Asian Pacific Journal of Tropical Medicine

1-6

Authors: Simpore J, Zeba B, Karou D, Ilboudo D, Pignatelli S, Nacoulma OG, Musumeci S

Burkina Faso (West Africa) is a tropical country with a high incidence of infectious diseases. The uncontrolled use of antibiotics against bacterial pathogens has given rise to the emergence of antibiotic resistance in this country. The aims of this study were. i) to determine the prevalences of the most important pathogenic bacteria, isolated in the town of Ouagadougou. ii) to identify the bacterial species which have acquired resistance as a result of antibiotic selection. iii) to compare antibiotic-resistances of Escherichia coli isolated from stool culture in the present study, with results obtained in 2002 from strains collected in the same structure in Burkina Faso. iv) to determine the trend of antibiotic resistance in Burkina Faso in order to give local advice on the most appropriate empiric antibiotic therapy. Six thousand two hundred and sixty four samples of blood, stools, urine, sputum, pus and vaginal secretion were collected and analyzed in Saint Camille Medical Center (SCMC) laboratory from May 2001 to May 2006. Out of the 6264 samples tested no pathogen was identified in 1583 (25.31%), whilst 4681 (74.73%) were positive, with the incidence of the microrganisms isolated being as follows: Escherichia coli 1291 (27.6%),Staphylococcus aureus 922 (19.7%),Salmonella spp 561 (12.0%), Streptococcus spp 499 (10.7%), Klebsiella spp 359 (7.7%), Shigella spp (6.3%), Acinetobacter spp 266 (5.7%) and others 783 (16.7%). Among the isolated pathogens, the highest resistance was found to Amoxycillin: Proteus spp 95.6%, Escherichia coli 78.2%, Salmonella spp 62.2%, Shigella spp 73.4% and Klebsiella spp 89.9%, followed by resistance to Ampicillin and cotrimoxazole. Comparing the prevalence of antibiotic resistance of Escherichia coli from stool cultures isolated during 1999-2000 to that of 2001-2006, a significant reduction was found, which could be due to the improved use of antibiotics in recent years. The reduced antibiotic-resistance observed in pathogens isolated in Burkina Faso during this study as compared to previous data, could be the result of setting up microbiological epidemiological monitoring centres, in tropical countries, to better control the emergence of bacterial antibiotic-resistance.

12-15

Authors: Asad U Khan, Saeedut Zafar Ali, Mohammed S Zaman

This study was to investigate the current trends of multiple drug resistance in bacteria against antibiotics for the proper empirical treatmen. Clinical isolates were collected from community-acquired infection of urinary tract patients in Aligarh India from March 1999 to August 1999. Antibiotic susceptibility test was performed, using the disc diffusion method followed by plasmid isolation by the method of Kado and Liu. Transfer experiments were performed by the method of Lederberg and Cohen. Clinical study revealed that this infection was more common in young women. Various strains of E. coli isolated during the course of study were found to show multiple antibiotic resistance which was further characterized as plasmid-borne drug resistance. This study shows that E. coli may be one of the important causative agents of urinary tract infection(UTI) in young women.

21-27

Authors: Arun Kumar，Ramiah Sivakanesan

Dyslipidemia the major cause of atherosclerosis are suggested to act synergistically with non-lipid risk factors to increase atherogenesis. Low-density lipoprotein cholesterol (LDL-C) is the main therapeutic target in the prevention of CVD. Increased triglycerides (TG) and decreased high-density lipoprotein (LDL-C) are considered to be a major risk factor for the development of insulin resistant and metabolic syndrome. Although the TG/HDL-C ratio has been used in recent studies as a clinical indicator for insulin resistance, results were inconsistent. The TG/HDL-C ratio is also widely used to assess the lipid atherogenesis. How ever the utility of this rate for predicting coronary heart disease (CHD) risk is not clear. We encountered myocardial infarct patients with normal serum lipid concentration so this study was undertaken to evaluate the usefulness of these lipid ratios in predicting CHD risk in normolipidemic AMI patients and to compare the results with healthy subjects. The aim of the present study was to evaluate serum TC/HDL-C, TG/HDL-C and LDL-C/HDL-C in myocardial infarct subjects with normal lipid profile.To study this, lipid profile was determined in 165 normolipidemic acute myocardial infarction patients and 165 age/sex-matched controls. Total cholesterol, triglycerides, and HDL-cholesterol were analyzed enzymatically using kits obtained from Randox Laboratories Limited, Crumlin, UK. Plasma LDL-cholesterol was determined from the values of total cholesterol and HDL- cholesterol using the friedwalds formula. The values were expressed as means ± standard deviation (SD) and data from patients and controls was compared using students 't'-test.The results and conclusion of the study were: Total cholesterol, TC: HDL-C ratio, triglycerides, LDL-cholesterol, LDL: HDL-C ratio were higher in MI patients (p<0.001). HDL-C concentration was significantly lower in MI patients than controls (p<0.001). Higher ratio of TC/HDL-C, TG/HDL-C and LDL-C/HDL-C was observed in AMI patients compared to controls.

31-33

Authors: Seyedeh Atefeh Emadi, Marzieh Akbarpour, r. Shahram Azhdari

Lymphomas form a heterogenous group of clonal(neoplastic) diseases. Primary renal lymphoma(PRL) is rare. Diagnosis of primary renal lymphoma is important for the patients to receive appropriate therapy. Laparoscopic nephrectomy should be the standard procedure in most cases of both malignant and benign, renal tumors with the possible exception of tumor >10cm. Probably this case report of laparoscopic surgery of primary renal lymphoma is the first report of this kind and may be useful for the other laparoscopic surgeons. A 53 years-old man with unilateral primary renal lymphoma who had a history of renal colic and ESWL(Extracorporeal Shock Wave Lithotripsy) of the left kidney stone 3 years ago, he underwent laparoscopic radical left nephrectomy and chemotherapy. The patient was monitored for follow up for 4 months and had a significant improvement. Although treatment of lymphoma is now guided by phenotype of tumor, we found that appropriate treatment is possible after radical nephrectomy and assessment of pathology. Renal lesions may compeletly regress by appropriate treatment. There was not any report of laparoscopic surgery of PRL in our literature. We are reporting the first case of successful laparoscopic surgery of PRL successfully.

36-37

Authors: Bava Javier, Troncoso Alcides

41-60

Authors: Cristóbal S. Berry-Cabá

Schistosomiasis is an infection with one of a series of related trematode parasites that are endemic to at least 76 tropical and subtropical countries. Schistosomiasis affects over 200 million people in tropical and subtropical regions of South America, Africa and Asia. This paper reported more than 1500 soldiers of US troops and 560 men of Australian Air Force were affected schistosomiasis japonicum in the Leyte of the Philippines during the liberation of the Philippines from Octorber 1944 to the early months of 1945. Many troops there were affected by contaminated water with snail hosts. At first, the medical corps knew little about the situations of the schistosomiasis japonica in the Leyte, no preventive measure was adopted. On December 23, 1944 CPT morris Goldberg discovered schistosomes first from the hospitalized soldiers while conducting a liver biopsy. Some soldiers with markedly signs and symptoms were admitted to hospital for treatment. Preventive measure was taken since. The US sent a lot of experts to Philippines for the research of schistosomiasis japonicum, including epidemiology, prevention, diagnosis, treatment and so on. Nineteen chemicals were used to control snail hosts. In clinical, schistosomiasis has acute and chronic stages, the manifestations are plenty and various, the liver, intestine, veins, spleen and skin etc are common sites of impingement. An extensive educational program was carried out in the troops through different means, which yielded remarkable effect, the new incidence of schistosomiasis dropped. Though hospitalized soldiers were a few, but there were scare and some morale and psychological problems among them and the other affected victims, they worried about their prognoses or being infected. Some patients were evacuated to United States for treatment after diagnosis, some patients were treated in Leyte. Before World War II, schistosomiasis was treated generally with trivalent antimony compounds, Fuadin and tartar emetic. In this event, no case died, relapses were rare. It was a successful campaign against schistosomiasis in the army.

65-70

Authors: Shikha Baisakhiya DOMS, FGO

As the number of HIV infected patients is multiplying exponentially day by day so are the associated ocular complications. The increasing longevity of individuals with HIV disease has resulted in greater numbers of patients with ocular opportunistic infection. By the means of this article we describe various opportunistic ocular infections in AIDS and their clinical manifestations, discussed under four headings; 1) adnexal manifestation; 2) anterior segment manifestation; 3) posterior segment manifestation; 4) neuro ophthalmic manifestation . Herpes zoster ophthalmicus, molluscum contagiosum and Kaposi sarcoma are common adnexal manifestations. Molluscum contagiosum being the commonest. Varicella Zoster Virus (VZV) and herpes simplex virus (HSV) most commonly cause infectious keratitis in HIV-positive patients . As compared to the immunocompetent individuals the frequency of bacterial and fungal keratitis is not more in HIV patients, but it tends to be more severe. Posterior segment structures involved in HIV-positive patients include the retina, choroid, and optic nerve head. The herpesvirus family is implicated most commonly in infections of the retina and choroid in HIV positive patients. CMV is the most common cause of retinitis and the commonest intraocular infection in AIDS. Atypical presentations resistance to conventional treatment and higher rate of recurrence make the diagnosis and therapeutic intervention more difficult and challenging. In addition, in one eye, several infections may occur at the same time, rendering the situation more difficult.

76-82

Authors: Asad U. Khan and Shahper N. Khan

The discovery that RNA can act as an enzyme led Thomas Cech to win the Nobel Prize in Chemistry and led immediately to the next wave of attempts to find an effective RNA-based therapy. The tantalizing idea that RNA enzymes called trans-cleaving ribozymes enables them to act as potential antiviral and powerful tool for functional genomic studies. The efficacy of ribozyme function in a complex intracellular environment is dependent on the intracellular fate of the RNA that is being targeted. Recently, ribozymes have been used successfully to inhibit gene expression in a variety of biological systems in vitro and in vivo. Ribozyme has also been used successfully to combat many cases of viral infection, as clinical trial. Despite it needs to be investigated and explored as far as its structural and functional aspects are concern. In view of the significance of ribozyme in modern medicine, we reviewed the recent literature on general approach to control viral infection.

1-6

Authors: Tienboon P, Wangpakapattanawong P, Thomas DE, Kimmins JP

Malnutrition results from insufficient intakes of food including micronutrients such as vitamin A, iron, iodine, zinc, and folic acid. This paper reported the results from a study of dietary intakes of Karen hill tribe children aged 16 years in the north of Thailand. All children aged 16 years (n=158; 83 boys, 75 girls) from the three Karen villages (Mae Hae Tai, Mae Yot, Mae Raek) of Mae Chaem district in the north of Thailand were studied. All children were examined by a qualified medical doctor and were assessed for their nutrient intakes using 24 hours dietary recall. All families had income lower than the Thailand poverty line (US $ 1000/year). For children aged 13 years, the nutrients generally consumed were much less than the Thai RDA. Compared with the Thai RDA, all children consumed much less energy (28%-40.5% RDA) than protein (55.8%-96.1% RDA). Interestingly, all boys and only girls from Mae Raek village consumed vitamin A more than the Thai RDA but girls from Mae Hae Tai village and Mae Yot village consumed vitamin A less than the Thai RDA. For children aged 46 years, boys from Mae Raek village consumed protein (128.4% RDA) and vitamin C (143.1% RDA) above the Thai RDA. Girls from Mae Yot village also consumed vitamin C (132.9% RDA) above the Thai RDA. Both boys and girls from Mae Raek village and also girls from Mae Yot village consumed vitamin A more than the Thai RDA. Other nutrients were consumed much less than the Thai RDA by all children. All children consumed protein more than 10% of the total energy consumption per day. Most of the energy consumed by children came from carbohydrate. Nearly all children consumed carbohydrate more than 50% of the total energy consumption per day except boys aged 13 years from Mae Raek village (consumed 45%). All children from Mae Hae Tai village and boys aged 46 years from Mae Yot village (consumed 27%) consumed fat less than 30% of the total energy consumption per day. It appeared that the priority recommendations for improving nutrition in Karen villages in Mae Chaem would be increase energy consumption such as fat and oil. More general work is needed on how children's diets might be improved in a culturally acceptable manner, so as to bring consumption patterns closer to recommended allowance levels.

14-18

Authors: Gupta AD, Dhundasi SA, Dhara PC , Das KK

We studied the effect of the simultaneous treatment with α-tocopherol (100 mg/kg; im) and nickel sulfate (20 mg/kg , ip) on nickel-induced changes in serum lipid profiles. Nickel-treated rats showed a significant increase in serum LDL cholesterol, total cholesterol, triglycerides, and a significant decrease in serum HDL cholesterol. Simultaneous administration of α-tocopherol with nickel sulfate improved LDL-cholesterol and HDL-cholesterol level when compared with rats receiving nickel sulfate alone. The results indicate that α-tocopherol is beneficial in preventing nickel-induced lipid profile alterations.

25-29

Authors: Nwodo NJ, Omeje EO, Brun R

Objective: Aqueous extracts of Zapoteca portoricensis are used traditionally as antidiarrhea agent and in the treatment of diverse gastrointestinal disorders here in Nigeria specifically, the southern part. Similarly, the aqueous extract of the plant is also used traditionally as anticonvulsant, antispasmodic and in the treatment of tonsillitis. Recently too, the antiinflammatory and antimicrobial activities of the methanol extracts of the root of Zapoteca portoricensis was reported. In this research, we are set to investigate the trypanocidal activity of Zapoteca portoricensis. Methods: The methanol extract of the root of Zapoteca portoricensis was investigated for both in vitro and in vivo trypanocidal activity following established models. In summary, phytochemical analysis was carried out on both the crude powdered root and on the methanol extract following standard procedures. The oral acute toxicity test (LD 50) of the crude methanol extract was determined according to the method described by Lorke (1983). Albino mice (17g-21g) of either sex were used. The methanol extract was suspended in 3 % v/v tween 85 and administered orally at doses of 10 mg/kg, 100 mg/kg and 1 000 mg/kg to three groups of mice (n=3). The animals were observed for 24 hours. Based on the result obtained in this initial test, doses of 4 mg/kg, 6 mg/kg, and 8 mg/kg were administered to three different mice. The LD 50 was calculated as the geometric mean of the lowest dose killing a mouse and the highest dose showing no death. The in vivo/ in vitro anti-trypanosomal evaluations were carried out in experimental animals and tissue cell culture respectively. Results: The result of the in vitro studies shows the inhibitive concentration 50(IC50) against Trypanosoma brucei rhodesiense (T.b. rhodesiense) to be 0.372 mg/kg, while the control drug melarsoprol was 0.006 mg/kg. On Trypanosoma brucei brucei (T. cruzi), the IC50 is 6.42 mg/kg against 0.87 of the reference drug Benznidazole. The cyctotoxicity on L6 cells exhibited an IC50 of 0.039 6 mg/kg against the reference drug, podophyllotoxin of 0.01 mg/kg. However, the in vivo study shows that the extract, at the administered doses, could not exhibit appreciable reduction of parasitemia and hence resulted to the death of test animals. Conclusion: The present data suggests that Zapoteca portoricensis could yield useful leads for the development of potentially potent antitrypanocides.

29-30

Authors: Meunier Y.A.

Strongyloidiasis is endemic to the entire inter-tropical zone. Newly infected people are the most prone to experience the symptoms of this intestinal nematodosis. In this article, a 38-year old German citizen consulted for bowel movement disturbances and dyspepsia as well as diffuse and erratic pruritus, and was finally diagnosed with to have strongylodiasis is presented and discussed.

50-55

Authors: Li F, DeWolfe Miller F

Staphylococcus aureus (S. aureus) is one of the most common human pathogens, causing a wide range of afflictions from minor infections of the skin to serious wound infections, bacteraemia, pneumonia and endocarditis. Methicillin, the first semisynthetic derivative of penicillin, was a new hope to treat penicillin resistant S. aureus in the early 1960s. Nevertheless, only one year after its introduction, the first methicillin-resistant S. aureus (MRSA) strains were detected. There is no golden rule in the control of MRSA. Nevertheless, using surveillance cultures of patients and healthcare personnel, strictly enforced contact precautions, and judicious use of broad-spectrum antibiotics have helped several countries, including Finland, Denmark, and the Netherlands to keep MRSA at a very low level. Conversely, countries including China, Japan, US, Italy, Greece, UK, where stringent counter-measure were not able to be installed, MRSA have become hyper-endemic. Control of MRSA in those countries were obliged to concentrate available resources to prevent MRSA infections only at patients at high risk of serious morbidity and mortality.

60-62

Authors: Wiwanitkit V

All human beings have to ingest food to get the nutrition. The epidemiology of nutritional problem is quite different in different part of the world. Most of the problematic cases come from the underdeveloped tropical countries. Of several methods, nutritional surveillane adding to the standard nutritional promotion should be used. Not only the basic medical and nutritional science but also other sciences should be integrated into a complete nutritional surveillance. Applied new technology especailly for the medical informatics should be used. The multidisciplinary project between medical science workers and other non -medical science workers is also recommended.

69-82

Authors: Tyagi P, Biswas S

The research scenario for malaria has improved in the last three decades to understand the epidemiology and host immune responses to plasmodial infection. Due to the augmented episodes of resistance development against the commonly used antimalarials in plasmodium parasites, especially in Plasmodium falciparum, neutralization of infection through effective vaccine(s) remains the feasible alternative in malaria control. In this direction, lot of attention was paid towards the identification of stage specific malaria antigens targeted by host's immune system. Preparation of synthetic or recombinant peptides and evaluation of their immunogenecity in naturally occurring antibody response were also given much importance, as these studies could help in finding potential candidates for future malaria vaccine(s). Attention was also paid on the pathogenic consequences of antibody formation in malaria infection as polyclonal activation of B cells, which is a very prominent feature in malaria infection. Formation of circulating immune complexes in chronic malaria infection was also viewed as pathogenic parameter of severe malaria. The present survey focuses mainly on protective and pathogenic aspects of malaria antibodies (eliciting against various stage specific antigens), and future research plan in antibody-mediated immune response.