A Study of Prognostic Markers for Dengue Infection

Introduction: Early diagnosis and prognostication of infections such as dengue are crucial for better patient outcomes, as they help predict the likelihood of patients developing severe dengue, allowing more comprehensive patient triage and therapeutic interventions. This study aimed to determine clinical, laboratory, and radiological factors predicting prognosis in dengue infection. Methods: This prospective observational study included 250 patients seropositive for dengue. They were classified into dengue fever (DF), dengue hemorrhagic fever (DHF), and dengue shock syndrome (DSS); and evaluated both on admission and at the end of their hospital course, the latter was performed for factors responsible for the progression of dengue to severe dengue. Data were statistically analyzed using R 3.6.1, with P<0.05 considered statistically significant. Results: Final diagnosis correlated significantly with systolic blood pressure (P=0.004), lowest platelet count (P<0.001), serum glutamic-oxaloacetic transaminase (P=0.001), urine protein (P<0.001), urine red blood cells (P<0.001), pleural effusion (P=0.0064), serositis (P<0.001), vomiting (P<0.001), rash (P<0.001), restlessness (P<0.001), and bleeding manifestations (P<0.001). Conclusion: The prognosis of dengue is significantly associated with blood pressure, lowest platelet count, serum transaminases, serum creatinine, proteinuria, hematuria, pleural effusion, abdominal pain, persistent vomiting, rash, restlessness, serositis, and bleeding manifestations. Monitoring these parameters is useful for the effective management of dengue.

Iteratively reweighted ℓ1-ℓ2 norm minimization using wavelets in inverse scattering: publisher's note

This publisher's note corrects the author list in J. Opt. Soc. Am. A37, 680 (2020).JOAOD60740-323210.1364/JOSAA.381365.

Iteratively reweighted ℓ1-ℓ2 norm minimization using wavelets in inverse scattering

Recently, many techniques have been employed to solve inverse scattering problems by exploiting the sparsity of the scatterer in the wavelet basis. In this paper, we propose an iteratively reweighted $ {\ell _1} $ norm regularization scheme within the settings of the Born iterative method (BIM) to effectively leverage the sparsity of the wavelet coefficients. This "iteratively reweighted $ {\ell _1} $ minimization" method is then used along with $ {\ell _2} $ norm minimization in order to achieve solutions that are not over-smoothened at the discontinuities. The proposed method is an expansion of a well-known joint $ {\ell _1} {-} {\ell _2} $ norm minimization technique. The advantage offered by the algorithm is that the reconstruction is now independent of the initial choice of weights. This technique accounts for the fact that sparsity is concentrated more in the detail wavelet coefficients rather than their coarse counterpart. The effectiveness of the method is demonstrated using several 2D inverse scattering examples by employing it in each iteration of the BIM.

P6378Characteristics of hypertensive iron ore miners with oral glucocorticoid induced diabetes mellitus and compromised lung function

Introduction

Oral glucocorticoids are efficacious agents for treating respiratory diseases, with high risk to induce metabolic diseases including diabetes and hypertension

Purpose

To analyse the hypertensive patient population from the rural setting on ongoing glucocorticoid treatment and diagnosed as diabetic due to the extensive chronic methylprednisolone equivalent glucocorticoid dose of more than 4 mg/day for at least 3 months for treatment of respiratory ailments due to occupational hazard

Methods

We diagnosed the identified and analysed a subset of patients from the Redi iron ore miners (n=25,500), who were newly diagnosed diabetics (n=1100) and with associated systemic hypertension (systolic BP >140 mmHg, diastolic BP > than 90 mmHg). Patients diagnosed as Oral Glucocorticoid Induced Diabetes Mellitus (GIDM) and hypertensives (n=847; 572 males and 275 females) were characterised on metabolic parameters. t-test was utilised for statistical analysis

Results

We observed a high incidence of GIDM (4.31%) with a high rate of hypertension (77%, 847/1100). Mean SBP was 150 mmHg (SD ± 9.9, 95% CI 147–152), mean DBP was 90 mmHg (SD ± 8.9, 95% CI 88–92). BMI in GIDM with hypertension (GIDM-H) group was similar to GIDM group (26 kg/m2) (Table), with relatively older age in GIDM–H (53 vs 51 years). The glycemic parameters were relatively more deranged in GIDM-H group. There was significant correlation for a high propensity of relatively younger <50 years (n=506) and near normal weight people with BMI <26 kg/m2 (n=594) to develop GIDM (p=0.006)

Metabolic Parameters GIDM Vs GIDM-H Mean ±SD, min, max, 95% CI GIDM (n=1100) GIDM with Hypertension (n=847) Age (yrs) 51 (SD ±14, 95% CI 48–54) 53 (SD ±13, 95% CI 50–56) HbA1c (%) 7.1 (SD ±0.62, 95% CI 7–7.3), 7.2 (SD ±0.60, 95% CI 7.1–7.3) BMI (kg/m2) 26 (SD ±3.6, 95% CI 25–27) 26 (SD ±3.4, 95% CI 25–27) Fasting Plasma Glucose (mg/dl) 146 (SD ±49, 95% CI 136–155) 149 (SD ±48, 95% CI 138–160) Post Prandial Glucose (mg/dl) 207 (SD ±74, 95% CI 192 - 221) 212 (SD ±74, 95% CI 195–228)

Conclusions

The high rates of hypertension in patients with GIDM is an alarmingly problem which has pronounced harmful comorbid implications, especially in younger, economically productive population in limited resource setting. The health care professionals need to be educated to limit use of glucocorticoids to inhalational therapy with minimal systemic effects. Specific pathophysiological approach to address the steroid induced insulin resistance, strategies to reduce cardiovascular risk and damage, makes treatment of hypertension and GIDM difficult, which calls for action to limit the mining activities and mitigate risk of chronic complications

Evaluation of near infrared spectroscopy as screening tool for detecting intracranial hematomas in patients with traumatic brain injury

Background

Traumatic Brain Injury (TBI) is one of the most common surgical emergencies in service hospitals of India. Computed tomography (CT) has been a consistent and reliable technique for detecting intracranial hemorrhages but is limited by its non-availability in most service hospitals. Therefore the need for a cheaper, portable and easily available option required to be explored. The aim of this study was to determine the sensitivity, specificity, Positive Predictive Value (PPV) and Negative Predictive Value (NPV) of Near Infra Red Spectroscopy (NIRS) against the gold standard of NCCT head.

Methods

An observational, prospective study was conducted in 100 patients of closed head injury, attending the emergency department or surgical OPD of a service zonal hospital with NIRS. All these patients were subsequently subjected to NCCT head. Sensitivity, specificity, and positive and negative predictive values of NIRS were calculated. The study was conducted from Oct 2010 to Jul 2012.

Results

All the 100 patients were evaluated with NIRS and subsequently subjected to NCCT head. The results were compiled and statistical analysis of the same was conducted. The data revealed a sensitivity of 58.46%, a specificity of 42.86%, a positive predictive value of 65.52% and a negative predictive value of 35.71%.

Conclusion

Near Infra Red Spectroscopy (NIRS) is a good screening tool for prediction of intra cerebral haemorrhage in the field and even intensive care units. This was the first study of its kind in the Indian subcontinent and the results suggest that NIRS is a good device to predict intracranial subdural and epidural haematomas. It is however not superior to computer tomography and magnetic resonance imaging.

Hydrogen peroxide test for intraoperative bile leak detection

BACKGROUND

Bile leakage (BL) is a common complication following liver surgery, ranging from 3 to 27% in different series. To reduce the incidence of post-operative BL various BL tests have been applied since ages, but no method is foolproof and every method has their own limitations. In this study we used a relatively simpler technique to detect the BL intra-operatively. Topical application of 1.5% diluted hydrogen peroxide (H₂O₂) was used to detect the BL from cut surface of liver and we compared this with conventional saline method to know the efficacy.

METHODS

A total of 31 patients included all patients who underwent liver resection and donor hepatectomies as part of Living Donor Liver Transplantation. After complete liver resection, the conventional saline test followed by topical diluted 1.5% H₂O₂ test was performed on all.

RESULTS

A BL was demonstrated in 11 patients (35.48%) by the conventional saline method and in 19 patients (61.29%) by H₂O₂ method. Statistically compared by Wilcoxon signed-rank test showed significant difference (P = 0.014) for minor liver resections group and (P = 0.002) for major liver resections group.

CONCLUSION

The topical application of H₂O₂ is a simple and effective method of detection of BL from cut surface of liver. It is an easy, non-invasive, cheap, less time consuming, reproducible, and sensitive technique with no obvious disadvantages.

A population-based screening program for early detection of common cancers among women in India - methodology and interim results

BACKGROUND

Cancers of the uterine cervix, breast, and oral cavity accounted for 134,420, 115,251, and 24,375 cases, respectively, and were responsible for 52.8% of the total cancers among women in India in 2008.

AIM

The major objectives were to create awareness regarding common cancers among women, to detect pre-cancers of the uterine cervix and oral cavity, and early cancers of the breast, uterine cervix, and oral cavity, by conducting screening with simple, low-cost technology, within the community, and to facilitate confirmation of diagnosis among the screen positives and treatment and follow-up among the diagnosed cases.

SETTINGS AND METHODS

This is a community-based screening program for early detection of breast, uterine cervix, and oral cancers, being implemented among the socioeconomically disadvantaged women in Mumbai, India. The process involves selection of clusters, household surveys, health education, and screening the eligible women for breast, uterine cervix, and oral cancers, by primary healthcare workers, at a temporarily set-up clinic within the community. The program is planned to cover a 125,000 disadvantaged population in five years.

RESULTS

Twenty-one thousand and fifteen people, with 4009 eligible women, have been covered to date. The compliance for screening for breast, cervix, and oral cavity has been 85, 70, and 88% and the screen positivity rates are 3.9, 14.9, and 3.9%, respectively. Twenty-seven oral pre-cancers, 25 cervix pre-cancers, one invasive cancer of the breast, two of the cervix, and one oral cavity cancer have been diagnosed among the screened women and all of them have complied with the treatment.

CONCLUSIONS

The program is raising awareness about the common cancers and harms of tobacco among the disadvantaged women population in Mumbai. It is also helping in detecting pre-cancers and cancers among asymptomatic women and is assisting them in receiving treatment.

The effect of laparoscopic sleeve gastrectomy (LSG) on glycemic control in morbidly obese patients

INTRODUCTION

Bariatric procedures have become popular in treating not only the morbid obesity but also the metabolic derangements. Sleeve Gastrectomy has recently become popular as a standalone procedure and its usefulness as a metabolic procedure especially glycemic control is still under investigation. One of the most commonly used measure of insulin resistance is statistically derived 'Homeostatic model assessment of insulin resistance (HOMA-IR).

AIM

The effect of Laparoscopic Sleeve Gastrectomy (LSG) on clinical and measurable change in glycemic control as seen by reduction of insulin resistance ie HOMA-IR levels in morbidly obese patients.

MATERIAL AND METHODS

All the patients with BMI ≥35 kg/m(2) with co morbidities and BMI ≥40 kg/m(2) even without co morbidities were included in the study. The period of the study was from Feb 2013 to Sep 2014. Fasting (FBS), post prandial blood sugar (PPBS) and Insulin levels were checked before the surgery, 1month and 3 month after the surgery. We also recorded BMI and diabetic status. HOMA-IR was calculated and trends were recorded.

STATISTICAL ANALYSIS

Statistical analysis was carried out using SPSS 16.0.

RESULTS

Out of 28 patients 8 were males and 20 were females. The mean age was 43 yrs. 11 (39%) patients were diabetic and mean BMI was 44 kg/m(2) and a range of (35-61.3) kg/m(2). 11 patients had BMI > 45 kg/m(2). The HOMA-IR values decreased significantly after the surgery both in diabetics and non diabetics.

CONCLUSION

LSG results in improvement in glycemic control in both diabetics and non diabetics.

Design of the 1.5 MW, 30-96 MHz ultra-wideband 3 dB high power hybrid coupler for Ion Cyclotron Resonance Frequency (ICRF) heating in fusion grade reactor

Design and developmental procedure of strip-line based 1.5 MW, 30-96 MHz, ultra-wideband high power 3 dB hybrid coupler has been presented and its applicability in ion cyclotron resonance heating (ICRH) in tokamak is discussed. For the high power handling capability, spacing between conductors and ground need to very high. Hence other structural parameters like strip-width, strip thickness coupling gap, and junction also become large which can be gone upto optimum limit where various constrains like fabrication tolerance, discontinuities, and excitation of higher TE and TM modes become prominent and significantly deteriorates the desired parameters of the coupled lines system. In designed hybrid coupler, two 8.34 dB coupled lines are connected in tandem to get desired coupling of 3 dB and air is used as dielectric. The spacing between ground and conductors are taken as 0.164 m for 1.5 MW power handling capability. To have the desired spacing, each of 8.34 dB segments are designed with inner dimension of 3.6 × 1.0 × 40 cm where constraints have been significantly realized, compensated, and applied in designing of 1.5 MW hybrid coupler and presented in paper.

Detection of mutations in mtrR gene in quinolone resistant strains of N. gonorrhoeae isolated from India

BACKGROUND AND OBJECTIVES

Emergence of multi-drug resistant Neisseria gonorrhoeae resulting from new genetic mutation is a serious threat in controlling gonorrhea. This study was undertaken to identify and characterise mutations in the mtrR genes in N.gonorrhoeae isolates resistant to six different antibiotics in the quinolone group.

MATERIALS AND METHODS

The Minimum inhibitory concentrations (MIC) of five quinolones for 64 N.gonorrhoeae isolates isolated during Jan 2007-Jun 2009 were determined by E-test method. Mutations in MtrR loci were examined by deoxyribonucleic acid (DNA) sequencing.

RESULTS

The proportion of N.gonorrhoeae strains resistant to anti-microbials was 98.4% for norfloxacin and ofloxacin, 96.8% for enoxacin and ciprofloxacin, 95.3% for lomefloxacin. Thirty-one (48.4%) strains showed mutation (single/multiple) in mtrR gene. Ten different mutations were observed and Gly-45 → Asp, Tyr-105 → His being the most common observed mutation.

CONCLUSION

This is the first report from India on quinolone resistance mutations in MtrRCDE efflux system in N.gonorrhoeae. In conclusion, the high level of resistance to quinolone and single or multiple mutations in mtrR gene could limit the drug choices for gonorrhoea.

Electromagnetic cloaking in convex and concave media with surface modelled as a parameterised function

The onset of transformation optics has opened avenues for designing of a plenitude of applications related to propagation of electromagnetic waves in anisotropic media. In this paper, an algorithm is proposed using a coordinate transformation and a piecewise function for the purpose of designing a three dimensional cloak having an arbitrary geometry which could be convex or non-convex in nature. The surfaces of the cloak as well as of the body under consideration are assumed to be conformal to each other. For an arbitrary geometry, the coordinate system needed to model the surface can be a non-orthogonal system. For the purpose of verification of the algorithm, a ray tracing process is carried out for an ellipsoid as well as for a concave surface having axial symmetry. In order to solve the Hamiltonian equation for the purpose of ray tracing, the process of finding the derivatives analytically, for an arbitrary geometry as considered here, becomes very cumbersome. Here, a numerical method is described which provides a better approximation to the partial derivatives than the conventional finite difference approach based on forward differences.

Community-based tobacco cessation program among women in Mumbai, India

BACKGROUND

Globally tobacco epidemic kills nearly six million people annually. Consumption of tobacco products is on the rise in low- and middle-income countries. Tobacco is addictive; hence, tobacco users need support in quitting.

AIMS

Providing tobacco cessation services to women in community enabling them to quit tobacco, identifying factors associated with quitting and documenting the processes involved to establish a replicable "model tobacco cessation program."

SETTINGS AND DESIGN

This is a community based tobacco cessation program of one year duration conducted among women in a low socioeconomic area of Mumbai, India.

SUBJECTS AND METHODS

It involved three interventions conducted at three months interval, comprised of health education, games and counseling sessions and a post intervention follow-up.

STATISTICAL ANALYSIS

Uni and multivariate analysis was performed to find out association of various factors with quitting tobacco.

RESULTS

The average compliance in three intervention rounds was 95.2%. The mean age at initiation of tobacco was 17.3 years. Tobacco use among family members and in the community was primary reasons for initiation and addiction to tobacco was an important factor for continuation, whereas health education and counseling seemed to be largely responsible for quitting. The quit rate at the end of the programme was 33.5%. Multivariate logistic regression analysis found that women in higher age groups and women consuming tobacco at multiple locations are less likely to quit tobacco.

CONCLUSIONS

Changing cultural norms associated with smokeless tobacco, strict implementation of antitobacco laws in the community and work places and providing cessation support are important measures in preventing initiation and continuation of tobacco use among women in India.

Design and development of ultra-wideband 3 dB hybrid coupler for Ion cyclotron resonance frequency heating in tokamak

Design and development of a high power ultra-wideband, 3 dB tandem hybrid coupler is presented and its application in ICRF heating of the tokamak is discussed. In order to achieve the desired frequency band of 38-112 MHz and 200 kW power handling capability, the 3 dB hybrid coupler is developed using two 3-element 8.34 ± 0.2 dB coupled lines sections in tandem. In multi-element coupled lines, junctions are employed for the joining of coupled elements that produce the undesirable reactance called junction discontinuity effect. The effect becomes prominent in the high power multi-element coupled lines for high frequency (HF) and very high frequency(VHF) applications because of larger structural dimensions. Junction discontinuity effect significantly deteriorates coupling and output performance from the theoretical predictions. For the analysis of junction discontinuity effect and its compensation, a theoretical approach has been developed and generalized for n-element coupled lines section. The theory has been applied in the development of the 3 dB hybrid coupler. The fabricated hybrid coupler has been experimentally characterized using vector network analyzer and obtained results are found in good agreement with developed theory.

Khat and stroke

Khat chewing, though a tradition followed majorly in African countries, has of late spread widely across the globe due to faster transport systems and advanced preservation techniques. Many complications such as psychosis, arterial hypertension, angina pectoris, and myocardial infarction have been reported in connection to khat abuse. We present a case of a young man who presented with acute onset left-sided weakness. He was a known khat addict for over three decades. A diagnosis of left hemiplegia due to right middle cerebral artery infarction was established. Detailed evaluation revealed no significant underlying cause for stroke. Since the main central nervous system effects of khat are comparable with those of amphetamines and there are established reports of stroke in amphetamine abuse, the former was assumed to be the etiological factor. The patient was discontinued from taking khat and was managed conservatively. The subject showed significant recovery with no further complications or similar episodes during follow-up. To the best of our knowledge, this is the second case of stroke associated with khat. Since the management is essentially conservative, a vigilant history eliciting of khat abuse in prevalent countries would cut down unnecessary healthcare costs.

Salmonella Paratyphi A in India - Changing trends in presentation and antibiotic susceptibility

Objective: Not only has the prevalence of enteric fever due to Salmonella paratyphi A increased over the last decade, there has also been a change in common presenting symptoms and antibiotic sensitivity pattern of these organisms. Knowledge of the existing epidemiology of the disease is essential for a rational approach to treat the same. Hence the present study was done to establish the existing epidemiology of enteric fever due to Salmonella paratyphi A-their common presenting symptoms and antibiotic sensitivity pattern- at our setting. Material & Methods: This prospective study was conducted in MS Ramaiah Hospitals, Bangalore between January 2008 and December 2008. Patients admitted to the hospital with clinical suspicion of enteric fever and whose blood culture grew paratyphi A were included in the study. Common presenting symptoms and signs were recorded in these patients and the sensitivity patterns of the causative organisms were studied. The difference in their response to Ciprofloxacin and Ceftriaxone was studied. The analysis was done using the statistical software package-SPSS Version 16. The difference in the defervescence period was calculated by 2-way Independent two-sample t-test. Results: A total 32 patients were included in the study. Fever and hepatomegaly were the most common symptom and sign among the study subjects. All isolates were susceptible to commonly used antibiotics except for Nalidixic acid. The mean defervescence period was shorter in patients treated with Ceftriaxone as compared to those treated with Ciprofloxacin (p<0.002). Conclusion: We report a change in the presentation and antibiotic sensitivity of paratyphi A infection as compared to existing literature. Ceftriaxone is a better drug as choice as it has shorter defervescence time. Key Words: Salmonella paratyphi A; Ceftriaxone; Ciprofloxacin; Defervescence DOI: 10.3126/ajms.v2i1.3546 Asian Journal of Medical Sciences 2 (2011) 14-17

Opportunistic parasitic infections in HIV/AIDS patients presenting with diarrhoea by the level of immunesuppression

BACKGROUND & OBJECTIVE

Enteric parasites are major cause of diarrhoea in HIV infected individuals. The present study was undertaken to detect enteric parasites in HIV infected patients with diarrhoea at different levels of immunity.

METHODS

The study was carried out at National AIDS Research Institute, Pune, India, between March 2002 and March 2007 among consecutively enrolled 137 HIV infected patients presenting with diarrhoea. Stool samples were collected and examined for enteric parasites by microscopy and special staining methods. CD4 cell counts were estimated using the FACS count system.

RESULTS

Intestinal parasitic pathogens were detected in 35 per cent patients, and the major pathogens included Cryptosporidium parvum (12%) the most common followed by Isospora belli (8%), Entamoeba histolytica/Enatmoeba dispar (7%), Microsporidia (1%) and Cyclospora (0.7%). In HIV infected patients with CD4 count < 200 cells/microl, C. parvum was the most commonly observed (54%) pathogen. Proportion of opportunistic pathogens in patients with CD4 count <200 cells/microl was significantly higher as compared with other two groups of patients with CD4 count >200-499 and >or= 500 cells/microl (P=0.001, P=0.016) respectively.

INTERPRETATION & CONCLUSION

Parasitic infections were detected in 35 per cent HIV infected patients and low CD4 count was significantly associated with opportunistic infection. Detection of aetiologic pathogens might help clinicians decide appropriate management strategies.

Distribution of IgG subtypes in maternal anti-D sera and their prognostic value in Rh haemolytic disease of the new-born

In 107 Rh(D)-immunized women having Rh(D)-positive pregnancy screening for IgG subtypes was carried out between the 34th and 36th week of gestation. Using polyclonal IgG subtype-specific reagents, all four IgG subclasses were detected in anti-D sera though IgG1 and IgG3 were the most predominant classes. IgG3 anti-D was usually low titre. At the same level of Rh(D) antibody titre, haemolytic disease of the new-born was more severe when anti-D was IgG1 type than IgG3 type. When the IgG1 and IgG3 anti-D subtypes existed together, the risk of having a stillborn child was very high compared to other subtypes (IgG1 + IgG3 34.8%, IgG1 19.2% and IgG3 15.4%).

Clinical significance of serum and cerebro spinal fluid bilirubin indices in neonatal jaundice

To assess the value of unbound bilirubin (UB) and saturation index (SI) in serum and CSF as indicators of Kernicterus, we studied 50 icteric neonates (serum indirect bilibrubin (IB) greater than or equal to 7 mg/dl) and 20 controls (IB less than 7 mg/dl) during the first week of life. Serum and CSF were obtained simultaneously in all neonates. Of 36 neonates with IB greater than 12 mg/dl 19 had evidence of kernicterus. UB was estimated by Sephadex gel filtration and SI by salicylate displacement technique. Positive correlation (r = +0.85) was obtained between serum and CSF UB levels. There was a significant difference (p less than 0.05) between mean serum and CSF UB levels in kernicterus and non-kernicterus neonates (kernicterus serum UB = 0.71 +/- 0.22) mg/dl, CSF UB = 0.16 +/- 0.06 mg/dl: non-kernicteric serum UB = 0.40 +/- 0.10 mg/dl, CSF UB = 0.10 +/- 0.03 mg/dl). A critical serum UB level 0.5 mg/dl and a danger zone of CSF UB (0.1 to 0.15 mg/dl) was observed in presence of kernicterus. Neonates with kernicterus and 30% non-kernicteric had serum SI greater than or equal to 8. Mean values of serum and CSF SI were comparable in all neonates. The serum and CSF UB and SI, and the mean percentage cross over of UB from serum to CSF when statistically compared were not significantly influenced by risk factors.