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Ahmad SS, Verma R, Commons RJ, Nitika, Singh-Phulgenda S, Chhajed R, Bharti PK, Behera B, Naser SM, Pal SK, Ranjit PH, Baharia RK, Solanki B, Upadhyay KJ, Guerin PJ, Sharma A, Price RN, Rahi M, Thriemer K. A randomised controlled trial to compare the efficacy, safety, and tolerability of low dose, short course primaquine in adults with uncomplicated P. vivax malaria in two hospitals in India. Trials 2024; 25:154. [PMID: 38424577 PMCID: PMC10905854 DOI: 10.1186/s13063-024-07987-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 02/15/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Plasmodium vivax remains a major challenge for malaria control and elimination due to its ability to cause relapsing illness. To prevent relapses the Indian National Center for Vector Borne Diseases Control (NCVBDC) recommends treatment with primaquine at a dose of 0.25 mg/kg/day provided over 14 days. Shorter treatment courses may improve adherence and treatment effectiveness. METHODS This is a hospital-based, randomised, controlled, open-label trial in two centres in India. Patients above the age of 16 years, with uncomplicated vivax malaria, G6PD activity of ≥ 30% of the adjusted male median (AMM) and haemoglobin levels ≥ 8 g/dL will be recruited into the study and randomised in a 1:1 ratio to receive standard schizonticidal treatment plus 7-day primaquine at 0.50 mg/kg/day or standard care with schizonticidal treatment plus 14-day primaquine at 0.25 mg/kg/day. Patients will be followed up for 6 months. The primary endpoint is the incidence risk of any P. vivax parasitaemia at 6 months. Safety outcomes include the incidence risk of severe anaemia (haemoglobin < 8 g/dL), the risk of blood transfusion, a > 25% fall in haemoglobin and an acute drop in haemoglobin of > 5 g/dL during primaquine treatment. DISCUSSION This study will evaluate the efficacy and safety of a 7-day primaquine regimen compared to the standard 14-day regimen in India. Results from this trial are likely to directly inform national treatment guidelines. TRIAL REGISTRATION Trial is registered on CTRI portal, Registration No: CTRI/2022/12/048283.
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Affiliation(s)
| | - Reena Verma
- ICMR-National Institute of Malaria Research, New Delhi, India
| | - Robert J Commons
- WorldWide Antimalarial Resistance Network, Asia-Pacific Regional Hub, Melbourne, Australia
- Menzies School of Health Research and Charles Darwin University, Darwin, Australia
- General and Subspecialty Medicine, Grampians Health, Ballarat, Australia
| | - Nitika
- ICMR-National Institute of Malaria Research, New Delhi, India
| | - Sauman Singh-Phulgenda
- Infectious Diseases Data Observatory - IDDO, Oxford, UK
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, New Richards Building, Old Road Campus, Roosevelt Drive, Oxford, OX3 7LG, UK
| | - Rutuja Chhajed
- Infectious Diseases Data Observatory - IDDO, Oxford, UK
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, New Richards Building, Old Road Campus, Roosevelt Drive, Oxford, OX3 7LG, UK
| | | | - Beauty Behera
- Delhi Skill and Entrepreneurship University, New Delhi, India
| | | | - Salil Kumar Pal
- Calcutta National Medical College, Kolkata, West Bengal, India
| | | | - Rajendra Kumar Baharia
- NIMR Field Unit, Academy of Scientific and Innovative Research, Ghaziabad, Gujarat, India
| | - Bhavin Solanki
- Ahmedabad Municipal Corporation, Ahmedabad, Gujarat, India
| | | | - Philippe J Guerin
- Infectious Diseases Data Observatory - IDDO, Oxford, UK
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, New Richards Building, Old Road Campus, Roosevelt Drive, Oxford, OX3 7LG, UK
| | - Amit Sharma
- International Centre for Genetic Engineering and Biotechnology, New Delhi, India
| | - Ric N Price
- WorldWide Antimalarial Resistance Network, Asia-Pacific Regional Hub, Melbourne, Australia
- Menzies School of Health Research and Charles Darwin University, Darwin, Australia
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, New Richards Building, Old Road Campus, Roosevelt Drive, Oxford, OX3 7LG, UK
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Manju Rahi
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India.
- Indian Council of Medical Research, New Delhi, India.
| | - Kamala Thriemer
- Menzies School of Health Research and Charles Darwin University, Darwin, Australia.
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Sahay RR, Shete AM, Yadav PD, Patil S, Majumdar T, Jain R, Nyayanit DA, Kaushal H, Panjwani SJ, Upadhyay KJ, Varevadiya CL, Vora A, Kanani A, Gangakhedkar RR. Sequential determination of viral load, humoral responses and phylogenetic analysis in fatal and non-fatal cases of Crimean-Congo hemorrhagic fever patients from Gujarat, India, 2019. PLoS Negl Trop Dis 2021; 15:e0009718. [PMID: 34460819 PMCID: PMC8432894 DOI: 10.1371/journal.pntd.0009718] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 09/10/2021] [Accepted: 08/08/2021] [Indexed: 11/18/2022] Open
Abstract
Background Thirty-four CCHF cases (17 fatal; 17 survived) were confirmed from Gujarat state, India during the year 2019. We aimed to find out the viral load, antibody kinetics, cytokine profile and phylogenetic analysis between fatal and non- fatal cases. Methods Thirty four cases were included in this study. Blood and urine samples were collected from all the cases on the day of admission to hospital. Non-fatal cases were followed weekly for understanding the profile of viral kinetics, anti-CCHFV IgM and IgG antibodies. We also quantified the cytokines in both fatal and non-fatal cases. For epidemiological correlation, livestock were screened for anti-CCHF IgG antibodies and the tick pool specimens were tested by real time RT-PCR. Virus isolation was attempted on tick pools and human specimens and phylogenetic analysis performed on human and ticks complete genome sequences. Results CCHF cases were detected throughout year in 2019 with the peak in August. Out of 34 cases, eight secondary CCHF cases were reported. Cases were predominantly detected in males and in 19–45 years age group (55.88%). The persistence of viremia was observed till 76th POD (post onset date) in one case whereas anti-CCHFV IgM and IgG was detected amongst these cases from the 2nd and 20th POD respectively. Positivity observed amongst livestock and tick pools were was 21.57% and 7.4% respectively. The cytokine analysis revealed a significant increase in the level of serum IL-6, IL-10 and IFN-γ during the acute phase of the infection, but interestingly IL-10 lowered to normal upon clearance of the virus in the clinically recovered case. Fatal cases had high viral RNA copy numbers. Bleeding from one or two mucosal sites was significantly associated with fatality (OR-16.47;p-0.0034 at 95% CI). We could do CCHF virus isolation from two cases. Phylogenetic analysis revealed circulation of re-assortment of Asian-West African genotypes in humans and ticks. Conclusions The persistence of CCHF viral RNA was detected till 76th POD in one of the survivors. The circulation of a re-assortment Asian-West African genotype in a CCHF case is also reported first time from India. Crimean Congo hemorrhagic fever is a zoonotic tick-borne viral hemorrhagic disease. This disease is reported from Europe, Mediterranean, north-western China, central Asia, Africa, and the Middle East. Several outbreaks of CCHF were reported from Gujarat and Rajasthan states, India from 2011 to 2019. In this study, we discuss the clinical, molecular, serological, and the cytokine data of 34 CCHF cases (17 fatal and 17 survived) which were detected from Gujarat state in the year 2019. A sequential weekly follow up of the CCHF survivors was performed to understand the viral kinetics and the antibody profile. Interestingly, the presence of persistence CCHF viral RNA was observed till 76th POD in one of the survivors. To our knowledge, we are reporting this long term persistence of viremia for the first time. We also observed that the anti-CCHFV IgM detection in the serum samples starts as soon as 2nd POD but anti-CCHFV IgG antibody could be detected in the majority of the cases only after the 28th POD. The cytokine analysis revealed a significant increase in the level of serum IL-6, IL-10 and IFN-γ during the acute phase of the infection, but interestingly IL-10 lowered to normal upon clearance of the virus in the clinically recovered case. We did the phylogenetic analysis and concluded the circulation of the Asian-West African re-assortment genotype in humans, which has not been reported from India prior to this study.
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MESH Headings
- Adolescent
- Adult
- Aged
- Animals
- Antibodies, Viral/blood
- Antibodies, Viral/immunology
- Cytokines/blood
- Female
- Genotype
- Hemorrhagic Fever Virus, Crimean-Congo/classification
- Hemorrhagic Fever Virus, Crimean-Congo/genetics
- Hemorrhagic Fever Virus, Crimean-Congo/isolation & purification
- Hemorrhagic Fever Virus, Crimean-Congo/physiology
- Hemorrhagic Fever, Crimean/blood
- Hemorrhagic Fever, Crimean/epidemiology
- Hemorrhagic Fever, Crimean/immunology
- Hemorrhagic Fever, Crimean/virology
- Humans
- Immunity, Humoral
- India/epidemiology
- Livestock/blood
- Livestock/virology
- Male
- Middle Aged
- Phylogeny
- RNA, Viral/genetics
- Ticks/virology
- Viral Load
- Young Adult
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Affiliation(s)
- Rima R. Sahay
- Indian Council of Medical Research-National Institute of Virology, Maximum Containment Facility, Pune, Maharashtra, India
| | - Anita M. Shete
- Indian Council of Medical Research-National Institute of Virology, Maximum Containment Facility, Pune, Maharashtra, India
| | - Pragya D. Yadav
- Indian Council of Medical Research-National Institute of Virology, Maximum Containment Facility, Pune, Maharashtra, India
- * E-mail:
| | - Savita Patil
- Indian Council of Medical Research-National Institute of Virology, Maximum Containment Facility, Pune, Maharashtra, India
| | - Triparna Majumdar
- Indian Council of Medical Research-National Institute of Virology, Maximum Containment Facility, Pune, Maharashtra, India
| | - Rajlaxmi Jain
- Indian Council of Medical Research-National Institute of Virology, Maximum Containment Facility, Pune, Maharashtra, India
| | - Dimpal A. Nyayanit
- Indian Council of Medical Research-National Institute of Virology, Maximum Containment Facility, Pune, Maharashtra, India
| | - Himanshu Kaushal
- Indian Council of Medical Research-National Institute of Virology, Maximum Containment Facility, Pune, Maharashtra, India
| | - Sunil J. Panjwani
- Government Medical College and Sir-T Hospital Bhavnagar, Gujarat, India
| | | | | | - Alpesh Vora
- Government Medical College and Sir-T Hospital Bhavnagar, Gujarat, India
| | - Amit Kanani
- Animal Husbandry Department, Foot and Mouth Disease Scheme, Ahmedabad, Gujarat, India
| | - Raman R. Gangakhedkar
- Epidemiology and Communicable Diseases (ECD) Division, Indian Council of Medical Research, New Delhi, India
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Anvikar AR, van Eijk AM, Shah A, Upadhyay KJ, Sullivan SA, Patel AJ, Joshi JM, Tyagi S, Singh R, Carlton JM, Gupta H, Wassmer SC. Clinical and epidemiological characterization of severe Plasmodium vivax malaria in Gujarat, India. Virulence 2020; 11:730-738. [PMID: 32490754 PMCID: PMC7549892 DOI: 10.1080/21505594.2020.1773107] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 04/24/2020] [Accepted: 04/30/2020] [Indexed: 02/07/2023] Open
Abstract
The mounting evidence supporting the capacity of Plasmodium vivax to cause severe disease has prompted the need for a better characterization of the resulting clinical complications. India is making progress with reducing malaria, but epidemics of severe vivax malaria in Gujarat, one of the main contributors to the vivax malaria burden in the country, have been reported recently and may be the result of a decrease in transmission and immune development. Over a period of one year, we enrolled severe malaria patients admitted at the Civil Hospital in Ahmedabad, the largest city in Gujarat, to investigate the morbidity of severe vivax malaria compared to severe falciparum malaria. Patients were submitted to standard thorough clinical and laboratory investigations and only PCR-confirmed infections were selected for the present study. Severevivax malaria (30 patients) was more frequent than severe falciparum malaria (8 patients) in our setting, and it predominantly affected adults (median age 32 years, interquartile range 22.5 years). This suggests a potential age shift in anti-malarial immunity, likely to result from the recent decrease in transmission across India. The clinical presentation of severe vivax patients was in line with previous reports, with jaundice as the most common complication. Our findings further support the need for epidemiological studies combining clinical characterization of severe vivax malaria and serological evaluation of exposure markers to monitor the impact of elimination programmes.
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Affiliation(s)
- Anupkumar R. Anvikar
- Indian Council of Medical Research (ICMR), National Institute of Malaria Research, New Delhi, India
- Indian Council of Medical Research (ICMR), National Institute of Malaria Research Field Unit, Civil Hospital, Nadiad, India
| | - Anna Maria van Eijk
- Center for Genomics and Systems Biology, Department of Biology, New York University, New York, NY, USA
| | - Asha Shah
- Byramjee Jeejeebhoy Medical College (BJMC), Civil Hospital, Ahmedabad, India
| | - Kamlesh J. Upadhyay
- Byramjee Jeejeebhoy Medical College (BJMC), Civil Hospital, Ahmedabad, India
| | - Steven A. Sullivan
- Center for Genomics and Systems Biology, Department of Biology, New York University, New York, NY, USA
| | - Ankita J. Patel
- Byramjee Jeejeebhoy Medical College (BJMC), Civil Hospital, Ahmedabad, India
| | - Jaykumar M. Joshi
- Byramjee Jeejeebhoy Medical College (BJMC), Civil Hospital, Ahmedabad, India
| | - Suchi Tyagi
- Byramjee Jeejeebhoy Medical College (BJMC), Civil Hospital, Ahmedabad, India
| | - Ranvir Singh
- Byramjee Jeejeebhoy Medical College (BJMC), Civil Hospital, Ahmedabad, India
| | - Jane M. Carlton
- Center for Genomics and Systems Biology, Department of Biology, New York University, New York, NY, USA
| | - Himanshu Gupta
- Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Samuel C. Wassmer
- Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
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Mourya DT, Yadav PD, Gurav YK, Pardeshi PG, Shete AM, Jain R, Raval DD, Upadhyay KJ, Patil DY. Crimean Congo hemorrhagic fever serosurvey in humans for identifying high-risk populations and high-risk areas in the endemic state of Gujarat, India. BMC Infect Dis 2019; 19:104. [PMID: 30709372 PMCID: PMC6359815 DOI: 10.1186/s12879-019-3740-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 01/25/2019] [Indexed: 11/10/2022] Open
Abstract
Background Crimean Congo Hemorrhagic Fever (CCHF) is a highly infectious zoonotic disease of humans transmitted by Hyalomma ticks. Earlier studies have shown CCHF seroprevalence in livestock throughout India, yet sporadic outbreaks have been recorded mostly from the Gujarat state of India since 2011. Occupational vulnerability to CCHF for animal handlers, veterinarians, abattoir workers, and healthcare workers has been documented. The current study was planned to determine the seroprevalence of CCHF with an intention to identify the high -risk population and high -risk areas from Gujarat state, India. Methods Based on the socio-clinical data, the human population of Gujarat was divided into eight categories viz. A: CCHF affected person/house/close contact, B: Neighborhood contacts, C: Animal handlers, D: General population, E: Farmers, F: Abattoir workers, G: Veterinarian, H: Healthcare workers. A total of 4978 human serum samples were collected from 33 districts of Gujarat during year 2015, 2016 and 2017. All the samples were screened for the presence of anti-CCHFV IgG using indigenously developed anti-CCHFV IgG ELISA. Univariate regression analysis was performed to recognize significant risk factors for CCHF seropositivity. Results Twenty-five serum samples were found to be positive with an overall CCHF human seropositivity of 0.5% (95% CI 0.30–0.74%). Gender predisposition to CCHF prevalence was observed in males (OR: 2.80; p-value: 0.020). The risk for seropositivity increased sevenfold when a person was in contact or neighbor with a CCHF case (OR 7.02; p-value: < 0.0001). No significant difference in seropositivity was observed within different age groups. Veterinarians, healthcare workers, and control group were found to be seronegative for CCHF. Conclusions In-spite of CCHF sporadic outbreaks reported in Gujarat, the seropositivity for CCHF in the state was low as compared to other endemic countries. Males, close contacts and neighbors were identified as a high-risk population for CCHF infection. To recognize the high-risk area, tick screening and animal serosurvey would be a wiser choice. The study also suggests circulation and under diagnoses of CCHFV in the naïve regions of Gujarat.
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Affiliation(s)
- Devendra T Mourya
- ICMR-National Institute of Virology, 20-A, Dr. Ambedkar Road, Pune, Maharashtra, Pin 411001, India.
| | - Pragya D Yadav
- ICMR-National Institute of Virology, 20-A, Dr. Ambedkar Road, Pune, Maharashtra, Pin 411001, India
| | - Yogesh K Gurav
- ICMR-National Institute of Virology, 20-A, Dr. Ambedkar Road, Pune, Maharashtra, Pin 411001, India
| | - Prachi G Pardeshi
- ICMR-National Institute of Virology, 20-A, Dr. Ambedkar Road, Pune, Maharashtra, Pin 411001, India
| | - Anita M Shete
- ICMR-National Institute of Virology, 20-A, Dr. Ambedkar Road, Pune, Maharashtra, Pin 411001, India
| | - Rajlaxmi Jain
- ICMR-National Institute of Virology, 20-A, Dr. Ambedkar Road, Pune, Maharashtra, Pin 411001, India
| | - Dinkar D Raval
- State Health Society, Health and Family Welfare Department, Gandhinagar, Gujarat, India
| | | | - Deepak Y Patil
- ICMR-National Institute of Virology, 20-A, Dr. Ambedkar Road, Pune, Maharashtra, Pin 411001, India
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Yadav PD, Patil DY, Shete AM, Kokate P, Goyal P, Jadhav S, Sinha S, Zawar D, Sharma SK, Kapil A, Sharma DK, Upadhyay KJ, Mourya DT. Nosocomial infection of CCHF among health care workers in Rajasthan, India. BMC Infect Dis 2016; 16:624. [PMID: 27809807 PMCID: PMC5094004 DOI: 10.1186/s12879-016-1971-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Accepted: 10/25/2016] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Ever since Crimean-Congo hemorrhagic fever [CCHF] discovered in India, several outbreaks of this disease have been recorded in Gujarat State, India. During the year 2011 to 2015 several districts of Gujarat and Rajasthan state (Sirohi) found to be affected with CCHF including the positivity among ticks and livestock. During these years many infected individuals succumbed to this disease; which subsequently led to nosocomial infections. Herein, we report CCHF cases recorded from Rajasthan state during January 2015. This has affected four individuals apparently associated with one suspected CCHF case admitted in a private hospital in Jodhpur, Rajasthan. CASE PRESENTATION A 30-year-old male was hospitalized in a private hospital in Jodhpur, Rajasthan State, who subsequently had developed thrombocytopenia and showed hemorrhagic manifestations and died in the hospital. Later on, four nursing staff from the same hospital also developed the similar symptoms (Index case and Case A, B, C). Index case succumbed to the disease in the hospital at Jodhpur followed by the death of the case A that was shifted to AIIMS hospital, Delhi due to clinical deterioration. Blood samples of the index case and Case A, B, C were referred to the National institute of Virology, Pune, India for CCHF diagnosis from the different hospitals in Rajasthan, Delhi and Gujarat. However, a sample of deceased suspected CCHF case was not referred. Subsequently, blood samples of 5 nursing staff and 37 contacts (Case D was one of them) from Pokhran area, Jaisalmer district were referred to NIV, Pune. CONCLUSIONS It clearly indicated that nursing staff acquired a nosocomial infection while attending the suspected CCHF case in an Intensive Care Unit of a private hospital in Jodhpur. However, one case was confirmed from the Pokhran area where the suspected CCHF case was residing. This case might have got the infection from suspected CCHF case or through other routes. CCHF strain associated with these nosocomial infections shares the highest identity with Afghanistan strain and its recent introduction from Afghanistan cannot be ruled out. However, lack of active surveillance, unawareness among health care workers leads to such nosocomial infections.
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Affiliation(s)
- Pragya D. Yadav
- National Institute of Virology, 20-A, Dr. Ambedkar Road, Pune, Maharashtra Pin Code: 411001 India
| | - Deepak Y. Patil
- National Institute of Virology, 20-A, Dr. Ambedkar Road, Pune, Maharashtra Pin Code: 411001 India
| | - Anita M. Shete
- National Institute of Virology, 20-A, Dr. Ambedkar Road, Pune, Maharashtra Pin Code: 411001 India
| | - Prasad Kokate
- National Institute of Virology, 20-A, Dr. Ambedkar Road, Pune, Maharashtra Pin Code: 411001 India
| | - Pulkit Goyal
- Goyal Hospital and Research Center, Jodhpur, Rajasthan India
| | - Santosh Jadhav
- National Institute of Virology, 20-A, Dr. Ambedkar Road, Pune, Maharashtra Pin Code: 411001 India
| | - Sanjeev Sinha
- All India Institute of Medical Sciences, New Delhi, India
| | - Divya Zawar
- National Institute of Virology, 20-A, Dr. Ambedkar Road, Pune, Maharashtra Pin Code: 411001 India
| | | | - Arti Kapil
- All India Institute of Medical Sciences, New Delhi, India
| | - D. K. Sharma
- All India Institute of Medical Sciences, New Delhi, India
| | | | - Devendra T. Mourya
- National Institute of Virology, 20-A, Dr. Ambedkar Road, Pune, Maharashtra Pin Code: 411001 India
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Mourya DT, Yadav PD, Shete AM, Sathe PS, Sarkale PC, Pattnaik B, Sharma G, Upadhyay KJ, Gosavi S, Patil DY, Chaubal GY, Majumdar TD, Katoch VM. Cross-sectional Serosurvey of Crimean-Congo Hemorrhagic Fever Virus IgG in Livestock, India, 2013-2014. Emerg Infect Dis 2016; 21:1837-9. [PMID: 26402332 PMCID: PMC4593432 DOI: 10.3201/eid2110.141961] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
We conducted a cross-sectional serosurvey of Crimean-Congo hemorrhagic fever (CCHF) among livestock in 22 states and 1 union territory of India. A total of 5,636 samples from bovines, sheep, and goats were screened for CCHF virus IgG. IgG was detected in 354 samples, indicating that this virus is widespread in this country.
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Upadhyay KJ, Parmar SJ, Parikh RP, Gauswami PK, Dadhaniya N, Surela A. Intravenous ranitidine: Rapid bolus can lead to cardiac arrest. J Pharmacol Pharmacother 2015; 6:100-2. [PMID: 25969659 PMCID: PMC4419240 DOI: 10.4103/0976-500x.155489] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Revised: 07/09/2014] [Accepted: 09/11/2014] [Indexed: 11/23/2022] Open
Abstract
This is a rare case report of a 30-year-old male, who was admitted to the Maxillofacial Surgery Department of the Dental College for a malunited fracture of the mandible and zygomatic bones. He was given oral medications namely, cefixime, metronidazole, ondansetron, and ranitidine for three days prior to the operation with complete normal preoperative workup. He had no significant past medical or family history. On the day of the operation, he was given injectable dexamethasone, cefotaxime, ondansetron, ranitidine, and metronidazole half-an-hour prior to the operation. In less than five minutes of giving a bolus ranitidine injection, the patient developed a cardiac arrest and was resuscitated by the anesthetist team on duty. He was transferred to the Intensive Care Unit (ICU) on a ventilator, which was soon removed and the patient was off vasopressors, with stable vitals for 24 hours after the event. He was then transferred to the general ward of Medicine Department and observed for a further two days during which the patient remained uneventful and was finally transferred back to the Dental Department.
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Affiliation(s)
| | - Sarita J Parmar
- Department of Medicine, B J Medical College, Ahmedabad, Gujarat, India
| | | | | | - Nikunj Dadhaniya
- Department of Medicine, B J Medical College, Ahmedabad, Gujarat, India
| | - Abhilash Surela
- Department of Medicine, B J Medical College, Ahmedabad, Gujarat, India
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Parikh RP, Upadhyay KJ. Cullen's sign for acute haemorrhagic pancreatitis. Indian J Med Res 2013; 137:1210. [PMID: 23852306 PMCID: PMC3734730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Rohan P. Parikh
- Department of General Medicine, B.J. Medical College, Ahmedabad 380 016, India,For correspondence:
| | - Kamlesh J. Upadhyay
- Department of General Medicine, B.J. Medical College, Ahmedabad 380 016, India
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9
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Gohel D, Oza JJ, Upadhyay KJ. Gene therapy. J Assoc Physicians India 1992; 40:706-7. [PMID: 1307374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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