ABSTRACT
Introduction: The coronavirus disease of 2019 (COVID-19) is a highly contagious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-COV-2). World Health Organization (WHO) declared it a pandemic on 11th March 2020. Injectable remdesivir (RDV), a repurposed antiviral, was first accorded approval by the United States of America (USA) Food and Drug Administration (FDA) on 1st May 2020, for emergency use to treat suspected or laboratory-confirmed COVID-19 patients. Interim analysis of the Solidarity trial revealed no benefits in patients treated with RDV in any group of patients with COVID-19. Here, we have attempted to place our data on the efficacy of RDV in patients of COVID-19 with moderate to severe categories. Materials and methods: A retrospective review and data analysis of 100 COVID-19 patients with reverse transcriptase polymerase chain reaction (RT-PCR)/rapid antigen test positive was performed. Among them, 50 received RDV in addition to the standard treatment protocol (STP), while the remaining 50 received only the STP. STP is an injectable steroid and heparin, along with other supportive management. Prevalent government guidelines were followed as per usual for the classification of the patients and treatment protocol. Every day of hospitalization, the status of respiratory support was checked, and every 3rd-day inflammatory markers [C-reactive protein (CRP) and D-dimer] were measured until the patient was discharged or died. Statistical analysis of the data was done using online software. Results: Age and comorbidity distribution in both groups ensures adequate matching between the two groups. A statistically significant difference in hospitalization days was obtained in RDV-treated patients (15 vs 19 days, p-value ?0.003). Statistically significant differences were not found in mortality (6 vs 10 deaths, p-value ?0.27) and reduction in oxygen (O2)/ventilatory support requirements (p-value ?0.75) in the RDV group as compared to other groups. The difference in the value of CRP (p-value 0.001) and D-dimer (p-value 0.049) on day 5 is statistically significant in the RDV group as compared to the other groups. Discussion: The finding of a reduction in days of hospitalization was similar to the Adaptive COVID-19 Treatment Trial (ACTT) 1 study conducted by Beigel et al. The mortality data were also comparable to those from WHO’s Solidarity trial. No similarity was found in data on the reduction in ordinal scale from higher to lower scale for O2/ventilatory support on day 10 from 0. Similarity regarding the reduction in values of inflammatory markers on day 5 was found in studies conducted by Kannan et al. and Stoeckle et al. Conclusion: We found mortality benefit and reduction in O2 requirements/ventilatory support in RDV plus STP-administered cases as compared to STP only, but statistically, this difference is not significant, which suggests that mortality benefit in the RDV group in our study is merely by chance. Here, we can definitely conclude that days of hospital stay and inflammatory markers are reduced in the RDV plus STP-administered group, and the difference between the two groups is statistically significant, which suggests that early use of RDV could shorten the time to clinical improvement.
ABSTRACT
Infestation is a state of being invaded or overrun by parasites. Myiasis is an infestation caused by dipterous fly. Even though human myiasis is a rare infestation particularly in newborn period unlike animal myiasis as neonate is just newly introduced to the environment and during this period neonate usually more protected and taken care by us. In rural areas of tropical countries where good hygiene conditions will not be there, authors are still identifying these cases. Risk factors for myiasis usually poor socioeconomic conditions and unhygienic environment. Finding cases of umbilical myiasis usually indicates poor environmental sanitary measures at that particular place. Here authors are presenting a case of neonatal umbilical myiasis caused by Chrysomya megacephala. These flies usually lay their eggs over the wounds or moisture dead necrotic tissues unlike other species of flies where they usually lay eggs over the animal fecus. But some other free-living flies(saprophagous) also cause myiasis due to accidental laying of eggs over dead necrotic tissues due to open defecation. In present case authors identified myiasis as early as third completed day of life, means infestation occurred at the time of delivery as incubation period for hatching eggs to larvae usually 4-8 days. These larvae able to survive inside deep tissue by breathing through a small hole. Even though myiasis usually have good prognosis it will become a focus for secondary infections. If deep-seated causes severe morbidity and even in extreme cases causes death also. Diagnosis is mainly clinical, authors can identify the species by microscopic examination of third stage larvae and finding age of the larvae also useful in identifying time of infestation. Treatments usually direct removal of larvae from the site by manipulation, irrigation, suffocation by ether and surgery if deep-seated. As they usually create nadir for infection by bacteria ruling out secondary infection and treatment is necessary. It is better to take preventive strategies like birthplace cleanliness and environmental sanitation. Tracking the case helpful in finding the places where authors need to improve sanitary measures it is better to give feedback to appropriate administrative officers to prevent home deliveries.
ABSTRACT
Background & objectives: Diabetes mellitus, both insulin and non insulin dependent, is an independent risk factor for coronary artery disease which have a larger infarct size, atypical ischemic symptoms and more post infarct complication than non diabetic patients.So the present study was undertaken with following objectives: (1) To study occurrences of various ischemic symptoms, complications and mortality between diabetics and non diabetics. (2) To find out the relation between duration of diabetes, glycemic control and mortality due to first episode of acute myocardial infarction. Methods: Total 100 cases of acute myocardial infarction included comprising 50 type 2 diabetic patients and 50 non diabetic patients. Patients having first episode of acute myocardial infarction and who is already known case of diabetes mellitus were included. Results: Highest incidence of first episode of acute myocardial infarction in diabetics was occurring at earlier age than non diabetics and more incidences in obese persons and diabetic females. There was less frequent occurrence of chest pain and perspiration in diabetics. Higher incidence of recurrent angina, bundle branch block, atrio-ventricular block and heart failure was noted in diabetics than non diabetics. 30 days mortality was higher in patients having Random blood sugar >198 gm% on admission and diabetes since more than 5 years. Interpretation & conclusion: In the present study, the overall conclusion has been made that in diabetic patients acute myocardial infarction occurs at earlier age, there are atypical ischemic symptoms and also higher incidence of complications and higher mortality rate. So in every patient of acute myocardial infarction glycaemia status should be assessed on admission and hyperglycaemia should be aggressively treated.