Prevalence of Chikungunya in Urban Field Practice Area of a Private Medical College, Chennai

Background:

The outbreak of Chikungunya in India started during December 2005 with more than 11,00,000 cases. Many cases with symptoms suggestive of Chikungunya reported to our urban health-training centre. Hence this study was done to estimate the prevalence of Chikungunya, to study the common treatment-seeking behavior, control measures and the sequalae of Chikungunya by follow-up.

Materials and Methods:

This cross-sectional study was done in Anagaputhur an urban field practice area of our college. The study was done on a sample selected by systematic random sampling. Any person with fever and joint pain, with an onset from 1 August 2006 to 31 August 2006, were enrolled as cases. The cases were followed up after three months.

Results:

Chikungunya prevalence in the community was 22.3%; 52% of them were females and 56% of cases were in the 15-44 years age group. Median duration of acute phase was three days. Ninety-one percent of them had multiple joints’ involvement. Seventy-eight percent sought treatment from the private sector. Sixty-seven percent reported artificial collections of water around their household and 44% complained of mosquito problems during the day. Eighty-eight percent used mosquito repellents for personal protection. On follow-up 95% of them had residual joint pain, 43% had residual joint swelling and 11% had disabilities with median duration of 30 days.

Conclusions:

Prevalence of Chikungunya was 22.3%, predominantly affecting the age group of 15-44 years and females. The private sector was commonly sought for treatment. Entomological survey indicated Aedes breeding. Eleven percent had disabilities due to the sequelae.     

Temporal trends in breast cancer presentation in the third world

Background

Third world breast cancer is characterized by late presentation, occurrence at relatively young ages and dismal mortality. This poor outcome has encouraged patients to patronize quacks and alternative healers. Public control measures have targeted mainly public education and provision of screening facilities. Recent reports from the developed world indicate a high association with obesity, tobacco and alcohol, habits which though not currently very popular in the third world are nevertheless increasingly accepted.

Methods

A prospective study initiated in 1985 for all breast cancer patients attending 4 hospitals located in the Eastern Nigeria heartland where the author practiced. On attendance to hospital detailed epidemiological data including social habits were collected from patients.

Results

Reports from our first series [1987–97] showed some improvement in terms of earlier presentation compared to a historical control of earlier reports from the sub-region. Reports from the present study showed that this improvement has not been maintained probably as a result of diversion of public health campaign finances to HIV/AIDS. However there is an increasing mean age of presentation due to a higher representation of above 70 years age group and a significant reduction in parity. Alcohol intake and smoking have remained at low levels among the patients.

Conclusion

There is need to take another look at cancer public health campaign mechanisms in the face of competing demands from HIV. Public control measures should include among others teaching of Breast Self Examination [BSE] to patients, Clinical Breast Examination [CBE] to health workers and opportunistic CBE to all patients. Strenuous efforts should be made to break the vicious cycle of late presentation, poor treatment outcome and reluctance of patients to present to health facilities because of poor outcome.     

Ankylosing spondylitis in a Malawian

I report a case of ankylosing spondylitis in a Malawian patient. I believe this is the first reported case of ankylosing spondylitis in a Malawian. Ankylosing spondylitis is rare in black Africans when compared with the Caucasian population. The clinical features of this disease are also different in these different racial groups. I will present a brief clinical history and a review of ankylosing spondylitis with special reference to the black African.