The objective of our study was to evaluate the pressurized metered dose inhaler (pMDI) with holding chamber technique of asthmatic children attending out patient pediatric chest clinic and determine factors associated with incorrect technique. All patients had previously received instructions regarding inhalation technique. The inhalation technique was assessed on a five-point checklist, four of which were considered essential. Two hundred and thirteen children (mean +/- SD age, 7.3 +/- 3.8 years; 151 boys) completed the study. Children were using their inhaler for a median duration of 6 months (range 1-96 months). One hundred and eighty-eight patients (88.3%) performed all essential steps correctly. The commonest mistake among the essential steps was not shaking the inhaler (n = 21, 9.9%) followed by inability to make a tight seal around the mouthpiece of the holding chamber (n = 12, 5.6%). Correct technique was not affected by gender, asthma severity and socio-economic indices: education level of parents, percapita monthly income, rural or urban background. Our study indicates that a large majority of children from a developing country setting, irrespective of lower education and income levels can be successfully educated to appropriately use inhalation device. Inhalation performance is not affected by socio-economic background of the patients. Comprehensive inhalation instructions and monitoring at each visit are however critical to ensure reliable and consistent performance of correct technique among asthmatic children.

Objective:To study the clinical profile and outcome in children with diphtheritic polyneuropathy (DP).Methodology:13 children with polyneuropathy were included in this study. Their demographic profile, age, sex and immunization status were recorded. Detailed clinical and neurological examination was done. Investigations like CSF analysis, NCV studies, MRI brain were done. The results were tabulated and analyzed.Results:All the children presented with bulbar palsy and had h/o membranous tonsillitis. Isolated palatal palsy was seen in 7 children (53%). 6 (46.1%) children developed quadriparesis. 1 child expired and recovery is complete in rest of the 12 children. Children with isolated bulbar palsy recovered within 2 to 4 weeks while children with quadriparesis recovered within 5-6 wks.Conclusions:Any child diagnosed with diphtheria should be followed for 3-6 months in anticipation of neurological complications. DP carries good prognosis hence timely diagnosis and differentiation from other neuropathies is a prerequisite for rational management.

Intra-pericardial teratoma, most often a benign tumor, is an extremely rare condition in a newborn. It can be a diagnostic and therapeutic challenge if it presents with massive pericardial effusion. Complete surgical excision of the tumor is necessary because of its association with tissues of malignant potential. A 16-d-old newborn was diagnosed with intra pericardial immature teratoma (IT) and managed successfully with multidisciplinary team approach by prompt referral for complete surgical resection followed by adjuvant chemotherapy with carboplatin, etoposide and bleomycin (JEB) to prevent recurrence. The infant is now on close follow up with monitoring of serum alpha fetoprotein (AFP) levels and imaging studies for early diagnosis of recurrence of tumor and chemotherapy related complications.

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Original Research ArticleVaccination has saved more lives worldwide than any other medical products or procedures. To accelerate immunization coverage, Mission Indradhanush was launched by Ministry of Health and Family Welfare in 2014. Under Mission Indradhanush, the immunization programme was strengthened and also newer vaccines like pentavalent, rotavirus and f-IPV vaccines were sequentially introduced. Mission Indradhanush was intensified in 2017 to further accelerate full immunization coverage. The present study was done for a period of 2 months in 2 urban areas, 2 rural areas and 2 tribal areas of East Godavari district of Andhra Pradesh with the objective to know the immunization coverage in children aged 1-2 years after launching Mission Indradhanush with the aim to evaluate the primary immunization coverage, coverage of newer vaccines after launching MI , assess the knowledge of mothers on routine vaccination with a special focus on newer vaccines and the reasons for delay or dropouts in vaccination. In the present study, the overall coverage of primary immunization was 94.8%. Overall immunization coverage is less in urban areas compared to rural and tribal areas. Literacy of mother, parity and place of delivery had significant association with complete immunization coverage. The main reason for high dropout rate of newer vaccines was nonavailability of vaccine. This study showed that Mission Indradhanush was successful in accelerating the overall primary immunization coverage in this area to a significant extent.