Heterogeneity and Hierarchy of Immune Response to Primary Immunization in HIV-Infected Children on HAART and the Impact of an Additional Dose of Vaccine.

The nature of vaccine response inferiority is not well studied in children living with HIV (CLHIV). The authors investigated Hepatitis B Virus (HBV) and Diphtheria/Pertussis/Tetanus toxoid (DPT) vaccination responses following primary immunization in CLHIV (n = 42) and healthy controls (HC) (n = 38) and the effect of an additional vaccine dose. Antibody responses, CD4 and HBV-specific T/B cells were analysed using CMIA/ELISA and flow-cytometry. CLHIV had significantly lower baseline median antibody titres for all vaccines than HC (p <0.02). Differential seroprotection rates observed in CLHIV were, 4.8% for pertussis; 9.5% for HBV; 26.2% for diphtheria and 66.7% for tetanus. WHO staging significantly influenced anti-HBs levels (p = 0.0095). HBsAg-specific CD4+T-cells were significantly higher in CLHIV than HC (p = 0.042). An additional vaccine dose (HBV and Tdap) conferred a higher protection rate for tetanus and diphtheria (p <0.040) in CLHIV. These findings suggest that CLHIV exhibit a hierarchy of vaccine responses affecting antibody levels and protection rate, which was rescued by administering additional vaccine dose.

Congenital Retinal Macrovessel Without Any Ophthalmic Complications: A Case Report.

Congenital retinal macrovessels (CRMs) are a rare entity. They are usually unilateral, abnormally large, and aberrant vessels. Although the majority of the patients are asymptomatic, CRMs may affect vision if they are associated with pigmentary changes at the macula, foveolar cysts, central serous retinopathy, macular hemorrhage, or if the macrovessel crosses the fovea. Here, we present the case of a young female who came for a routine ophthalmological evaluation. She was asymptomatic, and the macrovessel was an incidental finding. Visual acuity and slit lamp examination were normal, and dilated fundus evaluation was normal except for CRM in the right eye. Optical coherence tomography angiography imaging helped visualize the depth of the vessel and the analysis of the architecture of the foveal avascular zone.

Establishing the practice of birth companion in labour ward of a tertiary care centre in India-a quality improvement initiative.

BACKGROUND: Birth companion is a key component for providing respectful maternity care and has been recommended by WHO and Government of India. It is a low-cost beneficial intervention that is vital in improving quality of care during labour and delivery. LOCAL PROBLEM: Despite the available evidence on benefits of birth companion, there was no policy on allowing birth companion at our hospital in the past. METHODS AND INTERVENTIONS: We aimed to establish the practice of allowing birth companions in all eligible women in labour ward from existing 0% to 50% in 6 weeks' duration. This study was conducted in the Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi. A quality improvement (QI) team was formed, and after obtaining the baseline data, problems were analysed using fish bone chart. A new policy of allowing birth companion was made and efforts made to sensitise and train the doctors and nurses posted in labour ward. Changed ideas were executed in multiple plan-do-study-act (PDSA) cycles. Simple interventions such as dress code for birth companions, curtains for ensuring privacy, display of posters and frequent reminders on WhatsApp groups were planned . RESULTS: The median value of women accompanied by birth companion marginally increased to 25% after the first PDSA cycle. Implementation of further changed ideas led to increase in median, which reached 66.6%. Thereafter, there was a decline, but by the end of 6 months, it was possible to attain the goal and sustain it. CONCLUSIONS: Simple steps of QI methodology can be used to address the prevalent problems in our healthcare. Implementation of any new practice comes with major challenges, but we could achieve our goal because of a motivated team working together on multiple changed ideas applied sequentially in PDSA cycles.

Treatment of refractory mastocytic enterocolitis with budesonide.

Mast cells (MCs) are being increasingly implicated as a possible contributor to symptoms in diarrhea predominant irritable bowel syndrome (IBS). The term "mastocytic enterocolitis" was proposed to describe an increase in mucosal MCs in patients with chronic diarrhea due to functional gastrointestinal disease (FGID). The efficacy of anti-MC mediator therapy (antihistamines and MC stabilizers) has been well documented in this setting. Here we describe the treatment with oral budesonide of mastocytic enterocolitis refractory to standard anti-MC therapy.