Quantifying climatic and socioeconomic drivers of urban malaria in Surat, India: a statistical spatiotemporal modelling study.

BACKGROUND: Cities are becoming increasingly important habitats for mosquito vectors of disease. The pronounced heterogeneity of urban landscapes challenges our understanding of the effects of climate and socioeconomic factors on mosquito-borne disease dynamics at different spatiotemporal scales. Here, we quantify the impact of climatic and socioeconomic factors on urban malaria risk, using an extensive dataset in both space and time for reported Plasmodium falciparum cases in the city of Surat, northwest India. METHODS: We analysed 10 years of monthly P falciparum cases resolved at three nested spatial resolutions (seven zones, 32 units, and 478 worker units) with a Bayesian hierarchical mixed model that incorporates the effects of population density, poverty, relative humidity, and temperature, in addition to random effects (structured and unstructured). To reduce dimensionality and avoid correlation of covariates, socioeconomic variables from survey data were summarised into main axes of variation using principal component analysis. With model selection, we identified the main drivers of spatiotemporal variation in malaria incidence rates at each of the three spatial resolutions. We also compared observations to model-fitted cases by quantifying the percentage of predictions within five discrete levels of malaria risk. FINDINGS: The spatial variation of urban malaria cases was stationary over time, whereby locations with high and low yearly cases remained largely consistent across years. Local socioeconomic variation could be summarised with three principal components accounting for approximately 80% of the variance. The model that incorporated local temperature and relative humidity together with two of these principal components, largely representing population density and poverty, best explained monthly malaria patterns in models formulated at the three different spatial scales. As model resolution increased, the effect size of humidity decreased, whereas those of temperature and the principal component associated with population density increased. Model predictions accurately captured aggregated total monthly cases for the city; in space-time, they more closely matched observations at the intermediate scale, with around 57% of units estimated to fall in the observed category on average across years. The mean absolute error was lower at the intermediate level, showing that this is the best aggregation level to predict the space-time dynamics of malaria incidence rates across the city with the selected model. INTERPRETATION: This statistical modelling framework provides a basis for development of a climate-driven early warning system for urban malaria for the units of Surat, including spatially explicit prediction of malaria risk several weeks to months in advance. Results indicate environmental and socioeconomic covariates for which further measurement at high resolution should lead to model improvement. Advanced warning combined with local surveillance and knowledge of disease hotspots within the city could inform targeted intervention as part of urban malaria elimination efforts. FUNDING: US National Institutes of Health.

Anatomical Variations of the Suprascapular Notch and its Importance in Suprascapular Entrapment Neuropathy.

Background: Anatomical knowledge about the suprascapular notch is very important in understanding the risk of suprascapular nerve entrapment syndrome. Suprascapular nerve injuries have become commonly recognized as a cause of shoulder pain and dysfunction. This study aimed to describe the morphometrical influence of the suprascapular notch on the course of the suprascapular nerve. Method: A total of 138 dry human scapulae of both sides of the unknown sex were used. Four measurements were defined and collected for every suprascapular notch: maximum depth (MD), superior transverse diameter (STD), middle transverse diameter (MTD), and total circumferential diameter (TCD). Result: In the present study we found different shapes of suprascapular notches. Out of 138 scapulae, 67 (48.55%) had U-shaped notch, 29 (21.01%) V-shaped notch and 14 (10.14%) J-shaped notch. Nine (6.52%) scapulae had incomplete notch. Two (1.44%) scapulae had large double foramen. Six (4.34%) scapulae had complete suprascapular notch. In seven (5.07%) scapulae, the notch was absent. Interestingly, in two (1.44%) scapulae, we found a W-shaped notch. This observation was unique and not reported anywhere in the literature before. Conclusion: Anatomical knowledge about the morphology of the suprascapular notch is of extreme importance for clinicians, radiologists, neurosurgeons, and orthopedic surgeons in making a proper diagnosis and for planning the surgical procedures of the shoulder region.

A Morphometric and Radiological Study of Sacral Hiatus in Human Adult Sacra and Its Clinical Relevance in Caudal Epidural Anaesthesia.

Background: The knowledge of sacral hiatus anatomy is crucial in clinical situations requiring caudal epidural block for various diagnostic and therapeutic procedures of the lumbosacral spine to avoid complications and failure rate. This study was undertaken to compare morphometric characteristics of sacral hiatus in human dry sacra and pelvic radiographs for placing the needle more accurately in the sacral hiatus landmarks to permit correct, painless, and uncomplicated caudal epidural accesses. Materials and methods: The present study was done on 138 human adult dry sacra and 110 anteroposterior lumbosacral spine radiographs of the North Karnataka region of India. Sacral hiatus was evaluated in each sacrum based on its shape, level of its apex, and base according to sacral and coccygeal vertebrae, length, anteroposterior diameter at its apex, and transverse width at its base. Results:The mean length of sacral hiatus in men and women was 27.81+1.17 mm and 24.73+2.21 mm, respectively. The mean anteroposterior diameter of the sacral hiatus at the apex was 6.24+2.73 mm in males and 6.63+2.81 mm in females. The transverse width of the sacral hiatus at the base was 17.56+1.81 mm in males and 17.92+2.59 mm in females. The location of the apex of sacral hiatus was the highest in number at the level of the fourth sacral vertebra (23.63%). The location of apex in radiographs of all lumbosacral spine S3 showed 49.09% maximum. The location of the base of the sacral hiatus was observed in the dry sacra at the level of the fifth sacral vertebra (64.54%). In the present study, different shapes of the sacral hiatus were recorded. The most common shape in males and females was inverted U shape (42.02%), followed by inverted V shape (26.08%) and dumbbell shape (12.31%). The least common shape was observed in the bifid sacra (5.07%). In 2.17% of cases, sacral hiatus was absent. Percentage of absence, agenesis, irregular, and bifid shapes were found rather in female than male sacra. An anteroposterior view of spine radiograph showed sacral hiatus agenesis in both females (7.81%) and males (4.34%). The anatomical knowledge of sacral hiatus and its variations are important in caudal epidural anesthesia, and it may improve the success rate of caudal epidural anesthesia.

Urinalysis findings are not predictive of positive urine culture in patients with indwelling stents.

INTRODUCTION: Indwelling stents produce symptoms and urinalysis findings mimicking urinary tract infection (UTI). In this study, we investigated the correlation of urinalysis findings with urine culture in patients with indwelling ureteral stents. MATERIALS AND METHODS: All patients with ureteral stents who underwent stent removal in urology clinic from July 2013 to January 2015 and had urine culture available immediately prior to stent removal were included in this study. Urine culture results as well as age, gender, duration of indwelling stent, and reason for stent placement were collected. RESULTS: A total of 122 patients were included in this study. The two most common reasons for ureteral stent placement included urolithiasis (65.6%) and renal transplant (22.1%). Red blood cell (RBC), leukocytes and nitrite were positive in 92.9%, 70.2% and 17.9% of urine samples respectively. Only 17 patients (13.9%) had positive urine culture. Although renal transplant patients had significantly longer duration of stent retention, no statistically significant difference was noted in rate of positive urine culture compared to urolithiasis patients (p = 1.0). Among patients with positive urine culture, 62.5% had resistant bacteria to common antibiotic treatments and two patients had yeast in urine culture (12.5%). The duration of stent retention did not correlate with bacterial resistance. Multivariate analysis failed to show significant correlation of gender, reason for stent, stent duration, RBC and nitrite with positive urine culture. CONCLUSIONS: Positive findings on urinalysis in patients with indwelling ureteral stent have poor correlation to positive urine culture and therefore the use of urine culture to diagnose UTI is warranted.

Desmoid tumor: an unusual case of gross hematuria.

Desmoid tumors are rare soft-tissue masses originating from the proliferation of fibroblasts in the fibroconnective tissues. Intra-abdominal desmoid tumors pose special diagnostic challenge due to multiplicity of differential diagnoses, and difficulty to well characterize the lesions on imaging studies. Desmoid tumors can have atypical presentation making clinical correlation challenging to unsuspecting urologists. Only a few cases have been reported in the urology literature. In this report, we present a case of desmoid tumor presenting with gross hematuria.

Chronic lymphocytic leukemia of the bladder: an atypical etiology of gross hematuria.

Chronic lymphocytic leukemia (CLL) is a rare hematologic disorder with affected patients having complications of frequent infections and possible transformation to a more aggressive malignancy. The occurrence of CLL in the bladder is a rare event, with few reported cases. As a result, its aggressiveness and the optimal course for treatment are unknown. Despite this, its presence in the bladder warrants continued surveillance, as recurrence and progression to other bladder malignancies are possible. We present a 71-year-old woman initially diagnosed with CLL who was plagued by recurrent hematuria and dysuria for over a decade, which lead to multiple negative urologic workups. However, these continued workups eventually lead to her diagnosis of bladder CLL with a subsequent finding of carcinoma in situ that was prompted by a suspicious surveillance cystoscopy performed 4 months after her initial bladder diagnosis. Hence, infiltration of CLL in the urinary bladder merits close follow up, including additional urologic procedures.

Infant Deaths - Data Disparity and Use of Ante, Intra and Post-natal Services Utilization: An Experience from Tribal Areas of Gujarat.

BACKGROUND: Infant death depends upon the care during the infancy and also upon the service utilization during antenatal and intra-natal periods and with its decline, it is necessary to find the under-reporting if any and identify the most appropriate agency for its reporting. OBJECTIVES: (1) To document disparities between different reporting systems about infant deaths and find out the under-reporting if any and identify the most appropriate agency and (2) To identify utilization of health services during ante, intra and post-natal period for all infant deaths. MATERIALS AND METHODS: Study was conducted in 51 villages of 3 Primary Health Centers (PHCs) from a tribal dominated Taluka (block) of South Gujarat during September - November 2005. Information was gathered for 1 year (1 September 2004 to 31 August 2005) from 4 sources namely health care system, Integrated Child development services (ICDS) scheme, Civil Registration System (CRS) and Investigator himself (Gold standard). Data was collected in a designed verbal autopsy questionnaire by house to house survey and analyzed in Epi Info. RESULTS: A total of 48 infant deaths were recorded by investigator against reported 2, 10 and 8 infant deaths by CRS, Health System and ICDS respectively. While profiling these 48 infant deaths it was found that only 29.2% mothers received full antenatal care (ANC) and 60.4% delivered at home (by untrained personnel). Not a single delivery was done at PHCs or its sub centers (SC). In 25% cases there was poor cord care. 39.6% mothers did not breastfeed and 35.4% gave pre-lacteal feeding. CONCLUSIONS: There was gross underreporting of infant mortality in all 3 agencies. The utilization of ANC and post natal care (PNC) services was poor in these death cases. Health system and ICDS need to be sensitized to work in coordination to provide quality ANC, INC and PNC to prevent such avoidable infant deaths.

Short (≤ 1 mm) positive surgical margin and risk of biochemical recurrence after radical prostatectomy.

UNLABELLED: WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: It has been suggested that a very short positive margin does not confer additional risk of BCR after radical prostatectomy. This study shows that even very short PSM is associated with increased risk of BCR. OBJECTIVE: To re-evaluate, in a larger cohort with longer follow-up, our previously reported finding that a positive surgical margin (PSM) ≤ 1 mm may not confer an additional risk for biochemical recurrence (BCR) compared with a negative surgical margin (NSM). PATIENTS AND METHODS: Margin status and length were evaluated in 2866 men treated with radical prostatectomy (RP) for clinically localized prostate cancer at our institution from 1994 to 2009. We compared the BCR-free survival probability of men with NSMs, a PSM ≤ 1 mm, and a PSM < 1 mm using the Kaplan-Meier method and a Cox regression model adjusted for preoperative prostate-specific antigen (PSA) level, age, pathological stage and pathological Gleason score (GS). RESULTS: Compared with a NSM, a PSM ≤ 1 mm was associated with 17% lower 3-year BCR-free survival for men with pT3 and GS ≥ 7 tumours and a 6% lower 3-year BCR-free survival for men with pT2 and GS ≤ 6 tumours (log-rank P < 0.001 for all). In the multivariate model, a PSM ≤ 1 mm was associated with a probability of BCR twice as high as that for a NSM (hazard ratio [HR] 2.2), as were a higher PSA level (HR 1.04), higher pathological stage (HR 2.7) and higher pathological GS (HR 3.7 [all P < 0.001]). CONCLUSION: In men with non-organ-confined or high grade prostate cancer, a PSM ≤ 1 mm has a significant adverse impact on BCR rates.

HIV and STI prevalence and determinants among male migrant workers in India.

BACKGROUND: Our objective was to estimate for the first time the prevalence and determinants of human immunodeficiency virus type 1 (HIV-1) and sexually transmitted infections (STIs) among male migrants in India. METHODOLOGY/PRINCIPAL FINDINGS: We conducted a multi-stage stratified probability sample survey of migrant (defined as not born in Surat city) men aged 18 to 49 years working in the diamond and textile industries in Surat city. Behavioural and biological data were collected. Biological data included laboratory diagnosed herpes simplex virus type 2 (HSV-2), syphilis, chlamydia, gonorrhoea, Trichomonas vaginalis (together defined as 'any STI') and HIV-1. Likely recently acquired STIs included chlamydia, gonorrhoea, T. vaginalis and syphilis with rapid plasma reagin ≥1:8. The response rate was 77% (845/1099). Among 841 participants, HIV-1 prevalence was 1.0%, 'any STI' prevalence was 9.5% and 38.9% of these STIs were likely to have been recently acquired. Being a diamond worker, Surat resident for 10+ years and recent antibiotic use were each associated with higher odds of 'any STI' (aORs 1.83 (95% CI 1.09-3.09), 1.98 (95% CI 1.22-3.22) and 2.57 (95% CI 1 .17-5.64), respectively) after adjusting for the other two factors and age. The main study limitation was social desirability bias for self-reported sexual behaviour; STIs were diagnosed in some self-reported virgins. CONCLUSIONS/SIGNIFICANCE: HIV and STI prevalence were lower than expected, but prevention interventions remain necessary in Surat since almost 40% of STIs among participants were probably recently acquired and sentinel surveillance HIV prevalence remains high. The participants had a similar HIV prevalence to Surat antenatal clinic attendees, a proxy for the general population. This suggests migrants are not always at higher risk of HIV compared to the general population in their migration destination. Our findings highlight the need to contextualise research findings from a specific setting with other local information to guide HIV/STI prevention interventions.

Study of socio-demographic factors affecting prevalence of hypertension among bank employees of Surat City.

Cardiovascular diseases including hypertension are increasing in developing countries especially among high-risk group people like bank employees. A cross-sectional study of 1493 bank employees of Surat city was conducted during August, 2004 to September, 2005 to study the prevalence of hypertension among bank employees and the effects of socio-demographic factors on prevalence of hypertension. Data were analyzed using epi 6 software. The χ[2] -test was applied as a nonparametric test of statistical significance. Prevalence of hypertension was 30.4% and prehypertension was 34.5%. Out of 455 found as hypertensive, 258 (56.70%) were not having any symptoms at the time of examination. Prevalence was high among persons with age 50 years and above (48.5%); among male (32.5%) as compared to female (23.1%); among employees having small family size; among separated/divorcee person (40.0%). Prevalence of hypertension increased with seniority of the official position of bank employee with highest prevalence among managers (45.9%). Prevalence of hypertension was noted highest among the higher socioeconomic group; SEC I (35.0%) followed by class II (20.4%). Effects of different risk factors of hypertension were observed here. This study may help in identifying the common profile of hypertensive or persons at risk, which may further help in identifying the risk group and planning the group specific IEC interventions.

Spectrum of visual impairment among urban female school students of Surat.

AIM: Eye morbidities with or without symptoms delineate a significant morbidity among adolescent schoolgirls in India. The study was undertaken to assess the extent of visual impairment and ocular morbidity to identify influencing factors and the impact on scholastic performance. MATERIALS AND METHODS: A population-based cross-sectional study was undertaken among 3002 urban girl students of Surat in Gujarat, India. Overall prevalence of refractive error was found to be 15.22%; myopia affected 91.47%, hyperopia 4.60%, and astigmatism 0.04%. The prevalence of myopia and astigmatism was more in higher age groups, while hyperopia was more in lower age groups; even students with good vision reported ophthalmic symptoms. Of all spectacle users, in 29.73% cases the eyesight was not found to be with the best possible corrections. Refractive error was observed to be higher among the general caste (50.98%) and among Muslims (54.05%). Still, among those with problems of eyesight, 75.93% students had good academic performance. Associated ocular morbidity was noted in 20.35% participants along with the refractive error. CONCLUSION: This study highlighted the load of eye morbidities of adolescent Indian urban girls.

Knowledge and practices related to sexually transmitted infections and HIV among sex workers in an urban area of Gujarat, India.

This study is a part of STD prevalence study done in Gujarat amongst sex workers (SWs) of urban red light area during the year 2000. In the clinic specially set up in their area, after an informed consent from the participants, knowledge, attitude and practices (KAP) questionnaire schedule was administered to 125 SWs; 2/3rds of them were below the age of 30 years, 81.5% had never gone to school and 76.6% of them had their first sexual intercourse before the age of 20 years. Majority of SWs. (83.1%) has joined the profession before the age of 25 years; 60.5% were having 3-5 sexual partners on an average; 94.4% reported using condom all the time during a sexual encounter; 91.9% of them had suggested the use of condom to their client themselves, and 79.8% of them made it sure by helping the client to put on the condom. Out of 29 SWs who had regular partners, 44.8% use condom all the times with their regular partner, 92% had never seen female condom; 85 to 90% were aware about various symptoms/diseases transmitted by unsafe sexual practice in male and female; 23.4% took treatment from the health workers for such problems; 87.9% SWs were aware that HIV is transmitted by unprotected sex with an infected partner and 88.7% were aware that consistent use of condom could protect her from HIV infection. However, they did not know other measures, 65.3% don't perceive the risk of getting HIV infection. Out of those 39 who perceived this risk, 48.7% attributed it to having many clients, 30.8% to irregular use of condom and only 2.6% to non-treatment of STD. Fifty-eight per cent are not aware about any behavioural change needed to reduce the risk.

Robotic radical prostatectomy for elderly patients: probability of achieving continence and potency 1 year after surgery.

PURPOSE: We assessed the probability of achieving continence and potency after robotic radical prostatectomy in elderly patients. MATERIALS AND METHODS: The cohort included 1,436 robotic radical prostatectomy cases performed at our institution between 2003 and 2008. Continence (pad-free) and potency (erection sufficient for intercourse) at baseline and 1 year after surgery were evaluated by the UCLA-PCI questionnaire. Point estimates of the predicted probabilities of continence and potency for age 65, 70 and 75 years were calculated from multivariate logistic regression models adjusting for age, nerve sparing status, baseline International Prostate Symptom Score and baseline Sexual Health Inventory for Men score. Patients who were impotent before surgery or those who received hormones or radiation within 1 year after surgery were censored. RESULTS: Mean patient age was 60 years (range 38 to 85) with 25% older than 65 years and 77 (5%) 70 years old or older. Age (OR 0.97, p = 0.002), baseline I-PSS (OR 0.98, p = 0.02) and Sexual Health Inventory for Men scores (OR 1.02, p = 0.005) were independently associated with being pad-free. Age (OR 0.92, p <0.0001), baseline Sexual Health Inventory for Men score (OR 1.1, p <0.0001) and bilateral nerve sparing (OR 2.92, p <0.0001) were independently associated with achieving potency. Predicted probabilities (95% CI) of postoperative 1-year continence at age 65, 70 and 75 years were 0.66 (0.63, 0.69), 0.63 (0.57, 0.68) and 0.59 (0.52, 0.66), respectively. The corresponding probabilities of postoperative 1-year potency after bilateral nerve sparing were 0.66 (0.62, 0.71), 0.56 (0.49, 0.64) and 0.46 (0.36, 0.56). CONCLUSIONS: In our experience there is an acceptable probability of achieving continence and potency after robotic radical prostatectomy in selected elderly patients.

Assessment of immunization status in the slums of surat by 15 clusters multi indicators cluster survey technique.

RESEARCH QUESTION: What is the immunization status of children in the slums of Surat and what changes has it undergone in recent times? OBJECTIVE: To assess the immunization status of children between the ages of 12 and 23 months in the slums of Surat and to compare it with the MICS from previous years. STUDY DESIGN: This was a community-based cross-sectional study conducted in 15 clusters. SETTINGS: 15 urban slums selected out of a total of 299 slums using the cluster sampling method. STUDY TOOL: The Multi Indicator Cluster Sampling (MICS) method was used for sample selection and the proforma designed by UNICEF was used as a study tool. STATISTICAL ANALYSIS: Simple proportions and a Chi-square test. RESULTS: Only 25% of the children between the ages of 12 and 23 months were fully immunized; coverage was highest for BCG (75%) and lowest for measles (29.9%). As far as the dropout rate is concerned, it was 60.2%, 31.9%, and 31.5% for BCG to measles, DPT(1) to DPT(3), and OPV(1) to OPV(3), respectively. Vitamin A was taken by only 28.9% of the subjects. Between the two, female children were more disadvantaged in terms of vaccination. When compared with the coverage of 1997 and 1998, the current coverage is poor, more so in relation to DPT and OPV.

Sexually transmitted infections and reproductive tract infections in female sex workers.

The present study was conducted in 300 female sex workers (FSWs) from Surat city in 2005-2006. Vaginal swabs, endocervical swabs and serum samples were collected from each of these FSWs. Vaginal samples were screened for bacterial vaginosis (BV), candidiasis and Trichomonas vaginalis . Endocervical swabs were screened for gonococcal infection. Serological tests for human immunodeficiency virus (HIV), hepatitis B surface antigen (HBsAg) and syphilis were performed. From a total of 300 FSWs, BV was detected in 40 (13.33%), trichomoniasis in six (2%), candidiasis in 31 (10.33%), HIV seropositivity in 35 (11.66%), HBsAg reactivity in 10 (3.33%) and rapid plasma regain (RPR) reactivity in 20 (6.66%) cases. RPR-positive serum samples were confirmed by the treponema pallidum hemaglutination test. Gonococcal infection was not found in any of the FSWs. Of the total of 35 HIV-positive patients, 20 patients had associated coinfection. Of the 35 HIV-seropositive FSWs, BV was detected in six (17.14%), candidiasis in six (17.14%), syphilis in five (14.28%) and HBsAg in two (5.71%). One (2.85%) HIV-positive FSW was positive for both candidiasis and syphilis.

Prevalence of obesity among children and/or grandchildren of adult bariatric surgery patients.

BACKGROUND: Clinical experience suggests that some adults who undergo bariatric surgery have children who are obese. Childhood obesity is associated with increased morbidity and mortality in later life. This study examined the prevalence of obesity among children and grandchildren (< or =12 years of age) of adult bariatric surgery patients. METHODS: Patients in a prospective database of morbidly obese patients who underwent bariatric surgery between January 2004 and May 2007 were recruited by phone and in clinic. Patient demographics, body mass index (BMI) at surgery, and survey data were collected. The survey included questions regarding their child/grandchild's body habitus, weight, and height. Child obesity was defined as BMI percentile > or =95. Statistical significance was set at p < 0.05. RESULTS: One hundred twenty-two patients were enrolled in this study (77% women, mean BMI 49 kg/m(2)). One hundred thirty-four out of 233 children/grandchildren identified had complete data; 41% had a BMI percentile > or =95. Only 29% of these obese children were so identified by the adult respondents. Significantly more biological children/grandchildren were obese than nonbiological (p = 0.013), and significantly more biological children were obese than biological grandchildren (p = 0.027). CONCLUSIONS: This sample of bariatric surgery patients had a high proportion of obese preteen children/grandchildren. Obesity was most prevalent among biological children (vs. biological grandchildren and nonbiological children). Patients often did not recognize the degree of overweight in their children/grandchildren. Because families of bariatric surgery patients often include obese children, interventions aimed at all family members merit consideration.

RTI/STI prevalence among urban and rural women of Surat: A community-based study.

OBJECTIVES: To estimate the prevalence of RTI/STI among women in urban and rural areas of Surat and analyze the influence of socioeconomic, socio-demographic and other determinants possibly related to RTI/STI. METHOD: A community-based cross-sectional study. Women aged 15-49 years (n = 102) were interviewed and underwent a gynecological examination. Specimens were collected for laboratory diagnosis of chlamydia, gonorrhea, trichomonas, bacterial vaginosis (BV), candidiasis, hepatitis B, HIV, and syphilis. RESULTS: Out of 51 women in rural areas, 27 (53%) and among 51 women in urban areas, 35 (69%) were identified having RTI/STI. In total, the prevalence of trichomoniasis was found to be 41% by culture, 22% by wet mount, and 16% by Gram staining among urban women, while trichomoniasis among rural women was found to be 27% by culture, 18% by wet mount, and 14% by Gram staining. The prevalence of candidiasis was found to be 14% among urban women and 12% among rural women. By using Gram staining Nugent's criteria, the prevalence of bacterial vaginosis was found to be 24% among urban women and 25% among rural women. The prevalence of syphilis was found to be 2% by VDRL both among urban as well rural women.

Domestic environment and morbidity of under five children.

Healthy environment for children initiating an alliance for action (WHO) has reported that over 40% of the global burden of disease attributed to environmental risk factors fall on children below 5 years of age, who account for about 10% of the world's population. That is why to look into the new area of concern, this cross sectional study was carried out to explore the influence of domestic environment over the illness of under five children.

A case control study to explore the risk factors for acquisition of leptospirosis in Surat city, after flood.

BACKGROUND: Between August and November 2006, a population-based case control study was conducted to identify the probable risk factors for leptospirosis during flooding in Surat city. MATERIALS AND METHODS: Sixty-two laboratory confirmed cases out of 129 suspected cases, and 253 age and sex matched fever and healthy controls were interviewed with the help of predesigned questionnaire. The association of risk factors with acquiring leptospirosis was assessed by adjusted OR with the help of logistic regression model to control confounders. RESULTS: By univariate analysis, factors identified were, walking barefoot (OR = 10.34, 95% CI 5.09-21.31, P <0.05). CONCLUSIONS: Prompt and vigilant fever surveillance activities in pre-monsoon preparedness plan, intensive IEC messages, rodent control programs and improvement of environmental sanitary conditions may help to greatly reduce the incidence of leptospirosis.

Prevalence of Trichomonas vaginalis infection in and around Surat.

Trichomonas culture method was used for the diagnosis of trichomoniasis along with gram staining and wet mount preparation. We selected 51 urban women and 51 rural women in this study. Samples were taken from both symptomatic and asymptomatic individuals. Out of 102 samples 35 samples were positive for Trichomonas vaginalis by culture method. 20 women were positive for Trichomonas vaginalis by wet mount and 15 by gram staining technique. So it is a fact that culture of Trichomonas vaginalis is a "gold standard" in the diagnosis of trichomoniasis. As we had the opportunity to compare both urban and rural women in our study we were able to come to the conclusion that incidence of Trichomonas vaginalis is more in urban women than in rural women.