Perennial malaria transmission and its association with rainfall at Kalahandi district of Odisha, Eastern India: A retrospective analysis

@#India contributes substantially to global malaria incidents. Vector dynamics is the significant determinant of malaria risk. Hence, knowledge on the interaction between rainfall, malaria cases and malaria vector density can be very useful for controlling malaria transmission. Kalahandi was screened for malaria cases, Anopheline vector density and their temporal relationship with rainfall. Epidemiological data was obtained from National Vector Borne Disease Control Programme, Odisha, India. Three years vector population study was carried out. Rainfall data was obtained from a database maintained by the Govt. of Odisha and was analysed using Univariate ANOVA and Pearson correlation co-efficient tests using R-prog. Malaria was found to be prevalent throughout the year attaining peak between July to August and another peak in December, amidst which the clinical malaria cases being recorded implied highest incidents in the month of July. The results estimated the seasonality of the population of An. culicifacies, An. fluviatilis and An. annularis over the region and determined the influence of rainfall on the vector population dynamics. Simple linear regression analysis suggested that at one month lag monthly rainfall (P=0.0007) was a significant meteorological factor. Rainfall seemed to be one of the best malaria predictors because of its positive correlation with proliferation of malaria cases in conjunction with An. culicifacies density making malaria a serious health issue in Kalahandi.

A comparative study of prevalence and spatial distribution of major Anopheline vector fauna in a hyper- and a hypomalaria endemic district of Odisha, India with special reference to onset of first wet season

@#The state’s retrospective findings indicate the incidence of malaria deaths, which is more during the onset of first monsoon season. Based upon this fact, our objective was to study the distribution pattern of major Anopheles vectors in two endemic districts viz. Kalahandi and Cuttack of Odisha, India that differ significantly according to malariogenic stratification, under the impact of first monsoon shower. A comparative study of vector abundance, predominance, their habitats, resting site preference, impact of abiotic rhythm (light/dark period) on vector distribution, gonotrophic status as well as sporozoite rate was established in a high and a low endemic district of Odisha, when the degree of malaria transmission elevates to its peak level Anopheles culicifacies was found to be predominant in hyperendemic Kalahandi district while Anopheles subpictus was abundant in hypo-endemic Cuttack district. Both primary vector An. culicifacies and the secondary vector An. subpictus mostly prefer CS (Cattle shed) compared to HD (Human dwelling) in Kalahandi district where as there was slight shifting of resting habitat of An. culicifacies from CS to HD in Cuttack district. Anopheles culicifacies prefers to rest on wall besides objects in Kalahandi while no such site preference was observed in Cuttack district. On the other hand, distribution of An. subpictus was highly influenced by the daily rhythm of light/dark cycle (i.e. day and night) in Cuttack. The gonotrophic condition revealed the high tendency of the predominant vectors towards endophilic resting. The sporozoite rate was 0.66% in Kalahandi and nil in Cuttack district. The proper monitoring of vector prevalence and distribution, at least during the peak transmission period can avert a perpetuated upsurge in malaria.

Protective effect of eucalyptus globulus extract on glufosinate ammonium -induced hepatotoxicity in wistar rats

The present study aims to investigate the hepatoprotective effect of Eucalyptus globulus extract against pesticide liver damage in comparison to silymarin, a classical antioxidant liver medicine. Liver damage was induced by oral administration of toxicant i.e. Glufosinate ammonium. The extent of damage was studied by assessing biochemical parameters and histopathological evaluations. The aqueous extracts of Eucalyptus globulus were administered respectively to the animals pretreated with pesticide and its effects on biochemical parameters were compared with standard drug silymarin (100mg/kg b.wt). Eucalyptus globules showed significant reduction of serum enzymes AST, ALT, ALP & Bilirubin (Aspartate Transminase, Alanine Transminase, Alkaline Phosphatase & Total bilirubin) when compared to control counterparts. The hepatoprotective effect of Eucalyptus globules was comparable with the standard drug silymarin and it was confirmed by histopathological findings. Moreover, these effects presented in a dose-dependent manner.The present study showed that aqueous extract of Eucalyptus globulus at the dosage level of 500 mg/kgb.wt may play a protective role against pesticideinduced hepatotoxicity

Left pulmonary artery agenesis with pulmonary hypoplasia in an elderly patient: a rare case report.

Proximal interruption of the unilateral pulmonary artery is a rare congenital anomaly, which is often associated with other cardiovascular abnormalities. It is usually diagnosed in children but rarely discovered in adulthood as an isolated phenomenon, occurring more frequently on the right side and is often associated with a contralateral aortic arch. We are presenting a rare case of a sixty year old male who was diagnosed with left lung hypoplasia due to proximal interruption of left pulmonary artery with left sided aortic arch without any associated cardiovascular anomalies.

Preparation and evaluation of fermented Ayurvedic formulation: Arjunarishta.

Growing awareness about harmful side effects of modern medicine has led to interest in Ayurveda at the international level as well as within India. Ayurveda comprises of various types of formulations including fermented forms, namely, arishtas and asavas. Arishtas are regarded as unique and valuable therapeutics due to their efficacy, stability and desirable features. It prepared using decoction of herbal drug and contains self generated alcohol. Although these formulations are mentioned in traditional literature and used regularly their scientific investigation and reporting is essential to strengthen Ayurveda in global market. In present study attempt has been made for preparation and evaluation of arjunarishta. Terminalia arjuna is a active constituent of arjunarishta and prescribed in cases of cardiovascular diseases as a cardiotonic. 6.42% w/w alcohol was generated after fermentation of traditionally prepared arjunarishta formulation. It is palatable to use due to sweet taste combined with fine aroma which masks unpleasant taste and odour of added herbal ingredients.

Mediastinal cavernous haemangioma.

A 44-year-old man presented with palpable right supraclavicular swelling having no symptoms pertaining to respiratory tract. A routine chest radiograph showed an anterior mediastinal mass. Computerised tomographic scan (CT-scan) of chest showed an enhancing and homogeneous mass in anterior mediastinal space with few tiny calcific specks within the mass. Biopsy of cervical swelling showed cavernous haemangioma with chronic non-specific lymphadenitis. A sternotomy was undertaken and an encapsulated 9x7.5x5 cm, dark purplish mass was seen in anteior mediastinum adherent to pericardium and right pleura. The cut-surface was elastic and soft. Histology confirmed cavernous haemangioma. Post-operative course was uneventful. Mediastinal cavernous haemangioma is extremely rare and surgical excision is the treatment of choice.

Evaluation of trisodium phosphate as a transport medium and its utility in a single-step decontamination technique for the culture of M. tuberculosis.

Background Sputum specimens were received from various out-patient departments of a tertiary care referral hospital to acid-fast staining and mycobacterial culture. Material & Methods A simple, one-step decontamination and concentration method was adopted before subjecting the samples to acid-fast staining and mycobacterial culture. Trisodium phosphate, a cheap, “soft” decontaminant-cum-liquefying agent was used to treat the sputum specimens before Ziehl-Neelsen’s (ZN) acid-fast staining and Lowenstein-Jensen’s (LJ) medium culture. The sputum samples were collected directly into trisodium phosphate containing screw capped McCartney bottles (Day-0). The bottles were vortexed and left overnight at room temperature. On the subsequent morning (Day-1), the supernatants were discarded and smears made from deposits were stained by ZN stain. Results A total of 30 consecutive samples, which showed smear positivity by ZN technique, were selected for the present study. Deposits from these smear positive cases were cultured onto duplicate slants of LJ medium and incubated at 370C (Day-1). Duplicate slants of LJ media were inoculated from each of these preserved deposits on 2nd, 3rd , 4th, 6th and 8th days. Culture bottles were incubated at 370C for 8 weeks and positive growths were recorded. Culture retrieval was possible from 29 (96.7%) samples from deposits of Day –1 to Day-3. The culture positivity , however, had dropped to 26 (86.7%),18 (60%) and 6 (20%) from deposits of Day-4, Day-6 and Day-8, respectively. All the isolates were identified as M. tuberculosis and there was minimal contamination (0.83%). The culture retrieval dropped significantly only after Day-3. Conclusion This method is, therefore, suitable for transportation, preservation and decontamination of sputum samples before staining and culture, up to 3 days after collection. This will be helpful especially for collection of sputum samples from distant places and their transportation to nearest mycobacteriology laboratory as also for sputum samples arriving late in a working day’s schedule.

Fungal infections of lungs the emerging scenario.

Fungal infections of lungs are important infective processes which are being encountered more and more often in today’s practice. Fortunately, we only encounter a few of these pathogenic fungi. With more and more people undergoing organ transplantation and cytotoxic therapy, chances of encountering these diseases are steadily increasing. Though treatment is difficult, nevertheless, the results are encouraging. Hence, it is all the more important today to know these diseases well so that we are able to manage them scientifically. Diseases like ABPA, if diagnosed early, can be treated effectively so as to prevent progression to fibrotic stage and reduce the number of respiratory cripples. Invasive systemic mycosis is also amenable to multimodal therapy. With advent of newer imidazoles and newer modalities of drug delivery like liposomal amphotericin B, the so called complicated treatment modalities can be further simplified. Prophylaxis is today available for preventing PCP in immunocompromised patients and they need to adhere to prophylaxis.

Outcome in multi-drug resistant tuberculosis patientswith ambulatory treatment.

Background: Multidrug resistant tuberculosis (MDR-TB) is emerging as an increasingly important cause of morbidity and death. The patients continue to spread disease for a prolonged period and may pose a threat to the success of DOTS. Aim: To evaluate response to chemotherapy with second line drugs given on domiciliary basis in cases of MDRTB. Methods: Retrospective case records of 36 proven MDR-TB patients treated from April 1998 to April 2001 were analyzed. The patients were defined as cured when they had continued to be smear and culture negative for more than one year in addition to clinical and radiological improvement. All patients were followed up for relapse for one year. Results: Out of 36 patients, 27 had far advanced lesions and 8 had moderately advanced lesions. All patients had resistance to at least Isoniazid and Rifampicin. Additional resistance was observed to Streptomycin in 19, Pyrazinamide - 8, Ethambutol - 8, Ethionamide - 6, Cycloserine - 5, Thiacetazone - 4, Ciprofloxacin- 3 and PAS in one patient. Average duration of pre-treatment chemotherapy was 14 months. Twenty patients were cases of relapse. Ten patients had concomitant disease (NIDDM - 3, COPD-4, Bronchial asthma-2, IHD-1). Average time for sputum conversion was 5 months. Twenty-three patients had sputum conversion in less than 4 months after revised chemotherapy. Out of 36 patients, 28 patients were declared cured at the end of 24 months of therapy, 7 patients defaulted and one patient died due to massive haemoptysis. Adverse reactions to chemotherapy included photosensitivity to Sparfloxacin-4 patients, ototoxicity to Kanamycin-2 patients and hyperuricemia- one patient. Conclusion: Problem of MDR-TB can be managed to some extent by ambulatory treatment with other logistic supports like drugs, laboratory services and sympathetic motivated staff.

Solitary tracheal plasmacytoma.

Primary tracheal tumours are rare and trachea is an exceedingly rare site of extramedullary plasmacytoma. We report a case of extramedullary plasmacytoma involving trachea and causing symptoms of airway obstruction in a 44-year-old man. Chest radiograph was normal. Flow-volume loop showed characteristic pattern localizing the lesion at thoracic inlet. Computerised tomography and bronchoscopy demonstrated a broad based pedunculated intratracheal mass obstructing 85% of the lumen. Tracheal tumour was excised via low tracheostomy. Histopathology of resected mass revealed extramedullary plasmacytoma. Relevant investigations excluded multiple myeloma. He was managed with radiotherapy with good response and there has been no recurrence after one-year follow-up.

Serum immunoglobulin E in early childhood wheezing.

OBJECTIVE: To study the serum Ig E levels in patients presenting with wheezing under the age of 24 months. METHODS: The study was conducted on 38 cases and 35 controls. The children presenting with first attack of wheezing were clinically considered as bronchiolitis and those with recurrent attacks with positive history of atopy in the patient or in their first degree relatives were considered as bronchial asthma. The Ig E estimation was done by immune assay method. RESULTS: The mean serum Ig E was significantly higher in asthma patients (p < 0.001). It was also higher in bronchiolitis patients but the difference was not statistically significant. However, 26 per cent of these patients had values above 1 SD of the control mean. These patients were considered as potential cases of asthma. CONCLUSION: The determination of serum Ig E may be of value in identifying those children presenting with first wheezing attack, who may develop asthma in future. Only a long-term follow-up of these patients can give an answer to the postulation that raised Ig E level at the time of first viral lower respiratory tract infection is a potential marker for the development of recurrent wheezing in later life.

Evaluation of phytotoxicity and genotoxicity of uranyl nitrate in Allium assay system.

Uranyl nitrate inhibited root growth of Allium cepa at > or = 25 microM concentration. Fluorimetric analysis of metal uptake indicated the entry and accumulation of uranium into the root cell. Uranyl nitrate was neither clastogenic nor aneugenic as it failed to induce micronuclei significantly, but between 25 and 100 microM concentration, it increased significantly the frequency of sister chromatid exchange over that of control, implying its genotoxicity that possibly interfered with DNA replication and/or repair process.

Lung function in mitral stenosis.

OBJECTIVES: The aim of this study was to look to for a relationship between pulmonary artery pressure (PAP), left atrial pressure (LAP), mitral valve area (MVA) and transmitral gradient (Gr) on the one hand and the spirometric data on the other, in cases of mitral stenosis. METHODS: The spirometry values measured were forced vital capacity (FVC), forced expiratory volume in one second and as percent of FVC (FEV1, FEV1/FVC%), forced expiratory flow between 25% to 75% of FVC (FEF 25-75%), at 50% of FVC (FEF 50%) 75% of FVC (FEF 75%) and peak expiratory flow rate (PEFR). The PAP, LAP, MVA and Gr were measured at echocardiography and cardiac catheterisation. RESULTS: Analysis of results was done of 60 patients in four groups divided on basis of mean PAP: Group 1 with least and group 4 with highest mean PAP. FVC values were reduced in direct proportion to PAP, LAP, MVA and Gr in three out of four groups. FEV1% as a percent of predicted value showed uniform reduction in all the groups, PEFR was moderately affected in group 1 and most severely in group 4. Values of FEV1/FVC% were within normal range in all the groups. FEF 25-75%, and FEF 50% showed serial reduction in values in keeping with the elevation of the PAP. FEF 75% was also moderately affected in group 1 and most severely in group 4. CONCLUSION: We found that a moderate restrictive defect and a small airway defect which is found in cases of mitral stenosis, directly correlates to the PAP, LAP, MVA and Gr. There was no significant involvement of the larger airways.

Prevalence of high risk children under five--a study in rural Delhi.

678 under five children were surveyed in village Shahbad Mohammadpur, Delhi. Two weeks morbidity was also recorded. 47.9 per cent children had one or more risk factors studied. Significantly more female children (54.1 per cent) were at risk than male children (43.3 per cent). 433 risk factors were observed in 325 at risk children. Majority of them had one or two risk factors. Birth interval less than two years and malnutrition were most frequent risk factors. At risk children suffered significantly more than not at risk (21.2 per cent vs 14.4 per cent). The results confirmed the validity of the risk factors considered for the study.

Pattern of paediatric solid malignant tumours in southern Orissa.

Twenty-nine cases of solid malignant tumours in paediatric age group were studied. The incidence of different tumours in order of frequency were lymphomas (37.9%), Wilms' tumour (24.1%), neuroblastoma (17.2%), soft tissue sarcoma (10.4%) and rare tumours (10.4%). Maximum number of tumours occurred in 1-5 years' age group. Male predominance was noted (male:female as 2.2:1). Among the lymphomas, non-Hodgkin's lymphoma outnumbered Hodgkin's lymphoma. Left kidney affection was seen more than the right kidney among cases of Wilms' tumours. Neuroblastomas presented commonly as abdominal masses. All the 3 cases of soft tissue sarcomas were embryonal rhabdomysoarcomas. Rare tumours encountered in the study were ovarian tumours (arrhenoblastoma), endodermal sinus tumours and hepatoblastoma.

A comparison of ventilatory pulmonary functions between the National Cadet Corps (N.C.C.) of hilly and plain areas.

National Cadet Corps (N.C.C.) were tested for assessing their physical efficiency level with special reference to respiratory performances. The height and weight of the cadets from hilly and plain areas were noted to be similar indicating alike attainment of growth. The mean values of all pulmonary function tests (FVC, IC, ERV+TV, FEV1, MEFR) except MVV were observed to be similar in both the group of subjects. The mean value of MVV was significantly higher in subjects from hilly area than that in those from plain area.