Demineralization of drinking water: Is it prudent?

Water is the elixir of life. The requirement of water for very existence of life and preservation of health has driven man to devise methods for maintaining its purity and wholesomeness. The water can get contaminated, polluted and become a potential hazard to human health. Water in its purest form devoid of natural minerals can also be the other end of spectrum where health could be adversely affected. Limited availability of fresh water and increased requirements has led to an increased usage of personal, domestic and commercial methods of purification of water. Desalination of saline water where fresh water is in limited supply has led to development of the latest technology of reverse osmosis but is it going to be safe to use such demineralized water over a long duration needs to be debated and discussed.

Outbreak of Influenza (H1N1) amongst children in a residential school.

BACKGROUND: An outbreak of pandemic Influenza H1N1 occurred from 13 Feb to 20 Feb 2010 in a residential school at Belgaum, India. METHODS: On report of sudden increase in number of students reporting sick with symptoms suggestive of flu like illness, an investigation was launched to detect the source of infection and to control the spread of infection amongst those not affected. Six random samples of throat from the initial cluster were collected and RT-PCR was done to confirm the diagnosis. The outbreak in this institution was effectively controlled by standard preventive & control measures in the absence of vaccine. RESULT: In a school of 335 children, 96 cases of Influenza like illness possibly resulting from pH1N1 (2009) were reported with an attack rate of 28.6%. Out of a total of 96 cases reported, 73 (76%) were hospitalized and 23 treated as outdoor patients. Serogroup A of Influenza H1N1 pandemic was identified to be the agent responsible for this outbreak as 06 random samples drawn from initial cluster tested positive on RT-PCR. A visit to an exhibition in the city was possibly the source of exposure amongst the children. CONCLUSION: An outbreak of Influenza H1N1 infection amongst students in a residential public School was found to be linked to a visit to an exhibition following which the secondary transmission led to further occurrence of cases.

Pandemic influenza: Experience in a flu OPD of a tertiary care hospital.

BACKGROUND: In April 2009, Mexican health authorities announced an outbreak of a novel H1N1 influenza virus, which subsequently caused a pandemic. The world is now moving into the post-pandemic period. The experience gained in handling this pandemic at various levels under different settings has provided us many lessons for the future. OBJECTIVE: To study the profile of various activities undertaken at flu screening centre as a response to pandemic influenza in a tertiary care hospital. METHODS: Record-based study conducted in a tertiary care hospital of Pune. Required data was collected from records of flu OPD, ward and local health authority and interviewing related staff. Study included data from October 2009 to October 2010. RESULTS: A total of 8020 people presenting with influenza like illness (ILI) were screened in the flu OPD under study. Out of these, only 388 (4.84%) met clinical criteria where throat samples were collected, out of which only 81 were found to be positive (20.88%). Total three fatalities (3.7%) occurred out of 81 who had tested positive. Most cases of flu were managed at home (76.54%) while only 19 (23.4%) lab confirmed cases of H1N1 required hospitalisation. CONCLUSION: Majority of cases of H1N1 (2009) were managed at home. Early diagnosis, quick initiation of treatment, infection control measures, and good care at the hospital can effectively reduce morbidity and mortality in H1N1 pandemic.

Study of blood pressure profile of school children 6-15 years in a rural setting of Maharashtra.

BACKGROUND: High blood pressure in childhood is a major risk factor for heart disease and stroke in adulthood. There is enough evidence to suggest that the roots of essential hypertension in adults extend into childhood. There is a paucity of literature on the blood pressure measurements amongst children. This study was done to study blood pressure profile of school children in rural area of Maharashtra. AIM & OBJECTIVES: This cross sectional study was carried out to determine the prevalence of hypertension in children 6-15 years and to study the association between selected variables and blood pressure. MATERIAL & METHODS: This study was done using a predesigned questionnaire and making measurements of height, BMI and Blood pressure using standardized physical instruments following standard guidelines. The data was collected and analyzed using appropriate statistical tests. RESULTS: The prevalence of hypertension in the study was found to be 4.4% with 3.5% in females and 5.1% in males. CONCLUSION: In the study, hypertension in students was found to be significantly associated with higher BMI and with family history of hypertension. Age, height and BMI were found to correlate positively with Blood pressure levels in this study.

Stigma in leprosy: miles to go!

No disease has been more closely associated with stigma than leprosy such that it has become a metaphor for stigma. Stigma has been difficult to measure and little research has been done on this issue. Stigma reduction has not been an important component of anti-leprosy program. The study was undertaken to measure the stigma associated with leprosy by using P scale which is used for assessing participation restriction of those affected by the disease. This comparative questionnaire based study was carried out in two sets of patients. Two groups of 30 patients each were studied. First group belonged to a Government run Leprosarium and group two from a tertiary care skin and leprosy centre. The study used the Participation (P) scale and data was collected by interviewing the patients. Participation restriction was defined as any score equal to and more than 13. Participation restriction was observed in 27 (90%) cases of group 1while participation restriction was present in only 7 (23.3%) subjects of group 2. It was observed that mean score of participation restriction in group 1 was quite high at 31.9 while it was only 8.3 for group 2. The participation restriction was directly related to the duration of disease and the grade of disability. Longer the duration of disease, greater was the likelihood of restriction. The participation restriction was found to be negatively correlated with the education. Recommendation about prevention of disability would require program about early diagnosis of nerve damage and subsequent action at the patient-family-community level and health care providers.

Outbreak of Meningococcal Infection amongst Soldiers Deployed in Operations.

BACKGROUND: Meningococcal infection may lead to life threatening meningitis and fulminant meningococcal sepsis. Sporadic cases of meningococcal infection have been reported in soldiers but no outbreak in soldiers has been reported earlier from India. This outbreak in soldiers serving in counter insurgency role under field setting was effectively controlled without compromising their operational commitment. METHODS: This is an epidemiological investigation and control of an outbreak of meningococcal infection, bringing out the predisposing factors and highlighting the role of early diagnosis and management of cases. Mass chemoprophylaxis in contacts was used as an effective control measure in the absence of vaccine in this institution based outbreak. RESULT: Out of a total of 17 cases reported, 14 presented as meningitis and three as meningococcemia. Two cases of meningococcemia ended fatally. Serogroup A of Neisseria meningitidis was responsible for this outbreak. Gross over- crowding was the predisposing factor. CONCLUSION: An outbreak of meningococcal infection in soldiers deployed in counter- insurgency role was effectively contained using mass chemoprophylaxis in the absence of meningococcal vaccine.

Accidental Outbreak of Non-Bacterial Food Poisoning.

BACKGROUND: Troops deployed in isolated garrisons face erratic supply of rations. At times they resort to use of locally grown plants without knowledge of local flora, resulting in accidental food poisoning. METHODS: This is a descriptive, analytical and epidemiological study of one such outbreak of food poisoning, due to use of a locally grown plant as vegetable, amongst soldiers of a unit in high altitude. An epidemiological case sheet was made and food specific attack rates of those exposed and not exposed were calculated to identify the food item. The toxicological analysis of food item established the cause. RESULTS: Of the 39 people who consumed the meal, 29 fell ill with an attack rate of 74.35%. All the cases presented with classical features of atropine poisoning and were managed with sedatives, physostigmine and supportive care. Twenty one had symptoms severe enough to warrant hospitalization. All the cases made complete recovery. The attack rate for food item containing plant poison was 96.4%. The toxicological analysis of food sample established the presence of atropine alkaloids. The plant was identified on flowering as Atropa acuminata. CONCLUSION: An outbreak of non-bacterial food poisoning in soldiers at high altitude, caused by accidental ingestion of a dish made out of Atropa acuminata plant leaves containing atropine related alkaloids was investigated and conclusively established.