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Scrub typhus has struck back, albeit with renewed vigour, impacting areas with previously known endemicity as also impressing newer expanses. It is not surprising, therefore, that Scrub typhus has emerged as a leading cause of public health concern globally as well as in India, but are we ready to take on the challenge? Over the last decade, there has been a global increase in the number of outbreaks of Scrub typhus, be it the military occupied areas or the civil population at large. The innumerable outbreaks of Scrub typhus, although disconcerting, have nonetheless contributed phenomenally towards better understanding of the dynamics of scrub typhus. There have been significant contributions to awareness of the disease amongst medical professionals, scrub typhus as a cause of Acute Undifferentiated Febrile Illness (AUFI) and newer clinical manifestation – Acute Encephalitis Syndrome (AES), availability and advances in diagnostics and management, man-vector-pathogen interactions, new records of Leptotrombidium species, newer vectors and Orientia species. Antigenic diversity and the varied clinical presentation of scrub typhus, absence of scrub typhus surveillance system and a lack of political will to recognize the disease as one of the important reemerging public health problem are areas seeking concerted deliberations and actions so that the challenges posed by scrub typhus can be addressed.

Background Most studies on stress fractures in India have been carried out among recruits as against officer trainees and limited to males. With the continuous induction of women in the Armed Forces, it was decided to carry out a study among officer trainees of the three services and compare the epidemiology among genders. Methods A prospective study was carried out in 2011–2012 at Training Institutes of the three services where male and female cadets train together. Baseline data was collected for all trainees who joined the academy during the study period. All cadets were followed up for development of stress fractures for which details were taken. Additional information was taken from the Training Institute. Results A total of 3220 cadets (2612 male and 608 female cadets) were included in the study. Overall 276 cadets were observed to have stress fractures during training – making an incidence of 6.9% for male cadets and 15.8% for female cadets. Females were found to have a significantly higher incidence of stress fractures. Further the distribution and onset of stress fractures in females was observed to be distinct from males. Conclusion The significant gender differential observed in the study indicates differential role of intrinsic and extrinsic risk factors in the causation of stress fractures among male and female. Special consideration needs to be given to these while planning and implementing measures for prevention. Further studies may be carried out on subject and on the effect of interventions in stress fracture prevention.

Objective: To find the profile of blood pressure and the prevalence of hypertension in adolescents in an urban area. Methods: A cross sectional study was carried out in Adolescent students in the age group of 11-17 years, in a school in an urban area of Pune, belonging to upper socioeconomic group to measure their blood pressure and anthropometric parameters.Results: The mean SBP and DBP in both boys and girls were found to increase with increasing age and anthropometric measurements. The prevalence of hypertension was 12.23% in boys and 10.1% in girls and the prevalence of overweight as per BMI was 19.14% in boys and 18.62% in girls. The prevalence of hypertension observed in overweight children (36.1% in boys 30.8% in girls) was significantly (p

Background: Anti-retroviral therapy (ART) has substantially improved the survival of people living with HIV-AIDS (PLHAs). The individual and public health responsiveness to ART is, in turn, determined by ART-related knowledge of PLHAs. Objective: To study the knowledge of HIV positive individuals regarding ART and also to study its association with education and duration of HIV positivity. Materials and Methods: This cross-sectional study was conducted at a tertiary level hospital. The study participants were 102 PLHAs who were not yet started on ART and data were collected using a face-to-face interview. Results: The mean age was 35.5 years and 58.8% were educated to 10th standard. About 92.2% were married, and more than 70% belonged to rural areas. Nearly 11.8% felt that there is no treatment available. Surprisingly, 60.8% of the participants had incorrect knowledge about the correct time of initiating ART while 60 (58.8%) participants were aware that ART needs to be taken lifelong. 26.5% said that antiretroviral drugs were associated with side effects. As per predetermined knowledge scores, 79.4% had satisfactory knowledge regarding the treatment. A statistically significant (P = 0.03) relationship was observed between the knowledge scores regarding ART among the study participants and educational status while it was not statistically significant (P = 0.56) as regards duration of HIV positivity. Conclusion: There still exists a considerable gap in knowledge regarding treatment options for HIV/AIDS among the PLHA of this region. Hence, there is a need to increase the awareness regarding the same and implement the same into practice. Periodic counseling is necessary to increase awareness and to clear misconceptions about ART among PLHA.

Chickenpox is an acute, highly infectious disease caused by Varicella-zoster virus. Approximately 90% of cases occur in children and lesser in adults. As per literature 55 percent of Varicella-associated deaths occur among adults.1 One attack gives durable immunity and second attacks are rare.1 People who already had chickenpox and get it again – is known as “reinfection”.2 If this happens, a milder form of the illness usually occurs, with fewer symptoms. Diagnosis is usually made on clinical grounds, based on rash characteristics and on epidemiologic features, such as contact with other Varicella cases.2 Laboratory tests are available to confirm diagnosis of Varicella, assess immune status, and genotype of VZV strains. Varicella vaccine (OKA strain) is available in India. However, reports of Varicella outbreaks in highly immunized groups in Japan and USA have made effectiveness of Varicella vaccine questionable. We present a case of Varicella in a young adult patient who gave history of chickenpox in childhood and was previously immunized with Varicella vaccine, yet manifested a full blown disease.

Scabies is an important health problem characterized by continuous transmission throughout the year. It is ubiquitous, contagious, and debilitating parasitic dermatoses, known since antiquity and having widespread distribution in the tropics. The worldwide prevalence has been estimated at about 300 million cases yearly, although it may be an overestimate.1 Scabies occurs in both sexes, at all ages, in all ethnic groups, and at all socioeconomic levels. In India, the incidence ranges from 13% to 59% in rural2 and urban areas.3 Scabies is a Latin word that simply means to scratch and is caused by the mite Sarcoptes scabiei var-hominis, and is usually associated with conditions of overcrowding, low socioeconomic standards, low level of education and poor hygiene.4 Overcrowding and sexual contacts are the most common, but not exclusive modes of transmission. The mite of scabies burrows into the outer layer of the skin (stratum corneum) and feeds on skin cells and fluids. It is this feeding action, and its products (digestive secretions and feces) that provoke an immune reaction from the body which results in itching and other symptoms of scabies. Scabies causes considerable discomfort and can result in severe secondary complications such as impetigo, cellulitis, pyoderma, bacteraemia and post-streptococcal glomerulonephritis.5–7 The study was undertaken in the Rural Health Training Centre of a medical college located at Kasurdi village, in Pune district of Maharashtra. During routine visits, three school going children of a nearby orphanage reported with the clinical symptoms suggestive of Scabies i.e. insomnia due to severe itching at night, rashes, irritability leading to school absenteeism and poor quality of life. On examination, the children were found to be having scabies. Scabies in orphanages are not uncommon but unfortunately are hard to treat because of reasons like delayed diagnosis, inadequate treatment, malnutrition, associated allergic and bacterial infections and inadequate follow-up.8 It was thus decided that all the children at the orphanage be examined and an intervention to cure all children of the orphanage be undertaken. The study thus aimed to assess the prevalence of Scabies in an orphanage in a rural village of Maharashtra State and to conduct a mass Scabies treatment and follow-up of all children and care givers. The study in addition also provided health education and trained the care givers for timely management of scabies in the setup.

Early diagnosis and prompt treatment with effective antimalarials is a vital component of malaria control strategies. The second edition of the World Health Organization (WHO) Guidelines for the treatment of malaria revisits the global recommendations on the case management of malaria on updated evidence compared to the earlier 2006 edition. Though the recommendations are targeted at the country level policy makers providing a framework for the development of specific and more detailed national treatment protocols, it is a valuable read for all clinicians and post-graduate students.