PATTERN OF SEXUALLY TRANSMITTED DISEASES IN THE ARMED FORCES

Pattern of sexually transmitted diseases (STDs) in 1027 male patients admitted during 1990 to 1996 were analysed. Majority of cases (86%) were in age group of 20 to 40 years. Out of total 1027 STD cases 334 (32%) were having chancroid, 237 (23%) syphilis, 122 (11.9%) lymphogranuloma venereum, 130 (12.6%) gonorrhoea, 34 (3.3%) Herpes genitalis and 170 (16.5%) other STDs. 167 STD cases (163%) were found to have HIV infection. A rising trend in prevalence of HIV infection in STD patients from 2.8% (1990) to 27.8 (1996) was noticed contrary to declining trend of STDs from 213 cases in 1990 to 79 cases in 1996. The prevalence of HIV infection was 303% in LGV, 19.3% in chancroid, 13.5% in syphilis, 17.6% in herpes genitalis, 6.7% in gonorrhoea and 11.2% in other STD cases. Out of total 167 STD cases having HIV infection 65 (40%) cases were of chancroid, 37 (22.2%) of LGV, 32(19.2%) of syphilis, 8 (4.8) of gonorrhoea, and 6(3.6%) of herpes genitalis while 17 (10.2) cases were having other STDs.KEY WORDS: Chancroid, Gonorrhoea, Herpes genitalis, HIV infection, LGV, Sexually transmitted diseases (STDs), Syphilis     

CHANGING TRENDS OF LEPROSY IN ARMED FORCES

A total of 651 cases of leprosy were hospitalised from Jan 1987 to Dec 1992. Each patient underwent haemogram, total and differential white cell count, urinalysis, liver function tests, skin slit smear for AFB and skin biopsy. Nerve conduction studies, electomyographic studies and nerve/nerve sheath biopsies were undertaken as and when indicated. These patients were managed with multidrug therapy. Paucibacillary (PB) leprosy accounted for 476 (73.1%) cases which comprised of indeterminate leprosy 90 (13.8%), tuberculoid leprosy 14 (2.2%), borderline tuberculoid leprosy 310 (47.6%) and neuritic leprosy 62 (9.5%). The remaining 175 patients (26.9%) were multibacillary (MB) which included borderline leprosy 9 (1.4%), borderline lepromatous leprosy 129 (19.8%) and lepromatous leprosy 37 (5.7%) patients. There were total 153 patients in 1987. This number declined to 44 in 1992. PB declined from 113 in 1987 to 39 in 1992 and MB cases from 40 to 5.KEY WORDS: Leprosy     

PSYCHIATRIC EVALUATION OF HUMAN IMMUNODEFICIENCY VIRUS SEROPOSITIVES IN ARMED FORCES

Fifty five Armed Forces personnel detected to be seropositives for human immunodeficiency virus were the subjects of the study. After baseline clinical evaluation, laboratory investigations and Centre for Disease Control classification, through a semistructured interview, their sexual orientation, behaviour and psychiatric morbidity were assessed. Sixtynine percent had another sexually transmitted disease as comorbidity. Heterosexual contact was responsible for the infection in 54 out of 55 subjects. Seven patients were freshly diagnosed to have psychiatric illness.KEY WORDS: Human immunodeficiency virus, Psychiatric morbidity, Sexual orientation     

SALT IODINE MONITORING IN THE ARMED FORCES

Iodine deficiency is the most commonly implicated nutritional factor responsible for preventable mental deficiency in India and the world. The Government of India aims to control this through the supply of Iodised salt as the primary intervention strategy. Monitoring of the salt supplied, therefore becomes essential to ensure quality control. This study undertaken to assess the status of Iodised salt in the Armed Forces in the Pune-Kirkee complex found a great variation in the iodine content ranging from 10.6 ppm to 150.1 ppm. High levels of Iodine are potentially harmful. This calls for stringent quality assurance and monitoring as a cost effective long term measure in the Armed Forces.     

A STUDY OF HYPERINSULINAEMIA AND DYSLIPIDAEMIA IN HYPERTENSIVE PATIENTS OF ARMED FORCES

All patients attending the outpatient department were screened for hypertension. An attempt was made to correlate presence of hyperinsulinaemia (HI), dyslipidaemia and anthropometric characteristics in these hypertensives. Effect of angiotensin converting enzyme inhibitor (ACEI) and beta blockers on serum insulin was also studied. 85 patients with blood pressure (BP) ≥ 160/90 mm Hg and 94 controls with a BP of < 130/85 mm Hg were studied. All underwent clinical examination, anthropometric measurements (body mass index (BMI), waist hip ratio (WHR), skin fold thickness (SFT) and laboratory investigation (serum insulin, glucose, lipid profile) and post oral glucose load (POGL) for insulin and glucose. Serum insulin was estimated by I¹²⁵ radio immuno assay. Patients were randomly divided into group A (Tab enalapril) and group B (Tab atenolol). In 51 patients who completed the study, fasting and POGL insulin and fasting lipid profile were estimated two months after treatment. Mean age of cases was 38.91 years. 50% of patients had stage II hypertension. BMI was increased in 36 cases (42.35%) as compared to 9 in (9.57%) controls. Increased WHR was found in 40 cases as compared to 26 in controls. The SFT was more in cases compared to controls. 47 (55.29%) of 85 cases had abnormal lipid profile as compared to 25 (26.60%) in 94 controls. The fasting and POGL insulin levels (13.85 and 60.05 micro u/ml respectively) in cases were significantly higher than in controls (6.87 and 16.16 micro u/ml respectively). The mean POGL insulin values were much higher in obese compared to non-obese hypertensives. The decrease in mean fasting and POGL insulin values in patients taking ACEI and beta blockers were similar. Abnormal lipid profile was significantly more in cases than controls. Increased total cholesterol (TC), Low density lipoprotein cholesterol (LDLC) and total cholesterol (TC)/high density lipoprotein (HDL) ratio were the most frequent abnormality. The mean insulin (both fasting and POGL) levels were higher in obese hypertensives and those with abnormal lipid profile. Both drugs had equal efficacy in reducing the insulin values.KEY WORDS: Angiotensin converting enzyme inhibitor, Beta-blockers, Body mass index, Hyperinsulinaemia     

SEROLOGICAL DIAGNOSIS OF TOXOPLASMA GONDII INFECTION IN VARIOUS PATIENT POPULATION IN THE ARMED FORCES

The study included 200 healthy age and sex matched controls (120 healthy volunteers and 80 healthy antenatal cases without any bad obstetric history) and 300 cases comprising patients with bad obstetric history (BOH) 80 cases, seizure or encephalitis 50 cases, cervical lymphadenopathy 30 cases, congenital deformity 30 cases, HIV infected 80 cases and patients on long term immunosuppression 30 cases. Anti-toxoplasma IgG & IgM were measured by ELISA and individuals found positive for anti Toxoplasma gondii IgM or with high titre of IgG were subjected to repeat testing after 3 weeks for rise in titre. True sero-prevalence of T gondii infection was found to be 19% and it increased with increasing age in the population. 2.33% patients were found to have acute toxoplasma infection. Statistical significance was seen only in patients with BOH and children born with congenital abnormality.KEY WORDS: Bad obstetric history, Congenital abnormality, Serodiagnosis, Toxoplasmosis     

过敏性皮肤病接触变应原分析

目的分析过敏性皮肤病病人接触变应原特点。方法采用瑞典进口斑贴试验试剂盒对40例过敏性皮肤病病人进行斑贴试验。结果40例病人中阳性者25例,阳性率为62.5%。阳性率较高的过敏原依次为:硫酸镍、对苯二胺、芳香混合物、重铬酸钾、甲醛,斑贴阳性的病种有面部皮炎、湿疹、接触性皮炎、荨麻疹、瘙痒症。结论过敏性皮肤病临床表现为多种形态,过敏原主要为日常生活类物质,易于被医、患双方所忽视,临床医师须引起足够的重视。     

TRENDS AND ISSUES IN RELATION TO ALCOHOL DEPENDENCE IN THE ARMED FORCES

Alcohol dependence syndrome has an estimated prevalence of 1533% of all psychiatric hospitalizations in a year. There is an increasing trend in incidence among JCOs/ORs. The index of admission was highest in Armoured Corps, Mechanized Infantry and Army Medical Corps (AMC). Generally a service personnel becomes dependent at 35 years of age after about 11 years of drinking. The average consumption of alcohol dependent individuals was 6-7 pegs/day. A family history of alcohol abuse/dependence was found in 31 % cases. Alcoholics had high anxiety, depression, extroversion, neuroticism and psychopathic deviate traits. Alcoholism was associated with significantly low self esteem. Significantly more alcoholics were alexithymic as compared to non-alcoholics. The γ glutamyl transferase (GGT) and mean corpuscular volume (MCV) were found to be useful diagnostic aids for alcoholism. Almost a third of alcoholics have potentially serious physical problems, 20% suffer from various degrees of psychotic phenomena, 40-55% have significant marital, occupational and disciplinary problems, while 3-6.93% attempted deliberate self-harm. Despite wide variations in mode of disposal, after diagnosis only a small percentage of alcoholics remain in service beyond three years. There is need for concerted investigations into the precipitating and perpetuating factors, co-morbidity, the process of change towards betterment and the long-term outcome of alcoholism in service personnel.KEY WORDS: Alcohol dependence syndrome, Outcome, Personality, Prevalence     

OUTBREAK OF BANCROFTIAN FILARIASIS AMONG TROOPS AT AN ARMED FORCES STATION

A large number of microfilaria (MF) positive cases were reported at a Military Hospital in 1994. The epidemiological investigations included mass night blood survey, detection of sector breeding places and entomological studies. Control measures were instituted concurrently and this included treatment of positive cases, sector control measures, personal protection and health education. The mass blood survey was continued in 1995 as well to find the outcome of control measures. A total of 215 MF positive cases were detected in 1994 with MF rate of 9.63. The only MF species identified was Wuchereria bancrofti. 203% cases were in the station for less than six months. 71.3% of MF positive cases were asymptomatic. As per state health authorities, Culex quinquefasciatus was the known vector for spread of the disease in the region. However, in present study, it could not be implicated as dissection of over 200 mosquitoes of this species was negative for filarial parasite. Our study stresses the importance of close monitoring of the disease by night blood surveys and effective integrated vector control measures.KEY WORDS: Control, Epidemiology, Filariasis     

EPIDEMIOLOGY OF UPPER AERODIGESTIVE CANCERS AMONG ARMED FORCES PERSONNEL AND THEIR FAMILIES

Cancers of the oral cavity, pharynx, and esophagus are now suspected to have common etiologic factors and have been grouped together as “upper aerodigestive” cancers. Since this grouping is of relatively recent origin there have been no epidemiological studies on this group among Armed Forces personnel. 114 cases of upper aerodigestive cancers and an equal number of controls were studied. The largest number of cases were in the age group of 40–49 years with male preponderance. Lower level of education, smoking, quid chewing, and alcohol use were found to be the major risk factors for these cancers. A dose response relationship was observed for smoking, quid chewing and alcohol intake.KEY WORDS: Neoplasms, Smoking, Quid chewing, Alcohol