Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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On Sep 2018




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Prof. Somashekhar Nimbalkar
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Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
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On Sep 2018




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"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



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Saraswati Dental College
Lucknow
On Sep 2018




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On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
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Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
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Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


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Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
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In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
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Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2023 | Month : January | Volume : 17 | Issue : 1 | Page : SC30 - SC33 Full Version

Clinical Profile, Complications and Outcomes of Measles among Children: An Observational Study from a Tertiary Care Hospital, South Gujarat, India


Published: January 1, 2023 | DOI: https://doi.org/10.7860/JCDR/2023/59480.17410
Kirti Premabhai Mehta, Ashruti Mahesh Patel, Ankur Patel

1. Associate Professor, Department of Paediatrics, Government Medical College, Surat, Gujarat, India. 2. Senior Resident, Department of Paediatrics, Government Medical College, Surat, Gujarat, India. 3. Assistant Professor, Department of Paediatrics, Government Medical College, Surat, Gujarat, India.

Correspondence Address :
Dr. Ankur Patel,
D-304, Surya Flats, Behind Bhulka Bhavan School, Anand Mahal Road, Adajan, Surat-395009, Gujarat, India.
E-mail: dr.ankur.83@gmail.com

Abstract

Introduction: Measles is re-emerging as an infectious disease in children and hence the prevalence has been increasing worldwide. According to the World Health Organisation (WHO), in the year 2018, more than 140,000 deaths occurred globally due to measles and its complications; most common in children <5 years of age.

Aim: To evaluate the clinical profile of measles and its complications leading to death in children for better immunisation coverage and prevention of the disease.

Materials and Methods: This was a prospective, observational study carried out in the Department of Paediatrics, New Civil Hospital (tertiary care hospital), Surat, Gujarat, India. Patient data was collected from January 2021 to December 2021 and data was analysed from January 2022 to June 2022. Study was done on all children with history of fever with rash and laboratory confirmed positive patients for measles Immunoglobulin M (IgM) antibody titer. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) software version 27.0.

Results: During the study period only, 42 children with fever and rash had laboratory confirmed measles IgM positive antibody titre. Out of total, 42.86% of the study participants belonged to 1-4 years age group and 50% were unvaccinated. Males were more affected than female. Majority (81%) of cases occurred during late winter and spring seasons and most (78.57%) of the patients belonged to urban slum areas. Most common presenting complaint observed was maculopapular rash in all the children. Majority (95.24%) of the children were in eruptive stage of the disease. A total of 31 patients out of 42 developed complications with pneumonia as most common 38.71% children. All the patients recovered completely and were discharged from the hospital.

Conclusion: There was decreasing trend of measles in young children. It can be due to recent immunisation campaigns and better coverage. Half of the patients in study were unvaccinated which indicates, there’s still work left to be done to immunisation scheme for better coverage.

Keywords

Antibodies, Fever, Immunisation, Infection, Rubella, Vaccination

Measles, or rubella, is an infectious disease which occurs predominantly in children and is caused by measles morbillivirus. It is a highly contagious disease which is transmitted by one person to other by respiratory droplets when they cough or sneeze (1). In the last few years, cases of measles have surged worldwide and the disease has re-emerged despite the continuing vaccination campaign. According to the World Health Organization (WHO), in the year 2018, more than 140,000 deaths occurred globally due to measles; most common in children under five years of age (2). This occurred despite the availability of a safe and effective measles vaccine. The symptoms of measles usually occur seven to ten days after exposure and commonly include high-grade fever up to 104°F, cough, malaise, coryza or conjunctivitis. This is followed by a typical rash 3-5 days later (3). The rash is red in colour and maculopapular which starts on face and later on spreads to the neck and rest of the body. Sometimes, two to three days after fever, tiny white spots known as Koplik spots appear inside the mouth (3).

Complications in measles are common. Measles virus infection results in a state of immunosuppression ranging from weeks to months. It has been shown in various studies to result in bacterial superinfections such as otitis media and bacterial pneumonia (4),(5). The other complications of measles include diarrhaea, laryngotracheobronchitis or croup, pneumonia, otitis media, encephalitis or rarely subacute sclerosing panencephalitis and corneal ulceration (6). So, it is important to prevent measles using the vaccine available which is safe as well as cost-effective. In India, as per WHO guidelines, two doses of measles vaccine are recommended which is given as either Measles-Rubella (MR) vaccine or Measles-Mumps-Rubella (MMR) vaccine under the Universal Immunisation Programme (UIP) at the age of 9-12 months and second dose at the age of 16-24 months (7). Thus, with the re-emergence of this highly infective disease, it is important to study the clinical pattern and outcomes of measles in children in this region of south Gujarat. Since, there are migrants and overcrowding is very much prevalent, it is high-risk factor to develop measles. Hence, this study was planned with an aim to provide an insight into the clinical signs and symptoms, outcomes and complications in the children suffering from measles in the hospital setting.

Material and Methods

This was a prospective, observational study carried out in the Department of Paediatrics, New Civil Hospital (tertiary care hospital), Gujarat, India. Patient data was collected from January 2021 to December 2021 and data analysis was done from January 2022 to June 2022. The study was commenced after obtaining the required permissions from the institutional ethics committee (Reg no. GMCS/STU/ETHICS/approval/168/19). As the study population included children, the consent for the study was obtained from the parents/guardians of the child.

Inclusion criteria: All children ≤12 years of age, with history of fever with rash and laboratory confirmed positive patients for measles IgM antibody titer and children whose parents or guardians provided written informed consent were included in the study.

Exclusion criteria: Clinically diagnosed cases of fever with rash who were negative for measles IgM antibody titer, children suffering from other disorders for which they are taking concomitant medications and children of the guardians who did not provide informed consent were excluded from the study.

Study Procedure

After obtaining the required ethical clearance, the study was started in the Paediatric Department. All the children with complaints of fever, rash, cough, coryza and breathlessness who were admitted in Paediatric ward were suspected and investigated for measles. Measles IgM antibody titer test was performed with Elisa reader microlisa to confirm measles (Measles novalisa kit) as per kit instructions. The diagnosis of measles was confirmed by the attending physician based on the clinical and laboratory evidence. All 42 enrolled patients were given unique identification number to maintain the confidentiality throughout the study procedure.

The demographic details of the child such as age, gender were noted down in a preapproved and prevalidated patient data sheet. Immunisation status was also recorded. After the children were admitted and diagnosis of Measles was confirmed, they were followed-up daily until discharge for clinical and laboratory parameters. All the patients were closely monitored for complications like otitis media, pneumonia, diarrhaea, convulsions and encephalitis. Parents were also counseled about nutritional supplements, routine vaccination as per Indian Academy of Paediatrics (IAP) guidelines (5), and preventive measures against spread of infection to other children.

Statistical Analysis

All the data was collected and entered in the Microsoft Excel 2016. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) version 27.0 wherever required. The descriptive data was expressed in mean and percentages.

Results

In the present study, there were 14,886 paediatric admissions including 42 confirmed measles cases <12 of age. Both males and females were affected more in the age group of 1-3 years with male to female ratio was 1.5:1. Male predominance was seen in all subgroups of measles infection. The most common age group affected was 1-6 years and less in older children (Table/Fig 1). Most (78.57%) of the patients belonged to urban slum areas. Majority (n=34, 81%) of cases occurred during late winter and spring season from December to April (postwinter season) (Table/Fig 2). In clinical features, rash was present in all the patients of measles. Fever (95.24%) and cough (76.19%) were most common presenting clinical features, while coryza (28.57%), diarrhoea (30.95%), conjunctivitis (19.05%) and convulsions (7.14%) were least common presentation (Table/Fig 3). Among the general examination, rash was seen in all patients, pallor was seen in 66.66% of patients and cervical lymphadenopathy was seen in 9.52% of patients (Table/Fig 4). A total of 21 (50%) patients were immunised with only one dose of measles vaccine and 47.62% patients were immunised with both doses and one patient was not vacinnated for measles. These doses of Measles vaccination was taken according to IAP guidelines (Table/Fig 5). Two (4.76%) of the subjects had positive contact history with an active case of measles. The results of the immunisation coverage for measles showed half of the study participants vaccinated against measles (50%, n=21) while the other half was unvaccinated against Measles.

(Table/Fig 6) gives the incidence of chief presenting complaints of measles in the study participants. The main presenting complaints observed in the study was the typical appearance of the maculopapular rash on the face and behind the ears in all the children (100%). The other presenting complaint was fever which was present in almost all cases (n=40, 95.42%).Only two children presented with an afebrile rash. The other common symptom was cough which occurred in 32 (76.19%) children. The other symptoms were coryza, diarrhaea, vomiting, abdominal pain, dyspnea and conjunctivitis. None of the patients had koplik spots or lymphadenopathy on examination. Majority (n=40, 95.42%) of the children were in eruptive stage of the disease. A total of 31 patients out of 42 developed complications due to measles (Table/Fig 7). The most common complication was pneumonia which occurred in 12 (38.71%) children. The other common complications were laryngotracheobronchitis (16.12%) and ophthalmic complications (12.9%) such as conjunctivitis. There was one case of orbital cellulitis. None of the cases were complicated by subacute sclerosing pan encephalitis. All the patients recovered completely, mean hospitalisation five days and were discharged from the hospital while, otitis media, gastroenteritis and encephalitis were less commonly seen complications in the present study.

Discussion

Measles is an extremely contagious disease which predominantly occurs in children. It is responsible for more than 100,000 deaths worldwide every year (8),(9). It is transmitted through airborne droplets of the infected patients by sneezing or coughing. The symptoms of measles typically involve high-grade fever, cough, coryza, fatigue followed by the appearance of a characteristic rash. There is no specific therapy for measles. It is usually treated by symptomatic therapy and fluid therapy in addition to vitamin A and antibiotics to prevent Measles complications like pneumonia, diarrhoea and otitis media (10). Rarely, central nervous system complications such as encephalitis and Subacute Sclerosing Panencephalitis (SSPE) may also develop. There is a safe and effective measles vaccine available which is covered under immunisation programme in two doses few months apart. The incidence of measles has been rising in the past few years and hence, it is important to understand the clinical pattern, complications and outcomes of the disease to plan for effective therapy and immunisation coverage. Thus, this study encompasses such aspects of the disease.

It was observed that measles was highest in 1-5 years age group followed by less than one-year-old children. This could be due to the time of immunisation with first dose of measles vaccine is usually around nine to sixteen months of age. Hence, the children are not protected from measles till then.

In the current study, most of the cases were observed in the late winter months of December and January and early spring months. This corroborates with the findings of other study done in China which observed the same seasonal variation pattern with measles (11). This could be due to various climatic conditions which prevail in these months. It has been shown studies that measles virus becomes inactive after half an hour when exposed to sun (12), so, the transmission of measles is infrequent in summer months. Also, it survives best in the low humidity weather which is common in late winter and early spring months (12). It was reported that half the patients were fully immunised against measles and half were not. Increasing the immunisation coverage has been shown to decrease the incidence (13),(14).

The most common symptom reported was rash in the present study followed by fever. The rash was maculopapular in nature and red in colour. These symptoms were similar to the clinical features reported in a previous study by Lo Vecchio A et al., (15). Majority of the children were treated with antibiotics and in approximately 67% of the children fluid therapy was also started in addition to the antibiotics. A systematic review published in Cochrane also advocates the use of antibiotics in children suffering from measles (16). Though measles is a disease caused by a virus, antibiotics are added for treatment to prevent the bacterial superinfections due to compromised immune system which occurs as a complication of measles infection (17). The most common complication reported in the study was pneumonia which occurred in 38% children. It has been reported to be bacterial superinfection or viral pneumonitis (18).

Limitation(s)

There were a few limitations in this study. Only the children admitted for measles were included, so the children who were treated on outpatient basis were missed during the study period. The sample size was small hence the generalisation of results for the entire population may be difficult.

Conclusion

Measles is re-emerging as an infectious disease in children and hence the prevalence has been increasing worldwide. It is very common in children less than five years of age. With timely and appropriate treatment, all the children recovered completely without any sequelae. Knowing the clinical profile and prevalence of the disease, will help the policy makers to form key guidelines for the immunisation coverage of measles. Future studies analysing the effectiveness and preventive measures for measles could be planned.

References

1.
Parthasarathy S, Dubey A, Chaudhary P, Menon P. 2013. IAP Textbook of Pediatrics. 5th ed. pp.250-251.
2.
Chapter 2: Manual for the Laboratory-based Surveillance of Measles, Rubella, and Congenital Rubella Syndrome [Internet]. Who.int. 2022 [cited 22 September 2022]. Available from: https://www.who.int/publications/m/item/chapter-2-manual-for-the-laboratory-based-surveillance-of-measles-rubella-and-congenital-rubella-syndrome
3.
Anathanarayanan R, Paniker C. Virology. Ananthanarayan and Paniker Textbook of Microbiology. 7th ed. 2019;(2):401-13.
4.
Parthasarathy A, Shastri D, Kundu R. Common viral infections-Measles. Textbook of Pediatrics Infectious Disease- IAP. 2020.
5.
Soans S, Shastri D, Shah A. IAP Guidebook on Immunisation: 2018-2019 Indian Academy of Pediatrics. 3rd ed. 2019.
6.
Aggarwal R, Kundu R. Infectious Diseases (Measles). IAP atlas of Pediatric Infectious Disease. 5th ed. 2019.
7.
Measles vaccines: WHO Position Paper - April 2017.Weekly Epidemiol Records [Internet]. 92nd ed. World Health Organization; 2022 [cited 22 September 2022]. Available from: http://apps.who.int/iris/bitstream/10665/255149/1/WER9217.pdf
8.
Six-Year Surveillance of Diphtheria Outbreak in Indonesia Repository - UNAIR REPOSITORY [Internet]. Repository.unair.ac.id. 2022 [cited 22 September 2022]. Available from: https://repository.unair.ac.id/115017/
9.
Kondamudi NP, Waymack JR. Measles. Last Update: August 14, 2022. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK448068/#:~:text=Measles%2C%20also%20known%20as%20rubeola,availability%20of%20an%20effective%20vaccine.
10.
Measles. World Health Organization. 2019. https://www.who.int/news-room/fact-sheets/detail/measles.
11.
Vemula V, Li L, Thoon K, Chong C, Tee N, Maiwald M, et al. Risk factors and clinical profile of measles infection in children in Singapore. Infection, Disease & amp; Health. 2016;21(4):192-96. [crossref]
12.
Nas FS, Ali M, Yahaya A, Kabiru AG. Retrospective Study on Incidence of Measles in Kumbotso Kano, Northern Nigeria. Virol Immunol J 2018, 2(6): 000170. [crossref]
13.
Pandey A, Tejan N, Tripathi R, Chaturvedi R, Dhole T. Prevalence of Measles virus infection among vaccinated and non-vaccinated children in Northern India. International Journal of Pharmaceutical Sciences and Research. 2019;10(4):1953-58.
14.
Koniushevska AA, Parkhomenko TA, Sharunova MV, Kazantsev AB, Yakovenko DV. Epidemiology and features of Measles course in children during the outbreak of 2018- 2019 in the city of Mariupol. Regulatory Mechanisms in Biosystems. 2020;11:01-03. [crossref]
15.
Lo Vecchio A, Krzysztofiak A, Montagnani C, Valentini P, Rossi N, Garazzino S, et al. Complications and risk factor for severe outcome in children with Measles. Archives of Disease in Childhood Medical Journal (BMJ Group). 2020;105(9):896-99. [crossref] [PubMed]
16.
Kabra SK, Lodha R. antibiotics for preventing complications in children with measles. Cochrane Library. 2013;1(179):2373-95. [crossref]
17.
Choudhury J, Ganguly N. A Parthasarathy. Infectious diseases in children. IAP Color Atlas of Pediatrics. 2019;4(1):56.
18.
Onoja AB, Adeniji AJ, Faneye A. Measles complications in Nigerian hospital setting. Clinical Reviews and Opinions. 2013;5(2):18-23. Available online http:// www.academicjournals.org/cro [crossref]

DOI and Others

DOI: 10.7860/JCDR/2023/59480.17410

Date of Submission: Aug 09, 2022
Date of Peer Review: Sep 10, 2022
Date of Acceptance: Nov 01, 2022
Date of Publishing: Jan 01, 2023

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Aug 12, 2022
• Manual Googling: Sep 27, 2022
• iThenticate Software: Oct 28, 2022 (11%)

ETYMOLOGY: Author Origin

JCDR is now Monthly and more widely Indexed .
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