Electrocardiographic Manifestations in COVID-19 Patients — An Observational Study from a Tertiary Care Centre in North Eastern India

Introduction : The Coronavirus disease 2019 (COVID-19) primarily involves respiratory system but may also affect the Cardiovascular System leading to abnormal ECGs. Its early recognition is crucial as it may be associated with increased mortality. Hence we aimed to find out various Electrocardiographic (ECG) manifestations of COVID19 patients admitted in a Tertiary Care Hospital and its relation to disease severity. Methods : We performed a hospital-based retrospective observational study between April, 2021 to November 2021 and analyzed the ECG changes at admission by three Cardiologists according to standard definitions and diagnostic criteria. Results : Out of 579 patients, ECG of 473 was available for analysis. ECG was normal in 227 (48%) and abnormal in 246 (52%) patients. Most common abnormal ECG finding in COVID19 patients was Sinus Tachycardia(19.5%) and less common findings were Sinus Bradycardia (5.3%), Incomplete Right Bundle Branch Block (RBBB) (3.2%), atrial fibrillation (2.5%), complete RBBB (2.3%), atrial premature complexes (2.3%), S1Q1T3 pattern (2.1%), first degree AV block (1.5%), ST-T wave changes (1.3%), Atrial flutter (1.1%). In mechanically ventilated patients, incidence of acute Right Ventricular Pressure Overload (RVPO) related ECG findings were more frequent. Conclusion : There is a wide spectrum of ECG manifestations in COVID-19 patients which varies depending upon the severity of COVID as well as prior Cardiovascular status, associated comorbidities and need for ventilatory support. Knowledge of ECG changes might help in risk stratification and triaging of COVID-19 patients.

A study on patients with coronary artery disease with special reference to bone mineral density

Background: Osteoporosis and Coronary artery disease are known to share common risk factors, like inflammation, but a direct relationship between the two has not been established. Some of the previous studies showed low BMD (osteoporosis and/orosteopenia) as an independent predictive factor for coronary artery disease in ambulatory patients. However, some reports have failed to demonstrate a direct relationship between low bone mineral density (BMD) and CAD or cardiovascular risk factors. This study was carried out to estimate bone mineral density (BMD) in patients with coronary artery disease (CAD) and also to evaluate the association between bone mineral density and coronary artery disease.Methods: Hospital based prospective observational study, involving 96 consecutive patients who were referred for coronary angiography for the evaluation of established or suspected CAD and also patients who had acute coronary syndrome (ACS) are enrolled in this study. BMD was determined for the lumbar spine (L2-L4) and femoral neck using DXA scan.Results: The total number of subjects was 96. Out of 96, 24 (25%) patients were females and remaining 72 (75%) were males. Coronary angiography was carried out in all patients. 42 patients from the total had coronary angiography proven single vessel disease (SVD), 33 patients had double vessel disease (DVD) and 21 patients had triple vessel disease (TVD). DXA scan was carried out in all patients. T- score of neck of femur region and lumbar spine was calculated. Neither the presence of significant coronary stenoses ≥50% in two or more coronary vessels nor the prevalence of severe coronary stenoses ≥70% differed significantly between patients with normal bone density, osteopenia, or osteoporosis (p<0.05, respectively).Conclusions: The result of this study suggests that in patients undergoing coronary angiography for the evaluation of CAD, the prevalence of low BMD is high; however, there is no statistically significant relationship between osteoporosis, osteopenia and coronary artery disease state.

Association between Clinical Malaria and Blood Lipids in North Eastern India.

Background: Changes in lipid profile are seen in many patients infected with malaria parasite. The malaria parasite causes hepatocellular damage and disturbs lipid handling by the liver. Inside hepatocytes and erythrocytes the parasite replicates rapidly scavenging cholesterol and lipids required for its growth and metabolism from the host. It also requires host lipids for detoxification of free heme to form the malarial pigment, haemozoin. The important question is whether these changes are characteristic for malaria infection or are they simply part of an acute phase reaction? This study analyzes the correlation between malaria infection and derangements in lipid profiles. Materials and Methods: This study comprised of 29 confirmed malaria cases, and 29 subjects in apparent good health, without the infection were included as control cases. Malaria cases were confirmed using rapid antibody-based diagnostic card tests that detect histidine-rich protein 2 (HRP2) or lactate dehydrogenase antigens in finger-prick blood samples followed by microscopic confirmation of malaria parasite. A 12 -hour fasting lipid profile was estimated by enzymatic method on day 2. Data obtained were statistically analyzed using Student’s t Test, assuming p<0.05 as significant. All issues related to ethics were taken care of during the whole course of study. Results: As compared with control subjects, patients with malaria showed low HDL (16.48±6.490 mg/dL versus 41.38±15.110 mg/dL), low LDL (70.45±22.720 mg/dL versus 104.46±27.353 mg/dL), low cholesterol (103.52±35.331 mg/dL versus 169.45±34.040 mg/dL) and elevated triglycerides (214.24±109.365 mg/dL versus 131.15±30.813 mg/dL). The observations show a statistically significant difference in HDL, LDL, cholesterol and triglycerides between malaria patients and control subjects (p<0.05). Conclusion: These results show a characteristic pattern of derangements of lipid profile in malaria. Further studies are required to understand the diagnostic, prognostic and therapeutic implications of these derangements.

Valproic acid induced pancreatitis: a case report.

Valproic acid is a commonly used antiepileptic drug. Apart from its common side effect there is definite association between valproic acid therapy and acute pancreatitis. Since 1979, many cases of acute pancreatitis induced by valproic acid have been published in medical literature. Here we are reporting a case of valproic acid induced acute pancreatitis in a 27 years old boy. The treatment is supportive, re-challenge is hazardous and should be avoided.

Acute Inflammatory Demyelinating Polyradiculoneuropathy following Plasmodium vivax malaria- a case report.

Acute Inflammatory Demyelinating Polyradiculoneuropathy (AIDP) is usually preceded by infection with certain bacteria and viruses. Parasitic infection has rarely been reported as a causal factor for AIDP. Neurological manifestations following malaria is commonly seen with P. falciparum. There are only few case reports of Guillain–Barré Syndrome or facial diplegia following P. vivax infection. Here we are reporting a patient who developed AIDP and facial diplegia within two weeks following successful treatment of P. vivax infection.

Cerebral infarction: an unusual manifestation of viper snake bite.

Snake envenomation causes significant mortality and morbidity. Viper bite usually present with local cellulites, renal failure and bleeding disorders. Thrombotic manifestation of snake bite is rarely reported and early administration of Anti-Snake Venom Serum (ASV) also reduces the risk of thrombotic complications. Cerebral infarction in case of viper bite may be due to hypotension, hypercoagulability or direct action of venom on vessel wall. We report a rare case of viper bite, presented with renal failure and cerebral infarction in spite of early ASV institution. The thrombotic manifestation in this case was possibly due to disseminated intravascular coagulation.

Eye of the tiger sign in neurodegeneration with brain iron accumulation: a case report.

Neurodegeneration with brain iron accumulation (NBIA) is a rare autosomal recessive disorder characterized by abnormal accumulation of ferritin in globus pallidus of brain. Magnetic resonance imaging (MRI) of brain demonstrates a characteristic ‘eye-of-the-tiger’ sign. We describe a case of NBIA in a child with classical clinical and MRI of brain features.

Lupus cystitis with hydroureteronephrosis in a young female with lupus nephritis.

Systemic lupus erythematosus is an autoimmune, multisystem disorder. Lupus nephritis is a common manifestation of SLE. Though rare, SLE may also involve lower urinary tract in the form of lupus cystitis with associated complications like hydroureteronephrosis. Lupus cystitis may present with gastro intestinal (GI) symptoms as the initial manifestation. The case reported herein is concerned with concomitant lupus nephritis and cystitis in a young female who also had associated GI symptoms and hydroureteronephrosis.

Filariasis presenting with pancytopenia diagnosed by Microfilaria in bone marrow aspirate – Report of a rare entity from India.

Filariasis is one of the major public health hazards among Indian population. The common features are asymptomatic microfilariaemia, acute adenolymphangitis, hydrocele and chronic lymphatic disease. There are very few reported cases of pancytopenia as a presenting feature of Filariasis. We describe a case of Filariasis who presented with features of pancytopenia and microfilariae were demonstrated in bone marrow aspirate.