Vol 4, Issue 1, Jan-Mar, 2014

The present study quantitatively analyze Indian dengue research output during the 10 years from 2003 to 2012, using Scopus international multidisciplinary database. The study focused on global publication output, share, rank, and citation impact of top 15 most productive nations, India’s publications output, growth, global publication share and research impact, international collaborative papers share in national output and the share of major international collaborative partner countries in total India’s international collaborative papers, contribution of various sub-fields and distribution by population age groups, productivity and citation impact of its leading Indian institutions and authors and Indian contribution in most productive journals. Indian contribution in dengue fever research consisted of 910 papers, which increased from 27 papers in 2003 to 193 papers in 2012, witnessing an annual average growth rate of 28.19%.Among the top 15 most productive countries, India holds second position in dengue fever research output, with global publication share of 10.22% during 2003-12. The average citation per paper scored by India was 3.27, the least among the top 15 most productive countries during 2003-12. India’s share of international collaborative papers was 10.55% during 2003-12, which increased from 9.12% during 2003-07 to 11.13% during 2008-12. The present India’s research efforts in dengue research are low in view of the 50,222 cases of dengue in 2012 alone. The country needs to increase its research output and also increase its research impact substantially particularly through enhanced national and international collaboration, besides evolving a national policy for identification, monitoring and control of dengue cases and also evolving a research strategy with sufficient funding commitment to solve this growing national problem. Key words: Dengue, India, scientometric

Objectives: Analyses were done on the Indian publication outputs on liver disorder research during 2003-2012, on several parameters, including contribution and citation impact of the most productive countries, India’s overall contribution, its growth pattern, citation impact, the share of international collaboration, identification of the significant participating countries in India’s international collaboration, contribution and impact of different types of liver disorders, productivity and impact of leading Indian institutions and authors, and pattern of communication of Indian output in most productive journals. Materials and Methods: The Scopus Citation Database has been used to retrieve the data for 10 years (2003-2012) by searching with the keyword ‘liver,’ in the combined Title, Abstract, and Keywords field. Results: The Indian publication’s output in the liver disorder research consisted of 2380 articles during 2003-2012, which increased from 143 articles in 2003 to 378 articles in 2012, witnessing an annual average growth rate of 11.92%. The average citation impact per article registered by the Indian publications for liver disorder research was 4.68 during 2003-2012, which decreased from 6.43 during 2003-2007 to 3.71 during 2008-2012. The international collaborative share of India in the overall liver disorder research was 15.34% during 2003-2012, which increased from 12.65% during 2003-2007 to 16.84% during 2008-2012. Conclusions: Keeping in view the severity of liver disorders in India, there is a need to increase the investment in Research and Development (R and D) to bring about improvements in supportive care and a need to set up a Hepatitis Registry. Efforts must be made to develop state- and government-supported prevention and control strategies, including conducting mass awareness programs, formulation of universal guidelines for immunization, promotion of partnerships, development of an evidence-based policy, and development of programs for prevention of transmission, along with better financial and social support initiatives. Key words: Bibliometrics, India, liver, publication output, scientometrics

Background: Privatization of medical education can widen its scope and availability via creation of large no of medical professionals in allopathic system for Indian people, but can it be an alternative to create human resources with appropriate skill mix, especially when services in health system involves lives of the human being needs rethinking on an urgent basis. Objectives: To review the issues related with privatization of medical education system of India. Materials and Methods: A systematic review on key search word: “Privatization of medical Education in India” was done from main indexed journals of key medical search engines i.e. Pubmed, Cochrane, Bio-med Central, and Google Scholar etc. in all forms including e-journals till 15th August 2013 since last 20 years. Conclusions: Indian allopathic medical education system is one of the largest in the world. Medical Colleges in India have rapidly progressed in last 25 years, especially in private set ups; there is no doubt that they can help Indian health care system, but the need of hour is, to critically look at the quality of students opting M.B.B.S course, quality of medical faculties in terms of their skill mix for clinical as well as para-clinical services, and quality of medical education imparted by these institutions, which can be achieved by strict implementation of strict Medical Council of India (MCI) norms, in order to ultimately improve the health care system of India in long run. Key words: Health system, medical council of India, medical education, privatization

Introduction: The state of Chhattisgarh today faces several challenges in improving the health status of its people. The on-going problems of maternal and child mortality, communicable diseases, and HIV/AIDS pandemic still need greater interventions/support from the already overburdened health systems. In addition, the public health challenges include the escalating burden of chronic noncommunicable diseases. Keeping all these things in mind a study was carried out to have an overview of the public health scenario of Chhattisgarh. Aim: This paper aims to review the different public health indicators of Chhattisgarh. Materials and Methods: This study comprised of reviewing different health indicators of Chhattisgarh adopting three different methods during the period March-April 2013. The methods were: (i) extensive online search, (ii) reviewing the related literatures from different journals and other authentic printed materials, and (iii) information collected from public health experts through e-mail, telephone, or direct interaction. Results: Out of 2.55 crore populations in the state (as per Census 2011), 78% lives in rural areas and 37% of the population is tribal. The sex ratio is 968 and the literacy rate is 65.5% in population above 7 years of age. There is a shortage of trained health care providers in Chhattisgarh. The crude birth rate is 23.5 per 1000 (population Annual Health Survey [AHS] 2011-2012). The infant mortality rate is 48 per 1000 live births (SRS 2012). Malnutrition, anemia, sickle cell hemoglobinopathy, Beta thalassemia trait, and G6 PD enzyme deficiency are very high among the tribes of Chhattisgarh. Malaria has been a major health problem. Chhattisgarh is one of the states with annual parasite index >5 (MRC report). The other states are Rajasthan, Gujarat, Karnataka, Goa, Southern Madhya Pradesh, Jharkhand, Odisha, and Northeastern states. Conclusion: From a public health point of view, most of the health indicators are below national average and unsatisfactory. The human resources gap, poor physical infrastructure, inadequate health education and awareness, poor health-seeking behavior, and inadequate healthcare utilization compound the problem. Indicators related to health and health care delivery are outcomes of research in diverse fields other than the department of health. Putting them together and projecting them in a public health view point encourage others to focus on the neglected indicators/areas. However, further research is needed to have a clear database in this regard. Key words: National family health survey (NFHS-3), national rural health mission (NRHM), public health challenges

Community medicine broadly comprises of family medicine and public health; and community physicians are those trained in both. The primary professional role of a community physician is to manage a health center. Provision of primary healthcare: Curative, preventive, and promotive are an integral part of community medicine practice. Despite being a clinical specialty, community physicians in India are not performing this role and Rural and Urban Health Training Centers have become ornamental exhibits. Most departments of community medicine have restricted themselves to teaching undergraduates and postgraduate training has taken a back seat. Instead of pondering upon why this cadre of social/community physicians was prepared, we are hastily opening up other public health courses. Clinical subspecialties of community medicine should be given equal importance at par with academics and research. Community physicians should fulfill their primary role which would enable them to advocate public health policy with authority. Key words: Community medicine, community physician, family medicine, professional role, primary healthcare, public health

Background: Quality of care is central to current efforts under National Rural Health Mission (NRHM) in India to sustain gains in utilization of institutional maternal and newborn care. For effective planning around institutionalizing quality improvement systems, it is important to critically evaluate India’s maternal health policy and services in historical perspective. Objectives: The narrative review was conducted (i) to trace the evolution of concern with quality in maternal health in the context of health system development in India from independence (1947) to the present; and (ii) identify quality-related issues and areas for further action to improve maternal and infant survival outcomes. Materials and Methods: Peer reviewed scientific publications were identified through systematic searches of scientific databases, grey literature and policy documents. Altogether 174 documents were reviewed. Prospectively designed forms extracted data on (i) health system and quality development; (ii) service performance; (iii) health and safe delivery outcomes. Results: In the first four decades after independence, concerns with infrastructure expansion and vertical disease eradication programmes neglected quality of maternal healthcare in India. With growing concern for quality, strategies addressing this were incorporated in NRHM launched in 2005, including public health standards and quality assurance system in reproductive and child health services. Conclusion: Focus on quality in maternal health in India has increased in recent years, especially under NRHM, and this has helped accelerate progress in maternal and neonatal outcomes. Further action areas include the need to increase funding, match rising demand with quality services and enhance functioning of quality assurance system. Key words: Evolution, health policy, healthcare system, India, maternal health, quality of care.

Introduction: The use of mobile-health (m-health) technology in public health is rapidly growing in developing countries. Objective: The objective of this study was to critically analyze the role and incorporation of m-health into public health systems of developing countries. Materials and Methods: A systematic review of related studies in the literature published in the last 10 years on key search word “m-health role in developing countries” was conducted using abstracting databases such as PubMed, World Health Organization, Cochrane, Google scholar and Bio-med Central. m-health studies on impact, effectiveness and evaluation of m-health in public health were the three main criteria’s taken for inclusion and studies on m-health in developed world as well data from thesis/dissertation were excluded in this review. This study is unique in methodology as similar kind of studies with this type of method and focus has not been carried out previously in the literature. Results and Discussion: From 23 articles, which finally met the inclusion criteria it was found that, a variety of m-health applications and m-health strategies are available in the mobile phone market of developing countries; however, lack of appropriate governmental regulation and oversight from health-care authorities are impacting the results in terms of costs, benefits and utility of these applications. Conclusions: m-health technology has the potential to impact greater health-care access to larger segments of rural populations and an improved capacity to meet the demand in developing countries as seen from Indian strategies, provided it is also intelligently used for improving health-care of people in developing countries. Key words: Developing countries, health system, health technology, health technology regulation, mobile health, technology regulation, telemedicine

Public provisioning of quality health care to make available affordable and reliable health services constitutes the focal point of national health programs and policies. Significant progress has been achieved over the decades during the various 5-year plan periods. The present paper discusses the changes achieved in the key areas of health over the XI 5-year plan period and further proposals for important areas under the XII 5-year plans. Key words: Five year plans, health, India

Background: Ventilator associated pneumonia (VAP), a hospital acquired infection (HAI) is seen among critically ill patients on mechanical ventilation (MV) due to various causes, in intensive care units (ICUs). VAP increases morbidity, mortality, as well as the cost of healthcare. Materials and Methods: A prospective study was done over a period of 10 months in a tertiary care hospital in India to determine the incidence, etiological agents, their sensitivity profiles, and risk factors associated with VAP. Combination disc method, ethylenediaminetetraacetic acid (EDTA) disc synergy (EDS) tests, and AmpC disc tests were performed for detection of extendedspectrum beta-lactamases (ESBL), metallo-beta-lactamases (MBL), and AmpC beta-lactamases, respectively. Results: One hundred and forty adult patients, on MV for 48 h and more, were included and 28 (20%) developed VAP. The incidence density rate of VAP was 21.875 per 1,000 ventilator days. Most of the patients had late onset VAP (60.7%) with average number of days for onset around 8 days. Pseudomonas spp. and Acinetobacter spp. were signifi cantly associated with late onset VAP, whereas Enterobacteriaceae, Staphylococcus aureus, Haemophilus infl uenzae, Streptococcus pneumoniae, Burkholderia cepacia, and Candida species were commonly isolated from early onset VAP. Polymicrobial infections occurred in 14 cases, so overall 43 VAP pathogens were isolated. Thirty (69.7%) of them were multidrug resistant (MDR), among which ESBL contributed 23.25%, MBL 30.23%, AmpC beta-lactamases 9.30%, and to methicillin resistant S. aureus (MRSA) contributed 6.97%. Prior antibiotic therapy (P < 0.0001), hospitalization for 5 days or more (P < 0.0001), MV for 5 days or more (P < 0.0001), supine head position (P < 0.0001), reintubation (P = 0.0012), and impaired consciousness (P = 0.0191) were significant risk factors for VAP. Conclusions: Proper knowledge of risk factors can help identify high risk groups for VAP, among the critically ill patients on MV. MDR pathogens, with production of ESBL, MBL, AmpC beta-lactamases, and MRSA were commonly associated with VAP. So, judicious use of antibiotic is recommended. Key words: AmpC beta-lactamase, ESBL, metallo-beta lactamase, MRSA, ventilator associated pneumonia

Background: Routine immunization (RI) is one of the most cost-effective public health interventions, first introduced in India in 1978. Yet, despite the concerted efforts of the government and other health agencies, a large proportion of vulnerable infants and children in India remain unimmunized. Objectives: Objective of this study was to know about perception of caretakers of beneficiaries about RI in terms of knowledge about vaccines and vaccine preventable diseases and reasons for missed opportunity of immunization. Materials and Methods: Community based cross-sectional study was conducted during January-June 2012 in a rural area of Jamnagar district. A total of 200 children aged 12-24 months were selected using stratified random sampling method. Results: Nearly 52% children were fully immunized. Most common reasons for partially immunization were sick child (68.9%) followed by vaccine not available (32.3%) and being outside on the day of session (31.11%). Nearly 61% Guardians knew about Polio vaccine, main source of information about RI was health worker (83.5%). There was statistical significant association between education of mother and immunization status of children. Conclusion: There is a need to strengthen Information Education Communication activities to improve knowledge regarding immunization among people, motivation of health workers to disseminate information regarding immunization. Hence, that immunization coverage should be improved. Key words: Immunization, knowledge, vaccine, vaccine preventable diseases

Aim: To assess the spectrum of presentation of young (18-35 years) females to a rural cancer hospital and to correlate it with the level of education. Materials and Methods: Ninety cases of the selected age group were prospectively studied for the manner of presentation and level of education. Results: Majority patients (57.77%) presented with breast related symptoms. 81.1% of the patients were educated at least up to secondary school education. Conclusions: Owing to the improved education levels and awareness, the young rural females are more informed about breast related symptoms and are seeking proper care for the same. A robust rural cancer registry system may document this changing scenario that may well contrast with the traditional beliefs and learning of cancer epidemiology. Key words: Breast cancer, education, India, rural

Context: Postponement of fi rst pregnancy is known to be associated with a variety of interdependent factors such as age, education, income, occupation, religion, caste, and cash incentives. This paper examines the relationship and effects of some of these factors on postponement of fi rst pregnancy among newly married couples in Satara district. Objective: To study the interdependency of age, years of schooling, income, and cash incentive on postponement of fi rst pregnancy among newly married couples. Materials and Methods: This study employed quasi-experimental study design. Duly trained multipurpose workers interviewed husbands and auxiliary nurse midwives (ANMs) interviewed the wives; preferably in separate rooms using pretested semi-open proforma. Statistical analysis was done using STATA® version 12 statistical software. Results: Out of 1,355 participants; 704 couples successfully postponed fi rst pregnancy by 2 years, but 651 couples could not do so. Participants were significantly successful in postponing pregnancy by 569.13 vs. 353.89 days for controls. Age and education of female participants were significantly associated with postponement of fi rst pregnancy; while age, education, and income of male participants were not associated with postponement. Conclusions: Higher age, more education, and higher income appear to be associated with acceptance of postponement of pregnancy and appear to be acting synergistically in both male and female participants as compared to nonparticipants. Key words: Multivariate analysis, postponement of fi rst pregnancy, second honeymoon package

Background: Many modern surgical procedures could not be carried out without the use of blood. There are no substitutes for human blood. Thus, proper utilization of blood is necessary with minimal wasting. Materials and Methods: A total of 10,582 donors donated blood during the study period of 19 months in blood bank of a tertiary care hospital, central India from 1st of November 2009 to 31st May 2011, which were screened. Results: A total of 346 whole blood bags were discarded. Out of these 346 blood bags, 257 (74.30%) were discarded because of seropositivity for transfusion transmissible infectious diseases. A total of 542 blood components were discarded against 3702 blood components prepared during the study period. Among blood components discarded, most common units were platelets. The most common cause of discarding the blood components was expiry of date due to nonutilization (87.00%). Conclusion: A properly conducted donor interview, notification of permanently deferred donors will help in discarding less number of bags from collected units. Similarly, properly implemented blood transfusion policies will also help in discarding less number of blood bags due to expiry. These discarded bags, because they are unutilized are both financially as well as socially harmful to the blood bank. Key words: Blood bags, discard, expired blood and blood components

Background: Urinary tract infections (UTIs) are common cause of infections described in out-patient’s setting and increase in antibiotic resistance of Escherichia coli, is encountered world-wide. Antibiotic treatment is usually empirical; therefore, this study to provide the knowledge of local resistance pathogen patterns in Kermanshah. Materials and Methods: We conducted a retrospective analysis of all E. coli isolates from urine samples admitted to Kermanshah Central lab between March 2011 and 2012 were included. Antimicrobial resistance was tested by the Kirby-Bauer disk diffusion. Results: This study showed a total of 20,742 samples, 1228 (5.92) were positive for pathogenic bacteria. E. coli were the predominant 801 isolate (65.2%). Out of the 13 antibiotics tested for E. coli isolates, minimum and maximum resistance were observed to ampicillin (9.4%) and augmentin (68.6%). Almost 59-66% of the uropathogenic E. coli strains were resistant to amikacin, co-trimoxazole, tetracycline and cephalotin and nearly half of them were resistant to nalidixic acid and cephalexin. Conclusion: This study confirms that E. coli is still the most common uropathogen isolated. Augmentin and amikacin are not as a first choice for treatment of UTI in Kermanshah area. Ampicillin and nitrofurantoin may be considered as a first choice empiric agent in out-patients. Key words: Antimicrobial resistance, Escherichia coli, urinary tract infections

Introduction: Hepatitis C is a major public health problem globally. There are limited studies on age and sex related prevalence of hepatitis C virus (HCV). As hepatitis C is a preventable disease, the burden of the disease could be reduced to a significant extent if its seroprevalence is better known in different age groups. Objective: The objective of this study is to determine age-wise seroprevalence of HCV in clinically suspected infectious hepatitis patients. Materials and Methods: This prospective study was conducted in the Department of Microbiology at Lady Hardinge Medical College, New Delhi over a period of one year from January 2008 to December 2008. All the serum samples taken from subjects (600 study and 200 control) were tested for immunoglobulin M (IgM) anti HCV using commercially available enzyme linked immunosorbent assay kit. Study group consisted of patients with clinically suspected acute infectious hepatitis while the control group had age and sex matched patients showing no clinical evidence of acute infectious hepatitis. Results: Overall 33 (5.5%) samples tested positive for IgM anti HCV in the study group while 3 (1.5%) samples tested positive in the control group. On analyzing age-wise seropositivity, it was found that maximum seropositivity of IgM anti HCV was in 11-20 years of age group in the study group (9%) followed by 21-30 years (6.1%), 0-10 years (5.1%) and >40 years (3.7%) of age. On the other hand in the control group, the maximum seropositivity of IgM anti HCV was seen in 0-10 years (2.8%) followed by 11-20 years (2.7%). Conclusions: HCV infection is predominantly a disease of young adults, which is due to cumulative risk of exposure with increasing age. However infection in children is explained by the mother to baby transmission. Most of the HCV infected patients are unaware of their clinical status and hence the disease may be under reported. Key words: Enzyme linked immunosorbent assay kit, hepatitis C virus, immunoglobulin M anti hepatitis C virus, seroprevalence

Background: Morbidities have emerged as major threats to livelihoods of the poor. An estimated 150 million have been reported as spending more than 40% of their income on their health needs. Aim: To identify the determinants of enrolment and experiences of Rashtriya Swasthya Bima Yojana (RSBY) beneficiaries in Udupi district, India. Materials and Methods: A cross-sectional study was carried out in Udupi district between March and August 2012. A mixed method approach using qualitative and quantitative methods was used. The study included all households who were eligible under the RSBY scheme recognized by the Planning Commission of India as below poverty line (BPL) households and participants recruited above 18 years of age. The sample included in the study was 316 households and took into account 95% confidence interval and 20% precision. Results: Education of the household head, marital status, household size and awareness of the cost of enrollment to RSBY were seen to be significantly associated with enrollment to RSBY (P < 0.05). Logistic regression analysis of four variables which showed statistical significance including household size, marital status, education, and prior awareness about the cost of enrollment into RSBY showed that prior knowledge of the cost of enrollment into the scheme and household size of less than five were major determinants to enrolling for RSBY. On qualitative analysis, the majority of the scheme users reported that the enrolment under RSBY had benefitted them and they are willing to renew the scheme again in the next round of enrollment. Conclusions: The awareness on scheme details among those included in the present study was found to be low. Information and education campaigns could improve involvement of both the insurers as well as the local institutions offering care and possibly increase utilization rate of RSBY. Key words: Health insurance, India, RSBY

Background: The patient with hemoglobinopathy like thalassemia major (TM), bone marrow dysfunction, and sickle cell disease are requiring chronic blood transfusion for their life time to survive. Among these, TM is one of the most common hemoglobinopathy worldwide. Objective: This study is done to assess the quality of life (QOL) of the patients with chronic blood transfusion and chelation therapy. Materials and Methods: The QOL scores were obtained through the selfadministered SF-36 questionnaire. The study subjects were asked to answer the SF-36 questionnaire once every 3 months. Results: After 6 months, the SF 36 general health mean score was 63.58 ± 12.98 (P < 0.05). The highest mean score was 69.37 ± 11.61. The mean difference after the final reviews was statistically significant. Conclusion: The preponderance of scores used to assess QOL suggests that there is a direct and independent effect on QOL when treated with transfusion and iron-chelation therapy. Key words: Blood transfusion, chelation therapy, quality of life

Aims: 1) To assess and compare the knowledge and attitudes regarding biomedical waste (BMW) management in specialists, resident doctors, new medical interns, and final year nursing students. 2) To assess the effectiveness of a training program in changing the knowledge and attitudes regarding BMW management. Study Design: Stage 1-descriptive, Stage 2-quasi-experimental. Participants: Specialists, resident doctors, new medical interns, and final year nursing students. Setting: Tertiary hospital with attached medical college in Navi Mumbai. Data Collection tool: Pretested, precoded self-administered questionnaire. Intervention: Educational training program on BMW management, Period of Study: December 2010–March 2011. Statistical Analysis: Using software Statistical Package for Social Sciences (SPSS) version 20, chi-square, analysis of variance (ANOVA), Tukey’s post hoc, and Z tests applied. Results: There was a statistically significant difference in the knowledge scores between the groups as determined by a one-way ANOVA test (F (3,226) = 11.098, P < 0.001). A Tukey’s post hoc test revealed that the specialists (20.82 ± 5.121) knowledge scores were significantly higher as compared to resident doctors (16.96 ± 5.268), medical interns (18.44 ± 4.293), and nursing group (15.33 ± 5.144). The positive attitude towards safe management of BMW was not found to be significant. After the training program in the medical interns’ a statistically significant increase in their knowledge on BMW management was seen. Conclusion: The knowledge and attitudes between the groups of healthcare personnel varied and was not found to be satisfactory. Training programs with periodical sensitization sessions on BMW management are recommended, especially focusing at the junior level. Key words: Attitudes, assessment, biomedical waste, biomedical waste management, educational intervention, knowledge, training

Background: The postnatal period is critical to the health and survival of a mother and her newborn. Lack of care in this period may result in death or disability as well as missed opportunities to promote healthy behaviors, affecting women and newborn children. Hence, the study was carried out to explore determinants of postnatal maternity service utilization in the rural area of Belgaum. Materials and Methods: Community based cross-sectional study was carried out from August 2012 to January 2013 in rural Belgaum. Total 630 mothers with less than 1 year child were interviewed using pretested questionnaire with her written consent. Analysis was done in Statistical Package for Social Sciences (SPSS) version 20 applying appropriate statistics. Results were presented in tabular and narrative forms. Results: Among 630 mothers, 54.6% were 20–24 years of age, 61.6% were having secondary level of education, 89.8% house wives and 91.6% Hindus. About 69.7% were from joint family with low economic status. Regarding postnatal service use; 79.0% use properly. Almost; three-fifth met with nurse/health workers at least three times, four-fifth got advice about breast/nipple care, 92.5% about breast-feeding, 67.9% about post-natal exercise, 89.0% on nutrition education, and 85% got the advice of uterus care. About 29.8% perceived some health problems. Education, income, awareness, and delivery places were found most significant determinants (P < 0.01) of postnatal services use. Conclusion: More than three quarters of mothers had used the proper postnatal maternity services. Education, family income, awareness, and delivery place were found as most significant factors. Sustainable maternal and child healthcare (MCH) programs and awareness will support to achieve furthermore better results. Key words: Determinants, health service utilization, maternity services, postnatal care

Cervical cancer is one of the most common cancers in United Arab Emirates (UAE) as well as in the world; high-risk human papillomavirus (HR-HPV) infection is found to be the most common cause of cervical cancer. The objective of the study is to evaluate the status of HR-HPV infection among women with Pap smear tests negative for intraepithelial lesions/malignancy (NILM). This cross-sectional study was conducted at the GMC Hospital and Gulf Medical University Histopathology/Cytology and Molecular Biology Laboratories within a period of 6 months from December 2011-May 2012. All pertinent patients’ data were obtained from medical records. A total of 50 patients were included in the study. Cytology (PreservCyt) samples were tested for HR-HPV, using the polymerase chain reaction (PCR) based test AMPLICOR HPV. This test is designed to detect 13 HR-HPV type. Data was analyzed using the Statistical Package for Social Sciences (SPSS) software package and was presented mainly as percentages of total sample size. Results: Of the 50 patients, five (10%) were positive for HR-HPV. Only four patients out of the 50 patients (8%) underwent Pap smear test as voluntary routine check-up, while 46 patients (92%) underwent the test because they were symptomatic. Conclusions: We acknowledge the small size of our working sample, but in view of very limited data in the region and due to strong cultural taboos against the topic, we have drawn some high level statistical conclusion and found that a moderately high prevalence of HR-HPV positive patients among women with Pap smear test NILM was detected in UAE, a country where no community based cervical cancer screening program is practiced. The rate of opportunistic/voluntary cervical screening was very low indicating poor or lack of awareness about the importance of Pap smear test as a tool to screen cervical epithelial changes among study population. The results presented in this study may provide valuable data for physicians involved in decision-making regarding the current situation related to cervical screening practice and HPV infection in UAE. Key words: Cervical cancer, HPV, UAE

Context: Indians are prone as a community to coronary artery disease (CAD) at a much younger age. CAD is affecting Indians 5-10 years earlier than other communities. Lipoprotein (a) (Lp (a)) is now recognized as an independent risk factor for CAD. It is a genetic risk factor. Aim: We evaluate the Lp (a) in young patients with myocardial infarction (MI). Settings and design: Study population consisted of 50 patients having MI and 50 control groups. Subjects and Methods: Fasting samples were collected from patients and were analyzed for Lp (a), lipid profile, and blood sugar on fully automated analyzer. Statistical analysis used: Statistical analysis is carried out by using Student’s t-test. Results: The difference in total cholesterol (P = 0.8192), high density lipoprotein-cholesterol (HDL-C) (P = 0.11), low density lipoprotein-cholesterol (LDL-C) (P = 0.8143), triglyceride (P = 0.1177) levels, and total cholesterol/HDLcholesterol ratio (P = 0.2129) were observed between the case and control groups in this study was not statistically significant. The difference in the Lp (a) levels between the case and control groups was highly significant (P-value = 0.0001). Conclusions: This study demonstrated that in young patients with MI there was a male predominance. Lp (a) level is an important and independent risk factor for CAD. Serum Lp (a) level is not dependent on serum total cholesterol level. Key words: Coronary artery disease, lipid profi le, lipoprotein (a)

Background: Meditation has been shown to be an effective practice of mindfulness and psychological health. The aim of the study was to explore this relationship and to investigate the role of meditation on mindfulness skills and psychological health. Materials and Methods: Sixty-seven long-term ‘Om’ meditation practitioners and equal number of normal healthy subjects matched to the meditators on age (meditators: 23.96 ± 3.25 years; non-meditators: 21.72 ± 3.44 years), years of education (meditators: 15.13 ± 1.57 years: non-meditators: 14.12 ± 1.76 years) participated in the study. Anxiety and mindfulness were measured by the State-Trait Anxiety Inventory (STAI) and Freiburg Mindfulness Inventory (FMI), respectively. Statistical analyses were carried out using the Statistical Package for Social Sciences (SPSS) software version 18.00 (SPSS Inc., Chicago, USA). The mindfulness and state and trait anxiety scores were analyzed using one-way analysis of variance (ANOVA) and independent t-test. Results: The meditator group showed significantly lower state (P < 0.001) and total anxiety (P < 0.001) as compared to the nonmeditation group. ‘Om’ meditation practice was positively correlated to mindfulness (P < 0.001), acceptance (P < 0.001), and presence (P < 0.05); and negatively correlated to state (P < 0.01) and total anxiety (P < 0.001). Conclusions: The practice of meditation was associated with higher levels of mindfulness and lower levels of psychological anxiety. Key words: Anxiety, mindfulness, Om meditation, state and trait

Background: Both symptomatic and asymptomatic urinary tract infections (UTIs) are thought to occur more frequently in diabetic patients. Local data about the antimicrobial resistance of Uropathogens should be available for proper therapeutic interventions of UTI. Objective: To evaluate the spectrum of the Uropathogens and their profiles of antimicrobial resistance on a series of diabetic and non-diabetic patients. Materials and Methods: A Case-Control study with 100 participants was conducted targeting the Diabetic and Non-diabetic population, symptomatic or asymptomatic for UTI. Antibiotic sensitivity test was done on each of the isolates and the results of the antibiogram were compared with that of control group (nondiabetic group). The statistical analysis was done by Chi-Square Test, Fisher exact test using statistical product and service solutions formerly known as Statistical Package for the Social Sciences (SPSS) 16.0 Version. Results: Most common isolate responsible for UTI was Escherichia coli followed by Klebsiella, Enterobacter, Proteus, Citrobacter, Acinetobacter and Candida. 93.3% and 86.6% of the isolates were sensitive to Amikacin and Amoxycillin-clavulanic acid respectively for Non Diabetics. Whereas isolates from diabetic group were 77.7 and 50% sensitive to Amikacin and Amoxycillin-clavulanic acid respectively. Highest resistance was seen for Cefuroxime for the isolates from both diabetic and non-diabetic group with 53.3 and 72.2% respectively. Significant difference in resistance pattern was observed in Amoxycillin-clavulanic acid, cefazolin, piperacillin- tazobactam and ticarcillin-clavulanic acid. Conclusion: Culture of urine and susceptibility testing of isolated organisms is strongly advocated in the clinical management of impending complication in diabetic individuals. Key words: Diabetes, resistance pattern, symptomatic and asymptomatic, urinary pathogens

Introduction: Exclusive breast feeding practice ranks first among the most effective interventions to improve child health. Present study was undertaken to compare breast feeding practices among urban and rural mothers and the factors influencing these practices. Materials and Methods: One year long community based crosssectional study was done at villages namely Vantamuri, Kakati (A and B), Honaga, and Bhutramanahatti; and urban area Khasbag which are the field practice areas of Department of Community Medicine, J. N. M. C., Belgaum. By random sampling, 380 rural mothers and 400 urban mothers having 1-year-old child were selected. Information on sociodemographic variables, breast feeding practices was recorded. Results: In the present study, majority of urban (65.00%) as well as rural mothers (64.21%) were between 20 and 24 years of age and were literates (90.25 and 77.89%, respectively). Majority of the mothers in both urban and rural areas gave prelacteal feeds (54.25 and 57.11%, respectively). Many mothers in both rural and urban areas discarded the colostrum, (14.75% in urban vs 25.79% in rural). Initiation of breast feeding after delivery was delayed by 24.50% of mothers in urban and 33.68% of mothers in rural areas. As many as 67.89% rural mothers practiced demand feeding as opposed to 38.75% urban mothers. Age of the mother, education, socioeconomic status, type of family, place of delivery, and education about benefits of breast feeding influenced the breast feeding practices. Conclusions: Various inappropriate breast feeding practices are prevalent both in rural as well as urban areas. Elder’s advice played an important role in shaping the breast feeding practices. Key words: Colostrum, ghutti, prelacteal feeds

Solar disinfection (SODIS) is a simple, environmentally sustainable, low-cost solution for drinking water treatment at household level. It uses solar energy to destroy pathogenic microorganisms causing water borne diseases. Contaminated water is filled into transparent plastic bottles and exposed to full sunlight for 6 h. During the exposure to the sun, the pathogens are destroyed. Objective: To study the awareness of SODIS of drinking water among residents of an urban slum. Materials and Methods: A cross-sectional study imparting educational intervention to spread the awareness of SODIS of drinking water among residents of an urban slum. Result: A total of 50% increase in awareness regarding concept of SODIS; 66% increase in awareness regarding method of SODIS. The study was carried out with sample size of 100 which was not sufficient to corroborate the findings on a larger picture, needs more sample size to be incorporated which unfortunately was not contemplated owing to time constraint. Conclusion: It is recommended to fi nd the utility of SODIS on a scientific basis and in Indian context, so that this cost-effective method can be utilized on a larger scale. Key words: Household water treatment and safe storage, pathogenic microorganisms, plastic bottles, SODIS, solar disinfection, water borne diseases

Methanol poisoning is a rare, but potentially life-threatening condition. It can result in significant neurological toxicities such as optic neuritis, encephalopathy, ataxia, polyneuropathy and parkinsonism. Concomitant presence of optic neuritis, parkinsonism and peripheral neuropathy in a patient of methanol intoxication has been very rarely reported in the literature. We report a case of a young male who developed acute onset parkinsonism, optic neuritis and peripheral neuropathy with evidence of putaminal necrosis following methanol poisoning. Early therapy can salvage a patient as well as minimize potentially catastrophic complications. Despite adequate management, a significant proportion of patients do develop devastating neurological deficits, which plague them for the rest of their lives. Key words: Methanol poisoning, optic neuritis, parkinsonism, peripheral neuropathy, putaminal necrosis

We report a case of cryptogenic brain abscess caused by infection due to community associated methicillin-resistant Staphylococcus aureus (CA-MRSA) in a previously healthy, 2-year-old, girl child with a history of persistent headache and fever for several weeks. Headache acutely worsened the day before hospital admission with vomiting, right hemiparesis, and altered sensorium. Community-onset pyogenic brain abscess should be added to the growing list of life-threatening invasive infections caused by community-acquired S. aureus. Early diagnosis, prompt neurosurgical drainage, and appropriate medical therapy are important for management of such infections. In light of expanding community-acquired S. aureus epidemic and the life-threatening nature of the disease we recommend empirical use of vancomycin in all cases of community onset brain abscess. Key words: MRSA, pyogenic brain abscess, Staphylococcus aureus, vancomycin

A 70-year-old female patient presented with subcutaneous cystic swelling following cholecystectomy. The patient underwent surgery and was eventually diagnosed as having hydatid cyst (HC). Primary subcutaneous HC is rare, but primary implantation HC is unknown. This report is an index case of such an entity. Key words: Hydatid cyst, implantation, soft tissue, subcutaneous