Background: In the new millennium, the progress and success of primary health care (PHC) in India has been delegated to and nurtured in the hands of growing number of 'for-profit' and 'not-for-profit' public-private partnerships along with secondary and tertiary care. This article tries to analyze the adequacy and quality of the ever increasing public-private partnership (PPP) in PHC in India. Objective: To assess time trends and overall patterns of public-private partnership in PHC in India. Materials and Methods: We conducted a literature search for data sources through an extensive search in indexed literature and website-based population survey reports; 13 states with public-private partnerships working on PHC were identified. A broad criterion to define both 'for-profit' and 'not-for-profit' PPPs was taken. Outcome variables were success of PPPs in PHC implementation. Results: The study critically reviewed PPPs in the light of their services in the PHC segment and significant policy perspectives by an in depth analysis with operational issues in the management and functioning of the schemes. In the health sector PPPs in India, as social entities, pool the best features of the two merging authorities of Government and private sector. They have already shown their potential. Conclusions: In India, PHC, PPP have shown accountability to the people in India. The time has come to explore this to the fullest extent.

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Introduction: Typhoid fever still continues to be a major public health problem, particularly in developing countries. A simple, reliable, affordable, and rapid diagnostic test has been a long-felt need of the clinicians. We, therefore, prospectively evaluated the sensitivity and specificity of Typhidot (IgM), a serological test to identify IgM antibodies against Salmonella typhi. Materials and Methods: The study was carried out in the Department of Microbiology, Apollo Hospital, Bangalore between January 2009 and March 2009 on a total of 186 samples from clinically suspected febrile patients. Blood culture as well as Typhidot test was performed for each of the cases. Results: Out of 61 clinically diagnosed typhoid fever, 50 were blood culture positive for S. typhi all 50 were Typhidot (IgM) positive and 11 were missed out on both. The sensitivity, specificity, positive and negative predictive values of the test using blood culture as gold standard were 100%, 95.5%, 89.2%, and 100%, respectively for typhoid fever. Conclusion: Typhidot (IgM) test is rapid, easy to perform, and reliable for diagnosing typhoid fever, and useful for small, less equipped laboratories as well as for the laboratories with better facilities in typhoid endemic countries.

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Aim: The aim of the study was to compare the level of awareness on Hepatitis-B infection among medical and dental interns in Pondicherry, India. Materials and Methods: Questionnaire containing a set of 20 different questions on Hepatitis B infection was distributed among 64 Medical and 49 Dental Interns of Arupadai Veedu Medical College and Mahatma Gandhi Dental College, Pondicherry, India, respectively. Results: The majority of interns (94.7%) were aware that Hepatitis B virus is the major cause of Hepatitis. About 33.6 and 59.3% of interns had very good and moderate knowledge respectively. The study shows that dental interns (34.7%) had better awareness than medical interns (32.8%). About 52.2% believed that Hepatitis B virus can be transmitted by semen and vaginal secretions. Only 39.9% of the interns believed that doctors, dentists infected with HBV should not have direct contact with patients. Conclusion: One- third of the interns had very good knowledge about Hepatitis B. The majority had good knowledge regarding the mode of transmission and attitude towards HBV patients. However, there is a misconception about prophylaxis, vaccination and treatment of HBV. Hence there is an imperative need for health education to improve the knowledge and attitude of the interns towards Hepatitis B.

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To compare the actual white blood cell (WBC) counts, used to calculate malaria parasite densities against the standard WBC counts of 8000/µl. The WBC counts of 111 Plasmodium falciparum -infected children in north central Nigeria, Aged 1-4 (<5) and 5-14 (>5) years were estimated in a cross-sectional study. These gave average values of 7487/µl and 5985/µl against the assumed standard count of 8000/µl. A comparison of blood samples grouped into those with WBC counts of 8000/µl (3.95% and 8.57%), those below (57.89% and 82.86%) and above (38.16% and 8.57%) showed a significantly higher number in the group below the standard value for the two age groups (X2, df = 3, P > 0.05). This paper draws attention to the disparity between the assumed standard WBC counts and the real values encountered among Nigerian children and proposes a review for achieving more accurate malaria parasite density estimation among other reasons. To best of our knowledge, the present study is the first such report from north central Nigeria.

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Sickle cell disease is an genetically transmitted hemo-globinopathy. It is prevalent in many parts of India, where the prevalence has ranged from 9.4-22.2% in endemic areas. There is paucity of data with respect to its prevalence and manifestations in the non endemic areas of India. The present study attempts to evaluate varied manifestations of sickle cell disease in a tertiary care center in north India, which is a non-endemic belt. It was observed that 18% of the patients in the study to be the local inhabitants of Delhi- a nonendemic belt. Also this region had the largest percentage of the mixed cases particularly associated with beta thallesemia. A high index of suspicion is therefore required for the diagnosis of such cases in a nonendemic area like Delhi specifically in patients who presented with unexplained anemia and splenomegaly with or without pain abdomen. Various crises reported in sickle cell disease is not a common manifestation especially in a nonendemic belt in our experience.

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A total of 266 clinically suspected cases of neonatal sepsis due to Candida species were studied from January 2007 to June 2007. Candida species were isolated from 49 (19.14%) patients. Candida glabrata was the commonest isolate in 30 patients (61.22%) followed by Candida parapsilosis in 10 cases (20.40%), Candida albicans in 6 cases (12.24 %), Candida krusei in 2 cases (4.08%), while Candida tropicalis in a single case (2.04 %). Inspite of giving intravenous Amphotericin B, six infants died due to Candida glabrata septicemia. Commonest predisposing factors observed were antibiotic therapy (100%), prematurity (100%), low birth weight (100%), respiratory distress syndrome (66.67%), patients on ventilators (66.67%), patients on central line catheters (33.33%), and urinary catheters (50%). Clinical features were nonspecific, difficult to differentiate from bacterial sepsis.

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Cardiovascular diseases (CVD) formerly considered as developed countries pandemic, are becoming nowadays increasingly ubiquitous in developing countries, where in addition to a steady increase in different risk factors, there is substantial inaccessibility to health care. However, data about the burden of CVD is lacking in many sub-Saharan African countries, and their morbimortality characteristics have been poorly described. Authors carried out a descriptive and retrospective study over a 12-month period, to describe the inhospital morbidity and mortality of CVD in the Department of Internal Medicine at University Teaching Hospital in Kigali City. Data were collected from 226 CVD cases (91 males and 135 females). The patients' age ranged from 26 to 94 years (mean age of 47.17 ± 16.04). The 226 CVD cases account for the 8.2% of hospitalized patients. Hypertension was the principal cause of death (43.1% of deaths) and the predominant cause of patients' admission (42.9%), followed by cardiomyopathies (11.9%) and valvular heart diseases (11.5%). The association between a CVD and HIV/AIDS infection was observed in 23.9% of the total patients, but no causality relationship was investigated. Isolated heart failure takes the first place (33.6%) among the cardiovascular complications, followed by stroke (14.2%) and isolated renal failure (7.5%). Findings of this study confirm the importance of CVD in CHU Kigali, not only by their inhospital frequency but also- and especially by their lethality rate and their complications associated. This study stresses also a real need of CVD community survey in Rwanda.

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Context : Chikungunya is a re-emerging debilitating viral disease for which any specific cure or vaccine is not available. Aim : To study the impact of knowledge and practices on prevention of chikungunya. Settings and Design: Three primary health centers in rural area experiencing epidemic of chikungunya were selected for the study. Materials and Methods: The study was conducted in a coastal district of India, which was experiencing an epidemic of chikungunya during the study period. Patients above 18 years of age, attending out-patient department of three primary health centers, were included in the study. Patients diagnosed as case of chikungunya were taken as cases and those with other morbidity and having none of their relatives or friends suffering or had suffered in the last month from chikungunya were taken as controls. Sample size was 150 and controls were three times the number of cases. A pre-tested, open-ended questionnaire was used to collect information by face to face interview technique. Statistical Analysis Used: Percentage, proportions, and Chi-square were used for statistical analyses. Results: Controls who were not affected by chikungunya were having better knowledge and practices about the vector and methods of preventing the disease than the cases. Knowledge and practices were found to be skewed toward people having more number of years of schooling and higher per capita income. Striking differences between knowledge and practices were also observed among cases as well as controls. Conclusions: People who had knowledge about the vector and methods of preventing the disease and had put their knowledge into practice were less likely to be effected by chikungunya. In the absence of any specific cure or effective vaccine, health education can prove to be an important tool for the control of chikungunya epidemic.

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Defluoridation of water by the Nalgonda technique is a commonly used household process in areas of endemic fluorosis in villages around Nalgonda (Andhra Pradesh, India). The aim of this paper was to modify the existing well-known procedure minimally and without much change in the cost to bring about a greater removal of fluoride. By doubling the concentrations of alum and lime, water fluoride levels fell significantly (p<0.001) in tap water and drinking water while pH levels and other inorganic factors remained unaffected.

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The incidence of malaria is dramatically increasing, especially because parasites responsible for the majority of fatal malaria infections have now become resistant to commonly used antimalarial drugs such as chloroquine, mefloquine, and quinine. To combat this menace, the World Health Organization (WHO) introduced a new antimalarial drug called artesunate; a hemi-succinate derivative of artemisinin. The in vivo effects of artesunate on rat liver mitochondrial membrane permeability transition (MMPT) pore were investigated in Wister strain albino rats exposed to various doses of artesunate (1.5, 2.0, 3.0 and 5.0 mg per kg body weight per day) for five days. Membrane permeability transition was estimated under energized and de energized spectrophotometric method of Lapidus and Sokolove. The results revealed that artesunate tested at the various doses induced mitochondrial pore opening, induction being minimal (68%) at 5 mg/kg and maximal (240%) at 1.5 mg/kg. In vitro, artesunate at 30, 50 and 70 mg/ml also had an inductive effect in a concentration-dependent manner with minimum induction (18.1%) at 30 mg/ml and maximum induction (32.7%) at 70 mg/ml. Further, preincubation of mitochondria with artesunate for five minutes caused an induction of pore opening in a concentration-dependent manner, with minimum induction (7.9%) at 10 mg/ml and maximum induction (48.6%) at 70 mg/ml. In conclusion, these findings indicate that artesunate could be cytotoxic, opening mitochondrial membrane permeability transition pore, causing the release of cytochrome c and eventually apoptosis.

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Background and Objective: Brucellosis is recognized as a clinical and health problem in underdeveloped countries. This research is a descriptive study to determine the prevalence of brucellosis, clinical aspects and laboratory results as well as epidemiological analysis of hospitalized patients in Hamadan city in a five-year period. Materials and Methods: During our study period, 809 patients (61.2% men and 38.8% women) with confirmed brucellosis based on clinical symptoms and serological tests, from all Hamadan hospitals were looked into. Patients' data concerning age, gender, occupation, date of diagnosis and observed symptoms were collected from five regional hospitals. Blood samples were obtained by venepuncture needles and all samples were analyzed using serum agglutination test (SAT), Coombs and 2-mercaptoethanol (2ME) methods. Blood culture was performed by inoculation into biphasic blood culture media for isolation the brucella organisms. Results: The highest and lowest age groups were 11-20 (23.5%) and over 80 (1.11%) years. The highest brucellosis rate was observed in housekeepers (26.46%) followed by farmers (20.51%). The most common observed symptoms were arthralgia, chill and anorexia with 83.8, 63.10 and 59.45% respectively, while the lowest was urethritis (0.24%). The most common signs were fever and splenomegaly with 83.8 and 20.76% respectively. A combination of rifampin and doxcycline was the most applied treatment protocol (40.91%). Conclusion: Brucellosis program needs to be more concerned since most affected patients were young adults with predominance among males. The majority of brucellosis cases in this study were attributed to direct contact with animals or their products. In our study cotrimoxasol-rifampin reported to have the lowest relapse rate.

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Tuberculous adenitis is a common cause of lymphadenopathy, especially in areas where tuberculosis is endemic. Tuberculosis (TB) lymphadenitis in cervical, axillary, and inguinal areas can present as nontender swelling without significant systemic symptoms in immunocompetent young adults. we report a case of TB adenitis in a 26-year-old male from India, who was admitted with 1-month history of painless swellings in the lower neck on both sides. Fine-needle aspiration of the right lesion of this patient showed the presence of stainable acid-fast bacilli and cultured organisms on aspirate. His HIV serology was negative. Four drugs antituberculous regimen treatment was started with good response.

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India should have dedicated public health cadre by incorporating high quality training, appropriate career structure and recruitment policy to attract young and talented multi-disciplinary professionals committed to prevention and health promotion. In addition, rewarding good performance and offering continuing professional development are necessary.

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Background: Lay press creates awareness on issues related to health and illnesses, and thus influences the attitude of public. Objective: The present study was undertaken to find out the pattern of information provided in print media on Chikungunya fever and to elicit the readers' views. Materials and Methods: Information displayed on Chikungunya fever in one of the oldest English daily newspapers 'The Hindu' and its supplements published from Madurai and Chennai, India from April 1, 2006 to October 31, 2006 were read, analyzed, and classified into different categories. A readership questionnaire survey was carried out among policy makers (n = 25), health professionals (n = 170), medical students (n = 200), and the public (n = 150) to find out their preferences and usefulness on the category of information provided. The data were analyzed by simple descriptive statistics. Results: During the study period of 214 days, 74 items related to chikungunya fever, one in April, three in May, five in June, six in July, 15 in August, 18 in September, and 25 in October appeared. Most of the articles centered around the government policy matters (n = 37) and others in the order of preventive aspects (n = 32), statistics (n = 31), geographical distribution (n = 21), symptomatology (n = 16), transmission of illness (n=16), etc., Overall areas of interest of policy makers and health professionals were different significantly ( P < 0.01) from that of medical students and the public, but every one looked for treatment and preventive aspects. Conclusion: Media have provided information, improved knowledge, altered the attitude, and influenced decision making. It is suggested that students and researchers of health sciences should be motivated to read standard newspapers as it provides information on health and illnesses much earlier than they appear in their professional journals.

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Context: Hepatitis B virus (HBV) is highly infectious and can be transmitted covertly by percutaneous routes and overtly by blood transfusion. Earlier studies among Nepalese blood donors have shown a high seroprevalence of HBV. Regarding this problem Blood Transfusion Service in Nepal has focused seriously for improving its service by various motivation and education programs. Aims: The study was aimed to reveal the seroprevalence of HBV among different category of blood donors, in relation to their sex and age. Settings and Design: Descriptive cross-sectional Study. Materials and Methods: A total of 33,255 blood samples were screened from donors using enzyme-linked immunosorbent assay kits from December 1, 2006 to September 1, 2007 in Central Blood Transfusion Service, Nepal Red Cross Society, Exhibition Road, Kathmandu. Statistical Analysis: Chi-square test was used for significance testing by using the software SPSS ver. 11.5. Results: The seroprevalence of HBsAg among total blood donors was 0.53% (95% confidence interval [CI] = 0.46-0.62%). Significantly, higher seroprevalence was observed among male donors than in females (0.58% vs. 0.18%, respectively) ( P < 0.05). The seroprevalence was significantly higher in the age group 41-50 years (0.88%). Similarly, significantly higher seroprevalence was observed among replacement donors (0.81%) than among volunteer donors (0.5%) ( P < 0.05). Almost similar seroprevalence of HBV was observed among first time and among repeat blood donors (0.53% and 0.54%, respectively) ( P > 0.05). The hepatitis C virus coinfection rate among HBV-infected donors was 1.67%. Conclusions: On the basis of this study, we concluded that the seroprevalence of HBV among Nepalese blood donors in Kathmandu Valley, is decreasing compared to recent past years and is relatively lower than as described for most of the major cities in South Asia. However, similar seroprevalence rate among first time and repeat donors suggests that further improvements are essential.

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A variety of neurologic diseases have been associated with human immunodeficiency virus (HIV) infection either as a direct result of the virus itself (e.g., HIV-associated dementia and HIV-related painful distal polyneuropathy) or as a result of opportunistic infections or neoplasm. HIV-related neuropathies are one of the most common neurologic complications of HIV infection. There are a variety of neuropathies in patients with HIV and can be broadly classified into: (i) distal symmetric polyneuropathy (DSP), (ii) mononeuropathy multiplex, (iii) acute and chronic inflammatory demyelinating polyneuropathies, (iv) lumbosacral polyradiculopathy, (v) diffuse infiltrative lymphocytosis syndrome (DILS), (vi) autonomic neuropathy, mononeuropathies, (vii) herpes zoster radiculitis, and (viii) sensory ganglioneuritis. DSP represents the most common form of neuropathy seen in patients with HIV and affects about 30% of patients and pathologic findings of DSP occurring in almost all patients with advanced immunodeficiency at autopsy. But with highly active antiretroviral treatment (HAART), the incidence of DSP appears to be decreasing compared to the pre-HAART era. But some studies show a substantial increase in the prevalence of DSP and this may be related to an increased longevity of patients and neurotoxic effects of some antiretroviral drugs. Antiretroviral toxic neuropathy (ATN) occurs with the di-deoxnucleoside group of drugs (DDI: didanosine; DDC : zalcitabine) and is thought to be the direct neurotoxic effect of the drugs. Clinically the two forms are indistinguishable and present in a length dependent axonal polyneuropathy. DSP and ATN cause devastating complications and related to poor treatment compliance. The objective of this review is to update the current knowledge in the two main forms of neuropathy in HIV infection and we believe that physicians practicing in the highly HIV prevalent areas (Sub-Saharan Africa and other developing countries) need to look for these complications in their HIV patients and manage them accordingly.

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Though surgeons are not primarily responsible for the treatment of patients with human immunodeficiency virus (HIV) infection, the disease influences the performance and outcome of surgery. Surgeons may be called upon to operate for the diagnosis of an infection, for an unrelated condition, or for one of the surgical complications of acquired immunodeficiency syndrome (AIDS). This article reviews in brief the etiology, pathogenesis, and natural history of HIV and AIDS, the signs and symptoms which may help in recognizing HIV disease especially in emergency situations, the clinical presentations from a surgical point of view and their management, controversial issues related to the management of AIDS patients, and finally the guidelines for the precautions to be taken to reduce the potential risk of transmission of infection from patient to a health care workers and the postexposure prophylaxis. Methods: Literature review was conducted by the way of relevant English articles obtained from National Library of Medicine's Pubmed database with the key words as mentioned below. Additional articles were obtained from the reference lists of key articles and recent reviews.

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The enamel hypoplasia, the demineralization, and the dental fluorosis are the result of general or local lesions at the dental enamel, which causes esthetic damage, since they are in disharmony within the natural aspect of the teeth. The search for a perfect esthetic has become one of the main goals of the patient and the dental surgeon as well. Microabrasion is an efficient method for intrinsic and superficial spots removal from the enamel, restoring the esthetics with minimal tissue waste. This study presents a clinical case in which the patient who presented enamel hypoplasia heredity type (imperfect amelogenesis) distinguished by brownish spots, mainly in the upper medial incisor teeth, underwent the micro abrasion technique.

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Background : Globally, the spread of HIV/AIDS remains on the rise with young people at increased risk of infection. Sexual behavior change remains the most effective way of preventing further transmission. Aim: To gain the knowledge needed to develop appropriate interventions that will enable young people to adopt safe sexual practices. Materials and Methods: A cross-sectional study was conducted using structured questionnaires among 315 randomly selected students enrolled at a tertiary institution in Lagos State, Nigeria. Results: The mean age of the respondents was 23 years. Although the mean score of the participants' responses to ten HIV/AIDS knowledge questions was 8.3 of 10 points, 73.5% of them did not perceive themselves at risk of being infected. Majority (53.8%) had not changed their dating behaviors as a result of concerns for HIV/AIDS and 70.3% had multiple lifetime sexual partners. Those who perceived themselves at risk of infection are significantly (P = 0.019) more likely to always use condoms. Using the AIDS Risk Reduction Model (ARRM), it was found that the students are in the first stage of behavior change process: recognition of the problem. The low risk perception has prevented movement to the second stage of making commitment to change behavior. Conclusion: The awareness and knowledge of HIV/AIDS is high among tertiary education students in Lagos, Nigeria. However, risk perception is low with high-risk sexual behaviors. The failure to perceive HIV/AIDS as a personal risk has prevented commitment to behavior change. Interventions aimed at influencing risk perception are paramount to curb the spread of this dreaded disease.

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Myiasis is a parasitic infestation caused by the larvae of several species. The infestations reduce host physiological functions; destroy host tissues, and causes significant economical losses. It is very rare disease in USA and Europe, seen rarely in tropical and subtropical countries in persons with poor personal hygiene. Diagnosis and treatment are simple. The location of this infestation at genital region is, however, an extremely rare occurrence. The authors present here one case of genital myiasis affecting a village woman with genital prolapse and advanced vaginal malignancy.

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Malaria remains a major problem with the significant public health dimension affecting hundreds of millions of people annually, mainly in sub-Saharan Africa. The effectiveness of the measures currently used to control the disease is now drastically reduced because of the development of parasite resistance to the anti-malarial drugs and vector adaptation to the insecticides. On account of this development, efforts are ongoing to develop a malaria vaccine to help in the prevention of the disease as well as in reducing the severity in patients. Drug research and development have always raised a lot of ethical issues, especially in the context of developing countries like those of sub-Saharan Africa. This article discusses some of these ethical dilemmas using a template based on the four principles of biomedical ethics.

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Context: Studies identified prevalence of vitamin A deficiency among Indian preschool-aged children. Aims: The meta-analysis was conducted on peer-reviewed articles published between 1960 and 2007. Settings and Design: Thirteen epidemiologic studies were identified from 250 potentially relevant articles. Material and methods: Studies were selected on, Firstly; a broad criterion of vitamin A deficiency among Indian preschool-aged children was developed on information provided in the WHO publication. Secondly, 'Night Blindness (XN)' among preschool-age children along with Corneal Xerosis associated with Bitot's spot (X1B) was considered as positive clinical signs. Finally, in absence of universally accepted criteria of reporting of prevalence, weighted average data was considered as positive cases irrespective of criteria of diagnosis. Statistical analysis used: Median and inter-quartile range was used. Results: Wide differences in samples and primary outcome variables in these studies were observed. After adjusting for these confounding characteristics, consistent patterns of vitamin A deficiency among Indian preschool-aged children was calculated. The total number of children in this study population was 208379 [with median=1094 and IQR = 283.0 - 8978.0] and the number of children suffering from Vitamin A deficiency disorders was 12510 [with median =80 and IQR = 36.5 - 201.0]. The median prevalence was 7.0% and Inter-Quartile Range (IQR) = 3.3% - 9.3%. Though the study period varied between 1960 and 2005, the median study period was found to be 1999 [with IQR = 1981.5-2004.5]. Conclusion: Wide inter-regional variation in these studies on the prevalence was possibly because of the non-uniform adherence to the diagnostic criteria.

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We report a very uncommon case of isolated inguinal tubercular lymphadenopathy in a 35-year-old lady with no other pulmonary or extra pulmonary tubercular infection. She responded very well to antitubercular treatment following histological confirmation.

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