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April-June 2014 Volume 6 | Issue 2
Page Nos. 57-92
Online since Wednesday, May 7, 2014
Accessed 47,358 times.
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EDITORIAL |
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State of the globe: Hepatitis A virus - return of a water devil |
p. 57 |
Ekta Gupta, Neha Ballani DOI:10.4103/0974-777X.132036 PMID:24926164 |
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ORIGINAL ARTICLE |
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Investigating a community-wide outbreak of hepatitis A in India |
p. 59 |
PS Rakesh, Daniel Sherin, Hari Sankar, Marydasan Shaji, Saraswathy Subhagan, Sreekumar Salila DOI:10.4103/0974-777X.132040 PMID:24926165Background: There was an outbreak of acute hepatitis in Mylapore village, Kollam district, Kerala, southern India during February to June 2013. An outbreak investigation was initiated with the objective of describing the epidemiological features of the hepatitis outbreak. Materials and Methods: House-to-house visits were undertaken to identify symptomatic cases. The outbreak was described in terms of person, place and time. Hypothesis was generated based on findings from descriptive study, laboratory investigation of water samples, and environmental observations. A case-control study was designed to test the hypothesis. Chi-square test, univariate analysis, and logistic regression to identify the risk factors associated with hepatitis A infection were done. Results: Line list generated consisted of 45 cases. Attack rate was the highest among the age group 15-24 years (4.6%) followed by 5-14 years (3.1%). The geographical distribution of the cases suggested a clustering around the water supply through the pipeline and epidemic curve showed a sharp rise in cases suggestive of a common source outbreak. Water samples collected form pipeline showed evidence of fecal contamination and absence of residual chlorine. In the case-control study, having consumed water from the pipeline (odds ratio: 9.01 [95% confidence interval: 2.16-37.61]) was associated with the hepatitis A cases. Conclusion: The time frame of disease occurrence, environmental observations, anecdotal evidences, laboratory results and results of the analytical study indicated the possibility of occurrence of hepatitis A outbreak as a result of pipe water contamination supplied from a bore well. The study warrants establishment of an efficient water quality surveillance system. |
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REVIEW ARTICLE |
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Hepatic and biliary ascariasis |
p. 65 |
Anup K Das DOI:10.4103/0974-777X.132042 PMID:24926166Ascariasis mainly contributes to the global helminthic burden by infesting a large number of children in the tropical countries. Hepato-biliary ascariasis (HBA) is becoming a common entity now than in the past owing to the frequent usage of ultrasonograms and endoscopic diagnostic procedures in the clinical practice. There are a variety of manifestations in HBA and diagnosis depends on a high index of suspicion in endemic areas coupled with subsequent confirmation by sonographic or endoscopic demonstration of the worm. Most of them present with acute abdomen and jaundice. Oriental or recurrent pyogenic cholangiopathy is possibly the result of HBA, commonly encountered in South-East Asian countries. Conservative treatment with anthelminthic agents is used in the majority. Failure to respond to medical therapy usually indicates the need for endoscopic or surgical interventions. Overall, mortality is low and prognosis is good, but many epidemiological and immunological aspects of Ascaris infection are unclear, meaning our understanding the disease and infection still remains incomplete. Therefore, it is difficult to definitely put down a fixed modality of treatment for HBA. This underscores the need for further studies as ascariasis has the potential to adversely affect the national socio-economy by compromising the health of children and adults alike with its sheer number. |
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CASE REPORTS |
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Acute pneumococcal myelitis in an adult patient |
p. 73 |
Klaudija Višković, Matej Mustapić, Marko Kutleša, Dragan Lepur DOI:10.4103/0974-777X.132048 PMID:24926167Pneumococcal meningitis represents the most severe community-acquired bacterial meningitis. The disease is frequently associated with various complications. We present a case of pneumococcal meningitis in an immunocompetent adult patient treated with hypothermia. The disease course was complicated with severe myelitis and consequent paraplegia which is an extremely rare complication of pneumococcal disease. |
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Acute pancreatitis complicating severe dengue |
p. 76 |
Vishakha Jain, OP Gupta, Tarun Rao, Siddharth Rao DOI:10.4103/0974-777X.132050 PMID:24926168Dengue is an arthropod borne viral infection endemic in tropical and subtropical continent. Severe dengue is life threatening. Various atypical presentations of dengue have been documented. But we present a rare and fatal complication of severe dengue in form of acute pancreatitis. A 27-year-old male had presented with severe dengue in decompensated shock and with pain in abdomen due to pancreatitis. The pathogenesis of acute pancreatitis in dengue is not clearly understood, but various mechanisms are postulated. The awareness and timely recognition of this complication is very important for proper management. |
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Acute arthritis in Crimean-Congo hemorrhagic fever |
p. 79 |
Salih Ahmeti, Lindita Ajazaj-Berisha, Bahrije Halili, Anita Shala DOI:10.4103/0974-777X.132052 PMID:24926169Crimean-Congo hemorrhagic fever is a severe viral disease caused by a Nairovirus. An atypical manifestation in the form of acute arthritis was found in a confirmed Crimean-Congo hemorrhagic fever virus Kosova-Hoti strain positive patient. Acute arthritis in Crimean-Congo hemorrhagic fever (CCHF) may be as a result of immune mechanisms or the bleeding disorder underlying CCHF. |
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Intravenous immunoglobulin in the treatment of severe Clostridium difficile colitis  |
p. 82 |
Nihar Shah, Hamid Shaaban, Robert Spira, Jihad Slim, Jack Boghossian DOI:10.4103/0974-777X.132053 PMID:24926170Intravenous immunoglobulin (IVIG) has been utilized in patients with recurrent and refractory Clostridium difficile colitis. It is increasingly being used in patients with initial clinical presentation of severe colitis. Herein, we report a case of severe C. Difficile colitis successfully treated with IVIG with a review of the medical literature to identify the optimal timing and clinical characteristics for this treatment strategy. |
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Splenic infarct due to scrub typhus |
p. 86 |
Selvin Sundar Raj, Adhiti Krishnamoorthy, Manjeera Jagannati, Kundavaram PP Abhilash DOI:10.4103/0974-777X.132055 PMID:24926171Scrub typhus is a mite borne infectious disease that has the potential to involve multiple organs and can be fatal. Involvement of the abdomen in the form of hepatitis, gastric ulcerations and pancreatitis are well-documented, the pathology being disseminated vasculitis. However involvement of the spleen in scrub typhus is extremely rare and is reported only in a few autopsy studies. We report the case of a 50-year-old lady who presented with fever and left upper quadrant abdominal pain due to a splenic infarct due to scrub typhus. |
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IMAGES IN MEDICINE |
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Tuberculous optochiasmatic arachnoiditis |
p. 89 |
Rajesh Verma, Tushar B Patil, Rakesh Lalla DOI:10.4103/0974-777X.132057 PMID:24926172 |
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LETTERS TO EDITOR |
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Antimicrobial susceptibility pattern of Burkholderia cepacia isolates from patients with malignancy |
p. 90 |
Priyamvada Roy, Nishat Hussain Ahmed, Indu Biswal, RK Grover DOI:10.4103/0974-777X.132064 PMID:24926173 |
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Primary multi drug resistant extra-pulmonary tuberculosis presenting as cervical lymphadenitis |
p. 91 |
Saikat Datta, Sharmistha Bhattacherjee DOI:10.4103/0974-777X.132066 PMID:24926174 |
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