Professional Documents
Culture Documents
a)tetanus
b)measles
ANSB
REF:THEVACCINEHANDBOOKBY
GARYMMARSHAL
efficacyoftetanustoxoidhasneverbeenstudiedinclinicaltrial,butantibodyresponse
wouldsuggestefficacyofvirtually100%
MKhaswronglygivenansasmeasles
catchhere:singleormultipledoses
multipledoses::tetanusattainsbetterthanmeasles
singledose::measles
utthelinesabovethem,ifureadthemcarefullyaroramentions...
"efficacyoftetanustoxoidrangesfrom80100%.butprotectionisincompleteafterfirstdose>>>athirddoseinducesimmunityin
almost100%,,,
thefirsttwodosesdonttoit.
Now 4 to start anti TB treatment ONLY TWO SPUTUM SAMPLES taken.. One stat and second in next morning.
Also duration of cough is FIFTEEN DAYS and not three weeks.
vaccin vial monitering is now available for HBV vaccine.
new wonder drug for kala azar-Miltefosine.
DIAL THERMOMETER USED FOR COLD CHAIN TEMPERATURE MONITERING,BASED ON
THERMOCOUPLE PRINCIPLE
Yaws has been declared eliminated from india in 2007
India eliminated leprosy in dec 2005
vit A is now given upto 5 yr age.. instead 3 yrs.
Decision analysis measure: the relative value a patient places on a particular outcome.
Painless eschar *the tache noire are found in *rickettsia
STEPS Step 1: History
Step 2: Anthropometric measurements
Steps 3: Biochemical tests
Chickenpox Lesions concentrated more on trunk
Rate
Ratio
Recent Statistics:
CBR--> 23.4 (21.76-->2009)
CDR--> 8 (6.23 --2009)
IMR--> 54 (2007)
2009-->
o IMR: 30.15 deaths/1,000 live births
o Male: 34.61 deaths/1,000 live births
o Female: 25.18 deaths/1,000 live births
o Life Expectancy at birth Males - 62.3 (2005); 67.46 (2009)
Females - 65.3 (2005); 72.61 (2009)
Neonatal mortality rate : 37 per 1000 live births (2006); 34 per 1000 live births (2009)
Early neonatal mortality rate : 28 per 1000 live births (2006)
Under 5 mortality rate : 72 per 1000 (2007); 64 per 1000 (2009)
General fertility rate - 93.3 (2006)
General marital fertility rate - 111.7 (2009)
Total feritility rate - 2.72(2009)
GRR--> 1.3 (2006)
NRR--> 1.4
MMR--> 301/lakh Live Birth(2003); 2009 --> 254
CPR--> 58%
Sex ratio--> 933(2001); 927 (2009)
Least- Haryana
Least child sex ratio- Punjab
Favourable:Kerala,Manipur,Sikkim
Population--> Rural(72%): Urban(28%)
Q. Which of d following is an example of DISABILITY limitation1)Reducing occurence of polio by immunisation
2)Arranging for schooling of child suffering from PRPP
3)Resting affected limbs in neutral position------------------------ans
4)Providing calipers for walking
DiscussionIn Tertiary prevention, there are 2 phases: 1. Disability limitation: - It consists mostly MEDICAL/TECHNICAL measures that will limit the progression of further
disability caused by the disease. Like in this example, Resting the limb, may prevent progression of the further
damage to the limb. This this medical advice is Disability limitation.
2. Rehabilitation: - These are more of Social and Vocational measures to let the handicap patient establish in society.
Providing Calipers for walking can't limit the progression of his disease. It can only make him move. So, it is helping
the Handicap.
Economic benefit of any programme is compared with the cost of that programme
< 5*
200-400*
4-11 mths
05/07/09
400-600
1-2 yrs
8-10.9
600-800
2-4 yrs
11-15.09
800-1200
5-14 yrs
16-29.9
1200-2200
>15 yrs
>30
2200-4000
NRHM includes- RCH II, NDCP(National Disease Control Programmes), IDSP(Integrated Disease Surveillance Project).
NRHM will also enable main-streaming of AYUSH
Operational duration for various programmes RCH II--> 2005-2010
NACP III--> 2005-2010
NRHM--> 2005-2012
Millenium development goals--> Upto 2015
Child mortality rate reflects income, nutrition, health care and basic education. UNICEF--> best indicator of social
development and well being
Cows milk is not recommended for children until they are 1yr of age because the high level of protein causes increase in
the solute load to the kidneys. It is this overload that leads to lethargic dehydrated state of the child. Leinoleic, leinolenic,
calcium and vitamin B-Complex not present in high concentrations in cows milk.
Q. A diagnostic test has sensitivity of 64% and specificity of 99%. Such a test would carry the risk of which kind of
problem1. High relative risk
2. Low likelihood ratio
3. False negatives----------------ans
4. False positives
Discussion- Sensitivity is defined as the number of true positives divided by the sum of the number of true positives and false
negatives. It is the proportion of patients with the condition in question that the test can detect. Thus if the sensitivity is only
64% the number of false negative will most likely be unacceptability high.
High false positive are found in:
Low prevalence
Low specificity
Latest recommendations for supplementary nutrition under ICDS scheme, a malnourished child receives the following at
AWC--> 800 KCal
ESI Act(1948): Applicable thouroughout the country(in contrast to factories act which is not applicable to the state of J+K)
o Benefits:
Medical(no cash)
Sickness benefit : 91 days* --> 50%(new park) of daily wages
Extended sickness benefit: 2 yrs* --> 50% of daily wages; applicable for only 34 diseases(not all); only
people of same organisation are eligible for the benefit
Enhanced S.B. :Sterlisation(full wages),Vasectomy(7 days),Tubectomy(14 days)
Maternity benefit :
@ full wages(3 mths for full term delivery/confinement) --> 6 mth recommended in 6th pay
commission for government institutions(still not applicable to ESI Act)
Miscarriage: 6 wks
Complication due to confinement: 30 days
Disablement benefit:
Temporary:@ 70% of daily wages
Permnent: Full time life pension
Dependents benefit
Rehabilitaion benefit: @ Rs 10 per month of premium
Funeral benefit: 2500/ Factorys Act(1948): Applicable in whole country (except J/K)o Hrs of work: 48 hrs/wk --> 9 hr/day (With OT: 60 hrs/wk)
o Age of employment: <14 yrs not allowed; 15-18 yrs (considered adolescent)
o Per capita space requirement for workers *500 cu.ft.(350 before 1945)
o Others:
If >1000 employees present--> Safety officer
If > 500 employees present--> Welfare officer
If > 250 employees present--> Canteen
If > 30 women employees present--> Creche
Peumoconiosis(usually takes 10-12 yrs to develop): 0.5-3 micron dust cause pneumoconiosis. No treatment so prevention
is the only option. Initial stages--> Disease is arrested with stoppage of exposure(not reversed)
o Silicosis: Shortest incubation period(few mth - 6yrs); involves *upper lobe, Intense nodular fibrosis--> hence
snow storm appearance on CXR, crazy paving appearence on HRCT
o Asbestosis: Referred to as fibre of death; *Diffuse peribronchial fibrosis, CXR-Ground glass appearance,affects
Perinatal period:
o >28 wks of gestation to--> first 7 days of life
o but when age is not known: >1000 gm wt. or >35 cm CRL
National population policy:
o In NPP all targets are to be achieved by 2010 (except population stabilisation--> 2045)
o NRR: current level--> 1.4
Indirect measure- so not included in NPP
NRR= 1 when (Direct measurements included in NPP):
TFR= 2.1(by 2010)
CPR= 60%
Contraceptives:
o POP(Only 3 indications):
Women >35 yrs of age
Lactating women in first six months of lactation
Younger women with risk of neoplasia
o IUD:
Should not be prescribed to a woman who does not have a single living child
Should not be prescribed to woman with multiple sexual partners--> PID--> Infertility
o Condom: Most widely used contraceptive worldwide except INDIA
FR: 4-14--> so not a choice for a newly married couple
o OCPs: Recommended for newly married couple
FR: <1%
Within 3 mths of stoppage ~98% of woman can conceive
Advantages of Nested Case Control Study:
o Temporality of association(i.e. cause must precede the event)
o No recall bias
o Confounding is minimised
Q. Randomisation in a clinical trial is done mainly to:
1. Help ensure the study subjects are representative of general population
2. Reduce selection bias in allocation of treatment
3. Ensure groups are comparable on baseline characteristic
4. Facilitate double blinding
Option 2 is correct.
1=2(same thing.1 defines selection bias)
1,2,3 all are independently correct
Q. False about RCT:
1.Sample size depends on hypothesis
2.Dropouts are excluded from analysis
3.Interviewers bias can be eliminated by double blinding
4.Groups are comparable on baseline characteristics
Option 2 is ans(given wrong in guides)
It is assumed that dropped out people could have behaved in a similar manner like the people who continued the study
About option 1
Factors on which sample size of RCT depends:
Effect size:
o Difference in response rate in 2 groups
o Larger the effect size, smaller the sample size
3. Testes
4. Uterus-------ans(Clarified by AA)
Discussion- Lepra bacilli affects the cooler areas of the body eg. Nerve,Testis,Nasal tip etc. According to WHO leprosy is a
public health problem if prevalence is more than 0.01
Vaccine preservatives:
o Live attenuated bacterial vaccine eg. BCG Preservative esp. antibiotic not added
o Thiomersal:
Used as preservative in DPT,HiB,HepB,Measles,MMR
Contains Hg--> not used as a preservative now
o Measles--> Live viral vaccine--> add antibiotic as preservative to prevent bacterial contamination
o OPV: MgCl2, phenolphthalein
Biological transmission
Propagative*
Cyclo-Propagative(CPM)
Cyclo-developmental
Characteristic change
MultiPlies
Change in form and number
Only development
Example
Plague
Malaria
Filaria
C. Early identification of a new born at risk of HIV infection will improve survival
D. Zidovudine therapy can be offered to reduce the chances of transmission of HIV to the newborn
Answer is DNow DOC is Nevirapin
Q. All are targeted in Target intervention for HIV except:
A. Street children
B. Industrial worker
C. Migrant labourers
D. Sex workers
Answer is B.
Target intervention in high risk group:
Commercial sex workers
MSM(Homo)
IV drug users
Truck drivers
Migrant labourers
Prison inmates
Street children
o Risk of prick injuries
o IV drug use
o Homosexual activity
Q. In HIV maximum risk of transmission is by:
A. Homosexual
B. Blood transfusion
C. Heterosexual
D. Needle prick
Answer is B.
Mode of transmission/Route of transmission
Sexual--> heterosexual--> 85%(max.)
Perinatal,IV drug, Bld. Transfusion--> 2-3%
Others--> 7%
o Locomotor disability
o Hearing impairment
o Mental retardation
o Mental illness
At least 40% disablementrequired to qualify for the benefits under disability act
Carrying or issuing false disability certificate both persons are liable for fine upto Rs. 20,000/- or imprisonment
upto 2 yrs
Initiate BF within 1 hr of birth even in C/S(mother is fit with spinal/epidural anesthesia to BF within
1 hr)
Under National Cancer Control Programme,oncology wings are sanctioned to Medical colleges
Janani surakha yojna:100% centrally sponsered programme
o Coverage:
All women in low performing state
All women below poverty line in a high performing state
o Eligibility:
Women age > 19 yrs of age
Only for first 2 living children
Also for third child if she undergoes sterlization(only in low performing states)
o Benefits: Cash incentive + Intranatal + Postnatal + Neonatal care(Antenatal care is not a part of janani
suraksha yojana)
Anganwadi workero is for population of 1000 and not 1 for 1000 children
o is ICDS worker
o training for 4 months, honorarium of Rs. 200-250 per month
o about 100 such workers in each ICDS project
o Services rendered-health check up, immunisation, supplementary nutrition, health education, non-formal preschool education & referral services
Shake test- can be used to determine if vaccine has been frozen at anytime--> useful for DPT/DT/TT/Typhoid(T-Series
vaccine) and HB vaccines which should never be frozen
Socratic method of teaching--> Panel discussion(ck-p-718)