Asian Pacific Journal of Tropical Disease

259-262

Authors: Ani AE, Diarra B, Dahle UR, Lekuk C, Yetunde F, Somboro AM, Anatole Tounkara, Idoko J

Objective: To identify Mycobacterium tuberculosis (M. tuberculosis) and other acid fast organisms isolated from sputum of HIV positive adult patients with pulmonary disease in Jos, Nigeria. Methods: Acid fast organisms isolated from 80 acid fast bacilli (AFB) positive sputa of HIV positive adult patients suspected for tuberculosis in Jos, Nigeria were identified for members of M. tuberculosis complex (M. tuberculosis, Mycobacterium bovis, Mycobacterium africanum, Mycobacterium canetti, Mycobacterium microti and Mycobacterium caprae) by use of spoligootyping, Multiplex Gen Probe, Hain genotype assay and gene sequencing for spoligotype negative isolates. Results: Seven different spoligotypes of M. tuberculosis complex were identified fr om 70/80 (87.5%) total number of isolates. Mycobacterium kansasii (1), Mycobacterium dulvalii (1) Nocardia species (1) and Tsukamurella species (2) were detected from 5/10 spoligotype negative isolates. Conclusions: Although M. tuberculosis is the dominant AFB associated with chronic pulmonary disease in Jos, Nigeria, other clinically relevant mycobacteria were also observed in the study. This suggests that other AFB positive microorganisms associated with tuberculosislike symptoms might be misdiagnosed and incorrectly treated as M. tuberculosis. It is therefore necessary for laboratories in tuberculosis high burden countries to step up diagnostic procedures beyond routine smear microscopy.

270-274

Authors: Hien Tran Van

Objective: To evaluate the application of dengue mosquito-proof water containers in the reduction of dengue mosquito population (both adult and larvae) and the acceptance and satisfaction of community in new containers usage. Methods: A community intervention was carried out from July-2008 to October-2009 in Dong Thanh commune, Can Giuoc district, Long An province, Vietnam. A cluster of 100 households that has a relative separate position from surrounding areas were supplied with mosquito-proof water containers, every household with two containers installed under the roof-gutters; and another cluster of households in another hamlet of the same commune used normal water containers. Evaluation of the changes in Aedes aegypti (A. aegypti) population and usage of new water containers were conducted quarterly. Assessment of the acceptance and satisfaction of community was done by the end of the project. Results: The number of larvae per concrete tank in the intervention area were lower than those in the control area in most survey rounds with statistic significance in the first, second and fourth surveys (P < 0.05). The number of larvae per new tank were lower than those per jars in the intervention site with statistic significance from the second to fifth surveys (P < 0.01, P < 0.001, P < 0.01 and P < 0.05 respectively). However, with the presence of old containers, vector indices did not change in the intervention area. More than 94 percent households kept their containers tightly covered with two nets and used their new containers by taps in all the survey rounds. Average of times of cleaning new water containers during three months were small, changing from 0.40 to 0.80 times. Number of old jars decreased regularly from means of 5.3 to 2.24 by survey rounds and the number in the fifth suvey were statistically lower than in the second survey (P < 0.001). 100 percent households accepted the new containers and 96 percent households said they had ability to repair a broken nets/tapa or their materials. Conclusions: New containers prevented the development of A. aegypti mosquitos better than the same normal concrete containers and jars with statistic significance. Most households accepted, satisfied and used new containers in correct way and they could maintain new containers by themselves. However, the continuance of use of old water containers affected on the entomological indices.

279-281

Authors: Manisha DebMandal, Shyamapada Mandal, Nishith Kumar Pal

Objective: To determine the incidence of leptospiral jaundice and find the correlation among human leptospiral cases with or without jaundice. Methods: Patients suspected for leptospirosis, attending Calcutta School of Tropical Medicine, Kolkata, India during 2002 to 2008 were evaluated as per modified Faine’s criterion. Results: Out of 404 suspected cases, 214 were found positive for leptospirosis, 15 were jaundice positive but without leptospirosis and 175 cases had neither leptospirosis nor jaundice. Serum bilirubin and creatinine levels among leptospirosis patients were (1.89-42.70 mg/dL) and (0.60-6.40 mg/dL), respectively; serum glutamic-oxaloacetic transaminase (SGOT) and serum glutamic pyruvic transaminase (SGPT) were (99.00-410.00 U/L) and (57.00-887.00 U/L), respectively; IgM values by ELISA were (0.63-3.28 U/mL). Conclusions: There is no association between occurrence of jaundice and leptospirosis and it also does not confirm the expected 1:1 ratio of jaundice and leptospirosis (P<0.005).

287-288

Authors: Madhurima Mukherjee, Prabin Gyawali, Rajesh Kumar Thakur, Revathi P Shenoy, Anjali Rao

Objective: To assess the frequency of micronucleus in exfoliated buccal mucosa cells of patients with oral lichen planus (OLP) in relation to free radical toxicity since OLP is considered to be a precancerous lesion. Methods: The micronucleus frequency in exfoliated buccal mucosa cells of patients with OLP was assessed and compared to those in healthy subjects. Results: A significant increase (P<0.004) in frequency of micronucleated exfoliated cells (MEC) was observed in patients with OLP when compared to normal subjects. Conclusions: It can be concluded that DNA damage in MEC of OLP patients may be a consequence of increased free radical toxicity.

292-294

Authors: Nnodim Johnkennedy, Anyadoh Sylvia Onyinyechi, NwosuNjoku Emmanuel Chukwunyere

Objective: To determine the levels of antioxidants vitamins C and E as well as lipid peroxidation product malondialdehyde (MDA) in Mycobacterium tuberculosis (M. tuberculosis) patients. Methods: Sixty two M. tuberculosis positive patients and fifty five healthy controls within the age of twenty five to forty years without any systemic disease attending General Hospital Owerri were involved in this study. Forty one cases were longitudinally followed up with standard antituberculosis chemotherapy (ATT) for six weeks. Results: The results obtained showed that the levels of vitamin C (0.91±0.42 mg/dL) and vitamin E (0.84±0.31 mg/dL) were significantly decreased in M. tuberculosis patients before treatment when compared to the healthy controls [(1.64±0.41 mg/dL) and (1.46±0.38 mg/dL)] respectively at P<0.05, while the level of MDA (8.7± 1.81 nM/mL) in M. tuberculosis patients was significantly higher (P<0.05) before anti-tuberculosis treatment as compared with the healthy control (4.91±1.9 nM/mL). Also, there was a significant increase in vitamin C and E levels after 6 weeks of ATT, while MDA levels was decreased when compared with the control (P<0.05). Conclusions: The depletion of vitamins C and E as well as elevation of MDA in tuberculosis patients is suggestive of lipid peroxidation and oxidative stress. The increase in vitamin C and E as well as decrease in MDA after 6 weeks of anti-tuberculosis treatment is suggestive of good response to treatment with standard ATT. Hence, vitamin C and E supplementation improves the quality of life of tuberculosis patients.

299-303

Authors: Valentin Bhimba B, V Vinod, M Cindhu Beulah

Objective: To evaluate the biopotential activity of secondary metabolites from marine sponge Dendrilla nigra (D. nigra) collected from the Gulf of Mannar. Objective: Soxhlet extraction method was used to extract the secondary metabolites and various assays were carried out. Results: D. nigra showed potent antibacterial, antioxidant, anti-inflammatory and anticancer activities and it was also subjected for brine shrimp lethality and cytotoxicity assays. The secondary metabolites were characterized by gas chromatography-mass spectrometry (GC-MS) analysis. Conclusions: Based on the present study, it can be inferred that the bioassay guided fr actionation and purification of D. nigra may come up with potent bioactive drug.

308-316

Authors: Bhagavathy S, Sumathi P, Madhushree M

Objective: To evaluate the nonmutagenic and antimutagenic properties of the different carotenoids from the selected green algae Chlorococcum humicola (C. humicola) using Ames mutagenicity assay. Methods: Antimutagenicity of fresh water green algae C. humicola was tested using its carotenoid extract. From the crude carotenoid extract, the different carotenoids were fractionated by column chromatography and further identified by high performance liquid chromatography (HPLC). In the in vitro antimutagenicity assay the total and individual carotenoids were used to check the nonmutagenicity and antimutagenicity effect using the strains of Salmonella typhimurium (S. typhimurium) TA98, TA100 and TA102 with and without metabolic activation. The in vivo antimutagenic studies were carried out using animal model. Results: The results showed that the selected green algae were rich in carotenoids. In the crude carotenoid extract, astaxanthin, lutein and β-carotene were found to be the major concentration. α-carotene, zeaxanthin and violaxanthin were also found to be present. In the in vitro antimutagenic assay, the total carotenoids showed the maximum inhibition (P<0.001) against all three selected strains of S. typhimurium with and without metabolic activation. In the separated carotenoids, astaxanthin, lutein and β-carotene showed significant mutational inhibition and exhibited good antitumor activity in the presence of S9 fraction. For direct acting mutagens sodium azide, ethidium bromide and hydroxyl amine with the specified concentration, the total carotenoids gave 63%, 60%, 66% inhibition for TA98, TA100 and TA102, respectively. In vivo antimutagenic assay was also confirmed the effective antimutagenic activity of total and separated carotenoids. The results also confirmed that the total and individual carotenoids had no mutagenic activity. Conclusions: The overall findings of the present study conclude that the green algae C. humicola possess higher concentration of bioactive carotenoids having antimutagenic activity, therefore, it can be used as a chemopreventive agent.

323-329

Authors: Patel DK, Prasad SK, Kumar R, Hemalatha S

Cataract is a visual impairment caused due to opacification or optical dysfunction of crystallin lens affecting more than 17 million people around the world. Even though the incidences of cataract are increasing day by day among the elderly persons but, still except surgery no other ways of treatment have been successfully developed so far. Thus, the aim of writing the present review is to provide an insight over the pathophysiological and etiological aspects of cataract along with discussing the remedies available for the disorder. The review also describes different experimental models with their relevant mechanism and significance such as galactose-induced, naphthalene-induced and selenite-induced cataract models which are mainly used for evaluating the anticataract activity of a particular drug (mainly of natural origin). The review includes list of plants and their phytoconstituents which have been so far evaluated pharmacologicaly for the treatment of cataract. From the survey, it was confirmed that the antioxidant property of plants phytoconstituents are basically responsible for their effective anticataract activity. Thus, the valuable information provided in the present review will help researches in developing an alternative method rather than surgery for the treatment of cataract which will minimize the rate of blindness due to cataract thus, benefiting and extending protective aspects of eyes, an integral part of human body.

333-334

Authors: Rivonirina Andry Rakotoarivelo, Radonirina Lazasoa Andrianasolo, Dina Ranoharison2, Rado Olivier Sedson Rakoto, Fandresena Arilala Sendrasoa, Mamy Jean de Dieu Randria

Neurocysticercosis can simulate a paradoxical response during antituberculosis therapy with neurological ailments. We report the case of a 31 year-old-man, treated for tuberculous meningitis who developed neurological deficit after nine weeks of early antituberculous therapy. The diagnosis of neurocysticercosis was confirmed by CT scan and cerebrospinal fluid analysis. Neurocysticercosis should be sought as an important differential of paradoxical response during antituberculosis therapy.

177-180

Authors: Akhtardanesh B, Ghanbarpour R, Babaei H, Nazeri M

Objective: To detect the evidences of significant exposure of dogs with Brucella canis (B. canis) and other Brucella species in southeast of Iran by serological assays. Methods: Blood samples were prepared from 62 privately owned and 33 kenneled dogs and screened by indirect immunoflorescence assay for B. canis. Rose Bengal test (RBT) and standard tube test (SAT) or wright test were used for screening the other Brucella species. Results: Serological evidences of exposure to B. canis were found in 15.8% of the studied dogs, whereas RBT and SAT showed 29.5% and 12.6% seropositivity, respectively. Conclusions: This study shows that B. canis is endemic in southeastern of Iran and canine brucellosis can be considered as a new emerging disease. Moreover, our results demonstrate that dogs will be at high risk in brucellosis-infected farms. Therefore, further investigations must be performed to evaluate the seroprevalence and zoonotic potential of this disease in different geographical parts of Iran.

187-191

Authors: N Ben Alaya-Bouafif , Chahed MK, H El Bez, Bellali H, Ayari L, Achour N

Objective: To estimate the completeness of malaria notification to the public healthcare system (PHCS) and to describe retrospectively data of malaria cases in Tunisia. Methods: We conducted a retrospective epidemiological survey using a standardized questionnaire for all cases of malaria reported to PHCS and those diagnosed in parasitological laboratory or infectious disease service between January 2002 and December 2007. To estimate the total number of cases, we used a two sources capture-recapture analysis. Results: After record-linkage and cross-validation 317 cases of malaria were identified, of whom 231 were notified, resulting in an observed undernotification of 17%. The estimated number of malaria cases using capture-recapture analysis was 366.3 (95% CI: 335.8-396.8) for the period of study with a completeness of 63.1% which increased fr om 44.8% for 2002 to 78.7% for 2007. One hundred and sixty two patients (51.1%) had been born in sub-Saharan Africa, 113 (35.6%) in Tunisia, 35 (11.0%) in North Africa and 7 (2.2%) in Europe with predominance of men (87.1% of all cases). The median age was 25.0 years (21-30) for subSaharan Africans, 38.0 years (23.5-45.5) for North Africans, 38.5 years (30.75-38.5) for Tunisian and 39.0 (26-43) for European (P<0.01). The most predominant malaria species was Plasmodium falciparum with 216 cases (72.5%), and the most frequent area of acquisition was sub-Saharan Africa. In our study, information on compliance with malaria prophylaxis was only sporadically available and 34% of infected individuals had not used any chemoprophylaxis. Our study showed delayed identification of malaria that indicated a deficit in medical awareness and management of this infection. Conclusions: Our survey has marked variety in the type and availability of key data and shown an underreporting of malaria cases. Furthermore, it demonstrates that the two different sources of malaria registration are substantially incomplete. Of particular interest is the observation that a considerable number of patients could only be found in the records of PHCS, they were unknown to the laboratories, although malaria confirmation by thick or thin smear is obligatory in Tunisia.

195-202

Authors: Grace O Gbotosho, Titilope M Okuboyejo, Christian T Happi, Akintunde Sowunmi

Objective: To evaluate the features and risk factors associated with recrudescent infections that arose following artemisinin-based combination drug treatment of the primary infections. Methods: The clinical features and risk factors associated with subsequent recrudescence of primary Plasmodium falciparum infections were evaluated in 37 of 877 children following artesunate or artemisinin-based combination treatments (ACTs). Recrudescence was determined by polymerase chain reaction. Results: Compared to children with sensitive infections, children with recrudescent infections had significantly higher gametocytaemia and proportion with parasitaemia >50 000/μL. Compared with primary infections, recrudescent infections that arose from primary infections were accompanied by significantly fewer symptoms, lower body temperatures and asexual parasitaemias. In age- and gender- matched children with and without recrudescence, declines in parasitaemias following treatment were monoexponential but elimination half-life of parasitaemia was significantly longer in children with recrudescence. In a multiple regression model, at enrolment, 3 factors were independent risk factors for subsequent recrudescence of primary infections: parasitaemia ≥50 000/μL [adjusted odds ratio (AOR)=2.63, 95% confidence interval (CI): 1.17-5.90, P=0.018], parasite clearance time ≥2 days (AOR=2.47, 95% CI: 1.24-4.90, P=0.04) and treatment with artesunate compared with ACTs (AOR=2.35, 95% CI: 1.08-5.12, P=0.03). Conclusions: Recrudescent infections following artesunate or ACTs differ significantly from the primary infections from which they arose and have implications for malaria control efforts in Sub-Saharan Africa where ACTs are now first-line treatments.

206-208

Authors: Abhiram Chakraborty, Saikat Panja, Indranil Bhattacharjee, Goutam Chandra, Amiyakumar Hati

Objective: To find out the role of CT scan in the diagnosis of neurocysticercosis (NC) and also to get an idea of the nature and extent of this disease in a definite geographical ethnic location. Methods: CT scan of the brain of altogether 4 762 persons residing in a congested area of central Kolkata, was performed between 2004 and 2010, in an imaging centre in central Kolkata (Calcutta), of whom 1 114 (23.39%) suspected patients were investigated for NC, having complaints of convulsion (472), headache (272), right sided weakness (98), loss of consciousness (84), left sided weakness (61), abnormal behavior (48), slurring of speech (34), difficulty with keeping balance (33) and dementia (12). Results: NC was detected in 45, 1, 0, 2, 1, 0, 0, 1 and 0, respectively consisting 4.48% (50/1 114) of the suspected cases varying from as low as 2 (in 2006) to as high as 23 (in 2005) in different years indicating this parasitic infection is perennial. The age of patients varied from 6 to 59 years of whom 28 (56%) were vegan. We were also able to detect 4 types of lesions viz. calcified lesions (14), small hypodense i.e. vesicle (12), bright central spot i.e. vesicular lesion with central spot (2) and ring enhancement (22). For 3 patients, further imaging investigation (MRI) was needed to confirm the diagnosis. We calculated the specificity and sensitivity of CT scan of brain diagnosing NC which was found to be 64% and 100%, respectively. Conclusions: Although, the sample may not be the representatives of the whole community, the findings suggest that cysticercosis is a significant but under-recognized public health concern in Kolkata.

212-215

Authors: Mohammad Taghi Rahimi, Meysam Sharifdini, Ayat Ahmadi, Bahram Laktarashi, Seyf Ali Mahdavi, Eshrat Beigom Kia

Objective: To determine the rate of hydatid cyst in hospitalized patients and slaughtered animals in Mazandaran province, northern Iran. Methods: In this descriptive study, files of 34 hospitalized patients who underwent surgery for hydatid cysts during 2003-2008 in Mazandaran province were analyzed. Also, 1 678 343 sheep, 815 635 goats, 451 743 cattle and 1 130 buffaloes were examined carefully for the presence of hydatid cysts in slaughterhouse of Mazandaran province, during 2003-2008. Results: In human, the highest rate of hydatidosis was related to 30-39 age group. Infection rate in females was higher than that in males (61.8% vs 31.2%). Cyst involvement of different organs was as follows: liver 76.5%, lung 13.5%, spleen 5.4%, gall bladder 2.7% and abdomen septum 2.9%. In slaughtered animals, overall, 6.38% had liver cyst and 12.70% had lung cyst. Involvement of liver and lung in sheep, goat, cattle and buffalo were 7.09% and 14.70%; 5.12% and 10.20%; 5.97% and 9.60%; and 14.90% and 13.18%, respectively. In sheep, goat and cattle the most infected organ was lung but in buffalo it was liver. Conclusions: The results show that in human, all age groups and both sexes are exposed to hydatidosis. In livestock it causes economic loss to veterinary industries. Therefore, appropriate control method is needed to prevent this zoonotic disease.

222-226

Authors: Sumaporn Makkun, Jenjeera Prueksadee, Jatuporn Chayakulkheeree, Darunee Boonjunwetwat

Objective: To determine the diagnostic accuracy of ultrasound-guided 14-gauge core-needle breast biopsy (CNB) correlation with surgical excision or long term follow-up. Methods: One hundred and fifteen breast lesions which had undergone ultrasound-guided 14-gauge core-needle breast biopsy from May 2003 to Aug 2010 in the Breast Diagnostic Center, King Chulalongkorn Memorial Hospital were included in this study. Clinical history, palpability of the lesion, site of the lesion, the prebiopsy lesion size, ultrasound characteristic, level of suspicion according to the BIRADS classification, number of samples taken and pathologic results of CNB were reviewed and correlated with pathologic results of subsequent open surgery. For benign lesions without surgery, we correlated the result of CNB with stability of the lesion at or more than two-year interval follow-up. The accuracy rate, sensitivity, specificity, false positive rate, false negative rate, positive predictive value and negative predictive value were accessed. The falsenegative diagnoses of core needle biopsy were reviewed in detail. Procedural complications were also observed. Results: Among 115 lesions, 114 lesions were in female and 1 lesion was in male with their mean age of 50.87 years old (ranging from 27-72), 91 lesions were palpable (79.13%), 24 were non-palpable (20.87%). The prebiopsy size was 3.2 cm in diameter ranging from 0.5-20.0 cm. The pathologic results for the CNB were malignancy in 77.39% (89 lesions), high-risk in 0.87% (1 lesion) and benign in 21.17% (25 lesions). Five patients were negative for malignancy by core needle biopsy but positive for malignancy by surgical procedure. The sensitivity was 94.68%. The specificity was 100%. The false negative rate was 5.3%. The positive predictive value was 100%. The negative predictive value was 80.76%. The accuracy was 95.65%. There was no false positive case. Conclusions: Core needle biopsy under ultrasound guidance is a minimally invasive diagnostic tool and gives a high accuracy rate for evaluating breast lesions. This procedure reduces the surgical cases of benign breast disease. However, correlation between imaging and pathology is important for appropriate management of false negative cases.

230-231

Authors: Arya SC, Agarwal N

Objective: To detect a rapid disease diagnosis for clinical management and preventive measures of chikungunya virus infection. Methods: The utility of a point-of-care test that could be used in field and health care centers was investigated employing a commercially available diagnostic kit at a tertiary care, multidisciplinary hospital in the Indian capital metropolis during 2010. Results: During the 2010 spurt of chikungunya cases in Delhi, India, the performance of the OnSite chikungunya IgM Combo Rapid Test kit (CTK Biotech, San Diego, USA) well matched with the chikungunya IgM capture ELISA kits (National Institute of Virology, Pune, India). The sensitivity and specificity of the rapid test in relation to the IgM capture ELISA were 0.71 (95% CI: 0.30 to 0.94) and 1.00 (95% CI: 0.46 to 2.10), respectively. The respective positive and negative predictive values were 1.0 (95% CI: 0.46 to 1.00) and 0.7 (95% CI: 0.30 to 0.94). Conclusions: Commercial assay kits to detect chikungunya IgM antibody are essential in health care centers which lack facilities for cell culture or enzyme immunoassay. Hence, it should be possible for health centers even in poorer countries to use the OnSite Chikungunya IgM Combo Rapid Test kit as a matter of routine to early diagnosis and to initiate control measures for chikungunya.

235-238

Authors: Igbiks Tamuno

Objective: To evaluate the prescription pattern of clinicians in private health care facilities in Kano, Northwestern Nigeria. Methods: One thousand prescriptions from ten private health facilities in Kano were evaluated retrospectively using WHO prescribing indicators. Results: Average number of drugs per encounter in these health facilities was 3.20. Generic prescribing was low at 55.40% while encounters with antibiotic prescription were high at 43.80%. About 91.20% of prescribed drugs were listed in the national essential drug list while 83.30% of the drugs for treatment of common health problems were available in these facilities. Nearly 18% of encounters had at least one injection prescribed while antihypertensives, analgesics, antimalarials, vitamins and anxiolytics were prescribed in 11.80%, 61.30%, 30.20%, 21.50% and 12.30% of encounters, respectively. Conclusions: Polypharmacy, overuse of antibiotics and injections, and low rate of generic prescribing occur in private health facilities in Kano. Therefore, there is a need to draw attention to the educational intervention.

241-244

Authors: Chhabra S, Goyal D, Kakani A

Objective: To explore the incidence, types, profiles, gestation, therapies, maternal-fetoneonatal outcomes with special reference to conservative eclampsia management in preterm cases with live baby. Methods: A critical analysis of eclampsia cases over two decades was performed to explore outcomes with different therapies. Results: Of 64 014 deliveries, 416 cases of eclampsia were managed, giving an incidence of 0.65% of births with decreasing trends (0.79% in Block A and 0.56% in Block E). 132 (31.73%) had lytic cocktail, (58.69% in Block A and 2.66% in Block E), 76 (18.27%) had magnesium sulphate (MgSO4) and pethidine or diazepam (30.43% in Block A and 5.33% in Block E), 208 (50.00%) received MgSO4 and nifedipine (10.86% in Block A and 92.00% in Block E). Mean induction delivery interval with lytic cocktail was 23.2 hours (shortest), and MgSO4 with sedatives, 48 hours, and MgSO4 with nifedipine, 72 hours (longest). In 33 cases, induction could be postponed if babies were live, preterm and mothers’ convulsions could be controlled. Lytic cocktail perinatal mortality rate (PMR) was 765.15. PMR of MgSO4 with sedatives was 500. PMR of MgSO4 with nifedipine was 346. Conclusions: Though some babies died in utero, in carefully selected cases with close supervision, pregnancy may be continued with eclampsia to increase fetal maturity without risk to mother, in settings where resources are scarce for very very low birth weight babies. Conservative management improves perinatal outcome but a careful balance of maternal wellbeing is essential.

247-250

Authors: Nnadi Nnaemeka Emmanuel, Nimzing Loha, Okolo Mark Ojogba, Onyedibe Kenneth Ikenna

Landscape epidemiology describes how the temporal dynamics of host, vector, and pathogen populations interact spatially within a permissive environment to enable transmission. It also aims at understanding the vegetation and geologic conditions that are necessary for the maintenance and transmission of a particular pathogen. The current review describes the evolution of landscape epidemiology. As a science, it also highlights the various methods of mapping and modeling diseases and disease risk factors. The key tool to characterize landscape is satellite remote sensing and these data are used as inputs to drive spatial models of transmission risk.

94-99

Authors: Al Thbiani Aziz, Hamady Dieng, Ahmad Abu Hassan, Tomomitsu Satho, Fumio Miake, Md Rawi Che Salmah, Sazaly AbuBakar

Objective: To examine the insecticide susceptibility of Aedes aegypti (Ae. aegypti) from various sites in Makkah City, Saudi Arabia. Methods: This was examined based on WHO standard procedures. Results: The larvae of Ae. aegypti were susceptible to all larvicides examined, but this susceptibility was more pronounced in wild populations, which tended to show tolerance to icon. Icon was the most effective larvicide with LC 50 values of 0.007 ppm and 0.012 ppm for the laboratory and field strains, respectively. Ae. aegypti adults exposed to lambda-cyhalothrin showed a low mortality rate in comparison with those exposed to deltamethrin and cyfluthrin. Conclusions: The results of the present study indicate differential susceptibility between field and laboratory larval populations. Wild larvae are less susceptible to insecticide treatments than their laboratory-bred counterparts. Taken together, these results suggest that tolerance and the tendency toward resistance to commonly used insecticides are present in Ae. aegypti populations throughout Makkah City, Saudi Arabia.

106-109

Authors: Ravikumar H, Ramachandraswamy N, Puttaraju HP

Objective: To determine the status of Wolbachia subgroup and phylogenetic relationships in Indian mosquitoes. Methods: Recently we reported Wolbachia infection in eight out of twenty field-caught mosquito species of India, using wsp specific primers. DNA extracted from these mosquito species were used for PCR amplification and sequencing. Results: Wolbachia A harboured in Aedes albopictus and Culex gelidus belongs to the subgroup AlbA whereas Wolbachia B harboured in Aedes albopictus and Culex quinquefasciatus belongs to the subgroup Pip and of Culex vishnui belongs to subgroup Con. However, Wolbachia harboured in Armigeres subalbatus, Armigeres kesseli, Culex sitiens and Toxorhynchites splendens could not be placed into any known subgroup and may represent other unknown strains of Wolbachia. Our phylogenetic analysis revealed eight novel Wolbachia strains, four in the A group and four in the B group. Most of the Wolbachia strains present in Indian mosquitoes belong to the Albo, Pip and Con groups. Conclusions: The similarities and differences between Wolbachia strains infecting different mosquito species are fundamental for estimating how easily mosquitoes acquire new infections.

113-115

Authors: Olusoji Daniel, Eltayeb Osman, Peter Adebiyi, Gumusboga Mourad, Etienne Declarcq, Rasheed Bakare

Objective: To determine the prevalence of non tuberculosis mycobacteria (NTM) among new and previously treated tuberculosis (TB) patients in Nigeria. Methods: It was a retrospective study. A total of 102 sputum smear positive samples/culture isolates from pulmonary TB patients (41 new smear positive and 61 smear positive retreatment cases) were sent to the Institute of Tropical Medicine, Antwerp Belgium between 2007-2009. Data on patients' characteristics were retrieved fr om their treatment cards. Results: Among the 102 samples, 25 isolates results (20 were culture negative while 5 were contaminated) were excluded from the study. Data were available for 77 mycobacterium isolates. 70 (90.9%) were identified as Mycobacterium tuberculosis and 7 (9.1%) as atypical mycobacteria. Among the atypical mycobacteria, three of them were Mycobacterium fortuitum, two Mycobacterium intracellulare and two Mycobacterium chelonae. Of the seven isolates with atypical mycobacteria, 4 (57.1%) were from previously treated patients, while 3 (42.9%) were new sputum positive patients. There was no statistically significant difference in NTM infection between new and previously treated pulmonary TB patients (P=0.97). Conclusions: The study shows the involvement of atypical mycobacterium in pulmonary infection in both new and previously treated TB patients. Therefore, there is a need to carry out culture and drug susceptibility testing in all pulmonary TB patients especially those who had failed conventional DOTS treatment to rule out NTM infections.

119-122

Authors: Khan SA, Dutta P, Khan AM, Topno R, Chowdhury P, Borah J, Mahanta J

Objective: To confirm Japanese encephalitis (JE) cases from the state of Arunachal Pradesh (AP), India for the first time. Methods: Suspected acute encephalitis syndrome (AES) cases were screened from 2005-2010. The cases were initially tested for antibodies against JE by using IgM MAC ELISA kits (National Institute of Virology, Pune). RNA was extracted from the cerebrospinal fluid (CSF) samples followed by molecular amplification of JE virus specific gene primer. The data obtained were used to calculate relative risks between the age groups and between the genders. Epi info 6.0 was used for the statistical analysis. Results: Presence of JE cases in the state of AP, India was established. JE cases from 10 out of 16 districts were recorded. As part of control and preventive measures, mass vaccination for children (0-15 years) by SA-14-14-2 JE vaccine was taken up in 2010 in the district of Lohit. Vaccination coverage of 83.09% among the target population was achieved. Conclusions: The study presents the first report of confirmed JE cases fr om the state of AP, India. This finding attracts attention as JE cases are rarely seen to occur in hilly places.

127-130

Authors: Arjunan Isaac, Gopinath D, Murthy NS

Objective: To find the prevalence of diabetics, identify informal care providers for them in Kaiwara Primary Health Center (PHC) area, assess the level of knowledge and skills of an informal care provider in home based long term care and improve the level of knowledge and skill of the informal care provider through a structured training capsule. Methods: A cross sectional and an interventional study was conducted on diabetics and their informal care providers in Kaiwara PHC area. Data were collected using pre-tested, structured questionnaire by an interview method. A structured training capsule was developed and implemented. Evaluation of the knowledge and skills was assessed at the beginning and at the end of the training. Student’s paired/unpaired ‘t’ tests and correlation analysis were done. Results: Improvement scores were calculated by subtracting the pre-evaluation scores from the post-evaluation scores. The mean improvement scores was (2.66±0.32) and was statistically significant (P<0.001). No significant difference in mean values was found in the knowledge and skills scores in relation to the socio-demographic variables in the study. Conclusions: Knowledge and skills component of the informal care provider in home based care of diabetes could be perceived as a “felt need”.

137-141

Authors: Jyotishikha Nanda, Dipak Kumar Adak, Premananda Bharati

Objective: To investigate the contraceptive practices among adolescent married women of Tamil Nadu state, India. Methods: We used the data of District Level Household Survey-Reproductive Child Health (DLHS-RCH), Round-II which was conducted in two phases (phase-I during 2002-2003 and phase-II during 2003–2004) in Tamil Nadu. The data consist of 25 522 ever-married women. Results: About 92 percent of the subjects are not currently using any of the contraceptive methods. In terms of social characteristics of married women, who were currently using or not using any one of the family planning methods, caste is found to be highly significant (P<0.000). In economic characteristics per cent of using contraception is considerably higher in the women with medium standard of living. Difference between number of children ever born, gravida and using of contraception methods is highly significant (P<0.000). Conclusions: Study is indicative of implementation of new programme, which may increase awareness about family planning programme in Tamil Nadu state.

150-157

Authors: Shilpa Khullar, Rashmi Babbar

Age-related hearing loss or presbycusis is a complex phenomenon consisting of elevation of hearing levels as well as changes in the auditory processing. It is commonly classified into four categories depending on the cause. Auditory brainstem responses (ABRs) are a type of early evoked potentials recorded within the first 10 ms of stimulation. They represent the synchronized activity of the auditory nerve and the brainstem. Some of the changes that occur in the aging auditory system may significantly influence the interpretation of the ABRs in comparison with the ABRs of the young adults. The waves of ABRs are described in terms of amplitude, latencies and interpeak latency of the different waves. There is a tendency of the amplitude to decrease and the absolute latencies to increase with advancing age but these trends are not always clear due to increase in threshold with advancing age that act a major confounding factor in the interpretation of ABRs.

164-165

Authors: Omer Engin, Ali Coskun, Mehmet Yildirim, Mehmet Ali Demirkiran

Midesophageal diverticulum which has traction in etiology may be asymptomatic or symptomatic. Treatment is changed according to the severity of the symptoms and size of it. Midesophageal diverticula were developed after tuberculous infection in our case. It was released from adjacent tissue with adhesiolysis. It was small, esophageal wall was intact and diverticula’s wall returns to normal esophageal wall so diverticulectomy was not performed. The case was followed up for six months and no complaint occurred.

5-9

Authors: Ochuko L Erukainure, John A Ajiboye, Rachael O Adejobi, Oluwatoyin Y Okafor, Sunday O Adenekan

Objective: To investigate the ability of pineapple peels to protect against alcohol-induced oxidative stress in brain tissues using male albino rat models. Methods: Response surface methodology (RSM) was used to design a series of experiments to optimize treatment conditions with the aim of investigating the protective effect of pineapple peel extract on alcohol-induced oxidative stress in brain tissues. Oxidative stress was induced by oral administration of ethanol (20% w/v) at a dosage of 5 mL/kg bw. The treatment lasted for 28 days. At the end of the treatment, the rats were fasted overnight and sacrificed by cervical dislocation. Tissue homogenates were used for the assessment of protein concentration, reduced glutathione (GSH) content, catalase, and SOD. Results: Alcohol administration caused a significant decrease (P>0.05) in GSH level in the group which was only fed alcohol. Treatment with pineapple peel extracts caused increase in GSH level in alcohol fed groups. No significant difference (P<0.05) was observed in SOD levels of the negative control and group fed on only pineapple peel extract. Elevated level of catalase was observed in the negative control but pineapple peel extract significantly reduced the levels. Conclusions: This study indicates the protective effect of pineapple peel against alcoholinduced oxidative stress in brain tissues.

17-20

Authors: Abdulkabir Ayansiji Ayanniyi, Fatai Olasunkanmi Olatunji, Timothy Majengbasan, Rashidat Oluwafunke Ayanniyi, Mohammed Danfulani

Objective: To determine ophthalmic practice health hazards among ophthalmologists in a resource-limited setting. Methods: The study was conducted through a cross-sectional survey of 53 ophthalmologists’ experiences on ophthalmic practice health hazards using semi-structured questionnaire. Results: Most practitioners felt eye surgical procedures 40 (75.5%) and examination of eye patients (62.3%) were potentially hazardous to practitioners and, 49 (92.5%) thought clerking was not. Most, 92.5% had experienced patients’ halitosis/cough during ophthalmoscopy and, 77.4% experienced hand smeared with patients' eye discharges/tears. Important health hazards experiences included, having contacted systemic diseases (5.7%) and infective eye diseases (18.9%), knife cut during surgical procedure (7.6%), needle pricks (49.1%) and hand smeared with patients' blood (49.1%). Others were neck pain at ophthalmoscopy (35.9%), blurred vision at retinoscopy (20.8%) and hoarseness while performing visual acuities (1.9%). Conclusions: Eye practitioners are exposed to hazards in their practice including potentially life threatening ones. Necessary precautions at work, use of hazard free ophthalmic equipment and working conditions would reduce hazards in ophthalmic practice.

24-27

Authors: Arun Kumar, Brajesh Sathian

Objective: To assess lipid profile in patients with HIV positive infection and to correlate the variation in lipid profile with the CD4+ and CD8+ cell count and establish the relationship between the variables. Methods: Ninety-one participants were enrolled for the present study of which forty seven patients were HIV positive patients and forty four were controls. The study was carried out at College of Medicine & JNM Hospital, Kalyani. Ten mL of blood samples were collected from the participants. The CD4 and CD8 lymphocyte count was estimated by Fluoresence Activated Cell Sorter (FACS) count system (Becton Dickinson). Lipid profiles were analyzed enzymatically using kit obtained from Randox Laboratories Limited, Crumlin, UK. Results: The changes in total cholesterol (TC), HDL-C, TC/HDL-C and age were not significant when compared between cases and controls. Significantly higher levels of triglycerides, low-density lipoprotein-cholesterol (LDL-C), LDL /HDL-C, TG/HDL-C and CD4/CD8 ratio were observed along with decline in CD-4 cells/μL, CD-8 cells/μL (P=0.0001). Furthermore there was a strong correlation between CD-4 cells/μL and TG, LDL-C. Also triglycerides and LDL-C level increased proportional to the increase in CD-4 cells/μL. Conclusions: It can be concluded that the changes in lipid profile can be a good index of disease progression in HIV infection.

35-37

Authors: George Peter, Alexander Lobo Manuel, Shetty Anil

Objective: To compare the clinical profile of Plasmodium falciparum (P. falciparum) malaria in adults and children. Methods: In this retrospective study, data were collected from case records of patients admitted with P. falciparum malaria to the paediatric and adult critical care facility of a tertiary care hospital in an endemic area. A total of 20 adults and children were compared for their symptoms. Results: In this study, among all adults and children with P. falciparum malaria, the commonest symptom was fever with chills and rigors. Among children, the next common symptoms were altered sensorium and irritability. Nine children (45%) had cerebral malaria, among which five had seizures. Other common manifestations were reduced urine output (35%) and vomiting (35%). Among adults, vomiting (65%) was the most common symptom followed by headache (60%). Eight (40%) adults had jaundice while nine (45%) had complaints of decreased urine output. Among adults, 4 had altered sensorium, of which 2 had seizures and jaundice; and all 4 had renal impairment. Conclusions: Clinical symptoms and profile of P. falciparum malaria differ among age groups. Early recognition of symptoms and treatment of malaria is paramount especially in children who tend to have higher rates of complications compared to adults.

41-46

Authors: Santoshkumar R Jeevangi, RB Patil, SM Awanti, S Manjunath, Basavaraj Patil, Karuna Devi

Objective: To evaluate drug utilization and associated costs for the treatment of patients admitted in burn care unit of a tertiary care hospital. Methods: A prospective cross sectional study was conducted for a period of 15 months at Basaweshwara Teaching and General Hospital (BTGH), Gulbarga and the data collected was analyzed for various drug use indicators. Results: A total of 100 prescriptions were collected with 44% belonging to males and 56% to females. The average number of drugs per prescription ranged from 4.5 to 9.5. 9.5% of generics and 92% of essential drugs were prescribed. The opioid analgesics and sedatives were prescribed to all the patients who were admitted in burn care unit. The (Defined daily dose) DDD/1 000/day for amikacin (359) was the highest followed by diclofenac sodium (156), pantoprazole (144), diazepam (130), ceftazidime (124), tramadol (115), ceftriaxone (84) and for paracetamol (4) which was the lowest. Conclusions: Significant amount of the money was spent on procurement of drugs. Most of the money was spent on prescribed antibiotics. The prescription of generic drugs should be promoted, for cost effective treatment. Hence the results of the present study indicate that there is a considerable scope for improvement in the prescription pattern.

50-51

Authors: Depender Kumar Timshina, Pankaja SS, Himagirish K Rao, Vikram Kate

Objective: To assess and compare the risk factors in patients with benign gastric and duodenal ulcers and to correlate the prevalence of Helicobacter pylori (H. pylori) infection in benign peptic ulcer disease. Methods: A total of 30 consecutive patients with peptic ulcer disease were included in this study after upper gastrointestinal endoscopy. Their clinical profile and endoscopic findings were noted. Antral biopsies were subjected to histopathological examination and urease test for detection of H. pylori. Results were correlated. The study was cleared by the Institute Research Council and the Ethics committee. Results: The male: female ratio was 11:4. Overall, H. pylori infection was prevalent in 93.3% of the patients. Patients who took spicy food had a significantly higher rate of H. pylori positivity (P=0.04). Smoking, alcohol intake and NSAIDs did not affect H. pylori status in patients. There was no significant association between the site of the ulcer and H. pylori infection. Conclusions: Based on our observations we conclude that prevalence of H. pylori infection is similar in duodenal and gastric ulcers and intake of spicy food is a significant risk factor.

55-58

Authors: Mandal CR, Adak DK, Biswas S, Bharati P

Objective: To investigate the nutritional status of the males and females in two subgroups of the Bhotia tribe (Marcha and Tolcha) inhabiting in three different altitudes in Uttaranchal, India. Methods: Data were collected from the Tolcha and Marcha, two sub-groups of the Bhotia, inhabiting in Chamoli district of Uttaranchal. Bhotia adults of both sexes were considered. Field investigation was conducted in three ecological zones (high, middle and low altitude) of the district during April-August, in the years 2002-2004. Anthropometric measurements were obtained in accordance with the techniques recommended by Weiner and Lourie (1981). The variables like height, weight, waist circumference, hip circumference, waist-hip ratio and blood pressure were studied in relation to BMI. Results: Relatively higher value of mean BMI is recorded among the females than that of the males, which is true for different altitudes, in both subgroups. The BMI also indicates an inverse relationship with altitude, except for the Tolcha males in high altitude. Lowest mean BMI is recorded in middle altitude among the Tolcha subgroup. Chronic energy deficient (CED) individuals are much more than twice the number among the males of both the subgroups inhabiting in different altitudes. Interestingly, the percentage of CED individuals increases with the altitude. Conclusions: Regression analysis indicates that height, weight, hip circumference and waist circumference are dependent on body mass index in the studied populations. Probable reason for poor nutrition status among the Tolcha and Marcha of high altitude might be due to the fact that the Tolcha and Marcha of high altitude consume lesser amount of proteins, fat, milk and milk products in general than their counterpart inhabit in lower and middle altitude.

63-66

Authors: T Thirumalai, S Viviyan Therasa, EK Elumalai, E David

Objective: To assess the oxidative stress and antioxidant defense system in the skeletal muscle of male albino rats subjected to strenuous exercise programme. Methods: Wistar strain albino rats were subjected to exhaustive swimming exercise programme daily for a period of five days. The thiobarbituric acid reactive substances (TBARS), conjugated dienes, superoxide dismutase, catalase, glutathione peroxidase and glutathione-S-transferase were measured in the gastrocnemius muscle of the exercised animals. Results: The elevated levels of TBARS and conjugated dienes indicated the oxidative stress in the gastrocemius muscle of the exercised animals. The depleted activity levels of superoxide dismutase, catalase, glutathione peroxidase and glutathione-S-transferase in the exercise animals indicated the increased oxidative stress and decreased antioxidative defense system in the muscle. Conclusions: The study suggests that prolonged strenuous exercise programme can induce oxidative stress and therefore an optimal level of exercise schedule should be advocated to obtain the maximum benefit of exercise programme.

71-75

Authors: Echendu Dolly Adinma, Joseph Ifeanyi Brian-D Adinma, Nkemakolam Obinna Eke, Chima Iwuoha, Akinsewa Akiode, Ejike Oji

Objective: To determine the awareness and use of contraception by women seeking for termination of pregnancy in south eastern Nigeria. Methods: A descriptive cross-sectional questionnaire based on the study of one hundred consecutive abortion seekers attending a clinic in southeastern Nigeria was utilized. Results: Mean age of the respondents was (23.5± 4.4) years. The majority were students (55.0%) with 64.0% having secondary education and 33.0% possesing tertiary educational qualifications. Seventy five percent were nulliparous while 49% had one or more previous pregnancy termination. The majority of the respondents (73%) were aware of contraceptive methods but only 10% had ever used including 6% using male condom. Only 38% of the respondents desired to use contraceptives after the termination of index pregnancy. Conclusions: It is concluded that the majority have the high level of contraceptive awareness but contraceptive usage is shockingly low. Therefore, there is a strong need to conduct further and wide spread research not only into the various factors that influence access to contraception but also factors that promote induced abortion and overall unsafe abortion morbidity and mortality as a basis towards the enrichment of discussion related to family planning and contraception, the magnitude of abortion problems, and abortion laws in Nigeria.

80-82

Authors: Demet Karnak, Zeynep Çelebi Sözener, Yıldız Uçar, Ayten Kayı Cangır, Ahmet Demirkazık, Duygu Kankaya

Gelatinous or viscous pleural fluid can be seen in malignant mesothelioma. We reported a 65-year-old patient with mesothelioma, also diagnosed as non-hodgkin lymphoma and chronic lymphocytic leukemia. Mini-thoracotomy was performed in order to get the fluid out, and to make pleurodesis. This patient had been followed up for four years then he died. Gelatinous fluid can be manageable well with surgery and pleurodesis and can be the messenger of long survival.