Respiratory health of the small scale dairy workers of urban Bhubaneswar, Odisha

Background: Human in close inhabitation with the cattle due to unventilated or inadequately ventilated establishments or inadequate living space, is always at a risk of sustaining infection from the cattle through different modes of disease transmission. This study hints at the increased incidences in respiratory infections among dairy workers in unorganized and small scale dairy farms due to amendable unhygienic practices. Methods: This survey was part of a larger study, conducted after ethics approval. Number of households involved in dairy work surveyed were 60. From every house, two members actively involved in dairy work were chosen and total respondents were 120. The study tool was a semi structured, mixed questionnaire. Results: 67.5% dairy workers self-reported occurrence of respiratory symptoms which included the complaints like cough,breathing difficulty on exertion. None of the dairy workers were vaccinated against any milk borne disease.Conclusion: The housing, civic amenities accessed by them and their awareness are probably the main reasons for wide variety of self perpetuated practices and deviations of standard requirement.Use of protective gear (gloves,caps,masks) should be strictly emphasized and popularized.

Role of CBNAAT in the Diagnosis of Extra-Pulmonary Tuberculosis: Experience from a Tertiary Care Hospital in India

Background. Xpert-MTB/RIF assay or Cartridge-Based Nucleic Acid Amplification Test (CBNAAT) helps in rapid diagnosis of tuberculosis (TB). Methods. Specific samples were collected and carried to Regional Medical Research Centre where these were taken up for CBNAAT and culture in Lowenstein-Jensen media. Appropriate samples were sent to the Designated Microscopy Centre (DMC) of our institute for acid-fast bacilli (AFB) smear examination. Diagnostic measures, such as sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of Xpert-MTB/RIF were reported considering mycobacterial culture and a composite reference standard (CRS) as Gold standard. Results. We studied 335 samples. Lymph node fine needle aspirate was the most common sample (32.5%) followed by pleural fluid (29.3%). The overall sensitivity and specificity of Xpert-MTB/RIF was determined to be 26.5% (95% CI [confidence interval] 20.8�.8) and 100% (95% CI 96.8�0), respectively. The sensitivity and specificity of CBNAAT in relation to mycobacterial culture, however, was 78.8% (95% CI 61.1�.0) and 89.1% (95% CI 85�.4), respectively. Both were highest for pus, cerebrospinal fluid and lymph node fine needle aspirate samples. Conclusions. Xpert-MTB/RIF may be useful for samples, like cold abscess and lymph node fine needle aspirate or biopsy specimens. However, its routine use in case of serosal fluids is not recommended because of its lower sensitivity.

Epidemiology of stress among Nursing Undergraduate Students

Background: Stress is a double-edged sword that can either invigorate or decrease the student’s performance. Longer the duration of stress poorer the performance. Nursing students may develop feeling of inadequacy regarding the activities required during professional education which may lead to stress Aims & Objectives: To study the level of stress among undergraduate nursing students of Lucknow city and to determine the risk factors causing stress. Material & Methods: A cross-sectional study was conducted among 380 B.Sc. (Nursing) Students enrolled in government and private colleges of Lucknow city using semi-structured questionnaire and DASS 42 scale Results: 60 percent and 62 percent of total nursing student from government college and private nursing respectively were stressed. There was no statistical difference (p= 0.17) between median stress score of two colleges. Predictor for stress was gender (odds ratio =3.41) Conclusion: The study showed high level of stress among the nursing students from government college and private college. Risk factors which were responsible for stress among students were gender, sharing of room, educational expenses, academic performance, mobile phone and harassment in college.

Stress and safe health behaviour among mid adolescent school going children in urban Bhubaneswar, Odisha, India

Background: During adolescence, that the child is heavily influenced by his surroundings and attempts to change his or her habits and take on to newer habits. This has made relevant the emphasis of safe health behaviour in school and incorporation of stress assessment and subsequent counselling among the adolescent age group. The current study was planned among mid adolescent age group boys and girls, both from government and private schools of Bhubaneswar. Aims & Objectives: To see the association of socio-demographic characteristics with perceived stress among the adolescent children and to find the association of safe health behaviour with perceived stress among the adolescent children and determine the significant factors. Material & Methods: A total of 480 students (240 boys and girls each) selected randomly from 4 government and private schools were included in the study and administered a self-marking questionnaire which elicited information regarding safe health behaviour and also stress scores by using the Perceived Stress Scale which is a 10 points item. Results: Type of school and mother’s education emerged most significant in the sample in terms of stress experienced by the children. Children who were verbal abused by the teachers had higher stress (28.9%) compared to who were not abused (p = 0.012). In terms of health history, any report of sickness or illness in the past 3 months accounted for significantly higher stress levels (37%) compared to the group with no such history (22.5). Conclusion: These findings hint that school environment has a major role to play on the adolescent’s stress levels.

Palliative care in India: Situation assessment and future scope.

Palliative care is an approach that improves the quality of life of patients and their families facing the problems associated with life‑threatening illness, through prevention and relief of suffering by means of early identification, assessment and treatment of pain, and other problems – physical, psychosocial, and spiritual. It is estimated that in India the total number of people who need palliative care is likely to be 5.4 million people a year. Though palliative care services have been in existence for many years, India ranks at the bottom of the Quality of Death index in overall score. However there has been steady progress in the past few years through community‑owned palliative care services. One of the key objectives of the National Programme for prevention and control of cancer, diabetes, cardiovascular diseases, and stroke is to establish and develop capacity for palliative and rehabilitative care. Community models for the provision of home‑based palliative care is possible by involving community caregivers and volunteers supervised by nurses trained in palliative care. Training of medical officers and health care professionals, and sensitization of the public through awareness campaigns are vital to improve the scope and coverage of palliative care. Process of translating palliative care plan into action requires strong leadership, competent management, political support and integration across all levels of care.

Student-centred learning in Community Medicine: An experience from Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry.

Background. Student-centred learning (SCL) places the student at the centre of policies, practices and decision-making in the teaching–learning process. SCL methodology also advocates active involvement of students in the curriculum planning, selection of teaching–learning methods and assessment process. We planned an education innovation project to assess the perception of fifth semester undergraduate medical students towards implementation of an SCL methodology. Methods. The study was done among 87 fifth semester undergraduate medical students (batch of 2010–11) in the noncommunicable disease epidemiology section of Community Medicine at the Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry. The students divided themselves into seven groups and developed the learning objectives, selected teaching–learning methods and assessment process for each session. The facilitators had 3–5 rounds of interaction with each group before the session. Qualitative analysis of feedback collected from students and external faculty after each session was done. The effect of implementing the SCL methodology was assessed by the reaction level of Kirkpatrick’s training evaluation model by using a rating scale. Results. Of the 87 eligible students, 73 (83.9%) returned the forms for evaluation. All seven groups were able to formulate the learning objectives. Most of the groups had used PowerPoint slides and videos as a teaching–learning tool. Innovative assessment methods such as crosswords and ‘chocopati’ were used by some groups. In general, the perception of students was favourable towards SCL compared to conventional methods and they felt that this methodology should be adopted more often. Time management and organization of sessions were the main problems encountered by the students. The mean (SD) score for the items ‘sessions were useful’, ‘sessions were enjoyable’ and ‘sessions improved my knowledge’ were 6.2 (1.8), 7.1 (1.8) and 6.3 (1.9), respectively. Conclusion. The majority of students found the sessions on innovative teaching–learning and assessment techniques enjoyable, useful and informative. The sessions showed that students took an active part in curriculum planning, execution and evaluation.

Rapid spread of Chikungunya virus infection in Orissa: India.

Background & objectives : A large number of cases of undiagnosed fever and joint pain were reported from different parts of the State of Orissa since February 2006. Epidemiological and laboratory investigation were carried out to confirm the cause of emerging illness, which was provisionally suspected as Chikungunya (CHIK) fever. Methods: Upon getting the reports of suspected CHIK like illness in different parts of the State, epidemic investigations were carried out in the outbreak affected villages. Case history was recorded, clinical examination undertaken and blood samples collected for seroconfirmation for CHIK IgM antibody using ELISA based kit. Simultaneously vector survey was also carried out. Results: With no previous record of CHIK infection in the State, the first outbreak was confirmed during February 2006. Subsequently, the infection spread to 13 of 30 districts in different episodes covering 79 villages till November 2007. Attack rate was 9-43 per cent in the different outbreaks with average seropositivity of 24 per cent to CHIK specific IgM. Morbidity was high though no deaths were recorded. Aedes aegypti and Ae. albopictus were identified as the possible vectors for transmission. Interpretation & conclusions : The report confirmed emergence of CHIK infection in the State of Orissa, India, and its spread to a larger geographic zone in a short period which warrants public health measures to control further spread.

Study of attempted suicide in the catchment area of Mamatha general hospital, Khammam, India

Background: Persons with psychiatric co- morbidity have markedly high risk of suicide attempts.Aim To study the socio-demographic variables, role of life events and prevalence of psychiatric diagnosis in suicideattempters. The present study has been undertaken with an intention to have deeper insight in to the mental health ofsuicide attempters.Methods A semi structured interview consisting of socio-demographic details, a proforma to document suicide attemptdata, Presumptive Stressful Life Event scale (PSLE) to know the desirable or undesirable life events. Mini InternationalNeuropsychiatric Interview plus (MINI Plus) was used to assess the psychiatric abnormality. Data was statisticallyanalyzed using Statistical Package for the Social Sciences - Version 10 (SPSS -10).Results: Suicide attempters experience peaking of stressful events in the early months before the attempt. Most commondiagnoses were depression, personality disorders, followed by alcohol dependence and anxiety disorders.Conclusion: Suicide attempters are more among the groups of young age, female gender, rural background, married,belonging to nuclear family and low socio economic class. Majority of the suicide attempters are suffering with psychiatric illness.

Outcomes of respiratory diphtheria in a tertiary referral infectious disease hospital.

Background: Diphtheria is a fatal disease and may cause serious complications if not recognized early and treated properly. Objectives:To study the epidemiology, clinical features, complications, and outcomes in respiratory diphtheria. Materials and Methods:Diphtheria cases admitted in the infectious disease hospital, Beliaghata, Kolkata, India between January 2009 to January 2011 were evaluated in respect to demographic profile, immunization status, clinical features, complications, and outcomes. Results: 200 diphtheria cases were studied. 150 (75%) patients had history of an adequate immunization, and 100 (50%) patients were from lower socio-economic groups. Common clinical features observed were throat pain in 148 (74%) cases and fever in 112 (56%) cases. Complications observed were myocarditis in 136 (68%) cases, neuropathy in 30 (15%) cases, and respiratory compromise in 14 (7%) cases. Death occurred in 5 (2.5%) patients. Conclusions:diphtheria is still a public health problem in many developing countries. Strict public health measures like an increased immunization coverage, improvement of socio-economic status, easy availability of anti-diphtheritic serum (ADS), early recognition and effective treatment-all may reduce the incidence and mortality.

Risk factors for cardiovascular diseases: Is the social gradient reversing in northern India.

Background. In the past century, most developed countries witnessed a reversal of social gradient in cardiovascular diseases. To examine whether this phenomenon is also under way in developing countries, we assessed the prevalence of selected risk factors for cardiovascular diseases among different social groups living in urban and rural areas of northern India. Methods. Four hundred adults >30 years of age, selected by cluster sampling, were surveyed from 8 purposively selected communities of Chandigarh and Haryana during 2004–05. The WHO STEPS tool for surveillance of risk factors was used to enquire about sociodemographic characteristics, tobacco use, alcohol intake, physical activity and to measure weight, height, blood pressure, and waist and hip circumference. Prevalence of risk factors such as tobacco use, physical inactivity, overweight (BMI >25 kg/m2), and hypertension (>140/90 mmHg or on anti-hypertension treatment) were estimated according to the area of residence and across educational categories after controlling for the effects of confounding variables. Results. The prevalence of hypertension in urban (39%; 95% CI 29.5%–49.2%), slum (35%; 95% CI 27.2%– 42.9%) and rural (33%; 95% CI 25.4%–40.8%) communities was found to be statistically similar (p>0.05) after controlling for age, gender and education. The prevalence of physical inactivity (17% v. 12%), central obesity (90% v. 88%), overweight (20% v. 19%) and hypertension (34% v. 36%), were found to be statistically similar among literate and illiterate population after controlling for the effect of age, sex and place of residence (p>0.05). However, the risk of tobacco use was significantly lower among literates (OR 0.3, 95% CI 0.1–0.8). Conclusion. In selected communities of northern India, most of the cardiovascular disease risk factors did not have a social gradient except tobacco use, which was more common in the lower social group.

An epidemiological study of organophosphorus poisoning at manipal teaching hospital, Pokhara, Nepal.

Organophosphorus compounds are chemical compounds containing carbon-phosphorus bonds (apart from phosphate and phosphite esters), primarily used in pest control and are often persistent organic pollutants. Acute poisoning by organophosphorus (OP) compounds is a major global clinical problem, with thousands of deaths occurring every year in Nepal. Most of these pesticide poisoning and subsequent deaths occur due to deliberate self ingestion of the poison. Sixty five patients with severe organophosphorus poisoning were admitted to the emergency ward of Manipal Teaching Hospital, Pokhara, Nepal from January 2008 to December 2008. History of ingestion, clinical signs & symptoms and survival time in case of death was also recorded to diagnose the OP poisoning. The mean age of patients was about 27 years. Most of the admitted cases were of suicidal in nature and women are the main victim. Suicidal deaths due to ingestion of organophosphorus compound are very common in Nepal especially in women. The reason may be the increasing stress in the family and economic constraints. Further study should be needed by government and NGO to evaluate it.

Incidence and nature of complications arising from chronic alcoholism in West Nepal.

Medical complications caused by alcoholism are well documented. Alcoholism is among the leading causes of death in most parts of the world. However, many alcohol-related deaths go unreported, especially in developing countries. Nepal is no exception, and next to smoking, alcoholism is the most common preventable cause of death, especially in the western region. This study attempts to document the various common complications arising from chronic abuse of alcohol in this part of Nepal.

An Outbreak of Cholera Associated with an Unprotected Well in Parbatia, Orissa, Eastern India.

In November 2003, an outbreak (41 cases; attack rate–4.3%; no deaths) of severe diarrhoea was reported from a village in Orissa, eastern India. Thirteen of these cases were hospitalized. A matched case-control study was conducted to identify the possible exposure variables. Since all wells were heavily chlorinated immediately after the outbreak, water samples were not tested. The cases were managed symptomatically. Descriptive epidemiology suggested clustering of cases around one public well. Vibrio cholerae El Tor O1, serotype Ogawa was isolated from four of six rectal swabs. The water from the public well was associated with the outbreak (matched odds ratio: 12; 95% confidence interval 1.2-44.1). On the basis of these conclusions, access to the well was barred immediately, and it was protected. This investigation highlighted the broader use of field epidemiology methods to implement public-health actions guided by epidemiologic data to control a cholera epidemic.

Hepatitis E epidemic with bimodal peak in a town of north India.

INTRODUCTION: An epidemic of viral hepatitis occurred in Mandi Gobindgarh town of Punjab in northern India during year 2005-06. An attempt was made to study the outbreak clinically, serologically, and etiologically. METHODS: Line listing and spot mapping of all cases of jaundice presented to civil hospital was done. An active search of cases was made through house-to-house visit with the help of 33 teams and 6 supervisors. Twenty two blood samples collected from acute cases were tested for anti-HAV IgM and anti-HEV IgM by ELISA. HEV specific PCR was also carried out. Sanitary survey was also done and water samples were tested for coliforms. RESULTS: In house to house survey 3170 cases of jaundice were reported; of them 2171 (68.5%) were males. Mean age was 28.8 years. Overall attack rate was 5.2%. The epidemic continued for more than a year and bimodal peak was observed. Civil hospital campus which has separate water supply had no jaundice case. About 95% blood samples from icteric patients were found to be positive for IgM and IgG antibodies of HEV. Eighteen persons died during the epidemic, mostly in old age group. Case fatality ratio was 0.57%. No deaths occurred among 17 pregnant women who had developed hepatitis. CONCLUSION: The epidemic was caused by hepatitis E virus, which was transmitted due to faecal contamination of municipal water supply.

An evaluation of musculoskeletal disorder and socioeconomic status of farmers in West Bangal, India.

Rice cultivation contains several tasks and workers were compelled to adopt some harmful and awkward posture during performing those tasks. These type repetitive jobs may be related to occupational health hazards like musculoskeletal disorder (MSD). In the present investigation different MSD related problems of the workers have been assessed and also identify the socioeconomic status of the farmers considering the issues of community health development. In this connection a simple and easily applicable questionnaire technique has been apply in the agricultural field during performing rice cultivation tasks. The results showed that a large number of workers could not complete their primary education (33.0% to 43.0%) and remained below the poverty line (91.3%). From the MSD assessment lower back problem was prevalent (48.8%) among the workers when all rice cultivation tasks were consider together, but it was extremely prevalent in reaping job (92.0%) and transplantation job (84.0%). It was concluded that MSD among the workers might be related to the stressful work posture, long duration jobs, nature of jobs and use of ill-fitted hand tools. So, some free-hand exercise, proper work-rest scheduled and awareness program may be helpful for reducing the MSD and proper handling of hand tools.

Iodine deficiency in urban slums of Bhubaneswar.

OBJECTIVE: The present study aimed at assessing the population prevalence of goiter and iodine deficiency in school children of 6-12 yr living in urban slums of Bhubaneswer, the capital city of Orissa. METHODS: A cross-sectional study was performed using the 30-cluster sampling methodology and surveillance methods for iodine deficiency as recommended by WHO/ICCIDD/UNICEF. The total goitre rate (n=1248), urinary iodine concentration (UIC) (n=411) and iodine content of edible salt (n=368) were measured. RESULTS: The goitre prevalence was 23.6% (grade 1=18.9%, grade 2=4.7%) with no significant gender variation. Goitre prevalence was significantly higher in children of 10-12 yr (P=0.012) and scheduled caste and tribe (P=0.003). Median urinary iodine concentration was 50.0 microg/l with 85.7% of children having values less than 100 microg/l, indicating as biochemical iodine deficiency. Median UIC was inversely in association with gradations of goitre. Children of 10-12 yr and scheduled caste/tribe communities had significantly higher median UIC (P=0.001) than their counterpart peers. About 51% of children were consuming salt having stipulated iodine content of 15 ppm. CONCLUSION: The study indicates moderate iodine deficiency in the population, despite a mandatory salt iodization programme in Orissa that has been in force since 1989. There is a need to improve the situation through enforcing monitoring of salt iodization to ensure quality and increasing the level of awareness about the iodized salt for sustainable prevention and control of iodine deficiency.

Comparison of proteins, lethality and immunogenic compounds of Androctonus crassicauda (Olivier, 1807) (Scorpiones: Buthidae) venom obtained by different methods

Scorpions are venomous arthropods of the class Arachnida and are considered relatives of spiders, ticks and mites. There are approximately 1,500 species of scorpions worldwide, which are characterized by an elongated body and a segmented tail that ends in a venomous stinger. No specific treatment is available for scorpion envenomation, except for the use of antivenom. The current study aimed at comparing protein content and lethality of Androctonus crassicauda venom extracted by two different methods (electric stimulation and maceration of telsons). The LD50 calculated by probit analysis was 1.1mg/kg for venom obtained by electric stimulation and 39.19mg/kg for venom obtained by maceration of telsons. In the electrophoretic analysis, protein bands of the venom sample obtained by electric stimulation were between 12 and 53kDa (total: five bands), and those of venom extracted by maceration appeared as multiple protein bands, relative to the other venom sample. Low-molecular-weight proteins, revealed by western blotting, played an important immunogenic role in the production of antivenom. Lethality and protein levels varied according to the extraction method; venom obtained by the maceration technique showed lower toxicity than that obtained by electric stimulation.(AU)

Determination of potency and paraspecific effects of Androctonus crassicauda (Olivier, 1807) antivenom against Mesobuthus gibbosus (Brullé, 1832) venom (Scorpiones: Buthidae)

Scorpion envenomation remains a real health problem in many countries. In scorpionism cases, it is often recommended that patients be treated with species-specific antivenom. Androctonus crassicauda venom has been used as antigen for antivenom production in Turkey, where this antivenom, called Turkish antivenom, has also been effective in the treatment of envenomation caused by species other than A. crassicauda. The present study aimed at determining the paraspecific effects and potency of the Turkish antivenom against Mesobuthus gibbosus (Brullé, 1832) venom. To assess the venom toxicity and the antivenom efficacy, we determined the Minimum Lethal Dose (MLD) and the Minimum Effective Dose (MED) instead of LD50 and ED50, respectively. Androctonus crassicauda antivenom was capable of neutralizing M. gibbosus venom (20 MLD). This was the first study indicating that A. crassicauda antivenom can be used for the treatment of Mesobuthus gibbosus stings, especially in Aegean Region, Turkey.(AU)

Effects of Androctonus crassicauda (Olivier, 1807) (scorpiones: buthidae) venom on rats: correlation among acetylcholinesterase activities and electrolytes levels

Scorpions can be considered living fossils because they have changed so little during the last 400 million years. They are venomous arthropods of the Arachnida class and regarded as relatives of spiders, ticks and mites. The aim of the present study was to evaluate the toxicity of Androctonus crassicauda (Olivier, 1807) venom and its effects on the acetylcholinesterase (AchE) activity and on electrolytes levels in rats. Animals were divided into seven groups of five rats each. Test groups received 250æg/kg of venom solution while control group was treated with 200æl of physiological saline solution (PSS). Blood samples were collected from the animals on the 1st, 2nd 4th, 8th, 12th, and 24th hours after subcutaneous injection of venom. Animals were monitored for 24 hours. Androctonus crassicauda venom significantly reduced AchE activity on the 12th hour when compared with control group. A statistically negative correlation between Na+ and K+ (p<0.05) and a positive correlation between Na+ and CL- (p<0.001) ions levels were observed after the administration of A. crassiccauda venom to rats. We can conclude that the differences in the electrolytes levels are due to acute renal failure, since elimination of toxin occurs primarily via the kidney.(AU)