This study suggests that clinical features, including the duration of fever and laboratory parameters such as CSF pleocytosis, CSF lymphocyte proportion >50%, and ALT values are helpful in differentiating scrub typhus from bacterial meningitis.

Objectives To assess acceptability of teleconsultation among the socioeconomically marginalized sections of patients with rheumatic and musculoskeletal diseases (RMDs), to identify the socioeconomic barriers in continuing rheumatology care during the COVID-19 crisis and to identify patients who could benefit by shifting to tele-rheumatology consultations. Methods This was a cross sectional analytical study done at a tertiary care teaching hospital in India including patients with RMDs who were not on biological diseases modifying agents. Assessment of disease status, socioeconomic status and economic impact of COVID-19 was done via tele-consultation. Results Out of the 680 patients satisfying inclusion criteria, 373 completed the study. The format was found easy by 334 (89.6%) of them and 284 (76.1%) considered tele-rheumatology better than in-person consultation. During the pre-COVID months, the median monthly per capita income of the families of our patients and cost of illness was Indian rupees (INR) 2000 (US$ 26) and INR 1685 (US$ 21.91), respectively. Families whose financial needs were met (OR = 0.38, 95% CI: 0.239, 0.598) or those with schooling upto at least secondary school (OR = 0.442, 95% CI: 0.260, 0.752) ( P =0.002) were less likely to stop prescription drugs. In a hypothetical model, 289 (77.4%) could be successfully switched to tele-rheumatology follow-up. Conclusion The acceptability of tele-rheumatology among socioeconomically marginalized patients with RMDs is good. During times of crisis, patients from poorer strata of society and lower educational background are likely to abruptly stop medications. Switching to a telemedicine-based hybrid model is likely to improve drug adherence with substantial savings on loss of pay and out of pocket expenditure.

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BackgroundHighly active antiretroviral therapy (HAART) has reduced the morbidity associated with HIV infection, and prolonged the lifespan of HIV/AIDS patients [1,2], but reports of morbidity and mortality from adverse reactions (ADRs) associated with the antiretroviral (ARV) drugs have tended to reduce these benefits [3][4][5]. In Africa and most resource-limited economics, the incidence of ADRs and toxicities have been shown to be responsible for frequent changes in first-line antiretroviral therapy (ART), and/or to the few available second-line regimens [4,5]. The first-line ART consist of the generic, fixed-dose combination (FDC) regimen of stavudine (d4T) or zidovudine (AZT) plus lamivudine (3TC) and nevirapine (NVP) or efavirenz (EFV) [6], although tenofovir disoproxilfumarate (TDF) plus 3TC or emtricitabine (FTC) and NVP or EFV combination regimens can be found in some settings [7]. The second-line ART comprises the protease inhibitors [ritonavir-boosted lopinavir (LPV/r)] plus TDF/FTC plus either AZT, d4T, or didanosine (ddl) [4,7].Within the past decade, the World Health Organization (WHO) made ARV-associated ADRs the focus of many studies in patient safety and quality control, with the recognition that prevention of potential ADRs is a key element of efforts to improve patient care. This was sequel to increasing reports of ADRs and toxicities associated with the use of the first-line regimens from both developing and the developed countries [5,[8][9][10][11]. These reports led to the revision of ART guidelines which recommended, among other things, the reduction of the dose of d4T from 40mg to 30mg for all patients, irrespective of body weight; the substitution of d4T with AZT or TDF in the presence of d4T toxicity, and of NVP with EFV in females and males with baseline CD4+ cell counts above 250 /µl and 400 /µl respectively [12][13][14][15].Because ADRs may be influenced by many factors, it is necessary to monitor patients on ART by keeping accurate information on their morbidity. Such information can be helpful as a guide to the AbstractBackground: Highly active antiretroviral therapy (HAART) has reduced the morbidity associated with HIV infection, and prolonged the lifespan of HIV/AIDS patients, but reports of adverse reactions associated with the antiretroviral drugs exist in the literature. The aim of this research was to determine the frequency and pattern of adverse drug reactions (ADRs) in HAART-experienced patients in our facility from

A majority of the population of Kerala had timely access to PCI-capable hospitals. GIS-based mapping of Indian states, in terms of access to STEMI reperfusion, may help devise protocols to achieve seamless transfer of patients to reperfusion-capable hospitals. Such regionalization of STEMI care would enhance organizational synergies to achieve better access to reperfusion, especially in remote areas.

Background: Myocardial inflammation often complicates leptospirosis, a re-emerging global zoonosis. Leptospirosis associated myocardial dysfunction is equivocal and the pattern of cardiac involvement may not differ from that of sepsis associated myocarditis. Methods: We prospectively compared cardiac involvement in 113 intensive care unit patients with severe leptospirosis to 31 patients with sepsis syndrome using a comprehensive assessment comprising of clinical presentation, electrocardiography, two-dimensional echocardiography (with global longitudinal strain calculation), and cardiac biomarker evaluation. Binomial logistic regression was performed to identify independent predictors of left ventricular systolic dysfunction in leptospirosis. Results: Compared to sepsis syndrome, leptospirosis patients were younger, had higher body mass index measurements and were more likely to be smokers. Electrocardiography abnormalities were common and similar in both groups. Myocardial systolic dysfunction was common in both groups (leptospirosis: 55.86% vs sepsis syndrome: 51.61%, p=0.675) with subclinical left ventricular systolic dysfunction (characterized by abnormal global longitudinal strain and normal left ventricular ejection fraction) being most frequent followed by isolated right ventricular systolic dysfunction, isolated left ventricular systolic dysfunction, and bi-ventricular systolic dysfunction (leptospirosis: 31.43%, 18.42%, 13.16%, 10.53%, respectively; sepsis syndrome: 22.22%, 12.00%, 12.00%, 8.00%, respectively (p>0.05 for each comparator)). Leptospirosis patients had a trend towards greater troponin-T elevation (61.0% vs 40.0%, p=0.057). ST-segment elevation and elevated troponin were independent predictors of reduced left ventricular ejection fraction in leptospirosis. Conclusions: Cardiac involvement in leptospirosis appears to be similar to that of sepsis syndrome, with myocardial systolic dysfunction being common. As such, clinical vigilance pertaining to cardiac status is paramount in these high-risk patients.