A multicenter, prospective, open-label, non-comparative study to evaluate the immunogenicity and tolerance of a new, fully liquid pentavalent vaccine (DTwP-HepB-Hib vaccine)

The current study was planned to assess the immunogenicity and reactogenicity of a fully liquid pentavalent combination vaccine containing diphtheria, tetanus, pertussis, Haemophilus influenzae type B and hepatitis B vaccines. Infants six to eight weeks of age were enrolled and administered the study vaccine at 0, 4 and 8 weeks of enrollment. The children were kept under observation for 30 minutes after each vaccination for local and systemic reactions. A record was maintained of suspected adverse drug reactions (ADRs) for the subsequent three days. Blood was collected for antibody titer estimations prior to the first dose and four to six weeks after the third dose. 100% of children developed protective antibody titres to D, T and HepB. 97% and 81% of vaccinees responded (2-4 fold rise in antibody titres) to the anti-fimbrial and anti-pertactin components of the pertussis antigen respectively. 100% infants developed short-term protective antibody titres to Hib (> 0.15 microg/ml) and 90% developed titres indicative of long-term protection (> 1.00 mg/ml). Fever was most commonly reported adverse event but none of the children had fever more than 102 degrees F. A few infants had mild, expected local and systemic side effects such as tenderness, erythema, induration, excessive fussiness and a change in feeding pattern. Except for one child who was withdrawn from the study for persistent crying, there were no other severe or unexpected adverse reactions reported.

Need for strengthening of internship (rotatory housemanship) training in India

INTRODUCTION

Internship is a problematic phase in the training of doctors in India. At the end of their one-year Internship, students are not formally examined for proficiency, rarely a student is not given a satisfactory completion certificate and training is sometimes not supervised. Students are required to spend three months of this Internship in Primary Health Centres at rural postings. During this period the students often prepare for the written exams that would allow them to pursue post-graduate studies.

METHOD

In a personal reflection, this situation is described in the current article. The author suggests several approaches to improve this unwanted situation, so that the rural postings could be taken more seriously by the students.

OUTCOMES

Suggestions range from a post-internship examination, via the introduction of compulsory rural postings after graduation to an increase of the avenues for post-graduate training to include a course in family medicine and general practice.

CONCLUSIONS

The objective of providing excellent training during internship periods cannot be achieved unless interns actively participate. If the current situation does not change, for example according to the suggested solutions, this valuable component of medical training will remain problematic, thereby hindering the optimal preparation of doctors for the entire spectrum of necessary health care in India.

Facilitating behavioral change for acceptance of oral polio vaccine

A child aged 26 months could not be vaccinated initially during pulse polio immunisation due to parental fear of untoward side effects. Owning responsibility of child's welfare, in-depth counseling and involvement of community leaders are crucial in this regard.

Overcrowding and health

The present study correlates the disease profile of 2536 persons belonging to 542 families with the available per capita floor area (PCFA). It was observed that 91.9 percent individuals were living in overcrowded conditions. As the PCFA decreased, the communicable diseases, infective and parasitic diseases and respiratory disease episodes exhibited a significant increase.

Transforming growth factor-beta responsiveness in DPC4/SMAD4-null cancer cells

DPC4/SMAD4 is a candidate tumor suppressor gene with a strikingly high frequency of gene alterations in pancreatic cancer that suggests a discrete role for DPC4 in these tumors. DPC4 tumor-suppressive function has been implicated to mediate the transforming growth factor-beta (TGFbeta)-suppressive pathway; however, in a DPC4-null pancreatic cancer cell line, TGFbeta growth-inhibitory and transcriptional responses were found to be DPC4-independent. This was observed within native cells having a natural homozygous deletion and in clones engineered for stable expression of wild-type DPC4 integrated into the genome. This observation contrasted with the absolute DPC4 dependence of TGFbeta responses in a breast cancer cell line studied in parallel. This growth-inhibitory response to TGFbeta in DPC4-null cells relied on an intact ras effector pathway. These data further suggest a major categorization of TGFbeta responses into DPC4-dependent and -independent signaling pathways and specifically suggest that disruption of the TGFbeta-independent signal might be a basis of selection for the emergence of DPC4 alterations during tumorigenesis in the pancreas and other sites.