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   2013| March-April  | Volume 6 | Issue 2  
    Online since August 14, 2013

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Invasive aspergillosis in a HIV patient on prolonged steroid therapy
Himanshu Reddy, Sameer Saraf, Mohit Mohan Singh
March-April 2013, 6(2):245-247
Central Nervous System complications are the most dreaded complications in patients of HIV. CNS aspergillosis in HIV is a rare complication. The primary risk-factors for invasive aspergillosis are profound neutropenia and glucocorticoid use; risk increases with longer duration of these conditions. In our case report, the HIV patient was treated with Anti Tubercular Treatment and steroids for CNS tuberculosis previously. Use of steroids might have predisposed him for aspergillosis. Physicians should be aware that the CNS might be the only site of Aspergillus involvement and should include CNS aspergillosis in the differential diagnosis of HIV-infected patients presenting with focal neurologic signs and symptoms, especially, when the head Computed Tomography reveals hypodense lesions.
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An unusual case of acute painful calf swelling
Chandrashekhar A Sohoni, Dipti C Sohoni
March-April 2013, 6(2):258-260
Cysticercosis commonly involves central nervous system. Isolated involvement of skeletal muscles is rare. We have reported a case of cysticercosis herein presented as acute painful calf swelling, which is an extremely unusual presentation and, hence, a diagnostic challenge. The diagnosis was strongly suspected on ultrasonography and magnetic resonance imaging (MRI). The laboratory findings of peripheral eosinophilia and a positive enzyme-linked immunosorbent assay (ELISA) test for IgG antibodies against Taenia solium further supported the diagnosis. Complete clinical recovery was seen after 6 weeks of oral therapy with albendazole.
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Disinfection of stethoscopes: Gap between knowledge and practice in an Indian tertiary care hospital
Anshu Jain, Harshada Shah, Amit Jain, Megha Sharma
March-April 2013, 6(2):236-239
Context: Stethoscopes are used primarily to assess the health of patients and are one of the most commonly used medical devices. Thus, are the prominent tools for the spread of health-care associated infections (HAIs). Aims: The study was conducted to assess the knowledge and awareness about handling of the stethoscope and cleaning practices followed among the healthcare workers (HCWs). Materials and Methods: A total of 80 participants were included during a 4-month study period at a tertiary care hospital in Ujjain. A semi-structured questionnaire was distributed to HCWs and the surface of the diaphragm of their stethoscopes were swabbed for bacteriological analysis using standard techniques. Results: Out of total 80 stethoscopes, 69 (86%) were found to be contaminated with at least one type of microorganism. Pseudomonas aeruginosa was the most predominant bacterial species found on 58 stethoscopes, followed by Bacillus subtilis (n = 21) and Staphylococcus spp. (n = 16). Out of total 10 S. aureus isolated, 3 were methicillin-resistant S. aureus ( MRSA). Majority (97%) of the HCWs had good knowledge about the topic, but only 22 (27%) reported to apply it in the practice. Conclusions: Our study confirmed that majority of the stethoscopes were contaminated with microorganisms. Besides having knowledge about the importance of cleaning the stethoscopes, lower percentage of HCWs reported to follow it in practice. Thus, the authors recommend regularization of reminders such as circulars, motivating posters for the HCWs to clean the diaphragm of the stethoscopes.
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Strongyloidiasis of duodenum clinically masquerading as gastric malignancy
V Srinivasa Murthy, K Geethamala, B Deepak Kumar, M Sudha Rao
March-April 2013, 6(2):248-250
A 58-year-old male patient presented with pain abdomen since 1 month and bilious vomiting since 1 week. After admission to our hospital, in view of his age and clinical presentation, upper gastrointestinal endoscopy was done and biopsy sent for histopathological examination. A diagnosis of Strongyloidiasis of duodenum was made. Herein, we report such an unusual case, where the diagnosis was first made by duodenal biopsy, rather than simple stool examination. Since the case clinically masqueraded as gastric malignancy, the importance of routine simple stool examination and role of pathologist in identifying the parasite is hereby highlighted.
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A case of dengue fever complicated by acute transverse myelitis
Manish Gutch, Nirdesh Jain, Sukriti Kumar, Aniyang Modi
March-April 2013, 6(2):251-253
Dengue infection is now known to have varied neurological complications, involve central as well as peripheral nervous system. Only few isolated cases of acute transverse myelitis (ATM) have been reported. In this paper, we report a case of a 15-year-old female who developed acute onset quadriparesis following a dengue virus infection. Magnetic resonance imaging of the spinal cord disclosed signal-intensity abnormalities from C2 to T3. A diagnosis of ATM was considered. Because of the very rapid involvement of upper cervical cord, respiratory paralysis ensues. The patient condition necessitated her to be put on mechanical ventilation. Intravenous methylprednisolone was also given, but eventually patient expired.
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Invasive orbital Aspergillosis in an immunocompetent individual after functional endoscopic sinus surgery
M Ashok Kumar, Srikanth Krishnagopal, Divya Manivannan, Vathsalya Ramraj
March-April 2013, 6(2):254-255
Invasive orbital aspergillosis is a rare clinical entity reported in immunocompetent individuals from tropical areas like India. We are reporting a rare clinical presentation of this condition, which was precipitated by functional endoscopic sinus surgery (FESS).
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A rare case of acute eosinophilic pneumonia
Sameer Saraf, Vivek Kumar, Mohit Mohan Singh
March-April 2013, 6(2):256-257
Acute eosinophilic pneumonia (AEP) has been described as an acute febrile illness with severe hypoxemia, diffuse pulmonary infiltrates, and an increase in bronchoalveolar lavage eosinophils. There is also no evidence of infection, no history of asthma or atopic illness, and complete resolution of all abnormalities after treatment with corticosteroids. [1] It is a reversible cause of non-infectious respiratory failure. [1],[2] AEP is a rare disorder, and less than 100 cases have been reported to date, with the largest series including only 15 patients. [3],[4] We report a case, which had features of AEP with no radiological evidence of pulmonary infiltrates.
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Mild self resolving acute leptospirosis in an HIV infected patient in south India
Anand Pai
March-April 2013, 6(2):261-262
Leptospirosis is a zoonotic disease that occurs throughout the world. Clinical manifestations range from asymptomatic serological conversion to acute undifferentiated fever to malignant presentation with jaundice, renal failure in human immunodeficiency virus (HIV) patients. Here with we report a case of mild self resolving form of acute leptospirosis in a HIV patient as such cases are very sparse and reported in India.
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Recent resurgence of Chikungunya fever in Delhi, India
Tanmay Mahapatra
March-April 2013, 6(2):149-150
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Does naked eye examination of QBC capillary tube give a clue for malaria diagnosis?
Sarita Mohapatra, Jyotish C Samantaray
March-April 2013, 6(2):263-264
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Opportunistic intestinal parasitic infections
Sabitha Kandi
March-April 2013, 6(2):264-264
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Menstruation during dengue hemorrhagic fever: A case study
Viroj Wiwanitkit
March-April 2013, 6(2):265-265
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A cross-sectional study on patient satisfaction toward services received at rural health center, Chandigarh, North India
Abhiruchi Galhotra, Sandeep Singh Sarpal, Sorab Gupta, Naveen Krishan Goel
March-April 2013, 6(2):240-244
Background : Shortcomings in the delivery of primary health care services at state-run centers and more dependence on private health care service providers has resulted in lesser utilization rates. Feedback from patients is vital if deficiencies are to be identified and improvements achieved. This study attempts to assess client satisfaction of the PHC services provided by a rural health training center. Objectives : The main objective of the study is to measure the satisfaction of OPD patients at a rural health center, and also (1) to know the relationships between the various determinants and OPD patients satisfaction and (2) to correlate patient satisfaction with the sociodemographic profile. Materials and Methods : A cross-sectional study was done to assess the satisfaction of services provided at the rural health center which caters to population of around 40,000. The response was rated on a 5-point Likert scale. SPSS version 15 was used to analyze the data. Average satisfaction of each patient was taken and the overall mean and SD was calculated to know about the overall satisfaction. Results : The mean age is 33.45 ± 10.719 years. The mean waiting time for consultancy was 11.84 ± 8.932 min. The mean consultation time by the physician was 6.06 ± 3.002 min. The mean waiting time for drugs is 5.93 ± 5.213 min. Only 28.5% were highly satisfied with the available lab investigations. 58.5% of the clients were highly satisfied with the doctor's relationship with the patients. 63% felt that adequate privacy was given during consultation. Conclusions : The results of the present study showed that although the overall satisfaction was high, some aspects of services indicated some degree of dissatisfaction.
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Plasmodium index, prevention, and control of malaria in Dschang municipality, Cameroon
Vincent K Payne, Catherine K Fusi-Ngwa, Endah Ndambi, Mbida Mpoame
March-April 2013, 6(2):166-172
Background : Disease surveillance identifies prevention targets and provides information to monitor growth. Malaria eradication in Africa was a high priority within the United Nations Millennium Development Goals. This work aimed to accentuate the status of malaria in Dschang amid rigorous interventions. Materials and Methods : In a cross-sectional study, 515 persons, comprising 300 pupils in six primary schools and 215 individuals living around a municipal lake, were screened for malaria using standard parasitological methods. A questionnaire was administered for relevant epidemiological information. Results : Seventy-nine (15.3%) persons positive for Plasmodium were all asymptomatic; 71 (13.8%) cases had Plasmodium falciparum, and 8 (1.5%) Plasmodium malariae; Loa loa and Mansonella perstans (0.2% each) were also identified. There was a significant negative correlation between age and infection (r = -0.82). The parasite density ranged from 60 to 22590 parasites/mm 3 of blood, mean 1014.68 p/mm 3 , with 3 (0.6%) severe cases (> 5000 p/mm 3 ). Children aged 0-4 years were most vulnerable, Plasmodium index (PI)-33.3%. The PI was higher in pupils' resident on the semi-rural swampy outskirts conducive for mosquito development. Distance from the lake had no influence on PI. Parasitemia increased significantly in August. Dschang was established mesoendemic for malaria with a low density. Increasing urbanization, health promotion, good drainage and sanitation, the use of mosquito nets, chemoprophylaxis for pregnant women, treating children up to five years free, and the use of insecticides to kill adult mosquitoes seemed to reduce malaria transmission and its fly vectors. Conclusion : Scaling up, greater efficiency, and equitable delivery of malaria control initiatives would be fruitful.
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Hearing screening techniques for referral purposes: Our experience from a rural setting
Abdulazeez O Ahmed, Fatimah I Tsiga-Ahmed, Muhammad G Hasheem, Abdulrazaq Ajiya
March-April 2013, 6(2):173-178
Background: Two thirds of the burden of hearing loss is predominantly in low- and middle-income countries. The World Health Organization estimated about 642 million (10.6%) of the world's population has any level of hearing impairment in 2005. It becomes, therefore, imperative to gather data for the purpose of planning prevention strategies for hearing impairment and for monitoring and evaluation of these programs at primary and national levels. Aim: The aim of this study was to determine the prevalence of hearing impairment and report our findings on hearing screening in a rural setting. Materials and Methods: A total of 37 persons with hearing impairment were identified out of 650 seen with ages ranging from 3 to 60 years in a rural setting. They all had full clinical examination, tuning fork, and voice tests to assess hearing levels and otoscopy. Results: An overall hearing loss prevalence of 5.7% was observed, with commonest causes of hearing loss identified as febrile illness 48.6%, ear infections 32.4%, congenital and meningitis 8.1% each, and measles 2.7%. Conclusion: Prevalence studies and hearing screening programs are necessary to help formulate policies geared toward primary ear and hearing care. This will help reduce the burden of hearing loss as well as help to provide cheap and affordable hearing aids to the needy.
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Predicting changing measles epidemiology in an urban West African population
Baba Usman Ahmadu, Yakubu Mava, Jose Pwavimbo Ambe, Joda Aisha Abdallah, Emmanuel Onimisi Ovansa
March-April 2013, 6(2):179-182
Background: Measles remains a major cause of childhood morbidity and mortality. Control of measles is complicated by pattern of measles transmission in which children are infected after they lose their protection from maternal measles antibodies (MMAs). As such, infants become measles prone before the age of measles immunization. This study, therefore, aimed at predicting changing epidemiology of measles in children in Maiduguri, Borno State, Nigeria. Materials and Methods: One hundred and thirty six infants at the age of seven months were enrolled in this study using the stratified random sampling method, and were tested for MMAs using enzyme-linked immunosorbent assay. Results: Sixty nine (50.7%) of the infants were males and 67 (49.3%) females, giving an approximate male to female ratio of 1.03:1. Comparing mean MMA levels of infants, for those who were protective and those who were unprotective was significant (P<0.0001). Most of the infants (125, 91.9%) had unprotective MMAs at seven months of age. Conclusion: Majority of infants in this study had unprotective MMAs at seven months of age and are more susceptible to measles. There is the need to monitor similar trend of events in other parts of Nigeria and abroad in order to report changing ecology of measles.
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Incidence of Kell blood group in Kashmiri population attending blood bank SKIMS as donors
Mohd Younus Shah, Faisal Younis Shah, Faizan Younis Shah
March-April 2013, 6(2):183-187
Purpose: To determine anti-Kell in Kashmiri population. Material and Methods: Prospective study of One Year. Result: Six patients were tested positive. Conclusion: The incidence of Kell is very low i.e., 0.03% and correlates to the incidence of Japanese.
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Giant hydatid cysts of the lung: Analysis and surgical outcome of 67 cases
Fatih Meteroglu, Atalay Sahin, Sevval Eren, Canan Eren
March-April 2013, 6(2):188-191
Aims: We aimed to evaluate the results of surgical treatment of huge hydatid cysts diagnosed at our clinic. Ruptured cysts have caused severe complications. Perforation of very large cysts is always possible. These can result in fatal complications. We present our surgical experience with large hydatid cysts in this paper. Materials and Methods : We retrospectively reviewed 191 patients diagnosed as hydatid cysts who were treated surgically. Among these, 67 cases were studied with a dimension of 10 cm or more. Age, gender, symptom, ruptured or intact, dimension, quantity and radiologic findings of the cases were determined. Incipiency of complaint, postoperative morbidity and length of hospital stay for all cases were assessed. Results: The cases comprised 41 females and 26 males. The mean age was 20.20 ± 16.13 (5-52) years. Hospital stay for the huge and ruptured cysts group was 11.21 ± 4.04 days. The huge but unruptured cysts group had a hospital stay of 8.40 ± 2.48 days. All patients underwent thoracotomy. Cystotomy plus capitonnage in 52 (77.61%), decortication in addition to cystotomy plus capitonage in seven (10.6%), cystotomy in six (8.6%), cystotomy plus enucleation in one and primer closure in one were carried out. Postoperative mortality was absent; however, 17 cases were complicated; atelectasis was found in five cases, prolonged air leakage in five cases, apical aseptic pleural space in three cases, empyema in two cases, hemopthisis in one case and diaphragmatic elevation in one. Conclusions: Immediate surgery is of choice in giant cysts. Possibility of complication and longer stay in the ruptured group is higher compared with simple cystic disease.
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Is diagnostic protocol a cause of overestimation of extra-pulmonary tuberculosis in Himachal Pradesh? A report from a high-prevalence tuberculosis unit
Vishav Chander, SK Raina, AK Bhardwaj, S Kashyap, Anmol K Gupta, Abhilash Sood
March-April 2013, 6(2):192-196
Aims and Objectives: To study the diagnostic practices for diagnosis of extra-pulmonary tuberculosis (EPTB) in a high-prevalence tuberculosis unit (TU). Material and Methods: It was a cross-sectional study using a pre-designed and pre-tested structured questionnaire. The information was collected from new EPTB cases registered in Rampur TU between 1 July 2007 and 31 March 2008. Diagnostic practices of the medical practitioners for establishing the diagnosis of different types of EPTB were studied. Results: For the diagnosis of pleural TB the main tools used were X-ray chest (37 cases; 100.0%) and aspiration of pleural fluid (pleural tap) for color of pleural fluid (35 cases; 94.6%). For establishing the diagnosis of lymph node TB, eight (66.6%) cases were subjected to fine needle aspiration cytology (FNAC) examination of involved lymph nodes. Excision biopsy of lymph nodes was undertaken in the remaining four (33.3%) cases. The diagnosis of abdominal TB was primarily established on the basis of X-ray (six cases; 85.7%) and ultrasonography (USG) of abdomen for the presence of ascites in five (71.4%) cases. The patients of tubercular meningitis were diagnosed predominantly on clinical grounds whereas in bone and genitourinary TB, all appropriate investigations were performed for confirmation of EPTB of these organs. Conclusions: Except for lymph node TB and the patients in whom the diagnosis had been established in tertiary care institutions of the state, patients were being diagnosed on clinical grounds.
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Thrombocytopenia in malaria and its correlation with different types of malaria
Manmeet K Gill, Manisha Makkar, Sachan Bhat, Tanveer Kaur, Kalpana Jain, Geetika Dhir
March-April 2013, 6(2):197-200
Aim of the Study: Malaria is a major health problem in the tropics with increased morbidity and mortality. Thrombocytopenia is a common finding in malaria. Although a reliable diagnostic marker, prognostic implications could vary in the two types of malaria. This study was undertaken to assess the presence and severity of thrombocytopenia in malaria patients. Design: A total of 120 patients were included in the study and identified positive for malaria parasites on peripheral smear examination with conventional microscopy. Platelet count was done on a fully automated, quantitative, hematology analyzer. Results: Thrombocytopenia was noted in 63.33% cases. The mean platelet count in Plasmodium vivax (Pv) malaria was 1,27,652/μl (SD 78,269) with a range of 8000-3,50,000/μl, as against Plasmodium falciparum (Pf) malaria where the mean platelet count was 78,500/μl (SD 51,485) with a range of 9000-1,90,000/μl. Platelet count < 50,000/μl was noted in only 17.4% cases of Pv malaria as against 33.3% cases of Pf malaria. Conclusion: Although absence of thrombocytopenia is uncommon in malaria, its presence is not a distinguishing feature between the two types of malaria. Our study stresses the importance of thrombocytopenia as an indicator of acute malaria.
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Cysticercus cellulosae lies in the eyes of the beholder
Thomas Kodiatte, Prasad Chinaiah, Thej Mothakapalli, Harendra Kumar
March-April 2013, 6(2):201-205
Context: Cysticercosis is quite common in the tropics. Fine needle aspiration cytology (FNAC) plays an important role in prompt diagnosis of this disease. Aims: The aim of this study was to study the role of FNAC in the diagnosis of cysticercosis. Materials and Methods: Among all the subcutaneous swellings referred for FNAC to our tertiary care hospital during the time period from 2009 to 2011, we found thirty cases of cysticercus infestation which were clinically diagnosed as tuberculous lymphadenitis, reactive lymphadenitis and lipoma. We also reviewed all the reported subcutaneous swellings during that period, which were already classified as acute suppurative processes (forty), for the presence of any parasite fragments. Results: In twenty-eight cases, a definitive diagnosis of cysticercosis was obtained in the form of fragments of parasite bladder wall, and biopsy confirmed the diagnosis in three cases. Two of the forty cases, which were initially reported as acute suppurative lesions during routine reporting, were retrospectively reviewed and parasite fragments were observed. Remaining 38 cases were extensively searched for any evidence of the parasite: however, they only showed acute suppurative inflammation with eosinophils, neutrophils and histiocytes. Conclusions: FNAC for diagnosis of cysticercosis is a low-cost, outpatient procedure. The cytological diagnosis is quite clear where the actual parasitic structures are seen in the smears. However, in other cases, the presence of eosinophils, histiocytes, and a typical granular dirty background should always alert the pathologist to the possibility of this condition. In endemic areas, it should be considered as one of the differential diagnoses for all subcutaneous swellings.
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The use of estimated glomerular filtration rate in the evaluation of renal function in HIV-positive children in Enugu
Bertilla U Ezeonwu, Tagbo Oguonu, Henrietta U Okafor, Anthony N Ikefuna
March-April 2013, 6(2):206-210
Background: Glomerular filtration rate (GFR) is a measure of renal function that estimates the volume of fluid filtered from the renal glomerular capillaries. An assessment of renal function in HIV-positive children is timely due to the high prevalence of HIV-associated nephropathy (HIVAN) in HIV-positive children that progresses to end-stage renal disease (ESRD). Objectives: To estimate the glomerular filtration rate using creatinine-based Schwartz formula. To determine the renal function in HIV-positive children in UNTH, using the estimated glomerular filtration rate (eGFR). Materials and Method: A total of 159 HIV-positive children had serum creatinine estimation and GFR calculated using the Schwartz formula. Values of eGFR of 2SD below the normal for age and gender as determined by National Kidney Foundation (NKF) were taken as low renal function. Results: There were 80 males and 79 females enrolled. The mean eGFR for the study population was 109.44 ± 16.86 mls/min/1.73 m 2 . Ninety children (56.6%) had normal renal function while 69 (45.4%) had low renal function for their respective age groups. Those with low renal function were older (P < 0.001) and had lower CD4 cell counts (P = 0.01). The eGFR was inversely related to age (r = -0.30, P = < 0.001) and directly related to CD4 cell count (r = 0.30, P = < 0.001). Conclusion: There is derangement in renal function among HIV-infected children as seen from their eGFR.
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Isolation and molecular identification of actinomycetes from mycetoma patients in Sudan
Mogahid M Elhassan, Anas M Yousif, Miskelyemen A Elmekki, Mohammed E Hamid
March-April 2013, 6(2):211-214
Introduction: In order to minimize chance of amputation due to actinomycetoma, it is important to correctly identify the causative agents. Microscopic examination of grains is not definite and further confirmatory diagnostic tests are needed. This study aims to investigate the prevalence of actinomycetoma and to explore the usefulness of strb1 gene in the diagnosis of the disease. Materials & Methods: The present study is a prospective cross-section laboratory-based study in which clinical samples (n = 100) from patients with mycetoma lesions were collected. The samples were cultured on Lowenstein Jensen and glucose yeast extract agar media. Grown colonies were initially identified using Gram's stain, Ziehl Neelsen stain, and selected biochemical reactions. Confirmation was done by the analysis of polymerase chain reaction amplified strb1 gene. Results: Actinomycetoma was represented by a high ratio (12%) among the study population. Nine out of the 12 isolates (75%) were found to belong to the genus Streptomyces; whereas three isolates (25%) were identified as Nocardia spp. on the basis of phenotypic and mycolic acid contents. Conclusion: It could be concluded that actinomycetoma exists with significant prevalence (12%) among patients investigated in the present study. Streptomyces is the most important etiological agent of actinomycetoma compared to Nocardia.
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Reproductive tract infections among women in a peri-urban under privileged area in Bangalore, India: Knowledge, prevalence, and treatment seeking behavior
Shailendra K.B. Hegde, Twinkle Agrawal, Naveen Ramesh, Medha Sugara, Preethi M Joseph, Shipthi Singh, Sulekha Thimmaiah
March-April 2013, 6(2):215-220
Introduction: Globally, reproductive tract infections (RTIs) are a major cause of acute and chronic illness with severe consequences. Women are at a greater risk than men and are less likely to seek treatment because of the associated stigma. Objectives: To assess the knowledge and estimate the prevalence of RTIs, and treatment seeking behavior regarding RTI. Materials and Methods: A community-based cross-sectional study was done in a peri-urban underprivileged area, in Bangalore where all ever-married women in the reproductive age group were interviewed using a pre-structured and pre-tested schedule by female medical doctors in the privacy of their homes. Results and Discussion: Of the 179 women who participated in the study, 47.5% were in the age group of 25 to 34 years with the mean age being 29.84 years (±7.92). The mean knowledge score was found to be 3.78 (±2.3) and the maximum score was found to be 10, which indicated poor knowledge regarding RTIs which was similar to other studies done elsewhere. The prevalence of RTI was found to be 26.8%, while the period prevalence of RTI for the last 1 year was 39.1%, and 60% of these women sought some form of treatment. Other studies have reported prevalence ranging from 21.9% to 92% in India. The age-specific prevalence was highest in the 15 to 19 years age group (30%), with most common symptom being white discharge per vagina (43.7%). Conclusions: Knowledge regarding RTI was poor while the prevalence of RTI was high (26.8%) and the treatment-seeking behavior was inadequate.
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An evaluation of the pharmaceutical quality and antimicrobial effectiveness of some frequently used eye drop products available for sale in Nigeria
Ezekiel O Akinkunmi
March-April 2013, 6(2):221-226
Aim: Eye drop products must be properly packaged and must be sterile throughout the period of use. For this reason, we evaluated eye drops offered for sale and used for the treatment of eye diseases in Nigeria for their pharmaceutical quality and antimicrobial effectiveness. Materials and Methods: Eleven different sterile eye-drop product samples containing gentamicin, chloramphenicol, timolol, tropicamide, tetrahydrozoline, pilocarpine, antazoline-tetryzoline, diclofenac, dexamethasone, and flubiprofen were opened and tested for bacterial contamination after exposure to air over 56 days. To assess the possibility of contaminations by pathogens due to repeated handling during use about 10 7 -10 8 cells of Pseudomonas aeruginosa, Escherichia coli, Staphylococcus aureus, and Candida albicans were added to other newly opened eye drops and incubated at room temperature. Samples were collected and the number of viable organisms was estimated. Eye-drop product samples were also investigated for packaging, pH, and clarity. Results: No viable microorganisms were detected in the eye drops during and at the end of the 56 days exposure to air. All the samples exhibited rapid bactericidal and fungicidal activities at a rate which depended on the species of pathogens and the content of the sample. The anti-infective samples demonstrated the highest rapidity in microbicidal activities. There were no microbial survivors in any of the samples after 4 h of inoculation by pathogens. Conclusions: The study concluded that generally multi-dose eye drop products offered for sale in Nigeria were of acceptable microbial quality and possessed good antimicrobial effectiveness.
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Situation of P. vivax malaria in Ahmedabad city: A study in purview of national guidelines
Urvish Joshi, Anand Solanki, Umesh Oza, Rajashree Bhatt, Sheetal Vyas, Pinkal Patel, Apexa Rana, Leena Dabhi
March-April 2013, 6(2):227-231
Introduction: Malaria is still the most important cause of morbidity-mortality in India. National vector borne disease control program (NVBDCP) in urban areas is implemented through UHCs. In Gujarat, 89,764 malaria cases were reported in 2011 with 127 deaths, with 17.9% of them being the vivax cases. Ahmedabad is at the receiving end of malaria menace due to its rapid growth. Compared to 2011, significant rise in number of Plasmodium vivax (Pv) cases has been observed in Ahmedabad in 2012. Aims and Objectives: The study was carried out to assess the Pv malaria detection modalities, relevant indices, existing radical treatment strategies, and adherence to national guidelines in the urban areas of Ahmedabad. Materials and Methods: Data of all 9 UHCs of south zone, catering total population of approximately 1 million and showing significant rise in Pv cases, were verified clubbed with field analysis, for the corresponding quarters of March, April, and May of two consecutive years-2011-2012. Concerned healthcare staff was interviewed. Guidelines and definitions of national anti-malarial guidelines and operational manual were followed. Process indicators for surveillance, case finding, and disease burden were considered. Results: Out of total blood smears examined, Pv cases raised from 97 (2011) to 382 (2012). Statistically significant rise of Pv% was 0.35% and 2.79% in active and passive slide collection, respectively. 71% slides were actively collected in both years. Quarterly Blood Examination Rate (QBER) rose from 1.50% to 2.41%. Quarterly Parasite Index (QPI) rose from 0.12 to 0.39. Successful Radical Treatment of Pv Malaria (RT) completion decreased from 59.8% to 29.1%. Knowledge regarding national-anti-malarial-guidelines was satisfactory in more than 70% of healthcare functionaries. Interpretations: Number of cases significantly increased in two years, Pv-positivity rise being 1.04%. Active slide collection is static. Rise in Pv-positivity should trigger improvement in the same. Average QBER and QPI rose in two years. QBER never reached prescribed levels. Successful RT-completion is the key towards drug-resistance and relapse prevention. Adherence to national-anti-malarial-guideline is imperative.
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Diagnosis of malaria in red sea state, Sudan
Ali K Ageep
March-April 2013, 6(2):232-235
Background: Malaria is one of the world killers, but it is curable disease if patients have access to early diagnosis and prompt treatment. The aims of this study are to estimate the frequency of malaria cases among febrile patients, to evaluate the frequency of the parasite species, and to detect the best method for diagnosis of malaria in Red Sea State, Sudan. Materials and Methods: This study was carried out in laboratory of the Red Sea Medical center, Port Sudan, Sudan in period from July 2005 to May 2011. Blood samples were collected from 9,670 febrile patients suspected to have malaria and were examined by expert technologists under the supervision of senior pathologist. Another 717 blood samples seen in peripheral laboratories by routine microscopy were sent for confirmation by expert microscopy. Rapid diagnostic tests (RDT) were also done to these blood samples. Results: Out of the 9,670 febrile patients, only 283 had malaria by expert microscopy. The commonest plasmodium specie that causes malaria in the region was P. falciparum (50.2%), followed by P. vivax (43.8%). The specificity of routine microscopy was (52.7%) and that for RDT was (90.4%). The sensitivity of routine microscopy was (98.6%) while that for RDT was (99.8%). Conclusions: Small number of patients complaining of fever had malaria in Red Sea State with P. falciparum representing (50.2%), followed by P. vivax (43.8%). RDT is recommended for diagnosis of malaria in our region.
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Is there science behind the near-death experience: Does human consciousness survives after death?
Pranab Kumar Bhattacharya
March-April 2013, 6(2):151-165
Near death experiences (NDEs) have been reported throughout world in essentially all cultures, including amongst the believers of the Hindu religion The contents of NDEs are independent of the gender, age, profession, religion, belief of soul, belief in angels of death or ghosts and belief in death kingdom and heaven, of people who experienced it. The frequency of occurrence is estimated to be between 5% to 48% in adults, and around 85% in children who experienced near-death situations. This frequency may be higher still, perhaps even 100 percent, were it not for the dreamlike and dissociative character of these experiences, and the amnesia-prone participation of the temporal lobe cortex of brain, causing a clear tendency to forget the NDE. A number of experiences can be very similar to NDEs, such as review of one's life in this planet, or an out-of-body experience (OBE,) in which the physical body and its surroundings are observed from various external vantage points, often from above, such that the body is passing through a deep dark tunnel, or seeing flash of light equal to thousands of sun for pure souls. The experience of seeing God and conversing with him, seeing alien lands, seeing dead relatives or someone's future, can all be regarded as similar in nature. Many individuals have reported horror experiences as well. Numerous cases-are existing in which the reality of the the OBE-observation can be independently 'verified, by external conditions, situations, people, objects, etc. Even people who are non-religious, subsequent to NDE experiences have displayed a markedly decreased fear of death, and a corresponding increase in the belief in "life after death" and re-incarnation. Certain elements of NDE- experiences can be induced by drugs, such as hallucinogenic substances and anesthetic drugs like ketamine, and electrical stimulation of the right temporal lobe or the limbic system has also produced such effects. The possibility that the hallucinogenic transmitters (and endorphins) of the brain themselves play a role in the NDE has been postulated. Nevertheless, there are NDE-elements, such as the frequently reported quick life-reviews, and the acquisition of external, verifiable information about the physical surroundings, that cannot be explained. Wish-fulfillment, death-denial or fighting against death, and other defense mechanisms of the brain, are also not adequate explanations. The large body of NDE data now points to genuine evidence for a non-physical reality. The paranormal capacities of the human being also raises the question: Does the human soul exist?
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