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   2022| March  | Volume 15 | Issue 3  
    Online since March 30, 2022

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Sex differences in SARS-CoV-2 infections, anti-viral immunity and vaccine responses
Abhishek Mohanty, Aanchal Sawhney, Shefali Gupta, Vishal Rao, Periyasamy Govindaraj, Sambit Mohanty, Vandana Jain
March 2022, 15(3):97-105
The COVID-19 pandemic has revealed sex-based differences in anti-viral responses, with a higher rate of SARS-CoV-2 infections as well as a higher rate of morbidity and mortality in men than in women. Males and females also show disparate immune responses to COVID-19 infection, which may be important contributors to lower rates of infection, disease severity and deaths in women than in men. Here, the authors review sex differences in SARS-CoV-2 infections, anti-viral immunity and vaccine responses, putting forth the importance of sex, the underappreciated variables in vaccine response and disease infectivity.
  1,354 258 -
Prevalence and risks of soil transmitted helminths among Ethiopian school children: A cross-sectional study
Abebe Fenta, Bewket Mesganaw, Feven Belachew, Getachew Teshale, Gashaw Abebaw, Elias Tesfa, Getaye Alemayehu
March 2022, 15(3):121-127
Objective: To assess the prevalence and associated factors of soil transmitted helminths (STHs) among Endemata primary school in North West Ethiopia, 2021. Methods: A cross-sectional study with 195 school children was conducted from May to July 2021 at Endemata primary school. The study participants were selected by using systematic random sampling technique. Stool samples were processed via direct wet mount and formol-ether concentration techniques. Data was entered by Epi-Dara version 3.1 and data analysis was done using SPSS version 20.0. Variables were considered to be statistically significant if P<0.05 at 95% confidence level. Results: The overall prevalence of STHs was 10.8% (95% CI 7.1-16.0). The prevalence of Ascaris lumbricoides, hookworm and Trichuris trichiura were 5.6% (95% CI 3.1-9.9), 3.1% (95% CI 1.3-6.7) and 2.1% (95% CI 0.6-5.3), respectively. Grade 1-4 students were more likely to get infected with STHs as compared to grade 5-8 students (adjusted OR 4.7, 95% CI 1.3-16.6). Students who did not have latrines at their home were at higher risk to develop STHs infection comparing with those who had latrine at their home (adjusted OR 5.0, 95% CI 1.7-15.2). Similarly, the school children who did not wear shoes were more likely to be infected by STH parasite than those who did it (adjusted OR 6.3, 95% CI 1.9-20.7). The odds of being infected by STH parasites in children who did not trim their fingernails were 4.9 as compared to those who did it (adjusted OR 4.9, 95% CI 1.5-15.7). Conclusions: The prevalence of STHs among Endemata primary school children was low. Student grade level, latrine availability, shoes wear and nail status were significantly associated with STHs infection. Therefore, we recommend policy makers and stakeholders to follow the integration of deworming with water, hygiene and sanitation as well as the consistent health education of school children to control and prevent STH infections.
  1,180 225 -
Antimicrobial susceptibility and serotypes of Neisseria meningitidis and Streptococcus pneumoniae in Sri Lanka: Experience from the National Reference Laboratory
Lilani Karunanayake, Veeraraghavan Balaji, K. D.N. Gunawardana, Rosemol Varghese, Vayishnavi Ariram, Malka Dassanayake, Vaithehi Rajeevan Francis, Lakmini Yapa, Chamika Herath, Nambage Shirani Chandrasiri, Priyanka Wimalagunawardhana, K Dhananja Namalie, CT Hapuarachchi
March 2022, 15(3):114-120
Objective: To determine the antimicrobial susceptibility and serotypes of Neisseria (N.) meningitidis and Streptococcus (S.) pneumoniae in Sri Lankan patients. Methods: We retrospectively analyzed 11 blood culture specimens from suspected patients with invasive meningococcal disease and 26 S. pneumoniae clinical isolates. We tested 6 antimicrobials against N. meningitidis and 12 antimicrobials against S. pneumoniae. Meningococcal serogroup was determined by realtime PCR and Quellung serotyping was used for pneumococcal analysis. Results: N. meningitidis serogroup B was the most common in this study. Intermediate-susceptibility to penicillin was seen in 75.0% (6/8) of strains. Susceptibility to ciprofloxacin, levofloxacin and cotrimoxazole was 62.5% (5/8), 62.5% (5/8) and 87.5% (7/8), respectively. Excellent susceptibility was seen in cefotaxime and meropenem. In S. pneumoniae, the most common serotype was 19F in both invasive and non-invasive pneumococcal diseases. The majority of strains showed multidrug resistance. Penicillin non-susceptibility in non-meningeal strains were 13.6% and all meningeal strains were penicillin resistant. Erythromycin was highly resistant in both groups. Amoxicillin showed excellent susceptibility in non-invasive pneumococcal diseases strains. Linezolid, levofloxacin and vancomycin showed 100.0% susceptibility in all pneumococcal isolates. Conclusions: Implementation of vaccines should be considered, especially for children and high-risk populations. This may contribute to reducing pneumococcal and meningococcal invasive disease burden and help prevent emergence of antimicrobial resistant strains.
  1,038 243 -
Effectiveness of non-pyrimethamine-based regimens for toxoplasma encephalitis: A systematic and meta-synthesis study
David Susanto, Arthur H. P. Mawuntu, Finny Warouw, Windy M. V. Wariki
March 2022, 15(3):106-113
Objective: To examine the differences in effectiveness and side effects between pyrimethamine-based and non-pyrimethamine-based regimens for toxoplasma encephalitis since the availability of pyrimethamine in Indonesia is currently limited due to its withdrawal from the market. Methods: A systematic review and meta-synthesis study that was carried out by following a protocol guided by the Preffered Reporting Items for Systematic Review and Meta-analysis (PRISMA). Effectiveness measures included clinical improvement, mortality, and radiological improvement. We evaluated selected articles narratively because of the limitations of homogeneity. The risk of bias in RCTs was assessed using the Cochrane Risk of Bias tool for RCT (ROB 2.0) and cohort studies were assessed using the Risk of Bias In Non-Randomized Studies of Interventions (ROBINS-1) tool. Research quality was assessed using the GradePro software. Results: We included two retrospective cohort studies and one RCT. Narrative outcome assessment in these three studies did not show significant difference in effectiveness between pyrimethamine-based and non-pyrimethamine-based regimens for toxoplasma encephalitis treatment. However, drug side effects were consistently higher in the pyrimethamine-based regimen. Conclusions: This study has a high risk of bias. The quality of the research also has a low recommendation value. However, the results may be considered for application if a standard regimen is not available.
  1,070 170 -
Comparison of Cox proportional hazards model, Cox proportional hazards with time-varying coefficients model, and lognormal accelerated failure time model: Application in time to event analysis of melioidosis patients
Kamaruddin Mardhiah, Nadiah Wan-Arfah, Nyi Nyi Naing, Muhammad Radzi Abu Hassan, Huan-Keat Chan
March 2022, 15(3):128-134
Objective: To compare the prognostic factors of mortality among melioidosis patients between lognormal accelerated failure time (AFT), Cox proportional hazards (PH), and Cox PH with time-varying coefficient (TVC) models. Methods: A retrospective study was conducted from 2014 to 2019 among 453 patients who were admitted to Hospital Sultanah Bahiyah, Kedah and Hospital Tuanku Fauziah, Perlis in Northern Malaysia due to confirmed-cultured melioidosis. The prognostic factors of mortality from melioidosis were obtained from AFT survival analysis, and Cox’s models and the findings were compared by using the goodness of fit methods. The analyses were done by using Stata SE version 14.0. Results: A total of 242 patients (53.4%) survived. In this study, the median survival time of melioidosis patients was 30.0 days (95% CI 0.0-60.9). Six significant prognostic factors were identified in the Cox PH model and Cox PH-TVC model. In AFT survival analysis, a total of seven significant prognostic factors were identified. The results were found to be only a slight difference between the identified prognostic factors among the models. AFT survival showed better results compared to Cox’s models, with the lowest Akaike information criteria and best fitted Cox-snell residuals. Conclusions: AFT survival analysis provides more reliable results and can be used as an alternative statistical analysis for determining the prognostic factors of mortality in melioidosis patients in certain situations.
  1,040 189 -
Larvicidal activity of the pericarp extract of Garcinia mangostana against dengue vector Aedes aegypti in Sri Lanka
Nayana Gunathilaka, Yashoda Wijebandara, Deepika Amerasinghe, Lahiru Udayanga, Thusitha P Muhandiramlage
March 2022, 15(3):135-142
Objective: To assess the larvicidal activity of mangosteen (Garcinia mangostana) against larval stages of Aedes aegypti mosquitoes. Methods: A crude extract was prepared in ethanol from powdered mangosteen pericarps. A concentration gradient (0.01-4.92 g/ L) was prepared from the stock solution. Seven batches of 25 third instar larvae of Aedes aegypti were used for larval bioassays. Larval mortality rates were observed after one and 24 hours. Cholesterol and total lipid contents in 20 randomly selected dead larvae at each trial were assessed by colorimetric method. The experimental setup was repeated five times. The General Linear Model and Probit analysis were used to evaluate the relationship of mortality with cholesterol level, total lipid level and cholesterol to total lipid ratio. Results: The percentage mortalities significantly varied with different concentrations (F732=385.737; P<0.001). The LC50 and LC99 values were (0.041 ± 0.006) g/L and (10.616 ± 1.758) g/L, respectively after 24-hours. There was no mortality recorded within the one-hour exposure time. Only the cholesterol content (F524=173.245; P<0.001) in larvae exposed to different concentrations denoted a significantly decreasing trend within 24hour exposure. Larvae that were exposed to the lowest concentration (0.55 g/L) showed a higher cholesterol level (22.67 ± 1.33) μg. Conclusions: The Garcinia mangostana extract acts as an effective sterol carrier protein inhibitor that inhibits cholesterol uptake in Aedes aegypti mosquitoes. Hence, it could be explored for use as a key source for the development of an environment-friendly plant-based larvicide.
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