Prediction of dengue outbreaks in Kerala state using disease surveillance and meteorological data

Background: Dengue is one of the most serious and fast emerging tropical diseases. Its incidence of is influenced by many meteorological factors such as rain fall in mm, temperature, humidity etc. Information about these factors can be used to forecast the incidence of dengue fever cases in the next coming months.Methods: The current study was an analytical study using retrospective secondary data from Kerala state. The annual integrated disease surveillance reports of dengue fever cases. Rain fall data and mean monthly temperatures for a period of twelve years from 2006 to 2017 were used. Best fitted model was developed and accuracy of the prediction was tested. All analyses were performed in R software using the mgcv package and nlme package.Results: A total of 144 months study period from January 2006 to December 2017 was used for analysis. Five different models developed for prediction of dengue cases among them, best fitted model including optimal combination of meteorological variables and recent and long term transition of dengue was selected. Out of 84 months predictions in the training period, 68 months prediction was correctly negative, 5 months prediction was correctly positive, 2 months prediction was incorrectly negative and 9 months prediction was incorrectly positive.Conclusions: A better predictive generalized additive model can be developed using the optimal combination of meteorological predictors and dengue fever counts. It will enable the health care administrators to forecast future out breaks and to take better precautionary measures.

Prevalence of vitamin B12 deficiency among individuals with type 2 diabetes mellitus in a South Indian rural community

Background: To estimate the prevalence of vitamin B12 deficiency in a rural south Indian community and to evaluate the association between metformin use and prevalent vitamin B12 deficiency in people with T2DM stratified by oral vitamin B12 supplementation.Methods: Using a cross sectional study design, a random sample of people with T2DM (N=438) was recruited from a rural community. Vitamin B12 deficiency was defined as serum B12 ?200pg/ml. Data on metformin dose, duration of use, oral vitamin B12 supplementation, and diet were collected. Laboratory measurements included complete blood count, tests for hepatic, renal, and thyroid function, as well as serum vitamin B12 levels and HbA1c.Results: The prevalence of vitamin B12 deficiency in people with T2DM was 11.2% (95% Confidence Interval (CI) 8.2%-14.1%). The odds of vitamin B12 deficiency in patients receiving a metformin dose of 2 grams/day were 4 times higher compared to those receiving ?1 gram/day, after adjusting for oral B12 supplementation (odds ratio 4.2;95% CI 1.5-11.8). The odds of vitamin B12 deficiency in those taking metformin and receiving oral vitamin B12 supplementation were lower compared to those on metformin and not receiving vitamin B12 supplementation (adjusted odds ratio 0.20; 95% CI 0.06-0.70).Conclusions: Vitamin B12 deficiency affects 1 in 10 people with T2DM, is associated with higher dose metformin use, and oral vitamin B12 supplementation mitigates B12 deficiency in this group.

Evidentiary value and effects of contaminants on blood group factors in medico-legal grounds.

Background: Blood is considered to be the most common trace evidence obtained from the scene of crime. Blood grouping reveals vital information regarding identification, in relation to crime investigation. With this respect contamination with dust, rust, bacteria and detergent will have any effect on blood grouping was studied. Material and methods: Randomly A, B, AB, Rh positive samples were taken in duplicates and were added with rusted pins, dust particles, detergent, staphylocopcci bacteria and without any addition one tube was kept in room temperature. Controls were kept in refrigerator at 4-8 ˚C to compare the results. Results: There were lots of changes in blood groups after 10 days of incubation in all tubes with contamination. Blood samples in dust after 10 days incubation had changed from A, B, AB to O blood group with Rh negativity. Blood samples in rust had retained with original ABO group but Rh positives were converted to Rh negative. Detergent tubes had also changed Rh positive to negetive retaining original ABO. There was no change in either ABO or Rh blood groups in tubes with Staphylococci bacteria. Conclusion: Stains contaminated with common agents like dust, rust, bacteria and detergent give inconclusive results by mixed agglutination method with passage of time. The results may be accepted with caution, as the opinion might be medico legally significant.

Diabetes & coronary heart disease: Current perspectives.

Coronary heart disease (CHD) is currently the leading cause of death worldwide and together with diabetes, poses a serious health threat, particularly in the Indian Asian population. Risk factor management has evolved considerably with the continued emergence of new and thought-provoking evidence. The stream of laboratory- and population-based research findings as well as unresolved controversies may pose dilemmas and conflicting impulses in most clinicians, and even in our more well-informed patients. As results of the most recent clinical trials on glycaemic control for macrovascular risk reduction are woven into concrete clinical practice guidelines, this paper seeks to sort through unwieldy evidence, keeping these findings in perspective, to deliver a clearer message for the context of South Asia and cardio-metabolic risk management.

Teaching racial understanding to medical students.

Aim: To facilitate and promote racial understanding among medical students as part of their training Methodology: A descriptive study comprising of opinions of students and foster parents about the home stay programme and its influence on racial understanding. Results and Discussion: 229 medical students and 47 foster parents participated to state their opinions regarding living with other races, the home stay programme and racial understanding. Results showed a positive change post home stay among the students and foster parents on these three domains. There was also a significant change in the mean scores of the students’ perception about the villagers and their own skills and ability post home stay. Majority of the foster parents experienced moderate improvement of their understanding of the different races and their cultures. Conclusions: The home stay programme has made a positive change in the perception of the participants on racial understanding. It is particularly of importance because the students are in training for an important profession; that of a medical doctor.

Public health law in India: A framework for its application as a tool for social change.

Public health law focuses on the nexus between law, public health and the legal tools applicable to public health issues. Though there have been consistent interventions to address public health concerns in the past, there exists a need for a contemporary framework to appropriately use modern legal tools for complex health challenges. We identify a checklist of imperative indicators to assess whether public health legislations would be an effective form of intervention to bring about the desired social change.

Prevalence Of Exclusive Breast Feeding And Its Correlates In An Urban Slum In Western India

Background: The World Health Organization recommends the practice of exclusive breastfeeding of infants for the first 6 months after birth. The objective of present study was to estimate the prevalence and the factors influencing exclusive breastfeeding. The perceptions of mothers about breastfeeding in an urban slum area of Western India were also enquired. Methods: This cross sectional study was conducted over six months amongst 200 mothers of children in the age group of 6 – 12 months attending the growth and development clinic in one of the urban health centres. Data was collected using a pre-tested, structured questionnaire on breastfeeding practices. Factors related to exclusive breastfeeding were analysed using bivariate and multivariate analysis. Results: Prevalence of exclusive breastfeeding reported by the participants was 61.5%. Having a male child, maternal age < 30 years, level of education of mother, parity, receiving infant feeding advice, initiation of breastfeeding within one hour of birth and administration of colostrum to the baby were associated with exclusive breastfeeding (p<0.001). Multivariate logistic regression analysis revealed that male sex (adjusted odd ratios: 20.03), primiparity (0.19), home delivery (0.32), receiving infant feeding advice (5.90), initiation of breastfeeding within one hour of birth (0.26) and giving colostrum to the baby (2.56) were independently associated with exclusive breastfeeding. Prelacteal feeds were given by almost 35% of mothers. Conclusion: Prevalence of exclusive breastfeeding was higher than the national figures. However, practices like discarding the colostrum, giving prelacteal feeds, early/late weaning and use of formula feeds are still widely prevalent and need to be addressed.

Reconsidering the history of type 2 diabetes in India: Emerging or re-emerging disease.

The emergence of type 2 diabetes in India, coinciding with the country’s rapid economic development in the past several decades, is often characterized as a modern epidemic resulting directly from westernization. We draw on India’s agricultural, linguistic, medical, economic, religious and gastronomic history to examine the possibility that type 2 diabetes mellitus may have existed in ancient India, having subsequently declined in the two centuries leading up to the present. The implications of such a possibility vis-à-vis the role of westernization in the global diabetes aetiology are discussed. Additionally, an argument is made for careful application of the terms ‘westernization’ and ‘globalization’ in discussions of chronic disease aetiology, where their often totalizing discourses may obscure the sociocultural particularities of manifestations of these conditions in various global arenas.

Teaching community diagnosis: experience of a new institution.

Community diagnosis is one method of making medical education more community oriented and making the students learn and appreciate intellectual discovery and critical thinking. Being a relatively young institution with constraints of manpower, finances and logistic support we proceeded to developed a short programme which would allow students to achieve the skills of community diagnosis. Instead of a structured programme, we empowered the students to plan their own from meeting the villagers’ right up to developing and successfully implementing a health promotion campaign specially focused to the need of the villagers. The lecturers were present only to guide and supervise the students. Self assessment by the students at the end of the programme showed improvement in all the five domains assessed i.e. change in knowledge, change in skills, leadership and team work, attitudes and perceptions and humanistic attributes. The paper outlines how a brief programme can achieve substantial gain in skills and attitudes.

Body mass index and nutritional status of adults in two rural villages in Northern Malaysia

There has been a change in the lifestyles of populations, including reduced physical activity and consumption of foods high in calories. Overweight and obesity are now replacing the more traditional public health concerns such as under-nutrition and infectious diseases as some of the most significant contributors to ill health. Determination of the body mass index (BMI) profile and nutritional status of adults of two rural coastal villages in Northern Malaysia was part of a community diagnosis in a community survey. Height and weight were measured and BMI calculated. Blood pressure was measured using a manual sphygmomanometer according to WHO guidelines. A standardized questionnaire was used to interview the villagers concerning their health. Out of the total population, 504 were above 20 years of age. Data was available for 441 persons for analysis. There were 210 (47.6%) males and 231 (52.4%) females. The prevalence of underweight was 9.8% (n=43), overweight 25.9% (n=114) and obesity 17% (n=75). The problem of over-nutrition was significantly higher among females, especially housewives. (p< 0.05). Those in ages 41-70 years were the majority with problems of over-nutrition (p=<0.05). More than half (52.9%; n=39) of those who were obese had hypertension (p=<0.05). Results show that a higher number of women especially housewives were obese and more than half of those obese subjects had hypertension. A more thorough nutritional profile using waist, hip and body fat measurement as well as an assessment of the dietary intake and activity regime of these villagers is needed. Interventions need to be carried out before more serious complications of obesity become rooted in this community.

Byssinosis among male textile workers in Pondicherry: a case-control study.

BACKGROUND: In India, 20 million workers are involved in the manufacturing of textiles. However, there are few epidemiological studies from India that have assessed the magnitude or the risk factors associated with byssinosis. In Pondicherry, textile mills have been in existence for over a century. This case-control study aimed to find the factors associated with the development of byssinosis in textile workers. METHODS: The sample consisted of 761 men above the age of 30 years who had worked for at least 10 years in a textile factory. All the respondents were interviewed by a pretested questionnaire to gather information regarding the symptoms of byssinosis, certain personal characteristics and occupational history. Byssinosis was identified using the classification proposed by the World Health Organization. Two age-matched controls were selected for each case. RESULTS: Univariate analysis of the factors for symptomatic byssinosis showed that dusty worksites, heavy smoking and duration of service > or = 30 years were significant. Logistic regression analysis showed that working in the spinning (odds ratio 6.1) and weaving sections (odds ratio 1.9), heavy smoking (odds ratio 3.9) and > or = 30 years of service (odds ratio 2.0) were independent significant risk factors. CONCLUSION: Efforts to reduce dust levels in the working environment and to discourage smoking among textile workers need to be strengthened to minimize the risk of developing byssinosis.

Zoonoses: challenges and strategies.

Zoonoses account for about four fifth of the human infections. The health problems posed by these seem to be increasing. Newer problems are recognised. Older and endemic problems appear in different forms. Zoonosis management is getting complex and complicated. Attention on their control and eradication is essentially required.

Scorpion envenomation as a risk factor for development of dilated cardiomyopathy.

OBJECTIVES: Though scorpion envenomation is known to lead to acute myocarditis and a reversible decrease in left ventricular function, it has not been implicated as an etiological factor in idiopathic dilated cardiomyopathy. We studied the association of idiopathic dilated cardiomyopathy with a history of scorpion sting as well as with socio-economic status, history of smoking and alcoholism, rural habitation, and history of snake bites. METHODS: Consecutive cases of idiopathic dilated cardiomyopathy were recruited for this study: The association with putative risk factors was studied using a case-control study design with two sets of controls. One set of controls were age and sex matched inpatients selected at random, the other set of controls were spouse, or if not available, a close relative, ordinarily resident with the patient. RESULTS: On analysis, none of the factors except scorpion envenomation had a significant association. A past history of scorpion envenomation had an adjusted odds ratio of 8.01 (3.55-18.06) when compared to one set of controls and an odds ratio of 8.33 (6.55-10.59) when compared to the second group of controls. CONCLUSIONS: Our study indicates that a history of scorpion envenomation acts as a risk factor for the subsequent development of idiopathic dilated cardiomyopathy. Despite an apparently complete recovery from a scorpion sting, many patients probably retain sub-clinical deficits that predispose to the development of cardiomyopathy later in life, when other factors get added on. The known association of cardiomyopathy with catecholamine excess in experimental situations in animal studies, and in other disease states in humans, supports this hypothesis.

Infant mortality in Pondicherry--an analysis of a cohort of 8185 births.

Infant mortality rate is one of the 12 global indicators for monitoring Health for All. Reliable data on infant mortality are not available for the majority of developing countries including India. To plan strategies for bringing down the rate and, later, to evaluate them, 'Cause Specific Rates' would be necessary. Pondicherry has achieved low rates of infant mortality. A study was conducted in the Anganwadis of Pondicherry to determine the causes of infant deaths. The 8185 children born between 1-4-1987 and 31-3-1988 in Pondicherry formed the study group. The Anganwadi workers collected information on the cause of death for the 222 children dying within the first year. The infant mortality rate was 27.1 per 1000 live births. Acute respiratory infections and diarrheal diseases accounted for 45% of the deaths.

Mechanisms of Bacillus cereus enteropathy.

Three strains of Bacillus cereus isolated from sausages (Salami and Trekker, RANBAC, Ranchi) produced enterotoxin which caused vascular permeability in skin and haemorrhage in the ligated ileal loops of rabbits. Histopathological studies revealed haemorrhage and congestion in submucosa, mononuclear cell infiltration in lamina propria and submucosa and villous atrophy. Histochemical studies ruled out the effect on mitochondrial enzymes of intestinal epithelial cells. Purified enterotoxin given intradermally to rabbits caused severe necrotic reaction at the site of injection and death within 4 hr. Histopathological changes observed in liver included congestion of portal veins and sinusoids, vacuolar degeneration of hepatocytes, and hyperplasia of bile ducts. These suggested that B. cereus enterotoxin affected the capillaries of blood vessels locally and also systemically resulting into release of proteinaceous exudates and red blood cells.

Anaerobic bacteria in brain abscess, a review; observation of 18 consecutive cases.

The aerobic and anaerobic bacterial flora of 18 consecutive cases of brain abscesses were studied. Two cases were sterile. In five cases there was a single bacterial isolate. In five cases there was a single bacterial isolate the organism being Staphylococcus aureus in two cases, Bacteroides fragilis in two cases and Peptostreptococcus anaerobius in one case. In the remaining eleven cases, more than one organism was isolated. A combination of anaerobe with an aerobe was observed in five cases and infections with more than one anaerobe in as many as six cases. Anaerobic organisms are the important pathogens in brain abscess and occurrence of infections by more than one organism is a common factor.