NEW TOPICS IN THE EDITION OF PARK-21st Edition

PARK (21st Edition)

Chapter-Epidemiology and Vaccines :

MILESTONES IN VACCINATION

2009: Influenza A (H1N1) vaccine approved

Chapter – Communicable and Non-communicable diseases:

SMALL POX

· Case (confirmed) definition for notification under IHRs (2005) : [Mnemonic:FRALL]

o Fever (≥38.3º C/101º F) acute onset at any age, malaise, prostration, headache, backache occurring 2-4 days prior to onset of rash AND

o Rash maculo-papular starting from face & forearms, evolving to vesicles (48 hours) and pustules (umblicated/confluent) later AND

o Lesions at same stage of development at any part of body AND

o Absence of Alternative diagnosis to explain illness AND

o Laboratory confirmation.

Chapter- Preventive Medicine in Obstettris, Paediatrics and Geriatrics:

MEASLES

· Coverage of 1st dose of Measles vaccine in world: 82% [2007]

· Proportional mortality rate in children <5 years: 1% [2008]

· Children in difficult circumstances includes:

INFLUENZA: PANDEMIC (H1N1) 2009 INFLUENZA

· WHO declaration of Influenza pandemic: 11 June 2009

· World is now post-pandemic EXCEPT: INDIA & NEW ZEALAND (locally intense transmission)

· Problem statement India: 37000 cases, 1833 deaths [May 2009- August 2010]

· Incubation period : 2-3 days

· Clinical features:

o Uncomplicated influenza: Influenza like illness (Fever, cough, sorethroat, rhinorrhoea, headache, muscle pain), GIT illness (diarrhoea WITHOUT dehydration)

o Complicated/severe influenza: Pneumonia, CNS involvement, Severe diarrhoea, Secondary complications, Exacerbation of chronic diseases.

o Progressive disease: Oxygen impairment/cardiopulmonary insufficiency, CNS complications, Invasive secondary bacterial infection, Severe dehydration.

· Risk factors of severe disease:

o Infants & children < 2 years

o Pregnant females

o COPD

o Chronic cardiac disease

o Metabolic disorders

o Chronic renal/hepatic/neurological/hemoglobinopathies/immunosuppression (INCLUDING HIV) disorders

o Children on aspirin therapy

o Persons aged ≥ 65 years

o Morbid obesity.

· Laboratory diagnosis:

o Most timely & sensitive detection: RT-PCR test

o Samples: Nasopharyngeal + throat swabs [Tracheal/bronchial aspirates in lower respiratory tract infection cases]

o Point-of-care/Rapid diagnostic tests: Not recommended.

· Duration of isolation: for 7 days after onset of illness OR 24 hours after resolution of fever/respiratory symptoms whichever is longer.

· H1N1 Inactivated vaccine: Single i/m injection

o Strain : A/California/7/2009 (H1N1) V like strain

o Storage temperature: +2º to +8 º C

o Contraindications: History of anaphylaxis/severe reaction/Guillian Barre Syndrome, Infants <6 months, Moderate-to-severe illness with fever.

o Protective immunity: Develops after 14 days (NOT 100%).

· H1N1 Live attenuated vaccine: Nasal spray

o Side effects: Rhinorrhoea, nasal congestion, cough, sore throat, fever, wheezing, vomiting

· Priority groups (in order) for Influenza vaccines:

o Pregnant women

o Age > 6 months with chronic medical conditions

o 15-49 years healthy young adults

o Healthy young children

o Healthy adults 49-65 years

o Healthy adults >65 years.

· Antiviral therapy:

o Severe/progressive clinical illness: Oseltamivir (if not available or resistance, use Zanamivir)

o High risk of severe/complicated illness: Oseltamivir OR Zanamivir

o Not high risk OR Uncomplicated confirmed/suspected illness: No need of treatment.

· Dosage:

o Oseltamivir 75 mg BD X 5 days

o Zanamivir 2 inhalations (2 X 5 mg) BD X 5 days

ARI/PNEUMONIA: KEY INDICATORS (INDIA)-

· % under-five deaths due to Pneumonia: 20%

· % under-weight children : 46% (moderate to severe); 18% (severe)

· % exclusive breast-fed infants <6 months:46%

· % 1-year old immunised against Measles: 67%

· % under-five taken to appropriate health care provider for Pneumonia: 69%

TUBERCULOSIS

Daily self-administered Non-DOTS regime: ONLY if there are adverse reactions to drugs or patients compliance is not possible.

Non-DOTS regime 1 (ND1)

o Pulmonary (SS+ve) seriously ill

2 (SHE) + 10 (HE)

o Extra-pulmonary seriously ill

Non-DOTS regime 2 (ND2)

o Pulmonary (SS-ve) not seriously ill

12 (HE)

o Extra-pulmonary not seriously ill

· DOTS-PLUS (Category IV DOTS MDR-TB treatment):

Cat IV* MDR- TB

IP

CP

Duration

6(KOCZEEt)*

12-18 (OCEEt)

18-24 months

(* IP extended by 3 months if culture +ve at end of 4 months treatment

Follow-up sputum smears: 4, 6, 12, 18, 24 months of treatment)

POLIOMYELITIS

· WHO Strategic Plan 2010-2012: Is based on fact that >95% immunity is required (among under-five children)

In India/Pakistan and 80-85% in Sub-saharan Africa. Approaches indicated: [Mnemonic: BUS ME SCRAP]

o Bivalent OPV (P1, P3) in some SIAs + Trivalent OPV in Routine immunization & some SIAs + Monovalent OPV in some MOP-ups & few SIAa as appropriate.

o Under-served population; special teams/tactics

o Short-interval additional dose (SIAD) strategy (increase immunity + terminate outbreaks)

o Monitoring SIA coverage

o Expanded Environmental sampling

o Serological surveys (program status, prospects, adjustment)

o Communication/mobilization enhanced in priority areas

o Rehabilitation of Polio-affected individuals

o AFP surveillance enhanced

o Plans specific for state/district/block (endemic/re-established transmission areas)

· 107 Block Plan : Approaches for persistent transmission area:

o Optimize SIA coverage and additional activities against WPV transmission

o Newborn tracking data for routine immunization

o Special strategies for mobile population

o Supplementary approaches to reduce force of infection, increase mucosal gut immunity, and reduce risk factors.

CHOLERA: ORAL VACCINES

o Monovalent formalin/heat killed whole cells (Classical, El Tor, Inaba & Ogawa) + recombinant cholera toxin B subunit

o 3 ml single dose vials + bicarbonate buffer: Shelf life 3 years (2º - 8 º C) or 1 year (37 º C)

o In children aged 2-5 years: 3 doses more than 7days apart (1 booster every 6 months)

o In children ≥6 years: 2 doses more than 7days apart (1 booster after 2 years)

· Sanchol and mORCVAX:

o Bivalent oral cholera vaccines based on serogroups 01 and 0139

o 2 liquid doses 14days apart for age more than 1 year (1 booster after 2 years)

· CVD103-HgR:

o Single dose live attenuated vaccine NO LONGER PRODUCED

DENGUE HEMORRHAGIC FEVER

· Febrile phase:

o Incubation period 4-6 days

o Maculopapular rash less common than classical dengue fever

o Rising hematocrit + Moderate to marked thrombocytopenia

· Critical phase: Shock, hemorrhage, organ damage may occur

· Recovery phase: If patients survives 24-48 hours of critical phase

· Severe dengue:

o Shock and/or fluid accumulation with/without respiratory distress

o Severe bleeding, and/or

o Severe organ impairment

· Treatment guidelines:

o Group A (Patients with uncomplicated disease who may be sent home): Encourage ORS + PCM + Tepid sponge + Immediate visit to hospital if no improvement or worsening

o Group B (Patients for in-hospital management): Assess hematocrit + Fluid therapy with 0.9% Saline/RL/Hartmann’s + Maintain good perfusion, urine output 0.5ml/kg/hr.

o Group C (Patients who require emergency treatment and urgent referral): Admission to hospital + intravenous fluid resuscitation [isotonic crystalloid solution or colloid dextran solution (for shock)]

MALARIA

· Six primary Malaria vectors in India:

o Anopheles culicifacies: Rural and peri-urban areas [Species A-P, vivax & P, falciparum; Species B-P.falciparum]

o Anopheles stephensi : Urban and industrial areas

o Anopheles fluviatilis: Hilly, forest and forest fringe areas

o Anopheles minimus: Foot-hills of NE states

o Anopheles dirus : Forests of NE states

o Anopheles epiroticus: Andaman & Nicobar islands

· Diagnosis of Malaria in India:

o Microscopy: Thick smear (High sensitivity in searching for parasite, parasite load estimation) + Thin file (for species identification, stages)

o Serological testing: Malaria Fluorescent Antibody Test (MFAT) necomes +ve after 2 weeks of infection (not indicative of current infection)

o Rapid diagnostic test (RDT): Detect circulating parasite antigens.

· Active intervention measures for Malaria control:

o Micro-stratification of problem

o Vector control strategies

1) Anti-adult measures: Indoor residual spray (DDT/Malathion,Fenitrothion), Space

2) Anti-larval measures: Larvicides (temephos), Source reduction, Integrated control.

· Changes in WHO recommendations for Malaria control [2008] :

o New ACT recommended: Dihydroartemisin-piperaquine

o Artemisin derivatives should not be used as montherapies for uncomplicated malaria

o Single dose of Primaquine (anti-gametocyte) added to ACT treatment of P, falciparum.

JAPANESE ENCEPHALITIS: MANAGEMENT OF ACUTE ENCEPHALITIS SYNDROME (AES) & JE :

· Case definition of suspected case: Acute onset fever, <5-7 days duration + Change in mental status with/without new onset of seizures (EXCEPT febrile) or enhanced irritability/somnolence/abnormal behaviour

· Case classification:

o Laboratory confirmed case: IgM in CSF/serum OR 4-fold antibody titre rise in paired sera OR viral isolation from brain tissue OR antigen detection by immunofluorescence OR nucleic acid detection by PCR.

o Probable case: Suspected case in close geographic and temporal relationship to a lab-confirmed case in outbreak

o AES due to some other agent: Suspected case + diagnostic testing + some other agent identified.

o AES due to unknown agent: Suspected case + No diagnostic testing/ No etiological agent/Indeterminate test results.

o Management : Symptomatic.

LEPROSY

· LEPRA reactions:

o Signs of severe reversal reaction : Loss of nerve function, Pain/tender nerve, Silent neuritis/nerve-paralysis, Red swollen skin patch on face/over nerve trunk, Ulcerated skin lesion, Marked edema of hands/feet/face.

o Signs of severe reversal reaction: Pain/tender nerve, Ulceration of ENL nodule, Pain of eyes, orchitis/dactylitis, Marked arthritis/lymphadenitis.

o Treatment of lepra reactions: Bed rest + Splint to rest nerves + Analgesics + Prednisolone (Add Clofazimine in ENL)

o Follow-up after steroid treatment:

1) For patients on MDT: Monthly check-up of Nerve function

2) For patients MDT completed : 3 months and 6 months after course.

o Steroids contraindicated in (without starting treatment): TB, Diabetes, Deep ulcers, Osteomyelitis, Corneal ulcers, Other serious conditions.

· INDICATORS IN LEPROSY CONTROL:

o Epidemiological indicators:

1) Incidence: ONLY measure of effectiveness of measures taken

2) Prevalence: Case-load

o Main/core indicators to monitor progress:

1) Number and rate of new cases detected per 100,000 population per year

2) Rate of new cases with Grade-II disabilities per 100,000 population per year

3) Treatment completion/cure rate

o Main/core indicators to evaluate case detection:

1) Proportion of new cases with Grade-II disabilities.

2) Proportion of child cases among new cases

3) Proportion of MBL cases among new cases

4) Proportion of female cases among new cases.

o Main/core indicators to assess quality of services:

1) Proportion of new cases verified as correctly diagnosed.

2) Proportion of treatment defaulters

3) Number of relapsers

4) Proportion of patients developing additional disabilities during MDT.

HIV/AIDS: WHO RECOMMENDATIONS ON ART (2010):

· Start ART: CD4≤350 cells/mm3

· First line therapy: 1 NNRTI + 2 NRTIs (including Zidovudine/Tenofovir)

· Second line therapy: PI + 2NRTIs (including Zidovudine/Tenofovir)

· Treatment 2.0:

o Is a new approach ‘to simplify the way HIV treatment is currently provided, and to scale-up access to life-saving medicines.

o Could reduce newly HIV+ upto 1 million annually and avert additional 10 million deaths by 2025

o Requires progress across five areas: [Mnemonic: C2D3]

1) Reduce Costs

2) Mobilize Communities

3) Optimize Drug regimes: “Smarter,better pill”

4) Adopt Delivery systems

5) Provide access to point of care Diagnostics.

HOSPITAL ACQUIRED INFECTIONS: NOSOCOMIAL INFECTIONS:

· Nosocomial infections: Infections acquired during hospital care (occurring AFTER 48 HOURS OF ADMISSION)

· Most common Nosocomial infections: Urinary tract (UTI) > Lower respiratory tract > Surgical sites > Skin & soft tissue > Respiratory tract > Bacteraemia > Eye/ENT > Others.

· Standard precautions for all patients:

o Wash hands promptly after contact with infective material

o Use no-touch technique

o Wear gloves when in contact with fluids/blood/secretions/excretions.

ACCIDENTS AND INJURIES

· Main causes of accidental deaths in India:

o Traffic accidents (Most common)

o Drowning

o Poisoning

o Sudden deaths

o Fires

o Falls

o Electrocution

o Collapse of structures

PROBLEM STATEMENT OF DISEASES IN INDIA

· Diphtheria : 3480 cases, 113 deaths, Case fatality rate 3.25% [2009]

· Whopping cough: 55074 cases [2009]

· Meningococcal meningitis: 6386 cases, 460 deaths

· Tuberculosis:

o Incidence: 170 cases/100000 population

o Incidence: 75 new sputum smear +ve cases/100000 population

o Prevalence: 185 cases/100000 population

o Mortality: 24 deaths/100000 population

o % TB with HIV: 5%

o % new cases TB with Multidrug resistance: 2%

· Poliomyelitis:

o AFP: 50350 [2009]

o Non-polio AFP rate: 10.89 [2009]

o AFP with adequate specimens: 83 [2009]

o Polio cases: 756 [2009]; 46 [2010]; 03 [upto April 2011]

· Dengue:

o Cases: 15509, Deaths 89 [2009]

o Case fatality rate: 0.57% [2009]

· Malaria:

o Cases: 1.52 million (Plasmodium falciparum: 49.56%); Deaths: 924

o API: 1.40

o SPR: 1.60

· Japanese encephalitis:

o Cases: 4482; Deaths: 774 [2009]

· Kala azar: Endemic in 52 districts of Bihar, WB, UP, Jharkhand

o Cases: 20478; Deaths: 70 [2009]

· Tetanus (other than NNT):

o Cases: 2051; Deaths: 160

o NNT: Cases:889; Deaths: 31 [2009]

· Leprosy:

o Prevalence: 0.72 per 10000 population [2009]

o ANCDR: 1.1 per 10000 population

o Cases: 86000; 48% MBL cases; 10.1% children; 35.2% females; 2.8% visible deformity

o Cure rate: 90% (MBL) to 95% (PBL)

· HIV/AIDS:

o WORLD: Total People living with HIV 33.3 million (children 2.5 million)

o INDIA:

1) Total people living with HIV 2.27 million

2) HIV prevalence: 0.29%

Heterosexual route: 87.1% cases.

Chapter-National Health Programmes, Policies and Legislations in India

NATIONAL VECTOR BORNE DISEASE CONTROL PROGRAM (NVBDCP)- MALARIA:

· Operational principles:

o Delivery of malaria control services by ASHA at community level

o Supervision and monitoring by DVBDC consultants (district level) and Malaria technical Supervisors (MTS) (sub-district level)

o Strengthening of SPOs by project monitoring units

o Streamlined procurement and supply chain management

· Malaria Control Strategies: [Mnemonic: SIPS]

o Surveillance and case management

1) Case detection (Active + Passive)

2) Early diagnosis and complete treatment

3) Sentinel surveillance

o Integrated vector management:

1) Indoor residual spray

2) Insecticide treated bed nets (ITBN)/Long lasting Insecticidal nets (LLIN)

3) Antilarval measures (including source reduction)

o Epidemic: Preparedness and early response

o Supportive interventions:

1) Capacity building

2) Behaviour change communication (BCC)

3) Inter-sectoral collaboration

4) Monitoring and evaluation

5) Operational and applied field research.

· Surveillance:

o Active + Passive surveillance

o Pf Rapid diagnostic kits (RDT) are used where microscopy results are not available in 24 hours:

1) Test Falciparum Rate (TfR) ≥1%

2) Pf ≥30%

o Objective of program: >80% fever cases (suspected malaria) to be diagnosed either by RDTs or microscopy within 24 hours.

o Sentinel surveillance: 1-3 sentinel sites established in large hospitals for recording OPD/IPD cases + deaths.

· Criteria for Indoor Residual Spray (IRS): Village as UNIT OF INTERVENTION

o Spray all areas with API ≥ 5, where ABER ≥10% (Subcentre as unit)

o Spray all areas with SPR ≥ 5, where ABER ≤10%

o Pf > 50% proportion of cases

o Spray all areas with API/SPR < 5, in case of drug resistant foci, vulnerable migrant population

o Epidemics

o Entomological/ecological criteria.

· Goals for Strategic Plan 2007-12:

o ≥50% mortality reduction of malaria by 2010.

o ≥80% malaria sufferers get appropriate affordable treatment by 2012.

o ≥80% of those at high malaria risk protected by ITBN/LLIN or IRS by 2012.

NATIONAL VECTOR BORNE DISEASE CONTROL PROGRAM (NVBDCP) – FILARIA :

· Definition of Elimination of Lymphatic filariasis (by 2015): No. of microfilaria carriers <1% + Children born later are free of circulating antigenemia.

· Strategy of Elimination of Lymphatic filariasis (by 2015):

o Annual Mass Drug Administration (MDA) of single dose of Anti-filarial drug for 5 years to eligible population (EXCEPT Pregnant, Child <2 years, Seriously ill)

o Home-based management of lymphoedema + Upscaling hydrocoele operations at higher levels.

NATIONAL LEPROSY ERADICATION PROGRAMME:

· Disability Prevention and Medical Rehabilitation (DPMR) 2009-10:

o Implementation of DPMR activities and reporting its outcome (treatment of reactions, ulcers, physiotherapy, reconstructive surgery, MCR footwear)

o Integration of DPMR activities

o Developing a referral system

NATIONAL AIDS CONTROL PROGRAMME:

· HIV sentinel surveillance round 2008:

Item

General population

High risk groups (HRGS)

Special groups

Population group

15-49 years pregnant females

FSW, MSM, IDU, Migrants, truckers, Eunuchs

15-49 years STD clinic patients

Sample size

400

250

250

Sample collection

Routine i/v sample

Dried blood spot (Finger prick)

Routine i/v sample

Testing strategy

Unlinked anonymous

Testing protocol

2-test protocol

UNIVERSAL IMMUNIZATION PROGRAMME:

· Introduction of Japanese Encephalitis vaccine:

o Introduced in 2006 to cover 104 endemic districts

o Stain used: SA-14-14-2 (import from China)

o Routine immunization: Single dose 16-24 months.

Chapter-Essential Medicines and Counterfeit Medicines

ESSENTIAL MEDICINES MODEL LIST (WHO 2010): NEW CATEGORIES

· No.28 Ear, Nose and Throat Conditions in Children

o Acetic acid, Budesonide, Ciprofloxacin, Xylometazoline

· No.29 Specific medicines for Neonatal care

o Caffeine citrate, Ibuprofen, Prostaglandin E, Surfactant

Chapter-Demography, Family Planning and Contraception

WORLD POPULATION TRENDS [2008]:

· Total population: 6734 million

· Annual growth rate: 1.2%

· Highest population: China (19.9%) [Second highest: India 17.5%]

INDIA POPULATION TRENDS [2008]:

· Total population: 1181 million TFR: 2.6

· Crude birth rate: 22.8 per 1000 mid-year population

· Crude death rate: 7.4 per 1000 mid-year population

· Most populous state: UP (16.8% of total population)

TOTAL DEPENDENCY RATIO:

· Formula= [Children 0-14 y + Population >65 y]/ Population 15-64 y X 100

· Dependency ratio India: 61.1% [2005]

DEMOGRAPHIC TERMS:

· Demographic bonus: Period when the dependency ratio in a population declines because of decline in fertility, until it starts to rise again.

· Demographic burden: Increase in total dependency ratio during any period of time (mostly by increase in old-age dependency ratio).

Chapter-Preventive Medicine in Obstetrics, Paediatrics and Geriatrics

WHO CHILD GROWTH STANDARDS:

· New standards generated for age 0-60 months: Percentiles and Z-score for length/height-for-age, weight-for-age, weight-for-height, weight-for-length and BMI-for-age

· Changes from OLDER NCHS/WHO reference:

* BMI-for-age has been added

* Greater stunting will be assessed

* Greater wasting will be assessed in infancy

* Greater prevalence of overweight

GROWTH CHART USED IN INDIA:

· India has adopted new WHO child growth standards (2006) in 2009 for NRHM + ICDS

· Direction of growth is MORE IMPORTANT than position of dots

· Zones in the growth chart:

o Normal zone (weight-for-age)

o Under-nutrition: Below – 2SD

o Severe under-weight zone: Below – 3SD

· Joint “Mother and Child Protection Card” provides space to record:

o Family Identification and registration

o Birth record

o Pregnancy record

o Institutional identification

o Care in pregnancy

o Delivery Preparation

o Registration in Janani Suraksha Yojana (JSY)

o Immunization

o Breast feeding

o Supplementary foods introduction

o Milestones

o Birth spacing (Contraception)

o Reasons for Special care

INTEGRATED CHILD PROTECTION SCHEME (ICPS 2009-10):

· Beneficiaries: Children in need of care and protection, Children in conflict, Children in contact with law, Children of migrant families, Children of prisoners/prostitutes, Working children, Street children, Trafficked children, Sexually-exploited children, Child drug abusers, Child beggars.

· Objectives of ICPS: [Mnemonic: Such Important Release Emerged Responsibly]

o Structures establishment at all government levels for children in difficult circumstances.

o Improve access to and quality of CPS

o Raise public awareness about rights of children

o Evidence based monitoring and evaluation system

o Responsibility and accountability of child protection articulated.

· Services under ICPS: [Mnemonic:Emergency WINGS]

o Emergency outreach service (Helpline 1098: 24-hour)

o Web-enabled child protection management system

o Institutional services (Shelter home, Child home, Observation home)

o Non-institutional family-based care (sponsors, adoption, foster-care, cradle-baby centres, after care)

o General grant-in-aid for need based interventions

o Shelters (open) for children in need in urban, semi-urban areas.

XI FIVE YEAR PLAN (2007-12): CHILD HEALTH GOALS/TARGETS

· Reduction of IMR < 28 per 1000 live births by 2012

· To raise child sex ratio (0-6 years) to

935 by 2011-12

950 by 2016-17

MCH INDICATORS INDIA [2008]

Indicator

Value

Maternal mortality rate (MMR)

254

Infant mortality rate (IMR)

58

Neonatal mortality rate (NNMR)

Early NNMR

Post NNMR

36

29

23

Under five mortality rate (U5MR)

69

Still birth rate (SBR)

37

Perinatal mortality rate (PNMR)

9

Lifetime risk of maternal death

1 in 140

≥ 3 antenatal visits

51.1%

Institutional deliveries

47%

Safe deliveries

52.7%

100 days IFA tablets consumption

46.6%

Post-natal check-up within 2 days

47.9%

ICDS ANGANWADI NORMS:

o URBAN AREAS:

o 1 AWC for 400-800 population

o 2 AWCs for 800-1600 population

o 3 AWCs for 1600-2400 population

o 1 Mini-AWC for 150 population

o RURAL/TRIBAL AREAS:

o 1 AWC for 300-800 population

o 1 Mini-AWC for 150-300 population

Chapter-Nutrition and Health

WHO/FAO EXPERT GROUP FOR CVD PREVENTION:

· Total fat intake: 15-30% of total energy intake (minimum 20%)

· Total saturated fats: <10%

· PUFA: 6-10%

· n-6 fatty acids: 5-8%

· n-3 fatty acids: 1-2%

· Trans fatty acids: <1%

· MUFAs: by difference

· Total cholesterol: <300 mg/day

WHO/FAO EXPERT CONSULTATION ON FATTY ACIDS:

· Replacing SFAs with PUFAs: Decrease LDL + Decrease Total/HDL cholesterol + decrease CHD risk

· Replacing SFAs with Carbohydrates: Decrease LDL + Decrease HDL

· Replacing SFAs with TFAs: Decrease LDL + Increase Total/HDL cholesterol

· Replacing carbohydrates with MUFAs: Increase HDL

· Replacing SFAs with MUFAs: Decrease LDL + Decrease Total/HDL cholesterol

· TFAs (from partially hydrogenated vegetable oils): Increase CHD risk

· Minimum recommended intake for EFAs: 2.5% Linoleic acid + 0.5% alpha-linoleic acid

· Minimum recommended intake for PUFAs: 6%

· n-3 long chain PUFAs prevent CHD

· No role of n-3/n-6 ratio or n-3/linoeic acid ratios

· Replacement of TFA will be a challenge to food industry

GLYCAEMIC INDEX

· Definition : Area under the 2-hour glucose response curve (AUC)

· Low glycaemic index foods: Less readily digestible and lower absorption of sugar

· Classification of Glycaemic Index (GI):

Classification

GI range

Examples

Low GI

≤ 55

Most fruits & vegetables (EXCEPT potato/water-melon/sweet potato), Whole grains, Beans, Pasta, Lentils

Medium GI

56-69

Sucrose, Basmati rice, Brown rice

High GI

≥ 70

Corn flakes, Baked potato, White bread, Candy bar, Syrupy food, Jasmine rice.

REFERENCE BODY WEIGHTS

Reference Indian Man

Reference Indian Woman

Age

18-29 years

18-29 years

Weight

60 kg

55 kg

Height

1.73 metres

1.61 metres

BMI

20.3

21.2

Others

Free from disease, fit for active work; engaged in 8 hours of occupation (usually moderate activity), 8 hours in bed, 4-6 hours in sitting & moving about and 2 hours in walking and in active recreation or household duties.

Calculation

Average of values of age category 18-19 years, 20-24 years and 25-29 years.

· Infants:

o For computing reference weight 0-6 months: Average of weights at birth and 6 months

o For computing reference weight 6-12 months: Average of weights at 6 months and 12 months.

· Children:

· For computing reference weight 1-3 years: Average of weights at 18 months, 30 months, 42 months of WHO median weight

· For computing reference weight 4-6 years: Average of weights at 4+, 5+, 6+ years.

· For computing reference weight for other age groups: From 95th percentile value of body weights from Rural India.

ENERGY, PROTEINS & FAT REQUIREMENTS:

· Energy requirements based on 3 components: [first component same for all]

o Energy required for basal metabolism (1 Kcal/kg/hour)

o Energy required for daily activities

o Energy expenditure for occupational work (light/moderate/heavy)

· Proteins requirements: 0.83 gm/kg/day

Group

Body weight

Requirement

Energy

Proteins

Fat

Adult man

Sedentary

Moderate

Heavy

60 kg

60 kg

60 kg

2320 Kcal/day

2730 Kcal/day

3490 Kcal/day

60 grams/day

60 grams/day

60 grams/day

20% of total energy

20% of total energy

20% of total energy

Adult woman

Sedentary

Moderate

Heavy

55 kg

55 kg

55 kg

1900 Kcal/day

2230 Kcal/day

2850 Kcal/day

60 grams/day

60 grams/day

60 grams/day

20% of total energy

20% of total energy

20% of total energy

Pregnant woman

55 kg + wt gain

+350 Kcal/day

78 grams/day

20% of total energy

Lactating woman

0-6 months

6-12 months

55 kg + wt gain

+600 Kcal/day

+520 Kcal/day

74 grams/day

68 grams/day

20% of total energy

20% of total energy

Infants

0-6 months

6-12 months

5.4 kg

8.4 kg

500 Kcal/day

670 Kcal/day

1.16 gm/kg/d

1.69 gm/kg/d

40-60% of total energy

35% of total energy



VITAMIN-A REQUIREMENTS:

o Man/Woman: 600 mcg Retinol (4800 mcg beta-carotene)

o Pregnancy: 800 mcg Retinol (6400 mcg beta-carotene)

o Lactation: 950 mcg Retinol (7600 mcg beta-carotene)

o Infants (0-6 months): 350 mcg Retinol

o Infants (6-12 months): 350 mcg Retinol (2800 mcg beta-carotene)

CALCIUM REQUIREMENTS:

Pregnancy/Lactation: 1200 mg/day

FOLIC ACID REQUIREMENTS:

Pregnancy: 500 mcg/day

Lactation: 300 mcg/day

IODINE REQUIREMENTS:

Pregnancy: 250 mcg/day

IRON REQUIREMENTS:

Group

Body weight

Requirement (mg/day to be absorbed)

Adult man

60 kg

0.84

Adult woman

55 kg

1.65

Pregnant woman

55 kg

2.80

Lactating woman

55 kg

1.65

Infants

0-6 months

6-12 months

5.4 kg

8.4 kg

46 mcg/kg/day

87 mcg/kg/day

Chapter-Social Sciences and Health

SOCIO-ECONOMIC INDICATORS OF INDIA [2009-10]:

· Gross national income (GNI US$) : 1070

· GDP per capita (annual growth rate): 4.7%

· Human development index (HDI): 0.519

· Dependency ratio: 55.6%

· Adult literacy rate: 62.6%

· Gross primary school enrolment ratio: 113.1%

· Gross secondary school enrolment ratio: 57%

Chapter- Occupational Health

ESI ACT, INDIA 1948

· Beneficiaries: All employees- manual, clerical, supervisory, technical getting upto INR 15000/- per month.

· Beneficiaries total: 344 lakh beneficiaries, 143 lakh families, 138 lakh employees, 260 lakh females.

· Infrastructure: 143 hospitals, 43 hospital annexes, 27000 beds.

· Funeral expenses benefit: INR 5000/-

****************

9 comments:

kambupani dash said...

thnks sir

Dr. Satyaki Basu said...

thanks a lot.

prashantjazz said...

Thank you very much sir.

psmmcqbook said...
This comment has been removed by the author.
psmmcqbook said...

Nothing great. It is all copied from PSM MCQ book by Dr Vivek Jain (3rd edn), even all the mnemonics. A legal notice is on the way by JayPee Medical Publishers Pvt Ltd..

shabib said...

Excellent job sir ji....what an idea sir ji...
Thanks a lot..
Future me bhi updates karte rahna ji.

choduyadav said...

What an idea sir ji....thank you. Kamaal kar diya aapne, malamaal kar diya aapne !!!

malaria microscope said...

Amazing how simple it can be to communicate with people and have them understand a certain topic, you made my day.

Fluorescent Malaria Microscope Africa

Anil Kumar said...

Top Cancer Hospitals in Kolkata generate wakefulness and struggle alongside cancer in the midst of the people. One of the cancer patients is well known all the way through the world for her proficiency and just the thing concert was diagnosed with cancer.

Post a Comment