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India was certified free of polio in 2014. Until now, the oral polio vaccine (OPV) was being used in India. As the OPV is a live vaccine, vaccine-associated paralytic poliomyelitis may occur after its use. The aim is to replace the OPV with injectable polio vaccine. The Polio Eradication and Endgame Strategic Plan 2013-2018 has been made to eradicate polio. A switch from the trivalent OPV (tOPV) to bivalent OPV (bOPV) has been undertaken in all countries since April 2016. tOPV vials have been withdrawn and replaced by bOPV. In addition, the inactivated polio vaccine (IPV) has been introduced. The next step would be to remove the type 3 virus component followed by complete cessation of the OPV and a final switch to the IPV. The timeline has been fixed as 2018-2019. Replacement of a vaccine may raise fears in the community that need to be addressed. Re-emergence of circulating vaccine-derived poliovirus after withdrawal of the tOPV may occur. Proper disposal of vaccine vials needs to be ensured. Proper training of vaccinators is important. All stakeholders need to be incorporated, and focus should be more on deprived populations. The switch marks a significant step towards the final goal of polio eradication. Finally, the importance of community participation cannot be overemphasized. Sustained surveillance is the key to prevent occurrence of cases in polio-free countries through importation.

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When tested as the cathode material for potassium-ion batteries, K2V3O8 delivers a highly reversible capacity of over 100 mA h g-1 in the voltage range of 1.5-4.5 V with 73% capacity retained after 50 cycles. Charge-discharge is achieved by a nontopotactic process between K2V3O8 and KV3O8 (ΔV ∼ -23.4%), causing the slow capacity decay.

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Zika virus (ZIKV) infection has recently affected 4 million people across the globe. The World Health Organization has declared Zika a "Public Health Emergency of International Concern". The disease is caused by an arbovirus and transmitted by Aedes mosquitoes. Zika has followed a pattern already set in by Dengue and Chikungunya viruses. The virus exists in sylvatic form with spillovers to humans. The present outbreak in Brazil started in May 2015 and spread rapidly to Latin America and the Caribbean. The rapid spread is due to availability of non-immune population. The main concern of Zika is the association with microcephaly in infants and Guillain-Barré (GB) Syndrome. During the current Zika outbreak in Brazil, incidence of microcephaly in infants has shown a 20-fold rise. Increased incidence of GB Syndrome has been noticed during the 2013 outbreak in French Polynesia, and the current outbreak. However, causality has not been proved. It is possible that the ZIKV may enter and get established in India. Surveillance against the disease needs to be scaled up. Research needs to be undertaken regarding the dynamics of Zika spread and the development of vaccines. Inter-sectoral coordination and bottom-up approach along with vector control measures under the ambit of National Vector Borne Disease Control Programme may help fight the virus.

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Resistance to standard antimalarials has led to the need for newer options. Artemisinin-based combination therapies (ACTs), which require a tedious three-day treatment schedule, have been introduced for the treatment of drug-resistant malaria. Of late, the new generation artemisinin-naphthoquine (ANQ) combination has been developed, which requires a single dose treatment. Artemisinin initiates the action through the cleavage of the endoperoxide bridge while naphtoquine maintains the process by getting concentrated in the digestive vacuole of the parasite. One ANQ tablet contains 50 mg naphthoquine and 125 mg of artemisinin in the ratio of 1:2.5. The optimal dosage in adults is 400 mg of naphthoquine and 1000 mg artemisinin; which amounts to 8 tablets in a single dose. The dosage for children is adjusted based on the body-weight. The combination has been found to be quite effective with and safe. Studies have demonstrated an adequate clinical and parasitologic response of 98.1-100% in both adults and children. However, further trials are required to confirm its non-inferiority with other ACTs. Adverse reactions with ANQ have been mild. Further studies are needed before safety can be established during pregnancy. ANQ increases the compliance rates because of single dosage. It may be administered by the peripheral health workers as a directly observed therapy, which would be of special benefit to troops in the North-Eastern Sector.

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Dengue fever has re-emerged as a major public health challenge. Of late, several promising attempts have been made to control the disease with limited success. An innovative method of biological control of dengue is the use of the bacterium Wolbachia. Selected strains of Wolbachia have been introduced into Aedes aegypti to prevent transmission of dengue viruses by the vector. Wolbachia prevents dengue transmission by either directly blocking the virus or by decreasing the lifespan of the vector. The mechanism by which it causes these effects is not clearly understood. The main concern of this technique is the emergence of a new dengue virus serotype which may evade the protection offered by Wolbachia. The technique is environment friendly and holds promise for control of other vector borne diseases.

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BACKGROUND: In spite of many available contraceptives numerous unwanted and unplanned pregnancies occur. Though the couples desire contraception but are not able to accept it due to their ignorance and misconceptions. Intrauterine Contraceptive Device (IUCD); an effective contraceptive is usually inserted six weeks after delivery. It can be inserted within 48 h of delivery called postpartum insertion for which government has started the program in many states. The study was undertaken to find out the choices about contraception after delivery and awareness about postpartum insertion. METHODS: The present observational study was conducted in one of the zonal service hospitals. 500 antenatal cases were included in the study. Their choice of contraception after delivery and awareness was determined through a questionnaire. Reasons for refusal of postpartum insertion were recorded. A small sample of staff also was included in the study. RESULTS: 500 cases were included in the study, a large number had decided about contraception; mainly breast feeding supplemented by barrier contraceptive. 94 of 500 were willing for insertion of contraceptive device but not immediately after delivery due to apprehension in general and fear of side effects. Staff's awareness about postpartum insertion was poor. CONCLUSION: Knowledge and acceptance of postpartum insertion is very low among antenatal women; probably because the concept is new in the community. There is a strong need to increase the knowledge and awareness about this by health education and counseling.

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Dengue fever is a re-emerging public health problem with two-fifths of the world population being at risk of infection. Till now, dengue fever was believed to be caused by four different serotypes. The fifth variant DENV-5 has been isolated in October 2013. This serotype follows the sylvatic cycle unlike the other four serotypes which follow the human cycle. The likely cause of emergence of the new serotype could be genetic recombination, natural selection and genetic bottlenecks. There is no indication of the presence of DENV-5 in India. Recent clinical trials with the promising Chimerivax tetravalent vaccine suffered a setback. Discovery of DENV-5 and more such sylvatic strains in future may further impede the Dengue Vaccine Initiative. Integrated Vector Management holds the key to sustainable dengue control. Further epidemiological and ecological studies are needed to detect additional sylvatic dengue strains.

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Vector resistance to insecticides is becoming a major obstacle to malaria prevention measures. A baseline survey was carried out in Khartoum city, Sudan, during September-November 2007, to map the insecticide susceptibility status ofAnophelesarabiensis and to examine the correlation with insecticide usage in urban agriculture. Susceptibility tests were conducted in 6 sentinel sites representing urban and periurban strata of the city. Mortality rates and knockdown times were calculated for 8 insecticides on a total of 9820 specimens. An. arabiensis was susceptible to bendiocarb (98.1%), propoxur (100%), fenitrothion (100%), deltamethrin (99.8%) and lambda-cyhalothrin (99.2%). Susceptibility rates were significantly different between urban and periurban sites for malathion (80.8% vs 56.0%), DDT (99.0% vs 95.0%) and permethrin (98.5% vs 96.3%). The 50% knockdown times were significantly higher in periurban than urban populations of An. arabiensis for deltamethrin, lambda-cyhalothrin and malathion.

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Vector resistance to insecticides is becoming a major obstacle to malaria prevention measures. A baseline survey was carried out in Khartoum city, Sudan, during September-November 2007, to map the insecticide susceptibility status of Anopheles arabiensis and to examine the correlation with insecticide usage in urban agriculture. Susceptibility tests were conducted in 6 sentinel sites representing urban and periurban strata of the city. Mortality rates and knockdown times were calculated for 8 insecticides on a total of 9820 specimens. An. arabiensis was susceptible to bendiocarb [98.1%], propoxur [100%], fenitrothion [100%], deltamethrin [99.8%] and lambda-cyhalothrin [99.2%]. Susceptibility rates were significantly different between urban and periurban sites for malathion [80.8% vs 56.0%], DDT [99.0% vs 95.0%] and permethrin [98.5% vs 96.3%]. The 50% knockdown times were significantly higher in periurban than urban populations of An. arabiensis for deltamethrin, lambda-cyhalothrin and malathion

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BACKGROUND: An outbreak of food poisoning involving 121 persons of a military establishment was investigated. METHODS: On investigation, a total of 94 persons became ill, with an attack rate of 77.7%. The symptoms included nausea, vomiting, abdominal pain, diarrhoea, weakness and fever. The mean incubation period was 2.3 hours while the median was 1.7 hours. Retrospective cohort study incriminated raita as the food item responsible for the outbreak, with a risk ratio of 21.35. Left over food was not available for laboratory analysis. There were no deaths and all affected persons recovered within 24 hours. RESULT: Coagulase positive staphylococci were cultured from the vomitus and stool samples of cases. Nasal and fingernail swabs collected from food handlers also showed staphylococcal growth. The most likely cause of contamination of raita with the enterotoxin could be the staphylococci which had colonised the bodies of food handlers. CONCLUSION: The aggravating factor was the storage of raita at room temperature before its consumption, which provided ideal conditions for enterotoxin formation.

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Dengue fever is a re-emerging public health problem with two-fifths of the world population being at risk of infection. Since there are no antiviral drugs available against the dengue virus, and vector control programmes have been largely unsuccessful in preventing outbreaks, vaccination seems to be the most viable option for preventing infection. An ideal dengue vaccine should provide long lasting immunity against all four serotypes of the virus. The envelope protein of the virus plays a key role in vaccine development. The present day candidate vaccines includes a live attenuated tetravalent vaccine, intertypic chimaeric vaccines based on live attenuated dengue virus vectors, chimaeric vaccines based on the live attenuated Yellow Fever 17D vector and recombinant vaccines which include vaccines based on flavivirus and non-flavivirus vectors. Tetravalent live attenuated vaccines, intertypic chimaeric vaccines and chimaeric vaccines are being tested in human trials. Recombinant DNA vaccines based on flavivirus and non-flavivirus vectors are being tested in animal trials. Recent studies have shown that the tetravalent formulations may elicit an unbalanced immune response. Research is continuing to find means of obtaining a balanced response to all antigens in the tetravalent formulations.

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A cross-sectional health examination survey was carried out among a random sample of 406 people of 30 years and above from a rural community to investigate the prevalence of coronary heart disease risk factors. Prevalence of smoking and tobacco use was 16%, alcohol intake 9.4 %, daily Salt intake (> or = 5 gram) 34.2%, daily saturated fat intake ( > or =10 % of daily energy intake) 47.0 % and physical inactivity 18.5 %. BMI was > or =25 Kg /m(2) in 18 percent and it was > or =30 Kg / m(2) in 3.2 percent population. Truncal obesity (WHR: men> 0.9; women > 0.8) was found 18.5 percent more in case of males (20.7). Abdominal obesity(men > or =102; women > or = 88)was found 15.7 percent more in case of males (20.6).18.5 percent population was found suffering from systolic hypertension> or =140 mm Hg )and 15 percent from diastolic hypertension(> or =90 mm Hg). Awareness of CHD risk factors was present in 30.0 percent population. Differences in prevalence of riskfactor in male and female were found statistically significant in case of smoking, alcohol consumption and abdominal obesity. The present study shows that prevalence of CHD risk factors increases significantly in men and women having BMI equal or more than 25 Kg /m(2) so this cutoff, should be used to determine obesity in Indian population.

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OBJECTIVE: The aim of this study is to report a rare case of scalp and cranial bone metastasis of endometrial carcinoma and review the literature. METHOD: We report a 45-year-old multiparous woman with FIGO Stage 1A Grade II endometrial adenocarcinoma who presented 3 years following total abdominal hysterectomy and bilateral salpingo-oophorectomy with scalp and cranial bone metastasis. Similar cases in the literature are reviewed. RESULTS: The patient metastatic workup revealed local, distant, scalp, and cranial bone metastasis. She died within 6 months. The poor prognosis is similar to that of six other cases reviewed. CONCLUSION: Scalp and cranial bone metastasis following endometrial carcinoma is extremely rare. It is a reflection of a widely disseminated disease and poor prognosis. However, single bone metastasis has a better postmetastatic survival with the help of local radiotherapy than scalp and multiple bone metastasis.

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We report our experience of obstetric handling of a deaf pregnant patient antenatally, in labor and postpartum. The patient was deaf from childhood. The attending obstetrician had no training in the necessary skills for communication with the deaf. Fortunately, the patient could read and write English very well and communication was carried out through pen and paper. This proved to be difficult, time-consuming and required a lot of patience. The clinical, psychological and human aspects of the management were gratifying. The patient brought up interesting aspects that need to be considered when dealing with similar patients. Experience of deaf mothers and their ingenious approaches in dealing with babies, in the postpartum period, are quoted in this communication.

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An infant girl was born at 37 weeks gestation and found to be clinically thyrotoxic at 9 months of age. Thyroid autoantibodies were negative, and thyroid function failed to normalize with medical treatment. The patient underwent a total thyroidectomy. DNA obtained from her thyroid gland and leukocytes was analyzed for thyrotropin receptor (TSHR) mutations using single strand conformation polymorphism and direct sequencing. A mobility shift of polymerase chain reaction (PCR)-amplified DNA was detected on single strand conformation polymorphism gel. Direct sequencing identified a novel point mutation in the fifth transmembrane domain of the TSH receptor at codon 597 (GTC to CTC), resulting in the amino acid substitution of leucine for valine. The mutation was heterozygous and germline, and was not identified in DNA from either of her parents. Expression of the V597L mutant is transiently transfected COS 7 cells displayed increased constitutive cyclic adenosine monophosphate (cAMP) production compared with the wild-type receptor. The mutant is expressed at very low levels on the surface of COS cells, and its response to TSH is marginal.

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Extreme uterine torsion of 180 degrees at term is a rare obstetric event and raises several critical management considerations. We report such a case detected at laparotomy for a repeat Caesarean section. The existing literature on uterine torsion is reviewed and a plan of management is suggested, based on previous reports and our own experience.

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Surgically uncontrollable peri-operative obstetric haemorrhage associated with coagulopathy, developed in five women who were managed by emergency caesarean hysterectomy. All women had a morbidly adherent anterior placenta praevia and a previous lower segment caesarean section scar. Conventional medical and surgical therapy to control bleeding from pelvic and abdominal raw surfaces were unsuccessful. Abdomino-pelvic packing was performed with 10-12 dry laparotomy pads applied firmly over bleeding sites. The abdomen was closed after observation of the cessation of bleeding for 5-10 minutes. Following correction of coagulation and haemodynamic disorders relaparotomy for pack removal was performed 34-48 hours later. One patient developed small bowel obstruction on the 5th post-operative day, however, there was no long term gynaecological morbidity in any of the cases. Abdomino-pelvic packing achieved complete haemostasis in all of the five women which we believe may have been impossible using alternative measures.