Search

Coronavirus disease 2019 (COVID-19), may present with a myriad of clinical manifestations and complications. Patients with COVID-19 are at increased risk of pulmonary thromboembolism, acute cardiac injury, arrhythmias, acute stroke, and secondary infections. Mucormycosis is a catastrophic fungal infection characterized by vascular invasion, thrombosis, and necrosis of tissues. We report five cases of COVID-19 infection, who developed rhino-orbital mucormycosis, during the course of treatment. Early recognition of this life-threatening infection is the key to allow for optimal treatment and improved outcomes.

Introduction: Mother-to-child transmission of HIV can occur during pregnancy, labour, or breastfeeding. The first-line regimen for prophylaxis in HIV infected pregnant women is combination of Tenofovir, Lamivudine and Efavirenz (TLE). Aim: To evaluate the safety and efficacy of the TLE regimen in the Prevention of Mother-To-Child Transmission (PMTCT) of HIV. Materials and Methods: The present hospital-based, retrospective cohort study was conducted at ART centre, Prevention of Parent to Child Transmission (PPTCT) centre, and Department of Medicine, SP Medical College, Bikaner from July 2016 to June 2019. HIV positive gravidas, on triple-drug regimen TLE (Tenofovir 300 mg, Lamivudine 300 mg, Efavirenz 600 mg) before conception and, those detected HIV reactive antenatally during study period were included in this study and started on TLE regimen. After delivery, these newborns were given syrup Nevirapine as per the PPTCT guidelines. Infants were tested with Rapid test and PCR for HIV, at six weeks, six months, 12 months, and 18 months of life. Results: Out of 87 pregnant women, enrolled and delivered at the study institute, 85 were live births and two were stillbirths. Out of 85 live-born babies, four have died during infancy and two were lost to follow-up despite repeated counselling. Five babies were referred to nearby Anti-Retroviral Therapy (ART) centers. So, the study followed 74 babies out of which one girl child was found to be positive for HIV-1 at 18 months of age (transmission rate of HIV was 1.35 and efficacy of TLE 98.65%). No major adverse effects of TLE were noted and all women continued TLE. Conclusion: The use of a triple-drug regimen (TLE) declined the risk of transmission of HIV from mother-to-child at negligible level, without drug resistance and with safety and tolerability as compared to single drug.

Objective: To assess the knowledge, attitude, and practice (KAP) regarding COVID-19 among COVID-19 patients and their relation with the outcomes. Methods: This cross-sectional study was carried out among COVID-19 patients (18-year-old or older) consecutively admitted to a dedicated COVID-19 hospital located in northwest Rajasthan, India. Data regarding socio-demographic parameters, KAP, and primary composite outcome (admission to intensive care unit, mechanical ventilation, or in-hospital death) were collected. KAP scores were compared between different demographic variables and primary composite outcomes. Association between different demographic variables, primary composite outcomes, and KAP scores were determined through multivariate linear regression. Besides, the correlation among KAP scores was analyzed. Results: Out of the total 222 patients, most of them (65.76%) had average KAP scores towards COVID-19. The mean scores for knowledge were 7.88, with an overall correct rate of 71.63%; the mean attitude scores were 2.42, with an overall correct rate of 60.50%; the mean practice scores were 5.12, with an overall correct rate of 64.00%. Patients who met the primary composite outcomes had higher knowledge scores, but lower attitude and practice scores. The result showed a significant positive correlation between the level of education, socioeconomic class, and knowledge, attitude, and practice towards COVID-19. Knowledge towards COVID-19 was significantly associated with a positive attitude and good practice. Conclusions: Our findings show that adult COVID-19 patients have average KAP towards COVID-19 among COVID-19 patients. Poor attitude and practice towards COVID-19 are associated with adverse outcomes, so it is suggested to strengthen attitude and practice towards COVID-19 to improve the outcomes.

Objective: To describe the clinical, laboratory and radiological characteristics and outcomes of moderate-to-severe coronvirus disease 2019 (COVID-19) patients. Methods: We retrospectively analyzed 43 RT-PCR confirmed moderate-to-severe COVID-19 patients who were admitted to a tertiary care center. The primary composite outcomes were admission to intensive care unit, requirement of mechanical ventilation, and death. Results: The median age of the patients was 50 years, and 62.8% of the patients were male. Out of 43 patients, 15 (34.88%) were categorized as severe. A total of 26 (60.47%) patients had 1 or more comorbidities [diabetes (34.88%) and hypertension (30.23%)]. The median duration from the onset of symptoms to admission was 3 days, and the most common symptoms were dyspnoea (90.7%), cough (79.07%), fever (69.77%), and body ache (46.51%). Leucopenia was presented in 14 (32.56%) patients, lymphopenia in 26 (60.47%) patients, and monocytosis in 7 (16.28%) patients. Besides, 40 (93.02%) patients had bilateral patchy nodular or interstitial infiltration on chest X-ray. The primary outcomes occurred in 20 patients (46.5%), among whom 8 required mechanical ventilation. The patients who had met the primary outcomes were older. They were prone to have at least 1 comorbidity (P=0.004), diabetes (P=0.01), hypertension, higher sequential organ failure assessment score, more tachycardia, lower SpO2, lower PaO2/FiO2, more thrombocytopenia, and more pancytopenia. Conclusions: This retrospective study identified several risk factors for poor outcomes in adults with COVID-19. In particular, older age, tachycardia, high SOFA score, low SpO2, low PaO2/FiO2, presence of comorbidities in form of diabetes and hypertension, thrombocytopenia, and pancytopenia at admission were associated with higher odds of ICU admission, a requirement of mechanical ventilation and in-hospital death.

Histoplasmosis is a fungal infection caused by Histoplasma capsulatum and very few cases reported from North-West India. Adrenal histoplasmosis is an even more uncommon mycotic disease. We describe five immunocompetent men with adrenal histoplasmosis presenting with constitutional symptoms. Four patients had bilateral adrenal involvement, whereas one had unilateral adrenal mass. Three patients had adrenal insufficiency at presentation and the other two developed adrenal insufficiencies during follow-up. All the patients received amphotericin B and itraconazole treatment which led to symptomatic improvement but adrenal insufficiency persisted in all patients at the end of the follow-up.

This study aims to describe the epidemiology, predisposing factors, clinical manifestations, management, and outcome of post-COVID rhino-cerebralorbital mucormycosis.This is a prospective observational study of patients with post-COVID RCOM conducted tertiary care hospital during May-June 2021.The mean age of patients was 49.58±15.12 years and majority (64.80%) were male. The majority of patients were rural, Hindu and illiterate. Diabetes was present 78.10% patients, glucocorticoids were required in 66.30%, and supplemental oxygen was used in 27.60% of patients. Most of the patients developed symptoms of RCOM within 15 days of COVID-19. Majority of patients (46.67%) had stage 3 disease and orbit was involved in 60% of patients. All patients received intravenous antifungal drugs and combined antifungal drugs and surgical debridement was performed in 77.10% patients. Predictor associated with poor outcome were RCOM stage 3c or above and qSOFA score ≥2 at presentation.Diabetes and glucocorticoids are the most important risk factors for post-COVID RCOM. COVID-19 patients must be followed closely for 2-4 weeks to detect mucormycosis as earlier as possible. Antifungal drugs should be started immediately if clinico-radiological feature suggest RCOM before microbiological confirmation. Combined medical and surgical treatment significantly reduces mortality.

Objectives: Idiopathic hypogonadotropic hypogonadism (IHH) can be associated with anosmia/hyposmia. The objective of this study is to evaluate olfaction by Indian smell identification test (INSIT) and measure olfactory bulbs (OBs) and sulci using dedicated magnetic resonance imaging (MRI) in patients with IHH and correlate MRI findings with INSIT. Methods: Forty patients with IHH underwent (a) brief smell identification test (INSIT) and (b) MRI of the olfactory apparatus. The size of olfactory sulcus and bulb was quantified and compared with the normative data obtained in 22 controls. The agreement between INSIT and MRI was assessed using Kappa index. Results: Of the 40 patients, 8 patients who reported abnormal smell sensation and 12 of the remaining 32 patients who reported normal smell sensation historically had a low score on INSIT. Thus, there were 20 patients with Kallmann syndrome (KS) and the rest 20 were normosmic IHH (nIHH). Of 40 patients with IHH, MRI finding was suggestive of normal (n = 16), hypoplastic (n = 12), and aplastic (n = 12) olfactory apparatus. All 20 patients with KS have olfactory abnormalities (n = 12 aplastic, n = 8 hypoplastic), and 4 of 20 nIHH have olfactory abnormalities (hypoplastic only) on MRI. There is (a) significant positive correlation (r = 0.54, P = 0.013) between the OB volume (MRI) and smell test scores and (b) moderate agreement (Kappa index: 0.49) between smell defect (INSIT score ≤ 4) and aplastic olfactory apparatus. Conclusion: Self-reporting of smell significantly underestimates olfactory phenotype, and hence we recommend an objective smell test to differentiate KS from nIHH. Olfactory phenotype significantly correlates with MRI quantification of olfactory apparatus in IHH.

Introduction: Type 1 diabetes mellitus (T1DM) is associated with various autoimmune disorders like celiac disease, thyroid disorder, adrenal failure, etc. However, how common is this association in Indian children is not clearly known. Objective: To assess the prevalence of other coexisting autoimmune disorders in children with T1DM. Materials and Methods: In this cross-sectional study, patients requiring insulin and ketosis-prone diabetic and with history of diabetic ketoacidosis/undetectable fasting C-peptide levels were included. Beside demographic and clinical data, detailed biochemistry evaluations were performed. Celiac disease was diagnosed as per the ESPGHAN diagnostic criteria. ACTH stimulation test was done to confirm the adrenal insufficiency in patients with basal serum cortisol

Introduction: The differential diagnoses of patients hospitalised for Influenza-Like Illness (ILI) due to swine influenza virus vs other pathogens are challenging. Aim: To evaluate haematological indices such as lymphocyte (LYM), platelet (PLT), Neutrophil-to-Lymphocyte Ratio (NLR), Platelet-to-Lymphocyte Ratio (PLR), and Lymphocyte multiplied by Platelet Count (LYM×PLT) as potential indicators to discriminate swine influenza virus infection from another ILI in Adults. Materials and Methods: This study was conducted among 332 patients, admitted with ILI from January 2019 to December 2019. Complete Blood Count (CBC) and Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR) to detect swine influenza virus from throat/nasal swab were performed in each patient. Based on results, patients were divided into swine influenza-positive and swine influenza-negative groups. ANOVA test was used to compare different groups. The diagnostic values of the haematological indices in swine influenza infection were evaluated, using the ROC curve. p-value

Introduction: As per the International Diabetes Federation (IDF) statistics, around 463 million people are presently living with diabetes worldwide, and this is anticipated to be 578.4 million by 2030. Awareness regarding diabetes is a major determinant for early detection and prevention of diabetes. Information regarding Knowledge, Attitude, and Practice (KAP) among diabetics from Northwest Rajasthan, India is not readily available. Aim: This study was designed to assess KAP regarding diabetes among patients with Type 2 Diabetes Mellitus (T2DM). Materials and Methods: This hospital based, cross-sectional study was conducted over a period of one and half years from July, 2018 to December, 2019 in a Tertiary Care Center in Northwest Rajasthan, India among 960 patients with T2DM. KAP was assessed by a structured questionnaire derived from a validated set of questionnaires and was categorised as poor, average, and good. Bivariate and multivariate analyses were done to assess the association between diabetes-related KAP and sociodemographic variables. Results: The mean age of the subjects was 55.45±11.64 years. The proportion of good, average, and poor knowledge scores among subjects were 10.83%, 65.84% and 23.33%, respectively. The corresponding values for attitude scores were 9.16%, 74.17% and 16.67%, respectively. Subjects from young age group, urban habitats, higher educational background, upper socioeconomic class, longer duration of diabetes, with a family history of diabetes, those who attended diabetes education program and with higher Body Mass Index (BMI) demonstrated significantly greater KAP score (r=0.73, p=0.001). Better knowledge was associated with a better attitude and practice (r=0.81, p=0.001) and better attitude was associated with better practice (r=0.77, p=0.001). Conclusion: The overall level of KAP regarding diabetes was average. To prevent diabetes and its complications, there is an urgent need to carry out extensive awareness programs with a prioritised focus on poorer, rural and less educated groups.

Objective: To evaluate the etiology, clinical profile and outcome of acute abdomen presentation in Dengue Fever (DF). Methods: This clinical prospective study was done on confirmed cases of DF admitted in the department of medicine during recent epidemic (September 2015 to November 2016). All patients were evaluated clinically and by laboratory and imaging investigations and followed-up during hospital stay till discharge. The cause of pain abdomen was ascertained by blood tests (amylase, lipase and liver function test etc), radiology (Flat plate abdomen-erect, Ultrasonography of abdomen, CECT abdomen) and/or endoscopy. Results: Out of the 501 patients diagnosed as DF, 165 (32.93%) presented with acute abdomen. Some patients presented in other departments like surgery, gastroenterology and emergency, were later diagnosed as DF on laboratory evaluation. Various causes of acute abdomen in our study were nonspecific severe pain abdomen (67 cases), acute hepatitis (46) one had acute fulminant hepatitis, acute acalculous cholecystitis (31), ascitis (12), acute hyperemic gastritis with malena (5), acute pancreatitis (2), and 1 case each of acute appendicitis and acute jejuno-ileal intussuception. All patients were managed conservatively. One patient of acute pancreatitis died of multi-organ failure. Conclusion: Our study concludes that clinical vigilance about such type of presentations is important as timely recognition can influence outcome and may prevent unwanted surgery.

Antithyroid drugs (ATDs) have been used for the management of hyperthyroidism and rarely may cause life-threatening side effects such as agranulocytosis and pancytopenia. Lymphocytes of patients who develop agranulocytosis while on ATD may undergo blast transformation when exposed in vitro to ATD. A 26-year-old man with Graves' disease was found to have pancytopenia after treatment with carbimazole for 2 months, which was improved with supportive treatment. The patient restarted carbimazole and presented 4 months later with a diagnosis of acute lymphoblastic leukemia (ALL). This case of ALL was likely attributed by re-exposure to carbimazole, though the association of ALL with autoimmune thyroid disease cannot be denied.

Introduction: Type 2 Diabetes Mellitus (T2DM) affects bone metabolism at axial as well as the appendicular skeleton. Bone loss may vary at different sites. Besides spine and hip, the distal radius is commonly evaluated for osteoporosis in T2DM. The study represents the findings of osteoporosis at distal radius in otherwise healthy T2DM cases. Aim: To study osteoporosis at distal radius in relation to spine and hip in otherwise healthy T2DM cases. Materials and Methods: In this cross-sectional, observational study, adult patients above 50 years of age with T2DM with no other comorbidities or bone disease were assessed. All patients underwent Bone Mineral Density (BMD) evaluation with Dual-Energy X-Ray Absorptiometry scan (DXA) at spine, hip and distal radius. T-score of