Spiral T1 Spin-Echo for Routine Postcontrast Brain MRI Exams: A Multicenter Multireader Clinical Evaluation.

BACKGROUND AND PURPOSE: Spiral MR imaging has several advantages compared with Cartesian MR imaging that can be leveraged for added clinical value. A multicenter multireader study was designed to compare spiral with standard-of-care Cartesian postcontrast structural brain MR imaging on the basis of relative performance in 10 metrics of image quality, artifact prevalence, and diagnostic benefit. MATERIALS AND METHODS: Seven clinical sites acquired 88 total subjects. For each subject, sites acquired 2 postcontrast MR imaging scans: a spiral 2D T1 spin-echo, and 1 of 4 routine Cartesian 2D T1 spin-echo/TSE scans (fully sampled spin-echo at 3T, 1.5T, partial Fourier, TSE). The spiral acquisition matched the Cartesian scan for scan time, geometry, and contrast. Nine neuroradiologists independently reviewed each subject, with the matching pair of spiral and Cartesian scans compared side-by-side, and scored on 10 image-quality metrics (5-point Likert scale) focused on intracranial assessment. The Wilcoxon signed rank test evaluated relative performance of spiral versus Cartesian, while the Kruskal-Wallis test assessed interprotocol differences. RESULTS: Spiral was superior to Cartesian in 7 of 10 metrics (flow artifact mitigation, SNR, GM/WM contrast, image sharpness, lesion conspicuity, preference for diagnosing abnormal enhancement, and overall intracranial image quality), comparable in 1 of 10 metrics (motion artifacts), and inferior in 2 of 10 metrics (susceptibility artifacts, overall extracranial image quality) related to magnetic susceptibility (P < .05). Interprotocol comparison confirmed relatively higher SNR and GM/WM contrast for partial Fourier and TSE protocol groups, respectively (P < .05). CONCLUSIONS: Spiral 2D T1 spin-echo for routine structural brain MR imaging is feasible in the clinic with conventional scanners and was preferred by neuroradiologists for overall postcontrast intracranial evaluation.

Participation of Phosphatidylinositol-3 Kinase Signalling in Human Chorionic Gonadotropin, Bovine Insulin (B-Insulin) and Human-Insulin-Like Growth Factor-I Induced Oocyte Maturation and Steroidogenesis in the Grey Mullet, Mugil Cephalus.

CONTEXT: The grey mullet, Mugil cephalus, is an edible fish of high economic importance. Breeding biology with reference to hormonal/growth factor regulation of oocyte maturation needs to be known for its commercial production. OBJECTIVE: The present study was conducted to examine the potency of maturation inducing hormones, chorionic gonadotropin (hCG), bovine-insulin, and insulin like growth factor1 (h-IGF-1) I on ovarian steroidogenesis and oocyte maturation. DESIGN: The role of hormones and growth factors on steroidogenesis and oocyte maturation was investigated using specific inhibitors, Wortmannin for phosphatidylinositol-3 (PI3) kinase, trilostane for 3ß-hydroxysteroid dehydrogenase, 1-octanol and 1-heptanol for gap junctions, actinomycin D for transcription and cycloheximide for translation of signal molecules. METHODS: Actions of hormonal and growth factors were examined for steroidogenesis, by radioimmunoassay and oocyte maturation by germinal vesicle breakdown (GVBD). Specific inhibitors were used to determine the cell signaling pathways, PI3 kinase. RESULTS: All the inhibitors attenuated the hCG-induced oocyte maturation (GVBD%), steroidogenesis including transcription, translation, gap junctions and PI3 kinase signaling. These inhibitors failed to inhibit h-IGF-I and b-insulin-induced oocyte maturation, steroidogenesis, translation and PI3 kinase signaling. CONCLUSION: hCG induces oocyte maturation via steroid dependent pathway involving gap junctions, transcription, translation and PI3 kinase signaling, unlike h-IGF-I and b-insulin in the mullet.

Characterization of breast lesion using T1-perfusion magnetic resonance imaging: Qualitative vs. quantitative analysis.

OBJECTIVES: The objective of this study was to quantify the hemodynamic parameters using first pass analysis of T1-perfusion magnetic resonance imaging (MRI) data of human breast and to compare these parameters with the existing tracer kinetic parameters, semi-quantitative and qualitative T1-perfusion analysis in terms of lesion characterization. MATERIALS AND METHODS: MRI of the breast was performed in 50 women (mean age, 44±11 [SD] years; range: 26-75) years with a total of 15 benign and 35 malignant breast lesions. After pre-processing, T1-perfusion MRI data was analyzed using qualitative approach by two radiologists (visual inspection of the kinetic curve into types I, II or III), semi-quantitative (characterization of kinetic curve types using empirical parameters), generalized-tracer-kinetic-model (tracer kinetic parameters) and first pass analysis (hemodynamic-parameters). Chi-squared test, t-test, one-way analysis-of-variance (ANOVA) using Bonferroni post-hoc test and receiver-operating-characteristic (ROC) curve were used for statistical analysis. RESULTS: All quantitative parameters except leakage volume (Ve), qualitative (type-I and III) and semi-quantitative curves (type-I and III) provided significant differences (P<0.05) between benign and malignant lesions. Kinetic parameters, particularly volume transfer coefficient (Ktrans) provided a significant difference (P<0.05) between all grades except grade-II vs III. The hemodynamic parameter (relative-leakage-corrected-breast-blood-volume [rBBVcorr) provided a statistically significant difference (P<0.05) between all grades. It also provided highest sensitivity and specificity among all parameters in differentiation between different grades of malignant breast lesions. CONCLUSION: Quantitative parameters, particularly rBBVcorr and Ktrans provided similar sensitivity and specificity in differentiating benign from malignant breast lesions for this cohort. Moreover, rBBVcorr provided better differentiation between different grades of malignant breast lesions among all the parameters.

ARECOLINE CANNOT ALTER PINEAL-TESTICULAR RESPONSES TO METABOLIC STRESS IN WISTAR RATS.

CONTEXT: Betel nut is consumed by millions of people for stress reduction and increased capacity to work. One of its components is arecoline which is useful for Alzheimer and schizophrenia; it also influences endocrine and gonadal functions. OBJECTIVE: Objective is to examine whether arecoline can influence pineal-testicular function in metabolic stress. DESIGN: Rats were deprived of food or water or treated them with arecoline, each separately for 5 days. SUBJECTS: Pineal and testis with sex accessories were studied. METHODS: Ultrastructural (pineal, testis, Leydig cells and prostate), hormonal (melatonin and testosterone) and other parameters (fructose and sialic acid) were examined. Pineal indoleamines were quantitated by fluorometric method; testosterone by ELISA, and carbohydrate fractions by spectrophotometric methods. RESULTS: Inanition/ water deprivation caused pineal stimulation ultrastructurally (with enlarged synaptic ribbons) and elevation of melatonin level, but reproductive dysfunction by ultrastructural degeneration of Leydig cells and prostate with fall of testosterone, fructose and sialic acid concentrations. Arecoline treatment showed reversed changes to those of metabolic stress, but arecoline treatment in metabolic stress showed same results as in metabolic stress. CONCLUSION: The findings suggest that arecoline cannot alter the action of metabolic stress on pineal-testicular activity in rats.

Comparative study of the profiles of tribal and non-tribal tuberculosis patients in a tuberculosis unit of West Bengal, India.

BACKGROUND: Worldwide, the burden of tuberculosis (TB) is high in tribal populations. SETTING: Department of Community Medicine, Burdwan Medical College, Burdwan, India. OBJECTIVE: To compare the profile of TB patients among tribals and non-tribals in the Bhatar Tuberculosis Unit, Burdwan, India. DESIGN: A record-based cross-sectional study was conducted among 599 TB cases in 2009. RESULTS: Respectively 34.7% and 65.3% of the cases were tribals and non-tribals. Among tribal patients, 92.3% had pulmonary TB vs. 82.1% among non-tribals. The proportion of Category I cases (77.4%) was higher among tribals than among non-tribals (60.8%), while the proportion of Category II and III cases was higher among non-tribals. Among new sputum-positive Category I cases, the sputum conversion rate at the end of the intensive phase was respectively 92.4% and 87.7% in tribals and non-tribals. Unfavourable treatment outcome was higher in males and among failure, relapse, treatment after default and transferred out cases. CONCLUSIONS: Differences were noted in type/category of cases, sputum conversion as well as in outcome between tribal and non-tribal TB patients. Although ethnicity by itself was not significantly associated with outcome, factors related to ethnicity might have contributed to these differences between tribals and non-tribals.

Iodopovidone pleurodesis: experience of a tertiary hospital in Kolkata.

INTRODUCTION: The management of recurrent pleural effusion or pneumothorax has always been a cause for serious concern among chest physicians. Among the wide variety of agents that are available for pleurodesis, povidone iodine is now perhaps the most sought after agent as it is cheap, easily available, effective and safe. This study was conducted to establish the efficacy and safety of povidone iodine as an agent for pleurodesis in patients with recurrent pleural effusion and pneumothorax. METHODS: A total of 38 consecutive patients with symptomatic malignant or recurrent pleural effusion and pneumothorax received povidone iodine for pleurodesis over a period of 18 months. The mean follow-up period was 10.2 months, with a standard deviation of 2.9 months. RESULTS: Out of the 38 patients, 29 had malignant pleural effusion, eight had recurrent pneumothorax and one had tubercular pleural effusion which was nonresponsive to antitubercular therapy. A complete response with no recurrence during follow-up was obtained in 34 (89.5 percent) patients. All the cases of failure had malignant pleural effusion. Three (7.9 percent) patients experienced intense chest pains after the installation of sclerosing agent, but they recovered with immediate symptomatic management. CONCLUSION: Recurrent pleural effusion or pneumothorax due to any cause may be managed effectively and safely by chemical pleurodesis with povidone iodine. It may be considered as the agent of choice to achieve pleurodesis, especially in resource constrained countries like India, as it is inexpensive and easily available.

A study in awareness about eye health care and eye donation among secondary level students of North Kolkata, India.

BACKGROUND: Corneal blindness is one of the important types of blindness that can be prevented by proper health care education and conventionally cured by corneal transplantation for which awareness regarding eye donation is essential. OBJECTIVES: The aim of the study is to assess the awareness of eye health care and eye donation among secondary level school students of North Kolkata. METHODS: It was a cross-sectional study. SETTINGS: Eight Government aided schools of North Kolkata, West Bengal, India. A total of 1525 students of standard VIII, IX and X of Government aided schools of North Kolkata participated in this study. A pre-tested, semi-structured questionnaire was administered on eye health care and eye donation. RESULTS: 1284 (84.2%) participants opined that awareness on eye health care can prevent most of the blindness and 1206 (79.1%) students knew that Vitamin A has important role in prevention of childhood blindness. Majority, 1235 (81.0%) students were aware of eye donation after death while only 489 (32.1%) participants knew that the ideal time for eye donation is within 6 hours of death. 802 (52.6%) participants mentioned printed and electronic media (like newspaper and television) as the major source of information on eye donation. CONCLUSIONS: Media publicity to increase awareness of eye donation and eye health care is not enough. Strategies have to be developed to educate the students, so that they can act as motivators for enhancing eye donation and increasing eye health care awareness in the community.

Outcomes of different subgroups of smear-positive retreatment patients under RNTCP in rural West Bengal, India.

INTRODUCTION: This record-based study was undertaken at Bagula Tuberculosis Unit, Nadia, West Bengal, India to compare outcomes among sputum-positive TB retreatment patient groups (relapse, failure and treatment after default) at completion of therapy, under the Revised National Tuberculosis Control Program (RNTCP). METHODS: A total of 234 registered cases of TB retreatment (category II) between January 1999 and June 2005 were analysed and compared by Z-test for proportion. RESULTS: There was a uniform distribution in terms of age, grades of sputum positivity and sputum conversion at 2 and 3 months among the three groups. In spite of this, a favourable outcome was most likely for relapse cases, and cases with a low grade of sputum positivity in all three subgroups. Unfavourable outcome was most likely among the treatment failure subgroup and those with high grades of sputum positivity. CONCLUSION: The results are likely to be due to an increased incidence of multi-drug resistant TB in these patients. In rural areas of the developing world, as in India, there is a heavy burden of TB and resources are limited. Culture and drug sensitivity patterns prior to commencing therapy should be performed for failure and default patients who present with an initially high load of bacilli in their sputum.

Poisoning, stings and bites in children-- what is new? An experience from a tertiary care hospital in Kolkata.

Poisonings, stings and bites continue to be important cause of pediatric morbidity and hospitalization. The toxic product involved in the poisoning varies in different geographical areas and in same area over time. A retrospective study was conducted amongst the children of the age group up to 12 years admitted to a tertiary care hospital in Kolkata from January 2005 to December 2008. Total number of admissions was 17019 and that for accidental poisoning was 451 (2.65%). Kerosene constituted the largest group (54.55%). Mosquito coil and refill liquid were the new additions to the list of poisons and their ingestion was cause for admission of 15 (3.33%) children. The number of admissions due to stings and bites was 108 (0.63% of all admissions) during the above period. Of all the cases, 9 (1.83%) cases of accidental poisoning and 4 (3.7%) cases of stings and bites died.

Prevalence of hypertension and variation of blood pressure with age among adolescents in Chetla, India.

This community-based cross-sectional study was carried out to determine the prevalence of hypertension and variation of blood pressure with age among adolescents in an urban slum of Chetla, Kolkata, India. A total of 1081 adolescents aged 10-19 years were involved in the study. The prevalence of hypertension was 2.9% (31) and highest prevalence (5.6%) was observed in the age group of 18-19 years. The mean systolic and diastolic blood pressure was higher in males than females. Among males and females, average increase of mean systolic blood pressure was found to be 2.26mmHg and 1.95mmHg per year respectively. The mean diastolic blood pressure increased by 1.55 mmHg and 1.42mmHg per year, respectively. The age spurt of rise in mean systolic blood pressure in males was found at 10-11, 13-14, and 16-17 years age groups, whereas in females it was observed in 12-13, and 17-18 years age groups. The age spurt of rise in mean diastolic blood pressure in males was observed in the age group 16-17 years and in females it was noted in the age group 11-12, and 17-18 years. In conclusion, blood pressure measurement should be done routinely during health check up of adolescents to initiate secondary level of prevention at the earliest.

A study on catch up growth among low birth weight infants in an urban slum of Kolkata.

OBJECTIVES: To study the catch up growth among low birth weight infants in relation to the normal birth weight counterparts in first six months of age. METHODS: A longitudinal community based study was done in 2004 -05 in an urban slum of Chetla, Kolkata among 126 singleton live born babies. Growth pattern of these babies was followed up at 15+/-5 days interval by house visit till six months of age. RESULTS: The incidence of low birth weight babies was 28.6%. 86.1% LBW infants caught up in length at 3rd month, 63.9% in chest circumference at 4th month, 66.7% in head circumference at 5th month, while 72.2% in weight at 6th month. Regular growth monitoring is essential for LBW babies to detect signs of growth faltering at the earliest.

Post-traumatic fungal endophthalmitis--a prospective study.

PURPOSE: To study the incidence, clinical presentation, and the response of anti-fungals in cases of fungal endophthalmitis following open globe injury. METHODS: This is a prospective study of eight cases of post-traumatic fungal endophthalmitis among 110 patients who presented to us with open globe injury between August 2003 and January 2005. Patients with panophthalmitis were eviscerated and rest received intravitreal amphotericin B. Pars plana vitrectomy along with intravitreal miconazole was given in patients with inadequate response to intravitreal amphotericin. RESULTS: Two patients had panophthalmitis at the time of presentation and were eviscerated. Six different organisms were isolated from the culture of intraocular specimen of eight patients. The yield of vitreous aspirate was 87.5% and that of aqueous aspirate was 66.6%. Aspergillus sp. and Fusarium sp. were isolated in 62.5% of cases. Minimum inhibitory concentration of amphotericin B and miconazole was less than 3 microg/ml for all organisms except for Paecilomyces lilacinus and Fusarium solani, respectively. In total, 37.5% of patient had final visual acuity of 20/400 or better. CONCLUSIONS: Fungal endophthalmitis is a relatively rare complication of open globe injury. The final visual outcome after fungal endophthalmitis is dismal. Aspergillus fumigatus was found to be the most virulent organism. All organisms were found to be sensitive to amphotericin B, except P. lilacinus, which was sensitive to miconazole. Repeated intravitreal injection may be required to control the infection. The virulence of the organism and the site of injury are the main determinants of final visual outcome.

Declining trend in routine UIP coverage.

Routine UIP coverage status in the state of West Bengal and three selected Municipal Corporation areas (Calcutta, Howrah and Siliguri) were studied during 1997-98 and 1998-99. Also, UIP coverage status in the 'high risk' areas of the State (areas which reported Polio cases during 1998) was studied during 1998-99. UIP coverage in the state of West Bengal was only 54.3% in 1997-98, which further declined to 48.1% in 1998-99. In the three urban areas, UIP coverage ranged between 57.3%-70.9% in 1997-98, which further declined to 29.6%-47.1% in 1998-99. Antigenwise coverage revealed very poor performance with DPT3, OPV3, and Measles in 1997-98 and further decline in 1998-99. Dropout rate was also very high. In 1998-99 drop-out rate ranged between 30.1% to 54.2% in different studied areas. Some other studies suggested that PPI activities, which are very visible and targetted programme, may adversely affect routine UIP services. There is urgent need for further probing to identify the reasons for such poor state of affairs, keeping PPI angle in mind and to initiate remedial measure urgently.

Role of DNA flow cytometry and image cytometry on effusion fluid.

The objective of the study was to assess the value of DNA flow cytometry (FCM) and image cytometry (ICM) as an adjunct to routine diagnostic cytology. In this prospective study, 100 consecutive effusion fluids were studied for routine cytology, DNA FCM, and in selected cases, ICM. One half of the centrifuged fluid sample was used for routine cytology and the remaining portion was used for DNA FCM. Nuclear area, nuclear diameter, nuclear perimeter, nuclear convex perimeter, nuclear roundess, and nuclear convex area were measured on at least 100 cells by ICM in cytologically malignant or DNA aneuploid cases along with control cases. Clinical follow-up was done in all cases. There were 22 cytologically malignant cases and 78 cytologically benign cases. Among the 22 cytologically malignant cases, there were 11 aneuploid and diploid cases each by DNA FCM. Out of 78 cytologically benign cases, six (7.7%) were aneuploid by DNA FCM. Smears of these cases showed predominantly reactive mesothelial cells, but the DNA histograms showed hypodiploid (one), hyperdiploid (three), tetraploid (one), and hypertetraploid (one) aneuploidy. Follow-up of these cases showed clinical or histologic features of malignancy except in one case of tetraploid aneuploidy, which did not show any features of malignancy and responded well to antitubercular therapy. Therefore, out of 27 malignant effusions, DNA FCM picked up 16 cases and routine cytology detected 22 cases. Sensitivity and specificity of DNA FCM were thus 59.25% and 98.63%, respectively. There was a statistically significant difference (Student's unpaired t-test, P < 0.05) between cytologically malignant cases and control benign cases in all the nuclear morphometric parameters except for nuclear roundness. There was, however, no statistically significant difference of nuclear morphometric parameters between cytologically benign vs. DNA aneuploid cases and control benign cases. DNA FCM is a useful adjunct for routine diagnostic cytology. Visual diagnostic cytology and morphometric digital microscopy miss some cases of malignancy which can be detected by DNA flow cytometry. Diagn. Cytopathol. 2000;22:81-85.

Pulse polio immunisation, 1995-96: an evaluation in West Bengal.

An evaluation of the Pulse Polio Immunisation Programme (PPI), 1995-96 in West Bengal was undertaken. It was observed that the PPI coverage (with two rounds) was 84.1%. Variations in the PPI coverage level were documented in relation to age, sex, residential status and parental literacy status of the beneficiaries. However, significantly lower PPI coverage was observed among Muslims (p < 0.001) and Scheduled Tribes (p < 0.01). The principal agency responsible for disseminating information about PPI was identified to be the multipurpose health workers. Some of the major reasons for non-acceptance of PPI were lack of information, illness of the child, absence of the child on the "PPI day", lack of faith in immunisation and fear of adverse reaction.

Experience in running a Diarrhoeal Training cum Treatment Unit (DTTU) in a state teaching hospital in Calcutta.

The performance of the Diarrhoeal Training cum Treatment Unit (DTTU) of NRS Medical College and Hospital, Calcutta, in a 2-year period was evaluated by record analysis. The study revealed that 73.6% cases out of a total 4349 could be successfully managed at the oral rehydration therapy (ORT) area and only 16.5% cases required indoor admission. Rest of the cases (9.9%) with "no dehydration" were sent home with advice. There were 84.7% cases out 3919 dehydration cases who could be successfully treated by ORT and only 15.3% required intravenous (i.v.) therapy. A definite decline was also evident in the proportion of diarrhoea cases requiring antibiotic therapy (13.5% in 1991 to 6.8% in 1992). The case fatality rate due to diarrhoea was 1.7% in 1992. Had all cases of diarrhoea with dehydration being admitted and treated with i.v. fluids and antibiotics, the estimated cost would have been Rs 14.2 lakhs, which with ORT, actually cost Rs 2.4 lakhs. Thus estimated total cost reduction was to the extent of Rs 11.8 lakhs in a 2-year period.

PIP: The Diarrheal Training with Treatment Unit (DTTU) was established in the Department of Pediatrics, NRS Medical College and Hospital, in Calcutta, India, in 1990, to promote use of oral rehydration therapy (ORT) in diarrhea in children 0-5 years of age. To evaluate the success of this effort, a retrospective review was conducted of the 4349 child diarrhea cases presenting to DTTU in 1991-92. 3919 children (90.1%) were dehydrated at admission; the nondehydrated cases received counseling only and were discharged. 3202 children (73.6%) with diarrhea-related dehydration were successfully treated with ORT; intravenous fluids were administered in 598 (15.3%) of these cases. 717 children (16.5%) required hospital admission; 83.4% of these children received intravenous fluids. The proportion of diarrhea cases requiring antibiotics decreased from 13.5% in 1991 to 6.8% in 1992. Case fatality was 1.8% in 1991 and 1.7% in 1992. The actual cost of treatment was Rs. 1,50,048 in 1991 and Rs. 91,178 in 1992. These amounts represent savings of Rs. 6,00,912 and 5,77,867, respectively, over what would have been the costs if all cases had been treated on an inpatient basis with intravenous fluids and antibiotics. These findings confirm the effectiveness of DTTU's strategy of ORT management of children with diarrheal dehydration combined with proper training and motivation of both mothers and health workers.

A report of diphtheria surveillance from a rural medical college hospital.

A 5-year sentinel surveillance of diphtheria from 1989 to 1993 was undertaken at a rural medical college hospital. No significant change in the number of diphtheria cases was observed in spite of sustained high level of diphtheria, pertussis, tetanus vaccine-3 doses (DPT3) coverage. Most of the diphtheria cases occurred during July to November. Age distribution of diphtheria cases showed that more than 75% occurred above 2 years age (except in 1989) and around 65% cases above 3 years age. The age shift in diphtheria signified success of primary diphtheria immunisation, as well as indicated the lack of coverage with booster doses at appropriate ages. Because of high coverage with primary diphtheria immunisation there was decrease in circulating toxigenic C diphtheriae resulting in less natural boosting of antibody titre. Thus, in absence of booster immunisation, the older children and adults were more vulnerable to diphtheria. The findings of the study justified the need of emphasising importance of booster diphtheria immunisation at appropriate ages for effective control of diphtheria.

Sentinel surveillance on poliomyelitis and neonatal tetanus: a report.

A 5 year sentinel surveillance (1989-93) of paralytic poliomyelitis and neonatal tetanus was undertaken at a rural Medical College Hospital at Burdwan, West Bengal. Poliomyelitis incidence showed an overall declining trend, which corroborated with the increased OPV coverage over the years. Incidence was more in males than females. Male:female ratio varied between 2.31:1 to 1.2:1. From 1989 to 1992, age-shift in poliomyelitis was observed when more cases were occurring above 1 year subjects. Cases were reported to be high during the months June to September every year. Incidence of neonatal tetanus (NNT) also showed a declining trend during the 5 year study period. A male preponderance was observed. NNT cases were more prevalent during the months between August and November. In an attempt for eradication of paralytic poliomyelitis and elimination of NNT, containment and other public health measures were undertaken a part of surveillance activities. The obstacles encountered in the surveillance system, as well as lacunae identified in undertaking appropriate health measures was discussed.

PIP: The authors report on the 5-year sentinel surveillance (1989-93) of paralytic poliomyelitis and neonatal tetanus (NNT) undertaken at the rural Medical College Hospital at Burdwan, West Bengal. Overall, the incidence of poliomyelitis showed a declining trend in relation to increased OPV coverage over the years. From 1989 to 1992, an age shift in poliomyelitis was observed among children over 1 year old. Similarly to poliomyelitis, NNT also showed a declining trend during the 5-year study period. The NNT cases were observed to increased during the months from August to November. While performing the surveillance activities, a number of obstacles were encountered in data collection, data recording, and data transmission. Some of these problems include lack of motivation with concerned personnel, shortage of manpower particularly in the pediatric department and erroneous recording of address, nonrecording of immunization status and final diagnosis in the admission registry. As part of the surveillance activities, public health measures were undertaken to eliminate paralytic poliomyelitis and NNT.