Geographical distribution of primary & secondary dengue cases in India – 2017: A cross-sectional multicentric study

Background & objectives: Dengue virus infection is endemic in India with all the four serotypes of dengue virus in circulation. This study was aimed to determine the geographic distribution of the primary and secondary dengue cases in India. Methods: A multicentre cross-sectional study was conducted at Department of Health Research / Indian Council of Medical Research (DHR)/(ICMR) viral research and diagnostic laboratories (VRDLs) and selected ICMR institutes located in India. Only laboratory-confirmed dengue cases with date of onset of illness less than or equal to seven days were included between September and October 2017. Dengue NS1 antigen ELISA and anti-dengue IgM capture ELISA were used to diagnose dengue cases while anti-dengue IgG capture ELISA was used for identifying the secondary dengue cases. Results: Of the 1372 dengue cases, 897 (65%) were classified as primary dengue and 475 (35%) as secondary dengue cases. However, the proportion varied widely geographically, with Theni, Tamil Nadu; Tirupati, Andhra Pradesh and Udupi-Manipal, Karnataka reporting more than 65 per cent secondary dengue cases while Srinagar, Jammu and Kashmir reporting as low as 10 per cent of the same. The median age of primary dengue cases was 25 yr [interquartile range (IQR 17-35] while that of secondary dengue cases was 23 yr (IQR 13.5-34). Secondary dengue was around 50 per cent among the children belonging to the age group 6-10 yr while it ranged between 20-43 per cent among other age groups. Interpretation & conclusions: Our findings showed a wide geographical variation in the distribution of primary and secondary dengue cases in India. It would prove beneficial to include primary and secondary dengue differentiation protocol in the national dengue surveillance programme.

Genetic characterisation of influenza A(H1N1)pdm09 viruses circulating in Assam, Northeast India during 2009�15

Introduction: Influenza A(H1N1)pdm09 virus, since its identification in April 2009, has continued to cause significant outbreaks of respiratory tract infections including pandemics in humans. In the course of its evolution, the virus has acquired many mutations with an ability to cause increased disease severity. A regular molecular surveillance of the virus is essential to mark the evolutionary changes that may cause a shift to the viral behavior. Materials and Methods: Samples of Throat/Nasal swabs were collected from a total of 3715 influenza-like illness cases and screened by Real-time Reverse Transcription-Polymerase Chain Reaction for influenza viruses. Nucleotide sequence analysis was done to identify changes in antigenicity of the virus strains. Results: The present study describes the molecular characteristics of influenza A(H1N1)pdm09 viruses detected in Assam of Northeast India during 2009�15. Influenza A viruses were detected in 11.4% (425/3715), of which influenza A(H1N1)pdm09 viruses were detected in 41.4% (176/425). The nucleotide sequencing of influenza A(H1N1)pdm09 viruses revealed a total of 17 and 22 amino acid substitutions in haemagglutinin (HA) and neuraminidase (NA) genes of the virus, respectively, compared to contemporary vaccine strain A/California/07/2009. The important mutations detected in HA genes of A/Assam(H1N1)pdm09 strains included E391K, K180Q and S202T. Mutation 'N248D' which has an ability to develop oseltamivir resistance was also detected in NA gene of A/Assam(H1N1)pdm09 strains. Conclusions: Regular molecular surveillance of influenza A(H1N1)pdm09 is important to monitor the viral behavior in terms of increase virulence, drug resistance pattern and emergence of novel strains.

Molecular characterisation and phylogenetic analysis of dengue outbreak in Pasighat, Arunachal Pradesh, Northeast India

Background and Objectives: Dengue is one of the most prevalent arboviral diseases in the world with 390 million dengue infections per year. In this study, we report the molecular characterisation of dengue outbreak in Pasighat, Arunachal Pradesh, Northeast India during 2015. Subjects and Methods: A total of 613 dengue-suspected cases were screened for dengue virus by dengue NS1 Ag and anti-dengue IgM antibody depending on the duration of sample collection and onset of symptom. Further, molecular characterisation was done by amplifying the C-PrM region by real-time polymerase chain reaction followed by phylogenetic analysis. Results: Molecular characterisation revealed that the dengue outbreak was predominantly due to dengue virus serotype-1 (DENV-1) (90.9%) while DENV-2 was detected in 7.5% of samples. Co-infection of DENV-1 and DENV-2 was detected in one case. Phylogenetic analysis of the DENV-1 strains with the prototype revealed that the DENV-1 strains were grouped within genotype III. Similarly, DENV-2 strains were clustered within genotype IV. The study revealed a change in the predominant serotype in recent years with DENV-3 in 2012 to DENV-1, 2, 3 and 4 in 2014 to DENV-1 in 2015 in the study region. A unique L24M mutation was observed in the DENV-1 strains of Arunachal Pradesh which was absent in all the circulating strains in India except one strain from the state of Kerala in South India. Marked variation within the DENV-2 strains was observed at A102V and I163V in one strain similar to earlier circulating isolates in India. Conclusions: The present study reveals a shift in the serotype dominance in the study region. As serotype shifts and secondary infection with a heterologous DENV serotype are frequently associated with disease severity, there is an urgent need for sustained monitoring of the circulating serotypes and enhanced surveillance operations, especially in the monsoon and post-monsoon periods to prevent large-scale, severe dengue outbreaks in this region.

Knowledge regarding snake bite in rural Bengal – Are they still lingering on myths and misconceptions.

Introduction: Snake bite is a very common problem in rural India which even today leads to a large number of deaths. This is because the uninformed community members take recourse to harmful traditional healing measures which cause loss of vital time which is very important for the survival of the patient. Objectives: To assess the knowledge of the study population on snake bite and to elicit any association of this knowledge with their demographic and socioeconomic characteristics. Material and methods: An observational, cross-sectional study was done in a village in the Singur Block of Hooghly district of West Bengal. The head of the family or in his absence the senior most members was interviewed with a pre-designed, pre-tested schedule. Results: Farming was the occupation of the majority (36%) followed by business (20.6%) and service (17.7%). 45% belonged to the social class I and II (modified B.G. Prasad) while 39% were in the social class IV and V. Only 58.85% of the study population were aware that the incidence of snake bite can be reduced. 68% were aware of immobilisation of the affected part was the initial first aid measure and only 4% had the correct knowledge that application of collar was unnecessary and harmful. . Correct knowledge on the availability of specific treatment was present among 85.1% and 77.1% knew where specific treatment is available. Education OR 2.51 (1.26 – 5.00), Occuption OR 4.44 (2.35-8.40), PCI OR 2.05 (1.12-3.76) were significantly associated with good knowledge. Conclusion: There is a paucity of knowledge on different domains of snakebite. Hence dissemination of correct knowledge is necessary to remove their misconceptions.

Chronic Smoking, a Cause for Development of Peripheral Neuropathy in Chronic Obstructive Pulmonary Disease.

Background: Cigarette smoking is the most commonly encountered risk factor for COPD, and causes COPD by its noxious particles and or gases. Cigarette smoke contains some neurotoxin substances that might be important in the pathogenesis of peripheral neuropathy. Objective: To determine whether the effect of the duration of smoking leads to development of peripheral neuropathy in different groups of the COPD patients as measured by nerve conduction studies of upper extremities Material and Methods: The nerve conduction test, of the median and ulnar nerves of the upper extremities, was performed on the subjects (study and control group), who were assessed for their anthropometric measurements, history regarding pack years, the pulmonary function tests, SpO2 levels. Results: Significant difference was found between smoking history in pack years and in the values of Nerve Conduction Velocity of the nerves of upper extremities in different groups of COPD patients, which was found to be statistically significant at p<0.001. Conclusion: A decrease in nerve conduction velocity was observed in the nerves of upper extremities as duration of smoking in pack years increased in the different groups of COPD patients.

Modulation of anaerobic biomarker and lung functions by Rajyoga meditation in young badminton players.

Background: Exercises of different forms, if performed regularly, have a beneficial effect on the various systems of the body. Badminton is claimed to be the world’s fastest racket sport. Aside the technical, tactical, and training aspects of modern competitive badminton, the physical demands are continually changing. Relaxation techniques like Rajyoga meditation have been used in sport primarily to enhance recovery from training and competition, manage anxiety and improve performance. Aims & Objective: To compare the efficacy of physical performance in badminton players, before and after with regard to Rajyoga meditation. Material and Methods: 35 male badminton players were studied prospectively before and six months after practicing Rajyoga meditation. Blood lactate concentration and Pulmonary functions were assessed immediately after 10 minutes of exercise. Other Physical Parameters like BMI, pulse rate, blood pressure were also assessed before and after 6 months of meditation and analysed using longitudinal study. Results: Student’s paired ‘t’ test was used to compare pre & post interventional results. After the relaxation training, blood lactate concentration after exercise was significantly decreased (p<0.05). All parameters of lung functions showed statistical improvements after meditation, there was significant differences with regard to BMI, blood pressure and pulse rate all were significantly decreased (p<0.05). Conclusion: The results obtained emphasize the beneficial effect of Rajyoga meditation. Finding of the present study suggests that Rajyoga meditation can alter blood lactate levels and pulmonary functions after exercise.

Correlation between glycated haemoglobin and glucose testing for diabetes mellitus screening.

Hemoglobin A1C is used to screen and diagnose diabetes but measurement of glucose in the blood is subject to several limitations, many of which are not widely appreciated. Blood glucose testing should be taken into consideration before taking the patient to be diabetic on the basis of abnormal HbA1c values.

"Nonunion of Adult Humerus Fracture" - Management Using the Ilizarov External Fixator.

Humeral shaft fractures occur about three percent of all fractures in adults. A very high union rate is achieved with non-operative treatment, however when nonunion occurs conservative approach or after operative management they are often very difficult to treat, and often requires multiple procedures to achieve union. Even with multiple procedures, true pseudoarthrosis have only a 59% union rate. The aim of this study was to find out the results of such complicated cases treating with Ilizarov's external fixator. We conducted a prospective study of eleven patients with nonunion humeral shaft fracture in adult wherein the outcome of the treatment was analyzed. In our series we achieved union in all of the cases with a mean of 29.1 weeks with negligible complications like pin tract infections and in one case refracture occur due to forceful manipulation. So it can be concluded that Ilizarov's method is an excellent option for the treatment of nonunion of diaphyseal fracture of the humerus.

Comparison study of clinicoradiological profile of primary lung cancer cases: An Eastern India experience.

Context: According to the first population-based cancer registry from eastern part of India, Kolkata and its surrounding areas have the highest prevalence of lung cancer in India. However, there is very limited data from this part of the country. Aims: The aim of this study is to find out the demographic and clinicoradiological profile of primary bronchogenic carcinoma. Settings and Design: This is a retrospective review of lung cancer cases diagnosed in two tertiary institutes of Kolkata over a period of 4 years. Materials and Methods: We have reviewed the cases with proven histological or cytological diagnosis of primary bronchogenic carcinoma and chi-square test is done to calculate statistical significance. Results: Out of 607 patients, male 489 and female 118, 67.7% are from rural area, 67.2% are smoker and only 9.4% are ≤40 years of age. Smoking is the major risk factor for primary lung cancer (P = 0.000) but no significance could be established with the different histological subtypes (P = 0.207). Though squamous cell carcinoma (SCC) is the most predominant variety (35.1%), adenocarcinoma and undifferentiated type are overrepresented in ≤40 years. SCC occurs at a significantly higher age group (60.84 ± 12.16 years) than other subtypes (P = 0.000). At least 55.2% cases of nonsmall cell lung cancer and 54% of small cell lung cancer presented in very advanced stage. Conclusions: SCC is the most common histological subtype of primary bronchogenic carcinoma. The relatively increased frequency of adenocarcinoma in our study as compared to other studies from India is probably due to higher proportion of nonsmokers.

Population-specific left ventricular hypertrophy in three groups from the northeastern region of India.

Background. People living in the hills are continuously exposed to strenuous physical activity for their day-to-day work. Besides hypertension, left ventricular hypertrophy in different populations may be related to continuous physical activity. Methods. Electrocardiogram, blood pressure and sociodemographic information of 12 252 subjects >30 years of age from three different population groups living in Mizoram (hilly) and Assam (plain) were recorded. Of them, 8058 were from Mizoram and 3180 and 1014 were indigenous Assamese and tea garden workers of Assam. Results. Among the subjects from Mizoram the percentage of smokers (41.9%), mean (SD) BMI (21.9 [3.8]) and waist– hip ratio (0.87 [0.02]) were significantly higher than in those from other groups. Tea garden workers had a higher mean systolic blood pressure (145.2 [25.7]) and diastolic blood pressure (87.6 [13.6]). The prevalence of left ventricular hypertrophy was highest among tea garden workers (16.5%) followed by people from Mizoram (3.7%) and the indigenous Assamese (2%) people. In spite of a significantly higher prevalence of hypertension among the indigenous Assamese community than among those from Mizoram, left ventricular hypertrophy was found to be lower in the former. Conclusion. High prevalence of left ventricular hypertrophy among tea garden workers was possibly related to a higher prevalence of hypertension but the higher prevalence of left ventricular hypertrophy among people from Mizoram might be related to more physical activity.

Evaluation of the usefulness of phage amplification technology in the diagnosis of patients with paucibacillary tuberculosis.

The present study was undertaken to assess the performance of the Fast Plaque TB(TM) (FPTB) test in the diagnostically difficult group of paucibacillary tuberculosis (TB) and to compare its results with the conventional bacteriological methods. The study was conducted on a total of 139 patients, who were negative for TB in sputum-smear examination. Bronchoalveolar lavage (BAL) or pleural biopsy specimens collected from these patients were subjected to smear examination, LJ culture and FPTB test. The smear, culture and the FPTB positivity rates were compared between patients with pulmonary and pleuro-pulmonary involvement. The FPTB test was found to register an overall sensitivity of 58.8% and specificity of 97.9%. The positive and negative predictive values of the test were 98.1 and 56.5, respectively. Among patients with paucibacillary TB, on head-to-head comparison, we found that the sensitivity and specificity values of the FPTB test were marginally better than smear-microscopy and inferior to culture on LJ media.

Circulating genotypes of hepatitis B virus in Arunachal Pradesh.

BACKGROUND & OBJECTIVE: There is a paucity of information on distribution of hepatitis B genotypes from northeastern part of India. Arunachal Pradesh, one of the northeastern State of India bordering Bhutan, China and Myanmar, reported abnormally high numbers of hepatitis B surface antigen (HBsAg) positive cases in one of its districts during January-June 2005. We conducted this study in the subsequent months (August-December 2005) to know the prevalent genotypes by a rapid and specific method based on type-specific primers in Upper Dibang valley of Arunachal Pradesh. METHODS: A total of 438 randomly selected individual were screened for HBsAg positivity. Of the 93 HBsAg positive individuals, 36 HBsAg and HBV DNA positive samples were processed for HBV genotyping using type-specific primer based nested PCR (TSP-PCR). Representative samples were retested with RFLP-PCR based genotyping and nucleotide sequencing. RESULTS: Of the 36 samples, 29 (80.1%) could be genotyped by the TSP-PCR based method used. The predominant genotype was genotype A (41.6%) followed by genotypes C (27.8%) and D (11.1%). Seven isolates (19.9%) could not be genotyped by this method. INTERPRETATION & CONCLUSION: The presence of genotype C in this part of the country needs attention as genotype C takes a more aggressive disease course. Also, detection of genotype C in this isolated community bordering Tibet suggests viral gene flow from Tibet or other South-east Asian countries where genotype C of HBV is predominant.

Hyperendemic foci of hepatitis B infection in Arunachal Pradesh, India.

AIM: To study the prevalence of hepatitis B virus (HBV) infection among an isolated tribe of Northeast India that migrated long back from Tibet. METHODS AND MATERIALS: Randomly selected 438 subjects from Idu Mishmi tribe of Arunachal Pradesh were screened for hepatitis B surface antigen (HBsAg), hepatitis B core antibody (anti-HBc), hepatitis B surface antibody (anti-HBs), envelope antigen (HBeAg) using ELISA kits. RESULTS: The point prevalence of HBsAg was found to be 21.2% (93/438). Anti-HBc prevalence was 92.3% (193/209). Anti-HBs above 10 IU/ml were detected in 48% (96/200). Prevalence of HBeAg was higher (42.1%, 16/38) in children (less than 15 years) compared to adolescent and adults (32.7%, 18/55). History of hepatitis was significantly associated with positive HBsAg status (p < 0.000). CONCLUSION: Hepatitis B virus infection is hyperendemic among Idu Mishmi tribe of Arunachal Pradesh, India. Though, the route of transmission could not be ascertained, but the high HBV infection (78.6%) among less than 5 yrs and the finding of 58.4% of HBsAg positive mothers bearing HBsAg positive child indicates possibility of vertical transmission in this setting.

Comparison of immunoreactive proteins of commonly circulating serogroups of Leptospira in Andaman Islands, India.

BACKGROUND & OBJECTIVE: Early diagnosis is the key to the treatment of leptospirosis. For development of rapid diagnostic kits, a thorough knowledge about the nature of the proteins expressed by the pathogen during infection is necessary. The present study was undertaken to understand the nature of immunoreactive proteins from commonly circulating serogroups of Leptospira in the endemic Andaman and Nicobar Islands, India. METHODS: Proteins were extracted from six strains of Leptospira representing five different serogroups following four different preparation methods, viz., whole cell lysis by sonication, detergent solubilization, outer and inner membrane isolations, and were subsequently characterized on sodium dodecyl sulphate-polyacrylamide gel electrophoresis (SDS-PAGE). Immunoblots were made from the sonicated proteins using hyperimmune rabbit antisera, homologous and heterologous patient sera separately. RESULTS: The 67, 65, 45, 43, 35, 32 and 18 kDa major proteins in the whole cell lysate were common among all the five serogroups of Leptospira. The 67, 41, 35, 32, 28 and 22 kDa were the major outer membrane proteins, while 94, 32, 25 and 18 kDa protein were in inner membrane. Immunoblots with hyperimmune rabbit antisera detected 67, 65, 60, 45, 43, 41 and 32 kDa common proteins from the whole cell lysates of all strains while homologous and heterologous patient sera detected 32 kDa as the major immunoreactive protein in all pathogenic serogroups. This protein reacted against specific LipL32 antisera indicating that this protein was LipL32. INTERPRETATION & CONCLUSION: The circulating serogroups of Leptospira have common nature of expression of proteins during human infection. Among several immunoreactive proteins, three (67, 45 and 32 kDa) were recognized as major antigens by both rabbit hyperimmune sera and patients sera while the 32 kDa protein was recognized as the major immunoreactive protein by homologous and heterologous patient sera. These conserved immunoreactive proteins could be utilized in developing indigenous diagnostic tests for leptospirosis.

Hypertension in the native rural population of Assam.

BACKGROUND: Recent studies have reported an increasing prevalence of hypertension in India. However, there are few epidemiological data with regard to the occurrence of hypertension in the native population of Assam. METHODS: Three thousand one hundred and eighty individuals (1441 men and 1739 women), > or =30 years of age and from 25 villages of 5 districts in Assam were selected by the stratified random sampling method. They were interviewed and their blood pressure measured along with other anthropometric variables. Hypertension was defined according to the Sixth Report of the Joint National Committee on prevention, detection, evaluation and treatment of high blood pressure (JNC-VI). RESULTS: The overall prevalence of hypertension was 33.3%. Among the patients with hypertension, 21.6% were aware of their illness. The determinants of hypertension were age, intake of extra salt in the diet, body mass index and waist-hip ratio (derived by multiple logistic regression analysis with backward elimination of non-significant factors). Multivariate analysis showed that females had a higher risk of hypertension than males. CONCLUSION: The prevalence of hypertension in the native population of Assam is high. Implementation of an effective awareness programme with lifestyle modifications is necessary to control the cardiovascular disease burden in this population.

Molecular tools in leptospirosis diagnosis and characterization of isolates.

The incidence of leptospirosis in human beings has been increasing in recent years. Early diagnosis and treatment can prevent complications and reduce mortality. The conventional laboratory methods for diagnosis rely on the demonstration of leptospires in clinical specimens, recovering the organisms in culture or the demonstration of antibodies to leptospires. Demonstration techniques have low sensitivity and specificity. Leptospires grow slowly and the positivity rate in culture is very low. Although microscopic agglutination test has been the cornerstone of serological diagnosis, the procedure is complex. New tests, like ELISA, dipstick test, lateral flow, etc, are relatively simple and rapid, but sensitivity is low during the early stages of the disease. The cross agglutination absorption test (CAAT) and typing with monoclonal antibodies (MCA) are the techniques used for serological characterization. These techniques are complicated and might not help in the case of certain serogroups. An alternate method for early diagnosis and characterization focuses on DNA-based techniques. Polymerase chain reaction (PCR), in situ hybridization etc are some of the methods used for early diagnosis, whereas restriction endonuclease analysis (REA), random amplified polymorphic DNA (RAPD) fingerprinting, arbitrarily primed PCR (AP-PCR), pulsed field gel electrophoresis (PFGE), ribotyping and DNA sequencing are useful for characterization. PCR is the most popular and quickest method for diagnosis. It can detect even if only a small number of organisms are present in a clinical sample. Fingerprinting tools such as RAPD, REA, RFLP, PFGE etc translate the complex genetic code into easily recognizable patterns, which facilitates characterization of the isolates up to sub-serovar level.

A case of chronic osteomyelitis due to arcanobacterium hemolyticum.

We report here a case of chronic osteomyelitis, which appeared to be tubercular, from the clinical, radiological and histopathological points of view. But on culture an unusual bacterium, Arcanobacterium hemolyticum, was isolated and the patient responded to treatment with clindamicin, prescribed in accordance to the sensitivity reports.