Hand, Foot and Mouth Disease in the Andaman Islands, India.

OBJECTIVE: To investigate an outbreak of Hand, foot and mouth disease (HFMD) in Andaman Islands during 2013. METHODS: Epidemiological, clinical data and samples were collected from HFMD patients who attended selected hospitals. Data were analyzed and samples were processed for detection of Enterovirus and further confirmed by sequencing. Serotype-specific molecular typing was also done to identify the etiological agent. RESULTS: Of the 246 suspected patients, most were affected in August 2013 (92/246, 37.4%). Fever (71.2%) associated with typical HFMD rashes (100%) were the most common presenting symptoms and rashes were mostly distributed on hands (100%), legs (92%), mouth (77%), and buttocks (52.8%). All cases were reported as mild and recovered completely without any complications. Enterovirus was detected in 63 cases (50.4%). CONCLUSION: HFMD was mild, mostly reported in children <60 months of age, and in boys. Coxsackie virus A16 was found to be the only etiological agent for this specific outbreak.

B1c genetic subtype of coxsackievirus A16 associated with hand, foot and mouth disease in Andaman Islands, India.

BACKGROUND: An outbreak of hand, foot and mouth disease (HFMD) occurred in the Andaman Islands in 2013. Therefore, we aimed to identify the aetiological agent and to explore its genetic characteristics. METHODS: Clinical specimens were subjected to virus isolation, further confirmed by sequencing the partial VP1/2A region of enterovirus, and analysed using MEGA 6 software with intra-serotype reference sequences. RESULTS: Coxsackievirus A16 (CV A16) was found to be the causative agent, closely grouped with B1c genetic clusters of CV A16. However, it has significant genetic distance (K2P=0.059%) with B1c sub-clusters. CONCLUSION: Extended research work should be carried out to better understand the emerging nature of CV A16 associated with HFMD in these islands.GenBank accession numbers: KU523376-KU523387.

Chelonitoxism in Andaman and Nicobar Island: A report on mass poisoning including a death of an adult.

Chelonitoxism is a type of seafood poisoning which usually occurs due to consumption of certain marine turtle flesh. As the pharmacology or chemistry of the toxin is still unknown, antidote or treatment to chelonitoxism is unavailable. The symptoms can vary from common gastro-intestinal symptoms to neurological manifestations and even death. This case report of community poisoning following consumption of turtle meat includes the death of an adult male (56 yrs.) being reported for the first time in the Great Nicobar Island, Andaman and Nicobar (A&N) Islands, India in August 2012. The patient encountered common gastrointestinal symptoms after one day of ingestion of green turtle flesh and later, he developed neurological symptoms and did not respond to symptomatic treatment and expired after four days after the consumption. However, out of 30 villagers who took the same food, six others developed symptoms and recovered within a period of 3-7 days while two pets (a dog and a cat) died within 24 hours as they were fed with the same food. In spite of several existing wildlife protection acts, catching a turtle and making them a source of food-celebration is quite common in coastal areas of the Indian Ocean and the Bay of Bengal which includes A&N Islands. A proper monitoring and follow-up of the food-borne diseases along with a wide range of explorative health education protocol should be implemented especially for the people who are not reachable via media to avoid such incidents in future.

The potential risk factors and the identification of hearing loss in infants.

To identify potential risk factors for hearing loss from the infant with high risk criteria as guided by the Joint Committee on Infant Hearing (JCIH, 2000). 490 infants with age range of 2 days to 6 months who had undergone detailed audiological evaluation during for the period of 3 years at Gauhati Medical College Hospital were taken for the study. The hearing screening was performed on each infant using Distortion Product Otoacoustic Emission (DPOAE) testing. The infants who failed DPOAEs screening were followed up and Auditory Brainstem Response testing. Out of 490 high risk infants who had undergone detailed audiological evaluation 145 infants were found to be having hearing loss. Out of 145 infants 73 infants were male and 72 infants were female. The risk factor for hearing loss with the highest incidence was hyperbilirubenemia, Apgar scores of 0-4 at 1 min or 0-6 at 5 min was the second most prevalent risk factor, followed by TORCH infections. This study suggests the need for review of high risk register that is used along with the physiological and electrophysiological hearing test to screen the infants. The high risk register remains helpful in determining follow up plans so that children who may develop late onset of hearing loss will not be missed. Being aware of which risk factors are more likely to cause hearing loss in infants would be helpful to plan for follow up these children.

Solitary hydatid cyst in thigh without any detectable primary site.

Echinococcus granulosus causes a zoonotic infection called Cystic Echinococcosis (CE). Surgeons meet with hydatid cysts of the liver and lungs with reasonable frequency. However hydatid cyst may also appear in other parts of the body. A 30 years old lady presented with a smooth slow-growing subcutaneous nodule on the anteromedial side of the right thigh with no detectable primary site in the liver or lung. The case was subsequently diagnosed as hydatid cyst of muscle and radical surgery was done under coverage of anihelminthic drug. The common practice in this type of case is to do fine needle aspiration cytology (FNAC) taking the lesion to be a soft tissue neoplasm. The aim of this case presentation is to be aware of that in case of a diffuse non-tender swelling with history of gradual increase in size, hydatid cyst should be considered in the differential diagnosis.

Tobacco use among urban school boys of Paschim Midnapore, India.

OBJECTIVES: To assess the prevalence, perception and pattern of tobacco use among 13-15-year-old urban school boys along with associated factors of tobacco use. METHODS: A cross sectional, observational, study was carried out among 454 urban school boys aged 13-15 years studying in VIII, IX, X using self administered modified Global Youth Tobacco Survey Questionnaire. Data were analyzed by frequency distribution tables, proportion, line diagram, chi square test as required. RESULTS: Out of 454 students, 201(44.3%) were ever users of tobacco whereas 135(29.7%) were current users. Majority of the current users utilized both form of tobacco. Initiation of tobacco before 10 years were more in smokeless (11.4%) form than smoking (4.5%), but smokers showed steep rise (49.3%) at 14-15 years. Proportion of current users significantly (p < 0.001) increased along with increase in pocket money. Compared to non-users current users had more exposure to tobacco in the family and friends. Both current users and nonusers showed positive attitude towards tobacco use. Though knowledge of harmful effects of tobacco was well perceived but significantly more (p < 0.005) non-users had shown interest to prohibit smoking in public places. More non-users (75%) than ever users (26.4%) had shown favourable opinion regarding future tobacco use. CONCLUSION: Due increased exposure to the world through several ways and increased modern amenities to influence teenagers, there is high prevalence, average perception and variable patterns of tobacco at Midnapore town where tobacco is trapping teenagers which needs proper intervention.