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A hospital-based retrospective case study of admitted patients was undertaken in four major hospitals of Delhi during 1991, with a view to assessing (i) recording and reporting system of malaria cases, (ii) diagnostic criteria being followed, (iii) management of complicated and severe malaria cases, and (iv) availability of life-saving antimalarials. The study showed that none of the hospitals either followed the international coding system for recording or adopted the National Malaria Eradication Programme guidelines for diagnostic criteria malaria, i.e. by blood smear examination. Diagnosis of malaria in three out of four hospitals was not preceded by blood examination in all cases. Only 55% of the 283 clinically suspected malaria cases were screened for malaria parasite with overall positivity of 20.14 per cent and of 38.25 per cent in examined cases. Age and sex break-up indicated that males suffered more and 65 per cent of the patients belonged to 16-40 years' age groups as compared to 38.4 per cent population falling in this age group according to 1981 census. Out of 263 recovered study cases, 13 per cent came from adjoining states while this percentage went up to 35 per cent (7 out of 20 cases) in the case of malaria deaths. Over 80 per cent of the clinically suspected cases presented with signs and symptoms of fever or fever with rigour, chills or vomiting. In 38 per cent of the cases there was a definite time lag in reporting of the cases to hospitals but most of the cases (91 per cent) were administered antimalarials within 24 h of admission.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Management of admitted malaria cases in four major hospitals of Delhi: a case study. 145 11

An epidemic of dengue hemorrhagic fever occurred in Delhi during 1988. A total of 21 pediatric patients with that illness or dengue shock syndrome were evaluated from September-November 1988. All patients had fever, restlessness, ecchymotic spots, and ascites. Pleural effusion occurred in 19 patients (90%) and 18 (86%) exhibited each of the following: vomiting, thrombocytopenia, and hemoconcentration. Hepatomegaly was observed in 15 patients (71%) and splenomegaly in 3 (14%). Titers of hemagglutination inhibition (HI) antibodies against dengue virus type 2 were raised in all 15 cases from whom sera were collected during the acute stage. Convalescent sera from 5 patients had increased titers of HI antibodies to dengue virus type 2. The remaining 10 cases exhibited raised IgM antibody levels against dengue virus type 2. The fatality rate for serologically proven cases was 13% (2 of 15 patients) while for all patients (including those diagnosed clinically [n=6] and serologically [n=15]), it was 33.3% (7 of 21). Patients who survived had no sequelae, except 1 who had transient hypertension which continued for 2 weeks.
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PMID:Dengue haemorrhagic fever in children in Delhi. 156 74

Twenty-four cases of dengue haemorrhagic fever/dengue shock syndrome were studied in Delhi in the months of September and October, 1988. The majority of these cases were boys aged 6-10 years. Classical symptoms of dengue (fever, headache, aesthesia, myalgia) occurred in all the patients. Digestive symptoms (nausea, vomiting, anorexia, abdominal pain and hepatomegaly) were also common. Haemorrhagic manifestations were present in 41.7% of the cases. Of these, 90% had gastrointestinal haemorrhages. Shock occurred in 17 cases (70.8%). Thrombocytopenia and prolongation of coagulation profile were found in 62.5% of cases. Three patients (12.5%) who presented with encephalopathy died. The other 21 patients recovered after an average period of 2-8 days.
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PMID:An epidemic of dengue haemorrhagic fever and dengue shock syndrome in Delhi: a clinical study. 170 58

114 interns, 126 house physicians, and 90 postgraduate medical students working in pediatric departments of 24 medical colleges in India completed and returned a questionnaire on diarrhea, oral rehydration therapy (ORT), and case management to the Diarrhea Training and Treatment Centre in New Delhi. 20.2%, 19.1%, and 18.9% respectively did not know the signs of dehydration. Further only 19.3%, 23.8%, and 35.5% respectively knew the particulars of the National Control of Diarrheal Diseases Programme. Overall knowledge of ORT was limited. For example, only 68.4%, 66.6%, and 71.1% respectively knew the composition of oral rehydration solution (ORS). Further only 21%, 23.8%, and 23.3% respectively knew how much and what to feed children during and after diarrhea. Moreover only 63.1%, 57.1%, and 62.2% respectively knew how to calculate how much ORS to give to replace fluids. Significantly more interns knew that ORS should be used to treat moderate diarrhea (82.4% vs. 64.4%; p.005) and in cases with vomiting (64.9% vs. 51.1%; p.05) than postgraduate students. Furthermore only 29.8% of interns and 36.5% of house physicians did not favor prescribing medications to satisfy mothers. On the other hand, most postgraduate students (60%) did not favor this. These results reflect the deficiency in training of proper diarrhea case management in undergraduate and postgraduate settings. Therefore medical schools and teaching hospitals need to incorporate correct diarrhea case management into their curricula as well as give it high priority, especially since diarrhea related morbidity and mortality among children 5 years old is so high in India.
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PMID:Knowledge and perceptions of residents regarding case management of acute diarrhea. 180 76

Case management of children with diarrhea has been evaluated after the establishment of a Diarrhea Training and Treatment Unit (DTU) in Kalawati Saran Children's Hospital, New Delhi. Our one year experience has shown a decrease in hospital admissions on account of diarrhea by 13%. With the help of proper treatment protocol, 69.5% of total cases have been managed with home available fluids/ORS after educating the mothers on home management of diarrhea. Majority of admitted cases (80.7%) were managed in the ORT area and rehydrated under proper monitoring and supervision between 3-8 hours (mean duration of stay 4.28 +/- 1.8 hours). Out of 1951 cases with dehydration, 1585 patients (81.2%) were rehydrated with ORS and only 366 cases (18.8%) received intravenous fluids. In more than 85% of cases with associated vomiting, successful oral rehydration was achieved with ORS. Use of ORS and early feeding even in those patients who initially received intravenous fluids for rehydration significantly reduced the average duration of stay in the diarrhea ward (P = less than 0.001). During the first year of its inception the average cost of rehydrating one patient of diarrhea in the DTU came down to Rs. 18.54 from Rs. 31.69 in the preceding year. Rationalising drug therapy in the case management helped to significantly reduce the consumption of antibiotics (P = less than 0.001) and antiemetics (P = less than 0.001), which has helped to reduce the expenditure on drugs on an average from Rs. 17.60 to Rs. 4.92 per patient.
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PMID:Diarrhea training and treatment unit: experience from a teaching hospital. 181 71

Between October 1991 and September 1992, in six villages of the Najafgarh block in West Delhi, India, nursing students in community health interviewed 600 mothers aged 16-40 to determine the prevalence of breast feeding. 72.3% were 20-30 years old. All the women had breast fed their infants. The mean family size was 2.2. 52 (9%) had thrown away the colostrum because they believed it would harm their newborns and cause constipation, vomiting, and other gastrointestinal problems. Eight mothers threw out the colostrum because older women told them to, and without knowing its harmful or beneficial effects. 52.6% of the mothers began breast feeding within 6 hours. 22.7% began between 6 and 24 hours of delivery. Among the 47.4% of cases who delayed the first breast feed beyond 6 hours, 2.3%, 3%, 18.75%, and 37.3%, respectively, gave cow's milk, Ganga water, sugar solution, or honey as the first feed to their newborn. 28.7% of mothers were illiterate. Most mothers thought that breast feeding should continue as long as the child wants it. Women with three children were more likely to breast feed their third child for more than one year than primiparous women (22.6% vs. 5.2%). 81.6% thought that weaning should start before the infant reaches 6 months of age. Thus, most mothers understood the benefits of early weaning.
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PMID:Breast feeding practices among rural mothers of Delhi. 773 65

The present study was an attempt to evaluate epidemiological profile of adverse reactions of ciprofloxacin and factors influencing them in Indian population. The study was conducted in indoor patients of All-India Institute of Medical Sciences, New Delhi. The patients were in the age group of 21-65 years. Gastrointestinal upsets (nausea, vomiting, abdominal discomfort), headache, dizziness and skin rash were observed. Route of administration influenced the onset of ADRs. Severity of ADRs was proportional to dose. All reactions were reversible and the incidence of ADRs is lower in Indian population as compared to USA(1) but higher than seen in Japanese (2).
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PMID:Unwanted effects of ciprofloxacin in Indian population. 905 14

A major outbreak of dengue hemorrhagic fever (DHF) affected more than 10,000 people in Delhi and neighboring areas in 1996. The outbreak started in September, peaked in October to November and lasted till early December. The clinical and laboratory data of 515 adult patients admitted to Lok Nayak Hospital, New Delhi were reviewed. Fever (100%), myalgias and malaise (96%), abdominal pain (10.2%) and vomiting (8.7%) were the prominent presenting features. Hemorrhagic manifestations were seen in all patients- a positive tourniquet test (21.2%), scattered petechial rash (23.07%), confluent rash (2.7%), epistaxis (38.4%), gum bleeds (28.06%) and hematemesis (22.86%) being the major bleeding manifestations. Hepatomegaly was observed in 96% of the patients. Laboratory investigations revealed thrombocytopenia, hemoconcentration and leukopenia. Serological confirmation with a microcapture ELISA technic was done in 143/515 patients. The mortality rate was 6.6% and, multiple bleeding manifestations, severe thrombocytopenia, hypoproteinemia and dengue shock syndrome (DSS) were associated with a higher mortality.
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PMID:The 1996 outbreak of dengue hemorrhagic fever in Delhi, India. 1043 46

Dengue fever (DF) and Dengue hemorrhagic fever (DHF) are widespread in Southeast Asia. An outbreak of DF/DHF in Delhi in 2003 started during September, reached its peak in October-November, and lasted until early December. This study describes the clinical and laboratory data of the 185 cases of DF/DHF admitted to Lok Nayak Hospital, New Delhi. The mean age of the patients was 26 +/- 10 years. Fever was present in all the cases with an average duration of fever being 4.5 +/- 1.2 days with headache (61.6%), backache, (57.8%), vomiting (50.8%) and abdominal pain (21%) being the other presenting complaints. Hemorrhagic manifestations in the form of a positive tourniquet test (21%), gum bleeding and epistaxis (40%), hematemesis (22%), skin rashes (20%) and melena (14%) were also observed. Hepatomegaly and splenomegaly were observed in 10% and 5% of cases, respectively. Laboratory investigations revealed thrombocytopenia (with a platelet count of < 100,000/microl) in about 61.39% of cases, Leukopenia (WBC <3,000/mm2) and hemoconcentration (Hct >20% of expected for age and sex) were found in 68% and 52% of the cases, respectively. The mortality rate was 2.7%. Despite widespread measures taken to control outbreaks of DF, it caused major outbreaks. More stringent measures in the form of vector control, improved sanitation and health education are needed to decrease morbidity, mortality and health care costs caused by a preventable disease.
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PMID:The 2003 outbreak of Dengue fever in Delhi, India. 1643 42

A 22-year-old unmarried, male painter was found by neighbouring shopkeepers to be rolling on the ground inside his shop due to severe abdominal pain. The man had tried to commit suicide by intravenously injecting a solution of copper sulphate, used as an antifouling agent in paints. He was taken to the local hospital with severe epigastric pain, vomiting and diarrhoea. His condition worsened after three days and he was transferred to the All India Institute of Medical Sciences, New Delhi, but the victim died on his way to the hospital. His relatives and neighbours confirmed that he had recently been suffering from depression.
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PMID:An unusual suicide with parenteral copper sulphate poisoning: a case report. 1806 45


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