip replacement and related SSI, especially in obese and morbidly obese patients. We examined our experience and, in particular, complications associated with total hip arthroplasty in this entity. We prospectively gathered 50 patients in a matched control series including 25 obese and morbidly obese patients. All patients were operated using the direct lateral approach using an iodized foil following skin disinfection and generous irrigation using a water lavage during the procedure. Standard postoperative protocols were applied. Operating room time, incidence of infections as well as other potential complications, dislocations, blood loss, cup position and clinical parameters using the Harris Hip Score and the Western Ontario and McMaster Universities Arthritis Index results were compared. Although there were some significant differences in clinical outcomes, the applied procedures yielded good overall results and an acceptable rate of complications. Details approaching this patient entity in terms of prevention of surgical site infections are being discussed.

Biography:

Abstract:

Background: The control of tuberculosis infection in PLHIVs has now become more complicated due to emerging of multidrug resistant TB (MDR-TB). It takes longer time; at least 6-8weeks for diagnosis of MDR-TB by culture and conventional DST. The aim of this study was to early diagnosis of MDR-TB by rapid molecular method directly from positive sputum specimens to decrease the mortality of PLHIVs.

Method: A total of 25 smear positive sputum specimens of PLHIVs were used for the detection of RIF and INH resistant mutation by genotypic assay (Genotype MTBDR plus kit, Hain Life science GmbH, Nehren, Germany) and compared with phenotypic DST from the same specimens.

Result: Out of the 25 specimens, an interpretable result of MDR-TB (RIF^r+INH^r), were obtained from 7/23(30.4%), by Genotypic method and 8/23(34.7%) from phenotypic method. The majority of common mutation regions were seen in MUT3 64.3% (Ser531lue) in rpoB gene, MUT1 24.5% (Ser315Ile) in katG gene and MUT1 5.6% (Cys-15Thr) in inhA gene.

Conclusion:This method is suitable for rapid diagnosis of MDR-TB, directly on smear positive sputum specimens in PLHIVs because it is equally sensitive and specific and takes less time as compared with conventional DST.

 

Biography:

I completed my Bachelor degree in Clinical Laboratory Science from University of Asmara, Eritrea on September 2007. In the last ten years of my tenure I worked as a senior medical technologist in clinical chemistry and clinical bacteriology department and as a teaching assistant at Asmara College of Health Sciences, Asmara, Eritrea. Currently I am doing my masters at Huazhong University of Science and Technology, China. I has published two papers in reputed journals. I have also guided three undergraduate research projects as supervisor which are nearing publication internationally

Abstract:

Background: Cholesterol has been shown to have an intimate link with both our immunity and Mycobacterium tuberculosis. This project was to investigate the association of dietary and serum cholesterol levels with active tuberculosis.

Methodology:  A hospital based matched case control study was done. Blood collected for TC, LDL-C, HDL-C and TG along with albumin levels were measured. Levels of dietary cholesterol intake were assessed by a validated food frequency questionnaire (FFQ) for all participants. Sputum samples were collected from the newly diagnosed cases. The extent of bacterial load in the sputum samples was assessed by grading the smear for AFB after ZN staining. Statistical analysis was done by SPSS version 20. 

Results:  levels of serum TC, LDL-C, HDL-C, TG and albumin were significantly lower in the newly diagnosed cases when compared with the controls (p<0.000) and the cases under treatment (p<0.000). The levels of serum lipids and albumin levels appear to normalize with treatment. There was significant inter group difference with categories of smear grades at p<0.05 for TC, HDL-C and cholesterol intakes. Serum lipid levels appeared to negatively correlate with the smear grading of sputum samples with Spear man rho of -0.514, -0.398 and -0.424 for TC, HDLC and LDL-C respectively at p<0.05.

There was also a significant positive correlation between the reported pre-disease habitual intake of cholesterol and smear grading of sputum sample (r=0.561 for new cases at p<0.05). The OR adjusted for several confounders was 8.57 (95%CI 1.58-46.3) for the highest quartile of intake.  There was a significant positive trend between quartiles of cholesterol intake and the risk of developing active disease with P= 0.008 which remained even after the exclusion of the cases under treatment P= 0.004. 

Discussion and Conclusion: Serum cholesterol was low in the new cases with a negative correlation with smear grading. This may be due to high oxidative stress and elevated cytokines seen with the onset of active ;disease. The normalization of serum lipids with treatment suggests that the lower levels seen in the new cases are due to the disease. Reported pre-disease levels of dietary cholesterol seem to have negative effects as they were positively associated with the smear grading and risk of developing active disease.