Objectives Despite periodic outbreaks, the causes and risk factors of acute encephalitis syndrome (AES) in children of Muzaffarpur, Bihar, India, remain unknown. We explored the correlation between AES caseload and the climate parameters. Methods Data for 1318 hospitalized children with AES during 2012–20 were used. The correlation between AES cases and daily climate parameters (temperature, sunshine, rainfall, humidity and wind speed) for the previous 24, 48 and 72 h were examined using Pearson’s and Spearman’s rank-order correlation and Poisson regression or negative binomial regression analyses. Results Most (91.8%) of the AES cases occurred during the summer season (May–July months), especially June month. Pearson’s and Spearman’s rank-order correlation analyses revealed that AES caseload had positive correlations with maximum (r = 0.275, ρ = 0.293) and minimum (r = 0.306, ρ = 0.306) temperatures during past 24 h and heat index (r = 0.325, ρ = 0.325) and negative correlation with humidity (r = −0.222, ρ = −0.222) and rainfall (r = −0.183, ρ = −0.183) (all p < 0.05). The correlation was consistent for the climate parameters for the past 24, 48 and 72 h. Regression analysis also documented a significant association of AES cases with daily maximum (β: 0.32–0.36) and minimum (β: 0.53–0.62) temperatures and heat index (β: 0.92–1.03) over past 24, 48 and 72 h (all p < 0.01). The number of AES cases exponentially increased when the daily maximum and minimum temperatures crossed 40°C and 31°C, respectively. Conclusions The climate parameters, especially temperature appears to be a risk factor for AES in children. The definite aetiological role of heat for AES in children needs further exploration.
Background: Periodic outbreaks of acute encephalopathy in children have been reported from Muzaffarpur, Bihar, India. No infectious cause has been identified for this. This study presents the clinical and metabolic profile of children hospitalized with acute encephalopathy and the potential role of ambient heat stress.Methods: This cross-sectional study included children (<15 years) with acute encephalopathy admitted from April 4, 2019, to July 4, 2019. The clinical and laboratory investigations included infections, metabolic abnormalities, and muscle tissue analysis. The children who had metabolic derangements but no infectious cause were labeled as acute metabolic encephalopathy. The descriptive analysis summarized the clinical, laboratory, and histopathology findings, and their association with the ambient heat parameters was explored.Results: Out of the 450 children hospitalized (median age, four years), 94 (20.9%) died. Children had early morning onset (89%), seizures (99%), fever (82%), hypoglycemia at admission (64%), raised aminotransferases (60%), and high blood urea (66%). Blood lactate (50%), lactate dehydrogenase (84%), pyruvate (100%), ammonia (32%), and creatinine phosphokinase (69%) were raised. Viral marker tests were negative. The patients had abnormal metabolic markers like decreased blood-free carnitine, elevated blood acylcarnitines, and elevated urinary lactate, oxalate, maleate, adipate, and fatty acid metabolites. Blood carnitine and acylcarnitine levels normalized in 75% of the patients treated with carnitine and coenzyme-Q. Muscle tissues showed megamitochondria on electron microscopy and reduced respiratory enzyme complex-I activity. A significant correlation between the number of admissions and ambient heat indices was observed.Conclusions: The findings suggest secondary mitochondrial dysfunction as a possible mechanism for acute encephalopathy in children from Muzaffarpur, Bihar, and ambient heat stress as a possible risk factor.
Background: Surgical site infections (SSI) are an important post-operative complication. Knowledge about its risk factors is essential. The present study was conducted to find the profile of surgical site infection among patients admitted in surgical ward of SKMCH, Muzaffarpur.Subjects and Methods:The present cross-sectional study included 322 patients undergoing surgery. Clinical details, onset of SSI and microbiological profile were noted.Results:Mean age of the cases was 43.7 years. 61.2% of these were males. 11.8% of the cases suffered from surgical site infection. Of the emergency surgeries, 20.2% had SSI while 8.1% elective surgery cases had SSI. 36.1% of the cases with dirty wound had SSI while only 5.2% of the cases with clean wound had such infection. S. aureus was the most common organism isolated (57.9%) followed by Pseudomonas (39.5%) and Klebsiella (23.7%).Conclusion: Incidence of SSI is higher in cases of emergency surgery and in dirty wounds.
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