Improving immunization coverage

A study was made on the causes of unsatisfactory progress in immunization coverage in an area of Tamil Nadu, southern India. The findings led to the appointment of additional community health workers (CHW), improvement in supervision, the enhancement of accessibility to services through an increase in the number of peripheral clinics and the organizing of temporary clinics, and the concentration of effort on underprivileged groups. As a result, immunization coverage was more than doubled. The Community Health and Development Project, a primary health care program serving 68 villages since 1981 with a population of about 80,000 was the site of the study which was conducted by discussions with staff and various members of the community. Issues explored were nonacceptance or dropout reasons, and specific factors affecting immunization coverage. A special effort was made to obtain the views of staff working at the periphery, particularly CHWS. The service area was divided into 4 sectors and the CHWS, auxiliary nurse midwives, community health nurses and other development staff in each were brought together for discussions. Views were also solicited from mothers' clubs and youth groups and in meetings with village leaders. Issues raised were further considered by supervisory staff. Statistical studies and other studies were done to clarify doubtful issues and test hypotheses emerging from the discussion. Poor immunization coverage was linked to inadequate supervision of CHWs, scattered communities (village with houses clustered together had better acceptance rates), difficulty of access to health services (distance factors), and low economic and educational status. In light of the study findings, community health workers were increased from 42 in 1984 to 57 in 1987 to cover all the villages, with modifications in selection method to make the worker acceptable to all sections of the villages; abolishment of the auxiliary nurse midwife and addition of a new category, health aide, to link the CHW and the community health nurse, increase of peripheral clinics from 37 to 75 and holding of more temporary clinics, more efforts to reach all socioeconomic groups and increased health education through film shows, drama, and work with village groups.     

An echo-cardiographic (M-mode & 2D) analysis of thalassaemia major

25 cases of thalassaemia major were studied by 2D and M-mode echocardiography. A significantly increased (p less than 0.001) mean value (100.8 +/- 27.37 msec, range 80 to 140 msec) of A2-E (early relaxation period) interval on M-mode was observed in thalassemia in comparison to mean level (82.6 +/- 5.7, range 60 to 100 msec) of control population. No significant differences were noted in FS % (fractional shortening) and EF% (ejection fraction) when compared to corresponding normal values respectively. Mean serum iron concentration (142.2 +/- 29.1 micrograms/dl, range 102 to 192 micrograms/dl) was significantly higher in thalassaemia as compared to normal population (mean 106.3 +/- 11.4 micrograms/dl, range 75 to 120 micrograms/dl). There was also a direct correlation between serum iron concentration and A2-E interval. 11 patients (44%) showed abnormal A2-E interval but only 3 patients (12%) showed abnormal percentage of FS and EF. It is therefore concluded that A2-E interval will help to detect early left ventricular dysfunction much before overt and irreversible heart failure becomes manifest and which will also help to optimise transfusion and chelation therapy.     

Inhalational anaesthetics and n-alcohols share a site of action in the neuronal Shaw2 Kv channel

Background and purpose:

Neuronal ion channels are key targets of general anaesthetics and alcohol, and binding of these drugs to pre-existing and relatively specific sites is thought to alter channel gating. However, the underlying molecular mechanisms of this action are still poorly understood. Here, we investigated the neuronal Shaw2 voltage-gated K⁺ (K_v) channel to ask whether the inhalational anaesthetic halothane and n-alcohols share a binding site near the activation gate of the channel.

Experimental approach:

Focusing on activation gate mutations that affect channel modulation by n-alcohols, we investigated n-alcohol-sensitive and n-alcohol-resistant K_v channels heterologously expressed in Xenopus oocytes to probe the functional modulation by externally applied halothane using two-electrode voltage clamping and a gas-tight perfusion system.

Key results:

Shaw2 K_v channels are reversibly inhibited by halothane in a dose-dependent and saturable manner (K_0.5= 400 µM; n_H= 1.2). Also, discrete mutations in the channel''s S4S5 linker are sufficient to reduce or confer inhibition by halothane (Shaw2-T330L and K_v3.4-G371I/T378A respectively). Furthermore, a point mutation in the S6 segment of Shaw2 (P410A) converted the halothane-induced inhibition into halothane-induced potentiation. Lastly, the inhibition resulting from the co-application of n-butanol and halothane is consistent with the presence of overlapping binding sites for these drugs and weak binding cooperativity.

Conclusions and implications:

These observations strongly support a molecular model of a general anaesthetic binding site in the Shaw2 K_v channel. This site may involve the amphiphilic interface between the S4S5 linker and the S6 segment, which plays a pivotal role in K_v channel activation.     

Two doses of measles vaccine: are some states in India ready for it?

We present the results of two surveys of measles outbreaks near Vellore, which perhaps supports the cause for introduction of a second dose of measles vaccine. Survey one had 590 under 10-year olds. The attack rate was 15.1, 11.7 and 5.7% in the unimmunized, among those vaccinated at 6 months and at 9 months, respectively. The overall vaccine efficacy (VE) was 28% if vaccinated at 6 months and 66% if at 9 months. Second survey had 1702 children and adolescents. There were 59 cases of measles of which 49 were over 5 years of age, the mean age being 8.8 years. The VE was 66% for children up to 6 years and 48.4% for those aged 7-15. The data suggests that measles vaccine is better given at 9 months. The low VE in school age children could be improved by introducing a second dose of measles vaccine.     

Psychological wellbeing among carers of people with spinal cord injury: a preliminary investigation from South India

STUDY DESIGN: A cross-sectional study that assessed people with spinal cord injury (SCI) and their carers who attended the 3-day health care program. OBJECTIVES: The study examined the nature and prevalence of the factors associated with psychological morbidity among carers of people with SCI. SETTING: A community reintegrated population of persons with SCI and their carers attended the 3-day program in the Department of Physical Medicine and Rehabilitation, Christian Medical College Hospitals, Vellore, South India. METHODS: Thirty-eight people with SCI and their carers participated in this cross-sectional study. RESULTS: Thirty (78.9%) carers of people with SCI were psychologically distressed. While carers were distressed, they were not significantly depressed. Educational level of carers and suicidal behavior of people with SCI were significantly associated with psychological distress. CONCLUSION: The findings of this study suggest that health care workers should have a high index of suspicion of psychological morbidity, in carers of people with SCI. Identification of risk factors may lead to useful target interventions.     

N-acetyl-beta-D-glucosaminidase in the localisation of urinary tract infection in patients with spinal cord injury

This study evaluates the pattern of urinary N-acetyl-beta-D-glucosaminidase (NAG) isoenzyme excretion in patients with spinal cord injury (SCI) and its use as a diagnostic tool in localising the site of urinary tract infection (UTI). NAG-B excretion in 27 control SCI patients (mean 207.78 units) was significantly higher than in 10 normal controls (mean 12.6 units) p less than 0.001). The relative isoenzyme distribution as represented by NAG-B/Total NAG percentage is however similar in both groups, 24.27 and 20.38% respectively. NAG-B excretion in 6 SCI patients with upper UTI was not significantly higher than in 12 SCI patients with lower UTI. NAG-B/Total NAG percentage was significantly different between these two groups (35.3% and 24.98% respectively, p less than 0.05). There was no significant difference in NAG-B excretion or NAG-B/Total NAG percentage between control SCI patients and those with lower UTI. The results indicate that there is a non-selective increase in urinary NAG excretion in control SCI patients and those with lower UTI. In SCI patients with upper urinary UTI there is a selective increase in NAG-B excretion. The overlap in enzyme values between the different groups suggests that the test may not be clinically useful in localising the site of UTI.     

Double Gall Bladder—A Rare Entity

Cholecystectomy is the most commonly performed operation in surgery. Variations inanatomical disposition are not infrequent. However variations in number of cystic ductand gall bladder is quiet rare. This poses a diagnostic and management problem withcomplications during surgery and missed gall bladder being reported in world literature. We here by report a case of double gall bladder with double cystic duct that was managed by laparoscopic surgery.