APRI as a predictor of severe dengue fever.

Introduction: The AST/platelet ratio index (APRI) is a well-researched indicator of liver fibrosis. Some studies have shown that APRI can be used as a predictor of severe dengue, but the data is limited. As dengue epidemics are common in our country with limited healthcare resources, we believe APRI can help emergency physicians/primary physicians in predicting the severity of dengue and plan for the appropriate use of limited healthcare resources. Objective: 1) To determine the utility of APRI as a predictor of severe dengue. 2) To determine the association of APRI with length of hospital stay and platelet requirement. Materials and Methods: A retrospective cross-sectional study was done on patients presented to the Emergency Medicine department at Travancore Medicity Medical College with a positive Dengue NS1 antigen or IgM antibody. Results: We found from the univariate analysis results that ALT > 74.5 IU/L has a sensitivity of 59.6 and a specificity of 76.3 (AUC: 0.696; 95% CI: 0.606-0.786), AST > 160.5 IU/L has a sensitivity of 42.3 and a specificity of 93.7 (AUC: 0.747; 95% CI: 0.665-0.829), and APRI > 3.2 has a sensitivity of 69.2 and a specificity of 84.2 (AUC: 0.806; 95% CI: 0.72-0.884) to predict severe dengue. Patients with an APRI of >3.2 required a mean hospital stay of 5.47 days (P = 0.005); 27 (81.8%) requiring platelet transfusion had an APRI of > 3.2 (P = 0.00). Conclusion: APRI is a straightforward index that can be easily derived from AST and platelet values. APRI values of >3.2 can predict severe dengue with a sensitivity of 69.2 and a specificity of 84.2. APRI values of >3.2 are also associated with the length of hospital stay and requirement of platelet transfusion.

Chest CT severity score as a predictor of mortality and short-term prognosis in COVID-19.

Background: As India was slowly coming out of shock from the second wave wrecked by the Delta strain, the world population is now struck once again with a new strain of coronavirus disease 2019 (COVID-19), designated as B.1.1.529, named as OMICRON. Though several international studies have evaluated the role of computed tomography (CT) in diagnosis, predicting prognosis, and monitoring the progression of disease, to our best knowledge, there are no Indian studies published in this context. Objective: (1) To determine the use of chest CT severity score as predictor of mortality in COVID-19 patients. (2) To determine the prognosis based on length of hospital stay. Materials and Methods: A observational cohort study was done at Travancore Medical College Hospital. A retrospective analysis of patients who presented to the Emergency Medicine Department with a positive COVID antigen or reverse transcriptase-polymerase chain reaction (RT-PCR) results and those who underwent a CT chest at the time of presentation was conducted. Data was analyzed by using Statistical Package for Social Sciences (SPSS) version 16. Descriptive statistics such as mean, frequency, and percentages were calculated. Chi-square test was used to find the statistical significance. The Kaplan-Meier method was used to evaluate the relationship between CT score and mortality, which was compared with the log-rank test. Results: A total of 252 patients with positive COVID antigen or RT-PCR who underwent CT chest were included in our study. Our study population was composed of 139 (55.2%) males and 113 (44.8%) females. Only one patient with mild CT severity score required >14 days of ICU stay, whereas two (2%) and five (9.6%) patients with moderate and severe CT severity score, respectively, required ICU stay for >14 days. The P value was 0.001, which again is statistically significant. In our study, out of 44 patients categorized under mild CT severity score, only two (4.5%) patients had expired. Out of 98 patients categorized under moderate CT severity score, 14 (14.3%) patients had expired, whereas out of 52 patients categorized under severe CT severity score at the time of admission, 25 (48.1%) patients had expired. The P value was 0.001, which is statistically significant. Conclusion: Our study could prove that patients with CT severity score ≥15 had high risk of mortality and required prolonged ICU stay of >5 days. CT severity score helps the primary care physicians to predict probable outcome and length of hospital stay at the time of admission itself and allocate the limited resources appropriately.

Higher risk of developing active TB among adult diabetics exposed to TB during childhood: A study from Kerala, India.

INTRODUCTION: Factors associated with tuberculosis (TB) in Kerala, the southern Indian state that notifies approximately 33 microbiologically confirmed new cases per 100,000 population every year for the past two decades, are still unclear. We did a community-based case-control study in Kollam district, Kerala, to identify the individual-level risk factors for TB. METHODS: Structured questionnaire was applied to 101 microbiologically confirmed new TB cases registered under Revised National Tuberculosis Control Program and 202 age- and gender-matched neighborhood controls without present or past TB. Information was sought on socioeconomic status (SES), smoking, consumption of alcohol, close contact with active TB during childhood or recent past, diabetes mellitus (DM), and other comorbid conditions. RESULTS: Close contact with TB during childhood [odds ratio (OR) 15.88, 95% confidence interval (CI) 3.21-78.55], recent close contact with TB (OR 4.81, 95% CI 2.09-11.07), DM (OR 1.64, 95% CI 1.04-3.06), SES (OR 2.16, 95% CI 1.16-4.03), smoking more than 10 cigarettes/beedis per day (OR 3.32, 95% CI 1.27-8.96), consuming more than 10 standard drinks per week (OR 2.91, 95% CI 1.33-6.37), and the interaction term of having close contact with TB during childhood and DM at present (OR 7.37, 95% CI 1.18-50.29) were found to be associated with TB. CONCLUSION: Close contact with a case of TB, presence of DM, lower SES, smoking, and alcohol consumption were associated with active TB in Kollam. Having close contact with a case of TB during childhood and development of DM in later life together are significantly associated with active TB in the study population. The findings also direct further studies to confirm and explore mechanisms of interaction of diabetes with childhood exposure to TB.