Reliability and efficiency of three methods of calculating migration percentage on radiographs for hip surveillance in children with cerebral palsy.

PURPOSE: Hip surveillance programmes for children with cerebral palsy (CP) utilize the migration percentage (MP) measurement to initiate referrals and recommend treatment. This study assesses the reliability and efficiency of three methods of MP measurement on anteroposterior (AP) pelvis radiographs. METHODS: A total of 20 AP pelvis radiographs (40 hips) of children with CP were measured by three raters on two occasions using three methods: digital measurement (DM) on a Picture Archiving and Communication System monitor, computer-aided measurement (CA) using a digital templating tool and mobile device application measurement (MA) using a freely available MP measurement tool. For each method, the time required to complete the MP measurement of both hips on each AP pelvis radiograph was measured. Intra-class correlation coefficient (ICC) was used to determine reliability, and analysis of variance was used to compare groups. RESULTS: All three methods of determining MP showed excellent inter-rater and intra-rater reliability (ICC 0.976 to 0.989). The mean absolute difference in MP measurement was not significant between trials for a single rater (DM 2.8%, CA 1.9%, MA 2.2%) or between raters (DM 3.6%, CA 2.9%, MA 3.6%). The mean time to complete MP measurement was significantly different between methods, with DM = 151 seconds, CA = 73 seconds and MA = 80 seconds. CONCLUSION: All three MP measurement methods were highly reliable with clinically acceptable measurement error. The time required to measure a hip surveillance radiograph can be reduced by approximately 50% by utilizing a computer-based or mobile application-based MP measurement tool.

Epidemiological investigation of an outbreak of enteric fever in a village in Maharashtra.

Four hundred fifteen fever cases occurred in village Katkalamba, in Nanded district, Maharashtra during November-December, 1995. Explosive nature of the outbreak, non involvement of infants, significantly higher incidence rate in the age group 1-14 years and clustering of almost all cases in the users of a particular well indicated it to be a water borne outbreak. Laboratory investigations in selected cases confirmed it to be an outbreak of enteric fever. Chemical and microbiological examination of water samples from the suspected wells gave evidence of faecal contamination of water. Circumstances under which the contamination occurred and the outbreak spread are discussed.

Multidrug resistant non-typhoidal Salmonella infections.

Over a period of 2 years, 28 patients admitted to Government General Hospital (GGH), Sangli (which is attached to Government Medical College (GMC), Miraj) yielded multi-drug resistant non-typhoidal salmonellae from their clinical material. The pediatric age group predominated in the study, accounting for 93% of cases. Salmonella typhimurium was the main isolate (86%), the other being Salmonella newport (14%). Gastroenteritis was the commonest presentation. Septicaemia was seen with 100% mortality, in infants below 1 month of age. Two cases of meningitis were also seen.

Control of postresection gastroesophageal reflux: the intercostal pedicle esophagogastropexy experience of 26 years.

The devastating consequences of reflux subsequent to transthoracic esophagogastrostomy are aspiration, regurgitation, bleeding, recurrent pneumonias, and recurrent strictures in the majority of patients. The misery of eight such patients was personally witnessed. None of them could sleep in their bed at night. Sixty-eight patients were protected from reflux by the intercostal pedicle esophagogastropexy in the last 26 years. They were followed for 1500 months with esophagram, endoscopy, motility, and pH studies. None had disabling reflux or its complications. Eight patients died. Two patients who survived 18 and 10 years have controllable dumping. The histology of the pedicle was preserved without causing any morbidity. A most gratifying group of five patients with benign disease were protected by the pedicle and survived so far from 2 to 23 years. The intercostal pedicle esophagogastropexy is the only antireflux procedure which has consistently prevented reflux through intrathoracic anastomosis over the past 26 years and 1500-month patient follow-up.

Incidence of hepatitis B surface antigen in liver diseases and voluntary blood donors.

A total of 5,606 samples were collected during January 1978 to December 1983. Out of which 4,900 were of voluntary blood donors, 564 of acute hepatitis, 130 of liver cirrhosis and 12 from hepatocellular carcinoma cases. All these samples were studied by counter immune-electro-osmophoresis (CIEP) for the presence of hepatitis B surface antigen (HBsAg). The HBsAg were detected in 40 samples from voluntary donors (0.8%), 122 cases of acute hepatitis (21.6%), 20 cases of liver cirrhosis (15.3%) and 2 cases of hepatocellular carcinoma (16.6%).

Study of diphtheria carriers in Miraj.

Following a case of diphtheria, 131 contacts were studied for throat and nose carriage. The carriage of C. diphtheriae was found to be 19.8%, 65.3% of them were toxin producing by counter-immunoelectrophoresis (CIEP). The carriers were treated with erythromycin for 7 days. Repeat swabs found them to be negative for C. diphtheriae except in four who had erythromycin resistant and penicillin sensitive strains. Penicillin treatment eliminated the organisms.