Background:The association of the present Chikungunya pandemic with a mutation in the Chik virus is already established in many parts of the world, including Kerala. Kerala was one of the worst-affected states of India in the Chikungunya epidemic of 2006–2007. It is important to discuss the clinical features of patients affected by Chikungunya fever in the context of this change in the epidemiology of the disease.Aim:This study tries to analyze the clinical picture of the Chikungunya patients in Kerala during the epidemic of 2007.Setting and Design:A cross-sectional survey was carried out in five of the most affected districts in Kerala, India.Materials and Methods:A two-stage cluster sampling technique was used to collect the information. Ten clusters each were selected from all the five districts, and the size of the clusters were 18 houses each. A structured interview schedule was used for data collection. Diagnosis based on clinical signs and symptoms was the major case-finding strategy.Results and Conclusion:Of the 3623 residents in the surveyed households, 1913 (52.8%) had Chikungunya clinically. Most of the affected were in the adult age group (73.4%). Swelling of the joints was seen in 69.9% of the patients, followed by headache (64.1%) and itching (50.3%). The knee joint was the most common joint affected (52%). The number of patients with persistence of any of the symptoms even after 1 month of illness was 1388 (72.6%). Taking bed rest till the relief of joint pain was found to be a protective factor for the persistence of the symptoms. Recurrence of symptoms with a period of disease-free interval was complained by 669 (35.0%) people. Older age (>40 years), a presentation of high-grade fever with shivering, involvement of the small joints of the hand, presence of rashes or joint swelling during the first week of fever and fever lasting for more than 1 week were the significant risk factors for recurrence of symptoms predicted by a binary logistic regression model. In conclusion, we found that there is substantial acute and chronic morbidity associated with the Chikungunya epidemic of 2007.

Background:In India, indigenous cases of cutaneous leishmaniasis (CL) are mainly confined to the northwestern region. But now, more and more case reports are coming in from other parts of India. In January 2009, a 26-year-old lady residing in a forest area in Thiruvananthapuram district of Kerala State presented with bluish red nodules on her upper extremities, of six months duration, which was clinically more in favor of cutaneous leishmaniasis. She had never gone out of the district of Thiruvananthapuram in her life.Aim:To investigate whether the patient hails from a new endemic focus of cutaneous leishmaniasis.Setting and Design:An epidemiological investigation in the form of a survey was carried out in March 2009 by a multidisciplinary team among 63 persons residing in the Mele Aamala and Aayiramkala forest tribal settlements in Kuttichal Panchayat of Thiruvananthapuram district.Material and Methods:History taking and clinical examination of 38 persons in the area with special consideration to skin lesions was undertaken. Microbiological and histopathological examination of the skin lesions was done. Breeding places of sand fly and possible reservoirs of Leishmania were also simultaneously investigated.Statistical analysis used:The data obtained was tabulated as frequency and percentage. Chi-square test was done to find out the statistical significance of differences in distributions.Results:Out of the 38 persons examined, active lesions were found in 12 persons and six had healed lesions. Tissue samples were obtained from seven out of the 12 suspected cases. Four of them showed Leishman Donovan (LD) bodies in tissue smears. Out of the cultures taken from three patients, one showed promastigote forms in Novy McNeal Nicolle (NNN) medium. Histopathological study was done in five patients and two patients had LD bodies, one had epithelioid cell granuloma and the other two had mixed infiltrate with predominantly macrophages. All the three investigations were carried out in three patients and out of them one showed positivity in all the three investigations and the rest two were positive in tissue smear and histopathological examination. Sandflies collected from the area gave an indirect evidence of its role in the disease transmission in the area.Conclusion:The clinical, microbiological and histopathological evaluation of the skin lesions was consistent with cutaneous leishmaniasis. But none of the patients gave history of travel outside the district before the onset of the disease and no one had newly moved into this area within the last two years. So this may be considered as probably a new focus of cutaneous leishmaniasis

This article aims to study the relationship between socioeconomic position (SEP) and prevalence of self-reported diabetes in a rural population in Kerala, India. This study was designed as a cross-sectional survey. Data from PROLIFE, a prospective cohort study involving the long-term follow-up of the residents of an administrative unit in Kerala, India, was used. The 33 379 households in the study area were divided into 4 groups (SEP1 to SEP4) on the basis of household assets. Prevalence of diabetes was ascertained through a lifestyle questionnaire. The proportion of self-reported diabetes was highest (at 11.1%) in SEP4, the group with the highest socioeconomic status, when compared with 3.1% in SEP1. The trend was similar in both sexes. Prevalence of self-reported diabetes increases as one moves up the socioeconomic ladder in this rural community.

BackgroundDifferent surgical techniques for lumbar discectomy are in vogue. This study compares the outcomes of two techniques for lumbar discectomy, viz. micro lumbar discectomy (LD) and conventional fenestration discectomy.Materials and methodsSixty-six patients who had single-level 'virgin’ lumbar disc herniation with unilateral radicular symptoms were included. Of these, 39 had undergone MLD while 27 had undergone fenestration. Outcomes were measured using the visual analogue scale (VAS) for back and leg pain, Japanese Orthopedic Association (JOA) score, Roland-Morris score (RM) improvement and North American Spine Society (NASS) score. All quantitative data were summarised using mean and standard deviation, and qualitative data using proportions. Significance of differences across the two groups in terms of mean scores was assessed using independent sample t test, and the improvement within the same groups was measured using paired t test. Multiple linear regression analysis was done to assess independent predictors of improvement.ResultsThe MLD group showed statistically better outcomes with regard to improvement in JOA score at 6 weeks, 6 months and 2 years. Mean (SD) VAS for lower back ache at 6 weeks, 6 months, and 2 years was better for the MLD group. But the difference noted in VAS for leg pain was not statistically significant across the groups (P = 0.133). The improvement noted in JOA at 2 years postoperatively compared to the preoperative score was 13.67 (2.89) in the MLD group and 12.11 (3.30) in the macrodiscectomy group (P = 0.046).The mean (SD) RM improvement for the MLD group was 79.24% (8.96%) vs 71.72% (16.53), P = 0.02, in the macrodiscectomy group. Mean NASS score for the MLD group was 2.74 vs 2.96 in the conventional group (P = 0.407).The type of surgery was the significant predictor of improvement in JOA score (P = 0.046) even after adjusting for age, sex, level of lesion and the initial JOA score. MLD as the surgical procedure (P = 0.002) and a lower initial JOA score (P = 0.006) were found significantly contributing to the RM improvement.ConclusionThe study shows that both MLD and fenestration give comparable results at short-term follow-up. There is statistically significant improvement in MLD with regard to improvement in JOA, VAS and RM scores at 2 years. However, the difference is not large and may not be clinically significant.

It is possible to improve the QOL of elderly women by providing financial security, ensuring care, and by enhancing social relationships of elderly women.