Surveillance-based estimation of the malaria disease burden in a low endemic state of Punjab, India, targeted for malaria elimination.

BACKGROUND: The state of Punjab in India qualifies for malaria elimination because the number of cases reported through routine surveillance is in decline. However, surveillance system prevalence mainly provides malaria trends. Therefore, a prospective epidemiological study was designed to estimate the malaria burden in the state. METHODS: District-wise annual parasite incidence (API) was used for identification of three strata, representing high, moderate and low API zones. A total of 0.9 million people from nine districts was under malaria surveillance for 1 y. The weighted estimates of API for the three regions was calculated and combined to give an estimate of API for the total population of the state. RESULTS: Based upon the primary data generated, malaria cases from high, moderate and low malaria-endemic areas were estimated to be 3727, 904 and 106, respectively. Further, the total number of malaria cases in the state was estimated to be 4737 (95% CI 4006 to 5469) cases per annum. CONCLUSION: Actual burden of malaria in the state of Punjab, India, is about seven to eight times higher than that reported by routine surveillance activities. However, the state still qualifies for malaria elimination but needs vigorous efforts to strengthen the active surveillance and reporting system along with implementation of effective control strategies to achieve malaria elimination.

Sociocultural diversity and substance use pattern in Arunachal Pradesh, India.

An epidemiological study on substance use was carried out to assess the prevalence and pattern of tobacco, alcohol, and opium being used commonly in ethnographic diverse population of Arunachal Pradesh, India. Representative sample of 5135 people age > or =10 years were interviewed to collect information about their habit of substance use. Over all, prevalence of substance use was 30.9% tobacco (22.8% chewers and 12.1% smokers), 30% alcohol, and 4.8% opium, which vary across location, gender, race, age, education, and occupation. Though tobacco and alcohol was commonly used among all the tribes, but high alcohol use among Tangsa and Tutsa tribes reflects strong cultural belief. Religiously, opium use was low among Christian and Hindu at lower (< 1000 m) altitude, but high among Buddhist, Indigenous, and Hindu living at higher altitude. Among males, high multivariate rate ratio of opium users was seen among the population of high altitude (9.1). Moreover, it was also high among Singpho (7.1) and Khamti (9.7) tribes living in low altitude area, which shows the strong geo-ethnographic influence. Average age at initiation of alcohol use (12.4 years) was significantly lower than tobacco (17.6 years), and opium (23.3 years) indicate social acceptability of alcohol drinking at early age. Use of multiple substances and high prevalence of opium express the alarming situation of substance misuse in the region. Besides few limitations, varied results of socio-cultural and ethnic influences recalls integrated approach to break the traditional belief associated with alcohol and drug abuse from the society.

The association of selected sociodemographic factors and differences in patterns of substance use: a pilot study in selected areas of Northeast India.

Emergence of new addictive substances and progressive increase of 'drug abuse" has become a serious problem in many countries. Despite legal restriction and administrative control, the use of illicit drugs (like opium, heroin, proxyvan, etc.) has increased considerably in many parts of Northeast India. A sample of 1831 people (age 10 years and above) were interviewed during 1997-1998 about their drug use habits, if any, and types of substance used, in Meghalaya and upper Assam. Prevalence of substance use was 29.4% tobacco (20.5% chewers and 12.7% smokers), 12.5% alcohol, and 4.9% opium. In Meghalaya, prevalence of tobacco use was high (41.7%), which was mainly due to the large number of female chewers and male smokers. Opium and cannabis users were mainly confined in Assam close to the Arunachal Pradesh border, indicating a regional influence. Wide differences were observed in the prevalence pattern of tobacco and alcohol use across location, sex, age, education, and occupation. An association of sociodemographic factors with substance use was documented. Religion and ethnic group have significant association with tobacco use patterns but are insignificant with regard to alcohol use. Use of multiple substances and use of cannabis as a substitute for opium are the major problems indicating drug dependence. Mean ages for substance use initiation were: 18.5 years for tobacco, 21.8 years for alcohol, and 25.8 years for opium. Not with-standing the study's limitations, these findings are useful for planned prevention efforts and formulation of a specific program considering the importance of regional and sociodemographic factors.

Effect of fluvoxamine and N-methyl-D-aspartate receptor antagonists on shock-induced depression in mice.

We have earlier demonstrated that NMDA receptor antagonists possess antidepressant effect and also they show a synergism with imipramine. The present study attempts to investigate whether NMDA receptor antagonists also interact with selective serotonin reuptake inhibitors. The study was conducted in albino mice using shock-induced depression model. The mice were placed on a grid floor and shock delivered were of 2 sec duration with a 9 sec interval for 1 h. Twenty four hours later depression was measured by an open field test followed by a forced swimming test. Presentation of inescapable foot shock significantly reduced ambulation (from 159.50 +/- 5.42 to 80.50 +/- 4.61) and rearing (from 22.10 +/- 2.15 to 11.30 +/- 1.32) in the open field arena and increased immobility duration in the forced swimming test (from 82.20 +/- 3.51 to 158.90 +/- 4.61). Pretreatment with fluvoxamine, MK-801, ketamine and the combination of fluvoxamine with either of the NMDA antagonists antagonised shock-induced depression. Haloperidol and ketanserin pretreatment modified the effect of these agents. These findings suggest an interaction of NMDA receptor antagonists with fluvoxamine, and an involvement of brain dopaminergic and tryptaminergic mechanisms in the behavioural suppression observed after inescapable foot shock.

Interaction between N-methyl-D-aspartate receptor antagonists and imipramine in shock-induced depression.

In the past few years, literature has accumulated describing manifestation of seizures following administration of certain antidepressants. Such reports are of particular importance because depression is a frequent psychiatric problem associated with epilepsy. Therefore, in the view of the fact that NMDA receptor antagonists have been reported to reduce behavioural deficits and have been shown to be anticonvulsant, it was considered imperative to study their antidepressant effect using shock-induced depression model in mice. Presentation of inescapable foot shock significantly reduced ambulation and rearing in the open field arena and increased immobility duration in the FST. Pretreatment with imipramine, MK 801 and ketamine significantly prevented the effect of shock. Also, the combination of imipramine with either of the NMDA antagonists antagonised the effect of shock. Haloperidol, prazosin and ketanserin pretreatment modified the effect of these agents. These findings suggest an antidepressant effect of the NMDA receptor antagonists, and a complexity of neurotransmitter mechanisms, which are responsible for the occurrence of behavioural effects in shock-induced depression model.

Tobacco use in Mizoram, India: sociodemographic differences in pattern.

A study on tobacco use was carried out in Aizawl district of Mizoram, India, to assess the prevalence and pattern of tobacco use. An area served by two Sub-health Centers representing town and village population were selected for a household survey. 375 people (age 10 years and above) were interviewed about their habits of taking tobacco. Use of tobacco was high among males (56.6%) and females (45.7%), but the high prevalence of smoking among males (42.3%) and chewing among females (27.9%) indicates the existence of sex differences in tobacco use pattern. Age and occupation had significant association with tobacco use but influence of education was very low and its association was not significant. Mean age for start of tobacco chewing and smoking for males and females varied significantly. However, the mean age of start for adolescent and young age (10-29 years) tobacco users was 17.2 years (SD +/- 2.3). Though there are some limitations to this study, these findings revealed differential patterns of tobacco use which is valuable information for prevention effort.

Opium addiction in assam : a trend analysis.

A survey on opium use was earned out in Tinsukia district of upper Assam to assess the present prevalence and pattern of opium abuse and compared with earlier findings of the year 1981 (Baruah et al., 1995). A total of 75 addicts could be detected during the survey and 61 were interviewed using structured questionnaire. The results indicate significant decline in prevalence in opium use over the years in all the villages under high prevalence area. Out of 61 addicts, 51 addicts had started taking opium before 1980 and only 10 new addicts were added by 1990. The trend analysis of opium user's from 1979 to 1995 indicates a linear trend with high rate of decline in opium addicts statistical analyses, supports the hypothesis that linear declining trend is the best fit. By 1995, only four addicts were found having continued taking of opium.

Plantar acral melanoma--an experience from a regional cancer centre, India.

This is a retrospective analysis of all plantar acral melanomas treated at the Cancer Institute (WIA) Madras between January 1981 and December 1990. Acral melanomas constitute 26% of all melanomas in this population, the sole of the foot being the dominant site (35 of 36 cases). We have found that it is more common in the lower socioeconomic strata, occurs often over weight bearing areas and is usually advanced at presentation. The projected five year survival was 51% while the five year disease free survival was only 22%. Pathological nodal status was found to be the only factor significantly influencing survival in this study. Wide local excision was found to give results equivalent to radical amputation and is strongly recommended since it gives a much better quality of life with a disease that has an overall dismal prognosis.

Primary gastrointestinal lymphoma: 30-year experience at the Cancer Institute, Madras, India.

A retrospective study was conducted of 49 patients with primary gastrointestinal lymphoma to analyze clinicopathological features, prognostic factors, and results of treatment. Intestinal lymphomas (63%) were more common than gastric lymphomas (29%). Endoscopic biopsy was diagnostic in 64% of gastric lymphomas, while 97% of intestinal lymphomas required laparotomy for diagnosis. Lymphoblastic (35%) and diffuse large cell (33%) lymphomas were the most frequent histologic types. Complete remission (CR) was achieved in 61% of patients, with a 5-year survival of 72% in those who achieved CR. The overall 5-year survival and disease-free survival were 47% and 40%, respectively. All disease-related mortality occurred within 2 years of diagnosis, with 79% occurring in the first year. There was no overall significant difference in survival between the different treatment groups. Stage, extent of surgical resection, response to treatment, serosal involvement, multimodality treatment, and performance status were significant prognostic factors. Achievement of complete remission and complete surgical resection were the most favorable independent prognostic factors on multivariate analyses.

Ultrasound evaluation of pelvic nodes in cervical carcinoma.

This is a retrospective analysis to assess the utility of ultrasound in assessing pelvic nodes in patients with cervical carcinoma. Seventy five patients who underwent radical hysterectomy with lymph node dissection in a three year period were included in the study and the pre-operative ultrasound findings were compared with the final pathological nodal status. Ultrasound examination had a sensitivity of 66.67%, a specificity of 78.33% and an accuracy of 76%. The positive predictive value was 43.5% and the negative predictive value was 90.4%. The sensitivity and positive predictive value are likely to be higher in more advanced stages of the disease where operative staging is rarely performed. Ultrasound can be a fairly accurate non invasive diagnostic test to assess the pelvic nodes besides assessing the local extent of the disease, the kidneys and the retroperitoneum.

Role of radiation therapy in the treatment of carcinoma of the penis.

OBJECTIVE: To study the effectiveness of radiation therapy (RT) for the primary tumour and for groin node and distant metastases in patients with squamous cell carcinoma of the penis. SUBJECTS AND METHODS: Between January 1959 and June 1988, 156 patients with negative lymph nodes in the groin underwent RT of the primary tumour. RT was also administered to 120 patients with lymph node involvement in the groin and to nine with distant metastases. RESULTS: Local control of the primary tumour was achieved in 65% of patients with RT alone and in another 33% with salvage surgery. Lymph node recurrence in the groin was seen in 11% of patients and the corrected 5-year disease-free survival was 87%. Pre-operative inguinal RT was useful in patients with mobile lymph nodes > or = 4 cm in size in the groin, with only 8% of such lymphadenectomy specimens showing perinodal infiltration and only 3% of such patients having post-operative groin recurrences. Pelvic and/or para-aortic RT was ineffective in patients with pelvic node metastases. Palliative RT resulted in amelioration of symptoms in 56% of patients with fixed lymph nodes in the groin, all five patients with painful bony metastases and one of two patients with cord compression and paraplegia. CONCLUSION: Radiation therapy is ideal for patients with T1 and T2 primary cancers of the penis. Pre-operative RT is useful for patients with mobile lymph nodes > or = 4 cm in size in the groin. RT provides effective palliation in patients with advanced regional disease and/or distant metastases.

Rhinosporidiosis mimicking penile malignancy.

Rhinosporidiosis is a chronic infection which is endemic in India and Sri Lanka. Penile involvement in rhinosporidiosis is rare and we report one such case. The pathology, treatment and possible etiology of the condition are reviewed.