Clinical profile and mortality among novel influenza A (H1N1) infected patients: 2009-2010 Jodhpur, Rajasthan pandemic.

OBJECTIVES: Influenza causes annual seasonal epidemics around the world. Periodically, a genetically novel strain of influenza circulates worldwide, causing an influenza pandemic. The present study aims to assess the clinical profile, factors determining the response, prognosis of the disease and outcome in H1N1 positive patients during 2009-2010 H1N1 pandemic, so that epidemiology of the disease could be known and high risk groups can be identified. METHODS: Medical records of the H1N1 positive patients, confirmed by RT-PCR method, admitted in ICU/Isolation ward in M.D.M. Hospital, Jodhpur during pandemic of H1N1 influenza (2009-2010) were retrieved and retrospectively studied, the data collected was analysed. RESULTS: During the study period there were 221 H1N1 positive admissions. The age group most affected was 21-40 years in both males (52%) and females (67%). There were 80 deaths; mortality was high in rural population (64%) and pregnant women particularly in third trimester (80%). Common presenting symptoms were Cough, Fever, Breathlessness, Sore throat, Nasal Discharge, Expectoration and Body aches, other less common symptoms were Headache, Vomiting, Diarrhoea and Fatigue. CONCLUSION: Swine flu influenza infection took its heaviest toll in terms of human lives and economy because the young and productive population was mostly affected. Pregnant women and the patients with co-morbid conditions were the susceptible population and thus preventive and therapeutic interventions should be directed to them. Early vaccination of high risk groups and high index of suspicion in the symptomatic patients and chemoprophylaxis accordingly can save many human lives.

Shapiro syndrome.

We report here a case of Shapiro syndrome who presented with episodic generalized sweating, hypotension, and hypothermia. Brain magnetic resonance imaging demonstrated corpus callosum agenesis with colpocephaly. Patient was treated with Clonidine and Propranolol. This case is being reported here because only a few cases of Shapiro Syndrome are reported in world literature.

Case report of a small outbreak of epidemic dropsy.

Epidemic dropsy results from use of edible oils adulterated with Argemone mexicans oil. We report of the disease in a family caused due to sesame oil adulteration. Peculiarity to report this disease is that it occurred due to consumption of contaminated sesame seeds oil instead of mustard oiland secondly epidemic dropsy is also not very common in western Rajasthan. Five members of a family presented to the hospital with history of generalised body swelling, itching and marked cutaneous flush. Few of them also have shortness of breath, dry cough, palpitation, diarrhoea, vomiting and haemoptysis. On physical examination rashes, pallor and signs of cardiac failure were present in few patients. None of them had neurological symptoms and signs. After multiple interviews history of consumption of home made sesame seeds oil was explored in the family and the differential diagnosis of epidemic dropsy was made. Edible oil sample of the sesame seeds oil turned out to be positive for sanguinarine. Sanguinarine and dehydrosanguinarine are two major toxic alkaloids of Argemone oil, which cause widespread capillary dilatation, proliferation and increased capillary permeability. Leakage of the protein-rich plasma component into the extracellular compartment leads to the formation of oedema. There is no specific therapy. Removal of the adulterated oil and symptomatic treatment of congestive cardiac failure and respiratory symptoms, along with administration of anti-oxidants and multivitamins, remains the mainstay of treatment.

Effect of tobacco use on arterial stiffness in community dwelling females.

AIMS: The goal of this study was to investigate the changes in arterial stiffness by evaluation of arterial stiffness index and pulse wave velocity in community dwelling tobacco user females and to correlate those changes with duration of tobacco use, amount consumed and severity of addiction. METHODS: This observational cohort study was conducted in Department of Medicine at Dr. S N Medical College, Jodhpur, comprised of 100 females, out of which 55 were community dwelling females using tobacco (cases) and 45 are age-sex matched healthy control group. Out of 55 tobacco user females 21 (38%) were smoker and 34 [62%] were smokeless tobacco user. Pulse wave velocity and arterial stiffness index were evaluated by means of an 8-channel real-time PC-based simultaneous acquisition and analysis system (Periscope). RESULTS: Average C-F PWV in tobacco user female was 1327 +/- 515.2 as compared to 796 +/- 157.3 in control and average ASI was 71 +/- 20.9 in tobacco user female as compared to 62 +/- 13.9 in control that is statistically significant (p < or = .05). Both C-F PWV and ASI were significantly higher in tobacco user than control. Average C-F PWV in smoker group is 1683 +/- 566.7 as compared to 1108 +/-387.9 in smokeless group. Average ASI is 76 +/- 22.9 in smoker group as compared to 66 +/- 18.9 in smokeless tobacco user group. Both C-F PWV and ASI were higher in smoker group than smokeless group that is statistically significant (P Value 0.0018). CONCLUSIONS: This study has demonstrated that PWV and ASI are increased in tobacco user females and they are independent predictor of cardiovascular morbidity. Tobacco use either smoking or smokeless causes Atherovascular diseases. Smoking is more prone to increase atherosclerosis and cardiovascular morbidity in comparison to smokeless tobacco use.