ABSTRACT
Fever is one of the most common reasons for visit in primary care practice. Outbreaks of fever that occur at certain areas in a seasonal manner are usually recognized early by diligent general practitioners in primary care settings. At the community level, in order to tackle seasonal fever outbreaks, prevention and control strategies are widely implemented, targeting the locally prevalent endemic infectious diseases. However, what about seasonal outbreaks of diseases because of non-infectious endemic causes? How well are we aware of this and how prepared are we? In 2006, there was an outbreak of Chikungunya fever in Kerala, a southern state in India. A group of scientists discovered that many patients assumed to have Chikungunya also had exposure to a specific type of lepidopteran moth, Asota caricae, also known as tiger moth. Further research revealed that rats exposed to live tiger moths under experimental conditions produced features resembling Chikungunya and similar viral fevers, with symptoms comprising fever, arthralgia, arthritis, and thrombocytopenia. A moth-toxin-specific immunoglobulin E (IgE) antibody was identified in sera of patients who recalled exposure to tiger moths. Aims: 1. To screen subjects with clinical features resembling viral fevers for specific IgE antibodies against tiger moth toxin. 2. To assess the role of tiger moths in producing features resembling viral fevers in humans. Settings and Design: This hospital-based, cross-sectional analytical study was conducted from March 2015 to March 2016 in a tertiary hospital in North Kerala. The sample population included patients who had clinical manifestations suggestive of viral fevers and presented to the outpatient departments of Family Medicine, Internal Medicine, or Emergency Medicine and satisfied the inclusion criteria. Methods and Material: After collecting the informed consent, the blood sample needed for the study was collected simultaneously with the blood collected for other tests ordered by the consulting doctor. No extra needle insertion was needed for the study. A total of 234 samples were examined for the presence of moth-toxin-specific IgE antibodies. Statistical Analysis Used: Data were analysed using SPSS 17.0. Graphs were produced using Microsoft Excel. Categorical variables were expressed as frequencies with percentages and analysed using Chi-square test/Fisher's exact test. Incidence/prevalence was also expressed in percentages with confidence interval. The continuous variable was expressed as mean with standard deviation or median with inter-quartile range. For all tests, a probability value (p value) < 0.05 was considered as statistically significant. Results: Among the 234 subjects who were screened in the 13-month period, 44 subjects (18.8%) tested positive for moth-toxin IgE, of which 28 were males and 16 were females. The maximum percentage of samples with positive moth-toxin IgE antibodies was detected during the months of March, June, July, November, December, and January. Out of the 44 subjects who had positive moth-toxin IgE antibodies, 24 tested positive for Dengue fever (of which eight were positive for the Dengue NS1 antigen, 11 were positive for the Dengue IgM antibody, and five were positive for both Dengue NS1 antigen and Dengue IgM antibody), two tested positive for Leptospira IgM antibody, two tested positive for Rickettsial antibody, and three had a positive Widal test. It was found that association of moth-toxin IgE with all the presenting symptoms of subjects analysed in this study was not statistically significant, except for lymphadenopathy. Skin rashes of different morphologies were seen in the study group. 20.5% (n = 9) of the subjects who tested positive for moth-toxin IgE had skin rashes. A majority of these weffigurere erythematous and maculopapular rashes, with incidence of 44% (n = 4) and 33% (n = 3), respectively. Conclusions: 1. A seasonal variation is evident in the incidence of cases with positive moth-toxin IgE. 2. There is no significant age/sex preference for moth-toxin IgE positivity. 3. Subjects who tested positive for moth-toxin IgE also had positive serological tests for other infectious causes of fever, including Dengue fever, Leptospirosis, Enteric fever, and Rickettsial fever. The role of tiger moth exposure in producing fever and related symptoms hence needs to be studied further. 4. It was observed that moth-toxin IgE had significant association with lymphadenopathy. This should be investigated in further studies. 5. Even though the role of lepidopterism in seasonal fever epidemics is not clear, primary care physicians should be more aware of such entities which can present with a wide range of manifestations.
ABSTRACT
OBJECTIVES: To determine the relationship between maternal nutrition and their breastfed infants' anthropometric measures during the first 14 weeks after delivery. METHODS: A prospective, observational study, comprising 200 mothers and their infants. The weight, length, and head circumference of the infants and the weight and dietary intake of the mothers were recorded at 6, 10, and 14 weeks. RESULTS: The relationship between weight gain in babies and calorie intake at 6, 10, and 14 weeks were significant (P value < 0.05). The relationship between weight gain in babies and protein intake at 6 and 10 weeks was not significant (P value at 6 weeks = 0.896, P value at 10 weeks = 0.127) but was significant at 14 weeks (<0.05). Mothers' weight gain during 14 weeks was significant (P value < 0.05). When mothers were distributed into four groups according to their calorie and protein intake for comparison (median value: calorie-2034 kilocalorie, protein- 78.7 grams), the weight, length and head circumference gain in infants and mothers' weight were significantly higher in Group I and Group II compared to Group III and Group IV with P value < 0.05 at 6, 10, and 14 weeks. CONCLUSIONS: Calorie intake was low in mothers when compared to RDA recommendations. Infants showed lower weight, length, and head circumference gain than WHO Child Growth Standards. There is a direct relationship between the maternal diet and anthropometric measures of their infants. During postnatal period, mothers showed an increase in weight, rather than the decrease that is usually expected.
ABSTRACT
Outbreaks of diphtheria continue to occur in Kerala with an age shift to older population. Antibody seroprevalence studies are essential to understand the immune status of the community and to develop an effective immunization strategy. AIM: To assess the necessity of diphtheria vaccination among adults. SETTINGS AND DESIGN: Cross-sectional study, among 152 healthy adults (>18 years). METHODS AND MATERIALS: Diphtheria IgG antibody detection was performed by using ELISA technique. RESULTS: Out of 152 study population, 14 (9.2%) individuals had very low antibody levels, requiring basic immunization, 123 (80.9%) needed booster vaccination, 12 (7.9%) would need a booster dose in 5 years and 3 (2%) would need a booster dose in 7 years to maintain adequate antibody levels. Out of the total, 131 (86.2%) individuals had completed childhood immunization and 21 (13.8%) had incomplete or no immunization during childhood. In the population who had completed childhood immunization, 4 (3%) had very low antibody levels requiring basic immunization and 113 (86%) had antibody levels needing booster vaccine soon, with the remaining 14 (10.6%) individuals requiring a booster vaccine after 5 years and 7 years. In the partially immunized/unimmunized population, 10 (47.6%) had antibody levels requiring basic immunization and another 10 (47.6%) had antibody levels low enough to warrant a booster vaccine. CONCLUSIONS: Majority of the subjects who had completed childhood immunization showed an inadequate immunity against diphtheria during adulthood. This indicates waning immunity against diphtheria. Hence, modifying the present diphtheria vaccination strategy to include booster doses during adulthood is essential. CONTEXT: Even in developed countries where nearly 100% universal immunization is achieved, diphtheria outbreaks are known to occur. Several seroprevalence studies have been conducted in those regions to determine whether those populations have adequate levels of antibodies against diphtheria. In India, sporadic outbreaks occur, and an increasing number of diphtheria cases are being reported over the last few years. Large outbreaks in Kerala 2016 were about 533 cases. Recent outbreaks in 2019, in Trivandrum, about 175 cases were suspected and 19 cases were confirmed in laboratory. However, Indian studies to determine whether the adult population has adequate protective antibody levels are lacking. Knowing the immune status of the population and devising an appropriate strategies to prevent outbreaks of diphtheria are the integral parts of primary care. These concerns are the basis and evaluation of the seroprevalence of IgG antibody levels against diphtheria antitoxin among healthy adults in our region in this study.
ABSTRACT
INTRODUCTION: Nonalcoholic fatty liver disease (NAFLD) is a hepatic disorder that develops in the absence of alcohol intake. Obesity and diabetes are considered risk factors for the development of fatty liver; however, whether fatty liver is the cause or consequence of these conditions is not yet clear. Insulin resistance (IR) is found to be a common risk factor for the development of diabetes, obesity and fatty liver. AIMS AND OBJECTIVES: The aim and objective of this study is to determine the prevalence of undetected diabetes, dyslipidemia, and IR in subjects with NAFLD. MATERIALS AND METHODS: In apparently healthy 100 subjects, with ultrasound diagnosis of fatty liver, fasting and postprandial blood sugar levels, fasting insulin levels, and fasting lipid profile were checked. IR value was estimated using homeostatic model assessment-IR formula. Appropriate statistical methods were adopted to analyze the data. RESULTS: A total of 66 subjects out of the 100 had IR. It was noted that IR significantly correlated with raised fasting blood sugar and fasting plasma insulin values. There was no significant correlation between IR and lipid profile values. CONCLUSION: The chance of developing NAFLD was high if the subjects are having IR, or vice versa. There was an increased prevalence of prediabetes and diabetes in the subjects with NAFLD. Waist circumference, rather than body mass index, was found to be a strong predictor of central adiposity and IR.
ABSTRACT
CONTEXT: Drowning is a major, but often neglected, public health problem. Drowning is the second leading cause of death from unintentional injuries, after road traffic injuries. According to the World Health Organization, 0.7% of all deaths worldwide (>500,000 deaths) each year are due to unintentional drowning. In India, very little is known about the epidemiology of drowning. There is almost no awareness or protocols to prevent drowning. OBJECTIVES: The objective is to study the prevalence, risk factors, and types of drowning among school children in the Malabar region. MATERIALS AND METHODS: A cross-sectional, population-based study by semistructured interview method was performed among 8433 school children of 5-15 years. STATISTICAL METHODS: The prevalence of drowning was calculated. Odds ratio was calculated and represented under 95% confidence interval. Risk factors were analyzed as frequency with percentage. RESULTS AND DISCUSSION: The total study population was 8433 students, comprising 4795 boys (56.86%) and 3638 (43.13%) girls. A total of 342 (4.06%) students had a history of drowning. These survivors were further interviewed. The prevalence of drowning was much higher compared to figures reported in literature. CONCLUSIONS: Contrary to the general perception, drowning is a common occurrence among children. Swimming skills have no role in the prevention of drowning. Public awareness regarding supervision of children and restricting unsupervised access of children to water bodies need to be emphasized.
