Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
Schedules
I - categories, treatment and disposal
II - colour coding and containers
III - label for bags, containers
IV - label for transportation
V - standards for treatment and disposal
YELLOW CATEGORY
RED CATEGORY
WHITE CATEGORY
BLUE CATEGORY
● Glassware
● Metallic body implants - orthopedics, ENT, dental surgery
- cardiovascular thoracic surgery
Incineration
Autoclave
Hydroclave
Microwave
● Wavelength = 12 nm wave
● Frequency = 2450 mHz
● Principal: generation of convection currents in heated h20 molecules
● checks sufficiency - bacillus atrophaeus spore
NEWER METHODS
Encapsulation
● Filling container with Biomedical Waste and Immobilization material (foam,
sand, cement clay) and Seal the container.
Plasma pyrolysis
● Temperature: > 1200°C
Inertization
● Large volume of toxic Biomedical Waste is converted to non toxic/inert waste .
● Converted via 15% cement + 15% lime
Dry heat
● Temperature: > 185°C
Composting methods
● Land + cow dung
● Vermicomposting
1. Earthworms (Eisenia fetida) + Land + Mature cow dung (khad) + Coconut husk
Special waste
Waste Disposal
E-waste recycle
Contraceptive Failure/Efficacy
1. Contraceptive Failure - Assessed by measuring the Number of unplanned pregnancies
that occur during a specified period of exposure and use of a contraceptive method.
2. Pearl index (PI)
● Total number of failures per 100 women years (HWY) of exposure.
● HWY - 100 women using particular contraception for 1 year
● PI = total accidental pregnancy X 1200
total months of exposure
● Disadvantage: assumes constant failure rate over time.
● PI of few Contraceptive methods
Contraceptive Method PI (per HWY)
IUD 0.5-2.0
Sterilization 0.1
(Vasectomy -
superior)
3. Life Table Analysis (LTA)
● calculates failure rate per month of use by single women
● Better measure than Pearl Index.
Conventional contraception
1. Aka Coitus-dependent contraception
2. Contraceptives which are used at or just prior to the time of intercourse.
3. Methods of contraception
a. Male condoms
b. Spermicides (Non-oxynol-9)
● MAO: rupture the plasma membrane of acrosomal cap.
Interception / Emergency contraception
1. Aka Post-coital contraception or Coitus-independent contraception
2. Contraceptives which are used after unprotected intercourse.
3. Methods of contraception
a. Combined OCPs → taken < 72 hours of unprotected sex
● Yuzpe & Lancee Method - 4 pills followed by 4 pills with a gap of 12 hrs,
completed within 72 hrs.
b. Progesterone only pills → taken < 72 hours of unprotected sex
● 1 pill followed by 1 pill with a gap of 12 hrs, completed within 72 hrs.
● Dose: I pill = 0.75 mg
c. Mifepristone (RU 486) → taken < 72 hours of unprotected sex
d. High dose estrogen → given continuously for 5 days
e. IUDs → Within 5 days of unprotected sex
4. Recommended Contraception
● Most effective - IUDs.
● MC recommended by RCH - Combined OCPs.
i) IUDs are contraindicated in Nulliparous women. In India, most of the women
who report for pregnancy are Unmarried/Nulliparous.
1. Condoms
Male condom Female condom
Reuse X ✓
No. of rings 1 2
2. Diaphragm
● Used along with Spermicides.
● Reusable [Wash → Dry → Use].
● Inserted 4 hours before sex and remains in the vagina 6 hours after sex.
High level of motivation is required, hence used by educated women.
● Complication
a. yeast infection, bacterial vaginosis
b. toxic shock syndrome
1. Vaginal Sponge
● Brande name: TODAY.
● Used along with Spermicides.
● Inserted 4 hours before sex and remains in the vagina 4 hours after sex.
● Complication
c. yeast infection, bacterial vaginosis
d. toxic shock syndrome
1. Spermicide
2. Foam
3. Jelly
● Types of IUDs
1st generation IUDs 2nd generation IUDs 3rd generation IUDs
1. Combined OCP
● Combined OCP under RCH programme
MALA-N MALA-D
1. Centchroman
● BRAND name: Old - Saheli; New - Chhaya.
● Developed by Central drug Research Institute (CDRI), Lucknow, India.
● Synthetic NON-STEROIDAL oral contraceptive
● Contains: Ormeloxifene [SERM]
● Dosage - 1 tablet X twice a week X 3 months → 1 tablet X once a week.
● Pearl Index (PI) = 1.83-2.84 per HWY.
● Contraindication - Polycystic Ovarian Syndrome (PCOS).
1. Gossypol
● Male oral pill
● Derived from chineses cotton oil
● Limitation - permanent azoospermia
1. DEPOT formulation
● IM injectable hormone
● Depot formulation:
DMPA = Depot Medroxy progesterone Dose: 150 mg i/m every
acetate. 3 months
1. Norplant
● Subdermal implant
● Contains: 6 silastic capsules containing 35 mg LNG each.
● Capsules are inserted surgically beneath the skin of forearm.
● Effectiveness - 5 years
1. Vasectomy
a. Remove a minimum 1 cm of Vas deferens. Ends are ligated and folded back.
No scalpel vasectomy/ Keyhole vasectomy:
- Tiny puncture by surgical hook on scrotum → Vas pulled out → Cut, tie
ends & push back → bandage is applied over it [NO stitches].
b. Post-operative advice: use Barrier methods for 3 months till aspermia. Person is
not sterile UNTIL after 30 ejaculations post vasectomy.
c. MCC of failure of Vasectomy in India: misidentification of Vas deferens.
To prevent this: surgeons cut suspected Vas deferens → squeeze contents out &
examine under microscope → if sperm present → continue w/ procedure.
2. Tubectomy
a. Block both the fallopian tube.
b. Methods commonly used:
- Mini-laparotomy procedure
- Laparoscopic procedure
Ideal contraceptives
1. 35 yr old educated (temporary spacing) - Diaphragm.
2. Newly married - Combined OCPs.
3. Couple meet occasionally & Teenage girl - Condoms.
1. HDI vs PQLI
Human Development Index (HDI) Physical quality of life index (PQLI)
Components
Life expectancy at birth (LBb/LE0) Life expectancy at 1 year (LE1)
Range 0 to +1 0 to 100
Components
Dimension Indicators
Range 0 to +1
Value Interpretation
a. Calorie Intake
- Rural: < 2400 kcal/day
- Urban: < 2100 kcal/day
Endemic
1. Constant presence of a disease /pathogen in a defined geographical area.
2. ‘Usual or Expected frequency of a disease’.
3. Types
a. Hyperendemic - affects all age group equally.
b. Holoendemic - affects most of the children population
4. Example: In India → respiratory diseases, TB, HIV, diabetes, CHD.
Pandemic
1. An Epidemic affecting a large population over a large geographical area
[States → Nation → Continent → Globe]
2. Country to Country spread. Crosses international border.
3. Example:
a. Swine flu (H1N1)
b. Avian influenza (H5N1)
c. HIV
d. Ebola
e. Zika virus
Sporadic
1. There is No Epidemiological linkage
- Cases are scattered about in time,space & person.
- Cases shows little or no connection with each other.
2. Example: Schizophrenia, Snake bite, Arsenic poisoning
Disease control Disease elimination Disease eradication
Patient reports to health system - Health system goes to Helps in identifying missing
90% of cases reported community to search for cases cases and supplementing
- 8 to 10% cases reported notified cases.
1. Primordial prevention
a. It is prevention of the emergence or development of risk factors in population
groups where it has not appeared.
b. Modes of Intervention
● Individual health education
● Mass health education
2. Primary prevention
a. It is the action taken prior to onset of disease which removes the possibility that
the disease will ever occur. Risk factor present but no disease yet.
b. Modes of Intervention
● Health Promotion
● Specific protection
3. Secondary prevention
a. It halts the progress of disease at its incipient stage and prevents complication.
Disease has started in body.
b. Modes of Intervention
● Early diagnosis
● Treatment
4. Tertiary prevention
a. Is applied when disease has advance beyond early stages, it aims to reduce or
limit impairments and disabilities, minimise suffering caused by existing
departures from good health.
b. Modes of Intervention
● Disability limitation
● Rehabilitation
Cases of disease
Case - Person having particular disease and disorder or condition under investigation
1. Primary case: first case of communicable disease introduced into population.
2. Secondary case: all cases that develop from contact with primary case.
3. Index case: first case that comes to the notice of the investigator → registered.
Carrier of disease
Carrier - Infected person that Harbour is a specific agent in the absence of discernible clinical
disease, and serves as a potential source of infection for others.
1. Contact: Carrier who develops infection from Case.
2. Paradoxical: Carrier develops infection from Carrier.
3. Pseudo: Carrier harbouring avirulent organism.
4. Chronic: Carrier sheds infectious agent > 6 months.
5. Incubatory: Carrier sheds infectious agent during IP of disease.
6. Convalescent: Carrier sheds infectious agent during recovery phase.
Demographic cycle
● Age specific fertility rate (ASFR) = total live birth X 1000 per yr
women in any age specific group
Important relations:
→ GRR/NRR = ½ X TFR
→ CBR = (8 X TFR) + 1
→ Child Women ratio = total children (0-4yr) / total women (15-49yr)
Goals
→ TFR = 2.1 by 2017
→ NRR = 1 by 2017
→ Couple protection rate (CPR) > 60%; Ideal - Vasectomy
Literacy rate
1. Growth rate - change in the number of individuals in a population per unit time.
2. Growth Rate data [India]
a. Annual growth rate (AGR)
● AGR = Crude Birth Rate - Crude Death Rate
● AGR = 1.64%, since India is in very Rapid growth phase (1.5-2.0%),
population of India will double in 35 to 47 years.
3. Population distribution
a. Geriatric (>60yr): 8%
b. Children (0-5yr old): 10%
c. Urban India - 3%
Population (Age-Sex) pyramid
1. Census of India
● Conducted once every 10 years
a. first census: 1871
b. first disability census: 1881
● Census Stop - 00.00 hrs on March 01
● Big grade Indian divide: 1921
● Regulatory body - Ministry of Home Affairs.
● Identification by (newly included)
a. 10 fingerprint
b. Iris scan
c. Photograph
d. Aadhar number
e. National Population register
1. National family planning + Maternal child health (MCH) ----> Child survival and safe
motherhood (CSSM)
2. Child survival and safe motherhood (CSSM) + Reproductive tract infection (RTI)/
Sexually transmitted infection (STI) ---> Reproductive child health (RCH)
Postnatal Visits
IMR (Infant mortality Infant death (birth - 1yr) / Live Low birth weight 34
rate) birth X 1000 Premature birth
U5MR (Under five Children (birth - 5yr age) death / Low birth weight 43
mortality rate) Live birth X 1000 Premature birth
NNMR (Neonatal Neonatal death / Live birth X 1000 Low birth weight 25
mortality rate) 1] Early NNMR = birth - 7days Premature birth
2] Late NNMR = 7 - 28 days
3] Post NNMR = 28 days - 1yr
PNMR (Perinatal Late fetal + Early Neonatal death / Low birth weight 24
mortality rate) Live birth X 1000 Premature birth
1] Late fetal = 28th wk POG - birth
2] Early Neonatal = birth - 7days
SBR (Stillbirth rate) Still birth (28th wk POG - birth) / Maternal Infection 22
Live birth X 1000 Placental abruption
1. WHO guidelines:
a. Exclusive breastfeeding till 6 months of age
b. Continue breastfeeding till a minimum of 2 years
1. ‘Exclusive’ means no Prelacteal feeding except:
a. Vaccines: OPV, Rotavirus vaccine
b. Medication: ORS
c. Supplementation: Vit. B
1. Nutritional importance of breast milk
● Energy content = 65 Kcal/100ml
● Protein content = 0.9-1.1 g/100ml
● Most abundant Ig type = IgA
● Essential FA - DHA (Docosahexaenoic acid)
● Abundant AA: Taurine
● Vitamin: vit. A & C
Lactose, Iron, Water, Calcium, phosphate, Vitamin A Protein, Fats, Calcium, Phosphate,
& C, Copper, Cobalt, Selenium, Cysteine, Taurine, Vitamin B & D, Sodium, Potassium,
Linolenic acid, Linoleic acid, PUFA. Methionine.
Preventive Geriatrics
1. Age group > 60 years.
2. 8% of India is geriatric.
3. MC health disorder - Cataract.
4. MC cause of death above 70yrs age - CV disorder
Primary Health Care
Health Centres
Care delivered by Plains Hilly/Tribal Beds Number Staff
area (infrastructure)
Tertiary
1. Medical College and - - - 500 -
associated hospital
Secondary
1. CHC (community health 1/120000 pop. 1/80000 pop. 30 5500 46-52
centre)
Primary
1. PHC (primary health 1/30000 pop. 1/20000 pop. 4-6 25000 13-21
centre)
2. Sub-centre 1/5000 pop. 1/3000 pop. 0 155000 3-4
[Only sub-centre is run by Central Government. Rest is run by State Government]
Sub-centres
Type A Type B
Safai Karamchari 1 1
[ANM can substitute female health worker if required]
a. Total staff in Type A = 3
b. Total staff in Type B = 4
MBBS 1 2
AYUSH 1 2
[Health Assistant is present at PHC]
a. Total staff in Type A = 13-18
b. Total staff in Type B = 14-21
Pediatrics
[Health supervisor is present at CHC]
a. Total staff = 46-52
Grass root level worker
1. ASHA = Accredited Social Health Activist
2. MPW = Multi Purposes Health Worker
3. VHG/CHW = Village Health Guide (new) / Community Health Worker (older)
4. TBA = Traditional birth attendant
5. AWW = Anganwadi worker
Health workers
Location Population norm Education Training
Urban Healthcare
Health centres
Tertiary Medical College and Hospital
1. HEALTH CENTRES
Plains Hilly area
1 U-PHC 1/50000
1 U-CHC 1/250000
1/500000
1. WORKERS
1 ASHA 1/500
1 MPW 1/5000
1 VHG 1/1000
1 TBA 1/1000
1 U-ANM 1/10000
1 pharmacist 1/10000
1 doctor 1/1000
1 ophthalmologist 1/50000
1. TB control
1 TB microscope 1/ 100000
1 TB unit 1/500000
1. Malaria Control
1 Malaria microscopy 1/25000
1. Leprosy control
1 Set centre 1/25000
1. ISM and H (Indigenous Medicine and Homeopathy) have now been re-designated as
‘AYUSH system’ of medicine.
2. Father of Homeopathy - Samuel Hahnemann
3. Full form of AYUSH
● A - Ayurveda → [indian origin]
● Y - Yoga and Naturopathy → [indian origin]
● U - Unani → [greek origin]
● S - Siddha → [indian origin]
● H - Homeopathy → [german origin]
1. Additional component of AYUSH = Sowa-Rigpa → [chinese origin].
2. Types of Medicine
a. State medicine
- provision of free medical services to the people at Govt expense.
- present in India
b. Socialized medicine
- provision of medical services and professional education by Govt,
but program is regulated and operated by professional groups.
- started by Russia (absent in India)
- Advantages
---> prevents competition between practitioners and clients
---> provision of medical services supported by State govt
---> social Equity
Occupational disease
1) Physical agent
noise deafness
2) Chemical agent
Gas Poisoning
Dust Pneumoconiosis
3) Biological agent
Infections: Brucellosis, Anthrax, Leptospirosis.
4) Occupational Dermatitis
5) Occupational cancers
6) Others: neurosis, hypertension
Pneumoconiosis
2) Particle Size:
Particle Feature
size
3) Epidemiology
Disease Association
4. Clinical feaures:
a. Due to inorganic lead
→ Bartonian line - blue line on gum (PbS)
→ Pallor - 1st and most consistent sign
→ Wrist and foot drop - nerve palsy [Radial + Peroneal nerve]
→ Colic
b. Due to organic lead
→ Encephalopathy
6. Diagnosis
- aminolevulinic acid in urine > 5mg/L
- Pb Level in blood > 70 mcg/100mL
- Pb Level in urine > 0.8 mg/L
7. RBC findings:
- Basophilic stippling
- microcytic hypochromic anaemia
mesothelioma Asbestos
leukaemia Benzene
3. Treatment of choice
a. recompression chamber
b. hyperbaric oxygen therapy
Nutrition
PROTEIN
● Table
Quantity Quality
Definition - These fatty acids cannot be synthesized completely in human body they can only be
supplemented from the food.
List of Essential FA
1. Linoleic acid
2. Linolenic acid
3. Eicosapentaenoic acid (EPA)
4. Docosahexaenoic acid (DHA)
PUFA - safflower
SFA - Coconut oil
MUFA - olive oil
Linolenic acid - Flaxseed oil (not used in India) > Soyabean oil
EPA - Fish oil
Iron
Richest source
1. dried Pumpkin seeds
2. pistachio nuts
3. cashew nuts
Vitamin A
Richest source - Halibut liver oil
Richest ‘Fruit’ source - Ripe mango
Richest ‘Vegetable’ source - Carrot
Vitamin D
Richest source - Halibut liver oil
[no plant/vegetable source - it depends on sunlight(hv)]
Vitamin C
Richest source
1. amla (Indian gooseberry)
2. guava - noncitrus fruit
3. cabbage - vegetable
Golden rice
● Genetically modified crops (GMC)
● it is made rich → Iron
→ vitamin A (β carotene)
Poor sources:
1. Egg - Carbs and Vit C
2. Milk - Iron and Vit C
3. Meat - Calcium
4. Fish - Carbs and Iodine
Recommended dietary allowance [RDA]
- Nutritional requirement that can satisfy the need of > 97.5% (Mean + 2SD) of population.
- RDA is often higher than the recommended minimum requirement
→ RDA = daily requirement + additional requirements (for period of growth/ illness)
→ includes all nutrients except ENERGY
- RDA ‘safe level approach’ is NOT USED FOR ENERGY since excess energy intake
is stored as fat leading to ↑ risk of CVD. Here only actual requirement is taken.
Weight 60 kg 55 kg
Require Intake
Food Adulteration
● Any mismatch between the actual content and those mentioned on a food packets
● Specific adulterant
Food Adulterant
Vitamin B2 (Riboflavin)
Deficiency leads to:
1. Ariboflavinosis - it is a clinical triad of
→ Cheilosis - chapped and fissured lips
→ Angular stomatitis - inflammation at mouth corner
→ Atrophic glossitis - smooth glossy tongue
Vitamin B3 (Niacin)
Deficiency leads to:
1. Pellagra
● Characterized by ‘4D’s + ‘2D’s
a. Diarrhoea e. Delirium
b. Dementia f. Depression
c. Dermatitis
d. Death
● Common in maize/jowar eating populations:
- Limiting AA is tryptophan while Excess AA is Leucine.
- 50mg of Tryptophan is converted to 1mg of Niacin in body.
- Excess of leucine interferes in conversion of Tryptophan to Niacin.
Vitamin B6 (Pyridoxine)
Deficiency leads to:
1. Microcytic anemia & Peripheral neuritis
● Seen in Isoniazid therapy under RNTCP.
Gene - sequence of DNA which codes for a molecule that has function.
Genome - sum total of genetic information of an organism.
Genomics - study of Human Genome.
Gene therapy - introduction of a gene sequence into a cell to modify its behaviour.
Genetic counselling
Prospective type Retrospective type
Female
A (p) a (q)
B - 33% Rh-ve - 6%
A - 22%
AB - 5%
Amniocentesis
a process in which amniotic fluid is sampled using a hollow needle inserted into the uterus, to
screen for abnormalities in the developing fetus.
International classification of IQ
Classification IQ score
Idiot 0-24
Imbecile 25-49
Moron 50-69
Borderline 70-79
Normal 90-109
Superior 110-119
Normal IQ ≥ 70
Moderate MR 35-49
● Launched - 1982
● Aim
1. prevention and treatment of Mental Health disorders.
2. use of Mental Health technology to improve health.
3. Application of Mental Health principle in development
and to improve the quality of life.
● Objective
1. Availability and accessibility for all
2. Application of Mental Health knowledge in General Health Care
3. Promote community participation
The mental health act (1987) is currently known as The Mental Health care (2011)
Methods of Healthcare
1. Lecture
● aka chalk and talk method
● one person addressing audience
● Features
- group size < 30
- time < 15-20 min
- Advantage → large population covered in small time
- Disadvantage → no question and answers
1. Focus Group discussion (FGD)
● Group size of 6 to 12 persons
- 1 Group leader: initiates discussion, helps discussion in a proper manner,
prevents side conversation, encouraging to participate,
and sums up the discussion.
- 1 Recorder: records/draws sociogram (interaction b/w participants),
reports on issues discussed, and agreements reached.
1. Panel discussion
● Discussion among 4-8 experts in front of audiences
● Features
- no specific order of speeches
- no preparation of speech
- Ask doubt at the end
1. Workshops
● Series of 4 or more meetings
● Features
- imparts training and skills to participants
- group work, group discussion, plan of action
- help from consultant & resource person
1. Symposium
● Series (1st lecture on disease epidemiology → 2nd lecture on disease
management) of lecture by expert in front of audience
● Features
- No discussion among the experts
- Specific order of speeches
- set speeches/lectures
1. Conference / Seminars
● Combination of the ‘group methods’ organised on a big (macro) level
- university level
- state level
- national level
1. Demonstration
● it is a carefully planned presentation to show how to perform a skill or procedure
● demonstrator carries out step by step in front of audience and involves them
● Ex - health worker → ORS preparation.
● Features
- seeing is believing
- learning by doing
1. Flannelgraph
● Series of photographs → posted on a piece of cloth in chronological sequence.
● Ex- teaching the life cycle of plasmodium.
Based on 3 Levels
1) Intellectual - based on literacy and comprehension of doctor and patient
→ non-technical level
2) Emotion - bonding between doctor and patient
3) Cultural - Doctor and patient with same culture
→ religion, region, socioeconomic status
Types
● Default - neither doctor no patient has focus
● Paternalistic - doctor is dominant
● Consumeristic - patient is in focus
● Mutualistic - both doctor and patient jointly involved in decision making
Health education
1. Definition:
Diversified collection of media technologies intended to reach a mass audience.
1. Advantage
● reaches Large Population in small time
● highly effective for low literacy population
● reach to remote areas
● gets attention
1. Disadvantage
● One way communication
● may not effect in change of behaviour
Safe and Wholesome water Criteria - Water free from → colour/ order
→ chemical agent
→ biological agents
→ usable for domestic purposes
Disinfection of water
1. Boiling (BEST method) - destroys everything
2. Chlorine (2nd best method) - can’t destroy → Cyclops (copepods)
→ Poliovirus
→ Hepatitis a virus
→ cyst and ova of parasites
→ bacterial spore
3. UV rays
4. Ozone gas
CHLORINATION
● Use - To find out the dose of bleaching powder required for disinfection of water.
● Contents:
1. 6 white cups (200 ml capacity each)
2. 1 black cup (with a Circular mark inside)
3. 2 metals spoons
4. 7 glass stirring rods
● Indicator:
1. Starch iodide - producing blue colour
(development of blue colour indicates presence of free residual chlorine)
● Procedure
1. Take 1 level spoonful of bleaching powder (2g) in the black cup along with
normal water up to the circular mark (Stock soln). Fill the six white cups with
water to be tested. With the pipette, add 1 drop of stock solution to 1st cup ---> 6
drop to 6th cup. Stir and wait. Add 3 drops of Starch iodide Indicator to each of
the white cups. Wait until colour develops.
● Dose of bleaching powder required [Chlorine demand]
= n X 2 gms to disinfect 455 L of water
[n - number of first Cup which shows distinct blue colour]
Hardness of water
Compounds
1. fluorides < 1 ppm
2. nitrates < 45 ppm
3. nitrites < 3 ppm
Radioactivity
1. Alpha (α) particle < 0.5 Bcq/L
2. Beta (β) particle < 1.0 Bcq/L
Medical entomology
Breeding Clean water Dirty polluted water Artificial collection of Water bodies w/
Habitat water (rain) aquatic plants
Eggs - Laid singly Laid in small - Laid singly Laid in star shaped
- Boat shaped clusters/rafts - Cigar shaped clusters
- Lateral floats
Adults - Straight body inclined ‘Hunch back’ rest White Stripes on body
at an angle to Surface and legs
- Spotted wings
Instruments
1. Kata thermometer - low air velocity
2. Hygrometer and psychrometer - air humidity
3. Anemometer - air velocity
4. Wind vane - air direction
Types of ventilation
1. Exhaust ventilation - air is extracted to outside by exhaust fans given by electricity
2. Plenum ventilation - fresh air is blown into rooms by centrifugal rooms
3. Balanced ventilation - combination of exhaust and plenum ventilation
4. Air conditioning - simultaneously controls of all factors specially temperature, humidity
and air movement
4) Sound
5) Housing
● Housing standards
1. Floor space per person > 50-100 ft² (avg. = 70-90 ft²)
2. Cubic space per person > 500 ft³
3. Door and window area ≥ 40% of floor area
● Overcrowding criteria
1. Number of person per area > 2
2. floor space per person <70-90 ft²
3. 2 persons > 9 years age (not husband-wife) sleep in same room.
→ If any one of the above is present → overcrowding
→ Hazards: increases risk of communicable diseases
6) Radiation
● Radiation exposure in Chernobyl tragedy - Cesium (Cs), Iodine (I), Strontium (Sr)
● Thickness of lead apron to prevent exposure: ≥ 0.5 mm
● State receives highest solar radiation - Rajasthan
● Maximum utilisation of solar radiation - Gujarat
● Total natural radiation received = 0.1 rad/person/yr
● Maximum permissible radiation exposure
1. Man = 5 rad/ person /yr
2. Pregnant women = 0.5 rad/ person /yr
7) Waste Disposal
● Types of waste
1. Refuse - solid waste generated from living room, street, industry.
2. Garbage - solid waste from kitchen
3. Sewage - liquid waste containing human excreta (polio virus)
4. Sullage - liquid waste without human excreta
● Sewage contains 99% of water
● Strength of sewage
1. Biological oxygen demand [BEST indicator]
2. Chemical oxygen demand
3. Suspended solids
● Strong sewage: > 30 BOD
Ergonomics
Sickness absenteeism
1. Medical Cause
2. Non sickness cause
→ economic
→ social
→ others
Contribution to ESI
a. employer 4.75% of wages
b. employee 1.75% of wages
c. Central : State = 7:1
Coverage
a. all non seasonal factories ≥ 10person
b. other factories ≥ 20 person
Benefits
1) Medical benefit - full medical care
2) Sickness benefit - 90% wages X 91 days
Extended sickness benefit - 80% wages X 2 years
Enhanced sickness benefit - 100% wages X 7 days {Vasectomy}
- 100% wages X 14 days {Tubectomy}
3) Temporary disablement benefit - 90% wages till recovery.
4) Permanent disablement benefit - 90% wages (medical board)
5) Maternity Benefit - 100% wages X 26 weeks
6) Dependence benefit 90% wages (pension)
7) Funeral expenses - ₹ 10k
Disaster management
Disaster: an occurrence that cause damage ecological disruption loss of human life or
deterioration of health or health services on a scale sufficient to warrant an extraordinary
response to outside region.
From Colin grant: disaster is Catastrophe causing injury and/or illness simultaneously.
types of disaster
Natural
geological Earthquake
volcanoes
hydrological Flood
tsunamis
climatological Drought
Fires
biological epidemic
Man made
Wars
Accidents
Disaster cycle
(1) Disaster impact → (2) Health and Medical Relief → (3) Rehabilitation →
(4) Disaster mitigation → (5) Disaster preparation → (1) Disaster impact
Health and medical relief
Primary 0-6 hrs first aid, medical care
Triage - consists of rapidly classifying the injured ‘on the basis of severity of the injuries and
likelihood of their survival’ with prompt medical interventions
Tagging: is the procedure where identification, age, place of origin, triage category, diagnosis
and initial treatment are tagged on to every victim of disaster through a colour coding.
Types of triage
1. START: simple triage and Rapid treatment
if disaster occurs in: remote inaccessible area of our country
triage done by lay person
2. Reverse triage - minor injuries are given highest priority (wars, battle)
Smallpox
● Causative agent: Chordopoxvirinae (Orthopoxvirus).
● Last case of Smallpox
a. World: 26th October 1977, Somalia
b. India: 24th May 1975
● WHO declared global eradication of Smallpox: 8th May 1980
Chickenpox
● Causative agent: Varicella zoster virus [Human alpha herpesvirus-3]
● Incubation period: 14-16 days
● Source of infection: Case
● Mode of transmission: Air droplets
● Specimen & Diagnosis - vesicle fluid → microscopy
● SAR - 90%
● Vaccine: live attenuated, OKA strain
● Late complication: Recrudescence → Shingles
● Period of communicability: 2 days <--- Rash appearance ---> 5 days
● Differential diagnosis
Chicken pox rash Smallpox rash
Effects flexor surfaces, involves axilla Effects extensor surfaces, spares axilla
Measles (Rubeola)
● Causative agent: RNA paramyxovirus
● Incubation period: 10-14 days
● Source of infection: Case [No carriers seen → No Iceberg phenomenon]
● Mode of transmission: Air droplets
● Period of communicability: 4 days <--- Rash appearance ---> 5 days
● SAR - 80%
● Clinical features
a. Pathognomonic: Koplik spots (opp. to lower 2nd molar).
b. Rash is of Retro-auricular origin.
● Complication
a. Most common: Otitis media
b. Rare: Subacute sclerosing panencephalitis (SSPE)
[affects 7/million after 7-10 yr]
● Vaccine
a. Active immunization
- Live attenuated
- Diluent: distilled h20
- Strain: Edmonston-Zagreb
- Administration: 0.5 ml s/c in R arm
- Dose:
1) 1st dose: given at 9-12 months
2) 2nd dose: given at 16-24 months
b. Passive immunization
- Measles Ig (0.25 ml/kg BW)
Mumps (Rubula)
● Causative agent: Myxovirus parotiditis
● Incubation period: 14-21 days
● Source of infection: Case (clinical & subclinical)
● Mode of transmission:Air droplets
● Period of communicability: 4 days <--- Symptom onset ---> 7 days
● SAR: > 86%
● Most common complication
a. Adult: Orchiditis
b. Child: Aseptic meningitis
● Vaccine: live attenuated, Jeryl Lynn strain.
Rubella
● Causative agent: RNA Togavirus
● Incubation period: 14-21 days
● Source of infection: Case [No carriers seen → No Iceberg phenomenon]
● Mode of transmission: Air droplets
● Period of communicability: 4 days <--- Symptom onset → Rash appearance ---> 7 days
● Vaccine
a. live attenuated
b. strain RA 27/3
c. C/I in Pregnant/Lactating mothers & not given to infants.
d. 1st priority: reproductive age group ♀ (15-49 yrs).
● Congenital Rubella Syndrome
1. Syndromic triad
i) Sensorineural deafness
ii) Congenital heart defects (PDA)
iii) Cataracts
2. Time of transmission: 1st trimester [MOST DISASTROUS]
{if transmitted in 2ns trimester → only Sensorineural deafness
if transmitted in 3rd trimester → normal baby}
Influenza
● Causative agent: Orthomyxovirus
- Type A: epidemics every 2-3 yrs & pandemics every 10-15 yrs
[MC cause of Epidemic/outbreak]
- Type B: epidemics every 4-7 yr
● Currently circulating influenza virus
a. H1N1 (type A) → swine flu
b. H3N2 (type A) → swine flu
c. H5N1 (type A) → avian influenza
d. H7N9 (type A) → avian influenza
● Antigenic Variations in Influenza
Antigenic Shift Antigenic drift
Diphtheria
● Causative organism: Corynebacterium diphtheriae
● Source of Infection: Carrier >> Case
● Incubation period: 2-6 days
● Mode of transmission: air droplet
● Specimen & Diagnosis - Nasopharyngeal secretion
● Period of communicability: disease onset ---> 14-28 days
[POC = >2 culture done 24 hr apart → (+)ve → communicable]
● DPT Vaccine
a. Diphtheria toxoid + Tetanus toxoid + killed acellular Pertussis
b. DPT vaccine dosage = 0.5 ml
c. Site: anterolateral aspect of thigh, middle ⅓
d. Route - intramuscular (i/m)
e. NIS schedule (Vaccine vs when to give)
DPT-1 6 weeks of age
d. Action taken:
- Susceptible to diphtheria = vaccinate
- hypersensitive to diphtheria = desensitize
e. Schick test has been replaced by Hemagglutination Test
(it measures serum antitoxin level)
Pertussis
● Causative organism: Bordetella pertussis
● Source of Infection: Cases
● Incubation period: 7-14 days
● Period of communicability: pathogen exposure ---> 7-3 weeks
● SAR: > 90%
● Drug of choice: Erythromycin
● Vaccine: DPT vaccine
Meningococcal Meningitis
● Causative organism: N. meningitidis
● Source of Infection: Carrier > Case
● Incubation period: 3-4 days
● Period of communicability:
a. (-)ve → pathogen absent in nasal/throat discharge
b. (+)ve → pathogen present in nasal/throat discharge
● Mode of transmission: air droplets
● CFR: > 80%
● Drug of choice
a. TXT of Cases - penicillin
b. TXT of Carrier - rifampicin
c. Chemoprophylaxis of contacts - rifampicin
● Vaccine
1. Type: killed vaccine, cellular fraction
2. Contraindicated in
- Pregnant female
- Infant & children < 2 yr
3. Priority: early adolescents (10-13 yr)
Pneumonia
● New ARI guidelines, IMNCI 2017-18
Type of ARI Signs/Symptoms Management Colour code
Tuberculosis
● Causative agent: Mycobacterium tuberculosis
● Source: cases
● Period of communicability: infective as long as cases remain untreated
● Mode of transmission: droplet infection
● IP: 4-12 weeks
● Specimen & Diagnosis - sputum smear
● Epidemiological Indices for TB
a. Incidence of TB infection (annual risk of infection): 1-2%
- Estimation → Tuberculin conversion index
b. Prevalence of TB infection: 30-40%
- Estimation → Tuberculin test
c. Incidence of disease: 167/100000
- Estimation → Sputum smear examination
d. Prevalence of disease: 195/100000
- Estimation → Sputum smear examination
● TB situation in India
1. Mortality = 17 per 1 lakh cases
2. Infectivity = 1 case of TB spread → 10-15 cases in 1 yr
3. MC age group: 25-34 year
[TB is the MC opportunistic infection of HIV
Diabetes mellitus is a risk factor for TB infection].
● Mantoux test (tuberculin skin test)
a. Antigen: PPD (purified protein derivative)
b. Dose: 1 tuberculin unit(TU) in 0.1 ml [5000 TU/mg]
c. Site: intradermally on flexor surface of forearm
d. Strain: RT 23 with Tween 80
e. Readings - result read after 72 hrs:
- Induration > 9mm → POSITIVE [past/current infection]
- Induration 6-9mm → DOUBTFUL
- Induration < 6mm → NEGATIVE [never infected]
f. False reactions:
1. False (+)ve Mantoux test - prior BCG vaccine
2. False (-)ve Mantoux test - HIV/AIDS
● BCG (Bacillus Calmette–Guérin) Vaccine
1. Nature: Live attenuated vaccine
2. Strain:
a. WHO recommended: DANISH 1331 strain
b. derived from Mycobacterium bovis
c. Produced by 239 subcultures over a period of 13 yr
3. Diluent: normal saline
4. Dose: 0.1 ml (for all ages)
5. Site: intradermally [i/d]
6. Protective efficacy against severe form of TB: 0-80%
7. Protection duration: 20 yr
● National reference labs for TB
a. National Tuberculosis Institute (NTI), Banglore
b. Tuberculosis Research Centre (TRC)
c. National Institute of TB and Respiratory Diseases (NITRD), Delhi
● The End TB Strategy 2016-2035
1. Vision - world free of TB
2. Goal - end the global TB epidemic
3. Target of End TB strategy
Indicators Target by 2035
Poliomyelitis
● 3 Endemic countries - Pakistan, Afghanistan, Nigeria
● Poliomyelitis situation in India
- India declared ‘polio free’ by WHO on 27th March 2014
- last case of polio was detected on 13 January 2011 in Howrah, WB
● Causative agent: Poliovirus (serotype 1,2 & 3)
1. P1 → MCC of epidemics
2. P2 → MCC of Vaccine-derived poliovirus (VDPV)
→ Most antigenic & most easily eradicable
→ eradicated on 20 september 2015
3. P3 → MCC of Vaccine-associated paralytic polio (VAPP)
● Reservoir: Man
● Route of transmission: faeco-oral
● Incubation period: 7-14 days
● Period of communicability: 7-10 days <--- Symptom onset ---> 7-10 days
● Clinical presentations
Clinical spectrum Infections
Non-paralytic polio 1%
Hepatitis
● Types of Viral hepatitis
Type Causative agent Incubation period Mode of POC
Transmission
Cholera
● Causative agent: Vibrio Cholera
a. Serogroup - V. Cholera 01
b. El Tor biotype [Serotype: Ogawa → MC in India]
● Route of transmission: Faeco-oral
● Incubation period: 1-2 days
● Typical stool appearance: Rice-watery diarrhea
● Treatment of Cholera
1. Adults - Doxycycline
2. Children & Pregnancy - Azithromycin
● Chemoprophylaxis - Tetracycline
● In case of Epidemic → 1st step is Verification of diagnosis
- Identifying V.cholera in stools of few pt. is sufficient
- Not necessary to culture stool of all cases
● Most important Prophylactic measure - Health education
Typhoid
● Causative agent: Salmonella typhi
● Route of transmission: Feco-oral
● Incubation period: 10-14 days
● Clinical feature
a. Pea soup diarrhea
b. Coated tongue
c. Rose spot
d. Step ladder pyrexia
KCl 1.5 K+ 20
Food poisoning
Staphylococcal Salmonella Botulism Perfirengens Cereus
Cause Staph. aureus 1) S. Typhimurium Cl. Botulinum Cl. Perfirengens Bacillus cereus
(Enterotoxin) 2) S. Enteritidis (Exotoxin)
IP 1—6 hrs 12—24 hrs 12—36 hrs 6—24 hrs a) Emetic form:
1—6 hr
b) Diarrheal form:
12—24 hr
Worm Infestations
Guineaworm
● Causative agent - Dracunculus Medinensis (nematode)
● Epidemiology in India
- Last case: july 1996 Jodhpur, Rajasthan
- Eliminated (WHO): february 2000
● Type of transmission - Cyclodevelopmental transmission
● Type of disease - Water based disease
● Drug of choice → Niridazole, Mebendazole, Metronidazole
Roundworm
● Causative agent - Ascaris lumbricoides
● IP: 2 months
● MOT: feco-oral
Hookworm
● Causative agent
- Ancyclostoma duodenale
- Necator americanus
● IP: 5 week-9 month
● MOT: penetration of skin
● Association
a. Iron deficiency anemia (blood loss = 0.03-0.2 ml/day)
b. Hypoalbuminemia
● Chandler’s index (CI)
1. description - No. of hookworm eggs /gm of stool
2. technique - Kato-katz technique
3. If CI > 300 → major public health problem
Tapeworm
● Causative agent
- Taenia solium
- Taenia saginata
● Host of infection
Definitive host Intermediate host
Zoonotic infections
Rabies
● Causative agent: Lyssavirus Type 1 (Rhabdovirus)
● IP: 20-60 days
● Clinical feature: Hydrophobia - difficulty in swallowing food/water
● Pathognomonic feature → Negri bodies
● MOT: infected Animal bite Except Rat & Human.
● Geographical barrier - water body
● Specimen & Diagnosis
living person biopsy of skin follicle on Nape of neck
Plague
● Causative agent - Yersinia pestis
● Vector - Rat flea (Xenopsylla sp.)
● Reservoir - Wild rodents → Tatera indica in India
● Source - infected rats, flea & humans
● IP: 1-3 days
● MOT
- rat flea bite
- direct contact
- respiratory droplet
● Types of plague
Type IP
Pneumonic plague 1-3 days
Rickettsial disease
Disease Agent Vector Reservoir
Typhus group
Epidemic typhus Rickettsia prowazekii Louse Man
Non-Rickettsial group
Q fever Coxiella burnetii — Cattle
Trachoma
● Causative agent: Chlamydia trachomatis (serotype A,B,C)
● Epidemiology - India was declared ‘free from Trachoma’ on 8th Dec 2017.
● Incubation period: 5-12 days
● Mode of transmission
- fomites (indirect contact)
- eye-seeking flies
- sexual contact
● Field diagnosis (DD): ≥ 2 criteria must be fulfilled in children (0-10 yr)
1. follicles on upper tarsal conjunctiva
2. limbal follicles
3. conjunctival scarring
4. vascular pannus
● WHO classification of Trachoma
a. Trachomatous inflammation follicular (TIF): presence of > 5 large follicles on
upper tarsal conjunctiva.
b. Trachomatous inflammation intense (TII): obscuration of > 50% of deep tarsal
vessels of upper tarsal conjunctiva.
● Drug of choice - Azithromycin.
Leprosy
● Aka Hansen’s disease
● It is probably disease known to Mankind
● Causative agent - Mycobacterium leprae
● Specimen & Diagnosis - None {purely clinical diagnosis}
● MOT
- Droplet infection
- Skin to Skin contact
- Transplacental
- Breast milk from lepromatous mother
- Insect bite
- Tattoo needles
- Organ transplantation
● Leprosy situation in India
a. Annual new case detection rate (ANCDR): 9.71 /100,000 pop
b. Prevalence: 0.66 /10,000 pop
c. Elimination level of Leprosy - <1 case/ 10,000 global pop.
[India eliminated Leprosy in Dec 2005]
● Leprosy cannot be 100% Eradicated
1. long variable IP
2. multiple mode of transmission
3. no vaccine available
4. it has no culture media
● Classification of Leprosy
Paucibacillary leprosy Multibacillary leprosy
Tetanus
● Causative agent: Clostridium tetani
● Source & Reservoir: Soil
● IP: 6-10 days
● POC: None
● Neonatal tetanus (NNT) elimination Criteria
1. Rate: < 0.1/1000 live birth
2. TT-2 coverage: > 90%
3. Attended deliveries: > 70%
● Prevention of Tetanus in Wounded
Immune Category Wounds < 6 hr old, clean, Wound > 6hr old, unclean
non penetrating, negligible Penetrating, noticeable
tissue damage tissue damage
A [Complete dose of toxoid /booster Nothing required Nothing required
dose in previous 5 yrs]
Malaria
● Causative agent vs Incubation period
Cause IP [days]
Lymphatic Filariasis
Bancroftian filariasis Brugian filariasis
Dengue
● Causative agent: Dengue virus (4 serotypes) - ‘Group B Arbovirus (Flavivirus)’
— DENV-1, DENV-2, DENV-3, DENV-4, DENV-4
● Vector: Aedes aegypti
● Reservoir: Man, Mosquito
● IP: 5-6 days
● Diagnosis
Tourniquet test (spots = petechiae/sq inch) Serological test
Japanese Encephalitis
● Causative organism: ‘Group B Arbovirus (Flavivirus)’
● Vector: Culex tritaeniorhynchus
● Host factors:
a. Amplifiers host - pigs
b. Mosquito attractant host - cattles & horses
c. Actual host - Ardeidae birds
d. Accidental dead-end host - human
● IP: 5-6 days
● CFR: 30%
● Epidemiology: 85% cases occur in children <15 yr
● Vaccine = JE vaccine
1. Type - live attenuated
2. Source - cell culture derived
3. Strain - SA 14-14-2
4. NIS schedule: → 1st does - 9th month
→ 2nd dose - 16-24 month
Kyasanur Forest Disease (KFD)
● aka Money disease
● Causative organism: Togavirus ‘Group B Arbovirus (Flavivirus)’
● Vector: Haemaphysalis spinigera
● Reservoir: rats & squirrels
● Host factors
a. Amplifier host - Pigs
b. Accidental dead-end host - human
● IP: 3-6 days
● Vaccine: killed KFD vaccine
Leishmaniasis
Type Causative agent Vector (sandfly)
Treponematosis
Disease Causative MOT Drug of Status Vertical transmission
agent choice
HIV/AIDS
● Causative agent: Human immunodeficiency virus (HIV)/ Human T-lymphotropic virus III
(HTLV-III)/ Lymphadenopathy virus (LAD).
● Period of communicability: Life long
● IP: few weeks to 10 yrs
● Specimen & Diagnosis - Blood → ELISA & Western blot
● Vertical transmission - during delivery
● MOT
- Sexual - {most common but least dangerous}
- Blood - {least common but most dangerous}
- Needles/ Syringe
- Vertical transmission
● Nobel prize winners - Robert gallo, Luc Montagnier, Françoise Barré-Sinoussi
● HIV situation in India
a. Prevalence - 0.26%
b. MC age group affected: 30-44 years
c. Mother to child transmission rate: 30%
d. Breastfeeding transmission rate: 12-16%
e. 1st case - Chennai
f. Highset case - Tamil nadu
g. Fastest ↑ prevalence - Andhra pradesh
h. ↑ prevalence among inj. drug users - Manipur
i. Moderate prevalence - Gujarat, Goa, Pondicherry
j. Categorization of districts
State District Prevalence
High prevalence A
[Group I]
HRG ANC
Moderate prevalence B
[Group II]
HRG ANC
Low prevalence C
[Group III]
HRG ANC
Low prevalence D
[Group III]
HRG ANC
Severe acute respiratory syndrome (SARS)/ Middle East respiratory syndrome (MERS)
● Causative agent: Coronavirus