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   2012| July-September  | Volume 4 | Issue 3  
    Online since September 4, 2012

 
 
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ORIGINAL ARTICLES
Clinical profile and predictors of mortality of severe pandemic (H1N1) 2009 virus infection needing intensive care: A multi-centre prospective study from South India
Kartik Ramakrishna, Sriram Sampath, Jose Chacko, Binila Chacko, Deshikar L Narahari, Hemanth H Veerendra, Mahesh Moorthy, Bhuvana Krishna, VS Chekuri, Rama Krishna Raju, Devika Shanmugasundaram, Kishore Pichamuthu, Asha M Abraham, OC Abraham, Kurien Thomas, Prasad Mathews, George M Varghese, Priscilla Rupali, John V Peter
July-September 2012, 4(3):145-152
DOI:10.4103/0974-777X.100569  PMID:23055645
Background: This multi-center study from India details the profile and outcomes of patients admitted to the intensive care unit (ICU) with pandemic Influenza A (H1N1) 2009 virus [P(H1N1)2009v] infection. Materials and Methods: Over 4 months, adult patients diagnosed to have P(H1N1)2009v infection by real-time RT-PCR of respiratory specimens and requiring ICU admission were followed up until death or hospital discharge. Sequential organ failure assessment (SOFA) scores were calculated daily. Results: Of the 1902 patients screened, 464 (24.4%) tested positive for P(H1N1)2009v; 106 (22.8%) patients aged 35±11.9 (mean±SD) years required ICU admission 5.8±2.7 days after onset of illness. Common symptoms were fever (96.2%), cough (88.7%), and breathlessness (85.9%). The admission APACHE-II and SOFA scores were 14.4±6.5 and 5.5±3.1, respectively. Ninety-six (90.6%) patients required ventilation for 10.1±7.5 days. Of these, 34/96 (35.4%) were non-invasively ventilated; 16/34 were weaned successfully whilst 18/34 required intubation. Sixteen patients (15.1%) needed dialysis. The duration of hospitalization was 14.0±8.0 days. Hospital mortality was 49%. Mortality in pregnant/puerperal women was 52.6% (10/19). Patients requiring invasive ventilation at admission had a higher mortality than those managed with non-invasive ventilation and those not requiring ventilation (44/62 vs. 8/44, P<0.001). Need for dialysis was independently associated with mortality (P=0.019). Although admission APACHE-II and SOFA scores were significantly (P<0.02) higher in non-survivors compared with survivors on univariate analysis, individually, neither were predictive on multivariate analysis. Conclusions: In our setting, a high mortality was observed in patients admitted to ICU with severe P(H1N1)2009v infection. The need for invasive ventilation and dialysis were associated with a poor outcome.
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Virological investigation of hand, foot, and mouth disease in a tertiary care center in South India
Pavithra M Vijayaraghavan, Sara Chandy, Kavitha Selvaraj, Susanne Pulimood, Asha M Abraham
July-September 2012, 4(3):153-161
DOI:10.4103/0974-777X.100572  PMID:23055646
Context: Hand, foot, and mouth disease (HFMD) remains a common problem in India, yet its etiology is largely unknown as diagnosis is based on clinical characteristics. There are very few laboratory-based molecular studies on HFMD outbreaks. Aim: The aim of this study was to characterize HFMD-related isolates by molecular techniques. Settings and Design: Between 2005 and 2008, during two documented HFMD outbreaks, 30 suspected HFMD cases presented at the Outpatient Unit of the Department of Dermatology, Christian Medical College (CMC), Vellore. Seventy-eight clinical specimens (swabs from throat, mouth, rectum, anus, buttocks, tongue, forearm, sole, and foot) were received from these patients at the Department of Clinical Virology, CMC, for routine diagnosis of hand, foot, and mouth disease. Materials and Methods: Samples from these patients were cultured in Vero and rhabdomyosarcoma (RD) cell lines. Isolates producing enterovirus-like cytopathogenic effect (CPE) in cell culture were identified by a nested reverse transcription-based polymerase chain reaction (RT-PCR) and sequenced. The nucleotide sequences were analyzed using the BioEdit sequence program. Homology searches were performed using the Basic Local Alignment Search Tool (BLAST) algorithm. Statistical Analysis used: The statistical analysis was performed using Epi Info version 6.04b and Microsoft Excel 2002 (Microsoft Office XP). Results: Of the 30 suspected HFMD cases, only 17 (57%) were laboratory confirmed and Coxsackievirus A16 (CVA16) was identified as the etiological agent in all these cases. Conclusions: Coxsackievirus A16 (CVA16) was identified as the virus that caused the HFMD outbreaks in Vellore between 2005 and 2008. Early confirmation of HFMD helps to initiate control measures to interrupt virus transmission. In the laboratory, classical diagnostic methods, culture and serological tests are being replaced by molecular techniques. Routine surveillance systems will help understand the epidemiology of HFMD in India.
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Re-emergence of cholera in the Americas: Risks, susceptibility, and ecology
Mathieu JP Poirier, Ricardo Izurieta, Sharad S Malavade, Michael D McDonald
July-September 2012, 4(3):162-171
DOI:10.4103/0974-777X.100576  PMID:23055647
Background: The re-emergence of cholera in Haiti has established a new reservoir for the seventh cholera pandemic which threatens to spread to other countries in the Americas. Materials and Methods: Statistics from this new epidemic are compared to the 1991 Peru epidemic, which demonstrated the speed and complexity with which this disease can spread from country to country. Environmental factors implicated in the spread of Vibrio cholerae such as ocean currents and temperatures, as well as biotic factors from zooplankton to waterfowl pose a risk for many countries in the Americas. Results: The movement of people and goods from Hispaniola are mostly destined for North America, but occur to some degree throughout the Americas. These modes of transmission, and the probability of uncontrolled community spread beyond Hispaniola, however, are completely dependent upon risk factors within these countries such as water quality and availability of sanitation. Although North America has excellent coverage of these deterrents to the spread of infectious gastrointestinal diseases, many countries throughout Latin America and the Caribbean lack these basic services and infrastructures. Conclusions : In order to curb the immediate spread of cholera in Hispaniola, treatment availability should be expanded to all parts of the island and phase II epidemic management initiatives must be developed.
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Chlamydia and gonorrhea infections in HIV-positive women in urban Lusaka, Zambia
Maria L Alcaide, Deborah L Jones, Ndashi Chitalu, Stephen Weiss
July-September 2012, 4(3):141-144
DOI:10.4103/0974-777X.100566  PMID:23055644
Background: Sexually transmitted infections (STIs) remain an important public health issue in sub-Saharan Africa. STIs in HIV-positive women are associated not only with gynecological complications but with increased risk of HIV transmission to HIV-negative partners and newborns. Aims: The aims of this study are to determine the prevalence of chlamydia (CT) and gonorrhea (GC) and examine the demographic characteristics and risk behaviors associated with these STIs in a group of HIV-positive women in Lusaka, Zambia. Settings and Design: Cross-sectional study of a sample of HIV-infected women enrolled in two large studies conducted in urban Lusaka, Zambia. Materials and Methods: HIV-seropositive women (n = 292) were assessed for demographic and behavioral risk factors and tested for CT and GC. Univariate analysis was used to determine the demographic characteristics and risk behaviors associated with having CT or GC. Results: The identified prevalence of CT was 1% and of GC was 1.4%. There was an association of CT/GC with the use of alcohol before sex (OR = 9.I, CI = 0.59-0.15, P = 0.03). Conclusions: Rates of CT and GC are described in this sample of HIV-positive women. While being in HIV care may serve to increase medical care and condom use, alcohol use should be addressed in this population.
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CASE REPORTS
Mucormycosis of Pouch of Douglas in a diabetic woman
Palash K Mondal, Santosh K Mondal, Tanmoy K Mondal, Puranjay Saha
July-September 2012, 4(3):172-174
DOI:10.4103/0974-777X.100577  PMID:23055648
Mucormycosis is a severe fungal infection which is rare in clinical practice. This infection is usually acquired by inhalation; other portals of entry are ingestion and traumatic implantation, especially in immuno-compromised patients. Here, we present a case of mucormycosis in a 44-year-old diabetic woman. The patient had collection of fluid in the Pouch of Douglas (POD) and history of bleeding per vagina. Hysterectomy was done which showed a blackish serosal surface of the posterior uterus. Subsequent investigations revealed mycormycosis caused by Rhizopus oryzae (R. arrhizus) affecting the POD. Patient was treated with liposomal amphotericin B and is now keeping well.
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Immune thrombocytopenic purpura associated with pulmonary tuberculosis
Tapan Das Bairagya, Sibes Kumar Das, Pulak Kumar Jana, Somnath Bhattacharya
July-September 2012, 4(3):175-177
DOI:10.4103/0974-777X.100580  PMID:23055649
Thrombocytopenic purpura as a manifestation of pulmonary tuberculosis is very rare. We report a case of 25-year-old female who presented with thrombocytopenia-induced purpuric spots and an abnormal chest X-ray. There was no hepatosplenomegaly while the bone marrow examination revealed normal maturation of myeloid and erythroid series with increased megakaryocytes. Acid fast bacilli were seen in the sputum microscopy. A diagnosis of sputum smear positive pulmonary tuberculosis along with immune thrombocytopenia was made. High dose intravenous immunoglobulin therapy along with antituberculous drugs corrected the thrombocytopenia and also cured pulmonary tuberculosis. This case report illustrates the causal association between immune thrombocytopenia and tuberculosis.
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Adult patient with novel H1N1 infection presented with encephalitis, rhabdomyolysis, pneumonia and polyneuropathy
Ketan K Patel, Atul K Patel, Shalin Shah, Rajiv Ranjan, Sudhir V Shah
July-September 2012, 4(3):178-181
DOI:10.4103/0974-777X.100581  PMID:23055650
Neurological complications of influenza are well known. Influenza A is commonly associated with neurological complications. Neurological complications especially encephalitis is described in the pediatric age group of patients with current pandemic novel H1N1 infection. We are describing a case of novel H1N1 infection presenting with multi-system involvement (encephalitis, bilateral pneumonia, severe rhabdomyolysis leading to renal failure and polyneuropathy) in adult patient.
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EDITORIAL
State of the globe: Detecting HSV in clinical setting
Sheetal Vanjeri, Sagar Galwankar
July-September 2012, 4(3):139-140
DOI:10.4103/0974-777X.100565  PMID:23055643
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IMAGES IN MEDICINE
Liver hydatidosis extended to cava and lungs
Marta Díaz-Menéndez, Rogelio López-Vélez
July-September 2012, 4(3):182-183
DOI:10.4103/0974-777X.100582  PMID:23055651
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LETTERS TO EDITOR
Brucellosis masquerading as spondylodiscitis with multiple intervertebral disc prolapse
Syed Arshad Hussain Andrabi, Shamila Hamid, Sheikh Aijaz
July-September 2012, 4(3):184-185
DOI:10.4103/0974-777X.100585  PMID:23055652
  - 3,112 15
Prolonged cholestasis following hepatitis a virus infection: Revisiting the role of steroids
Ashwin R Saboo, Ramaa Vijaykumar, Sushma U Save, Sandeep B Bavdekar
July-September 2012, 4(3):185-186
DOI:10.4103/0974-777X.100588  PMID:23055653
  - 4,488 37
SPECIAL ORIGINAL ARTICLE
Serum HSV-1 and 2 IgM in sexually transmitted diseases - more for screening less for diagnosis: An evaluation of clinical manifestation
Dharmishtha G Tada, Nita Khandelwal
July-September 2012, 4(3):0-0
DOI:10.4103/0974-777X.100850  PMID:23055654
Background: Herpes simplex virus type 2 (HSV-2) is the cause of most genital herpes. Now, HSV-1 has become an important cause and represents even about 30% of genital herpes in some countries. So, study related to genital herpes should consider both HSV-1 and HSV-2. Aim: To examine trends in HSV-1 and 2 seroprevalence by Serum HSV-1 and 2 IgM in all type of sexually transmitted disease (STD) patients and also to evaluate correlation of serum HSV-1 and 2 IgM in STD. Materials and Methods: 150 patients attending the STD clinic attached to a tertiary care hospital of Ahmedabad were included in the study. Serum HSV-1 and 2 IgM correlations with clinical manifestations of recurrent and non-recurrent type of genital herpes patients and other non-herpetic STD patients were studied. Results: The overall serum HSV-1 and 2 IgM in STD seroprevalence were 15.66%. Female has significant higher prevalence (P < 0.05). STD cases and HSV seroprevalence were specially concentrated in persons aged 21 to 30 years. Among those positive with HSV, the distribution of STD are wide spread and found in non-herpetic group at high frequency. Out of total 23 serum HSV-1 and 2 IgM positive, 12 and 11 are distributed in herpetic and non-herpetic STDs, respectively. Discussion and Conclusion: Though serum HSV-1 and 2 IgM in STDs are less diagnostic, they help to see the iceberg part of the infection among the population concerned in recent scenario or in another words, it provides recent infective burden.
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Online since 10th December, 2008