Vaccines: Propaganda and Practice

Vaccines are a cost effective, time tested means of reducing morbidity and mortality. As more and more new vaccines are introduced and more diseases come under the purview of ‘vaccination net’, the routine immunization program is sidelined.\ud This is compounded by vaccination practices in private health care system and anti vaccine propaganda and confusing pro vaccine propaganda. The primary purpose of the vaccine is shifting from prevention of diseases to monetary gains for the health care providers and manufacturers. There is a need to regulate the vaccination practices in the private health care system especially in the developing countries. The regulatory process should educate not only the community but also the health care providers and take adequate measures to control the ‘vaccine market forces

YALE OBSERVATION SCALE AS A PREDICTOR OF BACTEREMIA AND FINAL OUTCOME IN 3-36 MONTHS OLD FEBRILE CHILDREN ADMITTED IN TERTIARY HEALTH CENTRES: A HOSPITAL-BASED CROSS-SECTIONAL STUDY

ABSTRACTObjectives: The objective of the study was to assess predictability of bacteremia in febrile children in the age group of 3-36 months by application ofYale observation scale (YOS) and to predict clinical course during hospital stay and final outcome by YOS.Methods: A hospital-based cross-sectional study was carried out at Kasturba Medical College, Mangalore, Karnataka, for a period of 2 years(September 2013-September, 2015) in 100 febrile children in the age group of 3-36 months with probable infectious etiology admitted in ward/PICU.Children with any non-infectious causes of fever (vaccination, autoimmune, and immunodeficiency disorder) were excluded from the study. Caseswere selected by simple random sampling. The primary study outcome was bacteremia based on positivity on blood culture and sensitivity sampledrawn at admission. Secondary outcomes are clinical course in the hospital, use of antibiotics, need for mechanical ventilation, hospital stay, andmortality.Results: 100 cases were included in the study out of which 18 cases were bacteremic with a mean YOS of 26 (non-bacteremic - 11), mean hospitalstay 19.5 days (non-bacteremic - 12 days). All 18 bacteremic children had YOS ≥20, but YOS ≥20 had 8 false positives cases. There was no significantinterobserver variability in YOS assessment (Cronbach's alpha - 0.993 showing good correlation with intraclass correlation coefficient - 0.986).Higher YOS scores had good sensitivity, specificity, positive and negative likelihood ratios, and area under curve for prediction of bacteremia atYOS >20 (100%, 90.2%, 10.2, 0.00, and 0.970), need for mechanical ventilation at YOS >21 (100%, 91.7%, 12.04, 0.00, and 0.969), need for scaling upantibiotics at YOS >21 (70.4%, 94.4%, 12.5, 0.31, and 0.822), and mortality at YOS >21 (90.9%, 85.4%, 6.2, 0.106, 0.878).Conclusion: YOS is a good tool to rule out bacteremia and to prognosticate the clinical course at the first visit. This simple scale can be of value inmonitoring admitted patients for deteriorating clinical state and for assessing the need for referral to higher centers for further management.Keywords: Yale observation scale, Bacteremia, Febrile patients

Bilateral Giant Hydronephrosis in a Ten-Year-Old Male

We describe a ten-year-old male with bilateral giant hydronephrosis due to pelviureteric junction obstruction presenting with abdominal distension and renal failure. The diagnosis was confirmed on computed tomography and required a two-stage procedure, initially percutaneous nephrostomy followed by Anderson–Hynes pyeloplasty with recovery of kidney function

Bilateral Giant Hydronephrosis in a Ten-Year-Old Male

We describe a ten-year-old male with bilateral giant hydronephrosis due to pelviureteric junction obstruction presenting with abdominal distension and renal failure. The diagnosis was confirmed on computed tomography and required a two-stage procedure, initially percutaneous nephrostomy followed by Anderson–Hynes pyeloplasty with recovery of kidney function

Perceived responsibilities and operational difficulties of anganwadi workers at a coastal south Indian city

Context: Anganwadi worker (AWW) is an important functionary in integrated child development scheme (ICDS). Aim: To study perceived responsibilities, workload, operational difficulties, and satisfaction level of AWWs. Materials and Methods: Prospective observational cross-sectional study of 66 AWWs using a pre-designed proforma: Analysis using Statistical package for social sciences (SPSS) version 11.5. Results: Pre-school education, house visits, records-keeping were perceived as important activities by 92.4%, 60.6%, and 57.6%, respectively, growth monitoring and immunization by 3% and 4.5%, respectively; 51.5% did not have adequate time for duties, and 74.2% were doing non-ICDS duties. Heavy workload was the major perceived operational difficulty for 66.7% of the respondents. Timely supplementary food was available as per 92.4%. Inadequacies in equipments, workspace, training, and staffing were noted by 47%, 18.2%, 7.6%, 7.6%, respectively. No operational difficulties were seen by 10.6%. Induction job training was provided to 36 (54.5%), and 17/66 (25.8%) felt they were inadequately trained despite yearly refresher courses. Dissatisfaction with monthly honorarium, availability of equipment, supplementary food, and maintenance of registries was reported by 89.4%, 53%, 54.6%, and 43.9%, respectively. Despite this, 62.1% (40/66) were satisfied. Conclusions: Supplementary nutrition, growth monitoring, and immunization of children along with health education though being primary duties were given less emphasis. Heavy workload was the major perceived operational difficulty. Adequate staff, workspace, equipments, timely monthly honorarium should be provided along with training and avoidance of non-ICDS duties would help in achieving the objectives of ICDS

Diagnostic and Prognostic Validity of Proadrenomedullin among Neonates with Sepsis in Tertiary Care Hospitals of Southern India

Introduction. To evaluate Proadrenomedullin (Pro-ADM) as the diagnostic and prognostic marker in neonatal sepsis. Materials and Methods. In this cross-sectional study, Pro-ADM levels were estimated in 54 neonates with clinical sepsis and positive sepsis screen (cases) and 54 controls without clinical sepsis. Repeat Pro-ADM levels were estimated after 72 hours in cases. Pro-ADM levels were compared with the clinical outcome. Results and Discussion. Median Pro-ADM levels in cases were 31.8 (IQR: 27.8-39.4) pmol/ml which was significantly higher than controls 5.1 (IQR; 3.1-7.7) pmol/ml. From the constructed ROC curve, a value of 14.5 pmol/ml was taken as the cut-off for sepsis. Pro-ADM had 100% sensitivity, specificity, and positive predictive values (PPV) in detecting sepsis at 14.5 pmol/ml. Among cases, a decrease in Pro-ADM level by 10 pmol/ml was associated with 99% survival. Pro-ADM value of 35 pmol/ml had 100% specificity and PPV in predicting mortality. Conclusion. Pro-ADM can be used as a single biomarker for detecting neonatal sepsis, predicting clinical outcome and prognosis

Thyroid Function in Chronically Transfused Children with Beta Thalassemia Major: A Cross-Sectional Hospital Based Study

Background. Thalassemia is the most common genetic disorder worldwide. Use of iron chelators has improved survival but endocrine complications have become more frequent. The frequency of hypothyroidism in Beta Thalassemia Major (BTM) children ranges from 6 to 30 %. Thyroid dysfunction mainly occurs by gland infiltration, chronic tissue hypoxia, free radical injury, and organ siderosis. Objectives. (a) To evaluate the thyroid function status in chronically transfused children with BTM, in the first and second decade of life and (b) to study the influence of factors like duration and amount of blood transfusions, serum ferritin level, and iron chelation therapy on thyroid function. Methodology. BTM children, 3 years old and above, on regular blood transfusions with serum ferritin > 1500 mcg/l were included in the study. Thyroid function and ferritin assessment was done using ELISA kits. Autoimmune thyroiditis was ruled out by antithyroid peroxidase and antithyroglobulin antibody testing. Results. A study population of 83 children consisted of 49 boys (59%) and 34 girls (41%). 4.8% of the children had evidence of subclinical hypothyroidism. Among them two belonged to the first decade and the other two to the second decade of life. Mean TSH, FT4, and ferritin values among children with thyroid dysfunction were 6.38 ± 0.83 mIU/ml, 1.08 ± 0.45 ng/dl, and 3983.0±1698.30 ng/ml, respectively. The severity of thyroid dysfunction was statistically significantly associated with higher serum TSH values in children in the second decade of life with a p value = 0.001. No other significant correlation was found between oral chelation, amount and duration of blood transfusion, or serum ferritin levels. Conclusion. Subclinical hypothyroidism was the thyroid dysfunction observed in our study. Regular blood transfusions with adequate chelation may decrease incidence of thyroid dysfunction

Prevalence of bronchial asthma among school-going children in Mangalore, South India

Background: Asthma in childhood is a major public health issue. Objective: To estimate prevalence and associated housing environment factors of asthma among school children. Material & Methods: We conducted a cross sectional study among school children aged six to fifteen years. Standard ISAAC (International Study of Asthma and Allergies in Children) Core Questionnaire for Asthma was used for determining the prevalence of wheezing and asthma. Demographic, housing and indoor pollution factors were collected. Data were analyzed by SPSS version 15. Results: Prevalence of ‘wheeze ever’ and ‘current wheezers’ was 10% and 9% respectively.  Physician diagnosed asthma was seen in 6.3 %. Severe asthma was noted in 28.6% of current wheezerswith 84.6% and 8.8% having one to two and four to 12 wheezing attacks per year respectively. Wheezing was present post exercise in 5.4%, nocturnal cough in 6.1%, sleep disturbance less than one night/week (40.7%), one or more nights/week (3.3%) and wheezing limiting speech to few words between breaths (20.9%). Prevalence was greater among boys (9.8%) than girls (7.5%) and maximal in age group eight to nine years. On multiple logistic regression presence of overcrowding and absence of smoke outlet were significantly associated with current wheeze. Socio-economic status, beedi rolling practices and absence of separate kitchen was statistically significant with severe asthma. Conclusions: Current wheezer prevalence was9% and more in boys. Adoption of improved housing conditions and avoiding environmental tobacco exposure may aid in reducing childhood asthma attacks in this developing city