Immunogenicity of measles-rubella vaccine administered under India’s Universal Immunization Programme in the context of measles rubella elimination goal: A longitudinal study

Background & objectives: There is a paucity of data regarding immunogenicity of recently introduced measles–rubella (MR) vaccine in Indian children, in which the first dose is administered below one year of age. This study was undertaken to assess the immunogenicity against rubella and measles 4-6 wk after one and two doses of MR vaccine administered under India’s Universal Immunization Programme (UIP). Methods: In this longitudinal study, 100 consecutive healthy infants (9-12 months) of either gender attending the immunization clinic of a tertiary care government hospital affiliated to a medical college of Delhi for the first dose of routine MR vaccination were enrolled. MR vaccine (0.5 ml, subcutaneous) was administered to the enrolled participants (1st dose at 9-12 months and 2nd dose at 15-24 months). On each follow up (4-6 wk post-vaccination), 2 ml of venous blood sample was collected to estimate the antibody titres against measles and rubella using quantitative ELISA kits. Seroprotection (>10 IU/ml for measles and >10 WHO U/ml for rubella) and antibody titres were evaluated after each dose. Results: The seroprotection rate against rubella was 97.5 and 100 per cent and against measles was 88.7 per cent and 100 per cent 4-6 wk after the first and second doses, respectively. The mean (standard deviation) titres against rubella and measles increased significantly (P<0.001) after the second dose in comparison to the levels after the first dose by about 100 per cent and 20 per cent, respectively. Interpretation & conclusions: MR vaccine administered below one year of age under the UIP resulted in seroprotection against rubella and measles in a large majority of children. Furthermore, its second dose resulted in seroprotection of all children. The current MR vaccination strategy of two doses, out of which the first is to be given to infants below one year of age, appears robust and justifiable among Indian children.

Risk of progression to overt hypothyroidism in Indian patients with subclinical hypothyroidism: a prospective observational study

Background:Subclinical hypothyroidism (SCH) is a common endocrine disorder but spontaneous course of SCH in India is lacking. The aim of the study is to determine the spontaneous course of SCH and to identify the risk factors, which enhances the occurrence of overt hypothyroidism (OH).Method: This is a real world prospective observational study. 58 SCH were followed up six monthly for one year to determine the course of SCH.Results: After one year of follow up 11 (18.97%) patients progressed to OH. 37 (63.79%) remained in subclinical hypothyroid category. In 10 (17.29%) patients TSH (thyrotropin) normalized. Rate of progression (odds ratio: 4.58; 95% CI: 1.14, 18.28) was significantly more in anti-thyroid peroxidase (TPO) positive group as compared to anti-TPO negative group. Conclusions: This first data from India clearly shows that SCH has a variable course. Rate of progression to OH is high (18.97%) in Indian SCH patients. In a cohort of 58 patients followed for one year only the presence of anti-TPO antibody waspredictive of OH. The initial risk stratification can identify patients with SCH at greatest risk for progression to OH in which treatment is mandatory.

Congenital cholesteatoma: a review

Congenital cholesteatoma (CC) is a whitish mass lesion found in the middle ear cleft behind the intact tympanic membrane in early life. It is a relatively uncommon disease and shows its growth and extension over a period of time. CC is evidenced with no prior history of tympanic membrane perforation, otorrhea, previous otologic procedures, normal pars tensa, and pars flaccida. The etiopathogenesis of CC is still controversial; however, the epithelial cell rest theory is the most commonly accepted one. The most common sites of CC are the anterior-superior and posterior-superior quadrants of the tympanic cavity. The most common clinical presentation of CC is conductive hearing loss. Early detection and intervention are needed to avoid the complications of CC. The treatment of choice in CC is still surgical. The frequency of recurrence seems to be lower in patients with CC than in acquired cholesteatoma. Rapid progression of the CC may occur in older children and the recurrence has been associated with advanced progression of the cholesteatoma. There are very few reports for CC available in the medical literatureThis objective of this review article is to discuss the prevalence, etiopathology, clinical manifestations, diagnosis, and treatment.

Loss of interest for training in paediatric surgery in India

BACKGROUND Despite the sizeable Indian paediatric population, few students have opted for postdoctoral (Magister Chirurgiae [MCh]/Diplomate of the National Board of Examinations [DNB]) courses in the past decade. We analyse the apparent loss of interest for training in paediatric surgery in India and suggest remedies. METHODS We did a combination of an online questionnaire-based survey and several interviews among students, teachers and practitioners of paediatric surgery. The results were collated and analysed. RESULTS Information from 238 questionnaires, 35 interviews and 75 feedbacks were distilled. About 83% of respondents agreed to a definite loss of interest among students in paediatric surgery, largely because of poor exposure during undergraduate/postgraduate courses and absence of a department in medical colleges. The blanket increase in seats has led to vacancies. The low saleability of paediatric surgery is linked to high personnel and infrastructure investment, modest remunerative potential and poor insurance cover for patients. Besides increasing public awareness, strategic governmental patronage in postdoctoral training (e.g. establishing a department in medical colleges, moderating the number of seats, encouraging performing training centres and rationalizing the bond after the training course) and facilitation of patient care (e.g. insurance cover for congenital conditions and paediatric surgeon in neonatal care units in district hospitals) is suggested. CONCLUSIONS The loss of interest in paediatric surgery among medical trainees is real and urgently requires a multipronged strategy by the medical fraternity, professional organizations and regulatory bodies across government and non-governmental sectors to facilitate a revival and cater to the sick surgical child in the future.

Comparison of Continuous Real Time Blood Glucose Measurement With Venous Laboratory Blood Glucose Level in Neonates During Perioperative Period

Objective: To compare the continuous real time blood glucose (CG) measurement with venous laboratory blood glucose (LG) level in neonates during perioperative period. Methods: Glucose levels were measured simultaneously by CG, glucometer glucose (GG) and LG at 40 time points in ten neonates during perioperative period. Intraclass correlation coefficient (ICC) and Bland Altman analysis were used for comparison. Result: Correlation between CG and LG was excellent (ICC= 0.953; P<0.001), and average difference was 23.8 (95%CI 52.9 to -5.3) mg/dL, showed better reliability than at hyperglycemic state (ICC=0.653; P=0.006). The GG-LG showed excellent reliability with ICC = 0.985; P<0.001 and average difference of 15.4 (95% CI 30.7 to 0.1) mg/dL. CG at euglycemic state (ICC= 0.880; P<0.001). Conclusion: CG measurement is reliable for blood sugar estimation in neonates; but has lower reliability for hyperglycemia. The continuous trend of glucose measurement by CG is helpful for timely diagnosis of hyperglycemia during perioperative period in neonates.

Manual Method vs Breast Pump for Breast Milk Expression in Mothers of Preterm Babies During First Postnatal Week: A Randomized Controlled Trial

Objectives: To compare breast milk volume between manual method and breast pump expression in mothers of preterm infants at different time point of first week. Design: Randomized controlled trial. Setting: Postpartum ward of Obstetrics department and tertiary level neonatal intensive care unit (NICU) in a single institution in Orissa between October, 2020 and May, 2021. Participants: Mothers who delivered before 34 completed weeks of gestation. Interventions: Manual breastmilk expression (ME) group using Marmet technique and breast pump milk expression (PE) group using pigeon manual breast pump, initiated milk expression within one hour of delivery. Outcome measures: Expressed breast milk (EBM) volume in mothers of preterm infants at different time point of first week, and cumulative milk volume. Results: Out of 170 mothers (83 PE and 87 ME group), 7-days milk volume data was available for 137 (71 ME and 66 PE) mothers. In per protocol analysis for 126 mothers (63 in each group), the median (IQR) EBM volume on day 2 and day 7 of ME and PE groups were similar [10 (5,20) vs 12 (5,28), P=0.10] and [280 (220-356) vs 280 (220-360), P=0.66]. The median (IQR) cumulative EBM volume over first 7 days in ME group was not significantly different from PE group [733 (593-995) vs 848.5 (571-1009)] P=0.55). A similar number of mothers in the PE and ME group [56 (88.9%) vs 58 (92%); P=0.14] provided exclusive breast milk for their neonates during the first week. Similar results were found on intention to treat analysis. Conclusion: EBM volume expressed was comparable between mothers expressing manually or with breast pump.

Antrochoanal polyp among elderly age group: Our experiences at a tertiary care teaching hospital of Eastern India

Background: Antrochoanal polyps (ACPs) are benign polypoidal mass originating from the maxillary sinus and they extend into the choana. The etiopathogenesis of ACP is not clear. These are found more commonly in children and young adults. ACP is almost always unilateral and common symptoms include nasal obstruction and nasal discharge. These lesions are extremely rare in the older adult age group. Materials and Methods: This is a retrospective study of 14 cases of ACPs managed between June 2017 and July 2022. Detailed clinical presentations, investigations, and treatment with surgical interventions for ACPs were studied. Results: Out of 14 cases of older adult patients with ACPs, there are 8 (57.14%) cases with a polyp on the left side and 6 (42.85%) cases on the right side of the nasal cavity. The most common symptom was constant and unilateral nasal obstruction in 12 (85.71%) patients, followed by purulent nasal discharge in 7 (50%) cases, clear rhinorrhea in 5 (35.71%) cases, facial pain in 4 (28.57%) cases, snoring in 3 (21.42%) cases, sneezing in 3 (21.42%) cases, and halitosis in 2 (14.28%) cases. Conclusion: ACPs are uncommon in the older adult age group. Diagnostic nasal endoscopy and computed tomography scans are important tools for the diagnosis of ACP. Functional endoscopic sinus surgery and power instrumentation are helpful for the complete removal of ACPs and are considered extremely safe procedures. Clinicians and otolaryngologists are often not aware of the prevalence of ACPs among the older adult age group.

Blood pressure trend of lowlanders during first 6 days of acclimatisation to high altitude

Objectives: The present study was planned to delineate the blood pressure (BP) response of the lowlanders during initial 6 days of acclimatisation to high altitude. Materials and Methods: 398 normotensive sojourners at sea level ascended to HA (3,500 m). Blood pressure response of these subjects were analysed for 6 consecutive days at HA. Based on the BP response of these subjects on the 6th day at HA they were divided into two groups: HBP-high BP group and NBP- normal BP group. Results: It showed that on 6th day at HA, 51 out of 398 subjects presented with BP?140/90 mmHg (HBP) while others remained normotensive (NBP). Comparative systolic BP of HBP and NBP groups during successive days at HA were as follows: HA day 1 (146.8 ± 13.7 mmHg vs 146.3 ± 8.8 mmHg, p>0.05), HA day 4 (144.5 ± 8.7 mmHg vs 135.0 ± 7.0 mmHg, p<0.05) and HA day 6 (148.1 ± 7.9 mmHg vs 131.7 ± 5.3 mmHg, p<0.05). Whereas, diastolic BP of HBP and NBP groups were: HA day 1 (94.0 ± 8.1 mmHg vs 93.2 ± 6.6 mmHg, p>0.05), HA day 4 (88.9 ± 6.0 mmHg vs 85.3 ± 5.1 mmHg, p<0.05) and HA day 6 (93.8 ± 6.3 mmHg vs 83.7 ± 3.8 mmHg, p<0.05). Conclusion: It was found that NBP had initially raised BP which returned to normal levels after acclimatisation period of 6 days, but in HBP, it started rising after 4th day. It can be concluded that those individuals whose BP on 6th day at HA does not return to normal after acclimatisation period needs regular follow up as these individuals can have a delayed acclimatisation normalising BP later on or can become hypertensive subsequently

Current criteria for selecting cochlear implant in deaf patients: areview

Cochlear implantation is indicated in patients with severe to profound hearing loss that cannot be adequately treated by other auditory rehabilitation measures.The definitive indication of cochlear implantation is made on the basis of an extensive interdisciplinary clinical,audiological,radiological, and psychological diagnostic work-up.There are numerous changes are happening in cochlear implant candidacy.These have been associated with concomitant changes in surgical techniques,which enhanced the utility and safety of cochlear implantation.Currently, cochlear implants are approved for individuals with severe to profound unilateral hearing loss rather than previously needed for bilateral profound hearing loss.Studies have begun using the short electrode arrays for shallow insertion in patients with low-frequency residual hearing loss.The advancement in designs of thecochlear implant along with improvements in surgical techniques reduce the complications and result in the safety and efficacy of the cochlear implant which further encourages the use of these devices.This review article aims to discuss the new concepts in the candidacy of the cochlear implant,cochlear implant in younger children and hearing preservation,a cochlear implant for unilateral deafness,bilateral cochlear implant, and cochlear implant with neural plasticity and selection of patients for the cochlear implant.

Hearing loss and tinnitus among pediatric patients with COVID-19 infection: our experience

Background: Hearing impairment and tinnitus are common otological manifestations found in the outpatient Department of Otorhinolaryngology. Hearing loss and tinnitus have been documented among coronavirus disease-2019 (COVID-19) patients. However, these clinical manifestations were rarely investigated among pediatric patients with COVID-19 infections. Objective: This study aims to evaluate the prevalence of hearing impairment and tinnitus among children with COVID-19 infection at a teaching hospital. Materials and Methods: This is a prospective and descriptive study where 192 children with COVID-19 infections were evaluated for hearing loss and tinnitus. There were 44 (22.91%) children with COVID-19 infections presenting with hearing loss and tinnitus. All of the children were confirmed as COVID-19 infection with the help of reverse transcription-polymerase chain reaction of the nasopharyngeal swab. Detailed history taking and clinical examination of the ear were done for the assessment of hearing loss and tinnitus and its outcome was analyzed. Results: Out of 44 children, 20 (45.45%) were presented with tinnitus, 16 (36.36%) were presented with hearing loss, and 8 (18.18%) were presented with both hearing loss and tinnitus. Out of 44 pediatric patients with hearing loss and/or tinnitus, 26 (59.09%) were males and 18 (40.90%) were females with a male child to female child ratio of 1.44:1. The mean age of the participants was 9.16 years with an age range from 5 to 18 years. The sporadic type of tinnitus is more common than any other type. Conclusion: This study showed that the presence of subjective neurological features like hearing loss and tinnitus can be found in children with COVID-19 infection. More studies are required to confirm the exact pathophysiology mechanism underlying this subjective symptom in pediatric patients with COVID-19 infection.

Cold abscess of dental origin in a 7-year-old child

Abscess related to an infected tooth is mostly associated with pyogenic infection, but sometimes, it can be asymptomatic and indicate a chronic condition. This case report shows cold abscess with a draining sinus due to dental origin. A 7-year-old female patient complained of pain with respect to grossly decayed tooth and recurrent swelling with no response to medications. After investigations and management of the lesion, it was concluded as abscess due to chronic granulomatous infection. Cold abscess is a classical manifestation of tuberculosis with no signs of inflammation. More than 60% of cases of this pathology occur in patients below 15 years old. It needs various clinical, histopathological, and laboratory investigations. Although rare, it should be considered as a differential diagnosis when no improvement occurs postroutine therapy to prevent serious complications. Furthermore, various precautions should be taken by the clinicians to prevent cross-infection.

Emerging Threat of Salmonella typhimurium in Extraintestinal Infections: Cases from a Tertiary Care Hospital in North India

Purpose:Infections due to invasive non-typhoid salmonella can be dangerous and fatal. The mode of infection and the severity varies from the typhoidal fevers. It is important to find the association between clinical features and the infecting serovar to understand the pathophysiology and course of treatment Methods:In the present study, extra-intestinal specimens (blood, cerebrospinal fluid and pus) from three patients suffering from septicaemia, meningitis and osteomyelitis were received. Micro-biological and biochemical test for species identification and antibiotic susceptibility was done as per standard protocol.Further, PCR based amplification and sequencing of a portion of the flagellin gene (FliC) was done to confirm the serovar.Results: Salmonellaentericawas identified from all the threeby microbiological and biochemical examination.The sequence of the Flic gene confirmed the serovar to be S.typhimurium. All the patients were treated successfully for the infectionby appropriate antibiotic therapy. Conclusion:The study highlights that serovarTyphimurium is common in invasive non-typhoidal salmonellosis and its pathophysiology and virulence factors expression should be understood in various organ types for better treatment options and outcomes

Effect of Curcumin Gel along with SRP in Chronic Gingivitis Cases

Introduction: Turmeric also known as Curcuma longa thatis widely used as a spice, preservative, coloring agent, and asa household remedy is coming a long way as an alternativemanagement option for periodontal conditions. Curcumin themain yellow bioactive part of turmeric has huge spectrum ofactivity such as anti-inflammatory, antioxidant, antimutagenic,anticarcinogenic, anticoagulant, antidiabetic, antifertility,antibacterial, antiprotozoal, antiviral, antivenom, antiulcer,antifibrotic, hypotensive, and hypocholesteremic activities.The present study was conducted with the aim to determinethe effect of curcumin gel along with SRP in chronic gingivitiscases.Material and methods: The present prospective studyconsisted of 30 subjects as cases and controls respectively.The study was conducted in the department of periodontics ofthe hospital. Scaling was performed by piezoelectric scaler bytrained personnel. After, thorough clearance curcumin gel waslocally applied amongst the cases. All the patients were givensame postoperative instructions and medicaments. Followup was performed after 30 days and the values of gingivalindex were noted. All the data thus obtained was arranged ina tabulated form and analysed using SPSS software. Studentt test was used for statistical analysis and probability value ofless than 0.05 was regarded as significant.Results: The present study consisted of 30 patients as casesand 30 as controls. The mean age of the subjects was 36.42+/-5.22 years. The mean value at day 0 amongst the cases and thecontrols was 2.61+/-0.54 and 2.65+/-0.66 respectively. Themean value at day 30 amongst the cases and the controls was1.90+/-0.38 and 1.45+/-0.45 respectively. On applying studentt test there was a significant improvement amongst the casescompared to the controls on Day 30.Conclusion: Application of curcumin gel could also lead to adecrease in the chances of surgical treatment after SRP as thepocket depth improves significantly

Effect of Curcumin Gel along with SRP in Chronic Gingivitis Cases

Introduction: Turmeric also known as Curcuma longa thatis widely used as a spice, preservative, coloring agent, and asa household remedy is coming a long way as an alternativemanagement option for periodontal conditions. Curcumin themain yellow bioactive part of turmeric has huge spectrum ofactivity such as anti-inflammatory, antioxidant, antimutagenic,anticarcinogenic, anticoagulant, antidiabetic, antifertility,antibacterial, antiprotozoal, antiviral, antivenom, antiulcer,antifibrotic, hypotensive, and hypocholesteremic activities.The present study was conducted with the aim to determinethe effect of curcumin gel along with SRP in chronic gingivitiscases.Material and methods: The present prospective studyconsisted of 30 subjects as cases and controls respectively.The study was conducted in the department of periodontics ofthe hospital. Scaling was performed by piezoelectric scaler bytrained personnel. After, thorough clearance curcumin gel waslocally applied amongst the cases. All the patients were givensame postoperative instructions and medicaments. Followup was performed after 30 days and the values of gingivalindex were noted. All the data thus obtained was arranged ina tabulated form and analysed using SPSS software. Studentt test was used for statistical analysis and probability value ofless than 0.05 was regarded as significant.Results: The present study consisted of 30 patients as casesand 30 as controls. The mean age of the subjects was 36.42+/-5.22 years. The mean value at day 0 amongst the cases and thecontrols was 2.61+/-0.54 and 2.65+/-0.66 respectively. Themean value at day 30 amongst the cases and the controls was1.90+/-0.38 and 1.45+/-0.45 respectively. On applying studentt test there was a significant improvement amongst the casescompared to the controls on Day 30.Conclusion: Application of curcumin gel could also lead to adecrease in the chances of surgical treatment after SRP as thepocket depth improves significantly

Correlation of serum uric acid with severity of airflow limitation in the patients of chronic obstructive pulmonary disease

Background: Serum uric acid (sUA) levels were previously found to be correlated with hypoxic states. We aimed to determine the levels of sUA in COPD patients and to evaluate whether sUA level can be used as predictors of exacerbation risk and disease severity.Methods: This cross-sectional study included COPD patients and healthy controls. The sUA levels in each group were evaluated and their correlations with the study parameters were investigated. ROC analyses for exacerbation risk were reported.Results: The study included 106 COPD patients and 110 healthy controls. The mean sUA levels were significantly higher in patients with COPD compared to healthy controls (p<0.05). Mean sUA levels were compared with different stages of COPD according to GOLD criteria. Stage 4 COPD subjects had highest sUA levels compared to other stages. Statistically significant trend was observed for GOLD staging of disease (p<0.05). Surprisingly non-smokers were having higher uric acid level than smokers (p<0.05). The ROC analyses indicated that sUA levels can be useful in predicting exacerbation risk (AUC, 0.412) especially at higher cut-off values, but with low specificity.Conclusions: Study suggested that sUA levels increased in patients with COPD compared to healthy controls. At higher cut-off values sUA levels might be useful in predicting COPD exacerbation risk and disease severity. However, more prospective cohort studies with large number of participants are needed to further analyse the possible different prognostic roles of hyperuricemia.

FNAC of Different Breast Lesions in Subset of Rural Areas of Sindh

Background: In the 1970’s the introduction of Fine Need Aspiration Cytology (FNAC) proved to be the key method for examining the nature and malignant potential of many palpable lesions like thyroid, salivary glands and lymphadenopathies. Breast pathologies is one of the entity that can also be diagnosed with FNAC. Breast cancer is the most common malignancy of women with overall 100,000 cases being reported annually around the globe. The most frequent lesion encountered using FNAC in breast is fibro-adenoma followed by fibrocystic disease, breast abscess, chronic inflammatory conditions and suspicious malignant masses. In current cross sectional study we tried to find frequency of different breast lesions by FNAC.Methodology and Results: 649 samples were recruited from the Vital Laboratory Larkana with different pathological lesions of breast during the year 2014 and 2015 by non-probability consecutive sampling. 613 (95%) were females and 32 (5%) were male withmean age of 30.812.8 years. Majority of case were of 20-39 years of age (55.8%). Most of the cases were diagnosed with benign lesions (329, 51%) followed by inflammatory lesions (132, 20.5%) and gynecomastia (15, 2.3%). Right breast was moreaffected (329, 51%). In present study we found a strong association of diagnosis with gender (p =0.000) and age (p =0.000).Conclusion: So in this study it isconcluded that large number of females with breast pathologies present with benign lesions like fibro-adenomaat the age of 20-39 years. It isalso concluded that in this age group mastitis and abscesses are common due to different risk factors

Aspiration Cytology for Thyroid Lump in Remote Areas of Sindh

Background: Scandinavian countries were the first to use fine needle aspiration cytology (FNAC) as a diagnostic tool in the 1930. Fine needle aspiration cytology is a diagnostic approach, which helps the clinicians in diagnosis of the various lesions. Most common sites which can be targeted include breast lumps, lymph nodes, thyroid masses and other palpable swellings. The most common lesion encountered isthyroid nodule. In current cross sectional study we tried to find frequency of different thyroid lesions by fine needle aspiration cytology in different rural areas of Sindh.Methodology and Results: 158 samples were recruited from the Vital Laboratory Larkana with different pathological midline neck (thyroid) swelling during 2014 and 2015 by non-probability consecutive sampling. 125 (79.1%) were females and 33 (20.9%) were males with a ratio of 4:1. Majority of case were of 20-39 years of age (52.5%). Most of the cases were diagnosed with nodular goiter (88.6%) followed by colloid goiter (4.4%). In present study we failed to find any association of diagnosis with gender (p =0.211) and age (p =0.553).Conclusion: So in this study we concluded that large number of thyroid lesions present with nodular goiter at the age of 20-39 years. The frequency is increased for these lesions due to different risk factors.