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Background: Thalassemia and hemoglobinopathies are a group of inherited conditions characterized by abnormalities in the synthesis or structure of hemoglobin (Hb). According to estimates, approximately 7% of the world population is a carrier of Hb disorders, leading to high morbidity and mortality. To reduce the burden of these highly prevalent monogenic disorders, detecting them in the carrier stage is crucial to prevent disease progression. Aim: We aimed to estimate the prevalence and spectrum of hemoglobinopathies in females in the reproductive (20–40 years) age group. Settings and Design: It was a retrospective observational study carried out for 2.5 years (from January 2018 till June 2020). Materials and Methods: All the females in the age group of 20–40 years age whose blood samples were received in the department for High-Performance Liquid Chromatography (HPLC) were included. The cases with abnormal HPLC findings were analyzed for hematological parameters including hemoglobin, RBC count, and RBC indices [mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), & red cell distribution width - coefficient of variation (RDW-CV)]. Statistical Analysis: Statistical package for social science (SPSS) statistics 21 version for Microsoft Windows (Chicago, USA) was used for statistical analysis of data. The data were described in terms of range, mean ± standard deviation (SD), frequencies (number of cases), and relative frequencies (percentage) as appropriate. Results: During the study period, 72.2% of the females were affected with ?-thalassemia trait, followed by HbD Punjab trait (17.8%), HbQ India trait (2.9%), ?-thalassemia major (1.8%), and two cases (1.2%) each of HbS trait, HbD Iran trait, and compound heterozygous of HbD Punjab and ?-thalassaemia, whereas HbE trait, compound heterozygous of HbQ and ?-thalassemia, compound heterozygous of HbJ-variant and ?-thalassemia had one case each (0.6%). Conclusion: Preventive strategies are cost-effective and include population screening, premarital screening, screening of spouses, genetic counseling, and prenatal diagnosis. Educating the carrier females about the potential risk and various screening methods may help in controlling the disease.
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Background: Epilepsy is an abnormal excessive electric neuronal activity and always represents by recurrent seizures. There is positive feedback cycle between epileptogenesis and brain inflammation. It has been proved that an inflammatory enzyme, cyclooxygenase (COX) (especially isoform-2, a constitutive enzyme), expressed in some important parts of the central nervous system and is responsible to induced inflammation locally and having seizurogenic property. Aim and Objective: The goal of this study was to see if celecoxib (a selective COX-2 inhibitor) could reduce the maximal electroshock seizure (MES)-induced seizures in mice. Materials and Methods: Celecoxib injected intraperitoneally in two different doses 5 mg/kgb/w and 10 mg/kg b/w, in albino Swiss mice and in two different phases. MES was elicited and length of different phases was noted. Length of tonic hindlimb extension was considered as indicator of anti-epileptic activity. Results: Celecoxib, when given intraperitoneally, exert significant reduction in the duration of THLE. This action of celecoxib strongly suggests the involvement of inflammation in the pathophysiology of epilepsy. Conclusion: The findings are suggestive of the therapeutic significance of celecoxib, as a future antiepileptic agent for seizure management.
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Gastric hyperplastic polyps (GHP) account for a majority of benign gastric polyps. Most of the GHPs are <2 cm, asymptomatic, and incidentally detected on endoscopy or radiologically. With increasing size, these polyps manifest as upper gastrointestinal bleeding, iron deficiency anemia, and gastric outlet obstruction (GOO). We report an unusual case of giant GHP simulating gastric carcinoma and posing as a diagnostic challenge for the surgeons emphasizing the diagnostic role of histopathology. A 46-year-old female presented with clinical features of progressive GOO for 1 year. Endoscopy revealed an eccentric proliferative lesion in the antrum. Computed tomography showed a polypoidal, enhancing mural thickening involving distal body and antro-pyloric region measuring 8.4 cm × 6.6 cm × 1.8 cm. Subtotal gastrectomy was done in view of clinical features of GOO and having a clinical suspicion of malignancy. Gross examination showed a giant sessile hyperplastic polyp with lobulated surface. Microscopy revealed features of a large, sessile hyperplastic polyp without any evidence of dysplasia. The patient was symptomatically relieved and is on follow-up. To conclude, giant GHPs can mimic gastric carcinoma on endoscopy and radiology. The possibility of giant GHP should be kept in mind in the presence of an intensely contrast-enhancing polypoidal lesion in the gastric antrum. Long-term endoscopic follow-up is recommended.
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Regional analgesia features a prime role within the multimodal analgesia approach for surgical pain management. currently each day it's common apply of using transverses abdominis plane block (TAP Block) with numerous sorts of native anaesthetics and adjuvants, as a multimodal pain relieving remedy used worldwide for intra and postoperative pain management in several surgeries. However, only a few studies are done wherever hemodyanamics effects when bupivacaine versus levobupivacaine have compared. Aim of this study to examine the consequences of bupivacaine vs levobupivacaine in patients undergoing lower abdominal surgeries and their effects on hemodynamics ( the blood pressure, HR, and SpO2). Method: A randomised double-blind management study conducted when approval from IEC Ref. code-92nd IIB Thesis / P4 . The study has fifty patients, with ASA I – II physical status, as well as each sex and 2-10 years cluster age and who set up for abdominal surgery notably lower abdominal . 25 patients set in every group and every which way allotted: cluster Bupiva and Levobupiva . All patients were well well-read regarding the procedure, drugs, and effects of drugs, and untoward complications. well-read written consent was taken from each patient before involving them within the study. primary objective is to examine the impact of those medicine on Blood pressure, HR, and SPO2 & Secondary objective was to check rescue physiological condition reduction within the surgical period. After the comparison between these 2 clusters, The mean SBP of group Bupiva was found below that of group Levobupiva . and located to be important at fifteen min, one hour, a pair of hr, and four hr and insignificant at baseline zero min, thirty min, half dozen hr (p=0.092), twelve hr, eighteen hr, and twenty four h.differences is insignificant in comparison the DBP at any purpose of your time from baseline to 24 hr. On comparing the center rate, variations were found insignificant from baseline (p = 0.897), 0 min (p = 0.651), 30 min (p = 0.096), 1hr (p = 0.192), 2 hr (p=0.390), four hour (p=0.525), half dozen hr (p=0.469), twelve hr (p=0.443), eighteen hr (p=0.288) to twenty four hr (p=0. 390) except at fifteen min (p=0.010) that was the mean pulse rate of cluster Bupiva is over that of group Levobupiva at one,5 min. On comparison the SPO2differences were insignificant at baseline (p = 0.620), 15 min (p = 0.108), thirty min (p=0.353), 1 hr (p = 0.789), 2 hr (p = 0.364), 4 hr (p = 0.292) and 6 hr (p = 0. 198) however important at 0 min (p = 0.002), 12hr (p = 0.012), 18hr (p = 0.002) and24 hr (p = 0.028) wherever the mean SPO2 of cluster Bupiva was abundant below the group Levobupiva. Stable hemodynamics for a extended period were provided by Levobupivacaine as compared to Bupivacaine.
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Background: Visual evoked potentials (VEPs) are electrical potential differences recorded from the occipital lobe in response to different visual stimulus. In myopic individuals, there is blurring of the stimuli, causing defocusing which tends to affect the VEP parameters. Aim and Objective: The study was designed and done to evaluate the effect of various degrees of myopia on VEP in medical students of age 18–24 years. Materials and Methods: A total of 120 subjects were included in this study, consist of 60 individuals without having any refractive disorders and 60 individuals having various degree of myopia, that is, 22 subjects with mild myopia of <?3D, 26 subjects with moderate myopia of ?3 to ?6D, and 12 subjects with severe myopia of > ?6D. The study was approved by Ethical and Research Committee, Govt. Medical College, Patiala. Results: In the present study, mean values for P100 latency were significantly high in myopic group as than in control group. Furthermore, mean values for N75 latency were significantly high in the myopic group as compared to the control group and mean values for N145 latency were significantly high in the myopic group as compared to the control group for both the right and left eyes. Mean values for amplitude (N75-P100) was significantly lower for the myopic group as compared to the control group for both the left and right eyes. There is prolongation of latencies in myopic individuals as compared to the control and latencies increase with the increase in degree of myopia. Furthermore, there is decrease in the amplitude in myopic individuals and it decreases with the increase in degree of myopia. Conclusion: The mean values for latencies were found to be comparable and the mean values of latencies were found to be increasing with increase of degree of myopia. Probably, the reason behind this result may be the optical blurring of the stimulus which lead to defocusing, therefore causes the prolongation of latency. The mean values for amplitude were found to be comparable and the mean values of amplitude were found to be decreasing with increase of degree of myopia. Probably, the reason for our finding is that in a pattern reversal VEP, the amplitude relies on the visual system’s ability to determine the pattern and on the degree of retinal image focus.
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Introduction: The association between obstructive sleep apnea (OSA) and insomnia is relatively common but is underrecognized. There are important diagnostic and therapeutic implications of comorbid OSA杋nsomnia overlap but there is no data available from India. Objectives: (1) To find out the prevalence of insomnia among patients with OSA; (2) To compare the demographic characteristics, Epworth sleepiness scale (ESS) scores and the presence of comorbidities among patients of OSA with insomnia vs OSA without insomnia. Materials and methods: It was a prospective observational study involving 250 patients with suspected OSA. A total of 189 patients had OSA based on type I polysomnography and were further analyzed. Insomnia was diagnosed based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) criteria. Results: The prevalence of insomnia among OSA was 15.34% (29/189). Overlap was seen in 22.45 and 12.86% of women and men respectively among patients with OSA. The prevalence of overlap increased with decreasing severity of obesity and OSA. Those with OSA杋nsomnia overlap had significantly lower ESS scores as compared to OSA without insomnia (12.31 vs 15.24; p = 0.019). A total of 10.34% (3/29) of patients of overlap had depression whereas none from OSA alone had depression. Conclusion: There is a high prevalence of insomnia among patients with OSA (15.34%), similar to findings worldwide. Insomnia is more common among women with OSA. Overlap patients have lower ESS scores and are likely to be depressed.
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<i></i>Background: Diabetes mellitus is a chronic hyperglycaemic syndrome prevalent worldwide which predisposes to increased cardiovascular mortality and morbidity. Dyslipidaemia significantly contributes to the increased risk of cardiovascular disease and other morbidities in these subjects. Several studies conducted in the past shows that the non-pharmacological approach such as lifestyle modification that is yoga practices on daily basis have resulted in improvement in dyslipidemia status in cardiovascular disease. Aim and Objectives: This study was conducted to study the effect of Yogic Asanas on lipid profile in type 2 diabetic subjects. Materials and Methods: This is a prospective randomized control study. We enrolled 80 Type 2 diabetic subjects both males and females in the age group of 40–60 years based on inclusion and exclusion criteria from January 2021 to September 2021. Before and after 3 months of yoga and pranayama repeat fasting blood samples were taken from all the participants for lipid profile parameters estimation. All the results obtained before and after yoga and pranayama were compared using Statistical Package for the Social Sciences version 20, student paired t test. A P < 0.05 was considered statistically significant. Results: Yogic exercises significantly benefits the diabetes patients with their lipid profile levels. Conclusion: Yogic exercises would give benefit to the patient by reducing cholesterol and low- density lipoprotein cholesterol levels as well as increasing high-density lipoprotein levels and improve the status of patients in terms of use of less medicine, improvement of physical well-being leading to complication-free life.
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Background: During MBBS course, the students’ study about cardiovascular system (CVS) in physiology, pathology, pharmacology, preventive medicine, pediatrics, and medicine for the management and diagnosis of cardiovascular disorders. Blood pressure measurement is a common and a beneficial tool for the diagnosis of cardiovascular disorders (hypertension, hypotension, etc.) along with their treatment and management. Thus, knowing the proper technique of measuring blood pressure becomes an essential part of learning the course and management of cardiovascular disease. This study is designed to teach and train the first phase undergraduate students to measure blood pressure in a proper way so that they do not stumble on the first step of examination of CVS. Competency-based training is an outcome-based approach that involves identifying the skills acquired by Indian medical graduate. Competency-based teaching involves teaching of undergraduate students to support their achievement and assessment of the communication and technical skills and to develop their ability to interpret the results of blood pressure measurement for apt patient management. Aim and Objectives: This study aims to assess and compare the effect of competency-based teaching and traditional teaching in learning the skill of blood pressure measurement. Materials and Methods: Two hundred students were taken from Phase I undergraduate medical students which were randomly divided in two Groups A and B. Competency-based teaching of blood pressure measurement was done in Group A in by teaching method of demonstrate, observe, assist, and perform and Group B was taught by traditional demonstration. Pre-test questionnaire was given to both the groups before beginning of the practical session. The students learning of skill to measure blood pressure was assessed by directly observed procedural skills (DOPS) checklist after which student feedback was provided along with filling up of the post-test questionnaire. Furthermore, feedback from both student and teacher was collected. Results: Highly significant difference was found between pre-test and post-test of both Group A and Group B. Significant difference was found between Group A and Group B post-test scores. It was found that Group A in which competency-based teaching was done scored higher post-test scores then Group B. Furthermore, highly significant difference was seen among the scores of DOPS checklist between Group A and Group B. Conclusion: In the present research study, it was found that the students who underwent competency-based training of the skill of blood pressure measurement showed significantly higher scores in learning and performing the skill. Furthermore, on feedback provided by the students, 96% of the students strongly agree that the competency-based teaching and learning is better than traditional teaching.
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@#Introduction: Controversies exist in treatment of proximal humerus fractures as treatment options vary greatly from conservative management, closed pinning, stacked intramedullary nails, plating and hemi-arthroplasty. The purpose of this study is to study the fracture patterns of each case and document the functional outcome and complications post-operative in the management of proximal humerus fractures operated with proximal humerus plate. Materials and Methods: Thirty five patients with closed proximal humerus fractures, above 18 years old, admitted in our tertiary care hospital during the study period were enrolled. Patients underwent open reduction internal fixation with proximal humerus locking plate under general anaesthesia. Post-operative patients were assessed using Constant and DASH scores. Complications were recorded. Results: In our study the absolute Constant score of the study population increases at three months and six months and was found to be significant. Mean Constant score for 4- part fractures was 45.6 which were inferior as compared to 2-part and 3-part fractures (43.1 and 44.6, respectively). The mean Constant score at six months was 51.80 +/- 6.71. All three types of proximal humerus fractures showed significant improvement in the mean DASH score over our study period of six months and was found to be significant. Mean DASH score at six months was 27.97+/-12.84. Out of the 35 cases in the study two had complications. One had implant failure (Neer’s type 3, 60-year-old female) and one had varus collapse (Neer’s type 3, 45-year-old male). Conclusion: Due to angular stability and effective maintenance of the intraoperative fracture reduction during follow-up period, early post-operative mobilisation is possible which helps the patient to attain better shoulder range of motion and return to activity faster.
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Purpose: To assess trends in antibiotic sensitivity of pseudomonas and compare multidrug resistance (MDR) between Pseudomonas endophthalmitis cases presenting in two consecutive 6-year time frames in a tertiary center in South India. Methods: This is a retrospective comparative series of all Pseudomonas endophthalmitis cases treated from June 2004 to May 2016. Microbiological culture results in all endophthalmitis patients were screened for pseudomonas. Positive cases in the initial 6 and final 6 years were compared for sensitivity to antibiotics and the proportion of MDR. MDR was defined as resistance to at least two different classes of antibiotics. Results: Pseudomonas accounted for 74 of 389 endophthalmitis cases (19%), 42 in initial 6 and 32 in final 6 years. Sensitivity to ciprofloxacin, ofloxacin, gatifloxacin, moxifloxacin, and ceftazidime was 85.7%, 82.9%, 76.5%, 76.9%, 88.1% up to 2010 which reduced to 75%, 59.4%, 68.8%, 56.3%, 56.3%, respectively, after 2010, being significant for ofloxacin (P = 0.0349) and ceftazidime (P = 0.0028). Susceptibility to amikacin, gentamicin, and tobramycin changed non-significantly from 83.3%, 43.9%, 47.6% to 71.9%, 61.3%, 61.3%, respectively. Twenty of 74 cases (27%) were MDR with 16.7% in first 6 years versus 40.6% in final 6 years. Postoperative MDR cases rose from 10.3% to 50% (P = 0.0048). Conclusion: This study shows rising resistance of Pseudomonas to fluoroquinolones, amikacin, and ceftazidime in endophthalmitis. MDR also showed an upward trend, particularly in postsurgical cases.
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The effect of cage or deep litter housing on production performance of White Leghorn was investigated in this experiment. A total 144 pullets of White Leghorn were randomly assigned to two treatments as; Cage housing and Deep litter housing. Results revealed that body weight at sexual maturity was significantly (P<0.05) lower in birds reared in cage than the deep litter housing. Moreover, lower feed intake was observed in birds kept in cages than that of deep litter housing. Feed conversion ratio in terms of feed intake/dozen eggs or feed intake/kg egg mass was better in birds reared in cages than the deep litter housing. The average hen day and hen house egg production were not affected due to different housing systems. Egg quality traits like albumen index, yolk index and Haugh unit score were significantly (P<0.05) higher for eggs produced by birds reared in cage housing than the deep litter housing. The profit of about 20% was observed in cage housing over deep litter housing. It was concluded that the lower feed consumption and body weight at sexual maturity, better feed conversion, egg quality and economic returns were achieved in cages compared to deep litter housing. However, cage or deep litter housing had no effect on egg production
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A novel, simple, optimized reversed-phase chromatography method for assay of Tofisopam in pure and tablet form is developed. The experimental trial was by Box Behnken design using the Design Expert® software 10 version. The attributes selected were peak symmetry, number of theoretical, and peak purity. The predicted data satisfied with actual experimental data. The optimized chromatographic conditions required a quaternary pump with a mobile phase of Water: Acetonitrile 25:75 v/v at 1 mL/min, oven temperature at 25oC at 310 nm using C18(250 × 4.6 mm Id, 5μm) column and PDA detector with a run time of 5 min. The method was validated for linearity, precision, accuracy, and specificity. The method produced a linear response over a concentration range of 4–24 ppm with an overall average accuracy of 99.98%. The method was robust, reproducible, and specific with respect to the retention time of tofisopam.
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Background: Autism is extraordinarily difficult for families to cope with for various reasons. Perceived burden and care for the child with autism, available forms of social support, and the interactions between the autistic child and other family members are areas of significant concern for families. Objective: The objective of this study was to determine the burden of care perceived by the principal caregivers of autistic children or adolescent visiting health facilities in Lucknow city. Methods: The cross-sectional study was conducted from October 2016 to September 2017 with a sample of 90 principal caregivers (aged <60 years) of autistic children and adolescents aged 3–19 years and diagnosed with autism, attending government and private health facilities providing treatment for autism in Lucknow, Uttar Pradesh, India. Validated tools were used to assess the burden of care and disability level of autistic children. Data were analyzed using the software SPSS version 16. Results: The caregivers of autistic children and adolescents perceived the burden of care in different domains in varying extent with “caregiver's routine” and “taking responsibility” domains affected the most. The burden perceived was found to be affected by the permanent residence of caregiver, rural/urban dwelling, type of family, socioeconomic status, age at which diagnosis was made, knowledge about autism and the severity of autism. Conclusions: Availability and easy accessibility of autism treatment facilities must be the most probable reason for less burden perceived in three domains, by caregivers of urban settings and those belonging to Lucknow. Furthermore, better knowledge on autism and family and friends' support led to decrease in the burden perceived by the caregivers in various domains. Thus, it was found that the burden perceived can be reduced by universal availability of evidence-based early diagnosis and treatment of autism and improving the knowledge of caregivers about autism.
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Background: Adolescents (10–19 years) constitute about one-fifth (21.4%) of India’s population. It has been identified as one of the vulnerable periods of life when the various health problems may occur. The prevalence of mental health problems among adolescents in India varies from 8.7% to 31.2% as shown in different studies. Objectives: The objectives of this study were to estimate the prevalence of mental health issues, violence, bullying, and unintentional injuries among adolescents. Materials and Methods: The present study is an observational descriptive study. After obtaining ethical clearance from the institutional ethics committee, 100 students from rural and 100 from urban areas of both sexes were randomly selected. A questionnaire based on global school-based student health survey was prepared. Responses obtained from self-administered questionnaire were entered into Microsoft Excel. Data were analyzed in Microsoft Excel using simple proportions and Chi-square test to find statistical significance if any. Results: About 11% felt lonely most of times, 13.5% had difficulty in sleeping at most of nights, and 2.5% even considered of attempting suicide. Girls (15%) reported being bullied more as compared to boys who reported it to be 9%. Furthermore, reports were more for urban area (15%) than for rural one (9%). Conclusion: Adolescents are being bullied or get involved in a physical fight (17%). Mental health issues are also widely prevalent among them. About 28% felt lonely, 30.5% could not sleep at night, and 2.5% even considered attempting suicide.
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Background & objectives: Humans are considered to be the principal host for hepatitis A virus (HAV) infection. In India, heterogeneous groups of susceptible individuals coexist in different regions. There has been a decline in antibody titres to HAV among young adults which may pose a major public health problem. The objective of this study was to assess the IgG anti-HAV level among healthcare workers (HCWs) in the age group of 20-60 yr and its association with the socio-demographic variables. Methods: Blood sample (2 ml) was collected under aseptic conditions from each participant followed by the preparation of serum and storing at ?20癈. ELISA-based kits were used for the determination of IgG antibodies to HAV in the human serum samples. Results: Two hundred and fifty four HCWs were enrolled. IgG anti-HAV antibodies were detected in 97.2 per cent of the samples analyzed. No differences were observed in the levels of IgG anti-HAV antibody and education, income, occupation and socio-economic classes of the HCWs. A seropositivity rate of over 90 per cent was seen amongst all the socio-economic classes. Interpretation & conclusions: High levels of IgG protective antibodies were seen among the studied HCWs, hence HAV vaccination may not be required. It will be advisable to do a cost-benefit analysis of vaccination for HAV.
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Background: Uremic milieu associated with chronic kidney disease (CKD) is associated with upper gastrointestinal (GI) symptoms such as nausea, vomiting, anorexia, and GI bleeding. Objective: The present study intended to ascertain the prevalence of various upper GI (UGI) symptoms and UGI endoscopic abnormalities in patients of CKD. Materials and Methods: Patients were stratified according to glomerular filtration rate and their respective GI symptoms score was determined and they were subjected to UGI endoscopy. Results: Thirty males and 24 females of CKD were compared with equal number of control group who have normal kidney function but may or may not have UGI disturbance. The severity of CKD correlated with high GI symptom score with maximum number of patients in dialyzed CKD subgroup. Anorexia followed by nausea and abdominal pain was dominant symptoms in the study group. On endoscopic evaluation, hiatus hernia and duodenitis were significantly more prevalent in the study group over the control group. Conclusion: Based on these observations, this study supports the routine usage of UGI endoscopy in evaluation of CKD patients.
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Background: To improve on Maternal and Neonatal Mortality Rates, newer technologies need to be explored to achieve Sustainable Development Goals of 2030. Objectives: To assess the use of mobile phones for essential obstetric care and associated factors among women availing obstetric services at a rural maternity hospital in South Karnataka. Material & Methods: A cross sectional study was done among the women availing obstetric services in Snehalaya Hospital, Solur in Ramnagara District. Results: There were 236 women included in the study, with a mean age 23.3 (3.22) and 11.78 (2.87) mean years of completed education. 99.15% had mobile phones but only 65% among them had their own phone. None of the women received text messages from MCTS (Government MCH Texts). Of the 53.4% women who had smartphone at home, only 42.4% used the smartphone to search for general health information and none of them used their mobile phone to access essential obstetric care. 48.2% watched health related advertisements and promotions on TV. Antenatal care was adequate among the women, but birth preparedness was found to be poor. Conclusion: The rural women in this study had poor utilization of mobile phones in obstetric care despite the presence of smartphones at home.
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Background & objectives: Dengue virus infection is endemic in India with all the four serotypes of dengue virus in circulation. This study was aimed to determine the geographic distribution of the primary and secondary dengue cases in India. Methods: A multicentre cross-sectional study was conducted at Department of Health Research / Indian Council of Medical Research (DHR)/(ICMR) viral research and diagnostic laboratories (VRDLs) and selected ICMR institutes located in India. Only laboratory-confirmed dengue cases with date of onset of illness less than or equal to seven days were included between September and October 2017. Dengue NS1 antigen ELISA and anti-dengue IgM capture ELISA were used to diagnose dengue cases while anti-dengue IgG capture ELISA was used for identifying the secondary dengue cases. Results: Of the 1372 dengue cases, 897 (65%) were classified as primary dengue and 475 (35%) as secondary dengue cases. However, the proportion varied widely geographically, with Theni, Tamil Nadu; Tirupati, Andhra Pradesh and Udupi-Manipal, Karnataka reporting more than 65 per cent secondary dengue cases while Srinagar, Jammu and Kashmir reporting as low as 10 per cent of the same. The median age of primary dengue cases was 25 yr [interquartile range (IQR 17-35] while that of secondary dengue cases was 23 yr (IQR 13.5-34). Secondary dengue was around 50 per cent among the children belonging to the age group 6-10 yr while it ranged between 20-43 per cent among other age groups. Interpretation & conclusions: Our findings showed a wide geographical variation in the distribution of primary and secondary dengue cases in India. It would prove beneficial to include primary and secondary dengue differentiation protocol in the national dengue surveillance programme.