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Objectives Post-coronavirus disease 2019 (COVID-19) symptoms were widely reported.However, data on post-COVID-19 conditions following infection with the Omicron variant remained scarce. This prospective study was conducted to understand the prevalence, patterns, and duration of symptoms in patients who had recovered from COVID-19. Methods A prospective study was conducted across 11 districts of Delhi, India, among individuals who had recovered from COVID-19. Study participants were enrolled, and then returned for post-recovery follow-up at 3 months and 6 months interval. Results The mean age of study participants was 42.07 years, with a standard deviation of 14.89 years. The majority of the participants (79.7%) reported experiencing post-COVID-19 symptoms. The most common symptoms included joint pain (36.0%), persistent dry cough (35.7%), anxiety (28.4%), and shortness of breath (27.1%). Other symptoms were persistent fatigue (21.6%), persistent headache (20.0%), forgetfulness (19.7%), and limb weakness (18.6%). The longest duration of symptom was observed to be anxiety (138.75±54.14 days), followed by fatigue (137.57±48.33 days), shortness of breath (131.89±60.21 days), and joint pain/swelling (131.59±58.76 days). At the first follow-up visit, 2.2% of participants presented with abnormal electrocardiogram readings, but no abnormalities were noticed during the second follow-up. Additionally, 4.06% of participants exhibited abnormal chest X-ray findings at the first follow-up, which decreased to 2.16% by the second visit. Conclusion The most frequently reported post-COVID-19 symptoms were joint pain, dry cough, anxiety and shortness of breath. These clinical symptoms persisted for up to 6 months, with evidence of multi-system involvement. Consequently, findings highlighted the need for long-term follow-up during the post-COVID-19 period.

Both Takayasu arteritis (TAK) and ulcerative colitis (UC) are uncommon diseases with diverse pathophysiological and clinical features. Their occurrence in the same patient is highly unusual and interesting. We describe the case of a 32-year-old female with UC who developed TAK, 4 years after the initial diagnosis. She was also found to have the HLA subtype B52 which has been commonly reported in these two conditions. We discuss the similarities and differences in clinico-epidemiological, pathophysiological, and genetic features of TAK and UC. We also performed a literature search and reviewed similar case reports and case series of co-occurrence of TAK and UC, between 2010 and 2021.

Introduction: Nature of disease, poor working conditions, prolonged work duration, stigma, and discrimination in the community have worsened the well-being of health care professionals in COVID-19. This survey is conducted to understand the quality of life and its key determinants among health care workers (HCWs) during the COVID-19 pandemic in a low middle-income country like India. Methodology: A cross-sectional study using a Google form-based online questionnaire survey was planned at two COVID dedicated centers of New Delhi. A convenience sample of 300 HCWs involved in patient care at the study sites was studied using an SF-36 questionnaire for quality of life assessment and a self-made questionnaire (risk exposure assessment). Results: In the study, 61.0% were males and 40.72% were females across all specialties. The majority (77%) were single and 81.4% were from the age group of 20 to 30 years. 84% of the study subjects belonged to clinical specialties. Nearly 56% of study subjects reported being not satisfactory or uncomfortable in the personal protective equipment (PPE). Shortage of PPE was reported by 10% of study subjects. The majority (82.35%) of study subjects were satisfied with the quality of PPE. Satisfaction of the study subjects was less than satisfactory among food provided, accommodation, and transport facilities. Social isolation (70.5%) and lockdown restraints (57.6%) were reported by the majority of study subjects. The median score for the domain of general vitality was 55, for the emotional domain was 33, and for social was 62. The domains of quality of life were not significantly affected by place of work, discipline, age, sex, and type of work. Conclusion: The overall well-being of HCWs was affected during the pandemic mostly across mental, social, and general vitality domains. Social isolation was a key concern reported by the majority of HCWs.

Abstract The venereal disease research laboratory (VDRL) test, a nontreponemal test for syphilis, may under a certain set of conditions give false positive results in patients who are not infected with Treponema pallidum. A false positive reaction is defined as a positive reaction to nontreponemal tests, and a negative reaction to treponemal tests, in the serum of a patient who has no history or clinical evidence of syphilis or other treponematosis. A prozone phenomenon in nontreponemal tests is seen largely with secondary syphilis due to high-titer samples that show nonreactive results unless the specimens are diluted. We report here perhaps the first case of lepromatous leprosy, which had a false positive reaction to the VDRL test with the prozone phenomenon. The case initially presented to the outpatient clinic with complaints of epistaxis with nasal stuffiness. The finding of septal perforation on nasal endoscopy is what led to the initial suspicion of syphilis and the subsequent syphilis workup. It was only when the false positive reaction to VDRL test with the prozone phenomenon was noted that the search for other causes was made, which eventually lead to the diagnosis of lepromatous leprosy.

Background: Nail fold capillaroscopy (NFC) is mainly used in connective tissue diseases (scleroderma, mixed connective tissue disease, and inflammatory myositis). It is not used routinely in the evaluation of diabetic patients and no specific patterns of nail fold capillary changes have been established in diabetes. We studied morphological patterns of nail fold capillaries by video capillaroscope in diabetic patients and their association with diabetic retinopathy (DR). Methods and Material: Fifty diabetics were recruited after informed consent. The mean age of patients was 49.5 ± 10.6 years. Seventeen patients had DR. Capillary length, capillary density, and various morphological parameters were assessed and these parameters were compared between patients with DR and without DR. Results: The most frequent NFC morphological alterations, among diabetics as a group, were tortuous capillaries (56%), giant capillaries (46%), and cross-linked capillaries (44%). Overall, mean nail fold capillary length was reduced in diabetic patients. When individual morphological alterations were compared in patients with DR versus without DR, statistically significant differences were seen for presence of giant capillaries, tortuous capillaries, and avascular areas. On further analysis, mean nail fold capillary length and mean nail fold capillary density were also significantly lesser in patients with DR versus without DR. Conclusions: The presence of nail fold capillary morphological abnormalities among diabetics and a significant association with microangiopathic changes in the retina suggest that microvascular changes can be detected early using a simple, non-invasive office-based method of NFC. More large-scale studies in the future can establish a characteristic pattern for diabetes as seen in systemic sclerosis so that microvascular changes in diabetics can be detected at the earliest with the simple noninvasive method by using NFC.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection causes a disease (COVID-19) with multisystem involvement. The world is now entering a phase of post-COVID-19 manifestations in this pandemic. Secondary hemophagocytic lymphohistiocytosis (sHLH) is a life-threatening hyperinflammatory event triggered by viral infections, including SARS-CoV-2. Both Multisystem Inflammatory Syndrome-Adults (MIS-A) and Cytokine Storm Syndrome (CSS) are considered close differentials of sHLH and add to the spectrum of Post-acute COVID-19 syndrome (PACS). In this report, we presented the case of a middle-aged Asian man who was initially discharged upon recovery from severe COVID-19 infection after 17 days of hospitalization to a private institute and later came to our hospital 13 days post-discharge. Here, he was diagnosed with sHLH, occurring as an extension of CSS, with delayed presentation falling within the spectrum of PACS. The diagnosis of sHLH was made holistically with the HLH-2004 criteria. Our patient initially responded to intravenous immunoglobulin (IVIG) and dexamethasone, later complicated by disseminated Candida auris infection and had a fatal outcome. Though many cases of HLH during active COVID-19 and a few cases post COVID-19 recovery have been reported, based on H-score, which has limitations as a diagnostic tool. We report the first case report of post-COVID-19 sHLH using the HLH-2004 criteria, complicated by disseminated Candidemia, emphasizing that the care of patients with COVID-19 does not conclude at the time of hospital discharge. We highlight the importance of surveillance in the post-COVID phase for early detection of sHLH which may predispose to fatal opportunistic infections (OIs).

Sarcoidosis is a multisystem disease with dominant pulmonary involvement (90%). Isolated extrapulmonary involvement is less common. Skeletal muscle (1-2%) involvement is even rare. We report a 40 year old lady presented with easy fatigability, low grade fever for 5-6 months and generalized myalgias. Examination revealed pallor, a receding hair line, hepatomegaly and proximal muscle weakness. Investigations revealed anemia, hypercalcemia and raised serum ACE level. During hospital stay patient developed right sided hemiparesis (acute vasculitic infarct in left parietal cortex). A FDG-PET scan was done which revealed that the muscles of upper and lower limbs showed diffuse, heterogenous areas of increased FDG avidity suggestive of myositis. Final diagnosis of extrapulmonary sarcoidosis (presenting as myositis along with CNS vasculitis and hypercalcemia) was made. Patient showed marked improvement in her symptoms with immunosuppressive therapy. This case is a rare manifestation of extrapulmonary sarcoidosis and emphasizes the role of FDG-PET in diagnosing these cases.

Introduction: Patients of rheumatoid arthritis (RA) are prone to osteoporosis and overt fractures. Subclinical vertebral fractures (SVFs) precede overt vertebral fractures. We studied prevalence and risk factors of SVFs among women with RA. Aim: To determine the prevalence of SVFs in women with RA and to study the various risk factors associated with presence of SVFs. Settings and design: Adult patients of RA attending the rheumatology clinic of medicine department at a tertiary teaching hospital in Delhi. One hundred eleven adult women with RA were included. Clinical assessment included anthropometry, Body Mass Index (BMI), duration of RA, disease activity using Clinical Disease Activity Index (CDAI), disease disability using Health Assessment Questionnaire (HAQ), and details of glucocorticoid (GC) use. Thoracic and lumbar vertebrae were graded for presence of VFs using the semi-quantitative method of Genant by two radiologists. Statistical analysis used: Simple descriptive statistics were used to describe prevalence of SVFs. Risk factors for SVFs were tested for significance using the Studentʼs t-test for quantitative variables and chi-square test for qualitative variables. Kappa statistics were calculated for assessment performed by the two radiologists. Two-sided alpha was set at 3 SVFs. Women with any SVF were significantly older as compared to women with no SVF. Fifty five percent of women using GCs had any SVF, while 44%, not using GC, had any SVF (P = ns). GC use, duration of RA, CDAI score, HAQ score, BMI, presence of RF, and anti-CCP were not different between women with and without SVFs. Kappa for inter-reader variability among the two radiologists was 0.98. Conclusions: This study provides evidence of very high prevalence of SVFs among women with RA. Traditional risk factors do not fully account for this enhanced risk.

Introduction: Autonomic Neuropathy (AN), found to be a strong predictor of sudden cardiac death, has been reported variably in patients with Rheumatoid Arthritis (RA). Manifesting as sweating disturbances, gastrointestinal irregularities, bladder or erectile dysfunction, AN can significantly affect a patient’s quality of life and alter the course of the disease. Aim: This study was undertaken to find out the prevalence and severity of AN in RA patients attending the Rheumatology Clinic at a Tertiary Care Hospital in New Delhi, India and also to investigate its correlation with patient and disease factors such as age, gender, disease severity, duration and serological status. Materials and Methods: In this cross-sectional study, AN was assessed subjectively by a survey of autonomic symptoms. Cardiac autonomic involvement was assessed by five cardiovascular reflex tests as described by Ewing: Heart Rate (HR) response to deep breathing, standing, and Valsalva and Blood Pressure (BP) response to standing and sustained handgrip. Results: A total of 31 RA patients and 31 age and sex matched healthy volunteers were recruited. Upon analysis it was found that the prevalence of cardiac AN was significantly higher in patients (80.65%) as compared to controls (51.61%) (p=0.016). Positive correlation with disease severity was observed with the patient reported questionnaire but not with the objective cardiovascular reflex tests. No significant correlation between grade of AN and patient’s age, gender, disease duration or serological status was established. Conclusion: At the end of the study, it was concluded that the pathological mechanisms responsible for autonomic dysfunction are more active in RA as compared to others.

Combined arterial and venous thrombosis in patients with ulcerative colitis is a rare extra vascular manifestation, which motivated the current report. Increased coagulability is a recognised feature of ulcerative colitis with frequency increasing during flares. We report the case of a 42-year-old lady who was a diagnosed case of ulcerative colitis, currently in remission. She presented with swelling followed by discolouration of left lower limb which later was diagnosed as deep venous thrombosis combined with femoral and popliteal artery thrombosis. This led to wet gangrene of the limb, sepsis, septic shock and death despite aggressive management with heparin infusion, ionotropes, and parenteral antibiotics therapy.