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First case  Previously health 12 year old boy, noticed swelling above his left ankle. Initially he was not disturbed with this as it was not painful and did nt limit his play and activities. Later he had minimal pain on brisk walking  and he observed swelling was gradually  increasing in size. He came to us three months after the onset. He did nt have  fever. No similar swelling anywhere else. He did nt have other symptoms like fatigue ,syncope bleeding manifestations. No family history of similar swelling on the body. On examination  Diffuse swelling on the medial aspect of lower limb, 4 X 4 cms. Surface normal ,there was no discoloration. No other swelling anywhere. No pallor  No lymph nodes. As the swelling was growing over the last three months we considered the possibility of malignancy.  We did a Plain X-Ray lower leg and foot AP and Lateral Differential diagnosis of lytic lesions of bone considered .   Within next three days pain increased and the sw

Sharing thoughts about few cases we encountered this week. First one is a case of Hand foot mouth disease. Just to highlight few atypical features. This entity was not a common before 2000. when we encounter fever with vesicles. most common possibility we considered was varicella (chicken pox). Even though we studied theoretical details of smallpox,and how to differentiate this from chickenpox it was not of much practical use as it was declared eradicated in 1980. This new entity of HFMD appeared once in a while in the beginning of this century but last ten years this became more common than chickenpox . If we examine the data in IDSP Kerala,last year we ll see the number of chicken pox cases in thousands. Most of this must be wrongly reported HFMD, some times if we are not careful it is very likely that Hand foot mouth disease is mistaken for varicella and many cases put on anti viral drugs and contacts vaccinated against varicella. In a way it is good. One interesting thing

6 year old boy. 1st child of non consanguineous marriage , developmentally normal unimmunised with no significant past history now presented with c/o low grade fever since 6 days associated with throat pain on day 1 of illness. On day 2,was taken to hospital and was treated as Out patient  basis. On day 3, developed 5-6 episodes of vomiting. On day 4,mother noticed swelling side of neck , which was gradually increasing in size So he was hospitalised on same day and started with Iv Ceftriaxone. On day 5, fever decreased but vomiting persisted. Day 6, swelling increased over right side and minimal swelling over left side and was referred to here i/v/o suspecting diphtheria. At admission, child was conscious, sick looking, Pulse rate 90/mt, good volume,occasional irregularity. Respiratory rate 24/mt, afebrile, swelling side of neck below mandible and ears both sides. tonsillitis with greyish white membrane in tonsil and posterior pharyngeal wall with bleeding spots and had

Hope NIPAH won't lead to any secondary case this time. This small write up is  not looking  things lightly,but analyzing the situation  comparing the previous years experience. This time  with early diagnosis containment,and awareness creation within such a short period was wonderful. Administration,  media and people from all walks of life  joined hands to achieve this comparatively relaxed state of affairs. This time no panic,awareness about the condition &need of precautions  reaching even to the layman and preparedness to tackle even the worst situation. Isolation and management facilities are set up in most of the major institutions. Calicut having the best experience taking the lead. In this context, sharing few thoughts/ dilemmas which most of us facing at this stage. Arrangements made in different institutions vary depending on the infrastructure manpower. But basic points considered will be same 1.Pick up the possible cases early so that chance of human to human