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ABSTRACT Introduction: Data on the prevalence of clinically significant antigens (Rh, Kell, Kidd, Duffy, MNSs, Lewis, P and Lutheran) among the Indian donor population is sparse. Objective: This prospective study was aimed at determining the prevalence of 21 clinically significant antigens for the first time in the South Indian donor population. Method: A total of 672 regular O group blood donors were enrolled for Rh (C, c, E, e) and Kell (K) antigens typing. Of these, 188 donors were typed for other clinically significant antigens (k, Kpa, Kpb, Jka, Jkb, Fya, Fyb, M, N, S, s, P1, Lea, Leb, Lua and Lub). Results: Antigen frequencies were expressed in percentages. In our study, R1R1 and rr were the most common phenotypes among D+ and D− donors, respectively. Among the Rh antigens, the e antigen was expressed by 97.5% and 100% of D+ and D− donors, respectively. The K antigen was found in only 0.15% of donors. In the Duffy and Kidd blood group system, Fy (a+b+) and Jk (a+b+) were the most frequent phenotypes, respectively. In the MNSs blood group system, M+N+ and S−s+ were the most common phenotypes reported. The Le (a−b+) was found to be the phenotype with the highest prevalence in the Lewis blood group system. The Lu (a−b+) was the only phenotype found in the Lutheran blood group system. Conclusion: Knowledge regarding the prevalence of antigens in a given population is essential in developing cost-effective in-house panels and a rare donor registry comprising donors typed negative for a high-frequency antigen or a combination of common multiple antigens.
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Purpose: Understanding the association between social determinants of health (SDoHs) and microbial keratitis (MK) can inform underlying risk for patients and identify risk factors associated with worse disease, such as presenting visual acuity (VA) and time to initial presentation. Methods: This was a cross?sectional study was conducted with patients presenting with MK to the cornea clinic at a tertiary care hospital in Madurai, India. Patient demographics, SDoH survey responses, geographic pollution, and clinical features at presentation were collected. Descriptive statistics, univariate analysis, multi?variable linear regression models, and Poisson regression models were utilized. Results: There were 51 patients evaluated. The mean age was 51.2 years (SD = 13.3); 33.3% were female and 55% did not visit a vision center (VC) prior to presenting to the clinic. The median presenting logarithm of the minimum angle of resolution (logMAR) VA was 1.1 [Snellen 20/240, inter?quartile range (IQR) = 20/80 to 20/4000]. The median time to presentation was 7 days (IQR = 4.5 to 10). The average particulate matter 2.5 (PM2.5) concentration, a measure of air pollution, for the districts from which the patients traveled was 24.3 ?g/m3 (SD = 1.6). Age? and sex?adjusted linear regression and Poisson regression results showed that higher levels of PM2.5 were associated with 0.28 worse presenting logMAR VA (Snellen 2.8 lines, P = 0.002). Patients who did not visit a VC had a 100% longer time to presentation compared to those who did (incidence rate ratio = 2.0, 95% confidence interval = 1.3–3.0, P = 0.001). Conclusion: Patient SDoH and environmental exposures can impact MK presentation. Understanding SDoH is important for public health and policy implications to mitigate eye health disparities in India.
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Despite the multidrug regimen, Hansen’s disease still remains a public health scourge. The present study aims to study the epidemiological and clinical trends of Hansen’s disease in a tertiary care center for a period of 1 year. A cross sectional study was carried out in the outpatient department of the institute for a period of 1 year from July 2020 to June 2021 and all leprosy cases were included in the study. The patients were examined thoroughly, and the diagnosis was done using WHO criteria. The nerves involved, lepra reactions were identified and disability was graded using WHO grading. Out of 62 patients, maximum number of patients (15 patients) were in the 21-30 years age group (24.2%). The most common type of leprosy was borderline lepromatous leprosy (32.25%) and nerve enlarged was the ulnar nerve (63.9%). As per WHO classification, 51(82.25%) cases were classified as MB and 11(17.7%) cases as PB. Among these 62 patients 25 ( 40%) were slit skin smear positive for AFB). A total of 18 patients (29.03%) presented with lepra reactions of which 10 presented with type 1 and 8 with type 2 reactions. A total of 25 patients (40.32%) presented with deformities which shows delayed diagnosis and inadequate timely treatment of disease and its complications. Our data shows that only 13% of cases reported within one year of noticing the symptoms. Community based studies are required to understand the reasons for such a situation in this area. Efforts must be made to prevent its spread, promote early detection, ensure proper treatment, and maintain patient follow-up
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Background: The injudicious and indiscriminate use of antimicrobials has led to the development of antimicrobial resistance (AMR), particularly in the low- and middle-income countries. Antimicrobial Stewardship (AMS) is the coordinated intervention to enhance the appropriate use of antimicrobials. Antimicrobial stewardship program (ASP) is a multidisciplinary program with interventions and strategies to encourage AMS to prevent emergence of AMR. Aims and Objectives: This study aimed at evaluating the knowledge, awareness, and practice (KAP) of AMS among prescribers of a teaching hospital in South India. Materials and Methods: A cross-sectional questionnaire based study conducted after obtaining Institutional Ethics Committee approval was conducted among prescribers of a teaching hospital from September 2022 to October 2022. Responses to the questionnaires issued to the prescribers through Google Forms were analyzed by descriptive statistics using Microsoft excel. Results: A total of 230 prescribers submitted the filled in questionnaires. The definition of AMS was known to 62%. The constitution and functioning of ASP was known to 59%. However, only a few (38%) prescribers agreed that antimicrobials are avoided in viral infections. More than 60% had good awareness of AMS. However, only 25% were aware of an ASP program is their hospital. Fifty percent agreed to the practice of reviewing antimicrobial use after 48–72 h and only 38% to the practice of obtaining cultures before prescribing antimicrobials. Conclusions: The prescribers had moderate knowledge and awareness and poor practice of AMS. To address these gaps, educational interventions and capacity building approaches are required.
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Purpose: To present the eye care seeking behavior among rural adults in South India. Methods: This cross?sectional study was conducted between 2019 and 2020 covering three blocks of the Thiruvannamalai district, Tamil Nadu, India. Door?to?door survey was performed to collect demographic information, status of literacy, occupation, and details of previous eye examination. Distance visual acuity was tested for individuals available in the house using a log MAR (logarithm of minimum angle of resonance) chart. Association between demographic details, details of previous eye examination, and status of vision was analyzed using logistic regression. Results: A data of 12,913 individuals were included for the analysis, of which 6460 (50.03%) were females. Of the total individuals, 2007 (15.54%) had undergone an eye examination previously. There were 1639 (28.50%) people who had a vision less than 0.2 log MAR in at least one eye. The odds of reported ‘previous eye examination’ were more among females [odds ratio (OR) 1.48, 95% confidence interval (CI): 1.32–1.66, P < 0.001]; individuals aged above 60 years [OR: 11.46, 95% CI: 9.44–13.91, P < 0.001], between 40 and 60 years [OR: 10.43, 95% CI: 8.85–12.30, P < 0.001], and between 18 and 40 years [OR: 2.48, 95% CI: 2.16–2.84, P < 0.001]; illiterates (OR: 1.76, 95% CI: 1.45–2.15, P < 0.001); and farmers (OR: 1.32 95% CI: 1.12–1.55, P = 0.001). Conclusion: The study presents the utilization of eye care among rural South Indian adults. Almost 84.46% of individuals had not undergone any eye examination. Robust measures to promote eye care management would help in effective utilization of eye care services among rural adults.
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The broad spectrum of causal variants in the newly discovered GIPC3 gene is well reflected in worldwide studies. Except for one missense variant, none of the reported variants had reoccurred, thus reflecting the intragenic heterogeneity. We screened all the six coding exons of GIPC3 gene in a large cohort of 177 unrelated prelingual hearing impaired after excluding the common GJB2, GJB6 nuclear and A1555G mitochondrial variants. We observed a single homozygous pathogenic frameshift variant c.685dupG (p.A229GfsX10), accounting for a low incidence (0.56%) of GIPC3 variants in south Indian population. GIPC3 being a rare gene as a causative for deafness, the allelic spectra perhaps became much more diverse from population to population, thus resulting in a minimal recurrence of the variants in our study, that were reported by authors from other parts of the globe.
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Background: Violence against women is an important public health problem, due to its consequences on women health. There is a considerable variation in the prevalence of domestic violence across the states and different settings in India. Objectives: The objectives of the study were to estimate the prevalence of different forms of domestic violence and determine the associated factors among women working in tea estates. Materials and Methods: A cross-sectional study was conducted in two tea estates in Tamil Nadu. All (266) ever-married women workers aged 15–49 years were included in the study. Data were collected using a pre-designed interview schedule including sociodemography and physical, psychological, and sexual domains of domestic violence. It was developed using the National Family Health Survey 3 interview schedule and the World Health Organization multi-country study on women’s health and life experiences questionnaire version 10. Results: The prevalence of domestic violence was 65%, while specifically psychological, physical, and sexual violence were 63.5%, 44.1%, and 4.1%, respectively. Domestic violence was significantly associated with socioeconomic status, spousal literacy status, age at marriage, and alcohol use (P < 0.05). Any form of violence and psychological violence were twice as common with illiterate (unadjusted odds ratio [OR]: 2.6; 95% confidence interval [CI]: 1.4–4.9) (unadjusted OR: 2.4; 95% CI: 1.1–4.9) and a spouse who consumed alcohol (unadjusted OR: 2.7; 95% CI: 1.6–4.6) (unadjusted OR: 2.5; 95% CI: 1.5–4.2), respectively. Conclusion: The prevalence of all forms of domestic violence was high among women in the selected two tea estates in South India. Significant association was found with spousal characteristics. This calls for stringent enforcement of laws and educating men toward changing the social attitude toward violence against women.
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Background: Early diagnosis is the mainstay for reducing complications associated with diabetes. Though blood sugar testing was made freely available, there is gap in utilization of the same. Hence, the current study was conducted to assess the detection gap in diabetes compared to regional estimates. Also, to assess the extent of screening and factors associated with not getting screened.Methods: A community based cross-sectional analytical study was conducted in the selected rural areas of Puducherry. House to house enumeration survey was conducted in the purposively selected rural areas during September-2016 to February-2017. Information on diabetes status, status of screening in last one year was collected from individuals aged more than eighteen years. Data was entered in Epidata 3.1 and analyzed using Stata 12 software. Percentages with 95% CI were used to estimate the detection gap in diabetes on comparing with regional estimates given by IDF (8.6%). Generalized Linear Models were used to assess the individual level characteristics associated with not screening for diabetes.Results: Of the total 1844 enumerated individuals, 1423 (78.6%) were above 18 years of age. The detection gap for diabetics based on IDF was 39% and based on DLHS-4 was 69.8%. Of the eligible individuals for screening 81.9% (95% CI: 79.7%-83.9%) were not screened for diabetes in last one year.Conclusions: With high detection gap and low utilization of screening, there is need for developing innovative strategies like task shifting, ICT utilization for screening and targeted screening.
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Purpose: The purpose of this study was to evaluate causes for profound visual impairment in children ?3 years of age at a tertiary eye care center in Andhra Pradesh, India. Methods: A retrospective study was conducted for all the children (?3 years) who attended the pediatric ophthalmology service between January 2012 and February 2017. Results: A total of 428 severely visually impaired children aged ?3 years were seen during the study period: 264 (62%) of them were boys and I64 (38%) were girls. The average age at presentation was 14.02 months. The causes of visual impairment were cerebral visual impairment (CVI) 142 (33%), a combination of CVI and ocular visual impairment (OVI) 48 (11%), and OVI only 236 (56%), which included congenital cataract 56 (13.1%), retinopathy of prematurity 52 (I2.6%), optic atrophy 17 (4.5%), congenital nystagmus (4.4%), congenital globe anomalies 2I (5.2%), and high refractive errors - 10 (2.8%). Delays in different areas of development were seen in 103 out of 142 children with CVI (72.5%), which included motor delay 53 (51.5%), cognitive delay 15 (14.6%), speech delay in 3 (2.9%), and delay in multiple areas of development (like combination of motor, cognitive, and speech delay) in 32 (31.1%). Conclusion: In children under 3 years of age, CVI is a major cause of profound visual impairment in our area and the majority of them manifest delay in several areas of development.
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Context: Dengue virus (DENV) causes acute febrile illness in tropical and subtropical countries. In India there is a steady increase in incidence since 1950s which could be attributed to emergence of new serotype or lineage\clade shifts in circulating DENV. Aims: We aimed to perform molecular characterisation and phylogenetic analysis on samples from the recent outbreak (August–October 2017). Settings and Design: Retrospective epidemiological analysis of dengue outbreak. Subjects and Methods: Samples positive for non-steroidal 1 antigen by enzyme-linked immunosorbent assay (n = 147) were included. The study was approved by our institute ethics committee (JIP/IEC/2018/496). Five hundred and eleven base pair of capsid and pre-membrane encoding genes (CprM) region was amplified using Lanciotti primers, followed by second round of polymerase chain reaction using serotype specific primers. Samples which were positive by second round (n = 68) were sequenced and genotyped using Basic Local Alignment Search Tool analysis and phylogenetic tree was constructed by MEGA7 software. Results: Phylogenetic analysis of CprM sequences identified all 4 serotypes in circulation during this outbreak. We observed both single (n = 50) and concurrent infections (n = 18), with DENV4 as the major contributor (64%). Within Genotype I of DENV4 we observed a distinct new clade (Clade E) which was 2.6% ± 0.9%–5.5% ± 1.1% divergent from the other clades. Among the concurrent infection, DENV 4 and DENV 2 combination was observed to form the majority (77.8%). Conclusions: Overall this study documents the emergence of DENV4 as the major serotype in circulation, replacing DENV1, 2 and 3 which had been previously reported from Tamil Nadu and Puducherry. This substantiates the need for continuous monitoring in endemic countries like India, where such data may impact the formulation of vaccine policy for dengue.
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Background: Aim was to estimate the prevalence of vitamin D deficiency in pregnant women and their infants and to analyse the effect of maternal vitamin D deficiency on the infant.Methods: A prospective study was done in the Department of Obstetrics and Neonatology in a tertiary centre in South India with 150 women seen in the antenatal clinic after 36 weeks of pregnancy were recruited. Serum vitamin D levels were obtained. Babies were followed up and sampled once between 10 and 20 weeks of age for vitamin D, calcium, phosphate and alkaline phosphatase. Vitamin D levels less than 20 ng/ml was considered as deficiency. Analysis of the data was done using SPSS 16.0 version.Results: Vitamin D deficiency was seen in 64.8% of the pregnant women. Follow up of 76 babies showed vitamin D deficiency in 72.6% infants. Significantly high levels of alkaline phosphatase were noted in infants who were born to mothers with vitamin D deficiency, which indicates risk of developing bone disease.Conclusions: This study highlights the high prevalence of Vitamin D deficiency in pregnant women and their infants in South India in a region with abundant sunshine. This study also emphasises treating vitamin D deficiency in pregnancy to reduce the risk of developing rickets in infancy.
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Background: Every 40 seconds a person dies by suicide. Suicide is the second leading cause of death among young people 15-29 years of age, globally. In India, there is an increasing trend of suicide from 10.4 per lakh in 2003 to 10.9 per lakh in 2009.Methods: A (QUAN – QUAL) sequential explanatory design was used. Among 200 patients admitted for attempted suicide in JIPMER and Indira Gandhi Government Hospital and Post Graduate Institute Pondicherry were assessed for the reasons for attempting suicide using a semi-structured questionnaire. For a subsample of 40 (20%) In-depth interview was done to explore and understand the reasons and the undermined situation associated with attempted suicide at their residence.Results: Among the study subjects (n=200), mean (±standard deviation) age of suicide attempt was 26±9.1 years. Commonest reason for attempting suicide was verbal abuse, most often by parents (31.9%). Other precipitating factors were physical abuse, illness, marital conflict, family related problem, etc. On IDI, it was found that there were several factors like, background factors, aggravating, and protective factor. A conceptual diagram was generated depicting the imbalance between the protective and aggravating factors acting on the background factors before the execution of a suicide attempt.Conclusions: There is lot of scope to reduce the suicidal attempts in our country. Opportunistic screening should be done to identify any psycho-social issues among patients attending OPD. Strong social support and enabling environment should be provided for counselling individuals with suicidal ideation and intentions.
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Objectives: To determine the prevalence and gender distribution of malocclusion in 13–15-year-old adolescents of Dravidian ethnicity, residing in urban and rural areas of Kerala, South India. Materials and Methods: A total of 1554 children (779 males, 775 females), from both urban and rural areas were examined in school settings. Survey proforma for personal details and occlusal registration according to Bjork et al. (1964) were used. Chi-square test was used for analysis. Results: Overall prevalence of malocclusion was 89.9% which included Angle's Class I, Class II (17.6%) and Class III (8%) malocclusions. Other anomalies detected were increased overjet (11.8%), anterior crossbite (27.5%), anterior open bite (1.6%), posterior crossbite (5.1%), scissor bite (4.4%), midline deviation (6.8%), bimaxillary protrusion (BMP-21.3%), crowding (66.6%), spacing (15.3%), rotations (45.4%), ectopic eruptions (11.1%), peg laterals (2.4%) and missing teeth (6.6%). Males showed a higher predilection for increased overjet, deep bite, spacing and missing teeth. Class III, BMP, midline deviations and rotations were found to be more prevalent among the rural group, whereas Class II, increased overjet, deep bite and ectopic eruptions were more prevalent among the urban. Conclusion: Information regarding the detailed pattern of malocclusion prevalence and the high prevalence of BMP among South Indian population of Kerala may provide a baseline data for planning orthodontic services.
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Background Isolated diastolic hypertension (IDH) has been actively discussed for the last two decades because of its prevalence in a younger population and its association with cardiovascular disease. Furthermore, the association of IDH is significant in South Asian Countries such as India because relatively younger populations are known to have a higher risk of cardiovascular events. Objective The objective of this study is to find prevalence of IDH and its risk correlates in a semiurban population of South Indian state of Andhra Pradesh. Methods Data were collected using the modified World Health Organization - STEPwise approach to Surveillance (WHO STEPS) questionnaire for 16,636 individuals from a group of villages under Thavanampalle Mandal. Collated data were analyzed for prevalence and risk factors of IDH. Results Prevalence of IDH was found to be 4.0% with mean age of 46.0 (±SD 13.6) years and a relatively higher prevalence in men (5.3%) as compared with women (3.2%). The prevalence of IDH peaked in the fifth decade of life (40–49 years of age) and declined thereafter. Among various risk factors that were analyzed for their association with IDH, only age, body weight, and body mass index retained their significance in multivariate binary logistic regression analysis. Conclusion There is a significant prevalence of IDH below 50 years of age in the semiurban population of South India. As IDH in young and middle age is known to be associated with increased risk of cardiovascular events and end organ involvement, it highlights need for study and development of effective IDH management strategies to reduce associated morbidity and mortality.
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Aim of the Study: The current research was conducted with the aim of determining the quality of life of head and neck cancer (HNC) patients using mixed method approach. Methods: A mixed method triangulation design (QUAN + QUAL) was adopted in the study. Quantitative data were collected among 54 and qualitative data were collected till data saturation using nested sampling technique. Data were collected from seven oncological wards of two tertiary care hospitals during the 4th week of radiation therapy. Quantitative data were collected through functional assessment of cancer therapy: head and neck, and a semi-structured interview schedule was adopted to elicit their experiences. Quantitative and qualitative data were compared during the analysis phase. Both qualitative and quantitative data were depicted in meta-matrices. Results: Results showed that the most affected domains were functional well-being followed by HNC subscale. Similar findings were observed in narrative description of participants. Most focused experience was pain, and difficulty in eating and swallowing was experienced due to pain. Their verbal communication was inefficacious due to loss of voice and tone. Moreover, communication was difficult owing to changes in the oral mucous membrane and pathology. Conclusion: Patients with HNC suffer from varying degrees of psychosocial problems, and it is important to identify the psychosocial adjustment of the patients since the symptoms are sufficient to lay heavy burden
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Purpose: To describe the prevalence of various types of childhood glaucomas, their clinical features and treatment methods. Methods: We prospectively included consecutive children with glaucoma presenting to glaucoma clinic for the first time between March 2013 and May 2014. We classified childhood glaucomas as per the classification proposed by Congenital Glaucoma Research Network. Results: Of the 275 children (449 eyes) with glaucoma during this period, primary glaucomas constituted 56% (n = 252 eyes of 145 children), including 169 eyes (37.64%) of 97 children with primary congenital glaucoma (PCG), 16 eyes (3.56%) of 10 children with infantile glaucoma, and 67 eyes (14.9%) of 38 children with juvenile open angle glaucoma. Among these, 85% (214 eyes of 107 children) had bilateral involvement. Secondary glaucomas constituted 44%; they were glaucoma associated with ocular anomalies 18% (n = 80 eyes), glaucoma associated with acquired conditions (steroid induced and traumatic glaucoma) 14% (n = 61 eyes), glaucoma following congenital cataract surgery 7.6% (n = 34 eyes), and glaucoma associated with systemic or syndromic conditions 5% (n = 22 eyes). In primary glaucomas, boys and girls were equally affected (1:1), and more boys (3.8:1) had acquired glaucomas. Close to 80% PCG eyes were managed surgically with combined trabeculotomy and trabeculectomy (CTT). Majority of secondary glaucomas were managed medically. Conclusion: In our cohort, PCG was the most common childhood glaucoma and CTT was the most common surgery performed in these eyes. Steroid-induced and traumatic glaucomas were the most common acquired glaucomas; appropriate measures should be taken to avert these preventable glaucomas in children.
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Leprosy is a major public-health problem in developing countries like India. Studies pertaining to proportion and characteristics of pediatric cases are few in number. As these reflect indirectly the effectiveness of programme, this study has been carried out to know the clinical, bacteriological and histopathological characteristics of childhood leprosy cases who came to Dermatology Venerology Leprology (DVL) Outpatient Department of a Tertiary Care Centre in South India over a period of 2 years (from January 2015 to December 2016). This prospective observational study had 26 (23%) pediatric cases of leprosy out of 113 who attended DVL OPD. The age of childhood leprosy cases ranged from 10 to 18 years with mean of 14 years. 76% cases were males and 24% cases were females. 84% cases presented with hypopigmented, anaesthetic patches, 11% cases with grade 3 disabilities and 3% with tingling and numbness of both feet. 80% cases were MB and 20% were PB. 76% of children had multiple skin lesions and 24% had single skin lesion (SSL). Of the 20 multiple skin lesions cases examined histopathologically, 11 showed features of BT, BL and LL with overall concordance of 55% (11/20). Among cases clinically classified as MB, 33 % cases were smear positive. Overall 7/26 ( 26%) of child cases in our study were bacteriologically positive. Only 19% of patients had history of contact within the household. 8% cases developed LR. Six cases had deformities. The mean duration of symptoms was around six months. All the patients were treated with MDT. The present study though small and may/may not be representative of distribution/profile of leprosy in children at population level indicates the severity of childhood leprosy in society as evidenced by MB nature, high bacteriological positivity and unacceptable disability rate. After in depth studies at community level, strategy need to be improved to ensure early diagnosis and treatment.
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Patients with leprosy may not be commonly reporting to the dental professionals. This study describes the oral hygiene status of the leprosy patients from a developing district of South India. A descriptive crosssectional study was conducted to assess the oral hygiene status of leprosy patients in Raichur district, Karnataka. A total of 225 patients were examined during 2012 as a part of the study. These are patients who registered at Raichur and Mudgal leprosy centres during this period for leprosy treatment. Oral Hygiene Index – Simplified was recorded according to the criteria given by Greene and Vermillion in 1964. Data was analyzed using SPSS version 16.0 software package. Male : female ratio was 2:1 and age of these patients ranged from 6-80 years, mean 33.25 ± 15.49 years. The mean Debris Index-Simplified score was 1.94 ± 0.66; mean Calculus Index-Simplified score 2.08 ± 0.64 and the mean Oral Hygiene Index-Simplified score was 4.02 ± 1.22. Percentage of leprosy patients with poor oral hygiene increased with increasing age. There was also association with habits of pan chewing, smoking, alcohol use and cleaning practice of not using tooth brush or neemstick. No relationship could be found with broader classification of leprosy, socio-economic status and other parameters. Patients with good and fair oral hygiene reported of lower dental problems than those with a poor oral hygiene. Lack of association with socioeconomic status and type of leprosy suggests a general awareness problem but this issue deserves in depth studies. The current study among leprosy patients in Raichur district is the first kind of study from this area which highlights the poor plight of these patients with respect to their oral hygiene status. Periodic surveys and interventions in terms of awareness campaigns among the leprosy patients as well as care providers and community in general will be useful. Orientation of health systems accordingly will be required to bring desired changes in the situation.
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Brucellosis, a common zoonosis, is under reported in India despite its endemicity and increased exposure to livestock among the population. This study was conducted to determine the clinical manifestations, antibiotic susceptibility pattern, treatment and outcome of culture confirmed brucellosis. Adult patients with culture confirmed brucellosis who presented to a large teaching hospital in South India between 2009 and 2015 were included. A diagnosis of brucellosis was confirmed on automated culture. Clinical profile, laboratory parameters, drug susceptibility, treatment and outcome were documented by reviewing the medical records. The cohort comprised of 22 patients with mean ± SD age of 42 ± 13 years. Twenty one (95.5%) was male. Thirteen (59%) patients were from rural area and risk of acquisition of brucellosis including occupational exposure or consumption of unpasteurized milk was evident in 16 (72.7%) patients. The mean duration of symptoms before presentation was 54.5 ± 52 days. The commonest clinical presentation was prolonged fever without a definite focus in 18 patients (82%), whereas 2 (9%) patients had osteoarticular involvement and one patient (4.5%) each had genital involvement and endocarditis. Eighteen patients (82%) with uncomplicated brucellosis were treated with aminoglycoside and doxycycline for 6 weeks. There was no relapse or mortality at 18 ± 9 months of follow up. Brucellosis in this cohort had acute or subacute presentation with prolonged fever and bacteremia. High index of clinical suspicion based on significant epidemiological history along with automated blood culture improves the efficiency of diagnosis. Cure with lack of relapse among these cases suggests a combination therapy with doxycycline and aminoglycoside is highly effective for the treatment.
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Purpose: Changing pattern of uveitis in a subset of a population is an important ocular health indicator. Methods: A comparative study was done between uveitis patients of 2013 and 1995 using two proportions Z-test. Results: In 2013, 352 new uveitis cases were examined. Males 56%, females 44%; unilateral 30.4%; bilateral in 69.6%. A specific diagnosis achieved in 66.2%. Anterior uveitis was seen in 35.22%, intermediate uveitis in 30.11%, posterior uveitis in 25%, and panuveitis in 9.65%. There was no significant difference in the incidence of new uveitic cases (1.04% vs. 1.8%). A decline in male preponderance from 64% to 56% (P = 0.0187) was observed. In both studies, anterior uveitis was the most common but human leukocyte antigen-B27 positivity uveitis had increased (29.83% vs. 14.5%; P < 0.05). Intermediate uveitis was the second-most common type instead of posterior uveitis (P = 0.0006). In posterior uveitis cases, etiology was established in 88.6% versus 56.06% cases (P < 0.05). The most common cause of posterior uveitis was tuberculosis (TB) (35.2%). Viral retinitis had increased to 6.81% from 0.76% (P < 0.05). However, a declining trend in cases of toxoplasmosis was observed (P = 0.0545). The cause of panuveitis was comparable in both studies. The prevalence of TB has significantly increased in the present era (22.5% vs. 0.64%; P < 0.0001) and was the proven etiological cause of uveitis in overall 22.5% of which 4.8% cases were of anterior uveitis cases, 7.1% cases of intermediate uveitis cases, 8.8% cases of posterior uveitis cases, and 1.8% of panuveitis cases. Conclusion: A shifting paradigm of uveitis over the past two decades was observed.