Vol 2, Issue 3, Jul-Sep, 2012

The high mortality rate in cancer such as oral squamous cell carcinoma is commonly attributed to the negligence in detection of the disease at an early treatable stage. A number of promising recent technologies have been proposed to improve the effectiveness of early oral cancer detection. The goal of a cancer-screening is to detect tumors at a stage early enough so that treatment is likely to be successful. Screening tools are needed that exhibit the combined features of high sensitivity and specificity. Moreover, the screening tool must be sufficiently noninvasive and inexpensive to allow widespread applicability. This paper will attempt to overview the recent advances in the dentistry with special emphasis on detection of oral cancer in early stages and also aim to familiarize, the various diagnostic tools among undergraduates’ and postgraduates’ from different medical fields. Keyword: Precancerous lesion, Nanotechnology, Heterozygosity, Saliva

Rukhsar, an 18 month old girl from Howrah district, West-Bengal was the last reported case infected with Type-I polio virus. On 13th January 2012, India surpassed one year without detecting a single case of wild polio virus. In 1988 when the Global Polio Eradication Initiative (GPEI)3 was started, with the intensity of transmission experts believed that India would be the biggest hurdle owing to the sheer size and the diversity of the population and it would be the last country in the world to eradicate Polio. Despite the pessimistic prophesies of failure and almost fifty years after the successful work of Jonas Salk, India managed one entire year with no new cases of Polio. But celebrations will have to wait for another two years because for certificate of eradication two more years have to pass without a single case of Wild Polio Virus. In the seventies, World Health Organization (WHO) required one year declaring India free from small pox but in case of Polio the virus can remain dormant for a longer period of time, still the fact that no new cases of polio were from anywhere in India for one year is a matter of national pride.

Background: Uncorrected refractory error and cataract are leading causes of preventable blindness in India. Objectives: To estimate prevalence and risk factors associated with uncorrected refractory error, cataract and selected eye diseases in urban and rural area near Chennai, Tamil Nadu. Methods: The present cross-sectional study was conducted in urban and rural areas near Chennai during May–August 2009. EPI 30-cluster sampling method was used and individuals in age group 5–70 years were selected with 450 subjects in both areas. Detail ophthalmic examination was done and socio-economic history for risk factors was obtained by trained interviewer. Data was analysed using SPSS version 15.0 software. To compare data sets chi-square test was used and Odds ratios calculated to assess association of risk factor. Results: 33.3% of the rural population had uncorrected refractory error as compared to 22.2% urban population (p<0.001); 24.2% rural population were having cataract compared to 13.1% urban population (p<0.001). Prevalence of pterygium and external hordeolum were 3% and 1% among total study population. Prevalence of internal hordeolum, corneal opacity and blepharitis were less than 1%. Subjects residing in rural area with low standard of living and using wood or cow-dung as cooking fuel were at significant higher risk of developing cataract (OR:2.43 and 2.88 respectively). They were also at significant higher risk of having refractory error (OR: 2.35 for low standard of living and 2.08 for wood or cow-dung as cooking fuel). Conclusion: Prevalence of uncorrected refractory error and cataract was high especially in rural area in the present study. Keywords: Cataract, eye diseases, uncorrected refractory error

Objective: The objective of this review was to explore the situation of coastal water pollution and its impact on child health and pregnancy outcomes in Bangladesh. Background: Globally coastal pollution is of greater significance than inland’s for its huge resources and contribution to livelihood. As a result it has been a source of increased Global Burden of Disease by means of consumption of seafood, involvement in risky jobs, and exposure to water related disastrous events. Almost sixty percent of the world’s population is at risk of costal contamination and developing countries like Bangladesh, geographically located at the tip of the Bay of Bengal, are facing significant challenges by this form of pollution. Method: This study was based on a critical review of published literature and unpublished documents from 1972 to 2011 retrieved from databases of scientific publications, from public-access search engines, reports from government, international organizations, and non-government agencies, and personal communications. Discussion: Huge noxious pollutants including heavy metals, oil spill and redionucleotides were found in the Bay of Bengal, those have enormous adverse impacts on child health and pregnancy outcomes. This review focuses on children and pregnant women because of their vulnerable physiological conditions to the impacts of environmental factors. The physiological systems of children and fetuses are developing fast and usually are sensitive to disruptions induced by environmental pollutants and exposures in utero increase the risk of future toxic insults. Conclusion: The coastal zone of Bangladesh is one of the vulnerable zones in the world which is predicted to disappear due to climate change impacts. This areas face huge weather-related disasters due to continuous changing coastal-configuration and man-made pollutions. However, these observations are indecisive due to limitations of supportive evidence. Therefore, further epidemiological studies are required to confirm initial observations. Keywords: Coastal pollution, Coastal zone, heavy metal, persistent organic pollutants, childhood disability, adverse pregnancy outcome.

Background: Placenta is a transient embryonic organ of communication between mother and fetus during pregnancy and is the only channel for transfer of nutrition as well as other factors from mother to fetus. Placental tissues from humans contain leptin and its receptors. As already known leptin is an endocrine hormone and growth factor that is important for the regulation of body fat, feeding and energy homeostasis and also plays a crucial role. Objectives: To assess and compare the expression of leptin in the products of consumption during early gestation (5 to 12 weeks) from mothers of low and high socioeconomic status groups (LSEG and HSEG) and to relate to their nutritional status. Material: Products of conception obtained at 5 to 12 weeks of gestation, from healthy women undergoing medical termination of pregnancy constituted the study material. Methodology: A total about 18 placental samples from low and 11 from high socio economic group (HSEG) were examined. Products of conception obtained from the scrapings of basal plate after vacuum extraction following termination of pregnancy were stored in formalin. Sections from basal plate were selected and stained for leptin. Imuuno histochemical stained sections were studied for percentage of villi, percentage of cytotrophoblast and percentage of stained positive blood vessels as well as intensity of staining pattern were carried out by using kits (Santa Cruz, Biotechnology, California). Nutritional status of the subjects were measured by recording weight, height, hemoglobin, serum retinol, serum folic acid and serum zinc levels. Results: Percentage of villi staining positively for leptin was significantly higher 80.7% (P<0.05) in the undernourished group when compared to well nourished 70.8% but expression of leptin in Cytotrophoblast (CTB) was significantly 59.7% (P<0.05) higher in well-nourished group. Conclusion: Expression of leptin in villi was significantly higher in the undernourished groups as compared to well nourished group. Keywords: Leptin and maternal nutrition

Background: Lymphatic filariasis is an important public health problem in India not only due to morbid condition but also due to social stigma, sexual incapacitation and considerable economic loss. The Government of India in 2004 began a nationwide mass drug administration (MDA) campaign in all the known Lymphatic filariasis endemic districts with an annual single dose of Diethylcarbamazine citrate with the aim of eliminating it as a public health problem by the year 2015. Inspite of implementing MDA annually for over 5 years yet uncertainty prevails about the coverage and compliance to treatment in order to achieve elimination. Methods: The present study was undertaken to evaluate the coverage and compliance to MDA and to assess the reasons for non-coverage and non-compliance. A community based cross-sectional study was conducted in the month of February 2011 for five days independently for the Government of India. A total of 1006 persons were interviewed from three villages and one urban ward. 54.28% were females and 45.72% were males. The coverage rate for DEC plus albendazole tablets were 82.97% and DEC only was 19 (1.96%). The compliance rate for DEC was 73.99%. Failure to drug deliver was reported by 61% of the eligible population and only 9 (1.23%) had side-effects. Results: The results suggests for an urgent need for revitalizing the program and to develop more effective drug delivery strategies. Keywords: Lymphatic filariasis, mass drug administration, compliance, coverage

Background: The rampant population growth has been viewed as the greatest obstacle to the economic and social advancement to the majority of people in the underdeveloped world. Objectives: To determine the social correlates of unmet need in a Community setting. Study Design: A cross-sectional, descriptive type of observational study. Methods and Materials: The sampling technique used was a Multistage stratified random sampling. One district was chosen randomly from the 19 in the state of West Bengal, India. Out of total 29 blocks in the district, 3 were selected randomly from different subdivision. From these blocks, 12 villages (4 villages from each block) and 4 urban wards were selected from municipality areas, so total 16 areas selected from the district. In West Bengal unmet need for family planning was 8% as per NFHS-3 (2005–2006), and considering maximum allowable error (20%), so minimum sample size works out to be 1150. From each village/ward, 125 eligible couples were covered, so (16 x 125) total 2000 currently married women of reproductive age constitutes the study population. Statistical Analysis: Proportions and Chi-square test. Results: 13.6% of currently married women of reproductive age group (15–49 yrs.) experienced unmet need for contraception. Unmet need was more in rural area than urban, lower age group than higher, Muslims than Hindus, lower level of literacy (including illiterates) than higher and also increase of joint families than nuclear families. Conclusion: Social correlates like age, religion, literacy status of respondent, type of family, age at marriage, even literacy status of husband also influenced the unmet need of family planning. Sustained and coherent Behavior Change Communication campaign is required to reduce unmet need. Keywords: Unmet need, social correlates, Family Planning

Objective: To assess the frequency of foot ulcers and their risk factors among diabetic patients visiting surgery department in a university teaching hospital in Ajman, UAE especially in relation to gender, nationality and age, blood glucose levels and lipid profile. Materials and Methods: This hospital-based retrospective record analysis was conducted for patients with diabetes mellitus visiting department of surgery for a period of 8 years from 2002 to 2010. Diabetic patients with foot ulcers were cases and those without were controls. Results: Among the diabetic patients recruited for this study, 75% were males and 25% were females. Among these diabetic patients, 76.3% of male patients were diagnosed with foot ulcers as opposed to 23.8% of female patients. Majority of diabetic patients were from Asia (53.1%) and Middle- East (33.8%). Diabetic foot ulcers were reported more in Asian patients (57%) compared to patients from Middle East (29.1%). Diabetic foot ulcers were most prevalent in the age group 50 to 59 years (42.5%) and least prevalent in the age group 20 to 29 years (5%). The mean HDL, total cholesterol, LDL and VLDL were all higher for diabetic patients with foot ulcer than controls with levels of only HDL being statistically significant (p<0.05). Mean HDL levels for cases was 37.3±8.3 whereas that for controls was 31.3±7.9. The mean Post Prandial blood glucose is 286.4 mg/dl for diabetic patients without foot ulcer which is significantly higher than diabetic patients with foot ulcer who had a mean value of 249.6 mg/dl but there was no significant difference in mean fasting glucose values. Conclusion: Asian middle-aged male diabetics are most likely to have foot complications. HDL levels were high whereas post-prandial blood glucose levels were comparatively low in diabetics with foot ulcers than without. Keywords: Middle-east, diabetic foot ulcer, diabetic neuropathy, peripheral arterial disease, amputations, dyslipidemia, risk factors.

Constitution of Village Health and Sanitation Committees (VHSC) is one of the special initiatives under the National Rural Health Mission (NRHM) to improve the availability and access to quality health care for people residing in rural areas through increased ownership and power to local people. Such committees are functional throughout the country. The main objective of the study was to assess whether VHSCs in the study area have been formed and function according to given NRHM guidelines and if the committee members were aware of various aspects under VHSC. This was a cross sectional study done with 17 VHSCs from one block of a district in a North Western state in India. The study district and block were purposively selected while 25% VHSCs (17 out of 66 VHSC in the block) were randomly selected from the block. The respondents of the study included all the members of the VHSCs. In total, 94 members from the selected VHSCs participated in the study. Primary data was collected with the help of an instrument while the secondary data was collected by observation records of ANMs; documents from district and block level NRHM branches; maintenance registers and other records maintained at the VHSC. The study found that composition of all the 17 VHSCs did not meet the NRHM guidelines and lacked participation from school teachers and ASHA workers. There was very low awareness among the members about functions of the committee. The study found low knowledge level related to activities and processes carried out by the VHSCs; areas where Village Health Fund (VHF) could be utilized. None of the VHSCs selected under study conducted any awareness campaign; did not prepare any Village Health Plan and did not do any budgeting for the future year. The monitoring, inspection and evaluation part of the VHSCs was also very weak. The study indicates many problems and gaps in composition, formation and functioning of VHSC when compared with the actual guidelines laid down under NRHM. The problems relating to selection of members, their training, supportive supervision, proper reporting and responsive feedback mechanism can only be improved with a strong will and action of Panchayat Raj Institution (PRI) along with the health department and other stakeholders. Keywords: Village Health and Sanitation Committee; India; Panchayat Raj Institution

Research Question: How important is acute respiratory tract infections in children less than 5 years of age and what are the main factors that need attention. Objective: To determine the magnitude of ARI under 5 years of age in rural areas of Kashmir valley. 2) To identify various risk factors responsible for ARI. Methodology: Community based Cross sectional study using multistage sampling procedure was used to study 1644 children. A house to house survey was carried out in the defined geographical region in order to determine the prevalence and risk factors of ARI less than 5 years of age. Results: Among 1644 children under 5 years of age studied, 886 (53.89%) were males and 758 (46.11%) female. An overall prevalence of 21.41% under 5 years of age was observed in a Kashmir valley. The prevalence of ARI varied according to the age of child being 19.3% in age group of 0–1 years, 23.0% in 1–3 years and 20.4% in age group of 3–5 years. Prevalence of ARI was more (22.5%) in male children as compared to female (20.05%) children [P>0.05]. The socio demographic variables that showed a significant relationship with ARI prevalence were parental literacy status (OR = 1.806; CI = 1.333 – 2.447; P < 0.05) and more so the Mother’s literacy status (OR = 1.635; CI = 1.284 – 2.083; P < 0.05). ARI risk being high among Malnourished children (OR = 2.38; CI = 1.804 – 3.157; P<0.05), inappropriately immunized children (OR=2.41; CI = 1.853 – 3.154, P<0.05), children lacking exclusive Breast feeding (OR = 4.854; CI = 3.735 – 6.309; P< 0.05) or put on early or delayed weaning (OR = 1.66; CI = 1.302 – 2.140; P < 0.05). Environmental / housing variables also showed significant association with ARI with risk being high in children living in poor ventilation (OR = 4.865; CI = 3.78 – 6.259; P < 0.05), overcrowded houses (OR = 1.829; CI = 1.442 – 2.320; P < 0.05), houses with kitchen not separate (OR = 1.829, CI = 1.442 – 5.481, P < 0.05), and using cooking fuel other than LPG (OR = 2.063; CI = 1.615–2.634; P < 0.05) Conclusion: Besides sensitizing mothers on childhood nutritional (exclusive breast feeding and early / delayed weaning) and immunization the role of environmental /housing variables (Poor ventilation, over crowding, combined kitchen and use of cooking fuel other than LPG) need attention. Keywords: Prevalence, ARI, risk factors.

Background: Shortage of medical graduates and post graduates in the government sector, especially in rural areas is a major problem in India. Rural and remote areas of Gujarat are facing shortages of MBBS graduates and post graduates. About 25 percent of posts in the health and family welfare department are vacant. The worst affected is the class I positions where over 40 per cent posts were vacant. This study is an attempt to identify the motivating and de-motivating factors, in joining government service, among the medical graduates and post graduates in Dahod district of Gujarat. Methods: Questionnaires were prepared for two groups of doctors: those who are in government services; those who left the government services. The questionnaire included both item wise response and likert scale questions. 36 in-service medical professional and 19 private doctors participated in the study. Results: 44% of in service professionals from urban areas are working in urban areas, while 56% of them are working in rural areas. On the contrary, only 15% of the in-service professionals from rural areas are working in an urban area, with majority of them (84%) are posted in a rural area. In services doctors believe that job security is more in government sector as compare to private sector. Variables like work environment, accountability, career development, social recognition and remuneration is less than satisfactory in government service. Conclusion: The decision to practice in rural areas is the result of complex interaction between a number of factors including individual background, service infrastructure, human resource practices including opportunity for career growth, remuneration, and autonomy. The study provide strong indication that promoting students from rural background to pursue medical education through reservation or scholarship may go a long way in addressing shortage of medical professional in rural areas. Following motivational factors can help in retention of skilled man power in government: positive work environment, adequate remuneration/compensation, career development and a supportive health system, adequate compensation and working conditions. Time bound promotion can be one of the important factors for retention of doctors in government sector. Keywords: Rural, Doctors, Shortages, Gujarat