Chlamydia pneumoniae infection and its association with coronary heart disease and cardiovascular risk factors in a sample South Asian population.

Recent studies have suggested that a chronic infection with Chlamydia pneumoniae (C. pneumoniae) may be associated with the risk of developing coronary heart disease (CHD). A case control study was conducted to investigate the association between C. pneumoniae infection and coronary heart disease and coronary risk factors in a sample South Asian population. C. pneumoniae specific IgG antibody was measured by microimmunofluorescence. Among controls 56.6% were seropositive (> or =1/32) compared to 58.5% of acute myocardial infarction (AMI) patients (n=41, odds ratio 1.08, CI 0.37--3.12, P=0.93) and 73.3% of stable coronary heart disease (SCHD) patients (n=30, odds ratio 2.1, CI 0.63--7.19, P=0.27). The highest geometric mean titre of control subjects (n=30) was significantly lower (74.7) compared to AMI patients (101.5, P<0.05) and SCHD patients (138.6, P<0.05). Patients who were non-smokers had higher odds ratios for CHD than smokers when seropositive at IgG antibody titres of 1/32, 1/64 and 1/128, suggesting an association between smoking and C. pneumoniae infection. In patients with CHD there was a significant association between diabetes mellitus and seropositivity (P=0.008) in those over 50 years of age. Non-smoking CHD patients with high cholesterol/HDL-C ratio had a higher trend for seropositivity. Other risk factors (smoking, systolic and diastolic blood pressure, waist/hip ratio, triglycerides) showed no association when controlled for age. In the control group, smokers with high cholesterol/HDL-C ratio had a higher trend for seropositivity. These results do not provide strong support for the hypothesis that C. pneumoniae infection is a risk factor for clinical CHD in this South Asian population. Results suggest that C. pneumoniae infection may be linked to CHD through its interaction with some of the known risk factors such as blood lipids, diabetes and smoking.

Elevated tumour necrosis factor in dengue fever and dengue haemorrhagic fever.

Acute and convalescent phase blood samples from five dengue fever (DF) patients and four dengue haemorrhagic fever (DHF) patients were tested for the presence of tumour necrosis factor (TNF). While all blood samples showed elevated levels, the acute phase blood sample levels were much higher. The mean TNF level in the acute samples of the five DF cases was 862 while in the DHF cases the level was 1722 pg/ml. Though the sample size is small, the difference appears to be statistically significant. Unlike in DF the distinctive features in DHF are the occurrence of shock, thrombocytopaenic purpura and sometimes disseminated intravascular coagulation (DIC). Increased TNF levels have not been reported in the literature in association with DHF, although it has been shown to contribute to these features which appear in some other diseases.

The prevalence of hepatitis B surface antigen in the Gampaha district.

OBJECTIVE: To assess the prevalence and some epidemiological features of hepatitis B surface antigen (HBsAg) status in the Gampaha district. DESIGN: Community based survey. SETTING: The district of Gampaha. SUBJECTS: All individuals over six months of age who were resident in the Gampaha district for a period over one month at time of survey. RESULTS: The HBsAg positivity rate in the Gampaha district was estimated to be 2.5% (95% C.I. 2% to 3%). This places the area in the intermediate endemicity zone as classified by WHO. The epidemiology indicates horizontal intrafamilial spread being more important in the population studied, than vertical, parenteral or sexual routes of transmission. CONCLUSIONS: The study suggests that immunisation in early childhood is an important measure in prevention of the infection in this district.

A new paradigm for international disease control: lessons learned from polio eradication in Southeast Asia.

OBJECTIVES: This study evaluated the impact of international coordination on polio eradication in Southeast Asia. METHODS: Active surveillance systems for acute flaccid paralysis were assessed. Analyses focused on surveillance proficiency and polio incidence. RESULTS: Ten countries coordinated activities. Importations occurred and were rapidly contained in China and Myanmar. Countries that have been free of indigenous polio transmission for at least 3 years include Sri Lanka, Indonesia, Myanmar, and Thailand. In the remaining endemic countries--India, Nepal, and Bangladesh--poliovirus transmission has been substantially reduced; however, these countries still harbor the world's largest polio reservoir. CONCLUSIONS: Unprecedented international coordination in Southeast Asia resulted in dramatic progress in polio eradication and serves as a paradigm for control of other infectious diseases such as malaria and tuberculosis.

Bacteriological assessment of patients undergoing major head and neck surgery.

The use of chemoprophylaxis in major Head and Neck surgery is controversial. Prior to conducting a prospective trial a controlled microbiological monitoring of 32 patients was performed to determine a suitable antibiotic for prophylaxis. Wound infection occurred in 22 (68%) patients with fistulae occurring in 10 of these patients (45.5%). Pre-operative cultures were of limited value in predicting subsequent sepsis. Gram-negative aerobic bacilli were the commonest group of pathogens (34.4%) isolated post-operatively. From projected resistance profiles of pathogenic and opportunistic bacteria amoxycillin and clavulanic acid (Augmentin, Beecham Pharmaceuticals) was chosen as a suitable antibiotic.