Clinical profile and outcome of patients admitted with swine-origin Influenza A H1N1 virus infection at a tertiary care hospital in Western India

Background: Most of the studies on swine flu H1N1 have been done during the pandemic phase. There was a sudden upsurge in virus activity in 2015 at many centers in India. The present study was designed to assess the current status and pattern of H1N1 infection. The primary objective of this study is to study the clinical profile of patients admitted with Swine-origin influenza A (H1N1) virus infection and Secondary objective is to study the clinical outcome in terms of morbidity and mortality.Methods: This was a retrospective observational study done at a tertiary care centre from March 2015 to April 2016. All admitted and confirmed cases of H1N1 swine flu infection were studied for demographic details, co-existing medical conditions and clinical presentation. Data regarding the course of disease, complications, treatments and outcomes were recorded from the clinical record.Results: Common presenting symptoms were cough and fever (95%). Common findings were fever (62.5%), tachycardia, tachypnea and crepitation on auscultation (58.5%). Associated comorbidities were Diabetes mellitus (19.5%), Chronic kidney disease (17%), immunosuppression (9.8%). Consolidation was seen in nearly half of the patients on radiological imaging. Complications noted in our patients were pneumonia (45%), respiratory failure (31%) and ARDS (14.6%). Seventeen percent of patients required non-invasive and invasive mechanical ventilation. Around 25 percent of cases, required ICU admission while two patients died during the hospital stay.Conclusions: The study emphasizes and restates the morbidities caused by H1N1 swine influenza infection as nearly half of the patients in this study experienced severe illness and complications.

Zinc, copper and hydrolytic enzymes in epididymis of hydrocortisone treated rat.

Administration of glucocorticoid (1, 2 and 4 mg) in excess leads to degeneration of epididymides as supported by cellular degeneration, sperm density and morphometric measurements. Zinc level increased statistically after 1, 2 and 4 mg hydrocortisone treatment while copper increased after 1 and 2 mg treatment. Cholesterol, protein and leucine aminopeptidase levels increased and decreased significantly in caput and cauda respectively. Activity of alkaline phosphatase reduced significantly while the treatment of hydrocortisone at different doses elevated acid phosphatase, aryl sulphatase and lactate dehydrogenase activities. Evidently, these changes are as a result of onset of cellular degeneration leading to impairment of metabolic/secretory activity of epididymal cells. The possible involvement of pituitary-testis axis in hydrocortisone induced epididymal degeneration and functional inhibition has been discussed.

Effect of adrenalectomy and adrenalectomy+hydrocortisone treatment on histopathological, biochemical and zinc and copper profiles in rat testes.

Degenerative changes such as decreased seminiferous tubule diameter, Leydig cell nuclear diameter, spermatogenic arrest, oedematous fluid in the interstitium and lumen of seminiferous tubules and increased levels of zinc, copper and enzymes (lactate dehydrogenase, LDH; leucine aminopeptidase, LAP; and aryl sulphatase) in adrenalectomised rats suggest a possible role of adrenal cortex and its hormones in spermatogonial cell proliferation and subsequent differentiation, homeostasis of biological trace elements and behaviour of enzymes. Atrophy of Leydig cells and the degenerative changes in testes of adrenalectomised rats can be attributed to reduced supply of testosterone. Hydrocortisone, administered through a single dose acted as hyperstate of hydrocortisone for a short duration, thereby inhibiting steroidogenesis either directly by affecting Leydig cell testosterone production or indirectly by affecting the release of LH from pituitary gland and thus caused degeneration of germinal epithelium. Once hydrocortisone (half life < 12 hr) was metabolized, the animals returned to adrenalectomised state, the degeneration persisted. Thus, hydrocortisone administered through a single dose was insufficient to sustain spermatogenesis. Chronic administration at physiological dose may renew spermatogenesis. Increased levels of LDH, LAP and arylsulphatase are, probably, necessary for cellular degeneration. Zinc and copper exhibited an increase and the rise can be corroborated to (1) failure of regulatory mechanism(s) that control the flow of the elements across the blood-testes barrier; and (2) increased oedematous fluid formed by cellular deaths of the germinal epithelium.

Anaerobic threshold as a measure of physical work capacity.

Fifty healthy subjects underwent incremental exercise on a treadmill. Anaerobic threshold (AT) and maximum oxygen consumed in litres per minute (VO2 max) were measured. VO2 max (mean +/- SD) in males and females was 2.71 +/- 0.5 and 2.014 +/- 0.4 L/min respectively. AT as a percentage of VO2 max predicted was 58 in males and 56 in females. These values were comparable to Western studies. Anaerobic threshold is the most sensitive indicator of exercise performance.

Effect of steroidal fraction of seeds of Abrus precatorius Linn. on rat testis.

Dose-dependent degenerative changes in the testicular weights, sperm count, later stages of spermatogenesis and Leydig cells are observed in testis of rats treated with steroidal fraction of seeds of A. precatorius. These are correlated with the dose-dependent decrease in the enzyme activity of 3 alpha, 3 beta, 17 beta-hydroxysteroid dehydrogenases, glucose-6-phosphate dehydrogenase, sorbitol dehydrogenase and leucine aminopeptidase. The steroidal fraction may also exert its influence indirectly at the pituitary level by a feedback mechanism, leading to decrease in production and release of testosterone which results in significant alterations in the testis.

Serum angiotensin converting enzyme in the diagnosis of pulmonary sarcoidosis.

Serum angiotensin converting enzyme (SACE) was estimated in 25 normal healthy subjects mean (15.62 +/- 6.5 mU/mL/37 degrees C), 26 patients with sarcoidosis (32.06 +/- 9.7) 15 with pulmonary tuberculosis (16.31 +/- 4.6) and 19 with diffuse interstitial lung disease (11.72 +/- 4.555). Significantly (P less than 0.05) elevated SACE values were seen in active sarcoidosis, and serial SACE levels correlated well with the course of the disease.

Ultrastructural study of epidermal Langherhans cells in leprosy.

ATPase staining and ultrastructural study of skin biopsies from six patients of leprosy (2TT, 4LL) and three normal subjects was carried out to study Langherhans Cells (LC). ATPase staining showed normal counts of LCs in tuberculoid patients, while significant reduction was observed in lepromatous cases. Electron microscopy revealed morphological changes in LL cases in the form of dense matrix and indistinct cristae of mitochondria; decreased number of lysosomes and rough endoplasmic reticulum; and numerous vacuoles in cytoplasm. TT cases showed normal morphology. Possible role of Langerhans Cells in pathogenesis of leprosy is discussed.