Background: The recent Ebola outbreak notified in West Africa recorded 6,553 cases and 3,083 deaths till 30^th September 2014. This is the longest reported outbreak, suggesting poor preparedness and inadequate public health response. Learning from these experiences can help taking future disease-control measures in West Africa and elsewhere. Materials and Methods: This scoping study was done to summarize a range of evidences available on the current “Ebola Viral Disease” (EVD) outbreak. All articles in English language related to the epidemiology of Ebola in humans, published between 1st March and 30th September 2014, were considered for review. Search engines, such as PubMed and Google Scholar, were used to search for the following keywords: “Ebola,” “Ebola Virus,” “Ebola Viral Disease,” and “Ebola Hemorrhagic Fever.” Snowballing using cross-references was done to find related literature on EVD. Related websites, blogs, and published news articles were reviewed. Studies of varying designs were considered without any quality assessment. Results: This is the first ever Ebola outbreak affecting large urban communities. Factors that worsened the outbreak were as follows: Weak health systems, unfavorable cultural practices, poverty, illiteracy, mistrust for the government, extensive cross-border movement, slow response from international agencies, and lack of tested treatment and prevention strategies. Simple measures of universal precaution, isolation and tracking of contacts, supportive treatment, and appropriate burial practices were difficult to implement. Conclusions: The outbreak in West Africa illustrates serious weaknesses in the ability of the international communities to respond to these outbreaks. Cost of setting up an infrastructure for early effective response is insignificant compared to the huge social and economic cost of the outbreak. Strong health system, improved preparedness, and effective community participation are imperative for control.

Background and Objectives: Quality of life may be reduced in patients with chronic liver diseases. The purpose of this study was to assess the impact of chronic viral liver diseases on health-related quality of life (HRQOL) among Egyptian patients compared to an interventional group of patients undergoing interferon (IFN) therapy and a control group of noninfected individuals via HRQOL specific assessment instruments focusing on liver disease. Subject and Methods: Quality of life was investigated in 150 patients with chronic viral liver disease, 150 patients undergoing IFN based therapy, and 150 matched controls. The generic short form (SF)-12 questionnaire, the Iowa Fatigue Scale (IFS), the chronic liver disease (CLD) questionnaire, and the Hospital Anxiety and Depression Scale (HADS) were applied to measure the HRQOL. Results: A significant difference in the mean IFS score was found among the three groups. Higher mean scores were observed among cases compared to controls [32.4 ± 11.3 vs 20.7 ± 5.8, OR (95% CI); 11.3 (9.6–13.7), P < 0.0001] and to the IFN group [32.4 ± 11.3 vs 25.1 ± 7.3, OR (95% CI); 5.8 (2.9–6), P < 0.0001]. The mean score was relatively higher among the IFN group compared to the controls [32.4 + 11.3 vs 25.1 ± 7.3, OR (95% CI); 7.3 (5.1–9.5), P < 0.0001]. Categorical scores of IFS in terms of cognitive, fatigue, energy, and productivity subscale were significantly lower among cases compared to the control and IFN groups. Mental and physical numeric and categorical scores for the absence of disability, CLD scale, and HADS were significantly worse in patients compared to the controls. Conclusion: Our results confirm that the quality of life is reduced in the patients with chronic viral liver disease in comparison with the healthy persons. Antiviral therapy with pegylated IFN-α and ribavirin can significantly improve physical and functional aspects of HRQOL.

Background: Dentistry may appear to be a rewarding and satisfying job, but the fear of coming up short may haunt many dentists as they approach retirement. Planning for one's retirement is an issue that concerns all working individuals. The aim of this study was to assess the retirement plans among dental professionals in the City of Navi Mumbai, India. Materials and Methods: It was a cross-sectional study involving 180 dentists and conducted with the help of a self-reported questionnaire. Results: The response rate was 83.33% (150/180). There was a general agreement that the preferred retirement income would be achieved. Nearly, 83% of the dentists were in debt from banks in the form of loans which were taken either for a house, clinic, or a vehicle. Most of the dentists had a private practice and nearly 60% of the dentists were self-employed. Conclusion: Future planning for dentists is important as decisions can be made based on age, investment planning, and their financial status until retirement. In general, dentists are well prepared for their retirement. They have a significant amount of wealth for a comfortable living standard.

Aims: Enterococcus species are major nosocomial pathogens and they most commonly cause urinary tract infections (UTIs), exhibiting vancomycin and high-level aminoglycoside resistance (HLAR) with increasing frequency, resulting in high mortality of patients with serious enterococcal infections. Detection of resistance is thus of paramount importance. The present study aims to detect and determine the HLAR pattern of Enterococci isolated from urine samples of patients diagnosed with UTI at our hospital. Materials and Methods: This study was carried out at a tertiary care hospital in Bengaluru for a period of 1 year from January 2013 to December 2013. A total of 105 enterococcal strains were isolated from urine samples and speciated as per the scheme of Facklam and Collins. Antibiotic susceptibility was determined for various drugs by Kirby–Bauer disc diffusion method. The results were interpreted as per the Clinical and Laboratory Standards Institute (CLSI) guidelines. Results: Ninety-three of the 105 (88.6%) isolates showed high-level resistance to gentamicin and/or streptomycin. Combined resistance to both the aminoglycosides, high level gentamicin and streptomycin (HLAR), was seen only in Enterococcus faecalis 20/105 (19.04%). Of the two isolates of Enterococcus faecium, 1 (50%) was seen to be resistant to high level gentamicin. The HLAR E. faecalis and E. faecium isolates also showed concordant resistance to multiple antibiotics including vancomycin. Conclusion: This study highlights the need to screen for HLAR in patients suffering from enterococcal infections. Routine screening for HLAR is important to limit the spread of resistance and to have a surveillance program.

Background: Tuberculosis remains a worldwide public health hazard even today. To diagnose tuberculosis in exudative pleural effusion still remains a challenge. Tests such as Tuberculin test, direct AFB demonstration by microscope, Acid Fast Bacili (AFB) culture and PCR have low sensitivity in pleural effusion. In a poor state like Bihar (India) a panel of investigations is not possible for the patient. Aim: The aim of this study is to diagnose tuberculous pleural effusion by estimating Adenosine Deaminase in the pleural effusion fluid that is both cost-effective and sensitive. Setting and Design: 100 cases of pleural effusion were studied in Patna Medical College and ADA values were estimated. For tuberculosis, the cut-off value was taken as 40U/L at 37°C. Statistical analysis: The sensitivity and specificity of ADA were 97.05% and 95.83% respectively. Material and Method: Alongwith physical, chemical and microscopical examination of pleural fluid, culture for AFB was also done and ADA was estimated by Galanti and Giusti's colorimetric method. Results: ADA is highly sensitive and specific and its value is significant in detection of tuberculous pleural effusion. Conclusion: ADA is a useful method to diagnose tuberculous pleural effusion among the people in a developing state like Bihar.

Context: The use of complementary and alternative medicine (CAM) is common among type 2 diabetes mellitus (T2DM) patients in Indonesia and may potentially affect adherence to prescribed diabetes medication, leading to uncontrolled blood sugar levels and complications. Aims: The objectives of this study were to analyze the association of CAM use with adherence to prescribed diabetes medication and to identify predictors of low adherence to prescribed diabetes medication. Settings and Design: A cross-sectional survey was done in a secondary health care facility in Bandung city, Indonesia. Data were collected between February and April 2014 from 114 respondents selected through consecutive sampling. Statistical Analysis Used: Chi-square test and ordinal logistic regression were used for statistical analysis. Results: The result showed that 64.9% of the respondents used CAM with herbal products (54.4%), ceragem (16.7%), and massage (12.3%) as the most widely used types. CAM use was found to significantly decrease adherence to prescribed diabetes medication (P < 0.05). The multivariate analysis suggested that the predictors of low adherence were CAM used [adjusted odds ratio (OR_adj) 6.16; 2.44-15.52], gender (OR_adj2.57; 1.05-6.31), and age (OR_adj4.25; 1.53-11.31). Conclusions: CAM use decreased adherence to prescribed medication in T2DM patients. Gender and age were also associated with adherence. Instead of ignoring CAM use among patients, health professionals should have increased awareness and better training about CAM so that they can provide patients with relevant information and assist them in their decision-making regarding CAM use.

Background: The first 2 years' experience of a colposcopy clinic at our teaching hospital was analyzed. Establishment of the clinic was supervised by consultants trained in colposcopy. Objective: To review the performance of the clinic from its inception in 2010. Materials and Methods: A study of 90 patients who were referred for colposcopy was conducted. Data were extracted from patients' folders and records in the colposcopy and histopathology register and analyzed using EPI INFO^TM 7. Results: Fifty-one women were referred on account of abnormal Papanicolaou (Pap) smears indicating either low grade squamous lesion (44%) or high grade lesion (12.2%). Thirteen patients (14.4%) had persistent inflammatory smears while 26 patients (28.9%) where referred on account of suspicious cervix. Abnormal colposcopic findings were reported in 48 patients who subsequently had colposcopically directed punch biopsy. The result of the biopsy showed that 18 patients had cervical intraepithelial neoplasia (CIN) I. Only two of these had high grade lesion; the remaining had low grade lesion (81% concordance). Nineteen women had either CIN II or CIN III. Only two cases were reported as low grade lesions and one case as suspected invasive cervical cancer on colposcopy. The remaining had high grade lesion (85% concordance %). Overall, the colposcopic impression was in agreement with the histological diagnosis in 87% of the cases. Conclusion: Our initial experience with colposcopy shows good correlation/agreement between colposcopic impression and histological diagnosis. This has improved the detection rate of premalignant and malignant disease of the cervix in our center.

Background: Postnatal depression is a serious psychiatric condition that occurs in puerperium. It is associated with increased morbidity and can overwhelm new mothers and interfere with the care of their babies. This study aimed to determine the prevalence rate of postnatal depression and assess factors that are associated with its development among northeastern Nigerian women. Materials and Methods: Edinburgh Postnatal Depression Scale (EPDS) questionnaire was administered to four hundred and eighty-three women who delivered at the maternity unit of a tertiary health institution in northeastern Nigeria. Their sociodemographic and clinical variables were also obtained using pro forma questionnaire designed by the researchers. Results: One hundred and eight respondents scored 13 or more points on EPNDS, making the prevalence rate of postnatal depression 22.4%. Factors that are associated with the development of postnatal depression are unemployment [odds ratio (OR) = 0.49, 95% (CI) = 0.27-0.86, P value = 0.018), lack of support from the husband (OR = 0.34, 95% CI = 0.19-0.60, P value = 0.000), and primiparity (OR = 0.56, 95% CI = 0.35-0.88, P value = 0.013); others are unplanned pregnancy (OR = 0.56, 95% CI = 0.35-0.88, P value = 0.013) and physical illness in the mother (OR = 1.81, 95% CI = 1.77-2.79, P value = 0.007). Conclusion: The study showed that a significant proportion of new mothers have postnatal depression. This may negatively affect their parenting skills and may have adverse effects on them and their children. Early detection and effective management, together with an efficient collaboration among psychiatrists, obstetricians, and other health workers who are involved in the care of new mothers, will go a long way in reducing the negative consequences that may result from this condition.

Tick bites are uncommon and are vectors of a number of skin diseases; some are innocuous and others deleterious. Herein, we report a case of tick bite in a 50-year-old man who presented with an insect in the abdominal wall, unassociated with systemic involvement. Examination revealed the presence of a tick in the abdominal wall (near the right hypochondrium) with head embedded in it. There is an erythematous, edematous swelling surrounding the bite with elevated skin fold covering the head of the tick. Biopsy from the swelling after the removal of tick revealed foci of fibrinoid material with perivascular lymphocytes, neutrophils, and histiocytes in the dermis.

Mycobacterium avium intracellulare complex (MAC) is the most common mycobacterial cause [after Mycobacterium tuberculosis(MTB)] of an opportunistic disease in human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) patients with low CD4⁺ cell count. We report a case of disseminated MAC disease in a 46-year-old retropositive patient, noncompliant to highly active antiretroviral therapy (HAART), with CD4⁺ T-lymphocyte count of 10 cells/mm³. MAC was isolated in culture from multiple specimens including bone marrow aspirate, blood culture, and bronchoalveolar lavage (BAL) fluid. The patient was successfully treated with the following second-line antitubercular therapies: clarithromycin, rifabutin, and ethambutol.