Dengue fever-like illnesses: how different are they from each other?

In tropical countries and possibly elsewhere, dengue fever can be confused with other common tropical infections like enteric fever, leptospirosis, typhus fever, malaria, etc. Many of these illnesses can present in significant numbers after rains, and because of similar early presentations, can cause confusion in decision-making. With global warming, these diseases can assume significant proportions even in non-endemic areas.

Nebulized hypertonic-saline vs epinephrine for bronchiolitis; proof of concept study of cumulative sum (CUSUM) analysis.

Objective: To apply cumulative sum (CUSUM) to monitor a drug trial of nebulized hypertonic-saline in bronchiolitis. To test if monitoring with CUSUM control lines is practical and useful as a prompt to stop the drug trial early, if the study drug performs significantly worse than the comparator drug.

Design: Prospective, open label, controlled trial using standard therapy (epinephrine) and study drug (hypertonic-saline) sequentially in two groups of patients.

Trypanosoma lewisi or T. lewisi-like infection in a 37-day-old Indian infant.

Trypanosomes were observed in the peripheral blood smear of a 37-day-old Indian infant admitted off feeds, with fever and convulsions. Trypanosoma (Herpetosoma) lewisi was identified in the blood. The species identification was confirmed by morphometry, polymerase chain reaction, and sequencing.

Comparison of alert verbal painful unresponsiveness scale and the Glasgow Coma Score.

To determine how the AVPU (alert, verbal, painful, unresponsiveness) scale corresponds to Glasgow Coma Score (GCS), we compared the two scales. Two months to 12 years old patients were included in the study. The median GCS score (inter quartile range) for A/V/P/U were 14 (12-15), 11 (10-12), 6 (5.

Takayasu's arteritis: Anesthetic significance and management of a patient for cesarean section using the epidural volume extension technique.

Takayasu's arteritis (TA) is a rare, chronic progressive pan-endarteritis involving the aorta and its main branches. Anesthesia for patients with TA is complicated by severe uncontrolled hypertension, end-organ dysfunction, stenosis of major blood vessels, and difficulties in monitoring arterial blood pressure. We present the successful anesthetic management of a 23-year-old woman having TA with bilateral subclavian and renal artery stenosis posted for emergency cesarean section by using the epidural volume extension technique, which offers the combined advantage of both spinal and epidural anesthesia and, at the same time, also avoids the need of sophisticated neurological monitors like EEG and transcranial Doppler.

Alstrom syndrome: A rare genetic disorder and its anaesthetic significance.

Alstrom syndrome is a rare autosomal recessive disorder that was first described in 1959, by Carl Henry Alstrom, characterised by multiorgan system involvement ranging from ocular, aural, endocrinal, hepatorenal, gastrointestinal, respiratory and cardiac to the musculoskeletal system, among many others. It exposes the patient to various risks ranging from pulmonary aspiration and increased cardiac morbidity to separational anxiety, and may necessitate postoperative elective ventilation. We hereby present the successful management of one such diagnosed case in a 12-year-old boy, who presented to us for incision and drainage of an abscess present over the nape of his neck, along with foreign body removal from his right ear.

Validation of "Signs of Inflammation in Children that Kill" (SICK) score for immediate non-invasive assessment of severity of illness.

Objective: To validate the SICK scoring system's ability to differentiate between individuals with higher and lower probabilities of death

Method: We performed a one year two-centre prospective evaluation of all children aged between one month and 12 years referred to the Paediatric team at St Stephens Hospital in Delhi and admitted to the Paediatric Department at West Middlesex University Hospital in London. We calculated SICK scores at presentation and correlated them with subsequent in-hospital mortality. We used discrimination by areas under receiver operating characteristic (ROC) curves to measure performance.

Hyperimmunoglobulin E syndrome with juvenile dermatomyositis and calcinosis.

Juvenile dermatomyositis (JDM) is a rare childhood disease with autoimmune association. Environmental factors are known to trigger JDM in genetically susceptible individuals (Schmieder et al., Dermatol Online 6:3, 2009).

Calculating prevalence of hepatitis B in India: using population weights to look for publication bias in conventional meta-analysis.

Publication bias can result from the propensity of researchers to document what is unusual. This can distort the inferences drawn in systematic reviews. To measure the distortion, it has been suggested that a second analysis be done; using weights proportional to the size of the population from which the samples are drawn.

Nasopharyngeal teratoma as a cause of neonatal stridor.

We report nasopharyngeal teratoma in a term female neonate, that presented within first week of life with episodic stridor, apnea and cyanosis. Laryngoscopy revealed a mass which was confirmed by MRI. The mass was surgically excised and diagnosed as nasopharyngeal teratoma on histopathology.

Proboscis lateralis.

Proboscis lateralis is a rare craniofacial malformation for which no embryological basis has been established. The condition presents with a tubular, nose like structure arising from the medial canthal area or orbit roof. We describe here such a case that was surgically treated.

Brugada pattern in toxic myocarditis due to severe aluminum phosphide poisoning.

Brugada pattern electrocardiogram (ECG) unmasking can occur due to various drugs. There are old reports of the acute infarction pattern in aluminum phosphide (rodenticide)-related toxic myocarditis. The given case illustrates the Brugada pattern and various other ECG abnormalities in a patient with this poisoning.

Antenatal diagnosis of Down syndrome: how good is state of the art.

A newborn with Down syndrome can be expected once in a thousand deliveries. Amniocentesis for karyotyping of foetal cells or detection of foetal cell in the maternal circulation ie, fluorescent in-situ hybridisation (FISH) and karyotyping, are definitive methods of making the diagnosis antenatally. The cost of doing this routinely in all pregnancies is prohibitive.

Validation of CRIB II for prediction of mortality in premature babies.

Objective: Validation of Clinical Risk Index for Babies (CRIB II) score in predicting the neonatal mortality in preterm neonates < or = 32 weeks gestational age.

Design: Prospective cohort study.

Setting: Tertiary care neonatal unit.

Refractive status at birth: its relation to newborn physical parameters at birth and gestational age.

Background: Refractive status at birth is related to gestational age. Preterm babies have myopia which decreases as gestational age increases and term babies are known to be hypermetropic. This study looked at the correlation of refractive status with birth weight in term and preterm babies, and with physical indicators of intra-uterine growth such as the head circumference and length of the baby at birth.

Missing girls in India: infanticide, feticide and made-to-order pregnancies? Insights from hospital-based sex-ratio-at-birth over the last century.

Background: There are 44 million missing women in India. Gender bias; neglect of girls, infanticides and feticides are responsible. The sex ratio at birth can be used to examine the influence of antenatal sex selection on the sex ratio.

A simple circuit to deliver bubbling CPAP.

Nasal continuous positive airway pressure (CPAP), especially bubbling CPAP, is known to reduce the need for more invasive ventilation. We here describe a circuit that can deliver bubbling CPAP in resource poor settings. We describe how the oxygen concentration can be altered from 98% to 21% oxygen using this system.

Swan-neck sign of the big toe - association with hypocalcaemia.

The sensitivity and specificity of a new clinical sign of hypocalcaemia were evaluated. The Swan-neck sign, wherein infants with symptomatic hypocalcaemia keep their big toe hyperextended at the metatarsophalangeal joint and flexed at the interphalangeal joint, was looked for in 25 infants presenting with non-febrile seizures, alongside their serum calcium levels. The study showed that the sign had a sensitivity of 63.

Audit of survival after premature birth.

Locally applicable data on prognosis in neonates of different gestational ages and birth weights is needed both for counselling individual families and for planning departmental resource allocation. We present data from our unit collected over one year on survival to discharge of infants below 32 weeks gestational age and discuss the difficulties of data interpretation in our setting. No infant below 26 weeks gestation survived and mortality at 26, 27, 28, 29, 30 and 31 weeks gestation was 875, 500, 500, 615,158 and 105 per thousand live births, respectively.

Sytematic review and meta-analysis of prevalence of hepatitis B in India.

Objective: To evaluate the point prevalence of Hepatitis B in India.

Design: Meta-analysis of data on point prevalence from different parts of the country.

Data Sources: Searches were made in Medline, Cochrane Library and Best bets and previous reviews.