This article is to understand the current status of Routine Immunization (RI) in India, the challenges and way forward with a perspective of enabling the medical institutions and civil society organizations to engage in the program objectively. Routine Immunization (RI) program in India caters to a birth cohort of 27 million infants and 30 million pregnant women. Thus the India’s Universal Immunization Programme (UIP) is one of the largest in the world in terms of quantities of vaccine used, number of beneficiaries, number of immunization sessions organized and the geographical spread and diversity of areas covered.

Background: Ventilator associated pneumonia (VAP) is the most frequent intensive care unit acquired infection and is one of the leading causes of morbidity and mortality in ICUs. Objectives: To isolate and identify the causative organisms of ventilator associated pneumonia with their antibiotic susceptibility patterns in ICU patients of tertiary care hospital in North Karnataka. Methods: A prospective cohort study was conducted over one year period in ICUs of a tertiary care hospital in North Karnataka. ICU patients who were intubated and on mechanical ventilation for more than 48 hours, in whom VAP was clinically suspected {Clinical Pulmonary Infection Score (CPIS) > 6} were included in this study. Endotracheal aspirates and endotracheal tube tips after extubation were collected as samples. Quantitative culture threshold of more than 105cfu/ml was considered as diagnostic of VAP. Fifty one isolates were obtained from 47 samples as mixed growth was seen from 4 samples. Results: The incidence of VAP in our study was 47.00%. The most common isolates were Pseudomonas aeruginosa (31.38%), Staphylococcus aureus (27.46%), Acinetobacter (11.76%) and Escherichia coli (11.76%). Most of the gram negative bacteria isolated were sensitive to Imipenem and Cefoperazone - sulbactum and gram positive bacteria were sensitive to Vancomycin. Conclusion: The sensitivity patterns of gram negative bacteria and gram positive bacteria vary according to the ICU and the population studied. The recovery rate (78.94%) was higher in the early onset VAP cases. Late onset VAP had higher mortality (64.28%) when compared to the early onset VAP group (21.05%).

Background: School going years are considered as the wonder years in a person’s life. These years are also the formative year which determines one’s physical, intellectual and behavioural development. Any problem in the vision during the formative years can hamper the intellectual development, maturity and performance of a person in future life. The public health and economic impact of myopia is enormous. Due to the high magnitude of uncorrected refractive errors, myopia is considered as one of the important public health problems, especially in the urban population in India. Objective: To compare the prevalence of myopia in Government and private school children. Methods: Total 1600 high school children in the age group of 13 to 15 years were selected, 800 each from Government and Private Schools respectively. Children were screened for myopia with the help of Snellen’s chart and refractionist confirmed the findings. Data was analyzed to assess the prevalence of myopia among high school children. Results: Overall prevalence of Myopia was found to be 23.18% (n=371). Prevalence of Myopia was more among children in Private schools when compared with Government school children 25.7% (n=206) (P=0.01 ). Conclusion: Private school children spent more time for near work activity than government school children. Association between total diopteric hours spent for the activity and type of school was statistically significant

Background: Premenstrual tension has been known since long to affect the behavioural and physical well being of women. Behavioural differences in emotional and cognitive processing have been reported during premenstrual phase in women of reproductive age. Reaction time provides a means to assess psychomotor performance of an individual. Objectives: This study aims to compare sensory motor processing using reaction time para-digms during premenstrual & postmenstrual phases of menstrual cycle. Methods: Audiovisual reaction time of 100 healthy female medical students in the age group 17-21 years during pre and postmenstrual phases was taken with the help of a reaction time apparatus. Data was analysed using paired t test. Results: An increase in both visual reaction time and auditory reaction time was found dur-ing premenstrual phase (P value <0.05) compared to the postmenstrual phase. Conclusion: Hormonal fluctuations during premenstrual period modulate activity of centrally acting neurotransmitters involved in the process, thus prolonging the audiovisual reaction time.

Background: Acute Abdomen is not a disease by itself but a description of complex symptomatology with severe pain developing with in 24hours. In a clinical situation like this other than a detailed history, a thorough clinical examination and necessary radiological & serological investigations, diagnostic Laparoscopy plays a major role not only in evaluation but also aids in a definitive therapeutic procedure in the same sitting. Objective: To ascertain the role of Laparoscopy as a diagnostic tool in the evaluation of Acute Abdomen among young adult females with uncertain diagnosis. Methods: This Prospective Observational study was carried out among 42 females with acute abdomen from the age group of 15 -35 years who were admitted to Emergency Department of General Surgery, Gandhi Hospital Musheerabad, Telangana. Results: Out of 42 patients a definitive diagnosis was possible in 31 patients (73.8%), where as it was still inconclusive among 11 patients (26.19%) Among 31 Patients with a definite cause for Acute Abdomen on diagnostic laparoscopy. Acute Appendicitis was the commonest cause in 22 patients (70.96%) where it was possible to perform an emergency Appendectomy in the same sitting.Relaparoscopy was done in two patients among the 4 patients who were readmitted with acute abdomen during their subsequent admissions and the cause was found to be Acute Appendicitis. Conclusion: Laparoscopy can be considered as an important tool for evaluating the cause for Acute Abdomen among Young Females with equivocal findings.

Background: The consequences of untreated sleep Apnea on daily function include increased day time sleepiness, impaired cognitive function, mood and personality changes, reduced quality of life and there can be adverse effects on others including impaired relationship between spouses and partners. Objectives: To evaluate the typical clinical features, mode of presentation, physical findings, diagnosis and effects of treatment that helps to identify patients with obstructive sleep Apnea along with documentation of associated risk factors and co-morbid conditions. Methods: We performed a study of total 40 patients with high index of suspicion of OSA (Loud snoring, daytime sleepiness, etc) after detailed examination and completing the questionnaire as per the format were advised to undergo PSG. Their data are analyzed and studied. Additional investigations were done wherever necessary. Results: Observations of our study showed obstructive sleep Apnea is a disorder of middle age, with male predominance 3:1; obesity was found to be a major risk factor. Hypertension (54%) was found in majority of patients suggesting strong relationship between the two. Among the females studied, even though the number was small, most of them were of post menopause status (6/10). Conclusion: Snoring and excessive day time sleepiness are most common presentation and obtaining a PSG for diagnosis and follow up of obstructive sleep Apnea.

Background: Adolescent girls are at high risk for anaemia and malnutrition. Anaemia, a manifestation of under - nutrition and poor dietary intake of iron is a serious public health problem, not only among pregnant women, infants and young children but also among adolescents. Inadequate nutrition during adolescence can have seriousconsequences throughout the reproductive years of life and beyond. Objective: To determine the prevalence of anaemia among adolescent girls of age 12-15 years residing in government residential schools. Methods: A cross sectional study conducted in Government residential schools of Balanagar mandai. 400 adolescent girls of age 12-15 years were the study subjects. Study subjects were interviewed using a pre-designed, pre-tested, semi structured proforma. Results: Prevalence of anaemia was 45.5% in study subjects with mean haemoglobin 10.42 ± 1.5090. Demographic characteristics like age, mothers education showed significant relationship with prevalence of anaemia (p<0.05).Lack of personal hygiene showed significant relation with presence of worm infestation (p < 0.05). Presence of parasitic infestation showed significant relation with prevalence of anaemia(p <0.05). Conclusion: Lack of personal hygiene, worm infestations were the major contributory factors for prevalence of anaemia.

Background: Allergic rhinitis (A.R) is one of the most common chronic conditions affecting patients attending ENT OPD. It has significant impact on the quality of life and productivity of people affected by it. There is no single test which is gold standard for its diagnosis. Objective: To compare the value of Nasal Smear Eosinophilia (NSE) with Absolute Eosinophilic Count (AEC) of peripheral blood as diagnostic test and establish a diagnostic tool for A.R. Methods: 50 patients were taken up for 1 year prospective study and NSE Count and AEC were done. There were 36 patients in study group and 14 patients acted as controls. Allergic rhinitis was diagnosed as per standard criteria and sensitivity and specificity of NSE and AEC as diagnostic tests were calculated. Results: The sensitivity of NSE and AEC were found to be 55.56% and 50% respectively. The specificity was calculated as 71.45% and 64.29%. So both the tests have moderate sensitivity and high specificity. Conclusion: Nasal Smear Eosinophilic Count can be considered as simple, economical and semi invasive diagnostic test for A.R in the peripheral setup.

Background: Corneal opacities are the common causes of corneal blindness. So, this study is to know the etiology of the corneal opacities. Objective: This study was to evaluate the etiology of corneal opacities, a common cause of corneal blindness. Methods: This was a hospital based observational study of 100 Patients of corneal opacities, who attended the outpatient department of Cornea, Sarojini Devi Eye Hospital, Osmania Medical College, Hyderabadover a period of 2yrs from August 2012 to August 2014. The patients were evaluated with a detailed history and comprehensive ophthalmic examination by slit lamp, Goldman applanation / Non Contact Tonometer, Indirect Ophthalmoscopy and Β scan mainly to know the etiology of the corneal opacities. The details of age and sex, laterality, literacy, socioeconomic status, occupation and complications were collected. The data was evaluated by simple statistical methods. Results: This study data analysis of 100 patients of corneal opacities showed that the causes were Trauma in 37 patients (37%), Infections in 33 patients (33%), congenital and developmental in 15 patients (15%) and degenerations and dystrophies in 15 patients (15%). The Age wise distribution was 27 patients (27%) in 0-20yrs, 39 patients (39%) in 20-40yrs, 29 patients (29%) in 40-60yrs and 5 patients (5%) above 60yrs. Laterality showed involvement of right eye in 43 patients (43%), both eyes in 35 patients (35%) and left eye in 22 patients (22%). 67 patients (67%) were males and 33 patients (33%) were females. 67 patients (67%) were from the Rural areas and 33 patients were from urban. 53 patients were Illiterate and 47 patients (47%) were literate. 53 patients (53%) were in Agricultural occupation, and 19 patients (19%) had complications like adherent leucoma. Complicated cataract. Secondary Glaucoma and Bullous keratopathy. Conclusions: The most frequent causes of corneal opacities were, trauma (37%) and infections (33%). Nearly 70% of all the causes of corneal opacities were avoidable. The prevalence of corneal opacities was significantly higher with illiteracy, rural agricultural background, decreasing socioeconomic status and with increasing age.

Background: Health care quality is a global issue. Consumer satisfaction is recognized as an important parameter for assessing the quality of patient care services, satisfaction regarding the attitude of providers towards the services is expected to affect treatment outcome and prognosis. Objective: To assess patient satisfaction with services provided in a tertiary care hospital in rural Jalna. Method: This cross sectional study was carried out in the outpatient department of, Noor hospital of Indian Institute of medical science and research Warudi Badnapur, District Jalna. A total of 250 patients were selected by systematic random sampling from 1 st march to 31 th August 2014 and interviewed. The data collected was analysed by applying appropriate statistical test. Results: The overall satisfaction rate in this study was 87.45%.Total 88.4% of patients are satisfied with the availability of essential medicine and 88% patients get medicine easily. Satisfaction with laboratory location was 93.6% and 90% of respondents agreed with investigation reports received in time. Regarding cleanliness of hospital 94.8% of respondents are satisfied. Total 85.6% of respondents were satisfied with the condition of the toilets. Satisfaction rate for availability of drinking water was 83.6%. About paramedical staff 95.6% of patients agree that paramedical staff talk politely with them and 94% of patients told they are helpful. Conclusion: Patient’s feedback is important as continuous quality improvement is linked to the use of timely and useful feedback from the clients.

Background: Domestic violence is the most common form of violence against women. It affects the life span from sex selective abortion of female foetuses to forced suicide and abuse and is evident, to some degree, in every society in the world. It is important that studies on domestic violence should be conducted and those women who are found as victims should be counselled to reduce/prevent the health hazards among them. Objective: To study domestic violence against working women. Methods: An Institution based cross sectional observational study was conducted in Malla Reddy Institute of Medical Sciences and Malla Reddy Hospital for a period of one month. All professionals and working class women including Faculty, nurses, clerks, and class-3 and class-4 employees were included. Total women working in Malla Reddy Institute of Medical Sciences and Malla Reddy Hospital were 355. Out of 355, 125 women agreed to participate in the study. Results: The prevalence of domestic violence was 23.2%. It was found that slapping was the most common type of physical violence i.e. 20.6%. 11 (37.9%) women out of 29 were facing the economic abuse (violence). 20 (69%) of women out of 29, reported emotional violence. Alcoholic husband was the most common cause in 43.7% of cases. 41.6% of women do not want to report the incidence to anyone. Similar number however has reported to their parents. Conclusion: Thus it can be concluded that the prevalence of domestic violence was very high among the working women.

Background: Perinatal strokes are not rare. In fact, the perinatal period ranks second only to adult age groups in the incidence of stroke and accounts for 30% of children affected with hemiplegic cerebral palsy (CP) who are born at term or late preterm gestations. Objective: To study the relationship of thrombophilicfactors related to perinatal stroke. Methods: 34 neonates comprising of inborn and outborn babies, admitted in NICU, Gandhi Hospital were subjected to cross sectional study. The cases were subjected to neurosonogram, EEG and MRI. Other investigations like Protein C, Protein S, antithrombin-lll, Antiphospholipid antibody and homocysteine were done on the blood samples to study some of the factors related to thrombotic state. Data was analyzed using SPSS. Results and Conclusion: There is no statistically significant difference in the mean and standard deviations of different factors related to thrombotic state with respect to sex of the child. No statistically significant association is seen between the levels of factors related to thrombotic state studied and the mode of delivery. Mean Protein C levels are found to be significantly elevated in babies with abnormal EEGs. Anti-thrombin III and APLA IgG levels are significantly lower in the group [(P = 0.047and 0.039 respectively)], of newborns with MRI abnormalities. There is a significant rise in homocysteine levels in relation to MRI abnormalities [(P = 0.004)]. The R² values for the model summaries of the regression tables with respect to Protein C, Protein S, Anti-thrombin III, APLA IgG & IgM, and homocysteine are associated with MRI Brain & EEG findings. Conclusions: The levels of factors related to thrombosis have no association to the stages of HIE in this study, but are associated with abnormalities on MRI.

Background: Tumours of eyelids are common in people of both sexes and all age groups representing more than 90% of all ophthalmic tumours. Most of the tumours are diagnosed clinically. The treatment depends on site, extent of spread and the invasiveness of the tumour. Objective: To study the clinical presentations, types and management of eyelid tumours and its histopathological confirmation. Methods: A prospective study was conducted on patients presented with eyelid tumours to the Sarojini Devi Eye Hospital, Hyderabad during December 2007 to November 2009. Tumours were diagnosed clinically. Treatment was planned according to the nature of lesion. Data were presented as frequencies, mean ± Standard Deviation (SD). Unpaired t test was used to test the significance of difference of the type of the tumour with age, eye and eyelid involvement. Results: A total of 100 cases, 52 were females, 48 cases involved right eye, 61 cases were benign and 39 malignant. The mean age of the participant in benign tumour was 37.02 ± 16.847 years and of malignant tumour was 58.59 ± 11.271 years and this difference was statistically significant (p<0.05). There was no statistically significant difference observed in the context of type of tumour, eye and eyelid involvement (p>0.05). Commonest benign tumour was intradermal nevus with 17 cases, whereas Basal cell carcinoma and Sebaceous gland carcinoma presented equally in 16 cases each. Conclusion: A significant proportion of tumours were malignant, predominantly Sebaceous gland carcinoma and Basal cell carcinoma. Majority of malignant tumors were observed above 60 years of age.

Vasectomy is one of the safest and most effective family planning methods and is one of the few contraceptive options available for men. Vasectomy is one of the least used contraceptive methods in the developing world including India. Objective was to determine knowledge, attitude and practice regarding vasectomy as a family planning method among married men in a rural. A Community based cross-sectional study was carried out among married men in rural field practice area of Department of Community Medicine, Osmania Medical College, Hyderabad. 400 married men below 60 years of age were interviewed using a pre-designed pre-tested Schedule. Statistical analysis: Data were entered using MS-Excel 2007 & analyzed using EPI INFO version 7. Awareness regarding vasectomy was present in majority (78%) of the respondents but acceptance of vasectomy was only 3.2%. Most common reason for not accepting vasectomy were fear of surgical procedure (37%) followed by fear of weakness (29%), fear of impact on sexual performance (26%) and lack of information (24%). There is an imperative need to launch a client cantered IEC campaign with emphasis on family couple and individual counselling on all aspects of Vasectomy.

Four percent of all deaths and Five percent of health loss to disability are due diarrhoea and nearly 2.4 million deaths and four billion cases are due to diarrhoea worldwide. Deaths are mainly due to dehydration which can be prevented by prompt treatment with home based oral fluids. The present study has been undertaken to study and compare the knowledge, attitude and practice regarding management and prevention of diarrhoea. A Cross sectional comparative study was designed in urban slums and residential colonies of Vijayawada. One Slum & Colony were selected by simple random sampling method. One respondent from each family were included in the study. All 180 families from slum and colony to be included were selected by systemic random sampling method. 360 respondents comprising of 90 males and 270 females were studied .Knowledge about diarrhoea was significantly better among Colony population (93.33%) compared to slum dwellers (84.4%). 24.4% of slum dwellers and 57.78 % of colony population had correct knowledge regarding home based oral fluids. Health care facility is approached by 78.33 % of slum dwellers in case of diarrhoea compared to only 40.56 % of colony residents. All colony residents used protected water, practiced appropriate disposal of refuge compared to only 65.56% and 11.67% of slum dwellers respectively. Colony residents were having significantly better knowledge and preventive practices related to diarrhoea compared to slum dwellers.

We undertook this study to evaluate the clinico-radiological profile, treatment modalities adopted and to know the relevant contributing factors. A prospective study of a hundred cases foreign bodies in food and air passages fifty each conducted over two years at a tertiary care centre. Only cases of laryngeal, tracheal, pharyngeal and upper esophageal foreign bodies are included. Radiological investigations were done as needed. A total of 100 patients were studied. The youngest was nine months of age and the eldest was 68 years. 58 (58%) were male, 42 (42%) were female. The commonest site of lodgment of FB was observed as crico pharynx (64%)and right main bronchus (48%) for food and air passages respectively. Mortality rate was observed as 2% for tracheobronchial foreign bodies while it was nil in pharyngo-esophageal. Foreign bodies in aero digestive tract constitute a common emergency in otolaryngological practice. A well planned procedure is always better and delay in diagnosis and management leads to morbid outcomes.

100 patients of senile cataract presenting to Sarojini Devi Eye Hospital, Hyderabad were included in the study. A Prospective, comparative study was carried out in which 50 patients were operated under Subtenon’s anesthesia (group 1 ) and 50 patients under Peribulbar anaesthesia (group 2). The efficacy, akinesia, lid movements and complications like Chemosis and subconjuctival hemorrhage were compared between the two groups. The percentage of patients with grade 0 pain in subtenon’s anesthesia group was 70% as compared to 30% in peribulbar group. Grade-4 pain in subtenon’s group was 0% compared to 4% in peribulbar group. Grade 0 akinesia was 0% in subtenon’s group compared to 62% in peribulbar group. Grade 0 lid movements are experienced by 70% in subtenon’s group and 88% in peribulbar group. Grade 0 Chemosis was 61 % in subtenon’s group and 64 % in peribulbar group. 44% of subtenon’s and 64% of peribulbar group had grade 0 subconjuctival hemorrhage. Intraoperative pain was dramatically lower in subtenon’s group of patients with very few patients experiencing unacceptable level of pain. Peribulbar anesthesia had an upper hand in terms intra-operative akinesia when compared to subtenon’s anesthesia. Intra-operative lid movements were slightly more in subtenon’s group. Incidence of Chemosis and subconjuctival hemorrhage was comparable in both the groups.

Clinical and hematological profiles of twelve patients with Pure Red Cell Aplasia (PRCA) are described. It was more common in fifth decade and in males. Eight patients had mild upper respiratory tract infection, eight patients had indigenous drug intake history, eight patients had hepatomegaly, six had splenomegaly and three had palpable lymph nodes. Experience with corticosteroids and immune suppressive agents are described.

Breast feeding is one of the most important determinants of child survival, birth spacing and prevention of childhood infections. Breast milk is an excellent food and meets all nutritional requirements of the baby for the first six months. The objective was to determine the breast feeding practices in Urban and Rural areas of Warangal. A cross-sectional study was conducted wherein the mothers of infants in the age group of 0-12 months attending the immunization session at rural and urban health centre were interviewed using a pre-designed pretested and pre coded proforma. Exclusive breast feeding for 6 months in infants above 6 months of age is better in rural area (60.6%) than in urban area (47.6%). Association between exclusive breast feeding and literacy status of mothers was found to be significant in both urban (p=0.02) and rural areas (p = 0.000). Pre lacteal feeding is observed more in the urban area (51.7%) than in the rural area (48.6%). Information, Education and Communication activities are required to avoid pre lacteal feeding, to improve early initiation of breast feeding and to improve exclusive breast feeding for 6 months.

Metabolic syndrome (MetS) is a cluster of cardiovascular risk factors that include obesity, diabetes, hypertension, and dyslipidemia. Oxidative stress may act as a common link to explain the relationship between each component of MetS and periodontitis. MetS is characterized by oxidative stress, a condition in which the equilibrium between the production and the inactivation of reactive oxygen species (ROS) becomes disrupted. ROS contribute to cellular dysfunction and damage. Patients with more components of MetS had a significantly greater probing depth and clinical attachment loss. Evaluation of relationship between periodontitis and various components of Metabolic syndrome (MetS).This prospective study was carried out on study group consists of 30 subjects. All the patients will be evaluated for the risk factors of MetS which are: B.M.I., B.R, Triglycerides, R.B.S. increase in these risk factors is associated with increase in periodontal pocket depth, gingival recession and clinical loss of attachment. Metabolic alterations related to MetS causes an augmented response to bacterial plaque favouring periodontal insurgence. Oxidative stress acts as common link to explain the relationship between each component of MetS and periodontitis. Thus, periodontitis the harbinger of MetS which is more severe and disproportionate to number of local factors related to it.

Chromoblastomycosis is a slowly growing fungal infection of skin and subcutaneous tissue. It is caused by a variety of pigmented fungal species growing in soil and decaying vegetation. We report a case of cutaneous chromoblastomycosis in a patient, who received chemotherapy and radiotherapy for carcinoma of gall bladder. A 40 years female patient had presented with vesiculobullous lesions coalesced to form plaques on both thighs and legs. Biopsy from vesiculobullous lesions was done. Histological features and special stains confirmed the diagnosis of Chromoblastomycosis.

Posterior reversible encephalopathy syndrome (PRES) is characterized clinically by the presence of headache, seizures, loss of consciousness, and cortical blindness in a woman with high blood pressure in the third trimester of pregnancy, and radiological findings in such patients are predominantly posterior cerebral edema all of which are reversible within three months. We report a 24 year old patient who presented with headache and visual loss on fourth day post delivery. Clinical improvement with complete resolution of visual disturbances was observed with supportive treatment

Langerhans cell histiocytosis (LCH) is a rare histiocytic tumour in adult. We report a case of LCH involving skull bones in a 35year old lady who presented with fever, headache and diabetes insipidus since two years. Radiological examination revealed osteolytic lesions in the parietal and occipital bones along with a solid, enhancing lesion in the pituitary infundibulum. Osteolytic lesions showed ttypical histomorphology of LCH on light microscopy and on IHC it was positive for SI 00 but negative for CD1 a. LCH with CD1 a negativity is very rare and hence we are presenting this case.