Objectives. Dengue fever, being hyperendemic with analogous presentations as in many other acute febrile illnesses, poses a challenge in diagnosis during the acute stage. Additionally, the coexistence of multiple serotypes further complicates the disease prognosis. The study was undertaken to determine the dengue virus serotypes, clinical, and laboratory markers as predictors in the severity of infection. Methods. A prospective study was conducted among 106 patients admitted with acute febrile illness having positive NS1 antigen/IgM ELISA. Clinical data were extracted from medical records including demographics, presence of comorbid conditions, clinical presentation, laboratory investigations, and course including length of hospital stay and outcome. Detection of dengue serotypes was done by multiplex reverse transcriptase polymerase chain reaction (RT_PCR). Results. Out of 106 RT-PCR-confirmed cases, DENV-3 was the most common serotype found in 56 (52.8%) patients, followed by DENV-3 and DENV-4 coinfection in 27 (25.4%) patients. Coinfection with more than one serotype was witnessed in our study. Raised liver enzymes and increased ferritin are good biomarkers in differentiating dengue from severe dengue with cutoff levels for AST (134 U/L), ALT (88 U/L), and ferritin (3670 ng/ml). Musculoskeletal, followed by gastrointestinal, manifestations were comparatively higher than respiratory and cutaneous manifestations. Conclusion. This study provides more information on the dengue serotypes. The clinical spectrum along with laboratory parameters such as ferritin, liver enzymes, platelet can be used as potential biomarkers in prediction of dengue severity. The data demonstrated will be useful in early detection and monitoring of the disease.

Background: HIV is an infectious disease affecting 36.7 million people worldwide. In recent times, Antiretroviral Therapy (ART) has become accessible to the majority of People Living with HIV (PLHIV) and this has transformed the course of infection to one that is chronic, characterized by fewer diseases pathognomonic of AIDS. In view of this, there is a pressing need for better markers, apart from the routine HIV indicators, to detect comorbidities such as Neurocognitive Impairment (NCI). The aim of this study was to find out the association between Veterans Aging Cohort Study (VACS) index and Neurocognitive function in HIV positive patients. Methods: In our study, we included 97 HIV positive patients and their Neurocognitive function was assessed using a combination of Montreal Cognitive Assessment and Grooved Pegboard Test, while VACS index was calculated using the most recent laboratory values. Binomial Logistics Regression analyses, adjusting for potential confounding variables, was performed to determine the association between VACS score and Neurocognitive Impairment. Results: We found that a higher VACS Index was associated with global and domain-wise Neurocognitive impairment (p < 0.01), specifically in the domains of attention (p < 0.01) and fine motor skills (p = 0.01). Our study also showed that among all the VACS components, older age (p = 0.02) and lower hemoglobin (p < 0.01) values were associated with global NCI. After plotting an ROC curve, a VACS cut-off score of 11.00 was identified as it had good sensitivity (87.0%) and specificity (71.4%) in identifying Global NCI. Conclusion: Our findings extend prior research on the use of VACS Index to predict global and domain-wise NCI in HIV-positive patients. However, further research with more comprehensive neurocognitive testing is required in our setting before VACS Index can be used as a tool to screen for neurocognitive dysfunction among PLHIV.

Non-Hodgkin’s lymphoma presenting as a primary cardiac lymphoma (PCL) is extremely unusual. Having a predilection for the right side of the heart and accounting for 1% of all cardiac tumours, the difficulty in diagnosing the lesion, owing to the location and vague presenting symptoms and signs, often leads to delayed diagnosis and poor prognosis. In our case report, a middle-aged male was diagnosed with PCL presenting as pyrexia of unknown origin with the help of F18-fluorodeoxyglucose positron emission tomography (18 FDG-PET). PET-CT is an invaluable tool in patients with pyrexia of unknown origin (PUO), especially caused by neoplasms as it helps in localizing the target lesion, aiding in selecting the appropriate intervention for rapid tissue diagnosis. This case serves to sensitize the physicians of PCL presenting with PUO and mimicking a relatively common cardiac tumour such as atrial myxoma.

Background: Kikuchi-Fujimoto disease (KFD) is a rare, benign condition of unknown etiology, presenting as cervical lymphadenitis. Lymphadenopathy is usually tender and maybe associated with systemic symptoms. Despite the extensive literature on this disease, it continues to be misdiagnosed owing to its misleading clinical presentation. Methods: A retrospective hospital-based descriptive cross-sectional study was conducted in tertiary care hospitals from 2011 to 2019. All patients with confirmed KFD diagnosis were included and after ethics committee approval the clinical details and histopathological data was retrieved from the medical records department and analyzed. Results: A total of 67 cases were included. The mean age was 26.9±11.3 years with a female: male ratio of 1.9:1. There were 50 patients with tender cervical lymphadenopathy which was the most common clinical presentation. The mean length and width of palpable lymph nodes were 2.3±1.0 cm and 2.2±0.7 cm respectively. Histology revealed proliferative stage in majority of patients (n=40, 59.7%). Lymphadenopathy resolved in 83.6% within 2 months. There were 42 patients who had complete recovery with symptomatic treatment within a period of 9 months. Conclusions: KFD is prevalent in young, female patients of Asian descent and often presents as tender cervical lymphadenopathy. Early diagnosis with excisional lymph node biopsy is crucial to avoid unnecessary investigations and treatment. Treatment is symptomatic unless complicated, where steroid therapy is considered. KFD has an excellent prognosis with almost no risk of fatality.

BACKGROUND COVID-19 has become a major cause of concern globally for the past couple of years considering the number of lives it has claimed. The spectrum of clinical manifestations related to nervous system ranged from ageusia, anosmia to stroke and encephalopathies. The burden of follow-up and review currently lies in front of us, considering the rise of post COVID manifestations in patients. The objective of this research is to determine the neurological complications of the COVID-19 pandemic in India. METHODS The current study is a record-based retrospective study conducted in a tertiary care hospital. The records of patients admitted to the hospital between January 2021 and July 2021 were reviewed. The information was assessed and analyzed using SPSS 25.0. The results are expressed in the form of mean, standard deviation and proportions. RESULTS 1,000 patients admitted with coronavirus were assessed, and 36 patients with a neurological diagnosis available were found. The mean age was 57.1±1.6 years. Most of the neurological diagnosis included cerebrovascular accidents in 44.4% patients followed by hypokalaemia in 25% of patients. Diabetes mellitus (58.3%) and hypertension (47.2%) were found to be the major contributing co-morbidities. There was a significant association seen between the final diagnosis and the age groups (p=0.039). CONCLUSIONS This research would aid in adapting to better management guidelines as well as an integrated approach to neurovascular complications of the same in future. This is vital considering the increase in various short-term and long-terms effects being reported in the hospitals.

Diabetes mellitus (DM) affects over 366 million people worldwide ; this figure is expected to rise to 522 million by the year 2030. The macrovascular complications of diabetes cause morbidity and mortality. Ankle brachial pressure index (ABPI) is a simple non-invasive tool which may indicate atherosclerotic changes in the blood vessels. It is useful in diagnosis of peripheral artery disease (PAD), and is also an indicator of increased cardiovascular morbidity and mortality. Previous studies have reported a correlation between ABPI and coronary artery disease (CAD). Despite the well-established association between diabetes and coronary artery disease, the role of ABPI in predicting the presence and severity of CAD in diabetics has not been proven. The study was done to find whether there was an association between ABPI and coronary angiogram in diabetics. Materials and Methods: This was a cross sectional study that included 100 patients of Diabetes Mellitus who had undergone a coronary angiogram during the current admission. All coronary angiograms were evaluated by a cardiologist. The ABPI was measured according to the standardized protocol before the patients underwent the coronary angiogram procedure. Results: Out of the patients, 4 patients (4.3%) had ABPI < 0.9 out of which 2 (50%) had double vessel disease and 2 (50%) had triple vessel disease. Conclusion: Though all patients with abnormal ABPI had CAD as assessed by CAG, not all patients with abnormal CAG had abnormal ABPI. Thus the utility of ABPI as a surrogate marker in screening of CAD is limited.