Factors Influencing the Accessibility of Education for Children with Disabilities in India

The Central and State governments in India have formulated programs and policies over the years for children with disabilities in order to help them to enter mainstream society. However, despite these policies, children with disabilities are amongst the most disadvantaged in terms of access to schooling and completion of elementary education, as their needs are not met effectively. ┬áBased on my personal experiences, research, and communication with different stakeholders involved in the field of education for children with disabilities over the last 30 years, this paper explores the broader challenges in the current education system with respect to issues of quality of education and drop-out rates of primary students with disabilities. A number of factors that influence the accessibility of education for children with disabilities are presented including: perceptions of parents of children with disabilities and their difficulties in helping their children with disabilities, the general attitude of society, government officials, school staff and infrastructure, inadequate levels of training of key stakeholders, invisibility of disability in community, poverty, lack of acceptance, lack of interest, gender discrimination, lack of awareness, poor physical access, availability of various support systems, and government policies focusing on the education of children with disabilities in specific.┬

COVID-19 mRNA vaccines and myopericarditis

Globally, vaccination against COVID-19 has prevented countless infections, hospitalisations and death and represents the most successful intervention in combating the pandemic caused by SARS-CoV2 infection. Utilisation of existing mRNA vaccine technology has allowed for rapid development of highly immunogenic and effective vaccines. Myopericarditis can occur as an adverse effect of COVID-19 mRNA vaccination, albeit at significantly lower rates than that which occurs during SARS-CoV2 infection. Higher rates are seen in adolescent males, usually within 1-5_days of receiving the second vaccine dose. Although most cases are self-limited and respond to first-line treatment, refractory cases can occur, with a limited evidence base on which to guide management. Here we present a brief review of COVID-19 mRNA vaccines and associated myopericarditis including risk factors, proposed mechanism, and treatment including management strategies for refractory disease. This article is protected by copyright. All rights reserved

Gastric cancer screening in common variable immunodeficiency

Individuals with common variable immunodeficiency (CVID) have an increased risk of gastric cancer, and gastrointestinal lymphoma, yet screening for premalignant gastric lesions is rarely offered routinely to these patients. Proposed screening protocols are not widely accepted and are based on gastric cancer risk factors that are not applicable to all CVID patients. Fifty-two CVID patients were recruited for screening gastroscopy irrespective of symptoms or blood results and were compared to 40 controls presenting for gastroscopy for other clinical indications. Overall, 34% of CVID patients had intestinal metaplasia (IM), atrophic gastritis or moderate to severe non-atrophic gastritis, which can increase the risk of gastric cancer, compared to 7.5% of controls (p < 0.01). Focal nodular lymphoid hyperplasia, a precursor lesion for gastrointestinal lymphoma, was seen in eight CVID patients (16%), one of whom was diagnosed with gastrointestinal lymphoma on the same endoscopy. High-risk gastric pathology was associated with increased time since diagnosis of CVID, smoking, Helicobacter pylori, a low-serum pepsinogen I concentration, and diarrhea, but not pepsinogen I/II ratio, iron studies, vitamin B12 levels or upper gastrointestinal symptoms. There was a lower rate of detection of IM when fewer biopsies were taken, and IM and gastric atrophy were rarely predicted by the endoscopist macroscopically, highlighting the need for standardized biopsy protocols. The prevalence of premalignant gastric lesions in patients with CVID highlights the need for routine gastric screening. We propose a novel gastric screening protocol to detect early premalignant lesions and reduce the risk of gastric cancer and gastric lymphoma in these patients