Hepatitis B and C virus markers among new entrant medical students

AIM

To investigate the presence of hepatitis B and C virus markers in new entrant medical students at the Faculty of Medicine, University of Kelaniya.

METHOD

456 students (mean age 24 years, SD 3.5, 257 men) were investigated before they were exposed to clinical work, using a questionnaire to assess sociodemographic factors and possible risk factors for contracting hepatitis B or C. Blood samples were tested for HBs Ag and anti HBs (n = 456), and anti-HCV (n = 162 randomly selected samples) with a third generation sandwich radioimmunoassay technique.

RESULTS

The students were from 20 of the 25 districts in the country, although their distribution was not inform. A past history of hepatitis or jaundice was obtained from 24 (5.3%) and 6 (1.3%) students respectively. None of them had been vaccinated against hepatitis B. At least one risk factor for hepatitis B or C was present in 32 (7%) of them. None of the samples were positive for HBsAg or anti-HCV, and only two (0.44%) were positive for anti-HBs.

CONCLUSION

Our results support the view that exposure to hepatitis B and C seems to be uncommon in this country, at least up to young adulthood. As most new entrant medical students are not immune to these infections there is a strong case to vaccinate them against hepatitis B before they are exposed to clinical work.

Do babies need water in Sri Lanka?

OBJECTIVES

To study the prevalence of exclusive breast feeding and the reasons for water supplementation, and investigate whether water is necessary in the humid climate of Colombo.

SETTING

Well baby clinic in De Soysa Maternity Hospital for Women, Colombo.

SUBJECTS

200 breast fed infants born in a baby friendly hospital between the ages of 1 and 4 months.

METHODS

The study sample was randomly selected. Sick infants and those of working mothers were excluded. The mothers' knowledge of feeding practices was recorded in an interviewer administered questionnaire. The infants' weights, lengths and rectal temperatures were measured and the osmolality of urine estimated. The room temperature and relative humidity were recorded on each day of study. The data were analysed using the Chi-Square statistical test.

RESULTS

69% of mothers introduced supplementary fluids within the first 4 months, because of advice from grandmothers or relatives, thirst, hiccups or constipation. 45% had introduced water with "rathakalkaya", a fluid traditionally given to infants in Sri Lanka. 90% of mothers had attended antenatal clinics in the De Soysa Hospital for Women. 70% of mothers who gave supplementary fluids were aware of the importance of exclusive breast feeding. The range of urine osomolalities of exclusively breast fed infants was 60 to 204 mosmol/kg. There were no significant differences in core temperatures and number of times urine was voided daily, or urine osmolalities, between exclusively breast fed and fluids-supplemented group of infants.

CONCLUSIONS

Despite delivery in a baby friendly hospital a majority of mothers supplemented breast milk with water or other fluids during the first 4 months. The advice of grandmothers had a significant influence on early feeding practices. Exclusively breast fed infants were found to maintain water homeostasis under the hot, humid climatic conditions of this study.

Re-examination of the diagnostic criteria of tropical pulmonary eosinophilia

There is no agreement on the minimum absolute eosinophil count essential for the diagnosis of tropical pulmonary eosinophilia (TPE) at present. The aim of this study was to determine this figure as well as to evaluate the other diagnostic criteria of TPE. The response to diethylcarbamazine (DEC) was tested in 98 patients [of whom 79 (80.6%) completed the study] be means of clinical scores, lung function tests and the absolute eosinophil counts. The minimum absolute eosinophil count necessary for the diagnosis of TPE was found to be 3300 for two reasons. Firstly there was a marked fluctuation in the mean percentage change of the absolute eosinophil count after treatment with DEC, when it was below 3225 cells mm-3, while the mean percentage reduction showed a remarkable stability when the eosinophil count exceeded 3600. Secondly there was a marked difference in the response to DEC in patients whose eosinophil counts were above and below these values. All patients who had eosinophil counts greater than 3600 responded to DEC and were diagnosed as cases of TPE. All of them were from filarial endemic areas. The total eosinophil count decreased by a mean of 92.5%, 3 months after administration of DEC. The sensitivities of the following tests in TPE were as follows: filarial antibody test (FAT) 30%, radiological changes 45.5%, erythrocyte sedimentation rate (ESR) 80%. The radiological changes and the ESR, but not the FAT, were helpful in differentiating TPE from those patients with TPE-like symptoms but with lower eosinophil counts, e.g. those with asthma. Patients with cough who had eosinophil counts of between 53 and 2000 cells mm-3, showed elevated filarial antibody levels in a significant number of cases when compared to asymptomatic subjects. (P < 0.001). Five of them responded to DEC. Three of these had filarial antibody in their serum and one had bilateral mottling on chest X-ray. These results suggest that atypical cases of TPE may exist. Our study has shown that the diagnosis of TPE rests on the following criteria: cough worse at night; residence in a filarial endemic area; the eosinophil count greater than 3300 cells mm-3, clinical and haematological response to DEC. The diagnosis is supported by radiological changes and elevated ESR. The FAT is of little value. The clinical benefit and the improvement in lung function which follows the administration of DEC was sustained up to a minimum period of 15 months.

Insecticide cross-resistance spectra and underlying resistance mechanisms of Sri Lankan anopheline vectors of malaria

Present status of insecticide resistance was investigated in two major vectors of malaria; An. culicifacies and An. subpictus, collected from a high malaria transmission area in Sri Lanka during 1996/1998. Adult and larval bioassays were carried out to obtain log-probit mortality lines for malathion, propoxur, permethrin and chlorpyrifos. Respective LD50 values were 4.45%, 0.002%, 0.16% and 0.001% for An. culicifacies and 0.66%, 0.004%, 0.004% and 0.04% for An. subpictus. Adults were also tested for WHO standard discriminating dosages of malathion, propoxur, permethrin, DDT, cypermethrin, deltamethlin and lambda cyhalothrin. Both populations were highly resistant to DDT. An. culicifacies was more resistant to malathion and An. subpictus was more resistant to chlorpyrifos. About 25% of both populations were resistant to permethrin. An. culicifacies was susceptible to propoxur, deltamethrin and lambda cyhalothrin and An. subpictus to cypermethrin and lambda cyhalothrin. Adult mosquitos were individually tested for their insecticide detoxifying enzyme activities and altered target-site, acetylcholinesterase. High general esterase activity indicated the presence of amplified esterase genes in both populations. Native gel electrophoresis resolved one elevated esterase isoenzyme, with high affinity to organophosphates, from each species. Malathion carboxylesterase mechanism was present in both populations. Higher glutathione-S-transferase activity was marked in An. subpictus. Synergistic studies showed the possible involvement of monooxygenases in resistance in both species. Acetylcholinesterase activity of approximately 80% of both populations was not inhibited by a standard dosage of propoxur. Low resistance to carbamates shows that the impact of agricultural pesticides is not significant in the development of resistance especially in An. culicifaies. Pyrethroids, other than permethrin, can be successfully used in vector control programs. Carbamates will be an alternative.

A new monospecific ovine Fab fragment antivenom for treatment of envenoming by the Sri Lankan Russell's viper (Daboia Russelii Russelii): a preliminary dose-finding and pharmacokinetic study

Russell's viper is the most important cause of life-threatening snake bite and acute renal failure in Sri Lanka. Only equine polyspecific antivenoms imported from India are available. They have not proved effective clinically or in clearing venom antigenemia and they frequently cause reactions. In an attempt to reduce mortality and morbidity, a new monospecific ovine Fab fragment antivenom (PolongaTab; Therapeutic Antibodies, Inc., London, United Kingdom) was raised against Sri Lankan Russell's viper venom. In a preliminary dose-finding study in 35 patients, an initial dose of 3-4 g restored blood coagulability permanently and stopped systemic bleeding, even in severely envenomed patients. Venom antigenemia disappeared within 1 hr of antivenom treatment but recurred, probably as a result of continued absorption of venom from the site of the bite, after the rapid clearance of therapeutic antibody. Twelve patients (34%) experienced early reactions that were usually mild and always responded to epinephrine.

Variation in iodine handling during normal pregnancy

Reports in the literature are divided on changes in thyroid volume and urinary iodine excretion (UI) during normal pregnancy. Reports from Ireland, an area of modest dietary iodine intake (median UI 70 microg/L) showed an increase in UI that rose to a median value of 135 microg/L in the first trimester (T1) and continued at 124 microg/L in the second (T2) and 122 microg/L in the third trimester (T3). In parallel with the increase in UI, mean ultrasound measured thyroid volume increased by a maximum of 47% over nonpregnant values in the third trimester (T3). Although these findings were consistent with studies in Cardiff, UK (median UI 73 microg/L), which also showed a pregnancy-associated rise in UI excretion (maximum 176 microg/L) accompanied by a 30% increase in median thyroid volume, they differed from findings in Sri Lanka (median UI 146 microg/L), a country in which a successful program of salt iodination has recently been implemented, which showed no significant changes in UI excretion (T3 maximum 154 microg/L) but did show a modest (20%) maximum increase in median thyroid volume at T3. Prospective studies on Irish subjects showed that median UI fell precipitously to nonpregnant control values (76 microg/L) at delivery. In addition, UI in neonates sampled at 3-days postdelivery showed that excretion was greater in breast-fed than in bottle fed infants. Differences in reported UI excretion patterns during pregnancy may may reflect the existence of a threshold above which increased renal clearance results in increased iodine loss but that is masked at higher iodine intakes. Assuming constant dietary iodine intake during pregnancy, any increased urine loss will inevitably lead to negative iodine balance and thyroid depletion. In these circumstances, increased thyroid volume may in part be a compensatory mechanism to allow for greater iodine storage.

A simple and rapid non-radioactive oligonucleotide based hybridization assay for the detection of Wuchereria bancrofti

Five biotin labeled oligonucleotides was designed based on a previously cloned and characterized repetitive DNA sequence specific for Wuchereria bancrofti. The oligonucleotide mix (containing five probes) when used in a hybridization assay, detected as little as 100 pg of purified W. bancrofti, microfilarial DNA, a single infective stage larva and a single microfilaria in 50 microl blood sample. A simple protocol was followed for the hybridization assay. Blood samples lysed with sterile distilled water and digested with proteinase K in the presence of a detergent were directly applied on to nylon membranes for dot blot assays. The DNA extract of mosquitos carrying infective stage larvae was eluted through sephadex G-50 minicolumns prior to blotting. The assay was also able to detect DNA extracted from microfilariae infected samples stored over five days at room temperature (28 degrees C). This simple and rapid oligonucleotide hybridization protocol with the highly sensitive chemiluminescent-based detection has significant potential for the development of a field kit to detect W. bancrofti infection.

The glass spherical hollow orbital implant: a prospective study

OBJECTIVE

Various types of orbital implants are in use in the rehabilitation of anophthalmic patients. The latest is the expensive hydroxyapatite implant. The study objective was to evaluate the effectiveness of low cost glass spherical hollow implants, as primary and secondary implants.

SETTING

St Michaels and Frazer Private Hospitals, Colombo.

STUDY DESIGN AND METHOD

65 patients had glass sphere orbital implants between 1987 and 1995; 51 primary (evisceration 46, enucleation 5) and 14 secondary (evisceration 2, enucleation 12). At 9 to 12 months follow up, patients were evaluated for mobility of implant, prosthesis mobility, lid sulcus deformity, cosmetic results and complications.

RESULTS

Primary glass spherical hollow implants provide excellent mobility of the implant (92%), cosmesis (88%), prosthesis mobility (67%), with a low rate of complications (9.5%). Results of primary implant was superior to that of secondary (p < 0.001).

CONCLUSION

Excellent results were obtained with spherical glass spheres as primary implants following evisceration.

Multiple host feeding in field populations of Anopheles culicifacies and An. subpictus in Sri Lanka

A histological technique was used to detect the multiple blood-feeding of female mosquitoes, within the same gonotrophic cycle, in field populations of the malaria vectors Anopheles culicifacies and An. subpictus (Diptera: Culicidae) at a village in the low country of Sri Lanka, during 1994-96. Among 3306 An. culicifacies and 871 An. subpictus engorged females examined, respectively, 34.4% and 30.4% were multiple-fed. In these two species, double meals accounted for 92.7% and 89.5%, and triple meals for 7.3% and 10.5% of multiple meals, respectively. More females of An. culicifacies (53.7%) than An. subpictus (44.5%) multiple-fed on different nights. Multiple feeding rates in the two species were independent of sample size and field abundance. In An. culicifacies, but not An. subpictus, these rates were proportional to ambient temperature but not to humidity. Bloodmeal ELISA showed that 8.3% of 242 An. culicifacies were human-fed and 80% of these (i.e. 6.6%) were concurrently bovid-fed. Combining the histological and ELISA data, it was estimated that multiple feeding involving a human host had occurred in 7.2% of the blood-feeding An. culicifacies population at this study site. Only 1.2% of 406 An. subpictus were human-fed and all of these were concurrently bovid-fed. Multiple bloodfeeding within the same gonotrophic cycle was attributed to a local 'frequent feeding strategy' in these primarily zoophagic and endophilic malaria vectors. Unfortunately this strategy enhances their human-biting rate and hence their vectorial capacity.

Multicentric origin of hemochromatosis gene (HFE) mutations

Genetic hemochromatosis (GH) is believed to be a disease restricted to those of European ancestry. In northwestern Europe, >80% of GH patients are homozygous for one mutation, the substitution of tyrosine for cysteine at position 282 (C282Y) in the unprocessed protein. In a proportion of GH patients, two mutations are present, C282Y and H63D. The clinical significance of this second mutation is such that it appears to predispose 1%-2% of compound heterozygotes to expression of the disease. The distribution of the two mutations differ, C282Y being limited to those of northwestern European ancestry and H63D being found at allele frequencies>5%, in Europe, in countries bordering the Mediterranean, in the Middle East, and in the Indian subcontinent. The C282Y mutation occurs on a haplotype that extends </=6 Mb, suggesting that this mutation has arisen during the past 2,000 years. The H63D mutation is older and does not occur on such a large extended haplotype, the haplotype in this case extending </=700 kb. Here we report the finding of the H63D and C282Y mutations on new haplotypes. In Sri Lanka we have found H63D on three new haplotypes and have found C282Y on one new haplotype, demonstrating that these mutations have arisen independently on this island. These results suggest that the HFE gene has been the subject of selection pressure. These selection pressures could be due to infectious diseases, environmental conditions, or other genetic disorders such as anemia.

A sensitive polymerase chain reaction based assay for the detection of Setaria digitata: the causative organism of cerebrospinal nematodiasis in goats, sheep and horses

A sensitive PCR assay for the detection of Setaria digitata has been developed. Two oligonucleotide primers (17 nt) were designed from a previously cloned and characterized tandemly arranged repetitive sequence of Setaria digitata. Using these primers, it was possible to amplify small quantities (100 fg) of S. digitata genomic DNA. A simple procedure, using proteinase K and non-ionic detergent NP 40, was followed to process the host blood samples and mosquitoes harbouring L3 larvae. The sensitivity of the polymerase chain reaction based assay surpasses the microscopic detection and the previously reported oligonucleotide based chemiluminescent detection of microfilariae in infected host blood samples and L3 larvae in mosquitoes.