Geographical distribution of primary & secondary dengue cases in India – 2017: A cross-sectional multicentric study

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.

Negative pressure pulmonary oedema after routine elective surgery.

Negative Pressure Pulmonary Oedema (NPPE) is known to occur in healthy subjects in the early post anaesthesia period, in the absence of fluid overload or left ventricular dysfunction. This type of non cardiogenic pulmonary oedema is also reported in literature following upper airway obstruction. We report two such cases of negative pressure pulmonary edema. Both the patients developed NPPE during postanaesthesia period due to persistent laryngospasm leading to upper airway obstruction. Both the patients were treated with diuretics, bronchodilators & antibiotics in intensive care unit. Within 24 hours the coarse crepitations disappeared and the patients were weaned off the ventilator. Awareness, early recognition and prompt treatment of negative pressure pulmonary oedema could be life saving.

Oral habits in school going children of Delhi: a prevalence study.

This study was conducted on 5554 children aged 5-13 years old with the objectives of recording the prevalence of oral habits among North Indian children according to sex. These children were selected from the schools of Delhi. The sample represented the entire school-going population of Delhi in the age group of 5-13 years. Statistical analysis was carried out using BMDP software and sex differences were calculated by using Fisher's exact test. The results showed that the prevalence of oral habits in Delhi school going children was 25.5%. Tongue thrust was the commonest habit (18.1%) followed by mouth breathing (6.6%). Thumb sucking was relatively less common habit and seen in only 0.7% of children. There were no significant differences between boys and girls for the prevalence of oral habits. However, for the specific habit types there was a sex difference. Thumb sucking was more common in girls (1.0%) when compared with boys (0.4%) and this difference was statistically significant (P < 0.001). There was a reverse trend for the mouth breathing, which was more common (P < 0.001) in boys (7.8%) than girls (5.3%). There were no differences for tongue thrust habit between boys (17.5%) and girls (18.6%).

High seroprevalence of hepatitis C virus and dual infection (hepatitis B and C virus) in non-alcoholic chronic liver disease in north India.

BACKGROUND: There are conflicting reports on the prevalence of hepatitis B and C virus (HBV and HCV) mediated chronic liver disease (CLD) in India. AIM: To study the prevalence of HBV and HCV associated in CLD in north India. MATERIAL AND METHODS: Eighty five patients (66 males, 19 females; age range 16-70 years) with unequivocal CLD were analysed. CLD patients with nonviral aetiologies were excluded. All sera were tested for anti-HCV by EIA (third generation), HBsAg, IgM and IgG anti-HBc, HBeAg/Anti-HBe by EIA (Abbott Diagnostics, IL). Positive anti-HCV results were confirmed by RIBA-II assay. RESULTS: Sixteen (18.8%), 22 (25.9%) and 21 (24.7%) patients had HBV, HCV and HBV + HCV infection, respectively. Twenty six (30.6%) CLD patients had no viral markers. CONCLUSION: HCV is emerging as an important cause of CLD in India. Dual infection (HBV + HCV) is seen in 25% patients. Dual infection influences the prognosis and response rates to interferon therapy.

Humoral immune response to mutans streptococci associated with dental caries.

BACKGROUND. Mutans streptococci are important aetiological agents in dental caries and their prolonged contact with oral tissues evokes a variety of immune responses through local secretory and systemic antibodies. Patterns of such humoral responses in Indian children have not been reported and we undertook the present study to examine these. METHODS. One hundred and twenty-six children with dental caries and 55 matched controls were studied and saliva and sera collected from them. The tests on these specimens included total salivary and systemic immunoglobulins of different classes using radial immunodiffusion and Streptococcus mutans specific IgA, IgG and IgM using specifically standardized enzyme immunoassays. RESULTS. Children with caries had higher levels of IgG (1350 +/- 9.9 mg/dl; controls 1110 +/- 6.7 mg/dl) and IgA (260 +/- 1.8 mg/dl; controls 190 +/- 1 mg/dl) in the serum but their saliva had lower levels of total IgG (160 +/- 0.7 mg/dl; controls 340 +/- 2.9 mg/dl) and IgA (130 +/- 0.5 mg/dl; controls 410 +/- 3 mg/dl). IgM levels in caries children and controls were not significantly different. Higher levels of Streptococcus mutans specific IgA were detected in the saliva of 95 out of 126 (75%) children with caries compared to 13 out of 55 (22%) controls. Specific serum IgG and IgA levels were also increased in 105 and 114 children with caries, although the levels were not as high as those in saliva. Total and specific salivary and serum IgM antibodies were similar in children with caries and control subjects. CONCLUSION. The nature of the humoral immune response in Indian children with dental caries suggests that Streptococcus mutans specific salivary and serum antibodies may play a major role in pathogenesis. Our findings may have importance when devising methods for follow up and prognosis as well as for vaccination strategies.

Ketosis resistant diabetes of the young: a profile of its exocrine and endocrine pancreatic dysfunction.

A subset of insulin requiring diabetes in the young (IRDY) is ketosis resistant. Its pathogenesis and pathophysiology remain ill defined. The current study was done to evaluate the exocrine and endocrine dysfunction in ketosis resistant young diabetics. Fecal chymotrypsin (unit/G), basal & stimulated c-peptide levels (pmol/ml) and sonographic evaluation of the pancreas were done in 59 IRDY patients: 34 ketosis resistant (KR) and 24 ketosis prone (KP). Fecal chymotrypsin levels in KR (11.1 +/- 3.4) and KP (10.3 +/- 5.1) were lower than in controls (22.4 +/- 7.3) (P < 0.01). KR subjects had better endogenous insulin reserves than KP subjects: the basal and stimulated c-peptide levels in KR patients (0.12 & 0.17) were higher than in KP subjects (0.06 and 0.07) (P < 0.05). A strong correlation was noted between the exocrine and beta cell dysfunction in KR subjects (r = 0.7, P < 0.05). Pancreas was smaller in KR and KP patients than in controls (P < 0.05) on sonography. Thus the resistance to ketosis is a reflection of the better preserved beta cell reserves in the KR patients. Loss of the trophic effect of insulin and associated malnutrition is responsible for their exocrine dysfunction.

Differential cell-mediated immune response to S. mutans in children with low and high dental caries.

Role of cell-mediated immune response (CMI) in dental caries was studied in 171 subjects, comprising of 86 children with low caries (LC), 31 with high caries (HC), and 54 age matched controls. [3H]thymidine mediated lymphoblast transformation test (LTT) using mutans streptococci antigen as stimulant was used to study the stimulation index (SI) of in vitro cultured lymphocytes from these children. The analysis revealed low stimulation index in high caries children whereas low caries children exhibited high stimulation index normally ranging between 2 to 6. The findings indicated that low caries children had strong CMI response as compared to high caries children. Although, the findings are based on limited number of samples, it certainly lays emphasis on protective or regulatory role of CMI in different phases of dental caries.