Renuka Kunte

WHO Guidelines for the treatment of malaria

Early diagnosis and prompt treatment with effective antimalarials is a vital component of malaria control strategies. The second edition of the World Health Organization (WHO) Guidelines for the treatment of malaria revisits the global recommendations on the case management of malaria on updated evidence compared to the earlier 2006 edition. Though the recommendations are targeted at the country level policy makers providing a framework for the development of specific and more detailed national treatment protocols, it is a valuable read for all clinicians and post-graduate students.

A cross-sectional study of gender differentials in disability assessed on World Health Organization Disability Assessment Schedule 2.0 among rural elderly of Maharashtra

Background: Disability is important public health problem especially among elderly. Gender difference between disability statuses of elderly is quite obvious. Very little information about disability in a rural area hinders the proper formulation of policies. Objectives: This study determines role of selected socio-demographic factors in explaining gender differences in disability among rural elderly. Materials and Methods: A community-based cross-sectional study was carried out from January 12 to December 12. 227 (Two hundred and twenty seven)(aged 60 years and above) were selected from a rural village of Pune, Maharashtra. Data collected using newly published World Health Organization Disability Assessment Schedule 2.0. Chi-square test and odds ratio used for determining the association. Results: The result confirms higher prevalence of disability among females than that of males. Disability was found to be statistically significant with gender. Marital status and education were effect modifier of disability. Disability in mobility was most common. In almost all domain disability was more common among elderly women. Conclusion: Greater prevalence of disability among aging women compared with men requires more attention to be given toward them for proper planning of scarce health services.

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.

Use of Kirkpatrick’s model for evaluation of reaction and learning of participant of national level workshop on linear regression

Workshop is a very useful learning method for increasing the understanding and knowledge of participant. Workshop is usually conducted among limited predecided participant. However the attendees may vary in their qualification and different knowledge of the subject, hence it throws a challenge to the organizer for taking every participant along. Like any other education process, the workshop needs to be evaluated. The evaluation is essential to generate empirical evidence whether the objectives of the workshop have been achieved. Also there is a increasing scrutiny to evaluate the academic programs for their stated objectives. 2

Gender differential and implications in the epidemiology of stress fractures among cadets of Indian Armed Forces

Background Most studies on stress fractures in India have been carried out among recruits as against officer trainees and limited to males. With the continuous induction of women in the Armed Forces, it was decided to carry out a study among officer trainees of the three services and compare the epidemiology among genders. Methods A prospective study was carried out in 2011-2012 at Training Institutes of the three services where male and female cadets train together. Baseline data was collected for all trainees who joined the academy during the study period. All cadets were followed up for development of stress fractures for which details were taken. Additional information was taken from the Training Institute. Results A total of 3220 cadets (2612 male and 608 female cadets) were included in the study. Overall 276 cadets were observed to have stress fractures during training - making an incidence of 6.9% for male cadets and 15.8% for female cadets. Females were found to have a significantly higher incidence of stress fractures. Further the distribution and onset of stress fractures in females was observed to be distinct from males. Conclusion The significant gender differential observed in the study indicates differential role of intrinsic and extrinsic risk factors in the causation of stress fractures among male and female. Special consideration needs to be given to these while planning and implementing measures for prevention. Further studies may be carried out on subject and on the effect of interventions in stress fracture prevention.

Reinfection of Varicella zoster in a vaccinated adult.

Chickenpox is an acute, highly infectious disease caused by Varicella-zoster virus. Approximately 90% of cases occur in children and lesser in adults. As per literature 55 percent of Varicella-associated deaths occur among adults.1 One attack gives durable immunity and second attacks are rare.1 People who already had chickenpox and get it again – is known as “reinfection”.2 If this happens, a milder form of the illness usually occurs, with fewer symptoms. Diagnosis is usually made on clinical grounds, based on rash characteristics and on epidemiologic features, such as contact with other Varicella cases.2 Laboratory tests are available to confirm diagnosis of Varicella, assess immune status, and genotype of VZV strains. Varicella vaccine (OKA strain) is available in India. However, reports of Varicella outbreaks in highly immunized groups in Japan and USA have made effectiveness of Varicella vaccine questionable. We present a case of Varicella in a young adult patient who gave history of chickenpox in childhood and was previously immunized with Varicella vaccine, yet manifested a full blown disease.

Tobacco consumption and its association with various sociodemographic factors among females (15-49 years) residing in an urban slum of Pune, Maharashtra

Context: Tobacco consumption among females is on rise and is increasing at an alarming rate. This epidemic among the females is emerging as an important public health problem especially in slums. Aim: Study was conducted to find out association between sociodemographic factors and tobacco consumption. Settings and Design: Community-based cross-sectional study was carried out among females (15-49 years) in an urban slum of Pune during February 12 to April 13. Materials and Methods: Sampling frame was prepared from records of urban health center. Required sample size was selected by simple random method. Data collected using pretested validated structured questionnaire after obtaining informed consent. Statistical Analysis: Statistical analysis was performed using SPSS 20, and Chi-square test was used for determining association. Results: Of 305 females studied, 31.5% of them were currently consuming tobacco. Most common form of tobacco consumption was smokeless that is, Mishri application 55.2%. About 64% females started using tobacco before 20 years of age. Most of them (32%) consuming tobacco for increasing concentration at work. Tobacco consumption was found to be significantly more common among ever-married and Muslim females. Lack of will power and ignorance about the harmful effects of tobacco were major hindrances (51%) for quitting tobacco Conclusion: Tobacco consumption was found to be prevalent in almost one third of females (15-49 years) residing in an urban slum of Pune. Most of them used smokeless tobacco, mainly Mishri. Tobacco consumption was directly associated with age, marital status and religion.

Human immunodeficiency virus infection/acquired immunodeficiency syndrome Vaccine: Biggest challenge in medical sciences - Some see a hopeless end, while others see an endless hope

One of the biggest challenges in the history of mankind has been the development of a vaccine against the human immunodeficiency virus (HIV). This is even more so complicated by the fact that the genetic makeup of the virus undergoes tremendous variations. The advent of a very effective and safe vaccine is a far dream as of now when the vaccine development processes are traditional and in the research process. The need for the hour is the development of an effective vaccine against HIV. The challenges to it are manifold. Starting from the level where the basic pathogenesis of HIV infection poses a great riddle to the development of the effective vaccine, to the arena of a variety of socioeconomic challenges, political pressures and ethical considerations. The research into vaccine development has to be highly coordinated in the midst of all these considerations. This issue is an urgent mission, which demands that governments, policymakers and civil society have to work in unison with the scientists to tackle this huge challenge.