Ritwika Majumdar

Bio: Ritwika Majumdar is an academic researcher from Medical College and Hospital, Kolkata. The author has contributed to research in topics: VIPeR & Dengue fever. The author has an hindex of 1, co-authored 2 publications receiving 10 citations.

Clinical spectrum of dengue fever in a tertiary care centre with particular reference to atypical presentation in the 2012 outbreak in Kolkata.

Abstract: During the summer of 2012, dengue fever epidemic has emerged in Kolkata and spread throughout West Bengal. During the epidemic period, wide spectrum of atypical presentations of dengue fever has been observed. Here, in this study, the spectrum of dengue fever was analysed in 300 patients who were found to have dengue serology positive (NS1, IgM, IgG). The study was done in the department of medicine, RG Kar Medical College, Kolkata. The patients were classified according to age, gender, duration of symptoms on admission, associated comorbidities and coinfections, complications that developed after admission, the final outcome and duration till death after symptoms developed. The dengue fever cases started to appear from April but it attained its peak during August-September this year. All ages were affected but the brunt was borne maximally by those between 15 and 40 years. Females were more affected than males. It may be concluded from the study that 30% had no complications while 70% cases developed complications, 4% cases had underlying comorbidities and coinfections, 68% developed thrombocytopenia and other haemorrhagic features, 55% serositis, 25% acalculous cholecystitis, 20% myocarditis, 15% pancreatitis, 5% had central nervous system involvement, 0.66% rhabdomyolysis and myositis, 0.33% secondary vasculitis and death occurred in 3% cases. More number of patients were having multiple and atypical complications requiring hospitalisation. Mortality was more common in patients with associated comorbidities and coinfection. Awareness, early treatment with aggressive fluid replacement therapy with close monitoring, supportive management andpatient education showed promising results.

Pituitary apoplexya rare and unusual complication following viper bite

Abstract: Envenomation resulting from snake bite is an important public health problem in tropical countries like South Asia and throughout Indian subcontinent. Snake bite is associated with myriad of complications that can be life threatening. Here, an 18 year old woman who was bitten by Russell's viper was reported and was treated with antivenom, other medications and supportive therapy like heamodialysis. Although the patient recovered from the acute effects, patient continued to remain unwell, developed amenorrhea, loss of axillary and pubic hair and was investigated and diagnosed 4 months later with hypopituitarism. Replacement started with essential hormones such as oral ethinyl estradiol/norgestrel and Levo- thyroxine. In this case report, it is discussed why it is important to evaluate for pituitary function in every patient who sustained a Russell’s viper bite.

Automated path selection technique while incorporating multiple assay operations and cross-contamination avoidance in cross-referencing DMFBs

Abstract: Digital Microfluidic Biochips (DMFBs) perform many biochemical reactions requiring relatively less cost and very less amount of space. DMFBs that use cross-referencing addressing requires less number of pins, therefore, less manufacturing cost. However, it suffers from a problem called electrode interference, i.e., unwanted droplet operation because of an extra activated cell. DMFBs also suffer from a problem called cross-contamination, i.e., mixing of droplets with unwanted residues of droplets containing different chemicals which results in incorrect diagnosis. In this article, our objective is whether a cross-referencing DMFB with an efficient module placement design can be declared as a multifunctional chip or not. We propose a chip design which incorporates parallelism for enhancing performance in terms of assay completion time while performing multiple types of bioassays. We also propose a novel method, which automatically selects a new cross-contamination free path while routing from the source to the sink. We have included an on-chip washing scheme. The whole method ensures no Electrode Interference.

Dengue-associated neuromuscular complications

Abstract: Dengue is associated with many neurological dysfunctions. Up to 4% of dengue patients may develop neuromuscular complications. Muscle involvement can manifest with myalgias, myositis, rhabdomyolysis and hypokalemic paralysis. Diffuse myalgia is the most characteristic neurological symptom of dengue fever. Dengue-associated myositis can be of varying severity ranging from self-limiting muscle involvement to severe dengue myositis. Dengue-associated hypokalemic paralysis often has a rapidly evolving course; benign nature; excellent response to potassium; and, often leads to diagnostic confusion with other dengue-associated neuromuscular disorders. Rhabdomyolysis is the most severe form of muscle involvement and may be life-threatening. Guillain-Barrι syndrome is another frequent neuromuscular dengue-associated complication. Dengue-associated Guillain-Barrι syndrome responds very well to intravenous immunoglobulins. Predominant spinal gray matter involvement has been reported in a patient presenting with areflexic paraparesis. Mononeuropathies often manifest with paralysis of the diaphragm due to phrenic nerve dysfunction. Brachial plexopathy, in the form of neuralgic amyotrophy, has been described much more frequently than lumbo-sacral plexopathy. Early recognition of these neuromuscular complications is needed for successful treatment and to prevent further disabilities.

Dengue Infections and the Surgical Patient.

Abstract: Dengue infections are increasing globally and account for significant morbidity and mortality. Severe dengue results in microvascular changes and coagulopathy that may make surgical intervention risky and the overall surgical management challenging. We outline the potential surgical manifestations and complications following dengue infections and describe the clinical, pathogenetic, diagnostic, and treatment aspects of dengue and surgical patients. The main surgical presentations were acute cholecystitis, acute pancreatitis, acute appendicitis, splenic rupture, bowel perforation, gastrointestinal bleeding, and hematomas. Dengue may also mimic an acute abdomen without any true surgical complications. A majority were treated nonoperatively. Misdiagnosis and unnecessary surgical intervention resulted in poor outcomes. Better knowledge of the potential surgical complications would help in early diagnosis, treatment, and referral to specialized centers and thus improve outcomes. A high degree of suspicion of dengue fever is necessary when patients in a dengue-epidemic area present with acute abdomen or bleeding manifestations. In endemic areas, early dengue antigen testing and abdominal imaging before surgical intervention may help in the diagnoses. Multidisciplinary team involvement with case-by-case decision-making is needed for optimal care.

Delayed hypopituitarism following Russell’s viper envenomation: a case series and literature review

Abstract: Hypopituitarism (HP) is an uncommon consequence of Russell’s viper envenomation (RVE). Delayed hypopituitarism (DHP) presents months to years after recovering from snake bites (SB). The clinical presentation, manifestations, and outcomes of DHP following RVE have not been systematically studied. Here, we present a case series of HP following RVE with delayed diagnosis and conduct a literature review. We retrospectively reviewed data of eight DHP cases and literature to outline the presentation, manifestations, hormonal profiles, and radiological features of DHP following RVE. Three men and five women, with a mean age at diagnosis of 39.5 ± 11.6 years, were included. The mean duration between snake bite (SB) and HP diagnosis was 8.1 ± 3.6 years. Secondary hypothyroidism and hypogonadotropic hypogonadism were present in all patients. Growth hormone deficiency (GHD) and secondary hypocortisolism were present in 6 (75%) patients. Magnetic resonance imaging (MRI) revealed empty sella and partially empty sella in three patients each (75%). The literature review revealed additional 20 DHP cases (mean age at diagnosis 32.4 ± 10.8 years), with 65% of patients being men. Fatigue, reduced libido, and loss of weight were the commonest symptoms among men. Secondary amenorrhea, fatigue, and loss of appetite were common manifestations among women. Acute kidney injury, GHD, secondary hypothyroidism, hypogonadism, and adrenal insufficiency were reported in 75%, 79%, 95%, 100%, and 85% of patients, respectively. DHP is an important complication of RVE, and a delay in its diagnosis is associated with significant morbidity. Patients with RVE should be followed up for a long term to identify DHP.

Clinical score to differentiate scrub typhus and dengue: A tool to differentiate scrub typhus and dengue

Abstract: Background: Dengue and scrub typhus share similar clinical and epidemiological features, and are difficult to differentiate at initial presentation. Many places are endemic to both these infections where they comprise the majority of acute undifferentiated febrile illnesses. Materials and Methods: We aimed to develop a score that can differentiate scrub typhus from dengue. In this cross-sectional study, 188 cases of scrub typhus and 201 cases of dengue infection who presented to the emergency department or medicine outpatient clinic from September 2012 to April 2013 were included. Univariate followed by multivariate logistic regression analysis was performed to identify clinical features and laboratory results that were significantly different between the two groups. Each variable was assigned scores based on the strength of association and receiver operating characteristics area under the curve (ROC-AUC) was generated and compared. Six scoring models were explored to ascertain the model with the best fit. Results: Model 2 was developed using the following six variables: oxygen saturation (>90%, ≤90%), total white blood cell count ( 7000 cells/cumm), hemoglobin (≤14 and >14 g/dL), total bilirubin ( 200 and ≥200 IU/dL), and altered sensorium (present or absent). Each variable was assigned scores based on its strength of association. The AUC-ROC curve (95% confidence interval) for model 2 was 0.84 (0.79–0.89). At the cut off score of 13, the sensitivity and specificity were 85% and 77% respectively, with a higher score favoring dengue. Conclusion: In areas of high burden of ST and dengue, model 2 (the “clinical score to differentiate scrub typhus and dengue fever”) is a simple and rapid clinical scoring system that may be used to differentiate scrub typhus and dengue at initial presentation.

NS1 Antigen Capture ELISA an Effective Method for Diagnosis of Early Dengue Infection - Report of an Outbreak at Angul District, Odisha, India.

Abstract: Background: An outbreak of dengue infection occurred in Angul district of Odisha in the month of August & September, 2011 The study was undertaken to detect NS1 antigen positivity among the study population, to compare IgM capture ELISA with NS1 antigen detection for diagnosis of dengue and to identify the predominant genotype of Dengue virus responsible for the outbreak Materials and Methods: Total 1020 serum samples were collected from clinically suspected cases of dengue from the outbreak All were subjected for NS1 antigen detection, 92 were selected based on their clinical severity of illness (fever, rash, bleeding manifestation, arthralgia) for further study of IgM ELISA and platelet count and 148 NS1 positive samples were selected from different Blocks of Anugul district for RT-PCR at NIV, Pune, India Results: Five hundred and thirteen (502%) samples were positive for NS1 antigen (highly significant p-value <00001, CI - 95%) with 88% positivity during 1-5 days The NS1 Ag positivity was peaked to 869% on days 3 to 5 (Sensitivity & NPV - 100% each) & declined to 62% during 6-10 days with a low sensitivity of 714% but 100% specificity & PPV However, the IgM antibody positivity was 812% on days 6 to 10 and 875% after 10 days (Sensitivity- 100%, Specificity-1333%,PPV-714% & NPV - 100%) RT-PCR resulted 324% positivity (6- DEN1, 39 - DEN 2 & 3- DEN 3) among which 20% were in IgM +ve & 68% in IgM -ve cases Conclusion: Therefore, early diagnosis of dengue could be mainly by NS1 antigen detection whereas Ig M ELISA is a better tool during the later stage of infection &RT-PCR is more effective in IgM -ve casesThe predominant genotype responsible for the outbreak was found to be DEN-2