The explosive spread of Zika virus (ZIKV) has warranted a great attention from national and international health agencies worldwide, including the World Health Organization, thus declaring the situation as a Public Health Emergency of International Concern in February this year. The virus bears a phenotypic and clinical resemblance to dengue, along with the vector Aedes aegypti. The abundance of vector along with favorable environmental conditions makes India a “ZIKV receptive” area, with just the virus itself missing from the epidemiological triad. High level of awareness regarding factors about re-emergence of the ZIKV decades after its discovery and preventive and control measures against the vector remains the cornerstone for planning, implementing, and monitoring surveillance activities against ZIKV and other emerging and re-emerging infections.

Over 130,000 humans in Brazil are infected with Zika virus (ZIKV) since March 2015, and presently 29 countries in Americas have reported local autochthonous ZIKV transmission. Besides the associated clinical features, Brazil has also reported a temporal and spatial association of ZIKV with Guillain-Barre syndrome (GBS) and Zika fetal syndrome. ZIKV vaccine approaches include purified inactivated virus, nucleic acid-based vaccines (DNA, RNA), live vector vaccines, subunit vaccines, virus-like particle technologies, and live recombinant vaccines similar to the technologies used against other human flaviviruses. At present, 15 commercial entities are involved in the development of ZIKV vaccine. Vaccines developed through different approaches would have their own inherent advantages and disadvantages. The presentation of disease in different populations and lack of clarity on the pathogenesis and complications is the most important obstacle. Second, Zika belongs to a genus that is notorious for the antibody-mediated enhancement of infection, which proved to be a stumbling block during the development of the dengue vaccine. Identifying large naive and yet uninfected at-risk populations may be an obstacle to demonstrating efficacy. Next, the association of Zika with GBS is being researched since the vaccine may have the potential to provoke similar neuropathophysiologic mechanisms. Zika's association with adverse fetal outcomes necessitates that pregnant women and women of childbearing age are considered for evaluating vaccines, which form a vulnerable group for vaccine trials.

Background: In a number of indigenous villages in Orissa, India, the possibility was explored that teaching of a new definition of health, the Meikirch model, might improve health behavior of inhabitants beyond what can be achieved by ordinary teaching. Methods: For this purpose, teaching about the Meikirch model was given in twenty experimental villages and conventional teaching about health in twenty control villages. Results: After 2½ years, health behavior in the two groups of villages was compared. Improvement of nutrition, wearing of slippers during use of latrines, washing of hands before meals, availability of latrines, childhood vaccination, use of mosquito nets, and attention to mother/child care were much better in experimental than in control villages (all P< 0.001). Yet, in several aspects of the experimental villages, there was room for further improvement. Conclusion: It is concluded that the Meikirch model was understood by the inhabitants of the villages and they improved their health behavior. These preliminary results justify formal studies with larger samples to validate the results and possibly to improve teaching methods.

Aim: The aim of our study was to compare the World Health Organization (WHO) and Indian Academy of Pediatrics (IAP) growth charts by assessing the height for age and weight for age among children under 5 years of age. Materials and Methods: This was a cross-sectional study conducted over a period of 13 months with a sample size of 500. The anthropometric assessments were taken and plotted on both WHO and IAP growth charts. Results: The WHO and IAP charts regarding weight were comparable for both boys and girls. However, the height chart in WHO showed more stunting as compared to IAP growth charts, with the difference between the two being statistically significant (P < 0.05). Conclusion: India's own growth standards (IAP growth charts) may be more ideal for assessing growth than WHO growth standards, especially as regards height of children.

Background: A large number Indian troops are deployed in International Peacekeeping Missions Worldwide and are exposed to emerging and re-emerging vectors and diseases in unfamiliar terrain. This article describes the experience of a flea outbreak among Indian UN Peacekeepers in a remote part of South Sudan. Methods: Health visits to the area confirmed presence of dog fleas. Flea bites disrupted daily routine of the unit and many troopers reported to medical facilities with severe dermatitis. Death of a field rat in the immediate vicinity along with detection of rat fleas was cause for worry as Plague and other flea-borne diseases are known to occur in the country in sylvatic form. Result: Conventional vector control measures had limited impact and unconventional measures had to be devised due to limited capacity in the inaccessible area. Severity of the problem, potential to cause flea-borne diseases and unavailability of conventional insecticides prompted the author to use Aviation Turbine Fuel (ATF) for area spray in the UN base. Conclusion: Healthcare providers in fast-evolving operational situations such as Peacekeeping Missions need to maintain high index of suspicion and often adopt innovative methods to ensure effective public health cover to troops.

Aims and Objectives: The incidence of ABO and rhesus (Rh) groups varies markedly in different races, ethnic groups, and socioeconomic groups in different parts of the world. The frequencies of ABO and Rh blood groups vary from one population to another and time to time in the same region. The present study was carried out to find the distribution of blood group in rural and tribal populations of Bastar district of Chhattisgarh. Materials and Methods: The present retrospective study was carried out at late Shri Baliram Kashyap Memorial Government Medical College and Maharani Hospital blood bank, Jagdalpur, Bastar district, Chhattisgarh, India, during the 2-year period from January 2014 to December 2015. The blood collections were taken from the voluntary donors at outdoor blood donation camp and in-house blood bank as well as from replacement donors at blood bank. Totally 12,852 donors were considered medically fit and accepted for blood donation during the study period. Results: Out of the total 12,852 donors, most of the donors, i.e., 3996 (31.09%) were with blood Group O followed by B (30.44%), A (24.95%), and AB (13.52%). Out of the 12,852 blood donors, majority, i.e., 12,779 (99.43%) were male and 73 (0.57%) were female. Maximum blood donors, i.e., 12,777 (99.42%) were Rh positive while only 75 (0.58%) were Rh negative. Conclusion: The knowledge of distribution of ABO and Rh blood groups at local and regional levels is helpful in effective management of blood banks and safe blood transfusion services.

Background: The occurrence of adverse reactions to blood donation significantly hampers donor retention and negatively impacts on the universal availability of adequate numbers of blood donor units. Objective: To analyze the spectrum and prevalence of adverse reactions in blood donors in a tertiary hospital-based blood bank in Nigeria. Subjects and Methods: The details of 3520 blood donors who presented for donation over a 12 months period were retrieved from the departmental archives for analysis. These included sociodemographic information, type of donor, type and frequency of adverse reactions to blood donation. Data were analyzed using the Statistical Package for Social Sciences version 20.0 (SPSS Inc., Chicago, IL, USA) computer software. Descriptive and inferential statistics were employed to represent the distribution of donor characteristics (as percentages) and compare reaction rates by gender and severity, respectively. Results: The prevalence of adverse reactions to blood donation was (56/3520) 1.60%; this occurred more frequently in male and family replacement donors (55.35% and 100.0%, respectively). The spectrum of donor adverse reactions included anxiety 25 (44.64%), generalized body weakness 11 (19.64%), hematoma 10 (17.86%), fainting 5 (8.93%), and vomiting 5 (8.93%). Vasovagal reactions were the most frequent adverse reaction encountered among the donors (46/56; 82.14%). Conclusion: Vasovagal reactions are common adverse phenomena in our blood donor set; this has implications on transfusion safety and blood donor retention.

Background: This study was undertaken to analyze the clinical profile and treatment outcome in pulmonary drug-resistant tuberculosis (TB) patients under programmatic management of multidrug-resistant tuberculosis (PMDT) at a tertiary care center in Mumbai. Methodology: A retrospective study was conducted at PMDT site of a tertiary care hospital. The data of 194 pulmonary multidrug-resistant (MDR) TB patients diagnosed at our hospital or prediagnosed patients referred to our hospital were meticulously reviewed to study demography, baseline drug susceptibility to first- and second-line drugs, treatment outcomes, comorbidities, and adverse drug reactions (ADRs). Results: Out of 194 patients, 48.4% (68 cured + 26 treatment completed) were successfully treated, 22 (11.3%) failed on therapy, 39 (20.15%) patients died, 23 (11.8%) defaulted, 26 (13.4%) completed treatment with outcomes unknown, 13 (6.7%) were transferred out and in 3 patients (1.5%) treatment was stopped due to ADRs. Most common ADRs were gastrointestinal 32 (16.4%) and psychiatric 37 (19%). However, there was no statistical significance between the prevalence of ADRs and unfavorable outcomes. Most common comorbidities were GERD 27 (40.2%) and diabetes mellitus 22 (32.8%). Conclusion: Baseline drug susceptibility testing (DST) with rapid diagnostic tests, performing DST for second-line drugs, i.e., fluoroquinolones and aminoglycoside and modification of treatment regimen based on the same at start of MDR treatment has prime importance. Early detection of ADR's and comorbidities and their prompt treatment are also equally important.

Background: Revised National Tuberculosis Control Programme (RNTCP) was introduced in the country as a pilot project since 1993 in a phased manner and expanded throughout the country by the year 2005. Although studies have shown the success of RNTCP, data pertaining to the indicators of programme performance in urban and tribal set up are rare. Objectives: The objective of this study was to assess and compare the RNTCP in urban and tribal areas of Maharashtra through the indicators of performance and outcome of the patients. Patients and Methods: A retrospective comparative record-based study was conducted in selected urban and tribal areas' tuberculosis (TB) units. Records of patients enrolled newly for TB treatment and those already undergoing treatment under RNTCP from April 2015 to September 2015 (6 months) were considered for analysis. Chi-square test and Z-test (test of significance) are applied where required by using Epi Info 7 and Microsoft Excel 2010.Results: Sputum smear collection was significantly higher in urban areas (P = 0.001). In urban areas, new TB case detection was 35%, while in tribal areas, it was 42% as per the RNTCP norms. Sputum positivity was marginally more in tribal (5.87%) than urban (3.28%) areas. Cure rate was more in urban areas than tribal (P = 0.001) areas. There were statistically significantly high default cases in tribal areas. Conclusions: Sputum collection and sputum positivity rate were low in urban and tribal areas, but TB screening, especially in tribal areas, was significantly low. Sputum positivity was significantly higher in tribal areas. Significantly low cure rate and high default rate in tribal area warrant the need for strengthening of RNTCP activities in tribal areas.

Background: Thrombocytopenia may be encountered in various hematological and nonhematological conditions and may be associated with dysplastic megakaryocytes which is a feature of myelodysplastic syndrome (MDS), even though they can be observed in non-MDS hematological conditions. Objective: To study the morphological variations of megakaryocytes on bone marrow aspiration smears in non-MDS-related thrombocytopenia in a Medical College in Bengaluru, Karnataka. Materials and Methods: It was a prospective study of 86 cases of non-MDS thrombocytopenia whose bone marrow aspirates were studied morphologically. Results: The most common cause of thrombocytopenia was acute leukemia followed by other systemic malignancies, megaloblastic anemia, and idiopathic thrombocytopenic purpura. Both dysplastic and nondysplastic features were observed in the above-mentioned conditions. The most common dysplastic feature was nuclear segmentation followed by micromegakaryocytes and hypogranular forms. Among nondysplastic features, the most common were immature forms, bare nuclei, and hypolobation. Emperipolesis and cytoplasmic vacuoles were noted in a case of pyrexia of unknown origin. Conclusion: Dysplastic megakaryocytes are common in non-MDS-related thrombocytopenia and their mere presence should not lead to the diagnosis of MDS. Hence, proper diagnosis should be made on megakaryocyte morphology, patient's clinical findings, and other hematological parameters. This understanding can improve the diagnostic accuracy for wide range of hematological disorders.

Background: The technique of imprint cytology has provided great impetus to cytodiagnosis due to its simplicity, cost effectiveness, rapid results. It plays a significant role in the rapid diagnosis of the lesions. Objectives: To analyze the sensitivity and specificity of imprint cytology and thereby to evaluate its diagnostic utility. Materials and Methods: The prospective study was carried out in a tertiary care hospital. It included 105 cases. Both benign and malignant lesions from different organ systems were included in the study. Various techniques like touch imprints scrape cytology and squash preparations were used according to the nature of tissue sample. The cytodiagnosis was correlated with histopathological (HP) diagnosis to evaluate the sensitivity and specificity of imprint cytology. Results: Maximum lesions were of central nervous system (25.7%) followed by breast, head, and neck. Imprint cytology diagnosis had sensitivity of 95.5% with 100% specificity for detection of benign and malignant lesions. Overall accuracy of detecting type of lesion was 98.1%. Total discordance with HP diagnosis was found in 1.9% of cases. Conclusion: The use of smear technique in intraoperative diagnosis provides a rapid and efficient means of pathological assessment which in experienced hand, is capable of obtaining a high degree of accuracy. Its use is highly recommended routinely.

Stevens–Johnson syndrome (SJS) is an acute reaction to medications. It is a severe form of erythema multiforme. It is characterized with vesiculobullous eroded lesions of the skin and mucous membrane. Anesthetic management pertains to the drugs that can be used for anesthesia and preventing injury of oropharynx and larynx due to lesions. We report a rare case of SJS with attention deficit hyperkinetic disorder and seizure disorder for circumcision.

Etiology of schizophrenia still remains a mystery. Schizophrenia with coexistence of myasthenia gravis in the same patient raises the suspicion of autoimmune mechanisms involved in causation of schizophrenia.

Hair tourniquet syndrome presents as a surgical emergency. Early recognition and urgent intervention are needed for salvaging the involved digit. We present a case of an infant with this syndrome and discuss the important points in its management.

Giant cell tumor of tendon sheath (GCTTS) is a benign soft tissue neoplasm. It is the second most common tumor of the hand after ganglion. The pathogenesis of GCTTS is not known. This tumor is known to recur after excision. We present a case of GCTTS in the palmar aspect of the right hand of a 41-year-old female. Ultrasonography of hand revealed a well-defined hypoechoic lesion in the subcutaneous plane with focal areas of calcification. She underwent fine-needle aspiration (FNA). The FNA smears showed the characteristic presence of stromal cells and multinucleated osteoclast-like giant cells. This is an uncommon case of GCTTS present in the palmar aspect of hand diagnosed by FNA.

Although the long-term use of immunosuppressives – supplemented with more aggressive treatments such as immunoadsorption, intravenous immunoglobulins, or plasmapheresis in recalcitrant cases has dramatically improved the prognosis of pemphigus vulgaris, opportunistic infections secondary to immunosuppression continue to cause significant mortality. We report four cases– three old ones, who had accumulated significant morbidities over their disease duration ranging from 5 to 10 years, and the fourth, a teenage female intolerant to corticosteroids and idiosyncratic to methotrexate– who achieved complete remission on administration of rituximab by the lymphoma protocol. One of the old cases who had recalcitrant mucositis experienced its complete subsidence without any adjuvant whatsoever. All continue to remain asymptomatic for 11–20 months. None had infusion reactions or any delayed side effects.

Human Nocardiosis has become more common in last two decades due to increase in the number of immunocompromised states of patients and the availability of better detection methods. We report three cases of Nocardiosis in which one was a renal allograft recipient who had developed pneumonia due to a relatively uncommon pathogen Nocardia brasiliensis. Other two cases were seen in immunocompetent hosts where ophthalmic infection due to Nocardia farcinica and subcutaneous infection in the leg due to N. brasiliensis were reported. The patients responded well to treatment. High level of suspicion helped in the detection of these cases.

Cutaneous infection with rapidly growing mycobacteria is not very commonly reported. Unless strongly suspected, its diagnosis can be missed. We report a case of persistent sinus discharge that developed after laparoscopic cholecystectomy surgery, in a healthy adult male, caused by Mycobacterium fortuitum. The case is being reported for its uncommon etiological agent. In this patient, both chronicity as well as repeated supra-added infection of the wound had led to significant discomfort and morbidity.

Anterior sacral meningocele (ASM) and neural tube defect are well-known clinical entity. Hirschsprung's disease is rarely associated with ASM, but the association with anorectal malformation is common.

Tuberculosis (TB) has been a major health concern since decades, and millions continue to be afflicted with this disease. Extrapulmonary sites of TB must not be neglected as there is paucity of systemic manifestations and absence of distinct clinical features which delay its diagnosis and can lead to functional disability and severe infirmities. Osteoarticular TB is an infrequent form of the disease and monoarthritis of the wrist accounts for 1% of all cases of skeletal involvement. Hereby, we report a 45-year-old female patient with history of progressive pain and swelling of right wrist joint which is refractory to analgesics and anti-inflammatory drugs. She was diagnosed to have tubercular monoarthritis after synovial fluid analysis and radiographic findings. Standard antitubercular treatment for 6 months was given. The joint was salvaged after 9 months from the start of the treatment. Pain and swelling of joint were subsided and joint was rehabilitated with full range of motion and weight bearing.