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2014| October | Volume 140 | Issue 4
Online since
December 5, 2014
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CLINICAL IMAGES
Brown-Séquard syndrome
Upasana Ranga, Senthil Kumar Aiyappan
October 2014, 140(4):572-573
PMID
:25488458
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REVIEW ARTICLE
Vitamin D & endothelial function
A Alyami, MJ Soares, JL Sherriff, JC Mamo
October 2014, 140(4):483-490
PMID
:25488441
There is increasing interest in the extra-skeletal roles of vitamin D for health and well-being. Poor vitamin D status has been associated with obesity, cardiovascular disease, type 2 diabetes and mental health. Endothelial dysfunction may underscore insulin resistance and hence predispose to both cardiovascular disease (CVD) and type 2 diabetes. The objective of this review was to gain an appreciation of the recent causative evidence linking vitamin D and endothelial function. The PubMed database was searched from 2009 to date. Key words used were vitamin D, supplementation, systemic inflammation, endothelium, endothelial dysfunction and humans. Selected articles were restricted to the English language and to randomized control trials (RCTs) of vitamin D supplementation with direct measures of endothelial function. Final inclusion was based on a quality rating ≥ 3, based on the Jadad score. Ten RCTs met these criteria and were summarized for their outcomes. Only two studies showed an improvement in flow mediated dilatation with vitamin D. Three other studies reported decreases in C-reactive protein, platelet activation inhibitor-1, tissue plasminogen activator or B type natriuretic peptide. Recent evidence from good quality RCTs did not support a beneficial effect of vitamin D on vascular reactivity. Future intervention studies may need to target a higher vitamin D status and longer duration to determine whether the vitamin has a regulatory role in endothelial function.
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CLINICAL IMAGES
Cri-du-chat syndrome
R Nandhagopal, AM Udayakumar
October 2014, 140(4):570-571
PMID
:25488457
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ORIGINAL ARTICLES
Detection of multi-drug resistance & characterization of mutations in
Mycobacterium tuberculosis
isolates from North- Eastern States of India using GenoType MTBDR
plus
assay
Ritu Singhal, Vithal Prasad Myneedu, Jyoti Arora, Niti Singh, Girish Chander Sah, Rohit Sarin
October 2014, 140(4):501-506
PMID
:25488443
Background & objectives:
Information on drug resistance tuberculosis is sparse from North-East (N-E) States of India. We undertook this study to detect multi-drug resistant tuberculosis (MDR-TB) among MDR-TB suspects, and common mutations among MDR-TB cases using GenoType MTBDR
plus.
Methods:
All MDR suspect patients deposited sputum samples to peripheral designated microscopy centres (DMC) in North-East States. The district TB officers (DTOs) facilitated the transport of samples collected during January 2012 to August 2012 to our laboratory. The line probe assay to detect common mutations in the
rpo
B gene for rifampicin (RIF) and
kat
G and
inh
A genes for isoniazid (INH), respectively was performed on 339 samples or cultures.
Results:
A total of 553 sputum samples from MDR suspects were received of which, 181 (32.7%) isolates were found to be multi-drug resistant. Missing WT8 along with mutation in codon S531L was commonest pattern for rifampicin resistant isolates (65.1%) and missing WT along with mutations in codon S315T1 of
katG
gene was commonest pattern for isoniazid resistant isolates (86.2%). Average turn-around time for dispatch of LPA result to these States from cultures and samples was 23.4 and 5.2 days, respectively.
Interpretations & conclusions:
The MDR-TB among MDR-TB suspects in North-Eastern States of India was found to be 32.7 per cent. The common mutations obtained for RIF and INH in the region were mostly similar to those reported earlier.
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CORRESPONDENCES
Adverse drug reactions reporting culture in Pharmacovigilance Programme of India
Vivekanandan Kalaiselvan, Thota Prasad, Akanksha Bisht, Surinder Singh, Gyanendra Nath Singh
October 2014, 140(4):563-564
PMID
:25488454
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ORIGINAL ARTICLES
Vitamin D levels in Indian children with intrathoracic tuberculosis
Deepchand Khandelwal, Nandita Gupta, Aparna Mukherjee, Rakesh Lodha, Varinder Singh, Harleen M.S. Grewal, Shinjini Bhatnagar, Sarman Singh, SK Kabra, Delhi Pediatric TB Study Group
October 2014, 140(4):531-537
PMID
:25488448
Background & objectives:
Deficiency of vitamin D, an immunomodulator agent, is associated with increased susceptibility to tuberculosis in adults, but only limited studies are available in the paediatric age group, especially regarding association of vitamin D with type and outcome of tuberculosis. We conducted this study to determine the baseline 25-hydroxy vitamin D levels in children suffering from intrathoracic tuberculosis and its association with type and outcome of tuberculosis.
Methods:
Children with intrathoracic tuberculosis, diagnosed on the basis of clinico-radiological criteria, were enrolled as part of a randomized controlled trial on micronutrient supplementation in paediatric tuberculosis patients. Levels of 25-hydroxy vitamin D were measured in serum samples collected prior to starting antitubercular therapy by chemiluminescent immunoassay technology.
Results:
Two hundred sixty six children (mean age of 106.9 ± 43.7 months; 57.1% girls) were enrolled. Chest X-ray was suggestive of primary pulmonary complex, progressive disease and pleural effusion in 81 (30.5%), 149 (56%) and 36 (13.5%) subjects, respectively. Median serum 25-hydroxy vitamin D level was 8 ng/ml (IQR 5, 12). One hundred and eighty six (69.9%) children were vitamin D deficient (serum 25-hydroxy vitamin D <12 ng/ml), 55 (20.7%) were insufficient (12 to <20 ng/ml) and 25 (9.4%) were vitamin D sufficient (≥ 20 ng/ml). Levels of 25-hydroxy vitamin D were similar in all three types of intrathoracic tuberculosis, and in microbiologically confirmed and probable cases. Levels of 25-hydroxy vitamin D did not significantly affect outcome of the disease. Children who were deficient or insufficient were less likely to convert (become smear/culture negative) at two months as compared to those who were 25-hydroxy vitamin D sufficient (
p
<0.05).
Interpretation & conclusions:
Majority of Indian children with newly diagnosed intrathoracic tuberculosis were deficient in vitamin D. Type of disease or outcome was not affected by 25-hydroxy vitamin D levels in these children. However, children who did not demonstrate sputum conversion after intensive phase of antitubercular therapy had lower baseline 25-hydroxy vitamin D levels as compared to those who did.
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Determinants of survival in adult HIV patients on antiretroviral therapy in Eastern Uttar Pradesh: A prospective study
Jaya Chakravarty, Narendra K Tiwary, Shashi Ranjan Prasad, Saurabh Shukla, Anurag Tiwari, Rabindra Nath Mishra, Shyam Sundar
October 2014, 140(4):491-500
PMID
:25488442
Background & objectives:
The National AIDS Control Organization (NACO) of India has been providing free ARV (antiretroviral) drugs since 2004. b0 y 2012, 486,173 patients had received treatment through the antiretroviral therapy (ART) centres. The objective of this observational study was to assess the factors determining survival of patients on ART under routine programme conditions in an ART centre in north India five years after its inception.
Methods:
Treatment naive HIV positive patients who were enrolled in the ART centre between May 2009 and May 2010 and started on ART as per the Revised NACO guidelines 2009, were included in the study and outcome was assessed after two years of follow up.
Results:
A total of 1689 patients were included in the analysis, of whom 272 (16.10%) expired, 205 (12.13%) were lost to follow up (LFU), 526 (31.14%) were transferred out to other facilities and 686 (40.63%) were alive at the end of two years. Majority (92%) of the deaths occurred in the first six months of therapy. Age >30 yr, male gender, poor functional status, haemoglobin level <11 g/dl, body weight <45 kg and CD4 count <100/μl at baseline had significantly higher relative hazard of death. Most LFU also occurred in the first six months and these patients had significantly low CD4 count, weight, haemoglobin level and higher number of patients in Stages III and IV as compared to those who survived.
Interpretation & conclusions:
The study findings revealed poor survival in the first six months of therapy especially in those with severe immunosuppression. This emphasizes the need for early enrolment into the programme. The high LFU occurring early after initiation of therapy suggests the urgent need to build an efficient patient retrieval system in the programme.
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Detection of New Delhi metallo beta lactamase-1 (NDM-1) carbapenemase in
Pseudomonas aeruginosa
in a single centre in southern India
Mariappan Shanthi, Uma Sekar, Arunagiri Kamalanathan, Balaraman Sekar
October 2014, 140(4):546-550
PMID
:25488450
Background & objectives:
New Delhi metallo β-lactamase-1 (NDM-1) producing
Pseudomonas aeruginosa
isolates are potential threat to human health. This study was conducted to detect the presence of
bla
NDM-1
in carbapenem resistant
P. aeruginosa
in a tertiary care center in southern India.
Methods:
Sixty one carbapenem resistant clinical isolates of a total of 212
P. aeruginosa
isolates cultured during the study period were screened for the presence of NDM-1by PCR. Clinical characteristics of the NDM-1 positive isolates were studied and outcome of the patients was followed up.
Results:
Of the 61 isolates, NDM-1 was detected in four isolates only. These were isolated from patients in the intensive care units and chest medicine ward. The source specimens were pus, sputum, bronchoalveolar lavage and endotracheal aspirate. The NDM-1 producers were susceptible only to polymyxin B. Only one patient responded to polymyxin B therapy, while the others succumbed to the infection. Conclusion: These findings reveal that NDM-1 is not a major mechanism mediating carbapenem resistance in
P. aeruginosa
in this centre. However, continuous surveillance and screening are necessary to prevent their dissemination.
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Double positive CD4+CD8+ T cells: key suppressive role in the production of autoantibodies in systemic lupus erythematosus
Yongkang Wu, Bei Cai, Weihua Feng, Bin Yang, Zhuochun Huang, Chuan Zuo, Lanlan Wang
October 2014, 140(4):513-519
PMID
:25488445
Background & objectives:
The presence of CD4+CD8+ (double positive) T cells (DPT) in the target organs of several autoimmune diseases has been reported. The aim of this study was to investigate the pathogenic role of DPT in systemic lupus erythematosus (SLE).
Methods:
A total of 175 SLE cases and 125 matched healthy controls were investigated for CD3+, CD4+, CD8+ lymphocytes and DPT by flow cytometry. Serum samples from SLE patients and controls were tested for antinuclear antibody (ANA), anti-double strain deoxyribonucleic acid (anti-dsDNA), anti-U1 ribonucleoprotein (anti-U1 RNP), anti-sjogren syndrome A (anti-SSA), anti-ribosomal P protein (anti-rib-P), anti-Smith (anti-Sm), anti-Sjogren syndrome B (anti-SSB), complement 3 (C3) and complement 4 (C4).
Results:
The DPT median and 5-95 per cent range of SLE cases and healthy controls were 0.50 [0.10-2.60] and 0.80 [0.20-2.74] respectively (
P
<0.001). SLE patients were divided into a ≥1:1000 subgroup and a <1:1000 subgroup according to the ANA titre. The DPT of the former subgroup was significantly lower than that of the latter (
P
=0.032). The DPT medians of positive subgroups with anti-dsDNA (
P
<0.001), anti-U1RNP (
P
=0.018), anti-SSA (
P
=0.021) or anti-rib-P (
P
=0.039) were also significantly lower than the negative subgroups. Likewise, DPT was significantly lower in SLE subgroups with low concentration of C3 or C4 than those with high concentration (
P
<0.006).
Interpretation & conclusions:
Our findings show that the DPT cells may play a key suppressive role in the production of autoantibodies in SLE. Direct evidence that DPT regulates the pathogenesis of SLE needs to be investigated in future work.
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EDITORIALS
The challenge of childhood cataract blindness
Jagat Ram, Aniruddha Agarwal
October 2014, 140(4):472-474
PMID
:25488437
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Schizophrenia - Enhancing hope with better care & research
R Thara
October 2014, 140(4):469-471
PMID
:25488436
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786
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ORIGINAL ARTICLES
Role of leptin on the expression of low density lipoprotein receptor
Naval Kishor Yadav, Albina Arjuman, Nimai C Chandra
October 2014, 140(4):524-530
PMID
:25488447
Background & objectives:
Leptin resistance oriented hyperleptinaemia is a common problem in obese subjects in association with hypercholesterolaemia. The most common target for hypercholesterolaemia is impaired low density lipoprotein receptor (LDLR). This study was carried out to investigate whether any alteration in LDLR expression could explain the occurrence of hypercholesterolaemia in the event of hyperleptinaemia.
Methods:
Expression of LDLR and SREBP2 (sterol regulatory element binding protein 2) were examined in HepG2 cells by RT-PCR and Western blotting. JAK2 inhibitor II was used to verify the effect of JAK-STAT (Janus Kinase-Signal Transducer and Activator of Transcription) pathway (common mediator for cytokine signaling). Co-localization of LDLR and insulin receptor (IR) was examined by confocal microscopy.
Results:
Leptin was found to reduce the expression of LDLR and its transcription factor SREBP2. On the other hand, a weak signal for stimulation of LDLR by leptin was noted to be mediated by JAK2 pathway. But the joint effect of the two signaling pathways kept LDLR only in depressed mode in presence of leptin. Confocal microscopy showed that LDLR made an intensively co-localized complex with insulin receptor in presence of leptin.
Interpretation & conclusions:
Our results show that though leptin stimulates LDLR expression very weakly through JAK-STAT signaling pathway, it mainly imposes inhibition on LDLR expression by inhibiting transcription factor SREBP2. The inter-association between LDLR and IR may be a reason to render LDLR functionally inactive in presence of leptin.
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COMMENTARIES
Early detection of multi-drug resistant tuberculosis in India using GenoType MTBDR
plus
assay & profile of resistance mutations in
Mycobacterium tuberculosis
Sarman Singh
October 2014, 140(4):477-479
PMID
:25488439
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705
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STUDENT IJMR
Fungal profile of funguria cases at a tertiary care hospital in southern India
Surumy P Sulaiman, Rakesh Singh, Jharna Mandal
October 2014, 140(4):556-559
PMID
:25488452
Background & objectives:
Candida albicans
is the most common aetiological agent in funguria cases commonly observed in hospitalized patients. But a few reports are available from India where non-albicans
Candida
species have accounted for >50 per cent of urinary
Candida
isolates. We undertook this study to know the fungal profile amongst funguria cases.
Methods:
A total of 123 consecutive fungal isolates obtained from clinically suspected cases of urinary tract infection from April to September, 2013, were included. Yeast species was identified by standard phenotypic methods. Antifungal susceptibility testing of yeast was performed for fluconazole (25 μg) by disc diffusion method as per Clinical and Laboratory Standards Institute (CLSI) guidelines.
Results:
The male to female ratio was 0.92. The mean age of patients was 42.7 ± 18.9 yr.
C. tropicalis
(58.5%) was the most common fungal agent followed by
C. albicans
(30.1%). Only one isolate of
C. tropicalis
was resistant to fluconazole.
Interpretation & conclusions:
C. tropicalis
and
C. albicans
were the predominant fungal pathogens responsible for urinary tract infection. Less resistance to fluconazole observed in the study may be due to restricted use of fluconazole in this area.
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COMMENTARIES
Reference range of serum prostate-specific antigen levels in Indian men
Rama Devi Mittal
October 2014, 140(4):480-481
PMID
:25488440
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ORIGINAL ARTICLES
A hospital based study on reference range of serum prostate specific antigen levels
Aditi Gupta, Deepa Gupta, Arun Raizada, Narmada Prasad Gupta, Rajiv Yadav, Kamini Vinayak, Vijay Tewari
October 2014, 140(4):507-512
PMID
:25488444
Background & objectives:
Serum prostate specific antigen (PSA) levels are known to vary with race and ethnicity, environmental factors, lifestyle, metabolic and physiologic changes and advancing age. This study was designed to determine age specific serum PSA level in healthy Indian men and its comparison with that reported in different populations of the world.
Methods:
A total of 1300 adult men who attended Executive Health Check-up programme in a tertiary care hospital in Haryana, India, were included in the study. Forty seven men were excluded from the analysis because of urological conditions affecting PSA values. Overall, 1253 men were analyzed for age specific PSA values.
Results:
The age specific reference range of serum PSA values was 0.71 ng/ml in those younger than 40 yr; 0.85 ng/ml in 40-49 yr; 1.13ng/ml in 50-59 yr group; 1.45 ng/ml in 60-69 yr group; 1.84 ng/ml in 70-79 yr group and 2.35 ng/ml in men older than 80 yr.
Interpretation & conclusions:
Our study provided the age-specific reference range of serum PSA in healthy men in India. The data suggested that the PSA levels were associated with increasing age.
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559
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COMMENTARIES
HIV/AIDS in India - Indigenous evidence through operational research
Gautam Ahluwalia
October 2014, 140(4):475-476
PMID
:25488438
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537
243
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CORRESPONDENCES
Efficacy of anti-pseudomonal antibiotics: Need to reconsider the empirical use of cefepime
A Kotwal, D Biswas, B Kakati, B Thakuria, N Bhardwaj
October 2014, 140(4):560-562
PMID
:25488453
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553
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A report on the presence of GES-5 extended spectrum beta-lactamase producing
Pseudomonas aeruginosa
associated with urinary tract infection from north-east India
Anand Prakash Maurya, Debarati Choudhury, Anupam Das Talukdar, Anupam Dhar (Chanda), Atanu Chakravarty, Amitabha Bhattacharjee
October 2014, 140(4):565-567
PMID
:25488455
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481
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ORIGINAL ARTICLES
Effect of extreme conditions of Antarctica on human leukocyte antigen-G in Indian expeditioners
KP Mishra, AP Yadav, YK Sharma, Lilly Ganju, SB Singh
October 2014, 140(4):520-523
PMID
:25488446
Background & objectives:
Immune activation and inflammation play critical roles in the stressful environmental conditions like high altitude, extreme cold,
etc
. Human leukocyte antigen-G (HLA-G) is a non classical major histocompatiblity complex class I (MHC class- I) protein, upregulated in the context of transplantation, malignancy and inflammation. We hypothesized serum HLA-G as a possible stress biomarker and studied levels of soluble form of HLA-G (sHLA-G) in Indian Antarctic expeditioners.
Methods:
sHLA-G ELISA was performed in the serum of summer (n=27) and winter (n=22) Indian Antarctic expeditioners. The summer expeditioners were evaluated at three different time points,
i.e
. before leaving India, after one month ship borne journey, and after staying one month at Indian research base, Maitri in Antarctica, while winter expeditioners were evaluated at five different time points,
i.e.
before leaving India, and in the month of March, May, August and November at Antarctica.
Results:
o0 ne month ship borne journey did not cause any significant change in the sHLA-G level as compared to the baseline level of the summer expeditioners. sHLA-G levels were not changed significantly in the months of March, May, August and November as compared to the baseline level of the winter expeditioners.
Interpretation & conclusions:
Our results indicated that the extreme conditions of Antarctica did not cause any significant change in the sHLA-G level in both summer and winter expeditioners.
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459
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Functional response analysis of
Anisops sardea
(Hemiptera: Notonectidae) against
Culex quinquefasciatus
in laboratory condition
Rajendra Prasad Mondal, Anupam Ghosh, Subhasis Bandyopadhyay, Goutam Chandra
October 2014, 140(4):551-555
PMID
:25488451
Background & objectives:
Culex quinquefasciatus
is the principal vector of lymphatic filariasis (LF). Application of alternative vector control methodologies are aimed at reduction of mosquito breeding sites and biting activity through the use of biological control methods. In the present study, functional response of aquatic Hemipteran backswimmer,
Anisops sardea
was assessed against
Cx. quinquefasciatus
larvae in laboratory bioassay.
Methods:
The functional respons of
A. sardea
was assessed against III
rd
instar larvae of
Cx. quinquefasciatus
. Respective handling times and coefficient of attack rates were determined by a non linear polynomeal regression equation.
Results:
The results of rates of predation in variable prey densities exhibited a 'linear rise to plateau curve', associated with 'Type -II' functional response. The logistic regression estimated a significant negative linear parameter (P
1
<0) which also supported the same observation. Associated 'attack rates' and 'handling times' were also calculated using the Holling Disc Equation. Interpretation & conclusions: The results of present experiments indicate that
A. sardea
can be used as a biocontrol agent against the larval forms of
Cx. quinquefasciatus
in temporarily available breeding places of mosquito with relatively clear water. However, a detailed field study has to be done to confirm these findings.
[ABSTRACT]
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BOOK REVIEWS
Chronotherapeutics for affective disorders: A clinician's manual for light and wake therapy
Subho Chakrabarti
October 2014, 140(4):574-577
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414
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Drug - drug interactions for therapeutic biologics
C Adithan
October 2014, 140(4):575-577
[FULL TEXT]
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401
206
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ORIGINAL ARTICLES
Effect of house spraying with lambdacyhalothrin 10 per cent capsule suspension (CS) formulation in comparison with 10 per cent wettable powder (WP) against malaria vector in Malkangiri district, Odisha, India
K Gunasekaran, SS Sahu, T Vijayakumar, S Subramanian, P Jambulingam
October 2014, 140(4):538-545
PMID
:25488449
Background & objectives:
Selection of an insecticide and its appropriate formulation is a prerequisite of formulating any chemical control strategy against vectors. A hut scale field trial was carried out to study the effectiveness of house spraying with capsule suspension (CS) formulation of lambdacyhalothrin in comparison with its wettable powder (WP) formulation on mortality, density and behaviour of malaria vector in Malkangiri district, Odisha, India.
Methods:
The two formulations were tested at 20 and 30 mg (a.i.)/m
2
for their effectiveness in terms of deterrence, excito-repellency, blood-feeding success, mortality and residual activity against
Anopheles fluviatilis
, the major malaria vector, in experimental huts in Malkangiri district, Odisha State, India.
Results:
Both CS and WP formulations prevented the entry of
An. fluviatilis
in to the sprayed huts by >90 per cent for >6 months, the entire peak malaria transmission season in the area. The exit rate increased (90-99%) with different treatments and the feeding rate was reduced (91-97%). There was no significant difference between WP 30, CS 20 and CS 30 mg/m
2
in these respects. However, WP 20 mg/m
2
caused a lesser effect than the other three groups. The formulations or the dosages differed only in causing vector mortalities. Overall, the total mortality rate of
An. fluviatilis
was higher in the huts sprayed with CS 30 (58%) than the huts sprayed with CS 20 (48%), WP 20 (37%) and WP 30 mg/m
2
(47%).
Interpretation & conclusions:
Considering the duration of residual action and the effect on entry, exit, feeding and mortality of
An. fluviatilis
, the dosage 20 mg/m
2
of CS formulation of lambdacyhalothrin could be considered for further use.
[ABSTRACT]
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CORRESPONDENCES
Cost calculations in health care
Kanica Kaushal
October 2014, 140(4):568-569
PMID
:25488456
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284
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Authors' response
NJ Gogtay, A Nagpal, A Mallad, K Patel, SJ Stimpson, A Belur, UM Thatte
October 2014, 140(4):568-569
PMID
:25630060
[FULL TEXT]
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292
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Online since 25 February, 2011