Lead toxicity is one of the most hazardous metal toxicities. It can enter the body through lead-based paint, dust, water, soil, tableware, and folk medicines. Children are especially prone to develop lead toxicity. Lead acts by inducing oxidative stress due to inefficient replenishment of glutathione. Lead can also cause hemolytic anemia due to disruption of the cellular membrane by lipid peroxidation. Lead toxicity also affects neurotransmitter levels and causes severe health issues related to organ damage, some even leading to death. The main aim of this review article is to summarize lead toxicity detection, its sources, and its mechanism including various toxicological effects on human health. It also focuses on the prevention and treatment of lead toxicity.

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According to the National Mental Health Survey-2016, one in every ten persons in India suffers from depression and anxiety, and 20% of these depressed Indians are pregnant women and new mothers. This systematic review was conducted to assess the burden of depression and risk factors associated with it among the Indian pregnant women. Electronic database (PubMed and Google Scholar) was used to identify any retrospective/prospective observational research studies published in English language which specifically examined antenatal depression (AD) among Indian women using a validated scale. A total of 995 citations were retrieved, out of which only eight studies were included. The prevalence of AD was found to be ranging from 9.18% to 65.0% in northern, western, and southern part of India. However, there is a lack of research on AD from the eastern part of country. The factors such as unplanned pregnancy, multigravidity, history of abortion, advancing pregnancy and age, lower/lower-middle socioeconomic status, poor education status of women, unemployment, bad relations with in-laws, male gender preference, and demand for dowry were significant predictors for AD. Therefore, it is necessary to provide the health-care professionals and women with the knowledge about these factors for early prediction of women at high risk of AD, which might help them to get timely intervention and reduce the burden of depression. Furthermore, the results from this review implicate that more research is needed in future in this field to further validate the findings of the present review.

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Background: The coronavirus disease-2019 (COVID-19) outbreak, first detected in Wuhan, China, has turned into a rapidly spreading pandemic ailing the human race throughout the world. Health-care workers (HCWs) are under immense physical and psychological pressure, adversely affecting their efficiency and decision making. Aim: We hereby intend to study the impact of COVID-19 pandemic in HCWs in reference with a variety of factors. Materials and Methods: A nationwide cross-sectional online study using semi-structured pro forma along with the Adjustment Disorder New Module and the Depression, Anxiety, and Stress Scale-21 was conducted among 200 respondents. Results and Discussion: Of the 200 respondents, 174 (87%) were doctors and 26 nursing staff, with a mean age of 42.1 ± 12.2 years, 62% were male, and 63% were working in the government sector. A significant number of respondents were found to be suffering from acute stress (9.5%), depression (17%), and anxiety (19.5%) which they attributed to the negative professional and personal influence of this ongoing pandemic scenario. HCWs on the front lines of this pandemic are facing compounding stressors and need robust psychiatric help to adequately take care of this need.

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Aim: To study the prevalence of cardiac manifestations in patients of dengue fever. Settings and Design: This cross-sectional study was done in a tertiary care hospital conducted for a period of 2 years from September 2016 to October 2018. Methods: Patients with complaints of fever and suspected to have dengue were subjected to dengue serology. Confirmed cases of dengue were then classified according to the World Health Organization criteria into dengue fever, dengue hemorrhagic fever (DHF), and dengue shock syndrome. The assessment of cardiac manifestations was done based on electrocardiogram (ECG), echocardiogram, and cardiac marker. The data was analyzed using statistical significance tests. Results: Out of 60 patients, 36 (60%) were male and 24 (40%) were female, and the male-to-female ratio was 1.5:1. The mean age of the patients was 38 ± 16.69 years. Patients of dengue fever, DHF, and dengue shock syndrome were 51, 7, and 2 respectively. The most common ECG abnormality was sinus bradycardia seen in 9 (15%) patients, followed by sinus tachycardia in 6 (10%) and ST-T changes in 5 (8.33%). Echocardiography was normal in 54 (90%) patients, systolic dysfunction was found in 4 (6.67%) patients, and pericardial effusion was found in 2 (3.33%) patients. Eight (13.33%) patients had abnormal creatine kinase-muscle/brain values. Conclusion: Cardiac manifestations are common in dengue fever, seen in one-third of the patients. Platelet counts < 100,000/mm³ and a higher hematocrit are more likely to be associated with cardiac manifestations.

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Background: Sickle cell disease commonly presents with unpredictable episodes of vasocclusion and pre mature RBC destruction, which manifest as acute pain and tissue ischemia. In kidneys, endothelial dysfunction occurs in the nephron leading to microalbuminuria, vaso-occlusion, ischemia, infarction, and ultimately nephron loss. Proliferative and non-proliferative retinal changes can also occur, due to similar underlying pathophysiology of vasospasm. Aims and Objectives: To study the correlation between Sickle Cell Nephropathy and Ophthalmic Complications in cases of Sickle Cell disease. Materials and Methods: Thirty five adults aged 18 to 60 years, having Sickle Cell disease were selected as study participants. Complete blood analysis was carried out, with assessment of Urine Albumin: Creatinine ratio and ophthalmic findings, studied by direct and indirect ophthalmoscopy, and slit-lamp biomicroscopy. Results: Patients were divided into two categories: Category I comprising of 7 patients who were admitted to the Medicine ICU with Crisis, and Category II comprising of 28 clinically stable patients. 5 patients from Category I (71.4%), and 2 patients from Category II (7.1%), were found to have findings of peripheral retinopathy. Category I patients had received a mean of 6.17 ± 2.14 blood transfusions, Category II patients had received 2.89 ± 1.81 transfusions, difference being statistically significant. Mean Hb in Category I patients was 6.37 ± 0.35 gm/dl, compared to 7.95 ± 0.81 gm/dl in Category II patients. The mean Urine Albumin/ Creatinine ratio of patients having Ophthalmic manifestations was found to be 286.71 ± 74.75 mg/g, while the mean Urine Albumin/ Creatinine ratio of patients with no Ophthalmic manifestations was found to be 31.82 ± 4.48 mg/g, difference being statistically significant. Conclusion: Sickle Cell nephropathy and retinopathy appear to stem as manifestations of a common underlying mechanism of sickle vasculopathy, and thus can be studied as markers for each other.

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Background: This study was conducted in nonintensive care unit COVID-19 patients admitted in a tertiary care center, to assess the clinical profile and find surrogate markers to predict the severity of COVID-19 at the time of admission. Methodology: It is a cross-sectional observational study. Clinical and laboratory data were compiled of patients admitted in COVID wards in a tertiary care center. Patients were stratified clinically according to the severity of COVID pneumonia. The admission clinical and laboratory parameters were compared between the severe and nonsevere COVID patients. Results: The study included 63 patients of which 46 were males, with a mean age of 47 years. Patients were classified into mild (32%), moderate (19%), and severe (49%) categories according to national guidelines. Fever (81%), cough (67%), and dyspnea (67%) were the most commonly observed symptoms. In comparative analysis, mean C-reactive protein (CRP), serum ferritin, and neutrophil–lymphocyte ratio (NLR) were significantly higher in severe COVID-19 patients and the admission PaCO₂ significantly lower compared to nonsevere patients. Conclusion: The study shows that raised NLR, CRP, serum ferritin, and low PaCO₂ levels at the time of admission are important predictors of disease severity.

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The ongoing pandemic of novel coronavirus disease 2019 (COVID-19) has received worldwide attention by becoming a major global health threat. We encountered one case with COVID-19 and tuberculosis (TB) coinfection, which has not been frequently reported. A 76-year-old female presented with acute respiratory symptoms superimposed on chronic symptoms, suggestive to have pneumonia. Oropharyngeal throat swab sample for COVID-19 was positive as detected by real-time reverse transcriptase–polymerase chain reaction assay. GeneXpert Ultra detected Mycobacterium tuberculosis complex with rifampicin resistance indeterminate. The patient was treated with appropriate management. Clinicians should suspect coinfection with TB during the ongoing pandemic of COVID-19 as therapeutic strategies need to be determined timely to improve outcomes and prevent transmission in the community.

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Background: Sleep is very important for humans and more so to hospitalized patients. Alterations in the normal sleep pattern have negative impact on the medical conditions, mental health, cognitive performance and recovery of the hospitalized individuals. The primary aim of this study was to assess the quality of sleep among hospitalized patients and to find the correlation between the factors affecting sleep and sleep quality. The secondary objective was to understand the quality of sleep in people admitted for surgical and medical treatment. Methods: In this cross-sectional study, the hospitalized patients were examined. Sleeping habits of 100 inpatients of surgical and clinical wards were assessed through the Pittsburgh Sleep Quality Index (PSQI). A self-designed questionnaire was also used to ascertain the factors affecting the sleep. Content validity and test–retest reliability were evaluated. The data obtained were analyzed by the statistical methods of frequency, percentage, and Chi-square. Results: The cross-sectional study showed that the mean score for PSQI was 7.58 ± 3.14 and that 69% of the patients had poor sleep as inferred from the global PSQI >5 scores. Age and gender had no effect on the PSQI total score, but the number of roommates, type of the ward, hospitalization period, presence and severity of pain, taking sleep medication, and attitude toward the overall atmosphere and interior of wards has caused deviation in scores. Conclusion: Sleep problems are quite frequent in medical inpatients. Pain management and modification of the ward interior and atmosphere can impact inpatients sleep quality.

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Background: Type 2 diabetes mellitus (T2DM) is a chronic metabolic disease affecting microvascular circulation causing complications such as retinopathy, nephropathy, and neuropathy. Nail fold capillaroscopy (NFC) is an in vivo study of microvascular circulation. Aim: The aim of this study is to describe and quantify NFC changes in type 2 diabetics. Materials and Methods: NFC was done for all 10 fingernails for 96 patients with T2DM (as per the American Diabetes Association criteria) and 40 healthy controls. The diabetics were further subdivided into two groups: those with microvascular complications (Group 1, n = 46) and those without any (Group 2, n = 50). Results: Demographic profile was comparable in both the groups. Overall, 80.2% (77/96) of the patients with T2DM showed NFC changes as compared to 12.5% of the healthy controls. Unique morphological alterations in T2DM were angulated and receding capillaries. Mean capillary density was overall reduced, especially in Group 1 (6.57 ± 1.02 capillary/mm) as compared to Group 2 (7.03 ± 1.09 capillary/mm) (P = 0.67). Overall, 89.13% of Group 1 patients had NFC changes as compared to 72% in Group 2 (P = 0.035). Specific morphological changes were also significantly more common in Group 1 than Group 2, including tortuosity (P = 0.035), meandering capillaries (P = 0.004), capillary dropouts (P = 0.012), and bizarre capillaries (P = 0.002). Limitations: A larger sample size study with different demographic populations could have provided a broader picture of NFC changes in T2DM. Conclusion: Our study suggests that NFC changes are correlated with microvascular complications in type 2 diabetics, possibly helping in noninvasive identification of patients at risk.

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Coronavirus disease 2019 (COVID-19) is an acute respiratory and systemic illness, and is a public health emergency which has involved all the continents. Though limited data is available for infection in pediatric population, infection seen in children is of milder form. During this pandemic, documentation of laboratory predictors to discriminate between mild and severe forms of this infection would be helpful. Various hematological parameter alterations in the pediatric COVID-19 cases show anemia, thrombocytopenia, eosinopenia, and inconsistent leukocyte indices. It may be too early to say right now as to what extent will these alterations help us in outlining the severity of disease or transmission of disease. However, it will be pertinent to understand these abnormalities, and keep track of them, so as to understand the disease, as the pandemic unfolds.

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SARS-CoV-2, the causative agent for COVID-19, originated in China in the fall of 2019 and soon became a pandemic engulfing the entire world, presenting with a myriad of presentations from asymptomatic to severe disease with acute respiratory distress syndrome and multiple organ dysfunction and severe inflammatory response. Little is understood about the new virus and its pathogenesis, and it is too early to ascertain its long-term sequelae at this point in time. New associations and clinical problems keep appearing with the new virus and thus we also got to encounter three cases of acute inflammatory demyelinating polyneuropathy (AIDP) in patients following COVID-19 infection. This case series aims to convey clinicians that AIDP can be seen in patients with COVID-19, particularly during the recovery phase, and thus not to miss it as postviral fatigue and malaise.

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Introduction: The ease of availability of antimicrobials and their excessive use is a growing issue which has significantly contributed to antimicrobial resistance (AMR). This is a matter of public health concern as the burden of AMR is far outpacing the research and development work done to develop new antimicrobials. India, being one of the top consumers of antimicrobials, now faces this threat which can only be curtailed through the implementation of antimicrobial stewardship program (AMSP). To address this issue, this systematic review attempts to study the implementation activities of AMSP in the country by the means of literature review. Methods: A comprehensive research using web-based search engines was performed employing a combination of search string: AMSP, ASP, implementation, impact, antibiotic stewardship, antimicrobial surveillance, infection control, and resistance control. The search yielded thirty papers between the time period of 2008 and 2019. 17 papers fulfilling the inclusion-exclusion criteria were taken up for review, employing PRISMA framework. Results: Results from different studies conducted on implementation of AMSP and its components were consolidated and analyzed to track the extent of AMSP activities. Moreover, by studying AMSP practices, gaps in implementation activities were identified by highlighting the AMSP components that were not fully utilized in the country. Conclusion: The results show that implementation of AMSP in India is still in its nascent stage as all the stewardship components are yet to be fully applied in the country. There seems to be a lot of scope in improving the implementation activities by building and strengthening of components such as use of information technology in monitoring and surveillance, use of antibiotic cycling and sensitizing staff, and broadening the role of different staff members to develop an effective program in the nation which meets the goals of National Action Plan-AMR.

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Background and Objective: Bladder cancer (BC) is the most common cancer of the urinary and genital tract. Many factors, including environmental and socioeconomic factors, also affect the incidence and mortality of BC. The aim of this study was to evaluate the epidemiology of BC incidence and mortality worldwide based on the data extracted in 2018. Materials and Methods: The present study is a descriptive-analytic study that extracts the incidence and mortality rates of cancer from the World Bank in 2018. The incidence and mortality rates and BC distribution maps were drawn for world countries. To analyze data, correlation test and regression tests were used to evaluate the correlation between the incidence and mortality with the Human Development Index (HDI). The statistical analysis was carried out by Stata-14 and the significance level was estimated at the level of 0.05. Results: The results showed a positive and statistically significant correlation between the incidence (r = 0.587, P < 0.0001) and mortality (r = 0.271, P < 0.001) of BC with the HDI index. The results showed that there was a positive correlation between the incidence of BC with Gross national income per 1000 capita (GNI) (r = 0.405, P < 0.001), mean years of schooling (MYS) (r = 0.525, P < 0.001), life expectancy at birth (LEB) (r = 0.566, P < 0.001), and expected years of schooling (EYS) (r = 0.574, P < 0.001). In addition, there was a positive and statistically significant correlation between mortality rate with GNI/1000 capita (r = 0.186, P < 0.01), MYS (r = 0.227, P < 0.01), LEB (r = 0.305, P < 0.01), and EYS (r = 0.250, P < 0.01). Conclusion: Given that the incidence and mortality of BC in high-HDI countries is higher, more research in these countries is needed to identify the factors affecting the incidence of disease in these countries. We can perform prophylactic actions to prevent the incidence and mortality of this cancer by identifying the risk factors of the aforementioned disease.

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Background: The present study was undertaken to determine the levels of interleukin-6 (IL-6) and evaluate its association with clinical presentation, severity, radiological imaging, management, and outcome in coronavirus disease (COVID-19) infection. Methods: The present study included 132 admitted COVID-19 patients, categorized into three groups. Group 1 had IL-6 within the normal reference range, Group 2 had IL-6 raised up to ten times the upper normal limit (UNL), and Group 3 had IL-6 level raised > ten times the UNL. The patient's data concerning medical history, clinical manifestations, laboratory findings, radiological imaging, management, and outcome were extracted from their medical records for subsequent evaluation, interpretation, and association among the groups. Results: COVID-19 patients with raised IL-6 levels exhibited frequent symptomatic presentations, severity, and critical illness, especially with extremely high IL-6 levels (P < 0.001). Radiological findings in terms of a digital chest radiograph and high-resolution computed tomography (CT) chest indicated severe lung involvement in patients with extremely high IL-6 levels (P < 0.05). The majority of patients with extremely raised IL-6 levels were associated with the classic COVID-19 CT images (P = 0.014). Patients with extremely raised IL-6 levels required intensive treatment as compared to normal IL-6 group in terms of tocilizumab therapy (P = 0.008), noninvasive ventilation (P < 0.001), and intensive care unit care (P = 0.009) associated with higher mortality (P = 0.046). Conclusion: Raised IL-6 levels in COVID-19 patients should be considered a risk factor for the severity of the disease, inflammatory storm, and rapid pulmonary invasion. There is an urgent need for establishing a treatment protocol in patients with extremely raised IL-6 levels.

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Background: Hepatitis B virus (HBV) infection continues to be a life- threatening health problem throughout world, infecting more than two billion people. While blood transfusion and unsafe therapeutic injection continue to be major risk factors, the role of vertical transmission remains under- estimated. Hence, this study was done to find out the prevalence of HBV infection and associated risk factors among healthy pregnant ladies in Southern Odisha. The present study was a prospective, observational study conducted, in the department of Microbiology, with collaboration of department of Obstetrics and Gynecology of MKCG Medical college from 1^st March 2017 to 28^th Feb 2018. Methodology: After collection of three to four millilitre of venous blood from the clients, sera was separated by centrifugation. They were then tested for Hepatitis B surface antigen (HBsAg) by Enzyme linked Immunsorbent assay (ELISA). Serological status of the subjects and correlation with their socio-economic characteristic was noted using a preset proforma. Babies born to HBsAg positive ladies were administered Hepatitis B vaccine and immunoglobulin. Results: Total 3,230 in non-duplicating serum samples were screened among which 150 (4.64%) were tested positive for HBsAg. Ladies with multiple sexual partners (57. 14%) followed by intravenous drug users (7.88%) were mostly positive for HBsAg. Conclusion: Exposure to risky social behavioural pattern, lack of awareness could be suggested as possible means of acquiring the infection. Immunization is the most effective and only way of preventing development of chronic carrier state. Hence all neonates were administered with hepatitis B vaccine and 0.5 ml of hepatitis B immunoglobulin within 12 hours of birth.

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Introduction: Intestinal parasitic infections (IPIs) are considered as a common cause of morbidity and mortality in children in the developing countries. The present study was aimed at examining the status of IPIs in the children of daycares and preparatory schools in the city of Khodabandeh located at Northwestern Iran. Materials and Methods: A total of 520 daycare and preprimary school-age children in the northwest of Iran were tested for the presence of intestinal parasites using direct smear and the standard formalin-ethyl acetate sedimentation techniques. Furthermore, the specific “scotch tape” test was used to identify the eggs of pinworm Enterobius vermicularis. Results: Of total 520 children, 55 cases (10.6%) were infected to intestinal parasites, including 9.2% monoparasitism and 1.4% double-parasitism. The prevalence rate for protozoan infections was 7.3% and 3.65% for helminths. Giardia lamblia infection was shown to have the highest prevalence rate among intestinal protozoa by 3.26%. The prevalence rate for E. vermicularis was 3.5% using “scotch tape” test and stool examination. There was a significant correlation between infection with intestinal parasites and daycares (P = 0.004). A significant inverse correlation was established between anal itching (as a sign of E. vermicularis infections) and hand-washing in children using soap or hand-washing liquid (P = 0.004). Conclusions: Infection with intestinal parasites in children of nursery schools and preschools of the study region, compared to the previous situation, is considerably decreased.

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Introduction: The health impact of air pollution caused by firecrackers used during festival time is an area of great concern in Indian population. Trapping of pollutants due to burning of firecrackers during Diwali and Dusshera festivals promotes the formation of smog, which leads to raise in respirable suspended particulate matter (RSPM) and SPM values above the standard values. Aim: This study was designed to assess the air quality pre- and post-Diwali and Dusshera in North India and also to find out the exposure effect of poor air quality on the health of population as well as health risk assessment of the population. Materials and Methods: A total of 470 individuals of different age groups were interviewed during Dusshera festival (i.e., both pre- and post-Dusshera) in four chosen areas. Besides, 788 individuals of different age groups were interviewed during Diwali festival (i.e., both pre- and post-Diwali) in the same four areas. A total of 223 individuals also underwent pulmonary function testing (portable spirometry) on a random basis (fifty in each area, 3 days before and after Diwali). Results: The comparison of respiratory disease complaints pre- and post-Diwali showed that there was a significant increase in the complaints of cough post-Diwali among the participants of Kotla (6.7% vs. 28.9%). However, there was a significant decrease in cough and breathlessness post-Diwali in Parivesh Bhawan. The ambient air quality of three residential areas was within normal limits both pre- and post-Diwali with respect to sulfur dioxide and nitrogen dioxide, but there was an increase in the levels of PM₁₀ and PM_2.5 post-Diwali. Conclusion: The level of suspended particles in the air increases alarmingly which can be associated with eye, respiratory, and allergic problems. Crackers and fireworks were found to be the chief sources of air pollution during festivals in India. Even though the impact of Diwali is short term, the short-term exposure of these pollutants in the environment affects the standard values of air particulate and can cause health complications.

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Background: Coronary artery disease (CAD) is known to adversely impact the quality of life (QOL) of the patients and poses an economic burden to the family and society. However, the same has not been estimated in India. Objectives: To estimate the annual economic burden (direct and indirect cost) and QOL in stable CAD patients at a Government Tertiary Care Hospital of Delhi, India. Materials and Methods: A cross-sectional study was carried out in a Government Tertiary Care Hospital of Delhi using a convenient sample of 113 CAD patients. A prestructured pretested questionnaire was used to collect information on direct and indirect costs of therapy for CAD patients, and QOL assessment was done using SF-36 questionnaire. Results: The total average annual cost incurred by patients of stable CAD was Indian National Rupees 15691.45, of which 78.49% was attributable to direct cost (drugs, supplements, diagnostic tests, and transportation charges) while 21.5% to the indirect costs (wage loss of the patient and caretaker, during the days of hospitalization). Both the components of QOL, namely, physical component score (PCS) and mental component score (MCS) were reduced in the stable CAD patients. PCS was 35.53 and MCS was 39.16. Conclusion: CAD poses not only an economic burden on the patient, family, and the society but is also associated with impairment of QOL of the patient too.

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Although malaria is caused most commonly by falciparum species, vivax malaria counts the second most common in India. Until recently, severe malaria infection was attributed to falciparum species. Various systemic complications including arrhythmia, heart failure, conduction disturbances, and myocarditis have been typically seen in association with Plasmodium falciparum infections. Nowadays, severe vivax malaria encompasses varied complications including cardiac complication as well. We report a case of sinus exit block due to myocarditis in a 40-year-old male infected with vivax malaria without any cardiovascular risk factors. Recovery was complete with a favorable outcome in this case.

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Among the various congenital anomalies of the respiratory system, the extrapulmonary bronchogenic cyst is a rare pathologic lesion. The bronchogenic cyst is a developmental anomaly, occurring due to malformation of ventral foregut during the first 6 weeks of the intrauterine life. The cystic abnormality presents in infancy, children, and often in young adults. A case of 27-year-old male presented with subcutaneous swelling in the presternal area. The nodular swelling was excised and subsequently sent for surgical pathology examination. The cystic swelling was diagnosed on histopathology as a cutaneous bronchogenic cyst.

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Introduction: A tuberculosis patient infects several healthy people prior to the diagnosis and initiation of treatment. Indiscriminate spitting in the community has been identified as a challenge to the prevention of tuberculosis; however, knowledge is still limited in terms of actual practices. Methodology: We conducted a descriptive cross-sectional study at a tertiary care hospital to evaluate knowledge, attitude, and practices relating to tuberculosis by interviewing patients of multidrug-resistant tuberculosis and extensively drug-resistant tuberculosis using a semi-structured questionnaire. We evaluated knowledge of tuberculosis on etiology, mode of spread, treatment factors, attitudes on the importance the respondent attributed to the factor and practices on adherence to treatment, and hygiene for the prevention of spread including safe sputum disposal. Results: We enrolled 250 patients (165 males) with a mean age of 29 ± 11 (mean ± standard deviation) years. On knowledge of tuberculosis, most of the patients had correct knowledge regarding tuberculosis symptoms (241, 96%), mode of spread (235, 94%), and correct duration of treatments 246 (98%) for drug sensitive tuberculosis. On attitude, all the patients consider adherence to their prescribed anti-tubercular treatment, 246 (98%) on covering mouth while coughing or sneezing and 239 (96%) on safe disposal of sputum as important. However, only 45 (18%) reported practicing correct sputum disposal and 66 (26%) patients reported disposing of their sputum in the open. Conclusion: This study suggests that despite good knowledge and attitude, there is a lack in practice of safe disposal of sputum by tuberculosis patients. Efforts toward sensitization regarding safe disposal of sputum need to be strengthened.

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The risk of transmission of hepatitis B, a global communicable disease, has become a matter of concern in recent years. Health-care delivery has the potential to transmit hepatitis B virus (HBV) and hepatitis C virus to both health-care workers (HCWs) and patients. The risk of transmission is most clearly related to the frequency of exposure or the extent of direct contact with human blood and body fluids. Health care must be provided with the best practice of safety and standards of care. Adherence to recommended improved safety devices, standard precautions, and fundamental infection-control practices is a must to prevent transmission of blood-borne pathogens. Long-term treatment with the goal of clearance of HBV is often required. Safe and effective hepatitis B vaccines along with postexposure prophylaxis with hepatitis B vaccination alone or in combination with HBV immunoglobulin have been available, the impact of which has been reported in several countries in preventing HBV transmission among HCWs.

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Japanese Encephalitis (JE) is an important re-emerging vector-borne zoonotic disease of the 21^st century which is the most important cause of morbidity and mortality due to pediatric viral encephalitis in Asian populations. India and China together report 95% of the disease burden where it is also an important cause of acute encephalitis syndrome. JE is a neglected tropical disease which disproportionately afflicts poor and economically disadvantaged populations in rural regions of low and middle-income countries which often lack well-equipped tertiary care centers for the management of JE cases presenting with central nervous system manifestations and related complications. JE has large animal reservoirs among pigs and water birds which renders JE elimination difficult. Hence, current strategy for JE prevention and control pursues a combined approach inclusive of expansion of JE vaccination coverage in endemic regions, vector control, and surveillance. Unfortunately, the lack of public health infrastructure, economic resources, and lack of political commitment has resulted in most endemic countries in the developing world failing to take adequate steps for achieving these recommended measures for JE control, especially with regard to developing surveillance capacities and reference laboratories for the diagnosis of JE. Moreover, the threat of JE has increased in recent years due to factors such as climate change and lack of economic development in several endemic zones even as the disease has begun affecting adult populations. Evidence from surveillance data in some countries also suggests that increase in vaccination coverage for JE does not necessarily correlate with decline in JE disease burden. Ultimately, JE is likely to persist as a major public health problem in the developing world and impede their economic development unless it receives adequate attention from the global health community.

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