scholarly journals Seroprevalence, clinical profile and knowledge, attitudes, and practices (KAPs) of brucellosis in North India in patients with pyrexia of unknown origin and chronic joint pain

Charul Mittal ◽  
Hiba Sami ◽  
K Gururaj ◽  
Fatima Khan ◽  
Asfia Sultan ◽  

Introduction: Brucellosis is a significant but lesser-known cause of pyrexia of unknown origin (PUO) in India. Studies documenting the prevalence of Brucellosis in different parts of India are sparse and few. Clinicians thus usually don’t consider it in their differential diagnosis. This study assesses its prevalence in two groups: febrile patients with unknown etiology and individuals presenting with arthritis and/or joint pains. Knowledge, Attitude, and Practices (KAP) among clinicians about the disease was evaluated.Materials and Methods: This is a prospective study conducted at a tertiary care center of North India catering to urban, semi-urban, and rural populace. Ninety-two patients with fever of unknown origin, arthralgia, or similar constitutional symptoms were recruited in this study. Detailed clinical history was elicited from all patients as per predesigned proforma and a rigorous physical examination was conducted. Following primary screening to rule out malaria, enteric fever, and leptospirosis, secondary screening for Brucellosis was done by Rapid Screen Test (PUO screen) and IgM and IgG ELISA. A predesigned survey was used for assessing KAP among clinicians about Brucellosis.Results: Brucella infection was diagnosed in 27 (29.3%) cases. The most common symptoms among the patients apart from fever were arthralgia (77.8%), fatigue (70.8%), pallor (66.1%), headache (59.2%), backache (53.8%) and cough (33.3%). PUO screen is a specific test for brucellosis but lacks sensitivity. It detects acute cases but misses chronic cases. IgM ELISA being more sensitive should be used for confirmation. Low ODs point to chronic brucellosis which was confirmed by IgG ELISA. Normal CRP levels in patients with PUO and chronic joint pains should point to brucellosis. KAP revealed that 25% to 50% of doctors considered Brucella in their differential diagnosis of acute and chronic fever respectively while 10% Orthopedics considered it in cases of arthralgia.Conclusion: Our results highlight the significance of Brucella as a cause of PUO and arthralgia. Brucellosis is an underrecognized but important cause of pyrexia of unknown origin and chronic joint pain. It should be actively suspected, diagnosed, and treated.International Journal of Human and Health Sciences Vol. 06 No. 01 January’22 Page: 80-88

2019 ◽  
Vol 18 (03) ◽  
pp. 135-140
Chandra Shekhar Pandey ◽  
Rashmi Kumar ◽  
Hardeep Singh Malhotra ◽  
Neera Kohli ◽  
Chandrakanta Kumar ◽  

AbstractMovement disorders (MDs) are disorders of pathological movements that cannot be fully initiated, modulated, or interrupted voluntarily. Spectrum and etiology of MDs are likely to vary with geographical location, but there are few studies on pediatric MDs from India, and severity of the disease is not well documented. Response to treatment of MDs is often unpredictable. Objective of the study was to describe the relative prevalence, types, severity, etiology, and response to treatment of pediatric MDs as seen at a public teaching hospital in northern India. Over a period of 1 year, consecutive children with MDs seen in outpatient department (OPD) or wards were enrolled, after excluding cerebral palsy and musculoskeletal disorders. Detailed history, examination, treatment, and outcome were recorded. Severity was rated according to Battini's scale at initial contact and each follow-up. Neuroimaging and relevant investigations were done for etiology. Serial 2-minute video recordings were obtained. Out of 93 patients enrolled, the most common MDs were dystonia (24.7%), tremors (22.4%), ataxia (19.6%), and chorea (12.9%). Tics, hemiballismus, and myoclonus were also seen and 4% could not be classified. Mixed MDs were seen in 9.7%. Etiologies of MDs were infectious (acute encephalitis syndrome, tuberculous meningitis, subacute sclerosing panencephalitis, and rheumatic chorea) or nutritional (infantile tremor syndrome) in 46%. Genetic neurodegenerations accounted for a significant proportion (15.1%). Improvement occurred in majority (63.4%) of patients. Etiology of MDs was largely specific to this part of the world, related to infectious and nutrition causes. In the absence of complex genetic investigations, many cases were left with unknown etiology.

2021 ◽  
pp. 55-57
Lokesh Raghav ◽  
Siddhartha Sinha ◽  
Sumit Gupta ◽  
Deonath Mahato ◽  
Rajesh K Kanojia

Introduction:Juvenile inammaory arthritis (JRA) is a common rheumatic disease of unknown etiology. There are few studies which objectively measure regional patterns of disease activity and effects on functionality. Methods: This observational study of 35 children with JRA was conducted in a university tertiary care center with paediatric rheumatology specialty. Clinical and radiological parameters using 27 joint Juvenile Arthritis Disease Activity Score (JADAS) and Child Health Assessment Questionnaire (CHAQ) questionnaire for assessing disease activity, radiological ndings and quality of life in over a period of 18 months. Results: Males were more commonly affected than females, with appendicular skeleton involvement more common. Oligoarticular subtype was most common. Knee joint was most commonly affected. Grade 1 pain, swelling, tenderness was most common clinical nding among all the subgroups. In early course of disease osteopenia and subchondral collapse were common radiological nding. Joint destruction was more common in radiographs of children with longer duration of disease. JADAS score was maximum on Polyarthritis Rheumatoid Factor Positive (PolyRF +ve) patients and CHAQ score for Systemic Onset Juvenile Inammatory Arthritis (SoJIA) subgroup with equal score in all subtypes for discomfort. Good correlation was found between JADAS and CHAQ score for all JRAsubtypes except Enthesistis Related Arthritis (ERA) subtype.

2020 ◽  
Vol 20 (4) ◽  
pp. 433-439
Monika Rajani ◽  
Molay Banerjee

Introduction: Tuberculosis (TB) is a one of the main causes of mortality and morbidity worldwide. Bactec MGIT (Mycobacteria Growth Indicator Tube) system is a rapid, reliable automated system for early diagnosis of pulmonary and extra pulmonary TB in setups where purchase of expensive instruments is not possible. The present study was thus carried out to evaluate AFB microscopy, culture on Lowenstein Jensen media and micro MGIT system for early and accurate diagnosis of Tuberculosis. Methods: A total of 280 samples were processed for direct AFB smear examination, and culture on micro MGIT and LJ media. The identification of Mycobacterium tuberculosis complex in positive cultures was done by MPT64 Ag card test (BD MGIT TBC Identification Test). Results: Out of the processed samples, (47.1%) 132/280 were positive for Mycobacterium spp by Micro MGIT, (35%) 98/280 on LJ medium and (25.7%) 72/280 by AFB smear. A total of (48.5%) 136 samples were positive by a combination of Micro MGIT and LJ medium. Among the total positive samples (136/280), Micro MGIT was found to be positive in 97% (132/136) of samples, LJ was positive in 72% (98/136), while 52.9% (72/136) were positive by AFB smear. Conclusion: Manual MGIT System is a simple and efficient, safe to use the diagnostic system. It does not require any expensive/special instrumentation other than the UV lamp for the detection of fluorescence. In areas with limited resources where the purchase of expensive instruments such as the MGIT 960 is out of scope, the use of manual MGIT for rapid susceptibility testing for MDR-TB could be an option. We would recommend testing MGIT 960 using first and secondline drugs to determine DST.

2019 ◽  
Vol 20 (6) ◽  
pp. 615-620
Narayan Prasad ◽  
Venkatesh Thammishetti ◽  
DS Bhadauria ◽  
Anupama Kaul ◽  
RK Sharma ◽  

Introduction: Arteriovenous fistula is considered as gold standard access for maintenance hemodialysis. Due to increasing burden of end-stage renal disease requiring dialysis, it is important for nephrologists to complement creation of arteriovenous fistula to meet the demand. Methods: This retrospective study was designed to assess the outcomes of arteriovenous fistula made by nephrologists at a tertiary care center from North India. The study included all radiocephalic arteriovenous fistula performed by nephrologists between November 2015 and January 2017. All arteriovenous fistulas were performed in patients whose duplex ultrasonography revealed both arterial and venous diameter of at least 2 mm. Data were collected with regard to age, gender, dialysis status, basic diseases, co-morbidities, and mineral bone disease parameters. The predictors of the primary and secondary patency rates were analyzed. Results: Five hundred patients (age 39.3 ± 14.4 years; 82.4% males; 21.6% diabetics) were included. In total, 83 (16.6%) patients had primary failure and 31 (7%) patients had secondary failure. Diabetes was associated with poor primary and secondary patency rates. Mean survival among the patients without primary failure was 11 months. The primary patency rates at 3, 6, 12, 18, and 21 months were 82%, 78%, 73%, 70%, and 70%, respectively. Conclusion: To conclude, the outcomes of radiocephalic arteriovenous fistulas created by nephrologists are at par with historic outcomes.

2017 ◽  
Vol 01 (03) ◽  
pp. 150-155
Arun Gupta ◽  
Ajay Mehta ◽  
Nitin Mishra ◽  
Rajendra Bansal ◽  
Ajit Yadav

AbstractVariceal bleeding is one of the most feared complications of cirrhosis and portal hypertension. Transjugular intrahepatic portosystemic shunt (TIPS) is an effective minimally invasive option to achieve adequate decompression of the portal system. The aim of the study was to assess the efficacy and complications of TIPS in patients presenting with variceal bleed. It was a retrospective study done in a tertiary care center in North India in cirrhotic patients with acute or recurrent variceal bleed who underwent TIPS from April 2010 to October 2013. All the patients were followed up till April 2014. We could successfully implant TIPS in 100% of our patients with 100% success rate in controlling variceal bleeding immediately and during the follow-up period. Our primary patency rate was 94.5% and overall patency rate was 100%. Major TIPS-related complication was hepatic encephalopathy in 20% of patients; 7 of 22 patients died during the follow-up period. TIPS is a safe and effective procedure for control of acute or recurrent variceal bleed. Emerging evidence in favor of early TIPS is further going to expand its indication in variceal bleed. Hepatic encephalopathy was the major procedure-related complication in our study consistent with previous literature reports.

2012 ◽  
Vol 70 (8) ◽  
pp. 571-573 ◽  
Abrahão Augusto Juviniano Quadros ◽  
Mônica Tilli Reis Pessoa Conde ◽  
Luis Fabiano Marin ◽  
Helga Cristina Almeida Silva ◽  
Tatiana Mesquita e Silva ◽  

OBJECTIVE: To determine the frequency and clinical manifestations of patients with post-poliomyelitis syndrome (PPS) in a Brazilian division of neuromuscular disorders. METHODS: A total of 167 patients with prior history of paralytic poliomyelitis was investigated for PPS, based on international diagnostic criteria. Other variables analyzed were: gender, race, age at poliomyelitis infection, age at PPS onset, and PPS symptoms. RESULTS: One hundred and twenty-nine patients presented PPS, corresponding to 77.2% of the studied population. 62.8% were women and 37.2% were men. Mean age of patients with PPS at onset of PPS symptoms was 39.9±9.69 years. Their main clinical manifestations were: new weakness in the previously affected limbs (69%) and in the apparently not affected limbs (31%); joint pain (79.8%); fatigue (77.5%); muscle pain (76%); and cold intolerance (69.8%). CONCLUSIONS: Most patients of our sample presented PPS. In Brazil, PPS frequency and clinical features are quite similar to those of other countries.

Indrajeet Singh Gambhir ◽  
Amit Raj Sharma ◽  
Sankha Shubhra Chakrabarti ◽  
Upinder Kaur ◽  
Bindu Prakash

Background: Depression is the commonest psychiatric disorder in the elderly. We attempted to analyze the prevalence and correlates of depression in the north Indian elderly. Methods: An observational study was carried out taking cases from patients attending the geriatric clinic for the first time. Depression was diagnosed by the Geriatric Depression Score short form (≥5). Various epidemiological parameters were assessed in 504 subjects (M = 304, F = 200; mean age = 66.47±13.71 years). Results: Depression prevalence was 45%. A significant correlation was found between depression prevalence and gender (F>M, p=0.011), level of education (p=0.002), marital status (p<0.001) and insomnia (p<0.001) on univariate analysis. On binomial logistic regression analysis, marital status (widowed > married, p=0.008) and insomnia (present > absent, p<0.001) showed significant correlation with depression prevalence.    Conclusion: Our study highlights certain epidemiological aspects of depression in the aged Indian population presenting to the tertiary hospital. Spousal loss and insomnia are documented as possible depression risks but longitudinal studies are needed to confirm the same. Keywords: Geriatrics, Depression, Epidemiology, Geriatric Depression Score, Prevalence, Logistic Regression

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