Investigating the Clinico-Demographic Characteristics of Dengue Fever and Its Seroprevalence at a Tertiary Care Hospital in Northern India.

Background and objective Dengue virus (DENV) is a major global health threat, causing over 50,000 deaths annually. The state of Uttar Pradesh (UP) in India faces significant challenges due to the increasing number of dengue cases detected. This study aimed to assess DENV seropositivity in the Raebareli district of UP, to offer crucial insights into the region's effective control and management strategies. Materials and methods This study, after obtaining approval from the ethics committee, analyzed blood samples of individuals suspected of having dengue at a teaching hospital in rural UP between January and December 2022. To determine the disease's seroprevalence, both dengue NS1 antigen ELISA and dengue IgM Microlisa were conducted. Furthermore, RT-PCR was performed on NS1-positive samples to confirm the serotypes. The collected data were analyzed using Epi Info 7.0. Results Of the 589 suspected dengue cases, 86 (14.60%) tested positive for dengue NS1 and/or IgM. Our findings showed that males (n=330, 56.03%) and adolescents and young adults (n=301, 51.1%) from rural areas (n=523, 88.4%) were predominantly affected. Cases peaked post-monsoon, and platelet levels were notably low in NS1-positive cases. Dengue serotype 2 (DEN-2) was found in all RT-PCR-positive samples. Our results revealed a dengue seroprevalence of 14.60% (n=86), which peaked in post-monsoon months. The higher incidence among males and young adults from rural areas attending the outpatient department highlights the importance of targeted interventions and community surveillance. RT-PCR confirmed the circulation of a single serotype in the region. Conclusions This study contributes crucial insights into dengue's epidemiology and clinical profile and its findings are all the more significant now as India prepares for phase 3 trials of a quadrivalent dengue-virus vaccine in 2024. Adolescent and young adult males have an increased likelihood of acquiring the virus, and this demographic can be prioritized for vaccine trials.

Clinico-etiological profile of the elderly population with altered mental status in a teaching hospital.

Background: This study aimed at evaluating the clinico-etiological profile of altered mental status (AMS) among elderly patients and making recommendations regarding management based on etiologies, thereby improving both morbidity and mortality outcomes. Materials and Methods: This retrospective observational study was conducted in a teaching cum tertiary care hospital. Two years data (from July 2017 to June 2019) were extracted from the medical records section, and 172 eligible participants were analyzed using descriptive statistics for clinical outcomes, demographic profiles, and various etiological factors. Results: A total of 1784 elderly inpatients (age >60 years) were screened from the records, and 172 eligible elderly AMS patients were found eligible for the study. The male elderly population consisted of 110 (63.95%), and the female elderly was 62 (36.04%). The mean age of the study population was 67.82 years. The etiological factors of AMS in the study population were neurological - 47.09% (n = 81), infection - 30.23% (n = 52), metabolic/endocrine - 16.27% (n = 28), pulmonary - 2.32% (n = 4), fall - 1.74% (n = 3), toxic cause - 1.16% (n = 2), and psychiatric illness - 1.16% (n = 2). The total mortality rate was 9.30% (n = 16). Conclusion: The main etiological factors of AMS in the elderly population were predominantly of neurological, septic, and metabolic causes. These factors were preventable and treatable by training physicians, staff (as most of the physicians in the developing countries are not trained in managing this fragile group of population with multiple comorbidities), and by decentralizing geriatrics health-care setups.

Predictors of Frailty in the Elderly Population: A Cross-Sectional Study at a Tertiary Care Center.

Introduction Frailty is a multidimensional complex state that leads to increased chances of hospitalization and death in patients, especially in the elderly. Our study aimed to determine the factors associated with the development of frailty and their predictors in the elderly population. Methods The study was conducted in the Outpatient Department (OPD) of General Medicine at a tertiary care hospital in Rishikesh town of Dehradun district, Uttarakhand, India. It was a cross-sectional study design, conducted from January 2019 to July 2020. Data regarding sociodemographic factors, medical conditions, and laboratory investigations were collected on a predesigned performa. Patients diagnosed with COVID-19 were excluded from the study. It being a hospital-based study, participants with one frailty criteria were considered as non-frail and those with two or more than two as frail. Results We enrolled 149 patients in our study, based on the inclusion and exclusion criteria. The mean age of the patients was 67.50+/-6.74 years. A total of 87 (58.38%) participants had a frailty score > 2. Region of residence, body mass index (BMI), albumin, transferrin saturation, ferritin, vitamin D3, sodium, calcium, creatinine, urea, hemoglobin, glycosylated hemoglobin (HbA1c), number of prescribed drugs, substance dependence, power grip strength (PGS), slow walking time (SWT), low physical activity (LPA), self-reported exhaustion (SRE), unintentional weight loss (UWL), and erythrocyte sedimentation rate (ESR) were independent significant predictors of frailty. Conclusion Various modifiable factors were found to be predictors of frailty in adults. Timely identification and necessary interventions of these risk factors can provide valuable information for future prevention of the progression of frailty in the elderly.

Evaluation of Remote Monitoring Device for Monitoring Vital Parameters against Reference Standard: A Diagnostic Validation Study for COVID-19 Preparedness.

CONTEXT: Vital parameters including blood oxygen level, respiratory rate, pulse rate, and body temperature are crucial for triaging patients to appropriate medical care. Advances in remote health monitoring system and wearable health devices have created a new horizon for delivery of efficient health care from a distance. MATERIALS AND METHODS: This diagnostic validation study included patients attending the outpatient department of the institute. The accuracy of device under study was compared against the gold standard patient monitoring systems used in intensive care units. STATISTICAL ANALYSIS: The statistical analysis involved computation of intraclass correlation coefficient. Bland-Altman graphs with limits of agreement were plotted to assess agreement between methods. P <0.05 was considered statistically significant. RESULTS: A total of 200 patients, including 152 males and 48 females in the age range of 2-80 years, formed the study group. A strong correlation (intraclass correlation coefficient; r > 0.9) was noted between the two devices for all the investigated parameters with significant P value (<0.01). Bland-Altman plot drawn for each vital parameter revealed observations in agreement from both the devices. CONCLUSION: The wearable device can be reliably used for remote health monitoring. Its regulated use can help mitigate the scarcity of hospital beds and reduce exposure to health-care workers and demand of personal protection equipment.

Amitraz poisoning: Early gastric lavage can prevent life-threatening complications.

Amitraz is a worldwide available pesticide of formamidine chemical family, proven to have reversible toxic effects on both animals and humans. Upon intoxication by ingestion, inhalation, or dermal route, it can cause various central nervous system (CNS), CVS, respiratory and gastrointestinal effects, some of which may be life threatening. Because of lack of specific antidote patients are usually managed with supportive and symptomatic management. We describe a case of 36-year-old female patient who presented to us with alleged history of 120 ml amitraz ingestion. She was given early gastric lavage with activated charcoal at emergency along with supportive and symptomatic management. She developed mild CNS depression, bradycardia, miosis, and fluctuating blood pressure. She was managed in intensive care unit and was kept under close hemodynamic monitoring. Her clinical course during hospital stay was uneventful and was successfully discharged without any residual deficits. According to previously published data, this amount of amitraz intoxication could have caused more serious clinical manifestations. This disproportionately less severe clinical manifestation in our patient is attributed to early gastric lavage. Ominous of reducing amitraz-related health hazards lies in the hands of primary health care physicians and regulatory bodies of government.

Prevalence, characteristics, and predictors of tuberculosis associated anemia.

Tuberculosis is an infectious disease caused by mycobacterium tuberculosis. It is one of the deadliest disease and a major burden on the healthcare system in India. India, a second most populous country in the world, has a very high global annual incidence of tuberculosis. Multiple hematological changes have been reported in patients with tuberculosis such as iron deficiency anemia, folate deficiency, and sideroblastic anemia. AIMS AND OBJECTIVES: The present study was planned to find the prevalence and characteristics of anemia in the new cases of pulmonary tuberculosis. The secondary objective was to assess the predictors of anemia in new cases of pulmonary tuberculosis. METHODS: The retrospective study was carried out at a tertiary care hospital of Uttarakhand and included all the new cases of tuberculosis aged more than 18 years attending medicine outpatient and inpatient departments over a period of 1 year. Detailed demographic, clinical, and biochemical data were obtained from the hospital record section and tabulated. RESULTS: Most patients with tuberculosis and anemia were more than 50 years of age. Clearly, males outnumbered females. Approximately, 80% patients were illiterates. A majority (71, 39.2%) of the patients had BMI within the range of 18.5 to 24.9 kg/m2. The most common symptoms of tubercular patients with and without anemia were cough, fever, breathlessness, and hemoptysis. However, pallor was the most common sign. Clearly, hematological indices were lower in patients with anemia. In total, 112 (60%) patients had mild anemia and 103 (56.9%) patients had normocytic normochromic anemia. Significant association was found between Body Mass Index (BMI) and anemia in patients with pulmonary tuberculosis. Similarly, severity of anemia co-related significantly with BMI of patients with pulmonary tuberculosis. BMI showed a significant correlation with hemoglobin, packed cell volume, mean corpuscular cell volume, and red cell distribution width (RDW). In addition, age showed a significant correlation with hemoglobin and RDW. CONCLUSION: Normocytic normochromic anemia is a common hematological abnormality in patients with pulmonary tuberculosis. Thus, it warrants frequent screening for anemia in all the cases of pulmonary tuberculosis to improve morbidity and mortality in these patients.