Healthy blue man: congenital methemoglobinemia

Congenital methemoglobinemia, though often discussed in medical teachings is rarely encountered in clinical practice as the condition is asymptomatic. Here we present such a case and discuss in detail the clinical presentation of both congenital and acquired methemoglobinemia. We also outlined the management of the conditions. One should suspect methemoglobinemia when cyanosis is not being corrected by supplementing oxygen and and when the oxygen saturation is low by pulse oximetry and normal by arterial blood gas analysis. Treatment modalities for congenital methemoglobinemia is of cosmetic purpose, but timely intervention in acquired methemoglobinemia could be lifesaving. Methylene blue, Ascorbic acid and Riboflavin are drugs of choice

Estimation of annual risk of tuberculosis infection (ARTI) among children aged 1–9 years in the south zone of India

OBJECTIVE: To estimate the annual risk of tuberculosis infection (ARTI) among children aged 1–9 years in the south zone of India. SETTING: The survey was carried out in a representative sample of villages and census enumeration blocks of towns in four south Indian states, as a part of a nationwide tuberculin survey. DESIGN: Six districts were selected through systematic random sampling. Four hundred and twenty rural clusters and 180 urban clusters were selected from these districts on the basis of the rural–urban ratio in the entire zone. To obtain the required sample of 12 000 children without bacille Calmette-Guérin (BCG) vaccination, 51 000 had to be covered. Eighty-five children from each cluster were tuberculin tested and read for reaction sizes. The ARTI was computed from the estimated prevalence of TB infection among children without a BCG scar. RESULT: Among 52 951 children registered for the study, 50 846 (96%) had a tuberculin test result. The BCG coverage for the study population was about 65%. Among 17 811 children without a BCG scar, the prevalence of infection was 5.9% (95%CI 4.0–7.7%); the corresponding ARTI was 1.7% (95%CI 0.7–1.4%). CONCLUSION: The estimated ARTI for the south zone is 1.0%, as compared to the national average of 1.7% used for programme evaluation. This baseline information should be useful for the assessment of future trends