Vol 9, Issue 1, Jan-Mar, 2019

Despite shouldering more than a quarter of the global TB burden, the Indian government has promised its citizens a “TB-Mukt Bharat” (TB-free India) by 2025, ten years ahead of the global target.1 To accomplish this feat, the government dramatically increased TB funding over the past few years. Indeed, the Indian TB budget in 2016 was 280 million dollars with 62% of the funding coming from international sources.1 In 2018, India spent 580 million dollars on TB programs with 79% coming from domestic sources— a marked increase.2 As the TB budget grows in girth, we must ensure that funding is directed toward addressing challenges particular to the India: pervasive undernutrition and the meteoric rise of diabetes which are driving the TB epidemic in India.

Background: Mysore was ranked as the cleanest city for the second successive time in 2016. Total sanitation is the goal of Swachh Bharath Mission and good practices and models need to be shared and adopted. In this context an explorative research was conducted to prepare the list of key drivers for sanitation in Mysore. Methods: The sanitation value chain for Mysore city was constructed. It consisted of containment, emptying, transport, treatment and disposal. The key stake holders in this chain were interviewed and field visits were done for status and process assessment. Stake holders in this chain were grouped for common roles and strength, weakness, opportunity and threat analysis was done. Individual interviews and focus group discussions were conducted. Results: In Mysore we have found that only 10% of the households depend on onsite facilities for faecal sludge management and 88% of the household have direct sewer connections. Only 12% of the sewage is left untreated into receiving waters or the natural environment. Door to door collection of solid waste is present in all the corporation wards. Open air defecation is far and few and restricted to couple of slums and construction sites. Bylaw framing, planning, implementation of solid waste management by the municipal corporation is satisfactory. Conclusion: The city of Mysore had a good history and basic infrastructure since a long time. The Swachh bharath mission played a catalytic role in the acceleration of sanitation process. Involvement of voluntary organizations, good leadership at municipal corporation level made this success possible. Key words: Swachh Bharath, Key sanitation drivers, Sanitation value chain, Faecal sludge management, Solid waste management.

Introduction: Middle East Respiratory Syndrome (MERS) is a viral respiratory disease caused by a novel coronavirus (Middle East Respiratory Syndrome Coronavirus, or MERS-CoV) that was first identified in Saudi Arabia in 2012. Since then more than 1400 cases were reported from KSA with substantial mortality of about 40%. Objective: To know the role of visual triage in early identification of acute respiratory infection cases in reference to (MERS-CoV). Material and Methods: Hospital Based cross sectional study. Results: This study was carried out to find the effectiveness of visual triage in timely isolation and control of acute respiratory infection in the health care settings. During January to December 2017 total patients passes through visual triage were 1,36,516 , out of that 2240 (1.64%) reported scores 4 and more. During same period 181(0.13%) of patients admitted in various wards from visual triage. Conclusion: Visual triage is very useful in timely isolation of acute respiratory infection cases and prevention of hospital outbreak due to acute respiratory infection, specially disease like MERS-CoV. Key words: General Hospital, Visual triage use, MERS-CoV, Role, Outbreak.

Background: Menopause is one of the most significant events in a woman’s life and brings in a number of physiological changes that affect the life of a woman permanently and can be influenced by various socio-demographic factors and coping activities. Objectives: To determine the commonly reported menopausal symptoms among women of 40 to 60 years and to correlate identified menopausal problems with coping strategies found in participants. Methods: By Modified Menopause Rating Scale [MRS] questionnaire, 150 menopausal women aged 40-60 years were interview to document of 12 symptoms (using divided into somatic, psychological and urogenital domain) commonly associated with menopause The women were asked whether or not they had experienced the 12 menopausal symptoms shown in the MRS in the previous one month (30 days) and grading was made to “present” or “absent” of symptoms. Results: Among those women studied, 34 (22.7%) were premenopausal, 59 (39.3%) perimenopausal and 59 (38.0%) postmenopausal and the mean age of menopause was 49.8 years (±4.9) range 43 - 57 years. The most prevalent symptoms reported were joint and muscular discomfort (70.6%); physical and mental exhaustion (61.3%); and sleeping problems (59.3%). Followed by symptoms of anxiety (48.6%); irritability (45.3%) hot flushes and sweating (38.6; dryness of vagina (37.9%); depressive mood (38.0%). Other complaints noted were incontinence/Frequency of urine (27.3 and heart discomfort (23.3%). Perimenopausal women (47.2%) experienced higher prevalence of somatic and psychological symptoms compared to premenopausal (n = 15.6) and postmenopausal (37.2%) women. However urogenital symptoms found more in postmenopausal group of women. There is a strong significant favourable association between the menopausal symptoms and coping strategies like exercise, yoga adopted by the menopausal women. Conclusion: Symptoms have variable onset in relation to menopause. Some women experience symptoms earlier during perimenopause while some experience them at a later time. The application of various coping methods,including the establishment of social support networks, is warranted to enhance postmenopausal women’s behaviors in different aspects. Key words: Menopausal Rating Scale (MRS), Menopausal symptoms, Middle age women, Coping strategies.

Background: Health care problems faced by migrant construction workers are always neglected. Seventeen patients were death due to malaria and complain of fever attributed in daily newspaper. Objectives: To find out more number of cases, the source of infection and to recommend necessary actions to control the outbreak. Materials and Methods: An epidemiological investigation and verbal autopsy of suspected deaths was conducted on 9th and 10th August 2017 in Ramkanda and Bhandariya blocks respectively. Sanitary survey and assessment of ecological correlation was also done. Results: Out of 13 deaths most were in the village Ramakanda, followed by Kurumdari in Block Ramkaand while four deaths were from village Gadhiya from Block Bhandhariya is having an approximate population 72,637. In block Ramkanda, whereas in 6 days of August 2017 alone (including active surveillance), there were total 571 fever cases and Pf +ve and PV +ve were 42 and 25 respectively. So it’s obvious that in such a short period of time i.e. 6 days, there is remarkable high number of Falciparum malaria cases. In Bhandariya block after the deaths were not available but on desk review of the available reports it was seen that in the last six months out of 3881 slides collected and tested for Plasmodium presence there were 29 Pf +ve slides and 155 Pv +ve slides. Conclusion: On client interview it was evident that most of the residents were reluctant to seek health care services from the HSCS or to reach the government system facility. They were more reliant on Quacks. Key words: Malaria, Verbal autopsy, Sanitary survey, Pf, Pv.

Background: The epidemiology of hematological diseases in India is largely unknown due to paucity of data. Our centre caters to a major chunk of hematological patients in Eastern India and is one of the largest centers in terms of patient attendance. Objective: The objective of this study was to analyze the OPD data to decipher the hematological disease spectrum in Eastern India. Methods: Hospital data of hematology OPD from July 2015 to June, 2018 was retrived from the hospital information management system. The number of new and follow-up (old) patients attending the OPD were analyzed to know the disease pattern in terms of various benign and malignant hematological disease was assessed. Results: The total number of OPD consultations for the three years was 78809, of which 21851 (27.7%) were new cases and 56958(72.3%) were follow-up (old) visits. Disease characterization could be done for 15517 (71.01%) patients; out of these, 73.3% (11377/15517) were benign and 26.7% (4140/15517) were malignant hematological diseases. Common reasons for consultation in hematology OPD were anemia 9170 cases (59.1%), leukemia 2544 (16.4%), bleeding disorder 1908 (12.3%), lymphoma 946 (6.1%) and myeloma 450(2.9%). Among the benign diseases, most common diagnosis was nutritional deficiency anemia 4403 (38.7%) followed by hemoglobinopathy 3868 (34%), immune thrombocytopenia 944 (8.3%), aplastic anemia 694 (6.1%), hemophilia 637 (5.6%), eosinophilia 148 (1.3%) and thrombosis 80 (0.7%). Among the malignant cases, common causes were leukemia 2351 (56.8%), lymphoma 940 (22.7%) and myeloma 451 (10.9%). Conclusion: Anemia remains the most common reason for OPD consultation even in a tertiary care hematology centre. The major burden of malignant hematological disease is leukemia. Key words: Tertiary Care Center, Hematology Disease, Spectrum.

Objectives: Dental illness and psychiatric illness are among the most prevalent health prob-lems all over the world. Evidence suggests that people with mental illness are more vulnerable to dental neglect and poor oral health. Health care professions including dentists are not im-mune to social prejudices and share the general public’s attitude attributed to people with mental illness, affecting quality of care. The aim of the study was to determine the extent to which dental interns are formally prepared to care for patients with mental illness, by as-sessing their attitudes towards people with mental illness. Materials and Methods: Cross-sectional descriptive design was adopted for the present study. A total of 36 dental interns were purposively selected to complete self-reported questionnaires, which consist of four items to seek the background of the participants in the study, which include “age, gender, residence and contact with persons with mental illness” and, 34 item Opinion about mental illness for Chinese community (OMICC) scale. which is a valid and reliable, self-report meas-ure of attitudes. Results: Dental interns have significant positive attitudes towards mental illness in two of the six attitude factors: Benevolence (30.58±3.14) and stereotyping (5.61±1.02). However, they have negative attitudes in stigmatization (10.08±3.02), separa-tism (26.33±4.83), restrictiveness (10.08±2.96) and pessimistic prediction (13.47±3.61) do-mains as they rated high. Conclusion: The findings of the present study have important implica-tions for care of person with mental illness by dental interns and thereby on dental training. Thus, academic education from courses in this area must be planned so as to favour the change in the attitudes and promote a commitment to provide holistic care to people with mental illness. Key words: Academic education, Attitudes, Mental illness, Dental interns.

Primary Hyperaldosteronism is excess production of aldosterone by the adrenal glands resulting in low renin levels. It is frequently associated with metabolic alkalosis and hypokalemia which may lead to intermittent attacks of paralysis. A young hypertensive male patient, on regular treatment with tablet losartan 50 mg and tablet amlodipine 5 mg, once a day since last 4 years, presented with acute onset weakness of all four limbs. Serum potassium levels were found to be 1.6 mmol/L, (normal range 3.5-5.1 mmol/L). He was treated with potassium supplements and after 3 days, his potassium levels were 3.6 mmol/L, with improvement in his weakness. Tablet losartan was stopped and aldosterone to renin ratio with simultaneous potassium levels were ordered. The ratio was high (42.53) [reference range: 0.9-28.9] with simultaneous potassium levels of 3.5 mmol/L. CECT abdomen also confirmed the presence of adrenal adenoma. One must be vigilant in evaluating for underlying causes in a patient presenting with hypokalemic hypertension. We report a case of conn’s syndrome presenting with hypokalemic paralysis. Key words: Hypokalemia, Primary hyperaldosteronism, Paralysis, Adrenal adenoma, Young hypertensive.