Two Atypical Cases of Hantavirus Infection: Experience from a Tertiary Care Unit in Sri Lanka.

Hantaviruses are a large family of enveloped viruses with two medically important families Cricetidae and Muridae which are known to cause rodent-borne diseases worldwide. Some strains cause clinical syndromes with multiorgan involvement in humans such as hantavirus haemorrhagic fever with renal syndrome (HFRS) and hantavirus cardiopulmonary syndrome (HCPS), which is also known as hantavirus pulmonary syndrome. Clinical differentiation of this infection from other endemic infections in Sri Lanka such as leptospirosis and rickettsial infections is extremely difficult due to overlapping clinical and epidemiologic features such as exposure to rodents and farming. Here, we report two serologically confirmed cases of hantavirus infection from Sri Lanka with different presentation. The first patient had a combination of HCPS and HFRS. The second patient was treated for HPS complicated with acute respiratory distress syndrome (ARDS). Both had a significant clinical, biochemical, and radiological response with early initiation of corticosteroids. However, further studies are required to assess whether steroids hasten the recovery of severe hantavirus infections. We believe that hantavirus infection is an important emerging disease in the country and should be considered as a differential diagnosis in patients presenting with an acute febrile illness as well as in patients presenting with ARDS. Early diagnosis and prompt treatment improve prognosis.

Comparison of two World Health Organization partographs.

OBJECTIVE: To compare two World Health Organization (WHO) partographs - a composite partograph including latent phase with a simplified one without the latent phase. METHOD: Comparison of the two partographs in a crossover trial. RESULT: Eighteen physicians participated in this trial. One or the other partograph was used in 658 parturients. The mean (S.D.) user-friendliness score was lower for the composite partograph (6.2 (0.9) vs. 8.6 (1.0); P=0.002). Most participants (84%) experienced difficulty "sometimes" with the composite partograph, but no participant reported difficulty with the simplified partograph. While most maternal and perinatal outcomes were similar, labor values crossed the action line significantly more often when the composite partograph was used, and the women were more likely to undergo cesarean deliveries. CONCLUSION: The simplified WHO partograph was more user-friendly, was more to be completed than the composite partograph, and was associated with better labor outcomes.

Adrenal metastases of malignant melanoma: characteristic computed tomography appearances.

Malignant melanoma is an extremely aggressive form of cancer. Adrenal metastases are found in 50% of cases of malignant melanoma, and are most often clinically and biochemically silent. Clinical presentation varies, and the diagnosis of adrenal metastases is often made incidentally, and frequently years after treatment of the primary lesion. An adrenal mass lesion seen on a CT scan, greater than 5 cm in diameter, with central or irregular areas of necrosis/haemorrhage (and no lipomatous component) is characteristic of a metastasis from malignant melanoma, in the setting of normal gland function. If these features are bilateral, they are pathognomonic. Oval, low-attenuation (on CT) adrenal masses less than 3 cm in diameter should not be considered benign in a patient with any prior history of melanoma. Careful imaging review of the adrenal glands should be undertaken in all patients with malignant melanoma. Early diagnosis of these distant metastases has important prognostic and therapeutic implications. The four cases presented illustrate the spectrum of presentations and clinical course of adrenal metastases from malignant melanoma. The accompanying CT images show the characteristic appearances of adrenal metastases.

Prevalence of anaemia and hookworm infestation among adolescent girls in one rural block of TamilNadu.

PIP: Adolescent girls are at particular risk of developing iron deficiency anemia as a result of the growth spurt that accompanies puberty. This risk is further increased in developing countries by hookworm infestation and the attendant intestinal blood loss. This study investigated the prevalence of both anemia and hookworm infestation among 197 female adolescents, 13-17 years of age, attending 10 schools in a rural block of India's Tamil Nadu State. 19% of subjects belonged to a scheduled caste, 72% to a backward caste, and 9% to a forward caste. The prevalence of anemia was 76.6%. Of the 130 girls who provided stool samples, 63% had hookworm. When questioned about personal hygiene practices, 48.5% of girls reported they did not wear slippers when they went outside. Only 65% were bathing daily. Since anemia during adolescence can have an adverse impact on future pregnancies, measures such as iron and folic acid supplementation, as well as improved hygienic practices, are recommended.^ieng

Prescription patterns and cost analysis of drugs in a base hospital in south India.

BACKGROUND: In the rural areas of developing countries the cost of drugs is a major concern to both physician and patient; yet there are few data on prescribing patterns and expenditure. We examined the cost of commonly prescribed drugs in a community health care programme in a base hospital of the Christian Medical College, Vellore. METHODS: The study was carried out over a period of 3 months during which 2756 prescriptions were analysed. The number and type of drugs prescribed and the frequency and total cost of the prescriptions were noted. RESULTS: The number of drugs prescribed for each patient ranged from 1 to 7 with a mean (SD) of 2.4 (1.1). The most commonly prescribed groups of drugs were vitamins, analgesics, antibiotics, sulphonamides and anti-inflammatory agents. The mean (SD) cost per prescription was Rs 8.8 (8.6). The expenditure on the most commonly used drugs was approximately 50% of the total cost. The cost per prescription was less than Rs 10 in 70% of the cases. All the drugs were from the World Health Organization's essential drugs list. CONCLUSIONS: Most prescriptions for drugs given at our hospital could be afforded by villagers.

Peak expiratory flow in rural residents of Tamil Nadu, India.

BACKGROUND: In a country such as India that covers several latitudes, climatic zones, ethnic groups, and dietary habits lung function within the normal population would be expected to vary. Several studies have looked at normal values of peak expiratory flow (PEF) in different regions of urban India but none has looked at rural South India. A study of PEF has now been carried out in a rural population of Tamil Nadu. METHODS: All subjects were of Dravidian stock and lived at sea level with rice as their staple food. Ten five year age groups from 10 to 59 years with 100 males and 100 females in each were studied. Peak flow was measured by mini-Wright peak flow meter, and height was also measured. Regression equations for predicting normal PEF were calculated. RESULTS: Peak flow ranged from 150 to 680 l/min in males and from 150 to 500 l/min in females. Maximum values of PEF were attained at the age of 32.5 years in men and 35.6 years in women. There was a significant linear correlation between height and PEF and a curvilinear relation between age and PEF in both sexes. CONCLUSION: Regression equations are now available for PEF values in normal subjects from rural South India. PEF was related to age and height and values were greatest in the fourth decade.