Efficacy of nasal irrigation of normal saline as compared to budesonide following functional endoscopic sinus surgery

Background: Nasal irrigation following Functional endoscopic sinus surgery (FESS) appears to be a nearly universal recommendation. FESS significantly improves the symptoms of the CRS (Chronic rhino sinusitis) and the postoperative endoscopy scores. The primarily objective of our study was to study the efficacy of nasal irrigation of normal saline as compared to budesonide following functional endoscopic sinus surgery. Methods: A total of 100 patients who underwent functional endoscopic sinus surgery were randomly divided into two groups on the basis of computerized generated random table with 50 patients in each group. In group 1 normal saline was used where as in group 2 budesonide solution was used for nasal douching. Post-operative evaluation was done using Lund Kennedy Endoscopic scoring (LKES) at the 7th and 30th postoperative day. Results: On 7th postoperative day, we found that none of our patient in the study groups had polypoidal change. There was decrease in scores of polyposis, discharge mucosal edema, scaring and crusting in both the groups. However, the reduction of discharge in the budesonide group was more significantly decreased than normal saline group (p value<0.05). We also noted that on 30th postoperative edema, scarring and crusting was significantly decreased in budesonide group as compared to normal saline group (p value <0.05). Conclusions: We concluded that the addition of budesonide in nasal irrigation resulted in improved scores of polyposis, discharge, mucosal edema, crusting and scarring and total score of LKES than normal saline alone.

Efficacy of nasal irrigation of normal saline as compared to budesonide following functional endoscopic sinus surgery

Background: Nasal irrigation following Functional endoscopic sinus surgery (FESS) appears to be a nearly universal recommendation. FESS significantly improves the symptoms of the CRS (Chronic rhino sinusitis) and the postoperative endoscopy scores. The primarily objective of our study was to study the efficacy of nasal irrigation of normal saline as compared to budesonide following functional endoscopic sinus surgery. Methods: A total of 100 patients who underwent functional endoscopic sinus surgery were randomly divided into two groups on the basis of computerized generated random table with 50 patients in each group. In group 1 normal saline was used where as in group 2 budesonide solution was used for nasal douching. Post-operative evaluation was done using Lund Kennedy Endoscopic scoring (LKES) at the 7th and 30th postoperative day. Results: On 7th postoperative day, we found that none of our patient in the study groups had polypoidal change. There was decrease in scores of polyposis, discharge mucosal edema, scaring and crusting in both the groups. However, the reduction of discharge in the budesonide group was more significantly decreased than normal saline group (p value<0.05). We also noted that on 30th postoperative edema, scarring and crusting was significantly decreased in budesonide group as compared to normal saline group (p value <0.05). Conclusions: We concluded that the addition of budesonide in nasal irrigation resulted in improved scores of polyposis, discharge, mucosal edema, crusting and scarring and total score of LKES than normal saline alone.

Chemical composition and insecticidal activity of Origanum floribundum Munby essential oil endemic plant from Algeria

@#Among strategies for decreasing diseases, the use of larvicidal plant extracts against mosquito larvae gain an important place in vector control. The aim of the present study was to reveal the insecticidal effectiveness of an endemic medicinal plant on Mosquito-Borne Diseases. The chemical composition of the dried aerial part from Origanum floribundum Essential oil, obtained by hydrodistillation, was characterized by Fourier-transform infrared (FTIR) spectroscopy and gas chromatography-mass spectrometer (GC-MS) system. The potential larvicidal activity of this extract as bioinsecticide was assessed against Culex pipiens. Results showed many functional groups such as phenols and alcohols, besides, the chemical composition by GC-MS identified thymol (86.9%) and p-Cymene (5.1%) as major components. A significant larvicidal effect against the target mosquito species was noted, with values of LC50 at 21.19 mg/l and LC90 at 68.37 mg/l. The results obtained showed that the essential oil of Origanum floribundum with chemotype thymol possess a potent larvicidal activity and could be considered as an eco-friendly alternative for vector control.

Study on Colorectal Cancer in Kashmiri (Indian) Patients Undergoing Colonoscopy

Carcinoma of the colon and rectum is a relatively uncommon malignancy in Kashmir (north India) when compared with the western world. Colorectal cancer is generally a disease affecting individuals 55 years of age and older and is much less common in persons under 35 years of age. Methods: One hundred and fifty six colonoscopies were performed by a single gastroenterologist in GMC Srinagar. We find the anatomical distribution and age at diagnosis of colorectal cancer patients diagnosed by colonoscopy for evaluation of their symptoms in a teaching hospital in Kashmir India, Records of patients who had complete colonoscopic examination till the cecum, presence of tumor in the colon or rectum, and biopsy showing adenocarcinoma, were scrutinized. Results: Age-stratified incidence of CRC showed that majority of the cases were in the age group 55–65 years (30.76%), followed by 45-55 years (20.5%). There were 19 (12.2%) cases of CRC below the age of 35 years. Conclusion: Colorectal cancer (CRC) in Kashmiri (Indian) occurs at a younger age and is often distal to the splenic flexure.

Field evaluation in Thailand of spinosad, a larvicide derived from Saccharopolyspora spinosa (Actinomycetales) against Aedes aegypti (L.) larvae.

Two formulations of spinosad, direct application tablet (DT) and 0.5% granules (GR), at 3 dosages (0.25, 0.5 and 1.0 mg/l) in 200-liter earthen jars were evaluated against the larvae of Aedes aegypti. Two water regimens were used in the jars: jar full all the time and a full jar in which half the volume of the water was removed and replaced at each assessment interval. All treatments and controls were replicated 4 times and challenged with cohorts of 25 third-instar larvae of Ae. aegypti at weekly intervals during the study. The number of pupal skins (indicating successful emergence of adults) in the treated and control regimens were counted 7 days post-addition and they were used to calculate inhibition of emergence (% IE) based on the original number of larvae used. The DT formulation at the highest concentration (1.0 mg/l) yielded 79-100% IE for 34 days in the full jars, efficacy declining beyond this period. However, the longevity of this dosage was much longer with 90-100% IE for 62 days post-treatment in the water exchange regimen. The target and manufacturer-recommended concentration of 0.5 mg/l of DT gave good control (92-100% IE) for 20 days, declining below 92% IE thereafter in full jars. This dose also yielded good control with IE of 97-100% for 27 days in the water exchange regimen. The 0.5% GR formulation at all 3 dosages showed higher efficacy and greater longevity in the jars than the DT. In the full jars, all 3 dosages produced IE of 76-100% for 55 days post-treatment. In the water exchange regimen, the efficacy and longevity were increased by about one week, up to 62 days post-treatment. It is clear that the DT formulation can be used effectively against Ae. aegypti larvae at a target dose of 0.5 mg/l in 200-liter jars. This dose can be increased to 1.0 mg/l if slightly longer residual activity is desired. In containers where water is consumed and more water added, the longevity of efficacy will be longer for the DT than in jars which remain full all the time. GR (0.5%) gave longer control than DT. GR (0.5%) floated on the surface and produced scum and an oily film, features not desirable in stored water.

Control of aggregated populations of the eye fly Siphunculina funicola (diptera: chloropidae) using pyrethroid aerosols.

Three commercially available insecticide aerosol compositions containing cyphenothrin, imiprothrin, cypermethrin, d-tetramethrin and permethrin, in various combinations and concentrations were evaluated for control of the oriental eye flies Siphunculina funicola (de Meijere) from their aggregation substrates in two villages in the Chon Buri Province, Thailand. Each aerosol produced almost complete kill of eye flies on most of the treated substrates. Time to reoccupation of each treated substrate was determined at 24, 48 and 72 hours post-treatment. All 3 aerosol preparations killed eye flies on most of the treated substrates and kept most of the substrates free of eye flies for at least 48-72 hours. The effectiveness and longevity of the aerosols varied depending on the type and location of the substrate. Smooth, hairy and polished substrates did not intercept sufficient insecticide; therefore providing low residual activity compared to porous and coated surfaces. Aerosols applied to substrates located at higher levels gave good initial kill, but reoccupation of these substrates by flies occurred relatively quickly (within 24-48 hours) following treatment. Attempts should be made to discharge aerosol flumes closer than 1 m from the aggregation substrates.

Repellent activity of essential oils against cockroaches (Dictyoptera: Blattidae, Blattellidae, and Blaberidae) in Thailand.

Seven commercial essential oils extracted from the plant species Boesenbergia rotunda (L.) Mansf., Citrus hystrix DC., Curcuma longa L., Litsea cubeba (Lour.) Pers., Piper nigrum L., Psidium guajava L. and Zingiber officinale Roscoe, and naphthalene as a control, were evaluated for repellent activity against the three cockroach species Periplaneta americana (L.), Blattella germanica (L.) and Neostylopyga rhombifolia (Stoll) under laboratory conditions. The essential oil derived from Citrus hystrix showed the best repellency over other candidate essential oils and naphthalene. The essential oil of Citrus hystrix exhibited complete repellency (100%) against P. americana and B. germanica, and also showed the highest repellency (among the essential oils tested) of about 87.5% against N. rhombifolia under laboratory conditions. In the field, Citrus hystrix essential oil formulated as a 20% active ingredient in ethanol and some additives provided satisfactory repellency of up to 86% reduction in cockroaches, mostly P. americana and N. rhombifolia with a residual effect lasting a week after treatment. Citrus hystrix essential oil has good potential for being used as a cockroach repellent. Further improvements in efficacy and residual activity may be realized with appropriate formulations.

Field evaluation of novaluron, a chitin synthesis inhibitor larvicide, against mosquito larvae in polluted water in urban areas of Bangkok, Thailand.

Novaluron, an insect growth regulator, a benzoylphenyl urea insecticide, was evaluated in the field against the larvae of polluted-water mosquitoes. The study was carried out in highly polluted sites infested with populations of mosquito larvae, mostly Culex quinquefasciatus Say, in low-income communities in urban areas of Bangkok, Thailand. An EC10 formulation was premixed in water and applied by pressurized spray tank to plots ranging from 180 to 1,000 m2 at the rate of 0.1 ml EC 10/m2 (equal to 10 mg a.i./m2) of the breeding sites. Assessments were made by sampling mosquito larvae and pupae to determine the trends of immature populations before treatment and weekly after treatment. Reduction of the populations in percents were then computed by comparing counts of immature mosquitoes (larvae and pupae) to the pretreatment counts at each particular site. It was found that the immature populations of mosquitoes in the treated areas were dramatically suppressed and remained at extremely low levels for 3-7 weeks after the treatment depending on the prevailing conditions of each experimental site. No negative impact on fishes or aquatic plants in the treated areas were detected during the study period and three months after the experiment was discontinued. Novaluron is an effective agent to control immature populations of polluted-water mosquitoes, especially Cx. quinquefasciatus in habitats in urban areas. This IGR larvicide may play an important role in vector control programs in terms of effectiveness, environmental friendliness and strategies for insecticide-resistance management in vector mosquitoes.

Simulated field evaluation of the efficacy of two formulations of diflubenzuron, a chitin synthesis inhibitor against larvae of Aedes aegypti (L.) (Diptera: Culicidae) in water-storage containers.

Tablet (40 mg a.i./tablet) and granular (2% a.i.) formulations of diflubenzuron, a chitin synthesis inhibitor, insect growth regulator, were evaluated for larvicidal efficacy against the larvae of Aedes aegypti (L.) in water-storage containers under field conditions in Thailand. Each formulation was applied to 200-1 clay jars at 5 different dosages (0.02, 0.05, 0.1, 0.5 and 1 mg/l a.i.). The jars were covered with solid celocrete sheets and placed in the shade under a roof. Another experiment was also carried out using 3 different dosages (0.1, 0.5 and 1 mg/l) where half the water in each treated jar and the control was removed and refilled weekly. Each treatment was replicated four times. The treatments were challenged by adding 25 3rd instar larvae/jar weekly. Assessments were made of each treatment through emergence inhibition (%EI) by removing and counting pupal skins one week after larval addition. Using these assessment techniques, a high degree of larvicidal efficacy (96-100%EI) was achieved with 4 dosages (0.05, 0.1, 0.5 and 1 mg/l) of both (tablet and granular) formulations for a period of 23 weeks post-treatment. The efficacy of the lowest dosage (0.02 mg/l) of tablet and granular formulations lasted for 21 and 22 weeks post-treatment, respectively. Under the conditions of water removal and weekly refilling, a high degree of larvicidal efficacy (96-100%El) at the 3 dosages was obtained with the tablet formulation 18 to 21 weeks post-treatment, whereas the efficacy of the granular formulation persisted 15 to 23 weeks post-treatment depending on the dosage. This study clearly demonstrates a high level of residual activity with both formulations of diflubenzuron against larvae of Ae. aegypti in water-storage containers. Considering environmental factors and water-use conditions, it is likely that dosages of 0.05 to 0.1 mg a.i./l are effective dosages providing long-lasting control for 3 to 4 months in the field.

Repellency of essential oils extracted from plants in Thailand against four mosquito vectors (Diptera: Culicidae) and oviposition deterrent effects against Aedes aegypti (Diptera: Culicidae).

In this study we evaluated and reported repellent effects of essential oils from Thai plants against 4 mosquito vectors: Aedes aegypti, Ae. albopictus, Anopheles. dirus and Culex quinquefasciatus under laboratory conditions using human volunteers. The essential oils were extracted from 18 plant species, belonging to 11 families, and the oils were then prepared as 10% solution in absolute ethanol with additives. Two chemical repellents, deet and IR3535, were also prepared in the same formulation as the essential oil repellents and tested for repellency as controls. The essential oils were also evaluated for oviposition deterrent effects against Ae. aegypti under laboratory conditions. The results show night-biting mosquitoes (An. dirus and Cx. quinquefasciatus) and Ae. albopictus were more sensitive to all the essential oils (repellency 4.5 - 8 hours) than was Ae. aegypti (repellency 0.3 - 2.8 hours), whereas deet and IR3535 provided excellent repellency against all four mosquito species (repellency 6.7- 8 hours). All essential oils exhibited oviposition deterrent activity against Ae. aegypti with various degrees of repellency ranging from 16.6 to 94.7%, whereas deet and IR3535 had no repellency. The present study demonstrates the potential for using essential oils as mosquito repellents and oviposition deterrents. These findings may lead to new and more effective strategies for protection from and control of mosquitoes.

Double infection of heteroserotypes of dengue viruses in field populations of Aedes aegypti and Aedes albopictus (Diptera: Culicidae) and serological features of dengue viruses found in patients in southern Thailand.

In order to understand more about the epidemiology of DHF, a study of the type of dengue viruses and vectors under natural conditions was carried out. Mosquito vectors in the field and the serum of DHF patients in southern Thailand were examined. The two mosquito species are abundant and DHF incidence remains high in this region. Dengue viruses were examined in field-caught mosquitoes by RT-PCR technique. The mosquitoes were caught in 4 provinces: Krabi, Phuket, Phang-Nga and Surat Thani during the late dry season until the early rainy season in 2005. Three dengue serotypes (DEN-2, DEN-3, DEN-4) were detected in Ae. aegypti males and females, and 2 (DEN-2, DEN-3) were detected in Ae. albopictus females. Double infection with 2 serotypes of dengue viruses (DEN-2 and DEN-3) were detected in Ae. aegypti males and females and Ae. albopictus females. DEN-2 and DEN-1 were the most prevalent serotypes found in the serum of the patients in this area, followed by DEN-4 and DEN-3. The prevalence of the predominant dengue serotype varied from province to province. Detection of viruses in adult male mosquitoes reveals the role of transovarial transmission of dengue viruses in field populations of DHF vectors and elucidates circulation of dengue viruses in vectors in the natural environment of endemic areas. The incidence of multiple serotypes of dengue virus in Ae. aegypti and Ae. albopictus in the same area points toward a high risk for an epidemic of DHF. These findings provide greater understanding of the relationship among mosquito vectors, virus transmission and DHF epidemiology in endemic areas.

A new assembly and technique for testing insecticides.

A new design of insecticide testing assembly has been devised that is highly versatile in testing the efficacy, potency and interaction of insecticides and other test chemicals. The merits of the assembly and technique have been explained.

Drug induced pellagra

A case of pellagra is reported in a fifty year old female who was on antituberculous drugs for past eight months for tuberculosis of lungs

dilemma of jumping syndrome

A retrospective review of 25 patients of Jumping Syndrome is presented. These females were admitted to King Fahd University Hospital, AI-Khobar between Ist January 1990 and 31st December 1992. The minimum age was 21 years and the maximum 40 years with a mean of 29.7 years. Thirteen of the 25 were Indonesian, 8 Sri Lankans and the remaining 4 Filipino nationals. they sustained 48 fractures and 1 dislocation the breakdown of which is; thoracolumbar spine 22, calcaneum 11, femur 3, tibia and fibula 3, radius and ulna 3, patella 2, pelvis 2, humerus 1, metatarsals 1 and 1 dislocated elbow respectively. Thirteen patients [52%] needed surgical intervention. the minimum hospital stay was 13 days and maximum 135 days with a mean of 56 days. There appears to be a rise in deliberate self harm and the new trend is by jumping from a height. This is causing a great socio-economic, medical care concern. We believe that our society as a whole must recognise this issue and attempts should be made to solve it sooner than later