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   Table of Contents - Current issue
Coverpage
March-April 2017
Volume 10 | Issue 2
Page Nos. 295-492

Online since Thursday, June 22, 2017

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COMMENTARY  

Vaccine coverage estimation using Global Positioning System and Google Earth: A commentary p. 295
Tanmay Mahapatra
DOI:10.4103/1755-6783.208723  
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EDITORIAL COMMENTARIES Top

Uniting the efforts of stakeholders to end tuberculosis globally by 2030 p. 297
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava, Jegadeesh Ramasamy
DOI:10.4103/1755-6783.196836  
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Accelerating progress to achieve the sustainable development goal target 3.3 worldwide p. 299
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava, Jegadeesh Ramasamy
DOI:10.4103/1755-6783.196843  
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Improving urban health standards: Promotion of equity and development of healthier cities for sustainable development p. 301
Saurabh R Shrivastava, Prateek S Shrivastava, Jegadeesh Ramasamy
DOI:10.4103/1755-6783.208705  
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Terminating the status of public health emergency of international concern for ebola outbreak in West Africa: What does it mean? What next? p. 303
Saurabh R Shrivastava, Prateek S Shrivastava, Jegadeesh Ramasamy
DOI:10.4103/1755-6783.196856  
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Moving ahead from leprosy elimination to leprosy-free world by 2020 p. 305
Saurabh R Shrivastava, Prateek S Shrivastava, Jegadeesh Ramasamy
DOI:10.4103/1755-6783.208708  
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The public health concern of mental illnesses: Strengthening of the mental health sector p. 307
Saurabh R Shrivastava, Prateek S Shrivastava, Jegadeesh Ramasamy
DOI:10.4103/1755-6783.196799  
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Addressing the public health concern of depression and anxiety disorders: Financial perspective p. 309
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava, Jegadeesh Ramasamy
DOI:10.4103/1755-6783.196801  
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Advocating for the implementation of the updated guidelines for the management of Hepatitis C infection universally p. 311
Saurabh R Shrivastava, Prateek S Shrivastava, Jegadeesh Ramasamy
DOI:10.4103/1755-6783.208709  
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Radiation exposure in pediatric imaging: Justification, optimization, and risk communication p. 313
Saurabh R Shrivastava, Prateek S Shrivastava, Jegadeesh Ramasamy
DOI:10.4103/1755-6783.196803  
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Aiming for Malaria elimination: World Health Organization p. 315
Saurabh RamBihariLal Shrivastava, Prateek S Shrivastava, Jegadeesh Ramasamy
DOI:10.4103/1755-6783.208711  
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Ensuring the universal adoption of health equity assessment toolkit to minimize health inequalities p. 317
Saurabh R Shrivastava, Prateek S Shrivastava, Jegadeesh Ramasamy
DOI:10.4103/1755-6783.196849  
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Conditional cash transfer to improve the status of the girl: Indian perspective Highly accessed article p. 319
Saurabh R Shrivastava, Prateek S Shrivastava, Jegadeesh Ramasamy
DOI:10.4103/1755-6783.188505  
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REVIEW ARTICLES Top

The assessment of patient clinical outcome: A literature discussion Highly accessed article p. 321
Mouíath A Hourani, Nidal M Turab, Qusai Y Shambour
DOI:10.4103/1755-6783.208728  
A patient's safety in clinical field is critical, important and complex. The patients are still suffering from preventable harms from diagnostic errors, procedure mistakes, teamwork failures, and the failure to deliver recommended therapies. Patient outcome is the status upon a patient's adherence to treatment. An assessment of patient's clinical outcome is one of the important aspects of patient safety, and requires the assessment of the benefits, harms and risks of therapeutic options and comparing between them. Very few methods are developed for the clinical field and there is still a need for more accurate methods for such assessment. To achieve the above objective, we have performed an integrative review of the literature using different online databases and search engines including PubMed, Scopus, Google, and Google Scholar to explore current issues regarding the assessment of patient clinical outcome. This paper presents:
  1. an overview of the existing assessment methods for patient clinical outcome and their conceptual limitations; and
  2. a discussion of the primitiveness of the current assessment methods.
Based on the literature research in this paper, researchers, clinicians and health care professionals working in the field of assessment of patient clinical outcome, will be able to
  1. understand all the critical issues in this area, and
  2. design and develop novel general methods for the assessment of patient clinical outcome that avoid the conceptual limitations of existing methods.
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Vibration exposure and work‐musculoskeletal disorders among traffic police riders in Malaysia: A review p. 334
Nur Athirah Diyana, Karmegam Karuppiah, Irniza Rasdi, Sivasankar Sambasivam, Shamsul Bahri Mohd Tamrin, Kulanthayan K. C. Mani, Putri Anis Syahira, Ihtifazuddeen Azmi
DOI:10.4103/ATMPH.ATMPH_91_17  
Background: The traffic police force is one of the occupations that utilize motorcycles as the main mode of transport. The main ergonomic hazard with the constant use of motorcycles is exposure of riders to vibration while riding their motorcycles, which can potentially lead to work.related musculoskeletal disorders (WMSDs). Objective: This review is meant to provide an overview of the available vibration exposure with WMSDs for traffic police riders and to review the related guidelines. Method: This study involved comprehensive search of database from 1945 to 2015. Published research paper that reported on the vibration exposure, prevalence, and/or risk factors of WMSDs and occupational riders were assessed and reviewed. Result: The review suggests that the main factors involving vibration in motorcycles come from the motorcycles itself, the posture of the hands and arms during the gripping of the handlebars, the surrounding environment, and the period of riding motorcycles. Majority of the studies agreed that police riders had higher percentage of WMSDs especially in lower back, neck, and shoulder. Conclusion: Overall, police riders have a high incidence of WMSDs, which in combination with exposure to vibrations with prolonged sitting and static posture may increase their susceptibility to WMSDs. Further research is required to explore the level of exposure to vibrations and WMSDs among traffic police riders, its potentially consequences, and ways to reduce exposure and risk associated with vibrations and WMSDs.
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ORIGINAL ARTICLES Top

Molecular identification, phylogeography, and genetic diversity of Culex quinquefasciatus in Central Java province, Indonesia p. 341
Irfanul Chakim, Winda Septi Tyasningrum, Hakiki Chandra Wardani, Sayono Sayono
DOI:10.4103/1755-6783.208718  
Species identification of Culex quinquefasciatus mosquitoes is crucial for planning vector control program. The progress of molecular entomology tool supports a better understanding of the species identification. In the molecular study, it has grown ITS2 sequences which are used as a potential marker for species identification and phylogenetic analysis. The genetic diversity of Culex quinquefasciatus mosquitoes has been reported worldwide, but until now there has been no study of diversity of Cx. quinquefasciatus mosquitoes in Indonesia. The purpose of this study is to determine the genetic diversity of Culex quinquefasciatus as a filariasis vector in Central Java on the basis of ITS2 genes from ribosomal DNA. This study is done descriptively by collecting samples from filariasis endemic areas in Central Java. Results of the morphological and molecular analysis showed a difference of identification. ITS2 sequence alignment results of Cx. pipien complex from Central Java isolates have similarities with some isolates in many worlds. Phylogenetic analysis showed that ITS2 sequence of mosquitoes in this study is not monophyletic. The further results indicate the fact of introgression history ITS2 from Cx. pipien toCx. quinquefasciatus in Central Java. The introgression may occur before Cx. quinquefasciatus proliferate and spread in the Central Java region.
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A clinico‐pathologic study of soft tissue neoplasms: An experience from a rural tertiary care hospital p. 348
BD Baste, Sunil Y Swami, VV Narhire, MP Dhamecha, Grace DíCosta
DOI:10.4103/1755-6783.208703  
Context: Soft tissue is a non-epithelial extra skeletal tissue of the body exclusive of reticuloendothelial system, glia and supporting tissue of the various parenchymal organs. Aims: To study the clinico-pathological correlation, relative incidence of benign & malignant neoplasms, frequency of age, sex & site wise distribution & histopathological pattern of soft tissue neoplasms [STNs]. Setting and Design: Comprises of soft tissue neoplasms studied during six months. Cases of STNs diagnosed based on history and clinical examination and subjected to biopsy or surgery and subsequent histopathological examination were included while patients who were treated conservatively or referred to other hospitals and STNs of systemic organs were excluded. Materials & Methods: The tissues were fixed in 10% formalin and were processed. Sections of approximately 5 microns were cut and stained by routine hematoxylin and eosin [H & E] and immunohistochemistry [IHC] was done where ever required. All STNs were classified as per 2013 WHO classification. Result: Out of 70 cases of STNs recorded, 95.72% were benign and 04.28% were malignant. STNs in general had slightly male preponderance. Of all benign soft tissue neoplasms, the commonest was lipoma (64.28%) followed by peripheral nerve sheath (11.4%), vascular (8.5%), fibroblastic (4.28%), fibro-histiocytic (2.8%) and tumors of uncertain differentiation (2.8%) in the decreasing order to frequency. Conclusion: Availability of a modern, more logical histopathologic classification and standard nomenclature now offers a better clinic-pathological co-relation. The clinico-morphological evaluation is still the gold standard for the proper diagnosis of soft tissue neoplasms.
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Urinary schistosomiasis among primary school children at Al‐Takamul area, eastern Khartoum state‐Sudan: An example for urban schistosomiasis p. 353
Babiker Salih Al-Basheer, Alfatih Saifudinn Aljafari
DOI:10.4103/1755-6783.208720  
Background: Urinary Schistosomiasis, caused by Schistosoma haematobium, is classically associated with rural areas that provide the hospitable condition for transmission. With the recent massive internal displacement, new communities were settled and created urban extensions to the big cities. These extensions bridged the space between the urban areas and the agricultural schemes around them. The area selected for this study is a good example for these settings. Given that the new population was displaced from known endemic areas, the transmission cycle seems to be completed. Objective: The aim of this study is to identify the frequency of urinary schistosomiasis among school children form Al-Takamul, which is a suburban district located in the Eastern Khartoum State. Materials and Methods: 150 school children were enrolled in this study, all were boys. Half of them were 11 year old or less. 20 ml of fresh voided urine (including terminal urine) were collected from each participant after a short period of exercise. Following physical and chemical examination, 10 ml sample of each specimen was centrifuged and the sediment was then thoroughly examined under the microscope. Results: 22% of study populations were found infected with S. haematobium (sensitivity 96.97%, specificity 100%), 87.9% of them were more than 11 year old (RR 2.23). 27.27% of the infected individuals had a history of past infection. 84.8% of infected population knew about schistosomiasis and its transmission. The results suggested that urban schistosomiasis is prevalent in the study area and it is presented with a distinguished pattern, that is, it is prevalent among children over 11 years old, and it is associated with knowledge but no awareness. Conclusion: The study area may be a potential focal point of urinary schistosomiasis transmission for neighboring areas. Massive survey and preventive chemotherapy is urgent.
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Risk factors and management modalities for sudanese children with hearing loss or hearing impairment done in Aldwha and Khartoum ENT hospitals, Sudan p. 357
Safa Ahmed, Mashair Abdelgadir Hajabubker, Satti Abdelrahim Satti
DOI:10.4103/1755-6783.208721  
Introduction: Hearing impairment indicate a full or partial decrease in ability to detect or understand sounds. Their first presentation could be with delayed speech, language and cognitive ability. The goal of universal newborn hearing screeningprograms (UNHS), which are widely used in developed countries, is early recognition and treatment of hearing impairment. All children should be managed by a multidisciplinary team. Objectives: To study the risk factors and treatment of hearing loss and impairement in children seen at Aldwha and Khartoum ENT Hospitals, Sudan. Material and Methods: This is a retrospective, descriptive and hospital-based study done at Aldwha and Khartoum ENT Hospitals, Sudan. Study period was four months. Study population were children with hearing loss and hearing impairment seen in the referal clinics of the two hospitals. Data was collected by using a questionnaire. General examination, developmental assessment and some investigations were done. Data was analyzed using Cochran's equation. Results: A total of 119 children with hearing impairment or hearing losswere selected. M to F ratio was 1.13 to 1. Sensory neural hearing loss was the commonest in 75.6% followed by conductive hearing loss in 21.0%, mixed in 2.5% and rarely central in 0.8%. Bilateral (HL) was detected in 89.1%. As a risk factors, early rubella during pregnancy account for 1.7% , birth asphyxia in 2.5% , prematurity in 5.9%, neonatal jaundice in 6.7% and otitis media in 19.3%. Quinine was the commonest drug that caused HL. Isolated hearing loss was detected in 42.0% , hearing loss and speech defect in 47.9%. Who received ear aids were 70.6%. There was a significant association between otitis media and conductive hearing loss. In conclusion the commonest age group affected were children between 1 and 4 years. Male to Female ratio was 1.13 to 1. Consanguineous marriage was reported in almost ¾ of studied families. Sensory neural hearing loss was the commonest and majority had bilateral (HL). Otitis media was a common risk factor followed by meningitis. Three quarters received ear aids. We recommend early screening of neonates and infants with risk factors by introduction of NHS program, safe administration of drugs, activation of primary health programs & establishment of audiological units.
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Seroepidemiological survey of toxoplasmosis among female university students in Shiraz, southern Iran p. 362
Hajar Taghizadeh, Reza Shahriarirad, Amirhossein Erfani, Fatemeh Nekouei, Sarvin Seifbehzad, Samaneh Abdolahi Khabisi, Bahador Sarkari
DOI:10.4103/1755-6783.208724  
Background: Seroprevalence of toxoplasmosis in different populations in Iran varies according to the people eating behaviors and also geographic and climatic differences of each area. Objective: The current study aimed to provide recent data regarding the seroprevalence of toxoplasmosis among female university students in Shiraz University of Medical Sciences, in Fars province, southern Iran. Materials and Methods: The subjects of the study were 503 female university students. Blood samples were collected from each participant and tested for anti-Toxoplasma IgG and IgM antibodies, using a commercial Enzyme-Linked Immunosorbent Assays (ELISA) kit. Demographic characteristics and risk factor related to Toxoplasma were also recorded during the samples collection. Results: The mean age of participants was 22.2 (±3.83) years and the majority (54.9%) of subjects was in the age group of 20-25 years old. Anti T. gondii antibodies was detected in sera of 43 out of 503 enrolled students, corresponding to an overall seroprevalence of 8.5%. Of these, 37 (7.4%) were seropositive for only IgG, 7 (1.4%) were seropositive for only IgM and 1 (0.2%) were seropositive for both IgG and IgM. The differences between age and animal contact with seropositivity to toxoplasmosis were not statistically significant. Conclusion: The findings of the study indicated that more than 90 % of the female university students in this study were seronegative for toxoplasmosis. As these students are in their childbearing age, there is a possibility for their newborns to become infected with Toxoplasma. The control and preventative measurements are necessary to reduce the rate of T. gondii infection in such individuals.
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Characteristics of mineral water from nature hot springs in Ranong Province, Thailand p. 366
Yuttana Sudjaroen, Kanittada Thongkao, Kowit Suwannahong
DOI:10.4103/1755-6783.196588  
Background: There is interest in characteristics of mineral waters from two famous hot springs in Ranong province, Thailand, including Raksawarin and Porn-Rang hot springs. Aims: To objective is to determine characteristics of thermal mineral waters of Ranong region and describe its classification and therapeutic indications. Material and Methods: Mineral waters were collected from Rahsawarin and Porn-Rang hot springs. All analyses were conducted according to American Public Health Association. Temperature was measured in the field at the time of sample collection. Analyses of fecal coliforms and total bacterial count were performed. Physical-chemical analyses were used to evaluate pH, total dissolved solids (TDS), and conductivity. Total hardness was measured in the laboratory by titration. Metals (Al, Si, Fe, Mn, Pb, Cd, Ni, Cu) were measured by graphite furnace atomic absorption spectroscopy (GFAAS); major ions (Ca, Mg, Na, K, Cl, F, HCO3-, SO4, S2-) and nutrients (NH4, PO4-, NO3) were measured by ion chromatography technique. Results and Discussion: The mean of pH, TDS, and conductivity values observed for hot springs were met to reference value of Thai tap water standard by WHO guideline. Neither hot spring contained fecal coliform bacteria. Chemical parameters were also within standard excepted aluminum concentration. Potassium levels from mineral waters were also high. Ranong mineral spring water can be thermal waters and define to hot waters. Ranong mineral spring water can be define to fresh and low sodium water. Conclusions: Our suggestions regarding this mineral water indication were properly for external use and may concern in case of drinking.
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Correlation between personality traits and organizational commitment in the staff of Kermanshah University of Medical Sciences in 2015 p. 371
Arash Ziapour, Alireza Khatony, Faranak Jafari, Neda Kianipour
DOI:10.4103/1755-6783.208725  
Background: The staff' personality traits are important factors that can affect their organizational commitment. Objective: The current research was aimed to determine the relationship between personality traits and organizational commitment among the staff of Kermanshah University of Medical Sciences. Materials and Methods: In this descriptive-analytic study, 270 staff working in the headquarters of Kermanshah University of Medical Sciences were selected through simple random sampling. The instrument of data collection included NEO personality inventory and Allen and Meyer's organizational commitment scale. Data were analyzed by descriptive and inferential statistics (Pearson's correlation coefficient and regression analysis). Results: The maximum and minimum means for personality traits were reported for conscientiousness (2.96 ± 0.40) and neuroticism (1.85 ± 0.55), respectively. With regard to organizational commitment, however, affective commitment (4.77 ± 0.80) and continuance commitment (4.77 ± 0.80) obtained the maximum and minimum means, respectively. From among the five personality traits, conscientiousness and agreeableness were significantly correlated with organizational commitment. Conclusion: Since conscientiousness and agreeableness variables were correlated with organizational commitment, it is suggested that the managers of organizations pay a special attention to the given personality traits in the selection and appointment of the staff in organizational positions in order to enhance the efficiency of human resources in organizations. They are also recommended to take these variables into account during job interviews.
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Community knowledge and attitude towards Japanese encephalitis in Darrang, India: a cross-sectional study p. 377
Akram Ahmad, Muhammad Umair Khan, Sadiqa Malik, Shazia Qasim Jamshed, Lakhya Jyoti Gogoi, Manabendra Kalita, Atul Prasad Sikdar
DOI:10.4103/1755-6783.208726  
Background: The prevalence of Japanese encephalitis (JE) in Assam was exceptional in a global context in the year 2014. Darrang district is amongst the most affected districts that is hit by deadly JE virus in Assam. Therefore, we conducted this study to evaluate the knowledge and attitudes of the residents regarding JE at Darrang. Methods: A descriptive, cross-sectional study was performed for the period of 3 months from November 2014 to January 2015 in Darrang. Multistage stage sampling was done to select participants from the district. A pretested interviewer-administered questionnaire was used to collect data from the participants. Descriptive analysis and logistic regression tests were used to analyze the data. Results: A total of 396 participants responded to the questionnaire, thus giving the response rate of 51.5%. One-fourth of the participants exhibited a good knowledge of JE (24.7%). The majority of the participants incorrectly answered the questions relating to management (83.3%) and prevention of JE (66.7%). Further, tertiary education and JE patient in family/relative were significantly associated with the knowledge of the participants (P < 0.001). A large proportion of the respondents exhibited positive attitudes towards JE (96.5%). Television was the major source of information of the participants regarding JE (29.2%). Conclusion: The findings of this study indicate a lack of knowledge regarding JE among the residents of Darrang. However, their attitudes towards JE were generally positive. Further studies on this topic need to be conducted throughout the state of Assam to identify and subsequently bridge the knowledge gaps among its residents.
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Phenotypic and phylogenetic relatedness of selected Staphylococcus aureus strains cultured from HIV seropositive mothers and their neonate's pair p. 384
Blessing Itohan Ebhodaghe, Kwashie Ajibade Ako-Nai, Olakunle O Kassim
DOI:10.4103/ATMPH.ATMPH_474_16  
Background: Staphylococcus aureus is a major pathogen to man and is invasive when the skin is breached as well as in trauma. The frequency and transmission of S. aureus was determined in high vaginal swabs (HVS), oropharynx, and breast milk of human immunodeficiency virus (HIV)-seropositive women to their neonates at healthcare centres, Ondo State, Nigeria between November 2014 and December 2015. Materials and Methods: A total of 114 HIV pregnant women were screened for S. aureus isolates in the HVS, oropharynx, and breast milk employing sterile cotton tipped applicator. The swabs were subsequently introduced into sterile thioglycollate medium and incubated at 37°C for 24 h. When growth was noticed, a loopful was introduced onto freshly prepared mannitol salt agar (MSA). Colonies of cocci that fermented mannitol on MSA were presumptively deemed as S. aureus, but confirmed as S. aureus isolates by the slide and tube agglutination tests in pooled human plasma. HIV seropositivity was determined by the HIV1/2 strip (Determine Test, Alére, London, England, UK) and confirmed as such by enzyme-linked immunosorbent assay (Abbot laboratories, Chicago, USA). Phenotypes were determined by susceptibility testing and phylogenetic relatedness by random amplified polymorphic DNA polymerase chain reaction. Results: Results showed that 50 (43.85%) were colonized by S. aureus; however, 4 (8%) showed mother-to-child transmission from the three sites. Although all isolates tested were resistant to nalidixic acid and penicillin, 93.75% of isolates were sensitive to imipemen. Conclusion: The study revealed a high frequency of colonization of S. aureus in HVS (64%), oropharynx (20%), and breast milk (16%). Horizontal transmission from mother to neonate was 8% while phylogroups showed similarities in genetic relatedness.
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Snake bite envenomation seen at a specialist hospital in Zamfara state, North-Western Nigeria p. 391
Aminu Muhammad Sakajiki, Garba Bilkisu Ilah, Abdul-Aziz Shehu Lukman, Ahmad Maifada Yakasai
DOI:10.4103/1755-6783.208730  
Introduction: Snake bite is an underreported public health problem in Nigeria, with a prevalence of 5 per 1,000 persons per year. Morbidity and mortality from snake bites is higher in developing than in developed countries. We aim to audit the clinical parameters, complications, and outcome of patients with snake bites admitted at our hospital. Materials and Methods: The study was a retrospective secondary data analysis whereby all children and adults managed for snake bite over a 2 and a half year period were included. Their case records were retrieved and relevant demographic and clinical information obtained and statistically analyzed using Statistical Package for the Social Sciences version 18. Results: Out of 5,375 admissions, 25 had snake bite giving an incidence of 0.00465 (4.65/1000). There were 17 (68%) children and 8 (32%) adults. Males were 18 (72%) giving a M:F ratio of 1.4:1. Mean age was 20.6 ± 14.36 with a range of 3–55 years. Most bites, 18 (72%) occurred on the lower limbs, during the day time 15 (65%) and happened in the farm. The highest prevalence of bite was between the months of May and August. Prior to presentation, 12 (48%) had received various interventions and features of envenomation including local swelling and pain (76%), prolonged clotting time (56%), bleeding from various sites (52%), while (32%) had various complications. All patients had antitetanus toxin, while 23 (92%) received antisnake venom. Majority of the patients were discharged 19 (76%), 4 (16%) signed against medical advice, and 1 (4%) absconded, while only 1 (4%) died. Conclusion: Snake bite in our environment commonly affects children and adolescents with majority of patients coming late to hospital. Protective clothing and health awareness campaigns to educate the community are urgent interventions needed to reduce the morbidity from snake bite.
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Knowledge, attitude and practice of Pap smear among Omani women p. 396
Nasar Yousuf Alwahaibi, Nasra Mohammed Alramadhani, Atheer Mohammed Alzaabi, Waad Abdullah Alsalami
DOI:10.4103/1755-6783.208731  
Background: Absence or low uptake of Pap smear is probably the main barrier for high incidence of cervical cancer. Aim: To assess the knowledge, practice, attitude, main barriers and motivating factors of Pap smear among Omani women. Methods: Cross-secal survey in a tertiary referral hospital. The participants were divided into three groups: the patients who attended Outpatient Gynecology Department in Sultan Qaboos University Hospital (SQUH), Oman, the female staff from SQUH, College of Medicine and Health Science and College of Nursing at Sultan Qaboos University (SQU) and the graduating female students at SQU. Results: There were 204 patients, 133 staff, and 157 students. The knowledge of Pap smear among patients, staff and students was as follows: 56.9%, 56.4% and 23.6%, respectively. Those who had an adequate knowledge, 36.8% patients, 23.3% staff and 0.0% students performed Pap smear. Those who performed Pap smear, 32.4% of patients were reminded by their health professionals and 23.3% of staff understood the importance of Pap smear. The common barrier that prevents the uptake of Pap smear among the three groups was their belief that they have a healthy lifestyle. All the groups (70 – 96%) believed that Pap smear can lead to more successful prevention and treatment for cervical cancer. Conclusions: The findings of this study show poor knowledge and performance of Pap smear and good attitude towards Pap smear. More public health education is required to inform the community about the importance of Pap smear as well as to strengthen the curriculum taught in undergraduate university.
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Comparison of virulence factors fimA, papC, and hly among uropathogenic Escherichia coli isolates producing and nonproducing extended spectrum beta-lactamases p. 404
Sargol Fattahi, Mohammad Aghazadeh, Mohammad Reza Nahaei, Mohammad Asgharzadeh, Hossein Samadi Kafil
DOI:10.4103/1755-6783.208732  
Introduction: The aim of present study was to investigate virulence factors fimA, papC, and hly in clinical isolates of uropathogenic Escherichia coli (UPEC) producing and nonproducing extended spectrum beta-lactamases (ESBLs) in patients with urinary tract infection (UTI). Materials and Methods: A total of 112 Escherichia coli strains isolated from patients with UTI were collected and characterized by biochemical and bacteriological methods. The presence of beta-lactamase enzymes were determined by phenotypic combined disk test. Then, for detection of fimA, papC, and hly virulence genes polymerase chain reaction assay was performed. Moreover, data analysis was conducted by using SPSS 16.0 software. Results: From 112 E. coli strains, 90% were producing ESBLs (resistant to beta-lactam antibiotics) and 10% were none producing ESBLs enzymes by phenotypic method. Out of 32 hly positive strains 28 (87.5%) were ESBLs positive, from 103 fimA positive strains 93 (90.3%) were ESBLs producer and among 52 papC positive strains 47 (90.4%) were detected that have ESBL enzymes by molecular method. Prevalence of ESBL enzymes among fimA, papC, and hly negative strains was closely similar with positive strains and demonstrated high resistance to beta-lactam antibiotics. Conclusion: The results showed the high prevalence of virulence genes hly, papC, and fimA. There is high resistance to beta-lactam antibiotics due to production of ESBLs regardless to prevalence of virulence genes in clinical strains of UPEC. Indeed, there is no significant relationship between presence of virulence gene and ESBL production. Thus, the virulence and drug resistance genes are needed to be examined as a target for therapeutic intervention.
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A study on the prevalence of direct vs indirect etiology, prognostic determinants and mortality in ARDS p. 409
Aakash Teja Durbesula, KB Chetan Reddy, Gangaram Usham, Rajesh Kumar Meriga, T Venkata Krishnan, Bhimasen Soren, Rohith Karnati
DOI:10.4103/1755-6783.208733  
Objective: The objective of this study is to determine the etiology and risk factors for the development of acute respiratory distress syndrome (ARDS) and also the association between clinical and laboratory parameters and outcome in patients with ARDS. Methodology: This was an observational prospective study conducted in the intensive care units of Narayana Medical College and Hospital, Nellore between November 2015 and May 2016. Patients who fulfilled the AECC definition for ARDS and who were mechanically ventilated for more than a 24 h period were selected for the study. Results: Fifty patients who met the predefined criteria were enrolled for the study. Of these 50 cases, females (52%) were slightly more than the male patients and the most common age group was 31–50 years. ARDS was mostly secondary to infectious causes (92%) and the most common etiology for ARDS in our study was direct cause (52%) followed by indirect cause (48%). Factors associated with poor outcome and high mortality are low PaO2/FiO2 (P value <0.001), high SAPS II score (P value <0.001), high SOFA scores (P value 0.001), high max SOFA scores (P value 0.001), and severe lung injury scores (P value <0.001). High procalcitonin levels and C-reactive protein (CRP) levels less than 226 mg/mL showed more number of nonsurvivors (71.8%). There was significant increase in the mortality among patients who were prescribed inotropic support when compared to those who were not (P <0.001). Of the 50 patients enrolled in the study, 33 patients succumbed to their illness with the mortality of 66%. Conclusion: Direct etiology by pulmonary infection was the most common cause for ARDS. Prognostic determinants like PaO2/FiO2 and clinical scores like SOFA, maxSOFA, SAPS II, and LIS had a statistically significant association with mortality. Laboratory parameters like serum albumin were associated with significant mortality whereas CRP and procalcitonin did not show a statistically significant correlation with mortality. The use of a combination of clinical factors and biological markers is a promising strategy that needs to be prospectively validated.
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Vibrio harveyi, V. parahaemolyticus, and V. vulnificus detection in Thai shellfishes by the triplex PCR method p. 417
Kanittada Thongkao, Yuttana Sudjaroen
DOI:10.4103/ATMPH.ATMPH_770_16  
Context: Shellfish sold in Southeast Asian markets are highly contaminated. Uncooked seafood samples were collected from markets in Bangkok, Thailand, which were contaminated with Vibrio species (27%) and in which antibiotic resistance was relatively high. Aims: To simultaneously detect V. harveyi, V. parahaemolyticus, and V. vulnificus in shellfish samples including life mussel (Perna viridis), blood clam (Tegillarca granosa), and baby clam (Paphia undulata) in the local markets in Bangkok. The sensitivity, accuracy, and specificity of triplex PCR method were also evaluated. Materials and Methods: The 150 frozen shellfishes were purchased from five local markets in Bangkok. Each sample was homogenized, enriched, and prepared for colony counting and isolation. Three Vibrio species were identified according to biochemical tests and then later confirmed by triplex PCR. The accuracy and specificity of triplex PCR were evaluated and compared with conventional tests. The sensitivity of triplex PCR was explained as total count (CFU/mL) of Vibrio species. Results: Using the biochemical test and triplex PCR method in the three Vibrio species of marine shellfishes, 14 and 15 isolates of V. harveyi, 8 isolates of V. parahaemolyticus, and undetectable and 1 isolate for V. vulnificus were identified, respectively. The accuracy of triplex PCR was higher than the conventional method. Triplex PCR was shown to be sensitive as total bacterial count for three Vibrio detection in marine shellfishes was 1.2 × 107-2 × 106 CFU/mL. Conclusions: Triplex PCR assay was higher in sensitivity, accuracy, and specificity, which proved to be convenient, simple, and effective method for Vibrio detection and identification in shellfishes.
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Cysteinyl leukotrienes as biomarkers of effect in linking exposure to air pollutants and respiratory inflammation among school children p. 423
Nur Faseeha Suhaimi, Juliana Jalaludin, Suhaili Abu Bakar
DOI:10.4103/ATMPH.ATMPH_89_17  
Background: Industrial activities contribute to poor air quality either directly or through background concentrations, bringing to fore health issues regarding the health effects of the release of malodourous air pollutants. Methods: This research focused on the effects of exposure of air pollutants from industrial facilities and traffic on school children by using selected airway inflammation biomarker, cysteinyl leukotrienes (CysLTs), in sputum. Questionnaires adapted from the American Thoracic Society (ATS) and the International Study of Asthma and Allergies in Childhood (ISAAC) were used to compile respiratory symptoms, history of exposure, and demographic data. Results: CysLTs level measured by using enzyme.linked immunosorbent assay (ELISA) was higher in the exposed group (0.402 ± 0.389 ng/mL) than in the comparative group (0.191 ± 0.231 ng/mL). A strong, significant correlation was established between sulfur dioxide (SO2) (r = 0.924, P < 0.001) and particulate matter 2.5 (PM2.5) (r = 0.242, P = 0.014), with the levels of CysLTs among school children in exposed group. This study reveals that SO2 is the most significant factor that influenced CysLTs levels among school children at P less than 0.001. Conclusion: CysLTs are proven to be reliable biomarkers of airway inflammation in healthy children, whereas sputum method is proven to be a reliable, safe and noninvasive procedure for school children with their reproducibility and sensitivity as portrayed in this study. Thus, the findings provide fundamental aspects relevant to future interventions to healthy children living near an industrial area from the environmental scope.
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Respiratory symptoms and sociodemographic factors among agricultural workers exposed to calcium carbide as fruits ripening agent in Kuala Kangsar, Perak: A preliminary study p. 432
Noor Shaeda Ismail, Irniza Rasdi, P Sarva Mangala, Emilia Zainal Adidin
DOI:10.4103/1755-6783.208693  
Background: In agriculture, calcium carbide (CaC2) is used as a chemical in fruit ripening and as a source of acetylene gas, which acts as a reducing agent with same fruit-ripening attributes as ethylene. The reaction between CaC2 and moisture produces acetylene, which consequently leads to ripening of fruits. Many existing studies focus on the effects of calcium carbide on fruit texture, taste, and nutritional content, but only a limited number explore the level of occupational exposure of CaC2 and its health effects among workers involved in the ripening process. Objective: The aim of this article is to assess the respiratory symptoms of agricultural workers through questionnaire and to determine the most significant sociodemographic factors contributing to respiratory symptoms. Methods: The respondents were interviewed using two set of questionnaires: a general structured questionnaire and IUALTD Bronchial Symptoms questionnaire. Data in this study were analyzed statistically using SPSS. Chi-square test was used to analyze the relationship between sociodemographic factors with respiratory symptoms. Significant level used for this study was P less than 0.05. Result: The most regular symptom exhibited by the respondents was morning phlegm (37.5%), followed by morning cough (33%), shortness of breath (25%), and chest tightness (16.7%). Age, duration of employment, smoking status, handling of calcium carbide, and awareness of the dangers of calcium carbide did not have a significant association with all the respiratory symptoms. Conclusion: Considering the prevalence of respiratory symptoms among the respondents, we suggest that further studies on the effects of CaC2 are warranted. Findings will be beneficial to creating public awareness on the effects of hazardous chemicals on human health and to increase awareness of impact of the use of calcium carbide on the health of workers working with CaC2.
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Sub‐center health profiling and health care delivery services in a rural community of northern India p. 436
Sheikh Mohd Saleem, S Muhammad Salim Khan, Shah Sumaya Jan
DOI:10.4103/ATMPH.ATMPH_100_17  
Background: Sub-Center is the most peripheral point of contact where the staffs is assigned tasks relating to bring behavioral changes in the community and offer services related to maternal and child health, nutrition, immunization, family welfare and contraception, school health services, adolescent health care, water and sanitation, disease surveillance, control of communicable diseases, implementation of national health programmes, house to house visits and outreach/field services. Material and Methods: This paper is based on the secondary data which was available at the Sub-Center which is located in a rural area, 25 kms from the capital city of Jammu & Kashmir state on the hilly terrains. The data was collected from April 2016 to January 2017 by trained FMPHW/ANMs who carried out the door to door visits of each household and recorded data on a predesigned pretested Pro forma. Results: Socio-demographic characteristics of the community subject's shows female predominant population with women outnumber men with a ratio of 94 men to 100 women. 74% of the population is in the adult age group. Among the total households (180), most are joint families with 100% non-vegetarian diet pattern see in the community. 66% of the total households belong to the middle socioeconomic status. Accessibility of health-care services was analyzed using indicators for which all the households mentioned to have easy access to the health care system, always find the health worker at the subcenter during duty hours and find the services provided at the sub-center cost-effective. Most of the households had easy access to the Sub-Center location while some of the households find in difficult in reaching the Subcenter and some household's complaint of non-availability of drugs. Conclusion: Our study was one of its kind studies which demonstrated the health profiling and health services assessment of a particular sub-center located in hilly rural area of Kashmir valley. The presence of the sub-center in the area and the services delivered by it are well accepted by the local rural community, which in turn has resulted in better health status of the community population.
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Study of antibiotic susceptibility pattern of Salmonella typhi in children suffering from enteric fever p. 440
Parmarth Chandane, Akansha Gandhi, Sneha Bowalekar
DOI:10.4103/ATMPH.ATMPH_103_17  
Background: Due to the lack of sanitation measures and clean water, typhoid fever is prevalent in developing countries such as India. Also, increasing cases of antibiotic resistance as well as multiple drug resistance (MDR) have been reported in Indian subcontinents. However, there is inadequate data available on the antibiotic sensitivity pattern of Salmonella enterica serovar Typhi (S. typhi) among children in Indian subcontinents. Materials and Methods: A total of 43 isolates of S. typhi were collected from the blood samples of children in the age group of 3-12 years and further were tested for antimicrobial susceptibility according to the CLSI guidelines. Results: Of the total isolates studied, 44% were found to be multidrug resistant (MDR) (defined as resistance against more than one group of antibiotic). The isolates showed the highest resistance against aminoglycoside antibiotics and least against carbapenem antibiotics. Conclusion: The presence of MDR S. typhi imposes a serious concern about the drug of choice for treatment of typhoid fever in children. A careful consideration should be given before deciding the antibiotic for treatment in order to prevent the emergence of antibiotic resistance.
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CASE REPORTS Top

Pulmonary tubercular cavitory lesion: An unusual presentation in systemic lupus erythematosus p. 444
Arvind Mishra, Shilpa , Shubham Agarwal
DOI:10.4103/1755-6783.208719  
A 26-year-old women diagnosed as having lupus nephritis was managed with immunosuppressive therapy, which included cycles of Inj. Cyclophosphomide along with Inj. Mesna and Inj. Leprolide. After 1-month therapy, the patient developed moderate- to high-grade fever associated with cough and expectoration. Sputum examination was positive for acid-fast bacilli by modified Ziehl - Neelsen (ZN) staining technique. Chest skiagram Posterioanterior (PA) view and Computed tomography (CT) scan thorax depicted thick-walled cavity in right upper zone of lung with air-fluid level. Patient was managed with second-line antituberculosis drugs during hospitalization and was followed.
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Breast abscess due to Mycobacterium abscessus: A rare case p. 447
Archana Bhimrao Wankhade, Dnyaneshwari Ghadage, Arvind V Bhore
DOI:10.4103/1755-6783.208722  
Non-tubercular mycobacterial infections (NTM-Non-tubercular mycobacterial infections) are becoming increasingly common. Mycobacterium abscessus is a rare cause of human infection and is difficult to diagnose unless suspected for the same. A 31-year-old patient, diagnosed to have right breast abscess associated with axillary lyphadenopathy with fever. When pus was sent to the microbiology laboratory, after culture it was confirmed to be due to M. abscess. Definitive identification of this species of mycobacterium was possible by growth characteristics and biochemical tests. The organism was sensitive to Kanamycin, Clarithromycin, Ciprofloxacin, and Amikacin. However, complete recovery from infection was possible after prolonged treatment with clarithromycin to which the organism was sensitive.
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Stenotrophomonas maltophilia: A rare cause of bacteraemia in a patient of end stage renal disease on maintenance hemodialysis p. 450
Sonal R Bangde, Lata B Galate
DOI:10.4103/1755-6783.208712  
We report a case of bacteraemia due to Stenotrophomonas maltophilia in 60-year-old male patient who presented with high fever to hospital. He was on maintenance hemodialysis (HD) suffering from end stage renal disease. Blood culture from central line was sent from which S. maltophilia was isolated which was resistance to most of antibiotics tested. Central line was removed and peripheral line was established for maintenance HD. Patient was started on levofloxacin to which it was sensitive for 2 weeks, the fever subsided thereafter, and repeat blood culture was negative. S. maltophilia is resistance to most of routinely used antibiotic so this case highlights the importance of early detection and antibiotic sensitivity workup.
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Lymphoid polyposis with pseudomembranous colitis in a 4-month child: A rare coexistence p. 453
Sunil Y Swami, GF D'Costa, BD Baste, VV Narhire, NC Vinay
DOI:10.4103/1755-6783.208727  
Lymphoid polyposis is a lymphoid hyperplasia of the gastrointestinal tract that usually presents as multiple small polyps in the colon during childhood. This should be differentiated from other neoplastic or familial polyposis of the intestine. Pseudomembranous colitis (PMC) is commonly associated with Clostridium difficile infection (CDI) but can be a consequence of other disease processes. We report a case of benign lymphoid polyposis of the colon with pseudomembranous colitis in a 4-month child.
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LETTERS TO THE EDITOR Top

Addressing the public health challenge of HIV infection among the vulnerable population group of transgender: An urgent global need p. 457
Saurabh R Shrivastava, Prateek S Shrivastava, Jegadeesh Ramasamy
DOI:10.4103/1755-6783.208710  
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Zika virus infection: Factor contributing to emergence and pathogenesis p. 458
Somsri Wiwanitkit, Viroj Wiwanitkit
DOI:10.4103/1755-6783.208734  
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Bhaisajyaguru and medical container in Mahayana Buddhist temples in eastern Thailand: A public health pharmacological study p. 460
Wasana Kaewla, Viroj Wiwanitkit
DOI:10.4103/1755-6783.196833  
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Committing suicide by physicians: A summary from Thai situation p. 460
Sora Yasri, Viroj Wiwanitkit
DOI:10.4103/1755-6783.208686  
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Spirometry screening results among a group of technology college personnel p. 461
Sora Yasri, Viroj Wiwanitkit
DOI:10.4103/1755-6783.208687  
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“Have you ever seen mosquito in the airplane?”: Risk implication p. 462
Pathoom Sukkaromdee, Viroj Wiwanitkit
DOI:10.4103/1755-6783.208688  
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Public health role of Mahayana Buddhist temple in urban and rural community: A comparison Highly accessed article p. 463
Wasana Kaewla, Viroj Wiwanitkit
DOI:10.4103/1755-6783.188506  
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Laboratory acquired skin infection: A concern for exhospital microbiology laboratory p. 464
Sora Yasri, Viroj Wiwanitkit
DOI:10.4103/1755-6783.208713  
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Severe eosinophilia in dengue patient: An interesting case study p. 465
Sora Yasri, Viroj Wiwanitkit
DOI:10.4103/1755-6783.208714  
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Walking severe thrombocytopenia dengue patient: How about its rate? p. 466
Pathoom Sukkaromdee, Viroj Wiwanitkit
DOI:10.4103/1755-6783.208715  
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Forgotten human malarial species: Do not forget it p. 467
Beuy Joob, Viroj Wiwanitkit
DOI:10.4103/1755-6783.208716  
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Not only thrombocytopenia but also normal platelet count and thrombocytosis can be seen in dengue patients p. 467
Pathoom Sukkaromdee, Viroj Wiwanitkit
DOI:10.4103/1755-6783.208717  
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Special characters in famous poem: Public health implication from literature analysis p. 468
Viroj Wiwanitkit
DOI:10.4103/1755-6783.208689  
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Health implications of some precepts from Buddhist eight precepts: A religious public health concept p. 469
Viroj Wiwanitkit
DOI:10.4103/1755-6783.208690  
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Ghost and God spirit procession: Cases in Thailand and nutritional public health reflection p. 470
Somsri Wiwanitkit, Viroj Wiwanitkit
DOI:10.4103/1755-6783.208692  
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Arogayasala in present Thai culture: Adaptation of ancient public health primary care system p. 471
Viroj Wiwanitkit
DOI:10.4103/1755-6783.208695  
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What to be concern from the sites of existed emerging cases of Zika virus infection in Thailand? p. 472
Sora Yasri, Viroj Wiwanitkit
DOI:10.4103/1755-6783.208696  
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Lymphadenopathy is not common among Thai patients with Zika virus infection p. 473
Won Sriwijitralai, Viroj Wiwanitkit
DOI:10.4103/1755-6783.208697  
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Afebrile Zika virus infection p. 473
Beuy Joob, Viroj Wiwanitkit
DOI:10.4103/1755-6783.208699  
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Not all cases with Zika virus infection have thrombocytopenia p. 474
Won Sriwijitralai, Viroj Wiwanitkit
DOI:10.4103/1755-6783.208700  
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Zika virus infection: Serious but low fatality p. 475
Won Sriwijitralai, Viroj Wiwanitkit
DOI:10.4103/1755-6783.208701  
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World Health Organization advocates for a two-point strategy to achieve eradication of Yaws from the endemic nations p. 475
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava, Jegadeesh Ramasamy
DOI:10.4103/1755-6783.208702  
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Limiting pesticide access to minimize suicide incidence p. 477
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava, Jegadeesh Ramasamy
DOI:10.4103/1755-6783.196834  
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Squirrel bite: Analysis of 35 cases p. 478
Won Sriwijittalai, Viroj Wiwanitkit
DOI:10.4103/1755-6783.196835  
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Gastric symptom in Zika virus infection: Do we forget it? p. 478
Sora Yasri, Viroj Wiwanitkit
DOI:10.4103/1755-6783.196837  
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Temperature that can promote Zika virus infection: A summary from Thai cases p. 479
Beuy Joob, Viroj Wiwanitkit
DOI:10.4103/1755-6783.196839  
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Estimated risk for Zika virus seropositivity among pregnant women in area with indexed case in Thailand p. 480
Somsri Wiwanitkit, Viroj Wiwanitkit
DOI:10.4103/1755-6783.196840  
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What can we interpret from the distance between sites with emerging Zika virus infection? A case of Thailand p. 480
Somsri Wiwanitkit, Viroj Wiwanitkit
DOI:10.4103/1755-6783.196841  
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Exploring the geographical burden and responding to the threat of the spread of dengue infection to the unaffected nations p. 481
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava, Jegadeesh Ramasamy
DOI:10.4103/1755-6783.196842  
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Hemorrhagic presentation and platelet count in dengue patients p. 483
Beuy Joob, Viroj Wiwanitkit
DOI:10.4103/1755-6783.196844  
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Peptide similarity, but no structure similarity: Can it explain the autoimmunity theory for pathology in Zika virus infection p. 483
Won Sriwijitalai, Viroj Wiwanitkit
DOI:10.4103/1755-6783.196858  
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Zika virus infection, blood glucose, and diabetes mellitus p. 484
Somsri Wiwanitkit, Viroj Wiwanitkit
DOI:10.4103/1755-6783.196857  
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Electrocardiography and echocardiography finding in Zika virus infection: Limited available data Highly accessed article p. 485
Sim Sai Tin, Viroj Wiwanitkit, Somsri Wiwanitkit
DOI:10.4103/1755-6783.188494  
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Is there any role of Porphyromonas endodontalis for dental implant failure or not? p. 486
Ali Mehrabi Tavana
DOI:10.4103/1755-6783.196590  
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Zika virus infection: Existence of hemoconcentration p. 486
Somsri Wiwanitkit, Viroj Wiwanitkit
DOI:10.4103/1755-6783.208706  
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Bilateral partnering as academic health institution's evolving perspective: What can be the early collaboration? p. 487
Achara Phanurat, Wasana Kaewla, Viroj Wiwanitkit
DOI:10.4103/1755-6783.208707  
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Childhood cancers in low-resource settings: Reinforcing the need for intensification of efforts p. 488
Saurabh R Shrivastava, Prateek S Shrivastava, Jegadeesh Ramasamy
DOI:10.4103/1755-6783.196851  
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Advocating for the community empowerment and family support to improve the quality of care to schizophrenia patients Highly accessed article p. 490
Saurabh R Shrivastava, Prateek S Shrivastava, Jegadeesh Ramasamy
DOI:10.4103/1755-6783.188495  
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My experiences in hospital infection control: We have to learn hospital infection control at the first day of medical education for students, do you agree with me? p. 491
Ali Mehrabi Tavana
DOI:10.4103/1755-6783.196597  
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