ABSTRACT
Aims and Objectives:A study to determine the effect of glycemic variability measured by continuous blood glucose monitoring as assessed by standard deviation of each SARS CoV -2 patient's mean glucose level and to correlate with the severity of the disease.Study Design:Cross-sectional observational study of 13 patients with SARS CoV-2 infection with Acute Respiratory Distress Syndrome (ARDS) with and without diabetes.Place and Duration of Study:Department of Medicine, Dhiraj Hospital, Smt. Bhikhiben Kanjibhai Shah MedicalCollege and Research Institute; between June 2020 to July 2020.Results:13 patients of SARS CoV-2 with ARDS were enrolled in the study. The median age of the enrolled patients was 55±12 years. Out of the 13 patients, 5 patients belonged to mild and severe category of ARDS each respectively and 3 patients belonged to the moderate category of ARDS. There was a gradual rise in inflammatory markers such as serum LDH, Ferritin, CRP from mild to severe ARDS and D-dimer level was more than double in severe category as compared to the mild ARDS. Normal glycemic variability in adults is 0-3 SD, and we found that there was a significant co-relation of glycemic variability with severity of the disease evidenced by the mean standard deviation of severe ARDS patients as 27.44 SD; whereas 19.26 SD and 9.7 SD for moderate and mild ARDS patients respectively. Hypoglycemia was documented in 10 patients. The maximum stay in the hospital was that of the patients with high glycemic variability that is 22 ± 2 daysConclusion:This preliminary study relates glycemic variability with severity of ARDS in patients of severe SARS CoV-2. Frequent episode of hypoglycemia is not uncommon and should be monitored
ABSTRACT
Paraquat is a herbicidal agent used extensively, mainly in developing countries where there is a high incidence of its poisoning. It causes damage to kidneys, lungs and liver. Reports of mucocutaneous manifestations following paraquat ingestion are rare. Here we describe a case of Stevens-Johnson syndrome(SJS) presenting in a case of paraquat ingestion. A 22 year old male was admitted to our hospital for difficulty in swallowing and micturation since ingestion of 10-15 ml of paraquat 7 days before. He had multiple hemorrhagic crusted erosions over lips and left maxillary area with diffuse erythematous erosions over bilateral buccal mucosa, palate, labial mucosa and urethral mucosa with whitish slough over them. Upper GI endoscopy revealed oral, esophageal and fundal sloughing. Patient was treated with oral corticosteroids and antibiotics which caused complete resolution of skin lesions within 15 days.Paraquat dichloride exerts its toxicity by generation of reactive oxygen species. Skin lesions following topical application of paraquat are common, but very few cases have been reported of the same after oral ingestion. SJS is caused by a variety of drugs and commonly presents with muco-cutaneous tenderness, hemorrhagic erosions and erythematous macules with 90% developing oral, genital and gastrointestinal mucosal involvement. As the oral and genital manifestations in our patient developed the day after paraquat ingestion, possibility of SJS developing due to the same are the highest. Paraquat should not be ruled out as a drug causality if mucocutaneous manifestations of SJS/TEN appear in a patient of paraquat ingestion.