Rickettsial Fever Presenting with Gangrene: A Case Series.

Rickettsial diseases comprise a wide spectrum of diseases which are reported from different parts of India quiet long ago. Many cases of rickettsial diseases go undiagnos due to lack of diagnostic techniques and the reported incidence and prevalence may be an underestimation of the actual burden of the disease. A higher index of suspicion, clinical awareness and proper use of available diagnostic tools would increase the frequency of diagnosis. Gangrene is an uncommon complication in cases of rickettsial fever. Extensive gangrene of the digits or whole limb, even requiring amputation has been more commonly reported with Rocky Mountain spotted fever. These cases are being reported to highlight the occurrence of gangrene in rickettsial fever and the importance of appropriate management at the earliest.

Developmental Dysplasia of Spastic Hip in Children with Cerebral Palsy in Southern India.

We studied the proportion of developmental dysplasia of spastic hip in children with cerebral palsy. Children with cerebral palsy aged 2-12 years were enrolled. Migration percentage was measured on pelvic radiographs. Hip dysplasia was seen in 15 (12.7%) children.

Clinical profile, predisposing factors, and associated co-morbidities of children with cerebral palsy in South India.

INTRODUCTION: Cerebral palsy (CP) is the most common physical disorder of children. Causes like jaundice and birth injury though are decreasing; complications resulting from the survival of low birth weight babies are replacing some of the older etiologies. Hence, this study was planned. OBJECTIVES: The objective was to study the clinical patterns, predisposing factors, and co-morbidities in children with CP. MATERIALS AND METHODS: The present study is a hospital based prospective study conducted from January 2012 to January 2013 in children presenting to neurodevelopmental clinic at a tertiary care teaching hospital in India. Hundred cases with clinical features suggestive of CP were included in the study. Cases were evaluated by history, clinical examination, and necessary investigations. RESULTS: Results of the study showed 81% of spastic, 12% of hypotonic, 5% of dystonic, and 2% of mixed CP cases. The mean age of presentation was 2 year, 2 month, and male to female ratio of 1:2. Pregnancy-induced hypertension (PIH) was the most common antenatal complication observed in 6%. Four percent had neonatal sepsis and 19% were born premature. Associated co-morbidities were mental retardation (55%), seizure disorder (46%), visual problems (26%), hearing problems (19%), and failure to thrive (47%). DISCUSSION: Sex distribution observed in our study was male to female ratio of 1.2, which was comparable with a multicenter study in Europe. PIH was observed in 6% of cases, which was comparable with prior studies. Birth asphyxia was observed in 43% of cases. Eighty-one percent of the cases constituted a spastic variety of CP which was comparable to other studies. CONCLUSION: Perinatal asphyxia was the important etiological factor. We found preventable intranatal causes (60%) and antenatal causes (20%) forming a significant proportion. Co-morbidities were significantly observed in our study.

Ohtahara syndrome associated with hemimegalencephaly and intracranial lipoma.

Hemimegalencephaly is a disorder of cortical malformation and is associated with various disorders including various neurocutaneous syndromes and many seizure types. We present a case of hemimegalencephaly associated with Ohtahara syndrome and intracranial and facial lipoma.

Paralytic rabies following cat scratch and intra-dermal anti-rabies vaccination.

Only few reports of failure of intradermal postexposure prophylaxis for rabies following cat scratch exist in the published literature. We are reporting such a case in a 15-year-old girl. The child had category III cat scratch on her face. She presented with progressive paralysis, finally developing quadriplegia and respiratory paralysis. Typical hydrophobia and aerophobia were absent. She received intra-dermal anti-rabies cell culture vaccine. She did not receive anti-rabies immunoglobulin. The girl succumbed on the 10(th) day of weakness. Diagnosis of rabies was confirmed by isolation of rabies virus RNA in cerebrospinal fluid and skin biopsy sample by reverse transcription polymerase chain reaction.