Molecular and serological evidence of chikungunya virus infection with high case fatality among pediatric population with acute encephalitis syndrome: first report from Eastern Uttar Pradesh, India.

Acute encephalitis syndrome (AES) outbreaks in children of Eastern Uttar Pradesh (E-UP) region of India have been a longstanding public health issue, with a significant case fatality rate of 20-25%. Since past decade, a rise in chikungunya (CHIK) cases has been occurring, which is a reported etiology of AES. However, the burden of chikungunya virus (CHIKV) among pediatric AES (pAES) is unknown from E-UP. We included 238 hospitalized pAES cases. The presence of IgM antibodies for CHIKV, and Dengue virus (DENV) was tested, and RT-PCR was performed for CHIKV and DENV in serologically confirmed CHIKV and DENV pAES cases. Positive samples were sequenced using Sangers sequencing. Further, to check for co-infection, IgM antibodies for other AES etiologies including Japanese encephalitis virus (JEV), Leptospira and Orientia tsutsugamushi (OT) in serum were also investigated. IgM ELISA demonstrated 5.04% (12) positivity for CHIKV. Among CHIKV IgM positive, 3 (25%, 3/12) pAES patients died. CHIKV genome was detected in 3 pAES specimens. Among which, 2 CHIKV cases were also positive for OT DNA. Partially sequenced CHIKV were genotyped as ECSA. The overall finding indicates evidence of CHIKV infection with high case fatality among pAES patients from E-UP. This study advocates constant serological and molecular surveillance of CHIKV in AES endemic regions of India.

Post Endoscopic Retrograde Cholangiography Bilateral Loss of vision: A Case Report.

Endoscopic retrograde cholangiopancreatography is an invasive endoscopic procedure done more often for therapeutic rather than diagnostic purposes. There are various complications of this procedure like pancreatitis, cholangitis, hemorrhage, perforation and other rare adverse events. In this case report, we discuss a case of a 40 years female who was referred to our center for endoscopic retrograde cholangiography. After the procedure she complained of bilateral loss of vision which was an unknown complication to us. But after looking back to literature we found two such case reports attributed to isolated bilateral lateral geniculate body infarct.

Clinical Profile of End Stage Renal Disease Patients Undergoing Hemodialysis in Chitwan, Nepal.

BACKGROUND: There are very few researches from Nepal that have evaluated clinical profile of end stage renal disease patients. Our main objective was to study the clinical profile of end stage renal disease patients, who were under maintenance hemodialysis for at least three months duration in two dialysis centers located in Chitwan Nepal. METHODS: This was a descriptive, cross-sectional study conducted among 138 end stage renal disease patients, who were undergoing maintenance hemodialysis at two government centers located in Chitwan, Nepal. RESULTS: Among 138 patients in our study, 42 (30.4%) patients had diabetic nephropathy and 11 (8%) patients had hypertensive nephropathy as the leading causes of end stage renal disease; however the cause could not be ascertained in 63 (45.7%) patients. 47 (34.1%) patients had started hemodialysis within one month of diagnosis of their kidney disease. Fatigue and musculoskeletal pain were the commonest symptoms found in 78 (56.6%) patients, whereas hypotension and fever were the two most common intra-dialytic complications found in 73 (52.9%) and 61 (44.2%) patients respectively. Anemia was present in 127 (92%) patients, 41 (29.7%) had hyperkalemia, 54 (39.1%) had hypocalcemia, 116 (84.1%) had hyperphosphatemia and 43 (31.2%) had hyperuricemia. Regular use of erythropoietin analogs was significantly associated with higher hemoglobin levels (p value- 0.000) and lesser frequency of blood transfusions (p value- 0.000) in our study. CONCLUSIONS: Diabetic nephropathy was the leading cause of end stage renal disease in our study. Cause of ESRD could not be ascertained in nearly half of the total patients.

Genetic characterization of dengue virus serotype 2 isolated from dengue fever outbreaks in eastern Uttar Pradesh and western Bihar, India.

Dengue (DEN) is the most common cause of mosquito-borne endemic viral diseases in the tropical and subtropical countries. DEN outbreaks associated with multiple dengue virus (DV) serotypes have been regularly reported in different parts of India. This study was done during DEN outbreaks in 2015 to 2016 in UP and Bihar where DEN-2 was found as the only prevalent serotype. DV-2 was the only serotype amplified in serotype-specific reverse-transcription polymerase chain reaction from sera of 210 (65.21%) out of 322 DV NS1 antigen-positive patients. Further genetic analysis based on full-length envelope (E) protein sequence derived from patient's sera as well as DV isolate showed the circulation of lineages I and III of DV-2 cosmopolitan genotype during 2015 and lineage II during 2016. Finally, the phylogenetic analysis using the E gene sequence revealed that these DV-2 strains have a close genetic relationship with the recently reported DV-2 genotypes from DEN outbreaks reported from different parts of north India. These results showed the circulation of cosmopolitan genotype of DV-2 in eastern Uttar Pradesh and western Bihar, India. The genetic database generated on circulating DV strains in this study will be useful as reference for disease surveillance and strengthening laboratory diagnosis protocols.

Recurrent Positivity of SARS-CoV-2 RNA in a Clinically Recovered COVID-19 Patient with End Stage Renal Disease: A Case Report.

Recurrent or persistent positivity of SARS-CoV-2 RNA in clinically recovered COVID-19 patients have been reported worldwide. However, replication competent live viruses were not recovered beyond two to three weeks from onset of symptoms in mild to severe cases of COVID-19. End stage renal disease is characterized by uremia induced immune dysfunction that increases the risk of infectious diseases including COVID-19. The clinical implications of recurrent or persistently positive SARS-CoV-2 RNA in immunocompromised patients are difficult to be generalized to findings as in immunocompetent patients. We report a case of end stage renal disease with recent history of recovered COVID-19 pneumonia, who again presented with positive reverse transcriptase- polymerase chain reaction (RT-PCR) test for SARS-CoV-2 RNA.