ABSTRACT
@#The aim of the study was to assess the status of routine immunization status and reasons for drop-outs in five districts in Bihar India. A community based cross sectional rapid survey in five districts in Bihar was undertaken from 11th January to 5th February 2013. Of the 38 districts in Bihar, 5 districts prioritized by the state government for intensive routine immunization support were selected purposively for the rapid assessment. Samples of primary health centres, Health sub centres, villages were chosen for the study using geographic and performance criteria. Twenty households having babies 0 to 36 months old from each village were randomly selected. A total of 7,500 households were taken from the 5 study districts. Apart from household survey, cold chain points where vaccines are stored and vaccination session sites were also assessed for service delivery and community participation. The assessment findings revealed high access resulted in good coverage of the initial vaccination such as BCG and DPT1, while low utilization due to drop out of children from DPT1 to DPT3 (15%) and BCG –measles dropout (27%). The coverage was inequitable, with 12% difference in full immunization among children below poverty line and scheduled caste and tribe children. The reasons for low vaccination coverage were both related to demand and supply side. Lack of awareness on immunization, lack of correct information about the place and time of immunization, illness of the child at the time of immunization session, irregular session timing and fear of adverse effects were found to be the major causes for almost 60% of households. The health staff ascribed it mainly to erratic supply of vaccines and logistics, poor planning, insignificant role of media or past experience of Adverse Effect Following Immunization (AEFI) as major causes. Based on the assessment of cold chain and vaccination session facility and key informant interviews, it was recommended that special emphasis should be given to due list preparation and tracking of beneficiaries using local volunteers, self-help groups and mobilizers especially in hard to reach areas. In addition, to ensure regular vaccine and logistic availability, Microplanning to include disadvantaged communities like Scheduled Caste (SC)/Scheduled Tribe (ST) & Below Poverty Line (BPL) households and intensive monitoring using both internal and external supervisors for regular monitoring of the routine immunization activities
ABSTRACT
<p><b>AIM</b>To study the occurrence of Y chromosome microdeletions in azoospermic patients with Klinefelter's syndrome (KFS).</p><p><b>METHODS</b>Blood and semen samples were collected from azoospermic patients with KFS (n = 14) and a control group of men of proven fertility (n = 13). Semen analysis was done according to World Health Organization (WHO) guidelines. Blood samples were processed for karyotyping, fluorescent in situ hybridization (FISH) and measurement of plasma follicle stimulating hormone (FSH) by radioimmunoassay. To determine Y chromosome microdeletions, polymerase chain reaction (PCR) of 16 sequence tagged sites (STS) and three genes (DFFRY, XKRY and RBM1Y) was performed on isolated genomic DNA. Testicular fine needle aspiration cytology (FNAC) was done in selected cases.</p><p><b>RESULTS</b>Y chromosome microdeletions spanning the azoospermia factor (AZF)a and AZFb loci were found in four of the 14 azoospermic patients with KFS. Karyotype and FISH analysis revealed that, of the four cases showing Y chromosome microdeletion, three cases had a 47,XXY/46,XY chromosomal pattern and one case had a 46,XY/47,XXY/48,XXXY/48,XXYY chromosomal pattern. The testicular FNAC of one sample with Y chromosome microdeletion revealed Sertoli cell-only type of morphology. However, no Y chromosome microdeletions were observed in any of the 13 fertile men. All patients with KFS had elevated plasma FSH levels.</p><p><b>CONCLUSION</b>Patients with KFS may harbor Y chromosome microdeletions and screening for these should be a part of their diagnostic work-up, particularly in those considering assisted reproductive techniques.</p>