Microfilaria In Bone Marrow Aspirate: A Case Report

Wuchereria bancrofti is the most common parasite causing lymphatic filariasis. Microfilariae are dem­onstrated in the peripheral blood, body fluids, fine needle aspirates and in onchial ushings but it is an uncommon finding in the bone marrow. We report a case of a 45-year old male who presented with pyrexia of unknown origin and on peripheral blood and bone marrow examination found to have pan­cytopaenia with megaloblastoid changes in the bone marrow and W. bancrofti microfilariae.

Tubal Endometriosis Presenting As A Mass In Left Iliac Fossa - A Rare Case Report

Endometriosis is common cause of infertility. We report a case of 28 year old female presenting with left iliac fossa lump diagnosed as endometriosis of fallopian tube on histopathological examination.

An Unusual Case Of Myocardial Tuberculosis Alongwith Involvement Of Kidneys

Pulmonary tuberculosis is one of the commonest infectious disease encountered in clinical practice and more so in the developing countries. Despite of effectiveness of treatment,it is still a major cause of death. Tuberculosis can effect almost every organ of the body with maximum cases in the lungs accounting to 80%[1]. It is seen that extrapulmonary site have increased morbidity and mortality. Cardiovascular involvement is rare about 1-2%[2] and that too seen usually in the pericardium.The involvement of myocardium is even rarer. Here is a case of autopsy finding in 47 years old female showing myocardial involvement due to tuberculosis. Tubercular findings were also found in the bilateral kidneys.

Anti-biofilm efficacy of silver nanoparticles against MRSA and MRSE isolated from wounds in a tertiary care hospital.

Purpose: Different approaches have been used for preventing biofi lm-related infections in health care settings. Many of these methods have their own de-merits, which include chemical-based complications; emergent antibiotic resistant strains, etc. The formation of biofi lm is the hallmark characteristic of Staphylococcus aureus and S. epidermidis infection, which consists of multiple layers of bacteria encased within an exopolysachharide glycocalyx. Nanotechnology may provide the answer to penetrate such biofi lms and reduce biofi lm formation. Therefore, the aim of present study was to demonstrate the biofi lm formation by methicillin resistance S. aureus (MRSA) and methicillin resistance S. epidermidis (MRSE) isolated from wounds by direct visualisation applying tissue culture plate, tube and Congo Red Agar methods. Materials and Methods: The anti-biofi lm activity of AgNPs was investigated by Congo Red, scanning electron microscopy (SEM) and confocal laser scanning microscopy (CLSM) techniques. Results: The minimum inhibitory concentration (MIC) was found to be in the range of 11.25-45 μg/ml. The AgNPs coated surfaces effectively restricted biofi lm formation of the tested bacteria. Double fl uorescent staining (propidium iodide staining to detect bacterial cells and fl uorescein isothiocyanate concanavalin A (Con A-FITC) staining to detect the exopolysachharides matrix) technique using CLSM provides the visual evidence that AgNPs arrested the bacterial growth and prevent the glycocalyx formation. In our study, we could demonstrate the complete anti-biofi lm activity AgNPs at a concentration as low as 50 μg/ml. Conclusions: Our fi ndings suggested that AgNPs can be exploited towards the development of potential anti-bacterial coatings for various biomedical and environmental applications. In the near future, the AgNPs may play major role in the coating of medical devices and treatment of infections caused due to highly antibiotic resistant biofilm.

Strengthening Production End Salt Iodization: Computerized Management Information System in Salt Department, India.

Objectives: This paper presents the implementation of computerized Management Information System (MIS) in Salt Department, the nodal agency in India for regulation and control of manufacturer, supply and distribution of iodized salt, to strengthen production end salt iodization. Methods: The MIS was launched in March 2012 with the joint action of Salt Department and the non-governmental development agencies GAIN, MI, UNICEF, and ICCIDD through the platform of National Coalition for Sustained Optimal Iodine Intake. Web based MIS was installed in all offices of the Salt Department with its data centre located in salt Department Headquarter in Jaipur. The Salt MIS has modules on distribution and supply of salt, salt quality management, salt testing laboratories, and other functionalities of Salt Department. In the second phase, trainings of personnel from Salt Department were conducted for mainstreaming the use of MIS. Results: 81% of the 203 identified personnel were trained in MIS. All 104 factory offices and 30 out of 91% of 33 laboratories started using MIS for monthly reports. Real time information is available on production figures, quality of iodized salt and movement of iodized salt. Linking information to decision making process facilitated regulatory actions in salt producing pockets. Conclusions: Successful implementation of MIS in the Salt Department through the coordinated efforts of partner agencies resulted in improved functioning of Salt Department. Effective monitoring of iodized salt production, movement and distribution resulted in strengthening of production end salt iodization and improved access to quality iodized salt to consumers.

Iodized Salt Coverage Study 2010: Household Consumption and Consumer Behavior about Iodized Salt in Rural Areas of Select States of India.

Objectives: This study assessed the household coverage with iodized salt and consumer behavior with regards to edible salt in rural areas of eight selected states of India. Methods: The study was conducted by ICCIDD in association with MI and the Salt Commissioner’s Office in 2010. Iodine content of household edible salt was measured and consumer behavior in terms of knowledge and perceptions regarding iodized salt and edible salt buying behavior was assessed in 9600 rural household in selected states. Results: 47.2% of the households were consuming adequately iodized salt; 47%, 35%, 45%, 59%, 50%, 42%, 35%, and 64% respectively in states of Andhra Pradesh, Karnataka, Madhya Pradesh, Orissa, Rajasthan, Tamil Nadu, Uttar Pradesh and Uttarakhand. 58% of the respondents were aware about the iodized salt but only 13% of the respondents perceived ‘iodized salt’ to be an attribute of good quality salt. 54% of the households were using packaged crushed salt. Households with higher wealth index, awareness about iodized salt, using packaged crushed salt, and purchasing edible salt from general stores or Public Distribution System (PDS) were more likely to use adequately iodized salt. Conclusions: Despite an improvement of twenty percentage points from a previous survey in 2005-06, the coverage with adequately iodized salt in these states remains below the national average for rural areas. Increasing awareness and demand generation at the household level and introduction of good quality iodized salt in the Public Distribution System at affordable cost will help in improving the household coverage with adequately iodized salt in these states.

External Monitoring of Small and Medium Salt Processors Results in Improved Salt Iodization Levels in India.

Objectives: Small & medium scale salt processors are the main defaulters in the production of adequately and uniformly iodized salt. Monitoring of these processors by enforcement agencies is inadequate given the scale and geographic spread of the salt industry. The Government Salt Department requested Micronutrient Initiative’s (MI) support to strengthen the monitoring system of salt processors to improve enforcement and improve quality of salt produced. Methods: The salt samples are collected from 400 small and medium scale salt processors on daily basis and results of iodometric titration is communicated to the salt producers for corrective action. The results are analysed using web based software and shared with enforcement agencies and other stakeholders at routine intervals, for initiating necessary action to improve salt iodization. Results: In the past six years, this system has monitored an average of two million tonnes of salt produced per year by small and medium scale processors. Through this process, MI was able to engage directly with salt producers on technical issues, including encouragement to adopt improved iodization processes. Sharing monitoring data with the government and salt associations enhanced the effectiveness of government enforcement mechanisms and provided a platform to discuss problems and resolve issues. These activities contributed to improvement in adequately iodized salt, from 9% in 2007 to 35% in 2013. Conclusions: External monitoring of small salt processors resulted in more effective enforcement and adoption of better production processes. The increased compliance of small and medium scale processors has contributed to India’s progress towards Universal Salt Iodization.

Osteoarthritis of knee joint - role of quadriceps exercises.

Background: Osteoarthritis of knee joint is a common clinical condition among patients attending orthopaedics outpatient department. The role of quadriceps exercises in its management is not effectively stressed. Hence this study was carried out to assess the role of Quadriceps exercises in management of Osteoarthritis of Knee and reduce the morbidity associated with it. Methods: A total of one hundred patients in the age group of 40-65 years and suffering from mild to moderate Osteoarthritis of the knee joint were included in the study. Subjects were divided into two groups, Group I receiving drug therapy only and Group II receiving physiotherapy also, in the form of quadriceps exercises. Data was recorded on a proforma designed to assess symptomatic relief after two weeks. Results: Participants in group II with exercise program had improvements in physical function and symptom relief, decrease in knee pain and increase in range of motion, more than that of participants in group I. It was observed that majority of the study subjects, 39 (78%) had excellent result in group II, whereas 12 (24%) patients from group I had poor result. Conclusions: There is relationship between age, sex and quadriceps exercise with osteoarthritis of knee. Moderate quadriceps exercise is a safe and effective prevention and therapy for Osteoarthritis of knee.

Efficacy of Advanced Odomos repellent cream (N, N-diethyl-benzamide) against mosquito vectors.

Background & objectives: Repellents are commonly used personal protection measures to avoid mosquito bites. In the present study, Advanced Odomos cream (12% N, N-diethyl-benzamide) was tested for its efficacy against mosquitoes in comparison to DEET (N,N-diethyl-3-methyl benzamide). Methods: Bioassays were conducted to assess the repellency of Advanced Odomos and DEET creams against Anopheles stephensi and Aedes aegypti. Their efficacy was tested on human volunteers applied with different concentrations of test creams ranging from 1 to 12 mg/cm2 and by exposing them to mosquitoes at hourly intervals. Field evaluation was also carried out to test the duration of protection of the test creams against Anopheles and Aedes mosquitoes during whole night and day time collections, respectively on human volunteers. Mosquito collections were done using torch light and aspirator. Results: Complete (100%) protection was achieved at 10 mg/cm2 cream formulation of Advanced Odomos (1.2 mg a.i/cm2) dose against An. stephensi and 12 mg/cm2 (1.44 mg a.i./cm2) against Ae. aegypti on human baits. There was no statistically significant differences in per cent protection against mosquito bites between Advanced o0 domos and DEET cream (P>0.05) in respective doses. Complete protection up to 11 h was observed against Anopheles mosquitoes during whole night collections and up to 6 h against Ae. aegypti in day time collections. No adverse reactions such as itching, irritation, vomiting, nausea, etc. were reported by the volunteers. Interpretation & conclusions: Advanced odomos cream applied at 10 mg/cm2 concentration provided 100% protection from Anopheles mosquitoes up to 11 h whereas about 6 h protection was recorded against Ae. aegypti. The laboratory and field trials indicate that for longer protection against Anopheles mosquitoes 10 mg/cm2 will be appropriate and in case of Ae. aegypti more than 10 mg/cm2 application is required for complete protection. In conclusion, the Advanced Odomos cream was comparable to the known repellent cream DEET for prolonged protection against malaria and dengue vectors.

Global developmental delay and its determinants among urban infants and toddlers: A cross sectional study.

Objective To estimate the prevalence of global developmental delay among children under 3 years of age and study the determinant factors. Methods Cross sectional descriptive study was conducted in field practice areas of the Department of Community Medicine, JN Medical College, Aligarh, India. A total of 468 (243 boys and 225 girls) children aged 0–3 years were included. Developmental screening was performed for each child. A multitude of biological and environmental factors were analysed. Results As many as 7.1% of the children screened positive for global developmental delay. Maximum delay was observed in the 0–12 months age group (7.0%). Undernutrition and prematurity were the two most prevalent etiological diagnoses (21% each). Stunting and maternal illiteracy were the microenvironmental predictors on stepwise binary logistic regression while prematurity and a history of seizures emerged significant biological predictors. Conclusions Developmental delay can be predicted by specific biological and environmental factors which would help in initiating appropriate interventions.

Impact of etofenprox (Vectron® 20 WP) indoor residual spray on malaria transmission.

Background & objectives: A longitudinal study was carried out to assess the impact of indoor residual spray with Vectron® 20 WP (etofenprox) against Anopheles culicifacies and on malaria transmission in a selected village of Dadri primary health centre (PHC), District Gautam Budh Nagar, Uttar Pradesh, India. Methods: Two villages, namely Patadi and Anandpur in District Gautam Budh Nagar, Uttar Pradesh, with similar malaria incidence and vector prevalence were selected for the present evaluation. In one village two rounds of indoor spraying of etofenprox (0.1 g/m2) were done at an interval of 12 wk and the other village was kept as control where no intervention except intensive active surveillance for early detection and prompt treatment (EDPT) was undertaken during the study period. Entomological and epidemiological data were collected using standard procedures. Results: Persistence of the effectiveness of etofenprox against An. culicifacies was observed up to 12 wk. Spraying of etofenprox signifi cantly reduced the density signififi (P<0.001) and proportion of parous An. culicifacies mosquitoes (P<0.05) in the experimental village. There was a signififi cant reduction in malaria cases in the experimental village during the post-spray period when compared to the control village (P<0.05). No adverse effect was reported by the spraymen and inhabitants during and after the spray. Interpretation & conclusion: Indoor residual spray of etofenprox (0.1 g/m2) with an interval of three months in between two rounds of spray produced the desired impact in reducing the indoor resting density of vector mosquitoes and also in curtailing malaria transmission in the sprayed village when compared with the control village without spray.

Accuracy of ultrasonography in the diagnosis of acute appendicitis.

AIMS AND OBJECTIVES: To assess the accuracy of ultrasonography in the diagnosis of acute appendicitis. METHODOLOGY: A prospective randomized study was carried in the Dept. of Radiology and Imaging, Tribhuvan University, Teaching Hospital, Maharajgunj, Kathmandu, Nepal. A total of 120 patients, who were clinically diagnosed as acute appendicitis were subjected to ultrasonography of the abdomen. A detailed ultrasonography was performed and the findings were recorded. Twenty one cases had alternate diagnosis. Ninety nine cases ultimately underwent laparotomy and the retrieved appendices were sent for histopathological examination. Intra-operative, histopathological and ultrasonographic diagnoses were then statistically analyzed. RESULTS: Ultrasonographic, intra-operative and histopathological findings were statistically insignificant (P0.05). The sensitivity, specificity, positive predictive value, negative predictive value and accuracy percentage of ultrasonography in the diagnosis of acute appendicitis was 85.7%, 100%, 100%, 6.7% and 85.9% respectively. CONCLUSION: Ultrasonography has a high degree of accuracy in the diagnosis of acute appendicitis. However, the diagnosis should be considered with the diameter of appendix over 6 mm. Therefore acute appendicitis with diameter of appendix having less than 6 mm should be evaluated with other diagnostic parameters.

Impact of Olyset nets on malaria transmission in India.

BACKGROUND & OBJECTIVES: Efficacy of Olyset nets, long-lasting insecticidal nets were tested from August 2003 to August 2006 against Anopheles culicifacies, the vector which transmits 60% of all malaria cases in rural India. METHODS: Three villages in District Gautam Budh Nagar (Uttar Pradesh), India were selected for the trial and Olyset nets were distributed in one village, in another village untreated nets were distributed and the third village was kept as control where nets were not used. Entomological, and epidemiological data were collected using standard methods. RESULTS: The use of Olyset nets reduced the indoor resting density of An. culicifacies and also reduced mosquito entry into the structures where Olyset nets were used. No mosquitoes were caught landing on the Olyset nets. There was a reduction in the parity rate of An. culicifacies in the Olyset net village as compared with untreated net and no net villages. The impact of Olyset nets was observed on malaria incidence and only one case of Plasmodiumfalciparum malaria was reported in the Olyset net village but these continued to be found in the village with untreated nets and the control. CONCLUSION: Results of the present study confirmed that Olyset nets are highly effective in reducing the indoor resting density of mosquitoes, man-vector contact and malaria incidence.

Larvicidal and mosquito repellent activities of Pine (Pinus longifolia, family: Pinaceae) oil.

BACKGROUND AND OBJECTIVES: Various plant-based products are safe and biodegradable alternatives to synthetic chemicals for use against mosquitoes. Oil of Pinus longifolia is traditionally used for protection against mosquitoes in some rural areas but there is no documented report of its use against mosquitoes. The present study was undertaken to scientifically evaluate the activity of Pine oil against mosquitoes. METHODS: The oil was procured from the market and its contents were chemically analysed. Larvicidal activity of oil was tested in laboratory bioassays, while repellent action was studied during whole night bait collections in field by direct application on the skin and after its impregnation on mats. RESULTS: Results showed varying degree of larvicidal activity of Pine oil against mosquitoes with LC50 values ranging between 82 and 112 ppm. The Pine oil had strong repellent action against mosquitoes as it provided 100% protection against Anopheles culicifacies for 11 h and 97% protection against Culex quinquefasciatus for nine hours respectively. Electrically heated mats prepared from Pine oil provided, 94 and 88% protection against An. culicifacies and Cx. quinquefasciatus for 10 and seven hours respectively. INTERPRETAION AND CONCLUSION: Pine oil is effective against mosquito larvae at very higher doses which are not of any practical utility. However, Pine oil showed strong repellent action against An. culicifacies (malaria vector) and Cx. quinquefasciatus (pest mosquito). Thus its use could be popularised as mosquito repellent.

Efficacy of IGR compound Starycide 480 SC (Triflumuron) against mosquito larvae in clear and polluted water.

BACKGROUND AND OBJECTIVES: An environmental friendly formulation Starycide 480 SC (Triflumuron-OMS-2015 ), a new insect growth regulator with chitin synthesis inhibitor type mode of action was evaluated against mosquito larvae in laboratory and small-scale field trials carried out in and around Delhi. METHODS: The formulation was tested in laboratory for its bio-efficacy against late III instar mosquito larvae of different species using WHO bioassay procedure. In the field formulation was sprayed at doses of 0.3, 0.5 and 1 ppm (g/m3) in the natural breeding habitats of Anopheles and Culex mosquitoes. The impact was assessed by monitoring densities of larvae by dipper and observing the reduction in larval density and inhibition of adult emergence. RESULTS: In the laboratory, formulation was more effective against larvae of Anopheles stephensi and Aedes aegypti than Culex quinquefasciatus, but it produced 100% inhibition of adult emergence for all mosquito species at a concentration of 0.02 ppm. In the field trials, formulation did not produce 100% reduction in the density of late stage larvae even at 1 ppm (g/m3), the highest dose tested, but it resulted in 100% inhibition of pupal formation of both Anopheles and Culex spp in different types of habitats for 3-7 weeks even at a lower dose of 0.5 ppm. INTERPRETATION AND CONCLUSION: Application of triflumuron in the natural breeding habitats in both clean and polluted water @ 0.5 ppm (g/m3) resulted in complete inhibition of adult emergence of both Anopheles and Culex spp for 3-7 weeks. This formulation may be tested in large-scale field trials for further use in the vector control programme.

Impact of residual spraying of Reldan against Anopheles culicifacies in selected villages of District Ghaziabad (Uttar pradesh), India.

BACKGROUND & OBJECTIVES: Indoor residual spraying of Reldan 40% EC @ 0.5 and 1 g/m2 was done in Tatarpur and Chauna villages, respectively in Dhaulana PHC, Distt. Ghaziabad (U.P.) to evaluate its impact against Anopheles culicifacies and malaria incidence. Results were compared with that of Piyawali village which was taken as control area. METHODS: Four rounds of spray were done from 1999--2000 in human dwellings and cattlesheds in experimental villages. Entomological parameters--man hour density, parity rate, sporozoite rate, etc. were monitored using standard procedures. Epidemiological indicators such as SPR, SFR, cases/000, Pf/000 were also calculated. Cone bioassays as per WHO method were also carried out to assess the persistence of the insecticide on different surfaces. RESULTS: Entomological results revealed that spraying of reldan @ 0.5 g/m2 resulted in significant reduction in adult densities of An. culicifacies in sprayed villages over the control village. Spraying also resulted in reduction of percent parous females, reduction in malaria incidence (p < 0.05). INTERPRETATION & CONCLUSION: Reldan showed high efficacy @ 0.5 g/m2 in controlling the densities of An. culicifacies and malaria incidence. However, double dosage of reldan @ 1 g/m2 can be used for comprehensive vector control provided > 95% spray coverage is achieved.

Evaluation of pirimiphos-methyl (50% EC) against the immatures of Anopheles stephensi/An. culicifacies (malaria vectors) and Culex quinquefasciatus (vector of bancroftian filariasis).

BACKGROUND & OBJECTIVES: In India, temephos and fenthion are used as larvicides in fresh and polluted waters. Since use of same insecticide may precipitate resistant, as an alternative bioefficacy of pirimiphos-methyl--an organophosphorus insecticide was evaluated against immatures of Anopheles and Culex species in different breeding habitats in District Ghaziabad (U.P.) and Goa. METHODS: Laboratory bioassays were carried out using standard WHO procedure. LC50 and LC90 were calculated using Probit analysis. Abbott's formula was used to calculate per cent corrected mortality in laboratory exposures while, Mulla's formula was applied for calculating per cent reduction in mosquito immatures under field conditions. RESULTS: Pirimiphos-methyl was found to be most effective against larvae of An. stephensi followed by An. culicifacies and Cx. quinquefasciatus. The LC50 and LC90 values against three species were 0.023, 0.032 and 0.04 ppm; and 0.045, 0.057 and 0.114 ppm respectively. In field, pirimiphos-methyl @ 200 g a.i./ha against Anopheles species and @ 300 g a.i./ha against Culex species can produce > 80% reduction in density of immatures up to one week in different habitats. Pirimiphos-methyl < 0.25 ppm is not toxic to fish. INTERPRETATION & CONCLUSION: Pirimiphos-methyl is more effective against anophelines in clean water than culicines in polluted water. This larvicide should not be used at a concentration above 0.25 ppm in habitats harbouring the larvivorous fish.

Evaluation of repellent action of Cymbopogan martinii martinii Stapf var sofia oil against Anopheles sundaicus in tribal villages of Car Nicobar Island, Andaman & Nicobar Islands, India.

A field study was carried out to evaluate the mosquito repellent action of Cymbopogan martinii martinii Stapf var sofia oil in tribal village of Car Nicobar Island. Results revealed that application of 1 ml of the oil provided 98.7% protection in indoor and 96.52% in outdoor conditions during 12 h period of observation from the bites of An. sundaicus. Cymbopogan martinii martinii Stapf var sofia oil is an indigenous product, its application is safe and can be widely used for protection from malaria.

Bioecology of An. philippinensis in Andaman group of islands.

Studies on bioecology of An. philippinensis a vector of malaria was carried out in eight islands of the Andaman group. It was found that An. philippinensis preferred to rest and bite outdoors. Maximum biting was observed during 1800 to 2100 hrs on both cattle and human bait. The maximum breeding of An. philippinensis was recorded in slow moving stream followed by ponds with vegetation. The breeding sites infested with Chara and Spirogyra algae were most favourable whereas, with Lemna and Oscillatoria were unfavourable for the proliferation of this species. The breeding association of An. philippinensis was found with other seven anopheline species in different breeding habitats.

Bio-efficacy and operational feasibility of alphacypermethrin (Fendona) impregnated mosquito nets to control rural malaria in northern India.

Bio-efficacy and operational feasibility of alphacypermethrin treated nets was evaluated in certain villages of District Ghaziabad (U.P.). Results revealed that poly-filament nylon nets treated with alphacypermethrin suspension concentrate (g/l) formulation @ 25 mg/m2 has shown repellent action (26.5 +/- 8.1), excito repellent action (93.7 +/- 8.1) and killing action (100%) against An. culicifacies landed on treated nets. Significant reduction in indoor resting density of An. culicifacies in human dwellings was also observed in treated nets village (p < 0.05). Instant killing action of treated nets did provide complete protection to inhabitants sleeping inside the net from An. culicifacies bites. The persistent use of nets by the inhabitants has also resulted significant reduction in malaria cases (p < 0.05). It was interesting to note that not even a single case of falciparum malaria was observed after distribution of treated nets in spite of the fact that at no point of time cent per cent compliance of net usage was observed during the study period. Bio-assay tests revealed that treated nets can produce up to 70% mortality in An. culicifacies for about 22 weeks and as such only one treatment with insecticide is required in a year in seasonal transmission area to protect from malaria. The study also revealed that treated nets can be stored at room temperature for about 10 months without loosing their efficacy suggesting thereby that malaria outbreaks can be tackled by the nets if adequate treated nets are stored in core problem districts. It was also revealed that An. culicifacies is a late night biter and as such treated nets can be used successfully against this species.