Expert Commentary

Editorial

There is paucity in information on Serratia plymuthica causing human infections. Only few case reports worldwide have documented this organism as a pathogen causing human infections till date. We describe here a case of community-acquired urinary tract infection caused by S. plymuthica in an elderly man. To our knowledge, this is first human case report describing S. plymuthica as uropathogen.

Introduction: Influenza (H1N1) is very sensitive and newly emerged pandemic. Influenza (H1N1) pandemics are caused by new influenza viruses that have recently adapted to humans and resemble major natural disasters both in terms of recurrence and magnitude. Aims and Objectives: To study the outcome and epidemiological factors of suspected H1N1 influenza cases. Study Design: Hospitalbased descriptive study, Study Period: Study was conducted over a period of seven months from April 2009 to October 2009. Study Variable: Outcome, age, sex, time, place of residence. Results and Discussion: The total 110 cases of suspected H1N1 influenza were admitted in Infectious diseases ward of Government Hospital Solapur. Out of 110 total suspected cases, 91 (82.72%) were cured and discharged. Among these 91 (82.72%) suspected cases, 17 (15.45%) were laboratory confirmed for Influenza (H1N1). Conclusion: In present study, maximum case fatality rate (32%) was observed in females in age group of 15-44 years as compared to male.

Background: The risk of acquiring hepatitis B virus (HBV) and hepatitis C virus (HCV) infections through exposure to blood or its products and contact with other body fluids is high amongst health care workers (HCWs). Despite potential risks, a proportion of HCWs never get vaccinated. This study aimed to investigate the vaccination practices and the prevalence of HBV infection in HCWs. Aims: To determine the prevalence of HBV and HCV, their possible association with occupational and non-occupational risk factors. We also studied the prevalence of vaccination for hepatitis B in different subgroups of study population. Materials and Methods: In this cross-sectional study, total 1347 hospital staffs were screened for hepatitis B and hepatitis C. HBV is detected by HBsAg testing, and HCV is detected by anti-HCV testing by ELISA method. Positive results were confirmed by HBV DNA testing (Qualitative) and HCV RNA testing (Qualitative). A questionnaire used to collect data from study participants was pre-designed by the authors. Results: Out of total 1347 hospital staffs screened, 6 (0.4%) were HBsAg-positive and 2 (0.1%) were anti-HCV-positive. Only 54% had a history of complete vaccination, and 0.3% had incomplete vaccination. Vaccination coverage was highest in residents (76.7%), medical students (68.9%), nursing (66.1%), and teachers (61.4%) and lowest in servants (5.4%), office staff (6.6%), and lab technicians (24.3%). Awareness about the risk factor for transmission of HBV and HCV and complication related to them was 77.7%. It was highest in teachers (93.9%) and residents (97.8%), lowest in servants (16.3%). No statistically significant difference in the exposure to various risk factors among those who are HBsAg or anti-HCV-positive and HBsAg or anti-HCV-negative. Conclusions: The prevalence of HBV and HCV infection is not high in hospital staff than general population. Hepatitis B vaccination coverage was below expectation in all the subgroups even in resident doctors and teachers.

Background and Objective: HBeAg-positive chronic hepatitis B patients have high serum HBV DNA level showing high viral replication. Goal of treatment of hepatitis B is to prevent cirrhosis, hepatic failure and hepatocellular carcinoma by serum alanine transaminase (ALT) normalization, decrease in serum hepatitis B virus (HBV) deoxyribonucleic acid (DNA) and loss in hepatitis B e antigen (HBeAg). Interferons (IFNs) have antiviral, anti-proliferative, and immunomodulatory effects. IFN-a is effective in suppressing HBV replication and in inducing remission of liver disease. Materials and Methods: In this prospective, single treatment arm study, HBeAg-positive chronic hepatitis patients without decompensated liver disease were enrolled to receive indigenous recombinant IFN-a 2b in the dose of 5 MU daily for 6 days a week subcutaneously for 16 weeks. Quantitative HBV-DNA, HBeAg, and hepatitis B surface antigen (HBsAg) were assessed at baseline and at the end of treatment. ALT level assessment was done at baseline and during therapy at week 1, week 2, week 8, week 12, and week 16. Results: Out of 37 patients enrolled in the study, 8 patients (21.62%) did not complete study due to lost to follow-up (3 patients), discontinuation due to adverse event (3 patients), and consent withdrawal (2 patients). Among 29 patients who completed the study, 10 patients (34.48%) had clearance of HBeAg and 1 patient (3.44%) had lost HBsAg after 16 weeks of therapy. Mean ALT level started decreasing after 4 weeks of therapy but did not come to normal range till 16 weeks of therapy. At least 2 log decreases in HBV DNA was observed in 9 (31.03%) patients and at least 1 log decrease in 18 (62.06%) patients. Overall decline in HBV DNA level was observed in 62% patients after 16 weeks of therapy. Conclusion: IFN-a treatment does result in HBeAg and HBsAg loss and decreases HBV-DNA levels in chronic hepatitis B patients. Most of adverse events were mild to moderate in intensity. So, interferon-a therapy was well tolerated, safe, and efficacious to treat HBeAg-positive chronic hepatitis B patients without decompensated liver disease.

Background: Chronic liver diseases (CLD) are major public health concerns in North-Eastern India. Association of hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV) infections in CLD patients result in atypical presentations with increased severity and duration of illness. Understanding of agent, host, clinical profiles and their co-relationship for better management and prevention of such diseases in the community are important challenges. Aims: To assess sero-prevalance of HBV, HCV, HIV and their co-infection/triple infection in CLD patients from North-East India. To determine risk factors predisposing to development of CLDs. To find out if any correlation exists between risk factors for CLDs and that of HBV/HCV/HIV infections. Materials And Methods: This study was conducted from December 2009 to June 2011 in North-Eastern Indira Gandhi Regional Institute of Health and Medical Sciences. Blood samples were collected from 57 clinically diagnosed CLD patients after obtaining Institutional ethical clearance. Detail clinical profile with relevant biochemical test results were recorded. Viral markers - hepatitis B surface antigen, hepatitis B e (HBe) antigen, anti-HBe and anti-HCV were assessed employing commercial ELISA kits. Specimens were subjected for detection and confirmation of HIV infection as per NACO Guidelines. Results: Male to female ratio was 1.85:1 with most cases in range of 31-50 years. HBV markers were detected in 35 (61.40%) and anti-HCV in 2 (3.5%) patients. Anti-HIV was reactive in 7 (12.28%) patients; 4 co-infected with HBV and 2 with HCV. Conclusion: HBV is still a major cause of CLD, followed by HCV in North-East India. Co-infection of HBV/HCV with HIV was low (7.14%) in comparison to rest of India. Confections of HIV with HBV/HCV in CLDs patients was observed to be major public health concern in terms of risk factors and transmission dynamics of these chronic diseases in North-East India.

Background: The effects of probiotics on ulcerative colitis has still remained a contraversy. The aim of this study was to assess the effects of Lactobacillus casei strain ATCC PTA-3945 in treating ulcerative colitis. Materials and Methods: Thirty four patients with mild to moderately active ulcerative colitis randomly received a probiotic preparation of L. casei strain ATCC PTA-3945 (n = 17) or its placebo (n = 17) plus conventional medical therapy for their active disease. After a maximum of 2 months, remitted patients were again randomised to receive L. casei strain ATCC PTA-3945 or placebo, and also maintained on mesalazine or sulfasalazine tablets for a maximum of 6 months. Results: The numbers of patients achieving remission did not statistically differ between probiotic and placebo groups (82% vs. 76% at intention to treat analysis [P = 1.00], and 100% vs. 81.2% at per-protocol analysis [P = 0.23], respectively). The mean time to clinical remission were 25 days and 32 days in probiotic and placebo groups, respectively (P = 0.11). Relapse rates also did not significantly differ between probiotic and placebo groups (14.3% vs. 26.7% at ITT analysis [P = 0.65] and 16.7% vs. 33.3% [P = 0.64], respectively). Mean time to relapse were 96 days and 74 days in the probiotic and the placebo group, respectively (P = 0.51). Conclusion: The results of this preliminary study showed no significant effect by using L. casei strain ATCC PTA-3945 probiotic in the treatment of ulcerative colitis patients.

Background: Malaria is a protozoan disease, transmitted by the bite of infected female anopheles mosquito. It is the most important parasitic disease of human with transmission in 107 countries containing three billion people and causing 1-3 million deaths each year. P. Vivax and P. Falciparum infections are always associated with haematological abnormalities like normocytic normochromic anaemia, initial leukocytosis followed by leukopenia with monocytosis and thrombocytopenia. Materials and methods: Total 250 indoor patients of medicine and paediatric department, over the period of 2 years from April 2007 to March 2009, were included in the study. All the study subjects were identified positive for malaria parasites on peripheral blood smear examination with conventional microscopy. For the conformation of the isolated infections of P. Falciparum and P. Vivax, we had also used ‘OptiMAL ® Rapid Malaria Dipstick Test’. Platelet count was done on a fully automated, quantitative Abacus BC 3200 Auto Haematology Analyzer. Results: Severe thrombocytopenia is more common with P. Falciparum (20.83%) and mixed infection (16.67%) as compared to P. Vivax infection (7.33%), although P. Vivax infection had significant number of cases with moderate (36.67%) and mild thrombocytopenia (38%). Conclusion: Presence of thrombocytopenia is not a distinguishing feature between the P. Falciparum and P. Vivax infection. In patients with acute febrile illness and with marked thrombocytopenia, P. Vivax should also be kept as a differential diagnosis.

The world has seen the emergence of many micro-organisms in the recent past which can curb the human population with their newly built genetic make-up. The latest addition to this list of panic creating organisms is, bacteria encoding the gene for New Delhi metallo-beta-lactamase (NDM)-1. NDM-1 is an enzyme that can hydrolyse and inactivate carbapenems, which are used as a last resort for the treatment of multiresistant bacterial infections. Name of these bacteria were not found in the medical literature before December 2009, because of which it can take the credit of becoming a powerful emerging bacteria which are difficult to treat. Besides Escherichia coli and Klebsiella pneumoniae, other bacterial strains have also expressed the gene for NDM-1, which are detected in many countries.

Introduction: Diarrhea Alleviation through Zinc and ORS Therapy (DAZT) project was started in six demonstration districts of Gujarat in 2011. The aims of the research were to understand prescription practices for childhood diarrhea, assess knowledge and practice about zinc therapy among health care providers in the government/private sectors and among caretakers. Methodology:It was a cross-sectional study conducted in six DAZT demonstration districts of Gujarat. Information was collected on structured questionnaires by interviewing 127 care providers & 43 care takers in six districts. In addition, case records were reviewed for 228 prescriptions – all from the government sector. Results: Government functionaries dispensed ORS in 97% & Zinc in 90% cases of diarrhea while, private providers prescribed it in 79% & 71% respectively. Antibiotics were prescribed in 24% & 59%, anti-amoebic in 20.2% & 64.7% in public and private sectors respectively. Knowledge of dosage and duration of zinc therapy was better among public sector providers than private sector ones. Amongst caretakers, 74.4% gave correct dose of zinc to their children but was given for 14 days in 67.4% of cases. Conclusions:For all the parameters studied, responses were better amongst government providers than those from the private sector.

Background and Objective: Loss of appetite (LOA) during illness impacts individual well-being and quality of life. An epidemiological survey was conducted on the prevalence of LOA. Methodology: Multi-centre, non-interventional, cross-sectional, survey of LOA in Indian participants recuperating from various health disorders. Results: A total of 15914 participants were enrolled into the study. Of the 15914 participants enrolled, 63.5% were men and 36.5% were women, with a mean age of 38.5 years and majority of participants (68.7%) had infectious diseases. Of which, 80.3% participants were reported with infections and infestations disorders as the most frequent infectious condition. The prevalence of LOA was 93.1% (95% CI: 92.7%, 93.5%) with 33.8% participants having mild, 47.7% had moderate and 11.6% had severe to very severe LOA problem. The prevalence of fatigue was 91.1% (95% CI, 90.5, 91.4) of which, 44.4% had mild, 36.8% had moderate, and 9.8% had severe to very severe fatigue. LOA and fatigue was highest in participants with infections and infestations (93.8% and 91.7% respectively), with typhoid being the most common cause. The risk of LOA was 1.5 times more in participants with a past history of any medical condition and 1.31 times more in subjects with infectious diseases (p<0.0001). The risk of fatigue was 1.19 times more in participants aged >40 years and 1.27 times more in participants with family history of any medical condition (p<0.0001). Conclusions: The survey observed that about 93% and 91.1% of Indian participants with various health conditions suffered from LOA and fatigue respectively. Infectious disease especially typhoid was the commonest cause of LOA and fatigue. This is the first study documenting the extent of the problem in pan-Indian participants.

Aim: : To evaluate the causes of increased incidence of strokes in winter as compared to summer in the city of Kolkata, India Protocol: 25 hypertensive middle aged patients, attending the Medical OPD were selected randomly for the study. Keeping there blood pressure under control with suitable therapy, Arterial BP readings were recorded monthly for 12 consecutive months. ResultsMean Arterial BP (Systolic) of the patients was 134.12 mm.Hg.±1.86 in summer and 149.24 mm. Hg.±2.17 in winter. The Mean Arterial Blood Pressure (Diastolic) was 83.40 mm. Hg.±0.88 in summer and 88.76 mm. Hg.±1.10 in winter. Both the differences were statistically significant. Overweight patients (BMI>25) showed almost similar seasonal variation in BP when compared with the standard weight patients (BMI up to 25) Conclusion: Blood Pressure level is greatly influenced by the environmental temperature generally irrespective of the body weight. This fact should be considered in the management of hypertensive patients in a long follow up period.

Background: Stigma has long been found to be present among caregivers of persons with psychiatric disorders, but there is a lack of studies examining this issue, especially from India. Aims: To measure stigma among caregivers of persons with psychiatric disorders, to correlate stigma with various sociodemographic and clinical variables and to compare stigma among caregivers of persons with psychiatric disorders and substance dependence. Materials & Methods: 202 caregivers of persons with schizophrenia and other psychotic disorders, depression, obsessive compulsive disorder and substance dependence were included. They were assessed on various sociodemographic and clinical variables. Stigma was measured using the stigma scale translated and adapted in Hindi. Results:Caregivers experience higher stigma if the patient or caregiver were less educated. Parents experienced higher stigma than the siblings and spouses. The stigma experiences were highest among caregivers of persons with substance dependence. In addition, stigma experiences among caregivers were higher if the patient was ill for a longer duration, was not in remission or was ever admitted to psychiatry ward. Conclusions:In addition to the burden of caring for the patient, family members face stigma and discrimination in various areas. The psychosocial interventions planned for the family members should deal with these experiences.

Beta Thalassemia major is a hereditary disease known long back in areas where malaria is endemic. In India more than 20000 children are born each year with this disease. Though regular blood transfusion is an effective treatment for the disease but has acted as double edged sword. One side it has given long term survival benefit to the patient on the other hand patient also has to face problem of iron overload. To combat this problem we already have a well-known chelating agent –Deferoxamine. Now newer agents are also being used like deferiprone, deferasirox and wheatgrass. Most of the studies for these agents are largely done in India and found satisfactory results. Deferoxamine still remains single most effective chelating agent. Studies on combination therapy are showing better results than any single agent alone

Letter to Editor

Background and Objective: Loss of appetite (LOA) during illness impacts individual well-being and quality of life. An epidemiological survey was conducted on the prevalence of LOA. Methodology: Multi-centre, non-interventional, cross-sectional, survey of LOA in Indian participants recuperating from various health disorders. Results: A total of 15914 participants were enrolled into the study. Of the 15914 participants enrolled, 63.5% were men and 36.5% were women, with a mean age of 38.5 years and majority of participants (68.7%) had infectious diseases. Of which, 80.3% participants were reported with infections and infestations disorders as the most frequent infectious condition. The prevalence of LOA was 93.1% (95% CI: 92.7%, 93.5%) with 33.8% participants having mild, 47.7% had moderate and 11.6% had severe to very severe LOA problem. The prevalence of fatigue was 91.1% (95% CI, 90.5, 91.4) of which, 44.4% had mild, 36.8% had moderate, and 9.8% had severe to very severe fatigue. LOA and fatigue was highest in participants with infections and infestations (93.8% and 91.7% respectively), with typhoid being the most common cause. The risk of LOA was 1.5 times more in participants with a past history of any medical condition and 1.31 times more in subjects with infectious diseases (p<0.0001). The risk of fatigue was 1.19 times more in participants aged >40 years and 1.27 times more in participants with family history of any medical condition (p<0.0001). Conclusions: The survey observed that about 93% and 91.1% of Indian participants with various health conditions suffered from LOA and fatigue respectively. Infectious disease especially typhoid was the commonest cause of LOA and fatigue. This is the first study documenting the extent of the problem in pan-Indian participants

Letter to Editor

Letter to Editor

Introduction: Diarrhea Alleviation through Zinc and ORS Therapy (DAZT) project was started in six demonstration districts of Gujarat in 2011. The aims of the research were to understand prescription practices for childhood diarrhea, assess knowledge and practice about zinc therapy among health care providers in the government/private sectors and among caretakers. Methodology:It was a cross-sectional study conducted in six DAZT demonstration districts of Gujarat. Information was collected on structured questionnaires by interviewing 127 care providers & 43 care takers in six districts. In addition, case records were reviewed for 228 prescriptions – all from the government sector. Results: Government functionaries dispensed ORS in 97% & Zinc in 90% cases of diarrhea while, private providers prescribed it in 79% & 71% respectively. Antibiotics were prescribed in 24% & 59%, anti-amoebic in 20.2% & 64.7% in public and private sectors respectively. Knowledge of dosage and duration of zinc therapy was better among public sector providers than private sector ones. Amongst caretakers, 74.4% gave correct dose of zinc to their children but was given for 14 days in 67.4% of cases. Conclusions:For all the parameters studied, responses were better amongst government providers than those from the private sector.