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Context: Fatigue is the most prominent feature of long COVID. With the increasing burden of long COVID cases post-acute phase of illness after recurrent waves of the pandemic, understanding its pathophysiology is of paramount importance. Such fatigue and post-viral illness could be associated with features of neuroimmune exhaustion and thus be a part of a larger syndrome such as myalgic encephalomyelitis (ME). Identifying the proportion of patients having ME from those experiencing fatigue would bring us one step closer to understanding the pathophysiology. International consensus criteria (ICC) originally published in English (ICC-E) is a valid and reliable tool for identifying cases of ME. However, a validated Hindi version of ICC-E is not available. Aims: To develop and validate an equivalent version of ICC-E in the native Hindi language (ICC-H) to suit Indian patients and health care workers even at peripheries and to make conducting large scales surveys more feasible. Subjects and methods: Once permission from the ethics board was granted, guidelines given by MAPI Research Trust were followed and ICC-H was developed from ICC-E, in the following steps: (a) translation to Hindi, (b) back translation, (c) comparison between the translated and back-translated version performed by experts, and (d) pre-pilot test in the intended population. The ICC-H was applied to 53 bilingual individuals knowing both Hindi and English. Statistical analysis used: The distribution of Hindi and English questionnaires was analyzed using the Chi-square test and Spearman’s correlation coefficient was used for correlation between answers of each question. Results: The score of individual items and its global score was highly correlated with each other (p

This study is conducted to observe the association of diabetes (DM), hypertension (HTN) and chronic kidney disease (CKD) on the prognosis and mortality of COVID-19 infection in hospital admitted patients with above mentioned comorbidities. This is a single centre, observational, retrospective study carried out at Sir Ganga Ram Hospital, Delhi, India. The burden of comorbidities on the prognosis and clinical outcome of COVID-19 patients admitted patients from April 8, 2020, to October 4, 2020. Chi-square and relative risk test were used to observe the association of comorbidities and disease prognosis. A total of 2586 patients were included in the study consisting of 69.6% of male patients. All the comorbidities were significantly associated with ICU admission and mortality. The relative risk showed that CKD is most prone to severity as well as mortality of the COVID-19 infection followed by HTN and DM. Further with the increase in number of underlying comorbidities, the risk of ICU admission and mortality also increases. Relative risk of the severity of COVID-19 infection in younger patients with underlying comorbidities are relatively at higher risk of severity of disease as well as to mortality compared to the elderly patients with similar underlying condition. Similarly, it is found that females are relatively at higher risk of mortality as compared to the males having same comorbid conditions except for the hypertensive patients. Diabetes, hypertension and CKD, all are associated with progression of COVID-19 disease to severity and higher mortality risk. The number of underlying comorbid condition is directly proportional to the progression of disease severity and mortality.

Background - Severe acute respiratory Syndrome-Coronavirus-2 (SARS-CoV-2) affects every organ system, especially the lungs. Vitamin D has been shown to modulate both infections and autoimmune diseases. It maintains the balance between angiotensin-1 and angiotensin II, thereby preventing lung tissue damage. Hence arises the question - can adequate circulating vitamin D prevent or modulate SARS-CoV-2 infection? In the present study, we attempted to find the answer to this question in the Indian population. Methodology -The study duration was April 1, 2020 to April 30, 2021, including only those patients whose vitamin D levels were estimated. Mann-Whitney test was used to compare age, hospital stay, and total vitamin D levels between the two waves. The gender difference, vitamin D status, pre-existing comorbidities, COVID-19 severity, and mortality were calculated using the chi-square test. Results - On curating the data, vitamin D levels were found to be estimated in 179 COVID-19 positive patients. In the first wave, 48.2% of the patients were deficient in vitamin D levels, yet no statistical association was observed for patients’ demographics (age, sex, and comorbidities), COVID-19 severity, and mortality. Similar results were observed in the second wave. The correlation coefficient of IL-6 (r=-0.08), CRP (r = 0.033), and ferritin (r = 0.027) was not significantly associated with vitamin D levels. Conclusion - The Indian population is known to be deficient in vitamin D, yet this study showed an absence of vitamin D correlation with severity, morbidity or mortality of COVID-19. Further research into the immune-modulatory effect of vitamin D on disease susceptibility and progression in COVID-19 would be beneficial.

Rabies is a viral zoonotic disease widespread across the world. In India, various cell culture vaccines are available for pre and post exposure prophylaxis (PEP) but are not sufficient to meet the rising demand. The present study evaluated the safety and immunogenicity of Rabies vaccine Human I.P. (Brand name: SURE RAB™) in PEP and demonstrated its non-inferiority to already approved rabies vaccine (Brand name: VERORAB).It was a phase-III randomized, open label, comparative, single centre clinical trial in post exposure subjects. Safety and immunogenicity were evaluated at Day 0, 14 and 45 ± 7 post vaccination. Day 14 serum samples were analyzed by Enzyme Linked Immunesorbent assay (IgG ELISA, Bio-Rad) and Day 0, 14 and 45 ± 7 serum were tested by Rapid Fluorescent Focus Inhibition Test (RFFIT). Paired t-test was applied to compare the results of Rabies virus neutralizing antibody (RVNA). The severity of adverse reactions was measured on a scale of excellent, good, fair and bad; p-value (p 0.05) was considered as statistically significant.All the subjects achieved a protective titer value between 0.5 and 9.0 IU/ml by Day 14 tested by ELISA and significant rise in the antibody titer in all the groups when tested after 45 days. Statistically significant p-value (p 0.001) observed with RFFIT test indicated biological potency of rabies vaccine. Adverse events and safety was comparable statistically between three groups (p ​= ​0.886) and Group I ​+ ​II combined versus Group III (p = 0.495).The study results conclusively demonstrate that SURE RAB™ is comparable to VERORAB in terms of safety and immunogenicity and can be used for PEP in rabies.

A 31 years old male presented with fever, dry cough, weight loss. Patient was found to be HIV positive and was started on empirical Anti-tubercular drugs (ATT). However, his symptoms persisted and he developed pancytopenia along with jaundice, and was shifted to our health care facility for further investigations. The patient has a history of travel to Bali and Thailand a few months ago. Patient was examined and relevant investigations were performed.

Objectives This study is conducted to observe the association of diabetes (DM), hypertension (HTN), and chronic kidney disease on the prognosis and mortality of COVID-19 infection in hospital admitted patients.Methods This is a single centre, observational, retrospective study carried out at Sir Ganga Ram Hospital, Delhi, India. the burden of comorbidities on the prognosis and clinical outcome of COVID-19 patients admitted patients from April 8, 2020, to October 4, 2020. Chi-square and relative risk test were used to observe the association of comorbidities and disease prognosis.Results A total of 2586 patients were included in the study consisting of 69.6% of male patients. All the comorbidities were significantly associated with ICU admission and mortality. The relative risk showed that CKD is most prone to severity as well as mortality of the COVID-19 infection followed by HTN and DM. Further with the increase in comorbidity, the risk of ICU admission and mortality increases.Conclusion Diabetes, hypertension and CKD, all are associated with progression of COVID-19 disease to severity and higher mortality risk. The number of underlying comorbid condition is directly proportional to the progression of disease severity and mortality.

Opsoclonus myoclonus syndrome secondary to scrub typhus infection is a rare clinical entity. Hence, it is important to know its clinical manifestations and complications, so that it can be properly managed. We report a 28-year-old female whose initial manifestation was only fever, which subsided in four days. Two days later, she developed opsoclonus myoclonus syndrome. This was managed with doxycycline and clonazepam, but as it persisted, intravenous immunoglobulin was added. She showed excellent response to treatment.

Disseminated gonococcal Infection (DGI), is a rare complication associated with Neisseria gonorrhoeae, and its incidence is 0.5–3%. It typically manifests as rash, tenosynovitis, polyarthralgia.[1] Prostatic and penile abscess are rare and uncommon manifestations. We discuss a case of a 44 year old married male working in Ethiopia with no known co-morbidities, presenting with complaints of burning micturition, difficulty in passing urine, fever, pus discharge from urethra and decreased urine output. The patient reported having engaged in unprotected sexual intercourse with multiple heterosexual partners in last 2 years. Patient also had penile abscess from which the pus was drained and Gram stain and single sequence PCR was suggestive of Neisseria gonorrhea, thus the diagnosis of DGI was confirmed.

Introduction India currently hosts 49% of the world's diabetes burden, with an estimated 72 million cases in 2019. The complex cascade of events which leads to cellular malfunction in response to high levels of glucose culminates upon formation of advanced glycation end products (AGEs). Accumulation of AGEs in vivo can induce insulin resistance and impair β-cells of islets of Langerhans, resulting in impaired glucose regulation and development of diabetes. Therefore, AGE is an early risk factor for diabetes. Skin autofluorescence (SAF) spectroscopic screening is the emission of light in the UV-visible, near-IR spectral range when biological substrates are excited with light at suitable wavelength. Materials and methods In this study, we estimated the subcutaneous AGE level in 197 nondiabetic healthy subjects and then stratified the population into risk groups for developing diabetes based on the result. Results In our study, a majority of the healthy population (82% subjects) were in the moderate group, followed by 7% and 3% in the mild and severe groups, respectively. Only 8% of the population screened was in the normal group. In subjects older than 50 years, 95.7% had AGE levels in moderate risk. Conclusion Autofluoroscence is an easy tool for early diagnosis; however, larger studies are required.

Chikungunya virus is an arthritogenic virus belonging to Alphaviridae group. The virus usually circulates in a sylvatic cycle between mammalian primates and Aedes mosquito. Outbreaks occur when mosquitoes bite and infect humans. From the first outbreak in early 1950s in Tanzania to the recent outbreak in New Delhi in 2016, a lot has been learnt about this virus. Outbreaks in the later part of 20th century and the 21st century have proven that the virus not only causes debilitating joint pains but also so many systemic symptoms, which were previously not recognized. The recent outbreak in New Delhi even led to mortality that was confirmed by several other studies in the recent past in different parts of the world. Similar to the virus, science in this field has also evolved much after the Tanzania outbreak. Now, we have enzyme-linked immunosorbent assays and polymerase chain reactions to detect this virus in blood. These modalities are quicker and more sensitive and specific. In recent times, physicians have started using nonsteroidal antiinflammatory drugs and disease-modifying antirheumatic drugs to treat joint pains. Several studies have come up to establish a proper protocol for treatment of the chronic joint pains, which is still the most common complication of this disease. Here, in this review, we have talked about the various outbreaks in the past, how the understanding of this disease has evolved, and about the new areas of research regarding this disease.

The pandemic of corona virus disease 2019 (COVID-19) caused by Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2) has aggravated human suffering with the number of suspected cases and deaths increasing daily. Since March 2020, when the first case was detected in Delhi, 340,436 confirmed cases and 6,128 deaths have been reported by 22 October 2020 [1]. Data regarding the clinical characteristics and associated markers in laboratory confirmed patients of COVID-19 is sparse from India. According to recent studies from China, where the disease was reported first, clinical spectrum of SARS-CoV2 varies from asymptomatic infection, mild upper respiratory infection to severe pneumonia resulting in respiratory failure [[2], [3], [4]]. But one challenging feature of COVID-19 in India has lately been identified as being asymptomatic in a large number of cases [5]. Given the rapid spread of COVID-19, an updated analysis of cases in New Delhi might help identifying the defining clinical characteristics and severity of this disease. The aim of the current study is to analyze the patient demographics, clinical presentations, laboratory findings and risk factors associated with mortality in SARS- CoV-2 infected patients in North India which is important in planning and execution of control strategies.

Cryptococcosis is a major life-threatening fungal infection in patients with severe HIV infection and other immunocompromised states. Lung and central nervous system (CNS) are the most commonly involved organs in disseminated cryptococcosis. Others include skin, prostate, medullary cavity of bones, eyes, heart, liver, etc. Pulmonary cryptococcosis may be misdiagnosed because of comparatively nonspecific clinical and radiological features. We report the case of a 61-year-old male patient who is a known case of gastroesophageal reflux disease (GERD), myasthenia gravis, and steroid-induced diabetes mellitus. He was diagnosed with gangrenous cholecystitis at another institution but refused surgery. At our hospital, he experienced loss of consciousness in the out-patient department (OPD) and was therefore admitted for further evaluation where he was found to have pulmonary cryptococcosis and pancytopenia. Pulmonary cryptococcosis is usually found in HIV-positive immunosuppressed patients. However, sometimes it is also seen in HIV-negative patients, and they tend to have a good prognosis with adequate treatment.

We report a patient with COVID-19 infection presenting with acute pancreatitis. The diagnosis of pancreatitis was based on laboratory as well as radiological evidence, and all the usual etiologies were ruled out. The temporal association with COVID-19 is strongly suggestive of novel coronavirus induced pancreatic injury.

Introduction Erectile dysfunction (ED) is one of the most common yet neglected medical problems which warrants screening at regular interval so that appropriate treatment can be delivered. The aim of this study was to determine the prevalence of erectile dysfunction in Type 2 diabetic men. Material and methods The study was conducted in Department of Medicine at Sir Ganga Ram hospital, New Delhi. All males diagnosed with type 2 Diabetes Mellitus between age group of 18–65, were included in the study. Non Diabetic males of same age group were also taken as control group. SHIM questionnaire was administered to all patients and controls. Association of ED with duration of diabetes ( 10 yrs.) were compared. Results Prevalence of ED determined by SHIM score was 78.7% which is more than in the control group (46%). ED was significantly more in diabetic population than in non-diabetics. In present study, 21.4% of the diabetic males had No ED, 12.3% had mild ED, 30.9% had mild to moderate ED, 19.1% had moderate ED and 16.4% had severe ED. Longer duration of diabetes consistently increased the risk of ED. Duration of diabetes had a significant correlation with ED. Conclusion Prevalence of ED in was significantly more in diabetic population than in non-diabetics.

Extensive skeletal involvement in any elderly is highly suspicious of malignancy. A simultaneous occurrence of lesions elsewhere strengthens the case for a detailed search of the primary cause. Despite the numerous advanced modalities at our disposal, differentiating between malignant, infectious, and inflammatory lesions often presents a diagnostic dilemma. Here, we report a case of an elderly gentleman who presented to us with multiple bony lesions. A further evaluation revealed a concomitant adrenal and liver involvement mimicking metastasis which later was found to be disseminated tuberculosis.

Present study focuses on the terminal penetration of tungsten heavy alloy (WHA) long rod penetrator impacted against armour steel at an impact velocity of 1600 m/s. The residual penetrator and armour steel target recovered after the ballistic test have been characterized using optical microscope, scanning electron microscope (SEM) and electron probe micro analyzer (EPMA). Metallurgical changes in target steel and WHA remnant have been analysed. Large shear stresses and shear localization have resulted in local failure and formation of erosion products. Severe plastic deformation acts as precursor for formation of adiabatic shear band (ASB) induced cracks in target steel. Recovered WHA penetrator remnant also exhibits severe plastic deformation forming localized shear bands, ASB induced cracks and shock induced cracks.

Background: *Soluble urokinase-type plasminogen activator receptor (suPAR) is a new biomarker, which is increased in conditions associated with inflammatory immune cell activation. In low resource, densely populated countries, there is a need for a quick test for triage and prognosticating in the emergency department. Materials and Methods: *A pilot, observational study was conducted wherein all consenting adult patients (>18 years) presented to casualty with acute medical illnesses were included. Detailed clinical history, examination, and suPAR quick tests were done and patients were categorized into five groups based on the emergency severity index (ESI) triage algorithm. Patients with suPAR level more than 5.5 ng/mL were advised hospitalization and those below were advised follow-up. All patients were followed-up after 3 days. Results: Total 190 patients (20–80 years), 80 males and 110 females participated. ESI triage 1, 2, and 3 had suPAR levels > 5.5 ng/mL and ESI triage 4 and 5 had suPAR level of

COVID-19 pandemic has been associated with increased morbidity, mortality and economic loss globally. In the absence of definitive treatment, the only way to develop herd immunity and to curtail the spread of infection is through an effective vaccination programme. Under normal circumstances, a vaccine development would have taken 8–12 years; however, in case of COVID vaccine, this process has been reduced to 10 months. Since the lockdown, multiple countries have used various platforms to develop COVID vaccines at a war footing and recently close to five vaccines that have been approved for emergency use. This has lead to confusion, controversy and debate among the medical fraternity about the safety and efficacy of these vaccines. This articles gives an overview of the vaccines present, various trial results and adverse effects seen till now.

Clinical research trials in India were a very successful industry till recently. The last few years have seen a decline in this industry due to multiple reasons. This loss to the Indian industry has resulted in a gain to clinical research trial industry in China, Russia, Taiwan and some other developed countries. The reasons for this decline has primarily been due to certain perceptions generated in the public domain by the media and social media as a result of a few poorly conducted trials. The industry needs to make a concerted effort to have better oversight over trials being conducted in India, for safety and ethics. Along with that, it is important to inform the public better about the safety of these trials.

Background and objectives Diabetes mellitus (DM) is one of the leading causes of morbidity and mortality because of its role in the development of retinopathy, nephropathy, neuropathy, and cardiovascular disease. Tumor necrosis factor (TNF-α) is a cytokine involved in systemic inflammation and is implicated in a variety of cases including autoimmune diseases, insulin resistance and cancer. The aim of the study was to study the level of co-relation of inflammatory marker TNF-α in DM patients and healthy controls. Materials and methods One hundred adult patients (>18 years of age) from outpatient department of Department of Medicine at Sir Ganga Ram Hospital, New Delhi were enrolled, and 100 healthy nondiabetic adults were taken as control. Both the groups were matched for age and sex. Complete evaluation of the patients was done, which included physical examination along with laboratory methods complete blood count, biochemical parameters, and TNF-α levels. Statistical analysis of the data was performed using SPSS version 17.0 software. Results Our study revealed that there was a significant positive correlation between TNF-α with HbA1C in the diabetic population though no correlation was found with the healthy nondiabetic controls. Our results suggest the linkage of inflammatory marker (TNF) α and development of DM.

Background & Aim H1N1 pandemic has been associated with increased morbidity and mortality. In India, a recent outbreak of H1N1 influenza has posed a serious challenge for health services with rapid spread across various states causing panic among public. The present outbreak data correlates clinico-laboratory findings with mortality. Method In a prospective observational study at a tertiary care centre in Northern India, data was collected from 1st January 2015 to 28th February 2015 related to H1N1 mortality in all patients tested positive using real-time reverse-transcription polymerase chain reaction testing on nasopharyngeal swabs. Results Data of 151 patients was analyzed. Age ranged from 3 months to 85 years with 47.6% females and 55%above 40 years. Comorbidity was seen in 52.9% (diabetes mellitus Type 2- 23.8%, hypertension - 25.8%) of the patients. The time between onset of symptoms and hospitalization ranged from 1 to 25days. Documented clinical features were fever - 96.6%, dry cough - 86.09%, productive cough - 13.01% and dyspnea - 80.7%. Management included oseltamivir and antibiotics if indicated along with 66.8% of the patients who required oxygen support, 22.5% required intensive care, 14.5% mechanically ventilated and 8% maintained on non invasive ventilation. Mortality was 8.6%. logistic regression were used to explore factors influencing mortality in H1N1 infection; the significant risk factors were- rising age (OR=1.041), longer hospital stay (OR=1.092), raised serum aspartate transaminase (OR=1.013), raised serum alanine transaminase (OR=1.027), raised total leukocyte count (OR=1.115) and raised bilirubin (OR=1.389) levels Conclusion The mortality rate in our study was 8.6%. H1N1 influenza patients who were older with deranged hepatic parameters and raised total leukocyte count had poor prognosis.

Low backache as an initial manifestation of acute lymphoblastic leukemia (ALL) in adults has been rarely reported. In this hematological disorder, although bone marrow is replaced by malignant cells, not many cases of low backache as an initial presentation of ALL are reported. We present a series of clinical cases with low backache, which on evaluation found to have ALL.

COVID-19 has led on to a global healthcare crisis, similar to none in the recent past. Special emphasis must be laid on the status of pregnant women amid this outbreak, considering the vulnerability seen in pregnant women toward previous coronavirus diseases. In this review, we will try to elicit the correlation between the complications of previous coronavirus diseases (Severe Acute Respiratory Syndrome and Middle East Respiratory Syndrome) and COVID-19, the possibility of materno-fetal vertical transmission and the obstetric management protocol.