Clinical Presentation and Platelet Profile of Dengue Fever: A Retrospective Study

Background: Dengue fever (DF) is a mosquito-borne viral illness carried worldwide by Aedes aegypti and Aedes albopictus mosquitoes. The aim of the present study was to observe the different clinical presentations of dengue fever and the platelet profile analysis in DF patients.

Methods: This retrospective study was performed on 130 diagnosed patients with dengue fever, aged over 14 years. Data collection included patient age, gender, clinical manifestations, hematocrit, platelet count, and evidence of plasma leakage.

Results: Most of the patients belong to the 21-30 year age group, with a greater number of males compared to females. The common presentation of dengue fever was fever and myalgia, observed in 100% and 95.3% of the patients, respectively. A platelet count of less than 1,00,000 was observed in 77% of patients, whereas decreased total leukocyte count (TLC) and hematocrit were observed in 52.3% and 40% of patients, respectively. About 46.15% of patients had bradycardia on examination. Pleural effusion and ascites were found in 20.7% and 15.3% of patients, respectively.

Conclusion: Patients presenting with fever, hemorrhagic symptoms, or signs of plasma leakage should be promptly suspected, timely diagnosed and managed on the grounds of dengue fever.

A Rare Case of Lymphatic Filariasis

Lymphatic filariasis is a parasitic infection caused by Wuchereria bancrofti, Brugia malayi and Brugia timori.Asymptomatic microfilaria, acute lymphatic filariasis, chronic lymphatic filariasis, tropical pulmonary eosinophilia are the different presentations of lymphatic filariasis. Systemic manifestation can involve joint, kidney, heart and nerve. This article is a case report of lymphatic filariasis with a rare presentation of anasarca and nephritic syndrome.

An Interesting Case of Melioidosis

Melioidosis also termed as Whitmore’s disease is an infectious disease which is caused by bacterium Burkholderia pseudomallei.Southeast Asia and northern Australia are endemic to this diseases which is predominantly transmitted in tropical climates.The coarse of disease involves multiple system involvement most common being lungs and it is mistaken as tuberculosis in many times.the other system involved are musculoskeletal and abscess over internal organs in spleen ,liver.This is a case report of 20 year old male presented with history of fever, swelling over multiple sites of the body, reddish discharge from the swelling, with history of planting trees in the past. Routine investigation showed leucocytosis and multiple abscess in liver and spleen .Blood culture showed positive for burkholderia pseudomallei .started treatment with meropenam and linezolid for 2 weeks and patient resolved from symptoms completely and discharged. Here we discuss about an clinical coarse and treatment response to bacteria burkholderia pseudomallei.

Recommendations to scale up dietary diversity data at household and individual level in India

BACKGROUND AND AIMS

An attempt to recommend scale up of dietary diversity data at household and individual level for improving the food and nutrition security, the study was conducted with the objective to explore the dietary diversity (DD) and its associated risk factors among reproductive age women in India.

METHODOLOGY

A total of 5,48,806 women aged 15-49 years were asked how often they consume various types of food groups (daily, weekly, occasionally, or never). Association between adequate DD and its covariates such as individual and household were measured by using logistic regression.

RESULTS

Most of the population consumed dark green leafy vegetables, milk/curd and pulses/beans. Only 1.7% of women consumed diet with adequate diversity or five or more food groups. Women's educations, gestation status, wealth status, sex of household head, household size, religion, place of residence and land ownership were significantly associated with adequate DD. The percentages of population with adequate DD varies from 7% to <1% in different states of India which shows that good-quality-diet is a major issue in entire country.

CONCLUSION

There is an urgent need of programs focused on availability of food with maximum diversity at minimum cost in order to reduce maternal and child mortality in India. To reduce geographic variation in achieving adequate DD, new approaches are required in developing multiple interventions to address major preventable causes of DD. Individual state government should also take serious measure to improve the consumption of variety of food groups.

Iodine Deficiency during Preconception Period of Adolescent Girls Residing in a District of Rajasthan, India

Background:

In India, iodine deficiency (ID) still remains a serious concern even after five decades of enormous efforts. ID during the preconception period of adolescent girls may negatively affect future neonates, resulting in neonatal hypothyroidism. Hence, the present study was conducted to assess the prevalence of goiter and associated factors among adolescent girls in a poor socioeconomic district of Rajasthan.

Methodology:

A cross-sectional study was conducted during January–March 2015 in Tonk district of Rajasthan. A total of 1912 adolescent girls were selected from thirty schools using population proportionate to size sampling. Adolescent girls were clinically examined for thyroid using palpation method. Casual urine (n = 344) and salt samples (n = 370) were collected from a subgroup of girls for the estimation of urinary iodine concentration (UIC) and iodine content in salt, respectively.

Results:

The overall goiter prevalence was 15.3% (95% confidence interval 13.6%–16.9%) and the median UIC was 266 μg/l (interquartile range: 150–300 μg/l) among 1912 adolescent girls (age, 15.7 ± 1.4 years). Around 16.8% of the families of adolescent girls were consuming salt with inadequate iodine (<15 ppm). Goiter prevalence was statistically significantly different with respect to age groups (P = 0.03). There was no statistically significant difference in goiter prevalence with respect to iodine content of salt (P = 0.98) and UIC (P = 0.41). The median UIC increased with an increase in consumption of iodine content of salt from inadequacy to adequacy (P = 0.15).

Conclusion:

Adolescent girls, residing in an underdeveloped district, are in the transition phase from mild ID (goiter prevalence 15.3%) to iodine sufficiency (median UIC 266 μg/l).

Prevalence of goiter and associated factors among pregnant mothers residing in a district with poor socioeconomic status in Rajasthan state, India

BACKGROUND

National survey documented that none of the Indian state is free from iodine deficiency (ID). Hence, the study was conducted with the objective to assess prevalence of goiter and associated factors among pregnant mothers (PMs) in a backward district of Indian state, Rajasthan.

METHODS

A cross-sectional survey was conducted during January to March 2015. Multistage random sampling was utilized to select PMs. A total of 1,183 villages were enlisted with their respective population, and 30 villages were selected using population proportionate to size sampling. Subjects were included from a cluster till the numbers reached to 17. PMs were clinically examined for goiter by palpation method. Casual urine (n = 226) and salt samples (n = 220), were collected from a subgroup of subjects, and iodine concentrations were analyzed by using wet digestion and iodometric titration methods, respectively.

RESULTS

The prevalence of goiter was found to be 14.2% (95% CI; 11.2-17.2). Goiter prevalence did not significantly differ with respect to trimesters of pregnancy (P = 0.09), iodine content in salt (P = 0.8), and urinary iodine concentrations (UIC, P = 0.69). The median UIC was 174 μg/L (IQR; 116-300 μg/L), which indicated adequate iodine intake. There was higher prevalence of goiter in PMs consuming salt with inadequate iodine than those with adequate, which was not significant (P = 0.8). Goiter prevalence was also insignificantly higher among PMs with UIC <150 μg/L than those with UIC ≥150 μg/L (P = 0.69).

CONCLUSION

The study population is in transition phase from mild ID (goiter prevalence 14.1%) to sufficiency (median UIC 174 μg/L).

Status of iodine deficiency among pregnant mothers in Himachal Pradesh, India

OBJECTIVE

Iodine is an essential micronutrient needed for the production of thyroid hormones. Pregnant mothers who are deficient in iodine provide less iodine to the fetal thyroid. This results in low production of thyroid hormones by the fetal thyroid, thereby leading to compromised mental and physical development of the fetus. The current study aimed to assess the current status of iodine nutrition among pregnant mothers in Himachal Pradesh, India, a known endemic region for iodine deficiency.

DESIGN

Three districts, namely Kangra, Kullu and Solan, were selected.

SETTING

In each district, thirty clusters (villages) were identified by utilizing the population-proportional-to-size cluster sampling methodology. In each cluster, seventeen pregnant mothers attending the antenatal clinics were included.

SUBJECTS

A total of 1711 pregnant mothers (647 from Kangra, 551 from Kullu and 513 from Solan) were studied. Clinical examination of the thyroid of each pregnant mother was conducted. Spot urine samples were collected from ten pregnant mothers in each cluster. Similarly, salt samples were collected from eleven pregnant mothers in each cluster.

RESULTS

Total goitre rate was 42·2 % (Kangra), 42·0 % (Kullu) and 19·9 % (Solan). The median urinary iodine concentration was 200 μg/l (Kangra), 149 μg/l (Kullu) and 130 μg/l (Solan). The percentage of pregnant mothers consuming adequately iodized salt (iodine content of 15 ppm and more) was found to be 68·3 % (Kangra), 60·3 % (Kullu) and 48·5 % (Solan).

CONCLUSION

Pregnant mothers in Kullu and Solan districts had iodine deficiency as indicated by a median urinary iodine concentration less than 150 μg/l.

Increase in iodine deficiency disorder due to inadequate sustainability of supply of iodized salt in District Solan, Himachal Pradesh

Himachal Pradesh is a known endemic area for iodine deficiency disorders. A study was conducted in district Solan with the objective of assessing the prevalence of iodine deficiency disorders in school-age children. Thirty clusters were selected by using the probability-proportionate-to-size cluster sampling methodology. Clinical examination of the thyroid of 1898 children in the age-group of 6-12 years was conducted. Urine and salt samples were collected. The total goiter rate was found to be 15.4%. Median urinary iodine excretion level was 62.5 μg/l. Only 39% of the salt samples had iodine content of ≥15 ppm. Mild iodine deficiency was present in the subjects studied.

Status of iodine deficiency in district Kangra, Himachal Pradesh after 60 years of salt iodization

BACKGROUND/OBJECTIVES

District Kangra, Himachal Pradesh(HP), India is a known endemic area for iodine deficiency disorders (IDD) since 1956. The present study was conducted in district Kangra, Himachal Pradesh with the objective to assess the prevalence of iodine deficiency in school-age children.

SUBJECTS/METHODS

A total of 1864 children in the age group of 6-12 years were included. Clinical examination of thyroid of all children was undertaken. 'On the spot' urine samples were collected from 463 children. The salt samples were collected from 327 children.

RESULTS

The total goiter prevalence of 15.8% was found. The proportion of children with urinary iodine excretion (UIE) levels <50.0, 50.0-99.9 and ≥ 100 μg/l was 2.2, 14.3 and 83.5%, respectively. The median UIE level was 200 μg/l. About 82.3% of the families were consuming salt with iodine content ≥ 15 ppm.

CONCLUSION

The population in district Kangra is possibly in a transition phase from iodine deficient (as revealed by total goiter rate of 15.8%) to iodine sufficiency (as revealed by median UIE levels of 200 μg/l).

Formulation and Evaluation of Cephalexin Extended-release Matrix Tablets Using Hydroxy Propyl Methyl Cellulose as Rate-controlling Polymer

The present investigation reports the design and evaluation of six-hour extended release film-coated matrix tablets of cephalexin using different grades of hydrophilic polymer hydroxypropylmethylcellulose (HPMC) employing direct compression method. The preformulation studies performed included the physical compatibility studies, Differential Scanning Calorimetry analysis, drug characterization using Fourier Transform Infra Red spectroscopic analysis and particle size analysis using sieve method. The tablets were evaluated for weight variation, hardness, thickness and friability. Results of the studies indicate that the polymers used have significant release-retarding effect on the formulation. The dissolution profile comparison of the prepared batches P1 to P8 and market preparation (Sporidex AF 375) was done by using Food and Drug Administration-recommended similarity factor (f(2)) determination. The formulation P8 (10% HPMC K4M, 15% HPMC 15cps) with a similarity factor (f(2)) of 77.75 was selected as the optimized formulae for scale-up batches. The dissolution data of the best formulation P8 was fitted into zero order, first order, Higuchi and Korsemeyer-Peppas models to identify the pharmacokinetics and mechanism of drug release. The results of the accelerated stability study of best formulation P8 for three months revealed that storage conditions were not found to have made any significant changes in final formulation F3. The release of cephalexin was prolonged for 6 h by using polymer combinations of HPMC and a twice daily matrix tablet was formulated.