Dengue infection among tribal population in the Nilgiris district, Tamil Nadu, India.

BACKGROUND & OBJECTIVES: Dengue emerged as an important public health problem in Tamil Nadu from 2000 onwards, reported in all the districts as an endemic disease of Tamil Nadu except Nilgiris district. So this study was carried out to understand the dengue epidemiology in Nilgiris district. METHODS: Block-wise study was made at the Nilgiris district. The clinicians at the Nilgiris Adivasi Welfare Association hospitals (NAWA) situated in Kotagiri, Kozhikarai and Primary Health Centers from Kunjpannai, Arayoor, and Soloor Mattam, examined and recorded symptoms and collected blood samples from the dengue-suspected patients. These samples were centrifuged at 4°C and stored. Serum samples (267 nos.) collected from dengue-suspected patients for two years period from 2014 to 2016 were screened for dengue infection. RESULTS: First year study conducted during 2014-15 showed 13 dengue positives (8.39%) mainly from Kotagiri block (9 nos. - 69.2%) and the second year study conducted during 2015-16 showed 12 dengue positives (10.71%) found mostly from Udagamandalam block (6 nos.- 50%). People belonging to 6 different tribes - Irular, Toda, Kota, Kurumba, Kattunaickan, and Paniya were found infected with dengue and more Irular positives were recorded in both the years (5 Irular-2014-15 & 11 Irular -2015-16). First year detected more female positives (92.3%) whereas the second year showed 5 males (41.7%) and 7 females (58.3%). INTERPRETATION & CONCLUSION: This study unearthed the hidden disease dengue to be prevalent among the tribal community and emphasized the need for the establishment of a permanent dengue surveillance system with improved disease diagnostics, to initiate effective vector control efforts to stop dengue transmission from this hilly region.

Comparison of cytokeratin expressions among orthokeratinized odontogenic cysts, epidermoid cysts and odontogenic keratocysts: An immunohistochemical study.

BACKGROUND: Orthokeratinized odontogenic cysts are keratinizing jaw cysts and due their association with impacted teeth and keratinaceous content, they resemble odontogenic keratocysts but differ in regards to biological behaviour, being less aggressive. To unravel the nature of OOCs, as they resemble epidermoid cysts histologically and due to their developmental resemblances to OKCs, this study was conducted. AIM AND OBJECTIVE: To compare the cytokeratin expressions of CK 10 and CK 19 among orthokeratinized odontogenic keratocysts, epidermoid cysts and odontogenic keratocysts by immunohistochemical study. MATERIALS AND METHODS: 30 cases of all three cysts were collected, 10 cases in each of these cysts (OOCs, EDCs and OKCs) were incubated with CK 10 and CK 19 markers respectively. IHC staining was performed and assessed all layers of epithelium. All the data were analyzed using SPSS software, P values were obtained by the Chi-square test and Fisher's test. RESULTS: The expression pattern of CK10 showed 100% positive in both OOCs and EDCs with significant difference in OKCs. CK19 expression, between EDCs and OKCs was significant but between OOCs & EDCs and OOCs & OKCs was found to be statistically insignificant. CONCLUSION: CK 10 expressions in both OOCs and EDCs were near identical both in terms of expression and patterns of expression in surface and spinous layers. OOCs may not be distinguished from EDCs both histologically and with CK 10 expression. CK19 expression between OOCs & EDCs and OOCs & OKCs was statistically insignificant. Thus, based upon CK 19 expression, no significant differences were found between OOCs & EDCs and OOCs & OKCs, implying that OOCs resemble both EDCs and OKCs.

Changing paradigm in the epidemiology of Japanese encephalitis in a non-endemic region.

BACKGROUND & OBJECTIVES: Japanese encephalitis (JE) is a mosquito-borne zoonotic disease. The JE virus (JEV) does not cause any disease among its natural hosts and transmission continues through mosquitoes belonging to Culex vishnui subgroup. This study was aimed to investigate the prevalence of JEV in mosquitoes and humans in the Thanjavur district, a non-endemic region for JE, in Tamil Nadu, by using standard available assays. METHODS: : A sero-surveillance study was conducted in Thanjavur district among the normal rural school children in the 5-12 yr age group, during the JE season (October) and post-JE season (February) from 2011 to 2013 for the detection of JEV infection. Vector abundance studies were carried out from 2011 to 2014. JE seropositivity and its association between the seasons were analysed statistically. RESULTS: : The occurrence of JE infection among children aged 5-12 yr was very high in the study area. The infection rates for JE in two consecutive seasons for 2011-12 and 2012-13 were 32.2 and 65.2%, respectively. The Cx. tritaeniorhynchus sp. dominated the catch, and was majorly responsible for the transmission. There was a significant difference in the human infection rate compared to the years 1991-92 and 1992-93; and a marked decrease in the cattle to pigs ratio (123 : 1) compared to the studies in 1991-93. INTERPRETATION & CONCLUSION: : The study unearthed the prevailing situation of JE among children, who are at higher risk of developing the disease during the transmission season. The decrease in the cattle to pigs ratio might be the one of the reasons for increase in the JEV infection among the children population compared to 20 years before. This trend requires urgent attention as it could be prevented with effective surveillance systems and vaccines.

Can community-based integrated vector control hasten the process of LF elimination?

Community-based integrated vector control (IVC) using polystyrene beads (EPS) and pyrethroid impregnated curtains (PIC) as an adjunct to mass drug administration (MDA) was implemented for lymphatic filariasis elimination, in the filaria endemic villages of Tirukoilur, south India. In all the villages, MDA was carried out by the state health machinery, as part of the national filariasis elimination programme. Thirty-six difficult-to-control villages were grouped as, viz, MDA alone, MDA + EPS and MDA + EPS + PIC arms. Implementation and monitoring of IVC was carried out by the community. After 3 years of IVC, higher reductions in filariometric indices were observed in both the community and vector population. Decline in antigenaemia prevalence was higher in MDA + IVC as compared to MDA alone arm. Vector density dropped significantly (P < 0.05) in both the IVC arms, and nil transmission was observed during post-IVC period. Almost 53.8 and 75.8 % of the cesspits in MDA + EPS and MDA + EPS + PIC arms were closed by the householders, due to the enhanced awareness on vector breeding. The paper presents the key elements of IVC implementation through social mobilization in a LF prevalent area. Thus, community-based IVC strategy can hasten LF elimination, as it reduced the transmission and filariometric indices significantly. Indices were maintained at low level with nil transmission, by the community through IVC tools.

Impact on prevalence of intestinal helminth infection in school children administered with seven annual rounds of diethyl carbamazine (DEC) with albendazole.

BACKGROUND & OBJECTIVES: One third of the world's population is infected with one or more of the most common soil-transmitted helminths (STH). Albendazole (ALB) is being administered with diethyl carbamazine (DEC) in filariasis endemic areas to eliminate lymphatic filariasis (LF) and helminth infections. In this study, the cumulative impact of seven annual rounds of mass drug administrations (MDA) of DEC and ALB on STH infection in school children in selected villages in southern India was determined. METHODS: During 2001-2010, seven MDAs were implemented by the Tamil Nadu s0 tate h0 ealth d0 epartment, India. LF and STH infections were monitored in school children from 18 villages of the two treatment arms (viz, DEC alone and DEC+ALB). Kato-Katz cellophane quantitative thick smear technique was employed to estimate STH infections at three weeks, six months and one year post MDA. RESULTS: Prior to treatment, an overall STH prevalence was 60 per cent. After each MDA, infection markedly reduced at three weeks post-treatment in both the arms. The prevalence increased at six months period, which was maintained up to one year. After seven rounds of MDA, the infection reduced from 60.44 to 12.48 per cent in DEC+ALB arm; while the reduction was negligible in DEC alone arm (58.77 to 52.70%). INTERPRETATION & CONCLUSIONS: Seven rounds of MDA with DEC+ALB reduced the infection load significantly, and further sustained low level of infection for 10 years. However, complete parasite elimination could not be achieved. To curtail STH infection in the community, MDA should be regularized and environmental sanitation measures need to be improved by effective community-based campaigns.

Seasonal abundance & role of predominant Japanese encephalitis vectors Culex tritaeniorhynchus & Cx. gelidus Theobald in Cuddalore district, Tamil Nadu.

BACKGROUND & OBJECTIVES: Japanese encephalitis (JE) is the leading cause of viral encephalitis in Asia. The first major JE outbreak occurred in 1978 and since 1981 several outbreaks had been reported in the Cuddalore district (erstwhile South Arcot), Tamil Nadu, India. Entomological monitoring was carried out during January 2010 - March 2013, to determine the seasonal abundance and transmission dynamics of the vectors of JE virus, with emphasis on the role of Culex tritaeniorhynchus and Cx. gelidus. METHODS: Mosquito collections were carried out fortnightly during dusk hours in three villages viz. Soundara Solapuram, Pennadam, Erappavur of Cuddalore district. Mosquitoes were collected during dusk for a period of one hour in and around the cattle sheds using oral aspirator and torch light. The collected mosquitoes were later identified and pooled to detect JE virus (JEV) infection by enzyme linked immunosorbent assay (ELISA). RESULTS: A total of 46,343 mosquitoes comprising of 25 species and six genera were collected. Species composition included viz, Cx. tritaeniorhynchus (46.26%), Cx. gelidus (43.12%) and other species (10.62%). A total of 17,678 specimens (403 pools) of Cx. gelidus and 14,358 specimens (309 pools) of Cx. tritaeniorhynchus were tested, of which 12 pools of Cx. gelidus and 14 pools of Cx. tritaeniorhynchus were positive for JE virus antigen. The climatic factors were negatively correlated with minimum infection rate (MIR) for both the species, except mean temperature (P<0.05) for Cx. gelidus. INTERPRETATION & CONCLUSIONS: High abundance of Cx. tritaeniorhynchus and Cx. gelidus was observed compared to other mosquito species in the study area. Detection of JEV antigen in the two species confirmed the maintenance of virus. Appropriate vector control measures need to be taken to reduce the vector abundance.

Decline in lymphatic filariasis transmission with annual mass drug administration using DEC with and without albendazole over a 10year period in India.

The National Programme for the Elimination of Lymphatic Filariasis is underway in the endemic districts of Tamil Nadu State, South India, since 2001. Annual mass drug administration (MDA) was carried out by the state health department to all eligible individuals. The impact of MDAs on transmission parameters was evaluated in 2 revenue blocks, viz, one with DEC alone and the other with a combination of albendazole. After 10 years with 6 annual MDAs, the transmission indices reached low levels in both treatment arms, but still persisted. However, the DEC alone arm showed higher transmission rates, compared to the DEC+ALB arm. Few villages which demonstrated persistent transmission need to be targeted with an additional control measure viz, vector control, to achieve LF elimination. It is evident from the 10 year period of the study that inclusion of albendazole along with DEC has significantly reduced the transmission indices to almost nil level, as compared to DEC alone.

Dengue vectors prevalence and the related risk factors involved in the transmission of dengue in Thiruvananthapuram district, Kerala, South India.

BACKGROUND & OBJECTIVES: A longitudinal, entomological and virological study was conducted from 2007 to 2010 in four dengue fever affected areas of Thiruvananthapuram district, Kerala to understand the risk factors involved in the dengue transmission. METHODS: Aedes surveys were carried out seasonally in the selected localities both indoors and peridomestic sites. Water holding containers were sampled for the presence of immature. Outdoor and indoor resting/landing mosquitoes were collected. Blood meal identification was performed by gel diffusion test and viral assay using the ELISA test. RESULTS: The species found were Aedes (Stegomyia) aegypti (Linn.), Ae. (Stegomyia) albopictus (Skuse) and Ae. (Stegomyia) vittatus (Bigot). Aedes aegypti and Ae. albopictus immature stages were also found during the study period. Aedes aegypti was the only prevalent species in the water-starved Vizhinjam, a rural coastal area with breteau index (BI) ranging from 40 to 271. Aedes albopictus was recorded in rest of the three surveyed localities­two urban and one rural ghat areas of Thiruvananthapuram district. INTERPRETATION & CONCLUSION: The vector control measures should be focused mainly on source reduction of water storage containers present in both outdoor (Ae. albopictus and Ae. vittatus) and indoor (Ae. aegypti). To achieve effective vector management, a public health response beyond routine larviciding or focal spraying is essential throughout the year.

Tuberculous pancreatitis complicated by ruptured splenic artery pseudoaneurysm.

Tuberculosis involving the pancreas is rare. We report a patient with pancreatic tuberculosis complicated by haemorrhage from a splenic artery pseudoaneurysm. As far as we are aware, the development of a splenic artery pseudoaneurysm in association with a large caseating mass of tuberculous pancreatic lymph nodes has not been reported previously. We review the literature and discuss the varied presentations of tuberculosis involving the pancreas or the pancreatic bed and its draining lymph nodes.

Masseter cysticercosis - a rare case diagnosed on ultrasound.

We present the case of a 50-year-old man with a large swelling on the left side of his face. He was diagnosed with intramuscular cysticercosis in the masseter muscle with surrounding phlegmon on high-resolution ultrasound and managed conservatively.

Inpatient management of diabetes: survey in a tertiary care centre.

AIMS: Good glycaemic control in hospitalised patients with diabetes mellitus improves wellbeing and aids recovery. This survey aimed to: (1) assess glycaemic control in patients with diabetes admitted to hospital for reasons other than diabetes, (2) compare the glycaemic control in patients treated in medical and surgical units, and (3) see the impact of specialists' input on glycaemic control. METHODS: The first 150 patients admitted to hospital were identified; those with acute metabolic complications of diabetes mellitus, acute myocardial infarction, pregestational or gestational diabetes, and patients in different intensive care units were excluded. Case notes were reviewed with particular attention to glycaemic control, frequency of blood monitoring, complications, and the actions taken to improve glycaemic control. RESULTS: Four of the 150 patients died in hospital. When subcutaneous insulin was used glycaemic control was good in 48%, suboptimal in 15%, and poor in 37% of patients. The results were not significantly different with subcutaneous or intravenous insulin. There was also no difference in glycaemic control among medical and surgical patients. Patients managed by designated specialists had better control than those managed by physicians (p<0.001). Hypoglycaemia was documented in 20% and two patients developed non-ketotic hyperosmolar coma while in hospital. In a few cases treatment at discharge was not changed despite poor control while in hospital. CONCLUSION: More attention should be given to improving glycaemic control in patients hospitalised for reasons other than diabetes. Particular care should be taken to modify the dose of insulin needed to get good glycaemic control; control was better with specialists' input. A follow up survey will be conducted.

Neurochemical correlates of alloxan diabetes: gamma amino butyric acid of amphibian brain.

The levels of gamma aminobutyric acid decreased, while glutamic acid and aspartic acid levels increased in the forebrain, and decreased in the mid and hind brain regions of frog, Rana cyanophlictis during alloxan diabetes. Since glutamic acid and GABA are intimately involved in the central nervous system (CNS) functions, the alterations occurring in their levels during alloxan diabetes may be significant in bringing about a correlation between the diabetic state and the altered functional dynamics of the CNS.