An outbreak of hand–foot–mouth disease: A report from the hills of northern India.

Background. Hand–foot–mouth disease (HFMD) is known to cause outbreaks around the world as well as in India. We report the clinical characteristics of an outbreak in Dehradun, Uttarakhand. Methods. The study was done in the Department of Paediatrics of a tertiary care referral teaching hospital in northern India. Children (<18 years of age) presenting with vesicular skin lesions distributed over the hand, foot and mouth were prospectively enrolled between August 2013 and October 2013. The diagnosis of HFMD was made clinically, and laboratory investigations were done for clinical care. Children were managed with supportive measures and followed for 6 weeks after discharge. No virological investigations were done to identify the offending agent. Results. Thirty-three children (18 boys, 54.5%; median [range] age 4 [1–17 years]) were enrolled. The majority of children were <5 years of age (75.8%), who presented with prodromal symptoms (93.9%), mostly milder (80.6%) in severity. The most common prodromal symptoms were fever (93.9%), cough (72.7%) and malaise (54.5%). All children had rash on their hands and feet whereas the majority (85%) had oral lesions as well. All children recovered completely and had no complications during 6 weeks of follow-up. Conclusion. HFMD was milder and all children (mostly <5 years of age) recovered completely without complications. Natl Med J India 2015;28:126–8

Prevalence of skin diseases among infants in a tertiary medical facility in Uttarakhand.

Background: Skin diseases are common in infancy. This study aimed to determine to prevalence of various dermatoses in infancy in Uttarakhand. Objectives: To determine the prevalence of different dermatologic diseases in infant in Uttarakhand. Methods: A prospective study was carried out for one year from 06 Sep 2013 to 05 Sep 2014, to study prevalence and patterns of dermatological lesions in infants, a tertiary care health facility in Uttarakhand. A total of 234 infants of both sexes were seen during this period. Results: Of 234 patients 58.9% were males. Noninfectious dermatitis was the largest group of skin disorders in infancy, constituting 35.89% of total cases. Seborrheic dermatitis was commonest type of non-infectious dermatitis in infancy (42.85%) followed by atopic dermatitis (19.04%), Ptyriasis alba (14.28 %), contact and diaper dermatitis (7.14% each). Seborrheic dermatitis did not display any gender or seasonal bias. Infectious/ parasitic infestations formed second largest group of dermatoses in infants (26.92%) with commonest being fungal infections (49% cases of infectious group) followed by parasitic infestations (26.98%). Bacterial and viral infections were formed only 12.69% and 11.11% of infectious group cases. Nonfungal and nonparasitic infections showed higher incidence in summers. Conclusion: Out of 234 infants who attended paediatric dermatology clinic, major dermatoses were of noninfectious origin with seborrheic dermatitis forming largest group. Infectious etiology dermatoses constituted second major group with fungal and parasitic etiology. Nonfungal and non-parasitic dermatoses showed higher prevalence in summer months.

Clinical Profile of Vivax Malaria among Children in a Tertiary Care Hospital.

Malaria is endemic in India. Vivax malaria has been traditionally described as benign tertian malaria but recent reports from many centers have revealed that it can cause life threatening disease as seen in case of falciparum malaria.There is paucity of data on this topic from this region. Objective: The present study is aimed to find out the clinical features, complications, response to treatment and outcome of patients suffering from vivax malaria in children. The study has also tried to focus on the severe illnesses associated with P. vivax infection. Material and Methods: The study was performed at a tertiary care hospital of Uttrakhand. The study period was of two years, from August 2011 to July 2013. Patients of 18 years of age or below it who were smear positive or antigen positive were included in the study. All such patients who were admitted in the hospital underwent detailed investigation. The data analysed to find out their clinical profile, laboratory manifestations and outcome. Result: 72 patients were identified as suffering from plasmodium vivax malaria. Splenomegaly, hepatomegaly, hepatosplenomegaly, were common findings. Renal, hepatic and cerebral dysfunctions were noted, severe malaria was observed in 28(38.9%). Thrombocytopenia was the commonest hematological abnormality. 5(6.9%) patients died. Cerebral malaria, shock and ARDS were associated with high mortality. Conclusion: Vivax malaria, in its severe form, may cause life threatening complications. The clinical profile in such patients is similar to those which have been traditionally described with falciparum malaria.

A study of complications of scrub typhus in a tertiary health care institute of Uttarakhand, India.

Background: Scrub typhus or tsutsugamushi disease is a febrile illness caused by Orientia tsutsugamushi. Uttarakhand State in the northern region of India has been witnessing increased incidence of this fever. There is paucity of data on this topic from this region. The present study was conducted to find out the clinical features, complications, response to treatment and outcome of patients suffering from scrub typhus in a tertiary health care institute of Uttarakhand, India. Methods: The study was performed at SGRR Institute of Medical & Health Sciences, Dehradun, which is a tertiary health care institute Uttrakhand. The study period was of 1year from December 2012 to November 2013. Patients of 12 years of age or above it who were IgM antibody positive by ELISA technique were included in the study. All such patients underwent detailed clinical examination and investigation. Results: 47 patients were found to be suffering from scrub typhus. The common symptoms noted fever, myalgias, headache, vomiting, diarrhoea, breathlessness, petechiae and jaundice. Common complications noticed were hepatitis (78.7%) acute respiratory distress syndrome (19.2%), thrombocytopenia (46.8%) and acute renal failure (31.9%), Mortality was seen in 3 (6.4%) patients. Conclusions: Scrub typhus is an important cause of mortality and morbidity in Uttarakhand. High index of suspicion, early diagnosis, monitoring of the clinical and laboratory parameters and prompt intervention may help in reducing the mortality.

A study of clinical and laboratory profile of dengue fever in a tertiary care centre of Uttarakhand, India.

Background: Dengue is an important cause of mortality and morbidity in India. Many recent studies have shown varied clinical manifestations from different geographical locations. There is paucity of data on this topic from this region. The present study was conducted to find out the clinical features, complications, response to treatment and outcome of patients suffering from dengue in a tertiary care centre of Uttarakhand, India. Methods: The study was performed at SGRR Institute of Medical & Health Sciences, Dehradun, which is a tertiary care hospital of Uttrakhand. The study period was of 1 year from July 2012 to June 2013. Patients of 12 years of age or above it who were antigen positive or antibody positive were included in the study. All such patients who were admitted in the hospital underwent detailed clinical examination and investigation. Results: Dengue infection was identified in 140 patients. Thrombocytopenia was the commonest hematological abnormality. Splenomegaly, hepatomegaly, and hepatosplenomegaly, were common findings. Renal, hepatic and cerebral dysfunctions were noted. Mortality was seen in 5 (3.6%) patients. Encephalitis, shock and ARDS were associated with high mortality and poor outcome. Conclusions: Dengue is an important cause of mortality and morbidity in Uttarakhand. High index of suspicion, early diagnosis, monitoring of the clinical and laboratory parameters and prompt intervention may help in reducing the mortality.

A comparative study of complications of vivax and falciparum malaria in Dehradun, India.

Background: Traditionally Plasmodium falciparum has been considered to cause severe malaria while Plasmodium vivax is known to cause benign malaria. However many recent studies have shown that Plasmodium vivax is also responsible for many cases of severe malaria. There is scarcity of data on this topic from this region. The present study was conducted to find out clinical and pathological manifestations of vivax and falciparum malaria in Dehradun. Methods: The study period was of one and half years, from January 2012 to June 2013. Patients of 18 years of age or above it who were smear positive or antigen positive were included in the study. Results: one hundred and thirty nine patients were found to be suffering from malaria. 90 (64.7%) had vivax malaria, while 49 (35.3%) patients suffered from falciparum. The study of morbidity profile showed that the complications related to severity, earlier attributed to only falciparum is equally seen in vivax case. Low platelet count was the commonest finding in both groups. Other complications seen in both groups were those of severe anemia, cerebral malaria, ARDS, renal failure, hepatitis, leucocytopenia, pancytopenia, and shock. Mortality in the two groups was of the same order. Conclusions: Vivax malaria causes significant mortality and morbidity. The morbidity and patterns are almost similar in both vivax and falciparum malaria.

Prevalence of Rheumatic Fever and Rheumatic Heart Disease Among School Children.

Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) are significant public health concerns in the developing countries like India. A total number of 10330 school children were examined clinically for evidence of acute rheumatic fever and rheumatic heart disease . Those suffering with the disease were subjected to electrocardiographic, rontgenographic and echocardiographic examination. Prevalence of acute rheumatic fever and rheumatic heart disease was found to be 0.87 per 1000.

Complications of vivax malaria in Uttarakhand, India.

Background: Malaria is an important cause of mortality and morbidity in India. Many recent studies have shown that vivax malaria which was once thought to be a benign condition has emerged in a more virulent form causing many cases of severe malaria and life threatening complications. There is paucity of data on this topic from this region. Objective: The present study was conducted to find out the clinical features, complications, response to treatment and outcome of patients suffering from vivax malaria. The study has also tried to find out severe malaria associated with P. vivax infection. Methods: The study was performed at SGRR Institute of Medical & Health Sciences, Dehradun, which is a tertiary care hospital of Uttarakhand. The study period was of two years, from September 2011 to August 2013. Patients of 18 years of age or above it who were smear positive or antigen positive were included in the study. All such patients who were admitted in the hospital underwent detailed clinical examination and investigation. Results: Plasmodium vivax infection was identified in 140 patients. Splenomegaly, hepatomegaly, and hepatosplenomegaly, were common findings. Renal, hepatic and cerebral dysfunctions were noted. Severe malaria was observed in 63(45.0%). Thrombocytopenia was the commonest hematological abnormality. Mortality was seen in 9(6.4%) patients. Cerebral malaria, shock and ARDS were associated with high mortality and poor outcome. Conclusion: Vivax malaria may cause life threatening complications. The complications of vivax malaria are similar to those which have been traditionally described with falciparum malaria.

Epidemiological Study of Morbidity Pattern of Critically Ill Children Admitted in Child Intensive Therapy Unit.

Background : In India 34.3% of the total population is constituted by the most vulnerable segment of our society i.e. infants and children. Malnutrition, respiratory and diarrhoeal diseases are three main scourges of the children but the great devils hovering upon them are lack of proper treatment and management. The present study was conducted to find out the morbidity pattern of our vulnerable children. Aims and Objectives : 1. To find out the prevalence of critically ill children admitted in the hospital. 2. To find out the morbidity pattern of critically ill children admitted in the child intensive therapy unit, in a hospital. Research Question : What is the epidemiological pattern of morbidity in critically ill children of age 1 month to 12 years? Study Design : Cross-sectional Study. Study Participants : All critically ill children coming to the emergency unit of the hospital during study period. Statistical Analysis : Simple percent and proportions, Chi square test.