Clinico-Epidemiological Study of Childhood Leprosy in Post Elimination Period at a Tertiary Care Hospital

Introduction: Childhood leprosy is important marker of thestatus of the ongoing leprosy program, as it is an indicatorof active disease transmission in the community, despite theachievement of the elimination status of leprosy in the year2005. The study was done to evaluate the epidemiological andclinical profile of childhood leprosy and to assess the changingtrends if any in the post-elimination period.Material and methods: A retrospective analysis of newlyregistered patients aged less than 15 years at leprosy outpatientin the department of Dermatology, Venereology and Leprosy,from January 2014 to December 2018 at a GovernmentGeneral Hospital, Vijayawada. Year wise data were analyzedaccording to age, sex, geographic area, clinical spectrum,reaction, deformities, and contacts.Results: During the study period, a total of 481 patients wereregistered, out of which 66 (13.72%) cases of childhoodleprosy was observed. Multibacillary (MB) cases constituteda total of 68.18% while Paucibacillary (PB) constituted a totalof 31.82%. The M: F noted was 1.4:1, urban to rural childrenwere 26 and 40. The majority of the patients were in the agegroup of 11 to 15 years.Conclusion: Rate of increase (doubled) in childhood leprosyis alarming, as an immediate and preventive measure,early diagnosis of childhood leprosy needs to be improved.Further, the importance of complete treatment, follow up,consequences, contact tracing should be stressed on.

Pattern of Dermatoses among Pediatric Population Attending Tertiary Care Centre

Introduction: Skin diseases are encountered quite commonlyin pediatric age group. There is wide variation in the patternand presentation of different skin conditions in children whencompared to adults. The aim of the present study was to studythe pattern and prevalence of dermatoses in the pediatricpopulation and the various etiologies causing them.Material and methods: This study was conducted in theGovernment General Hospital, Vijayawada. 1000 childrenbelow the age of 14 years presenting with skin diseases wereincluded in the study. Clinical diagnosis was made after athorough clinical evaluation and physical examination.Results: Among 1000 cases, 52.5% were males and femalesconstituted 47.5%. Infectious group of diseases (38.6%)were the most common cause of dermatological diseases inthe childhood followed by infestations (19.1%) and eczemas(12.6%). Hypersensitivity disorders (10.2%), diseases ofthe appendages (5.1%) and pigmentary disorders (4.9%)constituted the other important causes.Conclusion: This study provides a gross idea about the patternof skin diseases in children. The most common etiology in thepresent study belonged to infectious origin. Scabies was themost common disease seen. By providing information aboutthe various causative skin diseases in pediatric population, thisstudy helps in devising preventive measures and managementoptions.

Antibacterial activity of Indian cherry during its growth and ripening.

The fruits of Cordia dichotoma, which are underutilized, have been used to identify its antibacterial activity. Among the different non-polar to polar extracts used diethyl ether extracts showed inhibition of more number of bacterial strains than other extracts used. Methanol fraction however showed highest zone of inhibition against Salmonella paratyphi using premature and mature fruit extracts and recorded minimum inhibitory concentration value of 0.5 mg/ml. Among all the extracts used gram positive bacterial strains were more susceptible than the gram negative bacterial strains. Klebsiella pneumoniae and Bacillus cereus proved to be highly susceptible, while Escherichia coli proved to be most resistant among all the bacterial cultures used. Further studies are however needed to identify and ascertain the role of bioactive compounds responsible for the antibacterial activity.

Prevalence and distribution of cardiovascular risk factors in an urban industrial population in south India: a cross-sectional study.

BACKGROUND: Cardiovascular diseases (CVD) are leading cause of death in developing countries including India. The huge burden of CVD in Indian subcontinent is the consequence of the large population and high prevalence of cardiovascular risk factors. This study was done to determine the prevalence of cardiovascular risk factors in two industrial units in Chennai, India. METHODS: Survey of behavioural risk factors using structured questionnaires and anthropometric measurements were done for the study population. Blood samples were collected for the fasting plasma glucose and serum cholesterol. Trend chi-square was employed to test the linear trend. RESULTS: The total study population included 2262 male subjects. Blood samples were collected for 2148 (95.0%) subjects. Age range was 18-69 years. Prevalence of major cardiovascular risk factors was: current smokers 462 (20.2%), body mass index > or = 23 kg/m2 1510 (66.8%), central obesity 1589 (70.2%), hypertension 615 (27.2%), diabetes mellitus 350(16.3%) and total cholesterol > or = 200mg/dl in 650(30.3%). CONCLUSIONS: The study results indicated high prevalence of behavioural risk factors, central obesity, hypertension and diabetes in a select group of middle and high-income young urban males. The long-term follow-up in such settings will provide an opportunity to understand the influence of risk factors on cardiovascular disease outcomes.

Iodine nutritional status of adolescents.

OBJECTIVE: To estimate the nutritional status of the adolescent tribes in Purnia District of Bihar. METHODS: Iodine nutritional status of the adolescent children (10-12 yrs) of tribal communities of Purnia District (Bihar) was studied. Urinary iodine levels of the children was estimated. Iodine content of the common salt samples consumed by the tribals has been determined. Goiter prevalence among the children has been assessed. Iodine deficiency status and goiter-proneness of the target population has been discussed in the light of the data. RESULT: Total goiter prevalence of 11.67% estimated among the tribals from six well populated markets. CONCLUSION: The tribals of Purnia District should be encouraged to consume iodised salt.

Blood group and serum protein polymorphisms in turpu kapu population of vizianagaram district, Andhra Pradesh.

Data on two blood group and three serum protein polymorphisms of the Turpu Kapu, an endogamous population of Vizianagaram District, Andhra Pradesh (AP) is presented. The gene frequencies for the blood group systems ABO and Rh are within the ranges of distribution reported earlier among the caste populations of Andhra Pradesh. The study population shows highest frequency of Hp1 allele and the lowest frequency of Hp2 allele compared to the other populations of AP. The Cp system is monomorphic, all individuals being the BB type. The GC system exhibits polymorphism with the gene frequencies of GC1 and GC2 alleles showing the highest and lowest frequencies, respectively, as compared to the caste populations reported earlier. The c2 test suggest that this population is in Hardy-Weinberg Equilibrium.

Study of some genetic markers in sishta karanam population, Andhra Pradesh, India.

A total of 76 individuals belonging to Sishta Karanam population, Andhra Pradesh, were tested for polymorphism in ABO and Rh (D) blood groups, two serum proteins, Haptoglobin and Ceruloplasmin, and one red cell enzyme, Glyoxalase-I. All the systems except Caeruloplasmin showed polymorphism. The frequency of AB phenotype is found to be highest in the Sishta Karanam when compared to the other caste populations of Andhra Pradesh so far studied. It was observed that the ABO system was not in Hardy-Weinberg Equillibrium. The Hp1-1 phenotype was absent in this population. The Glyoxalase-I locus showed all the 3 phenotypes.

Japanese Encephalitis epidemic in Anantapur district, Andhra Pradesh (October-November, 1999).

Epidemic of Japanese Encephalitis has occurred in Andhra Pradesh during October-November, 1999 affecting 15 out of 23 districts. In total, 873 cases with 178 deaths have been recorded up to the day 29.11.99. The epidemiological investigation has been done in Anantapur district in western Andhra Pradesh, where the outbreak has started in the third week of October. In the district 47 PHC have been affected. On an average 4.5 per cent of 3175 villages have been affected. Average number of cases per affected village have been 1.5. Rural population has been primarily affected. Age groups 1-14 years including infants have been affected but nearly 86.8% of cases have been among 1-9 year age group. The overall case fatality rate has been 18.4 per cent. Clinical features have been high fever, headache, altered sensorium, convulsions and coma. A marked seasonal onset of a few cases per village and 93.75 per cent of human serum samples collected from hospitalised cases showed the evidence of J.E. virus infection indicating that the present outbreak was due to JE virus. High density of Culex vishnui complex mosquitoes has been observed in the area. All the environmental and ecological conditions, temperature, rainfall and relative humidity have been in favour of JE transmission. Analysis of the data for the last 10 years showed that the human JE cases occurred in Anantapur in September-October months, which shifted to October-November, 99. Prolonged draught conditions were observed till October. Possibly the delayed monsoon and congenial atmospheric conditions after monsoon were favourable to the vector species for extra-human cycle of transmission in 1999. Low level transmission leading to small number of cases continued during the succeeding years every September-October till the present epidemic. In all 24 PHCs and urban towns were identified with 212 cases and 39 deaths till 29.11.99.

Magnitude of recall bias in the estimation of immunization coverage and its determinants.

OBJECTIVE: To study the magnitude of recall bias in the estimation of immunization coverage and to identify its determinants. DESIGN: A follow-up study of cohort of children for one year; followed by a cross-sectional recall survey. SUBJECTS: All live births in two contiguous PHC areas in Villupuram district, Tamil Nadu. METHODS: The prospective data collected from mothers of 774 children was considered as 'Gold Standard' and the retrospective recall data from them was compared with it. This was carried out for individual immunization schedules, namely, DPT, OPV, BCG and measles and for the combined immunization status. Measures such as sensitivity, specificity, positive and negative predictive values were computed. Logistic Regression technique was employed for evaluating the determinants of agreement. RESULTS: Less than 50% of mothers has immunization cards with them and more than 70% of the cards did not have complete information. The sensitivity of the recall method was 41.3% and the specificity was 79.5% when the complete immunization status was considered. For individual immunization schedules, the sensitivity ranged from 95% for BCG to 53% for measles vaccination and the specificity ranged from 30% for BCG to 68% for measles vaccination. Mother's age emerged out as a significant determinant in the agreement of two methods. Maintenance of immunization cards were very poor. CONCLUSIONS: Method of obtaining immunization status through recall survey is not sensitive. Proper maintenance of immunization cards and ensuring the availability of them with mothers for inspection are recommended for obtaining accurate estimation of vaccine coverages.

Bacteraemia in a tertiary care urban hospital in south India.

A total of 1727 blood samples were cultured aerobically over a one year period, of which 201(11.8%) were positive. The ratio of Gram positive to Gram negative bacteraemia was 1:1. The three antimicrobials having the highest activities against the Gram positive isolates were amikacin, cefotaxime, and ciprofloxacin to which 88.5, 81.7 and 80.7 percent of the strains were susceptible: and the same agents were equally effective against Gram negative organisms with 84.5, 75.3 and 70.1 percent efficacy respectively. Coagulase negative Staphylococcus spp. was the most frequent organism isolated(60; 29.8%), followed by Pseudomonas aeruginosa (40; 19.9%), and Staphylococcus aureus (34; 16.9%).

Isolation and characterization of soluble antigens of sheep poxvirus.

A soluble antigen fraction of sheep poxvirus (SPV) isolated from infectious virus particles by ultracentrifugation and purified by subtractive immunoaffinity chromatography was characterized. Exclusion chromatography studies revealed 10 proteins of molecular weight (MW) 220, 168, 87.3, 71.5, 52.5, 36.7, 31.0, 23.4, 18.3 and 14.2 kDa. Nine of them were found to be precipitinogens and 5 were identified as structural components of the virus particles. SDS-PAGE analysis revealed a polypeptide profile of 10 bands with 2 prominent polypeptides of 64 and 42 kDa. Western blotting, however, detected 2 immunogenic polypeptides of MW 100 and 64 kDa. Moreover, crossed immunoelectrophoresis showed the presence of proteins of varied electrophoretic mobility and sharing of antigenic determinants among a few soluble antigens. Physico-chemical characterization further revealed that these precipitinogens can withstand ambient temperatures, but were sensitive to trypsin and ether whereas, chloroform had no effect on immunoprecipitation pattern of soluble antigens.

Randomised controlled field trial of two antenatal care packages in rural south India.

A randomised community intervention trial was undertaken in 12 subcentres in Karur health unit district, Tamil Nadu, to compare the efficacy of two antenatal care packages. A newly recommended 'high-risk' strategy package and a uniform package recommended by the Tamil Nadu Government were each implemented in 4 randomly selected subcentres by the study team, and the latter was also delivered by routine health services in the 4 remaining subcentres. Analyses were based on 294 pregnant women on the high-risk package (HR), 242 on the Tamil Nadu Government (TNG) package and 335 women in the control series. The HR package reduced the differences between the high-risk women and the others in mean haemoglobin and the percentages with preventable neonatal morbidity and low birth weight, and consequently the overall outcome was better in the HR series than in the TNG series. Finally, the results with the TNG package were better when it was implemented by the study team than by the routine health services, in terms of preventable maternal morbidity and preventable perinatal morbidity, but there was no impact on birth weight.

Age independent anthropometric index for identifying undernourished children in the age group 5-10 years.

An age-independent anthropometric index to identify undernourished children in the age group of 5-10 years is described. Employing a mathematical approach (linear regression analysis) on data from 238 children, the index was derived to be wt/(ht)2. Employing this index, a classification rule for identifying the undernourished was evolved, using as the 'Gold standard' a WHO classification based on NCHS standards. The sensitivity of the classification rule was 95%, the specificity was 92% and the overall efficiency was 92%.

Progressive supranuclear palsy. Report of 14 cases with special reference to unusual features.

The clinical features and course of 14 patients with progressive supranuclear palsy (PSP) were analysed. PSP formed 2.3 percent of the parkinsonian population. Blepharospasm, hypersomnia, athetosis, action dystonia, action myoclonus and family history of dementia were the unusual features. Half of the patients had dementia at presentation. Drug therapy was uniformly disappointing. The mean duration from onset to death in 4 patients who died was 4.5 years. The histopathological features in a patient with the disease for one year and who died of acute myocardial infarction showed moderately severe changes characteristic of the disease.

A modified technique to process peripheral nerves for light microscopy.

A new technique is described to fix, paraffin embed and cut routine peripheral nerve biopsies for light microscopy. Buffered glutaraldehyde pH 7.4 is used as a common fixative for both light and electron microscopy. The nerve bits for LM are embedded in paraffin using the 'reverse embedding' method and blocks are trimmed to cut sections on the ultra microtome using glass knives. The uniformly thin sections can be utilised for any special stain and the good resolution of these thin sections facilitates better observation and documentation.

Role of squash-smear technique for rapid diagnosis of neurosurgical biopsies--a cytomorphological evaluation.

The biopsy material obtained from lesions of CNS are subjected to squash smear technique for rapid diagnosis as it is easier to make and the cytological features of cells are well preserved. During the year 1982-1983 one hundred and seventy eight squash smears were made to offer rapid diagnosis to the operating surgeon. The diagnosis was verified on paraffin sections. Correct diagnosis was made in 87% of cases. Various lesions have distinct cytomorphological features on smears. These distinct characters and efficacy of the method are discussed.