As Kushwaha

Outbreak of Meningococcal Infection amongst Soldiers Deployed in Operations

BACKGROUND Meningococcal infection may lead to life threatening meningitis and fulminant meningococcal sepsis. Sporadic cases of meningococcal infection have been reported in soldiers but no outbreak in soldiers has been reported earlier from India. This outbreak in soldiers serving in counter insurgency role under field setting was effectively controlled without compromising their operational commitment. METHODS This is an epidemiological investigation and control of an outbreak of meningococcal infection, bringing out the predisposing factors and highlighting the role of early diagnosis and management of cases. Mass chemoprophylaxis in contacts was used as an effective control measure in the absence of vaccine in this institution based outbreak. RESULT Out of a total of 17 cases reported, 14 presented as meningitis and three as meningococcemia. Two cases of meningococcemia ended fatally. Serogroup A of Neisseria meningitidis was responsible for this outbreak. Gross over- crowding was the predisposing factor. CONCLUSION An outbreak of meningococcal infection in soldiers deployed in counter- insurgency role was effectively contained using mass chemoprophylaxis in the absence of meningococcal vaccine.

Stress fractures-a prospective study amongst recruits.

BACKGROUND Stress fracture (SF) is the single most common cause for the lost number of manpower days during training of recruits in the Armed Forces. This prospective study was undertaken with a view to develop baseline data on incidence of SF and to identify related variables. METHODS A prospective study over a period of five years during 2004-2009 in which a total of 8,570 recruits were enrolled at the start of their training to find out the incidence and pattern of SFs. RESULTS A total of 604 (7.04%, 95% CI 6.40-7.40%) out of a total of 8,570 recruits sustained SF during the study period. The majority of fractures occurred during basic training. The factors like urban residence, vegetarianism and those without prior history of physical activity were found to be associated with SF. Tibia was the commonest bone involved. CONCLUSION Prevention is undoubtedly the best approach in SF and other sports injuries. Priority should be given to individuals with good sports and physical activity background during recruitment. Intensity of training should be gradually increased during first three months (12 weeks) of training.

Mass scabies management in an orphanage of rural community: An experience

Scabies is an important health problem characterized by continuous transmission throughout the year. It is ubiquitous, contagious, and debilitating parasitic dermatoses, known since antiquity and having widespread distribution in the tropics. The worldwide prevalence has been estimated at about 300 million cases yearly, although it may be an overestimate.1 Scabies occurs in both sexes, at all ages, in all ethnic groups, and at all socioeconomic levels. In India, the incidence ranges from 13% to 59% in rural2 and urban areas.3 Scabies is a Latin word that simply means to scratch and is caused by the mite Sarcoptes scabiei var-hominis, and is usually associated with conditions of overcrowding, low socioeconomic standards, low level of education and poor hygiene.4 Overcrowding and sexual contacts are the most common, but not exclusive modes of transmission. The mite of scabies burrows into the outer layer of the skin (stratum corneum) and feeds on skin cells and fluids. It is this feeding action, and its products (digestive secretions and feces) that provoke an immune reaction from the body which results in itching and other symptoms of scabies. Scabies causes considerable discomfort and can result in severe secondary complications such as impetigo, cellulitis, pyoderma, bacteraemia and post-streptococcal glomerulonephritis.5–7 The study was undertaken in the Rural Health Training Centre of a medical college located at Kasurdi village, in Pune district of Maharashtra. During routine visits, three school going children of a nearby orphanage reported with the clinical symptoms suggestive of Scabies i.e. insomnia due to severe itching at night, rashes, irritability leading to school absenteeism and poor quality of life. On examination, the children were found to be having scabies. Scabies in orphanages are not uncommon but unfortunately are hard to treat because of reasons like delayed diagnosis, inadequate treatment, malnutrition, associated allergic and bacterial infections and inadequate follow-up.8 It was thus decided that all the children at the orphanage be examined and an intervention to cure all children of the orphanage be undertaken. The study thus aimed to assess the prevalence of Scabies in an orphanage in a rural village of Maharashtra State and to conduct a mass Scabies treatment and follow-up of all children and care givers. The study in addition also provided health education and trained the care givers for timely management of scabies in the setup.

Study of blood pressure profile of school children 6–15 years in a rural setting of Maharashtra

BACKGROUND High blood pressure in childhood is a major risk factor for heart disease and stroke in adulthood. There is enough evidence to suggest that the roots of essential hypertension in adults extend into childhood. There is a paucity of literature on the blood pressure measurements amongst children. This study was done to study blood pressure profile of school children in rural area of Maharashtra. AIM & OBJECTIVES This cross sectional study was carried out to determine the prevalence of hypertension in children 6-15 years and to study the association between selected variables and blood pressure. MATERIAL & METHODS This study was done using a predesigned questionnaire and making measurements of height, BMI and Blood pressure using standardized physical instruments following standard guidelines. The data was collected and analyzed using appropriate statistical tests. RESULTS The prevalence of hypertension in the study was found to be 4.4% with 3.5% in females and 5.1% in males. CONCLUSION In the study, hypertension in students was found to be significantly associated with higher BMI and with family history of hypertension. Age, height and BMI were found to correlate positively with Blood pressure levels in this study.

Outbreak of Influenza (H1N1) amongst children in a residential school.

BACKGROUND An outbreak of pandemic Influenza H1N1 occurred from 13 Feb to 20 Feb 2010 in a residential school at Belgaum, India. METHODS On report of sudden increase in number of students reporting sick with symptoms suggestive of flu like illness, an investigation was launched to detect the source of infection and to control the spread of infection amongst those not affected. Six random samples of throat from the initial cluster were collected and RT-PCR was done to confirm the diagnosis. The outbreak in this institution was effectively controlled by standard preventive & control measures in the absence of vaccine. RESULT In a school of 335 children, 96 cases of Influenza like illness possibly resulting from pH1N1 (2009) were reported with an attack rate of 28.6%. Out of a total of 96 cases reported, 73 (76%) were hospitalized and 23 treated as outdoor patients. Serogroup A of Influenza H1N1 pandemic was identified to be the agent responsible for this outbreak as 06 random samples drawn from initial cluster tested positive on RT-PCR. A visit to an exhibition in the city was possibly the source of exposure amongst the children. CONCLUSION An outbreak of Influenza H1N1 infection amongst students in a residential public School was found to be linked to a visit to an exhibition following which the secondary transmission led to further occurrence of cases.

Newborn care in India: a crying need of the hour

This editorial discusses the current state of neonatal health and mortality in India and presents evidence of effective interventions as well as recommendations for improving care through training and integrated services.

An interesting case of lump abdomen—gossypiboma

Lump abdomen is one of the commonest modes of presentation in different abdominal conditions encountered in routine surgical practice. However, this case of gossypiboma is being reported since it is extremely rare and has medico-legal implications. The case was seen at a small peripheral military hospital without facility for advanced investigations but patient wanted relief from the medical condition.

Accidental Outbreak of Non-Bacterial Food Poisoning

BACKGROUND Troops deployed in isolated garrisons face erratic supply of rations. At times they resort to use of locally grown plants without knowledge of local flora, resulting in accidental food poisoning. METHODS This is a descriptive, analytical and epidemiological study of one such outbreak of food poisoning, due to use of a locally grown plant as vegetable, amongst soldiers of a unit in high altitude. An epidemiological case sheet was made and food specific attack rates of those exposed and not exposed were calculated to identify the food item. The toxicological analysis of food item established the cause. RESULTS Of the 39 people who consumed the meal, 29 fell ill with an attack rate of 74.35%. All the cases presented with classical features of atropine poisoning and were managed with sedatives, physostigmine and supportive care. Twenty one had symptoms severe enough to warrant hospitalization. All the cases made complete recovery. The attack rate for food item containing plant poison was 96.4%. The toxicological analysis of food sample established the presence of atropine alkaloids. The plant was identified on flowering as Atropa acuminata. CONCLUSION An outbreak of non-bacterial food poisoning in soldiers at high altitude, caused by accidental ingestion of a dish made out of Atropa acuminata plant leaves containing atropine related alkaloids was investigated and conclusively established.

Journey from victim to a victor-a case study of people living with HIV and AIDS.

This case study is about Anamika (name changed) a 35-year-old female who is an empowered HIV-positive and presently works as Community Co-ordinator at an anti-retroviral treatment (ART) centre in Maharashtra India. Her transformation from a victim of social stigma and discrimination due to her HIV-positive status to her present role has been possible due to her determination and social support she received from our medico-social workers. This case is being presented as a case study which shows the potential of effective social rehabilitation and exploring utilisation of HIV-positives as a resource in our fight against this medico-social epidemic of HIV/AIDS.

Management of effects of heat—need for change

In Western and central parts of the country temperature touches an high of 50°C and more with relative humidity not > 30%. The central and northern plains, western deserts, and tropical forest areas of Northeast have environmental conditions predisposing soldiers to effects of heat stress. There is also a growing body of evidence that heat stress that is physiologically tolerable can impair human ability to accomplish complex tasks of military importance. 9 Medical personnel must be prepared to advise commanders on the potential adverse effects of heat and to propose practical options for prevention and control of heat stress under difficult circumstances. They must be aware of all relevant orders and instructions on the subject. All cases of effects of heat including deaths must be investigated. Exhaustive preventive measures to combat effects of heat stresses which are implementable at unit and individual level are clearly laid down in Army Orders and Manual of Health for Armed Forces. Instructions are also documented to reschedule training and physical activities to avoid heat stress on troops. The implementation of relatively simple preventive measures can have a dramatic effect on heat illness rates in military settings. 10 Acclimatisation, BPET in cooler parts of the day, and pre-BPET medical appraisal can be effective in reducing effects of heat. Conventionally, cool rooms and heat stroke centres (HSCs) are authorised in the army to tackle cases of effect of heat. The peripheral healthcare establishment (HCE) like medical inspection rooms (MI rooms) and medical aid posts (MAPs) are authorised to establish HSCs and cool rooms during summer months (April–September) to render first-aid and treatment nearest to the site of casualty provision exists to procure ice for cooling purposes at the scale of 45 g/diem/man when soldiers are required to stay in tents and bashas. 11 For each HSC and cool room ice is procured, varying from 200 to 400 Kg in quantity, for the period ranging between April and September to keep room temperature near comfort zone and use cool water to render first-aid. The practice of using ice in HSCs and cool rooms for control of ambient temperature is not only ineffi