An outbreak of hand-foot-mouth disease: A report from the hills of northern India.

BACKGROUND: Hand-foot-mouth disease (HFMD) is known to cause outbreaks around the world as well as in India. We report the clinical characteristics of an outbreak in Dehradun, Uttarakhand. METHODS: The study was done in the Department of Paediatrics of a tertiary care referral teaching hospital in northern India. Children (<18 years of age) presenting with vesicular skin lesions distributed over the hand, foot and mouth were prospectively enrolled between August 2013 and October 2013. The diagnosis of HFMD was made clinically, and laboratory investigations were done for clinical care. Children were managed with supportive measures and followed for 6 weeks after discharge. No virological investigations were done to identify the offending agent. RESULTS: Thirty-three children (18 boys, 54.5%; median [range] age 4 [1-17 years]) were enrolled. The majority of children were <5 years of age (75.8%), who presented with prodromal symptoms (93.9%), mostly milder (80.6%) in severity. The most common prodromal symptoms were fever (93.9%), cough (72.7%) and malaise (54.5%). All children had rash on their hands and feet whereas the majority (85%) had oral lesions as well. All children recovered completely and had no complications during 6 weeks of follow-up. CONCLUSION: HFMD was milder and all children (mostly <5 years of age) recovered completely without complications.

Profile of Amblyopia in School going (5-15 years) Children at State Level Referral Hospital in Uttarakhand.

INTRODUCTION: Amblyopia is one of the common causes of childhood visual impairment. The prevalence of amblyopia usually varies according to the age group of the studied population and the factors prevailing in that region. The upper limit of the critical time when amblyopia can develop is around eight years of age and it can be permanent if corrective measures are not taken in time. AIM: The purpose of study was to know the profile and pattern of amblyopia in children aged 5-15 years with refractive error in Uttarakhand and to compare it with national and regional (South Asian) studies. MATERIALS AND METHODS: In the present retrospective cross-sectional study, 360 children from 5-15 yrs of age who attended the OPD during the period between September 2014 to February 2015, had undergone detailed Ophthalmic examination. The children having vision < 6/12 with out organic lesion were included in the study. The children with strabismus, previous ocular surgery and ocular diseases were excluded. Chi-Square test was done for statistical analysis (IBM SPSS Version 23). RESULTS: The percentage of amblyopia was 8.6% (n=31) with insignificant gender variation (p-value>0.05). Amblyopia due to astigmatism (combined) was in 41.93% (n=13) followed by Hypermetropia [32.25% (n=10)] and least in myopia [25.8% (n=8)]. In 51.61% cases age of presentation was 5-10 years while rest belonged to > 10 years of age. Binocular amblyopia was more (58.06%) then unilateral amblyopia (41.93%). CONCLUSION: Refractory errors are second most common cause of paediatrc amblyopia. Amblyopia and associated strabismus can have devastating psychosocial and economical fall outs. Our study emphasizes the need of visual screening of school children and prescribing them correct spectacles at appropriate time.

Distal Femur Locking Plate: The Answer to All Distal Femoral Fractures.

INTRODUCTION: Good results have been published by researchers with distal femur nail, dynamic condylar screw and even addition of a medial plate to a distal femur locking plate for treating distal femur fractures. By this study, we explore the capability of a distal femur locking plate to counter distal femur fractures of extra- articular, partial or intra- articular nature. Positive results have been published by various groups from all over the world. AIM: To study the functional and radiological outcome of distal femoral fractures in skeletally mature patients treated by open reduction and internal fixation with distal femur locking plate. MATERIALS AND METHODS: This was a prospective study conducted from January 2012 to March 2014 at the Government Medical College and Hospital (GMCH) with a 2 year follow-up. Twenty five skeletally mature patients with post-traumatic distal femur fractures were included. Patients with open grade 3B and 3C distal femur fractures, according to the Gustilo- Anderson classification and pathological distal femur fractures were excluded from the study. Patients with any fracture other than the distal femur in the ipsilateral limb were excluded from the study. Follow-up at 3 months, 6 months, 1 year and 2 years was carried out and evaluation was done according to the Neer scoring system. The statistical data analysis was carried out using SPSS version 20 (IBM, Chicago, USA). The p-value <0.05 was considered significant. RESULTS: Following all principles of fracture reduction, union was achieved in all patients with mean time to radiological union being 19 weeks. The mean Range of Motion (ROM) was 109 degrees with 20 patients having a Neer score graded as excellent to satisfactory. Our study had nine cases which required additional surgeries. Out of these, all nine cases required bone grafting, three also required antibiotic cement bead insertion initially. Three patients developed complications in the form of infection (two cases) and mal-union (one case) during the course of our study, but were completely treated by the end of the study. CONCLUSION: Positive results can be obtained by distal femur locking plate alone as it is the main implant of choice for distal femur fractures of all varieties. Best outcome is expected if fracture fixation is done following all the basic principles of fracture fixation and taking benefit of the mechanical properties of a locking plate.