Observations of hepatic encephalopathy profile in a tertiary care centre.

A study was conducted among 67 patients presenting with hepatic encephalopathy to establish the aetiological diagnosis and record the incidence of acute and chronic liver diseases. They all had undergone thorough clinical and laboratory evaluation. The factor precipitating encephalopathy was also identified. Among 67 patients 19 (28.4%) had acute liver disease and 48 (71.6%) had chronic liver disease. Majority of patients had grade 2 encephalopathy at presentation. Among the acute cases most common aetiology was acute viral hepatitis due to hepatitis B and E viruses whereas alcoholic liver disease was the most frequent cause of chronic liver disease. The most common precipitating factor was gastro-intestinal haemorrhage.

An el tor cholera outbreak amongst tribal population in Tripura.

An outbreak of acute diarrhoeal disease occurred in Dhalai and North Tripura district, Tripura during month of May 2004. An investigation was done to identify causative agent with anti microbial susceptibility pattern and to know the epidemiological feature. Overall attack rate and Case Fatality Rate (CFR) was 18.8%. and 6.9/1000 respectively. Vibrio cholerae O1 biotype El Tor, Ogawa was isolated as sole pathogen in 40% of hospitalized acute diarrhoea patient and from a water samples examined. The strains were sensitive to Tetracycline, Doxycycline, Norfloxacin, Ciprofloxacin, Chloramphenicol, and Azithromycin. Bad peridomestic sanitation, use of contaminated surface water along with low literacy, lack of personal hygiene, frequent movement might be the factor associated with persistence and spread of pathogen amongst tribal groups leading to outbreak of cholera.

A localised outbreak of Vibrio cholerae O139 in Kolkata, West Bengal.

BACKGROUND & OBJECTIVES: An explosive outbreak of diarrhoeal disease which occurred in the Baishnabghata, Patuli area of Kolkata Municipal Corporation during September 28 to October 12, 2000, was investigated by a team from the National Institute of Cholera and Enteric Diseases, Kolkata, to identify the causative agent and determine the antimicrobial susceptibility pattern. METHODS: Clinical and epidemiological data were collected from domiciliary cases and also from patients attending two medical camps that had been set up for the purpose. Stool and water samples were collected for isolation of diarrhoeagenic pathogens. RESULTS: A total of 710 cases of diarrhoea occurred with an attack rate of 7.1 per cent; majority were adults. All 6 faecal samples and 2 water samples collected, were positive for Vibrio cholerae O139. The strains were uniformly (100%) susceptible to the commonly used drugs for cholera such as tetracycline, norfloxacin, ciprofloxacin, co-trimoxazole and nalidixic acid but resistant (100%) to furazolidone and ampicillin. INTERPRETATION & CONCLUSION: This is the first localised outbreak of V. cholerae O139 in Kolkata since the devastating epidemic in 1992. Extensive chlorination of all water sources resulted in a dramatic decline of the outbreak. The appearance of resistance in V. cholerae O139 to furazolidone is a matter of great concern since this drug is used for the treatment of cholera in children and pregnant women.

Maternal knowledge on risk behavioural practices and it's association with diarrhoea in a rural community of West Bengal, India.

Knowledge of rural mothers related to five diarrhoeagenic risk behaviours, identified in an earlier study, was ascertained. A high proportion of mothers (67%-79%) had knowledge about risk of bottle feeding, non-use of soap for cleaning feeding containers, storage of drinking water in wide-mouthed vessels and indiscriminate disposal of children's faeces. However, only around 31% of mothers were aware about danger of using pond water for cleaning feeding containers. Risk behavioural practices were less amongst mothers who had knowledge about them. Risk of diarrhoea amongst children of mothers having risk practice without knowledge as compared to those who utilised their knowledge to avoid risk practice was found significantly higher (p < or = 0.005) except for bottle feeding (p = 0.330). The results of this study indicate that children can be protected significantly from diarrhoea if mothers' diarrhoeagenic behaviours can be altered through educational intervention.

Value of faecal leucocyte count as an indicator of invasiveness in mucoid diarrhoea.

Importance of faecal leucocyte count as an indicator of invasiveness in mucoid diarrhoea was studied. A total of 290 faecal specimen, 170 from mucoid diarrhoea and 120 from watery diarrhoea were examined for faecal leucocyte count under high power field (hpf) from rural children below four years of age during the period from November 1992 to October 1995. Faecal leucocyte count > 10/hpf was noted in 45.9% of mucoid diarrhoea as against 19.2% of watery diarrhoea (p < 0.0001) samples. From faecal samples with > 10 faecal leucocyte count, invasive pathogens could be recovered in 19 (24.5%) to none of 23 patients with watery diarrhoea (p < 0.006 Fisher exact test). This sample test appears to be of value as an indicator of invasiveness in mucoid diarrhoea in the absence of culture facility.

Investigation of the outbreak of cholera in Alleppey & Palghat districts, south India.

In May 1996, a massive outbreak of cholera occurred in Alleppey district of Kerala which spread to Palghat district by July 1996. Of the 575 patients hospitalized at the Alleppey Medical College hospital between May 1 and August 2, 1996, 30 deaths occurred with a case fatality rate of 5.2 per cent while of the 638 diarrhoea patients admitted at Agali PHC of Attapadi area in Palghat district, 30 (4.7%) deaths were recorded. Clinically, the patients had profuse watery diarrhoea with vomiting. The epidemic of cholera in Alleppey and Palghat districts was caused by V. cholerae O1 of the EITor biotype, Ogawa serotype which possessed both the ctxA and tcpA genes when examined by multiplex PCR. Gross contamination of water sources was incriminated as the cause of the epidemic.

Risk behavioural practices of rural mothers as determinants of childhood diarrhoea.

Maternal behaviours related to certain child care practices which possibly have a contributory role in causation of diarrhoea in children were studied. Comparison was made between behaviours of mothers in 108 families having diarrhoeal children (Case families) with mothers of 72 families having age and neighbourhood matched non diarrhoeal children (control families) using a logistic regression model. Five risk behaviours were identified and these are bottle feeding (OR-2.87; CI-1.30 to 6.34), non-use of soap for cleaning feeding container (OR-2.61; CI-1.30 to 5.23), water storage in wide-mouthed container (OR-2.75; CI-1.27 to 5.96), use of pond water for the same (OR-2.36; CI-1.15 to 4.84) and indiscriminate disposal of children's stool (OR-1.99; CI-0.97 to 4.08). Around 83 per cent of diarrhoeal families could be predicted using these five variables only. The first three of these five risk behaviours were responsible for occurrence of significantly higher incidence (3 or more episodes) of diarrhoea in the case families. All these risk behaviours are amenable to change if suitable intervention is initiated. The result of this study would be helpful in reducing diarrhoea associated morbidity to a substantial level.

Intestinal parasitism: a childhood problem in rural Bengal.

A study was undertaken to assess the parasitic infection rate in a rural community of West Bengal amongst children below four years of age suffering from gastrointestinal complaints. A total of 221 faecal samples were examined during November 1992 to April 1994. G. lamblia (17.2%) and E. histolytica (8.1%) were the predominant protozoas, whereas E. vermicularis (12.2%) and A. lumbricoides (8.1%) were found to be common amongst helminthic infection. A significantly lower infection rate was observed in children below one year (24.4 per cent) as compared to older age groups (66.4 per cent).

Review on development and community implementation of oral rehydration therapy.

The review of the current status and implementation of Oral Rehydration Therapy at the community level have been presented in this communication with special emphasis on its development, ORS access rate, ORS use rate and home available fluids. The global ORS supply has gone up an increased eleven folds since 1981. Similarly the ORS access rate has also increase from 46% to 68% in 1991. However, the global ORS use rate was low (21%). The major constraints during ORT implementation which have been reported by several scientists are also discussed.