Coagulation profile of covid patients : A single tertiary teaching hospital in Rajasthan

Background: The COVID-19 has taken the world by storm. It primarily affects the lungs causing respiratory distress and leading to ARDS. Aim: The aim of this study is to evaluate the coagulation dysfunction in patients which predisposes the patients to venous and arterial thromboembolism due to excessive inflammation, hypoxia, immobilisation and diffuse intravascular coagulation (DIC). Material & Methods: We assessed 2281 COVID RT PCR positive patients who were admitted with moderate to severe disease in wards and ICU respectively. The coagulation profile was done for each of these patients and the tests included Prothrombin time (PT), Activated Partial Thromboplastin Time (APTT) and D-Dimer. The PT and APTT were estimated on ACL elite pro (Fully automated coagulation analyser) which is based on nephelometry. D- Dimer was measured using ACL elite pro and latex agglutination (semi quantitative method). Results: Out of 2281 COVID RT PCR positive patients 1655 (72.5%) were males and 626 (27.5%) were females. It was observed that percentage of patients admitted in ICU had increased D dimer values and it was statistically significant. Our study showed that larger number of patients admitted in ICU had PT value more than 12.5 seconds and APTT more than 35.5 seconds, however it was not statistically significant. Our study also demonstrated that patients having higher D dimer required longer hospitalization with significant p value. Conclusion: We concluded that assessment of coagulation profile is necessary for patients infected with this virus so as to prevent any thrombotic complications and therefore preventing morbidity and mortality.

Expert Opinion on Novel Fixed Drug Combination of Metformin Sustained Release and Vildagliptin Immediate Release for Type 2 Diabetes Mellitus Management in India

Type 2 Diabetes Mellitus (T2DM) is a highly prevalent cardiometabolic disorder in India and is further projected to rise (10.4% by 2030). In newly diagnosed patients, maintaining HbA1c 6.5-7.0% and minimizing glycaemic exposure, particularly during the first year following diagnosis, may be crucial for preventing complications. Early treatment initiation with a synergistic combination of vildagliptin and metformin is one of the many possible combinations to manage type 2 diabetes mellitus. In view of emerging clinical evidence on early initiation of combination therapy than monotherapy with metformin, there is a need for expert consensus on the use of the current approved Fixed Dose Combination (FDC) of Metformin SR + Vildagliptin IR in newly diagnosed diabetic patients. Experts framed final consensus statements based on available scientiûc evidence, experience and collective clinical judgment from practical experience this FDC.

Positioning of the fixed dose combination of Rosuvastatin + Clopidogrel + Aspirin in the Treatment of Cardiovascular Diseases

Dual anti-platelet therapy (DAPT) and statins are recommended by guidelines for the management of cardiovascular diseases (CVDs), even though the duration of treatment is guided by ischemic and bleeding risk. Clopidogrel and aspirin are the most commonly used DAPT in CVDs. Adding a statin to DAPT is helpful in reducing the thrombosis risk. Fixed-dose combination (FDC) therapy in CVD can help to address the factors of convenience, compliance, control, cost, and complication better than free drug combinations. Therefore, the FDC of rosuvastatin (10 mg or 20 mg) + clopidogrel (75 mg) + aspirin (75 mg) is likely to improve compliance in CVD patients, thereby reducing adverse cardiovascular outcomes and cost of treatment. There is lack of awareness on long term benefits of this FDC in Indian patients.

Estimates of major non-communicable disease risk factors for India, 2010 & 2015: A summary of evidence

Background & objectives: The National Monitoring Framework for the prevention and control of NCDs in India has set targets for reduction of risk factors relative to the measure recorded in 2010. Estimates for 2010 and 2015 were established using meta-analyses in the absence of a national risk factor survey till 2017. Methods: We searched national survey reports and also articles published in English from India between 2008 and 2017 in PubMed, Google Scholar and Cochrane review databases for specific risk factors among 18-69 yr Indians. Quality of studies was evaluated using Joanna-Briggs tool, but all studies were included in analyses. Estimates for each of the eight strata by age, gender and place of residence, respectively, were generated. MetaXL was used to calculate the pooled estimate for 2010 and 2015 using a random effects model. Strata-specific estimates were combined to arrive at national estimate using population weight of each stratum. The credibility of the estimates was determined using four parameters - average Briggs score; representativeness of the contributing studies and precision and stability of the estimates. Results: The estimates [95% confidence interval (CI)] for 2010 for different risk factors were as follows: current alcohol use, 15.7 per cent (13.2-18.2); current tobacco use, 27 per cent (21.4-32.6); household solid fuel use, 61.5 per cent (50.2-72.5); physical inactivity, 44.2 per cent (37.8-50.6); obesity, seven per cent (3.8-10.2) and raised blood pressure, 20.2 per cent (18.4-22.1). In 2015, compared to 2010, tobacco use showed a relative decline of 18 per cent, household solid fuel use of nine per cent and physical inactivity of 15 per cent. The estimates were stable for alcohol use, raised blood pressure and obesity between 2010 and 2015. All estimates varied between moderate and high degrees of credibility. Interpretation & conclusions: The estimates are consistent with other available estimates and with current national-level initiatives focused on tobacco control and improving access to clean fuel. These estimates can be used to monitor progress on non-communicable disease risk factor targets for India

Developmental and Morphological Variations of Frontal Sinus in Pediatric Age Group in Gurugram Region of Haryana – A Study

Background: The aim is to know gender wise development and morphological variation of the frontal sinus in the pediatric age group of Gurugram district of Haryana. The development and pneumatisation of the frontal sinus is the predictor of skeletal growth pattern. The craniofacial structures grow proportionately with the normal development of the body structures. Methods: In this prospective study, a total of 36 subjects were studied. The study was conducted in the Department of Radiodiagnosis of SGT Medical College, Budhera (Gurugram) Haryana from January 2019 to March 2019. This included 12 females and 24 males falling in the age group of 8-18 years. The frontal sinuses were evaluated on various morphological features. Plain X-Ray of paranasal sinus was evaluated by Caldwell’s view. The sinuses were evaluated for width, height, number of scallops, septations and supraorbital cells. Results: Average width and height of left frontal sinuses were 23.8 mm with the range of 5.5 – 43 mm and 28.4 mm with the range of 13-45 mm respectively. Average width and height of right frontal sinuses were 20.4 mm with the range of 9.8 – 39 mm and 20 mm with the range of 13-38 mm respectively. The average number of scalloping on right and left were 1.9 and 2.19 respectively. The septations were noticed in 13 (36.11%) on left and in 16 (44.44%) on right side. Supraorbital cells were found in 16 (44.44%) on left side and 17 (47.22%) on right side. Conclusion: There is a lot of variation in the appearance and development of the frontal sinus in pediatric age group. The dimensions had been found smaller on right side as compared to left side. Scalloping and supraorbital cells had been found more on right side than on the left side. Septations were more on left side as compared to right side.

Comparison of Conjunctival Autograft versus Amniotic Membrane Graft in Primary Pterygium Surgery

Purpose: The purpose of this study is to evaluate and compare the effectiveness of conjunctival autograft transplantation andamniotic membrane graft transplantation in pterygium surgery.Materials and Methods: This was a randomized, parallel group, Single-center study included 60 patients. 30 patients ofwhich underwent pterygium excision followed by Conjunctival autograft transplantation. The other 30 patients also underwentpterygium excision with amniotic membrane graft transplantation. Follow-up was done for 6 months to evaluate the post-operativecomplaints, graft integrity, and complications associated with each procedure.Results: Post-operative discomfort and watering were less in amniotic membrane graft group (P = 0.13%). Further, in amnioticmembrane group, there was less transient graft edema (P = 0.22) and conjunctival hyperemia (P = 0.004). However, graft losswas more (P = 0.33) and so was the conjunctival granuloma formation (P = 0.45) in the amniotic membrane group.Conclusion: Amniotic membrane graft is as effective and safe as conjunctival autograft with no major complications.

High-Dose-Rate Intracavitary Brachytherapy Boost Post-External Beam Radiotherapy Using Rotterdam’s Applicator In A Case Of Recurrent Carcinoma Nasopharynx

Long-term local control is possible in a highly radio-responsive tumor-like carcinoma of the nasopharynx, even in the recurrent setting. High-dose-rate brachytherapy boost with its steep dose fall-off helps achieve salvage by providing optimal dose coverage to the tumor volume which is in close anatomic proximity to critical structures at the base of the skull. Here, we report the case of a 58-year-old lady, an old case of carcinoma nasopharynx presented with recurrence of symptoms in the form of nasal blockade along with a right pre-auricular swelling. Further evaluation showed an fluorodeoxyglucose-avid nasopharyngeal mass, a biopsy from which was positive for nasopharyngeal carcinoma (NPC). She first received re-radiation with external beam radiotherapy using 6 MV photons to the face and neck along with concurrent chemotherapy withcisplatinfollowed by brachytherapy boost with Rotterdam’s Brachytherapy Applicator @5 Gray×2# 1 week apart. Brachytherapy is a feasible tool that allows dose escalation to achieve long-term tumor control in locally advanced NPCs.

A Comparative Clinical Study On Patra Pinda Sweda And Nadi Sweda In The Pain Management Of Gridhrasi W.s.r. To Sciatica

Gridhrasi as mentioned in Ayurveda explains a disorder where in pain starts from Sphik pradesha and radiates downwards to Kati, Prusta, Uru, Janu, Jangha and Pada, Due to this, the patient is unable to walk properly. Gridhrasi can be compared with Sciatica. Sciatica is a relatively common condition with a life time incidence varying from 13% to 40%. The corresponding annual incidence of an episode of Sciatica ranges from 1 to 5%. The incidence of Sciatica is related to age. It is rarely seen before the age of 20. Incidence peaks in fifth decade declines thereafter. Snehana and Swedana are considered as a general line of treatment for Vata Vyadhi which can be taken as a line of treatment for Gridhrasi also. Patra pinda Sweda (Vatashamak) and Nadi sweda (Vata Kapha shamak) is one such treatment modality comes under Snehana and Swedana is known for relieving the symptoms. Murchita Tila Taila due to its Vata Shamaka has been taken for the Sthanik abhyanga. 30 patients of Gridhrasi were randomly selected and divided into 2 groups. Group A: 15 patients received Patra pinda sweda and Group B: 15 patients received Nadi sweda up to Samyak Swinna lakshana. Overall assessment of both groups, out of 30 patients, 2 (6.67%) got complete remission, 13 (43.34%) patients got marked response, 6 (20%) patients got moderate response and 9 patients got mild response.

Drug utilization study in diabetic patients seeking medical treatment in a north Indian rural medical college hospital

Background: Diabetes Mellitus is a chronic disease and its life-long management causes burden on lifestyle and financial condition of the patients. Drug utilization studies provide useful insights into the current prescribing practices.Methods: To evaluate the drug utilization pattern of anti-diabetic drugs in diabetic patients. A prospective observational study was carried out in adult diabetic patients visiting the Wards and Outpatient Department of General Medicine of a tertiary care hospital. The demographic data and utilization of different classes of anti-diabetic agents as well as individual drugs were analyzed.Results: In 125 patients (Male-65, Female-60), a total of 379 drugs (average 3.032±2.05) were used per day, out of which 76 (20.05%) were rational fixed dose combinations (FDCs) and 261 (68.86%) were prescribed from National List of Essential Medicines (NLEM) 2015. The number of drugs prescribed to be ingested was 326 (86.01%) and 63 (16.62%) were injectables.Conclusions: It was found that the prescription tendencies of the doctors were quite rational. More improvement can be done by sensitizing them to prescribe more drugs from NLEM. The limitations in the affordability of rural population should be taken care of while prescribing drugs for this chronic disease.

Mature Ethmoid Sinus Osteoma - Incidental finding in CT.

Paranasal osteomas are not uncommon to be found as an incidental finding in routine radiological examinations. Many a times, this entity is found while undergoing computerized tomography (CT) for some other reason. Sometimes, patient comes with vague complaints not related to this finding but indirectly is responsible for few of these symptoms. We present a case of 18-years old male who presented with the complaint of vague headache of about one year duration. He underwent CT examination and was found to be having slightly uncommon mature type of ethmoid osteomas in addition to pan sinusitis.

Split Cord Syndrome (Type 1 Diastematomyelia): A Case Report.

Spinal dysraphism can present in various ways in the form of severity. Split cord is one of the presentations where two hemi cords are separated either by a fibrous septum or calcific spur. This may be accompanied with different other vertebral anomalies like block vertebra, hemi vertebra or spina bifida. We present a 8-years old girl who presented with weakness and gait disturbances since she started walking. She also had a tuft of hair on the back in the lumbar region. She underwent computerized tomography (CT) and magnetic resonance imaging (MRI) and was diagnosed as diastematomyelia with other associated anomalies.

Myroides Species: A Rare Cause of Endocarditis.

Myroides species are not part of human flora and are commonly found in soil and water. They are considered as low-grade pathogens. Genera Myroides are members of the family Flavobacteriaceae and comprise a group of yellow-pigmented, oxidase positive, non-motile, non-fermentative Gram-negative bacilli. However nowadays, they have been identified as causative agents in urinary tract infections, pneumonia, meningitis, fasciitis, and ventriculitis in immunocompromised patients, and a few life-threatening infections have been reported in immunocompetent individuals also. We present a case 32-year-old female known the case of rheumatic heart disease that underwent valve replacement around 17 years back. She was admitted with complaints of breathlessness since 3 days in an emergency for evaluation. She underwent redo mitral valve replacement. Intraoperatively, vegetations were present on the mitral valve. Subsequently, her blood culture grew Myroides spp. She responded well to treatment and discharged.

Protective role of diet supplements Spirulina and Tamarind fruit pulp on kidney in sodium fluoride exposed Swiss albino mice: Histological and biochemical indices.

Fluoride toxicity through potable water, particularly ground water, is not uncommon in countries such as India, China, Iran, Iraq, Turkey, parts of Africa and Afghanistan. Kidney being the main organ involved in fluoride removal, it accumulates considerable amount of fluoride. Here, we report toxic effects of oral exposure of Swiss albino mice to fluoride (sub-acute: 190 mg/kg body wt. for 7days; and sub-chronic: 94 mg/kg body wt. for 90 days) and recovery of sub-chronic fluoride exposed mice after 90 days of sodium fluoride (NaF) withdrawal. The role of diet supplements (Spirulina and tamarind fruit pulp @ 230 mg/kg body wt. independently as well as in combination) in amelioration of fluoride toxicity has also been screened. Compared with controls, feed intake decreased from 3-43%, body wt. 4-18%, and kidney wt. 5-12% in treated mice (except diet supplement groups of sub-chronic exposure) while their water intake increased from 4-43%. Histopathological changes in the cortical region of kidney in fluoride treated mice were as follows: dilation of bowman’s capsule and thickening of its parietal and visceral layer; alterations in glomeruli size and their sclerotization; increase in bowman’s space; proliferation of mesangial cells; reduction in podocyte counts; and dilation of proximal and distal tubules. Fluoride exposure altered tissue biochemistry (protein, acid phosphatase and alkaline phosphatase content) and increased urea (23-58%) and creatinine content (14-127%) in the serum. Sub-acute exposure was found more toxic. The diet modulation not only reduced fluoride toxicity but also led to better recovery of treated mice after withdrawal, especially in combination.

Fatal Superadded Nocardia Infection in a Case of Pulmonary Aspergillosis.

Pulmonary nocardiosis is a severe opportunistic infection in which chronic lung disease along with long term steroid therapy is the most significant predisposing factor. Demonstration of Nocardia in even potentially contaminated sample like sputum, warrant strong warning signal of association of the organism with the clinical condition because Nocardia are rarely encountered as laboratory contaminants. Immediate initiation of appropriate treatment is absolutely essential since any delay in diagnosis or treatment may prove detrimental to the extent of complete fatal outcome.

The role of melatonin in diabetes: therapeutic implications

Melatonin referred as the hormone of darkness is mainly secreted by pineal gland, its levels being elevated during night and low during the day. The effects of melatonin on insulin secretion are mediated through the melatonin receptors (MT1 and MT2). It decreases insulin secretion by inhibiting cAMP and cGMP pathways but activates the phospholipaseC/IP3 pathway, which mobilizes Ca2+from organelles and, consequently increases insulin secretion. Both in vivo and in vitro, insulin secretion by the pancreatic islets in a circadian manner, is due to the melatonin action on the melatonin receptors inducing a phase shift in the cells. Melatonin may be involved in the genesis of diabetes as a reduction in melatonin levels and a functional interrelationship between melatonin and insulin was observed in diabetic patients. Evidences from experimental studies proved that melatonin induces production of insulin growth factor and promotes insulin receptor tyrosine phosphorylation. The disturbance of internal circadian system induces glucose intolerance and insulin resistance, which could be restored by melatonin supplementation. Therefore, the presence of melatonin receptors on human pancreatic islets may have an impact on pharmacotherapy of type 2 diabetes.

Neonatal Aerophagia Dilemma – A Gastrointestinal Functional Disorder: Role of Imaging Studies.

Aerophagia is excessive swallowing of air which goes to stomach through oesophagus and causes abdominal distention. This may alert the parents of pediatric age group especially neonates and causes anxiety. Although it’s a functional condition, the clinical presentation can suggest malabsorption or obstruction, leading to unnecessary tests and investigations. We present a 15 days -old neonate who was brought to the pediatric surgical emergency with one such condition and was managed conservatively after imaging studies ruled out any underlying pathology. The case was discharged without any surgical intervention.

Antimicrobial Resistance Profile of Bacterial Isolates in Patients of Chronic Suppurative Otitis Media in a Tertiary Care Hospital in India.

Introduction: CSOM is a massive public health problem with incidence higher in developing countries like India, especially among low socio-economic society because of malnutrition, overcrowding, poor hygiene, inadequate health care, and recurrent upper respiratory tract infections. It is associated with various complications like persistent otorrhoea, hearing impairment, mastoiditis, labyrinthitis, facial nerve paralysis to more serious intracranial abscesses etc. The knowledge of microbiological profile is essential to enable efficacious treatment of this disease & thereby reducing the potential risk of complications. Methodology: This study was aimed to determine the microbial profile & their antimicrobial resistance pattern using Kirby Bauer disc diffusion method among the patients suffering from CSOM between April 2013 to March 2014. Results: Out of 216 samples processed, isolates were seen in 145 (67.1%) cases with male to female ratio of 1.5: 1 and age group affected was 10-20 years. Most common organism isolated was Pseudomonas spp. (49%) followed by S. aureus (35.9%). Pseudomonas spp. showed high degree of resistance to gentamicin (57.7%) and ciprofloxacin (53.5%). Also, S. aureus was found resistant to ciprofloxacin (61.5%) and cotrimoxazole (40.4%). Conclusion: Management of CSOM consists mainly of eradicating infection and closure of tympanic membrane. Periodical monitoring of bacterial isolates and their antibiotic susceptibility pattern is necessary for administering appropriate antibiotics for empirical treatment and also helps in reducing the potentially disabling and fatal complications of CSOM.

Pyogenic liver abscess caused by Salmonella Enteritidis: A rare case report.

Salmonella Enteritidis is one of the most important serovars transmitted from animals to humans and a serovar most commonly reported worldwide. Infection with Enteritidis is mainly limited to the intestinal tract, but under certain circumstances may cross the mucosal barrier to disseminate and get established as some localized infectious focus. Although cited as one of the very uncommon causes, Enteritidis may involve the liver and evolve into an overt abscess. Pyogenic liver abscess by a gas forming organism like Enteritidis usually follow a serious fulminant course and associated morbidity and mortality is unacceptably high unless immediate therapeutic interventions are initiated.

Protective effect of Spirulina and tamarind fruit pulp diet supplement in fish (Gambusia affinis Baird & Girard) exposed to sublethal concentration of fluoride, aluminum and aluminum fluoride.

Protective role of diet supplements (Spirulina, tamarind fruit pulp and their combination) on a freshwater fish G. affinis exposed at sublethal concentration of fluoride (F-) (10 ppm), Al+3 (3 ppm) and aluminum fluoride (AlF3) (35.4 ppm) in the microcosms (15 L sized) for 30-60 days in winter (90 days in summer) has been reported. Toxic effects of chemicals were manifested as higher fish mortality (4-50%) and acid (≈-30%) and alkaline phosphatase (25-50%) contents, but reduction in RBC counts (5-55%) and protein content (≈-29%) compared with controls. Alterations in values of these parameters were found maximum in aluminum exposed fish suggesting it as the most toxic among the tested chemicals. Diet supplements reduced toxicity of tested chemicals, especially when Spirulina and tamarind were given together.