Background: India was one of the first countries to adopt the World Health Organization’s Expanded Programme of Immunization (EPI). The program started globally in 1974 and was initiated in India in 1978. Immunization is considered to be one of the most important cost-effective and a powerful public health intervention. Achieving maximum coverage, however, has been a challenge due to many reasons, including high rates of defaulters from the program. The term ªdefaulterº is used to refer a child who misses the scheduled vaccinations for any reason. The objective of this study was to explore the reasons behind defaulting from the routine immunization program.Methods: A study was conducted in Bowring and Lady Curzon Hospital, Bangalore between January 2012 and December 2012. A total of sixty six children’s’ details were gathered from mothers of defaulted children. Children below 5 years attending OPD were included in the study. Children above 5 years and inpatients were excluded. Observations and review of relevant documents was done.Results: Of the 66 children, in our study, males were more than females. Children in the age group of 2 years to 5 years were 17(25%) as compared to those between 1 to 2 years. Mothers were more literate than fathers. Muslim children had the best immunization coverage. The main determinant of defaulting was lack of knowledge and awareness regarding immunization by the mothers (21/31%) followed by sickness in children (11/16%), causing them to default immunization schedulesConclusions: The main reason for defaulting from the immunization program was lack of awareness, regarding immunization by mothers in the community.
Diabetes Mellitus (DM) is a disease with multi-system complications. Left ventricular diastolic dysfunction (LVDD) is an early stage of diabetic cardiomyopathy that can develop to heart failure. It has no clinical symptoms and can be easily diagnosed with echocardiography. The study aims to evaluate the LVDD in Type-2 DM with no symptoms of cardiovascular disease and its association with glycaemic control (HbA1c), DM duration, and microangiopathy. The cross-sectional hospital-based study included 100 asymptomatic patients with type 2 DM without evidence of cardiovascular involvement were studied. LVDD was evaluated by doppler echocardiography, which included E/A ratio, assessed in relation with age, sex, duration of diabetes and HbA1c level. LVDD was present in 57 % of the type 2 DM patients with males accounting for the majority of cases (63.2%). Diastolic dysfunction was more common in patients on oral hypoglycaemic agents (78%), insulin (2%) and/or both (19%). There was a linear progression of diastolic dysfunction with the increase age group (P = 0.001). LVDD was significantly associated with uncontrolled diabetes as measured by HbA1c levels with higher number patients among HbA1c >8.5 (71.9%; P = 0.001) and a longer duration of DM with highest among 6 -10 years (38.6%; P = 0.001).
Johanson-Blizzard syndrome is a rare genetic entity reported in medical literature resulting from mutations in UBR1 gene, affecting pancreas, craniofacial and urogenital development, causing significant morbidity and mortality. We report a neonate presenting with anorectal malformation requiring surgical intervention at birth, with similar surgeries being performed in two elder siblings. Surviving sibling of the proband neonate also has similar dysmorphic features of absent ala nasi, aplasia cutis of scalp along with pancreatic insufficiency, profound sensorineural hearing loss, pheno-type corresponding to Johanson-Blizzard syndrome. Syndromic diagnosis helps in screening for associated potential issues, which can intervened at early stages.
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