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   Table of Contents - Current issue
Coverpage
February 2019
Volume 12 | Issue 2
Page Nos. 49-94

Online since Friday, February 1, 2019

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REVIEW ARTICLE  

Epidemiological, prevention and control updates of yellow fever outbreak in Brazil p. 49
Marli do Carmo Cupertino, Rebeca Garcia, Andréia Patrícia Gomes, Sérgio Oliveira de Paula, Nicholas Mayers, Rodrigo Siqueira-Batista
DOI:10.4103/1995-7645.250837  
Yellow fever is an acute viral disease endemic to tropical countries, like Brazil, where, since the 1940s, has no significant documented outbreaks similar to that observed between 2016/2018 (2 045 confirmed cases and 677 deaths; caused by the sylvatic form). The principal manipulating factors inciting this change were absence of appropriate vaccination campaigns and increased urbanization & population growth in forest areas, with prevalence of the virus in the species inhabiting of these areas. The 2016/2018 outbreaks exhibited incidence in areas with historically low or no yellow fever virus activity, triggering a surge in recorded deaths - mainly in the Southeastern states of Brazil. The Brazilian government aggressively responded, reforming the countries’ prophylactic measures, including vaccine implementation - as of March, 2018, switching from the former double dose regimen of the vaccine, to a single dose protocol, deemed as adequate. Moreover, some states appropriated the fractionated dosage (1/5 of the standard dose), in foresight of potential vaccine shortages. To prevent the uprising of new sylvatic yellow fever cases in Brazil, it’s obligatory the development of effective combative plans, including adaptation of prophylactic measures individually (use of repellents, protective clothing etc. ), applicable vaccination campaigns in every endemic region, to raise awareness to locals and visitors alike. Notwithstanding these preventative strategies, the persistence of cases and the recent outbreaks in Brazil, highlight the possible ineffectiveness of combative measures. Based on these considerations, the objective of this review was to raise more awareness of the epidemiological impact of the disease in Brazil.
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ORIGINAL ARTICLES Top

Modeling and predicting dengue fever cases in key regions of the Philippines using remote sensing data p. 60
Maria Ruth B. Pineda-Cortel, Benjie M Clemente, Pham Thi Thanh Nga
DOI:10.4103/1995-7645.250838  
Objective: To correlate climatic and environmental factors such as land surface temperature, rainfall, humidity and normalized difference vegetation index with the incidence of dengue to develop prediction models for the Philippines using remote-sensing data. Methods: Time-series analysis was performed using dengue cases in four regions of the Philippines and monthly climatic variables extracted from Global Satellite Mapping of Precipitation for rainfall, and MODIS for the land surface temperature and normalized difference vegetation index from 2008-2015. Consistent dataset during the period of study was utilized in Autoregressive Integrated Moving Average models to predict dengue incidence in the four regions being studied. Results: The best-fitting models were selected to characterize the relationship between dengue incidence and climate variables. The predicted cases of dengue for January to December 2015 period fitted well with the actual dengue cases of the same timeframe. It also showed significantly good linear regression with a square of correlation of 0.869 5 for the four regions combined. Conclusion: Climatic and environmental variables are positively associated with dengue incidence and suit best as predictor factors using Autoregressive Integrated Moving Average models. This finding could be a meaningful tool in developing an early warning model based on weather forecasts to deliver effective public health prevention and mitigation programs.
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Occurrence of Chlamydia spp. in wild birds in Thailand p. 67
Suksai Parut, Onket Rattanaporn, Wiriyarat Witthawat, Sangkachai Nareerat, Lekcharoen Paisin, Sariya Ladawan
DOI:10.4103/1995-7645.250839  
Objective: To determine the occurrence of Chlamydia spp. in wild birds in Thailand. Methods: Cloacal and tracheal swabs of 313 wild birds from 11 orders, 27 families, and 51 species were tested to determine the occurrence of Chlamydia infection. The outer membrane protein A (ompA) gene was amplified from positive samples to construct a phylogenetic tree. Results: At the time of sample collection, none of the birds showed clinical signs of any disease. Of 313 wild birds, two Asian openbill stork (Anastomus oscitans) were positive for Chlamydia spp., representing 0.64% (2/313) and 4.9% (2/41) occurrence for birds overall and for the Asian openbill stork, respectively. Phylogram analysis based on deduced amino acid of the ompA gene showed that Chlamydia spp. in Asian openbill storks was closely related to that in wildfowl (Pica pica and Cygnus olor) from Poland in a different branch with a 95% bootstrap value and had a shorter evolutionary distance to Chlamydia abortus. Conclusions: Asymptomatic Asian openbill storks could be a potential source of Chlamydia infection in domestic animals, poultry, and humans who share their habitat.
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Survival rate and the determinants of progression from HIV to AIDS and from AIDS to the death in Iran: 1987 to 2016 p. 72
Mohammad Mirzaei, Maryam Farhadian, Jalal Poorolajal, Parvin Afsar Kazerooni, Katayoun Tayeri, Younes Mohammadi
DOI:10.4103/1995-7645.250840  
Objective: To examine the prognostic factors of progression from HIV to AIDS and AIDS to the death in people living with HIV/AIDS in Iran. Methods: In this registry-based retrospective cohort study, we recruited 28 873 HIV-infected people from 158 Behavioral Diseases Counseling Centers of Iran. Two outcomes of interest included survival rates from HIV diagnosis to AIDS and from AIDS to the death. We used Kaplan-Meier and Cox regression model to investigate survival rate and factors affecting on survival controlling effect of confounding factors. Results: The one, three, five, and ten-year survival rate from HIV to AIDS were 85%, 73%, 61% and 32%, and for AIDS to death were 90%, 81%, 74% and 55%, respectively. Multivariate Cox regression analysis indicated that the risk of progression from AIDS phase toward death in individuals with CD4 less than 200/mm3, infected with tuberculosis (TB) and not treated by antiretroviral therapy (ART) was 2.17 (95% CI: 1.62-2.90), 1.49 (95% CI: 1.01-2.20) and 4.88 (95% CI: 3.42-6.96) times higher respectively. The risk of progression to AIDS in patients with baseline CD4 less than 200/mm3 was 2.32 (95% CI: 2.14, 2.51) times higher than patients with CD4 > 200/mm3 (P=0.001). On the other hand, tuberculosis increases the risk of death by 49.0% (P=0.04). The hazard ratio of death in patients who did not receive ART was 4.88 (95% CI: 3.42, 6.96) times higher than patients who received ART (P<0.001). Conclusion: The early detection of HIV, the screening and treatment of TB and receiving the ART improve the survival of HIV/AIDS patients significantly, and prevent the transmission of HIV to other people.
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Insecticide susceptibility status and resistance mechanism of Anopheles cracens Sallum and Peyton and Anopheles maculatus Theobald (Family: Culicidae) from knowlesi malaria endemic areas in Peninsular Malaysia p. 79
Ahmad Rohani, Abdul Rahman Aidil Azahary, Ke-Xin Yu, Mohamed Nor Zurainee, Wan Mohamad Ali Wan Najdah, Han Lim Lee
DOI:10.4103/1995-7645.250841  
Objective: To assess the insecticide susceptibility status of Anopheles cracens (An. cracens) and Anopheles maculatus (An. maculatus) from knowlesi malaria endemic areas in Peninsular Malaysia towards DDT, malathion and deltamethrin and to determine the resistance mechanism involved. Methods: Adult and larval mosquitos were collected for surveillance. Susceptibility status of Anopheles was determined using the standard WHO adult bioassay, larval bioassay and biochemical enzyme assay. Results: WHO adult bioassay results indicated An. cracens collected from Kampung Sungai Ular, Pahang was resistant towards 4% DDT, while An. maculatus collected from Kampung Sokor, Kelantan and Kampung Sungai Lui, Selangor exhibited resistance towards 4% DDT. However, the enzyme activity profiles varied according to strains and species. The resistance ratio of larval bioassay, showed that all strains and species tested were susceptible to malathion and temephos. Conclusions: Since only a few anopheline strains exhibited low level of insecticide resistance towards malathion, DDT and temephos. These insecticides are still considered effective for vector control program towards An. cracens and An. maculatus.
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Observational study to assess pregnant women’s knowledge and behaviour related to toxoplasmosis in Essaouira province, Morocco p. 87
Nadia Ouzennou, Samia Boussaa, Safa Ben Alla, Ali Boumezzough
DOI:10.4103/1995-7645.250842  
Objective: To assess knowledge and behaviour related to toxoplasmosis which remains a neglected disease in Morocco. Methods: Observational investigations were conducted among 600 pregnant women from Essaouira Province. The interview items covered respondents’ knowledge of the disease, its preventive practices and risk behaviours. Results: A total of 22/600 women had already carried out the anti-toxoplasmosis test, while, 96% have never done any screening of anti- Toxoplasma antibodies. Only 16/600 women have good information about the disease, its mode of transmission and its complications in both the fetus and his mother. Although most women adopt a healthy diet, the consumption of raw or undercooked meat is far to be considered as a risk factor, along with other potential factors that may foster the acquisition of the disease, such as possessing a domestic cat, educational status and knowledge of the disease. However, in this study, contact with soil was revealed the most important risk factor (P = 0.045), followed by the hygiene conditions after handling raw meat (P = 0.048). Conclusion: The underestimation of the Toxoplasma gondii sero-prevalence in Essaouira Province can be explained by the absence of toxoplasmosis serology in health institutions, as well as the gap of knowledge about the disease by local population.
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CASE REPORT Top

Hemorrhagic blisters in fulminant Aeromonas hydrophila bacteremia: Case report and literature review p. 91
Yao-Tien Chang, Sung-Yuan Hu, Che-An Tsai
DOI:10.4103/1995-7645.250843  
The Aeromonas species, belonging to the family Aeromonadaceae, are opportunistic pathogens found in humans with an incidence rate of 76 cases per million inhabitants in Southern Taiwan. The incidence of Aeromonas septicemia is relatively low, accounting for less than 15% of cases. Patients diagnosed with Aeromonas hydrophila bacteremia who were presented with skin blisters and septic shock have been reported to have a mortality rate of 100%. Aeromonas infection must be considered in the differential diagnosis of gangrene-like tissue damage or skin lesions in patients with end-stage renal disease, due to the potential sources of infections. A 49-year-old Taiwanese diabetic woman with end-stage renal disease had underwent regular hemodialysis. She was referred to our hospital due to a one-day course of fever, dyspnea, hypotension, and fulminant hemorrhagic blisters covering her whole body. A physical examination uncovered multiple hemorrhagic blisters, along with a ruptured blister over the lower left leg. Laboratory tests revealed an elevation of liver enzymes, impaired renal function, lactatemia, and high anion-gap metabolic acidosis. Cultures of both blood and hemorrhagic blister fluid grew Aeromonas hydrophila. However, she experienced persistent shock despite aggressive intravenous fluid, empiric antibiotics, and inotropic agents with norepinephrine and dopamine. Early diagnosis and prompt management using intravenous fluids, antibiotics and surgical debridement is recommended in order to improve a patient’s survival rate.
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