Sociodemographic profile and clinical outcome of mild–moderate COVID-19 patients admitted in a dedicated COVID hospital during first wave of pandemic

Background: COVID-19 pandemic quickly became significantly major cause of worldwide morbidity and mortality over the next years till date in an unforeseen manner. Aims and Objectives: Our study aims at unfolding the sociodemographic, epidemiological, and clinical characteristics of this disease, based on a metropolitan dedicated tertiary care hospital of India. Materials and Methods: Along with patient particulars, we recorded sociodemographic data, presenting symptoms, vital parameters, and blood parameters based on a pre-designed questionnaire, followed by complication analysis for 101 patients. Written consent was taken from each of the respondent before the interview and ethical approval was taken from Institution Ethics Committee (IEC) of Medical College and Hospital. [(Ref No. MC/KOL/IEC/Non-Spon/842/11/2020), Date- 5/11/2020]. Results: This study justified the trend of already available data such as median age of presentation (40–69 years), higher urban population (85.1%), higher rate of infection in health-care professionals (12.9%), and in patients with poor socioeconomic status. It revealed increased community transmission (74.3% with no definitive exposure), higher number of symptomatic cases admission (89.1%) with most common symptoms being fever (46%), shortness of breath (45%), sore throat (32%), and cough (26%). Hypertension (48%) and diabetes (34%) were major comorbidities in patients who were also proportionally more symptomatic and experienced more adverse effects compared to non-comorbid patients. A major chunk of the patients (46.53%) required some form of oxygen support for their treatment. Most common adverse effect was disseminated intravascular coagulation (23.76%) among which 67.74% had one or more comorbidities. We also reported slightly higher number of deaths (6.9%) compared to what other similar studies found. Conclusion: History of probable exposure was not a sole risk factor of acquiring infection, that is, community transmission was evident. Healthcare professionals were at high risk of getting infected, persons with comorbidity are at the highest risk of developing symptoms as well as complications.

A study on gender preference among pregnant mothers attending antenatal clinic of a tertiary care hospital, Kolkata

Background: A balanced sex ratio is needed to stabilize India, a patriarchal subcontinent. Aim and Objective: The study aims to find out whether there is any association between the socio-demographic characters and perceived gender preference among the study subjects. Materials and Methods: The study is an observational, descriptive study with cross-sectional study design. An exit interview of 80 pregnant mothers, both primi and multigravida, selected by systematic random sampling attending antenatal clinic of Medical College, Kolkata for 1st time was conducted for 1 month, using a pre-designed pre-tested semi-structured data collection form after ethics committee approval. Statistical analyses were done using Chi-square tests, at P ? 0.05 level of significance in Statistical Package for Social Sciences. Results: Mean age of study participants was 24.15 ± 4.38 years. The majority (77.5%) of them belonged to age group 20–29 years. 58.8% mothers were nulliparous, 53.8% from rural areas, 63.7% followed Islam, 52.5% from joint family, 31.3% belonged to middle class. 95% of the mothers had no history of abortion. Regarding education, the majority (32.5%) of the study participants were educated till secondary level. Among their husbands, 28.7% were educated till middle level. 40% study participants had no any gender preference, 40% had male preference and 20% had female preference. Main reason behind male preference was an earlier female child. Some preferred daughters due to their earlier male child. Nulliparous mothers had no gender preference while lesser-educated mothers had gender preference. Conclusion: The majority of the study participants had gender preference. Male preference was more than female preference.

Management protocols for chronic heart failure in India

Heart failure is a common clinical syndrome and a global health priority. The burden of heart failure is increasing at an alarming rate worldwide as well as in India. Heart failure not only increases the risk of mortality, morbidity and worsens the patient’s quality of life, but also puts a huge burden on the overall healthcare system. The management of heart failure has evolved over the years with the advent of new drugs and devices. This document has been developed with an objective to provide standard management guidance and simple heart failure algorithms to aid Indian clinicians in their daily practice. It would also inform the clinicians on the latest evidence in heart failure and provide guidance to recognize and diagnose chronic heart failure early and optimize management.

Serum lipoprotein ratios as markers of insulin resistance: A study among non-diabetic acute coronary syndrome patients with impaired fasting glucose.

Background & objectives: Recent data suggest that insulin resistance can predict cardiovascular disease independently of the other risk factors, such as hypertension, visceral obesity or dyslipidaemia. However, the majority of available methods to evaluate insulin resistance are complicated to operate, expensive, and time consuming. This study was undertaken to assess whether serum lipoprotein ratios could predict insulin resistance in non-diabetic acute coronary syndrome (ACS) patients. Methods: Ninety non-diabetic patients with impaired fasting glucose admitted with a diagnosis of ACS were included in the study. At the time of admission fasting glucose and insulin concentrations were measured. The homeostatic model assessment-insulin resistance (HOMA-IR) was used for insulin resistance. The fasting serum total cholesterol (TC), triglycerides (TG) and high density lipoprotein cholesterol (HDL-C) levels were checked, and then TC/HDL-C and TG/HDL-C ratios were calculated. The areas under the curves (AUC) of the receiver operating characteristic (ROC) curves were used to compare the power of these serum lipoprotein ratios as markers. Results: Lipoprotein ratios were significantly higher in patients with HOMA-IR index > 2.5 as compared to patients with index <2.5 (P < 0.05). Both TG/HDL-C and TC/HDL-C ratios were significantly correlated with HOMA-IR (P<0.05). The area under the ROC curve of the TG/HDL-C and TC/HDL-C ratio for predicting insulin resistance was 0.80 (95% CI, 0.67 to 0.93), 0.78 (95% CI, 0.65 to 0.91), respectively. Interpretation & conclusions: The findings of this study demonstrate that serum lipoprotein ratios can provide a simple means of identifying insulin resistance and can be used as markers of insulin resistance and cardiovascular diseases risk in adult non-diabetic patients.

Castlemans disease in HIV infected patient from eastern India.

Castlemans disease is a rare lymphoproliferative disorder. We report a patient of Castlemans disease with advanced HIV infection who responded well to conventional HAART. This case is interesting because of the rarity of the disease in the eastern part of India and its good out come with antiretroviral therapy.

Effect of chitosan on lipid levels when administered concurrently with atorvastatin--a placebo controlled study.

In a placebo controlled trialthe lipid lowering effects of chitosan, a unique dietary fibre, was assessed when given along with atorvastatin 10 mg in patients with chronic coronary heart disease. Altogether 100 patients were studied. They were randomly allocated in two groups of 50 patients each. Patients of group A received atorvastatin 10 mg before dinner plus 2 g/day chitosan in two divided doses. The groupB patients received atorvastatin 10 mg plus placebo. Patients were followed up for a period of 6 weeks. There was significant reduction in mean body weight in group A patients (3.14% versus 1,29% of body weight, p<0.05). There was also a significant rise in HDL cholesterol value (3.8% versus 1.07%, p=0.02) in group A patients. However, there was no significant reduction in the mean values of total cholesterol, LDL cholesterol and triglyceride in the two groups, although group A patients showed marginally lower values.

Carotid intima media thickness: an independent marker for assessment of macrovascular risk in diabetic patients.

In view of the global epidemic of diabetes with India being the hottest reservoir of the disease, it was tried to identify carotid intima media thickness as a surrogate marker for atherosclerosis in diabetic subjects. The study becomes more relevant because diabetes is now considered a disease of the endothelium and a risk equivalent of coronary atherosclerosis (paradigm shift). The study incorporated 41 normotensive patients of diabetes and 31 age and sex matched controls. Plasma glucose and lipid profiles were assessed in all and the carotid intima media thickness was measured. Results were statistically analysed for significance and correlation coefficient between values of plasma glucose and carotid intima media thickness. Results clearly showed that carotid intima media thickness abnormality can pick up atherosclerosis even if the lipid parameters are nearly normal. So it crystallises from this small study that, as a non-invasive test carotid intima media thickness is a better and early predictor of atherosclerosis in diabetic subjects. It also revealed the linear relationship between both fasting and postprandial blood sugar with carotid intima media thickness.

Predictive efficacy of Framingham's risk score in Indian scenario--a retrospective case-control study.

To assess the predictive ability of Framingham's risk score in primary prevention in our population, 252 cases and 212 age and sex matched controls were taken up for study. Those patients, who were presenting for the first time with acute coronarysyndrome (ACS) and who did not have any prior manifestations of coronary artery disease (CAD) and whose medical records were available formed the patient group. Framingham's risk score was calculated and the corresponding 10 years risk was assessed in each of them. The patients and controls were divided into two groups--diabetic and non-diabetic. Depending on the 10 years risk, they were further grouped into high risk (10 years risk > 20%), moderately high risk (10 years risk 10 to 20%) and low risk (10 years risk less than 10%). Results were compared and statistically analysed. In the diabetic patients with ACS 14% would have qualified as high risk, 33% as moderately high risk and 53% as low risk whereas in diabetic patients without any manifestation of CAD the distribution was 4% in the high risk, 54% in the moderately high risk and 42% in the low risk. In the non-diabetic subjects, amongst the patients of ACS, 20% would have been in high risk, 39% in moderately high risk and 41% in the low risk. The corresponding figures in the non-diabetic control subjects were 10% in high risk, 22% in the moderately high risk and 68% in the low risk. In the non-diabetic subjects, the mean risk was significantly more in patients than in controls (14.15% versus 8.61%, p <0.01). However, in the diabetic patients there was no significant difference in the mean projected risk between patients with ACS and patients without any manifestation of CAD (11.37% versus 10.41%, p>0.05).

Mucocutaneous manifestations of HIV infection.

BACKGROUND AND AIMS: Human immunodeficiency virus (HIV) is associated with various mucocutaneous features, which may be the first pointer towards the existence of HIV infection. This study was done to note the different mucocutaneous lesions present in the HIV population in eastern India. METHODS: Four hundred and ten HIV seropositive patients attending the outpatient and inpatient departments were included in the study. RESULTS: Out of 410 HIV positives, 40% had mucocutaneous involvement at presentation. The mean age of the study population was 29 years and male to female ratio was 2.5:1. The common mucocutaneous morbidities included oral candidiasis (36%), dermatophytosis and gingivitis (13% each), herpes zoster (6%), herpes simplex and scabies (5% each). A striking feature, noted in 36% males, was straightening of hairs. Genital herpes was the commonest genital ulcer disease. Lesions associated with declining immunity included oral candidiasis, oral hairy leukoplakia and herpes zoster with median CD4 counts of 98, 62 and 198/ L respectively. CONCLUSION: Early recognition of mucocutaneous manifestations and associated STDs help in better management of HIV/AIDS.

People living with HIV infection / AIDS - A study on lymph node FNAC and CD4 count.

Between July 1997 and December 2000, 1616 HIV seropositive persons were identified by Western Blot test at the School of Tropical Medicine, Kolkata. Four hundred seventy two (29.2%) of them had generalized lymphadenopathy. CD4 count could be done in only 54 of these 472 subjects (11.4%). These 54 patients, consisting of 40 males (74%) and 14 females (26%) were the subjects of the study. Their mean age was 29.5 years. In all these subjects, FNAC was done from the enlarged lymph nodes (non-inguinal). Reactive hyperplasia was seen in 30 cases (55.5%) whose absolute CD4 count varied between 411-945 cells/microL (median value 670 cells/microL). Evidence of tuberculous lymphadenitis was detected in 22 (41%) with CD4 counts varying between 113 and 422 cells/microL (median value 212 cells/microL). Non-Hodgkin lymphoma was diagnosed in 2 cases (3.7%) with CD4 count 79-113 cells/microL. All patients had evidence of HIV-1 infection, excepting one case of dual infection (HIV-1 and 2).

Study on early intervention with ACE inhibitor in myocardical infarction and short term outcome.

The present study was carried out on 100 patients with acute myocardial infarction (AMI) being treated with angiotensin converting enzyme (ACE) inhibitor and another 80 patients with conventional treatment but without ACE inhibitor during the period from May 1, 1995 to August 7, 1996 in Medical College, Calcutta. Clinical and other laboratory investigations including echocardiographic parameters were noted and recorded meticulously within 24-48 hours after AMI and repeated at 4th week. The present study based on non-invasive methods other than haemodynamic methods has shown that the echocardiographic assessment of left ventricular functional parameters after 4 weeks of ACE inhibitor therapy (n = 100) were better in treated group in comparison to control group without ACE inhibitor (n = 80) and the difference was statistically significant at 99% level of confidence. Overall mortality was 4% in ACE inhibitor group and 8.75% in the control group. This short term study with early intervention with ACE inhibitor within 48 hours of AMI has shown statistically significant evidence of beneficial effect of ACE inhibitor in improving the ventricular functional parameters and also reducing short term mortality from cardiac cause within 4 weeks compared to the group not receiving ACE inhibitors.

A comparative study of balloon mitral valvuloplasty and closed mitral commissurotomy in patients with rheumatic mitral stenosis.

Rheumatic mitral stenosis is frequently encountered in our country. It affects younger population and is a major cause of morbidity Mitral valvotomy is the definitive therapy for this disease and can be achieved by closed mitral commissurotomy (CMC), open mitral commissurotomy (OMC) or by percutaneous transluminal mitral valvuloplasty (PTMV). Compared to CMC, PTMV is less invasive but more expensive at this moment. With the reduction of cost, PTMV may become the procedure of choice for the treatment of rheumatic mitral stenosis in future.

Interplay of matrices in cartilage synovial fluid combine under moderate & high loadings.

Interplay of the constituents of the articular cartilage synovial fluid combine and its role was examined through the biochemical and rheological studies on bovine joints. The results showed an inverse relationship between the changes in the hyaluronic acid of synovial fluid and the proteoglycans content in articular cartilage together with alterations in the rheological properties of synovial fluid. The study indicated that the inter-movement of fluid solutes across the cartilage and synovial fluid may have an important role in the pathophysiology of osteoarthritis.

Efficacy of sodium antimony gluconate and ketoconazole in the treatment of kala-azar--a comparative study.

The present study was undertaken to determine the efficacy of ketoconazole in comparison to sodium antimony gluconate (SAG) in the treatment of kala-azar. The study was conducted at two centres: All India Institute of Medical Science, New Delhi and Calcutta School of Tropical Medicine, Calcutta. A total of 180 patients with proven kala-azar were recruited. After preliminary investigations, the patients were randomly divided into 2 groups: One group received ketoconazole in a dose of 600 mg/ day in 3 divided doses for 4 weeks while the other group was treated with SAG at a dose of 20 mg/kg/day up to a maximum of 850 mg/day for 4 weeks. The patients were followed up by clinical examination, liver functions, haemogram and the bone marrow/splenic aspiration. Responders were followed up at 3 and 9 months of intervals. Of 90 cases in SAG, 78 (81.7%) got cured initially while under ketoconazole group, only 26 (33.3%) of 78 patients responded initially (p < 0.001). After 3 months of follow up, 75 of 78 SAG-responders (96.2%) and 24 of 26 ketoconazole-responders (92.3%) continued to be in remission. Despite the fact that 2 patients in each group were lost to follow up at 9 months, similar observations were noted with only one relapse in SAG group. The response to SAG was comparable at the two centres. However, the response to ketoconazole was better at Delhi centre as compared to that at Calcutta. There were no significant side effects or hormonal changes in any of the patients in ketoconazole group at Delhi centre. Significantly higher side effects were reported at Calcutta centre in ketoconazole group (P < 0.05). No satisfactory explanation can be given for this difference in response to ketoconazole at two centres. However, it is known that leishmanial parasites of different geographical origin differ in their response to different drugs and this could be one of the reasons for difference observed in response rate to ketoconazole as the study involved different populations of people.

Effect of moderate & high loadings on the proteoglycans & water content of bovine knee joint articular cartilage.

Variations in proteoglycans and water content of the knee joint cartilage were found to occur when the joint was subjected to articulating motion under moderate and high loadings. It was found that at a moderate load of 150 kg there were an increase in the percentage of proteoglycans but the percentage decreased when the joint was articulated at a high loading of 300 kg. It has also been observed that the ratio of water content and the proteoglycans decreased at moderate load, whereas the ratio increased at high load. The observed changes in proteoglycans and water content in extracellular matrix with moderate and high loadings suggested that articular cartilage properties respond to mechanical stresses.

Risk factors and their implication on silent myocardial ischaemia.

Sixty-five cases were evaluated for silent myocardial ischaemia (SMI) by computerised treadmill test (TMT) and ambulatory electrocardiographic monitoring (AEM). There were 59 males and 6 females. The cases were divided into GP-I-stable angina (35 cases) GP-II-stable angina after myocardial infarction (15 cases) and GP-III-asymptomatic (15 cases). Age in each group ranged from 36 years to 62 years (GP-I), 40 years to 68 years (GP-II) and 36 years to 48 years (GP-III). Conventional risk factors viz. hypertension, diabetes mellitus, hyperlipidemia, smoking and family history were assessed with a view to see their implication on SMI. 43 patients (62.2%) were found to have SMI including mixed episodes. Out of these 43, TMT was positive in 29 patients (67.4%), AEM was positive in 41 patients (95.3%) and both TMT and AEM were positive in 27 patients (62.7%). Correlative analysis between risk factors and SMI revealed that higher number of was associated with not only more positive TMT and AEM test along with increased episodes of SMI but also increased degree of ST-T depression. It was also found that AEM is more sensitive than TMT (80% Vs 48%) for diagnosing SMI (SED = 9.03%), though specificity of the tests is same (93.3%).