Clinical profile of chikungunya fever in patients in a tertiary care centre in Maharashtra, India.

Background & objectives: In India a chikungunya fever outbreak started in December 2005 when the country experienced more than 13 lakhs of chikungunya infected cases. We undertook this study to study detailed clinical profile of chikungunya fever in both indoor and outdoor patients in a tertiary care hospital in Nagpur, Maharashtra in 2006. Methods: Suspected cases of chikungunya fever (n=405) during the period of July to September 2006, having clinical triad of fever, arthralgia and/or rashes were included in the study. Clinical profile was studied in all the cases. Of the 405 samples collected, 166 were tested for serum CHIK IgM antibodies. Results: Of the 166 samples tested for CHIKV IgM antibodies, 87 (52.4%) were positive (confirmed cases). Male: female ratio was 2.3:1. Fever and arthralgia were present in all cases. Rash was present in 27(31%) confirmed and 38(12%) suspected cases. Lymphadenopathy was present in 12 (13.8 %) confirmed and 4 of suspected cases. Chronic polyarthritis was seen in 22 (25.3%) confirmed and 75 (23.6%) suspected cases. Neurological manifestations were observed in 08 (9%) confirmed and 10(3.14%) suspected cases. Mortality was 7(2.2%) in 318 suspected cases and 3 (3.4%) in 87 confirmed cases. Interpretation &conclusions: Our findings showed that about half of the serum samples for CHIKV IgM antibody tested positive from cases suspected to have chikungunya fever. Fever, joint pain and headache were major symptoms. Certain rare manifestations like lymphodenopathy, oral ulcers and encephalitis were also seen. Mortality in confirmed cases was about 3.4 per cent.

Clinical profile of acute myocardial infarction in elderly (prospective study).

BACKGROUND: Heart disease is the leading cause of hospitalization and death in elderly patients. The role of conventional cardiovascular risk factors in older persons is incompletely understood because only fragmentary and inadequate data are available in most instances and the manifestations of acute myocardial infarction are generally believed to be atypical in the elderly. OBJECTIVE: The purpose of this study is to describe the risk factors, clinical features, outcomes in AMI in Elderly (>60 years) and to compare the same with the young subjects (<60 years) and to study the various complications in 30 days follow up. Study design: Prospective observational cross- sectional analytical study. SETTING: ICCU Department of Medicine, Indira Gandhi Government Medical College, Nagpur. PARTICIPANTS: 120 cases of AMI were categorized in two groups:--(a) Group I--age < 60 years, (b) Group II--age >60 years. Subjects were analyzed for baseline clinical history, complications, and risk factors of AMI. A detailed clinical examination and relevant investigations were done. The various complications at the time of admission were recorded. 07 days in hospital follow up and 30 days follow up after discharge from hospital was done for various complications. RESULTS: The male and female ratio was 3:1 in group I and 1.37:1 in-group II Atypical chest pain, sweating, dyspnoea and giddiness were observed predominantly in the elderly group with AMI than younger group, and less no. Of elderly subjects arrived at hospital within 6 hours of chest pain as compared to young subjects. (30/64 i.e. 46.8% vs. 40/56 i.e. 71.4%, p = < 0.05). Thrombolytic therapy and beta-blockers were under used in elderly (group II) (35.8% & 7.8% cases) as compared to( 60.8% and 60.8% cases) in(group I) respectively. Poor LVEF <55% (31 i.e. 63.2% cases) and presence of ventricular aneurysm in 2 cases were observed in-group II (>60 years). The incidence of major complications like congestive cardiac failure, arrhythmias, AV block were significantly higher in the elderly group (70.2%, 57.8%, 28.6%) as compared to (46.5%, 37.5%, 7.1%) respectively in younger group. Mortality, CCF, post AMI angina were the common complications observed in group (II), during one month follow up after AMI, whereas interventions like CABG/ PTCA were commonly performed in group I (<60 y). Mortality was significantly high in elderly group (II) than young (gr I) with AMI, 25 (39%) vs. 7 (12.5%) (p = 0.019). CONCLUSION: We conclude that the manifestations of AMI are more subtle in the elderly, with different risk factors. The elderly subjects are under thrombolysed and have higher complication and mortality rate.