(a) (i) Describe the uniqueness of Pulse Polio Programme in India. 10 marks (ii) A 28-year-old man with history of HIV antibody…

(a)(i) Uniqueness of the Pulse Polio Programme in India

Launched in 1995 (after a 1994 pilot in Delhi), India's programme was unique in scale and method. Oral polio vaccine was given to all children under five on fixed National and Sub-national Immunisation Days, irrespective of earlier doses, through booths followed by house-to-house visits.

• Transit and mobile teams covered railway stations, bus stands, nomads, migrants and construction sites; finger-marking recorded each child.
• Detailed microplanning and mop-up rounds reached missed children, with special focus on high-risk areas of Uttar Pradesh and Bihar.
• A social mobilisation network ("Do Boond Zindagi Ki") built community trust; millions of volunteers and partners (WHO, UNICEF, Rotary) supported the government.
• Acute flaccid paralysis surveillance was supplemented by environmental (sewage) surveillance, and cold chain was maintained.

The last wild polio case was in Howrah in January 2011; India was certified polio-free on 27 March 2014. IPV was introduced in 2015 and bivalent OPV replaced trivalent OPV in April 2016. Surveillance continues because of vaccine-derived poliovirus and importation risk.

(a)(ii) Case of HIV with meningitis

(1) Diagnosis: cryptococcal meningitis (Cryptococcus neoformans) in an HIV-positive patient.

(2) Laboratory diagnosis: CSF shows raised opening pressure, lymphocytic pleocytosis, high protein and low glucose. India ink shows budding encapsulated yeasts; mucicarmine stains the capsule. Cryptococcal antigen (latex agglutination or lateral flow assay) in CSF and serum is the most sensitive test. Culture on Sabouraud dextrose agar (urease-positive, colonies mucoid) confirms; brain imaging excludes mass lesions.

(3) Predisposing conditions: HIV with CD4 below 100/µL, corticosteroids or other immunosuppression, transplant, haematological malignancy, sarcoidosis, cirrhosis.

(4) Treatment: induction with amphotericin B (liposomal preferred) plus flucytosine for 1–2 weeks, then fluconazole consolidation for 8 weeks and lower-dose maintenance until CD4 recovers. Therapeutic lumbar puncture manages raised pressure. ART is deferred by 4–6 weeks to avoid immune reconstitution inflammatory syndrome.

(b)(i) Injury, hurt and grievous hurt

Under the Bharatiya Nyaya Sanhita, 2023 (BNS): injury is any harm illegally caused to a person in body, mind, reputation or property (Section 2(14); IPC Section 44). Hurt is causing bodily pain, disease or infirmity (Section 114; IPC 319).

Grievous hurt (Section 116; IPC 320): emasculation; permanent privation of sight of either eye; permanent privation of hearing of either ear; privation of any member or joint; destruction or permanent impairing of the powers of a member or joint; permanent disfiguration of head or face; fracture or dislocation of a bone or tooth; and any hurt that endangers life or causes severe bodily pain or inability to follow ordinary pursuits for 15 days (20 days in the old IPC).

Difference: hurt is any bodily pain or minor harm, usually temporary, while grievous hurt involves one of the eight listed kinds of serious or permanent harm. Punishment differs: voluntarily causing hurt, up to one year or fine up to Rs 10,000 or both (Section 115(2)); voluntarily causing grievous hurt, up to seven years and fine (Section 117(2)); grievous hurt by dangerous weapons or means, life or one to ten years and fine (Section 118(2)).

(b)(ii) Asphyxia, sexual asphyxia and semen

Signs of asphyxia: cyanosis, congestion, petechiae (Tardieu spots) on conjunctivae and serosa, dark fluid blood, congested viscera, froth in airways and pulmonary oedema, with a dilated right heart.

Violent asphyxial deaths: hanging, strangulation (ligature or manual), suffocation (smothering, choking, gagging), traumatic or crush asphyxia, and drowning.

Sexual (autoerotic) asphyxia: deliberate partial hanging or ligature to enhance arousal, mostly in young males; death is accidental when the self-rescue mechanism fails. Scene: found alone, in private, often nude or cross-dressed, with padding, mirror or pornography.

Semen tests: presumptive: acid phosphatase, Florence (choline iodide) and Barberio (spermine picrate) tests, and ultraviolet fluorescence; confirmatory: microscopic identification of spermatozoa, prostate-specific antigen or p30, and DNA profiling.

Collection in an alleged rape: informed consent (BNSS Section 184); no washing; swabs from vulva, vaginal fornices, cervix, anus and mouth as indicated; combed pubic hair, nail clippings, clothing and reference blood. Air-dry, pack in paper bags, label and seal each exhibit, and maintain chain of custody to the forensic laboratory.

(c)(i) Artemisinin-based combination therapy (ACT)

ACT pairs a fast-acting artemisinin derivative (rapid parasite clearance, gametocytocidal) with a longer-acting partner drug that clears residual parasites and delays resistance. WHO-recommended combinations are artemether–lumefantrine, artesunate–amodiaquine, artesunate–mefloquine, artesunate–sulfadoxine–pyrimethamine and dihydroartemisinin–piperaquine. India's 2014 guidelines use artesunate with sulfadoxine–pyrimethamine for falciparum malaria in most areas and artemether–lumefantrine in the north-east, with single-dose primaquine for gametocytes. Treatment lasts 3 days.

(c)(ii) Liposomal amphotericin B over conventional amphotericin B

• Much less nephrotoxicity, so it can be used in renal impairment.
• Fewer infusion reactions, such as fever, rigors and hypokalaemia.
• Higher doses are tolerated, with better tissue penetration into liver, spleen and CNS.
• Higher therapeutic index and shorter regimens (single-dose in visceral leishmaniasis); preferred in cryptococcal meningitis.
• Higher cost is the drawback.