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   2010| September-December  | Volume 2 | Issue 3  
    Online since August 17, 2010

 
 
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SYMPOSIUM ON INFECTIOUS AGENTS IN A MULTIDRUG RESISTANT GLOBE
Multidrug resistant Acinetobacter
Vikas Manchanda, Sinha Sanchaita, NP Singh
September-December 2010, 2(3):291-304
DOI:10.4103/0974-777X.68538  PMID:20927292
Emergence and spread of Acinetobacter species, resistant to most of the available antimicrobial agents, is an area of great concern. It is now being frequently associated with healthcare associated infections. Literature was searched at PUBMED, Google Scholar, and Cochrane Library, using the terms 'Acinetobacter Resistance, multidrug resistant (MDR), Antimicrobial Therapy, Outbreak, Colistin, Tigecycline, AmpC enzymes, and carbapenemases in various combinations. The terms such as MDR, Extensively Drug Resistant (XDR), and Pan Drug Resistant (PDR) have been used in published literature with varied definitions, leading to confusion in the correlation of data from various studies. In this review various mechanisms of resistance in the Acinetobacter species have been discussed. The review also probes upon the current therapeutic options, including combination therapies available to treat infections due to resistant Acinetobacter species in adults as well as children. There is an urgent need to enforce infection control measures and antimicrobial stewardship programs to prevent the further spread of these resistant Acinetobacter species and to delay the emergence of increased resistance in the bacteria.
  20 20,878 402
UPDATE ARTICLE
Human immunodeficiency virus and leishmaniasis
Navid Ezra, Maria Teresa Ochoa, Noah Craft
September-December 2010, 2(3):248-257
DOI:10.4103/0974-777X.68528  PMID:20927287
The leishmaniases are a group of diseases transmitted to humans by the bite of a sandfly, caused by protozoan parasites of the genus Leishmania. Various Leishmania species infect humans, producing a spectrum of clinical manifestations. It is estimated that 350 million people are at risk, with a global yearly incidence of 1-1.5 million for cutaneous and 500,000 for visceral leishmaniasis (VL). VL is a major cause of morbidity and mortality in East Africa, Brazil and the Indian subcontinent. Co-infection with human immunodeficiency virus (HIV) alters the immune response to the disease. Here we review the immune response to Leishmania in the setting of HIV co-infection. Improved understanding of the immunology involved in co-infections may help in designing prophylactic and therapeutic strategies against leishmaniasis.
  16 33,387 235
SYMPOSIUM ON INFECTIOUS AGENTS IN A MULTIDRUG RESISTANT GLOBE
Extended-spectrum ß-lactamases in gram negative bacteria
Deepti Rawat, Deepthi Nair
September-December 2010, 2(3):263-274
DOI:10.4103/0974-777X.68531  PMID:20927289
Extended-spectrum ß-lactamases (ESBLs) are a group of plasmid-mediated, diverse, complex and rapidly evolving enzymes that are posing a major therapeutic challenge today in the treatment of hospitalized and community-based patients. Infections due to ESBL producers range from uncomplicated urinary tract infections to life-threatening sepsis. Derived from the older TEM is derived from Temoniera, a patient from whom the strain was first isolated in Greece. ß-lactamases, these enzymes share the ability to hydrolyze third-generation cephalosporins and aztreonam and yet are inhibited by clavulanic acid. In addition, ESBL-producing organisms exhibit co-resistance to many other classes of antibiotics, resulting in limitation of therapeutic option. Because of inoculum effect and substrate specificity, their detection is also a major challenge. At present, however, organizations such as the Clinical and Laboratory Standards Institute (formerly the National Committee for Clinical Laboratory Standards) provide guidelines for the detection of ESBLs in Klebsiella pneumoniae, K. oxytoca, Escherichia coli and Proteus mirabilis. In common to all ESBL-detection methods is the general principle that the activity of extended-spectrum cephalosporins against ESBL-producing organisms will be enhanced by the presence of clavulanic acid. Carbapenems are the treatment of choice for serious infections due to ESBL-producing organisms, yet carbapenem-resistant isolates have recently been reported. ESBLs represent an impressive example of the ability of gram-negative bacteria to develop new antibiotic-resistance mechanisms in the face of the introduction of new antimicrobial agents. Thus there is need for efficient infection-control practices for containment of outbreaks; and intervention strategies, e.g., antibiotic rotation to reduce further selection and spread of these increasingly resistant pathogens.
  9 11,668 397
Methicillin and vancomycin resistant S. aureus in hospitalized patients
Poonam Sood Loomba, Juhi Taneja, Bibhabati Mishra
September-December 2010, 2(3):275-283
DOI:10.4103/0974-777X.68535  PMID:20927290
S. aureus is the major bacterial cause of skin, soft tissue and bone infections, and one of the commonest causes of healthcare-associated bacteremia. Hospital-associated methicillin-resistant S. aureus (MRSA) carriage is associated with an increased risk of infection, morbidity and mortality. Screening of high-risk patients at the time of hospital admission and decolonization has proved to be an important factor in an effort to reduce nosocomial transmission. The electronic database Pub Med was searched for all the articles on "Establishment of MRSA and the emergence of vancomycin-resistant S. aureus (VRSA)." The search included case reports, case series and reviews. All the articles were cross-referenced to search for any more available articles. A total of 88 references were obtained. The studies showed a steady increase in the number of vancomycin-intermediate and vancomycin-resistant S. aureus. Extensive use of vancomycin creates a selective pressure that favors the outgrowth of rare, vancomycin-resistant clones leading to heterogenous vancomycin intermediate S. aureus hVISA clones, and eventually, with continued exposure, to a uniform population of vancomycin-intermediate S. aureus (VISA) clones. However, the criteria for identifying hVISA strains have not been standardized, complicating any determination of their clinical significance and role in treatment failures. The spread of MRSA from the hospital to the community, coupled with the emergence of VISA and VRSA, has become major concern among healthcare providers. Infection-control measures, reliable laboratory screening for resistance, appropriate antibiotic prescribing practices and avoidance of blanket treatment can prevent long-term emergence of resistance.
  8 6,793 181
BIODYNAMIC MONITORING
High-level aminoglycoside resistance and reduced susceptibility to vancomycin in nosocomial enterococci
Luna Adhikari
September-December 2010, 2(3):231-235
DOI:10.4103/0974-777X.68534  PMID:20927283
Objectives: The objectives of the present study were to identify the species of enterococci isolated from nosocomial infections and to determine the antibiotic susceptibility pattern with reference to high-level aminoglycosides and vancomycin. Materials and Methods: Enterococci were isolated from various clinical samples collected from patients after 72 hours of hospitalization. Various species of Enterococcus were identified by standard methods. High-level aminoglycoside resistance and vancomycin susceptibility in enterococci were detected by disk-diffusion and agar-screen methods. Results: One hundred eighty enterococcal strains were isolated from various clinical samples. Various species of Enterococcus - Enterococcus fecalis 130 (72.22%), Enterococcus casseliflavus 24 (13.33%), Enterococcus fecium 17 (9.44%), Enterococcus durans 7 (3.89%) and Enterococcus dispar 2 (1.11%) - were isolated. The highest resistance to aminoglycoside was observed among E. fecium, followed by E. durans, E. fecalis and E. casseliflavus, both by disk-diffusion and agar-screen methods. The high-level aminoglycoside resistance (HLAR) was significantly (P<0.05) higher in E. fecium by agar-screen method. All enterococci showed minimum inhibitory concentration (MIC) of ≤8 ΅g/mL to vancomycin. Sixteen (12.31%) E. fecalis and 3 (12.5%) E. fecium strains were intermediately resistant to vancomycin (MIC= 8 ΅g/mL), whereas other strains were susceptible to vancomycin. Conclusion: The occurrence of high-level aminoglycoside resistance in enterococcal isolates in our setup was high. Even though none of the enterococcal strains showed resistance to vancomycin, yet reduced susceptibility to vancomycin was noticed in our study. This would require routine testing of enterococcal isolates for HLAR and vancomycin susceptibility. Agar-screen method was found to be superior to disk-diffusion method in detecting resistant strains to aminoglycosides and vancomycin.
  6 3,913 89
SYMPOSIUM ON INFECTIOUS AGENTS IN A MULTIDRUG RESISTANT GLOBE
Cephalosporin resistance in Neisseria gonorrhoeae
Manju Bala, Seema Sood
September-December 2010, 2(3):284-290
DOI:10.4103/0974-777X.68537  PMID:20927291
Gonorrhea, a disease of public health importance, not only leads to high incidence of acute infections and complications but also plays a major role in facilitating human immunodeficiency virus (HIV) acquisition and transmission. One of the major public health needs for gonorrhea control is appropriate, effective treatment. However, treatment options for gonorrhea are diminishing as Neisseria gonorrhoeae have developed resistance to several antimicrobial drugs such as sulfonamides, penicillin, tetracyclines and quinolones. Antimicrobial resistance (AMR) surveillance of N. gonorrhoeae helps establish and maintain the efficacy of standard treatment regimens. AMR surveillance should be continuous to reveal the emergence of new resistant strains, monitor the changing patterns of resistance, and be able to update treatment recommendations so as to assist in disease control. Current treatment guidelines recommend the use of single dose injectable or oral cephalosporins. The emergence and spread of cephalosporin resistant and multi drug resistant N. gonorrhoeae strains, represents a worrying trend that requires monitoring and investigation. Routine clinical laboratories need to be vigilant for the detection of such strains such that strategies for control and prevention could be reviewed and revised from time to time. It will be important to elucidate the genetic mechanisms responsible for decreased susceptibility and future resistance. There is also an urgent need for research of safe, alternative anti-gonococcal compounds that can be administered orally and have effective potency, allowing high therapeutic efficacy (greater than 95.0% cure rate).
  4 7,371 115
ORIGINAL ARTICLES
Surveying infections among pregnant women in the Niger Delta, Nigeria
FI Buseri, E Seiyaboh, ZA Jeremiah
September-December 2010, 2(3):203-211
DOI:10.4103/0974-777X.68525  PMID:20927278
Background: There is paucity of epidemiological data on infectious diseases among antenatal mothers in Bayelsa State of the Niger Delta, Nigeria. Aims: The aim of this study was to determine the seroprevalence of the serological markers Human immunodeficiency virus-antibody (HIV-Ab), Hepatitis B surface antigen(HBsAg), Hepatitis C virus antibody(HCV-A)and antibodies to T.pallidum among pregnant women in Yenagoa, Bayelsa State, South-South Nigeria. Settings and Design: This is a cross-sectional study which was carried out in Yenagoa city, the heart of the Niger Delta, Nigeria. Materials and Methods: Human immunodeficiency virus (HIV) antibodies were detected by using "Determine" HIV-1/2 test strip (Abbott Laboratories, Japan); hepatitis B surface antigen (HBsAg), antibodies to hepatitis C virus (anti-HCV) and antibodies to T. pallidum were carried out using ACON rapid test strips (ACON Laboratories, USA). All positive samples for HIV, HBV and HCV were confirmed using the Clinotech diagnostic enzyme-linked immunosorbent assay (ELISA) test kits (Clinotech Laboratories, USA), while all reactive samples to Treponema pallidum antibodies were confirmed by the Treponema pallidum hemagglutination (TPHA) test (Lorne Laboratories Ltd., UK). All test procedures were carried out according to the manufacturers' instructions. Statistical Analysis Used: The data generated were coded, entered, validated and analyzed using Statistical Package for Social Science (SPSS), version 12.0, and Epi info. The seroprevalence of syphilis, HBsAg, HCV and HIV was expressed for the entire study group by age, sex and other demographic features using Pearson chi-square analysis. Values below 0.05 were considered statistically significant. Results: A total of 1,000 apparently healthy pregnant women aged between 15 and 44 years with a mean of 27.34΁5.43 years were screened. In terms of percentage, 89.4% of the subjects were married, and 10.6% were without formal husbands. The overall seroprevalence of HIV, HBsAg, HCV and syphilis was found to be 4.1%, 5.3%, 0.5% and 5.0%, respectively. Conclusions: High prevalence of some infectious diseases was observed in the present study, which may pose serious health risk to women of reproductive age in this region. It is important to point out that there is need to improve antenatal care of pregnant women by mandatory screening for these infectious diseases.
  3 6,177 186
BIODYNAMIC MONITORING
Correlates of vaginal colonization with group B streptococci among pregnant women
Tsering Chomu Dechen, Kar Sumit, Pal Ranabir
September-December 2010, 2(3):236-241
DOI:10.4103/0974-777X.68536  PMID:20927284
Background: A study of genital colonization by group B streptococcus (GBS) was conducted in pregnant women in their third trimester, which is a known risk factor of morbidity and mortality among newborns. Aims: The present study was undertaken to study the prevalence and the correlates of vaginal colonization by GBS among pregnant women. Setting and Design: This observational cross-sectional study was conducted during September 2002 to March 2004 on 524 pregnant women. Materials and Methods: Three high vaginal swabs were obtained from all the pregnant women admitted at term and in preterm labor. Two swabs were used for aerobic culture and the third one for gram staining. The first set of swabs was cultured on 5% Sheep blood agar plates. The second set of swabs were inoculated into Todd-Hewitt broth and then subcultured in 5% Sheep blood agar plates. The main outcome measures were the presence of GBS infection in comparison to the age group, gravida, gestational age, premature rupture of membrane (PROM), preterm labor and association with febrile spells of the present pregnancy. Results: The culture positivity rate of GBS was 4.77% and coexistent organisms isolated were Candida species (36%), Staphylococcus aureus (8%) and Enterococcus species (8%). Culture positivity in the age group of 18-25 years was 5.71%, of which 5.74% were in their first pregnancy. The correlation between age group and gravida with GBS culture positivity was statistically insignificant. The culture positivity in <36 weeks of gestational age was 6.93%. This relation was statistically significant. Twenty-eight percent developed PROM. Sixty-four percent of culture positives had preterm labor. Conclusion: GBS infection among pregnant women was significantly correlated with the gestational age, PROM and preterm labor. In pregnancy GBS colonization causes asymptomatic bacteriuria or UTI. It is a well known cause of puerperal infections with amnionitis,endometritis and sepsis being the most commonly reported infections. [5]
  2 4,246 100
CASE REPORTS
Case series of adenocarcinoma of the prostate associated with Schistosoma haematobium infection in Tanzania
Humphrey D Mazigo, Maria Zinga, Jorg Heukelbach, Peter Rambau
September-December 2010, 2(3):307-309
DOI:10.4103/0974-777X.68540  PMID:20927294
In endemic areas, schistosomiasis has been associated with the pathogenesis of bladder, prostate, colorectal and renal carcinoma. However, the relationship between prostate cancer and schistosomiasis infection remains controversial. Here we present a series of three cases from Tanzania of prostatic adenocarcinoma associated with urinary schistosomiasis.
  2 2,670 35
ORIGINAL ARTICLES
Solar disinfection improves drinking water quality to prevent diarrhea in under-five children in Sikkim, India
BB Rai, Ranabir Pal, Sumit Kar, Dechen C Tsering
September-December 2010, 2(3):221-225
DOI:10.4103/0974-777X.68532  PMID:20927281
Background: Solar radiations improve the microbiological quality of water and offer a method for disinfection of drinking water that requires few resources and no expertise and may reduce the prevalence of diarrhea among under-five children. Aims and Objectives: To find out the reduction in the prevalence of diarrhea in the under-five children after consumption of potable water treated with solar disinfection method. Materials and Methods: This was a population-based interventional prospective study in the urban slum area of Mazegoan, Jorethang, south Sikkim, during the period 1 st May 2007 to 30 th November 2007 on 136 children in the under-five age group in 102 households selected by random sampling. Main outcome measure was the assessment of the reduction of the prevalence of diarrhea among under-five children after consumption of potable water treated with solar disinfection method practiced by the caregivers in the intervention group keeping water in polyethylene terephthalate (PET) bottles as directed by the investigators. The data were collected by the interview method using a pre-tested questionnaire prepared on the basis of socio-demographics and prevalence of diarrhea. The data were subjected to percentages and chi-square tests, which were used to find the significance. Results: After four weeks of intervention among the study group, the diarrhea prevalence was 7.69% among solar disinfection (SODIS) users, while 31.82% prevalence was observed among non-users in that period; the reduction in prevalence of diarrhea was 75.83%. After eight weeks of intervention, the prevalence of diarrhea was 7.58% among SODIS users and 31.43% among non-users; the reduction in diarrhea was 75.88% in the study group. The findings were found to be statistically significant. Conclusions: In our study, we observed that the prevalence of diarrhea decreased significantly after solar disinfection of water was practiced by the caregivers keeping potable water in PET bottles in the intervention group.
  2 2,936 73
POINT OF VIEW
Preventing post-transfusion hepatitis by screening blood donors for IgM antibody to hepatitis B core antigen
Nilima G Sawke, GK Sawke
September-December 2010, 2(3):246-247
DOI:10.4103/0974-777X.68526  PMID:20927286
  2 3,250 83
SYMPOSIUM ON INFECTIOUS AGENTS IN A MULTIDRUG RESISTANT GLOBE
Quinolone and cephalosporin resistance in enteric fever
Malini Rajinder Capoor, Deepthi Nair
September-December 2010, 2(3):258-262
DOI:10.4103/0974-777X.68529  PMID:20927288
Enteric fever is a major public health problem in developing countries. Ciprofloxacin resistance has now become a norm in the Indian subcontinent. Novel molecular substitutions may become frequent in future owing to selective pressures exerted by the irrational use of ciprofloxacin in human and veterinary therapeutics, in a population endemic with nalidixic acid-resistant strains. The therapeutics of ciprofloxacin-resistant enteric fever narrows down to third- and fourth-generation cephalosporins, azithromycin, tigecycline and penems. The first-line antimicrobials ampicillin, chloramphenicol and co-trimoxazole need to be rolled back. Antimicrobial surveillance coupled with molecular analysis of fluoroquinolone resistance is warranted for reconfirming novel and established molecular patterns for therapeutic reappraisal and for novel-drug targets. This review explores the antimicrobial resistance and its molecular mechanisms, as well as novel drugs in the therapy of enteric fever.
  2 7,738 158
GEOGRAPHIC MEDICINE
Oviposition deterrence induced by Ocimum kilimandscharicum and Ocimum suave extracts to gravid Anopheles gambiae s.s (Diptera: Culicidae) in laboratory
Eliningaya J Kweka, Ester E Lyatuu, Michael A Mboya, Beda J Mwang'onde, Aneth M Mahande
September-December 2010, 2(3):242-245
DOI:10.4103/0974-777X.68524  PMID:20927285
Background: In most of the past decades, mosquito control has been done by the use of indoor residual spray and insecticides-treated bed nets. The control of mosquitoes by targeting the breeding sites (larval habitat) has not been given priority. Disrupting the oviposition sensory detection of mosquitoes by introducing deterrents of plant origin, which are cheap resources, might be add value to integrated vector control. Such knowledge is required in order to successfully manipulate the behavior of mosquitoes for monitoring or control. Materials and Methods: Twenty gravid mosquitoes were placed in a cage measuring 30 Χ 30 Χ 30 cm for oviposition. The oviposition media were made of different materials. Experiments were set up at 6:00 pm, and eggs were collected for counting at 7:30 am. Mosquitoes were observed until they died. The comparisons of the number of eggs were made between the different treatments. Results: There was significant difference in the number of eggs found in control cups when compared with the number of eggs found in water treated with Ocimum kilimandscharicum (OK) (P=0.02) or Ocimum suave (OS) (P=0.000) and that found in water with debris treated with OK (P=0.011) or OS (P=0.002). There was no significant difference in the number of eggs laid in treated water and the number of eggs laid in water with debris treated either with OK (P=0.105) or OS (P=0.176). Oviposition activity index for both OS and OK experiments lay in a negative side and ranged from −0.19% to −1%. The results show that OS and OK deter oviposition in An.gambiae s.s. Conclusions: Further research needs to be done on the effect of secondary metabolites of these plant extracts as they decompose in the breeding sites. In the event of favorable results, the potential of these plant extracts can be harnessed on a larger scale.
  1 2,752 59
LETTERS TO EDITOR
Mycoplasmotic giant cell epitheliomatous inverted papillary carcinoma of the aural canal
Mohammed Naim, Vanesa T John, Amit Kumar, Khalid Iqbal
September-December 2010, 2(3):317-318
DOI:10.4103/0974-777X.68548  PMID:20927302
  1 2,070 25
ORIGINAL ARTICLES
Retrospective analysis of suspected rabies cases reported at Bugando Referral Hospital, Mwanza, Tanzania
Humphrey D Mazigo, Fredros O Okumu, Eliningaya J Kweka, Ladslaus L Mnyone
September-December 2010, 2(3):216-220
DOI:10.4103/0974-777X.68530  PMID:20927280
Aims: The aim of this study was to determine the incidence of humans being bitten by rabies-suspected animals, and the victims' adherence to post-exposure prophylaxis (PEP) regimen. Materials and Methods: A retrospective analysis of data of victims treated at Bugando Medical Centre during the period 2002-2006 (n=5 years) was done. Results: A total of 767 bite injuries inflicted by rabies-suspected animals were reported, giving a mean annual incidence of ~58 cases per 100,000 (52.5% males, 47.5% females). The proportion of children bitten was relatively higher than that of adults. All victims were treated by using inactivated diploid-cell rabies vaccine and were recommended to appear for the second and third doses. However, only 28% of the victims completed the vaccination regime. Domestic dogs were involved in 95.44% of the human bite cases, whereas cats (3.9%), spotted hyena (Crocuta crocuta) (0.03%), vervet monkey (Cercopithecur aethiops) (0.01%) and black-backed jackal (0.01%) played a minor role. The majority of rabies-suspected case reports were from Nyamagana district and occurred most frequently from June to October each year. Conclusions: In conclusion, this study revealed that incidences of humans being bitten by dogs suspected of rabies are common in Tanzania, involve mostly children, and victims do not comply with the prophylactic regimen. Rigorous surveillance to determine the status of rabies and the risk factors for human rabies, as well as formulation and institution of appropriate rabies-control policies, is required.
  1 4,843 106
CASE REPORTS
Kikuchi-Fujimoto disease from eastern India
Pankaj Singhania, Rudrajit Paul, S Maitra, AK Banerjee, MA Hashmi
September-December 2010, 2(3):305-306
DOI:10.4103/0974-777X.68539  PMID:20927293
Kikuchi's disease, a rare disorder which usually presents with fever painful lymphadenopathy, rash and arthritis, all of which are close mimickers of infective and immunological disorders. It is essentially a histopathological diagnosis and tests to rule out other connective tissue disorders or infective etiology must be undertaken. We present a series of two cases of kikuchi-fujimoto's disease presenting primarily with lymphadenopathy and fever in all cases. The first is a case of generalized lymphadenopathy and the second case of kikuchi's disease with SLE, a rare association. Lymph node excision biopsy and histopathology documented Kikuchi Fujimoto disease in above cases. All the cases improved on follow up and had no residual stigmata.
  - 4,384 72
EDITORIAL
State of the globe: Rabies is still rampant and needs action
Nicholas Johnson
September-December 2010, 2(3):201-202
DOI:10.4103/0974-777X.68523  PMID:20927277
  - 2,637 190
LETTERS TO EDITOR
Bilateral thalamic hyperintensities in a case of viral encephalitis
Kavitha Mohanasundaram, Srinivasan Narayanan, Subramaniyan Kumarasamy
September-December 2010, 2(3):310-311
DOI:10.4103/0974-777X.68541  PMID:20927295
  - 5,524 59
Hepatitis C and Helicobacter Pylori
Viroj Wiwanitkit
September-December 2010, 2(3):311-311
DOI:10.4103/0974-777X.68542  PMID:20927297
  - 1,657 52
Hepatitis B, needle stick and medical workers
Viroj Wiwanitkit
September-December 2010, 2(3):311-312
DOI:10.4103/0974-777X.68543  PMID:20927296
  - 1,652 51
A cross-sectional study among medical residents with noninvasive rapid serological test for Helicobacter Pylori
Mohanakrishnan
September-December 2010, 2(3):312-312
DOI:10.4103/0974-777X.68544  PMID:20927298
  - 1,585 41
Multiple-ring enhancing lesions in an immunocompetent adult
Amit Agrawal, Arvind Bhake, VM Sangole, Brij R Singh
September-December 2010, 2(3):313-314
DOI:10.4103/0974-777X.68545  PMID:20927299
  - 5,440 50
Severe rhabdomyolysis associated in meningococcemia
Vishal Sharma, Mukul P Agarwal, Subhash Giri
September-December 2010, 2(3):315-315
DOI:10.4103/0974-777X.68546  PMID:20927300
  - 3,230 28
Drug resistant urinary isolates of Pseudomonas Aeruginosa and Acinetobacter species
Jyoti Sharma, Neelam Gulati, Jagdish Chander
September-December 2010, 2(3):315-317
DOI:10.4103/0974-777X.68547  PMID:20927301
  - 2,305 99
ORIGINAL ARTICLES
Current knowledge attitudes, and practices of healthcare providers about leprosy in Assam, India
Sumit Kar, S Ahmad, Ranabir Pal
September-December 2010, 2(3):212-215
DOI:10.4103/0974-777X.68527  PMID:20927279
Background: Leprosy is a chronic infectious disease that is associated with serious morbidity and is a disease of public health concern because of the case load and the social stigma attached to the disease. Aim: To understand the knowledge of, and attitudes towards, leprosy amongst healthcare providers in Assam, India. Settings and Design: This cross-sectional study was conducted during March to June 2007 in different health institutions of the Kamrup district of Assam. Results: Among the program managers interviewed, only half were organizing training sessions, and 37.5% were involved in supervision of the program activities at the periphery level. Among the program managers who were involved with leprosy elimination, only half were organizing training session and 37.5% were involved in supervision of the program activities at the periphery level. Medical officers consistently demonstrated higher knowledge about leprosy, followed by health supervisors and multipurpose workers (MPWs), including nursing staff. Regarding training status with regard to leprosy, 90% of medical officers, 80% of health supervisors and around 87% of MPWs (83% of male MPWs and 89% of female MPWs) had attended training programs on leprosy. Regarding WHO MDT, 80% of health supervisors, 84.8% of male MPWs and 86.2% of female MPWs had an idea of MDT and treatment duration of various categories of patients. Conclusions: These observations suggest that there appear to be adequate knowledge and positive behavior among healthcare providers with regard to leprosy in this part of India. However, there is still a need to organize training programs at regular intervals to train new recruits, as well as reinforce and update the knowledge of those already trained.
  - 4,210 138
Time of default in tuberculosis patients on directly observed treatment
Geeta S Pardeshi
September-December 2010, 2(3):226-230
DOI:10.4103/0974-777X.68533  PMID:20927282
Background: Default remains an important challenge for the Revised National Tuberculosis Control Programme, which has achieved improved cure rates. Objectives: This study describes the pattern of time of default in patients on DOTS. Settings and Design: Tuberculosis Unit in District Tuberculosis Centre, Yavatmal, India; Retrospective cohort study. Materials and Methods: This analysis was done among the cohort of patients of registered at the Tuberculosis Unit during the year 2004. The time of default was assessed from the tuberculosis register. The sputum smear conversion and treatment outcome were also assessed. Statistical Analysis: Kaplan-Meier plots and log rank tests. Results: Overall, the default rate amongst the 716 patients registered at the Tuberculosis Unit was 10.33%. There was a significant difference in the default rate over time between the three DOTS categories (log rank statistic= 15.49, P=0.0004). Amongst the 331 smear-positive patients, the cumulative default rates at the end of intensive phase were 4% and 16%; while by end of treatment period, the default rates were 6% and 31% in category I and category II, respectively. A majority of the smear-positive patients in category II belonged to the group 'treatment after default' (56/95), and 30% of them defaulted during re-treatment. The sputum smear conversion rate at the end of intensive phase was 84%. Amongst 36 patients without smear conversion at the end of intensive phase, 55% had treatment failure. Conclusions: Patients defaulting in intensive phase of treatment and without smear conversion at the end of intensive phase should be retrieved on a priority basis. Default constitutes not only a major reason for patients needing re-treatment but also a risk for repeated default.
  - 2,792 97
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2008 Journal of Global Infectious Diseases | Published by Wolters Kluwer - Medknow
Online since 10th December, 2008