Demographic analysis of influenza-like illness categories including seasonal trend of swine flu cases attending a teaching hospital in Southern Rajasthan, India

Background: Influenza-like illness is a self-limiting non-specific acute respiratory illness characterized by common clinical features including fever, chills, malaise, headache, coughing, nausea, loss of appetite, and generalized weakness. Influenza A H1N1 is an important cause of ILI because it can lead to serious complications requiring hospitalization. Swine flu infection rates usually higher during the winter season in temperate regions. Objectives: This study is designed to analyze the demographic data of different ILI categories including seasonal trend of H1N1-related ILI in the patients attending a teaching hospital to know the spread and severity of diseases in Southern Rajasthan in India. Materials and Methods: It is a hospital-based retrospective study in which epidemiological and demographic data of all the patients attended swine flu outpatient departments, isolation wards, and intensive care unit were obtained and analyzed. All patients of ILI-B and ILI-C categories were tested for real-time polymerase chain reaction. Results: Of 3933 patients, 2686 (68.29%) patients were categorized in ILI-A, 724 (18.41%) patients were in ILI-B, and remaining 523 (13.30%) patients were in ILI-C. Overall, swine positivity among ILI-B and ILI-C categories was significantly (<0.05) higher in females than male and extremely statistically significant (P < 0.0001) higher in rural areas than urban. It was found that the transmission of influenza H1N1 peaked during winter season and affected the individuals of all age groups with high incidence in those aged 16–30 and 31–45 years. Conclusions: The higher incidence of H1N1 winter season emphasizes the need of special preventive and public health measures before the start of winter season. Information, education, and communication activities need to be strengthened specially for the rural people who were affected more in the present outbreak.

Alport's syndrome--a case report.

Alport's syndrome (hereditary nephritis with deafness), is an uncommon disease and is seen very infrequently in India. We report a fatal case in a young girl with characteristic ultrastructural changes in the kidney thus emphasising the exception noted in the observation that females have a better prognosis compared to males.

A simple accurate method of cataract classification. Cataract-I.

A simple and accurate system of cataract classification using slit lamp and direct ophthalmoscope is reported. Lens opacities are classified into cortical (anterior and posterior), nuclear and posterior sub-capsular and each sub-type of opacity is graded, extent and density wise, using both slit lamp and direct ophthalmoscope. A circle representing enface view of opacity divided into 100 equal parts is used in calculating the area of each opacity. This classification takes into account both the area and depth of opacity in arriving at the total extent of sub-type of each opacity. For density determination, we do not recommend the use of a resolution target projection ophthalmoscope. Intra-observer and inter-observer variability studies using this classification system indicated that the classification system is fairly reliable.

Methodology for studies on medical therapy of cataracts: cataract-II.

The methodology for testing any possible effect of potential anti-cataract agents is described. This is based on slit lamp and ophthalmoscopic cataract classification and on visual acuity. The difficulties encountered in such studies are highlighted. The presented methodology is suggested to be fairly adequate in assessing usefulness of any possible medical therapy of cataracts.

Topical glutathione therapy in senile cataracts. Cataract-III.

We undertook a prospective study in 66 cataract patients to study if topical glutathione has any effects on the progression of cataracts. The eye with more advanced cataract received topical glutathione drops q.i.d. and contralateral eye served as control. Only 32 patients completed the follow-up of three months or more. Data analysis revealed no beneficial effect of topical glutathione drops on any of the parameters studied. PSC opacity density in eyes treated with topical glutathione showed significant increase as compared to control eyes.

Topical sulindac therapy in diabetic senile cataracts: cataract-IV.

Sulindac, a non-steroidal anti-inflammatory drug has been found to be a potent inhibitor of enzyme aldose reductase. We used sulindac topically in diabetic senile cataract patients to note if it effects the progression of cataracts. More of sulindac treated eyes maintained initial vision and fewer eyes had visual loss of up to two lines or more as compared to control eyes. The extent and density of different opacities showed less progression in sulindac treated eyes but it was not statistically significant except that the ophthalmoscopically observed density of opacity showed statistically very significant lesser mean increase in sulindac treated eyes. We suggest that sulindac is a potential drug which should be further evaluated in large double blind photodocumented studies in diabetic senile cataracts.

Systemic aspirin and systemic vitamin E in senile cataracts: cataract V.

We undertook a prospective study in senile cataract patients using systemic aspirin and systemic vitamin E. Vitamin E treated eyes did show less progression of PSC opacities extent and less new nuclear opacities during the follow-up, but overall vitamin E treated eyes did no better than the control group eyes. More eyes in systemic aspirin treated group maintained the initial vision and loss of vision in the aspirin group was also less marked. Aspirin also caused a significant less mean increase in cortical opacity extent, nuclear/opacity and density and PSC opacity extent and density as well as in ophthalmoscopically graded opacity extent and density. We suggest that aspirin is a potential drug which should be further evaluated in large double blind photodocumentated studies. The present data does not justify the recommendation that aspirin be prescribed for slowing down cataract progression. This must await large studies and confirmation.