Clinical and Laboratory Profile of Dengue Fever in a North Indian Tertiary Hospital.

Objectives: The present study was done to ascertain the presentations of dengue fever in a North Indian tertiary care Hospital, and to compare the clinical and laboratory features among patients with and without warning signs in dengue fever. Methods: A total of 600 patients of dengue admitted to medical wards were included in the study. A detailed history as well as a general and systemic clinical examination were carried out. Haematological profiles and biochemical investigations were done at the time of admission and were followed daily or at times twice a day. Signs of plasma leakage were assessed by chest radiograph and abdominal ultrasonography, serum albumin etc. Patients were classified as dengue fever without warning signs and with warning signs and laboratory diagnosis of dengue was established by demonstration of NS1 antigen and specific antibodies to dengue in serum. Results: Of the 600 dengue positive patients, 421 (70.2%) were males and 179 (29.8%) were females. Mean age of the patients was 27.35±11.43 years. Among all patients of dengue, 21 (3.5%) presented with bleeding from any site. Out of these, only 7 of those presenting without warning signs had bleeding episodes whereas, 22 (34.3%) of patients presenting with warning signs had bleeding and this difference was statistically significant (p=0.01). Haematocrit was an important factor to predict severity of dengue. Whereas the mean haematocrit among all patients was 39.79±3.23%, it was 39.49±4.25% among those without warning signs and 42.22±3.54% among those with warning signs of dengue, and this was significant statistically, with a p-value of 0.002. Conclusion: Early diagnosis, monitoring and prompt supportive management can reduce mortality in dengue. In the present study, it was found that newer signs and symptoms are emerging and may cause delay in the diagnosis. It was found that the mortality rate was significantly higher in patients of dengue with warning sign.

Randomized controlled trial of molnupiravir SARS-CoV-2 viral and antibody response in at-risk adult outpatients.

Viral clearance, antibody response and the mutagenic effect of molnupiravir has not been elucidated in at-risk populations. Non-hospitalised participants within 5 days of SARS-CoV-2 symptoms randomised to receive molnupiravir (n = 253) or Usual Care (n = 324) were recruited to study viral and antibody dynamics and the effect of molnupiravir on viral whole genome sequence from 1437 viral genomes. Molnupiravir accelerates viral load decline, but virus is detectable by Day 5 in most cases. At Day 14 (9 days post-treatment), molnupiravir is associated with significantly higher viral persistence and significantly lower anti-SARS-CoV-2 spike antibody titres compared to Usual Care. Serial sequencing reveals increased mutagenesis with molnupiravir treatment. Persistence of detectable viral RNA at Day 14 in the molnupiravir group is associated with higher transition mutations following treatment cessation. Viral viability at Day 14 is similar in both groups with post-molnupiravir treated samples cultured up to 9 days post cessation of treatment. The current 5-day molnupiravir course is too short. Longer courses should be tested to reduce the risk of potentially transmissible molnupiravir-mutated variants being generated. Trial registration: ISRCTN30448031.

Rydberg energies and transition probabilities of Li I for np-ms (m ≤ 5) transitions.

Background: Mathematical modeling provides grounds for understanding scientific systems theoretically. It serves as a guide for experimentalists in determining directions of investigation. Recently, the Covid-19 pandemic has caused disturbances in almost every walk of life. Scientists have played their role and have continued research on the effects of the pandemic. Various mathematical models have been used in different branches of science (Djilali et al. in Phys Scr 96 12 124016, 2021; Math Biosci Eng 18(6):8245-8256, 2021; Zeb et al. in Alex Eng J 61(7):5649-5665). Well-established mathematical models give results close to those obtained by experiments. The Weakest Bound Electron Potential Model is one such model, which explains hydrogen-like atoms and ions. This model has been used extensively for hydrogen-like atoms and ions to calculate energies of Rydberg levels and ionization energies. This model has been used extensively for hydrogen-like atoms and ions to calculate energies of Rydberg levels and ionization energies. Results: This paper presents the energies of the Rydberg series, 2s2ns, and 2s2np of Li I, calculated using WBEPM. The energies are used to calculate transition probabilities from np to 2s, 3s, 4s, and 5s levels. The transition probabilities are compared with corresponding values in published data where available. The agreement with known values is good; most of the transition probabilities calculated in this work are new. A computer program was developed to find the value of the dipole matrix element. The calculations were further verified by calculating the lifetimes of some low-lying levels. Conclusions: Four series of Li I have been studied, and energies of the Rydberg levels in the series were calculated. The energies then are used to calculate transition probabilities from np to ms transitions, where m = 2, 3, 4, & 5 and n = 1-15. The results are compared where available. An excellent agreement with previously published data shows the reliability of calculations. Most of the transition probabilities are new.

A study of heart rate variability and QT dispersion in patients of acute ST elevation myocardial infarction.

AIMS AND OBJECTIVES: To study the effect of Heart Rate Variability (HRV) and QT dispersion (QTd) in patients presenting with acute ST elevation myocardial infarction (STEMI). METHODS: 100 patients of Acute myocardial infarction (AMI) were evaluated by history and examination. Electrocardiogram (ECG) and Holter monitoring was done in all patients. HRV, QTd, Standard Deviation of the mean RR interval (SDNN) and Standard Deviation of the average of RR interval measured every five minutes during 24 hr (SDANN) were calculated. Results were statistically analyzed using Student 't' test, Paired 't' test and Pearson's formula. RESULTS: The most common presenting symptoms were chest pain (88%) and dyspnoea (50%). Tachycardia was seen in 565 while congestive heart failure was present in 29% patients. Mean SDNN was 61.4 +/- 24.4 ms and SDANN was 50 +/- 18.2 ms. HRV values were significantly decreased while QTd was higher in patients who died in comparison to patients who survived. A strong negative correlation was seen between HRV and QTd. CONCLUSIONS: Markers of autonomic regulation of heart like HRV and QTd provide valuable information about the future course of events in a patient following acute STEMI which can be utilized to plan the future course of management in patients especially predisposed to adverse and catastrophic outcomes.

Homozygous noncanonical splice variant in LSM1 in two siblings with multiple congenital anomalies and global developmental delay.

Two siblings, one male and one female, ages 6 and 13 yr old, have similar clinical features of global developmental delay, multiple congenital anomalies affecting the cardiac, genitourinary, and skeletal systems, and abnormal eye movements. Whole-genome sequencing revealed a homozygous splice variant (NM_014462.3:c.231+4A>C) in LSM1 that segregated with the phenotype in the family. LSM1 has a role in pre-mRNA splicing and degradation. Expression studies revealed absence of expression of the canonical isoform in the affected individuals. The Lsm1 knockout mice have a partially overlapping phenotype that affects the brain, heart, and eye. To our knowledge, LSM1 has not been associated with any human disorder; however, the tissue expression pattern, gene constraint, and the similarity of the phenotype in our patients and the knockout mice models suggest it has a role in the development of multiple organ systems in humans.

One-year pilot study on the effects of nitisinone on melanin in patients with OCA-1B.

BACKGROUND: Oculocutaneous albinism (OCA) results in reduced melanin synthesis, skin hypopigmentation, increased risk of UV-induced malignancy, and developmental eye abnormalities affecting vision. No treatments exist. We have shown that oral nitisinone increases ocular and fur pigmentation in a mouse model of one form of albinism, OCA-1B, due to hypomorphic mutations in the Tyrosinase gene. METHODS: In this open-label pilot study, 5 adult patients with OCA-1B established baseline measurements of iris, skin, and hair pigmentation and were treated over 12 months with 2 mg/d oral nitisinone. Changes in pigmentation and visual function were evaluated at 3-month intervals. RESULTS: The mean change in iris transillumination, a marker of melanin, from baseline was 1.0 ± 1.54 points, representing no change. The method of iris transillumination grading showed a high intergrader reliability (intraclass correlation coefficient ≥ 0.88 at each visit). The number of letters read (visual acuity) improved significantly at month 12 for both eyes (right eye, OD, mean 4.2 [95% CI, 0.3, 8.1], P = 0.04) and left eye (OS, 5 [1.0, 9.1], P = 0.003). Skin pigmentation on the inner bicep increased (M index increase = 1.72 [0.03, 3.41], P = 0.047). Finally, hair pigmentation increased by both reflectometry (M index [17.3 {4.4, 30.2}, P = 0.01]) and biochemically. CONCLUSION: Nitisinone did not result in an increase in iris melanin content but may increase hair and skin pigmentation in patients with OCA-1B. The iris transillumination grading scale used in this study proved robust, with potential for use in future clinical trials. CLINICALTRIALS: gov NCT01838655. FUNDING: Intramural program of the National Eye Institute.

Acute phase reactant, Pentraxin 3, as a novel marker for the diagnosis of rheumatoid arthritis.

INTRODUCTION: Pentraxins are a group of highly conserved acute-phase reactant proteins and play crucial role as modulators of inflammatory processes. Pentraxin 3 (PTX3) is primarily produced and released by vascular cell wall, hence, we attempt to establish the role of PTX3 as a biomarker for Rheumatoid Arthritis (RA) compared to CRP. METHODS: Thirty patients having active RA as cases and 30 osteoarthritis (OA) patients as controls were recruited. Paired serum and synovial fluid samples were analysed for concentrations of both PTX3 and CRP by using high sensitivity ELISA kit and ROC curve was plotted. RESULTS: Concentrations of PTX3 and CRP were significantly higher in RA patient serum (p < 0.0001) as well as in synovial fluid (p < 0.0001) and correlated with disease severity. Upon correlation analysis, positive correlation was found between serum and synovial fluid concentrations of PTX3 and CRP. The diagnostic potential of PTX3 was observed in synovial fluid while combination of PTX3 and CRP showed better sensitivity in serum. CONCLUSION: PTX3 found to be sensitive non-invasive indicator of clinical arthritic activity in RA patients when compared to traditional markers like CRP. Combination of PTX3 and CRP could serve as better differential diagnostic markers for RA after validation in larger patient cohort.

A novel iris transillumination grading scale allowing flexible assessment with quantitative image analysis and visual matching.

PURPOSE: To develop a sensitive scale of iris transillumination suitable for clinical and research use, with the capability of either quantitative analysis or visual matching of images. METHODS: Iris transillumination photographic images were used from 70 study subjects with ocular or oculocutaneous albinism. Subjects represented a broad range of ocular pigmentation. A subset of images was subjected to image analysis and ranking by both expert and nonexpert reviewers. Quantitative ordering of images was compared with ordering by visual inspection. Images were binned to establish an 8-point scale. Ranking consistency was evaluated using the Kendall rank correlation coefficient (Kendall's tau). Visual ranking results were assessed using Kendall's coefficient of concordance (Kendall's W) analysis. RESULTS: There was a high degree of correlation among the image analysis, expert-based and non-expert-based image rankings. Pairwise comparisons of the quantitative ranking with each reviewer generated an average Kendall's tau of 0.83 ± 0.04 (SD). Inter-rater correlation was also high with Kendall's W of 0.96, 0.95, and 0.95 for nonexpert, expert, and all reviewers, respectively. CONCLUSIONS: The current standard for assessing iris transillumination is expert assessment of clinical exam findings. We adapted an image-analysis technique to generate quantitative transillumination values. Quantitative ranking was shown to be highly similar to a ranking produced by both expert and nonexpert reviewers. This finding suggests that the image characteristics used to quantify iris transillumination do not require expert interpretation. Inter-rater rankings were also highly similar, suggesting that varied methods of transillumination ranking are robust in terms of producing reproducible results.

Age-related spontaneous lacrimal keratoconjunctivitis is accompanied by dysfunctional T regulatory cells.

In both humans and animal models, the development of Sjögren syndrome (SS) and non-SS keratoconjunctivitis sicca (KCS) increases with age. Here, we investigated the ocular surface and lacrimal gland (LG) phenotype of NOD.B10.H2b mice at 7-14, 45-50, and 96-100 weeks. Aged mice develop increased corneal permeability, CD4+ T-cell infiltration, and conjunctival goblet cell loss. Aged mice have LG atrophy with increased lymphocyte infiltration and inflammatory cytokine levels. An increase in the frequency of CD4+Foxp3+ T regulatory cells (Tregs) was observed with age in the cervical lymph node (CLN), spleen, and LG. These CD4+CD25+ cells lose suppressive ability, while maintaining expression of Foxp3 (forkhead box P3) and producing interleukin-17 (IL-17) and interferon-γ (IFN-γ). An increase of Foxp3+IL-17+ or Foxp3+IFN-γ+ cells was observed in the LG and LG-draining CLN. In adoptive transfer experiments, recipients of either purified Tregs or purified T effector cells from aged donors developed lacrimal keratoconjunctivitis, whereas recipients of young Tregs or young T effector cells failed to develop disease. Overall, these results suggest inflammatory cytokine-producing CD4+Foxp3+ cells participate in the pathogenesis of age-related ocular surface disease.

Maternal care receptivity and its relation to perinatal and neonatal mortality. A rural study.

A longitudinal study was conducted on 212 pregnant women from May 1987 to April 1988. Maternal Care Receptivity (MCR) "an innovative approach" was adopted for the assessment of maternal care services provided to pregnant mothers at their door steps. During follow-up, scores were allotted to each of the services rendered and antenatal status of pregnant women. Depending on the score--MCR was classified as high (11 to 8), moderate (7 to 4) or poor (3 to 0). Perinatal and neonatal deaths were recorded and an inverse relationship between MCR and perinatal and mortalities was observed (z = 5.46, p < 0.0001). Significantly, no perinatal or neonatal deaths occurred in women with high MCR. One of the most important cause of high PNMR and neonatal mortality rate in developing countries is poor MCR, i.e., under utilization of even the existing maternal health services. The main reasons for this under utilization appear to be poverty, illiteracy, ignorance and lack of faith in modern medicine.

PIP: The receptivity of 212 pregnant women in rural Uttar Pradesh, India, to prenatal services provided at their homes was assessed during a May 1987 to April 1988 longitudinal study. The women, from four randomly selected villages, were assessed every month until completion of the neonatal period. Receptivity to doorstep prenatal services was calculated by developing a weighted score based on time when prenatal services began, frequency of visits accepted, number of doses of tetanus toxoid immunization accepted, and place of and person attending the delivery. Of the 212 women, 17% had poor, 75.9% had moderate, and 7.1% had high receptivity to the prenatal services. The pregnancies resulted in 5 stillbirths and 12 neonatal deaths before one week, for a perinatal mortality rate of 81.3/1000. 3 of the 8 infants who were in breech presentation died, 2 infants died from congenital defects, 2 from prematurity, 1 from cord prolapse, 1 from jaundice, 1 from fetal distress, and 2 from unknown causes. Another neonate died of meningitis. The perinatal mortality rates were 90.9, 86.9, and 0/1000 births in women with poor, moderate, and high receptivity scores, respectively. The inverse relationship between maternal care receptivity and the mortality rates was statistically significant. The poor receptivity to home-based prenatal care results from ignorance, illiteracy, and poverty and from a deeply rooted confidence in traditional birth attendants. This study also revealed that anemia persisted in 62.2% of these women even after iron and folic acid supplementation. This study highlights the importance of providing health education to pregnant women to increase their receptivity to maternal care services.

Family planning and tuberculosis.

PIP: The mutual impact of India's family planning program and tuberculosis control program on each other was examined, and the conclusion reached that close cooperation between the 2 programs would have mutually beneficial results. The impact of the diagnosis of pulmonary tuberculosis on the family planning practices of 367 male and 290 female patients at a treatment clinic in Aligarh District was assessed. Prior to diagnosis only 10% of the patients practiced contraception, after diagnosis 19% practiced contraception, and after disease stabilization 29.5% practiced contraception. Among those patients who began practicing contraception after diagnosis, about 1/2 were motivated to practice by their physicians, and the remaining patients were motivated to practice either for economic reasons or because they feared spreading the infectious disease to an infant. About 2/3 of the tuberculosis patients had 3 or more children, and about 90% belonged to the lower socioeconomic class. Among female patients, disease onset occurred for 49.7% within 1 year of childbirth, and for 29.3%, it occurred during pregnancy. These findings suggested that an increase in the acceptance of family planning among members of the lower class and among high parity women would contribute toward decreasing the incidence of tuberculosis in the country. Clients who practiced contraception were also more likely to attend the tuberculosis treatment clinic on a more regular basis than non-practicing clients.^ieng

Trauma patients in an Indian hospital.

The study was carried out at the Emergency Department of Jawaharlal Nehru Medical College Hospital, Aligarh Muslim University, Aligarh, India, to ascertain the pattern of trauma in the patients. A total of 2446 trauma cases were recorded in the year 1987. Accidental falls were the commonest cause of injury, i.e 35.7%, followed by motor-vehicle collisions (23.5%), pedal cyclists (8%), occupational injuries (5.2%) and sports injuries (5.2%). The commonest age group involved was 5-15 years which accounted for 32.8% of all trauma. Fractures (44%) were the most frequently observed nature of injury. Death due to trauma was highest in motor-vehicle collisions (31%) followed by accidental falls (16%), and occupational injuries (12%).

Mothers' attitudes to children's chest infections in India.

Acute Respiratory Infections (ARIs) account for a very high morbidity and mortality amongst children in the developing countries. A knowledge, attitude and practice study in relation to the literacy status of mothers whose children suffered from ARI was conducted. A sample of 140 mothers who had 265 children were selected for the study. The majority of literate mothers (75%) had complete knowledge regarding management of ARI. Literacy alone was not the only factor responsible for developing a positive attitude and adopting correct practices during ARI. Mass media and health personnel played an equally important role. Most women (89.3%) had obtained their knowledge regarding ARI through media and paramedical staff. Most mothers (96.4%) were concerned about the health of their children when they suffered from episodes of ARI and the majority of them (87.2%) were worried because they felt that their children or contacts could be adversely affected. Nearly 72% of mothers took early action during an episode of ARI. The majority of the medical practitioners practised non-allopathic medicine but all of them were prescribing allopathic drugs. Most of the mothers (70%) had no problem in taking their children to the desired health centers when needed.

PIP: In India as in other developing countries, acute respiratory infections (ARIs) are a major cause of morbidity and mortality in children under five years old. In order to correlate the literacy status of mothers with their understanding of ARIs, therefore, a KAP (knowledge, attitude, and practice) survey was administered to a random sample of 140 mothers with 265 children among the registered families of the Urban Health Training Centre in Aligarh, India. It was found that 58 mothers had complete knowledge about the management of ARIs, 61 had partial knowledge, and 21 had no knowledge or failed to respond satisfactorily. Among the 40 literate mothers, 75% had complete knowledge, as compared to only 15.5% of the illiterate mothers. Health personnel were the knowledge sources for 83 mothers; the media provided information for a third of the women; 6.4% gained information from friends, neighbors, or relatives; and 4.3% had no knowledge about ARIs. 71% of the women expressed concern about even a mild case of ARI, 20% were concerned about moderate ARI, and 3.6% expressed no concern at all. The mothers expressed concerns about mortality (25%), resulting weakness (45%), and spreading infection (17%). 71.4% of the mothers sought early treatment for ARIs. 74.3% visited nonallopathic practitioners, and 70% of the mothers had easy access to a treatment source. Whereas literacy had a significant impact on knowledge, it had little relationship with the mother's attitude and practice regarding ARIs. This finding points to the importance of the media in health education efforts.

Anthropometric measurements in rural school children.

Anthropometric measurements of 1012 rural school-going children, selected randomly, were performed. There were 776 males and 236 females in the age group of 5-15 years. The values of weight and height were recorded for every child in the study sample. Age and sex break-up was studied and compared with the ICMR (Indian Council of Medical Research) standard. The comparison made separately for boys and girls showed that the values for both sexes and in all age groups were less than the ICMR standard. The majority (83.6%) of the children belonged to the middle and low social class according to the modified Prasad's classification. An inference is, therefore, drawn that rural school children of middle and low socio-economic status are shorter and lighter as compared with even their own counterparts on whom the ICMR values are based. The state of health of school-going children in India is far from satisfactory despite the fact that school health programmes along with other nutritional programmes have been in operation for several decades. School-going children constitute a sizeable section of India's population, i.e. about 27%, which is easily accessible and also receptive. An early and convenient method of assessing nutritional and socio-economic status of growing children is anthropometry. Physical growth, in terms of weight and height, is considered an important parameter reflecting the pattern of growth and development in a community. In the developing countries, the growing children by and large are deprived of good nutrition on account of their poor socio-economic status, ignorance and lack of health promotional facilities. This nutritional deprivation results in relative stunting of growth.

Prognostic importance of admission versus persistent glycemia in acute coronary syndrome.

BACKGROUND: Whether persistent hyperglycemia (PG) during hospitalisation has a greater impact on adverse outcomes in acute myocardial infarction (AMI) than a single random glucose measurement is not well defined. AIMS: To find out the association of admission glycemia (AG) VS PG on outcomes in patients of ACS. STUDY DESIGN AND METHODS: Prospective, cohort, hospital-based. We evaluated 200 patients of ACS for admission and in-hospital glycemia and their impacts on outcomes. AG was defined as a plasma glucose >198 mg/dl and PG as a random glucose >140 mg/dl at any point during hospitalisation. Demographic and biochemistry including risk factors recorded. A multiple regression was done to evaluate association of various parameters with worse prognosis. RESULTS: Of the 200 patients evaluated, 35 (17.5%) presented with AG. 31 (15.5%) had PG. Males were predominant and 47 (23%) previously known diabetic patients. 62 (31%) had unstable angina, 52 (26%) NSTEMI and 86 (43%) STEMI, between PG and LEF, higher troponin levels and in-hospital mortality and between LEF and age (p<0.001), serum creatinine (p 0.023) and mean in-hospital glucose (p 0.005). F-indices were compared with AG for their ability to discriminate hospitalization survivors from non-survivors. All average glucose metrics performed better than AG. The ability of these models improved as the time window increased (F-indices for admission, mean 24h, 48 h and 72 h were 2.51, 12.05, 8.3 and 5.72, respectively). CONCLUSION: The present study demonstrates that PG is a better discriminator of prognosis than AG in patients of ACS.