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   2013| July-August  | Volume 6 | Issue 4  
    Online since February 26, 2014

 
 
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ORIGINAL ARTICLES
Preference of hospital usage in India
Sarda Prasad
July-August 2013, 6(4):472-478
DOI:10.4103/1755-6783.127804  
Health is important and money is not matter, if people are concerned for the treatment of various ailments. A collective acceptance with regard to hospital usage is that most of the people prefer to use private hospitals even if the cost of private hospital tends to be high. Public hospitals are not preferred due to poorer quality of their services, even though these services are provided at low cost. At the time of independence, nearly 15% of the people used private sector. In a recent study by World Bank, it has been found that about 80% of the people use the private hospitals in India. In order to understand the preference of hospitals of ailing persons, we make use of the National Sample Survey Organization's 60 th round data on morbidity and health-care conducted in 2004. Using this data, we first described the demographic, social and economic characteristics of person who use the hospitals. We have also used primary data collecting during May-September 2010 in Bundelkhand region, Uttar Pradesh. There were 360 farmers have interviewed from three villages from each Banda and Hamirpur districts. We have tried to understand the preference of hospital usage among the migrant and non-migrant households. We have found that migrant households preferred private hospital for any type of treatment whereas non-migrant households still have faith on herbal and magician for the treatment. Migrant household preferred institutional delivery and spent money on healthy food such as fruits and vegetables. Migrant households were more health conscious and more exposed about the health awareness programs such as polio, immunization and health check-up of the children. Interesting to note that migrants households have first aid box and some general medicine such paracetamol, B-complex table and syrup. Some of them have thermometer and they are able to measure the body temperature and apply medicine to control fever if any time appeared among the member of households.
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CASE REPORTS
A case of clinically inapparent bilateral adrenal histoplasmosis in an Immunocompetent person
Sanish Shringarpure, Joseph V Thachil, Abdul Gaffur, Geetha
July-August 2013, 6(4):479-481
DOI:10.4103/1755-6783.127805  
Histoplasmosis presenting as bilateral large adrenal masses is rare. We describe the case of a 35-year-old male with bilateral adrenal masses which turned out to be histoplasmosis on biopsy, so the masses were treated with antifungal agents. We describe the case for its rarity.
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Borreliosis: Recurrent fever due to spirochetes
S Veena, V Seema, Ramesh Babu
July-August 2013, 6(4):482-484
DOI:10.4103/1755-6783.127806  
Relapsing fever is a complex group of diseases caused by spirochetes of the genus Borrelia transmitted to humans by lice or ticks. The purpose of this study is to present a case of relapsing fever. A 50-year-old female was admitted with fever, headache, nausea, myalgia, and arthralgia. She had history of relapsing fever for 3-5 days with 15-21-day-intervals of apyrexia during the past 3 months. Laboratory exams were normal. Peripheral blood smear showed spirochetes. She was treated with doxycycline to which she showed good response. The patient is asymptomatic and without sequelae since 3 months. In the case we reported, relapsing fever due to spirochetemia was made during the differential diagnosis. Owing to the difficulty in identification, it is important to have a high clinical suspicion of this type of infection.
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Recurrence of esophageal carcinoma presenting as dermatomyositis
Muzafar Naik, Tariq Bhat, Irfan Yusuf, Imran Hakim
July-August 2013, 6(4):485-486
DOI:10.4103/1755-6783.127807  
A 55-year-old male was diagnosed of squamous cell carcinoma of esophagus and was treated by surgical resection of the tumor. Fluorodeoxyglucose (FDG) positron emission tomography performed before surgery did not show any evidence of local or distant lymph node metastasis. The patient was not given adjunctive chemotherapy or radiotherapy. Seven months later he presented with dermatomyositis and on evaluation was found to have metastatic deposit of squamous cell carcinoma in cervical lymph nodes. Despite steroids and radiotherapy he died within 2 months of diagnosis. We report the first case of dermatomyositis as a manifestation of recurrence of esophageal carcinoma.
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Isolated mucosal Leishmaniasis
Deepak Sundriyal, Naveen Kumar, Raj Kumar, Brijesh Sharma
July-August 2013, 6(4):487-488
DOI:10.4103/1755-6783.127808  
Leishmaniasis is a term used to define a group of clinical syndrome caused by various species of parasite Leishmania. Three main clinical types of leishmaniasis are visceral leishmaniasis, cutaneous leishmaniasis and mucocutaneous leishmaniasis. However, isolated presentation as mucosal disease is rare. We report a case of primarily mucosal leishmaniasis.
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IMAGES IN CLINICAL MEDICINE
Gall bladder ascariasis
Ranendra Hajong
July-August 2013, 6(4):489-490
DOI:10.4103/1755-6783.127809  
Hepatobiliary ascariasis is commonly reported from highly endemic regions like India, Bangladesh, Latin America, parts of Middle East and Africa. In humans, the usual habitat of Ascaris lumbricoides is the small intestine. When the worm load is high, going as high as more than 1000 worms, then the worms tend to migrate away from the usual site. Patients with hepatobiliary ascariasis may present with biliary colic due to obstruction caused by the worms in the gall bladder, common bile duct or as a result of obstructive symptoms caused by calcified worms or lithiasis, which is commonly found in patients with hepatobiliary ascariasis. Acute pancreatitis may also be caused by ascariasis. Management usually is conservative if it is still alive or can be extracted by endoscopic retrograde cholangio-pancreatography or surgery.
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ORIGINAL ARTICLES
Barriers to immunization coverage in DRC: An analysis of the GAVI-Alliance cash-based support
Paulo Ferrinho, Mohammed Dramé
July-August 2013, 6(4):401-407
DOI:10.4103/1755-6783.127773  
Context: Although many countries have improved their vaccination coverage in recent years, the Democratic Republic of Congo (DRC) remains with unsatisfactory levels. Aims: The objective of this study is to document the relative importance of the factors that have influenced the immunization coverage in DRC and to understand the extent to which cash support to the DRC by the Global Alliance for Vaccines and Immunisation (GAVI) addresses these issues. Materials and Methods: Data were collected using a modified Delphi and by the analysis of grants and annual progress reports submitted to GAVI. Results and Conclusions: The GAVI health systems strengthening (HSS) proposal is quite strategic. Therefore it should be complementary to other GAVI grants received by the DRC. This is not always so because the different GAVI windows [immunisation services strengthening (ISS), new and underused vaccines, HSS, and civil society support] do not overlap geographically and in the calendar. This is further aggravated by the narrow time horizon of all grants. Apparently, not enough thinking was done at the outset about how the GAVI HSS proposal was going to be implemented. Hence, the acknowledgement by the Delphi panelists that the major barrier to the effectuation of the GAVI HSS grants was in their implementation. The Delphi panel was silent about HR issues but the importance of these issues is captured in the 2006 GAVI HSS grant application. Significant delay in the implementation of the HSS proposal is associated with the lack of a reliable financial management system. GAVI HSS has been catalytic in uniting key stakeholders in the health sector around the HSS strategy, including the DRC government itself.
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Determinants of overweight and obesity among school children in Mehsana District, India
Jigna Samir Shah, Poonam K Patel, Bhoomika Patel
July-August 2013, 6(4):408-412
DOI:10.4103/1755-6783.127775  
Introduction: World Health Organization refers obesity as a global epidemic because of rapid increase in the number of overweight and obese individuals in last 20 years. Objective: To study the prevalence of overweight and obesity and determine their associated factors among school children aged 10-12 years in Mehsana district in India. Study Protocol: A single centric epidemiological study was conducted among 200 school children selected at random in Mehsana district school in the period from July 2011 to September 2011. Overweight and obesity were assessed using height, weight, waist circumference and hip circumference of each student in the class. A predesigned and pretested questionnaire was used to interview the students to elicit the information on family characteristics such as number of family members, education and occupation of parents, their usual physical activity, habit of watching TV and time spent with computer and for sleeping as well as the pattern of dietary intake. Results: Significant difference in body mass index for boys (P < 0.0010) as well as girls (P < 0.0123) was observed in all the three underweight, overweight and obese groups when compared to the normal group. Significant difference in hip and waist circumference was observed only in the underweight group when compared to normal. Risk of overweight and obesity was significantly higher in children who spent time in television viewing and/or with computer. Conclusion: The present study attempts to highlights childhood obesity is an emerging health problem which need to be confirmed by large scale studies and effective preventive strategies should be developed to halt this epidemic at its beginning.
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Efficacy of a single dose albendazole chemotherapy on human intestinal helminthiasis among school children in selected rural tropical communities
Ekaette Godwin Edelduok, Felicia Nkechi Eke, Ngozi Evelyn Evelyn, Chinedu Ifeanyi Atama, Joseph Effiong Eyo
July-August 2013, 6(4):413-417
DOI:10.4103/1755-6783.127776  
Introduction: The impact of chemotherapy on human intestinal helminthiasis among school children in semi-urban tropical communities of Igbo-Eze South Local Government Area of Enugu State, South-Eastern Nigeria, was investigated. Materials and Methods: Stool samples were obtained from 1296 school children (ages 4-15 years) from six schools randomly selected from the study area. Helminth eggs were recovered from stool samples. Those infected were treated with single oral dose of 400 mg albendazole tablets and re-examined for helminth eggs 4 weeks post-treatment. Results: Out of 1296 school children examined, 106 (8.1%) of the children were significantly (P < 0.05) infected with human intestinal helminths thus: 64 (4.9%) with Ascaris lumbricoides, 33 (2.5%) with hookworm and 9 (0.7%) with Trichuris trichiura. Out of the 64 children infected with A. lumbricoides, there was a reduction in the prevalence of infection by 18.8%. Furthermore, out of the 33 children infected with hookworm, there was a reduction in the prevalence of infection by 15.1%. Out of the nine children infected with T. trichiura, there was a reduction in the prevalence of infection by 22.2%. Conclusion: These findings suggest intestinal helminth specificity to the efficacy of albendazole. Thus, further research into the development of more effective antihelminthic drugs is necessary.
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Prevalence of cervical intraepithelial neoplasia in relation to knowledge, attitudes/beliefs, and practices among university students in North-Eastern Nigeria
James O Adisa, Sa'adatu B Tukur, Musa Bukar, Ejike C Egbujo
July-August 2013, 6(4):418-421
DOI:10.4103/1755-6783.127780  
Background: The involvement of communities in control of cervical cancer cannot be overemphasized, but this must take cognizance of their current knowledge, attitudes/beliefs, and practices (KABP) of the people if it will be sustainable. This study assessed the prevalence of cervical intraepithelial neoplasia (CIN) among university students and their level of KABP concerning cervical screening in Maiduguri North-Eastern, Nigeria. Materials and Methods: Two hundred and fifty-two subjects (age range: 18-69 years) were screened using pap smear screening method and acetowhite method. A structured questionnaire was administered on each subject to elicit information on KABP that could predispose them to the disease. Results: CIN was recorded in 12.8% of subjects with low-grade squamous intraepithelial lesion in 10.8% and high-grade squamous intraepithelial lesion 2.0% of the women, respectively. The average general level of knowledge of various aspect of was 43.3% average positive attitudes/beliefs about the disease was recorded in 17.1% of subject, while positive practices that could lead to prevention of the disease was obtained in 30.0%. Conclusion: The level of knowledge of the disease and screening is very low and together with high levels of negative attitudes and practices, will adversely affect control measures and therefore have to be addressed.
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Prevalence of dental caries and dental fluorosis among 12 and15 year-old school children in an endemic fluoride area of Nalgonda district, Andhra Pradesh, India
Jagadeeswara Rao Sukhabogi, P Parthasarathi, Shakeel Anjum, BR Chandra Shekar
July-August 2013, 6(4):422-429
DOI:10.4103/1755-6783.127785  
Introduction: The published literature on the prevalence of dental caries and fluorosis in Nalgonda district, an endemic fluoride belt in India was scanty. Objective: To determine the prevalence of dental caries and dental fluorosis among 12 and 15 years old school children in relation to fluoride concentration in Nalgonda district. Materials and Methods: Stratified random sampling technique was employed to select 20 schools from Nalgonda district. These areas were divided into four categories, low, medium, high and very high fluoride areas based on the fluoride concentration. The oral examination for dental caries and fluorosis among children who fulfilled the inclusion and exclusion criteria were conducted by a single trained and calibrated examiner using mouth mirror and CPI (Community Periodontal Index) probe under natural daylight. The data analysis was done using Statistical Package for Social Sciences SPSS version 16. Results: The prevalence of dental caries among 12 and 15 year old school children was 42.6% and 48.6% respectively. The prevalence was more among females (56.9%) than males (34.2%). The prevalence was more in low fluoride area (67%) followed by very high fluoride area (56.1%). The lowest prevalence was in medium fluoride area (20.5%). The prevalence of dental fluorosis increased with increasing fluoride concentration with no difference in the gender and age distribution. Conclusion: Defluoridation of water in areas where the concentration of fluoride is more than optimal is an immediate need as dental fluorosis is a major public health problem in these areas.
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Epidemiology of malaria in Nikshahr, Sistan and Baluchestan province, Southeast Iran, during 2004-2010
Hamzeh Alipour, Shokat Ali Amiri, Abolfazl Delavari, Adham Amiri
July-August 2013, 6(4):430-434
DOI:10.4103/1755-6783.127790  
Objective: Malaria is a major health problem in Nikshahr. In 2010, about 11.9% of the total malaria cases in Iran occurred in Nikshahr. The main purpose of this study was to survey the epidemiological features of malaria in Nikshahr, Southeast Iran, during a 7-year period, 2004-2010. Materials and Methods: The present survey is a descriptive study that involves positive cases of Malaria reported from the center of communicable diseases in Nikshahr. The data were entranced to a computer according to demographic and epidemiological characteristics of patients as well as plasmodium species; then they were analyzed by SPSS 16 software. Results: A total of 12233 cases were reported during 2004-2010 and three types of species of malaria parasite were detected. The highest positive number (2937) was reported in 2006 and the lowest number (221) in 2010. Malaria-positive cases of Nikshahr were mainly (60.2%) found among male individuals. The annual parasite incidence (API), which is the index of malaria incidence in the community, has decreased from 9.5 in 2004 to 1.09 in 2010. The slide positive rate among indigenous residents was significantly higher than that of the migrant population. Most (96.5%) of the malaria-positive cases were found among the Iranian population. About 0.3% of cases were identified to be mixed (falciparum and vivax), 98% Plasmodium vivax, and 1.7% Plasmodium falciparum. The largest number of malaria-positive cases occurred in October when the average percentage of humidity was 29.4 and the mean ambient temperature was 30.8°C. Conclusions: Several measures should ideally be implemented in an integrated pattern to contain the dissemination of malaria parasites and mosquito vectors; these include improvement of policies, regulations, and practices regarding malariological screening.
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The emerging trend in the epidemiology of gunshot injuries in the emergency department of a Nigerian tertiary hospital in a State without formal prehospital emergency medical services
Gabriel Uche Pascal Iloh, Abali Chuku, John Nnaemeka Ofoedu, Ogbonna Hyginus Ugwele, James Onyedikachi Onyekwere, Agwu Nkwa Amadi
July-August 2013, 6(4):435-440
DOI:10.4103/1755-6783.127794  
Background : Gunshot injuries (GSIs) though a rarity in Nigeria before the Nigerian civil war have now become rampant with variable epidemiology. It is emerging as a common cause of trauma-related emergency hospitalizations. Aim: The study was aimed at reviewing the epidemiology of gunshot injuries in the emergency department (ED) of a Nigerian tertiary hospital over a 5-year period. Materials and Methods: This was a retrospective study of GSIs seen at the ED of Federal Medical Centre, Umuahia, Nigeria using data from medical records, patients' case notes, ED admission registers, and nurses' report books. The data collected included age, sex, place of the incidence, time of the incidence, time of presentation to the hospital, anatomic sites, and etiology of the injury. Results : The age ranged from 14 years to 80 years with mean age of 47 ± 8.1 years. There were 95 males and 22 females with a male to female ratio of 4.3:1. The three most common causes were armed robbery (31.6%), kidnapping (21.3%), and police brutality (17.9%). The incident predominantly affected the middle age group (57.3%), occurred mostly during the day time (72.6%), affecting mainly the lower limbs (65.8%) and majority (84.6%) of the victims presented 1 hour after the injury. None of the victims received prehospital care. Conclusion: There was variability in the epidemiology of GSIs with kidnapping and police brutality emerging among preeminent contributors and downward trend of armed robbery-related GSIs. The incident occurred predominantly during the day time and most victims presented late to the ED. Interventional strategies including the responsible security apparatus system are advocated.
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Molecular detection of BRO β-lactamase gene of Moraxella catarrhalis isolated from Sudanese patients
Mazin O Mohager, Mogahid M El Hassan, El fadil A Omer, Miskelyemen A Elmekki
July-August 2013, 6(4):441-445
DOI:10.4103/1755-6783.127796  
Objective: To determine the frequency of BRO β-lactamase gene among Moraxella catarrhalis strains isolated from individuals with different clinical manifestations in Sudan. Design: Prospective cross-sectional laboratory-based study. Setting: Different hospitals and health centers in Khartoum State, Sudan. Materials and Methods: Fifteen (n = 15) β lactamase positive M. catarrhalis isolates, isolated from Sudanese patients with different clinical pictures were examined for the presence of BRO β-lactamase gene using restriction fragment length polymorphism (RFLP) technique. Results: Out of 400 patients, M. catarrhalis was isolated from 15 (3.75%) patients. All of the M. catarrhalis isolates were confirmed as β-lactamase producer, from which 11 isolates (73.3%) were positive for a BRO-1 gene using RFLP, whereas 4 isolates (23.7%) were BRO negative. Conclusion: The majority of β-lactamase gene of Moraxella catarrhalis in Sudan is BRO-1 gene. No BRO-2 gene was detected in this study; hence, the resistant phenomenon of Sudanese isolates of M. catarrhalis may attribute to BRO-1 gene.
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Antimicrobial resistance in Dschang, Cameroon
Fusi-Ngwa Catherine Kesah, Vincent Khan Payne
July-August 2013, 6(4):446-451
DOI:10.4103/1755-6783.127797  
Background: Health-care-associated and community infections remain problematic in most of Africa where the increasing incidences of diseases, wars, poverty, malnutrition, and general environmental deterioration have led to the gradual collapse of the health-care system. Detection of antimicrobial resistance (AMR) remains imperative for the surveillance purposes and optimal management of infectious diseases. This study reports the status of AMR in pathogens in Dschang. Materials and Methods: From May 2009 to March 2010, the clinical specimens collected at two hospitals were processed accorded to the standard procedures. Antibiotic testing was performed by E test, and antimycotics by disc-agar diffusion, as recommended by the Clinical and Laboratory Standards Institute on pathogens comprising Staphylococcus aureus (100 strains), Enterococcus faecalis (35), Klebsiella pneumoniae (75), Escherichia coli (50), Proteus mirabilis (30), Pseudomonas aruginosa (50), Acinetobacter species (20), and Candida albicans (150) against common antimicrobials. Results: There was no vancomycin resistance in the cocci, the minimum inhibitory concentration for 90% of these strains MIC 90 was 3 μg/ml, methicillin-resistant S. aureus (MRSA) was 43%, benzyl penicillin 89% resistance in S. aureus as opposed to 5.7% in E. faecalis. Low resistance (<10%) was recorded to cefoxitin, cefotaxime, and nalidixic acid (MIC 90 3-8 μg/ml) against the coliforms, and to ticarcillin, aztreonam, imipenem, gentamicin, and ciprofloxacin among the non-enterobacteria; tetracycline, amoxicillin, piperacillin, and chloramphenicol were generally ineffective. Resistance rates to fluconazole, clotrimazole, econazole, and miconazole were <55% against C. albicans. The pathogens tested exhibited multidrug-resistance. Conclusion: The present findings were intended to support antimicrobial stewardship endeavors and empiric therapy. The past, present, and the future investigations in drug efficacy will continue to be invaluable in health-care epidemiology.
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Bacterial isolates from the stools of children aged less than 5 years with acute diarrhea in Kaduna, Northwestern Nigeria
Edwin Ehi Eseigbe, Sam Iriah, Smart Ibok, Frank Anyanwu, Patricia Eseigbe, Sam John Adama, Godwin Iko Ayuba
July-August 2013, 6(4):452-455
DOI:10.4103/1755-6783.127798  
Background: Diarrhea is a significant cause of morbidity and mortality among children aged less than 5 years in sub-Saharan Africa. Bacterial organisms are important etiological agents and their identification is vital to effective management. Objective: To identify characteristics of bacterial isolates in the stools of children aged less than 5 years with acute diarrhea. Materials and Methods: The stools of children aged less than 5 years presenting with acute diarrhea were cultured using deoxycholate citrate agar and Salmonella-Shigella agar. Data were analyzed using Epi Info version 3.5.3 and P values <0.05 were regarded as significant. Results: Stool samples were obtained from 270 children aged 0.2 to 4.9 years (mean: 1.6 ΁ 1.4 years). Majority of the children were males (156, 57.8%) and aged <2 years (64.1%). Diarrhea was bloody in 28 (11.8%) children. Antibiotic therapy was instituted in 185 (68.7%) children before presentation and mostly prescribed by caregiver (87, 47%). Metronidazole (154, 83.2%) was the commonest antibiotic prescribed. Bacteria were isolated in 175 (64.8%) samples. The commonest isolate was Escherichia coli (105, 60%). Bacteria were isolated from 7 (25%) of bloody diarrhea stools and the isolates were E. coli (2, 28.6%) and Shigella spp. (5, 71.4%). Isolates were most sensitive to ciprofloxacin (167, 95.4%). Bacterial isolation was significantly (P < 0.05) associated with age <2 years, nonuse of antibiotics, and bloody diarrhea. Conclusion: Enterobacteria are still important etiological agents of acute diarrhea among children. The study highlights the need for appropriate treatment of children with diarrhea and promotion of its prevention.
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Experience of use of magnesium sulfate in the treatment of tetanus in a tertiary referral Infectious Disease Hospital, Kolkata, India
Alakes Kumar Kole, Rammohan Roy, Suvrendu Sankar Kar, Dalia Chanda Kole
July-August 2013, 6(4):456-459
DOI:10.4103/1755-6783.127799  
Background: Tetanus is still a public health problem in developing countries with high morbidity and mortality. Aims and Objectives: To evaluate the effects of magnesium sulfate in the treatment of moderate to very severe tetanus cases. Patients and Methods: Eighty-six patients suffering from of moderate to very severe tetanus, treated with injection magnesium sulphate in combination with injection diazepam were evaluated and compared to the tetanus patients from the hospital record (treated with only diazepam) regarding outcomes. Results: The average duration of reflex spasm was 12 vs. 8 days in moderate group, 18 vs. 15 days in severe group and 21 vs. 17 days in very severe group in the previous and study year respectively. Average duration of hospital stay was 20 vs. 17 days in moderate group, 27 vs. 22 days in severe group and 36 vs. 30 days in very severe group in the previous and study year respectively. It had been observed that in both severe and very severe tetanus cases, occurrence of autonomic instability, respiratory depression, aspiration pneumonia, cardiac arrhythmia and total death - all were decreased in the study period than previous year. Conclusion: Magnesium sulfate in combination with diazepam may be a better option in the treatment of tetanus particularly in developing countries with limited intensive care facility because of morbidity and mortality benefits.
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Microbial profile in women with puerperal sepsis in Gadarif State, Eastern Sudan
Mohamed Issa Ahmed, Mohamed Alkhatim Alsammani, Rabie Ali Babiker
July-August 2013, 6(4):460-464
DOI:10.4103/1755-6783.127801  
Background: Increasingly, women in rural areas in Sudan reported to hospital with puerperal sepsis. Aims: This study was design to identify the common pathogens causing puerperal sepsis and their susceptibility to current antibiotics. Materials and Methods: We prospectively studied 170 women from January 2011 through December 2012 who attended Hussein Mustafa Hospital for Obstetrics and Gynecology at Gadarif State, Sudan. We included patients if they met the criteria proposed by the World Health Organization (WHO) for definition of puerperal sepsis. Results: Out of the 170 patients, 124 (72.9%) were pathogen-positive samples. Out of 124 positive isolates, aerobes were the predominant isolates 77 (62.1%) which included Staphylococcus aureus 49 (39.5%), Staphylococcus epidermidis 7(5.6%), and Listeria monocytogenes 21 (16.9%). The anaerobe isolates were Clostridium perfringens 34 (27.4%) and Enterobactor cloacae 13 (10.5%). Standard biochemical test were for bacterial isolation. Higher rate of infections followed vaginal delivery compared to Cesarean section, 121 (97.6%) and 3 (2.5%), respectively. All strains of Staph were sensitive to vancomycin, gentamicin, and ceftriaxone. C. perfringens were sensitive to ceftriaxone, penicillin, vancomycin, and metronidazole, while E. cloacae was sensitive to gentamicin and ceftriaxone. Conclusion: In this study, the main bacteriological isolates were S. aureus, S. epidermidis, L. monocytogenes, C. perfringens, and E. cloacae. Despite the limited resources in the developing countries, treatment based on cultures remains the only solution to reduce maternal morbidity and mortality rates following puerperal sepsis.
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Prevalence and causes of ocular morbidity seen among rural adult population of Osun State, southwest Nigeria
Michaeline A Isawumi, Mustapha B Hassan, Esther O Asekun-Olarinmoye, Patience O Akinwusi, Wasiu O Adebimpe, Christopher O Alebiosu
July-August 2013, 6(4):465-471
DOI:10.4103/1755-6783.127802  
Context: World Glaucoma and Kidney Days were planned for community eye/health screening. Aims: To assess the prevalence and causes of common eye disorders and visual impairment (VI) in two rural communities of Osun State. Settings and Design: Descriptive cross-sectional. Materials and Methods: Ethical clearance was obtained. Serial recruitment of all consenting adults presenting at Alajue and Ibokun communities over 2 days was done. Sociodemographic data were obtained. Visual acuity and anterior and posterior segment examinations were done. Refraction was done as necessary. Intraocular pressures (IOPs) were checked for cup:disc ratio >0.6 and perimetry done at base hospital for glaucoma suspects. VI was classified according to the World Health Organization ICD.10. Descriptive analysis was carried out. Chi-square with P-values and 95% confidence intervals (CIs) were used to test for significance. Results: In all, 259 subjects-100 males (38.6%) and 159 females (61.4%)-participated. Mean age was 39.73 years (standard deviation [SD] 16.6). The commonest eye disorders were cataract 67 (25.9% CI: 20.5-31.2), refractive error 66 (25.5% CI: 20.2-30.8), glaucoma 17 (6.6% CI: 3.5-9.6), pterygium 14 (5.4%), conjunctivitis 11 (4.2%), hypertensive retinopathies 10 (3.9%, 95% CI 1.5-6.2), cornea opacities 3 (1.2%), and di glaucoma was abetic retinopathy 2 (0.8%). Glaucoma and IOPs were significantly correlated (P = 0.039). CVF changes and glaucoma was significantly associated (P < 0.001). Prevalence of moderate VI was 73 (28.2%, CI: 22.7-33.7), severe VI 9 (3.5%, CI: 1.2-5.7), and blindness 5 (1.9%, CI: 0.2-3.6). Conclusions: There is need to establish community eye-outreach centres to identify cases for cost-effective cataract, refractive error, and glaucoma services. This could reduce the occurrence of these vision and life-threatening disorders.
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REVIEW ARTICLE
Nonalcoholic liver disease and non-alcoholic steato hepatitis: A review in eyes of a histopathologist of West Bengal, India
Pranab Kumar Bhattacharya, Upasana Bhattacharya, Rupak Bhattacharya, Ritwik Bhattacharya, Soumyak Bhattacharya, Debasish Roy Barman, Dalia Mukherjee, Rupsa Bhattacharya, Oaindrila Mukherjee, Debasis Mukherjee, Anuradha De, Surajit Sarkar, Shyamal Haldar
July-August 2013, 6(4):393-400
DOI:10.4103/1755-6783.127769  
NAFLD characterized by steatosis, when NASH by steatosis, lobular inflammation or steatosis with fibrosis. NAFLD increasingly recognized today as hepatic manifestation of systemic 'metabolic complex" also in India and in province like West Bengal with BMI greater than equal 30kg/m 2 , 67% of overweight patients in which BMI greater than or equal to 25 kg/m 2 and even in 25% normal weight population or with uncontrolled type 2- NIDDM. NAFLD/NASH today one of most common liver diseases in USA, Australia, Europe, Asian countries like china, Dallas, India, and West Bengal with emerging epidemic of obesity due to DM, consumption of fast food and rich food habits in people of industrialized cities and towns even in rural villages of West Bengal . NASH a progressive form of the disease finally leads to cryptogenic cirrhosis of liver even HepatoCellular Carcinoma requires liver transplant for cure. In most cases of NASH, Insulin resistance is found. The responsible gene is fetuin-A (FetA), ethnicity, Familial clustering in first degree relatives (20% of NASH). Natural history of NAFLD variable, although most patients experience an indolent course, some others progress to cirrhosis and liver related death. Paired liver biopsy data of predominantly NASH patients shows that over a follow up period of 2-5 years 18% - 29% patients improved with life style modification and treatment, 34% to 53% remain stable and 26% to 37% develop Cirrohosis and 9% of Cirrohosis from NASH within short time, The two hit hypothesis is widely accepted theory to explain progression of NAFLD from benign steatosis towards NASH. Diagnosis of NASH is challenging before clinicians, Radiologists by USG, with fibroscan devices, MRI, PET scan unless live needle biopsy is done and final diagnosis of NASH remains in clinical knowledge of combined Hepatologists and Hispatothologists. Liver enzymes, several biomarkers for NASH availble like TNF- alpha, Adiponectin- TNF/adiponectin ratio, serum leptin, C reactive protein.
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