Dr Rajesh Deshwal - Academia.edu (original) (raw)

Papers by Dr Rajesh Deshwal

Research paper thumbnail of Clinical and laboratory profile of dengue fever patients : A clinical experience

Journal of Association of Physicians of India, 2016

Objective: To study the clinical features and laboratory parameters of dengue fever cases in chil... more Objective: To study the clinical features and laboratory parameters of dengue fever cases in children, to classify the cases based on WHO 2012 guidelines and to assess the outcome of these cases. Materials and Methods: This was a prospective observational study of 193 children less than 12 years diagnosed with dengue fever based on clinical and lab findings and confirmed by serological tests admitted in our institution between May to October 2017 Results: The maximum number of cases were in the age group 6-12 years. The male: female ratio was 1.19:1. Percentage of severe dengue, dengue with warning signs and dengue without warning signs were 12.4%, 18.1% and 69.4% respectively. 68.5% had a total WBC count below 3999. 36.2% had a platelet count below 100000. The most common presenting symptom was fever with myalgia (68%). Conclusion: Application of revised WHO classification helps in better stratification and management of patients admitted with dengue fever.

Research paper thumbnail of Clinical and Laboratory Profile of Dengue Fever

PubMed, Dec 1, 2015

Objective: Dengue fever is one of the most common arboviral mediated outbreaks reported with incr... more Objective: Dengue fever is one of the most common arboviral mediated outbreaks reported with increased prevalence year after year with considerable morbidity and mortality. This study was designed to assess the clinical and biochemical parameters of dengue fever patients. Methods: Prospective observational study was undertaken among adult patients in a military hospital. Five hundred fiteen patients were studied and analysed. All patients who were NS1 antigen/IgM dengue positive were included in the study. Clinical features, hematological and biochemical parameters were noted. Results: Of the 515 patients studied, majority were males (72.81%). Fever was the major symptom (100%) followed by headache (94.75%), myalgia (90.67%), retroorbital pain (18.25%), conjunctival injection (39.41%), rash (37.86%), abdominal pain (24.46%), pleural effusion (20%) and ascites (16.31%). Significant derangements in platelet (69.51%), leucocyte counts (20.19%) and serum transaminases (88.54%) were noted. Mortality rate was 0.77%. Conclusions: Fever associated with headache, retroorbital pain, erythematous morbilliform rash, conjunctival suffusion and itching in palms and soles along with thrombocytopenia, leucopenia, elevated liver transaminases should prompt a clinician on the possibility of dengue infection. Platelet transfusions have little role in management of dengue patients.

Research paper thumbnail of High Prevalence of Vitamin D Deficiency in HIV Infected on Antiretroviral Therapy in a Cohort of Indian Patients

PubMed, Mar 1, 2019

Objectives: The main aim of this study was to assess vitamin D [25(OH)D]levels in an HIV infected... more Objectives: The main aim of this study was to assess vitamin D [25(OH)D]levels in an HIV infected adult population and to define HIV and antiretroviral-related factors associated with vitamin D deficiency. Methods: This observational analytical study was conducted on 475 adult patients on follow up at Apex Immunodeficiency Center of Base Hospital, Delhi Cantt. We estimated the prevalence of vitamin D insufficiency/deficiency(<30 ng/ml). Age, gender, BMI, CD4 count, plasma viral load, HBV/HCV coinfection, smoking status, time since diagnosis of HIV infection and selected liver enzymes were recorded. Antiretroviral therapy regimen was taken into account and its relationship with vitamin D levels were noted. Results: Vitamin D insufficiency/deficiency was noted in 92.63% of patients out of which 65.68 % were males. Median age of vitamin D sufficient group was slightly higher(52.11 vs 49.95). Patients with higher body mass index (BMI) had a slightly higher rates of Vitamin D insufficiency(24.2 vs 22.3). More the time interval from the date of diagnosis higher were the chances of deficiency/insufficiency. Co-infected patients with hepatitis B and C had sufficient vitamin D levels in 71.92% patients. Efavirenz(66.93%), nevirapine(79.02%), tenofovir(64.84%) and ritonavir(84.90%) containing regimens had consistently low levels of vitamin D. Abnormal liver enzymes viz alanine aminotransferase, alkaline phosphatase and gamma glutamyl transferase were associated with higher rates of deficient vitamin D levels. Conclusions: Vitamin D deficiency is very high in HIV patients on antiretroviral therapy. . Efavirenz (EFV), Nevirapine (NVP), Tenofovir (TDF) and Protease Inhibitors (PI's) were associated with high levels of deficiency/insufficiency of vitamin D levels. Vitamin D supplementation as a global strategy in all HIV positive patients on antiretroviral therapy is advocated.

Research paper thumbnail of Vivax Malaria–Not Benign Anymore

Journal, Indian Academy of Clinical Medicine, 2011

ABSTRACT: Plasmodium vivax causing cerebral malaria has been reported rather frequently in childr... more ABSTRACT: Plasmodium vivax causing cerebral malaria has been reported rather frequently in children, but in adults it had been a rarity. Not-withstanding this now more and more reports are emerging implicating vivax as a cause of cerebral symptoms. A soldier presentedwith pyrexia of three days duration and abnormal behaviour of six hours duration. Clinical evaluation and investigations revealedPlasmodium vivax as the culprit. He was treated with artemisinin-based combination therapy successfully. The case is ...

Research paper thumbnail of Study of clinical profile and outcomes in progressive multifocal leukoencephalopathy in acquired immunodeficiency syndrome patients in the highly active antiretroviral therapy era – An observational study

Indian Journal of Sexually Transmitted Diseases and AIDS

Research paper thumbnail of Serum Alanine Aminotransferase Elevations in HIV Positive Patients on Antiretroviral Therapy in India

The Journal of the Association of Physicians of India, 2019

Background Alanine aminotransferase (ALT) is commonly used to measure liver injury in resource li... more Background Alanine aminotransferase (ALT) is commonly used to measure liver injury in resource limited settings. Elevations in ALT are predictive of increased mortality from liver disease and may be influenced by antiretroviral drugs and concomitant hepatitis B infection. Methods A cross-sectional analysis of the prevalence and predictors of elevated ALT (defined as> 40 IU/L) on HIV patients on antiretroviral therapy (ART) was conducted. Baseline ALT levels and at two weeks, six weeks, twelve weeks, twenty four weeks and one year were recorded for 320 patients on ART. Hepatitis B surface antigen was also recorded at baseline. Results Out of the total 320 patients, 249 were males and 71 females. A total of 252 patient records were used as controls who were not on ART. The mean ALT record before initiating ART was 30.6 IU/L. Peak rise in ALT was observed at twenty four weeks of therapy with mean ALT levels of 54.42 IU/L. Total toxicity was almost similar between the two regimes, ne...

Research paper thumbnail of Clinical and Laboratory Profile of Dengue Fever

The Journal of the Association of Physicians of India, 2015

OBJECTIVE Dengue fever is one of the most common arboviral mediated outbreaks reported with incre... more OBJECTIVE Dengue fever is one of the most common arboviral mediated outbreaks reported with increased prevalence year after year with considerable morbidity and mortality. This study was designed to assess the clinical and biochemical parameters of dengue fever patients. METHODS Prospective observational study was undertaken among adult patients in a military hospital. Five hundred fiteen patients were studied and analysed. All patients who were NS1 antigen/IgM dengue positive were included in the study. Clinical features, hematological and biochemical parameters were noted. RESULTS Of the 515 patients studied, majority were males (72.81%). Fever was the major symptom (100%) followed by headache (94.75%), myalgia (90.67%), retroorbital pain (18.25%), conjunctival injection (39.41%), rash (37.86%), abdominal pain (24.46%), pleural effusion (20%) and ascites (16.31%). Significant derangements in platelet (69.51%), leucocyte counts (20.19%) and serum transaminases (88.54%) were noted. ...

Research paper thumbnail of Clinical and laboratory profile of dengue fever patients : A clinical experience

The Journal of the Association of Physicians of India, 2016

Dengue a mosquito borne arboviral disease is caused by one of the serotypes of dengue virus (DEN-... more Dengue a mosquito borne arboviral disease is caused by one of the serotypes of dengue virus (DEN-1, DEN-2, Den-3, DEN-4) belonging to the family Flaviviridae. These serotypes are antigenically distinct but closely related to each other. Globally 50 million dengue infections are reported annually with annual incidence of 7.5 to 32.5 million cases in India. 1 The first case of dengue fever was reported from Vellore and dengue haemorrhagic fever from Kolkata. 2 The disease is endemic in more than 100 tropical and subtropical ABSTRACT Background: Dengue fever is a mosquito borne arboviral disease which is of global concern. It is endemic in tropical countries with annual incidence of 7.5 to 32.5 million cases. It commonly affects the young adults and paediatric cases of Dengue haemorrhagic fever has high mortality. The objective of this study was to assess the clinical and laboratory profile and outcomes of dengue fever in children of less than 18 years of age. The study was conducted for a period of one year during an outbreak, in a tertiary care hospital of Chennai, Tamilnadu, India. Methods: This was a prospective cross sectional study and 200 cases of dengue fever were enrolled and classified as per WHO guidelines. The clinical profile and demographic profile was recorded in a structured questionnaire form. Haematological parameters were recorded and followed till the day of discharge. The duration of stay was recorded and outcomes were noted. Results: A total of 200 cases with 113 males and 87 females, 177 non severe dengue cases and 23 severe cases of dengue fever were classified. The mean age of admission was 9 years and mean duration of stay in hospital was 4.61 days. Fever was most common presenting symptom (100%) and hepatomegaly (58.5%) was common clinical finding. Bleeding manifestations were seen in severe dengue cases. Statistical significance was seen in rise in SGOT levels, rise in haematocrit and pleural effusion with severe dengue cases and non-severe dengue cases. The case fatality rate was zero. Conclusions: Understanding the knowledge of presentations and associated features would help to predict the severity of the disease. In children, if symptoms like fever, pain, rashes, and vomiting are associated with Hepatomegaly and elevated SGOT in context of low total platelet count, a strong possibility of dengue fever is present, especially in an epidemic setting. Early suspicion and effective management can reduce the severity.

Research paper thumbnail of Splenic Tuberculosis in an Immunocompetent Individual: A Rare Diagnosis

Tuberculosis of the spleen is a rare clinical entity and only a few case reports have been publis... more Tuberculosis of the spleen is a rare clinical entity and only a few case reports have been published so far in immunocompetent individuals. We report a patient who presented with pain in left hypochondrium, loss of appetite and weight. Evaluation revealed low-grade evening pyrexia, positive PPD test, multiple hypoechoic lesions in the spleen on USG. Antitubercular therapy (HREZ) was administered and review after 2 months of therapy revealed weight gain (4 kg), resolution of pyrexia, improved appetite, and resolution of the hypoechoic lesions in the spleen.

Research paper thumbnail of Dengue Myocarditis Presenting as ST Segment Elevation MI

The Journal of the Association of Physicians of India, 2019

Dengue myocarditis masquerading as ST segment elevation myocardial infarction and was thrombolyse... more Dengue myocarditis masquerading as ST segment elevation myocardial infarction and was thrombolysed is being discussed.

Research paper thumbnail of Clinical and Biochemical Characteristics of Exertional Heat Stroke among Paratroopers in Agra, India

The Journal of the Association of Physicians of India, 2017

OBJECTIVE The purpose of this study was to assess the clinical profile, biochemical parameters an... more OBJECTIVE The purpose of this study was to assess the clinical profile, biochemical parameters and outcome in a series of 78 patients of heat stroke admitted and treated in a military hospital in India. METHODS This was a prospective study in a military hospital. A total of 78 patients of exertional heat stroke admitted and treated over more than 2 years are reported. Cooling measures started immediately on site of occurrence, carried on during evacuation and in hospital, IV normal saline initiated, clinical symptoms and signs were noted. Blood was collected and sent for hematological, biochemical and coagulation parameters. RESULTS Clinical features noted were violent behavior( 20.51%), confusional state (58.97%),coma (29.48%), seizure (33.33%),and vomiting (26.92%).Vital parameters were recorded and laboratory parameters revealed hypophosphatemia, hyponatremia, hypokalemia along with raised transaminases, creatinine kinase and lactic dehydrogenase. Patients were managed with cooli...

Research paper thumbnail of High Prevalence of Vitamin D Deficiency in HIV Infected on Antiretroviral Therapy in a Cohort of Indian Patients

The Journal of the Association of Physicians of India, 2019

Objectives The main aim of this study was to assess vitamin D [25(OH)D]levels in an HIV infected ... more Objectives The main aim of this study was to assess vitamin D [25(OH)D]levels in an HIV infected adult population and to define HIV and antiretroviral-related factors associated with vitamin D deficiency. Methods This observational analytical study was conducted on 475 adult patients on follow up at Apex Immunodeficiency Center of Base Hospital, Delhi Cantt. We estimated the prevalence of vitamin D insufficiency/deficiency(<30 ng/ml). Age, gender, BMI, CD4 count, plasma viral load, HBV/HCV coinfection, smoking status, time since diagnosis of HIV infection and selected liver enzymes were recorded. Antiretroviral therapy regimen was taken into account and its relationship with vitamin D levels were noted. Results Vitamin D insufficiency/deficiency was noted in 92.63% of patients out of which 65.68 % were males. Median age of vitamin D sufficient group was slightly higher(52.11 vs 49.95). Patients with higher body mass index (BMI) had a slightly higher rates of Vitamin D insufficien...

Research paper thumbnail of Mildly elevated transaminases: excellent diagnostic clue for anicteric leptospirosis

Correspondence were anicteric leptospirosis. 1 Main presentation in our cases was Weil's disease,... more Correspondence were anicteric leptospirosis. 1 Main presentation in our cases was Weil's disease, so, it is difficult to draw conclusions from only two patients of anicteric leptospirosis. As far as the study of Elizabeth F Daher et al is concerned this study also had Jaundice in 94.5% patients out of total 201 patients. 2 MAT is a highly specific test, though sensitivity is poor, whereas mildly raised transaminases in anicteic leptospirosis can be highly sensitive but have poor specificity for leptospirosis, thus these two tests are not comparable. In my view it will not be prudent to call it "Poor man's MAT" due to poor specificity, but it can definitely be used as a whistle blower for leptospirosis in the first week of illness. However, on the contrary, we need to be more vigilant in those patients who have disproportionately raised bilirubin levels(>3.5 mg%) 2 compared to only mildly raised transaminases and suspect leptospirosis in such patients as quoted by Elizabeth F Daher et al.

Research paper thumbnail of Nifedipine for the Treatment of High Altitude

This was a prospective cross-sectional study in a military hospital. In all, 110 patientswith HAP... more This was a prospective cross-sectional study in a military hospital. In all, 110 patientswith HAPE admitted and treated over a period of 3 years are reported. The following measurementswere noted: dyspnea, cough, chest pain, cyanosis, pulse rate, blood pressure, respiratory rate, crepita-tions, radiographic abnormalities, electrocardiogram, peripheral pulse oximetry (Sp

Research paper thumbnail of Clinical and Laboratory Profile of Hospitalized Malarial Patients: An Agra-Based Study

Objective: The clinical presentations and laboratory profile of malaria has been changing over th... more Objective: The clinical presentations and laboratory profile of malaria has been changing over the years. Therefore this study was undertaken to study the clinical profile and laboratory parameters of malarial patients.

Research paper thumbnail of Clinical and Laboratory Profile of Hospitalized Malarial Patients: An Agra-Based Study

OBJECTIVE The clinical presentations and laboratory profile of malaria has been changing over the... more OBJECTIVE The clinical presentations and laboratory profile of malaria has been changing over the years. Therefore this study was undertaken to study the clinical profile and laboratory parameters of malarial patients. METHODS This prospective observational study was undertaken in military hospital with high prevalence of malaria. A total of 320 patients were studied. All patients tested positive by peripheral blood smear or rapid diagnostic test were included. Clinical presentations, hematological and biochemical parameters were noted. RESULTS Of the total 320 patients, 249 had P vivax, 43 had P falciparum and 28 had mixed malaria.79% patients were male. Maximum (51.56%) patients were in 21-30 age group. The mean duration of symptoms was 2.54 days in vivax to 3.03 days in mixed malaria. Fever was observed in 97.8% of patients of vivax. Thrombocytopenia was observed in 99% of all patients. Splenomegaly was noticed in 24.84% patients of vivax and 34.5% of falciparum malaria. Herpes l...

Research paper thumbnail of Clinical, immunological, and virological outcomes in HIV patients on raltegravir-based salvage therapy

Indian Journal of Sexually Transmitted Diseases and AIDS

Research paper thumbnail of Clinical and Biochemical Characteristics of Exertional Heat Stroke among Paratroopers in Agra, India

The Journal of the Association of Physicians of India, 2017

The purpose of this study was to assess the clinical profile, biochemical parameters and outcome ... more The purpose of this study was to assess the clinical profile, biochemical parameters and outcome in a series of 78 patients of heat stroke admitted and treated in a military hospital in India. This was a prospective study in a military hospital. A total of 78 patients of exertional heat stroke admitted and treated over more than 2 years are reported. Cooling measures started immediately on site of occurrence, carried on during evacuation and in hospital, IV normal saline initiated, clinical symptoms and signs were noted. Blood was collected and sent for hematological, biochemical and coagulation parameters. Clinical features noted were violent behavior( 20.51%), confusional state (58.97%),coma (29.48%), seizure (33.33%),and vomiting (26.92%).Vital parameters were recorded and laboratory parameters revealed hypophosphatemia, hyponatremia, hypokalemia along with raised transaminases, creatinine kinase and lactic dehydrogenase. Patients were managed with cooling measures, IV fluids and...

Research paper thumbnail of Mildly elevated transaminases: excellent diagnostic clue for anicteric leptospirosis

The Journal of the Association of Physicians of India, Oct 1, 2011

Correspondence were anicteric leptospirosis. 1 Main presentation in our cases was Weil's disease,... more Correspondence were anicteric leptospirosis. 1 Main presentation in our cases was Weil's disease, so, it is difficult to draw conclusions from only two patients of anicteric leptospirosis. As far as the study of Elizabeth F Daher et al is concerned this study also had Jaundice in 94.5% patients out of total 201 patients. 2 MAT is a highly specific test, though sensitivity is poor, whereas mildly raised transaminases in anicteic leptospirosis can be highly sensitive but have poor specificity for leptospirosis, thus these two tests are not comparable. In my view it will not be prudent to call it "Poor man's MAT" due to poor specificity, but it can definitely be used as a whistle blower for leptospirosis in the first week of illness. However, on the contrary, we need to be more vigilant in those patients who have disproportionately raised bilirubin levels(>3.5 mg%) 2 compared to only mildly raised transaminases and suspect leptospirosis in such patients as quoted by Elizabeth F Daher et al.

Research paper thumbnail of English

Journal of Evidence Based Medicine and Healthcare, 2015

Research paper thumbnail of Clinical and laboratory profile of dengue fever patients : A clinical experience

Journal of Association of Physicians of India, 2016

Objective: To study the clinical features and laboratory parameters of dengue fever cases in chil... more Objective: To study the clinical features and laboratory parameters of dengue fever cases in children, to classify the cases based on WHO 2012 guidelines and to assess the outcome of these cases. Materials and Methods: This was a prospective observational study of 193 children less than 12 years diagnosed with dengue fever based on clinical and lab findings and confirmed by serological tests admitted in our institution between May to October 2017 Results: The maximum number of cases were in the age group 6-12 years. The male: female ratio was 1.19:1. Percentage of severe dengue, dengue with warning signs and dengue without warning signs were 12.4%, 18.1% and 69.4% respectively. 68.5% had a total WBC count below 3999. 36.2% had a platelet count below 100000. The most common presenting symptom was fever with myalgia (68%). Conclusion: Application of revised WHO classification helps in better stratification and management of patients admitted with dengue fever.

Research paper thumbnail of Clinical and Laboratory Profile of Dengue Fever

PubMed, Dec 1, 2015

Objective: Dengue fever is one of the most common arboviral mediated outbreaks reported with incr... more Objective: Dengue fever is one of the most common arboviral mediated outbreaks reported with increased prevalence year after year with considerable morbidity and mortality. This study was designed to assess the clinical and biochemical parameters of dengue fever patients. Methods: Prospective observational study was undertaken among adult patients in a military hospital. Five hundred fiteen patients were studied and analysed. All patients who were NS1 antigen/IgM dengue positive were included in the study. Clinical features, hematological and biochemical parameters were noted. Results: Of the 515 patients studied, majority were males (72.81%). Fever was the major symptom (100%) followed by headache (94.75%), myalgia (90.67%), retroorbital pain (18.25%), conjunctival injection (39.41%), rash (37.86%), abdominal pain (24.46%), pleural effusion (20%) and ascites (16.31%). Significant derangements in platelet (69.51%), leucocyte counts (20.19%) and serum transaminases (88.54%) were noted. Mortality rate was 0.77%. Conclusions: Fever associated with headache, retroorbital pain, erythematous morbilliform rash, conjunctival suffusion and itching in palms and soles along with thrombocytopenia, leucopenia, elevated liver transaminases should prompt a clinician on the possibility of dengue infection. Platelet transfusions have little role in management of dengue patients.

Research paper thumbnail of High Prevalence of Vitamin D Deficiency in HIV Infected on Antiretroviral Therapy in a Cohort of Indian Patients

PubMed, Mar 1, 2019

Objectives: The main aim of this study was to assess vitamin D [25(OH)D]levels in an HIV infected... more Objectives: The main aim of this study was to assess vitamin D [25(OH)D]levels in an HIV infected adult population and to define HIV and antiretroviral-related factors associated with vitamin D deficiency. Methods: This observational analytical study was conducted on 475 adult patients on follow up at Apex Immunodeficiency Center of Base Hospital, Delhi Cantt. We estimated the prevalence of vitamin D insufficiency/deficiency(<30 ng/ml). Age, gender, BMI, CD4 count, plasma viral load, HBV/HCV coinfection, smoking status, time since diagnosis of HIV infection and selected liver enzymes were recorded. Antiretroviral therapy regimen was taken into account and its relationship with vitamin D levels were noted. Results: Vitamin D insufficiency/deficiency was noted in 92.63% of patients out of which 65.68 % were males. Median age of vitamin D sufficient group was slightly higher(52.11 vs 49.95). Patients with higher body mass index (BMI) had a slightly higher rates of Vitamin D insufficiency(24.2 vs 22.3). More the time interval from the date of diagnosis higher were the chances of deficiency/insufficiency. Co-infected patients with hepatitis B and C had sufficient vitamin D levels in 71.92% patients. Efavirenz(66.93%), nevirapine(79.02%), tenofovir(64.84%) and ritonavir(84.90%) containing regimens had consistently low levels of vitamin D. Abnormal liver enzymes viz alanine aminotransferase, alkaline phosphatase and gamma glutamyl transferase were associated with higher rates of deficient vitamin D levels. Conclusions: Vitamin D deficiency is very high in HIV patients on antiretroviral therapy. . Efavirenz (EFV), Nevirapine (NVP), Tenofovir (TDF) and Protease Inhibitors (PI's) were associated with high levels of deficiency/insufficiency of vitamin D levels. Vitamin D supplementation as a global strategy in all HIV positive patients on antiretroviral therapy is advocated.

Research paper thumbnail of Vivax Malaria–Not Benign Anymore

Journal, Indian Academy of Clinical Medicine, 2011

ABSTRACT: Plasmodium vivax causing cerebral malaria has been reported rather frequently in childr... more ABSTRACT: Plasmodium vivax causing cerebral malaria has been reported rather frequently in children, but in adults it had been a rarity. Not-withstanding this now more and more reports are emerging implicating vivax as a cause of cerebral symptoms. A soldier presentedwith pyrexia of three days duration and abnormal behaviour of six hours duration. Clinical evaluation and investigations revealedPlasmodium vivax as the culprit. He was treated with artemisinin-based combination therapy successfully. The case is ...

Research paper thumbnail of Study of clinical profile and outcomes in progressive multifocal leukoencephalopathy in acquired immunodeficiency syndrome patients in the highly active antiretroviral therapy era – An observational study

Indian Journal of Sexually Transmitted Diseases and AIDS

Research paper thumbnail of Serum Alanine Aminotransferase Elevations in HIV Positive Patients on Antiretroviral Therapy in India

The Journal of the Association of Physicians of India, 2019

Background Alanine aminotransferase (ALT) is commonly used to measure liver injury in resource li... more Background Alanine aminotransferase (ALT) is commonly used to measure liver injury in resource limited settings. Elevations in ALT are predictive of increased mortality from liver disease and may be influenced by antiretroviral drugs and concomitant hepatitis B infection. Methods A cross-sectional analysis of the prevalence and predictors of elevated ALT (defined as> 40 IU/L) on HIV patients on antiretroviral therapy (ART) was conducted. Baseline ALT levels and at two weeks, six weeks, twelve weeks, twenty four weeks and one year were recorded for 320 patients on ART. Hepatitis B surface antigen was also recorded at baseline. Results Out of the total 320 patients, 249 were males and 71 females. A total of 252 patient records were used as controls who were not on ART. The mean ALT record before initiating ART was 30.6 IU/L. Peak rise in ALT was observed at twenty four weeks of therapy with mean ALT levels of 54.42 IU/L. Total toxicity was almost similar between the two regimes, ne...

Research paper thumbnail of Clinical and Laboratory Profile of Dengue Fever

The Journal of the Association of Physicians of India, 2015

OBJECTIVE Dengue fever is one of the most common arboviral mediated outbreaks reported with incre... more OBJECTIVE Dengue fever is one of the most common arboviral mediated outbreaks reported with increased prevalence year after year with considerable morbidity and mortality. This study was designed to assess the clinical and biochemical parameters of dengue fever patients. METHODS Prospective observational study was undertaken among adult patients in a military hospital. Five hundred fiteen patients were studied and analysed. All patients who were NS1 antigen/IgM dengue positive were included in the study. Clinical features, hematological and biochemical parameters were noted. RESULTS Of the 515 patients studied, majority were males (72.81%). Fever was the major symptom (100%) followed by headache (94.75%), myalgia (90.67%), retroorbital pain (18.25%), conjunctival injection (39.41%), rash (37.86%), abdominal pain (24.46%), pleural effusion (20%) and ascites (16.31%). Significant derangements in platelet (69.51%), leucocyte counts (20.19%) and serum transaminases (88.54%) were noted. ...

Research paper thumbnail of Clinical and laboratory profile of dengue fever patients : A clinical experience

The Journal of the Association of Physicians of India, 2016

Dengue a mosquito borne arboviral disease is caused by one of the serotypes of dengue virus (DEN-... more Dengue a mosquito borne arboviral disease is caused by one of the serotypes of dengue virus (DEN-1, DEN-2, Den-3, DEN-4) belonging to the family Flaviviridae. These serotypes are antigenically distinct but closely related to each other. Globally 50 million dengue infections are reported annually with annual incidence of 7.5 to 32.5 million cases in India. 1 The first case of dengue fever was reported from Vellore and dengue haemorrhagic fever from Kolkata. 2 The disease is endemic in more than 100 tropical and subtropical ABSTRACT Background: Dengue fever is a mosquito borne arboviral disease which is of global concern. It is endemic in tropical countries with annual incidence of 7.5 to 32.5 million cases. It commonly affects the young adults and paediatric cases of Dengue haemorrhagic fever has high mortality. The objective of this study was to assess the clinical and laboratory profile and outcomes of dengue fever in children of less than 18 years of age. The study was conducted for a period of one year during an outbreak, in a tertiary care hospital of Chennai, Tamilnadu, India. Methods: This was a prospective cross sectional study and 200 cases of dengue fever were enrolled and classified as per WHO guidelines. The clinical profile and demographic profile was recorded in a structured questionnaire form. Haematological parameters were recorded and followed till the day of discharge. The duration of stay was recorded and outcomes were noted. Results: A total of 200 cases with 113 males and 87 females, 177 non severe dengue cases and 23 severe cases of dengue fever were classified. The mean age of admission was 9 years and mean duration of stay in hospital was 4.61 days. Fever was most common presenting symptom (100%) and hepatomegaly (58.5%) was common clinical finding. Bleeding manifestations were seen in severe dengue cases. Statistical significance was seen in rise in SGOT levels, rise in haematocrit and pleural effusion with severe dengue cases and non-severe dengue cases. The case fatality rate was zero. Conclusions: Understanding the knowledge of presentations and associated features would help to predict the severity of the disease. In children, if symptoms like fever, pain, rashes, and vomiting are associated with Hepatomegaly and elevated SGOT in context of low total platelet count, a strong possibility of dengue fever is present, especially in an epidemic setting. Early suspicion and effective management can reduce the severity.

Research paper thumbnail of Splenic Tuberculosis in an Immunocompetent Individual: A Rare Diagnosis

Tuberculosis of the spleen is a rare clinical entity and only a few case reports have been publis... more Tuberculosis of the spleen is a rare clinical entity and only a few case reports have been published so far in immunocompetent individuals. We report a patient who presented with pain in left hypochondrium, loss of appetite and weight. Evaluation revealed low-grade evening pyrexia, positive PPD test, multiple hypoechoic lesions in the spleen on USG. Antitubercular therapy (HREZ) was administered and review after 2 months of therapy revealed weight gain (4 kg), resolution of pyrexia, improved appetite, and resolution of the hypoechoic lesions in the spleen.

Research paper thumbnail of Dengue Myocarditis Presenting as ST Segment Elevation MI

The Journal of the Association of Physicians of India, 2019

Dengue myocarditis masquerading as ST segment elevation myocardial infarction and was thrombolyse... more Dengue myocarditis masquerading as ST segment elevation myocardial infarction and was thrombolysed is being discussed.

Research paper thumbnail of Clinical and Biochemical Characteristics of Exertional Heat Stroke among Paratroopers in Agra, India

The Journal of the Association of Physicians of India, 2017

OBJECTIVE The purpose of this study was to assess the clinical profile, biochemical parameters an... more OBJECTIVE The purpose of this study was to assess the clinical profile, biochemical parameters and outcome in a series of 78 patients of heat stroke admitted and treated in a military hospital in India. METHODS This was a prospective study in a military hospital. A total of 78 patients of exertional heat stroke admitted and treated over more than 2 years are reported. Cooling measures started immediately on site of occurrence, carried on during evacuation and in hospital, IV normal saline initiated, clinical symptoms and signs were noted. Blood was collected and sent for hematological, biochemical and coagulation parameters. RESULTS Clinical features noted were violent behavior( 20.51%), confusional state (58.97%),coma (29.48%), seizure (33.33%),and vomiting (26.92%).Vital parameters were recorded and laboratory parameters revealed hypophosphatemia, hyponatremia, hypokalemia along with raised transaminases, creatinine kinase and lactic dehydrogenase. Patients were managed with cooli...

Research paper thumbnail of High Prevalence of Vitamin D Deficiency in HIV Infected on Antiretroviral Therapy in a Cohort of Indian Patients

The Journal of the Association of Physicians of India, 2019

Objectives The main aim of this study was to assess vitamin D [25(OH)D]levels in an HIV infected ... more Objectives The main aim of this study was to assess vitamin D [25(OH)D]levels in an HIV infected adult population and to define HIV and antiretroviral-related factors associated with vitamin D deficiency. Methods This observational analytical study was conducted on 475 adult patients on follow up at Apex Immunodeficiency Center of Base Hospital, Delhi Cantt. We estimated the prevalence of vitamin D insufficiency/deficiency(<30 ng/ml). Age, gender, BMI, CD4 count, plasma viral load, HBV/HCV coinfection, smoking status, time since diagnosis of HIV infection and selected liver enzymes were recorded. Antiretroviral therapy regimen was taken into account and its relationship with vitamin D levels were noted. Results Vitamin D insufficiency/deficiency was noted in 92.63% of patients out of which 65.68 % were males. Median age of vitamin D sufficient group was slightly higher(52.11 vs 49.95). Patients with higher body mass index (BMI) had a slightly higher rates of Vitamin D insufficien...

Research paper thumbnail of Mildly elevated transaminases: excellent diagnostic clue for anicteric leptospirosis

Correspondence were anicteric leptospirosis. 1 Main presentation in our cases was Weil's disease,... more Correspondence were anicteric leptospirosis. 1 Main presentation in our cases was Weil's disease, so, it is difficult to draw conclusions from only two patients of anicteric leptospirosis. As far as the study of Elizabeth F Daher et al is concerned this study also had Jaundice in 94.5% patients out of total 201 patients. 2 MAT is a highly specific test, though sensitivity is poor, whereas mildly raised transaminases in anicteic leptospirosis can be highly sensitive but have poor specificity for leptospirosis, thus these two tests are not comparable. In my view it will not be prudent to call it "Poor man's MAT" due to poor specificity, but it can definitely be used as a whistle blower for leptospirosis in the first week of illness. However, on the contrary, we need to be more vigilant in those patients who have disproportionately raised bilirubin levels(>3.5 mg%) 2 compared to only mildly raised transaminases and suspect leptospirosis in such patients as quoted by Elizabeth F Daher et al.

Research paper thumbnail of Nifedipine for the Treatment of High Altitude

This was a prospective cross-sectional study in a military hospital. In all, 110 patientswith HAP... more This was a prospective cross-sectional study in a military hospital. In all, 110 patientswith HAPE admitted and treated over a period of 3 years are reported. The following measurementswere noted: dyspnea, cough, chest pain, cyanosis, pulse rate, blood pressure, respiratory rate, crepita-tions, radiographic abnormalities, electrocardiogram, peripheral pulse oximetry (Sp

Research paper thumbnail of Clinical and Laboratory Profile of Hospitalized Malarial Patients: An Agra-Based Study

Objective: The clinical presentations and laboratory profile of malaria has been changing over th... more Objective: The clinical presentations and laboratory profile of malaria has been changing over the years. Therefore this study was undertaken to study the clinical profile and laboratory parameters of malarial patients.

Research paper thumbnail of Clinical and Laboratory Profile of Hospitalized Malarial Patients: An Agra-Based Study

OBJECTIVE The clinical presentations and laboratory profile of malaria has been changing over the... more OBJECTIVE The clinical presentations and laboratory profile of malaria has been changing over the years. Therefore this study was undertaken to study the clinical profile and laboratory parameters of malarial patients. METHODS This prospective observational study was undertaken in military hospital with high prevalence of malaria. A total of 320 patients were studied. All patients tested positive by peripheral blood smear or rapid diagnostic test were included. Clinical presentations, hematological and biochemical parameters were noted. RESULTS Of the total 320 patients, 249 had P vivax, 43 had P falciparum and 28 had mixed malaria.79% patients were male. Maximum (51.56%) patients were in 21-30 age group. The mean duration of symptoms was 2.54 days in vivax to 3.03 days in mixed malaria. Fever was observed in 97.8% of patients of vivax. Thrombocytopenia was observed in 99% of all patients. Splenomegaly was noticed in 24.84% patients of vivax and 34.5% of falciparum malaria. Herpes l...

Research paper thumbnail of Clinical, immunological, and virological outcomes in HIV patients on raltegravir-based salvage therapy

Indian Journal of Sexually Transmitted Diseases and AIDS

Research paper thumbnail of Clinical and Biochemical Characteristics of Exertional Heat Stroke among Paratroopers in Agra, India

The Journal of the Association of Physicians of India, 2017

The purpose of this study was to assess the clinical profile, biochemical parameters and outcome ... more The purpose of this study was to assess the clinical profile, biochemical parameters and outcome in a series of 78 patients of heat stroke admitted and treated in a military hospital in India. This was a prospective study in a military hospital. A total of 78 patients of exertional heat stroke admitted and treated over more than 2 years are reported. Cooling measures started immediately on site of occurrence, carried on during evacuation and in hospital, IV normal saline initiated, clinical symptoms and signs were noted. Blood was collected and sent for hematological, biochemical and coagulation parameters. Clinical features noted were violent behavior( 20.51%), confusional state (58.97%),coma (29.48%), seizure (33.33%),and vomiting (26.92%).Vital parameters were recorded and laboratory parameters revealed hypophosphatemia, hyponatremia, hypokalemia along with raised transaminases, creatinine kinase and lactic dehydrogenase. Patients were managed with cooling measures, IV fluids and...

Research paper thumbnail of Mildly elevated transaminases: excellent diagnostic clue for anicteric leptospirosis

The Journal of the Association of Physicians of India, Oct 1, 2011

Correspondence were anicteric leptospirosis. 1 Main presentation in our cases was Weil's disease,... more Correspondence were anicteric leptospirosis. 1 Main presentation in our cases was Weil's disease, so, it is difficult to draw conclusions from only two patients of anicteric leptospirosis. As far as the study of Elizabeth F Daher et al is concerned this study also had Jaundice in 94.5% patients out of total 201 patients. 2 MAT is a highly specific test, though sensitivity is poor, whereas mildly raised transaminases in anicteic leptospirosis can be highly sensitive but have poor specificity for leptospirosis, thus these two tests are not comparable. In my view it will not be prudent to call it "Poor man's MAT" due to poor specificity, but it can definitely be used as a whistle blower for leptospirosis in the first week of illness. However, on the contrary, we need to be more vigilant in those patients who have disproportionately raised bilirubin levels(>3.5 mg%) 2 compared to only mildly raised transaminases and suspect leptospirosis in such patients as quoted by Elizabeth F Daher et al.

Research paper thumbnail of English

Journal of Evidence Based Medicine and Healthcare, 2015