Esophageal cancer is the fourth common cause of cancer-related deaths in India. It is prevalent among both men and women. Squamous cell carcinoma (SCC) accounts for up to 80% of these cancers, although adenocarcinoma is on the increase due to changing lifestyles. The etiological factors for SCCs show a regional variation in different parts of India, but tobacco consumption in various forms, alcohol, hot beverages, and poor nutrition remain the predominant predisposing factors. Generally, these cancers present late and therefore have a poor prognosis. The current status of esophageal cancer in India in relation to the demographics, diagnosis, staging, multimodality treatment, surgical therapy, and the future perspectives are discussed in this review article.

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The use of mobile Internet devices (MIDs), smartphones, and proprietary software applications (also known as "apps" in short) can improve communication among medical caregivers. The utilization of these mobile technologies has further transformed health care, communications, commerce, education, and entertainment, among other fields. Newer technologies have the potential to be adapted for improvement in health care and medical education in general. Mobile technology is one of the latest strings of technological innovations that can be integrated into medical education. M-learning (the use of mobile technologies in teaching/training) has been used as a complimentary resource for interaction between students and instructors for motivation and learning. The main uses described for mobile devices in medical education can be divided into (a) information management (IM), (b) communication, and (c) time management. The field of mobile technology in health-care services and medical education is quite new and throws open ample opportunities for researchers to conduct further studies. Educators in medicine, dermatology, and public health as well as practicing physicians and surgeons need to embrace this new technology, study its further adoption, and assist in the responsible integration of these devices into the art and practice of medicine.

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Background: The National Rural Health Mission has introduced village-level female community health worker, accredited social health activist (ASHA) who acts as an interface between the community and the public health system. The is study was conducted to assess the awareness and perceptions of ASHA regarding their roles and responsibilities in health-care system and factors affecting their performance in delivering health-care services. Methodology: A qualitative study was conducted in seven selected villages under Talegaon Primary Health Centers, Wardha district, Maharashtra, which is also field practice area of a medical college. Nonprobability sampling (purposive sampling) was done. In-depth interviews were conducted on ASHAs (n = 7) of those selected villages till saturation of data. Data were analyzed using the thematic framework approach. Results: ASHAs perception regarding their job responsibilities appeared to be incomplete. They had good awareness regarding their roles and responsibilities as a link worker. They were found to be mostly interested in higher incentive performances. ASHAs clarity regarding their roles and responsibilities as facilitator, social activist, and service provider was found to be somewhat compromised. They were ignorant about their roles and responsibilities under various newly launched national programs. The positive factors influencing ASHAs performances were regular supervision of their performances and appraisal by higher authority and support from community, family, and good relations with coworkers and staff. Challenges faced by most of the ASHAs were more workload, poor orientation to program, lack of quality training, and inadequate and delayed monetary incentives. Conclusion: Good quality training with regular refresher training sessions and regularization of incentives are required to motivate them ASHAs.

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Suicide is a complex human behavior with multiple interacting determinants. Clinicians and practitioners often face difficulties in assimilating the evidence base for suicide prevention interventions, evaluating their effectiveness and decoding the best practice elements of each approach. In this article, we do not aim to provide an exhaustive coverage of every approach. Instead, we provide an overview of the following eight major suicide prevention interventions: awareness programs, screening, gatekeeper training, access to means restriction, follow-up care, hotlines, media strategies, pharmacotherapeutic and psychotherapeutic approaches. The evidence base and components of each approach are described to facilitate replication. The best practice elements are synthesized from each approach and presented to aid program development and practice. Although a number of approaches hold promise, there are difficulties in ascertaining the effective elements under each of them. Innovative research designs are needed to address this knowledge gap as it will facilitate optimal allocation of resources for suicide prevention.

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Background: Nutritional status especially that of preschool children is a sensitive indicator of health and nutritional status of a community. Aim: To estimate the prevalence of undernutrition among tribal preschool children and to assess the factors associated with variation in nutritional status. Methods: A cross-sectional survey was conducted among 438 tribal preschool children in 10 clusters of Wayanad district of Kerala. Height, weight, mid-arm circumference and hemoglobin level were measured. Children more than two standard deviations (SDs) below the standard median of World Health Organization Multi Centric Growth Reference Study were considered underweight (weight-for-age), stunted (height-for-age) and wasted (weight-for-height) respectively. Qualitative variables such as prevalence of underweight, stunting and wasting were summarized using percentages. Mean (SD) was used, to summarize, quantitative variables such as height and weight. Generalized estimating equation models were constructed to assess associations. Adjusted models included social factors and child morbidities. Results: More than half of the children say 58.7% (257/438) had deficits in at least one of the three anthropometric indicators. The prevalence of underweight, stunting and wasting was 39% (171/438), 38% (167/438) and 20.5% (90/438) respectively. The prevalence of anemia was 95.7% (419/438). Bivariate analysis showed significant associations between undernutrition and educational status of parents, tribe to which the child belonged, diarrheal episode and low birth weight. In adjusted analysis, lower educational status of mother (adjusted odds ratio 1.9, 95% confidence intervals 1.2-3) and an episode of diarrhea (1.8, 1.03-3.2) independently predicted undernutrition in a tribal preschool child. Conclusion: Undernutrition in the form of stunting, wasting and underweight is very high among the tribal preschool children. There is an urgent need to improve health care services to the tribal population and tribal children.

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Background: Seeking assistance from multiple physicians for an illness is a major obstacle in providing efficient care by the health care systems. It not only alters the disease condition but also adds to excess health care costs. This study aimed at exploring healthcare-seeking behavior in adult patients with diabetes and also to identify the factors associated with doctor-shopping behavior. Methods: This questionnaire-based cross-sectional study was conducted in an urban ward of Puducherry. A total of 100 patients aged more than 18 years with diabetes were included in the study. Results: Around 80% of the study subjects were availing treatment from government facilities. Prevalence of doctor-shopping behavior was found to be 14%. Reasons for change in their treatment facility were mainly due to patient-related factors like unaffordability of medicines and consultant fees, or illness-related factors like no improvement in symptoms. Physician/facility-related factors were due to prolonged waiting hours and poor interpersonal communication by the doctor. Various factors associated with doctor-shopping behavior in diabetics such as chronicity of illness (P< 0.005), past treatment facility being private (P< 0.001), and upper socioeconomic status (P = 0.045) were statistically found to be significant. Conclusion: The present study shows the prevalence of doctor shopping among diabetic patients to be 14% in urban Puducherry and this change in consultation was mainly due to the patient, illness, physician, or facility-related factors. Patient education, good interpersonal communication skills, and health system strengthening measures can increase responsiveness of the community toward the health systems and thereby reduce doctor shopping behavior among diabetic patients.

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Background: Currently, in India, many healthcare organizations and their managements appreciate the advantages of electronic medical records, but they often use them. The current push for universal health coverage in India with National Rural Health Mission (NRHM) and National Urban Health Mission (NUHM) helping toward healthcare reforms highlights the importance of implementing information technology as a means of cutting costs and improving efficiency in healthcare field. The quality of documentation of patient care rendered at healthcare destinations is very important to showcase the growing stature of healthcare in India. Aims: As maintaining the medical records is very important, storage and retrieval of the information is also important for future patient care. In this regard, implementation of electronic medical records in hospitals is essential. Through this study, we wanted to highlight the perceptions of healthcare personnel, who are in the core team of delivering healthcare, toward implementation of electronic medical records. Methods: A cross-sectional study was carried out among doctors (post-graduates) and staff nurses. The sample size for post-graduate students and nurses was 164 and 296, respectively, in this study. The study was carried out during the period from January to June 2013, and a survey was conducted with the help of a validated, pre-tested questionnaire in a tertiary care medical college hospital in India. Results: The results showed that 75% of the study population are comfortable working with electronic medical records. They mentioned that display of diagnosis, medications, and allergies of patients on the records was most important. Their perception was that electronic medical records improve timely decision-making and patient care due to immediate access to the patient's disease history. Conclusion: The major problems faced by nurses, as per our study, are delay in services due to dispersion of records, multiplicity of form types consuming major time, and inability to understand doctors' notes.

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Context: Intrauterine contraceptive device (IUCD) has been recommended for insertion within 10 min of placental delivery or within 48 h of delivery (postpartum IUCD [PPIUCD]) by the WHO. However, the acceptance across our country has been low. Aims: To determine the level of knowledge and the factors affecting it and the likely adoption of PPIUCD. Settings and Design: This cross-sectional study was carried out in the antenatal clinic and postnatal ward of a large tertiary care center in South India. Subjects and Methods: A total of 339 women were studied with the help of a validated structured pro forma. Proportions were expressed in percentage. Chi-square test was applied to compare proportions and univariate analysis for the factors affecting knowledge and likely acceptance. Results: Among the 339 women, 152 (44.8%) were aware of the method. Of the 152 women, 56 had a negative attitude about the method. Multiparity of the women was a significant factor affecting knowledge (χ² = 8.068, P = 0.045). Women who were not exposed to formal health counseling were significantly associated with a lack of knowledge (χ² = 23.332, P = 0.0001). Primiparity (χ² = 14.683, P = 0.0001), husbands with skilled jobs (χ² = 8.272, P = 0.0407), having shared information with their husband regarding the method (χ² = 38.1, P < 0.001), and family support (χ² = 58.25, P < 0.001) were the major factors associated with willingness to adopt the method. Conclusion: The level of knowledge about PPIUCD of our study population is 44.8%. Exposure to formal health counseling classes and prior discussion with husbands and family members could improve the knowledge and likelihood of acceptance of PPIUCD.

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Background: Stroke is one of the leading causes of death and disability worldwide. Poststroke, most survivors experience trunk control impairment and instability. Previous works on exercise on an unstable surface to improve trunk stability in nonstroke population had proven effective. Thus, physioball exercises (PBEs) in poststroke subjects may be useful in the recovery of trunk stability and thereby reduce disability. We hypothesize that PBE is feasible and effective in enhancing trunk stability. Aims: To test the feasibility and successful implementation of conducting a randomized controlled study to assess the clinical effectiveness of PBE and proprioceptive neuromuscular facilitation (PNF) technique to enhance trunk control in poststroke subjects. Methods: This study was conducted in a stroke unit of Global Hospitals and Health City, Chennai, India. Thirty patients with the first onset of stroke within 40 days of stroke duration, lesion to one side, and ability to sit independently with or without arm support for 15 days were recruited. All thirty poststroke subjects were randomized either into PBE group or PNF group, and outcome assessors involved in the trail were blinded to allocation. PBE group performed task-oriented activities on an unstable surface and PNF group were treated with PNF-specific trunk stability exercise program for 4 weeks (30 min/day, 5 times/week). Trunk impairment scale (TIS) was used as a main outcome measure. Results: Data were analyzed using Wilcoxon signed rank sum test and Mann–Whitney U-test for intra- and inter-group comparison. The baseline characteristics between both groups were statistically nonsignificant. Within groups, there were significant improvements between baseline and at 4 weeks in the measure of TIS. In addition, PBE group showed a significant increase in trunk control (mean 2.33, 95% confidence interval 1.14-3.52, P = 0.002) than the PNF subject. Conclusion: This pilot randomized controlled trial (RCT) showed the potential efficacy of PBE in developing more trunk stability than PNF in poststroke subjects. The current study had proved the feasibility of undertaking a large-scale RCT. Since this is a pilot study to establish any sort of conclusive evidence on the efficacy of PBEs in the poststroke population, a larger sample-sized trial is needed.

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Background: Awareness about danger signs during pregnancy is essential for a woman to seek prompt care. This can avert long-term morbidity and mortality. This study was aimed to find the level of knowledge and its related factors about danger signs of pregnancy and childbirth among pregnant women attending a tertiary care hospital in southern India. Patients and Methods: We conducted a cross-sectional survey of pregnant women attending a tertiary care hospital in South India. Systematic random sampling of every 10^th woman exiting the antenatal clinic was done. Results: We studied 382 pregnant women. Of them, 188 (49.2% [95% confidence interval (CI): 44%–54%]), 104 (27.2% [95% CI: 23%–32%]), and 81 (21.2% [95% CI: 17%–26%]) women had sufficient knowledge about danger signs during pregnancy, labor, and childbirth, respectively. On multivariable analysis, lack of exposure to formal awareness raising health counseling classes was the only factor found to be significantly associated with a lack of knowledge about danger signs of pregnancy (adjusted prevalence ratio, 95% CI: 1.8 [1.2–2.7]) and after childbirth (1.4 [1.1–1.7]). Lower education level was significantly associated with a lack of knowledge about danger signs of labor (1.2 [1.1–1.4]). Conclusion: We found that lack of exposure to formal awareness raising health counseling classes is a modifiable risk factor to improve knowledge about danger signs. We recommend structured mandatory health awareness sessions addressing the danger signs of pregnancy and child health to all pregnant women.

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Rabies is a fatal disease caused by rabies virus, a neurotropic virus and a prototype of Lyssavirus of Rhabdoviridae family. It is transmitted to human beings through infected saliva of dogs and cats during bite. Dog is the cause of more than 90% of human rabies in India. The incubation period is 4-8 weeks (but it may vary from 5 days to 7 years). There are two clinical types of rabies - encephalitic (furious) and paralytic (dumb) types. In the encephalitic (furious) form, the principal malfunction is in the brain stem and limbic system. Patient has hydrophobia in the full-blown form, but the mind remains clear till the end. Death occurs within a week after the onset of symptoms. Paralytic rabies resembles Guillain-Barre syndrome. Diagnosis is mostly clinical. However, direct fluorescent antibody test is used to identify the antigen in skin biopsy from the nape of neck. In the postmortem specimen, demonstration of Negri bodies in the brain confirms the diagnosis. Anti-rabies vaccine is used for pre- and post-exposure prophylaxis. The commonly used intramuscular (IM) regimen is being superseded by intradermal (ID) vaccine because it makes the treatment economical. Whereas touching of animal or lick on intact skin does not require vaccination, any transdermal bite with bleeding requires immediate administration of rabies immunoglobulin (RIG) and simultaneous vaccination with a tissue culture vaccine (TCV). Minor abrasion without bleeding may require only vaccination and no RIG. Rabies human monoclonal antibody (RMAb) is the newest entry in the prophylaxis of rabies which may ultimately replace RIG. Prognosis is grave since there are just six reports of survivors. Treatment is mainly palliative with heavy sedation and/or therapeutic coma (Milwaukee protocol).

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A wide variety of disorders of diverse pathogenic mechanisms can trigger spinal cord dysfunction in HIV-1-infected patients. The most common such condition is HIV-1-associated myelopathy (HAM) which characteristically seen during advanced HIV infection in patients with low CD4 cell counts and previous AIDS-defining diagnoses. Histologically seen in approximately 30% of AIDS patients, but only 10% have clinical symptoms related to the disease. We describe an unusual case of HAM in previously asymptomatic patient with relatively low CD4 cell count (78 cells/mm3). The patient unaware of her seropositive status presented with a clinically slowly progressive myelopathy with difficulty in walking without assistance. We discharged a patient on antiretroviral therapy. We also review the disorders reported to derange spinal cord function in previously asymptomatic HIV-1 infected patients with preserved counts.

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Adrenal myelolipoma is a rare benign tumor composed of an admixture of adipose and hematopoietic tissue. Most tumors are asymptomatic, small in size, right-sided, and usually detected incidentally. Though they are often smaller than four cm in diameter, they can reach larger sizes. Giant adrenal myelolipomas are extremely rare tumors having only about 10 reported cases in the literature. Presently, a case is being reported in a 59-year-old lady who presented with abdominal distention and dragging sensation in the upper left abdomen. Computed tomography of the abdomen revealed a retroperitoneal tumor which was suspected to be a retroperitoneal sarcoma. Other fat containing retroperitoneal tumors such as a lipoma, myelolipoma and teratoma were also considered as possibilities. All hormonal studies related to adrenal gland were within normal limits. The patient underwent surgical resection of the tumor. The resected mass was 23 cm × 16 cm ×9 cm in size and weighed 3.3 kg. Histopathological examination revealed the tumor to be an adrenal myelolipoma. This present case of adrenal myelolipoma is unusual in view of its left-sided location and its large size which clinically and radiologically simulated a retroperitoneal sarcoma.

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Pseudoaneurysm of the visceral arteries is a rare condition. The common causes for pseudoaneurysm are pancreatitis, infection, autoimmune disorders, vascular intervention, surgery, and blunt trauma. Pseudoaneurysm is usually noticed during investigation in an emergency situation. Such rare cases involving superior mesenteric artery, gastroduodenal artery, and splenic artery were managed recently using endovascular techniques.

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Background: Over the years, coronary angiogram (CAG) has evolved to become indispensable diagnostic and therapeutic procedure for coronary artery disease (CAD). The procedure even though minimally invasive with shorter length of hospital stay and low cost has some risk for morbidity and even mortality. Large extents of the risks are dependent on the clinical status of the patient at the time of the study and comorbid illness. Aims: The present study was planned to assess the complications and to identify the risk factors associated with complications among patients undergoing CAG for CAD. Methods: A cross-sectional observational design was used in 250 patients who underwent diagnostic or interventional procedure of CAG through either transradial or femoral route. The convenience sampling technique was used to select the study sample. Results: Majority (32.8%) of the patients were in the age group of 50-59 years, followed by 28.0% of the patients in the age group of 60-69 years. Male preponderance was noted (87.6%). About 6.8% of the participants had developed complications, among them 4.4% had hematoma, 1.2% had vasovagal reactions, and 1.2% had periprocedural myocardial infarction. History of current smoking was identified as risk factor for complications (P< 0.05). The risk of complications was higher in percutaneous coronary intervention (PCI) patients, (odds ratio 6.21 [1.96-19.68] at 95% confidence interval) and who had femoral access site (P< 0.05). Conclusion: Even as the improved patient outcome is seen with cardiac catheterization, it is not totally free from risk. Newer strategies such as radial approach have managed to reduce the risks considerably. History of smoking, femoral access, and PCI were identified as risk factor for complications following CAG.

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Background: Young people are most vulnerable to sexually transmitted diseases (STDs) and human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) in Bangladesh. Lack of knowledge about reproductive health issues is also common in this group. Aims: This study aimed to assess the knowledge and perceptions of STDs, HIV/AIDS, and reproductive health of young female university students (19-27 years) in Dhaka, Bangladesh. Methods: A cross-sectional study was carried out among 402 female students from seven universities in Dhaka, Bangladesh. Data were collected through face-to-face interviews using a structured questionnaire on sociodemographic information, knowledge, and perceptions of STDs, HIV/AIDS, and reproductive health. Descriptive analysis was used, and data were presented as frequencies and percentages. Results: The majority of the participants were young, unmarried, undergraduate students. Most of the participants reported that they knew about STDs (79%) and HIV/AIDS (66%). However, knowledge about the modes of transmission and prevention of the diseases was poor. HIV/AIDS was considered by 90% participants as a public health threat to Bangladesh, mostly due to illiteracy (76%), increased mortality (20%), existence of risky sexual behavior (18%), and aggression of Western culture (31%). About 65% of the participants mentioned that AIDS can be prevented by safe sexual practice, 55% mentioned prevention through upholding religious values and moral education, and 59% mentioned that education about AIDS would help prevent transmission. Conclusions: Although a majority of young Bangladeshi female students reported knowing about HIV/AIDS, their knowledge regarding transmission and prevention of the diseases was poor. Strategies for creating reproductive health education targeted at young female students are essential for the prevention of STDs and HIV/AIDS.

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Background: Human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) has become one of the significant public health problems in the world. Research regarding HIV/AIDS among nursing professionals is limited from India. Aim: The aim was to assess nursing student's knowledge and attitude toward people living with HIV/AIDS. Methods: A descriptive cross-sectional design was adopted among conveniently selected under graduate nursing students (n = 172) using self-reported questionnaires. Results: The overall mean knowledge (38.05 ± 4.91) and attitude score (51.26 ± 6.2) indicate that majority of the students have good knowledge (77.6%) and moderately favorable attitudes (67.4%) toward HIV/AIDS patients. However, statistically significant differences were observed between age (P < 0.001, P < 0.019) education (P < 0.34, P < 0.01) and experience in taking care of HIV/AIDS patients (P < 0.01, P< 0.01) with knowledge and attitude. Conclusion: Though, a majority of nursing students had adequate knowledge, few students hold discriminatory attitudes toward people with HIV/AIDS. These findings indicate that there is an urgent need to improve the level of knowledge and attitudes among nursing students toward HIV/AIDS as they have a key role in prevention, care and treatment in their future career as nurses.

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Background: Since there is a high mortality due to malaria, there is a need of a parameter to identify patients at risk of developing complications, whereby intensive care is given to those patients who are at higher risk for complications and mortality. Aims: This study was undertaken to estimate serum lactate levels in patients with Plasmodium vivax, Plasmodium falciparum, and mixed malaria, and also to correlate it with various clinical and biochemical parameters and with the severity and prognosis of malaria. Methods: This was a cross-sectional, analytical, and observational study, which was conducted on 100 patients diagnosed with malaria and older than 14 years of age. Diagnosis of malaria was made by the gold standard method of peripheral blood smear examination and rapid tests. The blood sample for plasma lactate levels on admission was collected from a stasis free vein. The Student's t-test for continuous normally distributed variables was used. For categorical data, the chi-square test was used and for the small numbers, Fisher's exact test was used for small numbers. P < 0.05 was considered as a statistical significance at 95% confidence intervals. Results: In this study, there were 90% survivors and 10% of patients succumbed. Out of 90 survivors, 43 patients (47.7%) had some form of complicated malaria, whereas all patients who succumbed (10) had complicated malaria. All the patients who had jaundice, severe thrombocytopenia, renal failure, severe anemia, or hypotension (hypotension was confirmed clinically, but the remainder were confirmed by biochemical parameters such as liver functions, renal functions, platelet count, and hemogram) had hyperlactatemia in this study. All patients who died had a serum lactate level of >2 mmol/l. Conclusions: Hyperlactatemia had significant associations with complications of malaria. Raised serum lactate levels were significantly associated with mortality (P < 0.05).

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Background and Aims: Mupirocin is a topical antibiotic that has been used extensively for treating methicillin-resistant Staphylococcus aureus (MRSA) associated infections. However, the prevalence of mupirocin-resistant MRSA has increased with the extensive and widespread use of this agent. The aim was to determine the rates of high-level and low-level mupirocin resistance in MRSA to study the antimicrobial resistance pattern and clindamycin resistance in mupirocin-resistant MRSA. Methods: A total of 267 non-duplicate clinical isolates of MRSA from various clinical specimens were tested for mupirocin resistance by the disk diffusion method using 5 and 200 μg mupirocin disks. MRSA isolates were tested for antibiotics by Kirby-Bauer disk diffusion method as per Clinical and Laboratory Standards Institute (CLSI) guidelines. Erythromycin-resistant isolates of MRSA were further studied for inducible clindamycin resistance by "D test" as per CLSI guidelines. Results: Of 267 MRSA isolates, high-level mupirocin resistance was observed in 5.99% and low-level resistance in 15.35%. Mupirocin-resistant MRSA isolates showed higher antibiotic resistance to fusidic acid (14.03% vs 7.14%), rifampicin (5.26% vs 2.38%), erythromycin (68.42% vs 58.57%), and clindamycin (52.63% vs 45.71%). No MRSA strains were found to be resistant to vancomycin and linezolid. Mupirocin-resistant MRSA isolates showed higher constitutive macrolide-lincosamide-streptogamin B (cMLS _B ; 51.28% vs 42.98%) and inducible macrolide-lincosamide-streptogamin B (iMLS _B ; 17.94% vs 13.15%) resistance, as compared to mupirocin-sensitive MRSA isolates. Conclusion: The emergence of mupirocin resistance could be limited by regular surveillance and effective infection control initiatives so to inform health care facilities to guide therapeutic and prophylactic use of mupirocin.

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Background: Neonatal jaundice is a common condition that can be treated with phototherapy. Phototherapy may cause oxidative stress in addition to the usual side effects. Aim: In this study, the oxidative stress in babies with neonatal jaundice was assessed before and after phototherapy by estimating plasma malondialdehyde (MDA) level. Methods: Eighty babies with neonatal jaundice were chosen for the study. Among them, 40 babies whose total serum bilirubin level was >15 mg/dl formed the case group and the other 40 babies with total serum bilirubin level <15 mg/dl who did not require phototherapy formed the control group. Total serum bilirubin was measured using Automated Clinical Chemical Analyser with standard reagent kit. Plasma MDA was estimated by Satoh's method using spectrophotometry. Results: The plasma MDA level, which is one of the oxidant markers, was significantly elevated in post-phototherapy cases compared to pre-phototherapy and controls. Conclusion: Phototherapy results in significant oxidative stress among babies with neonatal hyperbilirubinemia. So, usage of phototherapy should be restricted to those with significant hyperbilirubinemia.

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Background: Snakebite is a frequently encountered medical emergency faced mainly by rural populations. It is a significant public health problem in many parts of the world, especially in South Asian countries. Aims: This study aimed to analyze the epidemiological aspects of snakebite among human snakebite victims admitted to the emergency ward of a tertiary care teaching hospital between 2010 and 2012 in rural Haryana. Additional objectives were to study other factors that have a bearing on the outcome of snakebite. Methods: In this cross-sectional study, lists of addresses and contact numbers were prepared for all the snakebite cases admitted to the emergency ward of Maharishi Markandeshwar Institute of Medical Science & Research (MMIMSR), Mullana, Haryana, between June 2010 and May 2012. The subjects eligible for the study were then interviewed to gather epidemiological information. Necessary clinical data were obtained from records. Results: The majority or 49.4% of the victims were in the age group of 31-45 years, followed by 32.91% in the age group of 16-30 years. Of the victims, 20.3% were illiterates. A majority (48.1%) of the victims were manual laborers and farmers. The foot was the most commonly (62.03%) involved part of the body. Most (48.10%) of the snakebite incidents occurred while the victims were doing agricultural work. Further, 64.56% cases were reported during the monsoon season and 41.77% victims were bitten in the bush. Among the subjects, 60.76% received first aid at the site of incident, and 20.25% of them sought hospital care after consulting the traditional healers (ozhas). Time lapsed for seeking hospital treatment was less than 4 h in 55.69% of the cases. The overwhelming majority (83.54%) of snakebite victims recovered after the treatment. Conclusion: This study highlights the need for improving community education, prompt transport of bitten patients to medical care, capacity-building of medical staff at all levels, and availability of anti-snake venom in rural health facilities to reduce snakebite deaths.

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Background: In India, overall prevalence of blindness is 1.1%, the principal cause being cataract (62.6%) affecting over 9 million people. Aim: The present study was carried out to find the prevalence, barriers and facilitating factors related to cataract health services in a rural community of Tamil Nadu. Methods: The study was carried out in four villages in sub-center Kondur, under Primary Health Centre (PHC) Kondur, Villupuram district, Tamil Nadu, during November-December 2010. All adults of more than 50 years (n = 331) residing in the sub-center Kondur, were examined for lenticular opacity and visual acuity. A structured proforma was used to assess the awareness, barriers and facilitating factors related to available cataract health services. Results: The prevalence of cataract among the population studied was 62.8% (95% confidence interval [CI]: 57.5-67.9%). There was a significant increase in cataract with increase in age (P < 0.001). Only 13% (95% CI: 9.6-16.3%) of the persons with cataract were operated at the time of interview. The major barriers were no one to accompany (25.5%) and absence of felt need (22.6%). Less than one-fifth (17.8%) reported the awareness of cataract as a condition affecting eye. The facilitating factors were free surgery in camps (83.7%), self-decision due to defective vision (69.7%) and quality of service provided (65.1%). More than one-half (56.7%) of subjects diagnosed for cataract during the survey were willing to be operated. Conclusion: Prevalence of cataract was high in Kondur PHC area. It is vital to increase the level of awareness regarding the need and availability of cataract health services.

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