BACKGROUND Dengue is a rapidly progressing self-limiting systemic viral infection transmitted between humans by mosquitoes. About two-fifth of world's population, mostly those in tropical and sub-tropical countries are at a risk of dengue infection. MATERIALS AND METHODSA hospital-based cross-sectional descriptive study was conducted in Rajiv Gandhi Institute of Medical Sciences, Ongole. A total of 233 patients who were clinically diagnosed cases of Dengue with subsequent confirmation by Dengue NS1 Ag/ Dengue IgM were selected in the study. Data was collected using a semi-structured questionnaire, either by direct interview with patients or patient's relatives and by clinical examination and from relevant investigations. RESULTSOut of the 233 study population, majority (44.6%, n= 104) belonged to 40 -59 years age group. Fever was the most common presenting symptom (99.6%) in the present study followed by myalgia in 60%, headache in 43.8%, joint pain in 35.6% and backache in 28.8%. Majority had low platelet count (68.2%). SGPT was altered in 65.2%, serum albumin in 33% and SGOT in 73.7% of the patients. 16.7% of patients had high random blood sugar level and 7.3% had high serum amylase levels. Dengue NS1 antigen was positive in 187 (80.3%) patients and 50 (21.5%) had dengue IgM positivity. The most common radiological finding in the present study was gall bladder wall oedema, which constituted 19.3% cases followed by ascites (9.4%), pleural effusion (9.5%), free fluid in Morrison pouch/ pelvis (2.6%) and pancreatitis (2.6%). CONCLUSIONUltrasonographic features like gall bladder wall oedema, pleural effusion and ascites should strongly favour diagnosis of dengue fever in a patient who presents with fever and thrombocytopenia, especially during an epidemic.
BACKGROUND Fever with thrombocytopenia may manifest in infective and non-infective conditions. Thrombocytopenia is often missed, because it is not often looked for and the required investigations are not generally asked for. MATERIALS AND METHODS A hospital-based descriptive study conducted at Rajiv Gandhi Institute of Medical Sciences (RIMS), Ongole on 115 patients with fever associated with thrombocytopenia. Study duration was for one and a half years from January 2016 to June 2017. Data was collected using a semi-structured questionnaire, either by direct interview with patients or patient's relatives and by clinical examination and from relevant investigations. Patients were regularly monitored and depending on aetiological basis appropriate treatment was given. RESULTS Out of the 115 patients, dengue was the most common diagnosis found in the present study with 60% (n= 69) followed by unknown viral fevers (15.6%), then malaria (8.8%) and sepsis (6.1%). 5 cases were HIV positive, 3 cases had viral hepatitis and 3 enteric fever. Out of the total 69 dengue cases, 20 cases (28.9%) had platelet count in range of 40,001-60,000. 17 cases had in range of 20,001-40,000 and 15 dengue cases had severe thrombocytopenia (< 20,000). 110 cases (95.6%) showed good recovery, 2 patients expired, and 3 patients left against medical advice. CONCLUSION Febrile illness patients should be investigated for low platelet count whether they have bleeding manifestations or not. A routine CBC (complete blood count) investigation in all febrile illness cases will help to find its association with thrombocytopenia.
BACKGROUND HIV infection is not the end of life. Anti-retroviral therapy (ART) effectively suppresses replication. But adherence to ART regimen is therefore very vital. Any irregularity in following the prescribed regimen can lead to resistance to HIV drugs and therefore can weaken or negate its effect. MATERIALS AND METHODS A retrospective descriptive study was done from the ART centre at Rajiv Gandhi Institute of Medical Sciences (RIMS), Ongole. Data from case sheets was collected in a pre-designed format. This study was conducted from 2007 to 2017. Treatment failure is identified by clinical and/ or immunological and confirmed by the virological criteria. RESULTS Among the total of 8119 patients, total first-line failures who were on second-line drugs were 254; hence, the prevalence of failure of first-line anti-retroviral therapy being 3.12%. Out of the total first-line failures, 133 (52.4%) were males and 121 (47.6%) were females. The mean age of the first-line failures was 37.52 ± 10.41 years. Mean baseline CD4 count was 195.42 ± 81.56 mm 3. CONCLUSION The overall prevalence of first-line anti-retroviral therapy was found to be 3.12% with a slight male preponderance and majority belonged to relatively younger age group. Constant monitoring and individual counselling on all aspects of the treatment would play an important role.
BACKGROUND Central nervous system (CNS) involvement is one of the common manifestations of acquired immunodeficiency syndrome (AIDS). About one-fifth of AIDS patients die of CNS diseases. MATERIALS AND METHODS A hospital-based cross-sectional descriptive study was conducted in Rajiv Gandhi Institute of Medical Sciences, Ongole. 50 HIV patients with clinical features suggestive of meningitis were selected for the study. A brief history and detailed investigations were carried out for the patients. RESULTS Out of the 50 study population, majority (56%, n= 28) belonged to 30-39 years' age group and majority (60%, n= 30) were females. Tuberculous meningitis was found to be the most common cause of meningitis in HIV patients. In the present study, 30 patients (60%) were found to have tuberculous meningitis and 5 patients (10%) were found to have cryptococcal meningitis. 46 patients had CD4+ T-cell count < 500/uL, among whom 18 patients had CD4+ T-cell count < 200/uL. All the patients with tuberculous meningitis and cryptococcal meningitis were found to have CD4 count < 500/uL. CONCLUSION Tuberculous meningitis was found to be the most common cause of meningitis in HIV patients.
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