Scrub typhus and spotted fever among hospitalised children in South India: Clinical profile and serological epidemiology.

Background: Rickettsial infections are re-emerging. In India, they are now being reported from several areas where they were previously unknown. Objectives: The objective of this study was to describe the epidemiology, clinical profile and outcome of serologically-confirmed scrub typhus and spotted fever among children in a tertiary care hospital in Bengaluru. Materials and Methods: Hospitalised children aged <18 years, with clinical features suggestive of rickettsial disease admitted between January 2010 and October 2012 were included prospectively. Diagnosis was based on scrub typhus and spotted fever-specific IgM and IgG by enzyme-linked immunosorbent assay (ELISA). Results: Of 103 children with clinical features suggestive of rickettsial illness, ELISA test confirmed 53 cases for scrub typhus, 23 cases for spotted fever group and 14 with mixed infection. The average age was 7.3 (±3.9) years and 44 (71.0%) children were male. Majority of cases were from Karnataka (50%), Andhra Pradesh (32.3%) and Tamil Nadu (17.7%). Common clinical features included fever (100%, average duration 11 days), nausea and vomiting (44%), rash (36%); eschar was rare. Compared to the ELISA test, Weil-Felix test (OX-K titre of 1:80) had a sensitivity and specificity of 88.7% and 43.9%, respectively. Treatment with chloramphenicol or doxycycline was given to the majority of the children. Complications included meningoencephalitis (28%), shock (10%), retinal vasculitis (10%) and purpura fulminans (7%). Conclusions: These findings suggest that the burden of rickettsial infection among children in India is high, with a substantially high complication rate. Rickettsial-specific ELISA tests can help in early diagnosis and early institution of appropriate treatment that may prevent life-threatening complications.

Study of variations in the branching pattern of thoracodorsal nerve.

Background: Purpose of current study was to describe the variations in the origin of the thoracodorsal nerve of the posterior cord of brachial plexus and its distance of origin from mid-clavicular point in the South Indian population. These variations are important during surgical approaches to the axilla and upper arm, administration of anesthetic blocks, interpreting effects of nervous compressions and in repair of plexus injuries. The patterns of branching show population differences. Data from the South Indian population is scarce. Methods: Forty brachial plexuses from twenty formalin fixed cadavers were explored by gross dissection. Origin and order of branching of axillary nerve and its distance of origin from mid-clavicular point was recorded. Representative photographs were then taken using a digital camera (Sony Cybershot R, W200, 7.2 Megapixels). Results: In forty specimens studied, 72.5% of thoracodorsal nerves originated from posterior cord, which was predominant (75%) on the left side, 15% arose from axillary nerve which was observed in 20% of the right sided specimens and 12.5% had origin from the common trunk which was significant (15%) on the left side. In 32.5% of specimens, thoracodorsal nerve had origin at a distance of 4.1-4.5 cm, in 32.5% at a distance of 4.6-5.0 cm, in 17.5% at a distance of 5.1-5.5 cm, in 12.5% at a distance of 3.6-4.0 cm and in 5% at a distance of t more than 5.5 cm from mid-clavicular point. Conclusion: Majority of thoracodorsal nerves in studied population display a wide range of variations. Significant number of thoracodorsal nerve also takes origin from axillary nerve and from common trunk at various distances from a fixed point. Anesthesiologists administering local anesthetic blocks, clinicians interpreting effects of nerve injuries of the upper limb and surgeons operating in the axilla should be aware of these patterns to avoid inadvertent injury and this study provide the necessary insight into the branching pattern of the thoracodorsal nerve and its distance of origin. Further study of the origin of thoracodorsal nerve of posterior cord of brachial plexus and its distance of origin from mid-clavicular point is recommended.

Carbapenem resistance among Escherichia coli and Klebsiella pneumoniae in a tertiary care hospital in south India.

Carbapenem resistance among clinical isolates of Enterobacteriaceae, especially Escherichia coli and Klebsiella pneumoniae, is largely conferred by metallo-β-lactamase (MBL). Fifty-one non repetitive isolates of carbapenem-resistant (Meropenem and Imipenem) E. coli and K. pneumoniae were studied to determine the molecular mechanism for resistance. Presence of blaNDM and blaVIM was determined by polymerase chain reaction (PCR) and DNA sequencing. blaNDM was detected from majority of carbapenem-resistant K. pneumoniae (75%) and E. coli (66.6%). Timely detection and appropriate and aggressive infection control measures are required to control the spread of these bacteria in healthcare settings.

Perception among upper middle class adolescent in Bombay regarding sex and sexuality.

The study was carried out among the adolescents in respect to their beliefs about sexual behavior and their intended decision with regard to engaging in sexual activity. Both male and female respondents indicated that they believe that individuals of their age should wait until they are older before engaging in sexual activity. However, there were significant differences between the responses of male and female adolescents.

Dendritic cell, the immunotherapeutic cell for cancer.

Dendritic cells play an important role in the development of effective cancer vaccines. These cells have the potential to present tumour-specific antigens and thereby induce an immune response. Various studies involving clinical trials have investigated the efficacy of administering antigen-loaded dendritic cells for cancer therapy. In order to design such experiments it is important to consider specific antigens, which initiate either a CD4+ or CD8+ response or both. The present review discusses the unique properties of dendritic cells as an immunotherapeutic cell for cancer.

An epidemiological study of rabies in Bangalore city.

This multicentric study was conducted with the aim of knowing the nature and magnitude of the problem of rabies in Bangalore city. The disease was enzootic and endemic and the principal reservoir of infection was dog. There was stray dog menace due to ineffective dog control measures. Nearly 30% of animal bite victims did not wash their wounds and about 60% of patients started antirabic vaccine late after 24 hours of bite. The antirabies serum (equine) was not available at all. The victims of hydrophobia were both children (37.5%) and adults (62.5%) and the average incubation period ranged from 35-111 days. Pre-exposure antirabic vaccination was not given to dog catching and dog pound staff. Lastly, there was lack of proper laboratory diagnostic facilities for rabies in Bangalore.