Vol 2, Issue 1, Jan-Mar, 2012

Unintended pregnancy is a global problem, which affects women, their family and society at large. Abortion is a frequent consequence. There are about 50 million pregnancies terminated each year. In US almost 50% pregnancies are unwanted.[1] As long as condoms tend to slip or diaphragms break and cervical caps tend to move out of place, pill users forget to take their tablets regularly, there will be need for use of emergency contraception. Other potential users are women who engage in an unprotected sexual activity either being forced (as in case of rapes) or coerced into having unplanned, unprotected intercourse protected intercourse can use emergency contraception. Almost every woman of reproductive age who is sexually active and fertile and wishes to prevent unintended pregnancy can use emergency contraception.

Oral biopsy is considered essential for diagnosis of diseases of the oral mucosa, and subsequent treatment planning. Taking biopsies are widely used in all specialties of medical fields; the practice is not common among dental practitioners, this may be because of lack of awareness among Dental surgeons. The ability of the oral pathologist to interpret a lesion is mainly dependent on a good biopsy performed by the dental surgeon. The purpose of this review is to discuss indications, contraindications of taking oral biopsy and highlight important potential pitfalls that may occur during biopsy technique, an effort has been made to discuss the role of a Dental surgeon in diagnosing the pre-malignant, malignant lesions thereby helping in decreasing the incidence of oral cancers is also discussed here.

Vaccine technologies have remained a favorite tool for the techno-centric policy establishment to address the morbidity and mortality burden of disease while neglecting comprehensive social, economic and health systems development. Even as implementation of immunization for six primary vaccines remains far from optimal, misplaced arguments are furthered for introduction of newer vaccines. Policy on vaccines in India has tended to be swayed by unhealthy considerations that are extraneous to an epidemiological approach. The paper examines relevant literature to highlight the factors shaping the country’s vaccination policies; discusses methods for optimal cost benefit analysis of vaccines, and proposes desirable criteria of an epidemiologically guided vaccine policy. For newer vaccines, public health burden of the targeted diseases, their epidemiology, possible ways of ameliorating the disease burden are chronicled to evaluate the desirability of these vaccines in the current scenario. Rota virus vaccine, the Hib pentavalent vaccine and the HPV (Human Papilloma Virus vaccine) are discussed. The paper is organized in two parts. Part 1 deals with the influences guiding vaccine policy and the percepts of a scientific vaccine policy. Part 2 discusses the case studies of Rota virus and Hib pentavalent vaccines; the two vaccines being intensively targeted for inclusion. There is a structured impetuousness on part of the pro-vaccine lobby to push for the inclusion of newer vaccines, without adequate regard to epidemiology and feasibility. Accordingly the paper argues against adoption of these vaccines in public health programs under the present circumstances. Key words: Immunization, vaccine, Rota virus, Hib

Part 1 has dealt with agenda setting in vaccine policy, the percepts of a scientific vaccine policy. Part 2 of the paper discusses the case of Rota virus and Hib pentavalent vaccines. The background, methodology and the results / conclusions of Part 2 remain along the line for the first Part. The thrust of the paper is to strengthen the case for an epidemiologically guided decision regarding inclusion of new vaccines. Key words: Vaccine, Pentavalent, Carcinoma cervix, Hib

Aim: To evaluate the effectiveness of the STOC model for continuous quality improvement in improving patient care in two AIDSRelief (AR) HIV treatment facilities in Uganda Methods: In the initial stages, health workers in 17 AIDS Relief HIV treatment facilities were trained in continuous quality improvement (CQI). Consequently, the health workers built CQI teams and used a See Try Observe Continue (STOC) model adapted from the Plan Do Study Act (PDSA) approach to improve gaps identified for change and evaluated their success. A simple excel tracking tool was developed to follow up on the progress of the use of paediatric pharmacy order forms in Bushenyi Medical Centre (BMC) as well as missed ARV pick up in Kabarole hospital. Both descriptive and graphical findings were recorded during the pre and post follow ups. Results: The different clinics implemented at least one cycle of STOC for specific problems and registered improvements in patient care. At BMC, there was an improvement of usage of the paediatric pharmacy order forms from <5% to >50% of the paediatric patients seen in each month as well as improved recording of children’s weight and height, parameters crucial in growth monitoring. There was a significant reduction in number of patients who missed picking their ARVs from 28/1000 in Month 1 to 5/1000 in month 7 to 1/1000 patients in month 10. Conclusion: STOC model encourages and enhances evidence-based practices in the AR clinics. CQI activities enhanced by implementation of STOC to improve identified gaps at the facilities are imperative to achieving effective patient care. Key words: Continuous quality improvement, PDSA, teams

Aims and Objectives: To assess the applicability of WHO health related quality of life instruments [BREF version] on the adolescent medical students of West Bengal. Methodology: A cross sectional study conducted in six medical colleges of West Bengal, India. The medical students of less than 19 years were taken for the study. The questionnaires of WHO HRQOL BREF was prepared as a proforma and was distributed in six medical colleges and responses were collected .The data was computerized and was analyzed by SPSS version16 software. Results and Interpretation: 132 cases were examined finally with mean age of 18.76 years. The numbers of males were 91 [68.9%] and the numbers of females were 41 [31.1%]. The responses are different in males and females and in students from medical colleges of Kolkata [state capital] or outside Kolkata. The validity of the questionnaire in this subset of population is found mainly in the psychological domain. Conclusions: WHO HRQOL BREF is a good tool to assess the health related quality of medical adolescents. Key words: Adolescent; medical student; Health related quality of life [HRQOL]

Backgound: The adverse association of cardiovascular risk factors in both children and adults with parental history of disease is well recognized. A family history of hypertension has been shown to be a risk factor for the subsequent development of disease. This study is aimed to compare any observed differences in the mean BPs, BMI, Hip waist ratio in children of hypertensive and normotensive parents. Methodology: A cross sectional study was conducted among the 100 students of faculty of medicine of a University. Blood pressure and anthropometric measurements were taken. Results: Among the 100 participants studied, 63% were male and the average age was 19.76 years (SD ±2.01) with a median of 20 years, varying from 18 to 24 years. The mean systolic blood pressure in males with history of hypertensive parents was 131.7 ± 13.5 as against 121.2 ± 10.1 in females with history of hypertensive parents. The difference was statistically significant (p<0.002). The mean diastolic blood pressure was also significantly higher in males with history of hypertensive parents than females with history of hypertensive parents (86.2 ± 11.3 in males versus 78.7 ± 10.3 in females). The BMI positive correlation with systolic blood pressure (SBP) and diastolic blood pressure (DBP) was found. Conclusion: The findings of the present study suggest the need of monitoring the BP of children of hypertensive parents. Health care providers, therefore have an important role to play in educating families and children about approaches that are useful in preventing hypertension. Key words: Waist-hip Ratio; BMI; Hypertension; hypertensive parents

Background: The first goal of National Rural Health Mission (NRHM) and the fourth goal of Millennium Development are to reduce under-five mortality rate. In India, data is available for aprox. 3% of the perinatal deaths. The need for good quality data on perinatal deaths is mandatory for public health planning and resources allocation. This has lead to a renewed interest in Verbal autopsy (VA) in poor resource settings. Objective: To validate a simplified community-based VA instrument. Materials and Methods: A simplified community-based VA instrument was developed. The sample size of 50 was calculated at power – 80%, significance – 5% and sensitivity – 70%. ANMs were trained to assign COD according to the ICD – 10. Following which they administered Verbal Autopsies for every perinatal death occurring in their area. A panel of 3 Physicians was formed who reviewed the VA data and assigned cause of death according to the ICD–10. Kappa Statistics was used to measure the degree of agreement between the ANM and Physician panel assigned COD. Results: Out of 50 Perinatal Deaths, the COD assigned by ANM and the COD assigned by the Physician panel were same for 40 of the perinatal deaths, which showed the agreement of 80% [Kappa Statistics = 0.838; P = 0.000 (<0.001)] which indicates statistically significant agreement. There was agreement of 93% for 14 Stillbirths and 75% agreement for 36 Early Neonatal Deaths. Key words: Verbal autopsy, Perinatal deaths, Developing countries, Community intervention

Purpose: Gingivitis is the inflammation of gingiva and a mildest form of periodontal disease. Earlier studies have revealed that vitamin D has an anti inflammatory effect on gingiva and low levels of serum vitamin D are associated with many chronic diseases.. The objective of this study was to assess the association of serum level of 25-OHD to marginal gingivitis. Materials and Methods: This was a cross sectional study conducted in Maratha Mandal dental college, Belgaum, India. Out of the 451 people screened, 96 subjects who had Gingivitis score more than 1 and who satisfied the inclusion criteria and signed the informed consent were considered for the study. The gingival status was assessed by Loe and Silness Index and the serum vitamin D levels of 25-OHD were analysed by The Diasorin vitamin D Direct Elisa kit Germany. Also the information on the Demographic profile which included the age, sex, weight and calculus status was collected in the form. Results: On statistical analysis the relationship of serum vitamin D with gingival status was found to be negative and statistically significant at P<0.05. Further with multivariate analysis the total contribution of age, sex, vitamin D, weight and calculus on gingival status was 38.92% in which the calculus status contributed maximum of 20.11% compared to minimum of 0.83% by gender, followed by serum vitamin D 11.77%, age by 3.96% and weight by 2.25% respectively. Conclusion: Based on this analysis we can conclude that serum vitamin D and calculus are the most important contributors for the gingival status. Key words: 25 hydroxy vitamin D levels, gingival status, multivariate analysis.

Background: The burden of cardiovascular diseases in India has increased. The data regarding socio-demographic patterning of cardiovascular disease risk factors is scarce. Objectives: The socio-demographic patterning of cardiovascular disease risk factors in rural Lucknow was assessed. Methods: The cross-sectional survey was conducted among adults aged 18 years and above using a predesigned performa. Stratified random sampling and Probability Proportionate to Size technique was used. Three hundred and seventy three individuals gave consent and participated in the study. Prevalence rates of tobacco use, alcohol consumption, physical inactivity, low vegetable and fruit consumption, increased body mass index and raised blood pressure were determined. Data analysis was performed using SPSS windows version 14.0 software. Results: Only 14.7% of respondents admitted to alcohol consumption. The prevalence of smoking and smokeless tobacco use was 27.9% and 24.1% respectively. Sedentary physical activity was observed in 37.0% of respondents. Majority of respondents had low fruit intake (88.2%) and low vegetable intake (99.1%). Also 15.3% of respondents had an increased body mass index while 20.9% respondents had a raised blood pressure. Alcohol consumption, tobacco use, body mass index and waist circumference was higher among males. CVD risk factors studied were highly prevalent among those aged between 18-40 years of age. Hypertension increased with the increase in age. Alcohol and tobacco use and low fruit and vegetable intake were more common in the lower socioeconomic groups. Conclusions: High burden of cardiovascular disease risk factors was observed in the study population. Such information is useful for designing community based interventions to reduce risk factors in the population. Key words: Cardiovascular disease; risk factors; rural areas

Background: Neck circumference is a simple screening measure for identifying overweight and obese patients. The present study is planned to determine if NC is a valid measure of obesity in rural Indian population. Aims: To determine whether a single measure of NC might be used to identify overweight patients and to define NC cutoff levels for overweight and obesity according to existing BMI cutoff levels. Settings and Design: A prospective cross-sectional study from rural medical college at Wardha in central India. Materials and Methods: Main indicators included NC, weight, and height and body mass index according to WHO guidelines. Statistical Analysis: Chi squire test (dichotomous) and t test (continuous) had been done while making these comparisons using statistical software STATA 10.0. Results:Pearson’s correlation coefficients indicated a significant association between changes in NC and changes in body mass index. In men, BMI correlated positively with NC (Corr.coeff = 0.59, p < 0.01) and weight (Corr.coeff = 0.60, p < 0.01). In women also, BMI correlated positively with NC (Corr.coeff = 0.74, p < 0.01) and weight (Corr.coeff = 0.82, p < 0.01). ROC analysis showed that the area under the curve (AUC) for NC and BMI >25 kg/m2 was 0.89 for men, 0.91 for women, respectively. NC ≥ 38 cm for men and ≥ 34.7 cm for women were the best cut-off points for determining subjects with overweight. Conclusion: NC measurement is a simple and time-saving screening measure that can be used to identify overweight and obese patients. Patients with NC >36.6 cm for men and >32.1 cm for women require additional evaluation of overweight or obesity status. Key-words: Neck circumference; Anthropometry; Risk factors; obesity; overweight

Context: Complicated Plasmodium falciparum Malaria is a syndrome and a disease of protean, clinical manifestations including jaundice, ARF, ARDS and multi-organ failure. Aims: The objectives of the present study are to study clinical features, complications and factors affecting outcome of patients with complicated P. falciparum Malaria. Settings and Design: This retrospective descriptive study was conducted at tertiary care centre in western Maharashtra from January 2010 to December 2010. Methods and Material: Total 73 patients with complicated P. falciparum malaria who presented with fever having positive trophozoites of P. falciparum in blood smear were included. SPSS (version-10) software was used for all statistical calculations. Results: A total 73 patients had complicated P. falciparum malaria with 52 were males and 21 were female patients. Total 9 (12.32 %) patients were presented with shock as a presenting feature. Four (5.47 %) patients had hypoglycaemia at the time of admission. Total 43 (58.90 %) patients had jaundice, 37 (50.68 %) had anaemia, 28 (38.35 %) had cerebral malaria, 7 (9.58 %) had acute renal failure, 5 (6.84 %) had ARDS and 5 (6.84 %) had thrombocytopenia. Total 46 patients had single complication in the form of cerebral malaria 14 (19.17 %), jaundice 15 (20.54 %) and anaemia 16 (21.91 %). Total 14 patients had two complications in the form of jaundice with ARF 02 (2.73 %) with one (50 %) death and jaundice with anaemia 12 (16.43 %). Total 9 (12.32 %) patients had three complications in the form of cerebral malaria with jaundice with anaemia with 3 deaths (33.33 %). Total 5 (6.84 %) patients had multiple complications in the form of cerebral malaria with ARF with ARDS with thrombocytopenia with 4 (80 %) death. Case fatality rate was 10.95 %. The case fatality rate with ARDS was 80 % (4/5), with ARF was 57.14 % (4/7) and with cerebral malaria it was 25 % (7/28). Case fatality rate was highest in patients with pulmonary complication (ARDS) compared to ARF, cerebral malaria, jaundice and anaemia with ‘p’ < 0.001. Conclusions: Acute renal failure and ARDS were least common presentation with poor outcome. In present study most common presentation was with jaundice and anaemia next to that was cerebral malaria. The case fatality rate of P. falciparum malaria was 10.95 %. Overall case fatality rate was highest with multi-organ dysfunction (80 %). Unusual early renal and pulmonary complications were the presenting features of complicated P. falciparum malaria were observed in present study. Presenting feature as a shock was invariably associated with either ARDS or ARF with high mortality. This study highlights the burden of complicated malaria including multi-organ dysfunction in western Maharashtra. Key words: Plasmodium falciparum, ARF, ARDS, multi-organ failure