Study of Characteristics of COVID-19 Patients with Fatal Outcome during Wave-2 from a Tertiary Care Center in Western India

Background: A large surge of intensive care unit (ICU) admissions leading to mortal outcome was observed in wave-2 of coronavirus disease 2019 (COVID-19) due to the higher virulence of the Delta variant of the COVID-19 virus, which led to the scarcity of resources in hospitals. This study was done to observe the clinical characteristics of COVID-19 patients with fatal outcome. Materials and methods: We conducted a retrospective cross-sectional study in adults with COVID-19 pneumonia having fatal outcome during wave-2 of COVID-19, and their clinical characteristics were studied. Results: Out of 136 patients included in the study, the most common risk factors leading to adverse outcome were in the male gender, age (middle and elderly), with hypertension and diabetes mellitus (DM) as predominant comorbidities, early onset dyspnea, high C-reactive protein (CRP), high neutrophil to lymphocyte ratio (NLR), high D-dimer, bilateral lower zone involvement of lungs in chest X-ray (CXR), and development of acute kidney injury (AKI). Conclusion: The characteristics of the severely ill COVID-19 patients highlighted in the study could help clinicians in the early identification and management of high-risk patients. This study would help with resource planning and preparation for further COVID-19 waves and future pandemics.

Efficacy of a biosimilar ranibizumab monotherapy for the treatment of retinopathy of prematurity

Purpose: To evaluate the efficacy of a biosimilar ranibizumab (Razumab) on outcomes of retinopathy of prematurity (ROP) for the first time. Methods: This retrospective study included infants presenting with stage 3+ ROP either in zone 1 or zone 2 posterior or aggressive posterior ROP (APROP). All eligible infants received intravitreal razumab (0.25 mg/0.025 ml) monotherapy. Follow?up was continued monthly till complete retinal vascularization was achieved while retreatment with razumab was given when recurrent neovascularization was noted. In case of no recurrence but incomplete vascularization, laser photocoagulation was done to the residual avascular retina. Results: We included 118 eyes of 59 infants with a median gestational age of 30 weeks and median birth weight of 1250 grams. At presentation, APROP was found in 28 eyes (24%) of 14 babies while stage 3 disease was seen in zone 1 in another 28 eyes (24%) and the remaining 62 eyes (52%) had stage 3 ROP in zone 2 posterior region. Complete resolution of ROP along with complete vascularization was seen in 22 eyes (19%) at a median of 55 days (IQR = 31–56 days) and 42 eyes (35%) showed a recurrent neovascularization at a median of 51 days post razumab (IQR = 42– 55 days). The cumulative incidence of recurrence of neovascularization (21%, 95% CI = 14%–29%) peaked at seven weeks and was significantly higher in eyes with APROP (43%, 95% CI = 27%–63%) compared to eyes without APROP (13.4%, 95%CI, 8%?22%) (P < 0.001). Conclusion: Razumab appears to be safe and effective in treating ROP, with about a third requiring reinjection at seven weeks after the first dose.

Rhino-orbital-cerebral mucormycosis: An epidemiological study from a tertiary care referral center in Western India

Purpose: Rhino?orbital?cerebral mucormycosis (ROCM) is a rare opportunistic fungal infection with a fulminant course and an often fatal outcome. It can occur in immune?compromised patients such as those having uncontrolled diabetes, on long?term corticosteroid or immunosuppressive therapy, with COVID?19 infection, renal failure, AIDS, malignancy, or organ transplant. The aim of our study was to study the epidemiology of mucormycosis in COVID?19 patients and identify its risk factors. Methods: Ours was an epidemiological study wherein we gathered the demographic, clinical, histopathological, and radiological data of 458 patients of mucormycosis who presented to us between August 2020 and May 2021. Mucormycosis was defined through clinical and radiological findings or positive culture reports. Results: Out of all, 20.74% of patients did not have any past or concurrent history of COVID?19. The most common symptom of mucormycosis was orbital/facial pain (38.64%) and the most common sign was periocular/facial edema (50.74%). Mucormycosis involving the nose and sinuses (94.54%) was most common followed by rhino?orbital (45.41%) and brain involvement (10.04%). The most common risk factor for mucormycosis was diabetes [81.92%], followed by corticosteroid use [79.69%] and supplemental oxygen [48.90%]. Most of the patients received similar treatment with IV amphotericin B [88.64%] and local debridement [80.74%]. Conclusion: With the third wave of COVID?19 still lurking, a fatal fungal infection should be kept in mind in COVID?19 active as well as recovered patients, especially those who have co?morbid medical conditions such as uncontrolled diabetes and who are treated with large doses of corticosteroids.

Correlation of Red Blood Cell Indices and RBC Histogram with Peripheral Blood Smear Findings in Anemia

The advent of automation has made diagnosis of Anemia and to some extent its underlying cause easy. The objective of our study is to correlate RBC indices and RBC Histogram findings with peripheral smear to provide a better approach in accurate diagnosis of Anemia and to analyze their limitations. All cases of Anemia as per WHO reference range of Hemoglobin levels were included in our study. Patients who have received medical treatment for Anemia in past three months, patients having recent history of blood transfusion, patients having Leukemia or Leukemoid reactions were excluded from the study. Venous blood samples collected from these patients were run in SYSMEX automated hematology analyzer and complete blood count, Red Blood Cell (RBC) indices ie, Mean Corpuscular Volume (MCV), Mean Corpuscular Hemoglobin (MCH), Mean Corpuscular Hemoglobin Concentration (MCHC), Red Cell Distribution Width (RDW) and RBC Histogram were obtained and peripheral smears were examined. Anemia typing was done based on RBC indices and position, shape and skewing of RBC histograms, followed by peripheral smear examination for morphological typing of Anemia. The diagnoses made by peripheral smear versus RBC histogram and indices were compared and analysed

Evaluation of Risk Factors in Retinal Vein Occlusions (RVO).

Purpose: A study of various ocular & systemic risk factors in Retinal Vein Occulation (RVO) at Tertiary Eye Care Centre. Methods: A prospective study included 50 eyes of 50 patients, in period of September 2010 to August 2012.INCLUSION CRITERIA: 1.Age>25years, 2. All newly diagnosed cases of Vein Occlusion. EXCLUSION CRITERIA: 1) Age<25years 2) All other ocular diseases causing significant visual impairment. A detailed history, ophthalmic & systemic examinations with all necessary investigations- as and when required were done. Results: In our study, RVOs were more common in males-26(52%) & in 56-65 years of age group -16(32%). BRVOs were more common than CRVO- Nonischemic (26%)>Ischemic (24%). In risk factors –most common was hypertension –in 38(76%) patients. Followed by descending order, Hyperlipidemia 27 (54%)> Diabetes Malitus16 (32%)> Tobacco14 (28%)>HyperHomocystinemia4 (8%)> severe Alcohol2 (4%).The complications were more in Ischemic than Nonischemic-CRVO>BRVO-they were Macular edema 43(86%)>Neovascularization at Iris-14(28%)> Neovascularization at Angle-10(20%)> Neovascular Glaucoma-4(8%). Conclusions: RVOs are more common with increasing Age, in Males & most common risk factor is Hypertensive. Most common cause for vision loss is Macular Edema- Ischemic>Non-Ischemic.

A study of evaluation of various risk factors of retinal vein occlusion.

Background: A study of various ocular & systemic risk factors in Retinal Vein Occulation (RVO) at tertiary eye care centre. Methods: A prospective study included 50 eyes of 50 patients, in period of September 2010 to August 2012. Inclusion criteria: 1. Age >25 years, 2. All newly diagnosed cases of vein occlusion. Exclusion criteria: 1. Age <25 years 2. All other ocular diseases causing significant visual impairment. A detailed history, ophthalmic & systemic examinations with all necessary investigations-as and when required were done. Results: In our study, RVOs were more common in males – 26 (52%) & in 56-65 years of age group - 16 (32%). BRVO (Branch Retinal Vein Occlusion)s were more common than CRVO (Central Retinal Vein Occlusion) - Nonischemic (26%) >Ischemic (24%). In risk factors - most common was hypertension - in 38 (76%) patients. Followed by descending order, hyperlipidemia 27 (54%) >diabetes mellitus 16 (32%) >tobacco 14 (28%) >hyper homocystinemia 4 (8%) >severe alcohol 2 (4%). The complications were more in ischemic than Nonischemic-CRVO >BRVO - they were macular edema 43 (86%) >neovascularization at iris - 14 (28%) >neovascularization at angle - 10 (20%) >neovascular glaucoma – 4 (8%). Conclusion: RVOs are more common with increasing age, in males & most common risk factor is hypertensive. Most common cause for vision loss is macular edema - ischemic >non-ischemic.

Uterine leiomyoma: clinical profile at civil hospital, Ahmedabad.

Introduction: Fibroid is the commonest tumor of the reproductive tract. This study was carried out to observe the frequency of fibroids in relation to age, parity, type and method of diagnosis along with clinical manifestations. Material & Method: The material comprised of 100 specimens of lesions of uterus received from patients admitted in Civil Hospital, Ahmedabad. Among these 37 patients presenting with fibroid uterus were included in the study. All details of the case consisting of age & parity, clinical history, relevant investigations, gross features and microscopic features were noted. Observations: Out of the 100 cases, clinical diagnosis of leiomyoma was made in 30 cases and on confirmatory diagnosis by histopathological analysis leiomyoma was observed in 37 cases. Most cases were found in late reproductive and perimenopausal years (89.19%). Majority was multiparous (81.08%) and 5.41% were nulliparous. Menorrhagia was commonest (40.54%), pain was second common symptom (27.02%). Leiomyomas were multiple in 59.46% and commonest variety was intramural (67.57%). Conclusion: Leiomyomas are found frequently in late reproductive and perimenopausal years. Multiparous patients are found to have fibroids more frequently than nulliparous. Most leiomyoma were intramural. Menorrhagia was the commonest clinical feature observed in leiomyoma cases.

Study of prescribing patterns of antimicrobial agents in the medicine department at tertiary teaching care hospital in Gujarat.

Prescription of drugs which needs to be continuously assessed and refined accordingly. It is not only reflects the physician’s knowledge of pharmacology and pathophysiology of diseases but also his/her skill in diagnose and attitude towards selecting the most appropriate cost effective treatment. Antimicrobials are among the most commonly prescribed drugs in hospital. As per literature, they account for nearly 20% of all new and repeat prescription each year. Hospital purchase of these drugs is thought to be about 25 to 30 % of the total annual drug budget. Such studies have been sparse from Gujarat and hence, this study was undertaken. Objective: This study was carried out to find out the prescribing patterns of antimicrobial drugs in the medicine department at tertiary teaching care hospital, Vadodara (Gujarat). Methods: Retrospective study was carried out by collecting 350 prescriptions containing antimicrobial agents of the indoor patients admitted (Oct 2005 to June 2006) in the wards of medicine department at Sir Sayajirao General (SSG) Hospital, Vadodara to assess the prescribing patterns of antimicrobial agents. All the information about drugs details were recorded in pre-tested proforma. Results: In our study, total 350 prescriptions containing 539 antimicrobial drugs were prescribed in-patients during study. Of them β –lactam (except CP) (159; 29.49%) and cephalosporin (156; 28.94%) groups were commonly prescribed. Average number of antimicrobials per prescription was 1.54.Out of 539 antimicrobial agents prescribed, 486 (90.16%) were prescribed by generic name, while only 53(9.53%) were prescribed by trade name. Total numbers of antimicrobial prescribed by parenteral route were 313(58.07%), while 226(41.93%) antimicrobial agents were prescribed by oral route. Conclusion: Results indicate that noticeable controlled over the prescribing habits of the physicians for indoor patients at our hospital. It is suggested that further detail analysis to judge the rationality of the therapy is necessary.

A cross-sectional study of ocular morbidity in urban slums non-schooling children of Ahmedabad City, Gujarat.

Background: Data on eye diseases among non-schooling children is very rare. Considering the fact those 19 million visually impaired children, 12 million children are due to refractive errors while 1.4 million are irreversibly blind for the rest of their lives. Early detection and treatment of ocular morbidity among children is important. Objective: To estimate the prevalence of ocular morbidity among urban-slums, non-schooling children of age 0-15 years. Methods: A cross sectional community based study was carried out in five slum areas of urban health training center, Asarwa, adopted by Dept. of Community Medicine to cover non-schooling children of below 15 years of age, from November 2010 to December 2010. Information was collected on a pretested semi structured proforma. An ophthalmologist from Regional Institute of Ophthalmology (RIO) did visual acuity and detailed ophthalmic examination. Data was analyzed with appropriate statistical tests like simple proportions and chi-square (x2) test. Result: Total 391 (14.2%) children in urban –slums community, who were not going to school, were included. Prevalence of ocular morbidity was 21.2%, Trachoma 4.9%, vitamin A deficiency 3.6 %, conjunctivitis 3.3%, refractive errors 3.3% squint 2.5% & color blindness 1.0%. Overall prevalence of ocular morbidity in government hospital and non-schoolings did not show any statistical significant difference. Conclusion: A high prevalence of ocular morbidity among non-schooling children was observed. School health services should be further expanded as child health check-up for the benefit of non-schooling children as well.

Histological study of adenomatous goitre.

Background & objectives: Multinodular goitre is probably the most common endocrine problem in the world today. Neither a well formulated nor a simple procedure is available for the management of MNG, hence the need for the present study. The aim was to study the various modes of presentation, the distribution with respect to age and sex and the usefulness of histological evaluation. Methods: This was a retrospective study of 100 cases of thyroid lesions during the period of April 2009 to October 2010. Results: Adenomatous goiter was found to be the commonest lesion with a frequency of 52 cases (52%).Most of the patients were female accounting for 90.39%. Most of the cases (53.85%) were noted in 21-40 years age group. Commonest presentation was swelling in front of the neck noted in 98% of cases. Conclusion: Commonest histological observation in the present study was adenomatous goitre in 52%. Majority of the patients were females with a M:F ratio of 1:9.4, with the commonest age group being 31-40 yrs. Almost all patients presented with swelling in front of the neck, with other complaints being that of pain, discomfort, dysphagia, dyspnoea and features of hyperthyroidism.