Asian Pacific Journal of Tropical Medicine

1-8

Authors: M-C Luan, D-Z Yu, L Tang, L-J Zhang

Objective: To identify members of genera of rickettsia and O. tsutsugamushi simultaneously. Methods: Rapid and duplex and nested PCR methods have been established by designing primers based on the conserved regions of heat shock protein GroEL gene. 345 mouse viscera samples including liver, spleen and kidney, 96 Xenopsylla cheopis and 32 chiggers collected from Hongta areas of Yuxi city, Yunnan province were tested by the new PCR methods. Results: The result of the study showed that the new PCR methods could identify most members of genera -Rickettsia and Orientia simultaneously with 100% specificity and its sensitivity could test one copy per microliter. The results of detection prevalence of rickettsioses in mouse, flea and mites DNA samples showed that the total rickettsia infection rate in mouse was 34.78% (120/345). The total infection rates in R. typhi, O.t Karp and R. sibirica of mouse samples were 28.12% (97/345), 19.71% (68/345) and 0.29% (1/345) respectively. Co-infection rates in R. typhi and O.t Karp of mouse samples were 13.33% (46/345). O.t Karp type has been the main epidemic strain in these areas. Conclusion: We concluded that this PCR method could be used to detect multi-genera rickettsia simultaneously. Molecular evidences provided in this and previous studies strongly support that Hongta areas of Yuxi city are a natural focus for typhus and scrub typhus with the common occurrence of their confection.

14-19

Authors: Maysaa El Sayed Zaki

Objective: The inefficiency of conventional laboratory methods for diagnosis of Pleural tuberculosis (TBP) and the reliance on pleural biopsy have motivated the evaluation of alternative diagnostic strategies. Our goal was to evaluate different laboratory techniques Ziehl Neelsen, Mantoux skin test, determination of interferon gamma in serum and pleural fluid, polymerase chain reaction and serological study of specific IgG, IgM and IgA beside bacteriological culture by BACTEC 460 TB for rapid and accurate diagnosis of tuberculosis pleurisy. Methods: Patients presented with pleural effusions were subjected to study by ZN, PCR, serological study By specific IgG, IgM and IgA for A60 of tuberculosis compared to culture by BACTEC460 TB. Interferon gamma was determined both in serum and pleural fluid. Results: Mantoux skin test was positive in 19 TBP patients and four patients with exudative pleural effusion. Z.N staining results of pleural biopsy specimens were positive in only 1 of 23 patients (4.3%) in the tuberculous pleural effusion group. PCR was positive in 20 cases of group 1 (87%). Serum and pleural fluid interferon had significantly elevated levels (P<0.000 1) in TBP and both measurements had significant correlation in TBP (P<0.000 1). The serum IgA ELISA test was positive in 7/23 (30.4%), IgM was positive in 17/23 (73.9%) patients and IgG was positive in 16/23 (69%) patients. Non of the non TBP had either ZN, PCR or positive serum IgA, IgG, or IgM. When the positive results for IgG and IgM were combined together the serological tests correctly identified 20/23 (87%) of patients. Conclusion: We suggest that in TBP serological diagnosis by combined use of IgG and IgM for A60 antigen with serum determination of interferon gamma can provide rapid and non invasive diagnostic tool that can justify the starting of chemotherapy while awaiting the results of culture.

24-27

Authors: Sharanabasappa M, Sudhakar Nayak

Objective: The study was conducted to evaluate the effect of liver diseases on serum Lp(a) levels and also to study the relationship between Lp(a) levels with other lipid parameters and liver function tests in 32 hyperbilirubinemia patients with total bilirubin>3mg/dL. The results were compared with 20 healthy age matched individuals. Methods: Serum obtained from venous blood sample are used for estimating total cholesterol (TC), triglyceride(TG), high density lipoprotein cholesterol(HDL-c), low density lipoprotein cholesterol(LDL-c),very low density lipoprotein cholesterol(VLDL-c), total protein(TP), albumin(ALB), total bilirubin, direct bilirubin, aspartate amino tranferase(AST), alanine amino transferase(ALT), alkaline phosphatase(ALP), gamma glutamyl transferase (GGT), lipoprotein (a) ［Lp(a)］, serum phospholipids. Results: There was significant decrease in serum Lp(a) levels in liver disease patients and the decrease was directly correlated with reduced serum albumin levels and inversely with liver function parameters. Conclusion: Thus the present study indicates hepatic synthetic damage has possible biochemical basis for the reduction of serum Lp(a) levels

32-35

Authors: Banihashemi Kambiz, Naeeni K. Mohammad, Yasseri Mehdi, Ghasemi Saeed, Abutalebi Robabeh, Pourkhani Maryam

Objective: To decrease or delay the major un-wanted clinical consequences to improve the quality of life in the involved patients. Methods: A retrospective case series study has been made on the forty five pediatric patients admitted to nephrology department of Ali-Asghar Hospital during a period of nearly 10 years. The patients have been divided into two groups of good and poor prognoses according to their clinical outcomes. The routine laboratory records and clinical manifestations extracted and statistically analyzed as independent variables both by univariate and multivariate methods. Results: Forty three patients have been managed successfully with only two deaths occurred. According to clinical findings, nineteen patients were classified as poor prognosis and the rest were categorized as good prognosis. Multivariate statistical analyses showed that lesser age at the time of admission (age < 46 months, P<0.015) and the higher initial WBC count (count > 15 000, P<0.226) were well-interrelated to ominous clinical consequences like convulsion, coma and peritonitis and statistically different between the two groups of patients. Conclusion: Despite the importance of predictive variables in the course of Hemolytic uremic syndrome(HUS) in children and their critical influence on the clinical outcome, many aspects of these parameters have been remained to be elucidated comprehensively. Our study showed that simultaneous low age of child at the time of admission with simultaneous high WBC count will result in the poorer prognoses of the patients. This may warn the clinicians to provide more supportive cares for this group of patients.

40-43

Authors: Madhukar Mallya H, Revathi P Shenoy, Sreejith Ramakrishnan, Linta Thampi, Rashmi Stevens, M Sethukumar Kamath, Anupama Nayak, Anjali Rao

Objective: In the Ayurvedic system of medicine, body constitution (prakruthi) is said to play a vital role in the disease process as well as in its progression. Free radical toxicity is also involved in the etiopathogenesis of many disorders. Hence, in the present study an attempt has been made to correlate the body constitution type and the antioxidant status of that prakruthi. Methods: Healthy volunteers from Manipal University Campus, South Karnataka, India were classified into three main human constitutions (prakruthi) and their possible combinations and their serum total antioxidant activity was determined. Results: There was a significant negative correlation of the total antioxidant status with the pitta prakruthi whereas vata and kapha constitutions showed no significant correlation with the total antioxidant status. Conclusion: Ayurveda classifies each individual based on his/her prakruthi into three categories of Doshas: Vata, Pitta and Kapha (collectively known as Tridoshas). The three Doshas are fundamental regulatory principles responsible for maintaining organism functioning and manifesting those characteristics typifying each individual, that is, in equilibrium Tridoshas signify health and an imbalance leads to disease. Thus, in this study a significantly decreased antioxidant status in the Pitta group would render them more susceptible to damage by oxidative stress. Hence, we suggest that supplementation with antioxidants of herbal (Ayurvedic) origin to such a group would prove to be beneficial - opening up the arena for pharmacogenomics and customized antioxidant drug administration based on the prakruthi of an individual.

49-60

Authors: Bharati P, Pal M, Bharati S

Objective: The aim of the paper is to see how educational and working status of the parents affect the nutritional and immunization status of preschool children in India. Methods: We have used data of more than 24 000 preschool children spread over different states in India. The data were collected by National Family Health Survey (NFHS-2) in 1998-99. For assessing the nutritional status, only the Z-scores of weight-for-height (WHZ) have been computed and for immunization status, it has been seen whether BCG, DPT3, Polio3 and measles have been administered. Children who fall below-2SD(-3SD) from median are considered to be moderately (severely) malnourished. Results: According to the NFHS-2 data, 70% of children are vaccinated by BCG, 50% receive the full course of DPT, 54% get all the three dozes of polio and only 42% are protected from measles by vaccination in India. The percentages of moderately and severely wasted children in India are 12.1 and 2.8, respectively. There is a marked regional variation of these percentages. Bivariate and multivariate analysis clearly points to the need of educational status of mothers rather than fathers for proper nutritional and immunization status of preschool children. Parents' occupation and working status also have some effect, but not so pronounced as parents' education. Conclusion: The Indian preschool children need particular attention for high risk of wasting and low immunization. The prevalence of malnutrition can be arrested more by improving the mother's education level rather than their fathers and by raising the standard of living of their house-holds.

67-71

Authors: Onwere S, Okoro O, Chigbu B, Kamanu C, Aluka C, Feyi-Waboso P

Central nervous system tuberculosis can have protean manifestations. We review the clinical and radiological findings in two cases of cerebral tuberculoma in immuoncompetent patients. These two cases represent the spectrum of variations of clinical and radiological features of cerebral tuberculoma and highlight the controversies in the approach to diagnosis and management.

76-82

Authors: Asad U Khan

Drug resistance is becoming a great problem in developing countries due to excessive use and misuse of antibiotics. The emergence of new pathogenic strains with resistance developed against most of the antibiotics which may cause, difficult to treat infection. To understand the current scenario in different mode of infection is most important for the clinicians and medical practitioners. This article summarized some common infections and antibiotic resistance pattern found among these pathogens.