Vol 10, Issue 1, Jan-Mar, 2020

Onchocerciasis is a serious neglected tropical disease caused by the filarial nematode Onchocerca volvulus, transmitted by black fly which leads to blindness and chronic disability with estimated infection rate of about 37 million people in tropical Africa and in isolated foci in Yemen and Latin America and have caused a debilitating eye and skin disease in more than 5 million people with about 1.2 million visual impairment or blindness and half of this population residing in Nigeria. Background: Onchocerciasis or river blindness results from infestation by the nematode Onchocerca volvulus, characterized by eye affections and skin lesions with severe troublesome itching. It is a chronic, communicable, slowly progressive, parasitic disease which has being rated as the second-leading infectious cause of blindness worldwide annually. It is a neglected tropical disease of great public health concern which is transmitted by black fly with estimated infection rate of about 37 million people in tropical Africa and in isolated foci in Yemen and Latin America. It has caused a debilitating eye and skin disease in more than 5 million people with about 1.2 million visual impairment or blindness and an estimate of over 85 million people leaving in endemic areas with 99% of the cases resulting from Africa and half of this population residing in Nigeria. Also, estimate of about 120 million people are at a risk of contracting the disease due to the breeding habit of the vector. Methods: The databases Medline, WHO website, CDC website, PubMed, Web of Science World Factbook of Central Intelligence Agency, were searched for relevant studies published for the past five decades on onchocerciasis in Nigeria. Papers investigating it prevalence, clinical features, diagnosis, treatment, government policy, world health organisation policy and recent findings as well as further finding in Nigeria were included. Results: Extrapolation of data from the past five decades on onchocerciasis infection in Nigeria has shown that the rate of infection is significantly reduced in certain areas of the country due to repeated administration of Ivermectin. However, in most regions the infection rate still persist with a percentage of up-to 24 (75%), 45.2%, lizard skin and leopard skin were seen in 3.5% and 2.0% respectively, hanging groin 2.6% and scrotal enlargement at 8.6%, (Bakundi district of Taraba state with infection rate in excess of 30%), 54.2% (Ibarapa Local Government Area of Oyo state), 61% and 71% (Kuhe and Gube community of Benue state), 83% (Oria North Local Government Area of Edo state) and certain patients were blind due to onchocerciasis and were positive to onchocerciasis test. 79.5% in Oyo state (159 patients test positive for onchocerciasis out of 200 patients), 94.5% in Kaduna state, (189 patients tested positive for onchocerciasis out of 200 patients). Conclusion: The results of this systematic review suggest that there have been a significant decrease in onchocerciasis infection in several regions of the country. However, the prevalence still persists mostly in river line area and regions which are inaccessible to the program as well as lack of orientation.

Introduction: Middle East respiratory syndrome (MERS) has become a significant global public health concern. Recent outbreaks of this syndrome have occurred in several countries, with the major outbreaks in Saudi Arabia, Korea and United Arab Emirates (UAE). The present study assessed the awareness of students of a Medical and Health Sciences University in UAE towards MERS. Methods: This cross-sectional study was conducted in 500 university students. The study employed a specially designed, pretested and validated questionnaire based on World Health Organization factsheet for MERS for assessing the knowledge of the respondents regarding MERS. Results: Of the 500 participants, majority (303; 60.6%) presented with good knowledge regarding MERS. The mean knowledge score of the respondents was 10.71 ± 4.23 with medical college students having the highest score of 11.87 ± 4.07 followed by dental, nursing and pharmacy students. Gender, college and year of study and participation in educational lecture or conference on MERS were significantly associated with the knowledge level. Males possessed significantly (p<0.001) better knowledge than females. Medical students had significantly (p<0.001) better knowledge of MERS as compared to students from other colleges. As the year of study progressed the awareness regarding MERS also significantly (p<0.001) improved. Conclusion: The study participants presented with good knowledge of MERS – a novel viral respiratory potentially serious disease. With recent outbreaks of this syndrome in the region there is a need for medical and health sciences students, who will be the future healthcare providers, to appraise their knowledge of MERS and contribute towards raising awareness about such outbreaks. Key words: Health Care Providers, Awareness, United Arab Emirates, Middle East Respiratory Syndrome, Public Health.

Introduction: Diabetes Mellitus (DM) is a metabolic disorder of multiple etiologies characterized by chronic hyperglycemia with disturbance of carbohydrate, protein and fat metabolism resulting from impaired insulin secretion, insulin action, or both. Knowledge of the risk of diabetes development act as a primary prevention measure among the high-risk population. Objectives: To assess the risk of developing Type 2 Diabetes Mellitus using Indian Diabetic Risk Score among adults of age more than 30 years in a colony. Methods: A cross sectional study was undertaken among adults of age more than 30 years to assess the risk of development of DM. A prevalidated, structured questionnaire was used to assess the risk of development of DM including the Indian Diabetes Risk Score. The total scores were classified into low, medium and high-risk categories. Results: Mean age of the study population was 46.12±10.9 yrs. Nearly 62% of study population were female, 42.7% had high school education and 44.7% were daily wage employees. Majority (47%) of the study population belonged to high risk and 36.5% belonged to medium risk category for development of DM. Increasing age, BMI, waist circumference, high Blood Pressure, a positive family history, female gender, higher education, current usage of alcohol and tobacco, sedentary to mild physical activities and high waist to height ratio were significantly associated with increased risk of development of Diabetes Mellitus. Conclusion: The risk assessment should be put forward as a major prevention tool in the DM management. Key words: Assessment, Danger, Diabetes, Grown person, Risk.

Introduction: Unwanted or unintended pregnancy is common and in such a case access to safe abortion services is a women’s right. The MTP act of 1971 has provisions which make abortion services available and accessible freely. MTP pills make first trimester abortions possible safely without having to undergo any surgical procedure. But lack of correct knowledge limits its safe use. Objectives: To study the Knowledge, Attitude and Practices related to use of medical abortion pills among married women in an urbanized village of Delhi. Materials and Methods: A cross sectional study was conducted among 224 married women in reproductive age group residing in an urbanized village of Delhi. Mixed quantitative and qualitative methodology was used in Data collection and analysis. Results: 69.2% women were under 30 years of age. 79.7% women had at-least two children and 26.4% had at least one abortion. 69.64% women knew about at least one method of abortion (Medical or Surgical). Only 38.8% women knew that abortions are legal. 61.1% had heard about abortion “pills”. Of them, as many as 41% said these pills can be procured directly from the chemist. Only 5.8% had correct knowledge regarding use of these pills. Misconceptions about side effects were also common.50% said they would feel shy to discuss these pills with a male doctor. 12.5% reported using medical abortion pills, though ever having unplanned pregnancy was reported by 52.2% women. 78.57% of the women reporting MTP pill use, took the medicines directly from the chemist. Conclusion: Though the general attitude towards use of medical abortions was positive in the community, there were widespread misconceptions. There is an urgent need to increase the awareness about hazards of self-medication of medical abortion pills. Key words: Abortion, MTP, Women’s Health, Unmet Need, Reproductive health.

Background: Self-care in diabetes has been defined as an evolutionary process of development of knowledge or awareness by learning to survive with the complex nature of the diabetes in a social context. Methodology: A community based cross-sectional study was conducted with the objective to assess the level of self-care among known type-2 diabetes patients in rural field practice area. A total of 727 patients were involved and predesigned, pretested and semi structured questionnaire developed by referring the Summary of diabetes self-care activities measure (SDSCA), Diabetes self-management questionnaire (DSMQ) and patient health questionnaire-2 was used for the study. Data entry was made in Microsoft excel and analysis was done using the SPSS statistics 20.0 version. Results were expressed in proportions and percentages and appropriate statistical tests was applied to see the association. Results: A total of 727 known diabetes patients were participated, out of which 298 (40.9%) were males and 429 (59.1%) were females. With respect to self-care activities variables in diet modification except intake of fried foods, binge eating and skipping of the meals, good physical activity, drug adherence and some variables in problem solving are having good influence over glycemic control with P value <0.05. Frequency of glucose monitoring, variables in risk reduction except stopping smoking and alcohol and healthy coping were not influencing the glucose levels and it was not significant statistically. Conclusion: Self-care activities such as eating green leafy vegetables and fruits frequently, occasional consumption of meat, strict restriction of sweets and consuming salt restricted diet will have positive influence over glycemic control. Key words: Self-care, Diabetes mellitus, Knowledge, Practices, Rural.

Introduction: Genital dermatoses which can be venereal or non-venereal in nature are common in a significant number of women. The female non-venereal genital dermatoses can be classified into congenital anomalies, infections and infestations, inflammatory conditions, benign and malignant neoplasms. Local factors such as moisture, warmth, friction and irritants may alter the morphology of lesions involving the genital area thereby causing a diagnostic dilemma to the treating physician. Till date, few studies are published on the genital dermatoses of nonvenereal origin in females. Hence, the present study was undertaken to determine the various female non-venereal genital dermatoses for their appropriate understanding and management. Materials and Methods: A prospective observation study was carried out on women above 18 years of age attending the outpatient department of PESIMSR, Kuppam from September 2018 to June 2019 with complaints of genital lesions. A detailed clinical history, examination and basic investigations were performed on recruited women to rule out sexually transmitted infections. Women with only non-venereal dermatoses were included in the study. Results: A total of 97 women were included in the study. The most common dermatoses observed were vitiligo (15.4%), candidal intertrigo (13.4%), lichen sclerosus (11.3%), lichen simplex chronicus (10.3%) and irritant contact dermatitis (10.3%). Other dermatoses included were folliculitis, lichen planus, pemphigus vulgaris, drug eruptions, tinea cruris, herpes zoster, bartholin cyst, psoriasis and behcet’s disease. Conclusion: This study concludes that all dermatoses involving the genital area are not sexually transmitted and the need for health education regarding the non-venereal skin conditions is necessary. Key words: Candidiasis, Female, Genitalia, Non-venereal dermatoses, Vitiligo.

Background and Objectives: Health hazard due to arsenic exposure through ground water is a major problem in West Bengal. The State Government is involved in supplying arsenic safe water to the population. An epidemiological study is done on Malda, one of the severely arsenic affected district of West Bengal. Quality of drinking water and its availability to the people have also been assessed. Methods: A population based cross sectional study was done in Malda. Water from household tube well was tested for arsenic and availability of safe water was assessed. Results: Four hundred and forty-six (8.3%) cases of arsenicosis with typical skin lesion were detected out of 5355 participants examined in 2013 households studied in seven affected blocks of Malda. Out of 1638 water samples tested from home tube wells, 78% of water samples were found to be contaminated with arsenic >0.01 mg/L. Out of 81 habitations surveyed, 68 habitations had pipelines constructed for supplying arsenic safe water. However, supply was regular in four habitations only. Arsenic safe water (<0.01mg/L) was available from 5 tube wells out of 21 tube wells constructed by PHED in the habitations. Interpretation and Conclusion: Significant number of arsenicosis cases were identified in Malda district. Large number of home tube wells were contaminated with arsenic. In spite of presence of PHED tube wells and pipelines in most arsenic affected habitations, safe water was not available to most people. Key words: Arsenic epidemiology, Arsenicosis, Water quality, Safe water availability, Arsenic in West Bengal.

Introduction: Primary dysmennorhea is the commonest problem experienced by adolescent girls. Pain begins just prior to or with the onset of menstrual flow and resolves with end of menstruation. The pain may be experienced in the pelvis, abdomen and lower back or upper legs. Yoga provides benefits that prove extremely useful for people to lead a healthy life. Anulomaviloma is one of the pranayama which balances both the sides of the brain. This study is undertaken to find the effect of three yoga asanas (the cat, fish and cobra pose) and anulomaviloma in primary dysmennorhea on pain, severity and quality of life. Methods: The subjects were assigned to three groups by randomized controlled sampling Group A (n=10) who performed the three yogasanas Bhujangasana, Marjarasana and Matsyasana and Group B (n=10) who performed the anulom vilom pranayam technique and Group C (n=10) combination of these two intervention protocols. The subjects were assessed at the baseline and after 4 weeks which included the subjects having presence of dysmennorhea of Grade 2 and Grade 3 Severity on the Verbal Multidimensional Scoring system for Dysmennorhea Scale and Pain on the Numerical Pain Rating Scale and quality of life was assessed by using Short Form-12 questionnaire. The intervention consisted for a period of 4 weeks. Results: The study concluded that there is statistically significant difference in all the three groups. Conclusion: Yogasanas along with pranayama technique are more effective than using a single intervention protocol either of yogasanas or pranayama in primary dysmennorhea. Key words: Anulom Vilom Pranayama, Bhujangasana, Marjarasana, Matsyasana, Menstruation.

Introduction: Malaria is a disease with global public health importance. India is endemic for the disease and accounts for 4% of global deaths due to Malaria. Karnataka contributes 0.89% of cases annually of the country and is in the pre-elimination phase of the disease. The study was conducted in two districts of Karnataka to assess the awareness about malaria and practices on its prevention and treatment among residents of the districts. Materials and Methods: A crosssectional study was conducted in 2 urban and 6 rural randomly selected clusters in Raichur and Bagalkot districts of Karnataka. A total of 480 individuals were assessed for their perception and practices related to malaria prevention by direct interview and observation checklist using a pretested structured interview schedule. The data collected was analyzed using SPSS-22. Results: The present study found that 43.1% of study subject were aware that malaria is transmitted through mosquito bite. 39% of respondents were able to identify at least one symptom of malaria while 44.6% were aware of at least one preventive measure to be taken against transmission of the disease. 60.8% of households surveyed under the study owned at least one mosquito net in their house. The proportion of houses where indoor residual spraying was done was only 3.5%. Conclusion: The overall awareness about malaria and its prevention was notably low in the study region. So, we recommend additional behavioural change communication programmes and other appropriate interventions from the health system to improve them. Key words: Malaria, Knowledge and practices, Mosquito net, Prevention, Indoor residual spray.

Background: Insulin resistance can be broadly defined as subnormal biological response to normal insulin concentration. Insulin resistance (IR) is one of the major factors in the pathogenesis of sepsis. Aim: To study the Insulin Resistance as Prognostic Indicator in Severe Sepsis, Septic Shock and Multiorgan Dysfunction syndrome (MODS). Materials and Methods: A prospective observational study done at Intensive care unit of Department of Medicine, at the tertiary care health centre of Northern India, it was done between June 2016-to May 2017. Patients with age between 14 to 75 years and satisfying the criteria for severe sepsis, septic shock, MODS according to third international consensus 2016 guidelines was included in the study. Patients on statins and insulin, those who had chronic disease and who had CPR were excluded. Results: A total of 81 patients were enrolled. Mean of fasting blood glucose (FBG), fasting insulin level and insulin resistance of both groups were calculated and compared on Day 1 and Day of outcome. Out of 81 patients 42 were euglycemic (RBS<140 mg/dl) and 39 were hyperglycemic (RBS>140 mg/dl). Mean fasting insulin (13.36+4.95v/s 9.83+4.54) and insulin resistance (6.65+3.84v/s2.41+1.11) of hyperglycemic was found to be significantly (p<.01) higher than euglycemic group of patients. Of 39 hyperglycemic patients 30% (n=13) expired while out of 42 euglycemic patients 28.5% expired (n=12) showing mortality was higher in hyperglycaemic patients and the value was found to be non-significant. Conclusion: In patients of severe sepsis, septic shock and MODS stress induced hyperglycemia and insulin resistance are associated with increased mortality. IR is a good and easily estimated method for assessing, but it is not the appropriate indicator of mortality in patients with severe sepsis and organ failure as there are many other factors which come into interplay leading to poor prognosis. Key words: Insulin resistance, Severity, Sepsis, Septic shock, MODS.