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Purpose: To assess the incidence, visual impairment, and blindness due to retinitis pigmentosa (RP) in a rural southern Indian cohort. Methods: This is a population?based longitudinal cohort study of participants with RP from the Andhra Pradesh Eye Disease Study (APEDS) cohorts I and III, respectively. The study included participants with RP of APEDS I who were followed until APEDS III. Their demographic data along with ocular features, fundus photographs, and visual fields (Humphrey) were collected. Descriptive statistics using mean ± standard deviation with interquartile range (IQR) were calculated. The main outcome measures were RP incidence, visual impairment, and blindness as per the World Health Organization (WHO) definitions. Results: At baseline (APEDS I), 7771 participants residing in three rural areas were examined. There were nine participants with RP with a mean age at baseline of 47.33 ± 10.89 years (IQR: 39–55). There was a male preponderance (6:3), and the mean best?corrected visual acuity (BCVA) of 18 eyes from nine participants with RP was 1.2 ± 0.72 logarithm of minimum angle of resolution (logMAR; IQR: 0.7–1.6). Over a mean follow?up duration of 15 years, 5395/7771 (69.4%) were re?examined, which included seven RP participants from APEDS 1. Additionally, two new participants with RP were identified; so, the overall incidence was 370/ million in 15 years (24.7/million per year). The mean BCVA of 14 eyes of seven participants with RP who were re?examined in APEDS III was 2.17 ± 0.56 logMAR (IQR: 1.8–2.6), and five of these seven participants with RP developed incident blindness during the follow?up period. Conclusion: RP is a prevalent disease in southern India that warrants appropriate strategies to prevent this condition.
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Agriculture is the major source of food, fibre and raw materials essential to human life. Consequently agriculture has been one of the basic occupations of man throughout the world. Interest in the economic aspects of production, distribution and economic policy relating to agriculture and to the use of farm products is therefore, worldwide. The principle of agriculture is that it deals with life, and with living substances. Its products are the results of processes of life and its means of production is the living soil. A cubic centimeter of fertile soil contains million of living organisms, the full exploration of which is far beyond the capacities of man. Man's management of the land must be primarily oriented towards four goals-health, beauty, permanence and productivity. Agricultural Cropping pattern means the proportional are wider different crops at a particular point of time. The cropping pattern of any region is the outcome along process of historical evaluation. In the present paper attempts to analysea the trends of cropping pattern and appraises the impact of cropping pattern on agricultural development in Andhra Pradesh.
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Dengue is an acute febrile illness caused by mosquito-borne dengue viruses (DENV S) consisting of four serotypes (DENV 1 - 4) from flaviviridae family, genus flavivirus. These four are antigenically related serotypes designated as DEN V - 1, DEN V - 2, DEN V - 3 and DEN V – 4. In this context, the present study focuses on the circulating serotypes of dengue in coastal Andhra Pradesh. METHODSStudy was done at Andhra Medical College, Visakhapatnam, teaching hospital in Andhra Pradesh. Acute phase dengue serum samples were collected and tested for NS1 antigen and antihuman IgM antibodies by enzyme linked –immunosorbent assay (ELISA). NS1 positive samples were further serotyped by reverse transcriptase real time polymerase chain reaction (R RT - PCR). RESULTSA total of 796 serum samples were included in the study. 300 (37.7 % ) samples were positive for NS1 and IgM antibodies. 192 NS1 antigen positive samples were further processed for serotyping by r RT PCR. Among these samples 72 were negative by r RT PCR. DENV-2 (41 %) was the predominant serotype followed by DENV-4 (37 %), DENV-3 (12 %) and DENV-1 (10 %) in the descending order. CONCLUSIONSAll the four dengue serotypes are in co-circulation. Among all the four types, DENV-2 was predominant, followed by DENV-4. By knowing the predominant serotype in circulation, we can forecast dengue outbreaks and take necessary measures like control of vectors.
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Background and Objectives: Influenza virus is a typical human pathogen causing serious respiratory illness resulting in significant mortality throughout the globe. Andhra Pradesh witnessed the first case of influenza A H1N1 in India from Hyderabad (now in Telangana) on May 16, 2009. In the recent past, Andhra Pradesh witnessed exponential increase in the number of confirmed cases of influenza infection. In this study, we present the salient features of the recent outbreak of influenza during 2017�18 in the state of Andhra Pradesh, first of its kind after the division of the state. Materials and Methods: Clinically, suspected cases of influenza-like illness received in the Virus Research and Diagnostic Laboratory, Department of Microbiology, Sri Venkateswara Institute of Medical Sciences (SVIMS), Tirupati, from January 2017 to May 2018 were included in the study. The samples were tested for influenza A, influenza A (H1N1) pdm09, influenza A (H3N2), influenza B, influenza B/Yamagata and influenza B/Victoria. Results: A total of 1286 samples were received for testing. The positive samples were influenza A unsubtypable (109), influenza A (H1N1) pdm09 (356), influenza A (H3N2) (38) and influenza B (19; Victoria - 2, Yamagata - 17). There was no significant difference in positivity between genders with 260 (49.81%) females and 262 (50.19%) males being positive. Conclusion: The outbreak started in the late monsoon (January) of 2017 and had two peaks; one in summer months and another in winter months. Influenza B virus was reported from December 2017 to May 2018. Age groups ?5 years and 6� years had higher positivity as compared to other age groups. Regular surveillance programmes are required for assessing the trends of influenza infections due to various subtypes and to plan timely and adequate steps for preventing the spread to larger vulnerable population.
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Background: Dengue is one of the most important mosquito-borne viral diseases in the world. The emergence and spread of four dengue viruses (DENVs) (serotypes) represent a global pandemic. The four distinct serotypes are, namely, DENV-1, DENV-2, DENV-3 and DENV-4. Very few dengue serotyping studies have been reported from Andhra Pradesh. In this context, the present study focuses on the circulating serotypes of dengue in South-Eastern Andhra Pradesh. Methodology: Study was done at Sri Venkateswara Institute of Medical Sciences, a teaching hospital in Tirupati, Andhra Pradesh. Acute phase dengue serum samples were collected and tested for NS1 antigen and anti-human IgM antibodies by enzyme-linked immunosorbent assay (ELISA). NS1-positive samples were further serotyped by reverse transcriptase real-time polymerase chain reaction (rRT-PCR). Results: A total of 398 serum samples were received from clinically suspected dengue fever cases. Of these, 150 (37.7%) samples were positive for NS1 and/or IgM ELISA. The 96 NS1 antigen-positive samples were further processed for serotyping, of which 36 were negative by rRT-PCR. DENV-2 (41%) was the predominant serotype, followed by DENV-4 (37%), DENV-3 (12%) and DENV-1 (10%) in descending order. Conclusion: This study reports the all four dengue serotypes' co-circulation. This is the first report from South Eastern Andhra Pradesh. Amongst four, DENV-2 was predominant followed by DENV-4. The information of predominant serotypes can guide in forecasting dengue outbreaks and improving control measures of vectors thus may be helpful in the prevention of outbreaks.
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Background: DENV (dengue viral infection) is a non-hepatotropic RNA virus, but hepatic involvement is common. High level of viremia is associated with involvement liver and other organs. Present study is a prospective study which is aimed to know about the, pattern of hepatic involvement in dengue patients admitted in General Medicine Dept Konaseema Institute of Medical Science.Methods: This is a prospective hospital-based study conducted in the Department of General Medicine Konaseema Institute of Medical Science Amalapuram Andhra Pradesh, from December 2015 to December 2017. During two year of study period 126 clinically and serologically positive patients of Dengue fever, Dengue haemorrhagic fever and Dengue shock syndrome, classified as per the, definition of national vector borne disease control programme Govt. of India.Results: Mean value of total bilirubin was 0.8 mg/dl in DF patients, 0.96mg/dl in DHF patients and 1.08mg/dl in DSS patients. Mean value of AST was 77.44(IU/L) in DF group, 112.32 IU/L in DHF group and 486.28 in DSS group. In DF group mean ALT in DHF group was 94.36 (IU/L) and it was 386.42 IU/L in DSS group. Mean value of serum albumin was 3.97 gm/dl in DF group, 3.65 gm/dl in DHF group and 3.49 gm/dl in DSS group. Serum globulin mean value was 2.98mg/dl in DF group, 2.86 gm/dl in DHF group and 2.69 gm/dl in DSS group. Serum alkaline phosphate level was also increased in all the groups, mean value of ALP was 118.46 IU/L in DF group, 164.32 IU/L in DF group, 164.32 IU/L in DHF patients and 342.42 IU/L in DSS group.Conclusions: The pattern of hepatic involvement of liver in dengue fever varies as per the severity of disease. In milder case of dengue fever liver function test was normal but there was hepatomegaly was present commonly but in severe form of disease pattern of hepatic involvement varies from tender hepatomegaly to significant increase in liver enzyme.
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The prevalence of Diabetes Mellitus is increasing worldwide. India ranks second in the world with more than 61 million cases with diabetes. Diabetic foot ulcer is one of the most common and deadest complications of diabetes and it contributes not only morbidity, amputation and increased health-care costs but also to mortality. The aim of the present study is to evaluate various modes of presentation, complications, modalities of treatment and treatment outcome in cases with diabetic foot ulcer to show how early intervention and proper bedside medical attention will improve outcome. Regular foot-care examinations, including debridement of calluses and ingrowing toe nails, early identification and intervention of ulcer complications provide an opportunity to improve outcome.
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Background: Dermatosis is a term that refers to diseases of the integumentary system. The external genitalia are acommon site for rashes, itching, and minor infections. This area is warm, moist, and occluded, and it is frequently exposed to irritating urine, feces, and vaginal secretions. We aimed at know the prevalence and patterns of genital region noninfectious dermatoses among children, with its epidemiological factors. Methods: In this hospital based cross sectional study children of either sex in the age group of 1-18 years presented with features of noninfectious dermatoses were included. Localized skin lesions were examined carefully and systemic features also observed. Results: Non Infective dermatoses were seen in 14.8% (63) of total dermatoses cases. Phrynoderma (36.5%) was the most common followed by Vitiligo Vulgaris (15.8%), Eczema (14.2%), P.alba (6.3%), Fordyce spots (4.7%) Lichen Planus (3.1%), Lichen Striatus (3.1%), Haemangioma (7.9%), Traumatic ulcer (4.7%) Phimosis (1.5%), and Burns (1.5%). Conclusion: Noninfectious dermatoses significantly involve genital region, with varied presentations making the diagnosis difficult. Precise clinical insight into exact diagnosis, helps to provide accurate treatment.
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Objective: To report cases of neurocysticercosis (NCC) from three neighboring districts of Andhra Pradesh state in India where NCC burden was never explored before. Methods: A total of 160 patients presenting with recent onset seizures were recruited from neurology, general medicine, and pediatric outpatient clinics of a local major tertiary care teaching hospital serving above districts during the period 2011–2014. Brain imaging was performed in all the above cases. A commercial immunoglobulin G-ELISA kit (sensitivity=85%;specificity=94%) was employed for the serological diagnosis of NCC. Results: The recruited patients presented with generalized, simple partial, and complex partial seizures (55%, 31.25% and 13.75% respectively). NCC was diagnosed in 44 of 160 (27.5%) seizure cases based on imaging characteristics, and a positive serum anti-body ELISA. No association was detected between seropositivity with the number and location of the lesion(s) in the brain. Conclusions: The possible potentiality of NCC could be identified as an underlying cause of the recent onset of seizures in this region as explored in the present study. It is recommended that NCC should be suspected as one of the major differential in every recent onset seizure with or without a radio imaging supportive diagnosis, especially in areas endemic for taeniasis/cysticercosis.
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Objective To report cases of neurocysticercosis (NCC) from three neighboring districts of Andhra Pradesh state in India where NCC burden was never explored before. Methods A total of 160 patients presenting with recent onset seizures were recruited from neurology, general medicine, and pediatric outpatient clinics of a local major tertiary care teaching hospital serving above districts during the period 2011–2014. Brain imaging was performed in all the above cases. A commercial immunoglobulin G-ELISA kit (sensitivity = 85%; specificity = 94%) was employed for the serological diagnosis of NCC. Results The recruited patients presented with generalized, simple partial, and complex partial seizures (55%, 31.25% and 13.75% respectively). NCC was diagnosed in 44 of 160 (27.5%) seizure cases based on imaging characteristics, and a positive serum antibody ELISA. No association was detected between seropositivity with the number and location of the lesion(s) in the brain. Conclusions The possible potentiality of NCC could be identified as an underlying cause of the recent onset of seizures in this region as explored in the present study. It is recommended that NCC should be suspected as one of the major differential in every recent onset seizure with or without a radio imaging supportive diagnosis, especially in areas endemic for taeniasis/cysticercosis.
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Background: The fi rst case of pandemic Infl uenza A (H1N1) in India was reported from Hyderabad, Andhra Pradesh on 16th May 2009. Subsequently, all suspected cases seeking treatment from A (H1N1) treatment centers and their contacts were tested. Laboratory confi rmed cases were hospitalized and treated with antivirals according to national guidelines. We reviewed the surveillance data to assess the morbidity and mortality due to A (H1N1) in the state of Andhra Pradesh (population-76,210,007) during the period from May 2009 to December 2010. Materials and Methods: We obtained the line-list of suspected (infl uenza like illness as per World Health Organization case defi nition) and laboratory confi rmed cases of A (H1N1) from the state unit of integrated disease surveillance project. We analyzed the data to describe the distribution of case-patients by time, place and person. Results: During May 2009 to December 2010, a total of 6527 suspected (attack rate: 8.6/100,000) and 1480 (attack rate: 1.9/100,000) laboratory confi rmed cases were reported from the State. Nearly 90% of the suspected and 93% of the confi rmed cases was from nine districts of Telangana region, which includes Hyderabad. Nearly 65% of total confi rmed cases were reported from Hyderabad. The attack rate was maximum (2.6/100,000) in the age group of 25-49 years. The cases peaked during August-October. 109 case-patients died (Case fatality ratio: 7%) and most (80%) of these patients had comorbid conditions such as diabetes (24%), chronic obstructive pulmonary disease (20%), hypertension (11%) and pregnancy (11%). Case fatality was higher (16%) among patients who were older than 60 years of age compared with other age groups. Conclusions: In Andhra Pradesh, H1N1 transmission peaked during August-October months and predominately affected adults. Case fatality was higher in patients older than 60 years with comorbid conditions.
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Background: Over the years, single dose Nevirapine has been the cornerstone of the PPTCT program in India. However after successful scale up of ART program, initiation of ART for the pregnant was also considered another means of reducing the risk of transmission of HIV. As there were no specific studies to demonstrate the advantages of full-course ART during pregnancy compared to single dose Nevirapine, the current study was undertaken. Objectives: To study the socio-demographic variables, effectiveness of the different interventions and factors affecting the interventions among the PPTCT program beneficiaries. Materials and Methods: As part of the retrospective cohort study the details of the HIV positive pregnant women registered at four ICTCs of Andhra Pradesh were analyzed in two groups (Nevirapine and ART). Results: Total 145 pregnant women were studied and among them, 3.4% opted for MTP, 66.2% had live-birth and 60% had normal vaginal delivery. Upon testing for HIV at 18 months, 35% babies were HIV reactive in the Nevirapine group, 17.6% babies were HIV reactive in the ART group. Interpretation & Conclusion: The findings from the present study showed higher protection among babies with mothers on ART before delivery, compared to those with single dose Nevirapine.
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Background: Enteropathogenic Escherichia coli( EPEC) is a major cause of diarrhoea in children below 5 years of age. Serotyping is the classical method and PCR detection of virulence factors is a rapid way of detecting diarrhoeagenic Esch.coli. Objectives : To study the role of EPEC in Paediatric diarrhoea by both Serogrouping and Multiplex PCR assay and to analyse the antibiotic susceptibililty pattern of EPEC strains in our area. Materials and Methods : Prospective study of stool samples collected from children with diarrhoea and without diarrhoea who were below 5 years of age was conducted from May to November 2011. EPEC isolates were identified by Serogrouping. Escherichia coli isolates were subjected to Serogrouping and Multiplex PCR assay and those isolates which showed pathogenic genes were further serotyped. Antibiotic susceptibility pattern of EPEC isolates was determined by Clinical and Laboratory Standards Institute guidelines. Results : Among the Escherichia coli isolates in the diarrhoeal group, 36.8% were identified as EPEC by Serogrouping and 38.8% of them were found to possess EAEC genes by molecular characterisation. In the nondiarrhoeal Esch. coli strains , none agglutinated with EPEC polyvalent sera, 46.6% showed EAEC genes out of which 85.7% were of a single serotype O153. Among the Escherichia coli isolates which agglutinated with EPEC polyvalent antisera , 33.3% were positive for Enteroaggregative genes. Conclusion : EPEC is still an important pathogen in paediatric diarrhoeas . O serogrouping can still be relied upon for detection of EPEC. EAEC are present in classical ‘ O ‘ serogroups. Serotype O 153 has an increasing potential for asymptomatic carrier state in children below 5 years of age.
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Objective: -To assess Feto maternal Hemorrhage in pregnant Indian Females. Method: - 516 consecutive antenatal patients attending the Fetal Medicine Department of Vadilal Sarabhai General hospital under NHL Municipal Medical College, Ellis Bridge, Ahmadabad were analyzed for Feto maternal Hemorrhage by Kleihauer Betke test after taking informed consent. Result: - All the 516 antenatal patients including those who underwent invasive procedures like Chorionic villus sampling, Amniocentesis, Amnioinfusion and Intrauterine blood transfusion had Feto maternal Hemorrhage less than 2 ml. Conclusion: - Study shows that Feto maternal hemorrhage in Indian women is very insignificant even after invasive procedures. Feto maternal Hemorrhage has special importance in Rh Negative Women, carrying an Rh positive fetus.FMH can lead to isoimmunization leading to a wide spectrum of antenatal and postnatal fetal complications ranging from anemia to stillbirth. Answer to this is Antenatal Anti –D prophylaxis which is not a standard practice in our setup due to high cost of Anti D. As we have found FMH to be less than 2 ml even a dose of 50 microgram can suffice if given at 26 and 32 weeks of gestation to prevent isoimmunization thus reducing the cost and encouraging the practice of Antenatal Anti D prophylaxis.
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Background: Blood stream infections can lead to life threatening sepsis and require rapid antimicrobial treatment . The organisms implicated in these infections vary with the geographical alteration . Further , infections caused by MDR organisms are more likely to increase the risk of death in these patients . Objectives : To study the profile of organisms causing blood stream infections and analyse their antibiotic resistance patterns in our teaching hospital.: Materials and methods : Prospective study of 524 blood samples from clinically suspected cases of bacteraemia was performed over a period of three years. The isolates were identified by standard biochemical tests and antimicrobial resistance patterns were determined by CLSI guidelines. Results : Positive blood cultures were obtained in 22.9% of cases. Among the culture positives , gram positive bacteria accounted for 61.5% of cases ; the most common isolate being Staphylococcus aureus(29.2 %) . Of the gram negative isolates , bacteria belonging to Enterobacteriaceae were the predominant isolate , Klebsiella being the commonest isolate.The most sensitive drugs for gram positive isolates were Amikacin, Erythromycin , Ofloxacin and Piperacillin –Tazobactam.And the most sensitive drugs for gram negative isolates were Amoxyclav and Piperacillin – Tazobactam.The prevalence of MRSA in our Staphylococcal isolates was 37.1% and Vancomycin resistance in these isolates was 25.7%. Vancomycin resistance in E nterococcal isolates was 33.3 % .ESBL prevalence was 32.6 %.Conclusion : Increasing incidence of Drug resistant organisms in blood stream infections calls for increased efforts by clinicians to exercise caution in use of these drugs . Vancomycin should be replaced by simpler drugs like Linizolid or Cotrimoxazole to preserve this useful antibiotic and prolong its therapeutic usefulness.
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Background: HIV/AIDS has turned out into global pandemic. In India under National AIDS Control Program (NACP) –III Integrated Counseling and Testing Centers (ICTC) were established throughout the country for providing prevention services through a holistic approach for all segments of the population. Objectives: To study the sociodemographic profile and risk behavior pattern of clients diagnosed HIV positive in the ICTC. Material & method: Study Design: Cross-sectional study (record based) Setting: Mediciti Institute of Medical Sciences, Andhra Pradesh. Subjects- All the 448 seropositive attendees during the year 2007-2010. Data pertaining to total 8845 clients, who availed the services from the ICTC during the above period was assessed for the time trend of HIV infection .Study Variables- Year of reporting, in-referral of the clients, age, sex, educational status, marital status, occupation and pattern of risk behavior in relation to HIV/AIDS. Statistical analysis- Data was analyzed in SPSS version 17.0 . Results: HIV prevalence was found to be declining over the last 4 years, except in 2008. Among the seropositives 62.7% were males and 37.3% were females. 85% were in the reproductive age group 78.1% were married;53.1% were illiterates. Majority of them are labourers from the agricultural background and housewives. In 83.9% of the individuals it is acquired through unprotected heterosexual intercourse. Conclusion- These findings should call for greater introspection among the program managers and facilitate for more customized local planning involving various stakeholders.
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In India the presence of Rickettsial disease in human is documented in many states however, the data on presence of Rickettsial infection in Andhra Pradesh is very scare. Therefore, a study was undertaken in Chittoor district (A.P.) to see the prevalence of Rickettsial infection in human and rodent population. 3-5 ml of human blood samples were collected from the patients attending the nearest hospitals of Tirumala, Tirupathi, Palmner and Chittoor areas. Live rodents were trapped and blood samples were collected from them during January and February 2008. Sera was separated and tested by Weil Felix test. Two hundred human sera samples were tested. Of these 39 samples were found reactive with Weil Felix antigen. Of the 39 reactive, 31 were male and 8 female. All the human samples were showing reactivity at 1:20 dilution. Out of the 343 rodents samples tested, only 24 samples were showing reactivity. These were reactive at 1:20, 1:40 and 1:80 dilutions with different types of Weil Felix antigens. Eight rodent sera samples were having titer 1:80 with Proteus OXK which is suggestive of presence of Scrub typhus in this region.
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The Crow's index of opportunity for natural selection has been calculated for three endogamous subpopulations namely Arya Vysya, Thrivarnika and Kalinga Vysya of North Coastal Andhra Pradesh. The total index is in the order Arya Vysya > Thrivarnika > Kalinga Vysya. However, the mortality component is more in Kalinga Vysya, reflecting the poor medical facilities available to them due to their low socio- economic profile compared to other two populations. The results of the present study are compared with those among the other caste populations of Andhra Pradesh.