Vol 1, Issue 4, Oct-Dec, 2011

Japan’s situation since March 11, 2011, following the world’s fifth largest earthquake since 1900 and resulting tsunami, has been tragic. Many thousands of people drowned, swept away with coastal infrastructure. Hundreds of thousands were displaced and lost livelihoods. Situated on the coastline, nuclear reactors at Fukushima were damaged and went into meltdown: the nuclear debate was reactivated. Media emphasis became nuclear safety, despite the far greater impact of the earthquake and tsunami. According to the Washington Post, “Countries… best equipped to deal with nuclear mishaps are turning away from atomic energy… Europeans, most notably in Germany, and Americans are abandoning or delaying plans to replace or upgrade their electricity-producing nuclear plants - and extending the operational life of existing, less-safe reactors well beyond their original 40-year licensing period… But developing countries with little nuclear experience and spotty industrial safety records are moving ahead with ambitious plans to expand generating capacity. China and India… are adding about 80 new reactors over the next two decades.”[ 1 ]

An improved understanding of CD4 progression over time in resource-limited settings may aid in the discussion of when to initiate antiretroviral therapy (ART) and optimal timing for CD4 monitoring. We examined CD4 progression over time among 347 HIV-positive adults from 10 HIV care and treatment programs in Burundi, Cameroon, and the Democratic Republic of Congo (DRC). We applied a mixed model using restricted maximum likelihood to describe CD4 cell count evolution over time following ART initiation and to evaluate the association between other baseline variables and CD4 response over time. Depending on the initial baseline CD4 count, increases in mean CD4 cell count ranged from 24–46 cells/mm 3 from 3 to 6 months after treatment initiation, and from 80–117 from 6 to 18 months after treatment initiation. Females had higher CD4 count at the initiation of treatment than males. Patients with higher CD4 count at ART initiation achieved a higher CD4 count in the following months. We found that higher baseline CD4 cell counts predicted higher CD4 cell counts over time among the patients eligible for this analysis. We also observed increases in mean CD4 cell count from 3 to 18 months after treatment initiation. Key Words : ART , CD4 Count , HIV , AIDS

During the H1N1 -2009 Infl uenza A pandemic, 96 pregnant and postpartum women confi rmed positive by nasopharyngeal swab polymerase chain reaction were managed at Al Wasl Hospital, a tertiary referral centre in Dubai between 3 rd august to 17 th December 2009.we studied the characteristics, immediate outcome and complications of these cases. Majority presented with high fever, headache and one or more respiratory symptoms. They were managed according to WHO guidelines. 49% women needed hospitalisation. Most had mild illness and recovered completely. One case had severe illness needing ICU admission, culminating in maternal death. We conclude that the effect of swine fl u in our cohort was mild. Co morbidity and delay in seeking treatment led to worsening disease .Vaccination with Pandemrix (single dose vaccine) is recommended for all pregnant women and their health providers if there is onset of a new wave of infection. Key words : H1N1 infl uenza , pregnancy , maternal morbidity.

Title of the article: Knowledge, attitudes and beliefs about HIV among Young People- A baseline Survey in Navsari and Dang Districts of Gujarat. Objectives: To assess the knowledge and attitudes and beliefs of young people of rural and tribal areas as regards reproductive health, sexuality, STIs and HIV/AIDS Study design: Cross-sectional. Setting: rural and tribal areas of Navsari and Dang Districts of Gujarat Participants: young people of 15-24 years and 25-49 years age group. Methods: Using cluster sampling technique 30 Clusters (15 Navsari and 15 Dang) were surveyed in January and February 2007. Data entry and analysis was done using Epi-info software. Results & Conclusion: Total of 2144 young people were interviewed. The major sources of information about HIV/AIDS were mass media and friends. Half (50%) of young people had heard about HIV/AIDS. A majority of young people were aware of all four modes of transmission of it. About three-fourth of the young people (75%) believed that it can be prevented. The results signify that although some amount of awareness is prevalent in the study area; further efforts are needed to bring awareness about reproductive health, sexuality and HIV/AIDS. The awareness programs need to focus on strategies of prevention especially emphasizing the role of condoms in preventing HIV/AIDS and other STIs. Education programs should focus on the most vulnerable groups – the adolescent girls and young women- who are less aware as compared to men about different methods of prevention. Key words : HIV/AIDS , young people , awareness , attitudes

of the pre-school children and one-third of women in the age group 15–49 years being underweight. The problem of malnutrition is causing an economic pullback as India tends to lose 3–4% of the Gross Domestic Product (GDP) in terms of loss of productivity. This glaring problem of malnutrition and micronutrient defi ciencies is multi-factorial. Important causes include lack of improvement in agricultural productivity owing to inadequate resources, lack of education and inadequate job opportunities. Increased informal workforce due to rural-urban migration along with unplanned growth of slums is one of the key issues in the urban set-up. Other factors catalyzing the problem include overpopulation, gender inequality, inadequate distribution of food through public distribution mechanisms and lack of coherent nutrition policies. The government policies should focus on growth in agriculture and on improving the food storing facilities. An accurate targeting of “in need” population, so that they get food at substantially low price along with introduction of holistic employment schemes is required. Nutrition based programmes should have in-built system of evaluation based on key nutritional indicators. Social determinants of health such as water, sanitation and women empowerment also have to be addressed to achieve long term gains in the health of the community. Community awareness and mass movement is required to ensure that demographic dividend might not turn into demographic nightmare. Keeping in view that nutrition is not a ‘stand alone’ subject, a multisectoral approach is needed. Key words: Malnutrition , micronutrient defi ciency , prevention , India

Background: Venomous snake bite is a common and frequently devastating environmental and occupational disease, especially in rural areas of Maharashtra India. Aims & Objectives: To determine the clinical profi le and outcome of snakebite cases in rural western Maharashtra. Material & Methods: This was a retrospective study conducted over one year period (January 2009 to December 2009) at a tertiary health care centre in Maharashtra. Results: Out of 167 admitted snakebite 103 (61.67%) were complicated snake bites. Total 88 (85.43%) patients were with vasculo-toxic snake bite. Total 15 (14.56%) patients were with neuroparalytic snakebite. Total 35 (39.77%) patients out of 88 with vasculotoxic snakebite developed local cellulitis requiring fasciotomy and or debridement, 17 (19.31%) patients had clinical and laboratory parameters favoring DIC. Total 12 (13.63%) patients had ARF, one developed AMI and one developed cortical venous sinus thrombosis (CVT). Out of 88 patients with vasculotoxic snakebite 2 died with case fatality rate of 2.27% (2/88). Out of 15 patients with neuroparalytic snake bite 13 (86.66%) required artifi cial ventilatory support and one patient developed delayed peripheral neuropathy. Overall mortality was 1.94% (2/103). The needle to ASV time was positively correlated with duration of hospital admission, complications and mortality (‘p’ < 0.02). Conclusions: Snakebite is a common life-threatening emergency in the study area. Delay in hospitalization is associated with poor prognosis and increased mortality rate due to consumptive coagulopathy, renal failure and respiratory failure. Unusual complications like AMI, CVT and delayed peripheral neuropathy were observed in present study. Key words: Complicated snake bites , ARF , AMI , DIC , ASV

Vitamin A oil supplementation of under-five children has been an effective strategy in reducing nutritional blindness and other childhood morbidity and mortality. The present cross-sectional study was undertaken to assess the coverage and factors influencing its uptake among 60–72 months old children residing in an urban slum in Kolkata. Out of 150 children only 61 (40.7%) had completed all 9 doses of vitamin A while immunization was up-to-date in a substantially higher (96.0%) proportion of children. Incomplete dosage of vitamin A oil were found to be higher in females, birth order above 2, families with low per capita income and poor nutritional status of the child. The association between maternal education and knowledge about dietary source was found to be statistically significant (χ 2 = 15, p < 0.05). Diet survey revealed inadequate intake in the majority (70.7%). Inadequate supply and lack of awareness were the two most common reasons of non compliance. More efforts are needed to ensure availability and awareness regarding vitamin A oil supplementation, promote dietary diversification and monitoring of health workers to prevent both under and overprescription with vitamin A oil. Key Words : Coverage , Compliance , Vitamin A supplementation

Salmonella urinary tract infections (UTIs) are unusual and occur most often in infants and those over 60 years. S. paratyphi has been reported extremely rarely as a cause of UTI. Recovery of S. typhi is also rare from urine and can occur following a recent episode of typhoid fever, or in chronic carrier states involving the urinary system, and occasionally following localized UTI due to S. typhi. Studies have reported 0.07% of urinary tract infections diagnosed in 15 year duration to be due to nontyphoidal salmonella (NTS) and 0.24% of organisms cultured from urine were NTS. NTS species isolated from urine include S. enteritidis, S. typhimurium, S. heidelberg, S. infantis, S. newport. Cases of other unusual extra-intestinal infections caused by S. paratyphi A include fulminant hepatic failure, primary septic arthritis of the hip and pleural effusion. Because of its extreme rarity as a uropathogen, and importance of administering appropriate antimicrobial for treating urinary tract infection caused by nalidixic acid resistant and fl uoroquinolone sensitive Salmonella paratyphi A , we report such an infection from India in an elderly man with renal and ureteric stones. Key words : Nalidixic acid resistance , Salmonella paratyphi A , urinary tract infection.

A four-week-old infant born after a normal vaginal delivery presented with dyspnea of one month duration. His radiologic evaluation showed multiple cystic lesions involving the left upper lobe, although lower lobe is the usual site. It was removed after pnemonectomy and the fi nal pathological diagnosis was congenital cystic adenomatoid malformation (type II). The postoperative follow up showed excellent recovery and normal development of the child. Key Words : Congenital cystic adenomatoid malformation of lung , congenital diseases.

Caesarean scar pregnancy is a rare form of ectopic pregnancy. It is a dangerous condition that can potentially lead to uterine rupture and severe haemorrhage or even a secondary abdominal pregnancy. If it progress further in pregnancy it is likely to present as placenta accrete/increta with a high morbidity and mortality. Its early diagnosis can be challenging, and the optimal treatment has not been determined. We report a case of an ectopic pregnancy in a caesarean section scar, which was initially misdiagnosed despite using ultrasound. Although the use of ultrasound in combination with serum levels of human chorionic gonadotrophin [hCG] in the diagnosis of ectopic pregnancy is well established, the diagnosis of a rare kind remains diffi cult. However, early diagnosis allows appropriate management planning to preserve uterine integrity and future fertility. The surgical treatment includes curettage, laparoscopy, laparotomy with hysterotomy and excision of the gestational mass. A medical approach with systemic and /or intralesional methotrexate application, oral mifepristone and possibly local injection of potassium chloride or tricosanthin has been proposed by itself, or combined with surgical procedures. Key Words : Caesarean delivery , scar , ectopic pregnancy.

Chromobacterium violaceum is found in soil and water but human infections like skin lesions with pyemia and multiple abscesses are recorded in the tropics. Here we report a case of prostatitis due to Chromobacterium violaceum .

Blood group in 44 cases of A.F.B positive patients and 3476 non-tubercular normal persons were determined. A relatively increased incidence of A.F.B positive cases were observed in persons with O blood group and blood group B was observed as commonest group among north Bengalis. Key words : A.F.B , blood groups

Background: The vast majority of infections assumed to be caused by Coagulase-negative Staphylococcus (CoNS) are a signifi cant consequence of hospitalization. Current antibiotic-prescribing practices, including preoperative antibiotic prophylaxis, have led to the selection of antibiotic-resistant organisms. The purpose of the present study is to provide a current scenario, species distribution in clinical specimens and antimicrobial susceptibility testing, mainly to screen for methicillin resistance, multi-drug resistant strains. Methodology : Total 113 isolates of Coagulase- negative Staphylococci were isolated from clinical specimens over a 6 month period in a non consecutive non random manner. Antimicrobial resisitance pattern to 20 antimicrobial agents were performed Results : Coagulase-negative Staphylococci consisting of 10 different species were isolated. Staphylococcus epidermidis ( 49), Staphylococcus haemolyticus ( 19) , Staphylococcus hominis ( 11) were the most commonly isolated species. Antimicrobial susceptibility pattern revealed that they were all universally sensitive to vancomycin and linezolid. Methicillin resistance was noted among 48% of the isolates. Maximum resistance was seen with penicillin (91%) and least with Teicoplanin(3%) Conclusion : CoNS are a signifi cant cause of nosocomial bacteremia and their susceptibility to beta-lactamase-stable penicillins is unpredictable. Hence the methicillin resistant CoNS which are also multidrug resistant act as a reservoir for drug resistance in hospitals. Low level glycopeptide resistance encountered in recent years limits its use. For all these reasons, accuracy and promptness in the detection of resistance pattern is of key importance to ensure appropriate antibiotic treatment in infected patients as well as control the spread of resistance in hospital environments. Key words: Coagulase-negative Staphylococci , antimicrobial resistance