Profile of epidemic emergencies in India during 1991-95.

Epidemic emergencies have shown increasing trend in India and most parts of the country appear to be vulnerable to these emergencies. In this paper we present a profile of epidemic emergencies attended by the National Institute of Communicable Diseases in the last five years, to delineate aspects that will promote better preparedness and management. Water borne and water related disease epidemics constituted more than 70% of the epidemic emergencies in India. Non 01 cholera epidemics constituted one fourth of total cholera epidemics during 1991-95. Most of the hepatitis outbreaks were attributed to Non A Non B. The source of infection in majority of the cholera and jaundice epidemics was contaminated water. Dengue and resistant typhoid fever were among other emergencies reported during last five years. Some of these epidemic were reported to local health authorities as mysterious diseases due to lack of public health laboratory facilities. Encephalitis and encephalitis like epidemics in the form of Liquor poisoning and chronic Heat syndrome encephalopathy were also observed. The re-emerging disease epidemics like plague in Beed, Pneumonic plague in Surat and malaria in Rajasthan were also investigated during 1994. These observations indicate the weakness in the epidemiological and laboratory surveillance besides inadequacy in water management practices and other socio environmental reasons.

New focus of cutaneous leishmaniasis in India : Preliminary report.

An epidemiological investigation was carried out in hilly areas of western ghats of Kerala state, India during 1993, to verify a focus of cutaneous leishmaniasis. Out of 406 surveyed population, 11 cases were detected, among which two were positive for LD bodies in slit skin scraping examination. The disease was indigenously transmitted. Further investigation is advocated to identify leishmania species, vector and the reservoir.

A comparative study on the optimum time and method of collection of Phlebotomus argentipes and other sandflies. (Diptera: Psychodidae).

A uniform method of collection is imperative for generating comparable entomological data in connection with studies on efficacy of vector control measures against sandflies. Two commonly employed methods for sandfly collections i.e. hand collection by aspirator and sticky paper traps were compared under similar ecological conditions to determine the optimum time and method for generating data on relevant indices. Only two P. argentipes male specimens were collected at dusk time from 12 cattle sheds and 40 human dwelling by aspirator method. By sticky traps placed in the same resting shelters, 243 P. argentipes and 58 specimens of 5 other species were collected. However, the collection by sticky traps comprised only males and unfed females. In the morning collection by aspirators 268 sandflies of 8 species in all stages of gonotropic cycle were collected. It is concluded that morning collections by aspirator method can provide objective assessment of control measures. Sticky traps may be useful as additional method for confirming presence of P. argentipes in sprayed areas.

An investigation of an outbreak of viral hepatitis in a residential area of Delhi.

Epidemiological investigation of a focal outbreak of jaundice in the KD block of Pitampura, Delhi during February-March 1992 revealed that 7.0 per cent of the population of the block suffered from viral hepatitis. There was no age or sex predilection. Epidemiological findings and Serological studies suggest that the epidemic was due to Hepatitis E (Enterically transmitted Non A and Non B) virus.

Percutaneous intraaortic balloon pulsation for management of life threatening emergencies in an intensive coronary care unit.

The indications for the outcome of use of intraaortic balloon pulsation (IABP) in 66 patients (65 males, 1 female), in addition to the usual conventional medical therapy, are reported here. IABP was used for treatment of cardiogenic shock (5 patients), acute myocardial infarction with rupture of interventricular septum (2 patients), acute myocardial infarction with refractory left ventricular failure (2 patients), resistant ventricular tachyarrhythmias (5 patients), refractory angina (50 patients) and for hypotension following high risk coronary angiography (2 patients). A Datascope 10.5 F percutaneous balloon was inserted in all, mostly using the left femoral artery. Either definitive treatment (coronary artery bypass surgery or coronary angioplasty) was offered when feasible or the balloon was weaned off. Twelve patients underwent coronary angiography on IABP; while 31 patients had undergone the angiography earlier. Surgery was possible in 33 patients with 90% survival rate. The non surgical group showed 30% survival rate. The complications of IABP encountered were: leg ischaemia (2 patients), septicemia (4 patients) and balloon rupture (2 patients). Our experience suggests that percutaneous IABP is a very useful management procedure for seriously sick high risk patients prior to definitive therapy. Patients who could have a definitive treatment while on IABP, especially the group with refractory angina, did best on a short term follow up. Vascular complications are minimal while on IABP.

Placental and stillbirth tissue lead concentrations in occupationally exposed women.

The lead values in maternal and infant blood, in placental tissue, and in stillbirth liver, kidney, and rib- and skull-bones have been determined in samples from the Stoke-on-Trent area. The lead values in antenatal blood and placenta increase with occupational exposure; liver and kidney stillbirth lead values are lower than those of much older children and rib-bone lead values from stillbirths were on average three times as high as those from a control group comprised of cot deaths and early infant deaths from accidental causes.

Lead levels in human placentae from normal and malformed births.

Placental lead levels were studied in a series of Birmingham births classified by stillbirth, neonatal death, or survival beyond one week. There was an appreciable range of lead levels even in normal births (0.15-3.56 microgram/g) but nevertheless average results showed a pronounced excess of lead in those who failed to survive both birth and the neonatal period. There was no association of placental lead with impaired birthweight among survivors but, in common with other authors, we noted a seasonal variation. The placentae from Indian women had similar lead levels to those from European women and lower values were found in the normal sibs of stillbirths and neonatal deaths. The possibility is discussed that under conditions of impaired fetal health in late pregnancy the placenta may concentrate lead.