Measles outbreak among unvaccinated children in Bajura.

INTRODUCTION: Measles outbreak occurs when there are three or more laboratory confirmed measles cases in a village in a period of one month. Integrated surveillance system has helped to identify the measles outbreak, to characterize its epidemiology and to timely respond it. METHODS: This is a descriptive study of measles outbreak that occurred in Bajura district in February to March 2010. The epidemiological characteristics of the outbreak are described. The outbreak was investigated from 4-8 March 2010 with necessary epidemiological information and biological specimen collection. One month follow up was done to determine the clinical outcome of the measles cases. RESULTS: A total of 36 people had measles; 97% of them were under 15 years of age and 89% had not been immunized with measles vaccine. Attack rate and vaccine efficacy was 23% and 50% amongst children less than 15 years of age and case fatality rate (CFR) was 3%. Biological samples were collected from 11 patients; all of which tested IgM positive for measles and genotype D8 was isolated. CONCLUSIONS: CFR of this outbreak is higher than the national CFR. Vaccine efficacy of 50% points towards the need for investigation of vaccine logistics and cold chain system. Moreover, this laboratory test confirmed an outbreak showing that the measles virus could be imported from an endemic region and rapidly spread through a susceptible population who were previously not immunized.

Severe acute pancreatitis with pseudocyst bleeding due to hepatitis E virus infection.

Coincidence of acute pancreatitis caused by hepatitis E virus (HEV) infection is rare. We report a case of severe acute pancreatitis in the course of acute hepatitis E in a 35-year-old man who presented with jaundice for 1 week. Serum was positive for IgM anti-HEV and negative for hepatitis A, B and C viruses. There was upper abdominal tenderness and fullness with absent bowel sounds. A diagnosis of acute pancreatitis was made and confirmed with elevated serum lipase 2,032 U/L and amylase 1,287 U/L. Two weeks after admission he had an increase in abdominal pain associated with oliguria and hemodynamic instability. Serum creatinine had increased and hemoglobin had dropped along with metabolic acidosis. Ultrasound showed hemorrhage into the pseudocyst, which was confirmed by contrast-enhanced computed tomography scan (which also ruled any pseudoaneurysm as the cause of bleed). He was hemodialysed and transfused blood. However, he developed refractory hypotension and did not respond to inotropes. After a rapid downhill course, he did not survive. Hepatitis E virus infection was complicated with the development of acute pancreatitis, which was severe with multiorgan failure and had a fatal outcome.

Chronic hepatitis C in northern India--the pathological and clinical spectrum.

BACKGROUND: The aim of the study was to analyse the morphology, clinical presentation and predisposing factors for chronic hepatitis C infection. METHODS: Clinical presentation of 220 patients who presented with hepatitis C virus infection over five years period (January 1996 to December 2000) were recorded. Liver biopsy specimens from 80 adult patients with chronic hepatitis C virus were evaluated using a semiquantitative scoring system. The possible predisposing risk factors for infection in these patients were recorded. RESULTS: Grading of chronic hepatitis C was minimal/mild in 51 (64%) cases. Seven (8.7%) had high-grade necroinflammatory activity. Fibrosis was absent in 22(27.5%), mild in 29(36.25%), moderate in 11 (13.75%) and 18(22.5%) had evidence of cirrhosis. No significant correlation was found between the level of transaminases and degree of fibrosis or grade of inflammation. More number of patients with history of alcohol consumption had moderate/severe grade of necroinflammatory activity and cirrhosis as compared to those not taking alcohol at all. Potential predisposing factors were use of unsterile syringes, previous surgery and tattooing in multivariate analysis. CONCLUSION: Nearly two-thirds of patients of chronic hepatitis C where liver biopsy was possible have minimal/mild disease at time of diagnosis; 22% have cirrhosis. Though disease severity can only be assessed by liver histology, liver biopsy may not be possible in a sizeable proportion of patients as they present with advanced liver disease. Most of the patients do not have specific symptoms. Reusable needles/syringes is the commonest potential risk factor.

Methylprednisolone acetate versus oral prednisolone in moderately active ulcerative colitis.

BACKGROUND: Patients with active ulcerative colitis are treated with corticosteroids. We compared the efficacy and safety of intramuscular depot preparation of methylprednisolone acetate with oral prednisolone in the treatment of moderately active ulcerative colitis. DESIGN: Open labeled, randomized, prospective, four-month study. METHODS: 40 patients with moderately active ulcerative colitis (activity index 150-220) were randomized into two groups. Group A (n=21) received methylprednisolone acetate (80 mg intramuscularly once weekly for 6 weeks). Group B (n=19) received oral prednisolone (40 mg/day) in a 'tailing-off' regimen. In addition, patients in both the groups received sulfasalazine. Patients were followed up at 1, 2, 3, 4, 8, 12 and 16 weeks. The primary measure of therapeutic response was activity index. An index of <150 was considered as clinical remission. Secondary efficacy was assessed by subjective evaluation of acceptability of treatment by the patient. RESULTS: After one week of treatment, the decrease in mean activity index was significantly more with oral prednisolone (p<0.05), and five 5 patients (23.8%) in Group A and 12 (63.2%) in Group B were in clinical remission (p<0.05). However, after 2 weeks and beyond, the mean activity index and the number of patients with clinical remission were comparable in the two treatment groups. CONCLUSIONS: Methylprednisolone acetate as a depot preparation and oral prednisolone are equally effective in inducing remission in patients with moderately active ulcerative colitis. Though symptomatic improvement is quicker with oral prednisolone, the remission rate with the two drugs was similar after 2 weeks of treatment.

Chronic hepatitis C--treatment results in northern India.

BACKGROUND: There have been major innovations in the treatment of chronic hepatitis C in the last decade. The course of the disease is variable and host, viral and environmental factors can influence the disease course and response to various treatment protocols. Data on the therapeutic response among north Indian patients with chronic hepatitis 'C' is limited. Therefore, we analysed our results of treatment among patients with chronic hepatitis C. MATERIAL & METHODS: A total of 55 patients with chronic hepatitis C were treated. Forty nine patients completed treatment with either interferon alpha 2b alone (n = 12) or combination of interferon alpha 2b and ribavarin (n = 37). All the patients were seropositive for anti HCV and, HCV RNA. All of them had elevated ALT and histological features of chronic hepatitis. Response to treatment was evaluated as end treatment response (ETR) i.e. HCV RNA not detected at end of treatment and sustained response (SR) i.e. HCV RNA not detected six months after completing the treatment. Adverse effects were also recorded. RESULTS: Overall, ETR was documented among in 69% of the patients and SR in 45% patients. Sustained response rate was higher with combination therapy as compared to interferon alone i.e. (51% vs 25%). Sustained response with induction dosing was 57%. Treatment had to be stopped in 3 patients due to major side effects like psychiatric disorders (2) and hypotension (1) and 3 patients were lost to follow up during the course of therapy. CONCLUSION: Sustained virological response with combination therapy is better than with interferon alone. Induction dosing improves the sustained virological response further. Major side effects with the antiviral drugs necessitating drug withdrawal is infrequent.

Hepatitis C--knowledge & practices among the family physicians.

BACKGROUND: Hepatitis C virus (HCV) is an important cause of end stage chronic liver disease worldwide. There is plethora of informations on hepatitis C virus in the recent hepatology related periodicals. However, family physicians to whom such patients initially present, should be aware of various aspects of hepatitis C virus infection. Therefore, the present study evaluated the information on hepatitis C virus known to practicing family physician in the state of Punjab. MATERIAL & METHODS: Nine hundred thirty six family physicians were randomly selected from 7 districts of Punjab and were mailed a questionnaire designed to test their knowledge on HCV, its transmission, clinical presentation, complications and treatment. In addition, questions were asked to assess commonly employed mode of therapy for short duration illnesses and the practice of reusing syringes/needles. All question had unequivocal answer. The questionnaire reply was anonymous. RESULTS: Only 28% (n = 262) doctors returned the questionnaire. The response to different sections of questionnaire was variable. Seventy six percent doctors (n = 176) were aware that HCV is parenterally transmitted. 18% (n = 41) doctors were still reusing needles and syringes. Fifty eight percent (n = 134) doctors considered hepatitis C as a common cause of acute viral hepatitis. Only 72% (n = 166) of doctors knew about the relevant tests for diagnosis of hepatitis C. CONCLUSIONS: Despite having knowledge about parenteral route of transmission of HCV infection, a sizeable proportion of family physicians in the Punjab state continues to reuse needles and syringes. Information on the virology, clinical presentation, diagnostic tests and management approaches were lacking among a substantial proportion of family physician. Therefore, awareness about HCV need to be increased among the practicing physicians.