Search

Dengue fever (DF), caused by the dengue virus (DENV), is a major public health problem worldwide, with approximately 390 million reported annual infections. The lack of specific antiviral therapies and limited means of vector control has led to the development of a dengue vaccine as a promising strategy to combat this disease. The purpose of this review is to provide a comprehensive analysis of the current status and prospects of dengue vaccines. This review describes different approaches used in dengue vaccine development, including live-attenuated, inactivated, subunit, and viral vector vaccines. Each approach is evaluated for immunogenicity, safety, and efficacy based on preclinical and clinical studies, highlighting the strengths and limitations of each vaccine candidate. Future directions and research priorities in dengue vaccine development are highlighted. In conclusion, dengue vaccines have great potential to reduce the burden of DF worldwide. However, some challenges remain regarding vaccine safety, efficacy, delivery, and availability. By addressing these challenges and leveraging advances in vaccine technology, there can be more effective control and prevention of DF and protection of public health, leading to improvement in the quality of life.

Dengue is often seen as an acute infection with fever and thrombocytopenia where complications such as shock and hemorrhage need to be averted while the patient recovers with supportive care. However, dengue can also be a differential diagnosis in the emergency care setting. Acute encephalopathy, acute renal failure, hepatitis, liver failure, acute pancreatitis, noncardiogenic pulmonary edema, acute respiratory distress syndrome, compartment syndrome, intracranial bleeds, hemophagocytic lymphohistiocytosis are few of the emergencies that may be seen in the course of dengue fever. These complications need prompt recognition and management to ensure better outcomes.

Burkholderia pseudomallei, a Gram-negative bacterium, is the cause of Melioidosis, a disease that is known to cause significant morbidity and mortality in Southeast Asia. It is also classified as a potential biological warfare agent and is considered a category B priority pathogen. Despite being common in these areas, melioidosis is often underdiagnosed due to lack of awareness of its clinical and microbiological characteristics, limited health-care resources, and the varied ways in which it can present. It is important to recognize the clinical features of melioidosis early on and properly manage the disease to reduce its impact.

With time, newer pulmonary and extrapulmonary manifestations of postacute coronavirus disease (COVID) syndrome are being reported. This is a case report of a 67-year-old diabetic and hypertensive female who presented with persistent progressive cough and breathlessness 2 months after she was diagnosed and treated for COVID-19. The patient was admitted and worked up as a case of postacute COVID syndrome. She was radiologically detected to have diffuse, large, multiple cystic air-filled cavitary lesions all over the lungs bilaterally. Despite adequate treatment and support with oxygen supplementation, the patient's condition kept on worsening, and she was thus referred to a higher center for cardiothoracic vascular surgical intervention.

Background: Following partial recovery from acute COVID-19 disease, patients have been reported to suffer from long-term sequelae (beyond 12 weeks from the onset of symptoms), Symptoms vary from mild to life-threatening conditions. This phenomenon is now called post-COVID-19 or long COVID-19. Materials and Methods: Of the total 81 patients with a history of COVID-19, 72 patients were considered for the study. Their clinical data, risk factors, laboratory investigations, radiological findings, management, and outcomes were recorded and statistically interpreted and analyzed. Results: Majority of the patients belonged to the elderly age group. Respiratory symptoms persisted in 53 patients followed by musculoskeletal symptoms seen in approximately 40 patients (55.5%). Renal, neurological manifestations, gastrointestinal, cardiac manifestations, and thromboembolic phenomenon were also seen. Conclusions: In our study, it was concluded that majority of patients presenting with post-COVID-19 sequelae came with persistent respiratory symptoms followed by musculoskeletal and neuropsychiatric manifestations. The repercussions of COVID-19 illness are reverberating and should be managed extensively, as with the rising numbers the burden on health care will also rise. Hence, a need for more research in this field for better diagnosis and management of post COVID-19 syndrome.

The spectrum of COVID-19 continues to evolve, uncovering several manifestations with every passing day. One of the complications is multisystem inflammatory syndrome (MIS) that occurs both in children and adults. MIS in children (MIS-C) has become a recognized syndrome, whereas a parallel syndrome in adults (MIS in adults [MIS-A]) has not been yet well defined. Due to the overlap between COVID 19 and MIS-A, we tend to miss cases of MIS-A. In this review, we have focused on MIS-A, its diagnostic criteria, pathogenesis, treatment, its relationship with vaccination, and differentiation from COVID 19.

Background: With the ongoing onslaught of coronavirus disease-2019 (COVID-19) pandemic, identifying factors predicting the disease course and outcome become immensely important. Although globally reported, a potential association between electrolyte disturbance and COVID-19 disease has not been well researched. Dyselectrolytemia not only impacts patient care but also provides insight into the pathophysiology of COVID-19. Aims and Objectives: Our aim was to study electrolyte disturbances among COVID-19 patients and its impact on the disease outcome. Materials and Methods: This was a retrospective observational study conducted in a total of 397 patients detected to have electrolyte abnormalities among 2914 adult inpatients, diagnosed with COVID 19 infection in a tertiary care center over a period of 10 months (July 2020–December 2020 and April 2021–July 2021). Results: A total of 2914 patients were diagnosed with COVID-19 of whom 397 (13.62%) patients were found to have an electrolyte imbalance. Hyponatremia (n = 199) 51% was the most common electrolyte disturbance followed by hypokalemia (n = 94) 24.3% and mixed electrolyte abnormality (n = 81) 20.4%. Electrolyte imbalance was directly related to the clinical outcome of the disease which was statistically significant P = 0.0001. Conclusion: Hyponatremia has a significant direct correlation with mortality in patients with COVID-19. However, hypokalemia, hyperkalemia, and hypernatremia also influence the disease outcome. We recommend that the estimation of electrolytes should be done routinely for all hospitalized patients with COVID-19 as it adds to the prognostication of these patients.

Severe acute respiratory syndrome-CoV-2 infection has been known to cause an array of chronic consequences, most of which are yet to be studied in detail. These presentations are due to direct invasion of the tissues by the virus or other factors such as immune response to the virus. These sequelae affect the patient's quality of life implicating the importance of follow-up care in all coronavirus disease-2019 (COVID-19) patients and changing the definition of “post-COVID-19 recovery.” Adequate preparedness for post-COVID consequences with adequate health care is need of the hour. This also warrants for the patients' awareness, stressing upon the importance of educating the general public about keeping a watch for certain symptoms. Regular screening procedures may also aid in timely prevention, recognition, and management hence reducing morbidity and mortality in the post-COVID phase.

Dengue is a mosquito-borne viral infection found in tropical and subtropical climates worldwide, mostly in urban and semiurban areas. The virus responsible for causing dengue is called dengue virus. There are four dengue virus serotypes, implying that it is possible to be infected four times. While many dengue virus infections produce only mild illness, occasionally, this develops into potentially lethal complications, called severe dengue, dengue hemorrhagic fever, and dengue shock syndrome. Currently, there is no specific treatment for dengue/severe dengue. Due to a rise in mortality rates associated with dengue hemorrhagic fever, severe dengue, and dengue shock syndrome, a better understanding of the reason behind dengue hemorrhagic fever is required. Hence, in this article, we further describe the original antigenic sin in dengue and how the occurrence of Hoskins effect is a major determinant factor for the progression to dengue hemorrhagic fever.

Monkeypox (MPX) virus is an orthopoxvirus that causes human MPX, a viral disease with symptoms indistinguishable to smallpox, which includes fever and rash. Following the worldwide eradication of smallpox in 1980, MPX emerged as the most significant orthopoxvirus infection in humans. Cases are most often reported from rural areas of Central and West African countries, particularly in regions close to tropical rainforest where people may have contact with infected animals. MPX is transmitted through direct contact with respiratory droplets of another person who has MPX in the home or in a health facility, or with contaminated materials such as bedding. Laboratory diagnostics are the principal components for the identification and surveillance of the disease, and new tests are needed for a more precise and rapid diagnosis. New therapeutics and vaccines offer hope for the treatment and prevention of MPX; however, more research must be done before they are ready to be deployed in an epidemic setting.

Dengue is a major concern in India. It has a diverse spectrum of atypical manifestations across the various systems of the human body with significant mortality and morbidity rates. The following review emphasizes on the various systemic manifestations, including the need for their early recognition and treatment.

Emerging infectious diseases are now a concern worldwide and can evolve into a global health-care crisis or pandemic. Identification of the Omicron variant (B.1.1.529) of severe acute respiratory syndrome-2 (SARS-CoV-2) which is considered a variant of concern has added fuel to the eternal flame of the global COVID-19 pandemic. There is an apparent sharp rise in cases of the new variant which is setting off alarm bells. The emergence of this new strain of the virus has taken a disproportionate toll in few countries including India. The need of the hour is to track the concerning rise of the new variant of the SARS-COV-2 causing COVID-19 and to prevent the reinfection.

Rickettsioses are one of the common causes of undifferentiated febrile illness. Patients present commonly with fever, rash, and eschar. Posterior Reversible Encephalopathy Syndrome (PRES) also known as reversible posterior encephalopathy syndrome is a rare condition, in which parts of the brain are affected by swelling as a result of an underlying cause such as infection. However, PRES caused by spotted fever group of rickettsiosis is rarely reported. We are here with reporting such a case. A 55-year-old male was admitted to MVJ Medical College and Research Hospital, Bengaluru, with complaints of fever for 3 days and one episode of Generalized Tonic Clonic Seizures (GTCS) following which he was in altered sensorium. On examination, there was hepatosplenomegaly. Weil-Felix OX19 and OX2 were 1:320. Lumbar puncture was done which showed 15 cells 98% lymphocytes and 2% neutrophils, proteins-119 mg/dl, and sugar- 153 mg/dl. Magnetic resonance imaging of the brain showed bilateral symmetric hyperintensities on T2-weighted imaging in the parietal and occipital lobes. The calcarine and occipital lobes were spared suggestive of posterior reversible encephalopathy syndrome. Electrocardiogram showed ST elevation in V1 and V2 along with T-wave inversion (Brugada sign). Posterior reversible encephalopathy syndrome is usually commonly seen in hypertensive encephalopathy and in infections such as dengue and few cases of scrub typhus. This is one of the rare cases where spotted fever group of rickettsia has caused posterior reversible encephalopathy syndrome and Brugada syndrome.

Scrub typhus is an acute febrile illness caused by Orientia tsutsugamashi. CNS is the most crucial target in other rickettsial diseases and historically, the neurological disease burden was considered low in scrub typhus. However, there is growing evidence in literature that O. tsutsugamushi does invade the CSF and CNS invasion may be seen in 2–5 % cases of tsutsugamushi disease. O. tsutsugamushi parasitises endothelial cells both in the periphery as well as in the brain. The disease is characterized by focal or disseminated vasculitis and perivasculitis. Scrub typhus has protean manifestations. CNS involvement is rare but it should be considered as an important differential in the setting of known areas of scrub typhus outbreak. Meningoencephalitis with or without focal neurological deficits is the commonest clinical picture. However, the neurological manifestations can be highly variable. In our case series out of 81 patients who were diagnosed with scrub typhus, only 5 patients had neurological manifestations. All patients presented with altered sensorium. GCS was decreased in all patients. It was

COVID-19 has affected over 57,410,025 people and killed more than 1,368,848 of those affected in 220 countries as on November 20, 2020. Community-acquired coronaviruses are ubiquitous with a male preponderance. Unlike Western nations, majority of the cases in India are in the age group of 31–50 years, and the mortality rate is around 1.46%. The possible modes of transmission for severe acute respiratory syndrome coronavirus 2 include droplet, airborne, fomite, fecal-oral, bloodborne, mother-to-child, and animal-to-human transmission as per the World Health Organization. Apart from the known symptoms of influenza-like illness, COVID also presents with cutaneous, hematological, gastrointestinal, and neurological manifestations. In the absence of dedicated cures, until there is a hope of appropriate and effective vaccine development, the novel coronavirus will be a challenge to the existence of humanity.

The acute manifestations of diclofenac allergy vary from mild urticaria or skin rash to severe and life-threatening complications such as ARDS, and anaphylactic shock. Very few cases of diclofenac allergy have been reported in literature especially with respect to pulmonary manifestations. We are reporting a case of a 31-year-old who presented in respiratory distress consequent to diclofenac hypersensitivity. Our patient had non-cardiogenic pulmonary oedema and bilateral minimal pleural effusion 3 days following diclofenac administration. On examination the patient was conscious, alert and oriented, PR- 88 bpm, BP- 150/100 mmHg, RR-22 cpm temperature 98.6°F with oxygen saturation of 95% on room air. Her respiratory system examination revealed a dull note on percussion and decreased vocal fremitus, decreased vocal resonance, diminished air entry in bilateral infra scapular and infra axillary areas with fine inspiratory crepitations. The diagnosis of ARDS was ruled out as the ratio of PaO2 to FiO2 was 410. After treatment with I.V diuretics, antibiotics and inhalational bronchodilators she improved over a period of 5 days. She had complete resolution of her chest symptoms and chest findings both clinically and radiologically. Pulmonary manifestations such as ARDS, eosinophilic pneumonitis, pleural effusion, eosinophilic pneumonia, pulmonary oedema, hemoptysis, pulmonary infiltrates with eosinophilia and asthmatic attacks are rare. The temporal relationship between symptom onset and drug administration is the most important piece of history while making the diagnosis. History of allergic reaction to NSAIDs should be evaluated in detail. It is therefore important that the physician keep this in mind while prescribing.

Childhood immunization is recommended and publicized globally, whereas the adult population, which comprises more than 60% of the total population, still suffers from vaccine-preventable diseases due to factors ranging from personal neglect to immunosenescence. This burden is vastly seen in developing nations like India where adults constitute a large chunk of economic productivity. This article highlights the current scenario and recommendations for adult immunization globally taking into account special conditions such as immunization in the geriatric population, pregnant women, and in travelers.

When a young patient presents with ischemic stroke or recurrent venous thromboembolism of unknown aetiology or “young” myocardial infarction in the absence of traditional risk factors, a detailed thrombophilia workup becomes an imperative. In a setting of arterial and venous occlusive disorders hyperhomocysteinemia is an important risk factor in the absence of traditional contributory aetiologies. Here we present a case of 28-year-old man, never-smoker with no known comorbidities who initially presented to the hospital with acute, retrosternal chest pain, radiating to the left side. His ECG showed ST elevation in V1-V3 in the setting of raised cardiac enzymes, and 2d-echo demonstrating regional wall motion abnormality. He was diagnosed to have acute anteroseptal MI and thrombolysed with streptokinase. Subsequently, his coronary angiogram showed a non-occluded LAD. CT Angio with IVUS done at a staged interval revealed minimal luminal irregularities suggestive of MINOCA. 8 months later the patient presented with headeache, fever, and left focal seizure accompanied by signs of increased intracranial pressure. MRI brain with contrast-MR venogram showed complete thrombosis of superior sagittal sinus. Due to the previous history of MI, and present CVT the patient was subjected to detailed thrombophilic evaluation which was normal except the levels of vitamin B12 (126.9 pg/mL) was low his homocysteine level was abnormally elevated to a level of 38.23 μM/L. The patient was treated with heparin, anti-oedema measures and anti-epileptics followed by oral anticoagulant plus folate, vitamin B6, and vitamin B12. Young patients presenting with arterial or venous thrombosis without any risk factors for atherosclerosis and venous thrombosis which is recurrent, unexplained, or at unusual sites, need screening for thrombophilic states and hyperhomocysteinemia should be ruled out as it can lead to both arterial and venous disease.

The classic presentation of pulmonary embolism is rather uncommon. The lack of pathognomonic signs and symptoms makes the diagnosis of PE difficult. Here, we report a patient presented with symptoms suggestive of pneumonia and ultimately diagnosed as PE. A 75 years old male patient with no known co-morbidity, presented with of breathlessness for 1 week, cough for one week, productive in type, with scanty sputum, chest pain since one week, sharp, aggravated on coughing. His respiratory system examination revealed increased VF/VR in right mammary and left infrascapular areas, equal air entry with normal vesicular breath sounds, crepitations in the right mammary and left infrascapular areas. He was initially treated as pneumonia but did not respond. His chest X-ray PA view showed probable mass lesion in the right para cardiac region, ECG– sinus tachycardia with right axis deviation and RV strain pattern. CECT Thorax- Intraluminal thrombus in Rt and Lt pulmonary artery consistent with acute pulmonary thromboembolism.The patient was lysed with Inj. Streptokinase and subsequently improved over the next 6 days. Whilst established criteria aid in ruling in or out the diagnosis in a setting, the gestalt of a clinician is the most appropriate defence against a missed diagnosis especially in settings of confounded presentation. Therefore, until conclusively proven with the help of imaging and lab-work, PE should be a diagnosis that needs be considered in any case of atypical pneumonia who is not responding to first line therapies.

Mucormycosis has emerged as a disease of immense importance, especially owing to the surge of cases during the second wave of COVID pandemic. Various factors are being attributed to the sudden burst of cases in our country, such as higher fungal spore counts in tropical climate, uncontrolled diabetes mellitus, prolonged steroid therapy, contamination of oxygen facilities, respiratory equipment, reused face mask, and zinc supplements. The need of the hour is to emphasize on awareness of early warning signs, as the benefits appear to be time sensitive.

Background: COVID-19 has swiftly spread to emerge as a global pandemic with no visible signs of decline. It is imperative to identify the parameters contributing toward COVID-19 mortality to facilitate prompt evaluation and control measures. Materials and Methods: A total of 1754 patients with confirmed COVID-19 infection were admitted at MVJMC and RH, Bangalore, from July 1, 2020 to December 12, 2020. Various parameters such as demographical profile, symptomatology, risk factors, laboratory profile, and complications of 75 patients (4.27%) who succumbed were studied. Results: About 45.33% of the patients who died were older than 65 years. 77% of patients who died were males. About 61.33% had severe illness at the time of presentation. 84% of the patients who died had comorbid illnesses. Respiratory failure secondary to acute respiratory distress syndrome and bilateral pneumonia was the leading cause of mortality followed by sepsis/multiple organ dysfunction syndrome, myocarditis, coagulopathy, and acute cardiovascular event. The presence of lymphopenia elevated inflammatory markers, and comorbid conditions were identified as risk factors for the requirement of oxygen, mechanical ventilation, and death. Conclusion: Elderly patients (>65 years of age) and middle-age patients (45–65 years of age) comprised the highest and second-highest proportion of mortality respectively. The increasing proportion of deaths among the middle-aged patients and the narrowing gap of the same between these two groups are alarming. Old age, male gender, underlying chronic illnesses, and elevated inflammatory markers are some of the factors attributed to these trends. Hence, stringent preventive measures, early detection, and initiation of treatment pose a greater impact on reducing the burden of morbidity and mortality.

Infectious agents are still in circulation in different parts of the world, and globalization, with travel on the agenda, migration, and poverty, makes vaccination a tool more than ever necessary. Despite the impressive number of studies carried out since the virus was first characterized, there are still many unknowns about this disease. Moreover, it is precisely these unknowns that fully justify the very different conceptual and technological strategies that are currently pursued in the preparation of vaccines against COVID-19. Due to the short development time and the novelty of the technologies adopted, these vaccines will be deployed with several unresolved issues that only the passage of time will permit to clarify. Technical problems connected with the production of billions of doses and ethical ones connected will be needed to ensure equitable global access, protection of diverse subjects, and immunity against viral variants.

Background: While the name of the virus indicates respiratory disease, and the respiratory spread of COVID-19 has been well documented in the literature, the ongoing pandemic has shown that the virus is not confined to just the lung. Hence, physicians should be aware of the “many faces” that this singular disease can present with, for timely diagnosis and prompt initiation of best treatment options. Materials and Methods: A total of 1754 patients with confirmed COVID-19 infection were admitted at a rural tertiary care center, Karnataka, India. This study is a cross-sectional study done for a period of 6 months from July 2020 to December 2020. Demographic data, clinical manifestations, laboratory parameters, management, and outcomes were recorded and compared. Results: Out of 1754 COVID-19 patients, pulmonary manifestations were seen in 1222 patients, extrapulmonary manifestations in 360 patients, and 172 patients were asymptomatic. Males were affected more than females, with a male-to-female ratio of 1.2:1. Most common pulmonary manifestation seen was cough in 83.06%, followed by fever in 67.59%. Most common extrapulmonary manifestation seen was neurological followed by gastrointestinal in 60.83% and 35.8% patients, respectively. Fatality in patients with pulmonary manifestations was 5% and extrapulmonary manifestation was 3%. All patients were managed according to standard COVID-19 treatment protocol. Conclusion: Early recognition of COVID-19 infections remains a big challenge. COVID-19 can have diverse range of clinical manifestations. Hence, COVID-19 infection should be considered in the differential of any systemic disease during the current pandemic, even in the absence of pulmonary manifestations like fever or cough.

Rickettsial infections are reported from various parts of India. But despite the surging number of cases, these diseases are often under-diagnosed. Rickettsial diseases have re-emerged as some of the most covert infections of the present time. These diseases are generally incapacitating and notoriously difficult to diagnose. The greatest challenge lies in overcoming the difficult diagnostic dilemma posed by these infections early in their courses- when antibiotic therapy is most effective. Untreated cases have a fatality of up to 30% but when promptly and properly diagnosed, it is often easily treated. Clinical manifestations combined with a thorough history (travel, epidemiological environment, and place of residence) and knowledge of the distribution of rickettsial agents and their vectors may help clinicians to correctly diagnose a rickettsiosis. Weil Felix, although not sensitive, aids in initiating antibiotics when interpreted in the correct clinical context. Antibiotic treatment with doxycycline (including for children) must be started whenever a possible rickettsiosis is suspected, taking into consideration pregnant women and allergic patients. The factors that predispose to rickettsial infections are widely prevalent in this country hence the physicians and paediatricians need to include rickettsial infections in their differential diagnosis of febrile thrombocytopaenia or an acute febrile illness.

Much has been debated about routine periodic health screening in recent years. Those in favor of such screening of laboratory investigations point to the economic and social advantages of early detection and better diagnosis of disease to an individual and the community. The opponents of this type of blanket screening point to the dubious diagnostic value of many of the abnormal results found and the impracticability of making laboratory screening generally available even if it was shown to be of definite value. Despite contrary evidence, most primary care providers believe that an annual physical examination detects subclinical illness. This is partly driven and shaped by factors such as apparent perception of benefit, patient expectation, employer requirement, and insurance industry protocols. Healthcare institutions in India often offer structured health checkup “packages” for routine screening of common diseases. Some tests included within their ambit are in keeping with international and Indian recommendations; however, many are entirely unwarranted. Unnecessary and inappropriate screening tests cause financial and resource burden. Furthermore, there may be overdiagnosis and overtreatment, psychological distress due to false-positive test results, harm from invasive follow-up tests, and false reassurance due to false-negative test results. Evidence suggests that only certain diseases are amenable for screening in an asymptomatic adult. It is recommended that physicians should abandon recommending these general panels in favor of a more selective approach to prevent health problems individualized to every unique patient.

Background: The rickettsioses represent a major cause of acute febrile illnesses worldwide. The greatest challenge lies in diagnosing rickettsioses in a timely manner early in the course, when antibiotic use is most effective. In most cases clinical suspicion together with a positive serology is employed to make the diagnosis of rickettsiosis. Aim and Objective: To study the syndromic differences, if any, amongst the three groups of rickettsial infections present in India. Methods: This was a cross-sectional observational study that evaluated a total of 172 cases of rickettsial fever out of a pool of 778 cases of acute febrile illness between the June 2017 and March 2019. A careful search for eschar, lymphadenopathy and rashes was made. Weil Felix test was done after exclusion of other infections like malaria, dengue, enteric fever. To avoid the possibility of false positives, a single titer dilution >1:320 was considered positive for rickettsioses. Results: Fever was seen in all cases. Myalgia (81·5%), headache (72·8%), and splenomegaly (51·9%) were common in scrub typhus. Eschar was seen in only 8·4% cases. Spotted fever group presented with fever of shorter duration of less than seven days (64·7%), and gastrointestinal symptoms like vomiting (74·5%) and diarrhea (13·7%) were predominantly seen. Spotted fever group had macular rash as predominant sign. Typhus group presented with fever of longer duration of more than fourteen days (50%) and respiratory symptoms like cough (65%). Hepatomegaly was present in 35% and lymphadenopathy in 7·5%. Conclusion: Rrickettsial infections remain a diagnostic challenge in resource-poor settings. Therefore, it is important to recognize the clinical features promptly, include rickettsioses in the differential diagnoses, and consider early initiation of appropriate treatment.

In December 2019, a previously unknown coronavirus, named SARS-CoV-2, was discovered in Wuhan, Hubei province of China. It was sequenced and isolated by January 2020. SARS-CoV-2 is associated with an ongoing outbreak of atypical pneumonia (Covid-2019) that has affected over 2,118,700 people and killed more than 141,900 of those affected in >210 countries as of April 16, 2020. Community-acquired coronaviruses are ubiquitous. COVID-19 is predominantly seen in older population with chronic medical conditions. There is a male preponderance. Median age was 55-59 years. SARS-CoV-2 is also more likely to infect people with chronic comorbidities such as cardiovascular and cerebrovascular diseases and diabetes. Coronavirus has an R0 of 3.28. Unlike European countries and USA, majority of the cases in India were affecting people of age group between 31 and 40 years. Mortality rate is around 3.34%. WHO, described three main transmission routes for the COVID-19: 1) droplets transmission, 2) contact transmission, and 3) aerosol transmission. COVID presents with fever, dry cough, dyspnoea, chest pain, fatigue and myalgia. Less common symptoms include headache, dizziness, abdominal pain, diarrhoea, nausea, and vomiting. Characteristic cutaneous, haematological, gastrointestinal, neurological manifestations are also seen. Testing with RT-PCR, antibody testing, and quarantine, social distancing, contact tracing are the only arsenals to reduce the burden. Every case is different; beyond standard antipyretics, anti-tussives, the role of ventilation, anticoagulation, antivirals, steroids, hydroxychloroquine, retroviral agents are still being dynamically assessed. In the absence of dedicated cures, vaccines, the novel coronavirus, is a challenge and exercise of public health measures and effective governance like no other phenomenon in the 21st century.

Nipah virus has emerged as an important and severe zoonosis affecting South-east Asia, Bangladesh, and India. It is an RNA virus belonging to Paramyxoviridae family. There are two major genetic lineages: NiVMalayasia (NiV-MY) and NiV Bangladesh (NiV-BD). The viruscan jump the species barrier. Fruit bats are the major reservoirs of infection. It can infect a secondary animal host and transmit infection to humans. It may also affect humans directly. Patients infected with Nipah have initial non-specific symptoms that quickly progress to severe neurological deficit, coma, and death. Outbreaks in India have occurred in 2001, 2007, and in Kerala in 2018. Worryingly, in India, human-to-human transmission has been demonstrated. Close contact with the sick patient seems to be the most well elucidated method of transmission. In our country, with the acculturated norms of family care giving, coupled with swaths of people living in overcrowded homes, and poor access and willingness to seek timely medical care, gives any rational physician a moment of pause. The containment and management of this deadly virus will rely on the concerted efforts by all endemic areas, health care workers, policy-makers, and participation from appropriately-informed public to stop it from achieving epidemic proportions.

Introduction: The dyslipidaemia in Rheumatoid Arthritis (RA) is associated with accelerated atherosclerosis. A prospective clinical evaluation study was undertaken to find out the proportion of the rheumatoid arthritis patients who were suffering from dyslipidaemia, the change in the lipid levels and the disease activity after an intervention with antirheumatic therapy. Aims and Objectives: To study the disease activity in Rheumatoid arthritis patients by measuring the serum levels of interleukin-1β (IL–1β), to find out the proportion of rheumatoid arthritis patients who were suffering from dyslipidaemia, to correlate the disease activity with the lipid profile and to look for the change in the lipid levels and the disease activity after an intervention with antirheumatic therapy. Material and Methods: This study was done on 30 RA patients (fulfilling the American College of Rheumatology criteria). The lipid profile estimation was done by an enzymatic, colourimetric method and IL–1β was estimated by a chemiluminescence method. Dyslipidaemia was defined by taking the cut–off values of the NCEP–ATPIII guidelines. The patients with other comorbid illnesses and those who were on statins were excluded. The patients were followed up after 12 weeks of starting with the anti–rheumatic therapy. Results: 36.7% of the patients had high total cholesterols, 53.3% of the patients had high triacylglycerol levels, 73.3% of the patients had decreased HDL–cholesterol and 33.3% of the patients had high LDL–cholesterols. 86.7% of the patients had IL–1β levels which were above the reference range. After the treatment, the number of patients with dyslipidaemia came down, with 23.3% patients having high total cholesterol levels, 43.3% of the patients having elevated triacylglycerol levels, 46.7% patients having low HDL–cholesterol levels and 20% patients having elevated LDL–cholesterol levels. 66.7% of the patients had IL–1β which was above the reference range. Conclusion: The proportion of dyslipidaemic patients had decreased in the follow up visit, along with a decrease in the disease activity, as were indicated by the decreased levels of IL–1β. The management of dyslipidaemia in RA should be a part of the general cardiovascular risk management. Therefore, a good control of the disease activity should be given priority, so that both the quality of life and the long–term outcomes can be improved.

More and more cases of H1N1 influenza are being detected in India and so also the variety of complications this virus can cause. Here, we report a case of symmetric peripheral gangrene following H1N1 infection.

Acute Kidney Injury (AKI) is one of the most challenging problems faced by clinicians in the tropics owing to its fast-changing burden. Acute Kidney Injury is an important complication of membranous nephropathy. Causes are varied and include hypovolumia, crescentic conversion of preexisting nephropathy, renal vein thrombosis, NSAID’S, vasculitis, and sepsis. In this case report we discuss the case of membranous nephropathy in a young adult complicated by AKI. This report highlights the importance of early renal biopsy in patients with post GE AKI not improving on hemodialysis. Here we also discuss the potential differentials to be considered in a case of membranous nephropathy with AKI.