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   Table of Contents - Current issue
January-June 2021
Volume 15 | Issue 1
Page Nos. 1-58

Online since Wednesday, April 13, 2022

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Antimicrobial resistance: A silent progressive pandemic p. 1
Saibal Chakravorty
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A retrospective study at a tertiary care center in North India: Epidemiological, clinical characteristics and comorbidities among deceased patients with COVID 19 infection p. 4
Poonam Gupta, Anubha Srivastava, Sujit Kumar, Siddhartha Pandey, Virey Vireshwr Goyal
BACKGROUND AND AIM: To describe epidemiological, clinical characteristics and comorbidities among deceased patients with COVID-19. MATERIALS AND METHODS: Retrospective study among deceased patients with COVID-19 infection at SRN Hospital MLN Medical College a Tertiary Care Centre for COVID 19, Prayagraj (U. P) India. The study included patients who succumbed to COVID-19 between May 5, 2020 and February 8, 2021. RESULTS: A total of 497 patients were taken in the study. Mean age was 59.07 years with majority of them being males 350 (71%) and 147 (29%) females. The mean duration of illness was 5.9 days. The most common symptoms were breathlessness 472 (94.9%) and fever 383 (77%). Diabetes (48%) and hypertension (42%) were the most common comorbidities among the deceased. At the time of presentation, 328 (66%) patients had heart rate >100/min and 461 (92.8%) patients had respiratory rate >24/min. Mean oxygen saturation was 69%. The mean duration of hospitalisation is 4.7 days. CONCLUSION: Majority of the patients who contracted the illness and died due to COVID-19 were elderly, males with diabetes and hypertension. At the time of presentation, the majority had respiratory distress of acute onset. Elderly population with comorbidities are more prone to disease and have higher chances of respiratory failure and death.
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Thyroid profile in patients of liver cirrhosis and correlation with severity and etiology of liver disease p. 8
Smriti Singh, Sharad Kumar Maurya, Anubha Varma
INTRODUCTION: Thyroid disease has been observed to be associated with liver injuries or deranged liver function. This study was conducted to study thyroid dysfunction in patients of liver cirrhosis and any association between severity of liver cirrhosis and thyroid profile. MATERIALS AND METHODS: In this case-control study, liver cirrhosis patients aged >18 years with evidence of hepatocellular dysfunction with portal hypertension compared with apparently healthy age-gender matched. Data were collected on a semistructural questionnaire with general physical and systemic examinations, including thyroid examination. The etiology of disease was ascertained on the basis of clinical examination and investigation. RESULTS: The study included 72 case (70.8% male and 29.2% female) and equal number of control participants. Controls as compared to cases had free triiodothyronine (fT3) (2.45 ± 0.40 vs. 1.60 ± 0.50 pg/ml) and free tetraiodothyronine (fT4) (1.26 ± 0.21 vs. 1.15 ± 0.48 ng/ml). Thyroid-stimulating hormone (TSH) value of cases were 3.61 ± 0.95 μIU/ml and controls were 3.01 ± 0.66 μIU/ml. CONCLUSIONS: Liver disease cases as compared to controls had significantly lower fT3 levels and significantly higher TSH levels. Mortality rate of liver disease cases with thyroid dysfunction was also found to be significantly higher.
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Approach to anemia with caveats in focus p. 13
Amitesh Aggarwal, Sanat Kumar Thakur
Anemia being a very commonly encountered clinical condition can be a presentation of a wide range of underlying illness. This article tries to succinctly provide an approach to and give an overview of anemia without delving into any one particular type. To categorize anemia would help narrow down the list of differentials and enable diagnosing a large and varied number of conditions.
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Beneficial effects of Indo-Mediterranean type of diets, for double burden of diseases p. 24
Ram Bir Singh, Shaw Watanabe, Adrian Isaza, Saibal Chakravorty, Ghizal Fatima, Vikas Patel
The concept of Indo-Mediterranean type of diets was developed by Singh et al. based on Indian Experiment of Infarct Survival published in 1992, which was confirmed by a landmark study from France by De Lorgeril et al., who demonstrated that eating alpha-linolenic acid rich Mediterranean style diet can cause significant decline in mortality and cardiovascular diseases (CVDs). Recently, PREDIMED study from Spain also reported that a modified Mediterranean style diet can cause significant decline in CVDs, type 2 diabetes mellitus (T2DM), and cancer. It seems that Indo-Mediterranean diet is superior to Mediterranean diet as well as dietary advice to stop hypertension (DASH) diet because it contains millets, porridge and spices; turmeric, cumin, cinnamon and coriander, etc., These foods are rich sources of polyphenolics and flavonoids, calcium and iron as well as proteins which are useful in the prevention of double burden of diseases. It is possible that Mediterranean style diet and DASH diets have similar influence on coronary risk factors and CVDs and all-cause mortality. However, Indo-Mediterranean style diet may have additional protective effects due to improved food diversity and lower glycemic index as well as palatability.
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Effects of montelukast on clinical manifestations of coronavirus infection: A clinical observation among six patients p. 31
Ram B Singh, Ghizal Fatima, Saibal Chakravorty
Montelukast is an antiviral agent and anti-inflammatory agent used in the treatment of pro-inflammatory pulmonary diseases. Since coronavirus infection disease 2019 (COVID-19) involves mainly lung in majority of the patients, it may have a possible benefit among these patients. This report aims to emphasize about the role of montelukast in COVID-19 patients. After verbal consent and clearance from the ethics committee, all the patients (n = 6) presenting with common cold, fever, cough, and breathlessness, who were administered montelukast, were considered for entry to this study. The diagnosis of COVID-19 was confirmed via a positive reverse transcription-polymerase chain reaction test among all the patients. All the patients were given standard treatment including hydroxychloroquine 200 mg twice daily day 1 and then 200 mg daily for 5 days, azithromycin 250–500 mg twice daily for 7 days, Vitamin C 500 mg daily, and Zincovit 1 tablet daily for about 3 weeks. Clinical, radiological, and blood examinations were done in all the patients included in this report. All the patients were adults between 34 and 70 years, 3 females, and presented with fever, cough, breathlessness, and body ache simulating a respiratory tract viral infection. They were initially treated with levocetirizine and montelukast 10–20 mg twice or thrice daily, depending upon clinical status of these patients. Those patients who had lower oxygen saturation below 90% (n = 2) were also administered oxygen and cortisone (n = 2) for possible benefit. Only one patient was hospitalized and one was on noninvasive ventilation for 5 days due to lower oxygen saturation below 70%. All patients recovered. All patients received standard treatment for COVID-19, hence it is not clear that which treatment had provided the benefit. Since all patients received montelukast and only one was hospitalized, it poses the possibility that the role of montelukast should be examined in a large number of patients in phase II and phase III trials.
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Chronic pulmonary thromboembolism in a patient of erythema nodosum leprosum treated with thalidomide and corticosteroid p. 36
Sangam Singh, Mahim Mittal, Minakshi Awasthi, Neeraj Chaudhary
Thalidomide is the drug of choice for erythema nodosum leprosum (ENL) in men. Its use in patients with multiple myeloma has been reported to cause venous thrombosis. Postulated mechanism is an increase in procoagulant state with the use of thalidomide along with corticosteroids in the underlying hyperviscosity in multiple myeloma. We report a case of superficial and deep vein thrombosis and chronic pulmonary vein embolism in a patient of ENL treated with thalidomide and corticosteroid. An increase in procoagulant state with the use of these two medicines along with a persistent inflammatory state in ENL and an increased risk of venous thrombosis in type 3 hypersensitivity together may have resulted in thrombus formation.
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Acute pyelonephritis in diabetes mellitus: A series of six cases p. 39
Kavya Ronanki, K Kokila, Dheeraj , Nirmal Kumar, Mukesh Bairwa, Ravi Kant
Acute pyelonephritis is an inflammation due to infection affecting the kidneys and pelvis. Patients usually present with classical symptoms such as high-grade fever, loin pain, although sometimes present with atypical complaints. Diabetes mellitus is the common cause of pyelonephritis, sometimes increasing the rate of complications in patients with pyelonephritis. The most common organism responsible is Escherichia coli. We are reporting here our experience of six patients with acute pyelonephritis and their outcomes. Early diagnosis and treatment decrease mortality and long-term complications.
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Plummer–Vinson syndrome p. 44
Abhishek Deepak, Atul Kaushik, Shahzad Anwar, Kshitij Chauhan
Plummer–Vinson syndrome (PVS) is characterized by a triad of postcricoid dysphagia, upper esophageal webs, and iron deficiency anemia, mostly affecting middle-aged females. A 30-year-old female patient presented to the gastroenterology outpatient department with complaints of dysphagia for solid foods for 1 year, which increased over the last 4 weeks. She had iron deficiency anemia. Barium swallow revealed a single thin esophageal web at the level of C4–5 vertebrae. Upper gastrointestinal endoscopy confirmed this. The patient was diagnosed with PVS. PVS is known to be associated with esophageal or pharyngeal cancers such as squamous cell carcinoma. Thus, we recommend early diagnosis of PVS and close follow-up of these patients.
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Allergic bronchopulmonary aspergillosis misdiagnosed as other respiratory diseases: Case-based approach p. 47
Rajendra Prasad, Harshita Rani, Huda Shamim, Rishabh Kacker, Nikhil Gupta
Allergic bronchopulmonary aspergillosis (ABPA) is a complex clinical entity resulting from an allergic immune response to Aspergillus fumigatus and most often occurring in a patient with asthma. Here in this article, we are reporting several cases of ABPA misdiagnosed as other respiratory diseases.
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Reports of herpes simplex reactivation after COVID vaccination: A case series p. 54
Afroz Abidi, Ghizal Fatima, Shruti Srivastava, Saibal Chakravorty
Vaccination is a safe and effective way to control preventable infectious diseases. Since December 2019, the world has been facing a global pandemic of COVID-19. Physicians and scientists were totally baffled and unprepared for this sudden emergency, but the continued efforts of researchers help control the disease. Apart from the emergency use authorization of drugs, experts swiftly explored a number of candidate COVID-19 vaccines including live-attenuated, viral-vectored, nucleic acid–DNA and RNA, protein subunit, and inactivated vaccines. Post approval from regulatory authorities in India, the Ministry of Health and Family Welfare introduced a vaccine in the market after successful phase II/III clinical trials.
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Simultaneous occurrence of cerebral bleed and infarct p. 56
Amitesh Aggarwal, Luv Bansal, Meenakshi Jain
BACKGROUND: Simultaneous occurrence of ischemic and hemorrhagic stroke is extremely rare although the pathology of both types of strokes is similar. However, this poses challenges in management of such cases. CASE DETAIL: An 80-year-old Indian housewife presented to the hospital in altered sensorium with no significant comorbidity in the past. On neurological imaging, she was found to have both intracerebral infarct and bleed. She was managed conservatively. CONCLUSION: There are challenges in management of these types of patients as treatment is different in both scenarios. This case raised the question regarding the routine management of such cases. In the absence of published guidelines, individual tailoring of treatment is needed.
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