Maternal knowledge and perceptions aboutthe routine immunization programme--a study in a semiurban area in Rajasthan

A cross sectional study on immunization coverage in the town of Pilani was conducted and a total of 166 mothers were interviewed using a pre-tested interview schedule/questionnaire on Knowledge, Attitudes, Perceptions and Expectations (KAPE). The results showed that among the 12-24 month old children 50% fully, 31.3% partially and 18.7% not at all immunized. High levels of initial vaccination rates and low levels of OPV3/DPT3 (62.7%) and measles (51.8%) vaccines indicate that completing vaccination schedule needs attention. Almost all the children in the study, 165 out of 166 received two doses of polio vaccine from the Pulse Polio Immunization programme. Majority of the mothers expressed favourable attitudes and satisfaction regarding the programme. Though many were aware of the importance of vaccination in general, specific information about importance of completing the schedule and knowledge about vaccine preventable diseases other than poliomyelities was very limited. Obstacles, misconceptions/beliefs among the mothers of partially immunized children and lack of information among not at all immunized group were the main reasons of non-immunization. The implications of the study are: to enhance the maternal knowledge about the vaccine preventable diseases and importance of completing the immunization schedule through interpersonal mode and to overcome obstacles to immunization such as accessibility and lack of family support.     

A vapor-phase-assisted growth route for large-scale uniform deposition of MoS2 monolayer films

In this work a vapor-phase-assisted approach for the synthesis of monolayer MoS₂ is demonstrated, based on the sulfurization of thin MoO_3−x precursor films in an H₂S atmosphere. We discuss the co-existence of various possible growth mechanisms, involving solid–gas and vapor–gas reactions. Different sequences were applied in order to control the growth mechanism and to obtain monolayer films. These variations include the sample temperature and a time delay for the injection of H₂S into the reaction chamber. The optimized combination allows for tuning the process route towards the potentially more favorable vapor–gas reactions, leading to an improved material distribution on the substrate surface. Raman and photoluminescence (PL) spectroscopy confirm the formation of ultrathin MoS₂ films on SiO₂/Si substrates with a narrow thickness distribution in the monolayer range on length scales of a few millimeters. Best results are achieved in a temperature range of 950–1000 °C showing improved uniformity in terms of Raman and PL line shapes. The obtained films exhibit a PL yield similar to mechanically exfoliated monolayer flakes, demonstrating the high optical quality of the prepared layers.

Optimization of the sulfurization process of thin MoO₃ precursor layers, pushing the reaction towards vapor-phase-assisted routes to obtain large-scale, homogeneous monolayer MoS₂.     

Evaluation of immigrant tuberculosis screening in industrialized countries

In industrialized countries, tuberculosis (TB) cases are concentrated among immigrants and driven by reactivation of imported latent TB infection (LTBI). We examined mechanisms used to screen immigrants for TB and LTBI by sending an anonymous, 18-point questionnaire to 31 member countries of the Organisation for Economic Co-operation and Development. Twenty-nine (93.5%) of 31 responded; 25 (86.2%) screened immigrants for active TB. Fewer countries (16/29, 55.2%) screened for LTBI. Marked variations were observed in targeted populations for age (range <5 years of age to all age groups) and TB incidence in countries of origin of immigrants (>20 cases/100,000 population to >500 cases/100,000). LTBI screening was conducted in 11/16 countries by using the tuberculin skin test. Six countries used interferon-γ release assays, primarily to confirm positive tuberculin skin test results. Industrialized countries performed LTBI screening infrequently and policies varied widely. There is an urgent need to define the cost-effectiveness of LTBI screening strategies for immigrants.     

Antiviral treatment and prevention of seasonal influenza: a comparative review of recommendations in the European Union.

BACKGROUND: Specific anti-influenza drugs are available for the management of seasonal influenza. OBJECTIVES: To evaluate European recommendations and guidelines for the use of antiviral drugs in treatment and prevention of seasonal influenza. DESIGN: Guidelines issued between January 2003 and September 2007 were scored using the AGREE appraisal instrument and evaluated. RESULTS: Guidelines were obtained from France, Germany, Italy, Netherlands, Poland, Portugal, Sweden and the UK. Most guidelines recommend neuraminidase inhibitors over M2 inhibitors, but three countries were unclear or suggested M2 inhibitor use in some circumstances. Clinical diagnosis of patients eligible for treatment during periods of influenza activity is acceptable except in Poland where virological confirmation is required. Guidelines recommend antiviral use in patients at high risk of complications, except in Germany where there is a strong recommendation to treat all patients. Post-exposure prophylaxis for household contacts is recommended in Sweden and Germany, but not other countries. Only UK guidelines are regularly updated. All scored fairly poorly by the AGREE instrument. French, Polish, Swedish and UK guidelines were recommended. CONCLUSION: Major variations exist in recommendations for treatment and prevention of seasonal influenza. Development of Pan-European guidance should be considered. Updating is important to reflect emerging patterns of antiviral resistance.     

Emergence and Molecular Characterization of Extensively Drug-Resistant Mycobacterium tuberculosis Clinical Isolates from the Delhi Region in India

We screened 194 Mycobacterium tuberculosis strains isolated from tuberculosis (TB) patients in Delhi and neighboring regions in India to identify the prevalence of extensive drug resistance (XDR) in clinical isolates. Among these, 104 isolates were found to be multidrug resistant (MDR), and 6 were identified as XDR isolates, which was later confirmed by antimicrobial susceptibility testing against the respective drug screening panel. Genotyping was carried out by amplifying and sequencing the following genes: rpoB (rifampin), katG (isoniazid), gyrA (fluoroquinolones), and rrs (amikacin, kanamycin, and capreomycin). Our analyses indicated that mutations at the hot spots of these genes were positively correlated with drug resistance in clinical isolates. The key mutation observed for rpoB was in the codon for amino acid position 531 (S531L), and other mutations were seen in the hot spot, including those encoding Q510P, L511H, D516V, and H526Y mutations. We identified S315T and R463L substitutions encoded in the katG locus. An S95T substitution encoded in the gyrA locus was the most common mutation observed in fluoroquinolone-resistant isolates. In addition, we saw D94G and D94N mutations encoded in the QRDR region. The 16S rRNA (rrs) gene encoded mainly the A1401G mutation and an additional mutation, G1484T, resulting in ribosomal modifications. Taken together, the data in this report clearly establish the presence of phenotypically distinct XDR strains in India by molecular profiling and further identify specific mutational hot spots within key genes of XDR-TB strains.In recent years, the control of tuberculosis (TB) has become a global challenge due to the emergence of multidrug-resistant tuberculosis (MDR-TB) and extensively drug-resistant tuberculosis (XDR-TB). With 9.2 million new cases and 1.7 million deaths in 2006, TB remains one of the major life-threatening diseases worldwide (22). XDR-TB isolates are resistant to isoniazid and rifampin, to any fluoroquinolone (FQ), and to at least one of the three injectable second-line drugs (amikacin, kanamycin, and capreomycin) (6). As of June 2008, XDR-TB strains have been found in 49 countries, including the United States (6, 22). Furthermore, a recent report points to an alarming increase in the number of tuberculosis patients in the South Asian subcontinent, with India being singled out as having the greatest burden of XDR-TB, with a poor prognosis and high mortality among HIV-infected individuals (4). The risk of XDR-TB spread across country borders has heightened global concern over a potentially untreatable epidemic that may jeopardize recent advances made in global TB control.The prevalence of XDR-TB in India was reported in 2007, but no further efforts have been made to identify its genotypes or geographical spread (9). The present study was undertaken to characterize mutations prevalent in clinical isolates from India with respect to various drug target loci. We examined the drug target genes for rifampin (rpoB), isoniazid (katG), fluoroquinolones (gyrA), and aminoglycosides (rrs), which are commonly prescribed for the treatment of tuberculosis in India. The loci studied were rpoB (RNA polymerase B subunit), katG (catalase-peroxidase), rrs (16S rRNA), and gyrA (DNA gyrase A). Here we report, for the first time, the molecular characterization of XDR-TB isolates from India. This study confirms the presence of XDR-TB in India and simultaneously raises an alarm about its prevalence among TB patients, as many of them may initially have MDR-TB that slowly progresses and mutates to XDR-TB. Furthermore, the fact that some of these patients have HIV infection or the possibility of later coinfection with HIV has the potential to make this global HIV-TB epidemic untreatable with current therapies.     

Baseline Blood Pressure,the 2017 ACC/AHA High Blood Pressure Guidelines,and Long-Term Cardiovascular Risk in SPRINT

Background

The 2017 American College of Cardiology (ACC)/American Heart Association (AHA) guidelines include lower thresholds to define hypertension than previous guidelines. Little is known about the impact of these guideline changes in patients with or at high risk for cardiovascular disease.