Recent increases in the immigration of persons from Latin America into North America, particularly from regions endemic for Chagas disease, suggest the possibility that pregnant women may be latently infected with Trypanosoma cruzi. This study was undertaken to assess the magnitude of seropositivity in parturient women in our institution. Umbilical cord blood was collected from Hispanic surnamed women delivering infants at Parkland Health and Hospital System (PHHS), the public hospital serving Dallas County, Texas, and affiliated with UT Southwestern. When possible the specimens were collected from consecutive deliveries. Serum was tested for antibodies to Trypanosoma cruzi by commercial systems. Two hundred delivering women were tested as described. Of those tested, 4 were found to be positive for T. cruzi antibody (2%). This confirms a potential risk for transplacental transmission of T. cruzi in populations residing outside the traditional endemic zone, such as those seeking medical care at PHHS.
Aim: There is lack of information on the severity of diarrheal disease with etiology. Thus the study aimed to compare the etiology of under-five children with moderate-to-severe disease (MSD) and mild disease (MD). Study Design: Diarrheal disease surveillance. Place and Duration of Study: Mirzapur Kumudini Hospital, Tangail, rural Bangladesh, January 2010 – December 2011. Methodology: Overall, 2,324 under-5 diarrhea children were enrolled in the hospital who came from the demographic surveillance system (DSS) catchment area. Whole stool samples were collected from each enrolled child to detect rotavirus, Shigella, ETEC and V. cholerae. Information on socio-demographic and clinical characteristics was also collected. Results: Among all the study children, 1,098 (47%) were aged 0-11 months; 789 (34%) were 12-23 months, and 437 (19%) were 24-59 months. Rotavirus (33%) was mainly responsible for diarrhea amongst children under-5 and 90% of them were less than 2 years. Shigella represented 14%; of which, 45% were 24-59 months old. However, ETEC and V. cholerae represented only 3% and 2% respectively. Shigella was the most commonly detected pathogen (27%) for MSD followed by rotavirus (16%). Conversely, rotavirus (43%) was responsible for MD. MSD were most likely to be infected with Shigella flexneri [OR-9.81; 95% CI (6.38, 15.18)] and Shigella sonnei [6.29; (3.67, 10.87)] compared to their counterparts with MD. In logistic regression analysis, Shigella was responsible for a 2.25 times higher risk for MSD. Children with Shigella were 3.28 times at higher risk for bloody stool and 2.45 times more likely to have fever. However, rotavirus diarrhea was more likely to be presented with vomiting (OR-2.46) and fever (OR-1.28), and Vibrio cholerae, most often with watery diarrhea (OR-4.35). None of the clinical features were significantly associated with ETEC. Conclusion: Shigella was the leading pathogen that was detected most often in MSD, whereas rotavirus was often associated with MD.
Aims: This research is aimed to determine the occurrence of female genital schistosomiasis (FGS), Candida albicans, Trichomonas vaginalis, Bacteria vaginosis and HIV concomitant infections among women of reproductive age in schistosomiasis endemic communities in the Volta Basin of Ghana. Study Design: Cross-sectional study. Place and Duration of Study: Schistosomiasis endemic communities in the Volta Basin. July 2005 to June 2006. Methodology: During the conduct of the study, 402 out of 420 women who volunteered to participate were screened for genital infections by collecting high vaginal swabs (HVS). These were analysed for T. vaginalis by wet mount, C. albicans by wet mount and culture and B. vaginosis by wet mount and Whiff test. HIV infection was diagnosed from venous blood using HIV1/2 immunochromatographic test. Also 395 of the women were screened for female genital schistosomiasis (FGS) using cervical biopsy which was analysed using the compressed biopsy technique. Results: About one third, 24/402 (30. 9%) of women screened were positive for at least one of the genital infections assessed. C. albicans was the most frequently occurring infection, with a prevalence of 15. 6%. This was followed by B. vaginosis (13. 5%) and T. vaginalis (1. 5%). HIV prevalence rate found in this study was 7. 2% and FGS 10. 6%. Almost half (46.3%) of FGS positive women were diagnosed with at least one of the genital pathogens compared to 30% of the FGS negative women. Candida albicans infection was significantly associated with FGS (P=0. 005). As much as a third (31. 6%) of women with FGS were diagnosed with C. albicans infection. Conclusion: This study revealed a positive association between FGS and C. albicans infection among study participants. The lack of association between FGS and HIV was not conclusive because of low sample size. Findings from this study provide baseline data for conducting further studies between FGS, C. albicans and HIV infection.
Aim: To assess the feasibility of implementing "one health approach" to prevent human rabies and control animal rabies in a rural community. Study Design: Health services research in a rural setting. Place and Duration of Study: A medical college and a veterinary college along with an animal welfare organization delivered a wide array of "integrated services" in three villages' i.e. Kumbalagodu, Thagachikuppe and Gerupalya near Bangalore, India comprising a population of 10,220 persons for a period of two years from December, 2009 to November, 2011. The nearby three villages of Ramohally, Vinayakanagara and Bhimanakuppe with a population of 6,023 persons formed the control group, with no project inputs. Methodology: This consisted of household surveys at the beginning and end of two years ; rabies awareness campaigns; clinical and laboratory surveillance of rabies in dogs; rabies post-exposure prophylaxis (PEP) in humans; pre-exposure rabies prophylaxis (PrEP) by intradermal route in school children, pet dog owners and veterinarians ; mass dog vaccination and deworming; and sero-surveillance in both dogs and humans. Results: The ratio of veterinary and medical manpower in study villages was 1: 11 and dog to human ratio was 1: 23.The information, education and communication materials developed and used were domestic outdoor wall writings (11), domestic indoor annual wall calendar (2000), school book labels (1000); game charts (16); wall posters (65); flip chart (15); rabies educational DVD (1). There were 102 local cable television transmissions on rabies prevention. 69 persons received rabies PEP. PrEP was given to 368 school children, pet dog owners and veterinarians. Sixty one human serum samples were analyzed by rapid fluorescent focus inhibition test for rabies antibody detection. Sixteen veterinarians were trained to use direct rapid immunohistochemical test (dRIT) for rabies diagnosis. Six ruminants were confirmed rabid by dRIT. There were no cases of human rabies. The cost of entire project was US $ 85,958. Conclusion: A blend of medical, veterinary and animal welfare services were successfully delivered through a "one health" approach. Based on this success a "conceptual model" was evolved to propagate its replication in other rural communities across India.
Aims: The aim of the study was to determine the pattern and factors influencing exclusivebreast feeding and weaning practices in a homogenous urban slum. Study Methods: The study was a descriptive cross-sectional among 143 mother-child pairsusing a combination of simple and systematic sampling methods. Interviewer administered questionnaire was used to obtain information on pattern of breastfeeding, weaning and weaning foods. Results: The ages of the mothers ranged from 13-41 years while the infants were aged 0-26 months. Breastfeeding was initiated by 83 mothers within 30 minutes of delivery and the main reason for delayed initiation of breastfeeding was the belief that colostrum was dirty 99(69.2%). only 32 (22.3%) of the mothers commenced weaning before the age of 4 months mainly on pap made from corn or millet.Out of the 143 respondents, only 46 (32.2%) practiced exclusivebreast feeding. There was a statistically significant relationship (P=0.006) between the age ofthe respondents’ and the practice of EBF as the mothers who were more than 30 years of agewere more likely to practice EBF compared to those younger than 30 years. However, the level of education andoccupation of the mothers had no significant bearing on the practice of EBF. Conclusion: The practice of exclusive breast feeding is low and is influenced by socialdeterminants that need to be addressed by policy makers. Risk factors for early weaning should be identified and appropriate interventions put in place.
Aims: To evaluate the prevalence of malaria parasites among some pregnant women attending antenatal clinics in Rivers State, Nigeria. Study Design: Cross-sectional study. Place and Duration of Study: Five healthcare centres in Rivers State, Nigeria, between April and September 2011. Methodology: Peripheral blood samples were collected using venous procedure and the presence of malaria parasites was observed microscopically on thick and thin blood smears prepared from each sample. Personal data were collected through questionnaires and the general results gotten during this study were analyzed statistically using two-way Analysis of Variance (ANOVA). Results: The only species of malaria parasite identified in this study was Plasmodium falciparum. A total of 104 (26%) pregnant women were infected with P. falciparum in this study. Pregnant women in their first, second and third trimesters had prevalence rates of 27%, 27.3% and 21.8% respectively (P<0.05). Prevalence rates for primigraviidae, secundigraviidae and multiparous women were 26.1%, 31.5% and 20% respectively (P<0.05). prevalence rates of 26.9%, 27.8% and 21.5% were observed in pregnant women between the ages of 11-20, 21-30 and 31-40 respectively (P<0.05). Conclusion: Malaria still needs to be given more attention due to its negative impact on pregnant women and their unborn children.
Aims: Erythrocyte complement regulatory proteins, complement receptor 1 (CR1) and decay accelerating factor (CD55) protect red blood cells (RBCs) from complement mediated damage by controlling complement activation cascade and potentially protect RBCs from complement mediated damage that may occur when immune complexes are formed following malaria infection. Given the important role of RBCs in regulation of complement activation, we considered the competence of sickle cell trait RBCs in these functions. Methods: Children (age 0-192 months; n=116) were enrolled in a nested case controlled study conducted in Kombewa Division, Kisumu west District between October and December 2004. Based on hemoglobin (Hb) type, children were stratified into those with HbAS (n=47) and HbAA (n=69). The 47 HbAS individuals were matched to the 69 HbAA individuals of similar age (± 2 months or ± 24 months for those below or more than 192 months, respectively) at a ratio of 1:1 or 1:2. Circulating CR1 levels and CD levels were quantified using a FACScan cytometer under normal and reduced oxygen saturation. Results: The mean CR1 copy numbers per RBC was comparable in the two groups. However, between the ages of 49-192 months, the mean CR1 copy numbers per erythrocyte was significantly higher in children who had HbAS compared to those with HbAA (P=0.0332). The mean CD55 levels were comparable between the two groups but after deoxygenation, the mean CD levels in RBCs of individuals with HbAS was significantly higher than in the HbAA (P=0.011). Conclusion: The mean CR1 and CD55 copy numbers per RBC were comparable between the two groups under normal and reduced oxygen saturation. Beyond the age of 49 months, the CR1 copy numbers was higher in the HbAS compared to HbAA and this was also true for CD55 levels under deoxygenated conditions. Taken together, these results demonstrate that in the younger age groups, the protection afforded by HbAS against severe manifestations of malaria may be due to other factors other than complement regulatory proteins but beyond the age of 49 months, this protection may be partly due to the high CR1 copy numbers in the HbAS individuals.
Background: The thyroid gland is an endocrine organ which has an important function in regulation of physiological functions of normal body metabolism. Thyroid neoplasms are usually presented with palpable solitary or multiple nodules. This retrospective study aimed at describing the histopathological patterns of various thyroid neoplasms at the Pathology Department, University College Hospital (UCH), Ibadan between 1987 and 2006. Methods: We reviewed 174 cases with thyroidectomy and diagnosed thyroid neoplasm. We evaluated heamatoxilin and eosin stained slides retrieved from the records of the department and the population based cancer registry and where necessary the paraffin blocks were recut and stained. The World Health Organization Histological Classification of Thyroid tumour (2004) was used in this study. Results: A total 74,202 biopsies were received in the department over the study period. 1,207 cases were thyroidectomy specimens constituting 1.6% of all biopsies in the study period. 174 cases (14.4%) were thyroid gland neoplasms 122 (70.1%) of which were females and 52 of which (29.9%) were males. The ratio of female to male is 2.3:1. Seventy six (43.7%) cases were benign and 98 (56.3%) cases were malignant. Follicular adenoma accounted for 89.5% of benign thyroid neoplasms which makes a peak in the 5th decade. Papillary carcinoma was the most common malignant thyroid neoplasm in this study with a peak in the 3rd decade. Conclusion: This study showed that thyroid neoplasms were showing female predominance. The most common benign neoplasm was follicular adenoma and the malignant neoplasm was papillary carcinoma.
Background: Hepatitis B virus (HBV) infection still has a relatively high incidence and prevalence worldwide. In the post-vaccination era in developing countries, perinatal vertical transmission remains the most common mode of transmission. Prevention of mother-to-child transmission requires screening for HBV surface antigen (HBsAg) in pregnant women to identify which newborns that must be immunized. Aim: This study aimed to evaluate the prevalence of HBV infection among pregnant mothers who were attending outpatient clinic of the Obstetric Department, and Social and Preventive Medicine Center at Cairo University Hospital Campus, for routine antenatal care. Methods: A cross sectional study included 2,000 pregnant women. A rapid screening test for HBV “One Step HBsAg Rapid Test” was done for all women and all HBsAg-positive cases were confirmed by ELISA for HBsAg. A structured questionnaire for risk factors for HBV acquisition was filled for every pregnant mother positive for HBsAg and a control group of HBsAg negative mothers. Results: Out of 2,000 pregnant women, 35 (1.75%) were positive by the rapid test, out of whom 32/35 cases (91.43) were confirmed to be positive by the confirmatory test representing 1.6% of the study population. Family history of HBV, previous intravenous (IV) injections, medical clinic attendance, hospital admission, and surgeries were the risk factors for acquiring HBV infection (P-value=0.001, 0.003, 0.002, 0.000, and 0.011, respectively). Conclusion: HBV infection is prevalent among pregnant mothers attending our outpatient services. Therefore we recommend screening for HBV in all Egyptian pregnant mothers to prevent neonatal infection by immunoprophylaxis.
Objective: To review the progress towards the goal of elimination of visceral leishmaniasis (Kala azar) from the Indian sub-continent by 2015. Method: Both electronic and print databases were searched for studies related to Kala azar. Finding: The burden of Kala azar is grossly underestimated by the health systems in the Indian sub-continent due to over-reliance on passive surveillance. Poly-parasitism and co-infections are the major emerging problems in the world of Kala azar. Resistance has been reported for DDT indoor residual spraying. Treatment drugs are not ideal, and supplies of these drugs are irregular as well. Conclusion: Achievement of elimination of Kala azar from Indian sub-continent is still unpredictable. To improve the elimination of Kala azar it should be classified as a notifiable disease. There is a need to refocus current strategies and monitor the program more closely. Furthermore, there is a need to assess alternative vector control methods. Policies to control Kala azar will have to include health education and behaviour change. Kala azar may not affect the national economy or the national GDP, but it devastates the families affected.