Vol 4, Issue 3, Jul-Sep, 2014

The aim of this study was to determine lithium concentration in potable water, surface water, ground, and mineral water on the territory of the Republic of Macedonia. Water samples were collected from water bodies such as multiple public water supply systems located in 13 cities, wells boreholes located in 12 areas, lakes and rivers located in three different areas. Determination of lithium concentration in potable water, surface water was performed by the technique of inductively coupled plasmamass spectrometry, while in ground water samples from wells boreholes and mineral waters with the technique of ion chromatography. The research shows that lithium concentration in potable water ranging from 0.1 to 5.2 μg/L; in surface water from 0.5 to 15.0 μg/L; ground water from wells boreholes from 16.0 to 49.1 μg/L and mineral water from 125.2 to 484.9 μg/L. Obtained values are in accordance with the relevant international values for the lithium content in water. Key words: Ground water, inductively coupled plasma-mass spectrometry, ion chromatography, lithium, mineral water, potable water, surface water

Background: Late initiation of treatment for illness secondary to the human immunodeficiency virus (HIV) remains a major challenge in developing countries. Despite the World Health Organization (WHO) recommendation that treatment be initiated early in disease management, health providers conducting quality improvement monitoring in one region of Tanzania noted that common management practice relies upon clinical signs of advanced disease alone for initiation of combination antiretroviral therapy (ART). Although Tanzanian National Treatment Guidelines followed standard WHO recommendations, few patients initiated ART based on laboratory parameters. As a potential barrier to optimal patient outcomes, further investigation of this inconsistency led to recognition of challenges reflecting patient, healthcare staff, and laboratory levels that might inhibit the use of CD4 cell counts as the entryway to care. Materials and Methods: Using a quality improvement approach, investigations were pursued for six discrete activities of HIV care delivery with before and after measures of selected indicators. With respect to patient engagement, meetings and informal educational sessions were held to promote understanding of the meaning of and need for CD4 testing. For clinic staff: (1) Qualitative interviews were conducted with providers to understand why laboratory data was not being used and (2) on-site interviews were conducted with laboratory personnel to review beliefs, methods, and practices related to measurement of CD4 cells testing. A large scale local campaign was mounted to (1) educate and empower patients to recognize a need for CD4 information in management of their own care; (2) re-educate and encourage providers to use measured, rather than clinical observation alone to initiate ART; and (3) understand and resolve clinical and laboratory challenges. Based upon findings from the interviews: (1) Meetings with hospital administrations were effected to resolve institutional barriers to using CD4 cell testing. Specific on-site training was initiated for both providers, with regard to use of CD4 cell counts, and nurses, with advanced training to initiate routine CD4 testing. These activities were well received because all staff were able to review unlinked, site-based clinical data to appreciate gaps in a local care. Results: The number of CD4 samples obtained and recorded increased by 114% between May and October 2007 at targeted health facilities. ART enrollment increased by 62% between June and September 2007 without other significant change in care delivery. The median baseline CD4 at enrollment increased from 110 cells/mm3 in June to 150 cells/mm3 in September. Overall retention rate was 77% for 13,333 HIV patients enrolled in seven facilities. Key words: Antiretroviral therapy, community empowerment, human immunodeficiency virus/AIDS, quality improvement

Objectives: The aim was to evaluate the utilization pattern, efficacy and safety of drugs prescribed for opportunistic infections (OIs) in human immunodeficiency virus (HIV) positive patients. Materials and Methods: In this observational, prospective, single center study, HIV positive patients were followed-up for a period of 1 year to record the OIs; their clinical course and outcome. Utilization pattern, efficacy and safety of the drugs used were evaluated. Rationality of treatment was assessed using National AIDS Control Organization and Standard Treatment Guidelines. Results: A total of 222 OIs were detected in 134 patients. Majority of patients (90.2%) were adults. The commonest OIs included tuberculosis (TB) (89), oropharyngeal candidiasis (OPC) (37), bacterial infections (30) and chronic diarrhea (22). Use of supportive drugs and empirical treatment of certain OIs contributed to a higher number of drugs (average of 3.5 drugs) per prescription. Drugs, prescribed in accordance with the above mentioned guidelines, were effective in most cases. Drugs were well-tolerated with only two serious adverse drug reactions (ADRs) reported. Majority of ADRs were associated with anti TB drugs. Conclusion: Tuberculosis, oropharyngeal candidiasis, bacterial infections and chronic diarrhea are the commonest OIs. Overall, a rational approach to therapy and good tolerability and efficacy of drugs was observed. Empirical treatment of infections should be minimized. Key words: Adverse drug reactions, efficacy, human immunodeficiency virus, OI, utilization pa􀄴 ern

Background: There is an increasing incidence of patients infected with humanimmunodeficiency virus (HIV) in India. The neurological manifestations of the disease are being seen more frequently. The nervous system is the most frequent and serious target of HIV infection. Aims and Objectives: To elucidate the spectrum of neurological involvement in patients with HIV infection at a tertiary care teaching hospital in western Maharashtra. We investigated various neurological manifestations of HIV including opportunistic infections (OPIs) and non-opportunistic infections (non- OPIs). Settings and Design: This was a retrospective observational study conducted at a tertiary care center in western Maharashtra over a period of 2 years from Jan 2009 to Dec 2010. Materials and Methods: A total of 81 HIV seropositive patients of both genders, of age >18 years, with neurological manifestations admitted at a tertiary care center were studied for clinical parameters, laboratory investigations and imaging. Statistical Analysis: Data were coded by numbers and double entered in a computer software SSPE-11 trial version. Results: A total of 179 patients admitted with HIV infection, of which 81 (45.25%) presented with neurological manifestations (neuro-acquired immunodeficiency syndrome [AIDS]), were enrolled in the study. Overall, 53 (65.43%) patients were male (34 years ± 11) and 28 (34.56%) were female (29 years ± 8). The male patients were outnumbered compared with the female patients, with P = 0.02. A total of 45 (55.55%) patients had OPIs and 36 (44.44%) patients had non-oppurtunistic neurological manifestations affecting the nervous system (P = 1573; insignificant). A total of 15 (18.51%) patients had immune reconstitution syndrome on antiretroviral therapy (A total of 11 (13.58%) patients had seizures, eight (9.87%) had ischemic stroke, eight (9.87%) had aseptic meningitis, two (2.46%) had intracranial hemorrhage, two (2.46%) had vacuolar myelopathy, four (4.93%) had AIDS-associated dementia, three (3.70%) had Guillain Barré syndrome (GBS), two (2.46%) had acute motor sensory axonal neuropathy (AMSAN), one (1.23%) had chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) and two (2.46%) had mononeuritis multiplex cranialis. A total of 17 (20.98%) patients had TB meningitis, 11 (13.58%) had cryptoccocal meningitis, one (1.23%) had Pott’s spine, two (2.46%) had progressive multifocal leukoencephalopathy (PMLE), two (2.46%) had herpes zoster, one (1.23%) had herpes simples encephalitis and one (1.23%) had cerebral toxoplasmosis. The CD4 was significantly low in patients with PMLE, ADC (AIDS Dementia Complex) and cryptoccocal meningitis compared with other neurological manifestations (P < 0.002). The case fatality rate was 7.4% (6/81). Mortality was significantly high in patients with cryptoccocal meningitis and PMLE compared with the other neurological manifestations (P = 0.034). Conclusion: We found a high prevalence of neurological manifestations in HIV seropositive patients (45.25%) in this setting. Central nervous system (CNS) tuberculosis was the most common secondary infection seen in HIV patients. Cryptococcal meningitis was the next

Background: Auditory brainstem response is an objective electrophysiological method for assessing the auditory pathways from the auditory nerve to the brainstem. The aim of this study was to correlate and to assess the degree of involvement of peripheral and central regions of brainstem auditory pathways with increasing severity of hypertension, among the patients of essential hypertension. Method: This study was conducted on 50 healthy age and sex matched controls (Group I) and 50 hypertensive patients (Group II). Later group was further subdivided into - Group IIa (Grade 1 hypertension), Group IIb (Grade 2 hypertension), and Group IIc (Grade 3 hypertension), as per WHO guidelines. These responses/ potentials were recorded by using electroencephalogram electrodes on a rootmean- square electromyography, EP MARC II (PC-based) machine and data were statistically compared between the various groups by way of one-way ANOVA. The parameters used for analysis were the absolute latencies of Waves I through V, interpeak latencies (IPLs) and amplitude ratio of Wave V/I. Result: The absolute latency of Wave I was observed to be significantly increased in Group IIa and IIb hypertensives, while Wave V absolute latency was highly significantly prolonged among Group IIb and IIc, as compared to that of normal control group. All the hypertensives, that is, Group IIa, IIb, and IIc patients were found to have highly significant prolonged III-V IPL as compared to that of normal healthy controls. Further, intergroup comparison among hypertensive patients revealed a significant prolongation of Wave V absolute latency and III-V IPL in Group IIb and IIc patients as compared to Group IIa patients. These fi ndings suggest a sensory defi cit along with synaptic delays, across the auditory pathways in all the hypertensives, the deficit being more markedly affecting the auditory processing time at pons to midbrain (IPL III-V) region of auditory pathways among Grade 2 and 3 hypertensives. Conclusion: Hence, we conclude there has been greater involvement of pontomesenchymal region with the increasing severity of the disease. Key words: Auditory brainstem responses, auditory pathways, hypertension, interpeak latency

Background: Bronchial asthma (BA) is a chronic non-communicable disease affecting children and adults. Despite the availability of written guidelines for diagnosis and management, yet still knowledge and application were inadequate. The aim of this study was to assess asthma knowledge of primary health care centers (PHCCs) personnel in Dammam city, eastern Saudi Arabia. Materials and Methods: This was a cross-sectional study conducted in 22 PHCCs. The sample consisted of 194 personnel (50 physicians and 144 nurses). Data was collected through a self- dministered questionnaire which contained 58 questions. Knowledge score about asthma was coded as good and poor. Descriptive statistics, paired t-test and logistic regression were used for statistical analysis. Results: The majority of PHCCs personnel (96.9%) had no postgraduate studies and 78.4% of them didn’t receive any training about BA. More than half (55.2%) of the PHCCs personnel showed good total knowledge score about BA. Also, 81.8% of the physicians and 52.7% of the nurses had goodtotal knowledge level regarding the total aspects of BA in children. Physicians had statistically higher mean knowledge score than nurses regarding all components and total knowledge scores. Knowledge about role of exercise and prognosis was inadequate. Being a physician, female, younger, less years of work in PHCCs were statistically significant and associated with good knowledge level. Conclusions: There are still some deficiencies in knowledge about different aspects related to bronchial asthma. It is recommended that both physicians and nurses receive training about national asthma guidelines through continuing medical education. Key words: Bronchial asthma, childhood, knowledge, primary health care personnel, Saudi Arabia

Introduction: Enteric fever is an endemic disease in India and warrants rapid and affordable diagnosis. The Widal slide agglutination test is a commonly used rapid screening test for this purpose. The literature available on its diagnostic ability in comparison to the tube agglutination test is however scanty. Hence, this study aims to evaluate the efficacy of the Widal slide agglutination test and the tube agglutination test for the diagnosis of enteric fever. Materials and Methods: A total of 1470 sera were collected during the study period of one year from patients having pyrexia of unknown origin. All the samples were tested for the presence of anti O and anti H agglutinins against S. typhi and S. paratyphi A by semi quantitative slide and quantitative tube agglutination tests as per standard protocols. The titers of 1:80 (O agglutinins) and 1:160 (H agglutinins) were taken as the significant titer for the diagnosis of enteric fever. The results of the slide agglutination test were compared with the tube agglutination test and analyzed using Fisher’s exact test. The sensitivity, specificity, positive and negative predictive values of slide agglutination were calculated using the tube agglutination method as a standard for comparison. Results: Of the 294 slide positive samples, 209 (71.1%) samples tested negative by the tube agglutination test. The sensitivity, specificity, positive and negative predictive values for the slide agglutination test were observed to be 100 % (CI 95.75-100%), 84.91% (CI 82.93-86.73%), 28.91% (CI 23.84-34.45%) and 100% (CI 99.69-100%) respectively. Conclusion: Serological diagnosis of enteric fever should always be confirmed by the tube agglutination test rather than depending solely upon the rapid slide agglutination test results. Key words: Paratyphoid fever, rapid test, typhoid fever, Widal test

Aims and Objectives: To determine efficacy of analgesia of Analgesic drugs +Interferential Therapy (IFT) or without IFT. Material and Methods: The 80 eligible patients (30 male, 50 female) of acute and chronic low back pain were assigned to 5 groups (Grp), i.e., Grp A, B, C, D and E. The Orthopedician prescribed tablet Xenodol (Aceclofenac 100mg + Paracetamol 500mg 1 BD for 7 days) for Grp A, tablet Patrol (Tramadol 37.5mg + Paracetamol 325mg) 1 BD for 7 days) for Grp B, IFT 25 - 100Hz application at lumbar region for 15 min daily for 7 days for Grp C, tablet Xenodol of same dose with IFT 25 - 100Hz application for 7 days for Grp D and tablet Patrol of same dose with IFT 25 - 100Hz application for 7 days for Grp E patients. Eligible patients pain were assessed twice, i.e., pre-treatment and post-treatment, by SF-LF-MPQ (Short Form-Long Form McGill Pain Questionnaire’s Rating Index. Results: The post-treatment mean±SD was 1.3±0.9, 1.4±1.5, 1.6±0.85, 1±0.73, 0.93±1.16for Grp A, B, C, D and E respectively, while the pre-treatment pain intensity score mean±SD was 1.9±0.5, 2.4±1.1, 2.13±0.8, 2.25±0.9, 2.25±1.1 for Grp A,B,C,D,E respectively. The differences was statistically signifi cant, i.e. (P < 0.05) 0.03856, 0.03601, 0.0002027, 0.002136 of Grp A, B, D, E respectively and insignifi cant, i.e. (P > 0.05) was 0.06603 for Grp C. Conclusion: Tablet Xenodol Aceclofenac+Paracetamol) and tablet Patrol (Tramadol+Paracetamol)alone showed effi cacy in pain reduction, while when the tablets Xenodol and tablet Patrol of same doses given with IFT 25 - 100Hz application at lumbar regionin Grp D and Grp E the pain reduction was highly signifi cant than the medication alone groups, i.e., for Grp A, B, C. Key words: Aceclofenac+paracetamol, interferential therapy (IFT ), low-back pain (LBP ), McGill pain questionnaires, tramadol+paracetamol

Background: Inhalant use, an important, yet-under recognized form of substance abuse has been reported commonly among adolescents in India but the true extent of the problem is not known due to paucity of data. Aims: To assess the prevalence and determinants of inhalant substance used amongst the adolescents in Manipur. Settings and Design: This cross sectional study was conducted among 1671 adolescent studying in Eighth to Twelfth standard in schools of Imphal-East District Manipur, India during March to June 2013. Materials and Methods: Schools were selected by simple random method and a semi-structured self-administered questionnaire adapted from the ‘UNDCP/WHO Global initiative on Primary Prevention of substance abuse’ was used for data collection. Univariate and Multiple logistic regression analysis were performed for association between ever users and selected variables. Results: Mean (SD) age of the students was 14.5(1.32) years, with males constituting 923(55.2%). Prevalence of ever users was186 (11.1%) and glue/ dendrite was the commonest substance abused 98(52.7%). Being male, belonging to joint family and increase in age were found to have significant higher risk of being a user, whereas higher level of parental education shows a protective effect. Conclusion: An increased effort for prevention, treatment along with sensitization of parents and teachers is a distinct challenge for policy makers. Key words: Adolescents, glue/ dendrite, inhalant use, Manipur

Context: Lymphatic fi lariasis or elephantiasis a serious public health problem in India. Millennium Development Goals and National Health Policies purport to eliminate fi lariasis by 2015. The concept of mass drug administration (MDA) is to approach every individual in the target community and administer annual single dose of anti-fi larial drugs (DEC or DEC+Albendazole). Aims: 1. Assess the coverage and compliance to MDA in the district. 2. Assess the awareness of elephantiasis among benefi ciaries. 3. Assess the knowledge of drug distributors about fi lariasis and the MDA program. Materials and Methods: This cross-sectional study was conducted in one urban and three rural clusters in Uttara Kannada district of Karnataka for the period of one week. A total of 50 houses were selected in each cluster by systematic random sampling method and data were collected in a structured proforma by interview technique. Statistical Analysis Used: Descriptive statistics such as percentage, mean, and standard deviation. Results: Among 1,022 beneficiaries, the overall coverage of MDA was 82.3%. Compliance among those who had received the tablets was 52.1%. Effective coverage rate was 42.9%. The compliance rate was significantly higher in rural areas [376 (58.6%)] compared to urban areas [62 (31.0%)]. The most common reason quoted for not consuming drugs was “Don’t want” (50.4%). A total of 56% of the respondents were aware of the elephantiasis disease and MDA program. Conclusions: Even though there was high coverage of MDA in Uttara Kannada district, compliance and effective coverage rates were found to be poor. Key words: Compliance, coverage, elephantiasis, lymphatic fi lariasis, MDA, Uara Kannada

Background: The nutritional status of under five children in urban slums is an important health indicator for assessing the health status of entire population and one of the major predictors of child survival. Objective: A nutritional survey was carried out in September- October 2012 in the field practice area of a medical college in Pimpri, Pune area with an objective to assess the nutritional status of under-five children. Materials and Methods: All the under five students in the field practice area of the medical college were examined. A total of 658 children were examined. Results and Conclusion: It was observed that the prevalence of under weight 34.3% (226/654) (30.7 to 38.0 C.I.), stunting 58.7% (386/654) (54.9 to 62.4 C.I.) and wasting was 16.9%(109/654) (14.0 to 19.7 95% C.I.). The prevalence of under weight 37.6% (114/303) and stunting 61.4% (186/303) was more in girls whereas wasting was more in boys 18%.(64/355) Key words: Malnutrition, under-five, urban slums

Introduction: Heavy metal pollutions of soil and wastewater are a significant environmental problem as they are not degraded or destroyed. Several metal resistance mechanisms have been identified which is responsible for alteration of normal cell physiology leading to development of drug resistance in microorganisms. Heavy metals used in industry and in household products are, along with antibiotics, creating a selective pressure in the environment that leads to the mutations in microorganisms. The present study was carried out to study the heavy metal lead tolerance by bacteria and change in antibiotic-sensitivity pattern after its exposure. Materials and Methods: 30 clinical isolates from various samples received in the Department of Microbiology, Government Medical College, Surat, were included in the study. To check the lead tolerance capacity, isolates were exposed to graded concentration of lead nitrate by plate dilution method, starting from 50 up to 1000 μg/ml strength. Antibiotic susceptibility was performed by the Kirby Bauer disc diffusion method. A change in antibiotic susceptibility pattern was studied before and after lead exposure. Result: 30 clinical isolates were included in the study, 25 Gram negative (83.3%) and 5 Gram positive (16.7%). MIC to lead was higher in Acinetobacter spp. and Pseudomonas spp. (600-1000 μg/ml) as compared to E. coli, Klebsiella spp., S. aureus (50-150 μg/ml). Multiple antibiotic resistance indexes were changed significantly after lead exposure. Conclusion: Bacteria exposed to high levels of heavy metals in their environment have adapted to this stress by developing various resistance mechanism. Infection with antibiotic-resistant organisms create problem in treatment and management of patients. We should take efforts to prevent environmental pollution with such heavy metals and transmission of antibiotic-resistant microorganism from environment to health care set up. Key words: Bacteria, drug resistance, heavy metal, lead tolerance, multiple ntibiotic resistance

Objectives: To know the clinical profile of the students affected due to food poisoning, the possible source of infection and the causative agent for food poisoning. Background: Food-borne diseases due to microbial contamination of food, represent serious threat to the health of millions of people henceforth, we investigated into the outbreak of food poisoning in a nursing hostel of urban Mysore. Materials and Methods: A descriptive study was conducted using semi-structured questionnaire to gather information on regarding time and type of food item consumed, onset of symptoms, presenting symptoms, medical care provided and time taken for recovery. A case for the outbreak was defined as any person who had consumed lunch on 9/12/12 from the implicated kitchen and had experienced vomiting or diarrhea or pain abdomen or all the three symptoms within 24 hours of eating lunch. Results: Out of 171 inmates,46 people suffered from food poisoning within a period of 3 days, thus leading to the attack rate of 26.9%.Commonest symptom reported among the students was pain abdomen (26.9%) followed by diarrhea. Highest risk of food poisoning was associated with consumption of “Kerala matta rice” This association was statistically significant with relative risk of 31.49 (95% CI 10.82-95.6). Samples of ‘Kerala mattarice” was subjected to bacteriological analysis, which showed colonies of coagulase-positive Staphylococcus aureus. Conclusions: In the present outbreak, the results of investigation revealed that ‘Kerala matta rice’ was the food item responsible for occurrence of food poisoning due to Staphylococcus. Environmental factors that could have played an important role in bacterial proliferation and enterotoxin production are manual handling of cooked rice by the food handlers and storage of the rice at room temperature for a long duration between time of preparation and consumption. Key words: Hostel, outbreak, staphylococcal food poisoning

Introduction: Childhood obesity& hypertension are global health problems as they caused increase in morbidity & mortality. Objective: To fi nd out the prevalence of obesity, overweight in school going children and adolescents of north Karnataka. Also to study obesity related morbidities like Prehypertension and Hypertension and associated risk factors for sustained hypertension. Materials and Methods: Total 2800 children in age group from 10-16 years from 3 schools of Urban and rural region of Bijapur district were screened. Weight, height, BMI and Blood pressure were recorded. These values were compared with WHO child growth standards. Children then classified as overweight (OW) and obesity (OB). Blood pressure values were compared with reference charts given by American heart association guidelines and grouped as prehypertensive (PHTN) and Hypertension (HTN). Results: This study revealed that 3.6% rural school children were overweight (OW) in age group of 13 years, 1.4% children were obese (OB) in age group of 15 years. In urban school children, 3.3% OB in age group of 12 years and 11.1% OW in age group of 10 years. In Rural school children, prevalence of systolic HTN was 21% in OW children and 25% in OB children. Among urban schoolchildren prevalence of systolic PHTN was 5.1% among OW and in OB group it was 16.6%. Conclusions: This study revealed that prevalence of hypertension was significantly higher in overweight and obese compared to children with Normal BMI. Also the prevalence of overweight and obesity is more in urban school children than rural children population. We need further large scale studies to study obesity and associated morbidities like hypertension school children and adolescents. Key words: Body mass index (BMI), Hypertension (HTN), India, North Karnataka, Obese (OB), Overweight (OW), Prehypertension (PHTN)

Aim: The aim of this study is to highlight the histopathological synopsis of ovarian lesions with emphasis on functional ovarian cysts and to compare our study with findings of other centers. Materials and Methods: Hematoxylin and eosin stained slides of ovarian biopsies diagnosed at the Ashamas Foundation Diagnostic Centre, Benin City for 10 years were archived, scrutinized, and studied. Request forms were analyzed for clinical biodata and diagnosis, and data were analyzed with Statistical Package for Social Sciences (SPSS) version 17. Results: A total of 236 ovarian biopsies were reviewed. Of this, 121 (51.3%) were nonneoplastic. Again 79 (33.5%) were benign neoplastic tumors and 36 (15.6%) were malignant tumors. Out of the 121 nonneoplastic (functional cysts) lesions, corpus luteal cyst was the most commonly encountered, constituting 41 (33.9%). The peaks age incidence for nonneoplastic and benign neoplastic lesions occurred in the 3rd decade. Two peaks age incidence was noted for malignant tumors-5th and 7th decades. Germ cell tumor constituted the most common neoplastic ovarian tumor (n = 59; 51.8%) diagnosed. Conclusion: Functional ovarian cysts were the most commonly encountered ovarian lesions in our locality. The most common variety of functional cyst was corpus luteal cyst and hemorrhagic cyst with majority occurring in the reproductive age groups. Among the ovarian tumors, germ cell tumors were the most commonly seen. Key words: Follicular cyst, functional cysts, luteal cysts, ovarian lesions

Introduction: Huge investments have been made in implementing computerized Hospital Management Information Systems (HMIS) across the world, including developing countries. Economic evaluation studies have shown that HMIS implementations are beneficial. While measuring effectiveness, studies have compared the quality of data generated in the HMIS with paper-based systems and have shown that HMIS is more advantageous. However, not all HMIS implementations are successful. Many successful implementations are the result of a continuous process of re-engineering, with inputs obtained from the end-users at every stage of the implementation process. The aims of this study were to compare cost-effectiveness, end-user satisfaction and perspectives between HMIS and traditional paper-based system (TPBS). Materials and Methods: This cross-sectional study evaluates the HMIS in government hospitals in Tamil Nadu using a mixed method approach. The study sample included 24 hospitals (13 HMIS and 11 TPBS), and hospital staff in four professional categories (doctors, staff nurses, pharmacists and lab technicians). Results: Cost-effectiveness analysis showed that HMIS implementation has high cost and high effectiveness with an ICER value of 3301.33. The Likert scale used to measure end-user satisfaction levels found that end-users were highly satisfied with HMIS as compared to TPBS. Conclusions: The study demonstrated the high cost and high effectiveness of HMIS implementation. The ‘accuracy of data’, ‘content of the system’ and the ‘timely availability’ characteristics of HMIS were highly appreciated by the users, whereas in TPBS, the users appreciated the ‘user friendly’ nature of this system. Key words: Cost-effectiveness, health information system, user satisfaction

Background: COPD is a chronic disease which may have substantial effect on quality of life of patients. Aim: The aim of this study is to study the impact of COPD on activities of daily living and quality of life of patients and to correlate the impact with severity of disease in the set up of Indian conditions. Materials and methods: In this prospective study conducted at a tertiary level hospital, stable COPD patients without any other coexisting co-morbidity were enrolled. The severity of COPD was classified as per GOLD 2006 guidelines. The quality of life and impact of COPD on activities of daily living was assessed using Seattle obstructive lung disease questionnaire translated in local language, 6 minutes walk test and visual analog scale for dyspnoea. Results: Seventy eight patients and 20 controls were enrolled for the study. The scores for physical functions, emotional functions, coping skills and treatment satisfaction obtained from questionnaire were decreased in COPD patients. The physical function and emotional function score, decreased significantly (P < 0.05) when compared from mild through moderate, severe and very severe stages of COPD, these scores also correlated positively with percent predicted FEV1 values in spirometry (r=0.855 and r = 0.735 respectively) There was a significant fall in the six minute walk distance as the stage of disease progressed. The Visual analog scale score significantly increased (P < 0.05) with the stage of COPD. Conclusion: Assessing quality of life and ability to perform activities of daily living is also important for assessing the disease severity. Key words: COPD, Global Initiative for Chronic Obstructive Lung Disease (GOLD), Health-related quality of life (HRQoL), Sea􀄴 le obstructive lung disease Questionnaire (SOLDQ)

Background: Given the increased number of four wheel drive (4WD) vehicles in Qatar and their involvement in crashes, casualties and road fatalities, it is important to understand the association between risky driving behavior and 4WD crashes. Aim/Objective: This study aimed to determine the association between risky driving behaviours and 4WD vehicles and its impact on road traffic accidents in the State of Qatar. Materials and Methods: A cross sectional survey was conducted using a multistage stratified cluster sampling technique to recruit 1824 drivers of two wheel drive (small cars) and 4WD across different primary health centres (PHCs) in Qatar. The Driver Behaviour Questionnaire (DBQ) and Driver Skill Inventory (DSI) were used to collect the data. Information regarding socio-demographic and road traffic crashes during last three years was also obtained. Multivariate logistic regression was used to analyse the data. Results: 762 (41.8%) owned 4WD vehicles. Drivers of 4WD were signifi cantly higher between 30-50 years age (P < 0.001), urban dwellers (P = 0.003), having more driving experience (atleast 5 years) (P < 0.001) and annual mileage higher than the drivers of small cars (P < 0.001). A significantly higher proportion of 4WD drivers had previous penalties for traffic violations such as crossing a red traffic signal (51.6% vs. 21.4%; P < 0.001) or exceeding the speed limit (35% vs. 27.8%; P < 0.001). A higher proportion of 4WDs’ drivers reported previous involvement in accidents as compared to the drivers of small cars (42.4% vs. 35.7%; p 0.004). The risk of accident involvement was 1.21 times higher among drivers of 4WD as compared to the counterparts (OR 1.21; 95%CI; 1.01-1.46). Besides, excessive speed, annual mileage, male gender, traffic violations, lapses, errors and driving skills were significantly associated with crashes. Conclusion: The drivers of 4WD cars are at higher risk of crashes as compared to the drivers of small cars. Also, they have significantly more traffic violations, lapses, and errors. Future interventions and control measures should target the drivers of 4WD for better results. Key words: Accident, driver behaviour questionnaire, four-wheel drive, Qatar, road traffic crashes, risk taking behaviour, speed, seat-belt usage, small car, traffic offence

Background: Since 2007, Satara district is implementing a pilot project named “Second Honeymoon Package” (SHP). SHP gives cash incentives to encourage postponement of first pregnancy in newly married couples. At the same time, contraception services are also provided under National family welfare program. There requires a significant amount of commitment and expenditure from the beneficiaries to avail the benefits of governmental programs, which is often overlooked by the system. The costs of these two reproductive health interventions are compared in this study. Objective: To calculate the cost of providing and utilizing contraception services for the newly-wed couples in Satara district from the perspective of the Government of Maharashtra and that of beneficiaries’. Materials and Methods: This was a cost-minimization study of two reproductive health interventions in rural part of Satara district. Information about expenditure incurred was calculated from 17th June 2010 to 16th June 2012. Cost analysis was conducted from the perspective of Government of Maharashtra and that of beneficiaries’. Costs of SHP were evaluated in comparison with those of routine family welfare program. Results: One thousand and ninety-fi ve out of 1355 participants (80.8%) have used condoms, 125 participants (9.22%) have used oral pills while only 15 (1.1%) have used safe period method. The average distance of health facility from the homes of participants has been 4.24 km ± 6.54. Annual unit cost of implementation of SHP was Rs. 883 (16.35$/ year) during the study period while the opportunity cost of utilizing the contraception services was Rs. 383.40 (7.1$) per person per year. The annual unit cost of implementation of family planning program was Rs. 323.73 (6$). Conclusions: In districts like Satara that have a strong family planning infrastructure, reorienting the program to provide contraception services for newly married couples may be achieved with minimal additional inputs. Key words: Conditional cash transfer, cost-minimization study, opportunity cost, second honeymoon package, unit cost of contraception services

Background: Tobacco use in any form has increased throughout the world. Total tobacco related deaths are projected to rise from 5.4 million in 2004 to 8.3 million in 2030 globally. In India, eight to 10 lakh people die due to tobacco related disease every year. The Global adult tobacco survey (GATS) in India in 2009-2010 revealed that 163.7 million use the smokeless form, 68.9 million smoke, 42.3 million use both smoking and smokeless form of tobacco. Aim and Objective: To fi nd the prevalence, reasons for initiation, willingness to quit tobacco among adults (≥ 20 years) in Ramanathpuram village of Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) rural health centre service area. Materials and Methods: A cross sectional survey was carried out among adults >20 years (n = 315) in one of the four villages of rural field practice area of the JIPMER, Pondicherry. Considering prevalence of tobacco use as 25%, with 20% relative precision, sample size was calculated to be 300. Interns trained in interview techniques collected information using a structured questionnaire after taking informed consent. Data were collected on demographic parameters, current tobacco use, age at initiation, reasons for initiation, harmful effects of tobacco, sources of information and the willingness to quit. Result: Among the 315 people studied, 51.42% were males. Seventy-nine of them (20.6-30.1) used tobacco in any form. The proportion of females exceeded males in the use of smokeless tobacco. The age of initiation of smoking was found to be 22.6 ± 5.7 years, earlier than that for the smokeless form 27.5 ± 12.2 years (P = 0.032). The majority (50.6%) initiated tobacco use due to peer pressure, followed by influence of their family members (30.3%) and stress (17.7%). Although awareness about the harmful effects of tobacco was found in 64% (58.3-68.9) of the subjects, only 21.9% (13.06-32.2) of the tobacco users were willing to quit. Conclusion: About one-fourth of the study population used tobacco but only about one fifth of the users were willing to quit. Hence, targeted awareness activities will be needed for those unwilling to quit tobacco use. Key Words: Awareness, prevalence, tobacco

Leptospirosis, a zoonotic disease, may present with cardiovascular, gastrointestinal, neurological, hematological, and ocular manifestations apart from the classical presentation of renal failure and jaundice. In this report, we present a case of leptospirosis with pancytopenia as the prevailing manifestation, which reversed completely with intravenous cephalosporins. In conclusion, this case study suggests that Leptospira infection should be included in the differential diagnosis of febrile pancytopenia, even in the absence of classical signs of severe disease such as jaundice, meningitis, renal failure, and pulmonary infiltrates. Key words: Cephalosporins, leptospirosis, pancytopenia

A 10-year-old male child presented with recurrent hemoptysis since 1 month and a bout of massive hemoptysis on the previous day of admission. Chest radiography and CT scan revealed a soft tissue inflammatory mass in the right lower lobe. Emergency right lower lobectomy revealed a cavitatory lesion with membrane, communicating with bronchus. Histopathology confirmed the diagnosis of hydatid cyst. Key words: Child, hemoptysis, hydatid cyst

Sclerosing stromal tumor (SST) is a rare sex cord stromal neoplasm of the ovary. Precocious puberty resulting from this tumor is extremely rare. We report a case of SST of the ovary in a 7-year-old Indian girl, who presented with the complaints of excessive development of breasts, early menarche, growth of pubic hairs, accelerated growth and abdominal distension. On clinical examination, a large right sided abdomino-pelvic mass was palpable. Magnetic resonance imaging revealed a large, heterogeneous, solid and cystic tumor in the right adenexal region, suggestive of an ovarian neoplasm. Hormonal profile le showed markedly elevated estradiol and low follicle stimulating hormone levels. Clinical diagnosis of precocious puberty with right-sided ovarian mass was thus concluded. Right-sided salpingo-oophorectomy was then performed. Histopathology showed features consistent with SST of the ovary. Postoperatively, signs and symptoms of precocity gradually regressed and her serum estradiol level came down to normal. Key words: Precocious, puberty, sclerosing stromal tumor