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   2013| January-February  | Volume 6 | Issue 1  
    Online since July 18, 2013

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Epstein-Barr infection: Current treatment options
Abubakar Yaro
January-February 2013, 6(1):10-13
Epstein-Barr virus is one of the causes of known human cancers such as PLTD, BL and XLP. It is persistent in about 90% of the global population. Prevalent antiviral agents are not effective. A systematic review was undertaken to discuss current treatment options available for EBV infection. A search was made of PubMed to identify relevant papers published from 2000 to 2010 using various search indexes. The review is based on 11 articles included in the study. The result showed that there is no studies which analyzed antiviral agents in EBV infection. Combinational therapy using antiviral agents, immunotherapy and anticancer agents should be considered while antibiotic regimen should be considered to take care of any sepsis. Resistance to antiviral agents especially cross-resistance is burden in EBV infection Studies should be undertaken to evaluate resistance pattern in EBV infection. To assess the efficacy of EBV therapeutics. Viral load using molecular techniques should be used as biomarker of efficacy.
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Burning feet syndrome: An old tropical syndrome revisited
Ellen Welch, Nowell Peach, Meg Parkes, Geoffrey V Gill
January-February 2013, 6(1):65-70
Background: Burning feet syndrome (BFS) has been described anecdotally in the literature for over 200 years. Described subjectively by patients as burning, prickling and unremitting with nocturnal exacerbations, the condition draws parallels with the burning dysaesthesia found in diabetic peripheral neuropathy, and appears to display a similar chronicity. Despite being a common symptom, especially among the elderly, its etiology in non-specific and often marked by a lack of objective clinical signs. Historically, burning feet syndrome has been recorded in situations of poor nutrition, including malnourished African populations in the early 20th century, South American plantation workers in the 1920s and during food shortages in the Spanish Civil War. Perhaps the best described and largest outbreak of burning feet occurred amongst prisoners of war (POWs) of the Japanese during the 2nd World War in South East Asia and the Far East. In this review we summarise reports of the condition, in particular amongst Far East POWs (FEPOWs), using both the available literature as well as a unique and previously unknown contemporary study carried out in a POW camp. Materials and Methods: During his stay in the Tandjung Priok POW camp, Nowell Peach recorded 54 cases of burning feet seen over a 4 month period during captivity. This data was concealed from his captors and survived to return home with him. Results: 54 prisoners presented over a 4 month period with a mean age of 28 years and mean duration of symptoms of 12 weeks. Neurological signs were meticulously documented. All were on an inadequate diet, 20 (38%) were on less than a full ration. Accompanying tropical infections were common including malaria (73%), dengue (45%) and dysentery (41%). Discussions: The Peach survey confirmed the frequency of burning feet amongst FEPOWs and was unusual in that the neurological examination and conditions endured were documented in captivity. A paucity of physical signs was noted, and a suggestion that burning feet could be precipitated by intercurrent infection. Conclusions: Burning feet syndrome can be regarding as an antique medical condition as chronic malnutrition becomes less common. This hidden study carried out during captivity provides remarkable new insight into the disease which is now essentially unknown to modern practitioners.
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Ticagrelor: A new antiplatelet drug for acute coronary syndromes
Tirtha V Patel, Jigna S Shah, Chaganbhai N Patel
January-February 2013, 6(1):14-19
Coronary heart disease and acute coronary syndrome (ACS) are a significant cause of morbidity and mortality all over the world. Antiplatelet agents play an essential role in the treatment of acute coronary syndrome (ACS), usually with aspirin and a thienopyridine. Currently, clopidogrel, a second generation thienopyridine, is the main drug of choice, and the combination of aspirin and clopidogrel is administered orally for the treatment of ACS. Clopidogrel, the most commonly used thienopyridine, is limited by a high degree of interpatient variability and inconsistent inhibition of platelets. Ticagrelor, a new, oral, direct-acting P2Y12 receptor antagonist, produces a more profound and consistent antiplatelet effect than clopidogrel. The U.S. Food and Drug Administration approved Ticagrelor on July 20, 2011. Furthermore, ticagrelor has at least one active metabolite, which has pharmacokinetics that are very similar to the parent compound. Therefore, ticagrelor has a more rapid onset and more pronounced platelet inhibition than other antiplatelet agents. The safety and efficacy of ticagrelor compared with clopidogrel, in an ACS patient, has been recently evaluated by the PLATelet inhibition and patient Outcomes (PLATO) trial. Clinical studies of patients with both ST-elevation and non-ST-elevation ACS have shown that ticagrelor, when compared with clopidogrel, reduces the rates of vascular death and myocardial infarction. The clinical data currently available indicate that ticagrelor is a promising option for the treatment of patients with ACS and may be of particular use in those at high risk for ischemic events or in those unresponsive to clopidogrel.
  8,339 23 1
The recurring epidemic of heat stroke in children in Muzaffarpur, Bihar, India
Gopal Shankar Sahni
January-February 2013, 6(1):89-95
Context: Characterization of heat stroke cases on arrival to hospital may lead to early recognition and improved management. Delay in treatment leading to high rate of mortality and poor outcomes so a high index of clinical suspicion in appropriate setting is warranted. Aims: Recurring seasonal(summer) outbreak of heat stroke among children from Muzaffarpur district, Bihar was investigated to describe clinico-epidemiological features. Materials and Methods: A retrospective study involving 50 patients of classic heat stroke admitted to Sri Krishna Medical College and Hospital (SKMCH) Muzaffarpur in June 2005 and June 2011 were carried out. These patients had presented with a rectal temperature of more than 40°C and central nervous system disturbance. The patients were treated with standard regimen of management of heat stroke and sponging in ICU after emergency resuscitation. Results: A total of 50 case records were studied of children below12 years of age. Case fatality ratio was 60% .The disease had peak incidence in June. Previously healthy, rural children (mean age-3.78 yr) of very low socio-economic background were found most vulnerable. The main presenting feature ware high fever (100%), convulsion (100%), unconsciousness (100%), decebrate rigidity (50%), tachycardia (80%), and tachypnea (80%). No one had splenomegaly. Cerebrospinal fluid (CSF) was under high pressure but normal otherwise in all cases. Biochemical investigation reveled hyponatremia (50%), hypokalemia (5%), mild raised SGPT (30%), blood urea (40-50mg/dl) (40%) with normal creatinine. Smear for malarial parasites were negative. CT scan of head done in 20 cases; 10- showed feature of generalized cerebral edema while rest was normal. ECG showed non-specific ST-T changes and tachyarrhythmia. Moderate to severe residual neurologic deficit was observed in 20% of survivors. Male to female ratio was 1.5:1.No infective organism or its antigen or antibody was found in the any of the samples tested locally or at various apex virological centers of India. Conclusions: Heat stroke is a medical emergency with serious complication and requires prompt treatment. It is associated with multi-organ dysfunction with high mortality and substantial neurological squeals.
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Pelvic-peritoneal tuberculosis presenting as an adnexal mass and mimicking ovarian cancer
Amit N Gupta, KN Shivashankara
January-February 2013, 6(1):117-119
Diagnosis of pelvic- peritoneal tuberculosis is often difficult, because of its nonspecific clinical, laboratory and radiological findings. The presence of an adnexal mass, ascites, and raised CA 125 level, may be mistaken as ovarian malignancy. Peritoneal tuberculosis should be considered in the differential diagnosis of adnexal masses, ascites and elevated CA 125. Ascitic fluid adenosine deaminase (ADA), polymerase chain reaction (PCR) for Mycobacterium tuberculosis and endometrial biopsy may help to distinguish pelvic-peritoneal tuberculosis from ovarian malignancy. Peritoneal tuberculosis can be managed by antituberculosis therapy (ATT), therefore these test should be performed before surgery to exclude peritoneal tuberculosis, so that invasive and expensive surgery could be avoided.
  5,470 15 -
Extrapulmonary tuberculosis and HIV coinfection in patients treated for tuberculosis at the Douala General Hospital in Cameroon
Luma Henry Namme, Doualla Marie-Solange, Mbatchou Ngahane Hugo Bertrand, Temfack Elvis, Joko Henry Achu, Kuaban Christopher
January-February 2013, 6(1):100-104
Context: Human immunodeficiency virus (HIV) infection and resulting immune depression are associated with increase proportions of extrapulmonary tuberculosis (EPTB). The prevalence of EPTB varies across studies between 15 and 50% and depends on the region, ethnic group studied, and HIV coinfection rates. In Cameroon, no studies have been done so far to evaluate the magnitude of this form of tuberculosis (TB), the various sites involved, and their association with HIV infection. Aims: To determine the prevalence of EPTB, the various organ sites affected and their association with HIV infection in a population of patients treated for TB. Settings and Design: We did cross-sectional analysis of the data from the TB register of the Douala General Hospital, a tertiary health institution situated in Douala, Cameroon. All cases of TB diagnosed between 1 st July 2007 and 30 th June 2011 were included. Results: Of total of 749 patients recorded for anti-TB treatment, the overall prevalence of HIV was 41.5% (95% confidence interval [CI]38-45.1). The prevalence of EPTB was 42.9% (321). HIV infection was present in 33.6% of patients with EPTB. The most affected sites of disease were bones and joints (29.6%), lymph nodes (17.8%), the pleura (15%), peritoneum (14.3%), and the central nervous system and meninges (9%). Neuromeningeal TB however, less common was most strongly associated with HIV infection, odd ratio (OR)2.3 (95% CI 1.1-5.0, p < 0.05). Conclusions: The proportion of EPTB among TB patients treated in the Douala General Hospital is relatively high with bone and joints being the most affected sites. HIV infection is most strongly associated with neuromeningeal forms.
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Two cases of nephrotic syndrome with different etiologies
Sanjay K Mandal, Koelina Sil, Jacky Ganguly, Koushik Chatterjee, Sumanta Chatterjee, Souma S Mandal
January-February 2013, 6(1):105-108
There are various causes of secondary nephrotic syndrome. Finding an underlying etiology in a case of nephrotic syndrome or subnephrotic range proteinuria can markedly alter the therapeutic options and disease course. We describe two cases of secondary nephrotic syndrome. The first case was a 22-year-old male with pulmonary tuberculosis with nephrotic syndrome secondary to renal amyloidosis, whereas the second case was a 17-year-old male with chronic hepatitis B-associated nephrotic syndrome. It is important, especially in developing countries, to be aware that tuberculosis and infections like hepatitis B, C, etc. continue to be part of the differential diagnosis of secondary nephrotic syndrome in adolescents and young adults.
  5,032 13 -
The various etiological agents in the causation of gastroenteritis
Ujwala U Ukey, Dhruv S Chitre
January-February 2013, 6(1):112-116
Over the past many decades, the incidence of gastroenteritis has not changed much, although overall diarrhoeal mortality has declined. For children aged less than five years in developing countries, a median of 3.2 episodes of diarrhoea occurred per child-year, which is similar to that reported previously. Estimates of mortality indicate that 4.9 children per 1000 per year died in the developing regions as a result of gastroenteritis in the first 5 years of life. A wide assortment of organisms causes gastroenteritis. Thorough search regarding the subject was done in the library textbooks, journals as well as on internet. The concussed data on various etiological agents of gastroenteritis was limited in the journals. This article is an attempt to put forth the varied etiology of gastroenteritis as a disease.
  5,004 24 -
Moraxella catarrhalis: An emerging pathogen in bronchopulmonary infections
Siddesh B Sirwar, Amrutha S Indupalli, Ranabir Pal, Forhad A Zaman, Sumit Kar
January-February 2013, 6(1):76-79
Background: Moraxella catarrhalis (M. catarrhalis) is a common pathogen in the human upper respiratory tract. This microbe is also implicated in chronic lower respiratory tract infections as well as conjunctivitis, sinusitis, meningitis, otitis media, osteomyelitis, endocarditis, etc. Objectives: This study was carried out to know various facets of M. catarrhalis infection among adults with bronchopulmonary infections and the related antibiotic susceptibility pattern. Materials and Methods: A hospital-based study was carried out among adult participants with history of respiratory tract infection admitted to a tertiary care teaching hospital in Karnataka during the period of May 2007 to April 2010. A total of 912 early morning sputum samples were collected, processed with standard procedures, and analyzed. Results: Out of all the sputum samples, M. catarrhalis was the third most important pathogen (16.01%). Most of these M. catarrhalis isolates were sourced from participants with bronchopneumonia (31.51%), followed by chronic bronchitis (25.34%), bronchiectasis (25.34%), and bronchial asthma (17.81%). M. catarrhalis infection was predominantly noted among males (78.08%) and in older age group (22.60%), i.e., 61-70 years. All strains of M. catarrhalis were sensitive to tetracycline, co-trimoxazole, chloramphenicol, and gentamicin; 75.34% were resistant to penicillin, ampicillin, and amoxycillin. Surprisingly, all strains were resistant to erythromycin; 37 (25.34%) were beta-lactamase positive. Conclusions: M. catarrhalis is one of the emerging pathogens in bronchopulmonary infections, and the beta-lactamase-producing strains imply its ability for antibiotic resistance.
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Prevalence and risk correlates of hypertension among adult rural population in Bihar
Ayan Ghosh, Deblina Sarkar, Bijay Mukherji, Ranabir Pal
January-February 2013, 6(1):71-75
Background: Cardiovascular diseases will be prime cause of morbidity by 2020 in India. Objective: To determine prevalence and correlates of hypertension in an adult rural community. Materials and Methods: A cross-sectional study was carried out in the field practice area of the Department of Community Medicine of tertiary care teaching institute of Bihar among adult population to find out the prevalence of hypertension with the sociodemographic correlates from October 2009 to September 2010. A pretested predesigned questionnaire was used to collect sociodemographics data by interview technique from 997 study participants. The blood pressure was assessed and classified using recent JNC 7 and WHO criteria to grade hypertension. Results: Majority of the study participants were Muslims (89%) and in 40-49 age group (21.26%). In males and females, the overweight and obese combined were, respectively, 13%. In the dietary habit, 85.36% were non-vegetarian; 8.83% consumed salt more than 10 grams per day; 26.78% reported themselves as alcoholics; tobacco smokers were 58.28%, highest in 40-49 age group (23.58%). Overall, 11.43% were hypertensive and 16% were prehypertensive. Among hypertensive, majority were male (61%); and in 60-69 age group (27.27%), overweight and obese (56.14%), smokers (75.44%), non-vegetarian (67.54%). There was a significant linear trend between age and salt intake with prevalence of hypertension (P<0.0001). Conclusions: Hypertension in the rural population of Bihar was lower than previous estimates.
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Case of recurrent fever with late lymphadenopathy: Think of Kikuchi's disease
M Abdul Jaleel, Farah Naaz Fathima, Bushra Naaz Fathima Jaleel
January-February 2013, 6(1):134-138
Kikuchi's disease or histiocytic necrotizing lymphadenitis, a relatively uncommon and self-limiting entity of varied manifestations including prolonged fever, is diagnosed primarily by excluding other more common causes of fever and established finally by the typical histological finding on lymph node biopsy. The appearance of palpable lymph nodes may be delayed and become clinically detectable only after the initial fever subsides, and the patient having spent a few days without fever comes back with episodes of recurrent fever before the lymph nodes become clinically palpable. One such case is presented here to stress upon the importance of complete and thorough systematic clinical examination on each and every visit by the patient to the physician.
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Knowledge and practice of barbers regarding transmission of blood-borne viruses in Khartoum state
Nagla Hassan Eltayeb, Hatim Mohamed Yousif Mudawi
January-February 2013, 6(1):80-83
Background : Blood-borne viruses constitute a major public health problem affecting millions of people worldwide. One mode of transmission of these viruses is use of contaminated razors and blades by barbers. The aims of this study were to assess the awareness of shop barbers and roadside barbers in Khartoum state regarding knowledge and modes of transmission of Hepatitis B virus, Hepatitis C virus and Human immunodeficiency virus and to observe their practice regarding proper use and disposal of razors and blades. Design and Setting : This is a cross-sectional comparative community-based study carried out in Khartoum state, Sudan. Materials and Methods : The study included two groups of barbers-shop barbers and roadside barbers. Barbers were questioned on their level of education, basic knowledge and modes of transmission of HBV, HCV and HIV, their knowledge about HBV vaccine and their vaccination status. Statistical Analysis: Was done using SPSS software program to calculate frequencies, X 2 and t-tests. P value was taken at a significant level of <0.05. Results: Barbers in both groups had good basic knowledge about HIV infection and its modes of transmission, while in both groups knowledge about hepatitis and its modes of transmission were poor. In both groups standard cleaning and sterilization of equipment procedures were not followed and special sharps' disposal containers were not used. Conclusion: Practice in both groups may lead to spread of HIV, HBV and HCV between customers. The public media should spend more effort on spreading information and knowledge about hepatitis as it does with HIV. Local authorities should distribute leaflets with detailed information on proper modes of cleaning and sterilization of equipment and of disposal of used blades to all those seeking to open a barber's shop and roadside barbers should be encouraged to use disposable razor blades on customers as they lack proper water supply and sterilization equipment.
  4,378 16 -
Human immunodeficiency virus disease management in highly active antiretroviral therapy era: A comprehensive review
KV Ramana, Ratna Rao
January-February 2013, 6(1):5-9
Human immunodeficiency virus (HIV) is a retrovirus belonging to the family Lentiviruses, which are responsible for chronic and long-lasting infections including the simian immunodeficiency virus (SIV) in monkeys. Since 1981, when the first acquired immunodeficiency syndrome (AIDS) cases were reported, HIV poses a challenge to human beings, and the UNAIDS global estimate reveals that currently more than 33.2 million people are living with HIV infection worldwide. HIV infection leads to variable disease course in different people. The biological basis of this variability in the disease progression is still unknown. Initiation of highly active antiretroviral therapy (HAART) although reduced the mortality, morbidity arising from antiretroviral side effects was a cause of concern. HIV-infected patient care has now shifted from complications arising from opportunistic infections to other causes attributable to HIV pathogenesis and toxic effects of HAART. Monitoring the disease progression and the response to HAART is traditionally carried out using TCD4+ cell counts and HIV/RNA viral load. Many clinical and laboratory markers have been used to estimate disease progression in HIV1 infection. HIV/AIDS after introduction of HAART has taken a different course where people infected with HIV have been considerably living longer due to reduced incidence of opportunistic infections and other AIDS-related conditions. HIV patient care should be multifaceted involving specialist HIV primary care physicians, infectious disease specialists, and emergency physicians considering the ways by which HIV and HAART have changed treatment and management of HIV-infected individuals.
  4,086 18 1
Amoebic liver abscess: Unusual manifestations
Shyam Chand Chaudhary, Rajneesh Avasthi, Safal , Deepali Mohanty
January-February 2013, 6(1):128-130
The clinical spectrum of amoebiasis is broad ranging from asymptomatic passage of cysts through fulminant colitis to localized abscesses of the liver, lung, brain, and other tissues. Amoebic liver abscess (ALA) is a serious, but readily treatable form of hepatic infection. It usually presents with high-grade fever, associated with right upper abdominal pain, constitutional symptoms, and pleuropulmonary complications mainly in the form of pleural effusion and leucocytosis. However, pneumonitis, leukemoid reaction, and jaundice are an uncommon association. We hereby report a young nonalcoholic immunocompetent female, diagnosed to have ALA associated with multiple unusual complications,who showed excellent response to intravenous metronidazole.
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Healthcare-associated infections in three hospitals in Dschang, West Region, Cameroon
N Fusi-Ngwa Catherine Kesah, K Payne Vincent, Nchang Chrysanthus
January-February 2013, 6(1):23-29
Background: There is a dearth of knowledge on healthcare-associated infections (HAIs) in Cameroon. This study scrutinized HAI prevention and burden in three hospitals in Dschang, West Region of the country, in order to inform on current practices. Materials and Methods: From September 2008 to April 2009, patient records in three hospitals were assessed, questionnaires administered, and hand washing examined in 29 consenting nurses. A retrospective study on nosocomial infections (NIs) was performed by reviewing the records of 12917 in-patients who survived longer than 72 hours and were not transferred to other hospitals. Modified National Healthcare Safety Network protocols were employed and data analyzed using SPSS. Results: Study respondents (77%, P 0.0089) were aware of HAI control but lacked detailed knowledge including the five moments for hand hygiene. Of 35 staff evaluated, 74% (P 0.0093) used non-disposable hand towels, 9% disposable and a further 9% air-dried hands after washing. An alarming 72% of hand cultures grew coagulase-negative staphylococcus, Enteroccocus, Bacillus, fungi, Klebsiella, Enterobacter and other coliforms indicating fecal contamination. NI rates averaged 2.6 infections/100 admissions and four infected patients/1000 patient days; 17.4% and 12 infected patients/1000 days in surgical patients. Surgical site (38%), respiratory (26%), gastrointestinal (19%), bloodstream (8%) and urinary (7%) infections were predominant NIs, with a mean development time of 7-11 days and prolonged hospital stay by 12 days. Cost constraints precluded routine culture and antibiotic susceptibility testing; thus no data on clinical pathogens. Conclusion: Scrupulous hand hygiene and rub usage, adequate care facilities, staff education and HAI surveillance were paramount.
  3,817 15 -
Emotional distress among people with epilepsy in Kaduna, Northern Nigeria
Folorunsho T Nuhu, Abdulkareem J Yusuf, Marufah D Lasisi, Saad B Aremu
January-February 2013, 6(1):42-46
Background: Epilepsy is associated with significant psychiatric morbidities. However, little is known about epilepsy and emotional distress in northern Nigeria. Aim: To assess the prevalence and determinants of emotional distress among people with epilepsy (PWE) in Kaduna, northern Nigeria. Settings and Design: This cross-sectional study was conducted between January, 2011 and June, 2011. Materials and Methods: We administered the Hospital Anxiety and Depression Scale as well as the Oslo 3-Items Social Support Scale to 209 consecutive PWE of at least 1 year duration attending the outpatient clinic of Federal Neuropsychiatric Hospital, Kaduna in order to measure their levels of anxiety and depression, and social support. The socio-demographic and clinical characteristics of the subjects were also recorded. Results: The 209 subjects consisted of 123 (58.7%) males and 86 (41.3%) females with mean age of 28.7 (SD, 12.1) years. Majority have strong social support (56.3%) and less than 6 months seizure-free periods (82.3%). The prevalence of anxiety and depressive symptoms were 20.2% and 15.4% respectively. Older age, being a female, poor social support and short seizure-free periods were significantly associated with emotional distress (P value < 0.05) while female sex (OR = 2.201, P value = 0.024, 95% CI = 1.108 - 4.373) and poor support (OR = 0.361, P value = 0.024, 95% CI = 0.149 - 0.875) predicted anxiety and depressive symptoms respectively. Conclusion: Emotional distress is quite common among PWE and should be taken into consideration in the management of patients with this disorder.
  3,149 14 -
Investigation of Oxyuris (Enterobios vermicularis) prevalence in kindergarten and primary school children of Babol city, Mazandaran, Iran 2009
Mohammad Bagher Nourozian, Mohammad Reza Youssefi
January-February 2013, 6(1):20-22
Background: Pinworm or Oxyuris (Order: Nematoda) is the most common nematode parasite in humans. One of the most frequent parasitic diseases in kindergartens, school-going children, and in places where many people live together is Oxyuriasis or Enterobiosis. The aim of this study was to determine the prevalence of Oxyuris contamination among kindergarten and primary school students of Babol city, Mazandaran province, Iran. Materials and Methods: During this study, which was done on 702 students, first in an explaining meeting with students' parents, they got to know this disease and its importance in public health. Then correct method of sampling was taught to them, a scotch test tape with two slides and questionnaire requesting personal information, including age, gender, and location of residence were given to them. Results: This study was done on 702 students of Babol kindergarten and primary schools. Among them 352 (50.1%) were boys and 350 (49.9%) were girls. All of the studied children were in the age group of 4-7 years. According to location of residence, 313 (44.6%) were in urban areas and 389 (55.6%) were in rural areas. From total 702 investigated children, 234 (33.33%) were positive and were infected by pinworm, including 101 (43.16%) boys and 133 (56.84%) girls. Discussion: The distribution of these infections depends on principles and standards of hygiene in society, economic conditions of the society, and climatic conditions of the area. Conclusion: Considering the data obtained from this study, because oxyuriasis infection rate in kindergartens and primary school children of Babol was high, it is suggested that oxyuriasis be described in parent-teacher meetings to increase knowledge of the involved families.
  3,145 16 2
An observational study on the prevalence of dyslipidemia and dysglycemia in human immunodeficiency virus patients
Nirdesh Jain, Himanshu Dandu, Shailendra Prasad Verma, Anil K Tripathi, Arjun Khanna, Manish Gutch
January-February 2013, 6(1):84-88
Context: Dyslipidemia and dysglycemia are prevalent among patients with human immunodeficiency virus (HIV) infection. Besides antiretroviral therapy, other factors like opportunistic infections may contribute to the development of these disorders. Aims: The objective of this study was to determine the prevalence and pattern of dysglycemia and dyslipidemia in HIV patients. Settings and Design: An observational cross-sectional study was done over a period of six months at the Gandhi Memorial and Associated Hospital, Lucknow, India (a tertiary care centre in north India). Materials and Methods: A total of 85 consecutive HIV patients, >15 years of age attending the outdoor clinic were enrolled. A single fasting blood sample was taken to estimate the sugar and lipid parameters. Acutely ill and previously diagnosed patients of diabetes mellitus were excluded. Statistical Analysis Used: Data were presented in percentage and mean values. Statistical analysis was done by using software "Stata Version 11 Texas". Results: The mean (SD) age of the studied patients was 34.34 (8.3) years. The prevalence of dysglycemia was 30.9%; 10.9% patients were diagnosed to have frank diabetes mellitus while 20% patients had their blood sugars in the range of glucose intolerance. Prevalence rates of low high density lipoprotein (HDL), hypertriglyceridemia, raised low density lipoprotein (LDL) and total cholesterol were 69.41%, 29.41%, 10.58%, and 9.41% respectively. Conclusions: Dysglycemia and dyslipidemia are more prevalent among HIV patients. Advanced disease and antiretroviral therapy (ART)-naïve patients have higher rates of dysglycemia and dyslipidemia. High prevalence of low HDL, hypertriglyceridemia and impaired glucose intolerance comprising three components of metabolic syndrome are found in HIV patients. Hence, HIV disease "itself" is a major risk factor for cardiovascular disease.
  3,014 15 1
Human cytomegalovirus infection in Nigerians living with human immunodeficiency virus
Olaoluwa P Akinwale, Babatunde Afilaka, V Pam Gyang, Monsuru A Adeleke, Adeniyi Adeneye, Dan Onwujekwe, Fatimah Alimi, David O Akande
January-February 2013, 6(1):59-64
Context : Human immunodeficiency virus (HIV) patients are at higher risk for Human cytomegalovirus (HCMV) infection. Aim: To identify HCMV and HIV co-infection among Nigerian patients for prompt therapeutic interventions. Materials and Methods: The study drew samples from the antiretroviral clinic of Nigerian Institute of Medical Research and patients' informed consent was taken at enrollment. Variables collected included socio-demographic characteristics such as sex, occupation, marital status, educational status, income, and religion, while health-related variables were CD4 counts and HIV viral load. Genomic DNA from whole blood samples of 236 patients, 164 (69.5%) females and 72 (30.5%) males, was subjected to polymerase chain reaction (PCR) amplification of 2 genes within conserved immediate early (IE) and late (LA) transcribed regions of HCMV genome. Statistical Analysis: Statistical Package for Social Sciences was used to determine frequencies of HMCV infection, while Chi square was used to examine associations between patient's characteristics and HMCV infection. Results: A total of 35 (14.8%) patients; 25 (10.6%) females and 10 (4.2%) males were positive for HCMV infection. Although there was variation in prevalence of HCMV in different marital status, it was statistically insignificant (P = 0.734; P > 0.05). Results also showed that 22 (62.9%) of HCMV positive patients had HIV viral load greater than 10,000, prevalence of HCMV decreased as CD4 counts increased, while 12 (34.3%) of HCMV positive patients had CD4 counts between 1 and 200. Conclusions: This study is the first molecular survey of HCMV/HIV co-infection in Nigeria and has provided valuable information for prompt therapeutic intervention to reduce morbidity among HIV patients.
  3,017 12 -
Facial talon cusp in multilobed mesiodens: A rarest case report
Shilpa J Busnur, Saraswathi V Naik, Kodhandarama S Govindappa, Harini C Thakkilipati, Santosh V Shanbhog
January-February 2013, 6(1):109-111
Talon cusp is a well-delineated, talon shaped additional cusp arises during the morphodifferentiation stage of tooth development. It occurs on lingual/palatal or facial surface of either primary or permanent anterior teeth.Occurrence of talon cusp on supernumerary teeth is extremely rare. We report a case of facial talon cusp in a multilobed mesiodens in a 8-year-old girl, which is a rarest of the rare.
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Bacterial spectrum of neonatal septicemia with their antibiogram with reference to various predisposing factors in a tertiary care hospital in Southern India
Bheemasamudra Patel Mallikarjunappa Rajendraprasad, Kurubanahalli Nandyappa Basavaraj, Beena Antony
January-February 2013, 6(1):96-99
Background: Various factors predispose to neonatal septicemia (NS) and study of these factors and a change in bacterial spectrum and antimicrobial susceptibility pattern was noticed in this study, which will certainly help in treatment of septicemic neonates. Objective: To isolate the causative agents of NS, antimicrobial susceptibility pattern of the isolates and to analyze the various predisposing factors to NS. Materials and Methods: Study was done over a period of two years. Blood samples from 200 clinically suspected NS cases were subjected to aerobic culture and their antimicrobial susceptibility pattern was determined. History of sex, gestational age, birth weight, term or preterm, outborn, or inborn babies were taken. Results: Of 200 cases, 95 (47.5%) were blood culture positive. Of them, 64 (67.37%) were males, 64 (67.37%) were preterm, birth weight <1.5 kg were 41 (43.16%), 71.58% outborn neonates with 55.79% mortality rate. Gram-negative isolates were 67 (70.53%) and Gram-positive isolates were 28 (29.47%). Enterobacter cloacae and Staphylococcus aureus were commonest isolates in 20% and 11.58% of cases, respectively. Gram-negative isolates were sensitive to amikacin, ciprofloxacin, and ofloxacin and least sensitive to ampicillin and amoxiclav. All Gram-positive isolates were sensitive to vancomycin. Conclusion: NS was found to be 47.5% in our study. In this study, we have analyzed various predisposing factors of NS. Blood culture is the gold standard for diagnosis of NS. A change in bacterial spectrum and change in their antimicrobial susceptibility pattern was noticed in this study, which will certainly help in treating such cases.
  2,774 19 -
Frequency of biofilm formation in toothbrushes and wash basin junks
Abdulazeez A Abubakar, Musa S Pukuma, Fadilat Bintu Abdulazeez
January-February 2013, 6(1):55-58
Background: Biofilms are known to be resistant to several antibiotics once they are allowed to form on any surface. Aim: To investigate the biofilm forming ability of some bacterial isolates in toothbrushes and wash basin junks. Materials and Methods: A total of 606 students of Federal University of Technology, Yola were provided with new toothbrushes, which were collected after 1 month of usage and screened for biofilm formation. Another 620 swabs were collected from the wash basins of Federal Medical Centre, Specialist Hospital, Federal University of Technology, and students' hostels in Yola and from some residence in Jimeta, Yola Metropolis; they were all screened for biofilm formation. Results: A total of 38.3% biofilm formation rate was recorded. Three types of bacterial isolates were identified in the biofilms of toothbrushes and wash basin junks, namely Staphylococcus aureus, Escherichia coli, and Pseudomonas aeruginosa at the prevalence rate of 48.0%, 29.1%, and 22.6%, respectively. Overall, 83.3% of the toothbrush biofilm were identified from female students, while 16.7% were from their male counterparts. Statistically, the frequency of biofilm formation showed a significant difference by gender (X 2 = 10.242, P < 0.05). However, frequency of biofilm formation in students' toothbrush had no association with age (X 2 = 1.0312, P > 0.05). Conclusion: This study identified three microorganisms namely S. aureus, E. coli, and P. aeruginosa that were involved in wash basin junk biofilm formation. The findings also showed that occurrence of biofilm in females' toothbrushes were significantly higher than in males' (X 2 = 10.242, P < 0.05).
  2,716 14 -
Mapping and opportunities of human resource capacity building initiatives for HIV/AIDS in India
Kavya Sharma, Sanjay Zodpey, Syed Zahiruddin Quazi, Abhay Gaidhane, Shailendra Sawleshwarkar, Sunil Khaparde
January-February 2013, 6(1):30-41
Background: The complex nature of the HIV /AIDS epidemic in India demands for a skilled technical and managerial human resource. India's response to the human resource capacity building initiatives for better response to HIV/AIDS seems to be impressive; however it faces some key challenges. Aim: The purpose of this paper is to identify and catalogue human resource capacity building initiatives and outline the challenges for better response to HIV/AIDS in India. Materials and Methods: We reviewed and ana­lyzed published articles and reports, grey litera­ture, including organizational websites, self-published tools and articles, non-academic reports and telephonic interview with some stakeholders. Snowballing approach was used to collect information. Results: We hope that this paper would provide an understanding of the current status of capacity building initiatives in India. We have identified certain challenges, particularly related to monitoring and evaluation that need to be addressed in capacity building programs at the planning stage. Conclusion: Moreover these challenges can be viewed as potential areas for operational research.
  2,709 14 -
Challenges for ready-to-use therapeutic food in the Indian context
Harshal T Pandve, Kevin Fernandez, PS Chawla, Samir A Singru
January-February 2013, 6(1):140-141
  2,601 14 -
Invasive Aspergillus sinusitis in a young immunocompetent host: Call for early diagnosis and treatment
Ravinder Kaur, Megha Maheshwari, Dewan Richa
January-February 2013, 6(1):120-122
Invasive fungal infection of the sinuses is a rare disease entity most commonly encountered in the immunocompromised, debilitated host. We report a case of invasive fungal rhinosinusitis due to Aspergillus fumigatus in a young immunocompetent male who presented with only headache. The patient was initially taken up for fiber-optic endoscopic sinus surgery. A week later, he developed right-sided hemiparesis and left-sided facial weakness and therefore, he was given antifungal treatment. The patient, however, succumbed to the disease.
  2,464 10 -
A study on serological correlation of clinically suspected leptospirosis cases in West Bengal, India
Monalisa Majumdar, Anirban Bhaduri, Madhuchhanda Mandal, Krishna Kumar Haldar
January-February 2013, 6(1):47-49
Context: Leptospirosis is a zoonotic infection with worldwide significance. It is caused by a spirochete Leptospira interrogans, which has many serogroups and a large number of serovars. Leptospirosis is an emerging public health problem in India. Aims: Leptospirosis is an emerging public health problem and keeping this in mind 216 clinically suspected cases of leptospirosis have been considered for serological study. Failure to recognize these cases leads to serious morbidity and mortality. Hence, the present study was undertaken to identify these cases by simple laboratory techniques so that timely management could be undertaken. Settings and Design: Hospital-based cross-sectional case control study. Subjects and Methods: Patients with unexplained fever for more than seven days with or without jaundice or renal failure were taken up for this study. IgM ELISA tests were performed with the serum samples of the patients. Statistical Analysis Used: Simple statistical methods applying Epi info. Results: Total 77 patients were found to be reactive for IgM ELISA. Total 100% of seropositive patients had fever and 40% had jaundice. Peak incidence of the disease was found in the period from July to November (monsoon and post-monsoon period). Male preponderance was seen and mainly urban population was found to be seropositive in our study. Conclusions: Seroprevalence of leptospirosis was found to be remarkable in our study; 35% of the clinically suspected patients showed positive IgM ELISA tests.
  2,432 14 1
Polymerase chain reaction: The panacea for diagnosing tubercular breast disease?
Mahima Lall, AK Sahni
January-February 2013, 6(1):131-133
Tuberculosis is common in India but tubercular breast abscess still remainsa rare entity. This paradox exists due to misdiagnosis and underreporting. A high index of suspicion is required in diagnosing the condition which mimics pyogenic abscess or benign breast disease. We present a case of a 21-year-old college student who presented to surgical OPD with lump in right breast. Prolonged treatment with antibiotics did not show any clinical response. Polymerase chain reaction (PCR) performed on the pus indicated the presence of Mycobacterium tuberculosis. Only repeated Fine needle aspiration cytology (FNAC) revealed acid-fast bacilli. Antitubercular therapy was initiated with favorable clinical response.
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Immuno-epidemiology of leishmanial infection among tribal population in kala-azar endemic areas: A community based study
Rajan R Patil, Jaya Prakash Muliyil, Amitabha Nandy, Manjulika Addy, Ardhendu Maji, Prabir Chatterjee
January-February 2013, 6(1):50-54
Objective: Immuno-epidemiology of kala-azar in terms of Leishmanial infection rates among specified age groups in tribal community, Utility of some diagnostic tools in eliciting evidence of recent and past infection. Materials and Methods: A cross sectional study among tribal communities, using Leishmanin skin test (LST) and direct agglutination test (DAT). Results: The prevalence leishmanial infection was found to be 44.4% past infection (LST positivity) and the prevalence of recent infection 44% (DAT positivity), respectively. The annual rate of infection in age groups up to 40 years was 3-5%. Statistical association was significant only for the effect of age on LST c 2 = 16.83 (P<.05) OR = .14 [95% CI= .05 to .42]. Associations with other important variables like sex, fever, spleen, family size were insignificant for both LST and DAT. Conclusion: Kala-azar infection rates are high in the tribal communities of Jharkhand. There was no association found between LST and DAT results. The DAT seropositivity to leishmanial infection in any age group is an indication of individual's experience with the leishmanial infection. One can't conclude for the active disease based on the seropositivity since the antibody levels (IgG) remain high even in a disease-free state.
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Tubercular lymphadenitis and abdominal tuberculosis with autoimmune hemolytic anemia and severe intravascular hemolysis
Ashutosh M Somalwar, Archana A Aher, Vinay G Zanwar, Kuldip S Kolpakwar
January-February 2013, 6(1):123-124
Tuberculosis, a common disease in the developing world and a resurging problem in the developed world, is associated with numerous hematological manifestations. The most common manifestation is normochromic normocytic anemia of chronic disease. Hemolytic anemia is rare, and there are only a few previously reported cases. We report a case of autoimmune hemolytic anemia with severe intravascular hemolysis in a case of abdominal tuberculosis. To our knowledge, this is one of the few cases reported in the literature.
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Dengue and swine flu: An existed co-infection in clinical practice
Somsri Wiwanitkit, Viroj Wiwanitkit
January-February 2013, 6(1):140-140
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An unusual case of double jeopardy
Dilip Gude, Dharam P Bansal, Hemalatha R Kotari
January-February 2013, 6(1):125-127
Brucellosis is an underrated and often neglected re-emerging zoonosis in India with palpably ill public health outcomes. In some cases, the diagnosis is not forthright especially when plagued by mixed infection. We bring to light a highly uncommon case of brucellosis coinfection with Mycobacterium tuberculosis (MTB) and review the literature.
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Paralytic squint in dengue fever- a report of three cases: Further reports of a rare, once before reported phenomenon of abducens palsy in dengue
Mitrakrishnan Shivanthan
January-February 2013, 6(1):3-4
With dengue becoming endemic, more complications are being recognized including a variety of neurological complications such as mononeuropathies. Abducens palsy causing paralytic squint has been reported only once previously in medical literature. Demyelinating infective and immune-mediated mechanisms are believed to be the pathogenesis behind mononeuropathies. Neither an effective vaccine against dengue nor proven treatment for dengue neuropathy is currently available. Further studies are needed to elucidate the exact mechanism and develop effective treatment for dengue neuropathy.
  1,708 12 -
Commentary on: Predicting changing measles epidemiology in an urban West African population
Tanmay Mahapatra
January-February 2013, 6(1):1-2
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Cutaneous larva migrans in a nonendemic area
Satyaki Ganguly, Kranti C Jaykar, Sambeet K Mallik, Abhijeet K Jha
January-February 2013, 6(1):139-139
  1,418 11 -
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