R. S. Sharma

Unnatural deaths in Delhi during 1991

An analysis was undertaken of 3623 post-mortems conducted in the Civil Hospital, Delhi, during 1991, covering 75 per cent of civil police stations and all three railway police stations. The study showed that the death rate was highest in the age group of 30–39 years (29.6%), road traffic accidents being the most common cause (33.9%). In general four times more deaths occurred in males than in females. However, in deaths by burning it was three times higher in females. The attention of all concerned should be drawn to this huge, untimely and tragic loss of lives.

Epidemiology of Cholera in Delhi—1992

Cholera is endemic in Delhi and is a highly seasonal disease. Suspected cholera cases are referred to Infectious Diseases Hospital, Delhi. Rectal swabs from 2783 cases were bacteriologically examined during 1992, out of which 1075 were found to be positive for Vibrio cholerae O1 biotype El Tor. First isolation was made on 3 April and the last on 14 December. About 87 per cent isolations were made between May and September, which are summer and monsoon months in Delhi. Detailed epidemiological information was collected for about 198 cases of diarrhoea out of which 103 were confirmed cases of cholera. Half of these cases occurred in children below 10 years of age. The other major group affected was adult females, especially housewives. All the cholera cases occurred in those who were illiterate or educated up to primary level. Important risk factors were: contact with person having similar illness, storage of water in wide-mouthed containers, use of glass or mug to draw water from containers, absence of sanitary latrines and habit of washing hands with water alone after defecation, before cooking and eating food. About 30 percent cases had access to piped water supply which was found safe in Delhi during 1992. The findings suggest that the hygienic practices were more important than contaminated water sources for transmission of cholera in Delhi during the year 1992.

Concurrent evaluation of immunization programme by lot quality assurance sampling

The current EPI methodology for identifying immunization coverage is simple and easy to carry out under field conditions and gives a good idea about immunization coverage. However, it is not useful for local managers. It does not identify small health units with poor performance. Information on performance at the local level is vital to enhance overall immunization coverage. Estimation of coverage on a small area basis can be made by Lot Quality Assurance Sampling (LQAS). LQAS was used in nine sub-centres of district Saharanpur. The methodology was found to be feasible and identified seven sub-centres with poor current performance. Although LQAS may not be a good substitute for current EPI methodology to evaluate immunization coverage in a large administrative area, it is suggested that LQAS is a useful additional method for routine monitoring and evaluation of health programmes on a small area basis, especially as the overall coverage increases.

Epidemiological evaluation of oral polio vaccine efficacy in Delhi.

Forty seven cases of poliomyelitis and 94 controls were studied for immunization status. Unmatched analysis with one control per case and two controls per case was done to find out the ratio of the odds of immunization in diseased individuals as compared with the nondiseased (odds ratio). This ratio (OR) was used further to calculate oral polio vaccine efficacy. OPV efficacy was found to be 93% with 95% confidence limits of 75–98%.

Epidemiological Considerations on Age Distribution of Paralytic Poliomyelitis

Despite a declining trend of poliomyelitis due to high coverage of OPV, the age distribution of poliomyelitis cases have not shown any change over the years in India. More than 90 percent of the cases have continued to occur in children below 5 years of age; the median age of cases remained below 2 years of age. The authors examined the issue and suggest that any major shift in age at paralysis may not occur in India, in spite of high vaccine coverage with OPV unless there is concomitant improvement in sanitation and hygiene.

Diet and thyroid - myths and facts

Thyroid gland is located in the neck and synthesize thyroid hormones, which have an indispensable role in the metabolic functions of the body. Iodine is an essential compound for the synthesis of thyroid hormones and is mostly derived from the environment. Other important nutrients for the thyroid function include selenium, iron, Zinc and vitamin A. Dietary alterations of the micronutrients lead to structural and functional alterations in thyroid function. The alternative medical practitioners and nutritionists advocate plenty of dietary modifications without a scientific rationale. In this article, we review the role of dietary micronutrients in thyroid physiology and dispel few myths surrounding the same topic.

Acute paralytic poliomyelitis in Delhi (1975–1992)

Incidence of poliomyelitis in Delhi between 1975 and 1992, estimated from available data, shows a ladder-pattern type of decline from 15.65 in 1975 to 5.90 in 1992. The linear regression analysis shows a declining trend of incidence by 66.28% during the period. Huge increase of population with fast growing slums and resettlement colonies in Delhi was attributed to be responsible for partly counteracting different poliomyelitis control/eradication activities. The population representativeness of estimated incidence showed constant improvement during 1980 to 1991.

Depression and anxiety in patients with epilepsy

Background: Anxiety and depression are commonly found in epileptic patients. However, the etiology behind the mechanism remains multifactorial, mostly because of variability in study settings. In order to fill the knowledge gap, we investigated the prevalence of anxiety and depression among epileptic patients and their correlation with certain demographic variables. Methods: In a Cross Sectional Out Patient Based Study, a total of 147 patients with epilepsy were recruited and evaluated for inclusion and exclusion criterion. Participants who met the inclusion criterion were assessed using standardized scales HARS and HADS rating scale for anxiety and depressive symptoms respectively. Results: 100 participants were included with mean age of 33.63 years for men and 30.16 years for females. 27% showed mild to severe anxiety and 21% had mild to moderate depression. Prevalence of both anxiety and depression was found more among females, singles, participants from urban background and having partial epilepsy. Significantly (p-0.020*) higher anxiety was seen in patients with partial epilepsy than those with generalized epilepsy. Conclusions: Individuals with partial epilepsy are more prone to get affected from comorbid disorder like anxiety and depression, especially females, singles and those from urban domicile.

The ominous octet of “S” in noncommunicable disease

Noncommunicable diseases (NCDs) have surpassed the infectious disorders as the major causes of morbidity and mortality worldwide. This is the first decade in the existence of humanity, where the prevalence of obesity has surpassed that of the malnutrition. Although the NCD rates have increased in developed countries, the mortality rates have reduced due to the effective management and prevention strategies. Similar trends are not seen in developing countries where the NCD-related mortality is on the rise. The risk factors for NCD are commonly encountered and require a lot of personal involvement to curb the rise. In this review, we shall discuss the common risk factors leading to the NCD and also suggest certain remedial measures. We propose the ominous octet of “S,” a constellation of risk factors starting with the letter “S,” leading to the NCD.

Palmoplantar keratoderma with growth hormone deficiency.

Abstract Palmoplantar keratoderma (PPK) is a diverse group of disorders, characterized by thickening of the palms and soles, which are subdivided into focal or diffuse; it can be acquired or hereditary. Syndromic association of PPK is described in literature with all patterns of inheritance. Skin and nail changes, predisposition to malignancy, skeletal deformities, dwarfism and enamel abnormalities are rarely associated with PPK. In this case report, we present monozygotic twin sisters with palmoplantar keratoderma and growth hormone deficiency. We speculate a common mutation leading to these two apparently unrelated entities.