A comparative study on efficacy of nepafenac and flurbiprofen in maintenance of intraoperative mydriasis during cataract surgery: an open label randomized controlled trial

Background: Surgery on the ocular tissue brings about activation of phospholipase A3 thereby releasing prostaglandins and leukotrienes. Prostaglandins bring about meiosis during surgery, changes in IOP, conjunctival hyperaemia. Newer topical NSAID抯 Nepafenac and Flurbiprofen are potent inhibitors of the cyclooxygenase enzyme thereby inhibiting the biosynthesis of prostaglandins. Objective of this study was to compare the efficacy of preoperative use of topical Nepafenac (0.1%) and Flurbiprofen (0.03%) in maintenance of intraoperative mydriasis during cataract surgery.Methods: A randomised, comparative study was performed on 104 patients, 52 were allocated in each group and were given either of the topical NSAID抯 Nepafenac or Flurbiprofen prior to cataract surgery. Pupillary diameter was measured at the beginning and at the end of the surgery and the values were compared between the groups. Mean and standard deviation was calculated and between two groups comparison was done using students t-test.Results: The mean pupillary diameter of the two groups were comparable at the beginning of surgery (p=0.34). The mean change in the pupillary diameter was 1.86�71mm in the Nepafenac group and 1.77�72mm in the Flurbiprofen group. There was no statistically significant difference among both the groups in maintenance of intraoperative mydriasis (p=0.47).Conclusions: Pre-operative use of Nepafenac and Flurbiprofen were equally effective in preventing meiosis during cataract surgery.

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.

Investigation of an outbreak of chikungunya in Malegaon Municipal areas of Nasik district, Maharashtra (India) and its control.

BACKGROUND & OBJECTIVES: An outbreak of chikungunya fever occurred in Malegaon town of Nasik district of Maharashtra state, India during February and March 2006. A total of 4530 fever cases were reported during this period including 1781 cases which were admitted in different hospitals of the town. An entomological and epidemiological investigation was carried out in the affected villages during the outbreak to study the possible causes of the outbreak and to isolate the virus responsible. METHODS: Entomological evaluation was done as per WHO guidelines. Sera samples were collected by venipuncture from clinically suspected chikungunya patients in hospitals and also during house-to-house survey in affected villages. IgM antibodies to dengue virus were detected using IgM capture ELISA (PANBIO) and by "Haemagglutination inhibition test" for detection of antibodies against Chikungunya virus. Acute sera samples were inoculated in cell lines for virus isolation. The isolates were confirmed by RT-PCR. RESULTS: On investigation, it was found that water storage containers like cement tanks, plastic containers or earthen pots placed in front of the individual houses were the potential breeding sites for Aedes aegypti. Entomological survey carried out in the most affected areas revealed high Aedes indices. House, container and breteau indices were found to be 27.2, 16.19 and 35.1, respectively. Out of the 13 acute sera samples collected, virus was isolated in 10 samples. The isolates were confirmed by RT-PCR and sequencing using primers from nsP1 gene of Chikungunya virus (CHIKV, Accession No. EF077609, EF077610). Of the 17 convalescent sera tested, significant level of HI antibodies to CHIKV was detected in five samples. One sample was positive for IgM antibodies against dengue virus. Based on clinico-epidemiological features and laboratory findings, the illness was confirmed to be of chikungunya viral disease. CONCLUSION: Control measures targeting the vector population and personal protective measures against the mosquito bites were instituted. Extensive IEC campaign with the involvement of community and religious leaders helped in containment of the disease.

Chikungunya viral disease in district Bhilwara (Rajasthan) India.

An investigation of chikungunya outbreak cases was carried out in Bhilwara District, Rajasthan during Aug-Sep 2006. Fever with multiple joint pains was the first presenting feature. Aedes larval surveys indicate high Breteau index (78.6 to 200), House index (48.0 to 83.3) & Container index (41.1 to 73.6) above the critical index. Out of 40 sera samples tested, 12 showed HI antibodies for chikungunya virus in high titres and another five were positive for IgM antibodies against chikungunya. The clinico-epidemiological, laboratory and entomological investigations confirm that this episode of fever was due to chikungunya fever. Strengthening and intensification of surveillance along with educating the community were recommended for control of outbreak.

Quick control of bubonic plague outbreak in Uttar Kashi, India.

A localized outbreak of bubonic plague occurred in village Dangud (population 332), district Uttar Kashi, Uttaranchal, India in the second week of October 2004. 8 cases were considered outbreak associated based on their clinical and epidemiological characteristics; 3 (27.3%) of them died within 48 hours of developing illness. All the 3 fatal cases and five surviving cases had enlargement of inguinal lymph nodes. None of them had pneumonia. The age of the cases ranged from 23-70 years and both sexes were affected. No such illness was reported from adjoining villages. The outbreak was fully contained within two weeks of its onset by supervised comprehensive chemoprophylaxis using tetracycline. A total of approximately 1250 persons were given chemoprophylaxis in three villages. There was no clear history of rat fall in the village. No flea was found on rodents or animals. 16 animal serum samples were found to be negative for antibodies against F-1 antigen of Y. pestis. However, Y. pestis was isolated from two rodents (Rattus rattus and Mus musculus) trapped in the village. One case and three animal sera showed borderline sero-positivity against rickettsial infection. The diagnosis of plague was confirmed by detection of four fold rise of antibody titre against F-1 antigen of Yersinia pestis in paired sera of three cases (one of the WHO approved criteria of diagnosis of confirmed plague). This outbreak and the occurrence of earlier outbreaks of plague in Surat (Gujarat) and Beed (Maharashtra) in 1994 and in district Shimla (Himachal Pradesh) in 2002 confirm that plague infection continue to exist in sylvatic foci in many parts of India which is transmitted to humans occasionally. Thus, there is a strong need for the States to monitor the plague activity in known sylvatic foci regularly and have a system of surveillance to facilitate prompt diagnosis and treatment of cases to control the disease. This investigation highlights that with high index of suspicion the disease can be diagnosed early and mounting of supervised comprehensive response can prevent the disease to proceed to pneumonic stage where man to man transmission gets established and outbreak assumes larger dimensions.

Outbreak investigation of scrub Typhus in Himachal Pradesh (India).

Scrub Typhus outbreak investigation was undertaken during September 2003 in the three worst affected districts Shimla, Solan and Sirmaur in Himachal Pradesh (India). A total of 113 cases and 19 deaths (17.27 percent case fatality rate) were reported from the eight districts, which were reporting cases. Cases were prevalent in all age groups and in both the sexes among the persons frequenting forest for occupational work. 35.7 percent of the patients serum samples showed a titer of > 1: 80 against OX 19 and OXK antigen is suggestive of Scrub Typhus. Entomologically Rattus rattus (39.5 per cent) was the most prevalent species followed by Suncus murinus (22.91 percent), Bandicoota bengalensis (29.16 percent) and Bandicoota indica and Mus musculus (4.16 percent each). Vector species Leptotrombidium deliense and Gahrliepia (schoengastilla) sp. were recorded. The chigger index 23.0 was found to be highest in Vill. Baldian and 5.0 in Vill. Bhatakuffer (Shimla) and 1.0 in Vill. Rebon (Solan), which is above the critical limit of 0.69 per rodents. Other mite species, ixodid ticks, fleas and lice have been recorded.

Prevalence of ixodid ticks in Nilgiri district of Tamil Nadu state (India).

The Nilgiri hills provides favourable ecological conditions for the propagation of haematophagous arthropods due to its richness in vegetation and animal fauna. A study was undertaken by the NICD during August to November 1996 on the prevalence of ectoparasitic ticks from different localities of the Nilgiris district of Tamil Nadu state. The ticks were hand picked from various domestic animals of the study area and identified. A total of 1232 adults and immatures of ticks were collected from domestic animals which comprised of the various species in the order of abundance Boophilus microplus, Haemaphysalis bispinosa, Riphicephalus haemaphysaloides and Riphicephalus sanguineus. Studies carried out in the grass lands, meadows and areas adjoining to tea plantations by flagging method revealed mainly immature stages and few adults of Riphicephalus Spp. and Haemaphysalis Spp. The public health importance of the above species have been discussed.

Feeding pattern of anopheline and culicine mosquitoes in relation to biotopes and seasons in Delhi and environs.

In the studies to know the feeding pattern of various species of mosquitoes, a total of 7461 specimens comprising of Anopheles culicifacies (150), An. stephensi (61), An. subpictus (990), An. annularis (572), Culex quinquefasciatus (5217) and C. vishnui group (471) of mosquitoes were collected from different biotopes of selected localities in Delhi and environs during all the months of the year. The mosquito blood samples were processed by Gel diffusion technique to know the source of blood meal. Results of study revealed that the mosquito species tested in the study were by and large zoophilic and opportunistic feeders. The feeding behaviour was found to be highly influenced by biotopes from where the mosquitoes were collected, village and areas, different climatic seasons, sleeping behaviour of human beings and availability of alternative hosts particularly animal population. Overall anthropophilic index was found to be 24.66% for An. culicifacies, 20.96% for An. stephensi, 16.93% for An. subpictus, 9.96% for An. annularis, 26.33% for C. quinquefasciatus and 36.39% for C. vishnui group of mosquitoes. Feeding behaviour towards other animals viz: bovine, goat, dog, pig and bird for all these mosquito species in different months and biotopes e.g. human dwellings, cattle sheds and mixed dwellings; in different months and seasons of the year have been presented.