Prevalence and analysis of associated risk factors for Cryptosporidium infection in lambs in Jammu district.

An epidemiologic study was carried out to investigate the prevalence and analysis of risk of Cryptosporidium infection in lambs in Jammu district. Faecal samples of 120 lambs of different age groups viz., <1 month, 1-3 months and 3-6 months were assessed. Cryptosporidium oocysts were identified by using modified Zeihl Neelsen technique. Statistical analysis showed that infection rates were significantly higher in lambs of <1 month age group (65 %) than other two age groups (p < 0.05). Similarly, cryptosporidial infection rates were significantly higher in diarrhoeic (54.41 %) than in non diarrhoeic lambs (34.61 %). Winter records highest prevalence (73.33 %) which varied significantly. Sex wise higher prevalence was observed in females (51.56 %) as compared to males (39.28 %). The relationship between intensity of infection and various epidemiological factors showed that highest intensity was observed in lambs of 0-1 month age group, having diarrhoea, in winter season.

Injection practices among practitioners in private medical clinics of Karachi, Pakistan.

The aim of this study was to determine the frequency and determinants of sharps injuries among private health practitioners in slum areas of Karachi, Pakistan. All practitioners with at least 1 year of experience in a private medical clinic were asked to complete a self-administered, structured questionnaire (317/397 responded). Only 7.9% of practitioners were qualified from medical school, 12.3% were registered nurses and 8.8% lacked any professional qualifications. At least 1 sharps injury in the previous 12 months was reported by 26.7%, mostly due to needle recapping. Only 25.2% reported using a new syringe for each patient. In multivariate regression analysis shorter work experience, < 14 years of schooling, > 20 patients per day, administering > or = 30 injections per day, reuse of syringes and needle recapping after use were significantly associated with sharps injury in the past year. Better awareness and training on standard precautions is needed for private practitioners in slum areas of Karachi.

Public-private partnership scenario in the health care system of Pakistan.

Public-private partnerships (PPP) in basic health services delivery aim to improve service provision, such as better coverage, quality and infrastructure of health care, as well as raising the demand for health by the community. This paper outlines some examples of public-private partnerships in Pakistan and examines barriers to further development of such initiatives. We argue that to meet the challenges of globalization and achievement of the Millennium Development Goals, Pakistan needs to improve the health status of its society by promoting and practising PPP in providing health care services.

Public-private partnership scenario in the health care system of Pakistan

Public-private partnerships [PPP] in basic health services delivery aim to improve service provision, such as better coverage, quality and infrastructure of health care, as well as raising the demand for health by the community. This paper outlines some examples of public-private partnerships in Pakistan and examines barriers to further development of such initiatives. We argue that to meet the challenges of globalization and achievement of the Millennium Development Goals, Pakistan needs to improve the health status of its society by promoting and practising PPP in providing health care services

Prevalence of depression and the associated risks factors among adult women in a fishing community.

OBJECTIVE: To determine prevalence of depression and its associated risk factors with depression among adult women in a fishing community. METHODS: This study was conducted in Sualehabad, a small community with a population of 5000 of Manora Island in two stages. In first stage door to door survey was conducted and about 1200 women were screened for depression by using Mini International Neuropsychiatric Interview by Sheehan which was supplemented by ICD-10 Diagnostic Classification. In order to determine the associated risk factors, 91 controls were selected among the non-depressed women randomly from the same community with the 91 identified cases of depression. In second stage, a semi-structured questionnaire was administered to both the cases and controls, which was then subjected to reliability and validity exercises. The total duration of the study was six months. RESULTS: The point prevalence of depressive disorder was 7.5%. Only 13% reported treatment from government facility and 14% reported previous consultation with a psychiatrist. Sixteen percent of women were aware about mental health facility available in the area. Twenty seven percent reported that they got relief from alternative treatment. The characteristics that demonstrated a statistically significant association related to risk factors were increasing age, being married, more than four children in family, illiteracy and financial difficulties at home. There was a significant association observed in reporting social, behavioral and relational factors related to depression by cases as compared to control group. CONCLUSION: The prevalence of depressive disorder among adult women of the fishing community was 7.5% which is at a high magnitude keeping in view the prevalence rate of the country and the global estimates. There is a need for more community based studies in order to assess the magnitude of depression which is posing one of the major public health problems.

Factors affecting utilization of antenatal care among reproductive age group women (15-49 years) in an urban squatter settlement of Karachi.

OBJECTIVES: To describe the socio-demographic characteristics and utilization pattern of antenatal care of reproductive age group women (15-49 years) in an urban squatter settlement of Karachi and to assess and compare the knowledge on antenatal care between women who received and those who did not receive antenatal care. METHODS: A community-based cross sectional survey was conducted and a sample of 323 women was taken through systematic sampling. Two hundred ninety five (295) women were interviewed and 28 were excluded, as they never experienced a pregnancy. Socio-demographic characteristics and knowledge about antenatal care were compared on the basis of having received and not having received antenatal care, utilizing bivariate and multivariate analysis. RESULTS: Multivariate logistic regression analysis showed that higher income women were twice likely to use antenatal care services (AOR = 2.11 95% CI 1.14-3.89) than those of lower income. Women receiving antenatal care were more knowledgeable about the importance of dietary protein (AOR = 1.97 95% CI 1.16-3.33), intake of green leafy vegetables for the prevention of anemia (AOR = 2.34 95% CI 1.33-4.11), and reporting danger signs (AOR = 2.25 95% CI 1.07-4.74). CONCLUSION: Women of reproductive age need to recognize the importance of receiving antenatal care in the community. Uplifting the socio-economic status and literacy rate of women is required to provide community based education. There is a potential need to increase nutrition education, highlighting the importance of iron supplementation, appropriate food during pregnancy and recognition of signs and symptoms and danger signs in pregnancy.

Womens' perceptions regarding obstetric complications and care in a poor fishing community in Karachi.

OBJECTIVE: To assess the knowledge of women about obstetric complications and care. METHODS: The study was conducted in a remote coastal community in Karachi in 1999, where the Department of Community Health Sciences of Aga Khan University is operating its primary health care project since 1996. The information was collected using a structured questionnaire, interviewing a representative sample of 329 married-women of reproductive age, selected systematically from the community. RESULTS: The mean age of the respondents was 29 years. On average they were married for 11 years and had four living children. Almost half of them had no antenatal care in their last pregnancy and 75% delivered at home. The findings indicate a poor knowledge of common and serious pregnancy related complications based on their perception related to danger signs. Five percent of the women perceived absent/decreased fetal movement as a danger sign of pregnancy. Other reported danger signs included premature uterine contraction by 3%, premature rupture of membranes by 3%, convulsions by 13%, obstructed labor by 23% and bleeding by 39%. Moreover, the women's perception regarding obstetric care suggests that unsafe practices prevail: 86% of women thought that a case of ante-partum hemorrhage should be examined internally and 50% thought that no precaution is required to sterilize the instrument for cutting the cord. CONCLUSION: There is a clear need to create awareness regarding obstetric complications through a targeted community based health educational intervention aiming to promote early recognition of the obstetric emergency at the household level and also to create a demand of safe obstetric practices.

Role of molecular typing in an outbreak of Salmonella paratyphi A.

During the post monsoon season of 1996 an outbreak of human Salmonellosis caused by Salmonella serovar-paratyphi A occurred in New Delhi and had continued for over 2 months. A total of 36 clinically diagnosed enteric-fever cases were reported during this outbreak. The isolates were compared following their characterisation by biotyping, antibiogram-analysis, plasmid-profiling and IS200 probing, to study the relatedness in order to delineate a common source. The study included representative strains from both outbreak (15) and sporadic (7) cases for comparative analysis. Biotyping, antibiogram, whole cell protein-analysis and plasmid-profiling could not discriminate sporadic cases from outbreak strains, suggesting that a single clone/type (PT-1) may be prevalent in our region. In contrast, molecular-typing using IS200-probing revealed 2 clonally related strains circulating during the outbreak, as compared to the unrelated sporadic strains which exhibited considerable genetic diversity. Molecular analysis by IS200-probing, helped to assign an index case which provided a history of later outbreaks, since paratyphi A was repeatedly cultured in later outbreaks also. The study also suggests that genetic rearrangements can occur during the emergence of outbreaks. It reaffirmed the usefulness of IS200-probing in epidemiological investigations of Salmonella enterica serovars.

Mycoplasma pneumoniae and community-acquired pneumonia.

BACKGROUND: Community-acquired pneumonia is an important cause of mortality and hospitalization in all age groups. In temperate climates, Mycoplasma pneumoniae is a common respiratory pathogen causing pneumonia. Information on human Mycoplasma infection in India is scarce. METHODS: We aimed to determine the frequency of Mycoplasma pneumoniae infection among patients with community-acquired pneumonia in a prospective cross-sectional study. The assessment included clinical and radiological evaluation followed by microbiological evaluation for the specific pathogen. Microbiological investigations included aerobic and anaerobic blood culture, anti-Mycoplasma IgM antibody detection by gelatin particle agglutination test and ELISA, culture of respiratory tract secretions for Mycoplasma pneumoniae and other organisms, and detection of specific Mycoplasma pneumoniae antigen by indirect immunofluorescence. RESULTS: Sixty-two patients (42 men and 20 women; mean age 41.7 years) with community-acquired pneumonia were investigated prospectively. They included 42 immunocompetent and 20 immunocompromised patients. Six patients had definitive evidence of Mycoplasma pneumoniae infection and an additional 16 patients had a probable diagnosis. In all, 22 (35.5%) patients with pneumonia had Mycoplasma pneumoniae infection. Of these, 12 patients belonged to the immunocompromised group and 10 to the immunocompetent group. Patients with Mycoplasma pneumoniae infection also had secondary bacterial infection as evidenced by organisms isolated from blood in 50% and from respiratory tract secretions in 68%. CONCLUSION: Community-acquired pneumonia has a polymicrobial aetiology, of which the prevalence of Mycoplasma pneumoniae is 35%. The study has two implications: (i) Mycoplasma pneumoniae infection is frequently associated with secondary bacterial infection; and (ii) initial empirical antibiotic therapy for community-acquired pneumonia in India must include antibiotics with activity against Mycoplasma pneumoniae.

Acute respiratory tract infections in Indian children with special reference to Mycoplasma pneumoniae.

A total of 70 Indian children of either sex and under 5 years of age who were admitted to the All India Institute of Medical Sciences, New Delhi during a 1-year period (January 1994-December 1994) with complaints suggestive of acute respiratory tract infections (ARTI), were investigated for bacterial aetiology of infection with special reference to Mycoplasma pneumoniae. Microbial aetiology could be established in 44/70 (62.8 per cent) of cases of ARTI. Mycoplasma pneumoniae infection was seen in 21/70 (30 per cent), aerobic bacteria in 14/70 (20 per cent), Chlamydia pneumoniae in 2/70 (2.8 per cent), and mixed infection with mycoplasma either with bacteria and/or chlamydia in 7/70 (10 per cent). However, in 26/70 (37.1 per cent) cases no cause could be detected. Diagnosis of infection with M.pneumoniae was based on culture in 2/20 (10 per cent) cases, antigen detection in throat swab by indirect immunofluorescence assay using specific antibody in 16/70 (22.8 per cent) cases, and demonstration of IgM antibody in serum by serodia Myco II particle agglutination test in 17/70 (24.2 per cent). Streptococcus pneumoniae (9/70, 12.8 per cent) and Staphylococcus aureus (5/70, 7.1 per cent) were the aerobic isolates from blood in these patients. Results of this study indicate that M.pneumoniae plays a significant role in respiratory tract infection in an Indian paediatric population. Rapid diagnostic procedures, such as antigen detection and IgM antibody demonstration, should be used more widely to determine the infective aetiology early in the course of illness. The study also highlights the mixed aetiology in ARTI in children, which has important therapeutic implications.

Comparative analysis of pulsed (activated) and resting chicken cytochrome c oxidases with sodium chloride dependence of the enzyme.

Comparative investigation of pulsed (activated) chicken cytochrome c oxidase and resting enzyme are compared with other species and pH dependent properties are also monitored Sodium chloride dependence of chicken oxidase is analysed and compared with that of beef cytochrome c oxidase. Carbon monoxides binding and spectral changes during this process are also discussed. S values are also determined at different pH of the enzyme ultra centrifugation.

Anaerobic septicaemia by Fusobacterium necrophorum: Lemierre's syndrome.

Lemierre's syndrome is characterized by acute pharyngotonsillitis with secondary thrombophlebitis of the internal jugular vein which is complicated by multiple metastatic foci of infections. This syndrome is caused by Fusobacterium necrophorum in healthy young persons and is extremely rare in occurrence. A pre-school child with Lemierre's syndrome is reported. The diagnostic and therapeutic aspects are emphasized in order to sensitize physicians to this uncommon condition.

Standardisation of polymerase chain reaction for the detection of Salmonella typhi in typhoid fever.

To improve the diagnosis of Salmonella typhi infection, a polymerase chain reaction (PCR) assay was developed for the amplification of the dH flagellin gene of S typhi. Primers were designed from dH flagellin gene sequence which will give an amplification product of 486 base pairs. In tests to study the specificity of the assay, no amplification was seen in non-salmonella strains or salmonella strains with flagellar gene other than "d". Sensitivity tests determined that 28 pg of S typhi target DNA or 3 x 10(2) target bacteria could be detected by the PCR assay. Subsequently, the PCR technique was used for detection of S typhi in blood or clot cultures from 84 patients clinically suspected of having typhoid fever, and from 20 healthy control subjects. Twenty five of 84 samples from clinically suspected cases were positive by PCR; four of which were culture negative. No amplification was seen in samples from patients who were culture positive for organisms other than S typhi or from controls. The time taken for each sample for PCR analysis was less than 48 hours compared with three to five days for blood or clot culture. PCR appeared to be a promising diagnostic test for typhoid fever.

Metastatic soft tissue calcification in chronic renal failure detected by radionuclide imaging.

Metastatic calcification has been reported in several disease entities, including chronic renal failure. Various imaging modalities have been shown to be useful in the detection of metastatic soft tissue calcification. Radionuclide imaging may detect metastatic soft tissue calcification more readily than routine diagnostic modalities and be a valuable noninvasive method to establish an early diagnosis in high-risk patients. The authors report a patient with extensive soft tissue metastatic calcification who had a myriad of clinical symptoms. The extensive calcification was detected with a radionuclide imaging.

Congenital vascular malformation of the uterus in a stillborn: a case report.

A case of a rare condition of uterine vascular malformation is reported in a stillborn fetus. No other vascular lesion was identified in the fetus during autopsy. The finding of a uterine vascular malformation in a stillborn fetus confirms the congenital nature of some uterine vascular lesions. Congenital uterine vascular malformations warrant clinical and pathomorphological differentiation from acquired arteriovenous fistulas of the uterus.

Molecular and functional analysis of a lymphocyte chemoattractant factor: association of biologic function with CD4 expression.

Lymphocyte chemoattractant factor (LCF) is a lymphocyte cell product that stimulates a migratory response in CD4+ lymphocytes, monocytes, and eosinophils. In concert with its chemoattractant activity, LCF induces human T-lymphocyte expression of interleukin 2 receptor. Here we describe the molecular cloning of cDNA encoding human LCF. It is a novel interleukin with no significant homology to any previously described cytokine families. There is an absolute requirement for both autoaggregation of LCF monomers and for membrane-expressed CD4 molecules for LCF-induced migration in lymphocytes.

Varicella gangrenosa.

A four year old girl presented with varicella gangrenosa, and haematological investigations showed a disseminated intravascular coagulation. The child subsequently developed a unilateral deep venous thrombosis. She was treated with oral steroids and intravenous heparin and made a full recovery.