Vol 1, Issue 2, Apr-Jun, 2011

warmly welcome you to this second issue of the International Journal of Medicine and Public Health. I feel that it is great that the need for Public Health: health promotion and disease prevention, is now being recognized within Medicine. However, at the same time it still is odd that medicine in itself does not imply public health. This is clearly illustrated by the addition of the word ‘and’ between these two important societal issues. The reason for public health and medicine not being integrated may originate from the focus on the individual from the medical point of view, whereas the focus of public health is on groups and society as a whole. So, medicine and public health are not one and the same, even though they strive the same goal: improving health. Nevertheless, improving health at a societal level, may differ from improving health at an individual level. This is where the ‘Prevention paradox of Rose’ comes in.

Life expectancy of Indians during the past fifty years has been steadily increasing exponentially matching the trend that took several hundred years shown in Developed countries.1,2,3 Some of the possible reasons for such exponential rises gained by Indians in years are controlling deaths caused by epidemics and pandemic infectious diseases, and absence of famines or wars since India’s independence. The high death rates due to infectious diseases were dramatically curtailed due to availability of antibiotics and further with introduction of Universal Immunization program. This was followed by improved living conditions, advances in public health, and availability of advanced medical interventions.

A great majority (72%) of Indian population lives in un-sanitary conditions and nearly 50% suffers from chronic undernutrition that pre-dispose them to frequent episodes of diarrhoeas of different etiologies. The diarrhoeal outbreaks contributed to 44.9% of infectious disease outbreaks in 2008 despite significant improvement in safe drinking water supply. The article has a view point that the available vaccines against diarrhoeal diseases should be used in India for vulnerable populations living in settings wherein safe drinking water at point-of-use; and sanitation is still a distant reality. Immunization service should not merely emphasize on prevention of diseases in an isolated manner but it needs to be re-oriented synergistically with other public health interventions leading to health protection, health promotion and subsequent overall health improvement. Key words: Immunization, diarrhoeas in India, vulnerable population, health protection

Objective: Tuberculous meningitis (TB M) is the commonest form of neurotuberculosis caused by Mycobacterium tuberculosis bacilli (MTB). The diagnosis of TBM is often difficult. A reliable, cost effective and rapid diagnostic test, which can be performed in any routine laboratory, could be of help in the diagnosis of TBM. In the present study we measured the adenosine deaminase (ADA) activity in cerebrospinal fluid (CSF) of TBM and non-TBM patients. Method: ADA activity in CSF was determined according to a method based on the modified Berthlot reaction, which is the formation of a colour indophenol complex from ammonia liberated from adenosine, and quantified spectrophotometrically. Results: ADA activity was studied in CSF of 45 cases of tuberculous meningitis, 20 cases of pyogenic meningitis and 20 controls (patients without any neurological disorders who were given spinal anaesthesia). The mean ADA activity was 13.43 ± 4.76, 8.23 ± 2.91 and 2.64 ± 1.57 IU/L in tuberculous meningitis, pyogenic meningitis and controls respectively. The higher level of ADA in tuberculous meningitis was statistically significant (p < 0.0001). The sensitivity and specificity of ADA test in CSF at cut-off 10 U/L was 100% and 93.75% respectively. Conclusion: This study demonstrated that adenosine deaminase activity in CSF, a relatively inexpensive and easy procedure, can be of great value in the diagnosis of tuberculous meningitis. This test can be performed in any routine laboratory where more sophisticated methods are not available. Key words: Adenosine deaminase, meningitis and cerebrospinal fluid

Background: Despite prevalence of fluorosis in India, previous studies did not emphasize on the effect of maternal fluorosis on fetal outcomes. Objectives: To study the associations of higher maternal serum Fluoride (F) with low birth weight and poor APGAR count. Methods: One hundred and eight apparently healthy pregnant women aged 17-36 years were included in the study. Samples collected were maternal and cord blood, placenta and drinking and ground water. The samples were processed and analyzed for Fluoride. Fetal gestational age was measured on ultrasound scan and the birth weight of the baby on a digital scale. Fifth minute APGAR score was measured. Results: A significant negative correlation was found for maternal serum F vs Birth weight, Gestational Age and APGAR score. Significant negative correlations were also found for cord serum F vs Birth Weight, Gestational Age and APGAR score. Fairly negative correlations were also found for birth weight, APGAR score and Gestational age compared to Fluoride concentrations in maternal surface of placenta, fetal surface of placenta and marginal side of the placenta. However, significant positive correlations were observed when Gestational age was compared with Birth weight and APGAR score. When the maternal serum F was greater than 1 ppm, there was 10.58 times higher risk for low birth weight, 8.65 times higher risk for preterm delivery and 3.8 times higher risk for low APGAR score. When the cord serum F was greater than 0.22ppm, there was 2.76 times higher risk for low birth weight, 4.6 times higher risk for preterm delivery and 2.5 times higher risk for low APGAR score. Conclusion: With increased serum F in the mother, there is an inclination towards pre term delivery, low birth weight and poor APGAR count. Key words: APGAR score, Placenta, Low Birth weight, Endemic fluorosis, Gestational age.

Background: Recent era of agricultural boon is partially the result of extensive use of insecticides and pesticides. But these compounds also have potential to significantly alter the ecosystem and can cause acute poisonings as well as long term detrimental health effects in humans. These compounds can cause toxicity through all routes of exposure. They exert their effect mainly by the inhibition of Acetylcholinesterase (AC hE), which functions by removing acetylcholine (AC h) from its postsynaptic receptors. Aims and Objectives: Human exposure to Organophosphorous (OP) pesticides can develop lowered cholinesterase levels. The aim of the present study was to estimate the plasma levels of AC hE in personnel involved in handling of these compounds, during the period of active spraying operations. Methodology: The present study was conducted on 38 subjects working as Multipurpose Health Workers (MPHW GROUP-1) and Field Workers (FW GROUP-2) involved in the actual spraying of the insecticides, in District Rohtak, Haryana, India to see the effect of exposure to OP insecticides. Plasma cholinesterase activity was measured by a kinetic method based on hydrolysis of butrylthiocholine. The data was statistically analyzed using SPSS statistical package (SPSS version 5.0). Results and interpretation: The mean cholinesterase activity in group-2 was lower by 27.76% than that in group-1 and this difference was statistically significant (p < 0.05). The workers involved in actual spraying of the insecticides had a more marked reduction in the levels of Plasma AC hE, compared to the workers involved only in the handling of the insecticides indicating that this group is at a bigger risk.

Background: Recent experimental and clinical studies have identified maternal malnutrition at conception or during early period of gestation as an important factor determining the fetal growth as early as the first trimester of pregnancy. Placenta is a transient embryonic organ of communication between mother and fetus during pregnancy and is the only source of nutrient transfer to the fetus. Hence its proper development is essential for fetal growth and development right from embryonic stages of development. Objective: To assess and compare the placental morphology by measuring the villous structure, vascular endothelial growth factor (VEG F) and placental growth factor (PLGF) expression from placental tissue at 7-10 weeks of gestation of low socioeconomic status (LSES) and high socioeconomic status (HSES) groups, in relation to their nutritional status. Material: Placental tissue samples obtained at 7-10 weeks of gestation from healthy women undergoing medical termination of pregnancy constituted the study material. Methodology: A total of 99 placental tissue samples, 59 from LSES and 40 from HSES groups were examined to assess the morphology of placental villi and also stained for VEG F and PLGF expression. Nutritional status of the subjects was measured by recording weight, height and hemoglobin, serum retinol, serum zinc and folic acid using standard methods. Results: Women belonging to both the income groups were of comparable to age. Body Mass Index (BMI) was significantly lower (P < 0.001) in the LSES group. Hemoglobin concentrations were significantly (P < 0.05) more in HSES groups when compared to LSES group. Hematoxylin-eosin stained placental tissue sections showed that number of floating villi (P < 0.001), villous vascular density (P < 0.001), central disposition of blood vessels (P < 0.05) and syncytial sprouts (SS) (P < 0.05) were significantly higher in the LSES group. While the intensity of staining for VEGF was higher, the decidual vascular density was significantly (P < 0.05) lower in the LSES group. Serum retinol, folic acid and zinc of both groups were within normal range and comparable. Conclusions: The significant disparity in placental morphology observed in this study between LSES and HSES groups at a comparable gestational period is interesting and suggestive of predominant hypoxemic placental development under the stress of under nutrition. Key words: Maternal Nutrition, Placenta and Growth factors.

Background: Malaria is the most important infectious disease of mankind. Though, smear examination is gold standard in diagnosing malaria, it has many drawbacks particularly in developing countries. Methods: A prospective study was designed with duration of the study was six months. Based on previous work, we identified the most specific clinical features of malaria and assigned with score. Maximum score was 14. Only adult patients with more than 13 years of age with complaint of fever were included for the study. Clinical Score was calculated for each patient by two different persons (clinician and intern). All the patients were subjected for peripheral smear by specialist or trained person to diagnose malaria. Clinical Score were compared with smear diagnosis of malaria. Sensitivity, specificity, positive predictive value (PPV) and negative predictive values (NPV) for each score were analyzed. Receiver Operative Curve (ROC) was prepared to assign a particular score which can diagnose malaria with good certainty. Results: A total of 142 consecutive fever cases were included in the study. 67 (47.18%) cases were of malaria and rests were control cases. Using score of more than eight, the sensitivity, specificity, positive predictive value and negative predictive value of clinical scoring system to detect malaria (either vivax or falciparum) were 95.52%, 85.33%, 85.33% and 95.52% respectively. Using score of more than nine, the same statistics were 91.04%, 93.33%, 92.42% and 92.10% respectively. Using ROC curve score more than or equal to nine can give the clinical diagnosis of malaria with good certainty. Conclusion: Score more than nine can be used in clinics to assign as malaria with good confidence and can be treated empirically with antimalarials. This score can substitutes smear examination however, can not replace it. This scoring system is very helpful where smear examination is remote possibility or it can not be relied upon due to technical or staff problem specifically in rural part of India or peripheral health centre with least facilities. Key words: Peripheral smear examination, malaria, clinical score system.

Introduction: Scrub typhus is a zoonosis caused by the rickettsial bacteria Orientia tsutsugamushi. The disease in endemic in many parts of India and continues to be a public health problem. Materials and Methods: This study describes the clinical profile of eight consecutive scrub typhus positive cases admitted in a tertiary care hospital. After complete physical examination, complete blood count, liver function tests, renal function tests, urine analysis, blood & urine cultures were done in all cases. In all the cases, scrub typhus was diagnosed using a rapid single step immunochromatographic assay. Results: Of eight cases five were females and three were males. Fever was the chief present symptom in all the cases. Other signs and symptoms were headache, myalgia, cough, hepatosplenomegaly, abdominal pain and lymphadenopathy. Eschar was present in all the cases. Liver enzymes were elevated in all the patients. Hypotension, thrombocytopenia, hepatic dysfunction, hypoalbuminemia, hematuria and proteinuria were the complications observed. All cases were successfully treated with doxycycline and there was no mortality. Conclusion: Our report emphasizes the fact that a diagnosis of scrub typhus should be suspected when a patient presents with fever and laboratory evidence of liver dysfunction, as early detection of the disease could reduce morbidity and mortality. Key words: Zoonosis, Eschar, Hypoalbuminemia, liver dysfunction

Tracheobronchial foreign body (TFB) aspiration can be a life-threatening emergency associated with significant morbidity and mortality. Aspiration of foreign bodies into the tracheobronchial tree is common in pediatric age group but rarer in adults. Adults account for only about 20% of the reported cases. The clinical presentation in adults may vary from being asymptomatic to severe respiratory distress. In this case report, we describe two cases of bronchial foreign body one with an unusual presentation of a common foreign body and the other an unusual foreign body. Key words: Tracheobronchial foreign body, Bronchoscopy, Central obstructive collapse, Intubation Stylet

Introduction: Double gallbladder is one of the rare congenital anomaly of the gallbladder and a surgeon may come across it once in life time. Case Presentation: We present a case of double gall bladder separated by a common wall. This case was neither diagnosed nor suspected by radiologist on routine ultrasound. The patient was reported as a usual case of cholelithiasis and an inoperative surprising rare surgical anomaly of gall bladder was observed. Conclusion: This congenital anomaly can present as a surprise on the operating table and may pose a difficult cholecystectomy. Key words: Double Gall bladder, cholelithiasis, imaging, case report

Preduodenal portal vein (PDPV) is a rare congenital anomaly and occurs either as a single malformation or in association with other malformations. PDPV is mainly asymptomatic and associated intestinal anomalies are often more likely to cause high intestinal obstruction. A neonate with recurrent bilious vomiting since birth is presented. Laparotomy revealed PDPV but it was intestinal malrotation that was causing intestinal obstruction. Key words: Duodenal obstruction, preduodenal vein, malrotation

A cross-sectional study was carried out on multiparous women attending the ante natal clinic of a tertiary care hospital in the government setting. Information was primarily gathered regarding infant feeding practices in their previous childbirth. More than 2/3rd of the participants were urban dwellers with 62% of them being housewives. 23.9% had exclusively breast fed their babies during first six months.19.7% had started breastfeeding with in first hour of birth .Most of the mothers knew the benefits of breastfeeding but only 39% and 34% had correct knowledge regarding initiation of breast feeding and dangers of prelacteal feeds respectively. Only 5.14% of mothers knew about birth spacing benefits of breastfeeding. Place of residence of studied women was found to be significantly associated with introduction of prelacteal feeds and type of feeding during first six months. Although majority of women breastfeed their babies certain harmful practices still persist in our community. The situation can be improved by training of grass root health workers on lactation management and making these services universally available along with intensive IEC efforts to generate demand for these services.

Background: Health care workers (HCWs) are regularly exposed to blood, and other body fluids which make them prone to a risk of acquiring the infection. Despite following ‘universal precautions’, accidental exposure may occur while performing invasive procedures and handling high risk fluids. Objectives: (a) To assess the awareness of post exposure prophylaxis (PEP) in case of needle-stick injury from confirmed or suspected source of HIV amongst I-year postgraduate residents of Kasturba Medical College & Manipal College of Dental Sciences, Mangalore, India. (b) To educate them about the post-exposure prophylaxis guidelines against occupational exposure to HIV. Methodology: This is a cross sectional study among 85 postgraduate residents based on response to structured questionnaire. Results were analyzed and tabulated using National AIDS Control Organization Guidelines as reference standard for comparison. Results: N ineteen respondents (22%) were aware of the true risk of transmission. About half of the respondents identified all the high risk fluids correctly. Twenty-five respondents (29%) knew whom to contact immediately after accidental exposure while only 20respondents (23%) knew that washing with soap and water was the initial measure. Though half of the respondents knew that prophylaxis should be initiated within 1hour of injury, a mere 30% knew the correct duration of PEP. 42% respondents were aware of the availability of drugs and only 28% knew the approximate cost of therapy. Conclusion: T here is a considerable lack of awareness among the medical and dental postgraduate residents about the PEP against accidental exposure to HIV suggesting a need for training and awareness programmes to improve the awareness. Key words: Post exposure prophylaxis, HIV, occupational exposure, post-graduate residents, Mangalore, questionnaire.

Soil transmitted helminth (STH ) infections represent a major health problem in poor and developing countries. We conducted a pilot study to determine the prevalence of STH among school going children of Kancheepuram district. Three hundred and fifty eight children in the age group of 5-10 years were examined for STH. One hundred and fourteen of the 358 (40%) were tested positive for various intestinal helminths. The various intestinal helminths are Ascaris lumbricoides, Trichuris trichiura and Taenia species. At least one intestinal helminth was detected in 25.13% (90/358) children and multiple helminth infestation was recorded in 15.08% (54/358). The most common parasitic helminth was A. lumbricoides 60% (84/144) followed by T. trichiura 4.17% (6/144). A. lumbricoides was found as single type infection as well as in association with other helminths in mixed type infection. This study emphasizes the need for improved sanitation and better living conditions for the school-age children in rural areas.

Background: The tsunami disaster in the Indian Ocean is one of the worst natural disasters in the modern times. The grief and worry created by the disaster has affected the health status of women and children. Malnutrition and ill health are major problems. This study investigated the nutritional status of the children and provided a nutrition education program for the mothers. Aims: To study the demographic profile, dietary habits, anthropometric measurements, clinical assessment, incident rates of infectious diseases among the 500 children. To assess the dietary intake of 100 malnourished children and to formulate ten low cost nutritionally balanced recipes and to provide nutrition education program for the mothers. Sample: 500 preschool children in the age group of 3-6 years of the tsunami affected Nagapattinam district were the samples of this study. Method: Interview schedule was administered to 500 mothers. Anthropometric measurements such as height, weight, mid arm circumference, head circumference and chest circumference were recorded by the investigator. Three day dietary recall method was used to assess the nutrient intake. Clinical assessment was conducted with the help of a doctor. Nutrition education was provided to the mothers with the help of posters and charts. Results: The results found that, majority of the children were under nourished and there was a significant difference between the mean nutrient intake and the recommended dietary allowance. Mean scores of nutritional knowledge and awareness significantly increased after the nutrition education program. Conclusion: Nutrition education must be provided to the mothers to improve the nutritional status of the children. The gained knowledge had to be put into practice. Key words: Malnutrition, Tsunami, Anthropometry, dietary assessment, Nutrition education program.

Background: The control of Sexually Transmitted Infections (ST Is) is an important strategy in reproductive health and HIV/AIDS control. It should be such that comprehensive management of patients with ST Is is available at the primary health care level. This study was to assess the quality of ST I care at the primary health care level in Zaria. Method: It was a descriptive cross-sectional study in which a three-part structured questionnaire was administered to all staff who provided clinical services to patients seeking ST I services in the 28 operational health centres in the local government area and these facilities were also assessed using a checklist. Results: Over half of the respondents are females (54.5%), while the modal age group was 35-39years (36.4%). Most of the staff providing clinical including ST I services were Senior Community Health Extension Workers (SCHEWS) (72.7%) with only 5(9.1%) nurses/midwives and 2(3.5%) being Community Health Officers (CHOs). There were training gaps identified with only 16.3% trained on STI counseling only; the 3.6% trained on syndromic management were the CHOs who had no knowledge of the 4Cs of syndromic management. While counseling of patients was routinely done by 92.7% of respondents and 70.9% promoted the use of condoms; assessment of attitude to ST Is showed that 70.9% of respondents felt that ST Is are as a result of promiscuity, 78.2% believed that condoms would encourage promiscuity and 45.5% felt religion is against the use of condoms. However, 92.7% are of the opinion that condom use is protective against ST Is. Many of the respondents (81.8%) support that all STI patients be screened for HIV; while 23.6% support the screening of spouses for STIs. Assessment of facilities available at the health centres show that none was adequately equipped for the syndromic management of ST Is. No centre had the syndromic management manual or chart; none had the STI-01 or -02 reporting forms. Only 39.3% had drug dispensing sections. Conclusion: Primary prevention of STI should be an integral part of the PHC package; conscious effort should be made to involve the PHC level in the surveillance and treatment of ST Is by proper training and provision of pertinent materials.

The delighted news in the budget is that ministry has hiked the remuneration of two cadres of grass root workers namely Anganwadi workers (AWW) and Anganwadi helpers (AWH) who are also the backbone of Integrated Child Development Services (ICDS).2 This hike will be implemented with immediate effect from April 1, 2011 onwards. The remuneration for AWW would be increased from Rs. 1,500 per month to Rs. 3,000 per month and for AWH from Rs. 750 per month to Rs. 1,500 per month. Thus the 100% hike in remuneration is pleasuring for ICDS workers. The budget does little to correct the inverted duty structure that the pharma sector has been complaining about. The current structure favours imports of finished dosage forms. Plus, at a time when countries like China, Israel and Taiwan are proactively promoting research and development in the pharmaceutical sector, the budget does little to boost efforts at R&D in this space.

With the evolution of mankind, biomedical research has continued to contribute to improvement of quality of life and life style. Over many generations several noble minds and dedicated scientist have made this difficult task possible. However newer and much more challenging tasks remain ahead of us to be solved by the current and upcoming scientific community. A collateral process in achieving such tasks is by optimal training of the upcoming scientific community so has to prepare them to face and effectively solve the current challenges. While highly skilled mentors are extensively contributing to this training process, the availability of a well-written book detailing the fundamentals of biomedical research starting from conception of ideas for research to effectively communicating/commercializing the research findings can synergize/potentiate the training efforts. Hence the publication of this book has been very timely and necessary, which is skillfully edited by experts in biomedical research and is targeted at any one interested in establishing a carrier in biomedical research. The book has key sections detailing specific aspects of biomedical research written simplistically with illustrations for easy comprehension.