Asian Pacific Journal of Tropical Disease

1-4

Authors: Vineeta Tewari, Ajoy Tewari, Nikha Bhardwaj

Objective: To investigate the histological and histochemical changes in placenta of diabetic pregnant females and compare them with normal placenta. Methods: The histological and histochemical features of 60 placenta, 30 obtained from normal pregnant females and 30 from diabetic pregnant females, were studied. These placenta were obtained from Department of Obstetrics and Gynaecology, GSVM Medical College Kanpur and ERA’s Lucknow Medical College and Hospital Lucknow. Results: On histological examination, the diabetic placenta showed increased syncytial knots, fibrinoid necrosis, trophoblastic basement membrane thickening, villous stromal fibrosis, villous oedema, crowding of villi, thickening of vessel wall and fibrin deposition. On histochemical study it was found that the PAS reactivity was stronger in diabetic placenta as compared to normal. Sudan Black reactivity was higher among diabetic placenta in comparison to normal placenta. Conclusions: It is concluded that distinct histological and histochemical changes could be seen in placenta of diabetic pregnant females.

10-16

Authors: GTA Jombo, MA Araoye, JG Damen

Objective: To assess people’s knowledge about malaria treatment which is one of the main components of the roll back malaria (RBM) programme instituted on the African Continent with the aim of bringing the disease under control. Methods: The cross-sectional study was carried out between October and December 2009, involving 3 171 adult women who were selected from households using systematic sampling methods. Quantitative information such as age, educational level, marital status, occupation, number of children and knowledge of malaria were obtained using structured and semi-structured questionnaires, while qualitative information was obtained using focussed and in-depth group discussions to complement quantitative data. Results: The modes of approach to malaria treatment were 41.1% (1 302), 36.0% (1 143), 10.7% (339) and 0.5% (15) would attend hospital/clinic, buy drugs from pharmacy/chemist shop, take traditional herbs, and take no action respectively. Factors that were found to increase the level of knowledge about antimalarial drugs among the respondents were increasing educational level, being married compared to singles, having children and increasing family income (P< 0.05), while occupation and age differences had no contributory factors (P> 0.05). Knowledge about artemisinin combined therapy (ACT) was less than 15% similar with intermittent preventive treatment (IPT); home-based management for malaria (HBMM) was not in place. Conclusions: The drug component of the RBM programme in the community should be reviewed and appropriate amends instituted in order to ensure efficiency of the overall malaria control programme in the community.

21-23

Authors: Onwuezobe IA, Ochang EA, Umoiyoho A, Bassey EA, Umoffia EM

Objective: To assess the seroprevalence of syphilis among women receiving antenatal care in University of Uyo Teaching Hospital (UUTH), Uyo, Akwa Ibom State, Nigeria. Methods: Between July 2009 to March 2010, blood samples of 415 consenting clients submitted for prevention of mother to child transmission (PMTCT) HIV screening programme were screened for syphilis antibodies using the Immunochromatographic ACON Ultra Rapid Syphilis Test Strip (ACON laboratory Inc. USA). Any positive result was repeated with another test strip (Diaspot Ultra Rapid Syphilis Test Strip, Diaspot Inc. USA). Results: Of the 415 samples, 9 (2.2%) were syphilis seropositive and 14 (3.4%) were HIV positive. Assessment of risk factors for syphilis revealed an observed trend with increasing parity though statistically not significant (P=0.268). More than half of the syphilis positive clients believed their spouses were promiscuous. Conclusions: There is still a substantial carriage of syphilis among antenatal clinic attendees in UUTH, Uyo. The need for routine screening is imperative. Point of care testing should conveniently be incorporated into the PMTCT programme.

28-34

Authors: Okoror LE, Eniolorunda TA, Okoror OI

Objective: To study the virulence diversity through molecular evolution, and to provide insight on circulating antibodies. Methods: The nucleotide sequences of 18 Lassa virus genomic RNA encoding Lassa virus nucleoprotein isolates collected from different parts of the world since the identification of the Josiah strain were obtained from the GenBank and nucleotide substitution among them studied using the computer program MEGA 4. The genetic distances among strains were predicted by pairwise nucleotide differences. Results: The rate of synonymous substitution was high 5.889 per nucleotide per year and nonsynonymous was higher at 49.664. The average predicted rate of synonymous and nonsynonymous using modified Nei-Gojobori (assuming transition/transversion bias=2) was 27.9 which was taken as the genetic distance between strains. The average number of synonymous sites is 150.741 while the average number of nonsynonymous sites is 392.259. The phylogenetic tree was inferred by unweighted pairwise grouping in MEGA4 and using neighbour-joining method. The time of emergence of Lassa virus was predicted to be around January 1920. However, the first human appearance of the virus was predicted to be around May (1 959暲24) months. In synonymous substitution the rate of (G-T) rare was high. The nucleotide frequencies were 0.314 (A), 0.246 (T/U), 0.204 (C) and 0.235 (G). The transition/transversion ratio k1=14.991 (purines) and k2=69.916 (pyrimidines). The overall transition/transversion bias R=16.662 with a total of 620 position in the final data set. These figures are far higher than an earlier study using Lassa virus glycoprotein. The nucleotide diversity were also very high using the Taijima’s model in MEGA 4. Conclusions: The divergence within strains always coincides with the period of epidemic which goes to confirm that the cause of epidemic outbreak should be the emergence of new strain and also why the infection remains endemic despite circulating antibodies. A comparison with a similar study with the viral glycoprotein concludes that the glycoprotein is more suited for vaccine development.

38-40

Authors: phori EA , Isibor C, Onemu SO , Johnny EJ

Objective: To determine Helicobacter pylori (H. pylori) immunologically. Method: The seroprevalence of H. pylori infection was determined by ELISA technique in 380 individuals who gave informed consent, comprising 180 males (47.4%) and 200 females (52.6%) in Agbor, Nigeria. 124 (27.4%) of the subjects lived in the rural communities while 276 (72.6%) lived in the urban areas of Agbor. They were aged 1 to over 70 yr [(mean age±SD)=(39±9. 42) yr]. Five milliliter of clotted blood was obtained from each subject for specific HP-IgG antibodies. Results: Antibodies to H. pylori were detected in serum of 159 males (88.3%) and 182 females (91.0%). This was not statistically significant (P> 0.05). A total of 341 (89.7±21.4%) subjects presented anti-H. pylori antibodies. The prevalence of H. pylori increased with age from 14.8% in age group 1-9 yr to 100% in age group 30-39 yr and 60-69 yr. At above 70 yr, the seroprevalence decreased to 93.3%. Conclusions: The prevalence of H. pylori in Agbor is very high among adults while comparatively low among children. Since a lot of factors have been attributed to affect the rate of infection, increased standard of living and improved public health measures are encouraged and studies on the development and administration of an effective vaccine is recommended.

47-49

Authors: Ranjani Ramachandran, Lakshmi R, Ravi Kumar D, Devika K, Fathima Rahman, Wares DF

Objective: To combine isoniazid (INH) and rifampicin (RIF) in a single media to detect and evaluate multi-drug resistant Mycobacterium tuberculosis (MDR-TB) strains using clinical specimens by direct and indirect drug susceptibility testing (DST). Methods: Drug susceptibility testing for INH and RIF using individual and combined drug media was performed by minimum inhibitory concentration (MIC) method on direct clinical specimens. Results: The combined drug media showed complete concordance with individual drug media in the detection of MDR-TB by direct DST method and 89% efficiency with indirect DST method. Susceptibility results were available by 3 weeks after the receipt of clinical specimen using direct DST on combined drug media. Conclusions: Combined drug media can be used as a fast track method in large scale studies warranting detection of MDR-TB.

52-54

Authors: Samuel Nwadioha, Daniel Egah, Emmanuel Nwokedi, Ifeanyi Onwuezobe

Objective: To detect some common microbial agents of female genital discharges in order to improve the current syndromic management of abnormal vaginal discharge. Methods: A prospective study of female genital swabs collected from Primary Health Care Centres, Jos, and analysed for microscopy, culture and sensitivity in Jos University Teaching Hospital, December 2006 to December 2007 was carried out. Results: Microbial agents were detected in 70% (700) of a total 1 000 female genital swabs studied. Candida species peaked with 42.0% (420) out of the 1000 samples, followed by Gardnerella vaginalis, an agent of bacterial vaginosis with 26.0%. The distribution of abnormal vaginal discharge was highest in young adults aged 21 to 30 years. Conclusions: It is concluded that abnormal vaginal discharge is most prevalent in the young sexually active age group with Candida species as the commonest agent. We recommend prevention, early diagnosis and prompt treatment of infective female genital discharge in order to reduce the menace of HIV transmission.

59-62

Authors: Rotimi S Owolabi, Olusoji Daniel, Margaret O Araoye, Gordon K Osagbemi, Louis Odeigah, Adeniyi Ogundiran

Objective: To assess the reasons for HIV testing among people living with HIV and AIDS (PLWHA) that were receiving care/treatment in the University of Ilorin Teaching Hospital(UITH), Ilorin. Methods: The study was a descriptive cross-sectional survey conducted on 300 people living with HIV and AIDS receiving care at the antiretroviral therapy (ART) clinics of the hospital. All the patients who came to the clinic during the period of data collection and met the inclusion criteria were recruited into the study consecutively. Data were analyzed using the EPI-INFO 2005 software package. Results: The mean age of the respondents was 39 years (SD=9.32), ranging between 19 and 65 years. About two thirds (64.7%) were females, among which 62.7% were married. Slightly less than half (47.3%) of the respondents were not informed before they were tested for HIV while 11% did not receive post-test counselling. The main reason for HIV test was because client was sick and not responding to the treatment for other illnesses and during routine medical test when spouse tested positive. Conclusions: The findings from this study reveal that the majority of respondents were tested for HIV/AIDS when they had protracted illness or lost their partners to AIDS. To achieve the WHO goal of universal access to HIV prevention, care, treatment and support, there is an urgent need to rapidly scale up HCT services at all levels of the health care system, while pursuing innovative human right approaches to provider-initiated testing and counselling (PITC).

67-70

Authors: Wilma Delphine Silvia C, Kavya N, Sweta Kulkarni

Objective: To identify the risk arising from polycystic ovarian syndrome (PCOS) which would help the clinician to make early interventions. Methods: Fasting and postprandial serum glucose and serum insulin levels were estimated in 26 cases of PCOS and 26 healthy women were selected as controls. Calculation of quantitative insulin sensitivity check index (QUICKI) in all the subjects was utilized to analyze its sensitivity and reliability. Also body mass index and waist circumference in all these subjects were measured as obesity plays a key role in the pathogenesis of PCOS. Results: Hyperglycemia was observed in 11% of the cases and hyperinsulinemia was a consistent feature in 46% of the patients. The postprandial insulin levels in cases were statistically significant (P=0.006). Sensitivity to insulin as indicated by QUICKI in the postprandial state was less in cases than in controls (P=0.13). The BMI was markedly raised in 15% and moderately raised in about 38% of the cases (P=0.024). Waist circumference was significantly raised in about 61% of the cases (>80 cm) (P<0.001). Conclusions: Our study indicates that QUICKI, BMI and waist circumference are simple, quick and may act as early markers in identifying the risks of developing metabolic syndrome. Obesity, being a consistent finding in most cases suggested its key role in the pathogenesis of PCOS.

76-79

Authors: Surendra Karki, Kuldeep Kumar

This review of literature was conducted to explore the various aspects of typhoid fever in Nepal and to identify the factors concerned in the possible use of the Vi polysaccharide typhoid fever vaccine in Nepal as the tool for prevention and control. There are hotspots of Typhoid fever in developing countries, urban areas and slums, where poor conditions of safe drinking water and sanitation prevail. The use of currently available typhoid fever vaccines, especially the Vi polysaccharide vaccine has been recommended by World Health Organization to control typhoid fever in endemic areas. However, factors like, the burden and the changing epidemiological pattern of the disease, efficacy of the vaccines, ease for intervention, cost effectiveness, financing, and programmatic issues should be considered in local settings before the introduction of vaccines as a public health tool for prevention. We concluded that the possible use of currently available Vi polysaccharide vaccine to control endemic typhoid fever in Nepal might not have the same positive impact as reported in trials from different Asian countries. The major issues to be considered are emergence of Salmonella Paratyphi A as a major cause of enteric fever, no difference in prevalence of typhoid fever in preschool and school children, similar clinical profiles and severity of typhoid and paratyphoid fever. So, an ideal vaccine that can provide the protection both to typhoid and paratyphoid fever, and the vaccination programs that also includes preschool children would be the best option for Nepal.

83-84

Authors: Amit Gupta, Sameer Singhal

Tuberculosis of central nervous system can be present in many different clinical and radiological patterns with disseminated or miliary brain tuberculomas as a rare presentation. Multiple central nervous system tuberculoma is commonly associated with human immunodeficiency virus (HIV) infection. Tuberculomas develop following haematogenous dissemination of bacilli from an infection elsewhere in the body, usually lung. Here we describe a case of immunocompetent host with a past history of pulmonary tuberculosis, presenting with headache and generalised weakness, and later was diagnosed as a case of multiple tuberculoma brain.