Obstructive sleep apnea (OSA) is an independent risk factor for increased cardiovascular and cerebro-vascular morbidity and mortality. OSA leads to loss of human life and huge economical burden to our Society worldwide. The adult's prevalence of OSA ranges between 9.3-13.5% in India. India is the second largest populated country of the world and by the end of 2030 it may become the most populated nation. This developing nation is already known as the world's capital of T2 DM, and other non-communicable diseases like Obesity, Hypertension, Stroke, Ischemic heart diseases (IHD), Hypercholesterolemia congestive heart failure are on a rising trend. These cardiovascular disorders were found to be associated with OSA. OSA treatment may improve these co-morbid conditions. Continuous positive airway pressure (CPAP) is a preferred choice for OSA treatment in western and developed countries. In India, where CPAP is out of the reach of most of the OSA affected population due to high cost and other socio-economic and cultural factors, MAD may become a preferred treatment option. MAD is cheaper than CPAP and generally equally effective. The patients suffering from sleep-related breathing disorder (SBD) may have an alternative to CPAP or surgery for their disease management. Mandibular Advancement Device (MAD) may become an additional standard treatment of OSA in India, and has great potential for reducing associated undesirable cardiovascular co-morbidities and mortalities. This review highlights the prospects of MAD as a preferred treatment of Obstructive Sleep Apnea in India by extensively researching scientific literature, PubMed, Google Scholar, scientific, and academic web portals.

Over the course of its existence in India, Artemisinin combination therapy (ACT), has emerged as the titular tool at mankind's disposal to counter falciparum malaria related mortalities. The dramatic slide in reported deaths due to Plasmodium falciparum is a testament to ACT's efficacy. However, a closer look reveals the successes so far achieved with ACT to be only a smokescreen. A large majority of the patients in the more remote and backward regions of India, still remain bereft of ACT, which might be the reason for the startling malaria mortality figures reported by the community surveillances. In our manuscript, we have laid focus on the key facets of the Indian health care system that has purportedly played a central role in the present successes with ACT. Further, we have highlighted as to how these key elements, for instance, health workers like Accredited Social Health Activists (ASHAs), sub-centers, supply chain of ACT can be improved upon further so as to ensure that ACT is able to reach the truly needy.

Context: Sand fly fever is a vector-borne viral infection and is endemic in many parts of the world, particularly in areas that are infected with different types of leishmaniasis. Clinical spectrum ranges from asymptomatic infection to very high fever and photophobia in patients. During the last decades, an increase in imported sand fly fever cases in developed and nonendemic countries have been pointed out from an international literature review. Among the possible causes are increasing international travelers, travel of immigrants from endemic area, and army operations. It has been noted that the main region for the diseases are west of Asia and east of Europe, and perhaps imported cases may be seen clinically in different parts of the world, either in developed or in developing countries. Materials and Methods: Two methods were used to gather the information for this article. First, PubMed was searched for English language references to published relevant articles. Second, the term sand fly fever was searched on Google Scholar too. Results: In PubMed, 156 articles and in Google Scholar, 70,400 articles mentioned the term sand fly fever. The most searched items in PubMed were epidemiology, treatment, prevention, and life cycle with incidences of 41.66, 20.51, 13.46, and 1.92%, respectively, and in terms of geographical distribution of the study, the maximum number of articles in PubMed were published from Europe, Asia, Australia, and America, with percentages being 26.92, 17.30, 17.0, 1.28, and 1.28%, respectively. Conclusion: Different countries have reported the disease either as an endemic or as an imported one. co-infection. Sand fly fever must be considered in the diagnostic assessment of patients presenting with a similar clinical syndrome and a history of travel to an endemic area, which are mentioned above. Adventure travelers, researchers, military personnel, and other groups of travelers likely to be exposed to sand flies in endemic areas; these travelers should receive counseling regarding sand fly fever appropriate protective health measures. In this review article sand fly fever situation will be studied.

Background: Worldwide, rural inequitable distribution and dearth of health professionals pose poor functioning of health services. In this study, we gather interventions aimed at increasing the proportion of health professionals working in rural and remote areas. Methods: We searched PUBMED, MEDLINE, EMBASE and google scholar database with key words such as “doctors”, “nurses” “health workers”, “health care professionals” and “human resources for health”. Further, comprehensive data base of relevant literature on recruitment or retention or both, of health workers in rural and remote areas has been searched through the websites of different government, non-government, national and international agencies. Results: We found that, there are mainly four interventions employed for improved rural retention. These interventions are generally grouped into educational, financial, regulatory, personal and professional strategies. We also judged the effectiveness of the intervention provided in the literature. Conclusion: Currently, there is limited reliable evidence regarding the effects of these interventions aimed at addressing the maldistribution of health professionals. Hence, well-designed observational studies are needed to confirm that educational, financial, regulatory, personal and professional strategies might influence the health workers' decision to stay in underserved areas. Further, the state governments, public health schools and medical colleges should ensure that when interventions are implemented, their impacts can be measured through scientifically rigorous approaches to establish the true effects of these measures for improved rural recruitment and retention.

Background: Presence of physical deformities in patients with leprosy reflects the rate of disease transmission in the community; delay in detection of cases; and inadequacy or failure of treatment. Objectives: To determine the spectrum of physical deformities in patients with leprosy, to analyze the various sociodemographic factors affecting the study population, and to assess the treatment history of the selected number of patients. Materials and Methods: The study was an analytical study conducted on all leprosy patients who visited the dermatology out-patient department in a tertiary care hospital during the period of 1 year. Results: Males constituted 70.66% and females constituted 29.34%. It was found that a majority were in the age group of 21–60 years than in the extreme age groups (0–20 years and 61–80 years). Among the 92 patients studied, it was found that majority of the patients (60.86%) had WHO grade 0 or grade 1 deformity. Those with visible deformities (WHO grade 2 deformity) constituted 39.13% of the study population. Among those with visible deformities, the most common deformity was seen to be trophic ulcer (21.73%). This was followed by claw hand, foot drop, madarosis, claw toes, lagophthalmos, ear lobe deformity, facial palsy, and finally nose deformity. Conclusions: Our study found that more than one third of number of leprosy patients had deformities. It reflects the need for further efforts to curb this infectious disease and increase education among masses.

Introduction: In recent years, there has been increasing concern regarding problematic use of mobile phones, and accordingly, it has been publicized extensively as an emerging social problem. Objective: The aim of the study was to assess mobile phone dependence among undergraduate medical students of the Nanded city. Material and Methods: A cross-sectional study was conducted among undergraduate medical students of a Government Medical college, Nanded, Maharashtra, during November to December 2016. All the 348 students in the college were enrolled in the study. A predesigned Test of Mobile Phone Dependence (TMD Brief) developed by Chóliz et al was used for collection of information. The participants scoring ≥ 50%, that is, a score of ≥ 30 were considered as mobile dependent. Data analysis was performed using SPSS Version 20 and Graph Pad Prism. Results: Out of 348 participants, data were collected from 251 students, and 206 (82.1%) students were found to be dependent on the mobile phone. In total, 137 (85.1%) students in the age group of 17–20 years were mobile phone dependent. Most of the mobile phone dependents were females 99 (83.9%) than males, that is, 107 (80.5%). Out of 206 mobile-phone-dependent students, majority 77 (90.6%) were from the first year. The chi square test showed that the mobile phone dependence was significantly dependent on the academic year (X²=6.82, P=0.033). The binary logistic regression also proved first year as an independent risk factor for mobile dependence compared to second and third years. Conclusions: A total of 82.1% undergraduate medical students were mobile phone dependent. Health education about the use of mobile phone is necessary in the first year.

Background: Indoor air quality (IAQ) in shopping malls is an interesting case of study since a shopping mall is a public place where people favor to spend their time. This study was conducted to investigate the IAQ of shopping malls in Kota Kinabalu, Sabah, whereby three shopping malls were selected as investigation sites. Methods: The parameters being studied include particulate matter (PM_0.3-∞, PM_0.5-∞, PM_2-∞ and PM_5-∞) and ozone. Indoor and outdoor air measurements were performed in the three shopping malls on weekdays and weekends to determine the I/O ratios. Results: In this study, overall average indoor PM concentrations on weekends were higher than weekdays, reaching maxima average concentrations of 421.44 ± 102.96 µg/m³ for PM_0.3-∞, 41.75 ± 15.54 µg/m³ for PM_0.5-∞, 1.30 ± 0.41 µg/m³ for PM_2-∞, and 0.21 ± 0.09 µg/m³ for PM_5-∞. Correlation between indoor and outdoor PM concentrations mostly showed poor relationship in the three shopping malls, showing that indoor sources such as re-suspension phenomena due to occupant's activities were clearly the main contributors to indoor PM concentrations. Poor ventilation system also affected IAQ by increasing the PM accumulation. However, I/O ratios were often less than 1.0, indicating that PM in indoor air arises predominantly from outdoor air transported to indoors. Average indoor ozone concentration at all the shopping malls was measured to be below the 0.05 ppm of ICOP-IAQ 2010. Conclusion: The overall assessment of IAQ in the three shopping malls showed that SM2 has a better IAQ compared to SM1 and SM3.

Introduction: Most of the farmers encounter the similar problems such as low-financial capacity and lack of information to control over the pesticide hazards. This study highlights the importance of the approach of As Low As Reasonably Practicable (ALARP) solutions to control and reduce the identified health risks from the pesticide use. Objective: To evaluate the decision of ALARP solutions for the safe use of pesticide among the pesticide handlers. Methodology: This cross-sectional study was conducted among 85 pesticide handlers to evaluate the ALARP practical solutions. The solution shall consider the factors that could control and mitigate the health risks suitably and cost-effectively. Result and Discussion: Pesticide handlers were aware of the fact that using hazardous pesticides without appropriate control equipment is detrimental to their health. When ALARP solutions are considered, respondents prefer to utilize the control strategies that are less likely to incur costs. Among all, the practices of the safe system of work and administrative control are highly recommended to mitigate the potential health risks during mixing and loading, application, and drift control and decontamination. Conclusion: It is recommended to apply the ALARP solutions to control and mitigate the pesticide risks sustainable during mixing and loading, application, drift reduction and decontamination.

Introduction: Acute respiratory infection (ARI) among children is one of the health effects associated with poor air quality. Objective: This study explores the distribution of ARI cases by subtypes among children in an urban region in tropical country and its association with the air pollution level. Method: Secondary data of primary air pollutants and the ARI data recorded at the selected main public hospital in the same area from 2006 to 2010 were analyzed descriptively using statistical software and spatially through the geographical information system (GIS). Results: In total, 54,542 cases of ARI hospital admission among children were reported with 16 subtypes. Most of the ARI cases were recorded at the general hospital located in the city center (Kuala Lumpur Hospital, N = 27,719, 50.82%), and other cases were distributed at the hospitals located at suburbs (Serdang Hospital, N = 6868 (12.59%), Selayang Hospital, N = 6548, (12.01%), and Klang Hospital, N = 5434, (9.96%). Most of the patients were boys (N = 31,682, 58.09%) and aged below 5 years (N = 45,393, 83.22%). Thirteen ARI subtypes were influenced by the particulate matter with diameter size less than 10 µm (PM₁₀)_, followed by NO₂ (eight subtypes), CO (four sub-types), and O₃ (two sub-types). PM₁₀ contributes to high risk of acute bronchiolitis (odd ratio (OR): 1.115, 95% CI: 1.093-1.138), acute upper respiratory infection of multiple and unspecified sites (OR: 1.065, 95% CI: 1.034-1.096), and unspecified acute lower respiratory infection (OR: 1.055, 95% CI: 1.051–1.059). In conclusion, this study supported the theory that children were mainly exposed to air pollution in urban area and they were at risk to experience ARI.

Background: Nowadays, eye shadows have become common cosmetics used by consumers. Previous studies proved that some of the eye shadows used had excessive levels of heavy metals. Objectives: The aims of this study are to (i) quantify the heavy metals concentration of lead and chromium in the eye shadows based on the color categories and types of eye shadows and (ii) assess potential non-carcinogenic health risk due exposure to heavy metals concentrations in eye shadows by using Hazard Quotient (HQ). Methodology: A conventional method using oven heating was applied to extract heavy metals from the samples. The analysis of heavy metals in the samples was performed using the Graphite Furnace Atomic Absorption Spectrophotometer (GF-AAS). The chronic non-carcinogenic health effect was evaluated quantitatively using HQ. Results: Both lead and chromium concentrations were found to be the highest in blue color category with the mean concentration of 161.8 ± 101.6 µg kg⁻¹ and 149.4 ± 53.1 µg kg⁻¹, respectively. The chromium levels were higher in the shimmering shade compared to the matte shade. The lead concentrations in all the samples analyzed were below the standard set by Health Canada (10 mg kg⁻¹) and United States Food and Drug Administration (20 mg kg⁻¹). The HQ values for chromium in all samples were less than 1. Conclusion: Lead concentrations were present within the permitted levels stated by the international standards in cosmetics intended for external use. The HQ values for chromium were less than 1 in all samples, indicating there was no significant chronic non-carcinogenic health risk to eye shadow users.

Introduction: The strong El Nino phenomena increase temperature in Malaysia that directly affects the health of traffic police officers who are highly exposed to high temperature and humidity while controlling traffic. Objective: The aim of this study was to determine the association between heat strain and work performance among police traffic officers. Methodology: The study is divided into two parts that is, first, a measurement of heat stress index at five different workstations at Kuala Lumpur during afternoon using wet bulb globe temperature. Second, the survey was distributed to gain information of work performances from the respondent. Result: Findings indicated that the heat stress index at five locations exceeded the threshold limit value ranging from 33.3 to 41.8°C for 75% work and 25% rest. The most prevalent heat strain symptoms were fatigue (57.9%), dizziness (31%), and muscle cramps (16.4%). Results from multiple regression showed that marital status and the perception of heat exposure are significantly associated with work performance after considering socio-demographical data, heat strain symptoms, and work characteristics. Conclusion: Traffic police officers were exposed to a high level of heat and perceived to reduce their work performance.

Context: The increased cases of dengue hemorrhagic fever (DHF) have been reported in the highland of Wonosobo District. Vector-control program are used for prevention and control of dengue cases. Vector's profile toward insecticide efficacy is important which need to be elucidated. Aims: The aim of this study was to describe the resistance status of the vector against malathion insecticide. Settings and Design: A cross-sectional survey was done in the highland area, Wonosobo sub-district, Indonesia. Methods and Material: The study included a sample of 37 villages, which were located at Wonosobo sub-district. At every village, we observed 15 houses. The observed variables were mosquito bionomic, and their resistance status was based on the biochemical and molecular parameters. To detect resistance status, we used ELISA equipment. Statistical analysis used: Data were collected by entomology students and were analyzed using descriptive statistics. Results: The study results showed that the population of Aedes sp in the Wonosobo District was higher than the standard control of dengue program. Vector indexes were HI (14.75%), CI (6.8%), BI (15.6%), and OI (11.3%). We identified that vectors have already developed resistant to organophosphate insecticide, as many as 50% out of the total sample tested. Conclusions: This finding indicated that Aedes sp strain in the Wonosobo District highland has competence to be dengue vectors. Therefore, it is important to use another type of insecticide such as pyrethroid.

Introduction: The government of Karnataka has introduced a new vaccine, i.e., pentavalent vaccine (PVV) in the Universal Immunization Programme (UIP) schedule from 1st April, 2013. There are no published studies on vaccination coverage of this new vaccine. Objectives: 1. To assess the coverage of PVV of infants in a rural area. 2. To find out the reasons for immunization failure. 3. To describe the use of Global Positioning System (GPS) technology and Google Earth as new tools for spatial mapping the vaccine coverage. Methodology: This exploratory study was conducted in September, 2014 by covering three rural Primary Health Centers near Bangalore by a team of field investigators. The population studied was children aged between 6 and 23 months at the time of the survey. WHO's standard EPI 30 cluster sampling technique was used for assessing the vaccine coverage. GarminGPS72H, a hand held GPS receiver, and Google Earth were used for spatial mapping the vaccination coverage. Results: A total of 210 children aged 6–23 months were included in the study. It was found that the completely immunized, partially immunized, and unimmunized children were 93.3%, 4.3%, and 2.4%, respectively. The most common cause for partial immunization and non-immunization was child being ill and the lack of information, respectively. Spatial mapping of vaccination coverage described the immunization coverage in the area and also gave insight into the probable reason for partial/non-immunized children. Conclusions: Coverage of PVV was very high and vaccine was well accepted by the community. GPS and Google Earth were useful in spatial mapping of the vaccination coverage.

Background: Metalworking fluids (MWFs) are commonly used during metalworking processes in the machining industry. Aims: This study was to determine the relationship between total serum immunoglobulin G (IgG) levels with the exposure to microorganisms among workers using MWFs and also to study associations between health symptoms with total IgG. Setting and Design: This cross-sectional study was carried out on 138 machine workers who were exposed to MWFs. Materials and Methods: Respondents were invited to participate in blood sampling for the total serum IgG level analysis. The microbial assessments were carried out on the MWF bulk samples and the aerosols in the air. The data were analyzed using the Statistical Package for the Social Sciences version 22.0. Results: The findings showed significant difference between work sections for serum IgG level (p value = 0.04). The environmental bacteria level had a significant correlation with the total serum IgG level (p value = 0.003). There were also significant relationships between body mass index (BMI) (p value = 0.044), work duration (p value = 0.014), smoking (p value = 0.014), and environmental contaminants (p value = 0.049), with the total serum IgG levels. Health symptoms, such as cough (p value = 0.031), wheezing (p value = 0.043), skin itching (p value = 0.033), and skin redness (p value = 0.005), also related with the total serum IgG levels. Conclusion: There were significant correlations between the total serum IgG levels with microbial contaminants of MWF in metalworking processes. Work duration, smoking, BMI, and environmental contaminants, and health symptoms of cough, skin itching, and inflammation significantly influenced the total serum IgG levels. Total serum IgG antibodies may serve as an indicator of occupational exposure to the microbial contaminants in MWF.

Background: This paper outlines the environmental health conditions arising from the synergistic effect of the rampant human activities (illegal logging and rapid expansion of oil palm plantations) that are exploiting the nature resources without proper planning. This led to the unsolved health problem caused by multifaceted of hazards among the remote indigenous Baram communities at Borneo, Sarawak. Methodology: This is an observational survey, which conducted in two phases, that is, June 2014 and January 2016. A random sampling of locations from the downstream and reservoir zones of the Baram River were selected for site surveillance. A total of 10 indigenous villages were visited and 3 main populations of affected indigenous people (Kayan, Kenyah, and Penan) were recruited for short interviews. Result: The result showed that at least 80% of the interviewed villagers held clear views on the identified environmental hazards; however, site surveillance to review the environmental health conditions of their living area showed that the health of the indigenous community is in the vulnerable and precarious conditions. Discussion and Conclusion: This observational survey provides insights of the current environmental health conditions among the remote aboriginal communities at Borneo Island. The data provides a detailed picture of the state of environmental health conditions and discuss the potential health consequences among the indigenous communities across Baram communities.

Background: This study highlights the presence of heavy metals as metal impurities in the skin-lightening product. The presence of metal impurities leads to accumulation in human vital organs and produce harmful effects to humans even at low concentration. Aim and Objectives: The aim of this study was to determine the concentration of heavy metals impurities (Pb, Cd, and Ni) in skin-lightening products available in Malaysian market and to assess the risks of application of products that contain heavy metals. Methods: This study sampled 33 skin-lightening products (facial moisturizing cream). Samples were tested for heavy metals using Inductively Coupled Plasma Optical Emission Spectrometry (ICP-OES). Health risk was assessed using Margin of Safety (MoS) and Hazard Quotient (HQ). Results: In general, all heavy metals were slightly higher in non-local samples. For example, the mean ± standard deviation (SD) of Ni in non-local samples was 0.207±0.15 mg/kg, slightly higher than local samples (0.180±0.17 mg/kg). Cd was determined as 0.018±0.02 mg/kg in non-local samples and 0.014±0.01 mg/kg in local samples. Pb was determined as 0.107±0.08 mg/kg in non-local samples and 0.049±0.03 mg/kg in local samples. All heavy metals were not exceeding the guideline referred. The MoS value of metal presence in the samples was higher than 100 and thus indicates that the presence of metal impurities was within an acceptable risk. The HQ for Ni and Cd were less than 1, whereas HQ for Pb was greater than 1, which indicates potential for adverse health effects. Conclusion: Heavy metals impurities detected in the samples were within the safe limit and at an acceptable risk to human except for Pb. Care should be taken as heavy metals are able to accumulate in human body and the health effects remain as concern.

Background: The management of dirty abdominal wounds has remained a challenge to surgeons because of the associated complications. Objective: This study was undertaken to determine the outcome of primary closure of dirty abdominal wounds in children. Design: A retrospective study (between 1^st January, 2006 and 5^th May, 2009) on the outcome of the primary closure of dirty abdominal wounds in children. Setting: Paediatric Surgery Division, Department of Surgery, Olabisi Onabanjo University Teaching Hospital, Sagamu. Materials and Methods: Cases of dirty abdominal wounds managed during the study period were retrieved from the medical records. Information regarding the age, sex, diagnosis, treatment, type of abdominal wound closure, duration of stay in hospital, complications arising from the abdominal wounds, and outcome was obtained and documented. Results: A total of 120 cases of dirty abdominal wound were managed during the study period. However, 90 case notes were retrieved and further evaluated for the proposed study. The age range of the patients studied was 2 months to 14 years. Males were 48 (53.3%), while females were 42 (46.7%). All the cases were acute abdominal emergencies. Differential diagnosis of dirty abdominal wounds managed during the study period are ruptured appendicitis/appendiceal abscess 30 (33.3%), intussusception 19 (21.1%), strangulated inguinoscrotal hernia 16 (17.8%), typhoid ileal perforation 14 (15.6%), and abdominal injuries 11 (12.2%). Healing without complications was seen in 70 (77.8%) patients, while complications occurred in 20 (22.2%) patients. The complications that occurred were wound infections 17 (68%), wound dehiscence 3 (12%), incisional hernia 3 (12%), enterocutaneous fistula 2 (8%), and duration of hospitalization 7-55 days and mortality of 4 (4.4%) was recorded.

Background and Objective: The acquisition and dissemination of antibiotic-resistant agents in Acinetobacter baumannii (A. baumannii) is highly facilitated through integrons that are DNA transposable elements and able to receive genes through site-specific recombination. Class 1 and 2 integrons are the most known integrons that are frequently available in A. baumannii. The aim of this study was to determine the frequency of class 2 integron in multidrug resistance (MDR) A. baumannii. Methods: A total of 100 isolates of A. baumannii were collected from patients that are admitted to hospitals in Kermanshah in the year 2014-2015. The isolates were identified using biochemical tests and the kit API 20 NE, and then their sensitivity to 20 antibiotics was examined. The prevalence rate of class 2 integrons among the isolates was determined using Polymerase chain reaction (PCR). The results were analyzed using Fisher's test and the non-parametric Chi-squared test. Results: The maximum drug resistance was observed against Cefotaxime (93%), Ceftriaxone (92%), Mezlocillin (91%), Ceftazidime (86%), Imipenem (82%), and Piperacillin (82%). The minimum drug resistance was observed against Colistin (12%), Polymyxin B (7%), Minocycline (10%), and Tigecycline (6%) and seems as the most efficient antibiotics. Twenty-nine (29%) isolates out of the 100 isolates were multidrug resistance (MDR); about 21 isolates (21%) were extensive drug resistance (XDR); and none were pan drug resistance (PDR). Thirty four (34%) isolates contained class 2 integrons. The results did not showed a significant correlation between the presence of class 2 integrons and incidence of MDR A. baumannii. Conclusion: The transmission of antibiotic-resistant agents by the class 2 integrons resulted in further durability and spread of these isolates in the environment. Therefore, it seems that resistance to A. baumannii is always changing, and different countries should attend to these changes.

Background: National Health Insurance in Indonesia that is processed by Social Security Agency of Health or known as Badan Penyelenggara Jaminan Social (BPJS) has been conducted for 2 years. The Public Health Center (PHC) as the partner of BPJS should have satisfied the patients. The preliminary study showed that 5 of 10 informants were not satisfied by the service of PHC. Objectives: This research aims to determine the satisfaction of BPJS' patients in some PHCs in Padang. Setting and Design: The design of this research is a Quantitative by observing the quality services and patients' satisfaction, which is based on five dimensions proposed by Parasuraman and Zeithm: Reliability, Responsiveness, Assurance, Empathy, and Tangible. This study was conducted in PHCs in Padang from September to November 2015. The populations were all of BPJS' patients who visited the PHCs of Padang. Samples were obtained by using cluster sampling selected from three PHCs with the total of 150 respondents. Statistical Analysis Used: The data were tested by using validity and reliability test and all of the data were valid and reliable. The data were displayed in univariate way to describe the quality and patients' satisfaction as well as the priority to improve the quality and the satisfaction by using Cartesian Diagram. Result: The results of this study showed that from the 18 attributes of services, the patients' satisfaction has been reached on two attributes, namely, “polite and friendly services” and “neatness and clean performance officers.” It is priority to improve four service attributes, that is,“speed of service,” “the ability of officers,” “attention,” add “equipment” for enhancing the quality of service

Background: Hypertension and diabetes are the two chronic noncommunicable diseases requiring lifelong care and management. The present study was conducted to understand the perceptions of diabetic and hypertensive individuals regarding the home-based monitoring of blood pressure and blood sugar. Materials and Methods: This cross-sectional study was conducted from August through November 2013 at Saveetha Medical College, Chennai city, located in South India. A convenient sample of 100 individuals was enrolled in this study. Individuals having hypertension or diabetes and visiting to the Internal Medicine, outpatient department (OPD) of Saveetha Medical College were approached for the inclusion in the study. Information about sociodemographic characteristics, disease information source, knowledge, attitude, and practices, and economic aspects related to home-based monitoring of blood pressure and blood sugar. Results: The average age of the participants was 59 years (standard deviation (SD) = 11). Half of the subjects were males (52%) from urban locations (89%). More than half of them have followed some form of dietary measures (58%) to control the blood sugar level in normal limits. Majority of them have heard about home-based blood sugar monitoring device (99%) and 71% of them have heard about home-based blood pressure monitoring devices (electronic or manual). Forty-seven percent of the participants were monitoring their blood pressure, and 90% of them were monitoring their blood sugar at home. Conclusion: There is a need of further research on large scale to evaluate the knowledge, attitude, and practices related to the management of hypertension and diabetes among the individuals monitoring their blood pressure and blood sugar at home.

Background: Ocular diseases of varying.etiologies do occur frequently and the use of harmful traditional eye substances worsens the prognosis in terms of visual outcome. Aim: To assess the uptake of traditional eye pencil and its association with glaucoma. Settings and Design: The study was conducted among adults in rural and urban communities of Ilorin West Local Government Area, North-Central Nigeria. Materials and Methods: This was a cross-sectional comparative study. Respondents were selected through Multi-stage sampling technique. Interviewer administered structured questionnaire, clinical report form were used to collect data. Data were analyzed using Statistical Package for Social Sciences. version 15. Level of statistical significance was set at P value less than 0.05. Results: More of the rural than urban respondents had ever used traditional eye pencil and this was found to be associated with glaucoma within rural (P=0.029) and urban areas (P=0.009).The prevalence of glaucoma was higher in the rural, 56 (12.4%), compared with the urban area, 37 (8.2%) with a P value of 0.037. Age, educational status.and religions were the significant predictors of uptake of traditional eye pencil common in both rural and urban areas. Conclusion: The high uptake of traditional eye pencil obtained from this study and association with glaucoma calls for urgent awareness/sensitization campaign in the communities.Regular community-based eye screening will be useful in early detection of glaucoma. In addition, government should make eye care services available at the primary health care centers at reduced cost to enhance geographical and financial access.

Objective: To study the risk factors in psychosocial profile of blind people undergoing vocational training. using a screening test ,Personality based hardiness index and suggest recommendations if any. Study design: Cross sectional study. Participants: Blind people. Study Variables: Sex, socioeconomic status, literacy, psychiatric morbidity. Statistical analysis: Fishers Exact test, χ² test. Results: Recently introduced technique of Personality based hardiness index was tested for its utility for screening of blind persons to detect possible psychological maladjustments and hardiness. Analysis of results of Personality based hardiness index revealed that 9% subjects were non hardy. Most of the non hardy subjects were

1. males 13% as compared to females 3%
2. belonging to lower socioeconomic class (100%)
3. illiterates 34.3% as compared to literates 2%
4. residing in rural area (12.7%) as compared to person in urban area (0%)

The overall results of the above detailed tests brought some salient risk factors that can be strongly associated with psychosocial maladjustments and hardiness in the handicapped persons. These risk factors are Lower socioeconomic class, Rural residence, Illiteracy, Sex These risk factors that emerged out of the statistical analysis of the data can be immensely useful in the planning stages of rehabilitation.

Context: Sarcophagidae is one of the most important families of Muscomorpha. They have been reported from various parts of Iran. Native biological control agents, which may be substantial candidates for control of Sarcophagidae, have not been extensively studied in Iran. Aim: To identify main parasitoid wasps that are actively parasites pupa of Sarcophagidae in Tehran. Setting and design: Mass collection was done primarily by means of bottle traps in three city parks of Tehran. Collected pupa were kept solely in each plastic cup, and the wasps or adult flies were counted after emergence. Statistical Analysis Used: Means and rates. Results: Two parasitoid species, Nasonia vitripennis (Hymenoptera: Pteromalidae) and Brachymeria podagrica (Hymenoptera: Chalcididae) emerged from the Parasited pupae. Parasitic rate for N. vitripennis was nearly 26.7%, and that for B. podagrica was closely 2.2%. The highest number of emerged adults from one pupa was 16 for N. vitripennis, with an average of about 10. In this study, Sarcophaga argyrostoma recorded as the dominant species of nonparasitized pupa and Wohlfahrtia nuba were fewer in number. Conclusion: Except for personal protection methods, there aren't other control measures for fly population in Iran. Before large-scale application of these parasitic wasps for the reduction of fly populations, their mass rearing and the methods of dispersing and their filed evaluations have to be done.

Introduction: Due to the increasing trend in gall bladder (GB) carcinoma in India, early diagnosis of GB lesion has become essential. Aim: It is to determine the accuracy of Ultrasonography (USG)-guided fine needle aspiration cytology (FNAC) and an attempt to classify the cytological material according to World Health Organization classification. Materials and Methods: This retrospective study for a span of 3 years was done in the Departments of Radiology and Pathology in Tertiary Teaching Hospital. US-guided FNAC of GB lesion and their histopathological finding were compared. Results: Sensitivity of US-guided FNAC was 98.6% and specificity 97.3%.

Background: Depression has been shown to be prevalent in the elderly; however, it is underdiagnosed and hence undertreated. Data on elderly depression in Caucasians are few and showed a high prevalence of major depression with few at primary health care level especially in Nigerians and rural Africans. This study assessed the knowledge of primary health care workers on depression in the elderly in Kubau, Nigeria. Materials and Methods: A cross-sectional descriptive study was carried out in June 2012, which elicited sociodemographic characteristics of the respondents and knowledge of depression using a semi-structured interviewer-administered questionnaire. The collected data were cleaned and entered into statistical package software for social sciences version 16 and the results presented as tables and charts with statistical significance set at P value less than 0.05. Results: Most of the respondents were community health extension workers (67.8%), with 46% having work experience in the range of 5–10 years. About half (55.9%) of the Community health extension workers have heard of depression while only 55% of the total respondents knew the definition of depression in medical terms. Only 12.6% of the health workers knew that old age was a risk factor for depression. Conclusion: The study revealed a poor knowledge of depression in the elderly among healthcare workers at primary healthcare level with the majority of Community health extension workers mostly implicated. Hence, the need for proper training in mental health and awareness campaigns in communities.

Background: This study may be a foundation pillar for future planning of school eye screening programs in Uttarakhand: Himalayan State of India as there is very little, if any, data is available till now. Aims: This study was done to know the prevalence and pattern of various causes of ocular morbidity among school children in Uttarakhand, India. Settings and design: A cross sectional multistage randomized study was done on school children between 5 -16 years of age in Doiwala block of Dehradun-capital of Uttarakhand, India. Material and Methods: School children were taken up for ophthalmological examination. Any child with subnormal vision or abnormal ocular finding was further evaluated in a tertiary care hospital. Statistical Analysis: Results were expressed in percentage and ratio. Chi-square test (with Yates correction whenever needed) was used for analysis of data. Ninety five percent CI was also calculated. The data with p value less than 0.05 was considered statistically significant. Results: Out of 5918 children, the prevalence of ocular morbidity was 4.92% (291 children). The most common causes of ocular morbidity were refractive error in 164 (2.77%) children, convergence weakness in 32 (0.54%), strabismus in 24 (0.40%) and conjunctivitis in 23 (0.38%) children. Ocular morbidity was more in children of age group 5 – 10 years in comparison to age group 11-16 years(P = 0.002). Conclusions: Refractive error was the commonest cause of ocular morbidity affecting school going children in Uttarakhand, India. The prevalence of ocular morbidity decreased with increasing age of child.

Background: Several efforts have been made in the past to study psychosocial risk factors and clinical profile associated with attempted suicide, but only few have addressed the issues of youth in a conflict area Kashmir. Aims: To study psychosocial risk factors and clinical profile associated with attempted suicide in young adult and adolescent patients in conflict zone-Kashmir. Material and Method: It was a hospital-based study in which 200 young adults and adolescent patients who were admitted following unsuccessful suicide attempts to the emergency and referred to Department of Psychiatry, Govt. Medical College, Srinagar, Jammu and Kashmir, India. Selected patients were subjected to Mini International Neuropsychiatric interview (MINI) and International Personality Disorder Examination (IPDE) for evaluation of symptoms and diagnosis. Subjects of age less than 15 years and more than 34 years have been excluded. Results: Majority of the suicide attempters 65% were < 24 years of age with adolescent over represented in the sample (Mean = 21.24 ± 4.66), females were 58%, low socioeconomic status (86%), oral agents (most common method) was used by 84%, 64% had expressed suicidal or death wishes before act and 72% made an impulsive attempt. Eighty-two percent of the suicide attempters were suffering from some psychiatric illness at that time. Out of which 40% had mood disorder with predominance of major depressive disorder, 15% had personality disorders, and 9% had posttraumatic stress disorder. Conclusion: Knowledge of clinical phenomenology may assist in identification and early intervention of youth who are at high risk. Overall, findings indicate a strong and immediate relationship between suicide attempt and psychiatry morbidity.

Background: Extra-pulmonary tuberculosis is difficult to diagnose by conventional methods, because they are less sensitive and more time consuming. Loop-mediated Isothermal Amplification (LAMP) is a novel gene amplification method that has been developed to diagnose Mycobacterium tuberculosis complex in pulmonary and paucibacillary extrapulmonary specimens even in resource poor settings. Aims and Objectives: To evaluate the sensitivity and specificity of LAMP to detect Mycobacterium tuberculosis complex in paucibacillary extra-pulmonary specimens and to compare the results with other conventional methods in extrapulmonary specimens. Materials and Methods: 45 specimens from suspected extrapulmonary tuberculosis patients were collected and tested by LAMP method after DNA extraction. Simultaneously, these specimens were tested by smear microscopy, solid and liquid culture methods. Culture positivity, either in solid or liquid culture, was considered as a confirmed case of extrapulmonary tuberculosis. Results: Sensitivity of LAMP was 95.6% whereas for liquid culture, solid culture and smear microscopy were 69.6%, 65.2% and 17.4% respectively. Specificity for LAMP was 95.4% and for other 3 conventional methods were 100%. Positive predictive values, negative predictive values and likelihood ratios were also evaluated. Turn-around time (TAT) for LAMP was 8 hours only whereas for liquid culture was 2-4 weeks, and for solid culture it was 4-8 weeks. Conclusion: LAMP was a simple, rapid and cost-effective procedure with good sensitivity and specificity. It was found to be better than conventional methods to diagnose extrapulmonary tuberculosis.

Background: The burden of mother-to-child transmission (MTCT) of HIV remains a major challenge in Nigeria, the country ranks highest globally. About 10% of global HIV-infected individuals live in Nigeria, of which 58% are women. The study analyzed risk and cofactors of MTCT in healthcare centers of Akure, Ondo State, Nigeria, between November 2014 and April 2016. Methods: A total of 240 pregnant women aged 19–43 years were recruited for the study, 114 HIV-seropositive mean age 31.81 years and 126 HIV-seronegative mean age 29.05 years as controls. High vaginal sawbs, breast milk, oropharynx, and neonates' nares were collected using sterile cotton-tipped applicator and introducing each into thioglycollate fluid medium for growth. Bacterial isolates were characterized by the standard microbiological methods and API kits. HIV serostatus of each participant was determined by HIV-1/2 strip and confirmed by Abbott enzyme-linked immunosorbent assay procedure. Sexually transmitted infections were detected by the enzyme immunoassays using commercial kits. Results: A total of 2,148 bacterial isolates were recovered from both cohorts (911 from HIV-seropositive, 864 HIV-seronegative, and 373 from neonates' nares). Predominant pathogens recovered were Staphylococcus aureus, Pseudomonas aeruginosa, and diverse corynebacteria as commensals. Coinfection of HIV with other sexually transmitted diseases (STDs) was prominent. About 92.1% of patients received combination ART. Neonates mortality rate was 10.5 and 7.8% mothers were potential transmitters. Spontaneous vaginal delivery accounted 91.7% deliveries. Conclusion: Incidence of STDs among HIV-seropositive was 77.5 and 22.5% for HIV-seronegative. Incidence of spontaneous vaginal delivery was 91.7% in HIV-seropositive women and 10.5% mortality rate recorded for neonates and 7.8% transmission for mothers posed high risk of MTCT, which is epidemiological significant.

Background: Phlebotomus species are solely responsible for transmitting leishmaniasis in the old world. The disease is endemic in several parts of Iran. Darab district located in Fars province of southern Iran is one of the most important endemic foci of cutaneous leishmaniasis. Sand flies and Methods: To identify the distribution of sand flies, a total of 5019 sand flies were collected in Darab district from May to September 2012. To determine the monthly activity, 2039 sand flies were biweekly collected from indoors and outdoors of two villages at lowland and highland regions. The relationship between the frequency of sand flies and wind speed (greater than 3 m/s as the influential factor) was studied. To determine the number of sand flies' bites per night, a native volunteer exposed his body every 1 h from sunset to sunrise. Results: In total, 13 species of Phlebotomine (five Phlebotomus spp. and eight Sergentomyia spp.) were identified. Besides, a relatively significant relationship was found between the frequency of sand flies and wind speed more than 3 m/s, especially in June and July 2012. Moreover, evaluation of the night blood-feeding peak during 8:00 P.M.–6:00 A.M. indicated that most bites occurred at 11:00-12:00 P.M. and 9:00-10:00 P.M. with 125 and 110 bites, respectively. Conclusion: Phlebotomus papatasi was the dominant species (49.2%). Additionally, wind speed more than 3 m/s showed a preventive effect on sand flies' activity. Thus, insecticide-treated nets are recommended to be used for all inhabitants, especially children and pregnant women, to prevent sand flies' bites through the night.

Background: Universal access to safe drinking water and improved sanitation are paramount sustainable development goals. This is critical for overcoming several health challenges in developing countries. This study analyzed access to safe drinking water and sanitation in relation to diarrhea morbidity among children younger than 5 years in South Africa. Methods: The data were collected by Statistics South Africa during the 2014 General Household Survey and were analyzed using Probit regression. Results: Results showed that majority of the children from this study lived in houses, who access improved drinking water and sanitation, although only 29.68% of households paid for safe drinking water. Lack of water for washing hands was reported by 12.41%, while diarrhea was most prevalent among 1-year-old children (3.34%). Probit regression results showed that air and water pollution significantly increased diarrhea morbidity (P < 0.10), while it reduced with the child's age. Conclusion: It was concluded that addressing the problems of air and water pollution would reduce diarrhea morbidity among children younger than 5 years.

Background: The risk of occupational lead exposure exists in lead smelting plants and battery industries, which may give rise to the issues related to lead poisoning among battery workers and low-exposed workers. Aims: To investigate the relationship between biochemical and hematological markers of lead effects and occupational exposure in battery workers and determine the role of work-related lead poisoning with emphasis on hemopetic system in exposed workers. Materials and Methods: Present study was carried out from July to October 2015, which collected demographic data, nonwork, and work-related symptoms from lead exposure nonexposed workers (N = 33) and battery wokers (N = 30), Nakhon Pathom, Thailand. Each blood sample was collected and analyzed for lead biomarkers, blood lead level (BLL)and δ-aminolevolinic dehydratase (ALAD) and hematological markers, such as complete blood count and recticulocyte count. Results and Discussion: Major non-work-related symptoms were droopiness and muscle pain among nonexposed groups. Major work-related symptoms in battery workers were occurred in lungs and nose. There was a significant increase in BLL, and a significant decrease activity of ALAD was observed in battery workers. Strong positive correlation between years of exposure and employment with BLL was observed and respiratorytract symptoms were also presented.Inverse correlation between the activity of ALAD and hemoglobin and a strong positive correlation between hemoglobin and BLL were found. Conclusion: The lead level and ALAD were good markers for screening lead exposures by significant related to hematological values, duration of work, and exposure and hypertension.

Background and Objectives: Hepatitis C virus (HCV) is an important cause of blood-borne viral hepatitis throughout the world. Acute infection is usually silent and detected on the basis of raised liver enzymes and antihepatitis C antibody in patient's serum. Chronic infection may lead to hepatocellular carcinoma and liver cirrhosis. The present study was done to evaluate the seroprevalence of anti-HCV antibodies among patients using rapid qualitative in vitro diagnostic test. Materials and Methods: A total of 1,076 patients' blood samples were taken for testing antiHCV antibodies using rapid in vitro diagnostic test kit. Results: Out of 1,076 patients whose sera were tested, 18 were found to be reactive to antihepatitic C virus antibody giving the prevalence to be 1.7%. Out of 18 reactive patients majority belonged to inpatient department (88.9%) as compared with outpatient department (11.1%). Majority of the reactive patients belonged to age group 26-35 years (72.2%), were from rural areas (83.3%), were illiterate (77.7%), were skilled workers (66.7%), and belonged to socioeconomic class 3 (55.5%). Among the reactive patients, the most frequent risk factor for antihepatitis C antibody was found to be history of injecting drug abuse and tattooing and body piercing (22.2% each). Conclusion: Hepatitis C infection is usually a silent disease and therefore stringent screening for antihepatitis C antibody should be done in all patients using rapid in vitro diagnostic kits in order to timely diagnose the infection and initiation of treatment, thereby, preventing its adverse sequelae and also its spread to other patients.

Introduction: The typhoid fever is one of the most common and serious infections in a developing country like India. An increase in the occurrence of typhoid fever in Indian children has stimulated the evaluation of alternative drugs for treatment in the Out Patient Department (OPD) without hospitalisation. Objective: To study the feasibility of using oral azithromycin for treating blood culture positive uncomplicated typhoid fever instead of intravenous ceftriaxone in a resource poor setting. Materials and Methods: We performed a randomised controlled trial to compare the efficacy and safety of azithromycin (20 mg/kg/day) as a once daily oral dose with intravenous ceftriaxone for 7 days for the treatment of uncomplicated typhoid fever in children and adolescents in India. A total of 124 children aged 3-18 years who were suspected to have typhoid fever were randomized and studied. Statistical analysis used: Data analysis was performed using Epi Info version 7 (Centers for Disease Control, Atlanta, GA.) and SPSS for Windows version 7.5 (SPSS, Inc., Chicago, Il.). Results: Our study showed that clinical cure was achieved in 30 (100%) of 30 patients in the azithromycin group and in 30 (88.2%) of 34 patients in the ceftriaxone group. The mean time taken for clearance of bacteraemia was longer in the azithromycin group than in the ceftriaxone. No patient who received azithromycin had a relapse as compared to 5 patients who received ceftriaxone. No serious side effects occurred in any subject under study. Conclusion: Oral azithromycin could be a convenient and cheap alternative for the treatment of typhoid fever, especially in children in developing countries where medical resources are scarce.

Background: The parasite-based diagnosis (malaria microscopy) remains the gold standard method for diagnosis of malaria in endemic areas, where 600 million individuals are infected. Malaria is the most common cause of hospital visits in Sudan. Objective: This study is aimed to assess and evaluate the capacity and quality of the Clinical Laboratories of the private sector at Khartoum State-Sudan, for the parasite-based malaria diagnosis. Method: 70 clinical laboratories form the private sector, were enrolled in this study.The quality and capacity for the study subjects were assessed and evaluated using novel scoring system. Six quality identifiers were selected as key performance indicators. The quality identifiers and their score were as follows: personnel (20%), microscope (25%), staining (20%), blood film and slide (15%), result and report (10%), and Building and safety (10%). For the evaluation of the quality and capacity of study subjects, the cutoff point was identified as (≥ 60%). Results: 64 (91.4%) individuals in this study have a bachelor degree in Medical laboratory sciences; only three of them major in Parasitology. 60 (85.7%) of the personnel have more than three years of experience in malaria diagnosis. Only 10% of the personnel in this study attended in-service training in malaria diagnosis. 58 individuals (83%) scored 10 or more for the total personnel quality score. For the quality of microscope, all the study subjects scored at least 15 points. Almost all the study subjects used Giemsa's stain, with only 5.7% using Field's stain. For the staining quality score, 52 subjects (74.2%) scored more than 10 points. Only 35.7% of study subjects reported the species of Plasmodium. 77.1% of study personnel reported the stage. Conclusion: Of the subjects, 88.5% were of a good quality and they were of an acceptable capacity for parasite-based malaria diagnosis. The quality could be improved by implementing an incentive program for quality inspection.

Background: Depression is significant disease burden and associated with poor health outcomes among people living with HIV (PLHIVs) globally. Majority of them are under diagnosed and untreated. Depression is also linked with poor antiretroviral therapy (ART) adherence causing ART inefficient and has a negative impact on the quality of life among PLHIVs. Objectives: This study aims to explore the prevalence of depression and potential associated factors among PLHIVs attending ART centers in Yangon region, Myanmar. Methods: This cross-sectional analytic study was conducted at public ART centers of Yangon region, Myanmar. A total of 425 PLHIVs were interviewed with pretested structured questionnaires. Center for Epidemiology Studies Depression Scale (CES-D) was used to assess the depression symptoms. Multiple logistic regression analysis was administered to determine the potential associated factors for depression. Results: The prevalence of depression among PLHIVs was 30.12% (95% CI = 25.74-34.49). The older age (Adjusted Odds Ratio (AOR) = 5.74; 95% Confidence Interval (CI) = 1.01-32.50), low education level (Adjusted Odds Ratio (AOR) = 0.11; 95% Confidence Interval (CI) = 0.01-0.85), unemployment (Adjusted Odds Ratio (AOR) = 2.81; 95% CI = 1.39–5.67), poor patient–provider relationship Adjusted Odds Ratio (AOR) = 1.82; 95% Confidence Interval (CI) = 1.01-3.30), lack of satisfaction (Adjusted Odds Ratio (AOR) = 4.61; 95% Confidence Interval (CI) = 2.03-10.46), and lack of exercise (Adjusted Odds Ratio (AOR) = 3.51; 95% Confidence Interval (CI) = 1.93-6.38) were found to be associated with depression. Conclusion: A considerable proportion of the clinic attendees at the public ART centers were found to have depression. It should be noted by the policy makers and program managers to establish early diagnosis and prompt treatment to achieve the better quality of life among PLHIVs.

Objective: Cutaneous leishmaniasis (CL) is presently occurring in Kerman province, southeastern Iran. The objective of this study was to determine the correlation between the different blood groups and the blood feeding behavior of sand flies. Materials and Methods: Sticky paper traps were used to collect sand flies in the study location. Traps were set at dusk and flies were collected at dawn. A total of 200-300 sticky traps were set each day in each area. Results: A total of 1320 sandflies were collected; 320 blood-fed female sandflies were selected for the analysis of blood meals by PCR-RFLP. In this study, 82 (25.6%) sandflies fed on human blood meals. Conclusion: The results of the current study clearly indicated that there is a significant relationship between the different blood groups and the blood feeding behavior of sand flies.

Among many infectious diseases prevalent in the world, a few are emerging and emerging infectious diseases, which include the influenza virus. There are some other infections, which are spread throughout the world causing pandemics like the human immunodeficiency virus (HIV). Human parasitic infectious diseases assume greater significance in public health perspective, as they contribute to majority of the morbidity especially in the developing and economically weak nations usually affecting the pediatric age and the young adults, as well as immunocompromised individuals. Human strongyloidiasis is one such parasitic disease, which is least studied and under reported undermining its clinical significance. This manuscript attempts to reinvent the pathogenic potential of Strongyloides stercoralis infection, laboratory identification of human strongyloidiasis and future perspectives.

From 2012 till the present, the name of Middle East respiratory syndrome (MERS) has been heard many a times in the mass media and many papers that have been published in different scientific journals, but one question has remained – What is the lesson learned about MERS epidemic at the present time and what can really be done in order to prevent the matter? I would like to bring your attention to what could be done at the present time, based on lessons learned from MERS outbreak in the world.

We present four cases of atypical presentations of tuberculosis: TB meningitis with secondary myelofibrosis, tuberculous prostatic abscess, tuberculous aortitis, and tuberculous midline neck swelling.

Sudden onset of symmetric peripheral gangrene (SPG) is a relatively uncommon clinical entity manifested by distal ischemic damage at two or more sites in the absence of large vessel obstruction. Here, we report a case of a 27-year-old female with complicated falciparum malaria with SPG involving the toes of both the lower limbs.

Back ground: Histoid Hansen's disease is a rare form of multibacillary leprosy whereas isolated mucosal histoid is rarer with distinct clinical and histopathological features. This type of leprosy is a variant of lepromatous leprosy with a very high bacterial reserve. Case Report: A 45 year old male was diagnosed as mucosal histoid lepromatous leprosy.It is a matter of concern as we found an isolated mucosal histoid leprotic lesion inside the nasal cavity in post-global leprosy elimination era. Our case had no history of leprosy or exposure to dapsone/ multidrug therapy, with heavy bacillary index. Discussion and Conclusion: We are reporting this case to highlight the rarity of mucosal lesion of histoid leprosy, nasal cavity involvement and to create awareness and so as to avoid misdiagnosis, which will help in prompt treatment so that we can minimize the complications and deformities of the patient and also prevent its spread in the community.

Amoebiasis is a common intestinal protozoan infection due to Entamoeba histolytica. In India, the prevalence of the disease varies from 2% to 67%.^[1] Acute Fulminant Colitis is a rare complication of intestinal amebiasis. Life threatening lower Gastrointestinal bleed is very rare presentation of amebiasis. Here, we are presenting a case of severe lower GI bleed proved to be caused by amebiasis along with extra intestinal complications.

Celiac artery aneurysms (CAAs) account for 4% of all visceral arteries aneurysms. They are rare, vascular lesions, usually asymptomatic and recognized coincidentally while searching for causes of abdominal pain or other intra abdominal problems. Their significance is in their potential to rupture, which can lead to death. CAAs have no gender predilection, with most manifesting during the fifth decade of life. The diagnosis of these rare aneurysms is being established more frequently as our use of cross-sectional imaging increases. We present the case of isolated celiac artery aneurysm diagnosed incidentally by routine ultrasonography (USG) of abdomen for lower abdominal pain, followed by three dimensional CT angiography of abdomen in a 65-year-old female.

Cardiovascular corroborate and salutary can be done by adolescents through physical exercises or gymnastics regularly. Aerobic exercise is included in the physical exercise type. If someone does aerobics regularly, it influences the body's health because aerobics is an exercise that needs oxygen to form its energy persistently and rhythmically. It's assumed that the person who does several activities and be able to follow the movements combination that being systematically has good lungs, heart, and blood vessel. Furthermore, to cope with problem of low capacity of lungs and low cardiovascular ability of the students, the solution is by doing MOSESAHI (Abbreviation: Mo'o Sehati, Mo'o Sanangi Hilaw: make people health, happy and cheerful). This paper employed factorial program experimental, with a sample 72 students of the State University of Gorontalo. Data analysis used the statistical test analysis of variance. The result concludes that the changing of lung capacity and cardiovascular ability caused by Mosesahi gymnastic exercise done twice a week for 20 min with an intensity of 60%, 70%, and 80% is better than once and three times a week. By exercising three times a week with thirty minutes and 60%, 70%, 80% of intensity, the increasing is better than thirty minutes with frequency once and three times a week as well as in frequency three times a week with forty minutes duration, regularly 80% intensity, the increasing is better than at frequency once or twice a week