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Background: Dengue is known to cause multi-organ dysfunction including cardiac involvement, In the clinical setting with limited resources, high degree of suspicion is needed to diagnose cardiac involvement including myocarditis. Although myocarditis not reported as a common complication we present a case series of dengue fever with cardiac involvement observed during a period of month August to December 2021 at PBM & Associated Group of Hospital, Bikaner Rajasthan. Case presentation: We have been reported 9 cases of dengue complicated with cardiac involvement admitted to Wards and ICU at PBM & Associated Group of Hospital. Age group ranging from 15 to 65 years. In our case series out of 9 cases comparising 2 females and 7 males. The group had 5 cases of Dengue hemorrhagic fever with dengue shock syndrome, 2 cases had Dengue hemorrhagic fever, 2 cases had dengue shock syndrome. There is co-infection of dengue with malaria in 2 cases. All cases had acute dengue hepatitis. Blood transfusion and other empirical therapeutic methods used apart from meticulous fluid management to suit issue of each patient. Bed side USG, digital chest x-ray PA view & 2D ECHO scanning help in early detection of critical phase of dengue. Out of 9 cases with complicated dengue 7 patients recovered and 2 patients expired. Data were collected during hospital admission, stay and follow up visits. Methods: A prospective observational study was conducted on patients with age group more than 15 years and having confirmed dengue fever. Patient on medication affecting heart Rate, Rhythms, pre-existing heart disease and electrolytes abnormalities excluded. A base line ECG, Troponin I NT Pro BNP were done for all patients. The biomarkers were measured using Enzyme linked immune fluorescent assay and recommended cut off were used. Patients with increased biomarkers gone for 2D ECHO (As per criteria of European society of cardiology 2019). Conclusion: Myocarditis and cardiac involvement in dengue may be overlooked due to Nonspecific clinical finding and co-existing multi organ dysfunction. Atypical presentation of this case series may be due to micro-geographical variation and unusual out break of dengue. Co-infection of malaria should be considered in managing patients especially in endemic area. [ABSTRACT FROM AUTHOR]

Background: Mucormycosis is a life-threatening fungal disease in immunocompromised patients. There has been increase in the number of mucormycosis associated with COVID-19 patients in second wave. Now country battle with both COVID-19 and mucormycosis. An invasive mucormycosis infection has been a significant burden in India after COVID-19. It has been recently emerged a notifiable disease by the Rajasthan government. Our aim is to develop awareness regarding the importance of early detection and treatment of mucormycosis with COVID-19 and reduce the morbidity and mortality. Materials and Methods: This is a Prospective longitudinal study including 34 patients diagnosed with acute invasive fungal infection by contrast enhancement magnetic resonance imaging studies of paranasal, orbit and brain or nasal biopsy for KOH/culture. Diagnosis is made through routine blood tests, biopsy, and radiological imaging. The patients taken for the study were COVID-19 reverse transcription-polymerase chain reaction positive or recent post COVID-19 (within 15 days) or symptoms of COVID-19 with bilateral pneumonitis. The study was conducted with 34 patients admitted to the department of medicine with mucormycosis within a month may 2021. Results: A total of 34 patients with a mean age of 50.92 years old and male female ratio 24/10 (70.5/29.41) were included in this study. The most common comorbidity was diabetes mellitus (23 patients 67.64%). Nine patients were newly diagnosed or recent onset of diabetes with or after COVID-19 infection. Twenty-four (70.58%) patients were COVID-19 positive or recent (within 15 days) history of COVID-19 positive. Seven (20.58) patients had the history of steroid as a treatment during COVID-19 and 5 (14.70) patients was on oxygen inhalation. One (2.94%) patient was fully vaccinated, and 5 (14.70) patients had the history of steam inhalation. The most common involvement was naso-orbital mucormycosis found in 28 patients (82.35%) followed by nasal-and orbital 26 (76.47) and 18 (52.94), respectively. Naso-Orbito-Cerebral was seen in 16 (47.05) patients. The more common reported symptoms and signs were headache (76.47), facial numbness (64.70), Nasal discharge (52.94), and ophthalmoplegia (52.94). Cranial nerve involvement was seen in 10 patients (facial palsy in 8 patients and bulbar palsy in 2 patients). Total mortality was 7 (7/34 20.58%). Conclusion: COVID-19 infection associated with the wide range of invasive mucormycosis. Early diagnosis and Clinical suspicion of acute invasive fungal sinusitis among COVID-19 patients is essential for better outcomes and higher survival. [ABSTRACT FROM AUTHOR]

Background: Malnutrition in all its forms remains a serious global concern, particularly affecting children, a highly vulnerable population group. Home visits during the first year of life using the community worker platform is an unexplored opportunity for making improvements in nutritional status. Objective: To analyze the nutritional status (weight for age) of a cohort of infants between 3 and 12 months of age. Design: Tracking weight for age of infants by ASHA workers. Settings: 13 districts in the states of Bihar, Madhya Pradesh, Odisha and Rajasthan. Intervention: Home visits under a home-based newborn care program, home-based newborn care plus (HBNC+). Methods: Norway India Partnership Initiative (NIPI) project supported implementation of HBNC+, in 13 districts across four states in India. A descriptive analysis of infants based on retrospective record based program data was done. The nutritional status (weight-for-age) of the cohort was analyzed. Categories were defined based on the z-scores of weight for age (≤−3 SD; ≤−2 SD and > −3 SD; and > −2 SD). Trend of malnutrition and proportions of children in each category at 3, 6, 9 and 12 months were assessed. Results: At 3 months of age, out of 3,50,986 infants provided home visits, 1,82,049 (51.9%) were underweight as per WHO definition with weight for age z-score ≤− 2 SD; this reduced to 11.1% at 12 months of age. Difference of means at 3 months and 12 months significantly different for weight for age z-score (P<0.001). There was a decline in the proportion of children in severe and moderate malnutrition categories by 15% and 26%, respectively. Conclusion: Catch-up growth in terms of weight-for-age among malnourished children is possible within one year of age. Frequent contacts with the health care functionaries may result in this improvement, though it is difficult to conclude in the absence of an appropriate control. [ABSTRACT FROM AUTHOR]

Objective: To develop a composite index that serves as a proxy marker of quality of clinical service and pilot test its use in 11 special neonatal care units (SNCUs) across two states in India. Design: Secondary data from SNCU webportal. Settings: Special new-born care units in Rajasthan and Orissa. Intervention: We developed a composite SNCU Quality of care Index (SQCI) based on seven indices from SNCU online database. These included rational admission index, index for rational use of antibiotics, inborn birth asphyxia index, index for mortality in normal weight babies, low birth weight admission index, low birth weight survival index, and optimal bed utilization index. Outcome: Based on the SQCI score, the performance of SNCUs was labelled as good (SQCI 0.71–1.0), satisfactory (SQCI 0.4–0.7) or unsatisfactory (SQCI <0.4). Results: The mean difference in SQCI between Jan-Mar 2016 and 2017 was 0.20 (95% CI 0.13–0.28; P<0.001). Similar results were obtained for rational admission index, rational use of antibiotics, mortality in normal weight babies, low birth weight survival and optimal bed utilization. A significant improvement in the overall composite score was noted in Odisha (Mean difference 0.22, 95% CI 0.11–0.33, P=0.003) and Rajasthan (Mean difference 0.17, 95% CI 0.05–0.3, P=0.002). Conclusion: QI approach using SQCI tool is a useful and replicable intervention. Preliminary results show that it does lead to strengthening of implementation of the programs at SNCUs based on the comprehensive scores generated as part of routine system. [ABSTRACT FROM AUTHOR]

Objective: To study special newborn care units (SNCUs) in terms of family participatory care (FPC) quality initiative as per Government of India guidelines in select public health facilities, and to document the perspectives of the doctors and mothers. Design: Cross-sectional. Settings: SNCUs with functional FPC units in the states of Odisha, Madhya Pradesh and Rajasthan. Participants: 38 SNCUs; doctors and nurses in-charge of the unit; and two eligible mothers per unit, one inside the step-down unit and second outside the step-down unit whose newborns were admitted to special new-born care unit, having a stable baby weighing above 1500 g. Intervention: The states implemented FPC as per Government of India guidelines using National Health Mission funds across special newborn care units. This assessment involved onsite observation and interviews of key providers. Outcome: Proportion of facilities providing regular counselling sessions, enabling support to mothers, recording FPC information; perspectives of health providers on improvement of breastfeeding and kangaroo mother care; proportion of eligible mothers practicing FPC, exclusively breastfeeding, and providing kangaroo mother care services. Results: Out of 38 SNCUs, we found that FPC sessions for mothers were happening in 36 (95%) facilities. SNCUs provided enabling support to mothers on FPC (74.2%), held regular sessions for the families (70.6%), nurses assisted mothers and family members for breastfeeding and kangaroo mother care (76.4%) and FPC information were recorded (70.6%). Conclusions: The assessment of facilities where FPC was implemented showed that SNCUs were equipped to implement FPC in public health settings. [ABSTRACT FROM AUTHOR]

Aim and Objective: To study the presentation and clinical profile of thyroid disorder in elders in the North-West Rajasthan. Subjects and Methods: This study was carried out on 553 elderly patients in the Department of Medicine, S P Medical College, Bikaner, North-Western Rajasthan. All patients above 60 years were included. Clinical examination was done for detection of thyroid disorders and, keep in mind, the sign and symptoms of hypothyroidism and hyperthyroidism. Recently, a new immunoassay methodology has been applied to the measurement of thyroid stimulating hormone (TSH)/T3/T4 level. The analysis was undertaken using SPSS (version 10). Chi-square test was used to examine the association and trends for categorical. Results: There were 456 cases in the age group 60-71 years. 71-80 and >80 years patients were in numbers of 57 and 20, respectively. Prevalence of hyperthyroidism, euthyroidism, and hypothyroidism according to age was 5.9%, 80.9%, and 13.2%, respectively. When we compared TSH with age, no statistically difference was found (?2 = 9.366, df = 4; P = 0.05). Of 456 cases, 27 (5.9%) were in decrease level, 359 (80.9%) were within normal range, and 60 (13.2%) cases were having increasing pattern of TSH. Around 8 (4.8%) females having decrease level, 135 (81.8%) were having within normal range of TSH, 22 (13.3%) females having increase level. Around 24 (6.5%) male having decrease level while 40 (10.9%) were having increase level of TSH. Weakness is the most common symptoms of thyroid dysfunction. A highly significant difference was found in weakness, feeling cold, constipation, palpitation, and diarrhea (P < 0.001) while significant difference was found in menstrual irregularity, hoarseness of voice, and irritability (P < 0.01). Conclusion: The current study aimed at spectrum of various clinical aspects in the elderly population that differs from typical presentation. As the age advances, the incidence of thyroid disorders increases. Hypothyroidism was more common than hyperthyroidism. Hence, we recommended that more study required knowing clinical presentation of thyroid disorder in elderly populations. [ABSTRACT FROM AUTHOR]