An algorithmic approach to identifying the aetiology of acute encephalitis syndrome in India: results of a 4-year enhanced surveillance study.

BACKGROUND: Annual outbreaks of acute encephalitis syndrome pose a major health burden in India. Although Japanese encephalitis virus (JEV) accounts for around 15% of reported cases, the aetiology of most cases remains unknown. We aimed to establish an enhanced surveillance network and to use a standardised diagnostic algorithm to conduct a systematic evaluation of acute encephalitis syndrome in India. METHODS: In this large-scale, systematic surveillance study in India, patients presenting with acute encephalitis syndrome (ie, acute onset of fever with altered mental status, seizure, or both) to any of the 18 participating hospitals across Uttar Pradesh, West Bengal, and Assam were evaluated for JEV (serum and cerebrospinal fluid [CSF] IgM ELISA) per standard of care. In enhanced surveillance, JEV IgM-negative specimens were additionally evaluated for scrub typhus, dengue virus, and West Nile virus by serum IgM ELISA, and for Streptococcus pneumoniae, Haemophilus influenzae, Neisseria meningitidis, dengue virus, herpes simplex virus, and enterovirus by CSF PCR across five referral laboratories. In 2017, chikungunya and Leptospira serum IgM by ELISA and Zika virus serum and CSF by PCR were also tested. FINDINGS: Of 10 107 patients with acute encephalitis syndrome enrolled in enhanced surveillance between Jan 1, 2014, and Dec 31, 2017, 5734 (57·8%) of 9917 participants with available data were male and 6179 (62·7%) of 9856 were children aged 15 years and younger. Among patients who provided a sample of either CSF or serum in enhanced surveillance, an aetiology was identified in 1921 (33·2%) of 5786 patients enrolled between 2014 and 2016 and in 1484 (34·3%) of 4321 patients enrolled in 2017. The most commonly identified aetiologies were JEV (1023 [17·7%] of 5786 patients), scrub typhus (645 [18·5%] of 3489), and dengue virus (161 [5·2%] of 3124). Among participants who provided both CSF and serum specimens, an aetiology was identified in 1446 (38·3%) of 3774 patients enrolled between 2014 and 2016 and in 936 (40·3%) of 2324 enrolled in 2017, representing a 3·1-times increase in the number of patients with acute encephalitis syndrome with an identified aetiology compared with standard care alone (299 [12·9%]; p<0·0001). INTERPRETATION: Implementation of a systematic diagnostic algorithm in an enhanced surveillance platform resulted in a 3·1-times increase in identification of the aetiology of acute encephalitis syndrome, besides JEV alone, and highlighted the importance of scrub typhus and dengue virus as important infectious aetiologies in India. These findings have prompted revision of the national testing guidelines for this syndrome across India. FUNDING: US Centers for Disease Control and Prevention.

Unusual presentation of dedifferentiated liposarcoma as paratesticular mass.

A 75-year-old male presented with complaint of painless left inguinoscrotal mass slowly increasing in size since 9 years. Clinical impression was malignancy arising in left testis or cord. Initial incisional biopsy was reported as fibromatosis. Later on wide excision of tumor was done and histopathology showed dedifferentiated liposarcoma with areas of fibromatosis.

Viral burden in genital secretions determines male-to-female sexual transmission of HIV-1: a probabilistic empiric model.

OBJECTIVE: To develop a model to predict transmission of HIV-1 from men to women. DESIGN: HIV-1 in seminal plasma, and endocervical CCR5 receptors were correlated with epidemiological studies of HIV-1 transmission to develop a probabilistic model. SETTINGS: Semen samples were collected from patient subjects in Seattle Washington, Chapel Hill, North Carolina, and St. Gallen, Switzerland. Endocervical biopsy specimens were obtained from women in Chicago, Illinois. PARTICIPANTS: Eighty-six men (not receiving antiretroviral therapy) in whom CD4 cell count and semen volume were available, and 24 women in whom the number of endocervical CCR5 receptors were determined. MAIN OUTCOME MEASURES: Prediction of transmission of HIV-1 from men to women per episode of vaginal intercourse based on the absolute burden of HIV (volume x HIV RNA copies/ml seminal plasma). RESULTS: The model suggests efficient heterosexual transmission of HIV-1 when semen viral burden is high. When semen contains 100 000 copies of non-syncytium-inducing (NSI) HIV RNA the probability of HIV-1 transmission is 1 per 100 episodes of intercourse; conversely, with 1000 copies NSI HIV RNA in semen, transmission probability is 3 per 10 000 episodes of intercourse. CONCLUSIONS: This model links biological and epidemiological data related to heterosexual HIV-1 transmission. The model can be used to estimate transmission of HIV from men with high semen viral burden from inflammation, or reduced burden after antiretroviral therapy. The results offer a biological explanation for the magnitude of the HIV epidemic in places where earlier studies have shown men have high semen viral burden, such as in sub-Saharan Africa. The model can be used to develop and test HIV-1 prevention strategies.

The long-term outcome after central cord syndrome: a study of the natural history.

We studied 32 patients with central cord syndrome who were managed conservatively. Six were under 50 years of age (group 1), 16 between 50 and 70 years (group 2) and ten over 70 years (group 3). At the time of discharge all patients in group 1 could walk independently and had good bladder control compared with 11 (69%) and 14 (88%) in group 2 and four (40%) and two (20%) in group 3, respectively. At follow-up after a mean of 8.6 years (4 to 15), ten patients had died leaving 22 in the study. All those in group 1 were alive, could walk independently and had bladder control. In group 2, 13 were alive of whom ten (77%) could walk independently and nine (69%) had bladder control. In group 3 only three were alive of whom only one was independent and none had bladder control. Function at discharge as measured by the ASIA motor scoring system was usually maintained or improved at follow-up, but patients over 70 years of age at injury did poorly.

Statistical analysis of impact parameters of soft nose bullet fired on windowpane.

Proper collection of glass evidence from crime spot is very important for its latter probative values. Glass evidence when properly collected and analyzed becomes a powerful witness and it can speak truth long after the crime. In criminal investigation glass evidence can tell what had happened and when it had happened. In the present study, a statistical regression analysis relationship between thickness of windowpane used as targets by soft nose bullet using.315"/8mm caliber sporting gun made in ordnance factory, India and various associated impact parameters were investigated. The relationship is found to be reasonably linear. The ballistics performance of windowpane has been found to correlate with the shear strength behavior above the elastic limit.

Pattern of occlusive peripheral vascular disease in India. (clinicopathological study of 79 cases).

The pattern of peripheral vascular disease in India was studied in 89 patients undergoing amputation for vascular insufficiency. A control group of 26 limbs was studied for aging changes. Clinically, cases were classified into TAO (25), ASO (54) and thrombo-embolic disease (10). Angiographic, macroscopic and microscopic study of dissected vascular tree was done in view of clinical diagnosis. No significant difference was noted in the frequency and extent of involvement of limb arteries in TAO and ASO. Histologically angiitis was noted in 4 cases of TAO and one of ASO but these did not form a distinct clinical group. Primary thrombotic occlusion was seen in 21 cases of TAO and 23 cases of ASO. Atheroma with and without thrombosis was found in 26 cases. In 4 cases the arterial tree was normal. Atheromatous lesions were not seen in control group. In the groups under study they were thought to represent old thrombi rather than degenerative lesions predisposing to thrombosis. In view of these findings it was felt that Buerger's disease was primarily a thrombotic disorder. Angiitis was rare and was probably secondary. The two clinical groups TAO and ASO are not pathologically distinct as very high percentage of the latter showed primary thrombosis. The genesis of thrombosis in two groups however may be different.

Resurgence of malaria in eastern and north-eastern region of India: a critical appraisal.

The implication of recent resurgence of malaria in eastern (E) and northeastern(NE) states of India critically urges an in-depth viewpoint into the rationale of implementation of National Malaria Eradication Programme (NMEP). The article highlights the regional scenario, considering the programme performance in this context.

Nutritional status of under five children in an urban slum community of Calcutta.

Nutritional status particularly in relation to the possible risk of morbidity and mortality in children has long been recognised as a field of major concern. A cross-sectional study was undertaken with 1280 under five children in the urban slum community of Chetla, the field practice area of All India Institute of Hygiene & Public Health, Calcutta, during 1991 to identify their nutritional status. Wt/age being the most sensitive indicator was considered; and the children were graded using the Indian Academy of Pediatrics classification. It is evident from table 1, that more than half of the under five children were undernourished in the series, 27.7%, 16.8%, 5.3% and 1.8% being suffering from grade I, II, III and IV undernutrition respectively.

Acute respiratory infections in children admitted in a hospital of Calcutta.

Analysis of records of admitted children (0-12 years) in Chittaranjan Sishusadan Hospital, Calcutta during 1987 revealed that acute respiratory infections contributed 20.1% of all admissions. Lower respiratory infections were common. 93.7% of children were below 5 years of age. Case fatality rate due to ARI was the highest (17.6%) during infancy. Higher number of admissions were observed during the monsoon months.