Recurrent heat waves, already a concern in rapidly growing and urbanizing South Asia, will very likely worsen in a warming world. Coordinated adaptation efforts can reduce heat’s adverse health impacts, however. To address this concern in Ahmedabad (Gujarat, India), a coalition has been formed to develop an evidence-based heat preparedness plan and early warning system. This paper describes the group and initial steps in the plan’s development and implementation. Evidence accumulation included extensive literature review, analysis of local temperature and mortality data, surveys with heat-vulnerable populations, focus groups with health care professionals, and expert consultation. The findings and recommendations were encapsulated in policy briefs for key government agencies, health care professionals, outdoor workers, and slum communities, and synthesized in the heat preparedness plan. A 7-day probabilistic weather forecast was also developed and is used to trigger the plan in advance of dangerous heat waves. The pilot plan was implemented in 2013, and public outreach was done through training workshops, hoardings/billboards, pamphlets, and print advertisements. Evaluation activities and continuous improvement efforts are ongoing, along with plans to explore the program’s scalability to other Indian cities, as Ahmedabad is the first South Asian city to address heat-health threats comprehensively.

Summary Studies on urban metabolism have provided important insights in the material and sociopolitical issues associated with the flow of water. However, there is a dearth of studies that reveal how infrastructure, as a hybrid of social and material construct, facilitates disease emergence. The article brings together urban metabolism, political ecology, and anthropological studies to examine the social construction and reconstruction of the material flow through everyday practices for addressing the water problem and its health burden in Ahmedabad city. The article georeferences the water problems and occurrence of diseases and, through interviews, documents Ahmedabad's sociospatial characteristics of water problems and health burden in two case study wards. Through a situated understanding of the everyday practices, the infrastructure is exposed through leakages, reveals the citizens desire for better water quality, and struggle to gain access to water using diverse ‘pressure’ tactics. It is these social‐material constructs of water that give structure and coherence to urban space, which spatially coincides with the occurrence of diseases. It reveals the sociopolitical drivers of the water problems and identifies different hypotheses of the hotspots of disease emergences. The methodology offers a way forward for researchers and development agencies to improve the surveillance and monitoring of water infrastructure and public health through an incremental approach that takes into consideration the diffuse interplay of power by diverse actors. It charts out avenues for building on the urban metabolism by emphasizing the importance of examining the sociospatiality of the everyday practices for improving resource use efficiencies in cities of rapidly growing economies.

INTRODUCTIONPneumonia remains the number one cause for under five deaths worldwide. Out of 6.3 million children dying before 5 years, 0.935 million patients die due to Pneumonia.1 Different approaches have been tried to reduce the morbidity and mortality due to pneumonia such as immunization, vitamin A supplementation and zinc supplementation. 3 The vitamin D converts immune response from TH1 to TH2 response. It also helps in rapid response at the cellular level. It helps in activation of macrophages. 4,5 It is also noted that children with pneumonia had lower vitamin D levels.6-8 They also may have lower dietary vitamin D intake. 9Keeping this in mind, we decided to perform an evaluation of vitamin D levels in patients diagnosed to have pneumonia. We also aimed to investigate impact of severity of vitamin D deficiency on severity of pneumonia. We also investigated the prevalence of ABSTRACT Background: Pneumonia remains number one cause for morbidity and mortality in children. Vitamin D has been shown to have immunomodulatory activity. Hence to find correlation between vitamin D and pneumonia cases the study was carried out. Methods: A case control study was conducted at a rural hospital in Vadgaon. From September 2015 onwards all children under 5 years of age hospitalized with pneumonia were invited to participate in our study. Patients who consented for study underwent serum vitamin 25 (OH) D3 estimation along with other routine investigations as indicated. During the same study period, parents of otherwise healthy children fewer than 5 years age who came to our immunization clinic were invited to participate in the study as a control group. Results: Vitamin 25(OH) D3 levels in pneumonia cases study group (N=40) 12.048±6.015 ng/ml (mean±SD) and in control (N=35) 22.65±11.77 ng/ml (mean±SD) that is statistically significant (P<0.0001) and hemoglobin (Hb) in Cases (N=40) with 8.55±1.27 gm/dl (mean±SD); control group (N=19) with 10.31±0.9 gm/dl (mean±SD)levels was found to be statistically significant (p < 0.0001).All patients with severe pneumonia needing ICU management were found to be deficient in vitamin D levels. Children with pneumonia had higher level of anemia. All children admitted to ICU had Moderate to severe anemia. Conclusions: There is a correlation between Vitamin D deficiency and severity of pneumonia and there is also correlation between level of anemia and severity of pneumonia.

Background: Teaching undergraduate students by bedside clinics has remained cornerstone of medical education because it imparts knowledge, teaches proper behaviour and can be used to teach skills effectively. Case based learning (CBL) is a newer modality of teaching in medical education. CBL involves preparing students for clinical practice through use of authentic clinical cases.  Aim of the study is to study the effect of integration of case based learning and bed side clinic on motivation, deep thinking and cognitive improvement in final MBBS studentsMethods: The study group was undergraduate students of final MBBS posted for clinical posting in pediatric ward. The study was carried out on 59 students posted from March 2018 to September 2018. MCQ based pretest was done initially. The students were taught the topic by case based learning method for one hour. They were asked to take the case and bedside clinic was conducted. Relevant clinical examination was demonstrated to the students. Students were asked to practice the skills in front of the teacher. This was followed by the post-test and   questionnaires.Results: 88.67% students thought that this method was motivating. 82.7 % students perceived that it increases deep thinking. 52.83% students showed more than 20% improvement in score of pre-test and post-test.Conclusions: Integration of case based learning with bed side clinic was associated with Better motivation of final year MBBS students and development of deep thinking in students.  3. Significant change in cognitive learning in final MBBS students.

Introduction: Diabetic Ketoacidosis (DKA) presents with spectrum of clinical manifestations and awareness regarding this amongst physicians is crucial. The study aimed to chronicle the clinical profile of DKA in type 1 diabetes mellitus (T1DM) children. Methods: The study was conducted at a tertiary care hospital including patients with signs and symptoms of DKA with either debut or established T1DM (n = 38). Detailed clinical history, examination and laboratory investigations were carried out. Differences in frequency distribution concerning demographics and clinical data were analysed in R-studio software (v.1.2.5001). Results: Kussmaul breathing (49.97%) was the commonest presentation. Infection (39.46%) and poor compliance due to inadvertent omission of insulin therapy (50%) were the commonest precipitating factors. Mild, moderate and severe dehydration was present in 44.74%, 39.47% and 15.79% respectively. Forty-five percent patients had moderate while 34.21% and 21.05% had mild and severe DKA respectively. Seventy-five percent and 52% patients were below 3rd percentile for height and weight respectively. High number of patients had past history of viral infections, were diagnosed in winter, belonged to 2nd or 3rd birth order and from lower middle class. Patients with poor compliance to insulin belonged to lower middle (40%), upper lower (53.33%) and lower class (6.67%). Conclusions: DKA can be diagnosed early by identifying dehydration, Kussmaul breathing, polyuria and altered sensorium. Infection and poor compliance due to omission of insulin therapy were the commonest and preventable precipitating factor for DKA. Poor compliance to insulin can be attributed to lower socioeconomic class. Awareness among physicians concerning clinical profile of DKA is crucial.