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   2008| January-June  | Volume 1 | Issue 1  
    Online since September 20, 2008

 
 
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ORIGINAL ARTICLES
HBsAg serosurveillance among Nepalese blood donors
Surendra Karki, Prakash Ghimire, Bishnu Raj Tiwari, Manita Rajkarnikar
January-June 2008, 1(1):15-18
DOI:10.4103/1755-6783.43072  
Context: Hepatitis B virus (HBV) is highly infectious and can be transmitted covertly by percutaneous routes and overtly by blood transfusion. Earlier studies among Nepalese blood donors have shown a high seroprevalence of HBV. Regarding this problem Blood Transfusion Service in Nepal has focused seriously for improving its service by various motivation and education programs. Aims: The study was aimed to reveal the seroprevalence of HBV among different category of blood donors, in relation to their sex and age. Settings and Design: Descriptive cross-sectional Study. Materials and Methods: A total of 33,255 blood samples were screened from donors using enzyme-linked immunosorbent assay kits from December 1, 2006 to September 1, 2007 in Central Blood Transfusion Service, Nepal Red Cross Society, Exhibition Road, Kathmandu. Statistical Analysis: Chi-square test was used for significance testing by using the software SPSS ver. 11.5. Results: The seroprevalence of HBsAg among total blood donors was 0.53% (95% confidence interval [CI] = 0.46-0.62%). Significantly, higher seroprevalence was observed among male donors than in females (0.58% vs. 0.18%, respectively) ( P < 0.05). The seroprevalence was significantly higher in the age group 41-50 years (0.88%). Similarly, significantly higher seroprevalence was observed among replacement donors (0.81%) than among volunteer donors (0.5%) ( P < 0.05). Almost similar seroprevalence of HBV was observed among first time and among repeat blood donors (0.53% and 0.54%, respectively) ( P > 0.05). The hepatitis C virus coinfection rate among HBV-infected donors was 1.67%. Conclusions: On the basis of this study, we concluded that the seroprevalence of HBV among Nepalese blood donors in Kathmandu Valley, is decreasing compared to recent past years and is relatively lower than as described for most of the major cities in South Asia. However, similar seroprevalence rate among first time and repeat donors suggests that further improvements are essential.
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Inhospital cardiovascular morbidity and mortality in the department of internal medicine at CHU Kigali (Rwanda)
Etienne Amendezo, Marc Twagirumukiza, Osée Sebatunzi, Abel Kagame
January-June 2008, 1(1):9-14
DOI:10.4103/1755-6783.43071  
Cardiovascular diseases (CVD) formerly considered as developed countries pandemic, are becoming nowadays increasingly ubiquitous in developing countries, where in addition to a steady increase in different risk factors, there is substantial inaccessibility to health care. However, data about the burden of CVD is lacking in many sub-Saharan African countries, and their morbimortality characteristics have been poorly described. Authors carried out a descriptive and retrospective study over a 12-month period, to describe the inhospital morbidity and mortality of CVD in the Department of Internal Medicine at University Teaching Hospital in Kigali City. Data were collected from 226 CVD cases (91 males and 135 females). The patients' age ranged from 26 to 94 years (mean age of 47.17 ± 16.04). The 226 CVD cases account for the 8.2% of hospitalized patients. Hypertension was the principal cause of death (43.1% of deaths) and the predominant cause of patients' admission (42.9%), followed by cardiomyopathies (11.9%) and valvular heart diseases (11.5%). The association between a CVD and HIV/AIDS infection was observed in 23.9% of the total patients, but no causality relationship was investigated. Isolated heart failure takes the first place (33.6%) among the cardiovascular complications, followed by stroke (14.2%) and isolated renal failure (7.5%). Findings of this study confirm the importance of CVD in CHU Kigali, not only by their inhospital frequency but also- and especially by their lethality rate and their complications associated. This study stresses also a real need of CVD community survey in Rwanda.
  2 3,941 153
Sickle cell disease: Experience of a tertiary care center in a nonendemic area
Neeraj Awasthy, KC Aggarwal, PC Goyal, MS Prasad, S Saluja, M Sharma
January-June 2008, 1(1):1-4
DOI:10.4103/1755-6783.43069  
Sickle cell disease is an genetically transmitted hemo-globinopathy. It is prevalent in many parts of India, where the prevalence has ranged from 9.4-22.2% in endemic areas. There is paucity of data with respect to its prevalence and manifestations in the non endemic areas of India. The present study attempts to evaluate varied manifestations of sickle cell disease in a tertiary care center in north India, which is a non-endemic belt. It was observed that 18% of the patients in the study to be the local inhabitants of Delhi- a nonendemic belt. Also this region had the largest percentage of the mixed cases particularly associated with beta thallesemia. A high index of suspicion is therefore required for the diagnosis of such cases in a nonendemic area like Delhi specifically in patients who presented with unexplained anemia and splenomegaly with or without pain abdomen. Various crises reported in sickle cell disease is not a common manifestation especially in a nonendemic belt in our experience.
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Candida glabrata : Emerging pathogen in neonatal sepsis
VP Baradkar, M Mathur, S Kumar, M Rathi
January-June 2008, 1(1):5-8
DOI:10.4103/1755-6783.43070  
A total of 266 clinically suspected cases of neonatal sepsis due to Candida species were studied from January 2007 to June 2007. Candida species were isolated from 49 (19.14%) patients. Candida glabrata was the commonest isolate in 30 patients (61.22%) followed by Candida parapsilosis in 10 cases (20.40%), Candida albicans in 6 cases (12.24 %), Candida krusei in 2 cases (4.08%), while Candida tropicalis in a single case (2.04 %). Inspite of giving intravenous Amphotericin B, six infants died due to Candida glabrata septicemia. Commonest predisposing factors observed were antibiotic therapy (100%), prematurity (100%), low birth weight (100%), respiratory distress syndrome (66.67%), patients on ventilators (66.67%), patients on central line catheters (33.33%), and urinary catheters (50%). Clinical features were nonspecific, difficult to differentiate from bacterial sepsis.
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CASE REPORT
A 26-year-old male with lower neck masses
A.Haleem A El-Hiday, Mehdi M Errayes
January-June 2008, 1(1):31-32
DOI:10.4103/1755-6783.43079  
Tuberculous adenitis is a common cause of lymphadenopathy, especially in areas where tuberculosis is endemic. Tuberculosis (TB) lymphadenitis in cervical, axillary, and inguinal areas can present as nontender swelling without significant systemic symptoms in immunocompetent young adults. we report a case of TB adenitis in a 26-year-old male from India, who was admitted with 1-month history of painless swellings in the lower neck on both sides. Fine-needle aspiration of the right lesion of this patient showed the presence of stainable acid-fast bacilli and cultured organisms on aspirate. His HIV serology was negative. Four drugs antituberculous regimen treatment was started with good response.
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LETTERS TO EDITOR
Application of molecular over immunological techniques in rapid diagnosis of viral infections
KV Ramana
January-June 2008, 1(1):33-33
DOI:10.4103/1755-6783.43076  
  - 2,924 130
Scientific publications on neglected tropical diseases: How was the last decade?
Bronner Pamplona Augusto Gonçalves, Brynna Pamplona Augusto Gonçalves
January-June 2008, 1(1):33-34
DOI:10.4103/1755-6783.43077  
  - 537 34
ORIGINAL ARTICLES
Human immunodeficiency virus-neuropathy with special reference to distal sensory polyneuropathy and toxic neuropathies
Belachew Degefe Arasho, Schaller Bernhard Jacob, Guta Zenebe
January-June 2008, 1(1):19-24
DOI:10.4103/1755-6783.43073  
A variety of neurologic diseases have been associated with human immunodeficiency virus (HIV) infection either as a direct result of the virus itself (e.g., HIV-associated dementia and HIV-related painful distal polyneuropathy) or as a result of opportunistic infections or neoplasm. HIV-related neuropathies are one of the most common neurologic complications of HIV infection. There are a variety of neuropathies in patients with HIV and can be broadly classified into: (i) distal symmetric polyneuropathy (DSP), (ii) mononeuropathy multiplex, (iii) acute and chronic inflammatory demyelinating polyneuropathies, (iv) lumbosacral polyradiculopathy, (v) diffuse infiltrative lymphocytosis syndrome (DILS), (vi) autonomic neuropathy, mononeuropathies, (vii) herpes zoster radiculitis, and (viii) sensory ganglioneuritis. DSP represents the most common form of neuropathy seen in patients with HIV and affects about 30% of patients and pathologic findings of DSP occurring in almost all patients with advanced immunodeficiency at autopsy. But with highly active antiretroviral treatment (HAART), the incidence of DSP appears to be decreasing compared to the pre-HAART era. But some studies show a substantial increase in the prevalence of DSP and this may be related to an increased longevity of patients and neurotoxic effects of some antiretroviral drugs. Antiretroviral toxic neuropathy (ATN) occurs with the di-deoxnucleoside group of drugs (DDI: didanosine; DDC : zalcitabine) and is thought to be the direct neurotoxic effect of the drugs. Clinically the two forms are indistinguishable and present in a length dependent axonal polyneuropathy. DSP and ATN cause devastating complications and related to poor treatment compliance. The objective of this review is to update the current knowledge in the two main forms of neuropathy in HIV infection and we believe that physicians practicing in the highly HIV prevalent areas (Sub-Saharan Africa and other developing countries) need to look for these complications in their HIV patients and manage them accordingly.
  - 2,318 87
Chikungunya epidemic: Analysis of reports of a lay press
P Thirumalaikolundusubramanian, M Srinivasan, A Vinodhkumaradithyaa, A Uma
January-June 2008, 1(1):25-28
DOI:10.4103/1755-6783.43074  
Background: Lay press creates awareness on issues related to health and illnesses, and thus influences the attitude of public. Objective: The present study was undertaken to find out the pattern of information provided in print media on Chikungunya fever and to elicit the readers' views. Materials and Methods: Information displayed on Chikungunya fever in one of the oldest English daily newspapers 'The Hindu' and its supplements published from Madurai and Chennai, India from April 1, 2006 to October 31, 2006 were read, analyzed, and classified into different categories. A readership questionnaire survey was carried out among policy makers (n = 25), health professionals (n = 170), medical students (n = 200), and the public (n = 150) to find out their preferences and usefulness on the category of information provided. The data were analyzed by simple descriptive statistics. Results: During the study period of 214 days, 74 items related to chikungunya fever, one in April, three in May, five in June, six in July, 15 in August, 18 in September, and 25 in October appeared. Most of the articles centered around the government policy matters (n = 37) and others in the order of preventive aspects (n = 32), statistics (n = 31), geographical distribution (n = 21), symptomatology (n = 16), transmission of illness (n=16), etc., Overall areas of interest of policy makers and health professionals were different significantly ( P < 0.01) from that of medical students and the public, but every one looked for treatment and preventive aspects. Conclusion: Media have provided information, improved knowledge, altered the attitude, and influenced decision making. It is suggested that students and researchers of health sciences should be motivated to read standard newspapers as it provides information on health and illnesses much earlier than they appear in their professional journals.
  - 2,676 126
Standard white blood cell count for malaria density estimation: A need for review?
Innocent C Omalu, S Oguche, VP Gyang, TM Akindigh, DZ Egah, B Gokop
January-June 2008, 1(1):29-30
DOI:10.4103/1755-6783.43075  
To compare the actual white blood cell (WBC) counts, used to calculate malaria parasite densities against the standard WBC counts of 8000/µl. The WBC counts of 111 Plasmodium falciparum -infected children in north central Nigeria, Aged 1-4 (<5) and 5-14 (>5) years were estimated in a cross-sectional study. These gave average values of 7487/µl and 5985/µl against the assumed standard count of 8000/µl. A comparison of blood samples grouped into those with WBC counts of 8000/µl (3.95% and 8.57%), those below (57.89% and 82.86%) and above (38.16% and 8.57%) showed a significantly higher number in the group below the standard value for the two age groups (X2, df = 3, P > 0.05). This paper draws attention to the disparity between the assumed standard WBC counts and the real values encountered among Nigerian children and proposes a review for achieving more accurate malaria parasite density estimation among other reasons. To best of our knowledge, the present study is the first such report from north central Nigeria.
  - 9,406 126
PRACTITIONERS SECTION
Human immunodeficiency virus from the surgeons' viewpoint
Prosanta K R Bhattacharjee
January-June 2008, 1(1):35-42
DOI:10.4103/1755-6783.43078  
Though surgeons are not primarily responsible for the treatment of patients with human immunodeficiency virus (HIV) infection, the disease influences the performance and outcome of surgery. Surgeons may be called upon to operate for the diagnosis of an infection, for an unrelated condition, or for one of the surgical complications of acquired immunodeficiency syndrome (AIDS). This article reviews in brief the etiology, pathogenesis, and natural history of HIV and AIDS, the signs and symptoms which may help in recognizing HIV disease especially in emergency situations, the clinical presentations from a surgical point of view and their management, controversial issues related to the management of AIDS patients, and finally the guidelines for the precautions to be taken to reduce the potential risk of transmission of infection from patient to a health care workers and the postexposure prophylaxis. Methods: Literature review was conducted by the way of relevant English articles obtained from National Library of Medicine's Pubmed database with the key words as mentioned below. Additional articles were obtained from the reference lists of key articles and recent reviews.
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