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Background The World Health Organization on 11 March 2020, declared COVID-19 as a pandemic. India initiated social distancing measures to combat the epidemic of COVID-19. The course of the epidemic of COVID-19 for India was predicted using stochastic probability–based mathematical modeling. Methods Data synthesis for the top few countries affected was studied for various factors affecting the epidemic. For projections of infected cases for India, the modified susceptible-exposed-infectious-removed/recovered framework modified for the effect of social distancing (Rho) was used. Simulation was carried out for 10,000 runs using Python. Projections for infected cases and hospitalization requirement were estimated. Results The epidemic curve will peak in the third week of June in India with 17,525,869 and 2,153,200 infected people with reproduction number of 1.8 and Rho of 0.7 and 0.6, respectively. Compared with the baseline scenario of no social distancing, for transmissibility with R0 = 1.8, the reduction in infections due to social distancing measure is 78% (Rho = 0.7) and 97% (Rho = 0.6). Similarly for R0 = 2.2 and 2.4, the reduction in infected numbers slightly lowers to 62% and 66% with Rho = 0.7 and 92% and 75% with Rho = 0.6, respectively. With R0 = 1.8 and Rho = 0.6, the Intensive Care Unit (ICU) bed requirement is 107,660, whereas if transmissibility is high, the ICU bed requirement would increase to 1,994,682. Conclusions The social distancing measures seem to have been working for India in absence of treatment in sight for COVID-19. Although with the government's response strategy of social distancing, the peak of the epidemic is extended giving more months for preparedness to the country; however, the sustainability of these measures is uncertain.

Novel coronavirus (COVID-19) rapidly spread from China to other parts of the world. Knowledge of incubation period and reproduction number is important in controlling any epidemic. The distribution of these parameters helps estimate the epidemic size and transmission potential of the disease. We estimated incubation period and reproduction number of COVID-19 for India utilizing data reported by Ministry of Health and Family Welfare (MoHFW), Government of India (GOI) and data in public domain. The mean incubation period seems to be larger at 6.93 (SD=±5.87, 95% CI: 6.11-7.75). and 95th percentile estimate for best fit normal distribution is 17.8 days. Weibull distribution, the best fit for the reproduction number estimated pre lockdown reproduction number as 2.6 (95% CI=2.34 - 2.86) and post lockdown reduced to 1.57 (95% CI=1.3 – 1.84) implying effectiveness of the epidemic response strategies. The herd immunity is estimated between 36-61% for R0 of 1.57 and 2.6 respectively.

Background Management of novel viral respiratory disease outbreak on-board a ship with person-to-person transmission can be a public health challenge because of close proximity of inhabitants due to confined space and air-conditioned environment. It has a potential to be explosive, with high secondary attack rate (SAR) and cause significant morbidity and mortality. This study compares control measures instituted on-board two ships with similar outbreaks and recommends a standardized evidence-based outbreak response against them. Methods This is a descriptive study, showing comparative analysis of control measures instituted on-board two ships, a cruise ship in case of COVID-19 and a warship in case of H1N1 influenza, with novel viral respiratory disease outbreak, at different span of time. Data of the date of onset, clinical details, laboratory results, history of travel, history of contact with positive case and control measures initiated were collected, analysed and compared. Results Of the two ships compared, one was a cruise ship with 712 COVID-19 cases, with an attack rate (AR) of 19.2% and 13 deaths, and other a warship with 14 cases of H1N1 influenza and an AR of 4.83%. The epidemic curve for both the outbreaks was plotted to study time distribution. Conclusion Active surveillance, early self-reporting and immediate disembarkation of the suspects, along with strict compliance of hand hygiene, cough etiquettes and disinfection enhancement, will help in early mitigation of the outbreak. Health education should be undertaken to impart evidence-based knowledge and alleviate fear of the unknown. Vaccination may not be present but if available should only be administered after strict risk–benefit, cost–benefit and effectiveness analysis.

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.

Context: Tobacco consumption among females is on rise and is increasing at an alarming rate. This epidemic among the females is emerging as an important public health problem especially in slums. Aim: Study was conducted to find out association between sociodemographic factors and tobacco consumption. Settings and Design: Community-based cross-sectional study was carried out among females (15-49 years) in an urban slum of Pune during February 12 to April 13. Materials and Methods: Sampling frame was prepared from records of urban health center. Required sample size was selected by simple random method. Data collected using pretested validated structured questionnaire after obtaining informed consent. Statistical Analysis: Statistical analysis was performed using SPSS 20, and Chi-square test was used for determining association. Results: Of 305 females studied, 31.5% of them were currently consuming tobacco. Most common form of tobacco consumption was smokeless that is, Mishri application 55.2%. About 64% females started using tobacco before 20 years of age. Most of them (32%) consuming tobacco for increasing concentration at work. Tobacco consumption was found to be significantly more common among ever-married and Muslim females. Lack of will power and ignorance about the harmful effects of tobacco were major hindrances (51%) for quitting tobacco Conclusion: Tobacco consumption was found to be prevalent in almost one third of females (15-49 years) residing in an urban slum of Pune. Most of them used smokeless tobacco, mainly Mishri. Tobacco consumption was directly associated with age, marital status and religion.

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

The incidence of juvenile delinquency has increased in the past decade in India and juvenile crimes are increasingly being reported. This has been attributed to many biopsychosocial factors. It is essential to understand these issues in the context of India to determine the response of acts of children in conflict with the law. We aimed to assess the sociodemographic characteristics and the aggression quotient of children in conflict with the law (juvenile delinquents) in observation homes across India and compare them with those who were not.We did a case-control study in five juvenile homes in the cities of Hyderabad, Lucknow and Pune. Ninety inmates (74 boys, 16 girls) were included in the study. Sociodemographic characteristics and aggression quotient of children in conflict with the law were evaluated using two separate questionnaires, i.e. a sociodemographic questionnaire and the modified Buss and Perry aggression questionnaire. These were compared with a control group of similar age, sex and income status.All the children in conflict with the law surveyed belonged to the lower socioeconomic strata, had a significantly higher chance (p0.05) of coming from broken homes, have addictions, jailed family members and suffered physical and sexual abuse than controls. They also scored higher on all domains of the aggression questionnaire than controls.A collection of sociodemographic attributes such as broken homes, addictions and abuse seem to have an important association with juvenile delinquency. Children in conflict with the law are also more likely to be associated with a higher aggression quotient as compared to children who were not.

Background: Workshop is a very useful learning method for increasing the understanding and knowledge of participant. We conducted a workshop and evaluated it using Kirpatrick's model for evaluation.Methods: A national level workshop was conducted for MBBS and MD students. Feedback about the reaction of the participant was taken at the end of the participant and also a pre-test and post-test assessment was done.Results: Out of total 28 participants 19 (67.9%) were females and 9 (32.1%) were males. All (100%) attendee said that they liked, enjoyed and considered the training relevant. For learning evaluation the pretest score and posttest score were taken. The average pretest score was 4.1 (SD=2.1). The average posttest score was 6.5 (SD=2.1). The difference was statistically significant (p=0.0002). On question of rating of overall conduct of the workshop 11 (39.3%) rated the workshop excellent, 13 (46.4%) good and 4 (14.29%) did not answer the question. On asking the question on the topic on future workshop they would like to be conducted 16 (57.1%) said multiple linear regression, 12 (42.3%) each on logistic regression and met-analysis, 09 (32.1%) on cox proportional hazard ratio, 3 (10.7%) on SPSS, and 01 (3.5%) on infectious disease modeling.Conclusions: Evaluation of workshop is important for continuing improvement of teaching learning process. Participant positive feedback and objective evidence of improvement in learning proves effectiveness of the workshop. Kirpatrick’s offers a model for various stages of learning process and can be used for assessment of workshops.

Background: The hierarchies of Bio-Medical Waste (BMW) is largely based on the concept of the “3Rs”, namely reduces, reuse and recycle, and broadly relates to the sustainable practice of resources. The objectives of the study were to assess the Bio-Medical Waste (BMW) Management operating system in a multispecialty hospital and discuss the situation in terms of newly introduced BMW Rules 2016.Methods: A hospital based cross-sectional study was carried out by collecting data by means of independent surveys involving on-ground operating system of BMW management across different wards, outpatient departments, emergency departments, intensive care units and laboratories in the hospital.Results: The hospital was following Bio Medical Waste (Management and Handling) Draft rules, 2011 in the management of BMW. All the wastes were categorized into 8 categories as per 2011 draft rules. Efficient waste segregation, collection, storage, transport and waste treatment were followed as per norms with regular training of all health care workers under the close supervision and monitoring by dedicated BMW management committee. The hospital was registered for BMW management and renewal was being carried out every three years.Conclusions: It can be concluded that the hospital had an efficient and a well-organized BMW management system in place that was even conforming to the latest BMW Management Rules 2016 to some extent. Moreover, the hospital could upgrade the techniques of BMW management as per the newly introduced latest guidelines. As far as the categorization of BMW is concerned, it has to be changed accordingly to the new rules. Needless to say, a regular training and monitoring of BMW Management at all hospitals is the need of the hour and has a long way to go for environmental and human health.

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.