Objective:Plasmodium vivax infection has been recognized to be a cause of severe malaria in recent time. We report findings from a prospective observational study aimed at analyzing the clinical spectrum, complications, and outcome of patients infected with P. vivax malaria.Materials and Methods:The study was conducted in a tertiary care hospital of Delhi over a period of 2 years. All adults hospitalized with P. vivax malaria, confirmed on peripheral smear and/or rapid diagnostic test, were included in the study. The cases were categorized into uncomplicated and severe malaria groups according to WHO criteria. The clinical and biochemical profile of cases in each group were compared for determining the predictors of severe malaria.Results:One hundred and fifty consecutive cases of P. vivax monoinfection were included in the study. All patients had fever, and 63 (42%) developed severe malaria, while 87 (58%) were uncomplicated. Vomiting, abdominal pain, headache, altered consciousness, cough with breathlessness, icterus, and hepatosplenomegaly were more frequent in severe malaria. Severe malaria was associated with severe thrombocytopenia, leucopenia, raised serum bilirubin, elevated serum creatinine, and prolonged prothrombin time. Jaundice (54 patients) was the most common complication, followed by acute respiratory distress syndrome, spontaneous bleeding, metabolic acidosis, shock, renal failure, and cerebral malaria. Multiple complications were observed in 17 (26.9%) cases of severe malaria. Overall mortality of 1.33% was recorded. However, case fatality of 40% was observed in cases with evidence of multiorgan dysfunction.Conclusion:P. vivax malaria has a varying clinical profile, from a relatively benign uncomplicated form to severe, even fatal disease. Certain clinical and laboratory parameters may serve as predictors of severe disease.

Aim:This work was carried out to study the hematologic profile of human immunodeficiency virus (HIV)-positive patients and its association with the clinicoimmunologic stage of the disease.Materials and Methods:A total of 187 patients with HIV, whether symptomatic or asymptomatic, diagnosed by enzyme-linked immunosorbent assay (ELISA) method according to the National AIDS Control Organization (NACO) guidelines were included in this study. Patients in the study population were divided into two groups: (1) Group A (antiretroviral therapy (ART) included patients receiving ART [ART-Y]) and (2) Group B included treatment naïve patients (ART-N). The patients were tested for hemoglobin (Hb), total red blood cells (RBC) count, RBC indices, reticulocyte count, packed cell volume (PCV), total lymphocyte counts(TLC), differential leukocyte counts (DLC), platelet count, and erythrocyte sedimentation rate (ESR). Cut-off values were determined as Hb < 10 g/dl, platelet count < 1.5 lakh/cumm, and TLC < 4,000/cumm. The group or categorical data were tested for statistical significance using Chi-square test and Z-test. The difference was reported as significant if P < 0.05.Results:(1) Anemia (predominantly normocytic normochromic) was prevalent in 40.1%, with slightly higher prevalence in those not receiving ART. It occurred with high frequency in patients with immunological (42.05%) and clinical acquired immunodeficiency disease syndrome (AIDS) (70.58%) compared with those who had an asymptomatic HIV infection with CD4 > 200/μl (28.57%). Patients on zidovudine (AZT) therapy had 34.6% anemia with increased mean corpuscular volume (MCV). (2) Thrombocytopenia was seen in 3.74% patients (higher percentage in untreated patients). (3) Leucopenia was observed in 5.88% in ART-Y (Group A) and 8.14% in ART-N (Group B) patients. (4) Pancytopenia was found in 1.6% patients.

Objective: HIV virtually affects every organ system of the body. The skeletal system is no exception, and antiretroviral therapy (ART) has been implicated in bone diseases. However, not many studies have been done to evaluate bone disease in treatment (ART) naive HIV-infected patients, and hence, the present study was executed. Materials and Methods: One hundred and twenty HIV-infected ART-naive patients and 80 age- and sex-matched healthy controls were recruited for this study. A thorough history and physical examination was done followed by laboratory investigations after an overnight fasting. Bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry scan at the level of lumbar spine, femur, and forearm. Results: Of 120 ART-naive HIV-infected cases, the prevalence of osteoporosis and osteopenia was 13% and 41%, respectively, as compared to 0% and 17.5% in controls ( P < 0.001). The mean BMD in cases was 0.842 g/cm 2 which was approximately 25% lesser than that in controls. Hypovitaminosis-D was seen in 100% of cases as compared to 65% of controls ( P < 0.01). A significant association of low BMD was seen with HIV-infection per se ( P < 0.001), low CD4 cell counts ( P < 0.001), low Vitamin D levels ( P < 0.001), long duration of disease ( P < 0.04), history of opportunistic infections ( P < 0.03), and history of tuberculosis in the past ( P < 0.05). Conclusion: Bone diseases such as osteoporosis and osteopenia characterized by low BMD are very common in HIV-infected patients. Virus per se , along with low CD4 cell counts and low Vitamin D levels are major predictors of pathological fractures in these individuals.

There were spurts of swine flu cases every year, even though the pandemic was over in August 2010. Most of the studies on swine flu pivoted around pandemic years 2009 to 2010. Here, through this retrospective study conducted at a tertiary care hospital in New Delhi, India, we compared clinical characteristics between H1N1-positive and H1N1-negative patients admitted in years 2015 to 2016. Among H1N1-positive patients, variables were compared among survival and death groups. Among 122 suspected H1N1 patients, 30 were positive for H1N1 reverse transcription–polymerase chain reaction. Symptom of rhinitis and low serum albumin were significantly more in H1N1-positive patients. Applying univariate analysis among H1N1-positive patients, respiratory rate, albumin level, alanine transaminase, aspartate transaminase, and Pao 2/fraction of inspired oxygen (Fio 2) ratio were statistically different between the survival and death groups. Further using simple logistic regression among H1N1-positive patients, Pao 2/Fio 2 less than or equal to 200 had an odds ratio of 9.2 (95% confidence interval [CI], 1.6–51.4), alanine transaminase level more than or equal to 40 U/L had an odds ratio of 7.3 (95% CI, 1.4–38.9), and albumin level less than or equal to 3.0 (gm/dl) had an odds ratio of 44.8 (95% CI, 4.0–497.4), and these were independently associated with death. After considering for causality/plausibility aspects, Pao 2/Fio 2 less than or equal to 200 had significant higher odds ratio of 12.3 (95% CI, 1.7–90.1) for death even if adjusted for age and sex. Hence, the value of Pao 2/Fio 2 at admission is a good predictor of mortality among H1N1-positive patients.