A Study of Hypertension and Obesity Among the Adult Population in a Rural Area Near NCT Delhi.

Background: The burden of non-communicable diseases (NCDs) in India is substantial and is estimated to increase, in rural areas too. Objectives: To study hypertension and obesity among the adult population in a rural area near Delhi. Materials/methods: A complete enumeration of the total population was done in Mandola village of Uttar Pradesh by conducting a house to house survey. After collecting information based data, the height, weight and blood pressure of all available family members were recorded as per standard procedures. Results: Data was collected from a total of 1124 persons. While there were 15.5% current smokers, 4.4% were consumers of alcohol. The prevalence of current smoking was 35.4% among the males and 3.3% among the females. It was observed that 20.2% of the males and 27.2% females were obese. Among the females, obesity was more likely among the housewives (p<0.001) and those of older age (p<0.001). The proportion of hypertensives was 16.0% in males and 13.0% in females. Among the males, hypertension was more common among the smokers than non-smokers (18.5% vs. 14.5%) and among current alcohol users than non-users (22.4% vs. 15.1%). We found several subjects, of both genders, who had both hypertension as well as obesity. Conclusion: The present study has shown that the burden of NCDs such as hypertension and obesity is quite substantial in a rural population.

State of globe: mitigating measles menace in era of MMR/V

In non vaccination ancient era, multiple epidemics of measles/german measles/variola used to occur in the cyclical trend of two to three years during spring months. Outbreaks in Faroe Islands in 1846 and in Fizi Island in 1875 are examples of this type of transmission where virgin epidemics took the highest mortality toll. According to WHO report, in the absence of immunization, 90% of the persons can be expected to develop clinical measles sometimes in their life time as noted in Greenland in 1951 epidemic and german measles in 2012 in Kangra. But the epidemiology of communicable diseases underwent tremendous change not only in the developed countries, viz America and European countries but also in the developing countries like India, Pakistan and African countries with the introduction of vaccination and thereby mortality and morbidity on account of vaccine preventable diseases in all the age groups around the world nose dived. This provided a big relief to the suffering humanity across the world. Different countries have various sets of immunization programme running in the countries; be it single dose of measles at the age of 270 days or second shot of measles or other vaccinations. Round the globe, MMR or MMRV or pentavalent vaccination with their pluses or minuses, still is the right choice to mitigate the menace of measles

Incidence of chikungunya fever in ghatampur municipality, kanpur nagar district, uttar pradesh, India

Objectives: [I] To estimate the magnitude, compare the results of two wards [Shivpuri and Achhimohal] and [ii] to formulate recommendations for prevention and control. STUDY DESIGN: Experimental study

Place And Duration: 1st October to 16th November 2006 in residents of Shivpuri and Achhimohal ward

Methodology: We selected and compared two wards; Shivpuri ward with high attack rate and the other Achhimohal one-low attack rate. We defined a case as the occurrence of fever with joint pain with or without skin rashes during the period of 1st October to 16th November 2006 in residents of Shivpuri and Achhimohal ward. We collected information on age, sex, residence, date of onset, symptomatology, history of treatment, deaths in the family. We described outbreak in time, place and person characteristics. We collected 14 random blood samples from shivpuri and 7 blood samples from Achhimohal ward for serological investigation. We conducted entomological survey for species identification

Results: We identified total 384 case-patients among 2,202 residents [overall attack rate [AR: 384/2202 [17%]; Median age: 31 year] in both the wards. [343/1173 [29%] in Shivpuri ward vs 41/1029 [4%]]; sex specific AR was 52% for females. The major symptoms were fever 384/384 [100%], arthralgia 380//384 [99%]. Severity of disease and oedema were less prevalent in children of age group 1-15 year as compared to older age group 31-45 years [109/239 [46%], 13/183 [7%]]. The attack rate was highest 88/239 [37%] and statistically significant [P<0.03] in Shivpuri ward adjacent to pond. Both wards, Shivpuri-141 of 343 [41%] and Achhimohal-23 of 41 [56%] reported consulting with unqualified private practitioners. 19/21 were positive for anti Chikungunya IgM antibodies. 38/43 households [88%] in Shivpuri ward and 6/43 households [13%] in Achhimohal ward identified three species of Aedes mosquitoes

Conclusion: Chikungunya is mosquito born and laboratory confirmed; severely debilitating disease. Recommended for aggressive Information, Education and Communication [IEC] for emptying the storage of water once in a week and rational use of drugs

Pediatric Scrub Typhus in South Sikkim.

We present five cases of paediatric Scrub typhus from Community Health Centre, Namchi, South Sikkim emphasize timely diagnosis of scrub typhus for appropriate management. Response to doxycycline was good, with fever subsiding within 48-72 hrs of starting the treatment. Four out of five cases completely recovered once appropriate medication was given.

Serological evidence of rickettsial infections in Delhi.

Background & objectives: Rickettsial infections remain under-diagnosed due to lack of diagnostic facilities in developing world. Here we present our experience at National Centre for Disease Control, Delhi, about a serosurvey done in Delhi for rickettsial disease with easy to perform low cost, low expertise Weil Felix test. Methods: On the basis of cut-off titre obtained in healthy population, Weil Felix test results were interpreted along with clinical data. Entomological investigation was also carried out in select areas of Delhi. Rodents were trapped from houses and gardens and vector mites were collected. Results: When serum samples were collected during initial 5 yr period from patients with fever of unknown origin, seropositivity was 8.2 per cent whereas when rickettsial infection was kept as one of the differential diagnosis by clinicians seropositivity increased to 33.3 per cent. Rickettsial infections detected were scrub typhus (48.2%) followed by spotted fever group (27.5%) and typhus group (6.8%) during 2005-2009. In preliminary entomological survey vector mite Leptotombidium deliense was found on rodents. Interpretation & conclusions: Our findings showed that results of Weil Felix test should not be disregarded, rather clinically compatible cases should be treated to save lives.

Moraxella catarrhalis as a respiratory pathogen.

Background: Moraxella catarrhalis is gaining significance as a pathogen over few decades because of increased rate of isolation in respiratory specimens and due to emergence of multidrug resistant strains. Therefore, appropriate antimicrobial agents are required for eradication and prevention of spread of the organism. Material and Methods: -The study was conducted over 1-year period inpatients of lower respiratory tract infections (L.R.T.I.) in P.G.I.M.S. Rohtak (Haryana) . Assessment of clinical significance of M.catarrhalis was ascertained on the basis of preformed criteria. Results: A total of 63 clinically significant M. catarrhalis were isolated from a tertiary care hospital. The isolates showed maximum resistance to cotrimoxazole (82.5%), pencillin (77.7%), and ampicillin (71.4%) while susceptibility was maximum to cefotaxime (87.3%) followed by tetracycline (85.7%) ciprofloxacin (84.1%), erythromycin (80.9%) amikacin (79.3%), gentamycin (77.7%), and cefazolin (76.2%). Multidrug resistance to >3 antimicrobials was seen in 22 (34.9%) of cases. Conclusions: Predominant or pure growth of M.catarrhalis in throat swabs from cases of L.R.T.I. should be reported and treated by microbiologist and clinician respectively. Antibiotic therapy should be decided based on sensitivity report for rapid respose and recovery of patients.

An outbreak of rubella in a hilly district of Kangra- Chamba, Himachal Pradesh,India, 2006.

Objective. We investigated the outbreak as a suspected outbreak of measles with the objectives of confirming diagnosis, estimating the magnitude of outbreak and formulating recommendations for control and prevention. Methods. We defined a case of the rubella as occurrence of fever with rash in any resident of these three villages between 20th October to 9th December, 2006. We line listed the cases and collected information on age, sex, residence, date of onset, symptoms, signs, treatment history, traveling history, vaccination status and pregnancy status. We described the outbreak by time, place and person characteristics. Sera of a sample of case patients were tested for IgM antibodies to measles and later rubella viruses. Results. We identified 61 cases in three villages - 39 cases in Hattli, 17 in Thulel and 5 in Dramman. The overall attack rate (AR) was 8.7%. Sex specific AR for males was 10% and females 7.4%. All case patients were less than 20 years of age and the attack rate was highest in the age group 11-20 years (median age 12 years). The index case was traced in Hattli Bengali slum and occurred on 20th October 2006 where majorities (41%) of the cases were reported. No pregnant woman was found to be affected. The number of cases peaked on 19th November and the last case was reported on 9th December 2006. Of 61 case-patients, 50 (82%) were immunized against measles while proportions of children vaccinated for measles were 96% (672/700) and none of them were immunized against rubella (including two (3%) who had MMR immunization privately). Out of six blood samples tested, all tested negative for measles IgM antibodies but four were positive for IgM antibodies to rubella. Only 36% (22/61) of the cases took the treatment from modern system of medicine. Conclusion. An outbreak of rubella was confirmed and was possibly due to the frequent traveling of Bengali colony patients to other areas for selling the food items. We advised the local health authorities to provide MMR vaccination to the unexposed and energetic IEC in three affected and neighboring villages.

Primary amoebic meningoencephalitis: first reported case from Rohtak, North India

A fatal case of primary amoebic encephalitis (PAM) in a 20 year old boy, a proven case of acute leukemic leukemia (ALL) type L2, in remission is described. No history of swimming could be elicited. The clinical presentation, the isolation of the amoeba from the cerebrospinal fluid (CSF), the poor response to amphotericin B, and the ultimately fatal outcome are all consistent with the diagnosis of PAM. On the basis of its ability to grow at temperature 42ºC and 45ºC, morphology of trophozoite, and the presence of flagellate forms in CSF, the amoeba was identified as Naegleria fowleri. Other drugs used in combination with amphotericin B are tetracycline, rifampicin, and miconazole. A possibility of PAM should always be considered in all cases of acute purulent meningoencephalitis in which no bacteria or fungus are found.

Dental caries, gingivitis, periodontitis: a review

Microbial populations colonizing the teeth and periodontal tissues are a major source of pathogens responsible for oral and dental infections including dental caries, gingivitis, periodontitis etc. Dental caries is a multifactor and infectious disease resulting dueto interaction of three different aspects like dietary sugar, susceptible tooth enamel and oral microbial colonization. Plaques from caries active sites have significantly higher proportion of Streptococcus mutans (principle acid producer) with pH levels of 5.0 or lower. Dental decay occurs when normal demineralization remineralization is disturbed. On the other hand the most common form of gingivitis is chronic or long standing plaque induced gingivitis while acute necrotizing ulcerative gingivitis is most aggressive, developing gingivitis is associated with increasing numbers of Actinomyces israeliwhereas gingivitis with bleeding is associated with A. viscosus and pigmented Bacteroides. Periodontitis is defined as loss of alveolar support to the tooth and can be differentiated microbiologically and clinically into adult, localised juvenile and pre-pubertal periodontitis. Various species of Bacteroides, Actinomyces, Fusobacterium etc. have been isolated from cases of active periodontitis. Thus wherever possible both aerobic and anaerobic culture should be performed and appropriate antibiotic therapy should be prescribed instead of empirical treatment.

Bacteriological study of paediatric and adult chronic suppurative otitis media.

Chronic suppurative otitis media (CSOM) is one of the commonest illnesses in ENT practice which requires medical attention all the more in children of poor socio-economic status having in past inadequate treatment and negligent medical care. The present study was conducted to find out the various aerobic and anaerobic microorganisms associated with CSOM in paediatric and adult cases and their current antimicrobial susceptibility pattern as a guide to therapy. Samples were collected from 109 clinically diagnosed cases of CSOM and processed according to standard protocols. Out of 74 paediatric CSOM cases, 72 (97.2%) were bacterial culture positive while out of 35 adult CSOM cases, 28 (80%) were culture positive. Bilateral CSOM was slightly more common in adults (25%) than paediatric (21.4%) age group. Polymicrobial nature of CSOM was noted in both paediatric (70.8%) and adult (71.4%) cases while number of organisms isolated per lesion was slightly higher in adults (2.5) as compared to paediatric (1.95) cases. In paediatric CSOM, Staphylococcus aureus was the commonest aerobic isolate while in adult CSOM, Pseudomonas aeruginosa was the commonest one. Among anaerobes Peptostreptococcus spp. was commonest in CSOM where as Prevotella melaninogenica in adult CSOM. Sensitivity of S. aureus to cefuroxime was 72.2% while that of gram negative bacilli was higher to cefotaxime (90 to 100%). Among anaerobes higher sensitivity was seen to metronidazole (98.6%), clindamycin (95.7%) and chloramphenicol (98.6%). In view of the polymicrobial etiology of CSOM, prompt appropriate antimicrobial therapy can effectively reverse the disease process thereby preventing longterm sequelae.

Surgical infections: a microbiological study

Surgical infections are mostly polymicrobial, involving both aerobes and anaerobes. One hundred seventeen cases comprised of abscesses (n=51), secondary peritonitis (n=25), necrotizing fascitis (n=22) and wounds with devitalized tissues (n=19) were studied. The number of microorganisms isolated per lesion was highest in secondary peritonitis (2.32). The aerobe/ anaerobe ratio was 0.81 in secondary peritonitis and 1.8 in necrotizing fascitis. Most secondary peritonitis (80 percent), necrotizing fascitis (75 percent) and wounds with devitalized tissues (66.7 percent) were polymicrobial. Common microorganisms isolated in our study were E. coli, Staphylococcus aureus, Klebsiella spp., Pseudomonas aeruginosa, Bacteroides fragilis and Peptostreptococcus spp. The most effective antibiotics for S. aureus were clindamycin (79.1 percent) and cefuroxime (70.8 percent). For Gram-negatives (Klebsiella spp., E. coli and Proteus spp.), the most effective antibiotics were cefotaxime, ceftizoxime, amikacin and ciprofloxacin. Pseudomonas aeruginosa was maximally sensitive to amikacin (35.2 percent) and ciprofloxacin (35.2 percent). The greatest degree of multidrug resistance to all the drugs was found in P. aeruginosa (52.9 percent), followed by Klebsiella spp. (33.3 percent), Proteus spp. (33.3 percent), E. coli (22.2 percent), and S. aureus (12.5 percent). All the anaerobes that we isolated were 100 percent sensitive to metronidazole and chloramphenicol, followed by clindamycin (95 percent to 100 percent). Apart from antibiotic therapy, non-antimicrobial methods, such as hyperbaric oxygen therapy and debridement also play an important role in the treatment of surgical infections.

Leptospirosis in India and the rest of the world

Leptospirosis is an acute anthropo-zoonotic infection of worldwide significance caused by spirochaete Leptospira interrogans which has 23 serogroups and >200 serovars. Various factors influencing the animal activity, suitability of the environment for the survival of the organism and behavorial and occupational habits of human beings can be the determinants of incidence and prevalence of the disease. The disease was considered inconsequential till recently, but it is emerging as an important public health problem during the last decade or so due to sudden upsurge in the number of reported cases and outbreaks. Since isolation rate of the microorganism from clinical specimens is low due to prior indiscriminate use of antibiotics, serological techniques remain the cornerstone of diagnosis

Antibiotic susceptibility of bacterial isolates in gingivitis and periodontitis.

The present study was conducted to isolate aerobic as well as anaerobic microbes from patients of gingivitis and adult periodontitis and to study the susceptibility patterns of these isolates to different antibiotics. In our study all the samples belonging to the control as well as the study groups yielded microbes. Aerobes and facultative anaerobes were isolated from 100 percent and 96 percent cases of normal gingiva and orodental infections respectively. Anaerobes were isolated from 80 percent of the normal gingival samples and 97 percent of the cases of orodental infections. Metronidazole was found to be the best for the anaerobes while the aerobes and facultative anaerobes showed good susceptibility to cefazolin and cefotaxime.

Evaluation of germ tube test in various media.

One of the most valuable tests for the rapid presumptive identification of Candida albicans is germ tube production. Previously researchers have concluded superior results with serum in germ tube test. However, handling of pooled human serum has danger of acquisition of hepatitis and HIV infections. Therefore, in the present study we compared various media--pooled human serum, sterile horse serum, peptone water and tryptic soy broth. It was observed that human serum remains to be the best with 100% positivity for identification of C. albicans followed by horse serum (76.3%), peptone water (61.8%) and tryptic soy broth (61.8%).

Sensitivity pattern of Salmonella serotypes in Northern India

BACKGROUND: Enteric fever continues to be a major public health problem, especially in the developing countries of the tropics. We determined the incidence of Salmonella bloodstream infections and their antimicrobial resistance patterns from May to August in the years 1997-2001 in Haryana, a large state of India. The minimum inhibitory concentration (MIC) was also determined for 60 isolates of S. typhi to various commonly used antimicrobial agents. MATERIAL AND METHODS: Blood cultures of 6,956 patients (PUO/septicemia) were processed by standard procedures and the Salmonella spp. isolates were identified with specific antisera and with standard biochemical tests. Antimicrobial susceptibilities were determined by Stokes disc diffusion method. The MIC of 60 randomly isolated strains of S. typhi was determined by agar dilution method using Mueller Hinton Agar medium. RESULTS: Isolation rates of Salmonella spp. increased in 2000 and 2001. Multidrug resistance (MDR) in S. typhi had increased while in S. paratyphi it had decreased markedly. Ninety per cent chloramphenicol sensitivity was seen in S. typhi by MIC method. There was a decrease in the susceptibility to ciprofloxacin of S. typhi with MIC showing an upward trend. All S. typhi tested were sensitive to third generation cephalosporins and aminoglycosides with MIC well below the breakpoint. DISCUSSION: Our study indicates that MDR in S. typhi is on the rise in our area. There is also re-emergence of chloramphenicol sensitivity. Rising MIC values of ciprofloxacin may lead to prolonged treatment, delayed recovery or pose treatment failure. Thus, sensitivity pattern of causative organism must be sought before instituting appropriate therapy to prevent further emergence of drug resistance.