Prevalence of hepatitis B & C infections in prospective blood donors deferred due to history of jaundice

Background & objectives: As per national guidelines, prospective blood donors with a history of jaundice of unknown cause are deferred permanently to prevent the transmission of hepatitis B and C. The validity of this guideline was tested by comparing prevalence rates of hepatitis B and C in prospective blood donors deferred due to a history of jaundice, with that of donors who were found fit. Methods: Blood samples of 212 consecutive donors (male, n=203) deferred due to a history of jaundice were studied for hepatitis B and C by rapid test kits as well as by chemiluminescence (n=115) or ELISA (n=97). Consecutive healthy donors (n=549; male, n=518) were also studied by ELISA (n=266) or chemiluminescence (n=283). Results: The cumulative prevalence detected by rapid test kit and ELISA/chemiluminescence tests of hepatitis B (n=10) and C (n=2) among donors deferred due to a history of jaundice (n=212) was 5.7 per cent [95% confidence interval (CI): 2.9, 9.9]. The prevalence of reactive results among healthy donors (n=549) by ELISA/chemiluminescence tests was 3.3 per cent (95% CI: 1.9, 5.2), which included hepatitis B (n=15) and hepatitis C (n=3) cases. Compared to healthy donors, the odds of seropositivity among jaundice-deferred donors was 1.7 (95% CI: 0.8, 3.6), P=0.15. For rapid test-negative deferred donors, the odds of seropositivity by ELISA/chemiluminescence declined to 0.4 (0.1, 1.5), P=0.19. Interpretation & conclusions: The prevalence rates of hepatitis B and C in prospective blood donors deferred due to a history of jaundice of unknown aetiology did not differ significantly from that in healthy donors. The current practice of permanently deferring such donors depletes valuable donor pool. A strategy of rejecting only those donors who are found reactive on pre-donation testing by rapid test needs further validation.

Canon CP-TX1 camera � As a screening tool for amblyogenic risk factors

Purpose: To evaluate the Canon CP?TX1 camera as a screening tool for ARFs in a pediatric population and estimate the prevalence of ARFs. Methods: In a pediatric outpatient space, largely in the immunization clinic, after obtaining parental consent, we encouraged children to be photographed from a distance of 5 feet in a dim room by using a CP?TX1 camera with the red?eye reduction feature off. Based on the captured red reflex, children were labeled as normal (symmetrical red reflexes in the two eyes, with no visible crescents); all others were considered as abnormal or positive for ARFs. All photographed children were assessed by an optometrist/refractionist for VA by age?appropriate methods. Data were entered into a 2 � 2 contingency table on statpages.org, and diagnostic indices were calculated with 95%CI. Results: With a sample of 262 children, we obtained a sensitivity of 0.82, a specificity of 0.98, a positive predictive value of 0.92, a negative predictive value of 0.94, a positive likelihood ratio of 41.06, a negative likelihood ratio of 0.17, and a prevalence of 0.24 for ARFs. Conclusion: CP?TX1 performed well as a screening tool to identify ARFs in children. Placing such a camera in an immunization clinic offers a chance to identify children with ARFs at a time when amblyopia is eminently reversible.

Medical Student’s Feedback towards Problem Based Learning and Interactive Lectures as a Teaching and Learning Method in an Outcome-Based Curriculum

Objective: To explore the medical student’s opinion about the effectiveness of problem-based learning and interactive lectures as a teaching and learning method. Method: The cross-sectional study was conducted at the College of Medicine, Majmaah University from April 2016 to June 2016. Results: Total 120 undergraduate medical students were enrolled in this study; out of these 97 students filled the questionnaire form for an interactive lecture and 112 completed the questionnaire form for PBL based learning. The response rate for interactive lectures was 80% and PBL was 93%. The comparison of the responses between the groups was done using independent samples Mann- Whitney U-test. Among the questions of VARK learning styles, the significance was found in PBL as a tool for auditory learning and reading and writing skills over interactive lectures. Conclusion: The study showed a preference of students towards PBL over interactive lectures in a system based hybrid curriculum where both of them used an instructional approach. The merit of the interactive lecture cannot be underrated in the system based integrated as evident from the previously conducted educational research. Based on the findings, there is a need to revisit the process of interactive lecture in our study settings. Exploration is required for the alignment of the assessment tools with the learning outcomes of the PBL.

Safety and Efficacy of Isotonic (0.9%) vs. Hypotonic (0.18%) Saline as Maintenance Intravenous Fluids in Children: A Randomized Controlled Trial.

Objective: To compare the safety and efficacy of isotonic versus hypotonic maintenance fluid in children. Design: Randomized controlled trial. Setting: Tertiary-level teaching hospital. Participants: 60 children (age 0.5 to 12 years) who were admitted and anticipated to receive intravenous fluid for the next 48 hours. Intervention: Hypotonic fluid (Standard maintenance volume as 0.18% NaCl in 5% dextrose) or Isotonic fluid (60% Standard maintenance volume as 0.9% NaCl solution in 5% dextrose). Outcome measures: Primary: Incidence of hyponatremia. Secondary: Serum sodium, serum osmolality, blood sugar, blood urea, serum creatinine, serum potassium, serum chloride, pH, urine output, change in weight, morbidity and death. Results: At 24 hours, hyponatremia was noted in 7 (24%) patients in the isotonic and 16 (55%) in hypotonic group (P=0.031). At 48 hours, hyponatremia was noted in 4 (14%) and 13 (45%) patients in isotonic and hypotonic group, respectively (P=0.02). There was significant change in sodium levels in both isotonic (P=0.036) and hypotonic (P<0.001) intervention groups. The peak fall in mean serum sodium level was noted at 24 hours (-6.5, 95%CI: -3.5, -9.6 mEq/L; P<0.001) in hypotonic group. In isotonic group, there was significant increase between 24 and 48 hours (4.3, 95% CI: 0.1, 8.4 mEq/L; P=0.04). Conclusions: Reduced volume isotonic fluid results in fewer episodes of hyponatremia than hypotonic fluid in sick children during the first 48 hours of intravenous fluid therapy.

Age-specific prevalence of hepatitis B surface antigen in pediatric population of Aligarh, North India.

OBJECTIVE: To estimate the age-specific seroprevalence of hepatitis B surface antigen (HBsAg) in children upto 14 years of age. METHODS: Equal number (115 each) of apparently healthy children of both sexes of different age groups i.e. < 1, 1-4, 5-9 and 10-14 years, attending pediatric outpatient services and Well Baby Clinic of the hospital were tested for HBsAg using ELISA test. Positive results were confirmed by a second ELISA. RESULTS: Overall 4.35% (95%CI, 2.44 - 6.25) of the 460 children tested were HBsAg positive. The prevalence rate was the highest (6.09%) in the 1-4 year age category. In the < 1, 5-9 and 10-14 year age groups it was 4.35%, 4.35% and 2.61% respectively. The overall male to female ratio was 2.1:1, with no significant difference in seropositivity rates (P = 0.816).The difference in the prevalence rates between the rural (4.84%) and urban populations (3.77%) was also statistically insignificant (P = 0.577). CONCLUSION: Average HBsAg positivity in the pediatric population in this region is 4.35% (95%CI, 2.44 - 6.25). The prevalence progressively increases and peaks in the 1- 4 years age group. It is least in 10-14 years age group.