Neurological complications in Chikungunya fever.

OBJECTIVE: The present prospective study was undertaken to study the clinical manifestations and mainly neurological complication of an acute febrile illness termed chikungunya which has recently attacked india after 43 years. METHOD: This prospective study has been conducted in hospitalised patients admitted in government and private hospitals of Kota city from August 2006 to October 2006. Patients showing neurological involvement with typical clinical picture of chikungunya infection were studied in detail and followed up for improvement and any permanent damage or death. RESULTS: Apart from typical clinical triad of high grade fever, arthralgia and rash of chikungunya infection we have observed a spectrum of neurological abnormalities in terms of altered mental functions, seizures, focal neurological deficit with abnormal CT scan of head and altered CSF biochemistry. Permanent neurological sequelae and even death has occurred. CONCLUSION: Typical clinical history of chikungunya infection, neurological complications with associated CSF abnormalities, supportive laboratory evidences, positive chikungunya IgM card test, exclusion of other causes and known predilection of arboviruses for CNS infection allows us to conclude the diagnosis of study cases as Chikungunya Encephalitis.

Sociodemographic characteristics of HIV infection in northern India.

134 patients testing positive for HIV antibody during the period 1986-1993 were included in the present study. An in-depth analysis of the subjects revealed that the adult males seemed to have the highest propensity for HIV infection in this part of the country. Marital status had no bearing on incidence and route of seropositivity. This was not so in females. Extramarital heterosexual contact was the mode of HIV acquisition in adults in contrast to blood transfusion in children. Clinically, most of these patients were still asymptomatic. At presentation, oral Candidiasis was common. Pneumocystis carinii pneumonia (PCP) was the leading cause of death.

Effect of aerosolised verapamil and nifedipine in bronchial asthma.

Twenty patients of bronchial asthma were given 5 mg of either nifedipine or verapamil as aerosol therapy in a randomized fashion. Both drugs showed a statistically significant improvement in FVC, PEFR at zero hours lasting through 90-120 minutes. Changes in respiratory rate, pulse rate, blood pressure were insignificant with verapamil while appreciable tachycardia and transient fall in BP occurred with nifedipine therapy.

Hepatic involvement in tuberculosis.

Seventy one cases of pulmonary and extrapulmonary tuberculosis (confirmed by clinical, sputum examination, Skiagram, lymph node or other organ biopsy) and 13 cases of PUO suspected to be tubercular in origin were included in the study. Besides, thorough clinical workup, LFTs and liver biopsy were also done in all cases. LFT alterations were seen in only 5 (7%) cases of tuberculosis while in PUO group, 3 (23%) cases showed deranged LFT. In all, alteration in SGOT/SGPT was most frequent observation. In Liver biopsy, histopathological changes were seen in 63 percent (45 out of 71) of cases of tuberculosis and in 46.16 percent cases of PUO. In tubercular cases, various abnormalities observed were caseating granulomas: 18.30 percent, nonspecific inflammatory infiltration: 25.32 percent, focal Kupffer cell hyperplasia: 11.2 percent and fatty changes: 8.45 percent. Four of the PUO cases, showing Kupffer cell hyperplasia and non-specific inflammatory infiltration responded to antituberculous therapy. Thus it is surmised that though the caseating granuloma is the hallmark of tuberculosis, but nonspecific inflammatory hepatitis and retothelial tubercle nodules may be the forerunner in the evolution of granuloma.

Changing profile of enteric fever--in summer-91.

The clinical presentation, complications and sensitivity pattern was studied in 30 cases of enteric fever. Fever was the main presenting feature in all. Other associated predominant presenting feature were vomiting in 15 (50%), Loose motion 9 (30%), Cough 6 (20%), headache 4 (13.33%) and altered sensorium in 2 (6.66%). The various complications observed during hospital stay were myocarditis 5 (6.16%), Paralytic ileus 2 (6.66%), Pneumonia 1 (3.33%) and Joint effusion in 2 (6.66%) cases respectively. In laboratory parameters-mild elevation of blood urea and SGOT/SGPT were detected in 1st week, which returned to normal in 2-3 weeks time. In vitro sensitivity of organism isolated (24 cases) were as follow--Chloramphenicol 7 (29.16%), Ampicillin 8 (33.33%), Gentamicin 22 (91.66%), Amikacin 24 (100%), Cefotaxime 22 (91.66%), Ciprofloxacin 24 (100%), and Ofloxacin 24 (100%). Clinical response to Ofloxacin and Ciprofloxacin was 100%, and fever subsided in 3-5 days.

Congenital hemihypertrophy: report of four cases.

Congenital hemihypertrophy is a rare condition. We came across four such cases within a period of six months. These cases are presented here and their unusual features highlighted.

Sero-epidemiology of measles--a three years prospective study in a rural population of Rajasthan.

A community based prospective study on measles was undertaken during 1986 to 1988 in Ramgarh village of Alwar district (Rajasthan) to elucidate epidemiological features of measles. The initial population of the village was 5258 with 2018 children (0-14 years) which rose to total population of 5923 with 2200 children in 1988. During the entire period of study, all the children (0-14 years) were covered regularly through monthly domicilliary visits by trained paramedical personnel under direct supervision of Medical Officers. A total of 208 measles cases were detected which gave an overall incidence rate of 31.5 per 1000 children (0-14 years) per year. Incidence rate was highest in children of 2-5 years of age group and lowest (4.6 per 1000) in 10-14 years of age group. The maximum number (86.5 per cent) of cases occurred during the first six months of year. The Kolmogrov-Smirnov statistical method validated the seasonal character of the disease (Vn = 5.36, p less than 0.01). A significant (P less than 0.005) rise in seropositivity with increase in age was observed in children (6-36 months) who had no previous history of measles and measles immunization during their life time. A higher rate of sero-conversion was observed in children vaccinated after 10-months of age than those before. No significant relationship of seroconversion following vaccination could be seen with age of vaccination (p greater than 0.50), sex and nutritional status (p greater than 0.10).

Dapsone syndrome--a case report.

A 31-year-old male patient with lepromatous leprosy developed fever, malaise, nausea, anorexia, lymphadenopathy, hepatitis, exfoliative dermatitis and ainhum like lesions while on multidrug therapy comprised of dapsone, clofazimine and rifampicin. The provocation tests confirmed the dapsone to be cause of this event.