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.

Role of diagnostic hysterolaparoscopy in the evaluation of infertility among the patients attending one of the tertiary care centers of Ahmedabad, Gujarat

Background: Reproduction is the basic expectation of human life. There is worldwide increase in incidence of infertility due to many factors such as delaying child-bearing, increase in lifestyle disorders, and stress to achieve personal and professional goals. The incidence varies between 5 and 15%. Aims and Objectives: The aims of this study were to evaluate the factors responsible for infertility using diagnostic hysterolaparoscopy among the patients attending tertiary care hospital. Materials and Methods: It was a prospective study conducted from December 2018 to May 2022 in Obstetrics and Gynecology Department of GCS Medical College, Ahmedabad. Around 150 patients were included in study. All patients of primary and secondary infertility whose hormonal profile was normal were included in the study. Results: In the present study, primary infertility was present in 73% of cases where as 27% were having secondary. Majority (43%) of patients of the primary infertility belonged to age 26–30 years and 29% of secondary infertility cases were in the age group 31–35 years. Tubal factors were highest (32%), followed by ovarian factors (29%), peritoneal factors (11%), and uterine factors (9%). Among tubal factors, bilateral block was present in 19% and unilateral tubal block in 11%; among ovarian factors, polycystic ovary syndrome was highest (18%) and in peritoneal factor, endometriosis was seen in 6%. In uterine factors, fibroid was present in about 8% of cases. Conclusion: Diagnostic hysterolaparoscopy provides reliable information in evaluation of infertility and determining various causes such as tubal, ovarian, peritoneal, and uterine.

Laparoscopic Management Of Adnexal Mass

Background:Laparoscopy is a widely used procedure in gynecological cases both for diagnostic and operative procedures. It is recommended due to lesser hospital stay, less post operative pain and better panoramic vision. Aim of the study is to assess the effectiveness of laparoscopic intervention of adnexal masses with benign pathology in recent series of consecutive patient. The focus is on pathology findings, length of stay, operating time, complications and laparotomy conversion rate. Material And Methods: This was a prospective observational study conducted at tertiary care hospital in Department of Obstetrics & Gynaecology during period of 1stAugust 2018 to 31st July 2020.This study consists of 70 patients, who presented with symptoms like pain in abdomen, bleeding per vaginum, irregular menses, excessive white discharge, distension of abdomen, infertility visiting outdoor patient department either diagnosed clinically(sign and symptoms) or by ultrasonography of adnexal masses. Result:Maximumpatients in this study were in age group 21-30 years. Maximum patients(21.42%)were having simple cyst. Among laparoscopic procedure most common procedure was left ovarian cystectomy(38.57%). Mean operative duration was 40.78 min and average duration of hospital stay was 3 days. There were minimal peri-operative complications; commonest being postoperative fever. Conclusion:Ade quatesurgical skill, case selection, multi disciplinary team approach and expert laproscopic surgical team are imperative for good patient outcome. This study gives an overview of experience in favour of laproscopic management of benign adnexal mass

Acro-osteolysis and mononeuritis multiplex as a presenting symptom of systemic angiitis of Wegener's type.

Wegener's granulomatosis is a multisystem disorder involving small- and medium-sized vessels, leading to granuloma formation and involvement of upper and lower respiratory tract with or without glomerulonephritis. However, limited forms of angiitis and granulomatosis of the Wegener's type with oligosymptomatic and atypical site involvement are known to occur. We present here a rare case of limited form of angiitis and granulomatosis of Wegener's type who presented sequentially with spontaneous resorption of digits with acro-osteolysis and mononeuritis multiplex over a period of 10 months. His vasculitic workup revealed high proteinase 3 antibodies (c-ANCA) titers and an almost asymptomatic lung involvement, detected on high-resolution computed tomography of chest. The patient was aggressively treated with immunosuppressive therapy, following which he showed good improvement.

Hyperhomocysteinemia as a risk factor for ischemic stroke: an Indian scenario.

BACKGROUND: Hyperhomocysteinemia has been proposed as an important risk factor for ischemic stroke worldwide, but data available from the Indian subcontinent is scarce. AIM: To study homocysteine levels in patients with ischemic stroke and compare it with age- and sex-matched controls. SETTINGS AND DESIGN: Case-control prospective study. MATERIALS AND METHODS: Fifty-seven patients with ischemic stroke and 30 controls were recruited for the study. They were subdivided into two subgroups (< 40 years and> 40 years of age) and plasma fasting total homocysteine (tHcy) levels were measured. STATISTICAL ANALYSIS USED: Student's 't' test and chi-square test. RESULTS: The tHcy were significantly high in patients with stroke, compared to controls (9.91 +/- 2.25 vs 8.00 +/- 2.74 micromol/l; P vs 8.45 +/- 2.72 micromol/l; P = 0.01) and female patients compared to controls (9.08 +/- 1.81 vs 6.79 +/- 2.60 micromol/l; P = 0.04). The tHcy levels were significantly high in patients with hypertension compared to normotensive patients (10.96 vs 9.49 micromol/l; P = 0.01) and smokers compared to nonsmokers (11.17 vs 9.33 micromol/l; P = 0.01). CONCLUSIONS: Hyperhomo-cysteinemia emerged as an important independent risk factor for ischemic stroke. A strong positive correlation was also observed between hypertension, smoking, and high-tHcy levels in the present study.

Molecular and functional characteristics, growth promoting effect and persistence of selected parent isolates and streptomycin resistant derivatives of rice rhizobacteria.

Molecular and functional characteristics of seven azospirilla and five phosphorus solubilizing bacteria (PSB) isolates of rice rhizosphere, growth promotion ability of two efficient strains, Azospirillum amazonense A10 (MTCC4716) and Bacillus megaterium P5 (MTCC4714) and their persistence based on streptomycin resistant derivatives (SRD), were determined. SDS-PAGE and isozyme banding patterns of the isolates were used to arbitrarily group the azospirilla into 4 and PSB into 3 clusters and as markers to ascertain their identity. The azospirilla produced 2.0 to 10.5 ppm of IAA like substances and showed nitrogenase activity of 0.02 to 3.55 nmole C2H4/hr/ml of pure culture. PSB isolates produced 7.8 to 15.0 ppm IAA like substances and 20 to 128 ppm soluble P. Induction of resistance to streptomycin resulted in changes of these properties. Co-inoculation of rice with SRD A10 and SRD P5 and their parental strains in separate treatments enhanced grain yield over control by 31 and 12.4%, respectively. Nitrogenase activity of rice roots under SRD co-inoculated treatment was higher (4.16 nmole C2H4/hr/hill) than that-under parental strains co-inoculated treatment (3.76 nmole C2H4/hr/hill). SDS-PAGE profile and population count of the strains confirmed their establishment in rice rhizosphere and persistence over a year after inoculation.

Naegleria meningitis: a rare survival.

Acute amebic meningoencephalitis caused by free-living amebae naegleria fowleri is extremely rare and uniformly fatal with only seven survivals reported till date. An interesting case of naegleria meningitis diagnosed by wet mount cytology of cerebrospinal fluid (CSF) and treated with amphoterecin B, rifampicin and ornidazole with complete recovery is presented. In cases of suspected pyogenic meningitis, if CSF staining, antigen detection or culture is negative for bacteria, a wet mount cytology of CSF for naegleria is suggested. Early treatment with amphoterecin B and rifampicin may improve survival.