Ongoing Outbreak of Extensively Drug-Resistant Campylobacter jejuni Infections Associated With US Pet Store Puppies, 2016-2020

IMPORTANCE

Extensively drug-resistant Campylobacter jejuni infections cannot be treated with any commonly recommended antibiotics and pose an increasing public health threat.

OBJECTIVES

To investigate cases of extensively drug-resistant C jejuni associated with pet store puppies and describe the epidemiologic and laboratory characteristics of these infections.

DESIGN, SETTING, AND PARTICIPANTS

In August 2017, health officials identified, via survey, patients with C jejuni infections who reported contact with puppies sold by pet stores. In conjunction with state and federal partners, the Centers for Disease Control and Prevention investigated cases of culture-confirmed C jejuni infections in US patients with an epidemiologic or molecular association with pet store puppies between January 1, 2016, and February 29, 2020. Available records from cases occurring before 2016 with genetically related isolates were also obtained.

MAIN OUTCOMES AND MEASURES

Patients were interviewed about demographic characteristics, health outcomes, and dog exposure during the 7 days before illness onset. Core genome multilocus sequence typing was used to assess isolate relatedness, and genomes were screened for resistance determinants to predict antibiotic resistance. Isolates resistant to fluoroquinolones, macrolides, and 3 or more additional antibiotic classes were considered to be extensively drug resistant. Cases before 2016 were identified by screening all sequenced isolates submitted for surveillance using core genome multilocus sequence typing.

RESULTS

A total of 168 patients (median [interquartile range] age, 37 [19.5-51.0] years; 105 of 163 female [64%]) with an epidemiologic or molecular association with pet store puppies were studied. A total of 137 cases occurred from January 1, 2016, to February 29, 2020, with 31 additional cases dating back to 2011. Overall, 117 of 121 patients (97%) reported contact with a dog in the week before symptom onset, of whom 69 of 78 (88%) with additional information reported contact with a pet store puppy; 168 isolates (88%) were extensively drug resistant. Traceback investigation did not implicate any particular breeder, transporter, distributer, store, or chain.

CONCLUSIONS AND RELEVANCE

Strains of extensively drug-resistant C jejuni have been circulating since at least 2011 and are associated with illness among pet store customers, employees, and others who come into contact with pet store puppies. The results of this study suggest that practitioners should ask about puppy exposure when treating patients with Campylobacter infection, especially when they do not improve with routine antibiotics, and that the commercial dog industry should take action to help prevent the spread of extensively drug-resistant C jejuni from pet store puppies to people.

Ocular Manifestations of Congenital Lamellar Ichthyosis

PURPOSE

To describe the ophthalmic manifestations in a series of children with congenital lamellar ichthyosis. These cases presented with varying types of eyelid abnormality associated with the systemic disease. The clinical features and ophthalmic management were studied.

METHODS

The case histories of three children presenting to the oculoplastic clinic were reviewed. All were diagnosed with congenital lamellar ichthyosis and under the care of the Dermatology department. Family history and pedigree analysis was performed to determine mode of genetic inheritance. Ocular examination for visual acuity, eyelid and eyelash malposition, lid function and closure were carried out. Corneal examination including tests for exposure was also done.

RESULTS

All three patients had eyelid position abnormalities from the systemic disease. There was no clinical evidence of conjunctival involvement. One patient required full thickness skin grafts to treat corneal exposure secondary to lower lid ectropion. One had mild lower lid ectropion but without corneal exposure. The third case had the unusual finding of inward turning of the anterior lamella of the upper eyelid with a marked lash ptosis and only mild ectropion of the lower lid.

CONCLUSIONS

Congenital lamellar ichthyosis is a heterogeneous disorder with phenotypic variability. The most common eyelid abnormality is cicatricial ectropion of the upper and mainly lower eyelids. Most cases are managed conservatively although in severe cases secondary corneal exposure may require surgical correction. In this condition, to the best of our knowledge, the tendency for the eyelids to turn inwards has not previously been described.

O'nyong nyong virus molecular determinants of unique vector specificity reside in non-structural protein 3

O'nyong nyong virus (ONNV) and Chikungunya virus (CHIKV) are two closely related alphaviruses with very different infection patterns in the mosquito, Anopheles gambiae. ONNV is the only alphavirus transmitted by anopheline mosquitoes, but specific molecular determinants of infection of this unique vector specificity remain unidentified. Fifteen distinct chimeric viruses were constructed to evaluate both structural and non-structural regions of the genome and infection patterns were determined through artificial infectious feeds in An. gambiae with each of these chimeras. Only one region, non-structural protein 3 (nsP3), was sufficient to up-regulate infection to rates similar to those seen with parental ONNV. When ONNV non-structural protein 3 (nsP3) replaced nsP3 from CHIKV virus in one of the chimeric viruses, infection rates in An. gambiae went from 0% to 63.5%. No other single gene or viral region addition was able to restore infection rates. Thus, we have shown that a non-structural genome element involved in viral replication is a major element involved in ONNV's unique vector specificity.

Venezuelan equine encephalitis virus activity in the Gulf Coast region of Mexico, 2003-2010

Venezuelan equine encephalitis virus (VEEV) has been the causative agent for sporadic epidemics and equine epizootics throughout the Americas since the 1930s. In 1969, an outbreak of Venezuelan equine encephalitis (VEE) spread rapidly from Guatemala and through the Gulf Coast region of Mexico, reaching Texas in 1971. Since this outbreak, there have been very few studies to determine the northward extent of endemic VEEV in this region. This study reports the findings of serologic surveillance in the Gulf Coast region of Mexico from 2003–2010. Phylogenetic analysis was also performed on viral isolates from this region to determine whether there have been substantial genetic changes in VEEV since the 1960s. Based on the findings of this study, the Gulf Coast lineage of subtype IE VEEV continues to actively circulate in this region of Mexico and appears to be responsible for infection of humans and animals throughout this region, including the northern State of Tamaulipas, which borders Texas.

Venezuelan equine encephalitis virus (VEEV) has been responsible for hundreds of thousands of human and equine cases of severe disease in the Americas. In 1969, an outbreak of Venezuelan equine encephalitis (VEE) spread rapidly from Guatemala and through the Gulf Coast region of Mexico, reaching Texas in 1971. Since this outbreak, there has been very little done to understand the ecology of VEEV in this region. Here, we present that the results of recent field studies that focus on confirming the continued existence of enzootic VEEV in the Gulf Coast region of Mexico. We performed serological analyses of sera collected between 2003 and 2010 from humans, cattle, horses, and dogs in various regions along the Gulf Coast of Mexico, and these data were complemented by wildcaught rodent serosurveys. Additionally, phylogenetic analyses were performed on VEEV isolates from this region to determine whether there have been substantial genetic changes in these viruses since the 1960s.

Iodine deficiency disorder control programme impact in pregnant women and status of universal salt iodization

BACKGROUND

Several studies pertaining to current status of Iodine Deficiency Disorder Control Programme in India have revealed goiter prevalence in the range of 1.5-44.5%, mean urinary iodine excretion level ranging from 92.5-160 mcg/L and iodized salt coverage ranging from 37-62.3%. Most of these studies were based on school children. However, very few studies have focused on pregnant women. This population is very sensitive to marginalized iodine deficiency throughout their gestational period.

METHODS

This 40 cluster cross sectional study was done in Raipur district. Iodine content of salt was estimated by using "Rapid Salt Testing Kits" along with observing salt storage practices, at household and in shops. Pregnant women were interviewed by using semi structured comprehensive questionnaire, which was based on knowledge attitude, and practices about salt use pattern and awareness about IDDCP, UIE level were also estimated.

RESULTS

Prevalence of goiter was 0.17%. Many (41.12%) pregnant women had <15ppm iodine content in the salt sample and 51.58% of women had subnormal iodine uptake. Wrong salt storage practice was observed in 36.3% of households.

CONCLUSIONS

There were lacunae in Iodine deficiency control program in Chhattisgarh. Implementation and monitoring of program was weak. Thus for monitoring purpose IDD Cell & IDD Laboratory should be established at district level. This will lead to periodic assessment of Iodine Deficiency Disorders, by monitoring of Iodine intake and all other preventive, promotive as well as curative measures in the state.

QTc interval prolongation by fexofenadine in healthy human volunteers and its correlation with plasma levels of fexofenadine: A demonstration of anticlockwise hysteresis

Aim:

The study was designed to establish relationship between the plasma concentration and QTc interval prolonging effect of fexofenadine and demonstrate the phenomenon of anticlockwise hysteresis.

Materials and Methods:

Six subjects were given fexofenadine 60 mg tablet orally under stable conditions, and their drug concentrations were measured at regular intervals. At predetermined time, their ECGs were recorded. Data were analyzed and plotted graphically.

Design and Setting:

Randomized parallel design, single group study conducted at clinical research organization of Ahmadabad.

Results:

In all subjects time taken for maximum plasma concentration of fexofenadine (T_max) was around 3 h and the value of average maximum plasma concentration was 460.63 ng/mL, the effect of fexofenadine on the heart (measured as QTc interval prolongation) was maximum (E_max) after 6 h and average QTc interval was 469.75 ms. Thus, the time to maximum concentration of fexofenadine did not match with the maximum effect on the heart as measured by QTc interval.

Conclusion:

The relationship between the drug concentration and drug effect on the heart are at two different time scales. It can be understood by two-compartment model of pharmacokinetics, and this retardation or lagging of an effect behind the concentration is known as hysteresis. The increase of QTc was not beyond 500 ms and not sustained, demonstrating overall cardiac safety of fexofenadine.

Treatment seeking behavior for urinary incontinence among north Indian women

BACKGROUND

Urinary incontinence is a common but neglected problem of women.

AIMS

To ascertain the treatment seeking behavior of north Indian women having urinary incontinence (UI).

SETTING

Two residential colonies of Chandigarh.

DESIGN

Cross-sectional face-to-face interview based study.

MATERIALS AND METHODS

This study was conducted by a trained nurse during April 2005-July 2005 among women aged 18 years and above. Women with UI were identified in a screening survey. They were interviewed individually regarding their treatment seeking behavior and socio-demographic data.

STATISTICAL ANALYSIS USED

Percentage, mean, standard deviation, chi-square test.

RESULTS

Of the 220 enlisted incontinent women 20% (44) women consulted some health agency. Only 8.6% (19) women had heard about pelvic floor muscle exercises. Seventy-two percent (158) cases had UI for more than one year. The most common reason quoted for not seeking treatment was, 'UI was considered as 'normal', 'did not take it seriously' and 'shyness.' Many (153;70%) women reported that UI affected their daily routine as well as social activities like shopping and visiting friends.

CONCLUSION

Urinary incontinence seriously affected the quality of life of women. Still, consultation rate for UI was low in the north Indian women.

Virulence variation among isolates of western equine encephalitis virus in an outbred mouse model

Little is known about viral determinants of virulence associated with western equine encephalitis virus (WEEV). Here, we have analysed six North American WEEV isolates in an outbred CD1 mouse model. Full genome sequence analyses showed < or =2.7 % divergence among the six WEEV isolates. However, the percentage mortality and mean time to death (MTD) varied significantly when mice received subcutaneous injections of 10(3) p.f.u. of each virus. Two WEEV strains, McMillan (McM) and Imperial 181 (IMP), were the most divergent of the six in genome sequence; McM caused 100 % mortality by 5 days post-infection, whereas IMP caused no mortality. McM had significantly higher titres in the brain than IMP. Similar differences in virulence were observed when McM and IMP were administered by aerosol, intranasal or intravenous routes. McM was 100 % lethal with an MTD of 1.9 days when 10(3) p.f.u. of each virus was administered by intracerebral inoculation; in contrast, IMP caused no mortality. The presence of IMP in the brains after infection by different routes and the lack of observed mortality confirmed that IMP is neuroinvasive but not neurovirulent. Based on morbidity, mortality, MTD, severity of brain lesions, virus distribution patterns, routes of infection and differences in infection of cultured cells, McM and IMP were identified as high- and low-virulence isolates, respectively.

Sequential Descemet's membrane detachments and intraocular lens haze secondary to SF6 or C3F8

PURPOSE

To report an unusual complication of treatment in the case of a Descemet's membrane detachment.

METHODS

Observational case report.

RESULTS

A 79-year-old woman presented for elective cataract surgery. Ocular risk factors identified preoperatively included moderately shallow anterior chambers bilaterally, previously treated with bilateral YAG peripheral iridotomies. After a clear corneal section during phacoemulsification, large Descemet's tears on introducing the micro finger and phaco probe were noticed. Conversion to an extracapsular technique was necessary because of poor view. Similar peroperative Descemet's detachments were noticed in the contralateral eye during phacoemulsification by a senior surgeon a year later. Postoperatively, the Descemet's detachments were managed by intracameral SF6 and later C3F8 gas. A few weeks later, a fine haze was noticed under the anterior surface of the intraocular lens (IOL). Corneal edema persisted and corneal decompensation ensued. Both eyes needed penetrating keratoplasties. The right eye needed an IOL exchange due to IOL haze.

CONCLUSIONS

In this case the SF6 or C3F8 gas may have produced the unexpected effect of an anterior IOL haze. The mechanism of this phenomenon is unknown. To the knowledge of the authors, this effect has not been observed previously with SF6 or C3F8 gas. This haze was visually significant and required an IOL exchange. To the knowledge of the authors this is the first report of this nature. The authors advise caution when using intracameral SF6 or C3F8 gas for repair of Descemet's membrane detachment with this type of IOL.

Late onset vitreoretinal complications of regressed retinopathy of prematurity

AIM

To report the clinical findings, management, and outcomes in eyes undergoing surgery for regressed retinopathy of prematurity (ROP) with vitreoretinal complications.

METHOD

Retrospective review of 40 eyes of 32 patients with regressed ROP who presented between 1989 and 2001 at two UK referral centres.

RESULTS

Of 29 eyes presenting with rhegmatogenous retinal detachment (RRD), 15 initially underwent a scleral buckling procedure and 14 initially underwent vitrectomy with or without additional buckling. Primary surgery was anatomically successful in 11/15 eyes that underwent a non-vitrectomy retinal detachment repair and 8/14 that required vitrectomy. The final reattachment rate after reoperation was 28/29 eyes. Median visual acuity improved from 6/60 to 6/36 following retinal detachment repair. A further 11 eyes of eight patients from this series underwent prophylactic surgery, laser, or cryotherapy for predisposing vitreoretinal pathology and/or retinal breaks, all of which were stabilised.

CONCLUSIONS

In eyes with RRD and signs of regressed ROP successful reattachment of the retina can be achieved using either vitrectomy or external surgery with an associated overall improvement in visual acuity. A range of external and closed microsurgical approaches is required to effectively deal with the diverse manifestations of regressed ROP.

A histological analysis of lens capsules stained with trypan blue for capsulorrhexis in phacoemulsification cataract surgery

PURPOSE

Staining of anterior lens capsules with dye to facilitate completion of continuous curvilinear capsulorrhexis is now being used more frequently in phacoemulsification of white and mature cataracts with poor red reflexes. This study examined the histological characteristics of anterior lens capsules stained with trypan blue. The layer(s) of the lens capsule that stained with dye and the extent of accumulation of dye in these layers of the lens capsule were determined. To the best of our knowledge this has not been described before.

METHODS

A series of 10 stained lens capsules were analysed histologically. The dye used in this study consisted of a standard sterile, noninflammatory, nonpyrogenic, 2 ml solution containing 0.6 mg/ml of trypan blue. Following capsulorrhexis, samples were sent to the laboratory for histological analysis. Frozen sections (8 microm) were prepared and examined with the light microscope. All 10 capsules were cut by frozen section to preserve trypan blue staining (which would be leached by processing) and then subjected to immunohistochemistry for collagen IV. Immunohistochemical analysis using markers for type IV collagen were done on formalin-fixed specimens for morphological comparison with the frozen sections. A counterstain highlighted the epithelium.

RESULTS

Continuous curvilinear capsulorrhexis was successfully and easily completed in all cases without any complications. Frozen section analysis using light microscopy demonstrated accumulation of trypan blue dye in the basement membrane of the lens capsule. Staining was concentrated in the portion of the membrane adjacent to the lens epithelium. The lens epithelium could not be clearly identified on the frozen sections. Consequently, immunohistochemical analysis with markers for type IV collagen was performed. A counterstain highlighted the epithelium. This confirmed that the layer staining with trypan blue was the basement membrane, a consistent feature on all the specimens.

CONCLUSION

Trypan blue selectively stains the basement membrane of the anterior lens capsule. There is a concentration of dye in the basement membrane adjacent to the lens epithelial cell layer. The lens cortex does not appear clinically to stain with trypan blue. This enables surgeons to distinguish the lens capsule from the cortex and provides sufficient contrast for successful completion of continuous curvilinear capsulorrhexis during cataract surgery.

The influence of counselling on patient return following uncomplicated posterior vitreous detachment

PURPOSE

To investigate the effect of patient counselling together with the use of information leaflets on the number of return visits for patients with acute, symptomatic, uncomplicated posterior vitreous detachment (PVD).

METHODS

The study group comprised the first 50 patients diagnosed with uncomplicated PVD in 1998 when a standard protocol of structured patient counselling and leaflet distribution was employed following diagnosis of PVD. The control group comprised the first 50 patients in 1997 diagnosed with uncomplicated PVD before structured patient counselling was in place. A retrospective analysis of casualty case notes was made comparing the two groups. The number of eye casualty attendances within 1 year of first presentation with PVD was compared in the two groups.

RESULTS

Seven patients from the control group returned because of photopsia or floaters; 3 of the 7 returned with no change in their original symptoms. Six patients from the study group returned. All had a definite change in their symptoms of photopsia or floaters. No patient in the study group who returned had old or persistent symptoms. Statistical analysis comparing return visits of patients with no change in symptoms in the two groups by Fisher's Exact Test gave a p value of 0.13.

CONCLUSION

Patients counselled following uncomplicated PVD did not return to eye casualty in the absence of new symptoms. Patient counselling is an important part of the management of PVD because it makes patients aware of which symptoms are important predictors of serious vitreoretinal pathology.

Cost-effectiveness of public-funded options for cataract surgery in Mysore, India

BACKGROUND

In India 3.8 million people become blind due to cataracts every year. We assessed the cost-effectiveness of public-funded options for delivering cataract surgery in Mysore, Karnataka State, India.

METHODS

Three types of delivery of cataract surgery were studied: mobile government camps, walk-in services at a state medical college hospital, and patients transported in from satellite clinics to a non-governmental hospital. We assessed outcomes in a systematic sample of patients operated on in 1996-97 by follow-up at home; average costs by provider derived from actual expenditures during the year.

FINDINGS

Almost half the patients operated on in government camps were dissatisfied with the outcome (34/70, 49% [95% CI 36-61]). More than one third were blind in the operated eye (25/70, 36% [25-48]). User satisfaction was higher with other providers (medical college hospital 82% [63-94]; non-government hospital 85% [72-93]), and fewer patients remained blind. Camps were a low-cost option, but the poor outcomes reduced their cost-effectiveness to US$97 per patient. The state medical college hospital was least cost-effective, at US$176 per patient, and the non-governmental hospital was the most cost-effective at US$54 per patient.

INTERPRETATION

The government of India should review its policy for government camp surgery, and consider alternatives, such as transporting patients to better permanent facilities. India and other developing countries should monitor outcomes in cataract surgery programmes, as well as throughput.

Partial liquid ventilation with and without inhaled nitric oxide in a newborn piglet model of meconium aspiration

The object of this study was to determine the effects of partial liquid ventilation (PLV) with and without inhaled nitric oxide (NO) over a 4-h period on lung mechanics, gas exchange, and hemodynamics in an animal model of meconium aspiration syndrome (MAS). Twenty-four fentanyl-anesthetized piglets were instrumented and administered a slurry of human meconium to create a model with hypoxia, hypercarbia, acidosis, and pulmonary hypertension. They were then randomly assigned to conventional ventilation, conventional ventilation plus inhaled NO at 40 ppm, PLV using perfluorodecalin, or PLV plus inhaled NO. The perfluorocarbon was added until a meniscus was visible in the endotracheal tube during expiration. Hemodynamics, lung mechanics, and gas exchange were monitored for 4 h, and then the animals were killed. The conventionally ventilated animals continued to deteriorate, and three of the six died prior to 4 h. All the animals in the remaining groups survived. Oxygenation improved significantly immediately with the start of inhaled NO (from 43.8 SD 10.3 to 62.6 SD 11.7 mm Hg after 30 min) and stayed elevated compared with the control group for the remainder of the study (62.4 SD 21.8 mm Hg at 4 h compared with 44.9 SD 1.6 mm Hg for the control group, p < 0.05). Oxygenation improved more slowly in the PLV alone group, being slightly less than control at 30 min (p = NS) but increasing to 104 SD 34.9 after 4 h (p < 0.01 compared with the control group), at which time it was also greater than inhaled NO alone (p < 0.05). The combined group had an acute increase in oxygenation indistinguishable from the NO alone group and maintained this until the end of the study. Lung compliance was unaffected in the inhaled NO group. In both the liquid ventilation groups the lung compliance improved with the instillation of perfluorodecalin (from 0.46 SD 0.18 to 0.62 SD 0.09 ml/cm H(2)O/kg in the PLV alone group at 1 h, p < 0.05 compared with the control group) and remained stable for the remainder of the study. Cardiac output and pulmonary vascular resistance were not significantly affected by any of the treatments. It was concluded that in this animal model of MAS, inhaled NO led to an acute improvement in gas exchange and prolonged survival compared with conventional therapy. PLV improved lung mechanics, which was maintained over the course of the study. The combination of PLV and inhaled NO produced both effects, acutely improving both gas exchange and lung mechanics. Combined therapy with PLV and inhaled NO may have benefits in the MAS.

Regulation of intracellular level of Na+, K+ and glycerol in Saccharomyces cerevisiae under osmotic stress

The intracellular level of Na+ and K+ ofS. cerevisiae strain AB1375 revealed that under KCl as well as sorbitol stress, the cationic level was comparable to the level under no stress conditions. On the other hand, there was a sharp drop in the intracellular K+ content and increase in the Na+ content on addition of NaCl to the medium. However, the total cationic level was close to that under control conditions. In addition to changes in the cationic level, an enhanced production and accumulation of glycerol were also observed under osmotic stress. A regulatory mechanism co-ordinating the intracellular concentration of glycerol as well as Na+, K+ content under osmotic stress conditions has been proposed.

Minor injuries in ninth class school children of Chandigarh and rural Haryana

OBJECTIVE

To estimate the incidence of minor injuries and to study the wound care practices of school children.

DESIGN

A fortnightly follow up of urban (n = 112) and rural (n = 110) high school children was done in Chandigarh and rural Haryana between 1990-1992. Initial point prevalence survey was followed by fortnightly follow up survey involving interview for assessing incidence and wound care practices among students.

SETTING

Government high schools of Chandigarh and rural Ambala in between 1990 to 1992.

SUBJECTS

Ninth class school children from urban (n = 112) and rural (n = 110) areas.

RESULTS

Average episodes of minor injuries per year were 2.9 in rural and 2.1 in urban area, point prevalence was higher in urban area. First-aid training of teachers or the students was lacking in both the areas. Many of the injuries (41-46%) occurred during the school time. Fingers/hand or feet were affected most. Main sources of injuries were farm implements, thorn, blade and stick in rural area and finger nails, kitchen appliances and furniture in urban area. Rural students were more tolerant to minor injuries. Lesser number of rural students had taken tetanus toxoid. Wound washing with water as the first action was reported by 20-22% students in both the areas. Application of urine or chewed grass was reported by rural students only, whereas use of ointment, tablet, bandage, injection as the first action was observed in urban students only.

CONCLUSIONS

Incidence of minor injuries was higher in rural area as compared to urban area. Training of students on elementary hygienic wound care is recommended.

Knowledge & practices of urban and rural high school children regarding minor injuries

High school students of urban (112) and rural area (110) were surveyed in 1990-91 to assess their knowledge and practices for regarding management of minor injuries. A variety of lacal application for wound were described. Burnol, Vaseline, talcum powered GV paint, mercurochrome were told only by urban students while irritating on wound was told only by rural students. Washing of wound with water, use of termeric, ointment, dettol, leaves spirit, sucking were told more by urban students while more of rural students told about use of mustard oil & mobile oil. Need of tetanus toxoid and immediate washing of would was told more by urban students. Need of relevant health education is emphasized.

Evaluation of cold chain system in rural areas of Haryana

Evaluation of cold chain system was done in a time bound study during August and September months of 1992 in two districts of Haryana as there were frequent breakdowns of icelined refrigerators during the previous year. The study revealed that defective stabilizers and electricity plugs and sockets were the reason of breakdown in many cases. Temperature maintenance and functioning of deep freezers was satisfactory. Retrospective analysis showed that the polio vaccine samples picked up during 1990-92 were found to be satisfactory by CRI, Kasauli. Use of two ice-pick carrier and thermos flasks was associated with poor temperature maintenance. Seven vaccine carriers out of 25 examined had cracked wall lining. Lids of carriers were also not kept tight during vaccination sessions. Response lag of the health workers and medical officers in case of breakdowns was delayed. A one day refresher course exclusively on cold chain maintenance at community health centre level is recommended.

An epidemiological study of congenital malformations in rural children

Children between 0-6 years of age from six villages of Ambala District were screened for congenital malformations. Of 1371 children, malformations were observed in 30 (prevalence 22/1000). Twenty children had major malformations and six had multiple anomalies. Cardiovascular malformations were the commonest (37%) followed by musculoskeletal (30%), gastrointestinal (23%), central nervous system (13%) and genitourinary anomalies (6.6%). An etiological factor (maternal rubella infection or drug exposure during early pregnancy) could be ascertained in only 3 cases. Traditional birth attendents (TBA) and Anganwadi workers (AWW) were helpful in identifying 95% of the cases with externally visible malformations in rural areas. In majority of cases no remedial measures were taken by the parents.

Identification of infertile couples in a rural area of northern India

An attempt was made to identify infertile couples in a rural area of India, utilizing the existing information structure. A three stage screening of the cases was done. Initial record based listing was done with the help of the health workers' records. Cases on initial list were screened on the basis of information obtained from key informants in villages. Verified cases were then individually contracted. Total catchment population (28839) in 40 villages of a Primary Health Centre (PHC) of north India was surveyed by a lady social worker. Of the total 4453 eligible couples in the PHC, 129 (2.9%) were infertile (46.5% primary and 53.5% secondary infertility). From the initial list of 298 cases, 161 (54%) were excluded during the survey. The yield from the health workers' record was 33 per cent whereas from key informants it was 93 per cent. The study revealed that the key informants and existing information structure can be utilized to identify conditions like infertility in rural areas, after proper verification of initial reports.

Attitude of Indian urban adults towards mental illnesses

In an urban area of Jhansi 238 adults were interviewed to asses their views regarding mental illnesses. Mental illness was not perceived as a serious disease. Cancer was perceived as the most serious disease. Worries, faulty upbringing, overwork were perceived as a cause of mental illness by majority. Early identification sings of mental illness described by them were difficulty in sleeping, changes in facial expression and feeling of impending mental imbalance. Marital alliance with them was not favoured. However, a sympathetic attitude towards mental patients was favoured. Avoiding tension, adapting oneself to circumstances, a consulting elders were considered as preventive measures against mental illness by majority.

Effect of zinc ion on the interaction of some amino acid compounds of copper(II) with hydrogen peroxide

Reaction of elemental copper and zinc powder mixtures with glycine (NH2.CH2COOH; HA) or aspartic acid (NH2CHCOOHCH2COOH; H2B) (in 1:1:2 ratio, respectively) in the presence of excess hydrogen peroxide (H2O2) at 50 degrees C, results in the formation of a new mixed metal peroxy carbonate compound corresponding to formula [Cu(Zn)2(O2(2-) (CO3)2(H2O)4], while the same reaction with elemental copper powder alone yields merely peroxy amino acid compounds having the formula [Cu(O2(2-)) (HA)2(H2O)] and [Cu(O2(2-)) (H2B) (H2O)2] for glycine and aspartic acid, respectively. These compounds have been characterized by elemental analysis, ESR, and electronic and IR spectra. It is interesting to note that both amino acids are converted to carbonate in the presence of zinc alone. A method analogous to that described above, for the reaction of elemental copper, zinc powder mixtures with succinic acid [(CH2COOH)2] or acetic acid (CH3COOH) in excess H2O2, on the other hand, gave a product essentially comprising copper succinate or acetate, respectively. These observations suggest an interesting and perhaps important phenomenon by which only the simple amino acids such as glycine and aspartic acid are converted to carbonates while their corresponding carboxylic acids form only their respective salts.

The role of operations research and systems analysis in holding down the costs of hospitals and clinics

In the past, medical care facilities have concentrated primarily on professional clinical evaluation. With the cost of treatment rising rapidly, it is becoming increasingly important to critically review and analyze our delivery systems so that scarce resources can be used optimally. In this paper the applications of operations research (O.R.) and systems analysis techniques that have been employed successfully in private industry are explored to find ways to improve clinical operations and hold costs down.

A systems analysis approach to planned change in a clinical psychiatric program

In health car facilities, systems studies are commonly conducted as ivory-tower operations with minimal impact and little practical result. A real-life case study was presented to demonstrate how it can be used effectively in a collaborative manner to implement constructive change. Systems Analysis techniques were succe-sfully used with the staff of a psychiatric ward to plan for a satellite outpatient treatment program. The focus was on collaboration to help the ward to obtain objective information for decisions concerning the need for changes in their existing system.