COVID-19 Vaccination status among Health care workers diagnosed with COVID-19 in a tertiary care institute of Uttarakhand: A Cross-sectional Study

Background: Vaccines are considered as the one of the main pillars in halting and ending the presently on-going coronavirus disease (COVID-19 disease) pandemic which has spread globally since it was first detected in Wuhan, China in December 2019. In the absence of specific therapy, infection prevention practices and mass vaccination remains the mainstay in controlling the disease. Objectives: Objective of the study was to assess COVID-19 vaccination status, socio-demographic and clinical profile among healthcare workers diagnosed with COVID-19. Methodology: A cross-sectional survey from 1st March 2021 to 30th June 2021 among healthcare workers who were diagnosed with COVID-19 in a tertiary care institute of Uttarakhand, India was conducted, and universal sampling was used. Institutional Ethics Committee approved this study. Results: Total 662 healthcare workers were diagnosed with COVID-19. 429 (64.8%) of these COVID-19 diagnosed healthcare workers had received either single (129,30%) or both dose (300,70%) of COVID-19 vaccine while remaining 233 (35.2%) belonged to non-vaccinated group. History of exposure to COVID-19 positive patients was higher in vaccinated (66.4%) than in non-vaccinated group (55%) (p = 0.004). Hospitalisation was found to be higher among non-vaccinated (5.6%) than vaccinated group (2.3%) (p = 0.029). Conclusions: This study concludes that being vaccinated against COVID-19 disease provides protection against severe infection and reduces the need for hospitalization.

The Effects of Calcium and Vitamin D Supplementation on Blood Glucose and Markers of Inflammation in Non Diabetic Adults

Introduction: Type 2 Diabetes mellitus is associated with considerable morbidity and mortality and its prevalence has been increasing globally. Present study was undertaken to see the effects of calcium and vitamin D supplementation on blood glucose and markers of inflammation in non-diabetic adults. Aim of the study: To compare the effects of combined calcium and vitamin D supplementation versus placebo on blood glucose and markers of inflammation in non-diabetic adults. Material and methods: 120 non-diabetic patients fulfilling the inclusion and exclusion criteria coming to OPD/wards of MGUMST, Jaipur were recruited. They were subjected to two study groups with two treatment arms, one group with normal fasting blood glucose and other group with impaired fasting blood glucose. Results: The effects of calcium and vitamin D supplementation on fasting blood sugar and CRP were statistically significant in impaired fasting blood glucose group. Conclusion: Supplementation with vitamin D and calcium improves blood glucose and markers of inflammation.

Irreversible Thyrotoxic Dilated Cardiomyopathy: Case Reports and Review of Literature.

Irreversible dilated cardiomyopathy due to thyrotoxicosis is a rare clinical entity. We report two cases, one who presented with congestive cardiac failure and other presented with severe left ventricular dysfunction and atrial fibrillation. Both cases were diagnosed as dilated cardiomyopathy with severe left ventricular dysfunction (ejection fraction <30%) due to thyrotoxicosis. Inspite of vigorous medical therapy, there was only symptomatic improvement. Restoration of euthyroid levels did not revert the cardiomyopathy but led to definite clinical improvement.

Inner preputial flap as tunica albuginea replacement in the management of previously untreated fracture of the penis

To assess the efficacy of an inner preputial skin flap as replacement for the tunica albuginea of the corpus cavernosum after excision of fibrous plaque. Patients and Methods In this retrospective study we evaluated 5 men who presented with impotence; chordee; painful erection and/or painful coitus after previously undiagnosed or untreated penile fracture. In two patients soft tissue X-rays suggested calcification of the plaque; while ultrasonography revealed extension of fibrosis in four cases. In all patients the plaque was excised and the defect in the tunica albuginea was closed with an inner preputial pedicle skin flap. Results The flaps had taken well in all cases at 3 months follow-up and all patients reported having normal sexual intercourse. Conclusion Surgical excision is the treatment of choice for management of symptomatic fibrous plaques occurring in undiagnosed; untreated or conservatively managed penile fracture. A defect of more than 1.5 cm after excision of the plaque requires tunica replacement; and an inner preputial flap is a good replacement

Granulomatous angiitis of the central nervous system associated with herpes zoster.

Granulomatous angiitis of central nervous system (CNS) is a rare inflammatory disease of blood vessels mostly confined to CNS. We describe a case which presented with right sided hemiplegia with aphasia, after herpes zoster ophthalmicus. CT scan and MRI brain showed a large left sided infarct in the left middle cerebral artery (MCA) territory. MRI angiography revealed narrowing and thinning of left internal carotid artery (ICA) and to a lesser extent, left MCA suggestive of granulomatous vasculitis. Herpes zoster is often associated with major CNS involvement and a vascular etiology was previously postulated. Recent pathological reports suggest that cerebral angiitis secondary to herpes virus infection may be more common than realised.

Antihypertensive efficacy and tolerability of once-daily sustained-release diltiazem alone and in combination with ramipril in hypertension.

This study assessed once-daily (OD), sustained-release (SR) diltiazem alone and in combination with ramipril in essential hypertension. Fifty patients with supine diastolic blood pressure (DBP) > or = 95-< or = 114 mm Hg were entered into the active treatment phase of the study after 2 weeks of placebo run-in. Sustained-release diltiazem 180 mg OD was administered for 2 weeks, then optimally titrated, at 2 week intervals, to SR diltiazem 240 mg OD and then SR diltiazem 180 mg + ramipril 2.5 mg OD to achieve supine DBP < or = 90 mm Hg. After 4 weeks of diltiazem monotherapy (SR diltiazem 180 mg or 240 mg OD) mean supine DBP was reduced from 102.84 +/- 3.81 mm Hg to 90.15 +/- 5.02 mm Hg (P < 0.01) and mean supine heart rate was reduced from 85.15 +/- 11.02 bpm to 77.62 +/- 11.45 bpm (p < 0.01). Diltiazem monotherapy reduced supine DBP to < or = 90 mm Hg in 35/45 (77.77%) patients. Combination therapy (SR diltiazem 180 mg + ramipril 2.5 mg OD), received by non-responders to diltiazem monotherapy, reduced supine DBP to < or = 90 mm Hg in 3/10 (30%) patients. Sinus bradycardia was observed in one patient. Sustained-release diltiazem alone and in combination with ramipril reduce blood pressure in a dose related manner and is well tolerated.

An open study to evaluate the efficacy of artemether in severe falciparum malaria.

An open clinical trial was conducted in 30 patients of severe falciparum malaria with heavy parasitaemia (parasitized erythrocytes above 5%). Artemether (methyl ether of dihydroartemisinin-active principle isolated from Chinese plant Qinghaosu) was administered as 80 mg intramuscular injection twice on first day and then single dose of 80 mg intramuscular on 2nd to 5th day. The trial could be completed in 28 patients and two patients expired. In our observation falciparum malaria affected the young adults in their most productive period of life i.e. 25-44 yrs. All patients became afebrile by the 4th day with fever clearance time approximately 31.92 +/- 15.30 hr. Twenty-five patients (83.33%) became parasite free by 5th day with mean parasite clearance time approximately 47.04 +/- 19.95 hr. Deranged liver function and renal profile was observed in 63% and 50% patients respectively. Two patients, who died had very high degree of parasitaemia (50% and 16%) with cerebral malaria. One died due to multiorgan failure and other due to massive hematemesis and shock. The type of response achieved by artemether therapy was analysed as per WHO criteria suggested for chloroquine resistance. S response was observed in 25 patients (cure rate 83.33%). Two patients (6.66%) patients showed R II response, one patient (3.33%) showed R III response and R I response was not observed in any patient. No significant side effects were noted. This pilot study demonstrated that intramuscular artemether is a useful addition to antimalarial drugs in this era of multidrug resistant P. falciparum malaria showing high clinical potency with virtually no side effect.

Low dose ketamine: an ideal supplementary anaesthesia for spinal block.

In a double blind clinical trial 100 adult patients were randomly divided into 2 groups. In group I after spinal block slow injection of diazepam (0.1 mg/kg) was followed by placebo (0.5 mg/kg as bolus and 0.5 mg/kg/hour in infusion). In group II patients, after spinal block slow injection of diazepam (0.1 mg/kg) was followed by injection of ketamine (0.5 mg/kg as bolus and 0.5 mg/kg/hour as infusion). Low dose of ketamine in combination with diazepam significantly improves quality of anaesthesia, gives better cardiovascular stability without significant increase in complication rate and significantly improves patients' acceptance for the technique.