Chikungunya infection in India: results of a prospective hospital based multi-centric study

Background

Chikungunya (CHIKV) has recently seen a re-emergence in India with high morbidity. However, the epidemiology and disease burden remain largely undetermined. A prospective multi-centric study was conducted to evaluate clinical, epidemiological and virological features of chikugunya infection in patients with acute febrile illness from various geographical regions of India.

Methods and Findings

A total of 540 patients with fever of up to 7days duration were enrolled at Karnataka Institute of Medical Sciences (KIMS), Karnataka (South); Sawai Man Singh Medical College (SMS) Rajasthan (West), and All India Institute of Medical Sciences (AIIMS) New Delhi (North) from June 2008 to May 2009. Serum specimens were screened for chikungunya infection concurrently through RT-PCR and serology (IgM). Phylogenetic analysis was performed using Bioedit and Mega2 programs. Chikungunya infection was detected in 25.37% patients by RT-PCR and/or IgM-ELISA. Highest cases were detected in south (49.36%) followed by west (16.28%) and north (0.56%) India. A difference in proportion of positives by RT-PCR/ELISA with regard to duration of fever was observed (p<0.05). Rashes, joint pain/swelling, abdominal pain and vomiting was frequently observed among chikungunya confirmed cases (p<0.05). Adults were affected more than children. Anti-CHIK antibodies (IgM) were detected for more than 60days of fever onset. Phylogenetic analysis based on E1 gene from KIMS patients (n = 15) revealed ∼99% homology clustering with Central/East African genotype. An amino acid change from lysine to glutamine at position 132 of E1 gene was frequently observed among strains infecting children.

Conclusions

The study documented re-emergence of chikungunya in high frequencies and severe morbidity in south and west India but rare in north. The study emphasizes the need for continuous surveillance for disease burden using multiple diagnostic tests and also warrants the need for an appropriate molecular diagnostic for early detection of chikungunya virus.

Spectroscopic, electronic structure and natural bond orbital analysis of o-fluoronitrobenzene and p-fluoronitrobenzene: a comparative study

Experimental FTIR, FT-Raman and FT-NMR spectroscopic studies of o-fluoronitrobenzene and p-fluoronitrobenzene have been carried out. A detailed quantum chemical calculations have been performed using DFT/B3LYP method with 6-311++G** and 6-31G** basis sets. Complete vibrational analyses of the compounds were performed. The temperature dependence of thermodynamic properties has been analysed. The atomic charges, electronic exchange interaction and charge delocalisation of the molecule have been performed by natural bond orbital (NBO) analysis. Molecular electrostatic surface potential (MESP), total electron density distribution and frontier molecular orbitals (FMOs) are constructed at B3LYP/6-311++G** level to understand the electronic properties. The charge density distribution and site of chemical reactivity of the molecules have been obtained by mapping electron density isosurface with electrostatic potential surfaces (ESP). The electronic properties, HOMO and LUMO energies were measured by time-dependent TD-DFT approach. (1)H and (13)C NMR spectra were recorded and (1)H and (13)C nuclear magnetic resonance chemical shifts of the molecule were calculated. The (1)H and (13)C nuclear magnetic resonance (NMR) chemical shifts of the molecules in chloroform solvent and in gas phase were calculated by using the Gauge-Independent Atomic Orbital (GIAO) method and are found to be in good agreement with experimental values. The theoretical parameters obtained at B3LYP levels have been compared with the experimental values.

Association of blindness and hearing impairment with mortality in a cohort of elderly persons in a rural area

Background:

Studies in developed nations have reported an association of blindness and hearing impairment with mortality in elderly persons.

Objectives:

To study the association of blindness and hearing impairment with mortality in a cohort of elderly persons in rural north India.

Materials and Methods:

This community-based prospective study was conducted in eleven randomly selected villages, in Ballabgarh block, Haryana. A cohort of 1422 participants, of age 60 years and above, was examined at baseline, for their visual and hearing status. Data on the sociodemographic factors, various comorbidities, activities of daily living, and self-rated health were recorded. Baseline data was collected for the period May 2008 to August 2008. Follow-up data collection for mortality was completed in December 2009. The median follow-up period was 518 days.

Results:

One hundred out of 1422 elderly (7.0%) participants died during the follow-up period. Significant hazard ratios were found after adjustment for various comorbid conditions. On adjustment for sociodemographic factors (age, sex, and literacy), neither blindness nor hearing impairment was found to be significantly associated with mortality. After adjustment for all covariates in the study, hearing impairment (Hazard Ratio = 2.13; 95% CI, 1.29 – 3.54) was found to be significantly associated with mortality in the age group ≥70 years.

Conclusions:

This study demonstrated that hearing impairment was an independent risk factor for mortality in people aged ≥70 years. Similar studies with a longer period of follow-up are required in India, to guide public health interventions.

Prospective study of infective endocarditis from a developing country

BACKGROUND

There has been a considerable change in the profile of infective endocarditis (IE) worldwide. However, prospective studies of IE from developing countries are rare.

AIM

The aim of this study was to evaluate predisposing factors, clinical presentation, echocardiography, microbiology, in-hospital course, and outcomes of patients with definite IE.

METHODS

This was a prospective observational study of consecutive cases of definite IE as per the modified Duke criteria.

RESULTS

Between 2004 and 2006, a total of 104 cases of definite IE were identified. The mean age was 23.5 years (interquartile range, 9-38 years), with a male preponderance (2.5:1). Congenital heart disease accounted for 39.4% cases of IE, followed by native valve disease (29.8%), prosthetic valve disease (20%), and normal valves (7.7%). Echocardiography was diagnostic in 96.7% of the patients. Positive cultures were obtained in only 41% of the cases, with staphylococci and streptococci being the most common organisms. Seventy-three percent of the cases had at least 1 major complication. Only 15% of the cases underwent surgery for IE. The in-hospital mortality was 26%. On multivariate analysis, an underlying heart disease other than native valve disease and septic shock were independent predictors of mortality.

CONCLUSION

The mean age of IE in India is significantly lower than that in the West. Unlike previous reports, congenital heart disease is the major predisposing factor. Culture positivity rates and surgery for IE are unacceptably low. In conclusion, IE in India is associated with a very high morbidity and mortality.

Structural, vibrational and quantum chemical investigations on 5-chloro-2-hydroxybenzamide and 5-chloro-2-hydroxybenzoic acid

The Fourier transform infrared (FTIR) and FT-Raman spectra of 5-chloro-2-hydroxybenzamide (5CBA) and 5-chloro-2-hydroxybenzoic acid (5C2HBA) have been recorded in the range 4000-400 and 4000-100 cm(-1), respectively. The complete vibrational fundamental modes of the compounds were assigned and analysed using the observed FTIR and FT-Raman data. The vibrational frequencies determined experimentally were compared with the theoretical wavenumbers calculated from ab initio HF and DFT-B3LYP gradient methods employing 6-31G** and 6-311++G** basis sets. The effect of halogen, hydroxyl groups and hydrogen bonding on the characteristic frequencies of the -COOH and -CONH2 group frequencies have been investigated. In 5CBA and 5C2HBA intramolecular hydrogen bond between a hydroxyl group and CO group makes a six membered ring, which causes the O⋯H interaction onto the resonance of the benzene ring. Comparison of the positions of the ν(OH) bands shows the ν(OH) band of 5CBA is located at considerably higher frequency which confirms a weaker hydrogen bond than in 5C2HBA.

Quality assessment of different marketed brands of Dasamoolaristam, an Ayurvedic formulation

Arista is a classical Ayurvedic preparation that is typically used as a digestive and cardiotonic. The present Investigation evaluated five different brands of Dasamoolaristam available in the market as per WHO and Indian Pharmacopoeial specifications. Various physicochemical parameters such as alcohol-soluble extractive, water-soluble extractive, total ash, acid-insoluble ash, total solid, and alcohol content were determined. The present investigation reveals that all the preparations contain acceptable levels of alcohol (less than 12% v/v). However, the preparations were found to contain unacceptable limits of microbial load although all showed the absence of Escherichia coli, Salmonella species, and Staphylococcus aureus.

Acute and short-term hemodynamic effects of metoprolol in Eisenmenger syndrome: a preliminary observational study

BACKGROUND

Progressive heart failure and sudden cardiac death are the common causes of death in Eisenmenger syndrome. β-Bockers may be useful in Eisenmenger syndrome, but the safety and efficacy are not proven. The objective of the study was to evaluate the hemodynamic effects and safety of metoprolol in Eisenmenger syndrome.

METHODS

Fifteen patients of Eisenmenger syndrome with a mean age of 22.6 (±8.9) years were studied. Hemodynamic parameters were measured at baseline, after 15 mg of intravenous metoprolol and 6 weeks after oral metoprolol (25 mg/d for 2 weeks and 50 mg/d for 4 weeks).

RESULTS

Intravenous metoprolol was well tolerated, although there was a significant decrease in pulmonary and systemic blood flows. The calculated pulmonary vascular resistance index (23.3 ± 8.6 to 27.4 ± 10.6 Wood U, P = .005) and systemic vascular resistance index (34.9 ± 9.9 to 41.9 ± 13.5 Wood U, P = .005) increased significantly. After 6 weeks of oral metoprolol, the pulmonary artery mean pressure declined significantly (79.9 ± 12.9 to 73.4 ± 14.0 mm Hg, P = .04), which was associated with a slight decrease in mean aortic pressures as compared with baseline. The 6-minutes walk distance increased (401.2 ± 99.9 to 462.5 ± 81.7 m, P = .005).

CONCLUSIONS

Preliminary observations suggest that metoprolol is safe and well tolerated in selected patients with Eisenmenger syndrome. Acute hemodynamic worsening recovers in the short term, and the exercise capacity improves in most patients. Larger studies are warranted.

Role of oxidative stress markers and antioxidants in the placenta of preeclamptic patients

AIM

The present study aimed to evaluate and compare the placental variables of oxidative stress markers in preeclamptic women.

METHODS

A total of 60 placentas were collected. Of these, 30 were obtained from normotensive pregnancies, and 30 from pregnancies with preeclampsia as per International Society for the Study of Hypertension in Pregnancy (ISSHP) criteria. Each placental tissue was analyzed for levels of pro-oxidant (malondialdehyde) and antioxidants (glutathione and superoxide dismutase) using the standard enzymatic assays.

RESULTS

Malondialdehyde levels were significantly higher (12.21 ± 4.1 versus 4.7 ± 2.1 nmol/g tissue, P < 0.0001) and glutathione (GSH) levels were significantly lower (0.46 ± 0.37 versus 1.03 ± 0.43 µmol/g tissue, P < 0.0001) in the placentas of preeclamptic women when compared to those of normal pregnancies. Though not statistically significant, decreases in superoxide dismutase levels were observed in placentas of preeclamptic women (4.14 ± 2.25 versus 5.22 ± 2.0 units/mg tissue protein, P < 0.055). Receiver operator characteristic curve analysis of malondialdehyde revealed a sensitivity of 87% and specificity of 87%, at a cutoff value 6.5 nmol/g. Similarly, GSH had a sensitivity of 77% and a specificity of 77% at a cutoff value 0.62 µmol/g.

CONCLUSION

The present study demonstrated that increased placental lipid peroxidation and decreased levels of antioxidants may play an important role in the pathogenesis of preeclampsia. These findings are suggestive of involvement of oxidative stress markers in preeclamptic patients.

Vitamin D deficiency in healthy breastfed term infants at 3 months & their mothers in India: seasonal variation & determinants

BACKGROUND & OBJECTIVES

Vitamin D deficiency with a resurgence of rickets and tetany are increasingly being reported in young infants from temperate regions, African Americans and also from India. The data on vitamin D status of healthy term breastfed Indian infants and mothers are scant. Therefore, we undertook this study to determine the prevalence of vitamin D deficiency and insufficiency [serum 25 hydroxyvitamin D (25OHD) ≤ 15 ng/ml and 15-20 ng/ml, respectively] among healthy term breastfed 3 month old infants and their mothers, evaluate for clinical and radiological rickets in those infants having 25OHD < 10 ng/ml, and check for seasonal variation and predictors of infants' vitamin D status.

METHODS

A total of 98 infants aged 2.5 to 3.5 months, born at term with appropriate weight and their mothers were enrolled; 47 in winter (November- January) and 51 in summer (April-June). Details of infants' feeding, vitamin D supplementation, sunlight exposure and mothers' calcium and vitamin D intake were recorded. Serum calcium, phosphate, alkaline phosphatase, 25 hydroxyvitamin D (25OHD) and parathormone were estimated.

RESULTS

Vitamin D deficiency was found in 66.7 per cent of infants and 81.1 per cent of mothers; and insufficiency in an additional 19.8 per cent of infants and 11.6 per cent of mothers. Radiological rickets was present in 30.3 per cent of infants with 25OHD < 10 ng/ml. 25OHD did not show seasonal variation in infants but maternal concentrations were higher in summer [11.3 (2.5 - 31) ng/ml] compared to winter [5.9 (2.5-25) ng/ml, P=0.003]. Intake of vitamin supplement, sunlight exposure and mother's 25OHD were predictors of infants' 25OHD levels.

INTERPRETATION & CONCLUSIONS

Prevalence of vitamin D deficiency and insufficiency was found to be high in breastfed infants and their mothers, with radiological rickets in a third of infants with 25OHD < 10 ng/ml in this study. Studies with large sample need to be done in different parts of the country to confirm these findings.

Effect of cholecalciferol and calcium supplementation on muscle strength and energy metabolism in vitamin D-deficient Asian Indians: a randomized, controlled trial

CONTEXT

Vitamin D deficiency is prevalent worldwide. Vitamin D supplementation has shown variable effect on skeletal muscle strength in the elderly with hypovitaminosis D. There is a paucity of similar data in young individuals.

OBJECTIVE

To study the effect of cholecalciferol and calcium supplementation on muscle strength and energy metabolism in young individuals.

SUBJECTS

Forty healthy volunteers (24 M/16 F, mean age (SD) 31.5 ± 5.0 year) with hypovitaminosis D were randomized to either oral cholecalciferol (60,000 IU D3/week for 8 weeks followed by 60,000 IU/month for 4 months) with 1 g of elemental calcium daily or dual placebos for 6 months.

MEASUREMENTS

Handgrip and gastro-soleus dynamometry, pinch-grip strength, respiratory pressures, 6-min walk-test and muscle energy metabolism on (31) P magnetic resonance spectroscopy were assessed at baseline and after 6 months.

RESULTS

The mean serum 25(OH)D in the supplemented and placebo groups at baseline, two and 6 months were 25.4 ± 9.9, 94.5 ± 53.8 and 56.0 ± 17.0 nm, and 21.1 ± 9.4, 32.8 ± 14.4 and 29.7 ± 15.0 nm, respectively. The supplemented group gained a handgrip strength of 2.4 kg (95% C.I. = 1.2-3.6); gastro-soleus strength of 3.0 Nm (95% C.I. = 0.1-5.9) and walking distance of 15.9 m (95% C.I. = 6.3-25.5) over the placebo group after adjustment for age, gender and respective baseline parameters. Muscle energy parameters were comparable at 6 months.

CONCLUSIONS

Six months of cholecalciferol and calcium supplementation results in enhanced skeletal muscle strength and physical performance despite no change in muscle energy parameters. Cholecalciferol supplementation of 60,000 IU per month could not maintain 25(OH)D levels in the sufficient range.

Swine-origin influenza A (H1N1) in Indian children

BACKGROUND

Swine-origin influenza A H1N1 (S-OIV) has not been systematically studied in Indian children.

OBJECTIVES

To study the clinical characteristics, morbidity and mortality pattern in children with S-OIV infection.

METHODS

This prospective study was conducted during the 'containment phase' of the pandemic in New Delhi from 10 June to 5 August 2009. All children suspected of being infected by S-OIV were admitted to the isolation wards and clinically evaluated according to WHO guidelines. Nasal and throat swabs were collected immediately for real-time reverse transcriptase polymerase chain reaction (RT-PCR). Haemoglobin, total leucocyte and platelet counts and chest radiography were undertaken in all patients. Those who tested positive for S-OIV infection were treated with oseltamivir for 5 days in isolation wards.

RESULTS

Thirty-seven children fulfilled the inclusion criteria. Twenty-one tested positive for S-OIV by RT-PCR and 16 tested negative. Comparison of the clinical characteristics of the two groups showed that duration of cough was longer in children with S-OIV (p<0.03). Total leucocyte and lymphocyte counts were significantly less in the S-OIV group (p<0.001 and , 0.02, respectively). Oseltamivir-related gastritis was seen in 38% of children. All improved and were discharged.

CONCLUSION

S-OIV infection in Indian children had features similar to those of seasonal influenza. Lymphopenia is an important feature of S-OIV.

Effect of creatine monohydrate in improving cellular energetics and muscle strength in ambulatory Duchenne muscular dystrophy patients: a randomized, placebo-controlled 31P MRS study

Randomized, placebo-controlled single blinded study was carried out to evaluate the effect of oral creatine supplementation on cellular energetics, manual muscle test (MMT) score and functional status in steroid-naive, ambulatory boys suffering with Duchenne muscular dystrophy (DMD; n=33). Eighteen patients received creatine monohydrate (Cr; 5 g/day for 8 weeks), while 15 received placebo (500 mg of vitamin C). Phosphorus metabolite ratios were determined from the right calf muscle of patients using phosphorus magnetic resonance spectroscopy ((31)P MRS) both prior to (baseline) and after supplementation of Cr or placebo. In addition, metabolite ratios were determined in normal calf muscle of age and sex matched controls (n=8). Significant differences in several metabolite ratios were observed between controls and DMD patients indicating a lower energy state in these patients. Analysis using analysis of covariance adjusted for age and stature showed that the mean phosphocreatine (PCr)/inorganic phosphate (Pi) ratio in patients treated with Cr (4.7; 95% CI; 3.9-5.6) was significantly higher (P=.03) compared to the placebo group (3.3; 95% CI; 2.5-4.2). The mean percentage increase in PCr/Pi ratio was also more in patients <7 years of age compared to older patients after Cr supplementation indicating variation in therapeutic effect with the age. In the placebo group, significant reduction in PCr/Pi (P=.0009), PCr/t-ATP (P=.05) and an increase in phosphodiester (PDE)/PCr ratios was observed after supplementation. Further, in the placebo group, patients <7 years showed reduction of PCr/t-ATP and Pi/t-ATP compared to older patients (>7 years), after supplementation. These results imply that the significant difference observed in PCr/Pi ratio between the Cr and the placebo groups after supplementation may be attributed to a decrease of PCr in the placebo group and an increase in PCr in the Cr group. Changes in MMT score between the two groups was significant (P=.04); however, no change in functional scale (P=.19) was observed. Parents reported subjective improvement on Cr supplementation versus worsening in placebo (P=.02). Our results indicated that Cr was well tolerated and oral Cr significantly improved the muscle PCr/Pi ratio and preserved the muscle strength in short term. However, this study provides no evidence that creatine will prove beneficial after long-term treatment, or have any positive effect on patient lifespan.

Detrended Fluctuation Analysis of EEG in detecting cross-modal plasticity in brain for blind

Cross-modality is the development of cross link between the modalities in the brain following sensory deprivation in the early stage. Cross modality analysis was previously done with fMRI, MEG and PET images for studying the changes in cerebral activities. Instead of these imaging techniques, this work involves in deriving self similarity parameter using Detrended Fluctuation Analysis of EEG from blind and blind folded normal individuals. This paper presents a novel technique of nonlinear spectral analysis to extract the information from electro encephalograms of humans for the detection of cross- modality existence in blind subjects.