Paediatric Fibromyxoma Maxilla- a rare entity.

Fibromyxoma is a rare benign tumour of mesenchymal origin that mostly involves the posterior part of the mandible. It is a locally aggressive and slowly growing painless tumour that mostly occurs in second and third decades of life. We report a case of 2 years old child with huge mass of the right maxilla. After proper diagnosis mass was completely excised via sublabial approach and reported histopathologically as fibromyxoma. Because of its rarity in the maxilla and in this age, it is being reported here.

Prompt laboratory diagnosis in timely containment of a plague outbreak in India.

A focal outbreak of pneumonic plague occurred in a hamlet of village Hatkoti, district Shimla, Himachal Pradesh in the first fortnight of February, 2002. A total of 16 cases with 4 deaths were reported. Diagnosis of plague was confirmed by the laboratory in 10 (63%) cases. Y. pestis was isolated from clinical samples of 3 cases and confirmed by bacteriophage lysis. Molecular tests confirmed the presence of Y. pestis specific pla and F1 genes in 4 cases; DNA fingerprinting had identity with the known sequence of plague bacilli. Paired samples from 5 cases showed more than 4 fold rise and 1 case showed more than 4 fold fall in antibodies against F1 antigen of Y. pestis. The present communication emphasises that timely and systematic laboratory investigations give confirmatory diagnosis in shortest possible time which forms the backbone of the outbreak control in a timely fashion and prevents confusion and controversy.

Nipah/Hendra virus outbreak in Siliguri, West Bengal, India in 2001.

BACKGROUND & OBJECTIVE: The viral encephalitides caused by animal or human viruses are characterized by sudden outbreaks of neurological disease in both tropical and temperate regions. An outbreak of acute encephalitis occurred in Siliguri (West Bengal) town of India between January 31 and February 23, 2001. This outbreak was investigated by a team of scientists from four major institutions, and the findings are presented here. METHODS: Detailed information about the outbreak was collected with the help of local health authorities. Limited entomological investigations were also done. Samples collected from cases and contacts were sent for analysis. RESULTS: A total of 66 probable cases and 45 deaths were reported. Epidemiological linkages between cases point towards person-to-person transmission and incubation period of around 10 days. There was neither any concurrent illness in animals nor was there any exposure of cases to animals. Centres for Disease Control and Prevention, Atlanta, USA concluded on the basis of tests carried out on serum specimen from four cases and two contacts that the causative pathogen appears to be Nipah/ Hendra or closely related virus. INTERPRETATION & CONCLUSION: This outbreak highlights the importance and urgency of establishing a strong surveillance system supported by a network of state-of-the-art laboratories equipped to handle and diagnose new pathogens and including patient isolation techniques, use of personal protective equipment, barrier nursing and safe disposal of potentially infected material in the prevention and control measures for Nipah/Hendra virus infection.

Health sector in India--progress, challenges and the way forward.

Health is a priority goal in its own right and a central input into economic development and poverty reduction. Significant achievements have been made in a number of areas which include health parameters, legislation, research and technology and disease control. The life expectancy has gone up by 17% since 1981. In disease control significant achievements are in sight. Some new programmes have been introduced with the changes in disease profile. Significant progress can be seen in leprosy control, blindness control, TB control and iodine deficiency disorder control. Some legislations were also enacted to protect life and personal liberty as the constitution holds the right to healthcare as a fundamental one. Immediate medical relief and preventing major outbreak following disasters is another area to fight with. There are some challenges to face with like propulation stabilisation, to reduce infant and maternal matality, mobilisationof funds on health, to increase manpower, to increase female literacy and so on. Control of some diseases like HIV/AIDS, vector borne ones, cancer, cardiovascular diseases, diabetes, trauma related injuries, mental disorders is another point to improve healthcare delivery. To meet challenges to the health system the way forward has to be multipronged, focusing on finance, manpower, research and social factors like sanitation, drainking water availability, female literacy, etc.

Surveillance of drug resistance to anti-tuberculosis drugs in districts of Hoogli in West Bengal and Mayurbhanj in Orissa.

The Central TB Division (CTD), Government of India, initiated a systematic drug resistance surveillance (DRS), as per the global guidelines, among new TB patients reporting to health facilities under RNTCP. The data obtained from two districts of the eastern part of the country conducted by National TB Institute (NTI) are presented in this study. Objective: To measure the levels and pattern of resistance to anti-tuberculosis drugs among “newly diagnosed” sputum smear positive pulmonary tuberculosis cases in two identified districts, namely, Hoogli of West Bengal and Mayurbhanj of Orissa. Results: Of the total 693 smear positive specimens subjected for culture from both the districts, 545 (78.6%) were culture positive for M. tuberculosis, 62 (8.9%) were culture negative and 86 (12.4%) were contaminated. Culture negativity and contamination rates were 7.9% & 9.9% from Mayurbhanj district and 10% and 14.9% respectively from Hoogli district. The resistance to any drug was 5.4% in Mayurbhanj and 16.7% in Hoogli district. The resistance level to all the four primary drugs ranged from 0.4% to 3.9% in Mayurbhanj and 1.9% to 13.7% in Hoogli district. MDR was 0.7% (95% CI: 0.0% - 1.7%) and 3.0% (95% CI: 1 % - 5.1 %) in Mayurbhanj and Hoogli districts respectively. Conclusion: The study demonstrates that the levels of H, R and MDR in these two districts are within the expected levels, when compared with other studies conducted in India as per global DRS guidelines. However, in order to document success of RNTCP in reducing the levels of MDR TB, particularly in younger population, it is now necessary to conduct DRS in much larger population.

Quick control of bubonic plague outbreak in Uttar Kashi, India.

A localized outbreak of bubonic plague occurred in village Dangud (population 332), district Uttar Kashi, Uttaranchal, India in the second week of October 2004. 8 cases were considered outbreak associated based on their clinical and epidemiological characteristics; 3 (27.3%) of them died within 48 hours of developing illness. All the 3 fatal cases and five surviving cases had enlargement of inguinal lymph nodes. None of them had pneumonia. The age of the cases ranged from 23-70 years and both sexes were affected. No such illness was reported from adjoining villages. The outbreak was fully contained within two weeks of its onset by supervised comprehensive chemoprophylaxis using tetracycline. A total of approximately 1250 persons were given chemoprophylaxis in three villages. There was no clear history of rat fall in the village. No flea was found on rodents or animals. 16 animal serum samples were found to be negative for antibodies against F-1 antigen of Y. pestis. However, Y. pestis was isolated from two rodents (Rattus rattus and Mus musculus) trapped in the village. One case and three animal sera showed borderline sero-positivity against rickettsial infection. The diagnosis of plague was confirmed by detection of four fold rise of antibody titre against F-1 antigen of Yersinia pestis in paired sera of three cases (one of the WHO approved criteria of diagnosis of confirmed plague). This outbreak and the occurrence of earlier outbreaks of plague in Surat (Gujarat) and Beed (Maharashtra) in 1994 and in district Shimla (Himachal Pradesh) in 2002 confirm that plague infection continue to exist in sylvatic foci in many parts of India which is transmitted to humans occasionally. Thus, there is a strong need for the States to monitor the plague activity in known sylvatic foci regularly and have a system of surveillance to facilitate prompt diagnosis and treatment of cases to control the disease. This investigation highlights that with high index of suspicion the disease can be diagnosed early and mounting of supervised comprehensive response can prevent the disease to proceed to pneumonic stage where man to man transmission gets established and outbreak assumes larger dimensions.

Clinical sequelae of Japanese encephalitis in children.

Over a five and a half year period, virological investigations for Japanese encephalitis (JE) were conducted in children admitted with acute encephalitis like illness to a large city hospital. The diagnosis of Japanese encephalitis was made by viral isolation from cerebrospinal fluid and/or a four-fold or higher rise in haemagglutination inhibiting antibodies in paired sera followed by demonstration of specific IgM antibodies by HI test after treatment with 2-mercapto ethanol. All children surviving the illness were contacted by post and followed up for sequelae. A total of 55 children could be followed up after 12-18 months and 22 of these even after 2 yr. A high rate of major sequelae (45.5%) in the form of frank motor deficits (32.7%), mental retardation (21.8%) and/or convulsions (18.2%) was observed. Neurological deficits were of diverse types and improved even after 2 yr of the illness. Fourteen patients (25.4%) had only minor deficits in the form of scholastic backwardness, behavioural problems and/or subtle neurological signs. Only 16 (29.2%) patients were completely normal on follow up. JE may therefore be an important cause of neurological handicap in this area. Sequelae of the disease were more severe if the initial illness was prolonged (P < 0.001, CI 2.45, 12.64), or associated with focal neurological deficits (P < 0.001, CI 1.97, 7.02).