The paradigmatic shift in the clinical profile of dengue patients: a prospective observational study from a tertiary care center in north India

Background: Dengue a vector-borne viral disease transmitted by mosquito and has several complications causing fatalities and a bad impact on society. The paucity of studies in Uttar Pradesh and lack of epidemiological data necessitated to take up this prospective study. Thus, the current study looked into the causes of heavy prevalence, urban v/s rural ratio, gender difference, various complications to formulate a strategy to limit the severity of the disease by early diagnosis and rapid intervention. The fever caused by dengue is characterized by body ache, petechial rashes, myalgia, and nausea and vomiting. There can be varied manifestations of dengue involving the lung, pleura, peritoneum, pericardium, and complications of liver, kidney, brain, muscle, eye, and other organs. The disease is characterized by thrombocytopenia, dehydration, bleeding tendencies, shock, and multiorgan dysfunction. Current estimates reports about 40% (2.5-3 billion) of the world population are at risk. Purpose: The study is aimed at detecting clinical signs and symptoms of patients with dengue fever presenting to TMU teaching hospital between January 2019 to December 2019. Material and Methods: A prospective observational study was undertaken in serologically confirmed cases of dengue. The disease was analyzed for its clinical profile, required investigations were done and evaluated. Results: In the present study the clinical outcome was: 1) Dengue fever without warning sign was (29.46%). 2) Dengue fever with a warning sign (57.87%). 3) Severe dengue fever (12.12%). Mortality noted in the present study was 1.8%. Bleeding manifestations were noted in 8.2% of patients. Thrombocytopenia (<100,000) was noted in (85.85%) patients. Fever was the presenting complaint in the majority of the patients (99.3%). Fever was followed by myalgia (91.9%), headache (58.8%), arthralgia (28.2%). Conclusions: Patients of dengue presented with fever, headache, myalgia, nausea, vomiting. Bleeding manifestations were looked for. Lab findings like leucopenia and deranged liver function test were more than other studies.

Identification of novel polymorphism in buffalo stanniocalcin-1 gene and its expression analysis in mammary gland under different stages of lactation

Stanniocalcin-1 (STC1) is secreted by the variety of tissues having a major role in the regulation of calcium ions in the involuting mammary gland. The present work aims to sequence and structural characterization as well as expression profiling of STC1 gene in buffalo. Polymorphism identified in the 3-untranslated region (UTR) was analysed by polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP) genotyping in riverine and swamp buffaloes. Expression profiling of STC1 was performed in different lactation stages of mammary gland and peripheral blood mononuclear cells to study the impact of 3'-UTR polymorphism on its expression. Different polymorphic sites were detected in the entire coding and noncoding regions of riverine and swamp buffaloes, including two INDELs. An identified polymorphic nucleotide locus A324G, having target sites for two miRNAs, namely bta-miR-2382 and bta-miR-1343, reported in cattle, was genotyped by PCR-RFLP to reveal variable allelic distribution among swamp and riverine buffaloes. Gene expression profiling across buffalo mammary tissues representing different lactation stages showed maximum expression of the STC1 gene in the involuting mammary gland. Ruminants’ specific genetic variation has been observed in STC1 and its implication in buffalo mammary gland involution as well as coregulation of gene expression throughmiRNA binding in the 3'-UTR is suggested.

Double-headed Monster Delivered Vaginally.

Double-headed monster is a rare and interesting variety of twin pregnancy. In this report, we describe a case of 26-year-old gravida 3 para 2 + 0 who was referred to our center with delivered head since one hour and failure to deliver rest of the body. Here, rest of the body with second head was delivered vaginally using McRobert’s maneuver with only few vaginal lacerations to mother.

The effect of use of pyridostigmine and requirement of vecuronium in patients with myasthenia gravis.

CONTEXT: Patients with myasthenia gravis receive pyridostigmine, an anticholinesterase agent, as a part of therapy. These patients demonstrate a heightened sensitivity towards non-depolarising muscle relaxants. Continuing pyridostigmine till the day of the surgery or omitting it on the night before surgery could provide variable results with regards to the effect of vecuronium. AIMS: Myographic evaluation of a dose of vecuronium in patients with myasthenia gravis on pyridostigmine therapy. SETTING AND DESIGN: A randomised, double-blind, clinical study conducted in a teaching hospital. SUBJECTS AND METHODS: Medically (oral pyridostigmine) well-controlled adult patients with myasthenia gravis who were posted for thymectomy, were randomly divided into two groups. Patients in Group 1 received their last dose of pyridostigmine on the night before surgery while those in Group 2 received even the morning dose of the drug on the day of surgery. Neostigmine (1-2 mg) intravenously was used as rescue medication. Vecuronium (0.01 mg/kg) was used for intubation and muscle relaxation during trans-sternal thymectomy and its effect was reversed using neostigmine and atropine. RESULTS: Fourteen patients (7 in each group) belonging to both sexes were enrolled in the study. The intubating dose of vecuronium showed quicker onset time (155 sec or 2.7 min approx.) and peak effect (99% T1 suppression) in patients belonging to Group 1, and 3/7 (43%) complained of respiratory discomfort while waiting for surgery. By giving the morning dose of pyridostigmine (Group 2), an identical intubating dose of vecuronium showed relative resistance (peak effect-97% T1 suppression) and delayed onset time (198 sec approx.). However, the reversal was complete at the end of surgery in both the regimens. CONCLUSIONS: Omission of the pyridostigmine dose on the day of surgery predisposed patients with myasthenia gravis to the possibility of respiratory discomfort and sensitivity to vecuronium. Continued administration significantly prolonged the onset time of vecuronium and the patients required a higher dose of vecuronium.

Pollution and sanitary quality of river Narmada in relation to human use at Mandla.

Study of physico-chemical characteristics and indicator bacterial population of Narmada river water at six different sites during summer, revealed extremely poor microbiological sanitary quality for human use. Free CO2 was found to be absent from all the sampling sites studied which indicates the trophogenic activity in the river water at Mandla. BOD value ranged from 1.0 to 2.5 mgl-1 and were less than the permissible limits of BOD in fresh waters i.e. 3-6 mgl-1.