April 1994, Volume 44, Issue 4

Practical Epidemiology and Biostatistics in Research

Abstracts from the Journals of the East

Fatema Jawad  ( 7/6, Rimpa Plaza, M. A. Jinnah Road, Karachi. )

Microbial Agents In Acute Watery Diarrhoea In Children during Hood and Rainy Season In Nawab­shah. Aithund, LA., Rajper, G.M., Soomro, At, Shaikh, A.R. Pak.J.Path., 1993;4:49-51.
A study was conducted to identify the microbial agents present in the stools of child patients suffering from acute watery diarrhoea admitted in the Paediatric Unit of Peoples Medical College Hospital, Nawabshah during the flood and rainy season. Freshly passed stools from 187 patients were collected in screw capped glass containers and direct microscopy performed with saline and iodine preparations. Cryptosporidium was isolated by the modified kinyoun\\\'s acid fast stain and culture of the stool specimens was done on Mac Conkey agar, blood agar, TCB agar,SS agar and Sabourud’s agar. Oxidase test and cholera red reaction were performed where re­quired. Yeasts were identified by colonial characteristics, pigmentation and morphology of spores whereas serotyping of E. coil and salmonella was done with standard sera. Microbial agents were found in 151 stool samples. There were 107 bacterial agents, 35 parasites and 9 yeasts. E. coli was present in 47, salmonella in 35, shigella in 23 and vibrio cholera in 2 specimens. The parasites identified were E. Histolytica in 16, Giardia Lamblia in 13 and Cryptosporidium in 6. All the yeasts found belonged to the Candida species. The maximum number of microbes were found in specimens from age group 7 to 12 months. The declining level of maternal antibodies in this age leading to diminished active immunity could be the probable cause. Contamination of food with human or animal excreta when infants start crawling could also be a contributing factor.
Frequency and Pattern of HDV Infection In Shaikh Zayed Hospital, Lahore. Pirkani, G.S., Khan, J.I. Pak.J.Pathol., 1993;4:41-43.
Hepatitis Delta Virus, a hepatotropic virus is present in association with hepatitis B virus (HBV) only. As HBV is endemic in Pakistan, so the co-infection or super infection of the Delta Virus has a high probability as it also makes the infection more severe. A study was conducted on 150 HbsAg positive patients in the microbiology department of the Shaikh Zayed Hospital, Lahore. Five milliliter of blood was withdrawn and the serum separated and stored at -20° centrigrade. The patient’s age, sex and occupation was noted. All sera were tested for Hbs Ag by Auszyme Monoclonal and for anti-delta antibodies by Abbott-An­tidelta, Abbott Laboratories, Illinois. Anti-Delta positive sera were further tested for anti-Hbc-IgM by Corzyme-M.Anti-delta antibodies were found positive in 25 sera out of the 150 specimen tested. There were 103 males and 47 females of which 20 males and 5 females were positive for the anti-delta antibodies. The largest number of anti-HDVpositive cases were in the age group 40-59 years (19.51%). The highest incidence of the anti-HDV positivity was determined in health care workers (25%). The overall positive HDV infection in the HbsAg infected person was 16.66 percent. The study revealed the high vulnerability of health care workers to acquire HDV infection which could be due to a comparatively frequent exposure to blood than the general population. Itis advisable that blood donors should be tested by sensitive methods to screen out HbsAg and HDV infec­tion. Health care workers should be vaccinated against HBV and positive carriers should avoid handling blood. Needle pricks and mouth pipetting should be avoided.
Mnlodiplne In the Management of Hypertension. Qazilbash, LA. Pak.Heart.J., 1993;26:2-4.
Amlodipine, a calcium channel blocker was given as a single dose to 44 patients with hypertension. There were 28 females and 16 males with the majority being in the age group 40 to 60 years. Essential hypertension was diagnosed in 41 cases whereas 3 had secondary hyper­tension to SLE, glomerulonephritis and cushings disease. Every individual underwent a clinical examination blood count, bio-chemical profile, chest X-ray and ECG. Am­lodipine was started in a dose of 5 mg daily for 4 weeks and then increased to 10 mg daily where necessary. Patients were followed up for 12 weeks. Mild hyperten­sion was diagnosed in 23, moderate in 14 and severe in 7 cases. Concomitant therapy with beta blockers was being t3ken by 5 individuals, diuretics by 4, insulin by one, oral hypoglycaemics by 6, steroids by one and analgesics by one subject By the end of the study it was observed that 19 patients were well controlled on 5 mg of amlodipine whereas 25 required 10 mg of the drug. No serious side effects were reported. An excellent blood pressure stabilization was obtained in 18 subjects, good in 21 and fair in 5 cases. Haematological and biochemical parameters showed no alterations at the conclusion of the study. Amlodipine, a new dehydropyridine, is an effective drug for stabilizing blood pressure. As it is used in a single daily dose, the compliance is good. No serious side effects have been reported.
Non-Surgical Female Sterilization. Bashir, A., Mustansar, M., Cheema, M.A., Akram, S, Naheed, R. Pak.J.Med.Res., 1992;31:147- 150.
Tubal occlusion has emerged as an important means of non-surgical sterilization in women who want to limit their ability to reproduce permanently. This is achieved by trans-cervical insertion of pharmacologically active agents to produce the desired effects. The most promising results have been shown by quinacrine hydrochloride. This is available in the pellet form for the purpose. Seven pellets contain a total dose of 250 mg of quinacrine which after introduction diffuses to the fallopian tube and causes fibrosis at the cornual area of the uterus and interstitial portion of the fallopian tube. It causes subepithelial hyalinization and scarring involving both the lamina propria and muscularis of the tubes. The technique of tubal occlusion by quinacrine hydrochloride was practised on 2100 women in the reproductive age in Faisalabad. Pelvic inflammatory disease, adnexal masses, tumours and uterine anomalies were ruled out. Seven pellets of quinacrine hydrochloride were inserted in the uterine cavity with the help of a sterilized copper-T IUCD inserter, in the proliferative phase. This method of contraception was accepted by 84 percent of the women attending the centres. Trans-abdominal tubal ligation was opted by 6.6 percent and transvaginal by 9.4 percent. Most of the acceptors of quinacrine pellets were grand multiparas. Minor side effects were reported by 6.8 percent of the women. Vaginal discharge for 5-10 days was reported by all the cases. The other complaints in a small number were lower abdominal pain (2.2%), amenorrhoea (1.11%), irregular menstruation (0.44%), menorrhagia (0.88%), backache (0.66%), heaviness, dyspareunia and itching. In one year follow-up, 29 women became pregnant with the maximum number being 2 months after insertion. The study proved that quinacrine pellets insertion for the purpose of non-surgical sterilization, has a high acceptance rate with negligible side effects. There is high efficacy with practically no chances of ectopic pregnan­cy. Being in the pellet form, the drug does not have a rapid intravascular absorption thus having no chances of toxic psychosis.

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