Effectiveness of One Health approach for control of Kyasanur Forest Disease in Wayanad, Kerala, India

Background & objectives: Kyasanur Forest Disease (KFD) is a vector borne haemorrhagic fever that is endemic in the Wayanad region located in Northern part of Kerala, India. The region is managing the outbreak well ever since the major epidemic of 2015. This was because of the successful implementation of One Health (OH) initiative concentrating on multisectoral collaboration between regional institutions involved in public, animal and environmental health domains. The article presents how OH was implemented for the first time in the district in the year 2015 and evaluates the degree OH-ness of the Initiative. Methods: The OH approach involved trans-disciplinary stakeholder meetings and reviews, outbreak management and integrated surveillance targeting ticks, monkeys and humans. The degree of OH-ness used for addressing KFD during the year 2015 was evaluated following the protocol developed by the Network for Evaluation of One Health (NEOH). In detail, we (i) described the OH initiative and its system (Aim, stakeholders, action strategy) and (ii) scored different aspects of this initiative (i.e., OH-thinking, -planning, -working, -sharing, -learning, -organization), with values from 0 (=no OH approach) to 1 (=perfect OH approach). Results: We obtained a median score for each aspect evaluated. We reached high scores for OH systemic organization (1.0), OH thinking (0.83) and OH working (0.83). Lower scores were attributed to OH planning (0.58), OH sharing (0.50) and OH learning (0.33). The OH index was 0.36 and OH ratio was 0.95, indicating a balance between the OH operations and supporting infrastructures. Interpretation & conclusion: With this we could high-light some critical issues related to communication on sharing data as well as learning gaps for consideration to control future outbreaks. The strengths and weaknesses detected may be used to refine the initiative, aiming to provide a basis for the development of shared recommendations in a more OH-oriented perspective. This model of evaluation criteria will serve to create a database of OH success stories in India that will in turn help to institutionalize the approach at ministerial level. Future India is moving towards implementing a One Health, hence, this study data will provide an ideal opportunity for all sectors to control any vector borne diseases.

Irrational Antibiotic Usage among Pediatric Patients in a Tertiary Care Hospital-A Point Prevalence Cross-Sectional Study

Background: Irrational practicing of antibiotic prescribing adds up to increased morbidity and mortality of pediatric patients, especially with infections such as pneumonia, meningitis, bronchitis, etc. Objective: To determine the prevalence of irrational usage of antibiotics among pediatric patients and its effect on them. Methods: A crosssectional observational study was conducted in a tertiary care hospital for a period of 6-months with 250 pediatric patients from various specializations. The exclusion was based on those with malnutrition, syndromes, congenital heart defects and other concomitant diseases including 80 patients. Medical and laboratory records were made use for the analysis. Results: Common age category of patients were from 0-12 months (57(22.8%)). Mean length of stay was about 6.3 (4; 1-40%). Blood culture reported Staphylococcus aureus (36.6%) to be the prominent organism. Cephalosporin (33.7%) was the commonly prescribed antibiotic class, with tetracycline (11.6%) commonly used as the prophylactic broad-spectrum antibiotic. The mortality rate due to irrational antibiotic prescription was about 37 [PR: 7.21 (1.75 to 22.59, p>0.005)]. Conclusion: Male gender was more liable to infections and mortality due to irrational antibiotic prescribing had been increased significantly in the population requiring monitoring and appropriate screening.

Lumbarisation of the first sacral vertebra a rare form of lumbosacral transitional vertebra / Lumbarización de la primera vertebra sacra: rara forma de una vertebra de transición lumbosacral

In the lumbosacral region, anatomical variations occur with changes in the number of sacral vertebra either by deletion of first sacral vertebra or by the union of fifth lumbar or first coccygeal vertebra with sacrum. Lumbasacral transitional vertebrae (LSTV) is the most common congenital anomalies of the lumbosacral region. It most commonly involves the fifth lumbar vertebra showing signs of fusion to the sacrum known as sacralisation or the first sacral vertebra shows signs of transition to a lumbar configuration commonly known as lumbarisation. Complete transition can result in numerical abnormalities of the lumbar and sacral vertebral segments. Lumbarisation of first sacral vertebra is seen with a very low incidence of 2%. Knowledge of presence of such vertebral variation will be helpful for the clinicians to diagnose and treat patients with low back pain. Although sacralisation of fifth lumbar vertebrae is most commonly seen when compared to lumbarisation of first sacral vertebrae, we report here a case of lumbarisation of first sacral vertebrae for its rarity among the LSTV and clinical implications.

En la región lumbosacra, las variaciones anatómicas se basan en cambios en el número de las vértebras sacras, ya sea por ausencia de la primera vértebra sacra o por unión de la quinta lumbar o primera vértebra caudal con el sacro. Las vértebras de transición lumbasacra (VTLS) son las anomalías congénitas más frecuentes de la región lumbosacra. La VTLS más común se produce a nivel de la quinta vértebra lumbar, con signos de fusión al sacro, proceso conocido como sacralización; mientras que la primera vértebra sacra también puede mostrar signos de transición a una configuración lumbar. A esto último se lo denomina lumbarización. La transición completa puede provocar anomalías numéricas a nivel de los segmentos vertebrales lumbares y sacros. La lumbarización de la primera vértebra sacra se observa con una incidencia muy baja, de solo 2%. El conocimiento de la presencia de dicha variación vertebral será de utilidad para los médicos al momento de diagnosticar y tratar a los pacientes con dolor en la parte baja de la espalda. Aunque la sacralización de la quinta vértebra lumbar se produce más frecuentemente en comparación con la lumbarización de la primera vértebra sacra, se presenta aquí un caso de lumbarización de la primera vértebra sacra, rara entre las VTLS, y con implicaciones clínicas.

Agenesis of Isthmus of thyroid gland with presence of pyramidal lobe and levator glandulae thyroideae.

A wide range of morphological and developmental variations of thyroid gland like hypoplasia, ectopic thyroid tissue, hemiagenesis or agenesis of thyroid gland has been reported. Out of these agenesis of the thyroid isthmus is a very rare congenital anomaly. Thyroid isthmus agenesis does not manifest clinical symptoms, and it can be confused with other thyroid pathologies. Also the presence of levator glandulae thyroideae and its anatomical variations gain importance in the pathologies which are related to thyroid gland and their treatment modalities. We hereby, report the absence of isthmus and presence of levator glandulae thyroideae and pyramidal lobe in a middle aged male cadaver. The present case report is an attempt to highlight the implications of variation of thyroid gland from diagnostic, phylogenetic and functional perspectives.

Assessment of Breastfeeding Practices: Findings from Urban Slum Area at Ahmedabad City, India.

Introduction: Correct breast feeding technique, proper position and attachment are very important to get all benefits of breast feeding. Integrated Management of Neonatal and Childhood Illness (IMNCI) has also given utmost importance to the correct breast feeding technique. Objectives: To describe the socio-demographic profile and feeding practices among lactating mothers, to identify factors associated with good breast feeding (attachment) practices and to evaluate the impact of video demonstration on breast feeding practices immediately after and at one month follow up. Methodology: An interventional study was conducted at urban slums of Ahmedabad city, India. Results from 150 lactating mothers were analysed. Interactive sessions in conjunction with video demonstrations of IMNCI regarding correct breast feeding techniques were conducted among 9 groups of lactating mothers. Number of lactating mothers in each group varied from 15 to 20. Good signs of attachment were measured pre IMNCI video sessions, immediately and one month after the session. Results: Mean age of mothers was 26.44 years. Total mothers who had more than 6 antenatal visits were 59.3%. Two-thirds of lactating mothers did not receive any kind of breast feeding related advice. Only 8.0% had initiated breast feeding after 48 hours of delivery. Some kind of pre lacteal feed was given to 41.3% of the newborns. Improvement in all four signs of good attachment (mouth widely open, lower lip turned outward, chin touching the breast and dark skin seen more above than below areola) was seen among lactating mothers while feeding their babies after training session. Mothers from higher social class and with education > 12 standard and mothers who have received advice during antenatal and postnatal period regarding breast feeding were found to have significant positive impact on determining good attachment while breast feeding. Conclusion: Breast feeding related counseling should be continued at frequent interval during post natal period, so that lactating mothers can follow correct breastfeeding practices.

Study of variations in medial sural cutaneous nerve, lateral sural cutaneous nerve and peroneal communicating nerve.

The sural nerve complex includes the Medial sural cutaneous nerve (MSCN), Lateral sural cutaneous nerve (LSCN), Peroneal communicating nerve (PCN) and Sural nerve. The sural nerve is the most frequently used donor nerve for peripheral nerve grafting. LSCN can be an alternative to sural nerve in situations requiring a limited length of nerve graft material, the peroneal communicating nerve may also be harvested. Fifty lower limb specimens were dissected and data was collected. The study included 16 male and 9 female cadavers. MSCN was observed in all 50 specimens, out of which 74% specimens had normal course and 22% had a transmuscular course. LSCN was present in 82% of specimens. PCN was arising from Common Peroneal Nerve (CPN) directly in 16% and as a common trunk with LSCN in 14% of specimens. PCN was absent in 28% of cases. So knowledge of variation in these nerves will help the surgeons while considering these nerves for nerve grafting.

Prevalance and antimicrobial susceptibility pattern of clinical isolates of pseudomonas aeruginosa in a Tertiary Care Teaching Hospital.

The study was conducted to know the prevalence of Pseudomonas aeruginosa in clinical infections and its antibiotic susceptibility pattern to commonly used antibiotics in a tertiary care teaching hospital. We received 897 relevant clinical isolates among, which 203 was P.aeruginosa. Antibiotic susceptibility was determined by Kirby Bauer’s disc diffusion method with first line and second line antibiotics. Results – Among the first line antibiotics the isolate displayed an increased resistance to Ciprofloxacin (28.57%) followed by Levofloxacin (25.61%), and the least was towards Amikacin (14.77%), whereas most of the second line antibiotics such as Polymyxin B and Colistin exhibited a high sensitivity (99.02 %.). Conclusion-The ability of the opportunistic pathogen P.aeruginosa to rapidly develop resistance to multiple classes of antibiotics during the course of treatment makes it important to determine the antibiotic susceptibility pattern. As the pipeline of new drugs continues to diminish, it is critical that we look for new strategies to combat the threat of antibacterial resistance.

Physical wife abuse in an urban slum of Pune, Maharastra.

The present cross-sectional study was undertaken during August-September 2004 in an urban slum area of Pune to find out prevalence & characteristics of physical wife abuse/wife beating & to ascertain women's views & behavior towards it in a social context. The prevalence of physical wife abuse/wife beating was reported to be 61.5%. The most commonly reported husband's behavior included slapping (98.8%) followed by pushing (39.8%) & kicking wives (33.7%). 17.8% women justified physical abuse by husband. The most commonly reported behavior of women included crying (85.2%) & silently bearing the physical abuse (59%).

Integrated practical examination: a novel approach to evaluate undergraduate medical students in physiology practices.

Background: The development of a reliable and valid method to assess laboratory exercises in preclinical sciences is a challenging task. The use of different assessment methods helps assess various aspects of clinical competence. Integrated Practical Examination (IPE) was thus incorporated as an assessment tool in physiology at Melaka Manipal Medical College (Manipal Campus), India aiming to test a wide range of practical skills and to improve the validity of our practical examinations. Methods: Three batches of first year medical students were tested by IPE which included two components: objective structured practical examination (OSPE) and performance exercise (PE). Scores of each student of the study sample in PE and OSPE in the 4th block were analysed. Results and conclusion: Analysis of student scores in the examinations revealed that student performance in PE was better than that in OSPE for all three batches. The correlation coefficients between the marks on OSPE and PE were found to be poor for all three batches. There was a significant difference in the mean scores on OSPE for all three batches (P value=0.014). There was also a significant difference in the mean scores on PE for all three batches (P value=0.013). Analysis of student scores also exposed some of the deficiencies of PE and OSPE. Students have differing strengths and weaknesses and each component of IPE thus tests different aspects of knowledge, understanding and abilities.

Smoking behaviour among arts student of a college in Mangalore, Dakshina Kannada.

176 Arts students out of 450 students doing their under-graduation in an age range of 17 to 24 years returned a questionnaire designed to test their level of knowledge about smoking, attitude towards smoking and practice of smoking. 96.6% of the respondents were aware of the injurious nature of smoking. Potential to induce lung cancer was known by 93.2% of them, but only 34.1% knew it was a factor for GI malignancy. A higher proportion of males had good knowledge whereas females had moderate knowledge (p = 0.04). The incidence of smoking was 33.1%. A higher proportion of smokers chewed pan and consumed supari. 68.2% of smokers wished to quit smoking. Easy availability (47.7%) and influence of friends (34.1%) were the predominant reasons to smoke. Interestingly, 48% of males felt that smoking women had appeal. Anti smoking campaigns in addition to provision of information has to focus towards a change in attitude to smoking.