Comparative Study of Efficacy of Addition of Prokinetics To Proton Pump Inhibitors in Patients with Gastroesophageal Reflux Disease

Abstract

Vector-borne diseases including malaria, dengue, and chikungunya remain significant public health concerns in tropical and subtropical regions, necessitating comprehensive epidemiological studies to guide prevention and control strategies. This prospective observational study was conducted over six months among febrile patients attending the In-Patient Department of General Medicine at King George Hospital, Visakhapatnam. Following Institutional Ethics Committee approval and informed written consent, detailed clinical histories and examinations were performed on all enrolled patients, with data analysis conducted using SPSS software and appropriate statistical techniques. Among 100 patients studied, males predominated (52%) compared to females (48%), with malaria accounting for 72% of cases, dengue 24%, and chikungunya 4%, reflecting the higher prevalence of vector-borne diseases among males attributed to increased outdoor occupational activities and greater exposure to day-biting mosquitoes. The highest prevalence was observed in the 13–35 years age group, consistent with other Indian epidemiological studies, as active adults engage in more outdoor work, thereby increasing infection risk. Gender-specific analysis revealed notable differences: females were more affected by malaria (55.5%), males predominated in dengue infections (66.6%), while chikungunya affected both genders equally (50%). Seasonal trends demonstrated that infection rates commenced rising in August, peaked in September and October, and coincided with increased mosquito activity during monsoon and post-monsoon periods, particularly facilitating dengue vector transmission. Clinical complications varied by infection type: malaria presented with thrombocytopenia, jaundice, anemia, acute kidney injury, hepatitis, and pneumonia, while dengue manifested with thrombocytopenia, acute kidney injury, and jaundice. Co-infections of malaria with dengue and dengue with chikungunya were documented. Geographic analysis revealed higher disease prevalence in rural areas including Paderu, Chodavaram, Pendurthi, Gajuwaka, Anakapalli, and surrounding villages, with Plasmodium falciparum and Aedes aegypti vectors predominating in these regions. Environmental factors such as marshy areas, inadequate sanitation, unplanned urbanization, and construction activities provided optimal breeding grounds for mosquito vectors. In tribal and high-humidity regions of Visakhapatnam, parasite growth contributed to life-threatening disease manifestations. Prevention strategies recommended include promoting awareness regarding clean living conditions, distribution and utilization of mosquito coils and insecticide-treated nets, and implementation of government-led vector control and disease prevention programs. As this hospital-based observational study encompassed a limited sample size with fewer patients presenting with febrile symptoms, the findings may not be generalizable to the broader population. Future investigations should prioritize larger-scale, longitudinal studies with extended follow-up periods to validate these findings and provide more robust epidemiological data for guiding public health interventions in endemic regions.