Entomological determinants of malaria transmission in an epidemic prone area of District Nuh (Haryana state), India.

BACKGROUND & OBJECTIVES: Entomological investigations were carried out in highly malarious villages under Ujina PHC of District Nuh (Haryana state) which is an epidemic prone area in northwestern region of India. The study was aimed to have an in-depth understanding of the entomological parameters influencing malaria transmission in the study area. METHODS: The seasonal prevalence and biological attributes of vector mosquitoes were investigated during 2015 and 2016. Indoor resting vector mosquitoes were collected from human dwellings/cattle sheds and morphologically identified. Anopheles culicifacies were categorized to sibling species by species-specific inversions in polytene chromosomes and An. stephensi to ecological races on the basis of ridge number on egg float. The blood meal source analysis and incrimination studies of vectors were done by counter-current immunoelectrophoresis and enzyme-linked immunosorbent assay, respectively. Insecticide susceptibility test on vectors was performed as per WHO guidelines. RESULTS: Seasonal abundance of An. culicifacies and An. stephensi in the study area showed variation; the peak densities of both the vectors were observed during monsoon months which correlated well with the average monthly rainfall data. Though both vectors were found to be primarily zoophagic, the human blood index of An. culicifacies (HBI = 0.17) was significantly higher than that of An. stephensi (HBI= 0.02). Analysis of sibling species composition of An. culicifacies population showed that it comprised almost of sibling species A (>98%) which is an established malaria vector. Anopheles culicifacies was incriminated for Plasmodium vivax and P. falciparum circumsporozoite (CS) antigen during monsoon months in 2015 and 2016. Assessment of insecticide susceptibility status of malaria vectors against 0.5% deltamethrin revealed that An. culicifacies is more susceptible (95% mortality) than An. stephensi (85% mortality). INTERPRETATION & CONCLUSION: The results suggest that An. culicifacies (species A) is playing a major role in malaria transmission in the study area and is almost susceptible to deltamethrin. Timely two rounds of indoor residual spray of synthetic pyrethroid with proper dosage and good coverage would be helpful in reducing vector population and consequently the malaria incidence. In addition, personal protection measures by the community would supplement the major intervention tool (IRS) in decreasing the man-vector contact.

Clinical Profile of Diabetic Ketoacidosis in Adults in Dhulikhel Hospital.

Background Diabetic ketoacidosis is one of the life-threatening acute complications of diabetes mellitus. Despite the improvements in diabetic care, it remains a major clinical problem in clinical practice. Objective To assess the clinical and laboratory profile of adults with diabetic ketoacidosis in Dhulikhel hospital. Method This is a descriptive cross-sectional study including adult patients admitted in Dhulikhel hospital from July 2014 to July 2016 with the diagnosis of diabetic ketoacidosis according to the guidelines of American diabetes association. The hospital records of these patients were reviewed for their clinical and biochemical profiles. Result Forty eight patients fulfilled the criteria of diabetic ketoacidosis and were included in the study. Seventy three percent of patients had type 2 diabetes mellitus. Twenty three percent of the patients were cases of newly diagnosed diabetes mellitus. Polyuria and polydipsia as presenting complaint was more common in patients with type 1 diabetes mellitus (p=0.002) whereas fever was more common in type 2 diabetes mellitus patients (p=0.03). Majority of patients had normal serum sodium and potassium level. Forty two percent of the patients have high serum urea level and just over one third had high serum creatinine level. The most common precipitating factor of diabetic ketoacidosis for patients with type 1 diabetes mellitus was omission of insulin whereas in type 2 diabetic patients was infection. Conclusion Diabetic ketoacidosis is complication of both type 1 and type 2 diabetes mellitus. High degree of suspicion is needed for early detection of this life threatening condition especially in patients without history of diabetes mellitus.

Prevalence of Respiratory Diseases According to Spirometry Findings Among Patients Attending the Spirometry Department of Dhulikhel Hospital.

Background Spirometry is a standard test for screening and evaluation of patients with symptoms of cough and shortness of breath. Despite its easy availability, low cost and ease of performance it has not been widely used in clinical practice in Nepal. Objective To assess the prevalence of respiratory diseases in a regional referral centre in patients referred for spirometry. Method This is a descriptive cross-sectional study including patients referred for spirometry to the spirometry unit of Dhulikhel Hospital, Kathmandu University Hospital from 2014 July to 2015 October. The spirometry findings of the patients fulfilling the criteria of American Thoracic Society/European Respitatory Society (ATS/ERS) guidelines were analyzed and categorized as normal, having obstructive lung diseases including chronic obstructive pulmonary disease (COPD) and bronchial asthma or restrictive lung disease. Data were analyzed using SPSS 20.0 software. Result Out of 821 patients, 755 patients (92%) fulfilled ATS/ERS criteria for satisfactory spirometry. The prevalence of COPD was 31.4%, bronchial asthma 24.2% and restrictive lung disease 8.1%. The mean age of patients diagnosed with COPD was 57.8±10.8 years; bronchial asthma 44.3±16.2 years; and restrictive lung disease 44.6±21.5 years. Both COPD and bronchial asthma were common in females. About twenty two percent of the COPD patients were non-smokers and 86.3% of these were females. The most common symptoms for referral was cough and shortness of breath: these symptoms were more likely to be associated with abnormal spirometry findings. Conclusion Spirometry is a crucial preliminary test for evaluation of patients with respiratory symptoms. It should be used more frequently to help stratify patients for appropriate treatment.