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Objective: The aim of this study was to determine the proportion of influenza-like illnesses (ILIs) caused by influenza A and influenza A H1N1 and to determine the proportion of influenza B in a smaller group of samples with ILIs and influenza A H1N1 negative by qualitative real-time reverse transcriptase polymerase chain reaction (RT-PCR) using TaqMan-based assay at a tertiary health-care center in Chennai, Tamil Nadu. Material and Methods: Laboratory samples of participants from all age groups who had ILIs were included in this study. The study was conducted from January 2018 to January 2019 at a tertiary health-care center in Chennai, Tamil Nadu. The sample size of the study was 1755. This is a cross-sectional study. RNA extraction was performed using QIAamp Viral RNA Mini Kit (Qiagen, U.S.A) as per the manufacturer instructions. The assay is a TaqMan®-based real-time detection of circulating novel influenza A H1N1 and H3N2. Real-time PCR for influenza B virus was performed in influenza A H1N1-negative patients using artus Infl/H1 LC/RG RT-PCR kit (Cat 4523003, Qiagen, Germany). Samples that had a crossing threshold value 15–35 cycles were considered positive. Results: The majority of the participants were in the pediatric and young adult age group (n = 798) were positive for influenza A, of which 32.7% (n = 575) were positive for influenza A H1N1. Both influenza A H1N1 and influenza A other than H1N1 incidence started to rise in September and spiked between October and December. Among patients with persistent ILI, screening for influenza B was done in 48 samples. Among 48 samples, 18% (n = 8) had influenza B. Conclusion: The need for increased vaccination is demonstrated through the high influenza A H1N1 positivity rate among pediatric patients with ILIs. Detection of influenza B among influenza A H1N1-negative individuals demonstrates the need for influenza B screening. Incidence of influenza is highest in cooler months. The implementation of vaccination against influenza before the beginning of the cooler seasons could possibly reduce the burden of influenza on the health-care system. The importance of surveillance for the continued screening of influenza could be expanded in the private sector as a majority of the disease burden is observed in that sector.

In decompensated cirrhosis, massive ascites and pleural effusion (hepatic hydrothorax) can be complicated by infection, which manifests either as spontaneous bacterial peritonitis (SBP) or spontaneous bacterial empyema (SBE). SBE is a distinct and often underdiagnosed complication having different pathogenesis and treatment strategy when compared with parapneumonic empyema. Hepatic hydrothorax in the absence of ascites is rare in patients with cirrhosis. The occurrence of SBE without SBP or ascites is even more of a rarity in cirrhosis and carries great morbidity and mortality. Here we report a case of an elderly female patient with cirrhosis (Child-Pugh Class B) who had unusual features of isolated right-sided hepatic hydrothorax without clinically evident ascites and was later diagnosed as having SBE based on imaging of the thorax, pleural fluid analysis, and cultures. The patient was initially treated conservatively with antibiotics, and diuretics, and later pigtail insertion and drainage was done.

Aim: Metabolic syndrome (MeS) refers to metabolic risk factors with different phenotype combinations. The study aim was to determine the clusters of MeS components by age and gender as predictors for the presence of fatty liver (FL). Materials and Methods: The cohort consisted of 990 subjects, undergoing executive health check between January 2019 and February 2020. Baseline data, anthropometric parameters, and ultrasound findings were noted. Patients with normal ultrasound were categorized as group 1 and those with FL as group 2. MeS is defined and clustered and risk of predicting FL was analyzed in age and gender. Results: Of the 990 subjects, 689 (69.6%) had FL (group 2); 554 patients (56%) were >45 years. Females had significant grade 1 (P < 0.05) and grade 2 (P < 0.01) FL, ≥45 years, and MeS of three or more components in FL, both above (P < 0.01) and below (P < 0.03) 45 years of age. Waist circumference (WC), diabetes mellitus (DM) with hypertension, triglyceride, and high-density lipoprotein (cluster 3) were statistically significant in males, both 45 years of age (P < 0.001); in females, the same cluster was statistically significant only for >45 years (P

Benign intrahepatic cholestasis (BRIC) is a rare genetic disorder characterized by episodic cholestasis. Each episode is characterized by repeated episodes of jaundice, intense pruritis last for weeks to months with complete remission. Although each episode is associated with significant morbidity, progressive liver injury and cirrhosis do not occur. In recent studies, few patients progressed to Progressive familial intrahepatic cholestasis. Here we report a case of 19 years boy with benign intrahepatic cholestasis due to an undulant course terminated by plasma exchange.

Presentation of severe pain syndromes prior to onset of motor weakness is an uncommon but documented finding in patients with Guillain-Barré syndrome (GBS). Sciatica in GBS is a difficult diagnosis when patients present with acute radiculopathy caused by herniated disc or spondylolysis. A middle-aged woman was admitted for severe low back pain, symptomatic hyponatraemia, vomiting and constipation. On further investigation, she was diagnosed with radiculopathy, and appropriate treatment was initiated. Brief symptomatic improvement was followed by new-onset weakness in lower limbs, which progressed to involve upper limbs and right extraocular muscles. With progressive, ascending, new-onset motor and sensory deficits and laboratory evidence of demyelination by Nerve Conduction Study, a diagnosis of variant GBS was made. She was treated with intravenous immunoglobulin 2 g/kg over 5 days. The presentation of severe low back pain that was masking an existing aetiology and possible dysautonomia and the unilateral right extraocular muscles instead of bilateral make our case unique and rare.

BACKGROUND Systemic Lupus Erythematosus (SLE) is a connective tissue disease with high morbidity that results in multiple admissions. This study was undertaken to determine trends in hospitalisation and outcomes in patients with SLE. MATERIALS AND METHODS This was a retrospective study of all patients admitted with SLE between January 2012 and 2015 at a tertiary care hospital in Chennai. Records were analysed and causes for recurrent admission looked at. RESULTS A total of 101 patients were included. Mean age was 33.4 years, mean number of admissions 3.44. Systemic symptoms were common, renal involvement 70.3% and haematological involvement 35.6%. 66 patients got admitted more than once. Infections, need for drug administration (cyclophosphamide) and disease flare were the causes for repeated admissions. CONCLUSIONS SLE results in high utilisation of medical resources, recurrent admissions are the norm and infections and disease flare are common causes for admission

Acute flaccid paralysis is a neuromuscular emergency characterized by rapidly worsening weakness that evolves quickly to cause diaphragmatic failure. The challenge for the treating physician is to stabilize the patient, generate the differential diagnosis and determine the management; all in quick time. Neurotoxic snake bites have inadequate signs of inflammation and are easily missed. Myasthenic crisis, on the other hand, could be the first sign of myasthenia gravis in up to 20% of patients. Both present with acute respiratory failure and inadequate history. Two of our patients presented with similar clinical picture, and received polyvalent anti-snake venom obtained from hyperimmunised horses (Equus caballus). Both tested positive for anti-acetyl choline receptor antibody. After recovery, both patients narrated a history suggestive of neurotoxic envenomation. We later discovered that patients, who are exposed to polyvalent anti-snake venom (Equus caballus) prior to radioimmunoassay, demonstrate high titers of Anti-AChR Ab in their serum erroneously.

Accurate diagnosis of glucose-6-phosphate dehydrogenase (G6PD) deficiency is required to avoid the risk of acute hemolysis associated with 8-aminoquinoline treatment. The performance of the BinaxNOW G6PD test compared with the quantitative spectrophotometric analysis of G6PD activity was assessed in 356 Plasmodium vivax-infected subjects in Brazil, Peru, Thailand, and India. In the quantitative assay, the median G6PD activity was 8.81 U/g hemoglobin (range = 0.05-20.19), with 11 (3%) subjects identified as deficient. Sensitivity of the BinaxNOW G6PD to detect deficient subjects was 54.5% (6 of 11), and specificity was 100% (345 of 345). Room temperatures inadvertently falling outside the range required to perform the rapid test (18-25 degrees C) together with subtlety of color change and insufficient training could partially explain the low sensitivity found. Ensuring safe use of 8-aminoquinolines depends on additional development of simple, highly sensitive G6PD deficiency diagnostic tests suitable for routine use in malaria-endemic areas.

BACKGROUND: Clinical effectiveness of previous regimens to treat Plasmodium vivax infection have been hampered by compliance. We aimed to assess the dose-response, safety, and tolerability of single-dose tafenoquine plus 3-day chloroquine for P vivax malaria radical cure. METHODS: In this double-blind, randomised, dose-ranging phase 2b study, men and women (aged >/=16 years) with microscopically confirmed P vivax monoinfection (parasite density >100 to 7500 per muL blood). The primary efficacy endpoint was relapse-free efficacy at 6 months from initial dose (ie, clearance of initial infection without subsequent microscopically confirmed infection), analysed by intention to treat. This study is registered with ClinicalTrials.gov, number NCT01376167. FINDINGS: Between Sept 19, 2011, and March 25, 2013, 329 patients were randomly assigned to a treatment group (chloroquine plus tafenoquine 50 mg [n=55], 100 mg [n=57], 300 mg [n=57], 600 mg [n=56]; or to chloroquine plus primaquine [n=50]; or chloroquine alone [n=54]). Relapse-free efficacy at 6 months was 57.7% (95% CI 43-70) with tafenoquine 50 mg, 54.1% (40-66) with tafenoquine 100 mg, 89.2% (77-95) with tafenoquine 300 mg, 91.9% (80-97) with tafenoquine 600 mg, 77.3% (63-87) with primaquine, and 37.5% (23-52) with chloroquine alone. Tafenoquine 300 mg and 600 mg had better efficacy than chloroquine alone (treatment differences 51.7% [95% CI 35-69], p

Background. Studies have shown that hypertensive retinal changes (HRC) have a moderate accuracy in predicting microalbuminuria (MA) in elderly hypertensive patients (age >65 years). This study is an effort to identify a similar relationship in hypertensive patients aged

Background: Though the association between microalbuminuria (MA) and inflammatory markers has been studied, the possible gender differences in these associations have not yet been analyzed. Our study aims to analyze the role of gender in the associations of MA and inflammatory markers. Methods: 1,060 hypertensive patients were assessed for MA (albumin-creatinine ratio), plasma levels of HsCRP (high-sensitivity C-reactive protein), IL-18, and sCD40L (soluble CD40 ligand). Patients with diabetes mellitus, metabolic syndrome and overt nephropathy were excluded. Results: Mean age was 46 ± 9.6 years, with 560 males and 500 females. The prevalence of MA was 35.6% (n = 378). MA was associated with HsCRP (OR: 2.13, CI: 1.155–3.168, p = 0.001) and sCD40L (OR: 2.35, CI: 1.014–3.912, p = 0.013) in the premenopausal females, whereas in males (OR: 1.83, CI: 1.037–3.920, p = 0.023) and postmenopausal females (OR: 2.31, CI: 1.688–3.274, p = 0.031) MA was associated only with HsCRP and not with sCD40L or IL-18. Conclusions: Association between MA and HsCRP is consistent in all hypertensive patients. However, MA is associated with sCD40L only in premenopausal females and not in males and postmenopausal females.

Increase in the incidence of drug resistance and association with HIV has led to a resurgence of tuberculosis. However, tubercular arteritis continues to remain a rare entity with a prelidection for the thoracic aorta. We report a tubercular ascending aortic pseudoaneurysm in a patient already on treatment for disseminated tuberculosis who underwent successful surgical repair and also review literature pertaining to this entity.

INTRODUCTI ON: Cerebral venous thrombosis (CVT) is an unusual cause of stroke that affects the young and is often missed or misdiagnosed . This study was undertaken to study the profile of patients who presented with CVT. METHODS: A cohort of 59 patients who presented to Sri Ramachandra Medical College and Research Institute, Chennai between June 2009 to September 2011 and were diagnosed to have CVT by neuro imaging were included in the study. Clinical and laboratory parameters were entered into a detailed questionnaire and patients were followed up during their stay in hospital. Data was analysed using SPSS software for Windows version SPSS 16.0. RESULTS: The mean age at diagnosis was 37 years. Headache was the most common symptom (86.4%) of patients followed by vomiting (44.1%) and seizures (42.4%). Papilledema was the most common sign in 37% of patients. Superior sagittal sinus was the most commonly affected. Hyperhomocysteinemia was the underlying etiological factor in 23% . 7 patients were in the pregnant and puerperal period. All patients were treated with anticoagulants. 2 patients died in hospital. CONCLUSION: CVT presents in the young, often with symptoms and signs of raised intracranial pressure. Response to therapy is better than with arterial stroke and there is a favourable outcome

Accurate identification of low-risk patients with acute pulmonary embolism (PE) who may be eligible for outpatient treatment or early discharge can have substantial cost-saving benefit. The purpose of this study was to derive and validate a prediction model to effectively identify patients with PE at low risk of short-term mortality, right ventricular dysfunction, and other nonfatal outcomes. This study analyzed data from 400 consecutive patients with acute PE. We derived and internally validated our prediction rule based on clinically significant variables that are routinely available at initial examination and that were categorized and weighted using coefficients in the multivariate logistic regression. The model was externally validated in an independent cohort of 82 patients. The final model (HOPPE score) consisted of 5 categorized patient variables (1, 2, or 3 points, respectively): systolic blood pressure (120, 100 to 119,99 mm Hg), diastolic blood pressure (80, 65 to 79,64 mm Hg), heart rate (80, 81 to 100,101 beats/min), arterial partial pressure of oxygen (80, 60 to 79,59 mm Hg), and modified electrocardiographic score (2, 2 to 4,4). The 30-day mortality rates were 0% in low risk (0 to 6 points), 7.5% to 8.5% in intermediate risk (7 to 10), and 18.2% to 18.8% in high-risk patients (≥11) across the derivation and validation cohorts. In comparison with the previously validated PESI score, the HOPPE score had a higher discriminatory power (area under the curve 0.74 vs 0.85, p = 0.033) and significantly improved both the discrimination (integrated discrimination improvement, p = 0.002) and reclassification (net reclassification improvement, p = 0.003) of the model for short-term mortality. In conclusion, the HOPPE score accurately identifies acute patients with PE at low risk of short-term mortality, right ventricular dysfunction, and other nonfatal outcomes. Prospective validation of the prediction model is necessary before implementation in clinical practice.

A 43-year-old farmer presented with acute onset pneumonia, septicaemia and peripheral facial nerve palsy (left side). Burkholderia pseudomallei was isolated from the blood culture of the patient. The patient was successfully treated with intravenous meropenem and oral cotrimoxazole for 2 weeks followed by maintenance therapy with cotrimoxazole. The case is reported to increase awareness among the clinicians and microbiologists regarding melioidosis.