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DENGUE

BY GROUP 4
XI B
2023-2024
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NAVDEEP PUBLIC SCHOOL

DECENT JN: 691 571

BIOLOGY PROJECT

Certified Bonafide Project done by

OMKAR SHINE of class XI B, during the year
2023-2024
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ACKNOWLEDGEMENT

The completion of this project could not have been possible

without the help and assistance of various people whose
names may not all be enumerated. However I would like to
express my deep appreciation and indebtedness particularly
the following.

Our senior principal Mrs preetha Cletus our principal Mr

Aravind Cletus our vice principal ignesious v and our
biology teacher Mrs Sreelatha R for their support. We would
also like to thank Dr T.R. Chandramohan.
For spending their valuable time helping us to complete the
project .
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GROUP MEMBERS

MEGHA JAYAKUMAR
NEHA BIJU
NAZNIN AMEEN
SARAH SHAJIR
SREELEKSHMI VR
OMKAR SHINE
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DENGUE
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AIM

To study the effect and causes of dengue

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Sl No TOPIC Page No:

1 WHAT IS DENGUE ? 9-14
DENGUE FEVER AND
HISTORY
EVOLUTION OF
DENGUE

SYMPTOMS AND
RISKS

2 DIAGNOSTICS AND 15-17

TREATMENTS

TRANSMISSION

PREVENTION AND
CONTROL

3 WHO RESPONSE 20-24

PSYCHOLOGICAL
FALLOUT FOR
DENGUE

HEALTH
INFORMATIONS TO
TRANSPORTATIONS
WORKERS

4 PSYCHIATRIC 25-26
MANIFESTATIONS

POSTULATED
MECHANISMS

MANAGEMENT
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OPTIONS

5 HISTONE 27-28
DEACETYLASE
(HDAC) ENZYME AND
EPIGENETIC
MODIFICATIONS

6 DOCTORS INTERVIEW 29-33

CASE STUDY

CONCLUSION
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INTRODUCTION

Dengue fever, a debilitating and potentially fatal mosquito-borne illness, poses a

significant global health threat. Caused by the dengue virus and transmitted primarily by

the Aedes aegypti mosquito, the disease affects millions of people annually in tropical

and subtropical regions worldwide. First identified in the 1950s, dengue has since

become a leading cause of illness and death in several countries, particularly in Asia

and the Americas.

The dengue virus exists in four distinct serotypes (DENV-1, DENV-2, DENV-3, and

DENV-4), all capable of causing the disease. Symptoms of dengue fever can range from

mild, flu-like symptoms to severe and potentially life-threatening complications, such as

dengue hemorrhagic fever and dengue shock syndrome.

Preventing dengue fever involves controlling the mosquito population and avoiding

mosquito bites through measures like insect repellents and bed nets. While there is no

specific antiviral treatment for dengue, supportive care can significantly improve

outcomes. Researchers and healthcare professionals continue to work tirelessly to

develop vaccines and effective treatments to combat this widespread disease and

reduce its impact on public health.

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DENGUE VIRUS
What is dengue?
Dengue is a viral infection caused by dengue virus(DENV).

This viral illness is transmitted by Aedes mosquitoes, primarily Aedes aegypti and also a
species of it named as Aedes albopictus.

Dengue is most common in tropical and subtropical regions of the world. Urban and
semi-urban areas with a high population density are particularly susceptible to dengue
outbreaks, as they provide a suitable environment for the Aedes mosquitoes that transmit
the virus. Factors like urbanization, increased travel, and the expansion of Aedes
mosquito habitats have contributed to its global reach.

Dengue can vary in severity from mild (dengue fever)to severe (dengue hemorrhagic
fever or dengue shock syndrome),which can be life-threatening. The severity of dengue
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depends on various factors, including the specific dengue virus serotype, an individual's
immune response, and timely medical care.

Early detection, monitoring, and proper medical treatment can greatly improve the
chances of recovery for individuals with dengue, particularly for the most severe forms
like Dengue Hemorrhagic Fever(DHF) and Dengue Shock Syndrome (DSS).

How does dengue occur?

Dengue occurs when a person is bitten by a female Aedes mosquito infected with the
dengue virus . The Aedes mosquito becomes infected with the dengue virus when it bites
a person already infected with dengue and draws blood containing the virus .

● Incubation period : The virus multiplies and replicates inside the mosquito over an
incubation period of about 8-10 days .

● Transmission : Once the mosquito is

infected,
it can transmit the virus to other people when
it bites them. This transmission occurs
through mosquito’s saliva which contains the
dengue virus .

● Human infection : When an infected

mosquito bites a human, it injects the
virus into the person’s bloodstream. The
virus begins to replicate within the
person’s body.

● Symptom Onset : After an incubation period of 4-10 days, an infected individual

may start experiencing symptoms. These can range from mid flu-like symptoms to
more severe manifestations like DHF and DSS.

It is important to note that dengue is not directly transmitted from one person to another.
It requires the involvement of the Aedes mosquito as a vector for the virus to pass from
infected individuals to healthy ones.
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Dengue Virus history and evolution

The history and evolution of the dengue virus are complex and have unfolded over many
decades.

● Historical background : Dengue fever has been documented for centuries , with the
first confirmed case believed to date back to the Chinese Jin Dynasty in the third
century. Historical records suggest that outbreaks occurred in various parts of the
world. The name “dengue” likely originated from the Swahili phrase “ki-dinga pepo”,
which means “sudden onset” or “ cramp-like seizure” .

● Discovery of the Virus : The dengue virus was first isolated in 1943 during an
outbreak in Japan. Over time, researchers identified and classified different dengue
virus serotypes, now known as DENV-1,DENV-2,DENV-3 and DENV-4 .

● Evolution of Serotypes : The dengue virus has evolved with distinct serotypes, each
of which can cause disease. Infection with one serotype provides immunity against
that serotype but not against the others. Subsequent infections with different serotypes
can increase of the risk of severe dengue as seen in cases of dengue hemorrhagic
fever and dengue shock syndrome.
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● Genetic Variability : The dengue virus exhibits genetic variability and can undergo
mutations, leading to the emergence of different viral strains. These variations can
impact the severity of the disease and the effectiveness of vaccines and treatments.

Vaccines like Dengvaxia have been developed to help reduce the impact of dengue in endemic
areas. The history and evolution of the dengue virus continue to the subjects of ongoing research
and surveillance, as scientists and health organizations work to better understand the virus,
develop effective prevention and treatment strategies, and mitigate its impact on public health.

Symptoms of dengue
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The symptoms of dengue virus infection can vary depending on the individual and the severity of
the disease. Dengue is typically characterized by flu-like symptoms, and it is often divided into
three phases:

1. Febrile Phase

● High fever, sudden in onset

● Severe headache
● Pain behind the eyes
● Joint and muscle pain
● Weakness and fatigue
● Skin rash

2. Critical phase (for severe forms like

DHF and DSS )

● Severe abdominal pain

● Persistent vomiting
● Bleeding from the nose or gums
● Easy bruising
● Rapid breathing
● Restlessness or lethargy

3. Recovery Phase

● After several days, the fever usually subsides .

● In some cases, there may be a period of fatigue and weakness that can last for weeks.

Risks caused by dengue virus

Dengue virus poses several risks to individuals and communities which includes

1. Health risks :

● Dengue fever , usually not life threatening but can cause high fever, severe joint
and muscle pain and flu-like symptoms which can be quite debilitating.
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● DHF and DSS , the severe forms of dengue can be life-threatening leading to
bleeding, organ failure and shock. Prompt medical treatment is essential to
manage these conditions .

2. Complications :

Severe cases of dengue can result in various complications, including organ damages ,
prolonged hospitalization and sometimes even death.

3. Public Health Risks :

Dengue can spread rapidly within communities, leading to outbreaks and straining
healthcare systems. Controlling the spread of dengue is a public health challenge

4. Economic impact :

Dengue outbreaks can have a significant economic impact on affected regions, including
Healthcare costs, reduced workforce productivity and increased public health
expenditures

5. Risk of secondary infections :

Infection with one dengue serotype provides immunity to that serotype, but subsequent
infections with different serotypes can increase the risk of severe dengue. This phenomenon
known as antibody-dependent enhancement ,can lead to more severe illness.

6. Climate change :

Changes in temperature and precipitation patterns due to climate change can influence the
distribution and prevalence of Aedes mosquitoes, potentially expanding the geographic range of
dengue.

7. Impact on Travel and Tourism :

Dengue-endemic regions may experience a negative impact on travel and tourism due to the risk
of dengue outbreaks. Travelers to these areas may also be at risk of infection
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DIAGNOSTICS OF DENGUE FEVER

diagnose dengue fever, healthcare professionals typically rely on a combination of medical
history, physical examination, and laboratory tests. Here's an overview of the diagnostic process
for dengue:

1. Medical History:

- Your healthcare provider will inquire about your symptoms, including the onset, duration, and
severity of fever, as well as any other accompanying symptoms like headache, body aches, rash,
or joint pain.
- They will also ask about recent travel history, especially to regions where dengue is prevalent,
as well as any possible mosquito exposure.

2. Physical Examination:

- The doctor will conduct a thorough physical examination to observe for dengue-related
symptoms, such as high fever, severe headache (especially behind the eyes), muscle and joint
pain, rash, and swollen lymph nodes.
- They will also check for any signs of bleeding, abdominal tenderness, or enlargement of the
liver.

3. Laboratory Tests:

- Blood tests are crucial for confirming the diagnosis of dengue fever. These tests can detect the
dengue virus or antibodies produced in response to the infection. Common laboratory tests
include:
- Dengue NS1 Antigen Test: This test detects the presence of dengue virus protein (NS1 antigen)
in the blood, usually within the first week of illness.

- Dengue IgM and IgG Antibody Test: This test examines the levels of immunoglobulins M
(IgM) and G (IgG) antibodies specific to the dengue virus. IgM antibodies are more detectable in
the early stages, while IgG antibodies are detectable later on and can indicate previous dengue
infection or immunity.
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- Polymerase Chain Reaction (PCR) Test: PCR is used to directly detect the presence of viral
genetic material (RNA) in blood samples. It is most effective in the early stages of infection.

- Other blood tests: A complete blood count (CBC) may be performed to check for
abnormalities such as low platelet count (thrombocytopenia), which is a common feature of
dengue fever.

The combination of clinical assessment and laboratory tests helps in establishing a definitive
diagnosis of dengue fever. Seeking medical attention is crucial for accurate diagnosis and
appropriate management of the disease.

TREATMENT FOR DENGUE FEVER

The treatment for dengue fever primarily focuses on supportive care to manage symptoms and
prevent complications. Here are the key aspects of dengue treatment:

1. Fluid Replacement:

- Dengue fever can cause dehydration due to high fever and potential fluid loss.
- Adequate hydration is essential. You may be advised to drink plenty of fluids like water, oral
rehydration solutions, fruit juices, or isotonic drinks to maintain hydration. Severe cases may
require intravenous (IV) fluids.

2. Pain and Fever Management:

- Acetaminophen (paracetamol) is typically recommended to reduce pain and control fever.

However, aspirin and non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen should be
avoided, as they increase the risk of bleeding.

3. Rest and Activity Management:

- Adequate rest is important during the acute phase of dengue fever to conserve energy and
promote recovery.
- Avoid strenuous physical activities that may worsen symptoms or increase the risk of
complications.

4. Monitoring and Symptom Management:

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- Regular monitoring of vital signs, fluid balance, and blood counts is important to detect any
complications or deterioration.
- Medications may be prescribed for symptom relief. For example, antihistamines can help
alleviate itching, and antiemetics may be used to control nausea and vomiting.

5. Hospitalization for Severe Cases:

- Severe dengue, such as dengue hemorrhagic fever or dengue shock syndrome, requires
hospitalization for intensive monitoring and management.
- Intravenous fluids, blood transfusions, or other supportive treatments may be necessary in
critical cases.

6. Mosquito Bite Prevention:

- Preventing further mosquito bites is crucial to avoid transmitting dengue to others or

acquiring additional infections. Measures include using mosquito repellents, wearing protective
clothing, and using mosquito nets.

It's important to consult with a healthcare professional for diagnosis, treatment, and monitoring
of dengue fever. They can provide personalized medical advice based on the severity of the
disease and individual circumstances.
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PREVENTION AND CONTROL

Prevention and control measures for dengue fever primarily focus on reducing mosquito
breeding sites and minimizing mosquito bites. Here are some key strategies:

1. Eliminating Mosquito Breeding Sites:

- Empty, clean, or cover any containers that can hold water, such as buckets, cans, flower pots,
and discarded tires, as stagnant water is where mosquitoes breed.
- Regularly clean and scrub areas that may accumulate water, such as gutters, drains, and water
storage containers.
- Use mosquito larvicides or biological control agents in standing water where mosquito larvae
are present.
- Implement community-wide efforts to clean up public spaces and raise awareness about
eliminating breeding sites.

2. Mosquito Control Measures:

- Install window screens, use bed nets, and maintain doors and windows in good condition to
prevent mosquitoes from entering homes.
- Use mosquito repellents containing DEET, picaridin, or oil of lemon eucalyptus on exposed
skin or clothing.
- Wear long sleeves, pants, and socks to minimize exposed skin.

3. Community Engagement and Awareness:

- Educate communities about dengue fever, its transmission, and prevention measures through
public health campaigns, schools, and media.
- Encourage community participation in clean-up drives and maintaining a clean environment
to eliminate mosquito breeding sites.
- Promote reporting of suspected cases to local health authorities for prompt action and
surveillance.

4. Urban Planning and Infrastructure:

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- Proper urban planning and infrastructure development can help reduce mosquito habitats,
such as improving water drainage systems and solid waste management.
- Implement integrated vector control programs, including regular monitoring and surveillance
of mosquito populations.

5. Vaccination (where available):

- In countries where the dengue vaccine is approved and recommended, getting vaccinated can
help prevent dengue infection. Consult with healthcare professionals to determine eligibility and
availability of vaccinations.

Remember, dengue prevention is a collective effort involving individuals, communities, and

government authorities. By adopting these preventive measures and raising awareness, the
incidence of dengue fever can be significantly reduced.
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WORLD HEALTH ORGANIZATION RESPONSE TO

DENGUE FEVER
The World Health Organization (WHO) has a comprehensive response to dengue, a
mosquito-borne viral infection that is a significant public
health concern in many parts of the world. WHO's
response to dengue typically includes:
Surveillance and Monitoring: WHO supports countries in
establishing and strengthening surveillance systems to
track the incidence and spread of dengue. This includes monitoring cases and conducting vector
(mosquito) surveillance.
Technical Guidance: WHO provides technical guidance to member states on dengue prevention
and control strategies, including vector control, case management, and laboratory diagnostics.
Capacity Building: WHO assists countries in building their capacity to prevent and respond to
dengue outbreaks. This includes training healthcare workers, improving diagnostic capabilities,
and enhancing laboratory capacity.
Research and Innovation: WHO supports research into dengue, including vaccine development,
diagnostic tools, and effective treatment options.
Risk Assessment: WHO assesses the risk of dengue outbreaks and may issue early warnings to
countries or regions at risk, which can help with preparedness and response planning.
Advocacy and Awareness: WHO raises awareness about dengue and its prevention, focusing on
educating communities, healthcare providers, and policymakers.
Global Strategy: WHO has developed a Global Strategy for Dengue Prevention and Control with
a goal to reduce the burden of dengue worldwide. This strategy provides a framework for
countries to develop their own dengue control programs.
Collaborative Efforts: WHO collaborates with other international organizations, research
institutions, and non-governmental organizations to coordinate a unified response to dengue
outbreaks.
Capacity for Epidemic Response: In case of large dengue epidemics, WHO may provide
additional support to countries in terms of logistics, technical expertise, and supplies to manage
the outbreak.
Advocating for Integrated Vector Management: WHO promotes integrated vector management to
control the Aedes mosquitoes responsible for transmitting dengue, which includes community
engagement and environmental management.
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WHO's response to dengue is an integral part of their efforts to combat vector-borne diseases and
protect public health, especially in regions where dengue is endemic. The specifics of the
response can vary based on the prevalence and impact of dengue in different countries.

PSYCHOLOGICAL EFFECTS ON DENGUE

PATIENTS

Dengue fever can have psychological effects on individuals, primarily due to the physical and
emotional stress associated with the illness. Some
potential psychological fallout of dengue may
include:

Anxiety:

Patients with dengue may experience anxiety

about their health, especially if the symptoms are
severe.
The fear of complications can lead to heightened
anxiety.

Depression:

Prolonged illness and the discomfort associated with dengue can lead to feelings of sadness and
depression.

Post-Traumatic Stress:

Some individuals may develop post-traumatic stress disorder (PTSD) if they had a severe case
of dengue, especially if they experienced life-threatening complications.

Fear of Recurrence:

People who have had dengue may develop a fear of recurrence, worrying about getting the
disease again in the future.
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Social Isolation:

During the acute phase of the illness, dengue patients may experience social isolation due to the
contagious nature of the virus. This can lead to feelings of loneliness.

It's essential for individuals who have had dengue and are experiencing psychological distress to
seek support and counseling if needed. A healthcare provider or mental health professional can
help address these psychological challenges

ADDITIONAL MEASURES TO BE TAKEN BY

TRANSPORT WORKERS BETWEEN COUNTRIES

When providing health information on dengue to transport workers who travel between
countries, it's essential to educate them about the risks and prevention strategies. Here's
additional health information specific to dengue for these individuals:

Understanding Dengue:

Explain what dengue is, its symptoms (fever, severe

headache, joint and muscle pain, rash), and how it's
transmitted by Aedes mosquitoes.

High-Risk Areas:

Inform them about regions or countries with a high

prevalence of dengue and the specific times of the year
when outbreaks are more common.

Mosquito Bite Prevention:

Emphasize the importance of protecting themselves from mosquito bites. This includes using
insect repellent, wearing long-sleeved clothing, and using bed nets in areas with a high risk of
dengue.

Avoiding Peak Mosquito Activity:

Encourage them to stay indoors during dawn and dusk when Aedes mosquitoes are most active.
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Eliminating Breeding Sites:

Transport workers should be aware of the need to eliminate or report any standing water
containers where mosquitoes can breed (e.g., discarded tires, containers, flower vases).

Dengue Vaccination:

If available and recommended by local health authorities, transport workers may consider
getting the dengue vaccine.

Symptom Recognition:

Educate them about dengue symptoms and the importance of seeking immediate medical
attention if they experience symptoms, as early diagnosis and treatment are crucial.

Treatment and Fluid Intake:

Stress the significance of staying well-hydrated and receiving appropriate medical care if
diagnosed with dengue to prevent severe complications.

Dengue Hemorrhagic Fever (DHF):

Explain the risk of progression to severe dengue, such as DHF, which can be life-threatening.
Transport workers should be aware of DHF symptoms like bleeding, abdominal pain, and
persistent vomiting.

Travel Insurance:

Encourage them to have comprehensive travel health

insurance that covers medical emergencies, including dengue
treatment.

Local Health Resources:

Provide contact information for local healthcare facilities and

medical services, as well as information about local public
health authorities.
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Dengue Awareness Campaigns:

Some countries conduct public health campaigns to raise awareness about dengue. Transport
workers should be informed about these campaigns and how to participate.

Travel Documentation:

Stress the importance of carrying medical records, including vaccination certificates and any
relevant prescriptions, in case they need medical attention abroad.

Personal Protection Equipment (PPE):

Encourage them to carry and use personal protective equipment (PPE), especially in areas with
known dengue outbreaks.

Environmental Responsibility:

Remind them of their role in preventing the spread of dengue by not contributing to the creation
of mosquito breeding sites and practicing responsible waste disposal.
Providing transport workers with this information and emphasizing the importance of dengue
prevention measures can help protect their health and reduce the risk of spreading the disease
across borders.

‘
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PSYCHIATRIC MANIFESTATIONS

Most reported patients are from Asian countries or involved travelers returning from
dengue-endemic regions. Depressive disorders were the most common psychiatric presentations.
During the acute phase, most (60% to 90%) patients had both anxiety and depression
symptoms,and syndromal depression was prevalent in 5% to 15% of patients in
convalescence.High rates (80% to 90%) of anxiety symptoms (thanatophobia) noted during the
acute phase subsided during convalescence, and only 5% had persistent symptoms at three
months’ follow-up.In another study, 62% and 59% met the criteria for depression and anxiety
during the acute phase. Women had more severe depressive symptoms than men.Severity of
depression, anxiety, and stress correlated negatively with the self-efficacy scores during acute
infection.A case-control study involving pediatric population observed the prevalence of
depression (13.3%) and anxiety symptoms (34.2%) during acute dengue infection to be
significantly higher than matched controls. Further, around 25% of the admitted children
exhibited agitation, aggression, irritability, and visual hallucinations. Delayed psychiatric
manifestations of dengue infection were reported to be predominantly depression and anxiety. At
6–24 months’ follow-up after dengue infection, the rates of depression were 15%.There are
multiple case reports of manic presentation, acute polymorphic psychosis, prolonged depression,
and catatonia and one on rapid cognitive decline. However, the evidence for a psychotic, manic,
or catatonic presentation from observational studies is lacking. It is also interesting to note that
psychiatric presentations such as compulsive hoarding lead to the accumulation of trash, thereby
endangering the proliferation of the Aedes mosquito and the increased spread of dengue. Such a
possible relationship is observed in a cross-sectional study from Brazil.

POSTULATED MECHANISMS

Although there was an argument that psychiatric presentations such as mania were mere
coincidental findings during dengue fever,with a rising incidence of dengue infections and
growing reports of such presentations in the existing literature, it is essential to review the
probable postulated mechanisms underlying psychiatric morbidity in dengue. Available
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observational or longitudinal studies did not elicit the etiopathogenetic mechanisms underlying
psychiatric manifestations. The mechanisms postulated are largely from case reports/series and
hence are anecdotal.

Interestingly, only a few reported patients with psychiatric symptoms had additional neurological
manifestations such as confusion, seizures, cognitive decline, delirium, and gait disturbances.
Cerebrospinal fluid analysis showed increased protein levels and lymphocyte cells in two
reports.Brain imaging studies such as computed tomographyand magnetic resonance imaging in
most reports were normal. Metabolic derangements, including elevated liver enzymes,electrolyte
abnormalities,vasculitis with capillary leak, and fluid extravasations, were postulated.Recently,
the role of secondary immune activation and epigenetic modifications in dengue-related
neuropsychiatric complications has been increasingly studied.Encephalopathy alone was not the
prerequisite to psychiatric presentations, and in fact, most patients exhibited clear sensorium
during manic/psychotic breakdown, making a case for other etiological possibilities. Further
systematic studies are necessary in identifying the underlying mechanisms better.

MANAGEMENT OPTIONS

Management options for the primary dengue infection are beyond the scope of the current
review, and detailed reviews on the topic are available.The supportive management for dengue
fever primarily involves anti-inflammatory agents and corticosteroids. But, studies on psychiatric
manifestations either completely neglected to report the management details of primary dengue
infection or did not clearly specify the agents and the doses used.The literature exploring
psychiatric manifestations in relation to these agents used to treat dengue is more important
given the well-known association of some of them in precipitating behavioral and mood
symptoms.Only limited information is available about the management of secondary anxiety and
depression symptoms. Most observational studies that aimed at understanding acute and delayed
psychiatric morbidity in dengue patients did not report the treatment provided for the identified
patients.Successful management of agoraphobic symptoms with oral sertraline and prolonged
depression with duloxetine was reported. Mania in dengue patients was managed with
antipsychotic/benzodiazepines or a combination of mood stabilizers and
antipsychotic/benzodiazepines.For psychotic presentations, a good response was achieved with
oral antipsychotic agents, mostly in low doses.Catatonic presentation responded well to
intravenous lorazepam 4 mg/day, which was tapered and stopped over four weeks.It was noted
that clonazepam and low-dose quetiapine were started for dengue patients with psychiatric
comorbidity without an appropriate specialist referral. Only less than 2% of the patients with
psychiatric morbidity were usually referred for formal assessment.There is a lack of evidence on
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the preference of any specific psychotropics in managing psychiatric symptoms, and the chosen
treatment seems to be in line with their conventional use in general psychiatric practice.

HISTONE DEACETYLASE (HDAC) ENZYME AND

EPIGENETIC MODIFICATIONS

Cancer is a disease of the genome, and many chemotherapeutic agents are cytotoxics-targeting
DNA. Epigenetics is the regulation of gene transcription. It is defined as the reversible heritable
changes in gene activity that occur without a change in the sequence of nuclear DNA. Regulating
gene expression and transcription by epigenetic
modulators is a key target for current cancer
therapeutics targets owing to their fundamental role in
modulating cellular activities such as cell proliferation,
survival and differentiation. Histones are basic proteins
that order and package DNA into nucleosomes
(fundamental subunits of chromatin). A nucleosome is
an octamer of two of each of four core histones (an H3
(2), H4 (2) tetramer and two H2A and H2B dimers,
surrounded by 146 base pairs of DNA)

The post translational modification (PTM) of histones can cause a functional change in gene
expression or chromatin structure—many epigenetic phenomena have testified to this. A
common form of histone modification and, indeed, one of the first discovered is acetylation,
which occurs at the ε-amino group of lysines, largely in the amino-terminal tail of histones.
Results from many early studies suggest that histone acetylation regulates gene transcription.
The exact number and combination of acetylated lysine residues that occur in histones that are
self-perpetuating and heritable in the cell is unknown. It is clear, nonetheless, that histone
acetylation is an abundant source of potential epigenetic information.
Histone lysine acetylation is highly reversible. A lysine residue becomes acetylated by the action
of the histone/lysine acetyltransferase enzymes (HATs/KATs), and is removed by histone
deacetylases (HDACs). In humans, there are 18 HDAC enzymes divided into four classes: the
Class I Rpd3-like proteins (HDAC1, HDAC2, HDAC3, and HDAC8); the Class II Hda1-like
proteins (HDAC4, HDAC5, HDAC6, HDAC7, HDAC9, and HDAC10); the Class III Sir2-like
proteins (SIRT1, SIRT2, SIRT3, SIRT4, SIRT5, SIRT6, and SIRT7); and the Class IV protein
(HDAC11). Like HATs, some HDACs possess substrate specificity. Accumulating evidence
suggests that many, if not all, HDACs can also deacetylate nonhistone proteins. It is therefore
important to take this fact into consideration when trying to ascertain an HDAC’s function.
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Structural comparisons among different Class I and II HDACs, as well as HDAC homologs from
different species that share significant homology with human classical HDACs, reveal a
conserved group of active site residues, suggesting a common mechanism for the
metal-dependent hydrolysis of acetylated substrates. The Class III HDACs use NAD+ as a
reactant to deacetylate acetyl lysine residues of protein substrates forming nicotinamide, the
deacetylated product, and the metabolite 2′-O-acetyl-ADP-ribose.
By removing acetyl groups from ε-amino lysines of proteins, HDACs not only alter transcription,
but also promote either the establishment or erasure of alternative posttranslational lysine
modifications such as methylation,
ubiquitination, and sumoylation.
Additionally, they may change the
dynamics of histone modification
“cross talk.” Like many important
cellular enzymes, HDACs are
subject to a variety of controlling
mechanisms, including
protein–protein interactions and
posttranslational modifications.
Abnormal HDACs play a key role in
many human diseases. A thorough
understanding of the functions and
mechanisms of HDACs action is a
prerequisite to further our understanding of how this family of enzymes impacts on human health
and disease.

The availability of HDAC inhibitors has accelerated our understanding of HDAC functions and
mechanism of actions. A number of compounds that inhibit HDAC activity have now been
developed and characterized. They reportedly cause cell growth arrest, differentiation and/or
apoptosis, and restrain tumor growth in animals. In parallel, research is increasingly showing that
epigenetic abnormalities are tightly associated with a large number of human diseases, providing
a rationale for the use of epigenetic-based therapies such as HDAC inhibitors.
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DR INTERVIEW

Dr . T R chandramohan

MBBS,DCH,pediatric

Experience. 31 years

Questions

1.How does dengue typically present in children are there any specific symptoms to watch out
for?

Symptoms can be observed from 4 days to 2 weeks after being bitten by an infected mosquito,
and generally last for about 2 to 7 days. Most people who get dengue won't have symptoms
typically children with Dengue makes parents have high fever severe headache joint and muscle
pain Rash vomiting and sometimes bleeding if you notice any of these symptoms in a child it's
important to seek medical attention.

2. What are the treatment options for pediatric patients with Dengue?

Treating dengue in children the main focus is on supportive care this includes ensuring they stay
hydrated getting plenty of rest and the Managing their symptoms . In severe cases hospitalization
maybe necessary for close monitoring and intravenous fluids

3. Are there any age specific consideration When diagnosing or treating dengue in children

Age is definitely an important consideration when diagnosing and treating dengue in children.
The symptoms and management may differ depending on the child's age. It's crucial to take into
account that development stages, weight and any underlying health condition they may have.

4. Are there any long term effects or complications that can arise from dengue in children

When it comes to dengue in children most cases resolve without long term complications
however in rare case severe dengue can lead to communication such as organ damage bleeding
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disorders or even dengue stroke syndrome with its important to closely monitor the child
condition and seek medical attention if there are any concerning symptoms with a proper care
and treatment the majority of children recover fully from dengue

5.Can you provide guidance on how parents can help their children recover from dengue at
home?

Encourage plenty of rest, Ensure hydration, Offer a balance diet ,Manage fever and pain ,
maintain a comfortable environment.

Dr S. sivan Arul Selvan, MD,DNB, Endocrinology

Experience : 13 years

Questions

1. What are the common symptoms of dengue?

High fever , headache, muscle and joint pain vomiting ,rash

2. How is dengue diagnosed and what tests are usually conducted

Dengue is diagnosed through laboratory tests that detect the virus, viral nucleic acid,
antigens, or antibodies. The virus can be detected in serum, plasma, circulating blood cells, and
other tissues for 4–5 days after the onset of illness.

Tests

IgM,IgG,NS1 Antigen , RCT

3.what are the treatment options for dengue.

Treatments mainly focuses on managing the symptoms and providing supportive care, like
rust ,hydration, and pain relievers

4 Are there any specific precautions or preventive measures that people should take to avoid
dengue?
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a . use mosquito repellent On exposed Skin.

b. wear long-sleeved shirts, long pants and socks

C. remove stagnant water from your surroundings

d. . Sleep under mosquito nets

e . Stay indoors during dawn and dusk

5. Is their any special wards for dengue patients in your hospitals

Yes they have one special ward for dengue patients.

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CASE STUDY
CASE STUDY 1

Patient name : KUTTAPPAN

Age : 78

Gender : male

Result : positive

1. What are the symptoms?

Body Pain ,fever , headache Shivering

2. Are there any tests conducted?

Yes , sugar test, bp test, blood test, x ray, trip

3. whether any special diet was given ?

No , they prescribed to drink lot of water

5. Are there any cases reported in your family other than you ?

No, I am the only case reported from my family.

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CASE STUDY 2

Patient name : ANJU

Age : 31

Gender : female

Result : positive

1. What are the symptoms?

Body pain, joint pain, Shivering, headache

2. Is there any tests were conducted

X ray, scanning, blood count

3. how has the virus affected your daily life and routines?

Her daily routines were totally changed. When she was admitted in hospital The doctor
prescribed to take complete rest in bed so she was not physically fit. And there was no physical
contact with family members and she was ordered to take leave from her company.

4. Have you faced any challenges during the recovery process?

No, during her recovery she only faced small small body pains .

5. what advice would you like to share with others who are Currently. dealing with viruses?

Please follow the Orders of the doctor for your save and should take necessary Precautions..
Don't lose hope .
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BIBLIOGRAPHY

http://www.nature.com

www.who.int.com

www.cdc.gov.com

https://www.ncbi.nlm.nih.gov

https://main.mohfw.gov.in

Dr. Chandramohan

Dr. S. Sivan Arul Selvan

Conclusion

Dengue is a common pathogenic disease often proving fatal, more commonly affecting
the tropics. Female Aedes aegypti mosquito is the vector for this disease. The current
review is an effort to present an insight into the causes, etiology, symptoms
,transmission ,diagnosing , major organs affected and line of treatment. Traditional
successful vaccine and immunization technology largely remains a challenge and a
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better anti-virus approach needs to be worked out. combination of fluid replacement
and antipyretics-analgesics like a molecule to provide symptomatic relief.

A big thank you to the doctors who took the time to share their insights and
experience during the interview with truly appreciates their valuable contribution in
racing awareness about dengue and the providing importance in information to the
community .thier dedication and expertise truly commendable and we admire their
efforts in combating this diseases.

I just want to take a moment to express my heartfelt gratitude to each and everyone of
you your hard work dedication and valuable contribution have been instrumental in the
success of a project I truly appreciate your ideas insight and the efforts you put in this
into making this project reality thank you all for being amazing team members and for
making this Experience so rewarding .

Thank you .