Hiramaya Disease - A Case Report.

A 20-year-old male was evaluated by us five months post development of weakness in right upper arm followed by intrinsic muscle atrophy in the right hand when his age was 18-years. Weakness was observed first during performing daily activities like mixing food in the plate, holding utensils, lifting books / schoolbag, opening bottles, and holding small objects. The weakness got worse over several months and got stabilized after around two years. Occasional cramps could be noted during the progression of the disease. Pain was pricking, sharp (not referred to other limb) associated with numbness and occasional burning along with dysesthesia in the right upper arm. His past medical history suggests wasting in the left lower limb below knee, noted when the patient was of the age of five years. He had to walk with the support of the stick. There is no history of trauma. There was no family history of any neuromuscular disease.

The Urgent Need to Understand Covid-19 Associated Coagulopathies and the Significance of Thrombotic Prophylaxis in Critically Ill Patients.

COVID-19 is a novel disease caused due to infection from the respiratory pathogen SARS CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2). It originated from the city of Wuhan in China in December 2019, and spread to become a pandemic in most of the world. The World Health Organization (WHO) declared COVID-19 to be a ‘public health emergency of international concern’ on January 30, 2020. Since then there have been countless cases and associated fatalities. In this article we focus on one aspect of the underlying conditions that may prove to be fatal in critically ill patients of COVID-19, namely hypercoagulative states and their associated thrombotic complications. We analyse data-driven studies that outline the manifold increase in instances of COVID-19 related thrombotic events and the patient demography that is most affected by it. There are several reflections and critical enumerations of the specific clinical features that patients with COVID-19 associated coagulopathies present with. We analyse and comment on several anecdotal instances of patients presenting with new-onset symptoms of severe large-vessel ischemic strokes and other coagulopathies. We determine how laboratory findings and specific markers can help identify patients most at risk of thrombotic events. These events may range from deep vein thromboses to fatal cerebrovascular accidents. There is an increased stress on how these coagulation problems may relate to other infectious conditions through presentation with similar markers. We also analyse the radiological investigations that such patients yield and identify peculiarities in them. There is further emphasis on the importance and efficacy of thrombotic prophylaxis and anticoagulant therapy in the management and reduction of fatalities. We also attempt to educate clinicians and intensive care providers regarding better management practices to mitigate fatal outcomes, including both pharmacological and supportive interventions.

Role of Vitamins and Minerals in Improving Immunity during Covid-19 Pandemic - A Review.

The COVID-19 pandemic has brought attention to the role of the immune system. The immune system can be strengthened by diet, supplements and good hygiene practices. The immune system is comprised of different cells contained in the blood, lymph, and tissues that are distributed across the body. A large number of cells and even greater numbers of chemical messengers engage in the body's immune defence. In immune response blood cells, B-lymphocytes and T- lymphocytes play a vital role. The world health organization, urges people to follow a healthier lifestyle, saying it will increase their chances of a quick recovery. Proper nutrition is required for proper functioning of immune system. Therefore, healthy balanced diet is the best way to support the immune function. Vitamins and minerals are important ingredients of the diet that the body requires to work properly. Vit D is required in limited amounts to maintain good health. Vitamins and minerals together are also called micronutrients, as they are required in very small quantities. On the other hand, carbs, proteins and fats are altogether termed as macronutrients. In recent years, vitamins A, C, D, and E, believed to have an effect on the immune system, have gained significant attention because they are involved in enhancement of immune systems. Solely, vit-A is involved in proper functioning of eye, immune system and also takes care of skin and genes. In green leafy vegetables, carrots, pumpkin, melons and mangoes vitamins are present in form of pre-vitamins, and further converted into active vit A inside the human body. It is surprising that liver, yolk of egg, butter, whole milk, and cheese are active source of vitamin A. Having a healthy diet including lots of fruits, vegetables is a key component of healthy lifestyles and plays a crucial role in maintaining a properly functioning and efficient immune system to defend against infections and other diseases. All the data was assessed from online search (PubMed, Google Scholar). In this review article we concentrate on vitamins and minerals.

Diagnostic and Prognostic Value of N-Terminal Brain Natriuretic Peptide in Patients of Heart Failure.

Heart failure is a clinical condition in which a deviation in normal cardiac structure or function is accountable for the incapability of the heart to eject or fill with blood at a proportion proportionate to the requirements of the metabolizing tissues. The detection of heart failure is based on clinical symptoms, signs, chest x rays and reaction to the treatment. BNPs are released by the heart ventricles in reaction to volume load or pressure load physiologically and they function to counteract rennin angiotensin system, cause vasodilatation and natriuresis. The BNP evaluation has gained approval already in the recommendations of European Society of Cardiology for the detection of heart failure. We wanted to study the potential of a new unconventional assay plasma N-Terminal pro BNP in detecting cardiac failure, and correlate the levels of plasma N-Terminal pro BNP with the severity of the cardiac failure and levels of plasma N-Terminal Pro BNP with systolic and diastolic dysfunction. MethodsIt was an analytical cross-sectional study conducted among 50 patients with clinical features of cardiac failure attending medicine OPD and emergency department of the hospital for the duration of 18 months and an equal number of age and sex equivalent fit controls. In subjects with clinical features of heart failure, and in healthy controls, 2 mL of blood sample is drawn for assay of plasma N-Terminal pro BNP within half an hour of presentation. Using biomedical kit plasma N-T pro BNP concentration was measured. The entire period of the assay is 18 min. Detectability range by this method of N-T proBNP is 5 pg/mL to 35,000 pg/mL. ResultsCases comprised of 28 males and 22 females with a mean age 50.80 (13.11) years while controls comprised of 28 males and 22 females with a mean age 50.86 (12.7) years. There was a statistically noteworthy difference in Mean N-T pro BNP between case and control groups, NYHA Class, and age group. Mean N-T pro-BNP is not significantly different at discharge and on 2nd follow-up. For the rest of the diagnoses, there is a notable difference in Mean N-T pro BNP at discharge and on 2nd follow-up. ConclusionsPlasma N-Terminal pro BNP levels are useful from therapeutic point of view (aggressive therapy if needed e.g. Heart transplantation / bilateral pacemaker or invasive therapy may be planned by N-T pro BNP levels).

Comparison between Fasting and Non-Fasting Sample for the Determination of Serum Lipid Profile.

For determination of serum lipid profile, traditionally we use fasting blood sample. Though it has been the most reliable method for testing lipid profile, it has some drawbacks. Fasting is not easy for some people specially children, diabetics and also it is a barrier for population screening. So, intent of our study is to check the authenticity of results obtained using non-fasting samples by correlating it with the results obtained using fasting samples. We wanted to estimate & compare fasting and non-fasting lipid profile values in severe diabetic patients and in apparently healthy controls.METHODSThis analytical cross sectional study included 40 apparently healthy controls and 40 diabetic patients as participants confirmed by history and biochemical tests. Blood sample was collected from each patient two times; once after 10-12 hours fasting and other as a random sample. Lipid profile parameters were estimated using standard tests. Statistical analysis was done by using Pearson’s correlation coefficient. Data analysis was carried by Statistical Package SPSS and Microsoft Excel and p<0.05 was considered as level of significance.RESULTSIn apparently healthy controls differences between fasting and non-fasting concentrations were small and clinically insignificant for lipid profile parameters like total cholesterol (p=0.861), LDL-cholesterol (p=0.203) and HDL-cholesterol (p=0.916). The difference was statistically significant (p=0.001) for triglycerides.CONCLUSIONSFasting samples are preferable for serum lipid profile measurement in all individuals with serum triglyceride levels greater than 350 mg/dL. But, non-fasting samples for lipid profile can be used for cardiovascular risk determination in the general people as it reduces patient’s inconvenience and promotes patient acquiescence towards lipid profile checking.