Vol 4, Issue 4, Oct-Dec, 2014

Analyses the 1293 Indian publications in cataract research during 2002-2011, with a focus on contribution and citation impact of 15 most productive countries, India’s overall contribution, its growth, citation impact, the share of international collaborative papers, identifi cation of signifi cant countries in India’s international collaboration, different types of cataract research, analyses of research by subfi elds and different population age groups, productivity, and impact of leading Indian institutions and authors and pattern of communication of Indian output in most productive journals. The Scopus Citation Database has been used to retrieve the data for 10 years (2002-2011). Indian publications increased from 87 papers in 2002 to 195 papers in 2011, witnessing an annual average growth rate of 10.03%, registering an average citation impact per paper of 3.26 and international collaborative share of 21.58% during 2002-2011. Suggest that the government should encourage the decision makers and ophthalmologists and allied persons involved in ophthalmic services to make serious efforts in reducing the burden of cataract disease by increasing the R&D, strengthening of national and international collaboration and improve the existing training programs for ophthalmologic professionals. Key words: Bibliometrics, cataract, eye disease, India, publication output, scientometrics

Qualitative research methodology enables researchers to explore social and behavioural issues related to public health that are not achievable with quantitative methods. Several complex public health issues can be better understood by exploration using qualitative methodologies. However, these methodologies are underutilized in public health research particularly in developing countries. This paper aims to introduce qualitative research to students and researchers in public health in developing countries and to encourage its use in research by presenting an overview of how to undertake a qualitative research study. Key aspects of this methodology include choosing and working within a theoretical framework, recruitment of participants, following the right process of data analysis, and presentation of fi ndings for publication. Key words: Qualitative research methodology, public health, developing countries

Around 2.5 million people become infected with HIV each year and after 30 years of the HIV epidemic more than 34 million persons are living with HIV infection. This extraordinary toll on human life and public health worldwide will only be reversed with effective prevention. There is a need for evidence-based interventions that can be implemented to treat the established infections and prevent the new ones from happening. This paper aims to discuss about different types of HIV prevention strategies that are effective and practiced in different countries with special emphasis on evidence for success. A review of the literature was done to get the information about the successful interventions for HIV prevention from different countries. The literature was accessed from health and medical sciences databases available on the internet. All the relevant peer-reviewed journals and reports were studied and were categorically discussed in detail with the evidence. For a successful reduction in HIV transmission, there is a need for an aggregate effect of radical and sustained behavioral changes in a suffi cient number of individuals potentially at risk. Reductions in HIV transmission need widespread and sustained efforts, and a mix of communication channels to disseminate messages to motivate people to engage in range of options to reduce the risk. The effect of behavioral strategies could be increased by aiming for many goals that are achieved by use of multilevel approaches with populations both uninfected and infected with HIV. These prevention programs operate on different levels to address the specifi c, but diverse needs of the populations at risk of HIV infection. There is an urgent need for greater demand and greater support from communities and policymakers for rights-based, evidenceinformed prevention strategies. And the prevention experts need to overcome the prejudices and political sensitivities that have impeded implementation of the HIV prevention programs Key words: Behavioral strategies, biomedical interventions, communication, HIV/AIDS, prevention

Background: Indian Public Health Standards (IPHS) are the prescribed quality norms for health care services in India. For the fi rst time this set of standards was introduced with the initiation of National Rural Health Mission in India. The first set of standards was released in 2007 and the second revised set was released in 2012. Among various services Ayurveda, Yoga and Naturopathy, Unani, Siddha, and Homeopathy (AYUSH) is one of the components and certain standards have also been prescribed for AYUSH facilities in concerned health institutions. Materials and Methods: A review was made based on the prescribed IPHS documents obtained from the web portal of Directorate of Health Services, Ministry of Health and Family Welfare, Government of India, New Delhi. Results and Discussion: Human resources and drugs have been dealt in detail in all the health institutions. Treatment of common ailments with AYUSH drugs as per the local need, training of health worker in AYUSH drugs and promotion of medicinal plants are some of the services prescribed at sub center level. Description regarding the drugs is only found in primary and Community Health Centers. Manpower under AYUSH has been categorized under essential services in all the institutions except Primary Health Center in which the same has been categorized in desirable services. Conclusion: Mainstreaming of AYUSH and prescribing IPHS standards are some of the important initiatives under NRHM as a substantial portion of rural India is still dependent upon the AYUSH systems of medicine as a way of availing health care services. However, a more detailed prescription for this sector would always be of signifi cance for the society and the sector itself. Key words: Ayurveda, yoga and Naturopathy, unani, siddha, and homeopathy, facilities, Indian public health standards

Context: Osteoporosis is a public health problem in India with high incidence of fractures. Aim: The aim of the study w to know the profi le of bone parameters and its factors associated with hip fractures in osteoporotic men and women living in low socioeconomic conditions. Settings and Design: A hospital-based case-control study was carried out in Orthopedics ward of the Osmania General Hospital (OGH), Hyderabad, Andhra Pradesh, India. Materials and Methods: A total of 72 men and 72 women aged 35-70 years admitted in OGH with hip fractures during April 2005 to March 2008 were recruited. Age, gender and socioeconomic background matched controls (men: 72 and women: 46) living in Hyderabad were employed. Clinical examination, bone mineral density (BMD), anthropometric measurements, and biochemical markers of bone metabolism were analyzed. Statistical Analysis Used: Descriptive and inferential statistics were carried using SPSS. Results: The mean age of men with fractures was 59.1 ± 9.42 years while, in women, it was 63.6 ± 9.97 years. BMD at the hip (P < 0.001) and calcium (P < 0.05), Vitamin D (P < 0.001), total alkaline phosphatase levels (P < 0.05) were signifi cantly lower in the cases. While, paratharmone activity and urinary calcium excretion (P < 0.001) were found to be high in cases compared to controls. Gender, body mass index, serum Vitamin D explained variation in BMD at all the sites. Conclusion: The high prevalence of Osteoporotic fracture rates in Indians at an early age compared to developed countries highlights the need for dietary diversifi cation, physical activity, self-care management, among the low-income group population to reduce the risk of osteoporosis and its associated risk factors. Key words: Bone parameters, fractures, osteoporosis, risk factors

Objectives: The objective was to assess drugs used in treatment of chronic obstructive pulmonary disease (COPD) and their impact on quality-of-life. Materials and Methods: All newly diagnosed patients visiting the pulmonary medicine OPD were enrolled for the study based on inclusion and exclusion criteria. All patients were followed up for 6 months. Symptom and drug therapy assessment was done every month, while spirometry and quality-of-life assessment was done every 2 months. St. George Respiratory questionnaire was used for quality-of-life assessment. Results: A total of 100 patients was enrolled in the study, 78 were males and 22 females with mean age being 58.91 ± 6.58 years. All 84 patients, who were smokers, smoked bidis. Statistically signifi cant improvement was seen in dyspnea, while all other symptoms did not show such improvement. 26 patients suffered from mild COPD, 48 had a moderate severity while remaining 26 belonged to the severe form of the disease. Improvement was seen in all parameters of spirometry. Statistically signifi cant improvement was seen in forced expiratory volume at 1 s (FEV1) at 4 and 6 months, in forced vital capacity at 6 months, in FEV1 % at 4 and 6 months as compared to baseline. Peak expiratory fl ow and forced expiratory fl ow 25-75 also showed statistically signifi cant improvement at every follow-up as compared to baseline. Methylxanthines, anticholinergics, β2 agonists, and corticosteroids were the commonly prescribed drugs. Improvement was seen in quality-of-life but overall improvement was not clinically signifi cant. A decrease in total score in quality-of-life was seen from 44.63 at baseline to 41.76 at the end of 6 months. Correlation between quality-of-life and FEV1 was found to be extremely signifi cant. Conclusion: Improvement in quality-of-life was not clinically signifi cant. However, correlation between FEV1 and quality-of-life was extremely signifi cant. Key words: Chronic obstructive pulmonary disease, quality-of-life, spirometry

Background: Preeclampsia/eclampsia is responsible for upwards of 20% of maternal morbidity and mortality in developing countries. Objective: We examined the relationship between frequency of food intake and symptoms of preeclampsia eclampsia and eclampsia among Indian women aged 15-49 (n = 39,657) for the most recent live birth in the 5 years preceding the National Family Health Survey-3 (2005-2006). Multiple logistic regression analysis was used to estimate the association between frequency of intake of specific food items, and self-reported symptoms of preeclampsia eclampsia and eclampsia, adjusting for maternal age, and other potential socio-demographic confounders. Results: Daily consumption of milk or curd (odds ratio [OR]: 0.88; 95% confidence interval [CI]: 0.81-0.96), green leafy vegetables, chicken/meat and weekly pulses/beans consumption are associated with substantially lower risk of preeclampsia eclampsia. Eclampsia risk is higher among those who consumed fruits (ORs ranges from 1.18 to 1.44) and chicken/meat occasionally (OR: 1.28; 95% CI: 1.11-1.48), and lower among those consuming vegetables daily. Conclusion: Frequency of consumption of specific food items is associated with occurrence of preeclampsia eclampsia and eclampsia symptoms in Indian women. Key words: Preeclampsia, eclampsia, food types, frequency of intake, India, National Family Health Survey-3, women

Introduction: Tuberculosis (TB) continues to remain one of the most pressing health problems, with India being the highest TB burden country. India has adopted and enforced Directly Observed Treatment Short course (DOTS) strategy to combat TB. The fi rst line medicines in DOTS are known to cause adverse effects like gastritis, hepatotoxicity and skin allergies. This study was done to determine the occurrence of such adverse effects in patients under DOTS therapy and to assess their impact if any on patient compliance. Methods: A hospital based cross-sectional observational study was carried out on all newly diagnosed cases of TB as well as those registered in DOTS centre in Chest and TB department of a tertiary care hospital. A structured proforma was used to collect information regarding adverse effects of medicines under DOTS. Biochemical tests were done after voluntary consent. Results: A total of 168 patients (132 male, 36 female) were interviewed for the study. Patients reported adverse drug effects which mainly involved Gastro-intestinal system (39%), Genito-urinary system (32%), Musculo-skeletal system (13%), Central Nervous System (7%), Dermatological (6%), Vestibulo-ocular system (3%). 68.5% of the patients gave consent for biochemical investigations out of which Serum bilirubin (direct) was raised in 52%, Serum albumin was below normal limit in 59% and ESR was raised in 59%. Conclusion: Majority of adverse effects were mild. Most commonly encountered symptoms were abdominal. Most patients reported adverse drug effects to be the most likely cause to stop the treatment. Special interventions to cure these mild adverse effects can lead to increased patient compliance and hence a better cure rate. Results also showed that family plays the most important role as a support to combat the illness. Key words: Tuberculosis, adverse drug effects, hepatotoxicity

Background: Retinopathy of prematurity (ROP) is a disease related to low birth weight, prematurity, oxygen administration, and various other factors, which are yet to be identified. Aims: The aim was to fi nd incidence of ROP and risk factors for causation in babies weighing <1800 g; and in the babies weighing between 1501 and 1800 g. Design: Prospective study. Materials and Methods: Neonates weighing ≤1800 g taking birth in our institution from January 2011 to January 2012 for a span of 1 year; were included in the study. The data were analyzed to determine risk factors for ROP causation. Information was collected using the standardized performa which included the maternal risk factors as well. Infants were classifi ed by ophthalmologic examination fi ndings using ICROP revisited. Statistics: Qualitative data were analyzed using Pearson’s Chi-square test with Yates correction or Fisher’s exact test and possible risk factors were analyzed by univariate analysis and multivariate analysis. Results: A total of 278 subjects was included in the study. Incidence of ROP in babies ≤1800 g was found to be 13.67% (38/278). Incidence of ROP in babies weighing between 1501 and 1800 g was 11.64% (17/146). Twenty-one risk factors were signifi cant on univariate analysis in babies weighing ≤1800 g and 18 risk factors in the babies weighing between 1501 and 1800 g. Multiple gestations (P < 0.01), blood transfusion (P < 0.01), antepartum hemorrhage (P < 0.01), pregnancy-induced hypertension (P < 0.01), mechanical ventilation (MV) (P < 0.01), and APGAR at 1 min (P < 0.01) were found to be independently signifi cant for ROP causation on logistic regression analysis in babies weighing ≤1800 g and MV (P < 0.01) and resuscitation (P < 0.01) were signifi cant for babies weighing 1501-1800 g. Conclusion: It should be considered to incorporate screening of babies ≤1800 g uniformly in developing nations. It is recommended that further studies be done taking representative population of babies in different sites with adequate follow-up. Key words: Birth weight, retinopathy of prematurity, risk factors

Introduction: Cardiovascular disease is a major cause of death in patients with chronic kidney disease (CKD). Mortality due to cardiovascular events is ten to twenty times greater than in general population. Left ventricular hypertrophy (LVH) is an independent predictor of mortality in chronic kidney disease patients. There are only a few studies which have looked at cardiovascular disease in Indian chronic kidney disease patients. Materials and Methods: This was a cross-sectional study of 100 consecutive chronic kidney disease patients in the nephrology department of our hospital. They were divided into mild, moderate and severe chronic kidney disease. The various parameters were then compared between these three groups using the Tukey’s test. A P value <0.05 was considered significant. Results: Out of the 100 patients, 69 had LVH. In the severe disease category, 39 patients (88.63%) had LVH. In the moderate group, 18 patients (51.42%) had LVH. In the mild group, 12 patients (57.14%) had LVH. Only anemia was found to correlate with the presence of LVH. Conclusion: A significant number of CKD patients had LVH and the highest numbers of LVH were found in the severe CKD group. Key words: Anemia, cardiovascular disease, chronic kidney disease, left ventricle hypertrophy, prevalence

Background: Tobacco use is one of the most important preventable causes of morbidity and mortality in India. It is essential to study perception, practices and factors determining tobacco use to formulate the intervention for addressing this problem in the community. Materials and Methods: A cross-sectional study was carried out in 28 villages in Ballabgarh block of Faridabad, Haryana. This study aimed to understand factors determining tobacco use and to assess knowledge, attitude, practices about tobacco use and antitobacco act. Systematic random sampling was done to select study subjects. Total calculated sample size was 880. One eligible male and one female were selected randomly from household. Knowledge was assessed using semi-structured interview schedule while attitude using fi ve-point likert scale. In addition, focus group discussions and in-depth interviews were conducted among various stakeholders and opinion leaders to get insight about practices and factors determining tobacco use in the community. Results: Total 892 subjects were enrolled in the study, of which 51% were male. The mean age of the study subjects was 49.5 years (standard deviation: 17.5). Though awareness about harmful effects of tobacco use was reported, awareness about legislations under an antitobacco act was poor. Early initiation and continued use of all forms of tobacco were reported. Prevalent practice of tobacco use was attributed to pressure from peer groups, social customs and lack of de-addiction services at the community level by study subjects. Conclusion: Tobacco use in this rural community was mainly attributed to social and cultural factors. A multi-pronged public health approach is needed for addressing this complex problem the community. Key words: Antitobacco act, determinants, perception and attitude, rural India, tobacco use

Background: The single most dreaded complication in severe malaria is cerebral malaria, but extracerebral serious complications are becoming frequent in endemic areas, which include hepatic dysfunctions with jaundice. Materials and Methods: This prospective case series study was undertaken to observe the clinical profile in 81cases of complicated malaria presenting with jaundice out of 344 hospitalized patients diagnosed with acute severe malaria. Liver function tests were assessed and the patients were followed up to 4 weeks. Results: 85% cases with jaundice had Plasmodium falciparum (Pf) infection. Significant findings included a predominantly hemolytic jaundice (mean bilirubin 7.6 mg%, unconjugated 4.83 mg%, conjugated 2.79 mg%), raised ALT > AST (mean 101.2 vs.74.7 iu) and a mean prothrombin time of 3 sec > control. Acute renal failure was common (77%). No residual hepatic dysfunctions were detected in survivors on follow-up. Mortality was 10%, mostly due to delayed diagnosis and associated serious co-morbid conditions. Conclusion: Differentiating fulminant viral hepatitis with multi-organ failure and early treatment of associated complications are crucial to reduce mortality in malaria presenting with jaundice. Hemolytic jaundice with mild and relatively early reversibility of hepatocellular dysfunction usually points towards complicated Pf malaria. Histologically, there is mild hepatic derangement. Acute renal failure is commonly associated. Vivax malaria can also cause hepatic dysfunctions. Mere presence of jaundice does not increase mortality compared to those without jaundice Key words: Acute severe malaria, complicated malaria, malarial hepatitis, malarial hepatopathy, malarial jaundice

Background: The management of health care waste is the subject of considerable concern to public health. Unscientific disposal of health care waste may lead to the transmission of communicable disease which is a risk for health care professionals. Objective: The main objective of this study was to assess the awareness in the medical and paramedical students about bio-medical waste (BMW) hazards and management and to see the impact of clinical posting in knowledge regarding BMW handling. Materials and Methods: This was a cross-sectional type of study. A total of 240 subjects was enrolled, 60 each from 1st year students of MBBS, BDS, nursing, and MLT. They were interviewed for health care waste management practices. Results: Study shows overall awareness regarding BMW in nursing and MLT students were better than MBBS and BDS students. We found that about the infection like HIV almost all the students were equally aware but awareness about hepatitis B infection was more in MBBS and BDS students and also in nursing students compared with MLT students. All the students from four groups were almost vaccinated for tetanus toxoid but only 50% students were vaccinated for hepatitis B. Conclusion: The nursing and MLT students comparatively were having better knowledge and attitude than BDS and MBBS students in many aspects. However, overall knowledge of 1st year students from all the groups was not satisfactory and number of students those who were vaccinated for hepatitis B was also low which put them at risk. Key words: Bio-medical waste, health care waste, hospital

Background: Integrated Counseling and Testing Centre (ICTC) is a place where a person is counseled and tested for human immunodeficiency virus (HIV) and also a key entry point to the prevention of HIV infection and treatment of HIV infected people. The ICTC services are cost-effective and noncoercive intervention in the prevention of HIV/AIDS. The satisfaction of the clients availing these services indicates the quality of the services provided. Objective: The objective was to study the profile and satisfaction of clients attending counseling services of integrated counseling and testing centers in Delhi. Materials and Methods: The study was a descriptive, cross-sectional, health facility based study. The study was done in 20 ICTCs of Delhi. The ICTCs were chosen on the basis of population proportion to size. Consecutive sampling method was followed for recruiting the clients. After obtaining written consent, exit interview of 300 clients was undertaken. Results: Among 300 clients, 204 (68%) were males, and 96 (32%) were females. Majority, 267 (89%) of the clients were staying with family and 33 (11%) were staying with friends/roommates. The total number of referred clients was 270 (90%) and self-referred or direct walk-in client was 30 (10%). Among the direct walk-in/self-referred clients, 12 (40%) clients were recommended by their friends to come, 4 (13.3%) clients seek to avail ICTC services because of high risk behavior and 14 (46.7%) clients wanted to get tested for HIV as their spouse was HIV positive. About 96.3% of the clients who attended the counseling services were found to be satisfi ed. Conclusion: The proportion of self-referred/direct walk-in clients was very low, and low level of awareness about the HIV test and counseling services was found among the clients. This reflects the need to enhance the efforts directed at increasing the awareness of HIV test and counseling services. The satisfaction of clients could be further improved by better counseling sessions. Key words: Client satisfaction, human immunodeficiency virus counseling, integrated Counseling and Testing Centre

Background: Maternal and infant mortality rates and prevalence of under nutrition are high in the State Madhya Pradesh. Regular ante-natal check-ups (ANC), delivery by trained health personnel, delivery practices and optimal infant feeding practices are important to reduce maternal and infant mortality. Objectives: The aim was to assess antenatal care, delivery and infant feeding practices of mothers of <1-year-old children in Madhya Pradesh. Materials and Methods: This was community-based cross-sectional study carried out in the rural areas of Madhya Pradesh by adopting systematic random sampling procedure. Data were collected from 5324 mothers having <1-year-old children. Information on household (HH) socioeconomic and demographic particulars was collected from the mothers. Bivariate and multivariate analysis was performed to study the association between dependent and independent variables. Results and Interpretations: About 36% mothers had undergone at least three ante-natal check-ups and 73% delivered either at government or private hospitals. Only 26% mothers initiated breastfeeding within 1-h of birth and 92% fed colostrum. Step-wise regression analysis showed that ante-natal care for <3 times was signifi cantly (P < 0.01) higher among women with high parity (≥5), illiterate women, and among lower socioeconomic group,s while home delivery was higher among women with high parity (≥5) (odds ratio [OR]: 2.3), among Scheduled Caste and Tribe women (OR: 1.5), illiteracy of head of HH (OR: 2), and among lower socioeconomic groups (OR: 1.3).

Context: Identification of the effect of valid factors on students’ academic performance is of great importance to student counseling and policy making. Aims: This study was carried out to fi nd the predictors of academic performance of 2nd year undergraduate medical students of a renowned Medical College of Kolkata. Materials and Methods: This cross sectional study was carried out in a tertiary care teaching hospital of Kolkata. The information on factors like attendance percentage, sex, place of residence, previous academic performance of the entire batch of 2nd year students was collected from the departments’ academic records and through personal interview. The association of the above mentioned factors with students’ academic performance was determined through statistical analysis using t-test and multiple linear regression modeling and the results were reported. Results: Academic performance is found to be weakly correlated with attendance. Better academic grade was observed for the group with high attendance percentage compared to the other with low attendance percentage (P < 0.01). Higher percentage of marks was observed to be scored by female students (P < 0.01), local students (P < 0.01) and high performers who were capable of successfully clearing their 1st year’s coursework in their first attempt (P < 0.01). Conclusion: All the factors studied in this paper which includes attendance, sex, place of residence and previous academic performance serve as predictors in understanding students’ performance. Among the above mentioned, the attendance of the students is an important factor that has to be monitored and regulated through corrective actions to improve the performance of the class. Key words: Academic performance predictors, attendance, gender, past performance, residence, undergraduate medicine

Introduction: Early neonates are more prone towards infections and deaths. As a result we are interested in finding out the health behavior of inborn early neonates in a district hospital of Mysore. Materials and Methods: A total of 24,578 live births were monitored for their morbidity status from September 2011 to June 2013. The number of morbidity causes was detected for every 100 early neonates, monthly wise. The non-conformities behavior was observed through Poisson u-chart with variable control limits. 20% vital few contributors that contributes to variations in morbidity and mortality aspects of early neonates were detected through checklists and super imposed Pareto charts. Results: The number of causes per inspection unit for sample number 9 is out of control. Values corresponding to samples 1 and 2 are within the warning region. It appears that hypoxic ischemic encephalopathy (HIE)/moderate-severe birth asphyxia is the major contributing factor for both morbidity and mortality based on the occurrences. However, in the process of detecting the impact of morbidity factor on their corresponding mortality, it is found that the major nonconformity factor is major congenital malformation (MCM) and not HIE/Moderate-severe birth asphyxia as MCM has 0.217 chance of causing mortality, whereas HIE has 0.19 chance standing at the fourth position. Conclusion: We conclude that the hospital management needs to develop appropriate preventive and management strategies for the major causes viz., MCM, sepsis/pneumonia/meningitis and respiratory distress syndrome. Key words: Check sheet, early neonatal morbidity, early neonatal mortality, pareto chart, poisson random variable

Background: Donors disqualified or rejected from donating blood are known as “deferred” donors. Blood donors are deferred for various reasons. Donors are deferred either temporarily or permanently. To make blood transfusion safe for the patients, many safety measures are undertaken, and the most important is a selection of the suitable blood donors. The rate and reasons of deferral differ from region to region and one center to the other. Aim: The aim of this study is to fi nd out the impact of counseling on temporary donors deferral. Materials and Methods: A total of 271 donors is deferred against 10,853 blood donors recruited on the basis of clinical history and brief medical examination by medical officer during the period of 19 months from 1st of November 2009 to 31st May 2011. Those who were deferred temporarily during this period were counseled regarding the importance of blood donation and asked them to recruit after removal of the temporary causes. Follow-up of these temporarily deferred donors was done for 1-year. During this period, data collected were analyzed after 1-year of follow-up. Result: Incidence of donor deferral in our study was low. Most common reasons for the donor deferral in our study were alcohol consumption, followed by anemia and then, history of sexual exposure. A total of 124 temporarily deferred donors were recruited for blood donation. Conclusion: Voluntary blood donors are the backbone of blood bank. Deferral of the donors creates negative feelings about blood donation. Education, motivation, and treatment of these deferred donors due to anemia or other temporary deferrals are important aspects in blood banking and hence that these donors can be recruited again. Thus, effective measures need to be initiated to fi nd out the issue of lost donors in terms of numbers and reasons. Hence, it is important to retain the stock of precious blood units lost due to these temporary deferrals. Key words: Donors, impact of counseling, temporary deferral

Background: Children signify eternal optimism in the human being and provide potential for the development. Every nation whether developed or developing, links its future with the status of child. An understanding of the physical, social and behavioral factors is conducive to assess the current situation and vulnerability of any child. To ensure the utmost level of health and safety of a child, we need to have an insight of the violation of child rights. We conducted this study to assess and measure the breaches in child rights. Materials and Methods: A cross-sectional study was carried out among 200 children between 10 to 18 years of age in one of the field practice areas of Community Medicine department, B. J. Medical College, Ahmedabad. Results: More than 90% of the children were born in the hospital settings, fully vaccinated and living with their parents. Of these, 60% of the children reported to have some kind of illness in the past one year, and majority of them approached healthcare facility for that the treatment. Of these, 26% of them had low birth weight (LBW) and 68% had body mass index (BMI) <18.5. About 93% of the children were enrolled in either government or private school and out of them, 54% complained of the burden of either homework or tuition. Of these, 6.5% children were school dropouts and all of them were girls; 4% of them were child labors. Conclusion: The study indicated positive findings in the areas of child survival, development and to some extent, in the domain of right to participation, though there were poor environmental conditions and recreational activities. Prevalence of malnutrition and child labor was also high. Study results highlighted the need for adequate services in these areas. Key words: Child rights, right to development, right to participation, right to protection, right to survival

Introduction: There is little published information exploring the perceptions and physical activity patterns among undergraduate medical students in our country. So this study was conducted with the following objectives: 1. To assess the perceptions about knowledge regarding physical activities among undergraduate medical students; 2. To assess their self-reported physical activity practices. Materials and Methods: This cross sectional study was conducted in Kasturba Medical College, Mangalore from 12th to 30th April, 2012. A total number of 427 students were chosen at by using the formula for infinite population. Tools: 1. A semi-structured questionnaire to know perceptions, barriers, and practices about physical activity; 2. Physical activity was assessed using International Physical Activity Questionnaire (IPAQ). Analysis was done by using SPSS version 11. Significance of differences across various levels of physical activity between different age-groups and gender were made by chi square test. Results: 376 students participated. Majority of them had high physical activity (54.75%). Knowledge was poor about prevention of diabetes (68.9%), stroke (61.6%), and osteoporosis (33.8%). Majority (82.4%) of them perceived health related benefits of physical activity as motivating factors rather than prevention of chronic noncommunicable diseases. Most of them (72.3%) have enrolled in life style modification activities like yoga, going to gymnasium, etc. Conclusion: Most of the students fall into moderate physical activity group. Health-related benefits were the driving force for doing physical activity. Key words: Barriers, medical students, motivating factors, physical activity pa􀄴 erns

Introduction: Age-related macular degeneration (ARMD) is the leading cause of irreversible blindness in individuals over 50 years in developed countries. The objective was to study the various fundus fluorescein angiogram (FFA) patterns of exudative ARMD and monitor the treatment response and the change in visual acuity, macular thickness, angiographic patterns following intravitreal injection of bevacizumab and to assess the systemic risk factors for exudative ARMD. Materials and Methods: This prospective nonrandomized clinical study was carried out among 50 patients of ARMD diagnosed by FFA and optical coherence tomogram (OCT) with best corrected visual acuity of <6/24 (Snellen’s chart), Macular thickness by OCT, FFA was done before and after giving injection of bevacizumab. Patients were asked for regular followup at 2 weeks, 4 weeks, 8 weeks, 12 weeks and 16 weeks. Results: Fifty-two percent cases with classic choroidal neovascular membrane (CNVM) showed 1 line improvement at the end of 2 months and 56% of cases showing 2 lines improvement at 4 months. About 50% of occult CNVM showed more than 2 lines improvement at 4 months. About 50% of Classic CNVM and 40% of occult CNVM showed reduction in macular thickness of 50 μ at the end of 2 months, and 52% of both CNVM types showed reduction of 100 μ at the end of 4 months. Conclusions: In India ophthalmologists feel that AMD is an uncommon condition. By this study, we proved that although its prevalence rate is low in India as compared with Western countries, Indians are not immune from developing AMD. Key words: Bevacizumab, fundus fluorescein angiogram, optical coherence tomogram

Background: Intestinal parasitic infection is an important public health problem in developing countries. Low socioeconomic conditions, lack of access to potable drinking water, poor personal hygiene and environmental sanitation are the factors associated with intestinal parasitic infection. Aim: The aim of this study was to estimate the prevalence of intestinal parasitic infections and identify the associated risk factors. Materials and Methods: Study was performed on 327 stool specimens of all age groups from August 2012 to May 2013. Specimen collected and examined with direct wet mount, formal ether sedimentation and salt flotation methods. Results: Out of the total 327 participants prevalence of intestinal infections was 11.62%. Among the Protozoa, Giardia lamblia (3.06%) was the most common, followed by Entamoeba histolytica (0.92%). Hookworm (2.75%) and Hymenolepis nana (2.14%) were the most common helminths found. Parasitosis was seen more in female (17.07%) than male (8.33%) and highest between 51 and 60 years (22.22%) age group with risk factors like open defecation (22.69%), untreated river water (17.91%) and among people living in rural areas (15.17%). Conclusion: There is a need to create awareness about safe drinking water, personal hygiene and environmental sanitation and to take urgent remedial steps to prevent and control intestinal parasitic infections. Key words: Ascaris lumbricoides, Giardia lamblia, India, parasitosis

Introduction: Occupational stone dust exposure may result in several health risks tuberculosis (TB) silicosis, obstructive as well as restrictive lung diseases, among which TB is more prevalent in developing countries like India. Most people residing in Bhedaghat engaged in carving statues from variable stones and marble rocks belongs to poor socioeconomic conditions and unaware of the preventive measures. Ultimately they end up in chronic respiratory problems and various complications. Objective: The study was carried out to fi nd the effect of marble stone dust exposure on the prevalence of TB and to study some of associated epidemiological factors and effect of working environment. Materials and Methods: The present study is cross-sectional study with a comparison group, which was matched for age, sex and socioeconomic status, unexposed to similar working environment, that is, carving and cutting marble stones. Using interview technique demographic, occupational and clinical details were recorded on the predesigned proforma. For pulmonary TB among study subjects already detected, cases were included, and those strongly suggestive on the basis of clinical history were confirmed by means subsequent sputum smear examination and radiography. Statistical analysis was carried out by using Statistical Software Package Epi Info 7. Results and Conclusion: Overall prevalence of pulmonary TB was 6.25% among marble stone workers while in the comparison group it was 4.38%. Among marble stone workers, the prevalence was more among workers working in closed and congested room and not using any personal protective measures and employed in stone cutting for >5 years. Key words: Marble stone dust, pulmonary Koch’s (tuberculosis), working environment

Background: A comprehensive health care services requires effective human resource (HR) management policy to ensure organizational success. Government is primarily concerned with the size of the workforce rather than the contemporary HR practices. This resulted into lack of attention to HR management in health sector. Objective: To critically examine HR policies and practice for primary health care system in Delhi. Materials and Methods: For critical analysis of HR policies and practices for primary urban health centers, related documents were examined from year 2005 to 2012. The policies and practices were examined with reference to HR planning, recruitment, selection, hiring, staffing, probation, induction training, performance evaluation, salary and transfer policy in the organization. Results: At present, updated HR planning is not done regularly and due to lack of such updated information actual HR requirement is not calculated leading to shortage backlog. To fi ll up this shortage contractual model to recruit staff has been adopted by health department. There is no induction training and training need assessment done in the organization. There is wide disparity in pay and leave provisions for different category of regular and contractual staff working under the same roof of health facilities. Conclusion: Disparity in salary, leave provision and other privileges in organization have brought discrimination and demotivation among employees. To deal with conflicting climate in organization comprehensive HR policy is suggested. Policy content should include HR planning, training and development, institute capacity building, HR information system, motivation, and retention strategies for HR. Key words: Contract, Delhi, health care, human resource

Context: On the basis of emerging evidence, it is now apparent that primary hypertension is detectable in the young and that it occurs commonly. The long term health risks for hypertensive children and adolescents can be substantial. Early diagnosis of hypertension (HT) is an important strategy in its control. Previous studies have documented that hypertension may begin in adolescence, perhaps even in childhood. Aims: To determine the prevalence of hypertension and its correlation with anthropometric variables like height, weight and body mass index (BMI) among school-going children in Nagpur city, Central India. Settings and Design: Cross-sectional study done in one randomly selected school. Materials and Methods: School-going children aged between 12 and 16 years were included in the study. The weight and height were measured using a standard procedure. Blood pressure measurements were taken by a mercury sphygmomanometer. Hypertension was diagnosed if blood pressure was more than 95th percentile for the age and height. The distributions of blood pressure by anthropometric characteristics were studied. Statistical Analysis Used: Mean, standard deviation, correlation coefficient and χ2 test were used for statistical analysis. Results: The overall prevalence of hypertension was found to be 11.77%. Blood pressure of both genders appears to have positive correlation with anthropometric characteristics. Conclusions: Increase in anthropometric measurements like height, weight and BMI were found to be positively correlated with hypertension among school children in the present study. Key words: Anthropometric measurements, hypertension, obesity, school children

Purpose: Remarkable and uncontrollable changes with modification during pregnancy are connected with the autonomic control and consequently with the heart rate variability (HRV). Heart rate variability is a sum of different mechanisms and if pregnancy is a state of change, these modifications could be extracted from HRV analysis. Objective: To assess the effect of pregnancy on heart rate variability among pregnant mothers during first trimester of pregnancy and third trimester of pregnancy. Materials and Methods: HRV was measured for 5 minutes of continuous recording of electrocardiogram (ECG) lead II, using windows based HRV analysis system variowin-HR after obtaining permission from the Institutional Review Board of Government Medical College, Bhavnagar and written consent from 30 pregnant subjects and 30 non-pregnant control subjects at autonomic function lab, Dept of Physiology, Bhavnagar. Result: Frequency domain parameters, very low frequency (VLF), low frequency (LF), high frequency (HF) and HF normalized unit (nu) were significantly decreased and LF (nu) and LF/HF significantly increased in pregnant subject in 3rd trimester as compared to their 1st trimester of pregnancy. Time Domain parameters like SDNN, RMSSD, SDSD, NN50 count, pNN50, SD1/SD2, triangular HRV index and average R-R interval were significantly decreased during 3rd trimester of pregnancy. Conclusion: The inhibition of resting parasympathetic activity or vagal blockage and an increment of the sympathetic modulation during the 3rd third trimester of gestation in pregnancy as compared to their 1st trimester and healthy non-pregnant subjects. Sympathovagal imbalance and abnormally low HRV may more pronounce during later stage of normal pregnancy. Key words: Autonomic function test, gestation, heart rate variability, pregnancy

Background: Meningitis is an inflammatory affection of the membranes surrounding the brain and spinal cord, which occurs as either a primary disease or secondarily to disease in some other part of the body. The epidemiological trend of acute meningitis varies with time and geography. Objective: To isolate the various agents of acute meningitis in all age group patients and to know the antimicrobial susceptibility pattern of bacterial isolates. Materials and Mathods: In this prospective study, a total of 316 cerebrospinal fluid (CSF) specimens were collected from patients showing signs and symptoms of acute meningitis and processed by standard microbiological methods in a tertiary care hospital in Guwahati, Assam over a period of one year, from August 2009 to July 2010. Results: Out of 316 CSF samples, bacterial and fungal culture positivity rate was found to be 16.13%. The most common bacterial isolate was Staphylococcus aureus, 29.41%. Isolation rate of Cryptococcus neoformans was 8%. All the Gram positive isolates were 100% sensitive to linezolid and vancomycin, whereas Gram negative isolates were 92% sensitive to polymyxin B. Conclusion: This study gives an idea about the changing trend of acute meningitis along with the changing in vitro antimicrobial susceptibility pattern of the bacterial isolates, which can help the clinicians to formulate the initial empiric therapy for patients of acute meningitis. Key words: Acute meningitis, MRSA, sensitivity patern

Background: In the pluralistic environment of Indian healthcare financing system, community based health insurance (CBHI) holds promise to reduce the share of out of pocket (OOP) expenditure on healthcare by the households. The present study explores the extent to which the mutual model of CBHI could reach the socially and economically marginalized population along with investigating the reasons of drop-outs from the scheme in the city of Mumbai and Pune. Methods: This study used a cross sectional exploratory study method, using simple random method, conducted in slums of Mumbai and Pune. Results: The financial protection provided through health mutual fund (HMF) is still on the lower side when compared with annual OOP expenditure due to health by the household. The enrolment pattern shows that the scheme covers the marginalized people belonging to lower castes and minority community, employed in the unorganized sector. HMF is playing an important role in providing financial protection against the high frequency illness which is not covered under state sponsored schemes. Conclusion: Factors behind the members dropping out of the scheme were found to be no benefit from the scheme, inability to pay a premium, member of Employees State Insurance Scheme, unsatisfactory services from network provider and past negative experiences including claim rejection or low reimbursement. The study holds larger policy implications as there is limited study conducted to know the pattern of enrolment and exploring reasons of low rates of renewals. Key words: Community-based health insurances, health mutual fund, “mutual” model of community-based health insurance, out of pocket expenditure

Introduction: Children spend most of the time in school where they are exposed to various types of minor injuries, which influence their present and future state of health. First aid is the treatment of any injury or illness before availability of professional medical aid. Teacher is the key person who can attend the children for minor injuries in school through complete knowledge regarding first aid management. This study was done among primary school teachers to evaluate the effectiveness of teaching program on knowledge and practice regarding first aid management of selected minor injuries in children. Materials and Methods: A Quasi-experimental study with one group pre- and post-test research design was conducted among the primary school teachers of Dehradun district of Uttarakhand. Fifty primary school teachers were selected by nonprobability convenient sampling. Data were collected by knowledge questionnaire (maximum possible score 42) and self-reporting checklist (maximum possible score 23). Result: Majority (94%) of the teachers were female. Paired sample t-test revealed that the mean posttest knowledge score regarding first aid management of selected minor injuries was significantly higher (34.76 ± 4.35) than that of mean pretest knowledge score (27.32 ± 5.73) (P < 0.005); mean posttest practice score was significantly higher (18.52 ± 2.63) then mean pretest practice score (14.52 ± 2.39) (P < 0.005). There was a significant positive correlation between knowledge score and practice score of participants (r = 0.9; P < 0.001). Conclusion: This concludes that the training program was effective in significant improvement of knowledge and practice score regarding first aid management of selected minor injuries among study participants. Findings stress the need for such training programs, which in turn may enhance the overall health standard of the children. Key words: Educational package of first aid, first aid management, knowledge and practices of teachers, primary school teachers, selected minor injuries

Introduction: Foreign bodies in the digestive tract are an important cause of morbidity and mortality in paediatric age group and pose diagnostic and therapeutic challenges We performed this study to evaluate our experience of foreign bodies of digestive tract in children over a five year period in a tertiary referral center. Patients and Method: A retrospective study was conducted over a 5-year period between April 2009 and March 2013. All patients who were managed for foreign body in digestive tract up to 12 years of age were included and analysis was performed from case record of patients. Results: Total 97 patients with FB in digestive tract were included in the study FB was most commonly lodged in Upper esophagus in 61 patients, middle esophagus in 12 cases lower third of esophagus in 14 cases and beyond gastro-oesophageal junction in 10 cases. The most common clinical presentations were dull pain. Coins were the most common type of foreign body in the esophagus accounting for 71.1% of patients. Plain neck and chest x-rays antero-posterior and lateral view was diagnostic in all cases, with all FB being opaque. Rigid oesophagoscopy and removal under general anesthesia was the main treatment modality performed in 63 (65.8%) and Magill forceps extraction was done in 20 cases. Conclusion: Foreign bodies in digestive tract of children are a common problem with diverse presentation. Disc battery ingestion is prone for complication and expedient removal is required & associated conditions can pose risk for lodgment of foreign bodies. Key words: Anesthesia, digestive tract, foreign body

Context: Respiratory diseases are one of the leading causes of deaths world-wide. There are no published studies on the pattern and determinants of respiratory mortality from South India. Aims: The aim was to fi nd out the pattern and determinants of respiratory mortality during July 1, 2002 to June 31, 2008 in Varkala, Thiruvananthapuram district, Kerala. Settings and Design: A nested case control study from a prospective cohort was done to fi nd out the determinants for respiratory mortality. The main outcome measure was mortality due to respiratory causes. Materials and Methods: The data collected here are from the Population Registry of Lifestyle Diseases study, a prospective cohort study involving the long-term followup of the residents of Varkala rural development block Thiruvananthapuram district of South Kerala. Statistical analysis used: The age specific respiratory mortality rate was calculated. Chi-square test and odds ratio (OR) were measured to fi nd out the association between exposure and outcome variables. Logistic regression was performed. Results: A total of 3467 deaths were reported among 77881subjects above the age group of 20 years during the follow-up period. Of which 531 (15.9%) were due to respiratory causes. On logistic regression smoking (AdjOR [95% confidence interval]; 1.65 [1.25, 2.17]), lower socioeconomic status (AdjOR; 1.52 [1.24, 1.87]), lower educational status (AdJOR; 2.22 [1.15, 4.29]) and old age (>60 years) (AdjOR; 2.6 [2.03, 3.33]) were found to be the significant risk factors for respiratory mortality. Conclusion: Mortality due to respiratory causes was found to be high in Kerala, a state which has the best health indicators compared to other states in India. Key words: Determinants, pattern, respiratory mortality, seasonal trends, smoking

Background: Menstruation is the physiological process, but its physiology and nature are very poorly understood among the female population due to many sociocultural factors which make them to adapt certain practices unknowingly whether it is correct or false. This study was done with the objectives of exploring the menstrual practices followed among urban and rural female population. Materials and Methods: This study was done as a community based – cross-sectional study at the outskirts of Chennai, among the randomly selected females in the reproductive age (15-44) group from both rural and urban field practice areas using questionnaire and interview method. The results were expressed in percentages, and appropriate test of significance was performed. Results: Approximately, a total of 212 from the rural area and 206 from urban slum were randomly selected for the study of which 9% (19) from rural and 5.3% (11) not aware of sanitary pads that can be used during menstruation. Among the study participants, 42.5% (90) of rural and 40.3% (83) of urban were unaware from which organ menstruation is from. The prevalence of better menstrual hygienic practices using the menstrual hygiene index was found to be 63.6% (131) in urban slum and 35% (75) in a rural area which was found to be statistically significant (P < 0.0001). Conclusion: Our study has revealed that most of the females are still unaware menstrual hygienic practices which suggest that appropriate health promotive measures to be implemented for their reproductive well-being. Key words: Knowledge and attitude on menstrual process and practices, menstrual hygiene, menstrual hygiene index, menstrual practices, rural and urban slum, sociocultural restrictions

Background: In India, there is low awareness about special needs of the elderly and their care takers. We are yet to understand the basics of elderly care (physical and mental health, psychological and social support). Objectives: (1) To study the dimensions of quality of life (QOL) of elderly people living in community and in old age homes (OAHs). (2) To determine the predictors of QOL among elderly people. Materials and Methods: A cross-sectional descriptive study was undertaken with elderly people (age ≥60 years) from the community and from OAHs residing in Lucknow city, India were the participants. Multistage sampling technique was used in the general population and all the elderly people living in OAHs were included in the study. 141 elderly people from community and 101 elderly people from OAHs were studied after taking oral consent and scoring ≥20 on Mini Mental State Examination instrument. Instrument used for assessing QOL was World Health Organization QOL-bref. Tools used to screen out anxiety and depression cases were Geriatric Depression Scale — Hindi version and Hamilton Anxiety Rating Scale. Results: The mean scores of QOL domains were higher among married elderly people, elderly people without mental health problem and elderly people without psychosocial issue/s. Similarly, it was higher among elderly people living in the community and paid OAHs than in free OAHs. Conclusion: QOL of elderly residing in paid OAHs were similar to those from the community. Financial dependency was the strongest predictor of QOL. Key words: Elderly people, old age home, quality of life, World Health Organization quality of life-bref

Introduction: Tuberculosis remains a worldwide public health problem. The emergence of human immunodeficiency virus infections (HIV) has further complicated the disease burden as it has rapidly increased the risk of pulmonary and extrapulmonary tuberculosis (EPTB). EPTB is an important clinical entity. The precise diagnosis is very important because early detection of cases and effective treatment if instituted at the right time completely cures the patients of the disease. Objectives: To fi nd out sensitivity and specificity of Ziehl-Neelsens staining (ZN), Auramine staining, and rapid slide culture technique (RSC), comparing them with growth on Lowenstein- Jensens medium (ZN) as the gold standard. Materials and Methods: The present study included 66 clinical specimens from patients suspected of EPTB inclusive of HIV-infected patients. They were subjected to ZN and Fluorescent method of staining, culturing by LJ and RSC method, and comparing growth on LJ medium as the gold standard. Results and Conclusion: Mycobacterium tuberculosis was isolated in 24.2%. Nontuberculosis Mycobacterium was isolated in 6% of the 66 samples processed. The highest number of isolation was from lymph node aspirates (83.3%). 2% of the samples were HIV seropositive. Key words: Extrapulmonary tuberculosis, Lowenstein-Jensens, rapid slide culture

Background: Violence is a major public health problem which affects the community and threatens the life of people. Objectives: To estimate the prevalence and different forms of violence among HIV positive young adults taking antiretroviral therapy (ART) in Udupi district. Materials and Methods: A cross-sectional study was carried out among HIV positive young adults (18-35 years) who were aware of their status. The participants were selected from ART Centre of Udupi district adopting convenience sampling. Data were collected from 200 young HIV positive young adults using a predesigned, pre-tested self-administered questionnaire. Results: The overall prevalence of domestic violence was 14.5% and was found to be more among females (17.6%) as compared to males (6.9%). This difference was statistically significant among gender with a P-value <0.05. Among the various forms of violence the prevalence of physical violence was found to be 14.5% with significant difference among gender. Among females who experienced physical violence, husband was perpetrator in 76% cases and among males, parents/relatives as the perpetrator in 75% cases. Around 8.5% of females had experienced sexual violence and husband was perpetrator in 50% of the cases followed by relatives and friend/acquaintance. Conclusion: Physical and sexual violence was found to be more in female HIV positive patients as compared to males. The presence of violence among HIV positive young adults especially among the females demands for the concerted efforts at combating underlying factors leading to violence among this vulnerable group of HIV positive young adults. Key words: ART, HIV positive, physical and sexual violence, young adults

Background: Stigma related to mental illness is linked with suicide, violence, and lack of self-care, and thus should be treated as a clinical condition. For effective intervention, objective information about the impact of stigma is required in order to offer the best client-centered care. Objective: The present study seeks to answer the question of how stigma and discrimination are perceived to be experienced by their patient family members, to determine factors helpful for development of antistigma intervention programs. Materials and Methods: Three hundred family members of patients with schizophrenia provided their perceptions on aspects of stigma including anti-stigma interventions. There were two types of intervention strategies suggested (1) clinical measures and (2) public health measures. The predominant strategy was clinical measures which encompassed areas of availability of treatment, complete treatment, relapse prevention, and early intervention. Results: Furthermore, caregivers’ emotional involvement (64.8%) in treatment was seen as an important measure to reduce stigma. No social and public awareness is going to bring change in patients’ lives if stigma is not addressed at an individual level in a client-centric manner. Conclusion: The responses of patient relatives clearly bring out this opinion when they suggest potential treatment components as intervention measures. Key words: Caregivers, intervention, public health, stigma

Background: To fi nd out the prevalence of hemoglobinopathies by screening large population in West Bengal from Eastern India. Materials and Methods: A total of 50,487 subjects are screened for hemoglobinopathies from June 2010 to August 2013. A 2.5 ml of venous blood samples were collected in the tri-potassium EDTA vacuum container from each subject and tested with automated blood cell counter (Sysmex KX21) for red cell indices. Diagnosis of hemoglobinopathies was done by VARIANTTM (Bio-Rad Laboratories, Hercules, CA, USA) high performance liquid chromatography (HPLC). Results: Out of 50,487 cases, 44,620 (88.38%) had normal and 5,867(11.62%) showed abnormal hemoglobin fractions on HPLC. Of these, 5,180(10.26%) were heterozygotes (traits) and 687(1.36%) cases were either homozygotes or compound heterozygote for different types of hemoglobinopathies. The following hemoglobinopathies were present: β-thalassemia trait 6.61%, HbE trait 2.78%, sickle cell trait 0.56%, HbD-Punjab trait 0.21%, β-thalassemia major 0.73%, HbEE 0.05%, compound heterozygosity for HbE-β-thalassemia 0.42%, and HbS-β-thalassemia 0.15%. Conclusion: Among the hemoglobinopathies, β-thalassemia trait (6.61%) and HbE trait (2.78%) are prevalent in rural Bengal. Key words: Hemoglobinopathies, HPLC, prevalence, West Bengal

Background: Bank employees are considered to have work situation bearing directly on the health status of individual. Materials and Methods: The employees were subjected to a detailed interview, examination and appropriate laboratory investigations. Data analysis was done using the SPSS 11.5. Results: About 50% of the population had presence of more than, one coronary risk factors. Conclusion: The prevalence of various risk factors for bank employees paralleled the prevalence rates in urban areas as per other studies and hence appropriate counseling and other interventional measures need to be instituted in this vulnerable population, to prevent cardiovascular disease. Key words: Bank employee, coronary risk factors, diabetes, hypercholesterolemia, hypertension, sedentary lifestyle

Joubert syndrome (JS) is a rare autosomal recessive disorder with key finding of molar tooth sign (MTS) on axial magnetic resonance images (MRI). Six phenotypic subgroups are known in JS: Pure JS, JS with ocular defect, JS with renal defect, JS with oculo renal defects, JS with hepatic defect, and JS with orofaciodigital defects. We are reporting a case of 14-year-old boy, who presented with oculoorofaciodigital defect (polydactyly, syndactyly, ankyloglossia, ptosis, retinal dystrophy) with endocrinopathy (gynecomastia, micropenis, low testosterone) and MRI suggestive of MTS. Such kind of oculo-orofaciodigital defect with endocrinopathy (without puebarche, thalarche and menarche until the age of 17 years with hormonal disturbance) was also found in his elder sister. JS with endocrinopathy is a rare presentation, this is either expansion of the spectrum of JS in Indian people or a combination with endocrinopathy can evolve in later age. Key words: Endocrinopathy, joubert, molar tooth sign, oculo-orofaciodigital

Human immunodeficiency virus (HIV) cases are on the increase in India and worldwide, so are its various complications. Neurological complications are important causes of morbidity and mortality in patients with HIV infection. They can occur at any stage of the disease and can affect any level of the central or peripheral nervous systems. In the literature, several cases of HIV-associated facial paralysis have been reported; however, bilateral facial palsy is rarely reported. Key words: Central nervous system, facial nerve palsy, human immunodeficiency virus

Oral submucous fi brosis is a chronic debilitating disorder, which is usually seen in adults with areca nut quid chewing habit. A rapid upsurge in the popularity of commercial areca nut quid products, especially among the younger generation, is a cause of grave concern, as satisfactory management is still lacking. A case of oral submucous fi brosis in an 11-year-old boy is presented along with histopathological findings, highlighting strong association of areca nut chewing as the potential factor in the etiology of this condition. Key words: Areca nut quid, oral submucous fi brosis, pouch culture

Hiatus hernia refers to upward displacement of the stomach through the diaphragmatic esophageal hiatus into the thoracic cavity. It is rare in children and may be asymptomatic or may present with various symptoms. We are reporting a case of sliding hiatus hernia detected incidentally in a 6 year old boy. Key words: Barium swallow, chest radiograph, computed tomography scan, hiatus hernia

Juvenile myasthenia gravis is a rare disorder acquired in childhood, representing 10% to 15% of all cases of myasthenia gravis. Like the adult form, it is generally characterized by an autoimmune attack on acetylcholine receptors at the neuromuscular junction. Most patients present with ptosis, diplopia, and fatigability. More advanced cases may also have bulbar problems and limb weakness and may progress to paralysis of the respiratory muscles. Key words: Acetylcholine receptors antibodies, opthalmoplegia, ptosis

Trichuristrichura (whip worm) is one of the most common intestinal parasite of humans in tropical countries. Often asymptomatic in humans, heavy infection can lead to chronic bloody diarrhoea associated with complications like rectal prolapse (particularly in children), appendicitis, colitis and proctitis. Very few cases of extensive Trichuriasis have been reported worldwide. We report a case of a 5-year-old girl who presented with generalized weakness, bleeding per rectum and rectal prolapse of 1 year duration. She was investigated for bleeding per rectum. Colonoscopy performed revealed extensive worm infestation involving the entire colon which was later confirmed as Trichuristrichura (whip worm) by microscopy. Child was diagnosed as Trichuris Dysentery Syndrome (TDS), treated for the same and discharged on improvement of the symptoms. The patient was traced back using the address available from the hospital records as she was not brought to the hospital for further follow up. Although none of her symptoms recurred, her stool microscopy however showed the presence of Trichuristrichura ova even at the end of 2 years indicative of persistent asymptomatic Trichuristrichura infection. Key words: Colonoscopy, Trichuris Dysentery syndrome (TDS), Trichuristrichura

International Diabetes Federation’s fifthedition of diabetes atlas estimates that there are around 63 million people with diabetes in India, second only to China.[1] Indians are more prone to develop diabetes due to their peculiar gene structure and lifestyle.[2] Despite having so many persons with diabetes in the country there is no nationwide data available for India.[3] A study was conducted in an urban slum of Delhi, the national capital of India in 2005 to fi nd out the prevalence of self-reported diabetes among females of age 18 years or above. The current treatment practices of these persons with diabetes were assessed. This was a community-based cross-sectional study wherein the respondents were selected by systematic random sampling from the three blocks selected randomly from the six blocks covered by the health workers from the All India Institute of Medical Science, New Delhi.

Oral pathology is a recognized specialty of dentistry, deals with the nature, identification and management of diseases affecting the oral and maxillofacial regions. It is always a fascinating and exquisite subject in diagnosing and managing the diseases affecting the oral cavity. Oral and maxillofacial pathologists (OMP) complete a 3 year accredited training program that provides education in the microscopic and clinical diagnosis of diseases within the oral cavity and maxillofacial complex. Medical error is a common problem and its human cost in terms of disability, suffering, and death is stunning. Steps toward reducing medical error will require the identification of mistake-prone practices within a complex health care system. Erroneous pathologic diagnosis has been identified as one source of error.[1] Among disease sites, the head and neck can be a particularly problematic area for pathologists, prompting a frequent secondopinion, which is intended to expose clinically significant errors that have a direct impact on patient care.[2]