RAJIVGANDHIUNIVERSITY OF HEALTH SCIENCES,

KARNATAKA. BANGALORE

ANNEXURE-11

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1. Name of the candidate: DR.PRASHANTH.B

and address No.22, I.T.I Mn Rd,

K.K.layout, near Deepa complex

Papareddypalya, Nagarbhavi 2ndstage

Bangalore-560072

2. Name of the institution : Bangalore MedicalCollege &

Research Institute

3. Course of study & : M.D General Medicine

subject

4. Date of admission : 03-05-2010

5. Title of the topic : Clinical Profile of Dengue in a Tertiary Care

Hospital

6)Brief resume of the intended work

6.1) Need For theStudy:

•India & in particular Bangalore would be an ideal place for this study as there has been increasing incidence of dengue in recent past due to population growth, rapid urbanization process along with the slower provision of public services as potable water, sewage, and garbage collection systems, especially in suburban settings. Water storage practices and disposable water containers in suburban neighbourhoods have created a wide spectrum of breeding sites that favour mosquito densities in highly crowded areas. Dengue virus transmission has also increased due to migration movements from endemicareas. There is a need to identify various clinical presentations, complications & prognostic factors for anearly diagnosis & to alert clinicians for prevention of a fatal outcome & proper managementof dengue. A study showed low platelet count as a prognostic factor 1 while other study showed bilirubin levels as a prognostic factor 2while another study showed absence of musculoskeletal pain as prognostic factor 3.A study also showed atypical presentations like diarrhoea, menorrhagia & seizures & no correlation between platelet count & bleeding manifestations 4in dengue.

6.2) Review of literature:

•A studyby Joel Navarrete et al 1 concluded that low platelet count, hematemesis & malena were main events associated with mortality.Other factors like male sex, older age, vomiting, pain abdomen, hepatomegaly, ascites, pleural effusion were associated with severe form of disease & mortality.

•A study by Srivenu Itha et al 2 concluded that bilirubin level was higher in patients with dengue shock syndrome than in those with dengue fever or dengue hemorrhagic fever. Alanine transaminase & aspartate transaminase level exceeding 5 times the upper limit & ascites were more frequently foundin severe forms of dengue. Biochemical picture was very much similar to acute viral hepatitis.

•A study by Nazim A Khan et al 3 concluded that clinical complications was significantly associated with absence of musculoskeletal pain, lower platelet counts & higher serum aspartate aminotransferase levels.

•A study by Rai et al 4 concluded that atypical symptoms, such as diarrhoea, menorrhagia and seizures were often the presenting complaints rather than the typical clinical features of dengue. No correlation was observed between platelet count and different bleeding manifestations until they dropped <20,000 per µL. Few patients developed a florid picture before seroconversion, highlighting a greater stress on the haematological rather than immunological profile of such patients.

•A study by Wali JP et al 5 concluded that a transient global hypokinesia on 2D-ECHO nonspecific ST & T changes in ECG may be noted in dengue hemorrhagic fever/dengue shock syndrome.Thus acute reversible cardiac insult may be noticed & could be responsible for hypotension or shock in dengue hemorrhagic fever/dengue shock syndrome

6.3) Objective of the study :

1. To study various clinical presentations,complications & outcome in confirmed cases of dengue

2. To identify prognostic factors to alert clinicians for prevention of a fatal outcome

7. Materials and methods:

7.1: Source of data:

The study will be conducted on 100 patients admitted to Victoria & Bowring & Lady Curzon hospitals affiliated to Bangalore Medical College & Research Institute, Bangalore.

7.2: Method of collection of data

•Patients with IgM dengue positive will be included classified into dengue fever, dengue hemorrhagic fever & dengue shock syndrome according to WHO criteria.A detailed clinical evaluation (including History & Clinical examination) will be done, appropriately investigated & suitably treated.The data will be compiled &appropriate statistical test will be applied.

•Period of study : October 2010 to September 2012

7.3: Inclusion criteria:

ELISA IgM dengue positive cases

7.4: Exclusion criteria:

IgM leptospira positive cases

PS for malarial parasite positive cases

Widal test positive cases

Blood culture positive for other bacterial & viral infections cases

HIV positive cases

7.5: Study design:

Cross sectional

7.6: Statistical method:

Student t test

Chi square test

ANOVA

7.7Does the study require any investigations or interventions to be conducted on patients or other humans or animal? If so please describe briefly

Yes.

Investigations to be done on patients

a. ELISA for IgM dengue

b. ELISA for dengue NS1

c. IgM leptospira

d. PS for malarial parasite

e. Widal test

f. Blood culture

g. Complete Hemogram with platelet count & hematocrit

h. Renal Function Test

i. Liver Function Test

j. Urine routine

k. Blood grouping

l. ELISA for HIV

Investigations in selected cases:

a.Chest X-ray

b.USG Abdomen

c.ECG

d.2D-ECHO

e.PT-INR

f.HBsAg & anti-HCV

7.8Has the ethical clearance been obtained from your institution in case of 7.7?

Yes

8. List of references:

1. Navarrete-Espinosa J, Gómez-Dantés H, Celis-Quintal JG, Vázquez-Martínez JL. Clinical profile of dengue hemorrhagic fever cases in Mexico. Salud Publica Mex 2005;47:193-200.

2. Srivenu Itha, Rajesh Kashyap, Narendra Krishnani, Vivek A. Saraswat, Gourdas Choudhuri, and Rakesh Aggarwal Profile of liver involvement in dengue virus infection.Natl Med J India. 2005 May-Jun; 18(3): 127–130.

3. Khan NA, Azhar EI, El-Fiky S, Madani HH, Abuljadial MA, Ashshi AM, Turkistani AM, Hamouh EA. Clinical profile and outcome of hospitalized patients during first outbreak of dengue in Makkah, Saudi Arabia. Acta Trop. 2008 Jan;105(1):39-44.

4. Rai et al. Sumit Rai, Anita Chakravarti, Monika Matlani, Preena Bhalla, Vijay Aggarwal, N Singh R Diwan Clinico-laboratory findings of patients during dengue outbreak from a tertiary care hospital in Delhi Trop Doct.2008; 38: 175-177

5.Wali JP, Biswas A, Chandra S, Malhotra A, Aggarwal P, Handa R, Wig N, Bahl VK. Cardiac involvement in Dengue Haemorrhagic Fever.Int J Cardiol. 1998 Mar 13;64(1):31-6

6. Anthony S.Fauci, Dennis L.Kasper, Dan L.Longo, Eugene Braunwald, Stephen L.Hauser, J.Larry Jameson et al,Infection caused by arthropod & rodent borne viruses, HARRISON’S PRINCIPLES OF INTERNAL MEDICINE, McGraw-Hill, 2008, vol 1, p.1230 & 1239.

7.Gordon C.Cook, Alimuddin I.Zumla, Suchitra Nimmannitya, Dengue & Dengue Haemorrhagic Fever, MANSON’S TROPICAL DISEASES, Saunders Elsevier, 2009, p.753-761.

9. Signature of the candidate:

DR. PRASHANTH.B

10. Remark of the guide:

There has been an increasing incidence of Dengue outbreak in different parts of our country so alsoin Bangalore city due to increase in migrant population from other endemic areas. There has been a change in profile of clinical presentation & hence there is a need to study the various ways of manifestations of dengue for early diagnosis & prompt treatment in order to prevent a fatal outcome.

11. Name and designation of

11.1 Guide : DR. VASANTHA KAMATH,

MD. FICP

Professor & Head

Department of Medicine

Bangalore medical college & research institute

Bangalore

11.2 Signature:

11.3 Co-guide (if any) – No

11.4 Signature:

11.5HEAD OF THE DEPARTMENT :

DR.VASANTHA KAMATH,

MD. FICP

Professor & Head,

Department of Medicine,

Bangalore medical college & research institute

Bangalore

11.6 Signature:

12.1 Remark of chairman and principal:

12.2 Signature: